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A radical behavioral understanding of the therapeutic relationship in effecting change
Abstract
This paper presents a behavior analytic understanding of the functional components of the therapeutic relationship. Whereas other models of understanding therapy have offered interpretations of the importance of the client-therapist alliance, few have specified mechanisms responsible for mediating change that have a foundation in experimental psychology. Consistent with the radical behaviorally based Functional Analytic Psychotherapy (FAP), we describe, using a contemporary understanding of verbal behavior, how the therapist establishes him or herself as a provider of social reinforcement in order to shape change using contingent and noncontingent responding. We propose a reason why a limited amount of client-therapist contact can produce large changes in behavior. The paper closes with a description of a research strategy for evaluating the proposed model of effecting client change as a function of the therapeutic relationship.
... Um vasto conjunto de pesquisas 2 RBTCC 24 (2022) sustentam esses princípios comportamentais básicos, e pesquisadores têm explorado uma miríade de complexidades de como o tempo e a força do reforço contingente afetam o comportamento (Catania, 1998). A aplicação direta desses achados da pesquisa básica à psicoterapia sugere que o responder contingente de um terapeuta ao comportamento alvo emitido pelo cliente, em especial o reforçamento positivo do comportamento de melhora do cliente, deve caracterizar um poderoso mecanismo de mudança (Follette, Naugle, & Callaghan, 1996;Kohlenberg & Tsai, 1991). ...
... Escritos anteriores sobre FAP, no entanto, não levaram às pesquisas empíricas necessárias para a avaliação da eficácia da FAP (Hayes, Masuda, Bissett, Luoma & Guerrero, 2004), já que a maioria dos escritos em FAP têm sido discussões teóricas sobre princípios e processos básicos da mesma Follette et al., 1996;Kohlenberg, Kanter, & Bolling, 2004;Kohlenberg & Tsai, 1987, 1991, 1994, 1995Kohlenberg, Tsai, & Dougher, 1993;Kohlenberg, Yeater, & Kohlenberg, 1998;Rodriguez-Naranjo, 1998;Tsai, Kohlenberg, & anter, 2010;Vandenberghe & Sousa, 2005), estudos de caso (Baruch, Kanter, Busch, & Juskiewicz, 2009;Callaghan, Summers, & Weidman, 2003;Carrascoso, 2003;Ferro, Valero, & Vives, 2006;Kanter, Landes, Busch, Rusch, Brown, Baruch, & Holman, 2006;Kohlenberg & Tsai, 1994;Kohlenberg & Vandenberghe, 2007;Lopez, 2003;Manos et al., 2009;Wagner, 2005), ou discussões teóricas da FAP como um aprimoramento para outras psicoterapias Callaghan, Gregg, Marx, Kohlenberg, & Gifford, 2004;Gaynor & Lawrence, 2002;Holmes, Dykstra, & Williams, 2003;Hopko & Hopko, 1999;Kanter et al., 2009;Kanter, Manos, Busch, & Rusch, 2008;Kanter, Schildcrout, & Kohlenberg, 2005;Kohlenberg, Kanter, Bolling, Parker, & Tsai, 2002;Kohlenberg & Tsai, 1994Manos et al., 2009;Rabin, Tsai, & Kohlenberg, 1996;Vandenberghe, 2007Vandenberghe, , 2008Vandenberghe, , 2009Vandenberghe, Ferro, & Furtado da Cruz, 2003;Wagner, 2005). Desses aprimoramentos, apenas a utilização da FAP como tratamento adjunto à Terapia Cognitiva (CT; Kohlenberg et al., 2002) foi submetida à investigação empírica, com um delineamento não-randomizado, mostrando que a FAP aumentou a magnitude da melhora clínica em medidas de redução de depressão e melhora nos relacionamentos interpessoais obtidas na Terapia Cognitiva tradicional. ...
... A aplicação das cinco regras e a estrutura lógica para interações discutidas abaixo ocorrem no contexto de uma relação psicoterapêutica já estabelecida e de um trabalho terapêutico contínuo. Estabelecer um relacionamento na FAP está além do escopo deste artigo, mas algumas ponderações são importantes (para uma análise mais completa, veja Follette et al., 1996;Tsai, Kohlenberg, Kanter, Kohlenberg, et al., 2009, pp. 71-74, 146-153). ...
A Psicoterapia Analítica Funcional (FAP) fornece uma análise comportamental da relação terapêutica que aplica dados de pesquisa básica ao contexto de psicoterapia. Especificamente, a FAP sugere que o responder contingente do terapeuta in vivo (i.e. na sessão) aos comportamentos alvo do cliente, especialmente reforçando positivamente seus comportamentos mais efetivos, deve ser um poderoso mecanismo de mudança. No entanto, grande parte da literatura até hoje produzida sobre FAP tem sido teórica, definindo amplamente suas técnicas ao invés de explicá-las com a precisão necessária para a replicação e ensino. Neste artigo, os autores explicam uma estrutura lógica para interações entre o cliente e o terapeuta turno a turno que podem orientar pesquisas, treinamentos e a disseminação da FAP. Esta descrição comportamental molecular dos eventos da interação lógica proposta se presta à metodologia de pesquisa de microprocesso, e segue uma discussão sobre hipóteses potenciais a serem exploradas. No presente artigo, é dada uma orientação prescritiva e direta para a aplicação da FAP para fins de treinamento e disseminação.
... Dando continuidade à análise de Rosenfarb (1992), Follette et al. (1996) fizeram um exame dos processos comportamentais envolvidos na relação terapêutica. Os autores caracterizaram a relação terapêutica (processo terapêutico) como um processo no qual o terapeuta modela sucessivamente comportamentos mais úteis no repertório do cliente, reforçando comportamentos que demonstram que o cliente apresentou melhora. ...
... O terapeuta durante o processo terapêutico ajuda, através de intervenções, a reduzir comportamentos contraproducentes dos clientes, deixando de reforçá-los e estabelecendo comportamentos concorrentes que são mais úteis ou, ocasionalmente, punindo-os quando são prejudiciais aos outros. O terapeuta é um provedor forte e ativo ou fornecedor de reforço social, com o objetivo final de generalizar melhorias para além do consultório (Follette et al.,1996). ...
... Ainda segundo Follette et al. (1996), o relacionamento terapêutico é um processo de influência mútua. Não apenas o terapeuta afeta as respostas dos clientes mas também os comportamentos do terapeuta são afetados por essa relação, na medida em que o terapeuta atua como um estímulo discriminativo para uma variedade de respostas do cliente e vice-versa. ...
O objetivo do presente trabalho foi verificar o efeito das vocalizações do terapeuta, que denotam atenção, sobre a frequência de respostas de uma classe específica do cliente em uma situação análoga a uma psicoterapia realizada na modalidade online. Participaram da pesquisa três estudantes universitários selecionados por conveniência. Foi utilizado um delineamento de reversão com condições ABCDEA. Cada participante foi exposto a seis condições experimentais de forma sequencial, sendo uma condição por sessão. Na condição de Linha de Base (Extinção) (LB) o participante falou sem ocorrer reforçamento e a praticante ficou em silêncio. A condição de modelagem foi dividida em três fases: na primeira, a praticante reforçou todas as frases emitidas que iniciaram com o pronome "eu", podendo estas conterem expressões negativas, positivas e de dúvida; na segunda fase, frases que continham o pronome "eu" e expressões de dúvidas; e na terceira fase, frases que não tivessem expressões negativas e de dúvidas, apenas as frases positivas de autorrefêrencia. Nas condições em que ocorreram os esquemas de intervalo variável, VI 30, VI 60 e VI 120, a praticante foi sinalizada pela observadora que controlou os intervalos e indicou o momento de reforçar a próxima frase que apresentava o comportamento alvo de autorreferência emitido pelo participante. Dentre os resultados encontrados, é possível observar que verbalizações do terapeuta tem efeito sobre a frequência das respostas do cliente mesmo que a relação terapêutica ocorra na modalidade virtual. E assim, como na modalidade presencial, muitas variáveis podem alterar o controle do terapeuta sobre suas intervenções. Sugere-se para outras pesquisas mudanças metodológicas para que outras variáveis sejam investigadas.
... This leads radical behaviorists to three major inter-related commitments: a) the dismissal of "truth-as-correspondence" and "truth-as-coherence" criteria in favor of a more pragmatic "truth-as-effective action" criterion for assessing scientific analyses; b) the dismissal of hypothetical-deductive scientific methods and the strict preference for the systematic observation of behavior, emphasizing the goals of prediction and control over theoretical correspondence; and c) the application of these assumptions to the analysis of the use of subjective terms, which grounds the rejection of "private events" as something distinct from behavior itself and which enjoys a central role in the causal explanation of behavior (Skinner, 1945(Skinner, , 1953(Skinner, , 1957(Skinner, , 1963(Skinner, , 1974(Skinner, , 1990; see also Chiesa, 1994;Moore, 2008;Zilio et al., 2021). Taking all these features into account, radical behaviorism entails the conceptualization of behavior as the radix of psychology, i.e., as the proper subject matter of psychological analysis, and not just a proper method of inquiry into other more central topics, e.g., cognition (see also Dougher & Hayes, 2004;Follette et al., 1996;Froján-Parga, 2020;Guinther & Dougher, 2013;Kohlenberg et al., 1993;Madden et al., 2016;Pérez-Álvarez, 1996Pérez-Álvarez, , 2012Sturmey, 2020). ...
... By contrast, third-wave therapies like ACT are mainly approaches to psychotherapy, typically implemented in outpatient settings, with verbally competent adults, where treatment is crucially based on the therapistclient verbal interaction. This is typically conceived of as a subfield of applied behavior analysis: clinical behavior analysis (see Dougher, 2004;Dougher & Hayes, 2004;Guinther & Dougher, 2013;Follette et al., 1996;Kohlenberg et al., 1993Kohlenberg et al., , 2002Madden et al., 2016), whose main research question is the following: how is it possible that psychotherapy, which is primarily conducted through verbal means, can promote the maintenance and transfer of insession clinical changes to extra-clinical, daily life contexts (Kohlenberg et al., 1993, p. 271)? ...
... As we saw in Chapter 1 (see section 1.5.2.2.), ACT is a "post-Skinnerian" functional analytic approach to mental health that primarily emerged within the field of clinical behavior analysis (hence CBA). In a nutshell, CBA encompasses a number of contemporary functional analytic approaches to psychotherapy that aim to provide an explanation of therapeutic change in out-patient, ambulatory settings with verbally competent users (Dougher, 2004;Dougher & Hayes, 2004;Guinther & Dougher, 2013;Follette et al., 1996;Kohlenberg et al., 1993Kohlenberg et al., , 2002Madden et al., 2016). In its origins, the main goal of CBA was to provide an answer to the "talk therapy question" (i.e., why therapeutic changes achieved inside the clinic following a number of relatively brief, weekly or even monthly sessions of "talk therapy" can generalize and transfer to extra-clinical settings; see Kohlenberg et al., 1993, p. 271). ...
Conceptual debates in the field of mental health have typically revolved around two core issues: the problem of mind and the problem of normativity. Against the reductivist and eliminativist tendencies that characterize most therapeutic models, in this dissertation we advance a pragmatist and non-descriptivist approach to mental health -a “philosophy of mental health without mirrors”. This approach rejects the idea that folk-psychological interpretation subserves a primarily descriptive and causal-explanatory function. Rather, it highlights its evaluative and regulative dimensions, while at the same time retaining their truth-aptness. In doing so, it offers a non-reductivist, yet compatibilist approach to the mind and normativity, which affords a better conceptual framework for mental health. We then explore its consequences for the debate around the doxastic status of delusional experiences and its implications for the intervention with people with delusions. Drawing from this non-descriptivist approach, we claim that doxasticism about delusions can and must be defended not on the grounds of its scientific value, but on the grounds of its ethical and political virtues. We conclude that non-cognitivist, functional-analytic approaches to the intervention with people with delusions offer a better model than their cognitivist counterparts, and we point out several ways in which our non-descriptivist approach could help to enhance their efficacy and clinical significance.
... A combination of descriptions for alliance has been suggested in literature: an emotional connection that has been labelled as affective attachment, affective bond, and affective experience of the client (Fosha, 2001;Schore, 2000) and client's perception of therapist's affect, empathy, trust, and comfort (Nienhuis et al., 2016). Sometimes, it has been additionally defined as a cognitive connection (e.g., agreement on goals; Bordin, 1979) and behaviourally described as a process of mutual shaping and learning (Follette, Naugle, & Callaghan, 1996;Lejuez, Hopko, Levine, Gholkar, & Collins, 2005). It can be referred to as collaboration on therapeutic tasks, negativity towards the therapist or client, client openness or therapist disclosure, and involvement in developing a treatment plan (Ackerman & Hilsenroth, 2001, 2003Horvath, 2017;Keijsers, Schaap, & Hoogduin, 2000;Safran & Muran, 2006). ...
... FAP focuses on detecting and responding to CRBs as they emerge in the psychotherapeutic relationship. The functional analytic and behavioural shaping process inherent in FAP offer a most useful framework to guide the detailed tracking of verbal and nonverbal PPEB needsseeking and needs-recognition behaviours of both client and therapist, allowing therapist and clients to generate contextual similarities between therapeutic and outside relationships; hence, the therapeutic relationship becomes the mechanism of change (Follette et al., 1996). ...
