The Functional Analytic Psychotherapy Rating Scale: a Replication and Extension

Few theories of psychotherapy give direction to the therapist on a moment-to-moment level or make predictions about how specific therapist techniques change client behavior in session. Functional analytic psychotherapy (FAP, Kohlenberg and Tsai in Functional analytic psychotherapy: a guide for creating intense and curative therapeutic relationships. Plenum, New York 1991) provides this direction and prediction. Specifically, FAP claims that client problem behaviors will be displayed in the therapeutic relationship and that the therapist can improve client in-session behavior through differential, contingent responding. Further, it is assumed that these improvements in session can be generalized to out of session relationships. The FAP rating scale (FAPRS) was developed for the purpose of coding in-session client and therapist behaviors in an effort to test FAP’s purported mechanism of change. The current study seeks to replicate and extend initial FAPRS findings (Callaghan et al. in J Contemp Psychother 33:321–339, 2003) regarding mechanism of change and to address transportability. FAPRS coding data from a single successful case of an individual diagnosed with Borderline Personality Disorder and treated with FAP is presented. Results indicate that the FAPRS system is transportable and are generally supportive of the claim that therapist contingent responding leads to client improvement.     

Psychotherapy Integration: Contributions from Lifestyle Theory

The lifestyle theory of intervention is evaluated with respect to its status as an integrated psychotherapy using theoretical integration, technical eclecticism, and the common factors approach as criteria. Because lifestyle theory integrates concepts from evolutionary biology, existential philosophy, cognitive psychology, social learning theory, and various therapeutic models it satisfies preliminary criteria for theoretical integration. To the extent that it provides an internally consistent model and makes use of techniques from disparate schools of psychotherapy, it adopts a technical eclectic approach to intervention. The lifestyle model also appears to qualify as an integrated psychotherapy by virtue of its attention to several common factors in psychotherapy.     

Therapist Grief and Functional Analytic Psychotherapy: Strategic Self-Disclosure of Personal Loss

Functional Analytic Psychotherapy (FAP), a behavioral approach that focuses on the development of genuine and meaningful therapeutic relationships including the strategic use of disclosure, provides a framework for therapist self-disclosure during times of personal loss. This article briefly outlines FAP and provides an example of FAP in practice following the death of the first author’s mother. Qualitative data from a client questionnaire on the impact of this disclosure are presented, which suggest that the disclosure was a positive experience for most but not all clients. The article concludes with clinical guidelines that can enhance therapeutic effectiveness whether or not therapists choose to disclose loss to their clients and general precautions for treading in this emotionally intense territory.     

Functional Analytic Psychotherapy for Nursing Home Residents: A Single-Subject Investigation of Session-by-Session Changes

Nursing home settings contain unique environmental factors that may promote the acquisition and maintenance of problematic interpersonal behaviors. Functional Analytic Psychotherapy (FAP) is a contextually-based behavior therapy that can be used to modify problematic interpersonal behaviors via carefully provided and contingent in-session responses of the therapist to client behaviors. Thus, FAP would appear to be a particularly well-suited intervention approach for nursing home residents. To date, the effects of FAP have not been reported for nursing home residents. The current single case study assessed the effects of FAP on three nursing home residents using a single-subject AB design. The AB design consisted of a 2-weeks baseline phase followed by a 4-week FAP treatment phase. The nursing home residents completed pre-treatment and post-treatment measures of interpersonal relating. Client interpersonal behaviors were also recorded during each session and coded into two categories: Maladaptive in-session behaviors and adaptive in-session behaviors. Using the reliable change index and Swanson’s dsw to evaluate questionnaire outcomes, results indicated that all three participants reported a significant change in interpersonal functioning. Analysis of in-session behavior indicated that there were significant decreases in maladaptive behaviors and an increase in adaptive behaviors for two clients. Finally, observed in-session behavior changes were congruent with self-reported changes in interpersonal behavior. These results indicate that FAP was an effective intervention for these nursing home residents.     

Special Aspects of Countertransference in Analytic Group Psychotherapy

The structure of health care delivery is in a period of rapid change. An understanding of psychotherapy service use patterns indicates the importance of time categories as well as the relevance of group techniques. Traditional interpersonal and psychodynamic group techniques may be modified for time-limited use without sacrificing basic values and with demonstrated effectiveness. Adapting to a more fiscally stringent practice environment requires the clinician to undertake a difficult process of transition. As professionals our task is to prepare ourselves for this challenge and to let the health care system know that proper practice guidelines are necessary to achieve effective treatment for our patients.     

