Functional analytic psychotherapy

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Functional analytic psychotherapy (FAP) is a psychotherapeutic approach based on clinical behavior analysis (CBA) that focuses on the therapeutic relationship as a means to maximize client change. Specifically, FAP suggests that in-session contingent responding to client target behaviors leads to significant therapeutic improvements.

Contents

FAP was first conceptualized in the 1980s by psychologists Robert Kohlenberg and Mavis Tsai who, after noticing a clinically significant association between client outcomes and the quality of the therapeutic relationship, set out to develop a theoretical and psychodynamic model of behavioral psychotherapy based on these concepts. Behavioral principles (e.g., reinforcement, generalization) form the basis of FAP. [1] [2] (See § The five rules below.)

FAP is an idiographic (as opposed to nomothetic) approach to psychotherapy. This means that FAP therapists focus on the function of a client's behavior instead of the form. The aim is to change a broad class of behaviors that might look different on the surface but all serve the same function. It is idiographic in that the client and therapist work together to form a unique clinical formulation of the client's therapeutic goals, rather than one therapeutic target for every client who enters therapy.

Basics

FAP posits that client behaviors that occur in their out-of-session interpersonal relationships (i.e. in the "real world") will, if clients are given a therapeutic relationship of sufficiently high quality, occur in the therapy session as well. Based on these in-session behaviors, FAP therapists, in collaboration with their client, develop a case formulation that includes classes of behaviors (based on their function not their form) that the client wishes to increase and decrease. [2]

In-session occurrence of a client's problematic behavior is called clinically relevant behavior 1 (CRB1). In-session occurrence of improvements is called clinically relevant behavior 2 (CRB2). The goal of FAP therapy is to decrease the frequency of CRB1s and increase the frequency of CRB2s.

The FAP therapist evokes (i.e. sets the context for) CRB1s and in response gradually shapes CRB2s.

The five rules

"The five rules" operationalize the FAP therapist's behavior with respect to this goal. It is important to note that the five rules are not rules in the traditional sense of the word, but instead a set of guidelines for the FAP therapist. [3]

The ACL model

Researchers at the Center for the Science of Social Connection at the University of Washington are developing a model of social connection that they believe is relevant to FAP. This model – called the ACL model – delineates behaviors relevant to social connection based on decades of scientific research. [4]

FAP has the potential to target awareness, courage, and love behaviors as they occur in session as described by the five rules above. More research is needed to confirm the utility of the ACL model. [5] [6]

Research support

Radical behaviorism and the field of clinical behavior analysis have strong scientific support. [7] [8] Additionally, researchers have conducted a number of case studies, [9] [10] [11] [12] [13] [14] [15] [16] [17] component process analyses, [13] [18] [19] [20] a study with non-randomized design on FAP-enhanced cognitive therapy for depression, [21] and a randomized controlled trial on FAP-enhanced acceptance and commitment therapy for smoking cessation. [22]

Third generation behavior therapy

FAP belongs to a group of therapies referred to as third-generation behavior therapies (or third-wave behavior therapies) that includes dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), behavioral activation (BA), and integrative behavioral couples therapy (IBCT). [23]

Criticism

FAP has been criticized for "being ahead of the data", i.e. having not enough empirical support to justify its widespread use. [24] Challenges encountered by FAP researchers are widely discussed [25] [26] There is also criticism of using the ACL model as it detracts from the idiographic nature of FAP. [27]

Professional organizations

Related Research Articles

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References

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