... The specific contingent reinforcement required in Rule 3 is the active change component that allows the therapist to reinforce approximations of improvement behaviours. Rule 3 establishes the need for therapists to pay attention to the function of clients' NVEs in order to actuate this key component of therapeutic change (Follette et al., 1996;Wampold, 2015). Enhancing the process of influence is inherent in the FAP process, what is needed is more precision over which behaviours clinicians need to target. ...
In order to increase therapeutic impact by enhancing awareness of clients' nonverbal communications, this article operationalizes the therapeutic alliance as a needs‐satisfaction process. The client's competence as a needs seeker and the therapist assisting with the client's expression and satiation of basic social needs are proposed as being key mechanisms of change.
Functional model of primary emotions derived from Panksepp's seven primary emotional systems (care seeking, caretaking, lust, fear and anxiety, anger, play, seeking, plus dominance and disgust) is integrated with Functional Analytic Psychotherapy's emphasis on in‐session contingent natural reinforcement of clients' target behaviours. By identifying in‐the‐moment cues of underlying emotional–behavioural functions drawn from a categorization of clients' nonverbal communication can bridge the gap between client private events and therapist observables, in order to maximize therapist attunement and responsiveness to clients, and to increase the effectiveness of clinical interventions.
... Functional Analytic Psychotherapy (FAP) is prescribed precisely for clients who do not stick to or do not respond adequately to traditional therapies (Follete, Naugle & Callaghan, 1996;Kohlenberg, Tsai, Parker, Bolling & Kanter, 1999). Among these clients are, e.g., those who avoid intimate interpersonal relationships (García, Aguaio & Montero, 2006), which hinders complaint clarification and the formation of therapeutic alliance and the effectiveness of traditional intervention strategies. ...
... Among these clients are, e.g., those who avoid intimate interpersonal relationships (García, Aguaio & Montero, 2006), which hinders complaint clarification and the formation of therapeutic alliance and the effectiveness of traditional intervention strategies. According to Kohlenberg et al. (1999), Follete, Naugle and Callaghan (1996), Kohlenberg and Tsai (2001), FAP is based on the principles of Radical Behaviorism of reinforcement, stimulus generation, and functional analysis of verbal behavior and stimulus equivalence relationships. This therapeutic proposal considers the therapist-client relationship is a real interaction that has the potential to evoke and change client problem behaviors (Kohlenberg et al., 1999). ...
... This therapeutic proposal considers the therapist-client relationship is a real interaction that has the potential to evoke and change client problem behaviors (Kohlenberg et al., 1999). Under the FAP perspective, clients tend to reproduce in the therapeutic context the same pattern of problematic responses found in other general life relationships, giving the therapist the possibility to consequence their emission in a contingent and natural form and to progressively create more adequate responses (Follete, Naugle & Callaghan, 1996;Kanter, Landes, Busch, Rusch, Brown, Baruch & Holman, 2006). To decrease problem behaviors, the therapist stops reinforcing them, creates more effective concurrent behaviors or occasionally punishes them when they are unpleasant in the client's interactions with other people (Follete, Naugle & Callaghan, 1996). ...
Therapeutic strategies described as effective for anxiety disorders include behavioral and cognitive-behavioral procedures of exposure and coping of aversive situations. However, considering that the behavioral pattern common in anxiety disorders is the phobic avoidance, the application of these strategies may difficult the adhesion or promote escape and avoidance of the therapeutic process. The Functional Analytic Psychotherapy is an alternative for dealing with these avoidance/escape behaviors and it can promote coping responses. This case report describes an analysis of the therapeutic relationship of a client with Panic Disorder and Agoraphobia. The intervention based on FAP was considered to help dealing with the avoidance behavior in the therapeutic process. Results show the efficacy of the procedures adopted and confirm the possibility of using FAP for improving the effectiveness of the empirically based psychotherapies.
... Sin embargo, normalmente, en un proceso de terapia conductual los objetivos terapéuticos se explicitan y discuten en la sesión de explicación de la evaluación funcional, siendo las sesiones de evaluación aquellas en las que el terapeuta intenta recopilar toda la información necesaria de cada caso y construir lo que se conoce como "alianza terapéutica", que no es más que el contexto que facilita y/o permite que el terapeuta ponga en marcha ciertos procedimientos de forma eficaz (Follette et al., 1996;Kohlenberg y Tsai, 1995;De Pascual-Verdú et al., 2019). En este sentido, en esas primeras sesiones los clientes emitirán verbalizaciones antiterapéuticas, ya que hablarán del malestar que experimentan en determinadas situaciones o del fracaso en la consecución de determinados objetivos. ...
... Hasta ahora las relaciones estudiadas han sido secuencias de dos términos en las que se analizaba la relación entre la conducta verbal del cliente y la verbalización que emitía el terapeuta después. Sin embargo, la terapia se concibe como un proceso de moldeamiento (Follette et al., 1996;Hamilton, 1988;Rosenfarb, 1992), por lo que se entiende que el terapeuta no esperará a que el cliente emita determinadas verbalizaciones para emitir aprobación ante estas, sino que buscará activamente que este las emita o que este proporcione información con respecto a las pautas realizadas, su nivel de satisfacción general o cualquier verbalización que pueda ser relevante para conseguir el cambio. Los resultados son acordes con lo planteado en nuestra tercera hipótesis: el terapeuta discrimina, el cliente emite verbalizaciones proterapéuticas y el terapeuta da muestras de aprobación. ...
El reforzamiento es uno de los procedimientos que se ha postulado como responsable del cambio conductual en la mayoría de las terapias. Es el principio de conducta más importante y apenas ha sido investigado en su modalidad verbal en contextos clínicos. El objetivo del presente estudio es ahondar sobre este procedimiento y arrojar conocimiento sobre cómo usan los terapeutas el reforzamiento verbal positivo en las diferentes fases de una intervención psicológica. Se analizan 60 sesiones clínicas de terapia conductual mediante un sistema de categorías de la conducta verbal del terapeuta y cliente diseñado para investigar la interacción terapéutica. Los resultados indican que los terapeutas hacen uso de reforzamiento verbal, emitiendo diferentes niveles de aprobación en función del tipo de verbalizaciones de los clientes. Este trabajo permite comprobar la utilidad de la metodología observacional para investigar los procesos que pueden explicar el cambio clínico, entendiendo el papel de los procedimientos de reforzamiento verbal y su relación con otras posibles funciones de la conducta verbal del terapeuta.
... It could, however, be argued that ignoring the role of the therapeutic relationship and alliance in behavior therapy may not only be problematic on a practical level but may also be inconsistent with basic principles that underlie behavior therapy (Kohlenberg et al., 1998;Raue et al., 1997). Indeed, Follette et al. (1996) proposed that the basic operant conditioning model (Skinner, 1957) and Relational Frame Theory (Hayes et al., 2001) could account for the alliance factors proposed by the alliance research. However, in contrast to a client-centered perspective, they do not assume that "unconditional positive regard" or wholly noncontingent responding are sufficient conditions in therapy to bring about change. ...
... Specifically, the therapeutic relationship and the strength of its alliance depend on a process of mutual influence. The therapeutic alliance is a mutual shaping and learning (Follette et al., 1996;Lejuez et al., 2005) process. The therapist works to influence clients' responses, and clients also impact therapist behavior (Walser et al., 2019). ...
Acceptance and Commitment Therapy (ACT) is a process-based intervention that promotes psychological flexibility by implementing six core processes. These include acceptance and awareness as well values and behavior change processes. Still, the primary vehicle for implementing these processes is the therapeutic relationship. Underscoring the importance of the relationship is paramount – it is the context in which the interventions emerge, allowing the therapist to shape psychological flexibility directly. We argue that the therapeutic alliance (TA) is co-created and is a critical factor contributing to the effectiveness of ACT. This paper focuses on the TA as a vital part of ACT treatment. We discuss the therapeutic alliance from an ACT perspective, explore different roles in implementing ACT, and conclude with a clinical case illustration. We more specifically focus on how the TA alliance and the therapeutic relationship can be a vehicle of change in ACT.
... Na medida do possível, o terapeuta FAP produz um ambiente terapêutico funcionalmente equivalente ao ambiente natural, no qual repertórios problemáticos do cliente surgem e as melhoras são modeladas em sessão pelo terapeuta. O terapeuta se torna um importante agente de reforços sociais, a fim de produzir um funcionamento melhor no comportamento do cliente, que é mais suscetível de generalizar e de ser reforçado em outros contextos (Follette, Naugle, & Callaghan, 1996;Kohlenberg & Tsai, 1991). ...
... O controle de antecedentes tem sido estudado como controle de estímulos, enquanto consequências têm sido estudadas como contingências de reforçamento e punição (Catania, 2007). Em FAP, a relação terapêutica é um contexto in vivo em que o terapeuta fornece es-tímulos com funções de antecedentes e de consequências em resposta a comportamentos problemáticos dos clientes e melhorias na sessão, a fim de produzir mudança terapêutica (Follette et al., 1996;Kohlenberg & Tsai, 1991;Kohlenberg, Tsai, Parker, Bolling & Kanter, 1999). ...
A Psicoterapia Analítica Funcional (FAP) é uma abordagem terapêutica que promove as mudanças comporta- mentais dos clientes por meio da modificação das contingên- cias de reforçamento, com a função de aumentar a probabi- lidade de acesso a metas valorosas dos clientes. Isso é feito por reforçamento diferencial de comportamentos dos clien- tes e treino de discriminação, no qual as melhorias compor- tamentais são modeladas e naturalmente reforçadas pelo te- rapeuta. À medida que as terapias evoluem e começam a ser disseminadas, geralmente seus princípios podem ser simpli- ficados e a linguagem tornada mais atraente para aqueles que adotam as novas técnicas. Este artigo levanta duas questões de interesse que ocorreram quando a disseminação da FAP ganhou mais impulso. Embora noções de ciência básica por trás da FAP incluam conceitos como discriminação de es- tímulo, responder e reforçamento diferencial, estes termos elementares foram reformulados como consciência, coragem e amor. Este artigo foca em dois problemas que podem resultar do uso do termo “amor” como representante para o reforçamen- to diferencial e positivo. Primeiro, o “amor” é problemático porque o uso do termo traz consi- go uma história cultural que pode ser confusa para terapeutas e clientes, criando riscos éticos. Segundo, “amor” como um termo representante para o reforço é inadequado porque não impli- ca as complexidades de reforço diferencial, da modelagem, e da punição com reforçamento di- ferencial de outras respostas no contexto do ambiente clínico.
... Entre los procesos de aprendizaje que podrían estar operando en la interacción clínica cabría destacar: (a) el reforzamiento de verbalizaciones proterapéuticas y el castigo de verbalizaciones antiterapéuticas (Follette, Naugle & Callaghan, 1996;Froján-Parga, Ruiz-Sancho & Calero-Elvira, 2016;Ruiz-Sancho, Froján-Parga & Galván-Domínguez, 2015); (b) el moldeamiento y encadenamiento de la conducta verbal del cliente hacia la emisión de verbalizaciones evaluables como más racionales (Calero-Elvira, Froján-Parga, Ruiz-Sancho & Alpañés-Freitag, 2013;Froján-Parga, Calero-Elvira, Pardo-Cebrián & Núñez de Prado-Gordillo, 2018;Poppen, 1989); (c) el empleo de operaciones de establecimiento y abolición que aumentan la probabilidad de emisión de verbalizaciones proterapéuticas (Dougher & Hackbert, 2000;Froján, Alpañés, Calero & Vargas, 2010;Luciano & Valdivia, 2006); (d) el reforzamiento del seguimiento de instrucciones dentro de sesión y de la descripción del seguimiento de instrucciones fuera de sesión (de Pascual & Trujillo, 2018;Leitenberg, Agras, Barlow & Olveau, 1969;Marchena-Giráldez, Calero-Elvira & Galván-Domínguez, 2013;Ortiz & Cruz, 2011); o (e) el empleo de emparejamientos pavlovianos que facilitarían el establecimiento de nuevas conductas en el contexto extraclínico (Froján-Parga et al., 2017). Este es, en nuestra opinión, el punto de partida que debe adoptar cualquier aproximación al estudio de procesos que aspire a lograr un enfoque integrador, conceptualmente coherente y capaz de explicar el éxito terapéutico de la intervención psicológica con personas diagnosticadas de EMG. ...
... Si bien los estudios de procesos también se han llevado a cabo desde muy diversas perspectivas(Frank, 1961;Rosenzweig, 1936;Toukmanian & Rennie, 1992), en nuestra opinión el análisis experimental de la conducta ofrece un excelente punto de partida, dada su potencia explicativa para dar cuenta del comportamiento humano y no humano y su historial de desarrollo de aplicaciones exitosas en el ámbito clínico. Esta perspectiva supone el abandono de la etiqueta diagnóstica como concepto explicativo y objetivo de la intervención, así como el restablecimiento de la interacción agente-entorno como el nivel de explicación adecuado para dar cuenta tanto del comportamiento considerado "normal" o "deseable" como del considerado "psicopatológico"(Pérez- Álvarez, 1996(Pérez- Álvarez, , 2004(Pérez- Álvarez, , 2011Follette et al., 1996;Rosenfarb, 2013).En este sentido, hemos destacado el papel que puede jugar la interacción verbal en terapia como principal vehículo de los procesos de cambio que se dan en la intervención psicológica, máxime cuando esta se produce en contextos de tratamiento ambulatorio e intermitente. A través de dicha interacción, el terapeuta puede modificar la conducta verbal y no verbal de la persona diagnosticada en sesión para, así, aumentar la probabilidad de que dichos cambios se generalicen al contexto extraclínico. ...
