A functional analytic approach to group psychotherapy.

Abstract

More than two decades ago, Kohlenberg and Tsai (1987) published the first book chapter on Functional Analytic Psychotherapy (FAP), an approach to psychotherapy that is based on the functional analysis of the therapist-client relationship in the individual talk therapy setting. Over time, FAP has consolidated its place among third wave behavior therapies. Third-wave behavior therapy is a strand of treatments that builds upon many of the acquisitions of first-wave (exposure-based) classical behavior therapy and second- wave (based on modifying thoughts and beliefs) cognitive behavior therapy, but differs from them in its distrust of verbal control and its focus on contextual meaning. These differentials give the third-wave behavior therapies an experiential flavor which is strongly evident in FAP. Relying on a client case conceptualization, the FAP therapist observes clinically relevant behavior when it occurs in-session. When it does not occur, he or she evokes it. The curative process depends on the therapist's allowing natural, direct consequences to affect these clinically relevant behaviors in-session. In addition, the therapist monitors and when necessary, promotes generalization. These tasks are interwoven to produce FAP's approach to the healing potential of a relationship. While FAP was developed mainly as an approach to individual psychotherapy, there have been translations into group therapy (e.g. Gaynor & Lawrence, 2002; Hoekstra & Tsai, in press). The present paper presents one such translation. It suggests that, when properly understood, FAP necessarily leads to a type of group therapy that is pragmatically quite different from traditional behavioral group therapy. How could we describe this difference? Since its early days, behavioral group therapy has been distinguished by its teaching technology, including training activities and streamlined learning modules (e.g. Rose, 1977). Group therapies in the cognitive mainstream of behavior therapy (e.g. Free, 1999; Bieling, McCabe & Antony, 2006) tend to maintain this characteristic, through activities such as lectures and structured exercises. Even when, for example, exposure for social phobia is done in-session, the programmed teaching focus is maintained (Becker & Heimberg, 2002). When we apply FAP to the group setting, however, it comes much closer to Group Psychotherapy, which has often focused on unexpected experiences and outcomes (Yalom, 1975; Rutan & Stone, 1984). However, group FAP is not a compromise between these two traditions. The combination of a flexible focus on spontaneously evolving interactions with a functional contextual approach to the healing nature of relationships adds a new dimension to group therapy. The aim of the present article is to discuss how this dimension works. For that purpose, personal experiences in supervising FAP in group therapy will be described. These groups functioned as free-of-charge services for socially disadvantaged patients. First, some points of inspiration for conceptualizing the work in the groups will be presented. Then, it will be described in an informal way how a group can be transformed into a network of healing relationships. It will be shown how this can be done on different levels of analysis, namely that of long-term strategy, of in-session tactics and of moment-to-moment technique. Finally, the transformation of unplanned events into in-vivo learning opportunities will be illustrated with a series of short examples. The chronic pain group experience Our first group, described by Vandenberghe, Cruz and Ferro (2003) was formed at the initiative of the two latter authors with the intention of helping people referred from a nearby pain center. These were patients who did not respond to medical treatment for chronic orofacial pain. The group started in August 2001 as the first in what would become a long series of FAP groups for chronic pain (e.g. Vandenberghe, Ferro & Cruz, 2003; Vandenberghe & Ferro, 2005; Martins-Queiroz & Vandenberghe, 2006). …