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Functional analytic psychotherapy: A radical behavioral approach to treatment and integration


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Although initially many readers may react negatively to the radical behaviorism on which this paper is based, we believe that the widespread view of radical behaviorism as miscreant is a vestige of its theoretical, philosophical, and methodological positions that used to be at odds with the zeitgeist. A re-examination of these positions reveals a well-developed theory with explicitly defined concepts that are uncannily relevant in terms of current interests in contextualism, the therapeutic relationship, and integration. In this paper we will demonstrate that a radical behav- iorally based approach to psychotherapy, functional analytic psychotherapy (FAP), is a compre- hensive theory that helps clinicians to be open to the potential usefulness of any therapeutic viewpoint and technique. The major question we address is, "What is the rational basis for se- lecting the technique which is appropriate for a particular client at a particular time?" In exploring the answers to this question, we examine the theoretical foundations of FAP, describe the five major guidelines for doing FAP, and illustrate how the principles of FAP embrace and enhance concepts and techniques from therapies as diverse as psychoanalysis and cognitive therapy. FAP offers not only translation across theoretical boundaries, an essential requirement for inte- grative theory, but also preserves deeper meaning and clinical implications. Most importantly, FAP calls for varied therapeutic stances and techniques that no single therapeutic orientation would predict, depending on 1) what will evoke client issues, 2) whether client problems are rule- governed or contingency-shaped, and 3) what will be naturally reinforcing of client target behav- iors.
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Journal of Psychotherapy Integration, 4, 175-201.
Functional analytic psychotherapy:
A radical behavioral approach to treatment and integration
Robert J. Kohlenberg
(Department of Psychology NI-15
University of Washington, Seattle, WA 98195.)
University of Washington
Mavis Tsai
Independent Practice, Seattle, Washington
Although initially many readers may react negatively to the radical behaviorism on which
this paper is based, we believe that the widespread view of radical behaviorism as miscreant is a
vestige of its theoretical, philosophical, and methodological positions that used to be at odds with
the zeitgeist. A re-examination of these positions reveals a well-developed theory with explicitly
defined concepts that are uncannily relevant in terms of current interests in contextualism, the
therapeutic relationship, and integration. In this paper we will demonstrate that a radical behav-
iorally based approach to psychotherapy, functional analytic psychotherapy (FAP), is a compre-
hensive theory that helps clinicians to be open to the potential usefulness of any therapeutic
viewpoint and technique. The major question we address is, "What is the rational basis for se-
lecting the technique which is appropriate for a particular client at a particular time?" In exploring
the answers to this question, we examine the theoretical foundations of FAP, describe the five
major guidelines for doing FAP, and illustrate how the principles of FAP embrace and enhance
concepts and techniques from therapies as diverse as psychoanalysis and cognitive therapy.
FAP offers not only translation across theoretical boundaries, an essential requirement for inte-
grative theory, but also preserves deeper meaning and clinical implications. Most importantly,
FAP calls for varied therapeutic stances and techniques that no single therapeutic orientation
would predict, depending on 1) what will evoke client issues, 2) whether client problems are rule-
governed or contingency-shaped, and 3) what will be naturally reinforcing of client target behav-
Functional Analytic Psychotherapy
(FAP) (Kohlenberg and Tsai, 1991), a re-
cently developed treatment whose theoreti-
cal foundations stem from radical behavior-
ism (Skinner 1953, 1974), offers a timely
and unique integrative approach. Undoubt-
edly, many readers will react negatively to
the prospect of a new radical behavioral
psychotherapy. The proliferation of thera-
peutic approaches is a recognized problem,
and a therapy based on behaviorism may
seem anti-integrationist and anachronistic.
We believe that the widespread view of be-
haviorism as miscreant is a vestige of its
theoretical, philosophical, and methodologi-
cal positions (discussed below) that used to
be at odds with the zeitgeist. Times have
changed, however, and a re-examination of
these positions reveals a well developed
theory with explicitly defined concepts that
are uncannily relevant in terms of current
interests in contextualism and the therapeu-
tic relationship. FAP is a logical extension
of one of modern psychology's earliest theo-
ries, and exemplifies a recent trend of be-
havior therapists returning to their roots (Ja-
cobson, 1991) and developing radically be-
haviorally informed treatments (Jacobson,
1992; Kohlenberg, Hayes, & Tsai, 1993;
Hayes, 1987).
Psychotherapy integrationists gen-
erally emphasize openness to other schools
and techniques (Norcross & Newman, 1992;
Goldfried & Newman, 1992), and integra-
tionism is differentiated from eclecticism in
that the former provides "some coherent
framework for predicting and understanding
change and for determining choices of ther-
apy procedures" (Arkowitz, 1992, p. 263). In
this paper we will demonstrate that FAP is a
comprehensive, well-established, laboratory
data-informed theory that helps clinicians to
be open to the potential usefulness of any
therapeutic viewpoint and technique. The
major underlying theme for this paper is the
question, "What is the rational basis for se-
lecting the technique which is appropriate
for a particular client at a particular time?"
Functional Analytic Psychotherapy 2
In exploring the answers to that question,
we will first lay the groundwork by examining
the theoretical foundations of FAP, then we
will describe the five major guidelines for
conducting FAP, and finally we will illustrate
how the principles of FAP embrace and en-
hance concepts and techniques from thera-
pies as diverse as psychoanalysis and cog-
nitive therapy.
The Theoretical Foundations of FAP
The theory upon which FAP is built
is deceptively simple--you and I and our cli-
ents act the way we do because of the con-
tingencies of reinforcement we have experi-
enced in past relationships1. Based on this
theory, it follows that clinical improvements,
healing, or psychotherapeutic change, all of
which are certain acts of the client, also in-
volve contingencies of reinforcement that
occur in the relationship between the client
and therapist. Important therapeutic impli-
cations, to be discussed below, follow from
the combination of this theory of change and
behavioral definitions of "act" and "contin-
gency." We complete this section on theory
with discussions of context, rule govern-
ance, and functional similarity, all of which
provide guidance for FAP as an integrative
Acts Most people see radical behaviorism
as a narrow theory, one that deals only with
overt behavior, not thoughts or feelings.
With an understanding of what an act or be-
havior is, it's possible to see how radical
behaviorism deals with the same phenom-
ena of interest that are considered to be
non-behavior by others. Specifically, acts,
also known as behavior, are anything a per-
son does. This includes private, beneath
the skin acts as well as public acts. Exam-
ples include talking, thinking, feeling, seeing,
hearing, experiencing and knowing. Every
aspect of being human is included is this
definition, as long as it is expressed as a
verb. Thus, instead of "memory", people
"remember." Instead of having values, peo-
ple value. Since behaviorism is a theory of
behavior change, if mental entities of inter-
est can be specified as a verb, an action, or
a process, it is much clearer what needs to
be focused on in therapy. For example, in-
stead of having low self-esteem, people
think, believe, attribute, feel, and act in other
ways that are labeled low self-esteem by
themselves and others. Instead of having
problems of the self, people have difficulty
with the experiencing or sensing of an abid-
ing awareness. Schafer (1976) has called
for and demonstrated the feasibility a similar
translation of psychoanalytic structures into
processes. Translating nouns into verbs
also facilitates the possibility of a common
language across different therapeutic sys-
tems, as discussed later.
Consider, for example, cognition,
which is defined as the activity of thinking,
planning, believing and/or categorizing.
Cognitions, although covert, are neverthe-
less nothing more or less than acts, and are
cut from the same cloth as any other behav-
ior. This casts the often made distinction
between thoughts, feelings and behavior
and the primacy of the "cognition--behavior"
relationship in a new light--the relationship
between these two becomes a behavior 1
(cognition)--behavior 2 (external or emo-
tional) relationship, e.g., a sequence of two
behaviors. This in turn raises two questions.
First, where do these behaviors come from
(e.g., how can we account for the differing
beliefs, attitudes, and cognitions of individu-
als)? Second, and perhaps more impor-
tantly, how, why and when does cognition
(behavior 1) affect subsequent behavior
(behavior 2)? Given this formulation, the
degree of control exerted by thinking over
behavior is on a continuum. Some clients’
subsequent actions (behavior 2) are greatly
influenced by the prior cognition (behavior
1). Other clients may have the same cogni-
tion but are not appreciably influenced by it,
e.g., they might say "I truly believe that I do
not have to be perfect but I still feel like I
have to be." In the former case, cognitive
therapy would be maximally effective and, in
the latter case it would be less so. In order
to account for individual differences in cogni-
tion and provide a framework for deciding
when to use cognitive therapy, the radical
behaviorist ultimately turns to the deeper,
more fundamental, and yes, unconscious
motivations that are best viewed as the re-
sult of past contingencies. This behavioral
approach to enhancing cognitive therapy is
discussed in more detail later.