El concepto de Enfermedad Mental Grave (EMG) ha sido desarrollado en el seno del modelo biomédico y ha determinado de forma teórica y práctica las intervenciones psicológicas dedicadas al tratamiento de estos problemas. Desde los inicios del análisis de conducta se han generado evidencias que hacen lícito el abandono de la conceptualización exclusivamente biomédica de las denominadas Enfermedades Mentales Graves. Se ha demostrado que las conductas problema de estas personas pueden ser sensibles a cambios en variables ambientales y se han instaurado diferentes técnicas de evaluación e intervención (e.g., modificación de antecedentes/consecuentes y establecimiento de economías de fichas en contextos hospitalarios). No obstante, el análisis del control verbal que puede ejercer el terapeuta sobre la conducta del cliente, tanto fuera como dentro de sesión, aún sigue siendo una tarea pendiente. El objetivo de este artículo es presentar las aportaciones del análisis de la conducta al estudio y tratamiento de esta problemática, además de poner de relieve la importancia del análisis de los procesos de aprendizaje que ocurren durante la intervención psicológica con personas diagnosticadas de EMG.
... producing change. To the degree possible, the FAP therapist produces a therapeutic environment functionally equivalent to a natural environment, where problematic client repertoires emerge and improvements are shaped in session by the therapist becoming an important agent of social reinforcement to produce a better functioning that is likely to generalize to and be reinforced in other settings (Follette, Naugle, & Callaghan, 1996;Kohlenberg & Tsai, 1991). ...
... Antecedents control has been studied as stimulus control while consequences have been studied as reinforcement contingencies (Catania, 2007). In FAP, the therapeutic relationship is an in-vivo context in which the therapist provides antecedent stimulus functions and reinforcing consequences in response to a client's problematic behaviors and improvements in session in order to produce therapeutic change (Follette et al., 1996;Kohlenberg & Tsai, 1991;Kohlenberg, Tsai, Parker, Bolling & Kanter, 1999 When FAP was initially described, it adopted the same purposes and technology of behavior analysis, which specifies three main principles to explain how changes occur when behavioral techniques are used to alter consequences (contingencies of reinforcement): (a) reinforcement, (b) punishment, and (c) extinction. Reinforcement results in increasing behavior under a particular stimulus condition, given that the organism obtains appetitive consequences, or withdraws aversive stimuli when responses occur. ...
Functional analytic psychotherapy (FAP) is a therapeutic approach that addresses clients’ change through modifying contingencies of reinforcement of behavior that function to increase the likelihood that clients can access valued goals. This is done by differential reinforcement of clients’ behaviors and discrimination training, in which the behavioral improvements are shaped and naturally reinforced by the therapist. As therapies evolve and are readied for dissemination, it is often the case that therapy principles may be simplified and language made more appealing to those adopting new techniques. This article raises two issues of concern that have occurred as the dissemination of FAP has gained momentum. Although notions of basic science behind FAP include basic ideas of stimulus discrimination, responding, and differential reinforcement, these elementary terms have been recast as awareness, courage, and love. This article focuses on two problems that may result from the use of the term love as a proxy for differential and positive reinforcement. First, love is problematic because the use of the term brings with it a cultural history that can be confusing for both therapists and clients alike, creating ethical risks. Second, love as a proxy term for reinforcement is inadequate because it does not entail the complexities of differential reinforcement, shaping, and punishment with differential reinforcement of other responses in the context of the clinical setting.
... He also emphasized collaboration, partnership, and building trusting alliances to foster humane behaviorism. Follette et al. (1996) also presented an early behavior-analytic discussion of the how the therapeutic relationship contributes to change using operant-conditioning principles to explain the mechanisms at play. As mentioned earlier, many works demonstrated a positive relationship between alliance and clinical outcomes, however, they fell short in explaining how. ...
As a result of feedback from communities affected by applied behavior analysis, there has been a recent shift in focus in the field to identify empirically validated approaches to teaching compassionate-care skills. Active listening is one vital component of these relationship-building skills. The specific context in which this was explored is with supervisors working at adult day programs, as staff have noted problems related to the quality of interactions with their supervisors. The study addressed this by answering the question, “What are the effects of a behavior skills training (BST) package on the acquisition of the identified active listening skills on supervisory staff?” The study was grounded in both operant conditioning and relational frame theory. It used a single-subject concurrent multiple-probe design across participants. There were three participants, all serving as supervisors at adult day programs responsible for overseeing direct care staff. The study was conducted via Microsoft Teams, a virtual platform. During the rehearsal and feedback phase of the training, they engaged in role-play with the researcher, in which they practiced the identified behaviors which compromised the active listening checklist. All three participants mastered the active listening checklist demonstrating a functional relationship between the BST intervention and the dependent measure, active listening skills. Furthermore, they continued to demonstrate mastery during a generalization probe addressing a novel situation and in two maintenance probes, two and four weeks after the final training probe. They completed three social validity surveys which reflected the highest possible scores on the goals and the procedures of the study, and positive narrative remarks about the outcomes of the study.
... En definitiva, la terapia psicológica se explicaría estudiando los procesos de aprendizaje que ocurren a través de la interacción verbal que se desarrolla durante la intervención terapéutica y las técnicas no serían otra cosa que procedimientos (más o menos estandarizados y en su mayoría instruidos) que, en el contexto de la relación terapéutica, facilitan la ocurrencia de dichos procesos (Follette et al., 1996;Froján-Parga et al., 2006;Hoffmann y Hayes, 2019). ...
En este trabajo se expone la necesidad de potenciar la investigación de procesos como el camino más adecuado para conocer y explicar el proceso terapéutico al tiempo que se cuestiona la metodología utilizada en la investigación de resultados, predominante en la actualidad para el estudio de la intervención clínica: la comparación de grupos, la asignación de sujetos al azar o la clasificación con etiquetas diagnósticas que dificultan el estudio del proceso terapéutico y la identificación de los elementos que hacen que un tratamiento tenga determinado efecto. Frente a este tipo de investigaciones, se presentan una serie de trabajos que defienden el uso de metodología observacional para la identificación de los procesos de aprendizaje que serían responsables del cambio en terapia, así como el análisis de la interacción terapéutica desde una perspectiva funcional: teniendo en cuenta que la terapia psicológica es fundamentalmente hablada, se plantea que la forma óptima de analizarla es a partir del estudio del intercambio verbal entre cliente y terapeuta. Se presenta un sistema de codificación de la interacción verbal que los autores proponen como herramienta para identificar las funciones de la conducta verbal del terapeuta durante el proceso de intervención clínica y en los distintos trabajos se analizan, entre otros, el papel que desempeñan las instrucciones, los procesos de reforzamiento y control discriminativo, la transferencia de funciones a través de emparejamientos o el lenguaje como proceso colaborativo.
... En FAP el terapeuta utiliza las contingencias sociales directas en sesión para disminuir unas conductas problemáticas (como clases de respuesta comunes) y para aumentar otras clases de respuesta más adaptativas. Las clases de respuesta se refiere a grupos de respuesta que pueden tener topografías o formas diferentes, pero que tienen la misma función o el mismo efecto sobre el ambiente (Follette et al., 1996). Este procedimiento se conoce como reforzamiento diferencial por aproximaciones sucesivas. ...
Se presenta una investigación sobre la interacción terapéutica directa, cuyo objetivo es analizar el mecanismo de moldeamiento progresivo y las contingencias implementadas por el terapeuta como un posible mecanismo del cambio terapéutico. Han participado tres personas con diferentes problemas psicológicos, en un diseño de caso único con líneas-base concurrentes, a lo largo de ocho sesiones de intervención. Se ha utilizado un sistema de observación, registro y clasificación (SCAFIT) de las respuestas verbales, siguiendo los principios de la Psicoterapia Analítica Funcional. Este sistema implica un análisis meticuloso de las conductas clínicamente relevantes del cliente y las consecuencias de reforzamiento/castigo del terapeuta. Los resultados han mostrado ese efecto de moldeamiento verbal, disminuyendo las conductas poco adecuadas (CCR1) y aumentando progresivamente las conductas adecuadas (CCR1 y 2). La fiabilidad de los observadores, evaluada a través del índice Kappa ha sido elevada (entre 0.56 y 0.65). Las correlaciones entre las conductas de cliente y terapeuta también han sido elevadas (entre r = 0.82 y 0.99). Por su parte, el análisis lag-secuencial y el índice de Q de Yule ha sido significativo y con valores elevados (entre 0.48 y 0.99). Estos resultados confirman la existencia de un proceso de moldeamiento progresivo, que puede atribuirse a las contingencias que va aplicando el terapeuta sesión a sesión. Este sistema introduce una herramienta analítica de utilidad, aplicable para estudiar las interacciones momento a momento que tienen lugar dentro una terapia, y que también podría aplicarse a cualquier otro tipo de terapia verbal.
... This kind of technique is used in psychodynamic traditions, such as short-term psychodynamic therapy (Blagys & Hilsenroth, 2000;Lemma et al., 2011), and relies on the implication that the clienttherapist relationship is analogous to other relationships that the client has, and thus similar problematic interpersonal patterns will emerge. The targeting of these patterns in the therapeutic relationship is thus seen to improve the client's general interpersonal functioning (Follette et al., 1996). This approach is also used in some behavioral traditions, such as DBT (Bedics & McKinley, 2020), which uses direct, honest, and irreverent statements like this to challenge a client's understanding of their experience and shift their perspective. ...
Youth who have experienced homelessness are impacted by disproportionately high levels of mental health symptoms, which contribute to vastly decreased well-being and early mortality. Despite a salient need for mental health support, several recent reviews have shown that few, if any, interventions currently applied to this group appear to improve mental health consistently. Furthermore, community mental services present many barriers to access for this population, given the impacts of social determinants of health on youths’ ability to engage in the available supports, the ongoing instability faced by many of these youths, and the lack of applicability of existing services to youth. A challenge exists for clinicians who work with this population of youth and wish to provide effective supports, given these obstacles and an inadequate evidence base on which to inform treatment. The purpose of this article is to propose a framework for care to inform psychotherapeutic treatment for clinicians providing mental health supports to youth with experiences of homelessness. This framework is cross-modality, transdiagnostic, and research-informed and seeks to provide a structure with which to frame treatment that acknowledges and responds to the various obstacles that practitioners frequently encounter in working with this population. The framework is accompanied by illustrative case studies to demonstrate how this framework may be applied using different treatment modalities. The hope in sharing this framework is to promote more intentional and effective interventions with this chronically underserved population of youth and also to increase the self-efficacy of those practitioners who are doing this important work.
... Based on the social erosion theory, it could be that these youth's perceived social support had already been eroded before they started treatment as they might have endured prolonged periods of high distress prior to starting treatment. Starting treatment might enhance perceived social support over time because positive experiences in therapy (e.g., building a therapeutic relationship, developing trust, disclosing thoughts and feelings) can serve as a model for youth to generalize to their relationships outside of therapy (Follette et al., 1996;Thompson & Goodvin, 2016). Prior research has, however, shown that the (newly built-up) effects of perceived support require some time to manifest (i.e., a sleeper effect of support; Torsheim et al., 2003). ...
Although social support and mental health associations have been extensively investigated, their reciprocal relations in vulnerable youth remain understudied. This study investigated the relations between perceived social support and symptom distress over time whilst differentiating between support from caregivers and significant others. The sample included 257 youth (79% self-identified women, Mage = 19.2, SD = 2.5) who were receiving mental health treatment. Using a Random-Intercept Cross-Lagged Panel Model, results revealed no significant concurrent associations, between-person effects, or cross-lagged effects. The autoregressive effects suggested that perceived social support from caregivers was relatively stable over time, while symptom distress and support from a significant other were not. In all, this study challenged the validity of the social causation and social erosion models in the context of perceived social support and symptom distress among vulnerable youth, revealing an absence of significant reciprocal associations. The stable nature of perceived social support from caregivers compared to support from significant others was highlighted. The study design, hypotheses, and target analyses were preregistered under https://osf.io/f4qpg.
... FAP identifies in-session occurrences of relevant daily life behaviors and labels them Clinically-Relevant Behaviors (CRBs), and further specifies both client problems (CRB1s) and improvements (CRB2s) that occur in session. The therapeutic task in FAP is contingent responding to naturally reinforce and increase the frequency of CRB2s while ignoring, punishing, or otherwise decreasing the frequency of CRB1s (Follette, Naugle, & Callaghan, 1996). As described below, in the case of PTSD the task may also include elicitation of respondent CRB1s and habituation and extinction of them through nonreinforced exposure. ...
Empirical evidence supports cognitive -behavioral interventions for the treatment Posttraumatic Stress Disorder (PTSD), with exposure therapy typically being the most frequently utilized. While the success of exposure treatments is well established there are factors which may hinder their use in “real-world” settings (e.g., poor treatment compliance, high drop-out rates, aversive nature of the procedures). These limitations indicate that the field of psychology needs to continue to search for effective and palatable PTSD interventions. Contextual behavior therapies, such as Acceptance and Commitment Therapy, Behavioral Activation, Dialectical Behavior Therapy, and Functional Analytic Psychotherapy, may be these alternatives. This paper reviews the theoretical rationale and available empirical literature related to the use of these treatments with trauma populations.
