Functional Analytic Psychotherapy:

Transcription

1 Functional Analytic Psychotherapy: The Basics (Part 1) Robert J. Kohlenberg, Mavis Tsai, Reo W. Newring, Christeine M. Terry, Mary D. Plummer, Madelon Y. Bolling, Chauncey Parker

2 FAP is A treatment built from a handful of basic behavior analytic principles Almost pure process; very few tricks or specific techniques How to implement your techniques more powerfully An extension of what many good therapists do naturally

3 Behavior Analysis: Stimulus Functions Therapists influence behavior via three stimulus functions: 1. Elicit client behavior 2. Evoke client behavior 3. Consequate client behavior These functions will have their strongest effects on in-session client behavior.

4 Behavior Analysis: The time-space relationship Reinforcement is MORE EFFECTIVE if the reinforcer is delivered closer in time and space to the behavior Example: Reinforcing a client for disclosure immediately after it occurs vs. reinforcing a client for disclosure 2 sessions later

5 Behavior Analysis: (cont.) Client Problems Can Be Observed and Reinforced Directly by the Therapist Reinforcement occurs whether or not we are aware of it. Therapists and clients inevitably and naturally shape each other s behavior. This usually occurs outside of awareness

6 Therapists & Clients Naturally Shape Each Other I m still pretty upset. Can we spend a few more minutes? CLIENT Ya, I m I don t sorry. mind going vee are a little out over off zee time time vor if vee today. need to.

7 Behavior Analysis: (cont.) Shaping client behaviors Match expectations to your client s current behavioral repertoire If your client is seeking help for her inability to trust others in relationships, do not expect her to offer disclosures readily Modeling Functional Analysis

8 Match expectations with client's current repertoire That s it, Dr. Linehan, I m quitting therapy because you can t spend enough time with me. THERAPIST CLIENT Well That s I m the certainly first time not going you ever to spend told me more the feelings time with that you make if you you think keep about treating quitting, me like so let s talk this! about our time arrangements. NOT MATCHING

9 Functional Analysis Function vs. Form (topography) of behaviors How does the client s behavior serve him/her?

10 Thinking Operantly (Video clip removed) What operants might be occurring? How might the operants be relevant to client s daily life problems? From an operant standpoint, what therapist activities are therapeutic? Countertherapeutic?

11 Basic Principles CRB: Clinically Relevant Behavior Let s define target behaviors (i.e. operants). Functional classes Idiographic Based on treatment goals and identified problems What behaviors, relevant to the client s treatment goals & identified problems, will be elicited, evoked and reinforced during the session?

12 Basic Principles CRB: Clinically Relevant Behavior CRB s occur in session and can be addressed on the spot CRB-1: Client problems occurring in session CRB-2: Client improvements that occur in session Identify these to maximize therapeutic change (Video clips removed)

13 FAP: Mechanism of Change The therapist s natural, contingent responding to decrease CRB-1s and increase CRB-2s This applies to workshops & supervision as well

14 Five Rules of FAP FAP comprises a set of simple rules for observing, evoking, responding to, and talking about CRBs. Concrete ways to bring more connection and intensity into your work!!

15 Five Rules of FAP #1

16 Rule #1: Watch for CRBs If nothing else, do Rule 1 (unobtrusively). The rest will follow naturally, if a) The behaviors are naturally in your repertoire. b) You have your clients best interests at heart.

17 Rule #1: Watch for CRBs (cont.) Use case conceptualization as a guide Assess for CRB-1s and CRB-2s: Use Typical, Beginning, Middle and End of Therapy Questions to Assess CRBs Therapeutic Opportunity Scale (TOS)

18 Rule #1: Watch for CRBs CLIENT How come so many people don t like me?! And how will talking to a %@^#*! JERK like you help? THERAPIST CRB-1? (Cranky Albert)

19 Rule #1: Watch for CRBs Will you call my doctor and ask him to renew my Xanax prescription? Therapist CRB-1 OR CRB-2?? Client

20 Five Rules of FAP #2

21 Rule #2: Evoke CRB s Treatment content will naturally evoke CRB s Free association, Agenda setting, Hypnosis, Homework assignments???? Prompt CRB-2s Do not change your behavior to evoke CRB s (Video clip removed)

22 Five Rules of FAP #3

23 The clinical application of natural vs. arbitrary reinforcement: Arbitrary reinforcer Serves to please therapist. In future, client values therapists approval. Natural reinforcer Related consequences that are available in client s daily-life environment. More likely to generalize.

24 Arbitrary reinforcement CLIENT Why must you always dissect my homework and evaluate my thinking? It seems like some of my thoughts are valid and it s kind of a put down to analyze them. Ben Stein (the epitome of non-emotive) It is so terrific that you are telling me how you feel! Good Job! What This might might be be a countertherapeutic more NATURALLY REINFORCING response to the client s emotional expression? THERAPIST

25 Five Rules of FAP #4

26 Rule 4: Notice your effect on the client (Video clips removed) If a client is stuck and doesn t seem to improve...

27 Five Rules of FAP #5

28 Rule #5: Provide functional interpretations of client behavior How does behavior serve the client? Help the client understand how their behavior functions It seems like after a difficult homework assignment, you come in here with a bunch of other crises to talk about. This makes it so that we never get to discuss those difficult assignments. Was the homework too hard? Did it bring up some stuff for you? Is this what you do when things get tough? THERAPIST

29 FAP Case Conceptualization Relevant History Daily Life Problems Psychotherapy Daily Life Goals IN SESSION CRB-1s CRB-2s Watch RULE for and evoke CRBs Identify reinforcers and reinforce CRB-2s Provide rules & generalization strategies 1 & 2 RULE 3 & 4 RULE 5

30 FAP Case Conceptualization Relevant History DL Problems IV Problems (CRB1s) IV Improvement s (CRB2s) Conceptualization is an ongoing process of assessing and revising hypotheses DL Goals

31 Some FAP Materials Therapy Questions Handouts: Typical, Beginning, Middle, End What do you think I m thinking about you/that/what you did/said? I note these similarities and differences between my usual style of beginning and how I am beginning this relationship What regrets do you have about the therapy or what would you like to have gone differently?

32 Some FAP Materials (cont.) End of Therapy Letter to Client In working with you, I have grown tremendously as a therapist and a person. I am proud to have been a part of your life in the last two months, to have been a part of the great changes that you have gone through. I admire your courage, your determination, and your strength; and I have learned to be silent, and encouraging, and centered in order to keep up with you. I am learning what it means to sit with someone who sits with pain, an invaluable lesson. You have enriched my life, and I am a better person for having had these eight sessions with you.

33 Some FAP Materials (cont.) Therapeutic Opportunity Scale (TOS) Time structure Therapist vacation Termination Fees Therapist mistakes

34 Some FAP Materials (cont.) Providing the Rationale FAP: The therapy relationship provides opportunities to learn how to express yourself fully and create better relationships. It will be helpful for us to focus on our interaction if you have issues or difficulties that come up with me which also come up with other people in your life (such as coworkers, acquaintances, supervisors, friends, partner or spouse). In this situation, you can learn new ways of being with another person, i.e., me, and then take that learning with you out into your other relationships. FECT

35 Some FAP Materials (cont.) FAP Case Conceptualization Exercise: completing a FAP case conceptualization for either a client, or for yourself.

36 THE END