Functional Analytic Psychotherapy

Description of the Strategy

Functional analytic psychotherapy (FAP) is a psychological treatment that draws on the therapist-client relationship to provide powerful in-therapy learning opportunities. This treatment is derived from B. F. Skinner's radical behaviorism, which accounts for our external actions, private feelings, and beliefs in terms of the types of past experiences that shape us. FAP produces change through the natural and curative contingencies of reinforcement that occur within a close, emotional, and involving therapist-client relationship.

Psychologists R. J. Kohlenberg and M. Tsai began to conceive of such a treatment after noticing that some of their clients treated with conventional cognitive and behavioral therapy techniques showed dramatic and pervasive improvements that far exceeded treatment goals. They noticed that these improvements occurred in those clients with whom they had particularly intense and involved client-therapist relationships. These intense relationships were not created intentionally, but seemed to emerge naturally over the course of therapy. As a result of these observations, Kohlenberg and Tsai used behavioral concepts first to develop a theory about the resulting dramatic improvement from intense therapist-client relationships, and then to identify the steps therapists can take to facilitate such relationships. The result was FAP, a treatment in which the client-therapist relationship is at the core of the change process.

In FAP, the therapist concentrates on the opportunities for therapeutic change that occur when the client's daily life problems are manifested within the therapeutic relationship. Although informed by behaviorism, FAP's emphasis on the therapist-client relationship also has some unexpected similarities to the Freudian concept of transference, defined as the client's reaction to the therapist, as if the therapist were someone important in the client's past. FAP can be used as a stand-alone treatment or, as illustrated later, can be used to enhance other approaches.

FAP underscores the importance of “therapist-client relationship learning opportunities,” that is, when problems in the client's daily life actually occur in interactions with the therapist. This concept, that the best way to learn is by doing (in vivo), is a well-accepted notion. For example, it is easier to learn to drive a car while actually driving with an instructor than via classroom instruction. Likewise, it is initially easier for a client to engage in appropriate forms of responding when the therapist is present to provide feedback than when they are between sessions, in a difficult situation, and trying to remember what their therapist has taught them. Experience has shown that these in-session improvements will almost always generalize to daily life.

Clinically Relevant Behaviors

The two main types of FAP learning opportunities are client problems that occur in the session and client improvements that occur in session. In vivo occurrences of the client's problems are “real” and are distinguished from the “role playing” or “behavioral rehearsal” that are sometimes used in behavior therapy. In FAP, in vivo occurrences of the client's problems are referred to as clinically relevant behaviors, type 1 (CRB1s).

On the other hand, clinically relevant behaviors, type 2 (CRB2s), are actual improvements that occur in session. Consider a male client, depressed because he feels he has no friends. He avoids eye contact during therapy, answers questions in an unfocused and tangential manner, and gets angry with the therapist for not having all the answers. All of these are possible CRB1s (problems). If the client subsequently increases his eye contact with the therapist and is more accepting of the therapist's limitations, these are CRB2s (improvements). In FAP, it is crucial that the therapist have an understanding of CRBs, is able to recognize them when they occur, and knows how to nurture the development of CRB2s.

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