... Por el contrario, la PAF se basa en una consideración diferente de la propia relación terapéutica, entendiendo que los problemas que llevan al individuo a buscar ayuda también pueden producirse dentro de la propia sesión, en su relación con el terapeuta, y que deben aprovecharse las oportunidades de aprendizaje que surgen en esa relación (Kohlenberg y Tsai, 1991, 1994a. Como destacan Follette et al. (1996), la relación terapéutica no se ve como una metáfora de algo que sucede fuera, sino que la conducta objetivo es la experiencia directa entre el terapeuta y el cliente, y el mecanismo de cambio es la historia de aprendizaje que el cliente genera interactuando con el terapeuta. ...
La Psicoterapia Analítico-Funcional se basa en los principios de la filosofía conductual radical y el análisis de la conducta clínica, y forma parte de las terapias contextuales de la conducta. Se elaboró sobre el análisis conductual del ambiente psicoterapéutico, y acentúa las contingencias que ocurren en el contexto terapéutico, la equivalencia funcional, el reforzamiento natural, y el moldeamiento. Esta terapia pretende ir más allá del entrenamiento de habilidades, para ser un contexto para el aprendizaje a través de la propia experiencia. En este artículo describimos una teoría conductual del cambio terapéutico en el que la relación clienteterapeuta es el centro del proceso del cambio. Presentamos los principios de la Psicoterapia Analítico-Funcional, e indicamos como este enfoque puede ayudar con algunos problemas y trastornos psicológicos.
... Further, when administered online (i.e., via self-guided administrations), SSIs inherently lack the prospect of building therapeutic alliance with a caring professional. This alliance, or the positive interpersonal connection that can form between a service provider and recipient, shows well-established links to improved treatment outcomes in traditional, face-toface psychotherapy (Ardito & Rabellino, 2011;Follette et al., 1996). It remains possible, albeit untested, that some youth may require therapeutic alliance, rapport, and trust to benefit from treatment. ...
At present, the mental healthcare system cannot meet the demand for services, and the need‐to‐access gap is widest among children and adolescents. Single session interventions (SSIs) are brief, intentional, and mechanism‐targeted programs that have shown promise in increasing the reach of effective, evidence‐based services; yet, a wide gap still remains due to structural barriers (e.g., lack of awareness, workforce shortages). The present paper posits the integration of SSIs and mentor‐delivered programs as a promising future step to further overcome the inaccessibility of youth mental health services. Capitalizing on the advantages of mentoring relationships (e.g., the associated interpersonal benefits and mentors' pre‐existence in most community settings) has the potential to complement and enhance the value of SSIs, and to expand the acceptability and reach of evidence‐based mental health services. In this paper, we discuss the anticipated benefits of mentor‐delivered SSIs, as well as cautionary considerations related to the proposed model. To conclude, we highlight the necessary implementation and research implications.
... First, group therapists who handle difficult interpersonal provocations from their child clients by exerting inhibitory control over their own expression of their own frustration and by effectively regulating their arousal are modeling key processes which can be instrumental for children learning to improve their own emotional regulation over time (Chapman, Baker, Porter, Thayer, & Burlingame, 2010;Stewart, Christner, & Freeman, 2007). Second, group leaders who respond more frequently in warm ways to the children in their groups are likely providing more social reinforcement for positive child behaviors within the sessions (Follette, Naugle, & Callaghan, 1996), and facil-itating sustained generalized reductions in problem behaviors outside of the group sessions. Third, in a related way, group leaders who respond to children with more warmth are likely to develop stronger therapeutic alliances with the children, and the children can become more engaged with the intervention. ...
The evidence-bas for cognitive-behavioral child interventions has continued to advance in the past several decades across many areas of psychopathology, including disruptive behavior problems. We know quite a bit about what works. However, despite earlier research efforts (e.g., Copeland & Hammel, 1981; Lochman, Lampron, Burch, & Curry, 1985; Conduct Problems Prevention Research Group, 2002), we are still in early stages of understanding “what works for whom.” Efforts to explore moderators of established interventions, rather than merely efficacy (La Greca, Silverman, & Lochman, 2009), can progressively help to identify how we can tailor interventions for different children, and tailor training for therapists. One example occurs in research efforts to clarify whether group-based interventions might have iatrogenic effects with some children with disruptive behavior problems.
... Existen en la actualidad propuestas explicativas de la eficacia del método socrático que se basan en el estudio de los procesos de aprendizaje cuya ocurrencia es facilitada por tal procedimiento. La explicación conductual del método socrático como un proceso combinado de moldeamiento y encadenamiento junto con aspectos pavlovianos derivados del uso del lenguaje como sistema referencial ha sido y es, desde hace varios años, una plausible propuesta explicativa fundamentada en trabajos de investigación, que abarca todo el proceso terapéutico Follette et al., 1996;Froján et al., 2017). ...
La eficacia demostrada de algunos procedimientos terapéuticos no siempre va seguida de una explicación coherente de su funcionalidad. En este artículo nos proponemos revisar tres de las estrategias terapéuticas más utilizadas en la actualidad: reestructuración cognitiva, defusión cognitiva y mindfulness, ofreciendo una explicación alternativa a las terapias tradicionales, partiendo de su definición como mayoritariamente verbales. La consideración de la cognición como una conducta cualitativamente diferente a cualquier otra conducta humana implica caer en una forma de pensar dualista que poco tiene que ofrecer al desarrollo científico de la psicología. Nuestra propuesta adopta un enfoque monista, basado en procesos de aprendizaje respondiente y operante, dentro de una tradición de análisis conductual. Se considera que las técnicas citadas operan sobre el comportamiento privado pero no difieren ontológicamente del público y, por tanto, están sujetas a contingencias en el proceso terapéutico de forma similar a cualquier otro comportamiento.
... However, verbal behavior is not a static element in psychological treatment; it changes throughout the therapeutic process and is also dependent on the therapist's goals (Follette, Naugle, & Callaghan, 1996;Froján, Montaño, & Calero, 2010;Rosenfarb, 1992;Ruiz, Froján, & Calero, 2013;Ruiz, Froján, & Galván, 2015;Tsai et al., 2009;Vargas et al., 2017). On this basis, it might be expected that how the therapist chooses to give instructions regarding homework and assesses the client's compliance will change over the different stages of the intervention, reflecting how clients incorporate new strategies into their behavioral repertoire. ...
Instructions are a common resource used by behavioral therapists to assign therapeutic homework. However, understanding how clients learn with instructions is better known in laboratory research than in clinical research. The present study aims to explore changes in the way of instructing and reviewing the client’s compliance throughout the therapeutic process. We analyzed the therapist’s verbal behavior during 211 recorded sessions corresponding to 19 cases treated by 11 behavioral therapists (53% male and 47% female). The sessions were divided into four stages according to the timing of the intervention and coded by using a previously validated coding system (SYST-INTER-INSTR). Results show that instructions become less specific towards the last stage of the intervention. However, therapists assess task compliance in the same way towards the end of the therapeutic process. The change in specificity suggests that the client’s behavior changes from being controlled by instructions to being controlled by natural contingencies. However, to make sure the clinical change remains; therapists assess and reinforce the client’s compliance until the end of the intervention. Although clinical implications of the results, some limitations (i.e., not considering the type of task instructed) should be addressed in future studies.
... Psychological flexibility increases through the interpersonal interactions between the coach and the coachee (Skews, 2018). The coach models psychological flexibility and reinforces target behavioural processes in their interpersonal interactions with the coachee (Follette, Naugle, & Callaghan, 1996), encouraging helpful behaviours and disrupting unhelpful behaviours. The coaching relationship will be effective if it meets the goals and values of the coachee and coach (Vilardaga & Hayes, 2010). ...
Acceptance and commitment theory (ACT) and positive psychology are deeply aligned despite their development in different traditions, as both focus on human flourishing and wellbeing. This chapter provides an overview of ACT, highlighting how the theory is applied to coaching in the workplace as acceptance and commitment coaching (ACC). A summary of research demonstrating the impact of ACT-based interventions in the workplace is provided, so practitioners can see the workplace outcomes ACC has an effect on. The chapter outlines the six behavioural processes for building psychological flexibility: Values; committed action; present moment awareness; self-as-context; defusion; and acceptance. The reader is given examples of how to apply the behavioural processes within the framework of ACC. The distinct features of the practitioner stance within ACC are presented, such as disrupting existing behaviours which allows the coachee to develop new, more effective behaviours aligned with their values. The chapter closes with an illustrative case study and discussion points to help the reader reflect on how they can apply ACC in their coaching practice.
... The agency selected three skills deemed important or relevant to their particular context and training goals. The skills chosen were derived from observations of staff interactions, a previous training program, and agency knowledge of the literature on motivational interviewing, as well as open questions, affirmation, reflective listening, and summary reflections (e.g., Christopher & Dougher, 2009); acceptance and commitment therapy (ACT; Hayes & Wilson, 2011); and the therapeutic alliance in behavior analysis (e.g., Follette et al., 1996). The agency was particularly interested in incorporating ACT into their practice, and thus the skills trained reflected this particular orientation (Wilson & DuFrene, 2008): mindful reflecting, asking questions with curiosity, and appreciating. ...
Recent research has emphasized the need for training and competency beyond the standard technical skills acquired by applied behavior analysis (ABA) practitioners, including essential relationship-building and compassionate care skills (Taylor et al., 2019). Clicker training is a well-established behavior-analytic method for improving performance via immediate feedback in the form of an audible "click." The effectiveness of clicker training has not yet been evaluated as a technique for shaping complex clinical repertoires. This study evaluated the effects of verbal instructions, clicker training, and role-play on the acquisition of therapeutic relationship skills in ABA practitioners. Data were obtained as part of a training program conducted within an ABA agency, and the acquisition of target skills was evaluated using a multiple-baseline design across behaviors for two participants. During baseline, participants rarely demonstrated target skills. During training, the procedure resulted in increased engagement in all three target skills for both participants. Skill generalization with respect to untrained and novel scenarios was observed but at levels below mastery. Findings have potential implications for trainers and supervisors seeking efficient, nonintrusive, socially acceptable methods of improving practitioner performance.
... The therapist works to influence clients' responses, and clients also impact therapist behavior (Walser, 2019). The therapeutic alliance is a process of mutual shaping and learning (Follette et al., 1996;Lejuez et al., 2005). A rupture and repair to the alliance would include an exploration of the function of both client and therapist's behavior. ...
The therapeutic relationship is an essential part of effective therapy. Therapists facing a rupture in this alliance are challenged to mend the discord in a forward moving and effective treatment service. In acceptance and commitment therapy (ACT) the alliance is characterized by client and therapist working together, using the core processes of ACT, creating a vital and moment‐by‐moment collaborative experience. As a transdiagnostic, behavioral intervention, acceptance, and mindfulness processes and commitment and behavioral change processes are used to create meaningful and engaged lives. ACT's core methods promote psychological flexibility in response to problems in living, psychopathology, and enhancement of general well‐being. However, flexibility in session can be lost to therapeutic ruptures. In ACT, processes such as defusion, perspective‐taking, choice, and values play a role in restoring a cooperative, engaged alliance repair. We will explore the therapeutic relationship within the ACT model and present its perspective on rupture and repair in psychotherapy.
... Despite this, little conceptual work has focused on relationships within behavior analysis (Some attention has been given to the topic of the therapist-client relationship within behavior analysis, especially within Functional Analytic Psychotherapy. For example, Follette, Naugle, and Callaghan (1996) provided an analysis of the therapeutic relationship in radical behavioral perspective). The present paper describes a behavioral conceptualization of interpersonal relationships and emphasizes factors that contribute to relationship closeness and conflict. ...
This paper presents an interbehavioral conceptualization of interpersonal relationships, emphasizing both interpersonal closeness and conflict. In doing so, processes of association and subsequent substitution of stimulus function are described, setting the foundation for an analysis of how relationships are formed from an interbehavioral perspective. Specific attention is given to factors that impact intimacy and closeness in relationships, especially ways in which closeness may be fostered and conflict made more likely. The topic of communication is addressed, and possible therapeutic targets are highlighted from a novel conceptual context. The analysis is contrasted with more traditional ways of thinking, including more common behavior analytic perspectives. The implications of adopting the proposed interbehavioral conceptualization are provided.
... First, group therapists who handle difficult interpersonal provocations from their child clients by exerting inhibitory control over their expression of their own frustration and by effectively regulating their arousal are modeling key processes that can be instrumental for children learning to improve their own emotional regulation over time (Chapman et al., 2010;Stewart et al., 2007). Second, group leaders who respond more frequently in warm ways to the children in their groups are likely providing more social reinforcement for positive child behaviors within the sessions (Follette, Naugle, & Callaghan, 1996), and facilitating sustained generalized reductions in problem behaviors outside of the group sessions. Third, in a related way, group leaders who respond to children with more warmth are likely to develop stronger therapeutic alliances with the children, and the children can become more engaged with the intervention. ...
This study originated in collaboration with Thomas Dishion because of concerns that a group format for aggressive children might dampen the effects of cognitive-behavioral intervention. Three hundred sixty aggressive preadolescent children were screened through teacher and parent ratings. Schools were randomized to receive either an individual or a group format of the child component of the same evidence-based program. The results indicate that there is variability in how group-based cognitive-behavioral intervention can affect aggressive children through a long 4-year follow-up after the end of the intervention. Aggressive children who have higher skin conductance reactivity (potentially an indicator of poorer emotion regulation) and who have a variant of the oxytocin receptor gene that may be associated with being hyperinvolved in social bonding have better outcomes in their teacher-rated externalizing behavior outcomes over time if they were seen individually rather than in groups. Analyses also indicated that higher levels of the group leaders’ clinical skills predicted reduced externalizing behavior problems. Implications for group versus individual format of cognitive-behavioral interventions for aggressive children, and for intensive training for group therapists, informed by these results, are discussed.