Contingencies of reinforcement
Unfortunately, saying "good" or of-
fering a reward to a client for doing what you
want are the typical images that come to
mind when the term "reinforcement" is men-
tioned. We say "unfortunately" because
Functional Analytic Psychotherapy 3
these images are not only technically erro-
neous but inappropriately focus on superfi-
cial aspects of reinforcement. We use the
term "reinforcement" in its technical, generic
sense, referring to all consequences or con-
tingencies that affect (increase or decrease)
the strength of behavior. Even though the
conscious experience of pleasure often ac-
companies contingencies involving positive
reinforcement, it is not a necessary part of
the shaping and strengthening process and
should not be confused with it.
Reinforcement is ubiquitous in our
daily lives and in psychotherapy--it almost
always occurs naturally and is rarely the
result of someone "trying" to reinforce an-
other. The strengthening occurs at an un-
conscious level--that is, awareness or feel-
ings are not required. In radical behavioral
theory, reinforcement is the ultimate cause
of our actions. However, it may be sufficient
or useful at times to view our client's prob-
lems as resulting from more proximal influ-
ences (causes) such as the current envi-
ronment, thoughts, and emotions.
There is an important implication of
the radical behavioral distinction between
higher level influences (the client's present
environment, feeling, and or thinking) and
the ultimate fundamental cause--
reinforcement. Complete radical behavioral
explanations require one to go back into the
past and necessarily involve reinforcement
history. For example, a client may say he
yelled at his spouse because he was angry.
As a behavioral explanation however, it is
incomplete, requiring information about the
past contingencies3 which account for 1) the
getting angry, and 2) the yelling. That is, not
every spouse gets angry under those cir-
cumstances, nor even if angry, do all
spouses yell. A complete explanation ad-
dresses these issues in addition to the inter-
nal states and current situation.
The implications of contingencies
for the practice of psychotherapy are based
on the interrelated concepts of within-
session contingencies, contingency-shaped
behavior, natural reinforcement and shap-
ing. Each will be discussed along with its
integrationist implications.
Within-Session Contingencies. A
well known aspect of reinforcement is that
the closer in time and place the behavior is
to its consequences, the greater will be the
effect of those consequences. It follows,
then, that treatment effects will be stronger if
clients' problem behaviors and improve-
ments occur during the session, where they
are closest in time and place to the available
reinforcement. For example, if a female cli-
ent states that she has difficulty trusting oth-
ers, the therapy will be much more powerful
if her distrust actually manifests itself in the
therapeutic relationship where it is reacted
to immediately by the therapist as opposed
to talking about such incidents that occurred
in between sessions. Thus, from this view-
point, significant therapeutic change results
from the contingencies that occur during the
therapy session within the client-therapist
Natural Reinforcement. We have
emphasized the importance of contingen-
cies of reinforcement in the change process.
Many misconceptions exist, however, about
the nature of the contingencies of rein-
forcement and how they enter into in the
change process in adult outpatient treat-
ment. The distinction between natural and
contrived reinforcement is especially impor-
tant (Ferster, 1967a; Skinner, 1982). Natu-
ral reinforcers are typical and reliable in the
natural environment, whereas contrived
ones generally are not. For example, giving
a child candy for putting on his coat is con-
trived, whereas being chilled for being coat-
less is natural. Similarly, fining a client a
nickel for not making eye contact is con-
trived, while the spontaneous wandering of
the therapist's attention when the client is
looking away is natural.
Contrived reinforcers can be highly
effective in treating clients who are restricted
in movement and/or who live in controllable
environments such as schools, hospitals, or
prisons. In these settings, contrived rein-
forcers can be used consistently and not just
in a brief therapeutic interaction. Contrived
reinforcement can fall short, however, when
the changed behavior is expected to gener-
alize into daily life. Consider, for example, a
client for whom expressing anger is a prob-
lem. Let's say the client actually expresses
anger during the therapy session about the
therapist's inflexibility regarding payment
terms. A therapist who then smiles and
says "I'm glad you expressed your anger
toward me" is probably delivering contrived
reinforcement. Such a consequence is
unlikely to occur in the natural environment,
and clients who learn to express anger be-
Functional Analytic Psychotherapy 4
cause it was followed by a smile would not
be prepared to appropriately express anger
during daily life. A natural reinforcer proba-
bly would have consisted of the therapist
taking the client seriously, discussing and
perhaps altering the payment policy. Any
changes produced by these consequences
would be more likely to carry over into daily
life. Unfortunately, the deliberate use of
natural reinforcers can become contrived or
"phony" and lose its effectiveness (Ferster,
1972). This problem was alluded to by
Wachtel (1977) who observed that behavior
therapists were often overly exuberant in
their use of praise, thereby diminishing its
effectiveness. Furthermore, deliberate use
of consequences can be viewed as manipu-
lative or aversive by clients, and induce ef-
forts to reduce or alter therapeutic change
efforts--what Skinner (1953) would call
The use of reinforcement in psycho-
therapy thus presents a major dilemma. On
the one hand, natural reinforcement that is
contingent on the goal behavior is a primary
change agent available in the therapeutic
situation. On the other hand, if the therapist
attempts to purposely "use" the extant natu-
ral reinforcers, they may lose their effective-
ness, induce countercontrol, and in the
process, produce a manipulative treatment.
The dilemma is obviated, however,
when the therapy is structured so that the
genuine reactions of the therapist to client
behavior naturally reinforce improvements
as they happen. More specifically, because
the dominant aspect of psychotherapy is
interactional, the immediate natural rein-
forcement of client improvements is most
likely when the client-therapist relationship
naturally evokes the client's presenting
problems. For example, an intense and
emotional therapist-client relationship may
evoke withdrawal in a client seeking help for
intimacy problems. If so, the necessary pre-
condition has been met, and a sensitive and
genuine therapist may naturally reinforce
improvements as they occur.
Shaping. The concept of shaping
implies that there is a large response class
of client behaviors for the therapist to rein-
force. Shaping is contextual in that it takes
into account a client's learning history and
the behaviors present and absent from the
client's repertoire. The same behavior may
be considered to be a problem for one client
but an improvement for another one. For
instance, let's take a male client who pounds
on his armrest and yells at the therapist,
"You just don't understand me!" If this be-
havior came from a client who came into
therapy unable to express his feelings, it
would constitute an improvement and the
therapist's openness to this outburst would
be important. If however, outbursts like this
were typical, the therapist may want to sug-
gest an alternative way to express feelings
of displeasure that did not involve aggres-
sive physical demonstrations.
Perceiving, like all other behavior, is
shaped by contingencies--the individual's
experiences from birth to the present. Thus,
reality, and even the notion of reality, re-
flects experiential histories. Therefore, radi-
cal behaviorism is at its core a contextual
theory that questions the existence of a
fixed, knowable reality and instead adopts
pragmatism (Hayes, S. C., Hayes, L. J., &
Reese, 1988). In this contextualistic ap-
proach to understanding people, a client's
reinforcement history, surrounding environ-
ment and circumstances help to give a total
picture of the meaning of a particular behav-
ior. If you take something out of this con-
text, it becomes meaningless.
The conception of psychopathology is
non-contextual; thus, any therapy that speci-
fies what is pathological behavior in ad-
vance probably can be enhanced by taking
context into account. The same behavior
exhibited by two people, as discussed in the
above section on shaping, could be consid-
ered a problem or an improvement depend-
ing on knowledge of the context in which the
behavior occurred. For example, arriving
late to a session would be considered mal-
adaptive for an avoidant person, but for an
obsessive compulsive person, such tardi-
ness would constitute an improvement.
The radical behavioral view of lan-
guage (Skinner, 1957) and hence, the ver-
bal interchange during psychotherapy is
also contextual. Thus, the psychoanalyst's
attribution of symbolic, metaphorical, and
latent meaning to client statements are em-
braced by radical behaviorists. For exam-
ple, Kohlenberg and Tsai (1993) discussed
the functional analysis of a client who began
a session by complaining about a speeding
ticket she received during the week. This
Functional Analytic Psychotherapy 5
analysis resulted in an exploration of the
client's issues about owing the therapist
money, an important client-therapist interac-
tion. Contextualism yields the notion that
any intervention from any therapy could be
effective under the right context. In this in-
tegrative stance of FAP, no technique can
be rejected off-hand as an intervention with
value. On the other hand, the same notion
suggests an intervention valuable under one
set of circumstances will be inappropriate
under others.
The contextual nature of radical be-
haviorism also has led to alternative meth-
odologies for the establishment of facts and
the definition of data. It is of interest to note
that Skinner (1953) viewed experimentation
as only one source of material relevant to a
functional analysis. He also mentioned cas-
ual observations, controlled field observa-
tions, clinical observations. Examples of
alternative approaches to data collection are
Ferster's functional analysis of depression
(1973) and most of Skinner's publications,
including his functional analysis of lan-
guage--Verbal Behavior (1957). In this tra-
dition, Willard Day (1969) has elaborated on
the compatibility of phenomenology and
radical behaviorism (also see Leigland,
1992). Dougher (1989) applied Day's ap-
proach and concluded that it offered prom-
ise as an empirical epistemology for the
analysis of verbal behavior in therapeutic
contexts. Cordova and Koerner (1993)
show how a radical behavioral approach to
psychotherapy data leads to consideration
of the contextual nature of truth.