Enhancing Interpersonal Intimacy in Colombian Gay Men Using Functional Analytic Psychotherapy: An Experimental Nonconcurrent Multiple Baseline Design

A growing body of research suggests that rejection sensitivity, a form of interpersonal guardedness associated with familial rejection and societal bias, is a transdiagnostic risk factor for anxiety and mood disorders in gay men. From a behavioral perspective, rejection sensitivity is conceptualized as avoidance of intimacy as the result of systematic social punishment of vulnerable behaviors. Despite the implications of rejection sensitivity for psychological well-being, clinical psychology lacks specific behavioral interventions for emotional intimacy at the level of the individual. Functional Analytic Psychotherapy (FAP) is a therapeutic approach developed to enhance interpersonal behaviors that promote intimacy and closeness through identification of, and contingent responding to, clinically relevant behaviors.A nonconcurrent between-participants design examined the effectiveness of 4 to 8 sessions of FAP on reducing intimacy-avoiding behaviors and increasing intimacy-promoting behaviors in three Colombian gay men.FAP implementation yielded significant increases in intimacy promoting behaviors (β = 65.65, S.E. = 11.48, p = .0004) with a large effect size calculated by the between-case standardized mean difference (BC-SMD (17.01) = 1.66, CI [0.69–2.73]). The increase in intimacy-promoting behaviors occurred without evidence for reduction or elimination of intimacy-avoiding behaviors.Recommendations for future research include (1) the implementation of longitudinal intensive studies to capture participants' out-of-session behavioral changes and (2) further research to determine FAP’s effectiveness for increasing intimacy-promoting behaviors among other sexual or gender minority individuals.     

The Treatment of Histrionic and Narcissistic Personality Disorder Behaviors: A Single-Subject Demonstration of Clinical Improvement Using Functional Analytic Psychotherapy

This article presents single-subject data for the treatment of histrionic and narcissistic personality disorder behaviors using a relatively brief course of an interpersonal therapy, Functional Analytic Psychotherapy (Kohlenberg & Tsai, 1991). The treatment produced significant changes in these behaviors both statistically and qualitatively. Empirical methods for analyzing the changes across sessions and for determining that the therapist engaged in the proposed mechanism of clinical change are discussed. While these data are for one subject, the results of treatment provide both a method of treating difficult and long-standing client behaviors such as these, and for assessing the progress of therapy.     

Analytic Group Psychotherapy: A Uniquely Effective Crisis Intervention

This paper describes the author's experience doing crisis intervention with survivors of the 9/11 attack on the World Trade Center in New York City. It focuses on enhancing the understanding of and potentially expanding the theory and technique of analytic group therapy as applied to this unique situation.Private practice in     

Some Characteristics of Dreams in Group - Analytic Psychotherapy

Abstract

Group psychoanalytic theory rests on many of the same psychoanalytic assumptions as individual psychoanalytic theory but has been slow in developing its own language and unique understanding of conflict within the group, as many group phenomena are not the same as individual psychic events. Regressive fantasies and alliances within and to the group are determined by group composition and the interaction of fantasies among members and leader. Bion’s useful but incomplete early abstract formulation of psychic regression in groups was the initial attempt to move beyond Freud’s largely sociological view. This paper explores some of the origins of Bion’s neglect of murderous violence in groups as a result of his own experiences in the first European war. In the following, I present evidence for the existence of a violent basic assumption and offer evidence as to Bion’s avoidance of murderous and violent acts.     

Behavior Analytic Contributions to the Study of Creativity

As researchers continue to study creativity, a behavior analytic perspective may provide new vistas by offering an additional perspective. Contemporary behavior analysis began with B. F. Skinner and offers a selectionist approach to the scientific investigation of creativity. Behavior analysis contributes to the study of creativity by investigating the controlling variables for novel behavior that people often times designate as creative. Specific environment‐behavior relations producing novelty include imitation, instructions, variability, interconnection of repertoires and contingency adduction.     

Creating Connection and Reducing Distress: the Effects of Functional Analytic Psychotherapy on Measures of Social Connection across Levels of Analysis

The Psychological Record - Research on functional analytic psychotherapy's (FAP) proposed process of change has focused on the turn-by-turn coding of FAP. In these studies, FAP-consistent...     

Functional assessment: Contributions and future directions

Functional assessment is at once redefining the standards for clinical interventions and reemphasizing the importance of studying basic behavioral mechanisms. This commentary describes one perception of what we are learning from current research on functional assessment and suggests directions for the future.