... Dada a singularidade e a relevância dessas interações, Silveira (2000) defende que esse relacionamento só deve ser denominado Terapêutico quando proporcionar o alcance das metas terapêuticas. A interação terapeuta-cliente ao longo das sessões psicoterápicas pode estabelecer um cenário no qual novos comportamentos possam ser modelados proporcionando ganhos terapêuticos para o cliente (Follette, Naugle, & Callaghan, 1996;Kohlenberg & Tsai, 2001. ...
Resumo: A clínica psicoterápica apresenta diversas demandas ao terapeuta, que vão desde as questões teóricas, relacionadas à abordagem adotada pelo profissional, até aquelas relacio-nadas ao cliente-suas características pessoais, demandas clínicas, expectativas com relação ao tratamento etc. Identificar como e quando responder a todas essas demandas é um desafio para o psicólogo, que deve ser responsivo às diferentes necessidades do caso clínico, visando a melhora do cliente. O presente artigo tem como objetivo conceituar o termo responsividade com base na visão analítico-comportamental e apresentar alguns aspectos relevantes para a sua consideração na produção de pesquisas no contexto clínico. Para isso, é apresentada a origem do termo, as definições do conceito de acordo com diferentes abordagens teóricas, o entendimento do conceito com base na perspectiva analítico-comportamental e sua impor-tância para a pesquisa em psicoterapia. Palavras-chave: responsividade; análise do comportamento; psicoterapia analítico-compor-tamental; pesquisa em psicoterapia. www.revistaperspectivas.org O conceito de responsividade na Terapia Analítico Comportamental e suas implicações para a pesquisa de processo-resultado
... A Psicoterapia Analítica Funcional (FAP) é uma das formas de terapia surgidas nesse período e que se debruçou em uma releitura da relação terapêutica em uma perspectiva analítico-comportamental ). Este modelo de terapia se configura como sendo teórico e conceitualmente sólido e demonstra-se bastante útil no processo clínico, como apontam diversas publicações (Follette, Naugle & Callaghan, 1996;Vandenberghe, 2003Vandenberghe, , 2007. ...
Functional Analytic Psychotherapy (FAP) is based on radical behaviorism and proposes that the shaping of clinically relevant behavior (CRB) is the instrument of behavioral change. Many researches demonstrated this mechanism, but a detailed analysis of the variables is necessary. The objective of this research was to study the effects of two different FAP interventions on CRBs: Non-signalized FAP Interventions (FAPNS) and signalized FAP interventions (FAPS), and compare those interventions with sessions of behavioral psychotherapy, with focus on analysis of contingencies external to therapy (ACE). FAPNS interventions consist of shaping the client´s behavior throughout the course of therapeutic interaction. FAPS interventions, in addition to shaping CRBs during therapeutic interaction, contain the following variables: 1) signaling and description by the therapist of the occurrence of CRBs during the interaction with the client, 2) description of the CRB’s impact on the therapist (e.g., the therapist’s feelings, thoughts, etc., produced by the client’s CRBs), and 3) description of parallels between CRBs and the client’s behavior outside therapeutic setting. We used a within-subject withdrawal design with multiple treatments (A1 - B1 - A2 - C1 - A3 - B2 - A4 - C2 - A5) to study those variables in two clients with interpersonal relationship problems. We controlled the order of presentation of each phase for the participants. The sessions were filmed and then coded using the Functional Analytic Psychotherapy Rating Scale-FAPRS. 27 sessions of each participant were analyzed. The results show that the shaping process of CRBs is the main mechanism of change in FAP since the CRBs 2 increased while the CRBs 1 decreased during FAPS and FAPNS phases. We observed the reversion of CRBs frequencies between FAP and non FAP phases (ACE), but we did not find differences between FAPS and FAPNS interventions. This indicates that the shaping process of CRBs occur when the therapist presents the precise consequences for each CRBs, even if the consequences do not include the description of the behaviors that take place between therapist and client.
... Alguns autores comportamentais apontam que mudanças ocorridas em terapia se dão através de procedimentos estruturados e do controle por regras (Skinner, 1989, Matos, 2001. Já autores como Hayes, Kohlenberg e Melacon (1989) e Follette, Naugle e Callaghan (1996) afirmam que a história de aprendizagem e a modelagem adquirida na interação com o terapeuta são um importante mecanismo de mudança. É importante produzir evidências empíricas para ajudar na análise teórica sobre os processos de mudança clínica. ...
Em busca de uma melhor compreensão do controle por regras em terapia, verificou-se a presença de orientação e auto-orientação em sessões de terapeutas analítico-comportamentais experientes e pouco experientes e se estas se diferenciavam quanto ao grau de especificidade. Foi considerada “orientação” uma indicação do terapeuta do que fazer fora da sessão e “auto-orientação” quando essa indicação era emitida pelo cliente. Participaram seis terapeutas pouco experientes e três experientes, cada um atendendo três clientes adultos por três sessões. Terapeutas experientes apresentaram grande variação quanto ao uso da orientação entre clientes e entre sessões e, em média, orientaram mais que os pouco experientes. A maioria dos clientes dos terapeutas experientes se auto-orientou mais que os dos outros terapeutas. Predominaram orientações e autoorientações para ação específica. Uma ou mais orientações e auto-orientações ocorreram em sessões conduzidas por terapeutas analítico-comportamentais, sugerindo que emissão e alteração de regras podem contribuir com mudanças no processo terapêutico.
... Por meio delas, os cientistas podem analisar o estado da produção relacionada ao tema e verificar o grau de replicação de pesquisas, o que, por fim, pode evocar novas estratégias a serem consideradas para a propagação do tema em análise. Portanto, a análise da produção científica assegura o intercâmbio das informações entre os cientistas (Le Coadic, 1994/1996. ...
O presente estudo visou caracterizar e discutir a produção científica a respeito de FAP, mais especificamente estender o estudo de Mangabeira et al. (2012) para a produção compreendida entre 2010 e 2013. O método consistiu em levantar e analisar artigos sobre FAP (a) indexados em cinco bases de dados, a saber: PubMed, SciELO, Virtual Health Library – Psychology, MEDLINE e Lilacs; (b) listados nas referências do site de FAP http://functionalanalyticpsychotherapy.com, bem como nos sites Science Direct e ISI Web of Knowledge; e (c) publicados nos jornais JABA, JEAB, The Behavior Analyst, The Behavior Analysis Today, IJBCT e JEIBI. A palavra-chave utilizada foi “Functional Analytic Psychotherapy”, considerando os idiomas inglês e português, e a sigla “FAP”. Os 46 estudos encontrados foram categorizados conforme suas características bibliográficas, metodológicas e temáticas. Os principais resultados encontrados foram que: houve um aumento na quantidade de publicações a respeito de FAP no último triênio, quando comparada aos períodos anteriores — resultado este que pode ter sido influenciado pela edição de um volume especial do periódico The International Journal of Behavioral Consultation and Therapy dedicado ao tema —; a maioria dos estudos são de campo/empíricos e lançam mão de medidas de observação para coleta de dados; há uma preferência por estudos com poucos participantes (sugerindo o uso de delineamentos de sujeito como seu próprio controle) e com população adulta; e os principais temas estudos têm sido tratamento com FAP, comparação com ACT e terapia de grupo com FAP.
... Entre as variáveis mais importantes para a produção de exposição e ampliação do repertório comportamental do cliente está a capacidade do terapeuta propiciar condições para formação de vínculo legítimo com o cliente (Follette, Naugle, & Callaghan, 1996). Esse dado é verificado em pesquisas de resultado que associam o desfecho do tratamento à qualidade da relação terapêutica. ...
O Brasil é um dos países que mais se destaca na formação clínica de analistas do comportamento. No presente estudo é apresentado um breve histórico da terapia analítico-comportamental, com seu surgimento e evolução da área no Brasil, incluindo as terapias de modificação do comportamento, com base filosófica no Behaviorismo Metodológico, até as Terapias de Terceira Onda, fundamentadas no Behaviorismo Radical. Ressalta-se a importância de habilidades do terapeuta ao atendimento clínico, com a discussão de questões relacionadas ao desenvolvimento de vínculo genuíno e positivo com o cliente, observação, identificação, descrição de como operacionalizar e analisar funcionalmente os comportamentos problema. São apresentadas considerações sobre a relação supervisor-supervisionando e sobre o papel do supervisor na aquisição de repertórios básicos na formação do clínico iniciante. Por fim, são descritos recursos que podem ser utilizados pelo supervisor para facilitar o desenvolvimento de habilidades em seus supervisionandos, como o ponto de escuta eletrônico, a observação direta a partir de salas com espelho unidirecional e as gravações de áudio e vídeo. Espera-se que esse artigo seja útil para práticos da clínica analítico-comportamental e sirva também como recurso didático para professores das disciplinas de Análise do Comportamento na graduação de universidades brasileiras.
... It is particularly important to assess the effectiveness and efficiency of adding FAP and BA and to identify whether one or another therapy is more or less effective for specific clients. For instance, it would be interesting to explore whether FEBA could be more useful than BA alone for clients who present interpersonal problems or a narrow social network because FAP is a therapeutic approach centered on the therapeutic relationship, where interpersonal repertoires are directly shaped in the clinical environment (Follette, Naugle,& Callaghan, 1996).Some limitations of this study are related to participant recruitment due to three participants dropping out before starting the intervention. We recommend increasing the num- ...
Functional analytic psychotherapy enhanced behavioral activation (FEBA) is a therapeutic approach that combines strategies from behavioral activation and functional analytic psychotherapy to improve therapeutic outcomes in clients who lack stable sources of reinforcement in their natural environments. In FEBA, therapists modify clients’ behaviors within the therapeutic session and simultaneously change clients’ environmental conditions in their natural contexts. A concurrent and nonconcurrent multiple-baseline design between participants was conducted. Four participants—2 men and 2 women—who reported depressive symptoms were independently treated in a psychological services center by 2 male therapists. FEBA increased the frequency of healthy behaviors (e.g., engaging in meaningful conversations with friends) in session and out of session. However, depressive behaviors in therapeutic and natural settings did not show stable changes. The implications for implementing some of the results of this study with clients with depression are discussed. Methodological recommendations for using FEBA with specific populations and in other contexts are also presented.
... For behavior analysts, the question is not whether strategies which are typically treated as being cognitive, or which were developed by cognitive researchers, work or not, but whether cognitive processes need to be hypothesized to account for their success. For example, the potential of motivational interviewing or of the therapeutic relationship to engender behavior change is widely accepted but it may be possible to explain how they work in terms of contingencies of reinforcement (Follette et al., 1996;Christopher and Dougher, 2009). ...
... Functional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1991) was described in 1991 to resolve an apparent paradox: How can psychotherapy consistent with fundamental behavioral principles be practiced in standard, adult, outpatient contexts without sacrificing a strong psychotherapeutic relationship? It was particularly important to early FAP theorists (e.g., Follette, Naugle, & Callaghan, 1996) to articulate a behaviorally grounded explanation for the well-established importance of the therapy relationship (e.g., Gaston, 1990;Horvath & Symonds, 1991). FAP proposed that a primary mechanism of effective psychotherapy was the in-session, natural, social reinforcement of improved client behavior by the therapist. ...
Functional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1991) is a transdiagnostic approach to outpatient psychotherapy that presented guidelines to instantiate the behavioral principle of natural, social reinforcement applied to idiographic behavioral targets within a genuine and authentic psychotherapy relationship. We present the first comprehensive review of research on FAP, including qualitative studies, uncontrolled and controlled single-case designs, group designs, and studies on training therapists in FAP. We conclude that current research support for FAP is promising but not sufficient to justify claims that FAP is research-supported for specific psychiatric disorders. There is stronger support for FAP's mechanism of therapist-as-social reinforcer: FAP techniques, when appropriately applied to idiographically defined behavioral problems-primarily in the realm of social functioning-produce positive change in those behaviors.
... En la línea que estamos presentando, esta percepción sería el resultado de una forma de proceder que desarrollaría el psicólogo caracterizada por, en el primero de los casos, reforzar adecuadamente lo que la persona está contando, verbalizando la aceptación a su discurso y repitiendo, en ocasiones, pequeños fragmentos de la exposición del paciente; y, en el segundo de los casos, presentar los estímulos discriminativos adecuados para la descripción de la problemática y reforzar adecuadamente las respuestas más adaptativas. Este último aspecto hace referencia directa a los procesos de moldeamiento que se dan en sesión y que caracterizan la interacción verbal en la clínica 8,9,11,[29][30][31][32] . Procesos en los que podemos entrenar con facilidad a los terapeutas inexpertos y que han mostrado su utilidad en estudios como el realizado por Busch et al. 33 . ...
