Functional Analytic Psychotherapy & Clinical Behavior Analysis

Transcription

1 How Skinner leads to an Interpersonal Psychotherapy: Functional Analytic Psychotherapy & Clinical Behavior Analysis Chauncey R. Parker

2

3 Philosophy of Science Guides how we conduct research and how we view/analyze behavior Goal = Prediction and Control Understanding role of phylogeny and ontogeny Function vs. Form Dualism of Descartes replaced by monistic view of behavior Metric = Rate of behaving Private & Public behavior cut from the same cloth Three Stimulus Functions of the Therapist Therapist Factors: e.g., Grief, Shame, Sense of Self The Five Rules Watch for CRB Evoke/Elicit R+ Notice effect Describe Fx relations Your case examples and?s

4 Skinner s philosophy of science influenced by Francis Bacon, Jacques Loeb & Ernst Mach Precision in terminology and experimental control The aim of Prediction and control, i.e., pragmatism Functional relations (Function vs. Form/Topography) Rejected dualism, adopted monistic view of human experience. (i.e., cognitive/emotional is not different from our overt behavior except that it is private)

5 Saw Watson s S-R model as only part of the picture. Influenced by Darwin & Thorndike, accepted selectionism in place of Watson s determinism paper (Operational Analysis of Psychological Terms) and the move to account for all behavior, public or private. What is behavior? anything that an organism does. (e.g., walking, talking, breathing, seeing, feeling emotions, etc.)

6 According to Skinner Radical behaviorism.... does not deny the possibility of self-observation or self-knowledge or its possible usefulness,.... It restores introspection.... It does not insist upon truth by agreement and can therefore consider events taking place in the private world within the skin. It does not call these events unobservable, and it does not dismiss them as subjective. (1974, p. 18)

7 Behavior is a joint function of phylogenic contingencies - those that operated in ancestral environments during the evolution of a species - and ontogenic contingencies - those that operated during interactions between an organism and its environment within its own lifetime (Catania, 1992, p. 39)

8 Respondent behavior (S-R): a reflex in response to stimuli, an adaptive behavior shaped over many generations. i.e., Unconditioned and conditioned stimuli & responses Operant behavior (S d R-S R+, etc. ) Emitted behavior that operates on the environment. The effect of the behavior affects future probability of behaving in that context.

9 Respondent Very consistent, The stimulus will elicit the response. Operant The context (S D ) evokes behavior, which is emitted under certain conditions.

10 The assumptions and principles behind this approach are analogous to those of natural selection in evolution; species do not change in order to survive Offspring vary, and their differing characteristics make them more or less successful in their environments. Likewise, operant behavior does not change in order to achieve something; behavior changes as a function of its effects. (Parker)

11 What are the effects (function) of behavior, Versus, what does it look like (form or topography).

12 Behaving can look the same across individuals and or settings (i.e. contexts) and yet it functions differently. Likewise, there are various forms of behaving that can serve the same function (e.g., using drugs &/or alcohol, gambling, video games, anger outbursts, etc. as avoidance behaviors)

13 This leads the therapist to ask: What am I reinforcing/punishing? [e.g., reacting to suicidal statements of client] What is the behavior that I see really doing? e.g., Disguised Mands: I was in such a rush this morning I forgot to bring my lunch might really mean, do you have any lunch you can share?

14 Consequences (literally, with-following, following closely) What is the definition of reinforcement (or punishment)? What is questionable about the statement, I am going to reinforce his behavior. A behavioral joke: I heard you went to that new restaurant, how did you like it? I don t know, I ll see if I go back.

15 Natural vs Arbitrary (aka Contrived) Proximal vs. Distal contengencies Competing contingencies, multiple factors Schedules Continuous vs intermittent. Which most resistant to extinction?

16 Early clinical interventions focused on behavior modification and behavior analysis with developmental disabilities and autism. Controlled environments and generalized (token) reinforcers used to establish and strengthen behaviors. More complex outpatient problems also treated with tokens, form mistaken for function; e.g., tokens (contrived R + ) for smiling, fines for crying.

17 Early 1980s Hayes paved the way (Kohlenberg & Tsai, 1991) [Comprehensive Distancing, later became ACT] Advances in understanding verbal behavior (i.e., Relational Frame Theory, Hayes, et al.) Clear focus on Contextual Functional Analysis Kohlenberg and Tsai (1987, 1991) Recognized that the most effective cases included an in-vivo focus on the therapeutic interaction.

18 Three stimulus functions of the therapist Elicit, Evoke, Consequate Clinically Relevant Behaviors (CRBs) CRB 1: In-session (in-vivo) problems CRB 2: In-session improvements CRB 3: In-session client descriptions of functional relations.

19 The Five Rules Watch for CRBs Evoke / Elicit Reinforce (consequate, extinguish) Notice your effect (cf. definition of reinforcement) Describe functional relations

20 Awareness, Courage, Love, and Clinical Behavior Analysis (1993, 2000) Challenges for the therapist Intensely engaging Your own interpersonal issues are more likely triggered Technically challenging, Not a cookbook recipe, Ongoing analysis

21 The Five Rules Watch for CRBs Evoke / Elicit Reinforce (consequate, extinguish) Notice your effect (cf. definition of reinforcement) Describe functional relations

22 Client Time-line / History Amplify (or moderate) your reactions (i.e., R +, etc.) Relational responding, (e.g., equivalence, etc.) your mind is not your friend, the lemon exercise: minds are productive and potent. Literality/Cognitive Fusion vs. Cognitive Defusion Life Values Mindfulness (a la, Kabat-Zinn, Chodron with a caveat)

23 Patience, Acceptance, Willingness vs. Avoidance Committed Action vs. impulsive, reactive ACT Hexiflex Experience of Self (aka, sense of self) Validation Emotion regulation and distress tolerance Interpersonal effectiveness Third wave?

24 Therapy Rationale [Form] Questions for therapists [Form] Case conceptualization [Form] Questions for in-session [Form] Case examples:?

25 What You May Expect in Our Therapy Work Together Robert J. Kohlenberg, Ph.D., ABPP University of Washington Clients come into therapy with complex life stories of joy and anguish, dreams and hopes, passions and vulnerabilities, unique gifts and abilities. Your therapy with me will be conducted in an atmosphere of caring, respect and commitment in which new ways of approaching life are learned. Our work will be a joint effort; your input is valued and will be used in the treatment plan and in homework assignments. I will be investing a great deal of care and effort into our work together, and I expect you to do the same. I will be checking with you in an ongoing way about what is working well for you in our relationship, and what needs to be changed.

26 FECT Treatment Development Study CT FECT BDI HRSD SCL90-T GAF

27 FECT Treatment Development Study CT FECT BDI HRSD SCL90-T GAF

28 FECT Treatment Development Study 4,8 4,6 4,4 4,2 ES =.91 p =.01 ES =.96 p =.01 FECT CT 4 3,8 3,6 Pre-Tx Post-Tx Follow-up

29 Functionalanalyticpsychotherapy.com Facebook Functional Analytic Therapy Group ACBS Facebook group (Assoc. of Contectual Behavioral Sciences)