Rule-Governed and Contingency-Shaped
Thus far we have emphasized the
central role of contingencies of reinforce-
ment. Acts that have been directly strength-
ened by reinforcement are called contin-
gency-shaped. Much of what we do,
however, is rule-governed rather than con-
tingency-shaped. Rules are verbal state-
ments that describe contingencies (Skinner,
1966; Zettle & Hayes, 1982). The classroom
instructions given in driver’s education are
rules that describe what happens when you
press down on the brake pedal. When
driver’s ed students first drive, they are
mainly doing rule-governed behavior and
may even be repeating the rules to them-
selves (self talk is a frequently occurring
although not a necessary feature of rule-
governed behavior) as they drive. In time of
course, the natural contingencies take over
and the driving of an experienced driver be-
comes contingency-shaped and is no longer
In the same way that a parent's
statement, "You have to do your homework
or you can't go out to play" is a rule for the
child, a theory of psychotherapy offers simi-
lar “if you do this then that will happen”
promises to the psychotherapist. That is,
the theory says, "if you classify clinical prob-
lems according to the theory and then act
according to its prescriptions, then the client
will get better." Thus, laws, logical princi-
ples, instruction and treatment manuals,
injunctions, maxims, and threats are rules.
The behavior that occurs as a result of the
rule being issued is referred to as rule-
governed behavior. Therapeutic interven-
tions are rule-governed to the extent that a
therapist's acts are guided by the theory.
There is no guarantee, of course, that a rule
of therapy will be followed. Therapists may
act on intuition or on the unconscious effects
of past experience rather than doing what
the theory or supervisors say they should.
As elaborated later, the distinction between
consciously following a treatment and being
intuitive is the same as the distinction be-
tween contingency-shaped and rule-
governed behavior. "Rule following" is an
act and will vary in strength from person to
person and from situation to situation de-
pending on history. Self rules are similarly
more or less effective depending on the in-
dividual’s experiences with "doing what you
think you should" or "doing what you tell
yourself to do." Rules have much in com-
mon with cognition and add to cognitive the-
ory by suggesting that some clinical prob-
lems are "rule-governed" and may be par-
ticularly well suited for cognitive treatment,
whereas other problems are not well suited
because they are contingency-shaped.
Rule-governed behavior is impor-
tant. Rules are extracted from one's own or
others' direct experience of the contingen-
cies of reinforcement or from the study of
systems that arrange them. The develop-
ment of the acts of "rule-extracting" and
rule-governed behavior becomes a large
part of what we do because it helps to
shorten the tedious process of shaping.
Functional Analytic Psychotherapy 6
From a therapeutic standpoint, it is
important to note that appearance alone
does not reveal whether a client's problem is
rule-governed or contingency-shaped. For
example, a poker player who figures out the
odds to himself before making a play might
make the same decisions as another player
who has been shaped by contingencies, but
their controlling variables are fundamentally
different. One player is thinking about what
to do before doing it and is highly influenced
by this thinking; the other is probably relying
on feeling or intuition, which is the experien-
tial aspect of previous reinforcement history.
The Evocative Environment--Functional
Although it may appear that therapy
sessions do not resemble the natural milieu,
the occurrence of daily life problems in the
session is evidence for its functional similar-
ity to daily life. That is, rather than looking at
physical characteristics in order to deter-
mine if therapy and daily life environments
are similar, the environments are compared
on the basis of the behavior they evoke. If
they evoke the same behavior, then they are
functionally similar. From a behavioral view-
point, all similarities are functional in nature
and reflect the history of the individual who
experiences the similarity. Thus, the client
who acts toward the therapist in the same
problematic way as with others is experienc-
ing the therapy in the same way that daily
life is experienced. For example, a man
whose presenting problem is hostility in
close relationships would show that the
therapy context is functionally similar to his
daily environment if he becomes hostile to-
ward the therapist as their relationship de-
velops. Further, if the client experiences
within-session contingencies that strength-
ens non-hostile ways to relate to his thera-
pist, the same functional similarity would
mediate generalization of improvements to
daily life. Generalization would be impeded,
however, if the therapy environment were
functionally different from real life and gains
made in treatment were confined to the
therapist-client relationship. FAP attempts
to deal with this problem in at least two
ways. First, the emphasis on natural rein-
forcement requires, by definition, that the
therapist represent the daily life community
as measured by generalization outside of
the client-therapist relationship. Second, it
is recommended that interpretations (see
Rule 5 below) involve comparisons between
behavior in the session and in daily life.
The notion of functional similarity
points to the possibility that a client's daily
life dysfunctional cognitions and maladap-
tive patterns of behavior that are the focus
of traditional cognitive/behavioral treatment
could be changed in the context of the cli-
ent-therapist relationship and generalize to
daily life. With certain notable exceptions
(Goldfried, 1982; Linehan, 1993: Safran,
1990a, 1990b), however, cognitive/behavior
therapists traditionally have not attended to
the therapeutic relationship. FAP provides a
theoretical rational for enhancing and inte-
grating traditional cognitive/behavioral with
interpersonal treatment. Functional similar-
ity is also central to the FAP focus on emo-
tional expression. Since many client prob-
lems are closely associated with emotional
expression (or its suppression), the thera-
peutic environment must evoke these emo-
tions if it is functionally similar. The integra-
tion into FAP of systems focusing on affect
is based on this concept.
The Clinical Application of FAP
Derived from the above radical be-
havioral constructs, the five strategic rules
or guidelines of therapeutic technique for
conducting FAP are: 1) Watch for clinically
relevant behaviors (CRBs); 2) Evoke CRBs;
3) Reinforce improvements; 4) Observe the
potentially reinforcing effects of therapist
behavior in relation to client CRBs; and 5)
Give interpretations of variables that affect
client CRB. Each rule is described in turn
Rule 1: Watch for Clinically Relevant Be-
havior (CRB)
The core guideline for doing FAP is
that a therapist should watch for clinically
relevant behavior (CRB): In-session in-
stances of the client's daily life problematic
behavior (CRB1) and improvements
(CRB2). FAP CRBs are similar to Linehan's
(1993) target relevant behavior.
Much of what clients complain about
in outside relationships have in-session rep-
resentations with their therapists. Examples
of CRB1s include: (1) A woman whose
problem is that she has no friends exhibits
these behaviors in session: Avoids eye con-
tact, answers questions by talking at length
in an unfocused and tangential manner, has
one "crisis" after another and demands to be
taken care of, gets angry at the therapist for
Functional Analytic Psychotherapy 7
not having all the answers, and frequently
complains that the world "shits" on her and
that she gets an unfair deal, (2) A man
whose main problem is that he avoids get-
ting into love relationships always decides
ahead of time what he is going to talk about
during the therapy hour, watches the clock
during the session so he can end precisely
on time, states that he can only come to
therapy every other week because of tight
finances (he makes a relatively large in-
come), and cancels the next session after
making an important self-disclosure.
CRB1's can also involve thinking2, perceiv-
ing, feeling, seeing, and remembering that
occur during the session. For example,
problems known as "disturbances of the
self," such as "not knowing who the real me
is" and multiple personality disorder, can be
translated into behavioral terms (e.g., prob-
lems with stimulus control of the response
"I") and conceptualized as CRB1 (see Koh-
lenberg & Tsai, 1991, chap. 6, for a detailed
discussion on how such disturbances are
acquired and treated).
CRB2s, or client improvements that
occur in session, typically are not observed
or are of low strength in the early stages of
treatment. For example, consider a male
client who withdraws and feels worthless
when "people don't pay attention" to him
during conversations. This client may show
similar withdrawal when interrupted by his
therapist. Possible CRB2s for this situation
include: a) being assertive and directing the
therapist back to what the client was saying,
or b) discerning the therapist's waning inter-
est in what was being said before the thera-
pist actually interrupted.
Given that contingencies are the
primary means of change in FAP, it might
appear inconsistent that there is no mention
of contingencies or reinforcement in Rule 1.