Introduction. In recent years they have appeared different publications that bring a new model to conceive and explain mental illness. This new model requires that the consumers cease to be conceptualized as patients, to turn it into agents of their own change process. This study is part of this new concept, and focuses on the study of functional analysis of therapeutic interaction during clinical intervention. Our working group has developed a system for categorizing verbal interaction in therapy that has been shown effective in patient attending a private consultation. The aim of this study is to assess whether this system can also be used for patients with more serious diagnoses. Method. 12 recording clinical sessions of 12 patients treated for 3 psychologist with varying degrees of experience were analysed. Clinical work was individual and was conducted with adult population. Results. Inter-rater reliability good values were obtained, and the frequency of occurrence of each verbal behavior is analyzed, both in the therapist and the consumer. Discussion. The present study offers a system to analyze the verbal interaction in consumers with serious pathologies that can help to understand what happens in the therapy process.
With increasing evolution and innovation within the technology and artificial intelligence (AI) space, coaching practice and research are increasingly moving into the digital realm. Scalable and remotely delivered digital coaching interventions may offer support to those who would not be able to access it otherwise. Technology can also provide support at the time when an individual needs it most. An important question is how coaching interventions can be effectively and safely adapted to digital formats. To build effective digital coaching interventions, we need to harness and activate the underlying change mechanisms that lead to improvements in coaching outcomes. To ensure digital coaching interventions are safe, we also need to explore the ethical considerations of developing digital coaching interventions. This paper argues that we can design effective and safe digital coaching interventions using theoretically informed and evidence-based approaches. The paper outlines how to approach this using an example from Contextual Behavioural Science (CBS). The paper highlights research that informs best practice for designing effective digital coaching interventions and outlines how processes of change underpinning Acceptance and Commitment Coaching (ACC) can be used to develop coaching interventions within technology. ACC is a process-based coaching approach developed using CBS which aims to maximise an individual’s personal and professional potential by increasing their psychological flexibility to improve both health and goal-related outcomes. The paper also summarises some key ethical considerations for designing safe digital coaching interventions, framing this within the British Psychological Society’s (BPS) ethical pillars of competence, integrity, respect and responsibility. The paper offers thoughts on future endeavours in this space and encourages other coaching psychology researchers to expand on the theoretical underpinnings of digital coaching in a similar way.
Does the empathy or personality of psychotherapists influence the way they do therapy? Is the therapeutic relationship the key to success? Questions such as these are commonly shared in Change Process Research (CPR) and outcome studies. However, these statements, posed in descriptive cross-sectional terms, often imply the use of strategies grounded in causal-linear explanatory models. The present study offers an alternative tool to measure elements of psychotherapy in dynamic, interactive, and interdependent terms. With nine observational categories defined under analytical-behavioral lens, the Acoveo System is an instrument designed to detect the potential functions of verbal exchanges that take place in the psychotherapeutic context from any theoretical orientation. A guide to its application is provided, and its usefulness is elaborated on two of the pivotal common factors in change process research: empathy and therapeutic alliance.
Understanding clinical change remains a significant challenge in the study of psychotherapy success. To address this issue, recently, there has been a call for studies that bridge the gap between change processes research and psychotherapeutic outcomes . However, studies have highlighted the challenges in establishing this connection without being reliant on the limited pre-post strategy inherent in the Western biomedical model. Therefore, this doctoral thesis aims to overcome this limitation by preserving the individuality of participants and providing an analysis tailored to the interactive nature of the psychological phenomenon through a sequential microanalytic strategy within a behavioral-analytic framework.
This work aimed to identify sequential relational networks that reflect behavioral patterns of verbal interactions linked to successful psychotherapeutic interventions. To accomplish this, three empirical studies was conducted. The initial study entailed a methodological systematic review designed to identify the presence of such patterns within the existing literature. A total of 28 sequential microanalytic studies from diverse theoretical orientations were included, facilitating the development of a relational network composed of conditional probabilities related to psychotherapeutic verbal interactions. The second study compared nine cases treated by three therapists over the span of 10 years of psychotherapy. The third focused on examining therapeutic failure and abandonment, enabling a comparison between effectiveness, experience, and failure. Through the analysis of 80 intervention sessions, we identified different patterns of covariation associated with success and failure in psychotherapy. The results indicated the existence of conditional probabilities between the absence and presence of specific verbal events. Based on these findings, we developed a post hoc descriptive-functional guide aimed at potentially assisting novice psychotherapists and providing guidance for future research in the field of change processes and outcomes research.
A literatura a respeito das habilidades terapêuticas considera que habilidades técnicas, teóricas e, especialmente, habilidades sociais são essenciais ao desenvolvimento da terapia. Todavia, em sociedades sexistas e patriarcais, enquanto mulheres são expostas a contingências de reforço de comportamentos que se relacionam ao cuidado e à expressão emocional, homens - em geral - são ensinados a se comportar agressivamente, a conter suas emoções e a participar menos de práticas de cuidado. Considerando tais condições, esse trabalho objetivou revisitar a literatura sobre habilidades terapêuticas à luz dos debates sobre masculinidade, discutindo potenciais incompatibilidades entre as habilidades destacadas e comportamentos característicos da masculinidade hegemônica na cultura ocidental. Dentre os principais resultados, aponta-se que a maior parte das habilidades destacadas pela literatura correspondem a repertórios sociais incompatíveis com os parâmetros da socialização masculina. Nesse sentido, destaca-se que o processo de socialização masculina, potencialmente, concorre com a aprendizagem de repertórios essenciais ao bom andamento da terapia. Tais discussões indicam a importância de considerar questões de gênero na formação, atuação e supervisão de terapeutas. Ainda, destaca a contribuição da literatura sobre gênero para a produção de conhecimento em terapias comportamentais.
In this chapter, we show how different contending therapeutic models are grounded on more general philosophical approaches to the problems of mind and normativity. Our main goal is to provide an introductory outline of these general problems and to point out the philosophical commitments underlying the different therapeutic models. In section 1 we introduce the problem of mind, as it appears in the Cartesian account of the relation between the mind, the body, and the world. We explain how this problem results from Descartes’s attempt to provide a solution to another one, i.e., the problem of normativity. The Cartesian solution is characterized in terms of its core ontological, epistemological, and semantic commitments, and we show how these are related to the ontological aspect of the problem of mind (i.e., the mind-body problem). In section 2, we lay out the different traditional responses to this problem in the philosophy of mind. The different approaches to the mind-body problem are divided into three broad kinds of naturalism: ontologically conservative, ontologically revisionary, and ontologically radical naturalisms. In section 3, we show how the different therapeutic models can be seen as implementations in clinical practice of the different kinds of approaches outlined in section 2. In section 4, we come back to the problem of normativity, which has been often neglected in contemporary discussions of the ontological and epistemological issues of Cartesianism. We point out that none of the naturalist approaches described in section 2, nor thus their implementation in mental health research and practice can offer an adequate answer to this problem. The reason is that purely descriptive reports of facts about a living being (e.g., its neural states, its dynamic patterns of interaction with the environment, its bodily constitution, etc.), are incapable of rendering its affairs intelligible in normative terms (i.e., in terms of correction and incorrection, merit and demerit, etc.). Finally, in section 5 we summarize the main points of the chapter and sketch out what is, in our opinion, the main challenge for a proper approach to mental health.
Este capítulo tem como objetivo apresentar algumas possibilidades de análise e intervenção dos comportamentos envolvidos nos chamados transtornos de ansiedade a partir de pressupostos da análise do comportamento. Para isso, apresentaremos brevemente algumas considerações a respeito da maneira com que este tipo de problema é concebido por essa perspectiva teórica. Em seguida, serão apresentadas algumas estratégias que têm sido propostas por analistas do comportamento que parecem responder às questões analisadas. Por último, dois casos clínicos atendidos pelos autores serão apresentados para ilustrar a aplicação das propostas aqui descritas.
Clinical behavior analysis (CBA) is the term used to refer to applications of behavior analysis to behavioral health presentations, such as anxiety, depression, or other disorders that interfere with quality of life. Assessment and intervention typically address lifestyle changes (e.g., management of sleep, diabetes, or hypertension) and build novel repertoires (e.g., in the case of mood disorders or serious mental illness). Therapists who consider themselves clinical behavior analysts translate the philosophy and science of behavior into action, implementing strategies consistent with a radical behavioral epistemology and based on behavioral principles emerging from the experimental analysis of behavior. The range of settings in which clinical behavior analysts work is expanding as the relationship between behavior and overall health is increasingly recognized. An overview of behavior analytically informed cognitive behavior therapies (CBTs) is provided as well as a description of the assessment, treatment, and broader professional repertoires necessary to be successful in this diverse profession.
O Laboratório de Avaliação, Pesquisa e Intervenção em Transtorno do Espectro Autista (LAPITEA) da Universidade Ceuma em São Luís - MA atende a 12 crianças com TEA que se beneficiam de ações norteadas por três eixos de intervenção advindos da ciência psicológica: (1) Análise do Comportamento Aplicada (ABA), (2) Avaliação Psicológica e (3) Psicologia Escolar e Educacional. Este capítulo trata-se de um relato de experiência institucional referente a algumas das atividades desenvolvidas nessas três áreas. Em relação à Avaliação Psicológica foi realizado um levantamento de indicadores de comportamentos externalizantes e internalizantes de oito das 12 crianças atendidas a fim de se obter dados acerca dos problemas de comportamentos associadas ao TEA, sendo contatados maiores escores em comportamentos internalizantes de retraimento/depressão e problemas de atenção. Em relação ao eixo da ABA, serão apresentados os resultados de ensino de operantes verbais de duas das 12 crianças e com as quais o ensino foi programado. Os dados indicaram o desenvolvimento dos repertórios importantes para a inclusão social e escolar das crianças, foco do terceiro eixo. A área de Psicologia Escolar e Educacional do Laboratório capacita estagiários de psicologia para promoverem intervenções nas escolas, visando, sobretudo a ampliação das práticas pedagógicas para a inclusão. Duas das 12 crianças foram observadas em suas escolas e a necessidade de ações de adaptação curricular e apoio ao trabalho do docente foram evidenciadas. O trabalho dos três eixos do LAPITEA é discutido neste capítulo quanto às possíveis contribuições da Psicologia para o desenvolvimento das crianças.
We introduce interpersonal behavior therapy (IBT) in the context of a brief history of evolving paradigms of psychotherapy research and the rise of the third-wave behavior therapies facing the challenges of the introduction of middle-level terms in the service of their dissemination. The article focuses on IBT as a response to the evolution of functional analytic psychotherapy (FAP) and its movement away from behavioral principles and functional assessment. IBT is proposed as a contemporary behavioral treatment whose focus is on interpersonal distress, emphasizes the need for a functional assessment to conceptualize client problems, and utilizes behavioral principles to specify the mechanisms of the problem and mechanisms of clinical change. Largely a retooling of the original proposals in FAP, IBT explicates the mechanism responsible for clinical problems and the corresponding mechanism of clinical change. Moreover, as a behavioral therapy, IBT emphasizes the need for functional assessment in conceptualizing client problems and determining clinical treatments. Finally, we call for a unified return to behavioral assessment across the third-wave therapies. This unified approach may help advance principle-driven treatments for complex forms of human suffering as well as offer a path forward to a program of behavioral science and preserve the longevity of behavioral therapies.
Functional Analytic Psychotherapy (FAP) is a behavior therapy aimed at changing interpersonal problem behaviors which led the client to treatment, immediately intervening on these behaviors when occurred during the therapeutic session. FAP has been successfully applied to clinical diagnosis, though little evidence has been shown when it comes to Substance Use Disorder (SUD). In the few researched found, FAP has been applied along with other behavioral psychotherapies, making it difficult to evaluate its isolated impact upon this population. This study focused on investigating the effects of FAP on clinically relevant behaviors (CRB) and out of session changes (assessed with collected data on psychiatric symptoms and substance abuse) of institutionalized individuals who fit the SUD diagnosis criteria. The therapist-researcher and two clients took part in this study. A single-case experimental design in an A/A+B format has been used, in which A was the stage of External Contingencies Analysis, and B the systematic use of FAP. Firstly, the therapist performed the conception of the cases and assisted the clients with Behavior-Analytic Psychotherapy (BAP) strategies, introducing FAP afterwards. Three months after the therapeutic sessions were over, a follow-up session was carried out in order to verify the maintenance of the changes. All sessions were recorded and five sessions from each experimental phase, for each dyad, were categorized according to the Functional Analytic Psychotherapy Rating Scale (FAPRS) to measure the changes within the session. The changes in the symptoms were assessed on a weekly basis with the Outcome Questionnaire (OQ-45.2), while the drug use frequency was assessed three months before and after using the Timeline Followback (TLFB). The data was compared inter-subject. The results indicated that the decrease in the frequency of problem-behaviors (CRBs1) and the increase in the improvement behaviors (CRBs2) during the sessions followed the introduction of FAP for both participants, specifically the manipulation of Rule 2 (evocation) and Rule 3-2 (contingent positve reinforcement from therapist to CRB2). During the follow-up session, the client who had been assisted longer was the only to maintain the CRBs2 frequency. As for the out of session changes, instrument OQ-45.2 was not sensitive to change in experimental phase to none of the participants. Instrument TLFB has shown quantitatively improvement in substance abuse for both clients. However, taking into account the CRBs frequency and the clients verbalization content during the follow-up session, the client assisted longer was the only to show improvement, while the second patient indicated a progressive revert to the dependency condition. The results support the hypothesis that FAP provides therapeutic changes to individuals who fit the SUD diagnostic criteria and that its mechanism of clinical changes is the therapist contingent response. Yet, at least within this study, only the client exposed to therapy for a longer period proved to maintain the progress achieved in the follow up session and change the frequency in the substance abuse.
