Functional Analytic Psychotherapy (FAP): A review of publications from 1990 to 2010.

Abstract

Functional Analytic Psychotherapy (FAP), a model for psychotherapy based on radical behaviorism first developed by Kohlenberg and Tsai in 1991 (translated into Portuguese in 2001), proposes that the therapeutic relationship is the primary context for behavioral change in the therapeutic process for clients with interpersonal problems (Kohlenberg & Tsai, 2001; Kohlenberg, Tsai & Kanter, 2009). The authors suggest that everything the therapist needs and can use to help clients through the change process occurs during the session, in the therapeutic relationship. Specifically, FAP encourages the therapist to identify three classes of client clinically relevant behavior (CRB) occurring in session: CRB1, defined as behavioral problems occurring in session; CRB2, defined as behavioral improvements or progress in session, and CRB3, defined as the client's descriptions about the functional controlling variables of his behaviors (both inside and outside the session). FAP systematizes five rules around which the therapist should base treatment, including: (1) Observe the occurrence of CRBs, (2) Evoke CRBs, (3) Reinforce CRB2s, (4) Observe the reinforcing effects of therapist behavior on CRBs, and (5) Provide interpretations about the variables that affect client's behavior (Tsai et al, 2009). Since the FAP book appeared in 1991, many theoretical and empirical papers have appeared. These papers have been quite diverse. For example, several studies have been conducted to demonstrate how to use FAP combined with other interventions (Callaghan, Gregg, Marx, Kohlenberg, & Gifford, 2004; Gaynor & Lawrence, 2002; Kohlenberg, Kanter, Bolling, Parker, & Tsai, 2002). Follette and Callaghan (1995) and Callaghan (2006) discussed supervision in FAP, and described what they consider a more efficient way to conduct FAP supervision. Busch and col leagues (2008) performed an empirical micro-process analysis of FAP's mechanism of change. Oshiro (2011) also investigated the mechanism of change using interventions based on FAP, with an ABAB experimental design. Follette, Naugle and Callaghan (1996) presented important theoretical contributions to understand how FAP's therapeutic relationship can function as a mechanism of change in therapy. Callaghan, Summers and Weidman (2003) used FAP to treat a client with Histrionic and Narcissistic Personality Disorder. These examples demonstrate the diversity of writings on FAP that have appeared. Despite this diversity of publications, FAP has been criticized for producing too many theoretical articles making claims of FAP efficacy, without supportive empirical studies (Corrigan, 2001), and for not yet having conducted a randomized controlled trial to support FAP's efficacy (Ost, 2007). According to Ost (2007), there continues to be a lack of empirical data for the validation and wide acceptance of FAP as an efficacious intervention. A comprehensive review of papers on FAP has yet to be performed. In particular, previous reviews (e.g., Baruch et al., 2009; Corrigan, 2001; Ost, 2007) have been limited to only English-language publications, while we were aware of important publications on FAP in Portuguese coming out of Brazil, as well as in other languages. Thus, the current review made an effort to survey the global literature on FAP, not just English-language literature. Recently, Garcia (2008) included some Portuguese language publications in his review of FAP studies, which categorized FAP papers into six categories: integration with other therapies, supervision and improving therapeutic skills, methods for evaluation and data recording in therapy, studies of effectiveness and efficiency, experimental investigations into the relationship between thoughts and emotions, and application to clinical problems and new types of applications. In the current review, we expanded on the review by Garcia (2008) and conducted a comprehensive international search for FAP publications from 1990 to 2010. …