Instead, this guideline merely calls for
"watching," on the part of the behavior
therapist, a private behavior. The sugges-
tion to watch for CRB has far reaching impli-
cations and is much more difficult to imple-
ment than it might appear. We contend that
"watching for CRB" will raise the therapist's
awareness level of CRB and automatically
lead him/her to naturally reinforce improve-
ments as they occur. Further, we argue that
therapists who are unaware of CRB, that is
do not follow Rule 1, might inadvertently
block therapeutic gains and punish client
improvements. For example, consider
Betty, who was in treatment with the first
author for speech anxiety, panic, and lack of
assertiveness with male authorities at her
work place. Her assertiveness problems
were even greater if she had an ongoing
relationship with the male authority. During
the session, she asked Dr. Kohlenberg to
call her physician and ask for a refill of her
tranquilizer prescription because her doctor
was resistant and she didn't want to confront
him. Dr. Kohlenberg had several strong
covert negative reactions: he was inclined to
discourage medication use in favor of be-
havioral methods; getting a prescription re-
filled was Betty's responsibility, not his, and
it was a chance for Betty to practice being
assertive with her doctor; calling her physi-
cian was an intrusion on his time. On the
other hand, because of Rule 1, he was
aware that this request itself was a CRB2, a
clear-cut within-session assertive response
with a male authority that previously was
absent from Betty's repertoire. Given his
awareness, he consented to call her doctor
and complimented Betty on her forthright-
ness in making this request. In a subse-
quent session, Betty described the consid-
erable fear she had to overcome before
making the request. She felt that interaction
was a turning point in her willingness to as-
sert herself with Dr. Kohlenberg, and most
importantly, with other authority figures in
her daily life. In contrast to this good out-
come, a lack of awareness on the part of Dr.
Kohlenberg that a CRB2 was occurring at
the time she made the request could have
led to an inadvertent punishment of her as-
sertive behavior by his refusal to call her
From a theoretical viewpoint, the
importance of Rule 1 cannot be over-
emphasized since it alone should promote a
positive outcome. In other words, a thera-
pist who is skilled at observing instances of
clinically relevant behavior as they occur is
also more likely to naturally reinforce, pun-
ish, and extinguish client behaviors in ways
that foster the development of behavior use-
ful in daily life. Any technique which helps
the therapist in the detection of CRB1 has a
place in FAP. For example, as pointed out
in our earlier discussion of context, FAP
therapists interpret latent content of what the
client says as a means to detect CRB al-
though these interpretations are based on
Functional Analytic Psychotherapy 8
the principles of verbal behavior and not on
unconscious drives (Kohlenberg & Tsai,
Rule 2: Evoke CRBs
Ideally, therapy should evoke CRB1s
and provide for the development of CRB2s.
The degree to which this ideal is met de-
pends, of course, on the nature of the cli-
ent's daily life problems. Couples therapy
easily provides such an ideal environment
because the interactions between the
spouses occur right in the session (as op-
posed to a partner working on marital issues
in individual therapy who is able only to talk
about the problems rather than to demon-
strate them). Even for clients working on
relationship issues in individual therapy,
CRBs occur without the therapist having to
take special measures. This happens be-
cause the typical structure of the therapy
relationship involves contradictory elements
such as the encouragement of trust, close-
ness and open expression of feelings versus
a time limit of 50 minutes, a fee for service
and clear boundaries. Such a structure of-
ten evokes clients' conflicts and difficulties in
forming and sustaining intimate relation-
Of course, a therapist can aid in
evoking CRBs by focusing on the client's
present moment feelings and relationship
issues between the client and the therapist
(see Kohlenberg and Tsai, 1991, chap. 3,
for a more complete discussion of the be-
havioral principles underlying the relevance
of "here and now" stimulus control to the
evocation of CRB). The beginning, middle
and termination phases of therapy each
provide stimuli which often evoke different
types of CRBs.
Rule 3: Reinforce CRB2s
Given the contrived versus natural re-
inforcement issues, it is generally advisable
to avoid procedures that attempt to specify
the form of therapist reaction in advance.
Such specification can happen whenever
one attempts to conjure up a reinforcing re-
action (e.g., phrases such as "that's terrific"
or "great") without relating it to the specific
client-therapist history. These specific forms
of response can be contrived because they
were thought of outside the context of the
client-therapist environment at the moment
of reinforcer delivery.
The ways that therapists can be
more naturally reinforcing are examined in
detail by Kohlenberg and Tsai (1991). One
such way is for therapists to observe their
spontaneous private reactions to client be-
havior and to describe these private reac-
tions. Such private reactions are accompa-
nied by dispositions to act in ways that are
naturally reinforcing.
To illustrate, consider a client who
has intimacy concerns and lacks friends.
Suppose that at some point in therapy this
client behaves in a way that evokes the fol-
lowing private, spontaneous reactions in the
therapist: 1) dispositions to act in intimate
and caring ways, and 2) private reactions
that correspond to "feeling close." Because
these responses probably are not apparent
to the client, the therapist could describe the
private reactions by saying, "I feel especially
close to you right now." Without such ampli-
fication, these important basic reactions
would have little or no reinforcing effects on
the client's behavior that evoked them
Rule 4: Observe the potentially reinforcing
effects of therapist behavior in relation to
client CRBs.
Rule 4 is directly derived from behav-
ior analytic principles that stress the impor-
tance of the effects of the consequences of
behavior on the future probabilities of that
behavior. If therapists have been emitting
behavior that they think is reinforcing, it
would be important for them to actually ob-
serve whether they are in fact increasing,
decreasing, or having no effect on a particu-
lar client behavior. Therapists' behavior and
the focus of therapy can vary along many
dimensions: a) structured versus unstruc-
tured, b) emotion-eliciting or cathartic vs.
emotion containing or cognitive restructur-
ing, c) changing behavior vs. attaining in-
sight, d) warm and self-disclosing vs. distant
and relatively silent, e) active and directive
vs. passive, f) past vs. present, g) present-
ing problems vs. latent factors, h) conscious
vs. unconscious. Ideally, by understanding
a particular client's CRB1s and 2s, a thera-
pist should be able to shift his/her behavior
and focus to match the needs of the client.
For example, a passive and distant stance
may work well at the beginning of therapy
with a client who is afraid of intimacy, be-
cause such a stance would not overwhelm
the client by eliciting too much avoidance. If
the therapist is not able to shift into a
warmer way of interacting, however, then
Functional Analytic Psychotherapy 9
the client's CRB1s won't be evoked, and no
opportunities for learning intimacy behaviors
(CRB2s) will be provided. Conversely, in a
"co-dependent" client with little sense of self,
starting out warmly and actively will allay the
client's anxieties, but a shift needs to be
made to a more passive stance so that the
client can develop private control over
thoughts and feelings. In all cases, observ-
ing the impact of one's behavior on a client
increases the likelihood that we will act in
ways that are naturally reinforcing to the
client. The therapist's observation of the
reinforcing effects of his or her reactions on
the client's behavior can help in giving inter-
pretations (Rule 5) and in developing similar
behaviors in the client. The most obvious
way this occurs is when the therapist tells
the client about the self-observation. For
example, Dr. Kohlenberg noticed that he
inadvertently had been punishing his client’s
talking about her spiritual beliefs. Once no-
ticed, he offered the following interpretation:
"I've noticed that each time you started talk-
ing about your spiritual beliefs I've changed
the topic and you no longer bring it up."
Thus, the therapist models making a state-
ment of a functional relationship for the cli-
ent. Rule 4 can also lead the therapist to
search for ways of enhancing the effects of
reactions that could be reinforcing of CRB
but that are not noticed by the client. For
example, consider a male client who has
had trouble expressing feelings because of
a history of being ridiculed or criticized when
he did so. He did not increase these behav-
iors even though his therapist listened in-
tently with empathic facial reactions and
softly spoken comments each time the client
expressed a feeling. Inquiries led to the dis-
covery that the therapist's reactions were
not discerned by the client because the act
of expressing feelings evoked such intense
emotions (collateral private respondents)
that outside stimulation was not noticed.
After the therapist amplified the empathic
reaction by speaking loudly and clearly, the
client's rate of feeling expression appeared
to increase.
Rule 5: Give interpretations of variables that
affect client behavior
As a general strategy, the therapist
can interpret client behavior in terms of
learning histories and functional relation-
ships. Giving interpretations or reasons for
behavior can affect the client in two ways.
First, the reason can lead to a pre-
scription, instruction, or rule. The interpreta-
tion, "You are acting towards your wife like
you did toward your mother" can easily be
taken as a prescription or rule that the client
hears as, "Don't be so unfair to your wife;
treat her differently since she obviously is
not your mother. And if you treat her fairly,
your marital relationship will improve." Sec-
ond, a reason can enhance the salience of
(increase contact with) controlling variables
and increase positive and negative rein-
forcement density (Ferster, 1979). For ex-
ample, a female client learns during FAP
that the reason she feels rejected at times
during the session is a function of the thera-
pist's lack of attentiveness and, further, this
lack of attentiveness is related to how har-
ried or rushed the therapist appears at the
beginning of the session. This interpretation
could increase the client's noticing the
therapist's mood at the beginning of the
session and significantly affect the client's
experience of a lapse in the therapist's at-
tention. As a result, the client is in better
contact (she notices how harried the thera-
pist is), and then experiences less aversive-
ness when he is inattentive.
