The challenge of understanding process in clinical behavior analysis: The case of functional analytic psychotherapy

Abstract

Whether explicitly acknowledged or not, behavior-analytic principles are at the heart of most, if not all, empirically supported therapies. However, the change process in psychotherapy is only now being rigorously studied. Functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009) explicitly identifies behavioral-change principles used to bring about therapeutic improvements in adult outpatients whose clinical problems stem from ineffective interpersonal repertoires. These principles include contingent responding to behavioral excesses and deficits by a therapist who has established him- or herself as a salient source of social reinforcement. Empirical support for FAP is emerging, but a variety of pragmatic and theoretical questions warrant investigation. Among the issues described in this paper are the training and dissemination of procedures for how to conduct a functional analysis, how to train therapists to identify functional stimulus classes, how to best address decreasing problem behavior without creating an aversive environment, how to enhance generalization, and how to account for the principle of equifinality when trying to specify therapeutic procedures. These and other issues stem largely from trying to disseminate a behavioral principle-based intervention rather than a topographically specified intervention. These issues present challenges and research opportunities for applied clinical behavior analysts if they wish to extend their science to address clinical issues important to the treatment of adult outpatients with normal intellectual functioning.

The interfering effect of emotional stimulus functions on stimulus equivalence class formation: implications for the understanding and treatment of anxiety

“…Similarly, with regard to therapeutic strategies employed to target problem behaviors, Follette and Bonow (2009) acknowledged that "In spite of the success derived from applying behavior analysis to adult outpatient problems whenever it has been attempted, clinical behavior analysts have been relatively slow to examine the processes of change that occur during the psychotherapy itself and the mechanisms by which changes are produced" (p. 136). However, a few modern behavior therapies have recently emerged, including Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), and Functional Analytical Psychotherapy (FAP; Kohlenberg & Tsai, 1991), that endeavour to examine some of the processes involved in producing lasting behavior change in psychotherapy settings.…”

The role of functional assessment in third wave behavioral interventions: foundations and future directions for a fourth wave

“…Unfortunately, translating functional analysis to outpatient psychotherapy for complex behaviors is not easy and has not been widely adopted [5,6 ]. These barriers are related to the difficulty in both standardizing a functional analysis in an outpatient setting and identifying treatment targets that include functional classes (rather than specific topographies such as self-injury).…”

Verbally Conditioning Client Behaviors in the Therapeutic Setting

“…FAP assumes that because many of the client's problem behaviors are the result of interper-sonal difficulties, such behaviors will be revealed in his or her interaction with a therapist and that those behaviors, referred to as clinically relevant behaviors, can improve in the same setting as a function of that interaction. As Follette & Bonow (2009) put it, Because many problems that lead to distress and impaired role function are the result of interpersonal deficits, the therapy environment can be made to have features much like the natural environment . .…”