This study analyzes the potential functions of the therapist's verbal behavior during actual in-session therapist-client interactions. The complete therapeutic process of a clinical case was recorded (10 sessions). The therapist's verbal behavior was coded by means of The Observer® XT software and the Therapists' Verbal Behavior Category System (SISC-CVT), which has shown high levels of inter and intra-rater agreement. Results showed a descriptive analysis of the therapeutic process. Our results help to understand the functional relations and learning mechanisms that may be involved during in-session verbal interaction. The approach illustrated in the present study could serve a first step to designing, training and putting into practice more effective psychological interventions.
In this paper, a functional analysis of the therapist's verbal behavior in a typical anxiety case is presented. Once all therapeutic utterances to be reinforced and anti-therapeutic utterances to be extinguished were listed, the extent to which the therapist's utterances had played a role in effecting the desired change in the client's verbal behavior was analyzed. In order to do so, four of the fifteen recorded sessions from the treatment were observed, and the occurrence of the desired operant chains was noted. After this, it was concluded that the therapist's performance is consistent with its aims, in that the clinical interaction is modeled as a verbal shaping process.
Many researches have described verbal and non-verbal behaviors emitted by therapists and clients during therapy. This paper presents information concerning the case of a client that were in therapy for 12 sessions. Client is a 54 years old woman who worked as a maid in a hotel. She lived with her son, who is 38 years old. Her religion is catholic. In the first session, she said she looked for therapy because she was very sad. In this paper, for each session, the most important data, functional analysis and therapeutic decisions are presented. In the early sessions, analysis indicated that the client emitted escape behaviors, especially not assuming difficulties in relation to her mother and to her son. As far as therapy evolved, client assumed that she had many problems concerning her family. She also assumed that she was unsatisfied about her job and that she had had bad experiences in affective relationships. Non-punishing audience is argued to be an essential intervention in therapy, because it establishes therapeutic relationship and it helps the therapist obtaining information about operating contingencies. The importance of shaping verbal reports is discussed in terms of guiding environmental observation and self-observation and in terms of providing relevant information for functional analysis. Self-rules formulated in bad-ended affective relationships are related to escape behaviors emitted in the therapy sessions and to escape behaviors emitted in the presence of other men the client was in contact to. Feelings of guilty and indignity are discussed as products from clients relationships with her parents and with religion.
In recent years a “new” approach to investigating the psychotherapy process utilizing social reinforcement and behavior control has gained increasing prominence. The research studies in this area, such as verbal operant conditioning, are reviewed, with their implications for personality theory, clinical applications and especially for the influencing of value systems.
Applauds C. J. Gelso and J. A. Carter's (see record
1994-38236-001) attempts to provide a complex, systems view of the common components in the therapeutic relationship and to develop potentially testable propositions about the interaction of the components. The author suggests, however, that more conceptual clarification and measurement development is needed before this attempt will yield fruit. The Gelso and Carter conceptualization of the therapeutic relationship is not highly generalizable and probably applies mainly to therapies conducted from a psychodynamic point of view. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
behavior therapy movement was never primarily a movement to bring behaviorism into applied psychology/trends over the last 10 years within behavior therapy/essence of radical behaviorism might be applied to adult clinical problems
causality and the analysis of behavior/behavior principles relevant to cognitive control/effect of rules/contextual approach to therapeutic change/comprehensive distancing
role of the therapist/common clinical errors/common clinical issues/resistance/generalization and maintenance/the therapeutic relationship (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Human Ss often show performances that differ in important ways from those of nonhumans. Over the past decade, many behavior analysts have concluded that many of these differences are due to human verbal behavior. Human behavior analytic research has evolved largely into the study of the nature of verbal events. New and exciting research methods, findings, and theories have emerged that are quite unlike stereotypical views of behavior analysis. This article reviews the literature, especially the work on stimulus equivalence, and describes relational frame theory, a behavioral perspective that distinguishes direct and derived stimulus functions at the level of psychological process. It is argued that at least 1 new behavioral principle (verbal or relational control) has been uncovered. This analysis is applied to issues of verbal meaning and rule following. These developments demonstrate the vitality of contemporary behavior analysis. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents a teleological model of human behavior in which therapists can use contingent and noncontingent responses with the same or different clients. The level of client-developed responsibility should determine the nature of therapeutic responding. Increases in client-assumed responsibility, as reflected by changes in client language, should be accompanied by decreases in noncontingent responding. The effectiveness of this proposal depends on a collaborative relationship between therapist and client and on the client's ability to differentiate self from behavior. Client movement toward differentiating these two therapeutic elements is suggested as a prerequisite for perceptions of causality and responsibility. Using verbalized reasons to ascribe client responsibility is a potentially valuable technique, consistent with the suggestions of S. L. Halleck (see record
1983-03935-001) and L. Shawver (see record
1984-12829-001). It is suggested that continued noncontingent responding toward persons who have assumed responsibility is tantamount to treating persons without the human dignity that responsibility presupposes. (30 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
C. J. Gelso and J. A. Carter (see record
1986-09708-001) suggested that all counseling and psychotherapy relationships, regardless of theoretical orientation, consist of 3 components: a working alliance, a transference configuration (including therapist countertransference), and a real relationship. Drawing on theoretical and research literature and using clinical examples, this article offers 19 propositions about how these 3 relationship components interact with one another, how each operates across the course of psychotherapy, and how they affect the treatment in both brief and longer term therapies. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Although different theories of psychotherapy emphasize the importance of the therapeutic relationship, these perspectives diverge when considering why this relationship matters clinically. This article proposes that different verbal constructions or definitions of the therapeutic relationship result in very different approaches to treatment and affect the way the client and therapist interact. An understanding of this relationship using a contemporary radical behavioral therapy, functional analytic psychotherapy (R. J. Kohlenberg and M. Tsai; see record 91-305029-000), is discussed and is contrasted with different conceptualizations of this relationship. Discussion emphasizes how specific constructions provide advantages to therapists that facilitate treatment, and offers a distinction between the therapeutic relationship and a friendship. A discussion of why it is important for the therapist to understand and convey this definition to the client during treatment is included, along with a brief description of how supervision helps the therapist gain an understanding of this relationship. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigated the determinants and predictive utility of the client's perception of the therapeutic relationship (CPTR) in the context of a behavior therapy clinical research project evaluating 3 approaches to assertion training. 39 22–60 yr old volunteers were studied. Measures included the Rathus Assertiveness Scale, the Social Avoidance and Distress Scale, the Fear of Negative Evaluation Questionnaire, the Bem Sex-Role Inventory, and the Multiple Affect Adjective Checklist. Individual differences in therapists were a significant determinant of CPTR. CPTR was an effective predictor of dropping out when measured early in therapy, and of immediate posttherapy client gains when measured in a mid- to late therapy session, but not of long-term maintenance of client improvements. Patterns of therapist behavior that were predictive of CPTR at 3 time points in therapy are delineated. It is speculated that CPTR is largely a function of the degree to which the client's expectation of the therapist and the consequences of therapy are being fulfilled. It is concluded that CPTR has significant predictive value, and perhaps also causal impact, in behavior therapy. (38 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
It is essential that a distinction be drawn between scientific psychology and radical behaviorism, if only to qualify the claims made by some orthodox behaviorists that their approach represents the only hope for or expression of psychological science. After some brief historical review, the declining popularity of radical (as contrasted with liberal) behaviorism is discussed. Although orthodox behaviorists report having changed their beliefs less often than their cognitive and cognitive–behavioral colleagues, recent longitudinal survey data suggest that they are beginning to show signs of basic ideological shifts. The intolerance of some radical behaviorists for other views (characterized as a scientistic rather than a scientific attitude) is discussed as one possible factor in the apparent decline of radical behaviorism. Also influential may have been the failure of orthodox behaviorists to recognize the impossibility of absolute objectivism in any epistemic venture, including scientific inquiry. It is concluded that traditions in science reflect a valuable legacy and that future developments in scientific psychology would be well served by open dialectical exchanges both within and among differing ideologies. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reviews and elaborates the psychoanalytic concept of the working alliance. It is argued that various modes of psychotherapy can be meaningfully differentiated in terms of the kinds of working alliances (WA) embedded in them. Moreover, the strength, rather than the kind of WA, will prove to be the major factor in change achieved through psychotherapy. Strength of alliance will be a function of the goodness of fit of the respective personalities of patient and therapist to the demands of the WA. The WA includes 3 features: agreement on goals, assignment of tasks, and the development of bonds. (36 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The chapter discusses stimulus classes and stimulus relations. Humans show remarkable forms of stimulus control based upon seemingly arbitrary relations among stimuli. Normal adults who are told that a bottle contains poison will probably avoid that bottle, perhaps for life. The research interest in equivalence and other derived stimulus relations documents the fascination such performances have for behavioral psychologists. As with any behavior, a satisfactory behavior analytic account of these performances requires a specification of the nature of the activity and the antecedent, consequential, motivative, and other variables involved in its manipulation and prediction. This chapter includes one such analysis and explores some of its implications for the understanding of human stimulus control. It discusses the basic premises of relational frame theory (RFT) and the ways in which it informs an understanding of complex stimulus control among verbally competent humans. Most of the work on derived stimulus relations has been done on stimulus equivalence. There are several preparations used to establish stimulus equivalence in an experimental setting, but by far the most popular is matching-to-sample (MTS). In arbitrary MTS, a sample stimulus appears with an array of comparison stimuli, one of which is then selected. The stimulus arrangements and responses required vary.
There is a limited amount of empirical data on how to train therapists. This article first presents limitations in commonly used training procedures. It then describes a training methodology based on contingent shaping, using video feedback to increase responsiveness to the ongoing client-therapist interactions. The approach attempts to overcome some of the problems encountered when teaching therapy by using primarily rule-governed or direct instruction. The authors describe the therapeutic approach used in this research, provide a clinical illustration of the training procedure, and discuss the role direct instruction plays in this training model. A methodology for determining whether the therapist's behavior changes as a result of training is described, as well as a method for identifying the relationship between the therapist's behavior and subsequent changes in client responding. This methodology is broadly applicable and can be empirically tested and compared with other approaches for its utility in training therapist effectiveness and changing client behavior.
Acceptance and Commitment Therapy (ACT) is a behavior-analytically-based psychotherapy approach that attempts to undermine emotional avoidance and increase the capacity for behavior change. An overview of this approach is given, followed by several specific examples of the techniques used within ACT. In each instance the behavioral rationale of these techniques is described. A contemporary view of verbal relations provides the basis for new approaches to adult outpatient psychotherapy.
Reviews the current status of self-help behavioral treatment manuals. Organizing concepts and strategies for the development and evaluation of such programs are described. Programs that have been published or empirically tested for the treatment of phobias, smoking, obesity, sexual dysfunctions, assertiveness, child behavior problems, study skills, and physical fitness, as well as general instructional texts, are reviewed. It is concluded that the validation of available self-help behavior therapy manuals is extremely variable at the present time. It is suggested that future research evaluate manuals under conditions of intended usage, recruit clinically relevant Ss, employ follow-through and cost-effectiveness indices, include appropriate controls and follow-up assessments, and attempt to identify S or other clinical predictors of treatment outcome. The clinical and ethical issues raised by self-help programs are also briefly considered. (5 p ref)
THE THERAPIST-PATIENT RELATIONSHIP IS A SHADOWY AND ILL DEFINED PART OF PSYCHOTHERAPY. BEHAVIOR THERAPY, OFFERS POTENTIALLY FRUITFUL LEADS TO ATTAINING A CLEARER UNDERSTANDING OF THE VARIABLES INVOLVED. THE RELATIONSHIP, OPERATIONALLY DEFINED IN SOCIAL REINFORCEMENT TERMS AND CONCEIVED OF AS AN INTEGRAL ASPECT OF MORE BASIC SOCIAL BEHAVIOR INFLUENCE METHODS, IS SYSTEMATICALLY USED TO ACHIEVE WELL DEFINED PREDETERMINED THERAPEUTIC GOALS. THE APPLICABILITY AND MEANS OF MAXIMIZING THE EFFICIENCY OF THIS THERAPEUTIC METHOD ARE DISCUSSED. (2 P. REF.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Excerpts from tape recordings of a single, long-term, successful therapy case handled by Rogers were analyzed to evaluate the adequacy of the client-centered view that empathy, warmth, and directiveness are offered throughout therapy in a manner not contingent upon the patient's behavior. Findings indicate that the therapists respond in a significantly differential way to 5 of the 9 patient behavior classes studied. Concomitantly, significant increases in the emission rates of 4 of the 5 behavior classes were noted throughout therapy. Findings thus indicated significant reinforcement effects in the client-centered therapy. (34 ref.)
Several year~ ago we edited a casebook on behavior therapy with children. The book appeared to fill a gap in the existing child literature and was quite well received. A similar gap appears to exist in the behavioral literature for adult cases, in that there are very few adult case books currently available. The present book was developed in order to devote an entire casebook to both standard and more innovative clinical applications of behavioral treatments to adult problems. The book, containing 19 chapters, is divided into two parts. In the first part, in a chapter entitled Clinical Considerations, we discuss a variety of clinical issues that are of importance to designing and executing behaviorally based interventions with adults. The bulk of the book, the remaining 18 chap ters, contains a variety of cases presented by our experts. Each of the treatment cases is presented using the same format in order to increase consistency and comparability across chapters. Specific sections for each chapter are as follows: (1) Description of the Disorder, (2) Case Identification, (3) Presenting Complaints, (4) History, (5) Assessment, (6) Se lection of Treatment, (7) Course of Treatment, (8) Termination, (9) Follow-up, and (10) Overall Evaluation. Thanks are extended to our many expert contributors, without whom this book would not be possible. We also wish to acknowledge the technical support of Mrs. Kim Sterner. Finally, we thank our editor at Plenum, Eliot Werner, for his support and forbearance in the face of the inevitable delays.
