Keeping the focus on clinically relevant behavior: Supervision for Functional Analytic Psychotherapy.

Abstract

Introduction Functional Analytic Psychotherapy (FAP) is an experiential interpersonal treatment belonging to the third wave in behavior therapy. It is compatible with state-of-the-art cognitive behavioral approaches. It is different, however, in that cognition is understood in terms of verbal behavior. In addition, the influence of beliefs on other behavior is analyzed in terms of rule -following and as depending on the effect of real-life contingencies (Kohlenberg & Tsai, 1994). The translation of cognitive therapy strategies into a behavioral framework is not typical of FAP. It has, been a theme in a broader section of the third wave movement from its beginnings (e.g. Zettle & Hayes, 1982). The hallmark of FAP, however, is its emphasis on clients' direct learning through experiencing their problems in-session, as opposed to learning about their problems. In order to appreciate this point, we may remember that cognitive behavior therapy concentrates on discussing actions, feelings and thoughts that arise in the client's daily-life settings. The main target for change is what the client believes and thinks while he or she is experiencing problems outside the therapy session. In contrast, the FAP therapist works directly on client behavior while it is affecting the therapist-client relationship. And only when therapeutic change is noticeable within the boundaries of the relationship will the therapist monitor and (when necessary) promote generalization of in-session improvement to daily-life settings. The whole process rests upon the idea that the therapist-client relationship offers the therapist an opportunity to observe the client's clinically relevant patterns firsthand and to respond to them in ways that promote change. For instance, a client whose romantic life has been on hold for years because she only feels attracted to inaccessible men may develop a crush on her therapist. In order to be able to work on this, the therapist must quickly become aware that what is happening in the relationship is a sample of the client's daily life problem. The therapist will also need to identify exactly what the client does that contributes to the problem pattern, both in her daily life environment and in-session. In this way, those client behaviors through which the client unwittingly brings her problem directly into the relationship with the therapist are identified. It is also possible to determine what clinical improvement would look like if it were to happen in-session. The therapist needs to have a clear view on what such improvement may look like, because he or she will need to respond to that improvement when it happens. For instance, if the client were to label her positive feelings towards the therapist in a better way and relate to the therapist in ways that helped the therapist help her professionally, such in-session improvements would need to be reinforced. Once therapist and client have agreed on what the target behaviors will be, the therapist will allow his or her reactions, which are the natural consequences of the client's actions, to affect the target behavior in-session. Sometimes the problem pattern will need to be evoked intentionally in order to give the client the opportunity to deal with it. The therapist may, for instance, appropriately express his or her positive non-romantic feelings toward the client so that she can react to them emotionally. The central process in FAP is to gradually shape improvement by patiently reinforcing progressive changes in the right direction. Therefore, the biggest challenge for the therapist is to identify initial shifts toward improvement in client behavior. By missing slight in-vivo improvements or mislabeling them as problem behavior, the therapist may be responsible for stalling therapeutic change. In our example, a distracted therapist may react aloofly to an appropriate approach behavior by the client. The therapist may thus miss the opportunity to reinforce the client's first move toward relating in more productive ways to him or her. …