It should be pointed out that Rule 5 is
based on the general idea that an interpreta-
tion is simply a verbal behavior and does not
carry any special truthfulness. The reasons
or explanations for problems that we teach
our client to give are good only to the extent
that they are useful. The rationale that we
presented for teaching clients to give ac-
counts of themselves in terms of history and
functional relationships is that it is useful.
This FAP approach to interpretation is inte-
grative in that it has much in common with
hermeneutics (Messer, Sass, & Woolfolk,
Embracing and Enhancing Other Sys-
tems of Psychotherapy
We will now explore how important
concepts and therapeutic methods from
other theories can be integrated into FAP in
a theoretically coherent manner. As contex-
tualists, we agree with Messer (1992) that
when you change the context, you change
the meaning, thus it is impossible to retain
all of the original meaning when a concept is
transported into another system. Our be-
havioral orientation requires that we change
Functional Analytic Psychotherapy 10
the ontological status of many imported no-
tions. That is, the action requirement will
result in changing "things" to "processes."
Even with these changes, however, we be-
lieve that we can capture the intent, essence
and clinical implications of the original con-
cept because the behavioral common lan-
guage is based on preserving context. In
other words, in embracing a concept, we
translate it into behavioral language while at
the same time trying to preserve its deeper
meaning and clinical implications. In en-
hancing a concept or method, we place it
into a larger context by viewing it with a wide
angle lens, and we discuss refinements and
differences added by a behavioral analysis.
Most importantly, we provide a theoretical
coherence for understanding why a particu-
lar technique is helpful, and when it should
be used with a client. Due to space limita-
tions, we chose to examine central concepts
only from two of the most dominant modes
of therapy today--transference from psycho-
analytically-oriented therapy and cognition
from cognitive therapy.
The Psychoanalytic Concept of Transfer-
ence The centrality of transference within
psychoanalytic treatment parallels the sig-
nificance given to rule 1 in FAP; in fact, Rule
1--"watch for CRBs" might be loosely trans-
lated as "watch for transference." FAP's
contribution to this topic is derived from its
view that transference phenomena are one
part of the larger set consisting of all behav-
ior that occurs within-session. From this
perspective, not all within-session behaviors
are CRBs, and of those that are, context
must be taken into account to decide
whether they are CRB1's (problems) or
CRB2s (improvements). This larger picture
of within-session behavior incorporates the
essence of what is clinically useful about
transference and yet adds to its utility by
pointing out some theoretical and clinical
limitations of this psychodynamic concept.
Since psychoanalysis is a complex, diverse,
and changing system, the meaning of trans-
ference is quite variable depending on which
definition is used. Thus, our analysis ap-
plies only to the meanings specified below.
The concept of transference is im-
bued with a variety of characteristics in addi-
tion to the generalization of responses to
important persons. Alexander and French
(1946) defined transference as "any neurotic
repetition of...stereotyped, unsuitable, be-
havior based on the patient's past" which is
differentiated from "normal reactions to the
therapist and therapeutic situation as reality"
(pp. 72-73). Our previously stated view is
that interpreting the abnormality of behavior
independent of its context is almost impos-
sible. Correspondingly, the terms neurotic,
stereotyped, and unsuitable all require arbi-
trary judgments--whether acknowledged by
the therapist or not. For example, it is obvi-
ous that not all "stereotyped" behavior is
transference (abnormal). The client might
"stereotypically" say hello at the beginning of
each session and a therapist is unlikely to
judge this as transference. Similarly, the
therapist must provide a context from which
to judge the unsuitability of a behavior. It is
possible, for instance, that a therapist could
have unconscious sexist values that lead to
regarding a female client's desire to pursue
a career as neurotic or unsuitable.
From a FAP viewpoint, including
abnormality criteria in the definition of trans-
ference creates mixed clinical effects. Such
a definition could serve as a rule that leads
the therapist to notice those problematic,
within-session behaviors specified in the
definition, and this could have positive ef-
fects if a client's daily life problems happen
to be included. On the negative side, rele-
vant behavior not included in the definition
might be missed.
Even if a CRB is noticed, a more se-
rious problem concerns such a rule's impact
on the reinforcing and punishing effects of
the therapist's response to the CRB. Recall
the assumption that a therapist who is vigi-
lant for and aware of the client's CRB1s will
naturally encourage and reinforce improved
behavior. At times, viewing a client's re-
sponse as transference would interfere with
the reinforcement of improved behavior. For
example, if a client historically has been
compulsive in his daily life, then his repeat-
edly verifying appointment times could be
appropriately classified as neurotic accord-
ing to the definition of transference. If, how-
ever, the client historically has been remiss
about keeping appointments, making sched-
ules, and keeping track of time, then con-
cern about appointment times would be an
improvement. In this latter case, the
therapist, who is guided by a fixed, noncon-
textual view of what is unhealthy, might offer
an interpretation that inadvertently punishes
Functional Analytic Psychotherapy 11
the improved behavior. Because formal
definitions of abnormality ignore context, the
therapist views the behavior as neurotic,
unsuitable, or stereotyped, and his or her
natural reactions are more likely to have
unintended punishing effects.
The second part of Alexander and
French's definition involves transference as
distortion of reality. In behavioral terms, this
meaning of transference could serve as a
rule that directs analysts to examine their
own "real" behavior and the "real" sequence
of events in order to determine if the client's
response is "normal" or not. In effect, this
situation leads the therapist to attend to vari-
ables present in the session which affect the
client's behavior. If the therapist would then
share his or her observations with the client,
even though this type of sharing is not usu-
ally part of psychoanalytic process, such an
interaction could be beneficial because it is
a description of functional relationships
called for in Rule 5.
Although the real versus the trans-
ference distinction can lead therapists to
examine their own contribution to the client's
response, this view also could have nega-
tive clinical implications because it pre-
sumes a static, single perspective (the
therapist's) of reality. The "I'm right and
you're wrong" outlook of reality perhaps is
not problematic when a client expresses
extreme accusations, such as the therapist
is secretly meeting with his boss and is plot-
ting to kill him. The "true" reality, however,
is not as clear in more typical client com-
ments such as "I don't think you care
enough about me," "You are bored with me,"
or "You're in this just for the money." Phi-
losophically, there is reason to question the
notion of a single, fixed truth. Even if there
were just one "true" reality, however, it is
unreasonable to presume that the therapist
will always be correct.
Clinically, we are concerned that a
therapist who accepts the distorted reality
aspect of transference will be less inclined
to genuinely consider the possibility that a
client's perception is valid when it differs
from the therapist's. This, in turn, could de-
prive the client of an opportunity to learn
how to process and resolve an interpersonal
situation in which each member of the dyad
has a justifiable but different view of the
world. Similarly, a submissive client with an
inadequate sense of self could be punished
for being assertive when his or her view of
reality is different from the therapist's. We
have similar concerns when validation (rein-
forcement) of a client's perceptions may be
essential to their improvement. Such
needed validation may be limited or ham-
pered by the distorted reality notion.
We are also apprehensive that the
distorted reality notion will inadvertently rein-
force an authoritarian or rigid stance for
therapists who are already inclined in those
directions. Along these lines, psychoana-
lysts themselves have expressed concern
that therapists might use the transference
concept of "not real" to avoid real involve-
ment with the client (Greenson, 1972). A
lack of genuine involvement with the client
deters the evocation of CRB and the occur-
rence of natural reinforcement, which is es-
sential for therapeutic benefit in FAP.
Psychoanalysts also recognize the
problems inherent in the assumption that the
client's view of reality is an illusion. For ex-
ample, Gill and Hoffman (1982) recently
have proposed a different view of transfer-
ence that is more consistent with the FAP
position: "We believe that the therapist's
actual behavior strongly affects the patient's
actual experience, including what are usu-
ally designated as the transferential aspects
of that experience....We differ, therefore,
from those who emphasize distortion of real-
ity as the hallmark of the transference" (p.
139). The rule-governing effects of Gill and
Hoffman's view would be more likely to pro-
duce analyst behavior that resembles FAP's
Rule 1.
It appears that Gill and Hoffman
would like to show how a naive interpreta-
tion of transference is not appropriate, but
they don't have a theoretical mechanism for
doing so. Our FAP analysis provides such a
mechanism by using the concepts of con-
text, and CRB1s and CRB2s.
Products and Structures in Cognitive Ther-
apy A fundamental formulation in cogni-
tive therapy is that a person's cognitions
affect subsequent feelings and actions. The
basic ABC paradigm, proposed by Albert
Ellis (1962,1970) and depicted in figure 1a,
shows that A represents external environ-
mental events, B represents cognition, and
C is the resulting emotion or action. In this
paradigm, it is suggested that a person's
Functional Analytic Psychotherapy 12
irrational beliefs about external events leads
to problematic feelings.
