Transitional probability analysis of two Child Behavior Analytic Therapy cases.

Abstract

Clinical behavior analysis (Dougher, 1993; Kanter & Woods, 2009) assumes behavior analysis as the fundamental science and Skinner's Radical Behaviorism as the philosophical foundation for clinical psychology. In Brazil, clinical behavior analytic ideas have produced Behavior Analytic Therapy (BAT; Meyer et al., 2010), and more recently, Child Behavior Analytic Therapy (CBAT; Del Prette, 2011). From these theoretical and clinical standpoints, a fundamental issue in therapy is that therapy may produce rule-governed or contingency-shaped changes in client behavior (Skinner, 1974). While much of talk therapy may be seen as the therapist providing rules for clients to follow to change their behavior, regarding contingency-shaped behavior when the client behavior to be targeted for change occurs in session the therapist can provide consequences, thus shaping it as already suggested by Krasner (1962) in therapist as a social reinforcing machine. This shaping process is specified in more detail in Functional Analytical Psychotherapy, or FAP (Kohlenberg & Tsai, 1991; Tsai, Kohlenberg, Kanter, Kohlenberg, Follette, & Callaghan, 2009). FAP's basic tenet is that the client's problem behaviors that appear in their daily relationships will also appear in therapy where the therapist can shape behavior through differential and contingent responding. The authors state that generalization occurs due to similarities between the therapy setting and the client's other environments, which implies that improvements achieved in session will generalize to the relationships that take place out-of-session. Therapist contingent responding is key to FAP and may start with general contingent reinforcement of broad classes of behavior relevant to simply to coming to therapy, and then reinforcement is funneled to focus more directly on clinically relevant behaviors relevant to the goals of treatment identified by the client and therapist (Follette, Naugle, & Callaghan, 1996). Recently, researchers have called for the identification of empirically supported principles of change (Rosen & Davison, 2003) and the development and use of novel methodologies in psychotherapy research, such as the direct observation of the therapeutic process instead of the use of randomized controlled trials or other group designs, to identify these change principles. Because contingent responding by definition is a change process that occurs in the turn-by-turn client-therapist interaction in session, it is a mechanism that is well suited to exploration by direct observation of the therapeutic process. It is important to note that contingent responding is a mechanism that is not specific to FAP but is fundamental to BAT and CBAT, broadly defined, and may be seen by behaviorists as occurring in, and potentially important to, all forms of therapy. For example, an early classic process study by Truax (1966) used direct observation of the therapeutic process to explore the use of contingent responding in sessions conducted by Carl Rogers, a therapist well known for espousing the belief that the therapist's behavior should be unconditional as per his humanistic theory (Rogers, 1957) rather than contingent on client behavior as per behavioral theory. Truax, using independent coders blind to the study hypothesis, found that Rogers in fact contingently responded to specific client behaviors with empathy and positive regard, and that these responses functioned as reinforcement as indicated by the fact that the client behaviors responded to in this fashion increased in frequency over the course of therapy. More recently, Busch, Kanter, Callaghan, Baruch and Weeks (2009) employed a similar micro-process analysis to explore the hypothesized change mechanism of FAP. They used the FAP Rating Scale (FAPRS; Callaghan & Follette, 2008) to code client clinically relevant behavior and therapist effective responding to in-session client behavior on a turn-by-turn basis over the course of therapy for a depressed adult client who received three phases of therapy: Assessment, Cognitive Behavior Therapy (CBT), and FAP. …