Application of functional analytic psychotherapy: Clinical analysis of a patient with depressive disorder.

Abstract

Abstract Functional Analytic Psychotherapy is based on principles of radical behaviorism, and emphasizes the contingencies that occur during a therapeutic session, the therapeutic context, functional equivalence, natural reinforcement, and shaping. Depression is a complex problem with multiple causes; the treatment of depression must therefore be approached from different angles. A clinical analysis of a patient with a depressive disorder and its treatment with this type of psychotherapy is presented. The different phases of intervention are described, with examples of the therapeutic relationship. The results were maintained for a period of one year and three months. Key words: DEPRESSION, FUNCTIONAL ANALYSIS, FUNCTIONAL ANALYTIC PSYCHOTHERAPY. Psicoterapia Analitica Funcional esta basada en los principios del conductismo radical y pone el enfasis en las contingencias que ocurren dentro de la sesion terapeutica, en el contexto terapeutico, en la equivalencia funcional, en el reforzamiento natural y en el moldeamiento. Por otro lado, la depresion es un tema complejo y de dificil solucion terapeutica que requiere de una explicacion y una intervencion pluricausal. Se presenta el analisis clinico de un caso que presentaba un trastorno depresivo y su tratamiento a traves de la aplicacion de esta psicoterapia. Se describen las distintas fases de la intervencion con ejemplos de la relacion terapeutica, y el mantenimiento de los resultados durante un periodo de un ano y tres meses. Palabras Clave: DEPRESION, ANALISIS FUNCIONAL, PSICOTERAPIA ANALITICA FUNCIONAL. ********** Functional Analytic Psychotherapy (FAP) (Kohlenberg and Tsai, 1991), along with Acceptance and Commitment Therapy (ACT) (Hayes, Strosahl, and Wilson, 1999), are two approaches to therapy based on the principles of radical behaviorism and on findings regarding functional generalization, functional analysis of language, and equivalence relations. For further information in Spanish about the implementation of FAP and ACT, two pioneering texts published by Perez Alvarez are highly recommended: Tratamientos Psicologicos (1996a) and La Psicoterapia desde un punto de vista conductista (1996b). Functional analytic psychotherapy places emphasis on the contingencies that arise during the session, within the therapeutic context, in functional equivalence, natural reinforcement and shaping (Kohlenberg and Tsai, 1991, 1995). This approach places major importance on what the client says and does in the presence of the therapist, rather than on homework, events that take place in the family setting, or the thoughts the client may have during other parts of his or her daily life. These manifestations are termed clinically relevant behaviors (CRB), and are classified into three types that the therapist should learn to identify as therapeutic goals (Hayes, Kohlenberg and Melancon, 1989; Kohlenberg, Hayes and Tsai, 1993; Kohlenberg and Tsai, 1991, 1994a, 1994b, 1995). The first category of CRB (CRB1) are actual instances of the client's problems during the session, and which the therapist should try to diminish in frequency. Normally, these behaviors are under the control of aversive stimuli and often consist of avoidance behaviors. These problems may involve thoughts, perceptions, feelings, visions or memories that occur in the course of the session. The second category (CRB2) are improvements shown by the client during the session. In the early phases of treatment these behaviors are absent or are manifested only weakly, but as therapy progresses they should become more frequent. Behaviors considered (CRB3) are interpretations by the client of his or her own behavior and its causes. They involve observations and descriptions of the client's own behavior and the reinforcing, discriminative and eliciting stimuli associated with these behaviors. Kohlenberg and Tsai (1991) refer to CRB3 as clients' talking about their own behavior and what seems to cause it, thereby expressing appropriate cause-effect relationships and describing functional relationships that have established the problem. …