As a step toward improving the ABC
model, Hollon and Kriss (1984) used cogni-
tive theory to revise what is meant by B
(cognition). They identified two types of
cognition, cognitive products and cognitive
structures. Cognitive products are directly
accessible, conscious, private behaviors,
such as thoughts, self-statements, and
automatic thoughts. This meaning of cogni-
tion corresponds with Ellis's formulation and
seems to be used in day-to-day cognitive
treatment in which the therapist tries to
change the client's dysfunctional automatic
thoughts, irrational beliefs, or maladaptive
self talk. Cognitive structures, such as
schemas, are defined as the underlying or-
ganizational entities that play an active role
in processing information. Structures oper-
ate at an unconscious level since their con-
tent cannot be known directly and must be
inferred from the products.
From the Hollon and Kriss perspec-
tive, the causal factor in the ABC formulation
is the cognitive structure, whereas the cog-
nitive products (irrational thoughts, self-
statements, automatic thoughts) constitute
"signs or hints of the nature of one's knowl-
edge structures." Hollon et al. and others
(Safran, Vallis, Segal, and Shaw, 1986;
Beck, 1984) suggest that any clinical inter-
ventions that change cognitive products are
merely symptomatic treatments.
Although necessitated by deficiencies
in the original ABC hypothesis (e.g., the fact
that C's sometimes occur in the absence of
a B and that cognition was inconsistently
defined, see review by Beidel & Turner,
1986), the shift in focus from products to
structures has produced a theory-practice
schism. The same cognitive therapists who
reject the causative role of cognitive prod-
ucts are the ones who provide treatment
manuals and clinical examples that focus on
changing cognitive products. For example,
Beck, Emery, and Greenberg (1986) stated
that the therapist "must be able to communi-
cate clearly that anxiety is maintained by
mistaken or dysfunctional appraisal of a
situation" and "gives this the
first session and reiterates it throughout
therapy" (p. 168). In addition, Guidano and
Liotti (1983) stated that first important step
in therapy occurs "when patients understand
that their suffering is mediated by their own
opinions" (pp. 138-142).
From a FAP view, the theory-
practice schism in cognitive therapy makes
sense. Since clinical interventions are al-
ways limited to the behavioral realm, such
as the client's thinking, feeling and talking
(i.e., products), it is impossible to devise
treatments that focus on nonbehavioral enti-
ties (i.e., structures) that cannot be directly
contacted or observed by the therapist. As
one cognitive researcher described it, a
schema is like "the holy grail" (Zuroff, 1992,
p. 274) of cognitive psychology. Thus, it has
been difficult for cognitive therapists to cre-
ate interventions aimed at structures that
are substantially different from those aimed
at products. For example, Beck et al. (1979)
stated that "the cognitive and behavioral
interventions (used) to modify thoughts...are
the same as those...used to change hidden
assumptions" (p. 252). It appears that the
only procedures that differentiate the clinical
treatment of products from structures is that
the latter must first be inferred (e.g., the cli-
ent must abstract or deduce the existence of
the structure). Once identified, however, the
same therapeutic methods used to change
products are applied. Directed by theory to
change a nonbehavioral entity (the underly-
ing structure) while restricted to working with
the behavior (products) of the client, the
cognitive therapist is in an untenable posi-
tion. These theoretically posited difficulties
in changing schemas and the tenuous link
between theory and how change occurs
have been termed a dilemma by Hollon et
al. (1984, pp. 46-48). Thus, it is not surpris-
ing that the actual nuts-and-bolts practice of
cognitive therapy mainly operates according
to an ABC model involving products.
The wholesale application, however,
of an ABC formulation involving products to
the exclusion of other possibilities leads to
questionable clinical procedures. For ex-
ample, clients may reject the ABC model by
claiming they experience no conscious B
that precedes the C, or they may report a B
that is inconsistent with a C (e.g., "I intellec-
tually accept I don't need to be loved by eve-
ryone, but I am still devastated when I'm
rejected"). In such cases a cognitive thera-
pist usually will continue to carry out an ABC
treatment plan by questioning the client's
logic or sincerity, or by proposing that there
are additional, unconscious cognitions to be
Functional Analytic Psychotherapy 13
discovered. Challenges can also be indi-
rect, such as giving additional homework or
assumption-testing assignments. Such
nonacceptance of alternative paradigms is
found in the cognitive therapy of Beck
(1976), even though he rejects the theory
implied by the ABC model. For example,
Beck suggested that clients who say that
they intellectually "know" they are not worth-
less, but who do not accept this on an emo-
tional level (the Figure 1c paradigm) need
more cognitive therapy because the dys-
functional feelings can occur only when they
do not "truly believe" the rational thought
(Beck et al., 1979, p. 302). Furthermore, a
client's objecting to cognitive interventions
could be desirable, that is, a CRB2. If such
a client were seeking help with becoming
more assertive or more confident with opin-
ions, then objecting to the therapist's ABC
theory would be an improvement that should
be reinforced by the therapist's acceptance
and not punished by the challenges.
The need for more flexible models is
demonstrated by the tendency for cognitive
therapists (as well as other types) to persist
in their approach even though the client is
not progressing (Kendall, Kipnis, & Otto-
Salaj, 1992). Given the complexity of hu-
man behavior, the exclusion of coexistent,
noncognitive mediated explanations as de-
manded by the ABC model seems unrea-
The FAP model, in contrast, does
allow for a client's experience that matches
the Figure 1c paradigm and also attends to
the limitations of this model. On a descrip-
tive level, Skinner's (1974) distinction be-
tween rule-governed behavior and contin-
gency-shaped behavior seems to capture
much of what is meant by the product-
structure distinction. This view retains the
clinical usefulness of that distinction, but
avoids the problems of the original ABC
cognitive hypothesis. In our revision of the
ABC paradigm, B is conscious verbal be-
havior such as thinking, believing, choosing,
reasoning, categorizing, labeling, self-talking
of which the client is aware. In behavioral
terms, B is a private verbal behavior that
can serve as a rule. Depending on whether
or not an individual has been reinforced for
following rules, the B may or may not affect
subsequent acting and feeling. The ABC
formulation shown in Figure 1a represents
the case in which B does have rule-
governing properties and does influence C.
Contingency-shaped behavior is repre-
sented by AC (Figure 1b). In this instance,
the client has problems but doesn't con-
sciously think, plan or attribute beforehand.
Finally, Figure 1c shows the case in which
both B and C are evoked by the same con-
dition, are correlated, and have no influ-
ence on each other. In this later case, C is
contingency-shaped and is directly evoked
by A.
(a) A B C
(b) A C
(c) A B
Figure 1. Paradigms showing relationships
between A (antecedent event), B (belief or
thinking), and C (consequent behavior or
feeling): (a) thinking influences subsequent
feelings and/or behavior; (b) feelings and/or
behavior occur in the absence of prior think-
ing, (c) thinking does occur but does not
influence subsequent feelings and/or behav-
ior. In other words, within the FAP frame-
work, the degree of control exerted by think-
ing over clinical symptoms is on a contin-
uum. Cognition (as products) can play ei-
ther a major, minor, or no role in the client's
problems. Correspondingly, cognitive ther-
apy methods will be of varying effectiveness
with different clients depending on the role
that cognitive products has in the clinical
problem. At one end of the continuum, the
client's problem is primarily rule-governed,
and treatment would be aimed at changing
self statements, beliefs and attitudes using
cognitive therapy techniques.
At the other end of the continuum the
symptom has been shaped purely by con-
tingencies. Although it is possible for a cli-
ent with a deeper, unconscious contingency-
shaped problem to improve when given a
cognitive interpretation, less favorable out-
comes are more likely. This is especially
true for clients who grew up in dysfunctional
families where they were abused, neglected,
negated, or otherwise punished for express-
ing their feelings. Children who are repeat-
Functional Analytic Psychotherapy 14
edly told, either directly or indirectly, that
"there's no reason for you to feel or think
that way" mistrust their feelings and are un-
sure of who they are. Suggesting to such
clients that their beliefs are dysfunctional or
irrational can replay the contingencies asso-
ciated with the invalidation and alienation
they experienced while growing up.
In clients whose symptoms are
shaped by contingencies, treatment involves
the "corrective emotional experience"--
building caring relationships by exposing the
client to positive reinforcement in therapy
that would shape and sustain new behavior.
Paying attention to contingencies is exactly
what Jacobson (1989) did when he de-
scribed how he used the therapist-client re-
lationship to change a client's core belief
about her "badness." According to Jacob-
son, the core structure was changed by the
client's taking "the risk of being known inti-
mately" by him, and the client's risk "paid
off" in his continued acceptance and positive
regard. Along these lines, Safran and col-
leagues (Safran, 1990a, 1990b; Safran,
McMain, Crocker, & Murray, 1990; Safran &
Segal, 1990) offer a significant modification
of cognitive therapy that gives a central role
to the therapist-client interaction in the
change process. However, Safran and col-
leagues view the therapeutic interaction
primarily as providing an opportunity to mod-
ify interpersonal schemas and not behavior.
