Therapists’ attitudes about and preferences to use Relationship Focused Interventions: New tools to measure a critical component of Functional Analytic Psychotherapy (FAP).

Abstract

The role of the therapeutic relationship is emphasized as an important factor across several therapies, including newer contextual behavioral therapies such as Functional Analytic Psychotherapy (FAP). FAP exclusively focuses on the use of the therapeutic relationship as a primary mechanism of therapeutic change. FAP requires that therapists assess for and consequate in-session behaviors that are characteristic of the client's presenting problems and approximations of behaviors related to their treatment goals. The focus on in-session behavior and the use of behavioral techniques to consequate in-session behaviors is termed in-vivo (Kohlenberg & Tsai, 1991). In-vivo interventions, briefly defined as the use of moment-to-moment therapy interactions (Kanter et-al., 2009), are believed to be potent therapeutic interventions because they enable therapeutic change to occur more rapidly or enhance the effectiveness of non-FAP related techniques (e.g., cognitive disputation) (Baruch et-al., 2009; Robert J. Kohlenberg, personal communication, March 27, 2007). Currently, there are no published measures of the factors (e.g., beliefs about in-vivo interventions, attitudes about in-vivo interventions) that may promote or inhibit therapists' use of this important class of interventions. The current study was a first step toward improving our understanding of the factors related to therapists' use of in-vivo interventions. For the purposes of the paper, the term Relationship Focused Interventions (RFIs) will be used in place of in-vivo interventions. The term relationship-focused intervention better captures the role of the therapeutic relationship in FAP. Also, invivo interventions are not unique to FAP and practitioners from other therapies may be more amenable to the term Relationship Focused Interventions. Thus, it may help facilitate research on RFIs by practitioners from other theoretical orientations or therapy approaches. Relationship Focused Interventions use the live momentto-moment interactions between the client and the therapist (Kanter et-al., 2009). Maximal behavior change occurs when a reinforcer is delivered close in time and location to the behavior's occurrence; thus, maximal therapeutic change is thought to occur when behaviors are consequated close in time and location to the behavior's occurrence (i.e., in-session behaviors; R. J. Kohlenberg, personal communication, March 27, 2007; cf. Baruch et-al., 2009 for a detailed examination of the empirical literature on basic behavioral principles underlying FAP). Basic behavioral research supports the idea that relationship focused processes are powerful behavior change strategies and many therapies promote the use of these processes (e.g., Beck, Rush, Shaw, & Emery, 1979). Several empirical studies suggest that RFIs are unique to interpersonally-focused therapies and that their addition may improve outcomes. A study of cognitive therapy for depression showed that the occurrence of RFIs was rare (Bolling, Parker, & Kohlenberg, 2000). This result was replicated in a second study that found that the use of RFIs in both behavioral activation and cognitive therapy was rare (Kanter et-al., 2009). A third study (Kohlenberg, Kanter, Bolling, Parker, & Tsai, 2002) suggested that the addition of RFIs to therapies that do not typically incorporate them might increase their efficacy. In this study, incorporating RFIs into typical cognitive therapy was related to increased satisfaction with social support and increased improvements in outside relationships. Research from Goldfried and colleagues (Goldfried, Castonguay, Hayes, Drozd, & Shapiro, 1997; Goldfried, Raue, & Castonguay, 1998; Wiser & Goldfried, 1998) also supports the idea that RFIs can improve therapy outcomes. In a study of expert psychodynamic therapists and cognitive-behavioral therapists, sessions that were identified as having an in-session impact on the client and that resulted in client change were found to have more in-session focus than lower clinically significant sessions (Goldfried, Raue, & Castonguay, 1998). …