Some years ago we edited a general casebook on behavior therapy that was well received. However, those professors who used the book as an adjunct text in child behavior therapy courses were concerned that only 9 of the 26 chapters dealt with the clinical application of behavioral prin ciples to children. Their contention was that a specific casebook on the topic was very much warranted. In considering their comments we took a closer look at the child behavior therapy area and were struck with how diverse it was, how it had expanded, and how it had matured over the last three decades. Given this apparent gap in the literature, we decided to devote an entire casebook to both the standard and the more innovative clinical applications to the behavioral problems presented by children. The resulting book, containing 28 chapters, is divided into two parts. In the first part, in a chapter entitled "How the Field Has Moved On," we briefly trace the historical roots of child behavior therapy, detail the relationship of psychiatric diagnosis and behavioral assessment, and con sider the importance of developmental norms, psychological testing, ef forts at prevention, and behavioral medicine. The bulk of this book, of course, appears in the 27 cases presented by our respective experts. Each of the treatment cases is presented in identical format for pur poses of clarity, consistency, and comparability.
Presents a teleological model of human behavior in which therapists can use contingent and noncontingent responses with the same or different clients. The level of client-developed responsibility should determine the nature of therapeutic responding. Increases in client-assumed responsibility, as reflected by changes in client language, should be accompanied by decreases in noncontingent responding. The effectiveness of this proposal depends on a collaborative relationship between therapist and client and on the client's ability to differentiate self from behavior. Client movement toward differentiating these two therapeutic elements is suggested as a prerequisite for perceptions of causality and responsibility. Using verbalized reasons to ascribe client responsibility is a potentially valuable technique, consistent with the suggestions of S. L. Halleck (see record 1983-03935-001) and L. Shawver (see record 1984-12829-001). It is suggested that continued noncontingent responding toward persons who have assumed responsibility is tantamount to treating persons without the human dignity that responsibility presupposes. (30 ref)
Applauds C. J. Gelso and J. A. Carter's (see record 1994-38236-001) attempts to provide a complex, systems view of the common components in the therapeutic relationship and to develop potentially testable propositions about the interaction of the components. The author suggests, however, that more conceptual clarification and measurement development is needed before this attempt will yield fruit. The Gelso and Carter conceptualization of the therapeutic relationship is not highly generalizable and probably applies mainly to therapies conducted from a psychodynamic point of view.
Dialectical behavior therapy (DBT) is a comprehensive treatment originally developed for chronically suicidal adults diagnosed with borderline personality disorder (BPD). Since its inception, DBT has been adapted for different patient populations in various therapeutic settings, including adolescents with borderline personality disorder. This chapter reviews the theoretical underpinnings of DBT and its application to suicidal youth with borderline personality features. Theoretical foundations of DBT are presented including dialectical philosophy, Zen practice, behaviorism, and the biosocial theory. The various functions and modes of DBT treatment used to target the multiple problems and behavioral patterns adolescents with BPD exhibit are explained. Empirical research on the effectiveness of DBT for adolescents with BPD is reviewed including recent results from the first randomized clinical control trials evaluating DBT with suicidal adolescents with BPD features. Adaptions of DBT for children, to other psychiatric populations, and for school settings are also summarized. Lastly, future directions for research on DBT for adolescents with BPD are considered.
Human subjects often show performances that differ in important ways from those of nonhumans. Over the past decade many behavior analysts have concluded that many of these differences are due to human verbal behavior. Human behavior analytic research has evolved largely into the study of the nature of verbal events. New and exciting research methods, findings, and theories have emerged that are quite unlike stereotypical views of behavior analysis. This article reviews the literature, especially the work on stimulus equivalence, and describes relational frame theory - A behavioral perspective that distinguishes direct and derived stimulus functions at the level of psychological process. It is argued that at least one new behavioral principle - verbal or relational control - has been uncovered. This analysis is applied to issues of verbal meaning and rule following. These developments demonstrate the vitality of contemporary behavior analysis.
This book presents [an] integration of theory, clinical practice and research, which will be useful for practising psychotherapists as well as for students of psychotherapy, nursing, clinical psychology, psychiatry, and social work.
The authors develop a model of the therapeutic relationship which is tailored to behavioural psychotherapy. . . . Part I examines the common interpersonal factors in the psychotherapy process, regardless of the mode or theoretical approach. A conceptual model of the therapeutic relationship is then developed which is informed by well-established social psychology theory, particularly social influence theory. Part II describes a model of the therapeutic relationship based on strategies to: prevent dropout; facilitate client engagement; and establish a working relationship. The different strategies are illustrated with examples from clinical practice. Part III reviews decades of research on the therapeutic relationship in psychotherapy, focusing on the outcomes as well as on the instruments used. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This volume [examines] standards of practice as a method of linking practical [applied and clinical] psychological work to contemporary scientific knowledge. This volume challenges the discipline to begin to ensure that scientific knowledge is actually used by practitioners. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
If we are to conceive of psychotherapy as a process involving reinforcement procedures, then the major research task is to investigate the conditions under which the reinforcement procedure is most effective. These variables involved can be considered under three categories: (a) variables related directly to therapist characteristics, (b) situational variables, (c) therapist-patient interaction variables. The "therapist characteristics" variables include: (a) the personal characteristics of the therapist, such as sex, personality, prestige, and socioeconomic status, (b) the specific influences on the therapist's concept of his role, such as his value and ethical system, and his formal and informal training, (c) the special techniques used by the therapist. The situational variables include the environmental setting and "atmosphere" in which the reinforcement process is taking place. The interaction variables are the result of the interaction of the therapist behavior with various characteristics of the patient population, such as diagnostic category, personality, response class, and awareness. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Used multivariate dynamic analyses to study dependence of the therapeutic alliance on the partner's alliance. 27 sessions of Ulm-therapy (brief psychoanalytic focal therapy) and 27 sessions of Bernese therapy (based on an experimental schedule guided by the schema-concept and K. Grawe's [1987] heuristic therapy), as described in U. Hentschel et al (see record
1993-14500-001), were studied. From videotapes, the alliance was rated by the Penn Helping Alliance Scales (Penn-HAS) and Therapeutic Alliance Rating System (TARS). For the Penn-HAS, overall ratings for patient and therapist were strongly mutually dependent; dependence for the TARS was less strong, requiring more in-depth analyses based on factor scores of the original ratings. Results suggest that the therapist, rather than the patient, determines formation of the therapeutic alliance. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
[discuss] a new behavior analytic perspective on verbal events, which [has been termed] Relational Frame Theory (RFT) / this approach is housed firmly in the behavior analytic tradition but . . . some proponents of that tradition are uncertain about or even worried about RFT / this chapter [addresses] that worry
walk through an operant explanation of derived stimulus relations as learned behavior, and . . . lay out some of the research that is supportive of this approach / describe how RFT can be part of a more general approach to verbal behavior, spanning the range from word-referent relations to the scientific analysis of the natural world / briefly . . . show that even though RFT greatly undermines Skinner's specific theory of verbal events, his sensitivities have a place in the overall view of verbal events RFT produces (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examines, from a behavior analytic perspective, the mechanisms through which change occurs within the context of the therapeutic relationship in individual psychotherapy. The analysis focuses on the therapist's shaping of the client's behavior through subtle nonverbal cues and explicit verbal analyses. In the relationship, therapists modify behavior that has created difficulties for the client in the natural environment, and clinical change is dependent on the extent to which those in the natural environment will reinforce functionally similar response classes. C. B. Ferster's (1979) distinction between natural and arbitrary reinforcement and B. F. Skinner's (1969) distinction between contingency-shaped and rule-governed behavior are also used to describe the manner through which change occurs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The therapeutic relationship in behavioral treatments has, for the most part, been ignored in the literature. The present review traces the history of attention to the relationship by behavioral writers and critically examines the results of the empirical evidence to date concerning the role these factors play in treatment outcome. The article concludes that relationship variables do interact with techniques to effect outcome. Further empirical investigation is needed to provide specific information for guiding the intra-therapy behaviors of clinicians. Implications for the training of behavior therapists are discussed. Suggestions for research avenues are offered.
A working relationship between the patient and therapist is an essential part of any psychotherapy, yet few guidelines exist for this component of cognitivebehavioral treatment. Findings of therapy process and outcome research suggest that the therapeutic relationship strongly influences treatment results, and that interpersonal factors and technical applications interact in forming an effective alliance. Considering the perspective of the patient, we identify general expectations and individual differences that can have an impact on the therapeutic relationship. Individual differences are discussed in four areas of clinical interest: situational concerns; the effects of Axis I psychiatric disorders; sociocultural influences; and personality structure and schemas. Efforts to understand the patients' perspective, based on an analysis of general expectations and individual differences, can assist therapists in optimizing the relationship component of cognitivebehavioral therapy.
Two new systems of adult outpatient psychotherapy based on Skinner's radical behaviorism are described. They do not resemble traditional behavior therapy. Functional analytic psychotherapy (FAP) relies on an involved, emotional, nonmanipulative client-therapist relationship as the vehicle of change. Acceptance and commitment therapy (ACT) gives the client a counterintuitive method of accepting, rather than changing or eliminating, troublesome thoughts and feelings. The descriptions of these therapies are offered (a) to illustrate how intensive, in-depth psychotherapies can be derived from radical behaviorism, and (b) to circumvent the frequent misunderstandings that characterize the discussions between behavior analysts and their critics. The nature of ACT and FAP methods appears to dispel many common myths about contemporary behavior analysis.
This article reviews the cognitive therapy of depression. The psychotherapy based on this theory consists of behavioral and verbal techniques to change cognitions, beliefs, and errors in logic in the patient's thinking. A few of the various techniques are described and a case example is provided. Finally, the outcome studies testing the efficacy of this approach are reviewed.
(This reprinted article originally appeared in the Journal of Consulting Psychology, 1957, Vol 21, 95–203. The following abstract of the original article appeared in PA, Vol 33:842.) For constructive personality change to occur, it is necessary that these conditions exist and continue over a period of time: (1) Two persons are in psychological contact. (2) The first, whom shall be termed the client, is in a state of incongruence, being vulnerable or anxious. (3) The 2nd person, whom shall be termed the therapist, is congruent or integrated in the relationship. (4) The therapist experiences unconditional positive regard for the client. (5) The therapist experiences an empathic understanding of the client's internal frame of reference and endeavors to communicate this experience to the client. (6) The communication to the client of the therapist's empathic understanding and unconditional positive regard is to a minimal degree achieved. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A discriminative stimulus is a stimulus condition which, (1) given the momentary effectiveness of some particular type of reinforcement (2) increases the frequency of a particular type of response (3) because that stimulus condition has been correlated with an increase in the frequency with which that type of response has been followed by that type of reinforcement. Operations such as deprivation have two different effects on behavior. One is to increase the effectiveness of some object or event as reinforcement, and the other is to evoke the behavior that has in the past been followed by that object or event. "Establishing operation" is suggested as a general term for operations having these two effects. A number of situations involve what is generally assumed to be a discriminative stimulus relation, but with the third defining characteristic of the discriminative stimulus absent. Here the stimulus change functions more like an establishing operation than a discriminative stimulus, and the new term, "establishing stimulus," is suggested. There are three other possible approaches to this terminological problem, but none are entirely satisfactory.
The role and function of the therapeutic alliance in psychotherapy has increasingly been the focus of clinicians' and researchers' interests over the last decade. Alliance concepts have, however, been criticized for lack of conceptual clarity. The paper presents a generic model as a heuristic means for clarifying the conceptual meaning of the therapeutic alliance. The model distinguishes between the personal relationship aspect, and the collaborative, task-related aspect of the alliance, with therapist, patient, and common contributions to each of these aspects. The model is compared to other alliance conceptualizations, and its implications for alliance theory and research are discussed. A content analysis of four widely used alliance scales in relation to the model shows the scales to represent conceptually different, yet overlapping constructs. It is argued that the componential nature of the therapeutic alliance will render difficult any interpretation of findings regarding the relationship between alliance and outcome in traditional process-outcome research. More complex research strategies guided by theory are called for, if the therapeutic alliance should remain a vital field of research.
A normally developing child, Charlie (16 months old at the beginning and 27 months old at the end of this study), was tested several times for the derivation of relations over a period of 8 months. In a series of studies Charlie was: (1) taught to match names to pictures or pictures to names and was tested for derived relations of mutual entailment, (2) tested for retention of trained and derived relations after a 2 week delay and for the derivation of mutual entailment relations after a 1 week delay from training, (3) taught to match sounds to pictures and names to pictures and tested for mutual entailment relations and name-sound and sound-name combinatorial entailment relations, and (4) tested for the matching of a novel picture to a novel name ("nonverbal" exclusion) and for subsequent naming of the novel excluded picture ("verbal" exclusion). The results show that Charlie derived mutual entailment relations and showed nonverbal exclusion as early as 17 months. Combinatorial entailment relations and verbal exclusion emerged later. These findings lend support to the view that derivation of relations is not dependent upon sophisticated verbal abilities, and that such performances can be viewed as historically and contextually situated actions that develop over time.