This leads to the same problems discussed
above regarding changing schemas and not
products. Further, Safran drew upon a non-
behavioral perspective, interpersonal theory,
which has psychodynamic roots (Sullivan,
1953) as the source for the focus on the
therapeutic interaction. The net result is an
approach without a cognitive or behavioral
rationale for the interpersonal focus.
In sum, our FAP analysis of cognitive
therapy: 1) translates cognitive products
and structures into rule-governed and con-
tingency-shaped behavior, 2) accounts for
instances where client problems are not in-
fluenced by prior conscious experiences, 3)
provides suggestions for schema-based
treatment, and 4) provides a theoretical ba-
sis for determining when cognitive therapy is
appropriate and when it may be deleterious
to clinical outcome.
Summary and Conclusions
We have discussed how FAP and
radical behaviorism can provide a theory
and perhaps a common language that could
serve the process of integration. Although
many other attempts at this type of integra-
tion have been made (for review, see Arko-
witz & Messer, 1984), we believe FAP dif-
fers from these previous attempts by provid-
ing an integrative framework for all systems
and not just a particular aspect of one theory
or another. In this respect, FAP can be
viewed from the perspective of Pepper's
(1942) World Hypotheses. According to
Pepper, a world hypothesis is a sufficient
and adequate explanation of the phenom-
ena of interest. All views exist independ-
ently and it is impossible to present data that
would invalidate one in favor of another. He
argues there are just four relatively ade-
quate views that he refers to as formism,
mechanism, organicism, and contextualism.
According to this view, all psychotherapy
theories could be characterized by one of
the four. For the purposes of this paper, it is
not important to detail each of these views
except to note that contextualism differs
from the others in that it uses a pragmatic
truth criterion. This, in turn, makes it possi-
ble for contextualists to strategically use one
of the other world views as advocated by
psychotherapy integrationists. Since radical
behaviorism has a contextualistic core
(Hayes et al., 1988), FAP seems well-poised
as an integrative theory from the world hy-
pothesis perspective.
Arkowitz (1992) pointed out that
integrative theory needs to be formal, as
opposed to having a general perspective,
and that the integration should lead to new
predictions. Although FAP does have some
abstract concepts, its radical behavioral un-
derpinnings are formal and coherent. And
although data are needed, our analyses of
psychoanalysis and cognitive therapy do
indicate differential predictions that neither
theory would have made on its own. Spe-
cifically, we identify the circumstances when
each of the two theories are most likely to
produce therapeutic benefit. Our analysis
suggests that very different therapeutic
stances and techniques are called for de-
pending on : 1) what will evoke the client's
problems and issues in the session, 2)
whether the client's problems are primarily
rule-governed or contingency-shaped, and
3) what will be naturally reinforcing of the
client's target behaviors. All three of these
Functional Analytic Psychotherapy 15
form the basis of matching problem to
therapeutic approach.
The question is often raised as to
whether or not FAP is a mere translation of
other theories into operant terms. It is our
position that translation across theoretical
boundaries is an essential requirement and
a necessary first step for an integrative the-
ory. FAP not only translates across theo-
ries, but attempts to preserve the important
deeper meaning and clinical implications in
the original theory by identifying the context
for the original theoretician’s techniques and
conceptualization. Most importantly, FAP
adds something new by going beyond the
original context to provide a theoretically
cohesive basis for predicting when proce-
dures from a particular theory should or
should not be used. Our discussion of
transference and cognition illustrated how
FAP both preserved deeper meaning and
formulated new predictions for when psy-
choanalytic or cognitive techniques would
be helpful versus not helpful for particular
Just as Ferster (1967b) acknowl-
edged the value of non-behavioral ap-
proaches in discovering what works, we also
favor a multilingual approach (Messer,
1992). FAP was enriched by not only psy-
choanalysis and cognitive therapy, but by
many other approaches we could not dis-
cuss due to space limitations: Gestalt ther-
apy, spiritualism, grief therapy, client-
centered therapy, conventional behavior
therapy, self psychological, and objects rela-
tions. In turn, our hope is that behaviorism's
qualities of comprehensiveness, objectivity,
and precision will offer a basis for openness
and communication among psychothera-
pists. Footnotes
1. To be more technically correct, we
do what we do because of genetic endow-
ment and our history of interactions with the
both the social and inanimate environment.
2. Another common misconception is
that radical behaviorists do not deal with
private behavior. Skinner has consistently
tried to set the record straight on this matter
since 1945 when he said, “My toothache is
as real my typewriter.”
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... The second possibility is that one of the commitment behaviors acquired from participating in the ACT-DEA program is the additional improvement effect acquired from increased pro-social behavior and interpersonal interactions in the participants' daily lives [47]. In this context, the further revision of the ACT-DEA program incorporating interpersonal approaches based on contextual behavioral science, such as functional analytic psychotherapy [48], may contribute to the improvement of the treatment effectiveness [43]. ...
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Background: This study is a preliminary study on an acceptance and commitment therapy (ACT) program that mitigates destructive experiential avoidance (DEA) behaviors, including self-harm behavior and addiction; Methods: Twenty participants aged 15–25 years who had confirmed DEA behavior within the last month participated in a total of six sessions of ACT. Demographic characteristics, history of psychiatric illness, and TYPES and patterns of DEA behavior were confirmed in the baseline survey. The severity of clinical symptoms, frequency of DEA behavior and impulsivity, characteristics of experiential avoidance (EA) behavior, depression, and quality of life (QOL) were measured before and after the program for comparative statistical tests using the intention-to-treat method. Furthermore, the severity of clinical symptoms was evaluated after each program, along with the frequency of DEA behavior and trends in impulsivity, which were investigated based on the behavior log; Results: After the ACT program, both the frequency of DEA behavior and impulsivity and the severity of clinical symptoms, depression, and anxiety decreased significantly. Furthermore, among the EA characteristics, pain aversion, distraction and inhibition, and delayed behavior significantly improved. Moreover, the overall QOL, psychological and social relationships, and QOL regarding the environment also improved; Conclusions: The results of this feasibility study demonstrate the potential of the ACT program as an effective intervention in DEA behavior. The results of this study may be used as preliminary data for future large-scale randomized studies.
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This study aimed to evaluate the efficacy of Internet vs. in-person Acceptance and Commitment Therapy intervention. The intervention aims to promote parental psychological flexibility and parental emotional regulation strategies in a 6-week/session program. Format efficacy was analyzed independently and comparatively in a non-randomized controlled clinical trial. The intervention protocol is the same, but the internet intervention was applied through a self-applied platform, and the in-person intervention was applied in a group setting. The sample consisted of 82 participants with a mean age of 42.79 (SD = 5.75), 62.2% of whom were women. The mean age of children was 8.41 (SD = 3.9). There were 41 parents each in online and in-person experimental groups. Parental psychological flexibility, experiential avoidance, emotion regulation skills, parental stress, satisfaction with life, and the effects of the intervention on their children’s psychological adjustment were measured at baseline, six-week postintervention, and follow-up at 91 days. The results showed no differences between groups were found in post-treatment. In the follow-up, the results showed that the workshop group reported significantly better scores in goal-oriented emotional regulation skills (F = 4.978; p < .05; η2 = .119) and children’s difficulties (F = 4.679; p < .05; η2 = .112) with a large effect size. The online group reported significant differences with a large effect size in satisfaction with life (F = 10.896; p < .005; η2 = .182) The subgroup analysis found that in-person intervention is more powerful with larger effect size than online intervention. The results of this study provide useful evidence for the use of Acceptance and Commitment Therapy strategies in a parenting intervention.
One solution to treatment of violence and aggression is to treat the individual aggressor or at least take the individual aggressor as the starting point for therapy. This chapter reviews cognitive behavior therapy (CBT), behavior modification, applied behavior analytic, and third wave behavioral interventions, such as acceptance and commitment therapy, dialectical behavior therapy, functional analytic psychotherapy, and mindfulness interventions. There is a very large quantity of research evaluating individual psychological treatments for many populations. This chapter focuses on these approaches which have very long histories, and so, informed by outcome data over the years, researchers have revised and refined these approaches and modified them for specific populations and contexts. Thus, the treatments with the best available support and that permit the most informed treatment and economic decisions are CBT and behavioral treatments. Although other approaches may be effective there may be much less evidence or they often lack evidence, and some approaches, such as catharsis, are known to be harmful.KeywordsAggressionViolencePsychotherapyCognitive behavior therapyBehavior modificationBehavior therapyApplied behavior analysisThird wave psychotherapyAcceptance and commitment therapyDialectical behavior therapyFunctional analytic psychotherapyMindfulness
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Several studies point out problems in interpersonal relationships as precipitating or aggravating mental health issues. Especially in the Covid-19 pandemic scenario, which requires isolation and social distance, it is necessary to pay attention to the issues that emerge in interpersonal relationships. Functional Analytic Psychotherapy (FAP), a form of behavioral therapy that emphasizes the role of the therapist-client interpersonal relationships in improving client problems, can contribute to the proposition of interventions to address mental health issues in this pandemic. This study aimed to describe a perspective about the application of FAP on the treatment of mental disorders, mainly with anxious or depressive symptoms, and correlate such findings with interventions aimed at the Covid-19 pandemic. A narrative review of the literature was carried out based on bibliographic searches on the "Portal de Periódicos da CAPES". The review materials were organized into (a) treatment of mental health problems using FAP, sorted into themes of anxiety, depression, and a combination of them; (b) FAP, mental health, and the Covid-19 pandemic. It is concluded that FAP can be used as an essential theoretical and methodological framework for planning interventions during and after the Covid-19 pandemic, minimizing its possible harmful effects.
