The challenge of developing a universal case conceptualization for Functional Analytic Psychotherapy.

Abstract

While Functional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai, Kohlenberg, Kanter, et al., 2009) has been used as an enhancement to other psychotherapy approaches (see e.g., Kohlenberg, Kanter, Bolling, Parker & Tsai, 2002), it is also, and perhaps most commonly, used as a standalone treatment. When employed in this manner, a FAP therapist attempts to improve a client's interpersonal functioning through in-vivo contingent responding in order to ultimately increase that client's quality of life. This contingent responding by a therapist is guided by a FAP case conceptualization (Kanter et al., 2009). Kanter and colleagues (2009) provide an excellent overview of FAP assessment processes, including the development and ongoing revision of a case conceptualization. The present paper is designed to supplement earlier discussions of FAP assessment and case conceptualization by discussing the possibility of a FAP case conceptualization applicable to all clients. This paper assumes a basic knowledge of FAP, which readers can obtain from the texts summarizing FAP (Kohlenberg & Tsai, 1991; Tsai, Kohlenberg, Kanter, et al., 2009). An attempt to identify a case conceptualization applicable to all clients initially seems completely contradictory to FAP's behavior analytic foundation, which emphasizes the importance of an idiographic understanding of a client's behavior and the environment in which it is emitted (see, e.g., Callaghan, 2006; Kanter et al., 2009). From this perspective, given that each client has a unique learning history and behaves within a unique context, his or her behavior should be analyzed in an individualistic manner. Thus, each client should have his or her own unique case conceptualization. (1) Ongoing discussions of FAP, however, have noted that it, as a principle-based psychotherapy, is typically very difficult to implement (Weeks, Kanter, Bonow, Landes, & Busch, 2011). This difficulty in implementation has led to calls for descriptions of the practice of FAP that are as clear and specific as possible, allowing for easier dissemination and competent practice of FAP (Weeks et al., 2011). The present paper provides one response to this call. It specifically attempts to identify a universal case conceptualization applicable to all FAP clients that will allow therapists to more efficiently and effectively implement FAP. There are many possible components of a FAP case conceptualization. These include but are not limited to: (1) a summary of historical variables potentially influencing a client's behavior, (2) a summary of a client's goals and values, (3) a description of a client's problem behaviors in session and more effective alternative behaviors (CRB1s and CRB2s), (4) a description of a client's problem behaviors outside of session and more effective alternative behaviors (O1s and O2s), and (5) a description of therapist problem behaviors and more effective alternative behaviors (T1s and T2s; for further discussion of typical contents of a FAP case conceptualization see Kanter et al., 2009). Before proceeding it is essential to emphasize that a widely applicable, universal case conceptualization is generally not possible with respect to these specific components. For example, it is obvious that historical variables uniquely influence each client's behavior and thus need to be described idiographically. Likewise, the unique interaction between a specific client's learning history and current context must be captured in a case conceptualization's identification of both the function and form of that client's behavioral targets. As a result, the specific proximal behaviors identified in a FAP case conceptualization, including client CRB1s, CRB2s, O1s, and O2s need to be idiographically defined (Kohlenberg & Tsai, 1991; Kanter et al., 2009). In contrast, a widely applicable FAP case conceptualization may be possible, appropriate, and useful at more foundational level. …