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The article describes the distinctive features of the therapeutic relationship in cognitive behavioral therapy (CBT) and the ways of dealing with problems in the therapeutic interaction. The development of the way that the therapeutic relationship is understood within the context of cogntive behavioral therapy is presented, from the initial view that the therapeutic relationship is a necessary but not sufficient condition in order to achieve therapeutic change, to the modern view that the therapeutic change is produced by the therapeutic techniques, as well as the therapeutic relationship. The role of the therapist and the features of the therapeutic alliance in CBT are described, central among which is collaborative empiricism and Socratic questioning. The difficulties in the therapeutic relationship and the ways that can be addressed are discussed in the context of the related concepts of resistance, of ruptures in the therapeutic alliance and of transference and countertransference. The rationale regarding boundaries to the therapeutic relationship is discussed. In conclusion, in CBT the emphasis on the therapeutic relationship is not so central as in other therapeutic models and the relationship is integrated with techniques, although there is ongoing effort to enhance and expand the understanding of the therapeutic interaction. Nonetheless the quality of the relationship is not inferior to that of other treatment models and the therapeutic change in CBT is attributed equally to the implementation of techniques and relationship factors.
Employment opportunities for substance abuse counselors are expected to grow by 23% over the next decade, making this an opportune field for Board Certified Behavior Analysts (BCBAs), particularly those at the master’s level. Although certification in behavior analysis is not currently needed for employment in substance abuse treatment, research has shown that interventions based on behavior analysis are among the most effective in changing behaviors of individuals with substance use problems. Despite these findings, credentialing requirements for substance abuse counselors do not follow a behavioral model, and few training opportunities exist to prepare BCBAs to work in specialty substance abuse treatment. This chapter outlines recommended additions to the BACB fifth edition task list that would be required to meet Advanced Substance Abuse Counselor credentialing standards. They are translated to behavioral concepts where possible, and the additional training necessary for a master’s level BCBA to provide treatment effectively is identified. These additions include training in the concepts and principles of pharmacology, behavior pharmacology, and behavioral economics. Training is also suggested in methods for measuring substance use and other related behaviors, in the application of individual analysis designs in this area, and in randomized clinical trial designs. Training in methods of functional assessment, in empirically established behavior change procedures (e.g., abstinence-based reinforcement, acceptance and commitment therapy, community reinforcement approaches), and in medication-assisted treatments is also recommended. Finally, ethical issues, regulatory frameworks, and supervision issues are discussed. Hopefully, as behavior analytic treatments become more widely implemented, training programs will consider incorporating these recommendations.
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The purpose of the present study was to examine, via meta-analysis, the efficacy of third wave therapies in reducing posttraumatic stress (PTS) symptoms. A secondary aim was to identify whether treatment efficacy was moderated by treatment type, treatment duration, use of exposure, use of intent-to-treat samples, and treatment format (i.e., individual, group, both). Risk of bias was also assessed. A literature search returned 37 studies with a pooled sample of 1,268 participants that met study inclusion criteria. The mean differences between pre-and post-treatment PTS symptoms were estimated using a random effects model (i.e., uncontrolled effect). Additionally, in a subset of studies that utilized a control condition, a controlled effect in which pre-to post-treatment PTS symptom changes accounted for symptom changes in the control condition was calculated. The overall uncontrolled effect of third wave therapies in reducing PTS symptoms was medium to large (Hedges' g = 0.88 [0.72-1.03]). Treatment type, use of intent-to-treat analysis, inclusion of exposure, and format moderated the uncontrolled effect, but treatment duration did not. The controlled effect of third wave therapies was small to large in size (Hedges' g = 0.50 [0.20-0.80]). Findings suggest that third wave therapies demonstrate enough promise in treating individuals with PTS symptoms to warrant further investigation. Implications and suggestions for future third wave research are discussed.
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Resumen Mucho se ha avanzado desde que modelos cognitivos de Beck y de Ellis propusieron integrar aspectos del pensamiento a los tratamientos conductuales de los trastornos mentales. La evolución de la terapias cognitivo conductuales en los últimos 20 años es uno de los ejemplos más claros de que los tratamientos no pueden mantenerse estáticos y que es necesario adaptarse a las nuevas demandas de la sociedad. En este marco, las terapias contextuales o de tercera generación brindan una nueva perspectiva sobre la conceptualización y tratamiento de los trastornos mentales. A pesar de la amplia evidencia de eficacia que tienen, las terapias contextuales no pueden ser entendidas como una sola corriente de trabajo, si bien comparten elementos propios del conductismo radical o skinneriano, no parten de los mismos conceptos teóricos y por ende existen diferencias que deben ser abordadas para comprender mejor su aporte al desarrollo de la psicología clínica. Dentro del presente artículo, se pretende hacer un análisis teórico de las principales terapias contextuales como son Terapia de Aceptación y Compromiso (ACT), Terapia Dialectico Conductual (DBT), Psicoterapia Analítico Funcional (FAP) y Activación Conductual (AC) con la finalidad de exponer las similitudes, las diferencias entre las mismas.
One widely used approach to constructing a case formulation is to assess and integrate information relating to a range of domains, including biological, psychological, familial, social, and cultural. The validity of the forensic case formulation will depend upon the quality of the evidence upon which it is based. Some important considerations include the fact that offending behavior is usually not observable and that violence or problematic sexual behavior is often low frequency, context‐specific, and cannot be elicited for ethical reasons. While case formulation can be based upon any theory of human behavior, in offender work cognitive and behavioral theories prevail. Where treatment planning is concerned, co‐production of the case formulation is an important means to engage the offender in the treatment process. The chapter presents a typical complex forensic case and illustrates the application of case formulation to this particular case using Offense Paralleling Behavior (OPB) as the theoretical framework.
This book has a question mark in its title because it aims to invite inquiry. The possibility of integrating psychoanalytic and behavior therapies has been controversial since it was first proposed about 50 years ago, and this has elicited a wide range of reactions from both psychologists and psy­ chiatrists. It was with the hope of fostering constructive interchange that this book was conceived. We wanted to spark further thinking about the question in the title in a way that could lead either to conceptual and clinical progress toward an integrated approach or to a clearer sense of the obstacles involved. In either case, we hoped that it would present a healthy challenge to current forms of psychoanalytic and behavior therapies. The present volume was stimulated by the appearance in 1977 of Paul Wachtel's book Psychoanalysis and Behavior Therapy: Toward an Integration. Al­ though many reviewers did not necessarily agree with Wachtel's proposals for integration, they (and we) were highly laudatory of his attempt. After reading the book, Hal Arkowitz organized a symposium on integration that took place in Chicago at the November 1978 meeting of the Association for the Advancement of Behavior Therapy. The symposium included Cyril Franks, Merton Gill, Hans Strupp, Paul Wachtel, and Michael Merbaum as moderator. Arkowitz subsequently proposed to edit a book on integra­ tion and invited Messer to be coeditor.
The concept of resistance rarely if ever arose in the early literature on behavior therapy. Most of the original descriptions of behavior therapy conveyed an underlying assumption that, apart from their presenting problems, clients were totally “rational” beings who readily complied with the intervention procedures set forth. As behavior therapists began applying their procedures to unselected cases and were confronted with a wide variety of complex clinical problems, it became strikingly evident that the simple application of the appropriate technique was not always successful. Although the therapist might have been clear about the determinants associated with any problem behaviors, and may also have felt confident that certain therapeutic techniques had a good chance of bringing about the needed change, the clarity of the clinician’s thinking was not always matched by the client’s desire or ability to comply with the intervention procedures. It has been in the face of such instances of therapeutic noncompliance that the topic of resistance has come to the fore in behavior therapy.
"Should be of considerable interest to a wider public, since it proposes a radical reformulation of psychoanalytical theory which, if accepted, would render outmoded almost all the analytical jargon that has crept into the language of progressive, enlightened post-Freudian people."-Charles Rycroft, The New York Review of Books "Schafer's arguments have considerable cogency. The tendency to over-theorize so that the translation of abstractions into the language of ordinary discourse between analyst and patient has become increasingly difficult is a fault; Schafer goes a long way towards redressing it, and his efforts to include meaning and the person in the form of his language is an achievement."-Michael Fordham, The Times Higher Education Supplement