Gareth I. Holman

Preliminary data from a randomized pilot study of web-based functional analytic psychotherapy therapist training.

Therapists of many persuasions emphasize the therapy relationship in their work, a priority backed by strong empirical evidence. Training in how to maximize the power and potential of the therapy relationship, however, has lagged behind. A novel approach to using the therapy relationship and to training therapists in its use is provided by Functional Analytic Psychotherapy (FAP). FAP training involves eight 2-hr weekly training sessions conducted online using web-conferencing technology. The training integrates behavioral principles with a focus on trainee-trainer and trainee-trainee relationships in a highly structured course that evokes the desirable FAP therapist-trainee behaviors and collectively shapes the behaviors through reinforcement by the trainer and other trainees. In a preliminary study, 16 therapist-trainees were randomly assigned to receive either immediate FAP training or training after a waitlist period. Significant and large effects of training were found on both self-reported and observer-assessed measures for the first training group, and the waitlist training group replicated the first training group with significant within-subject change over the course of training. Finally, qualitative feedback from therapists indicated high satisfaction with the primary elements of the training protocol. Several important limitations to this preliminary study are discussed.

Lines of Evidence in Support of FAP

What empirical evidence supports FAP? On the one hand, FAP is based on a handful of basic behavioral principles that were theoretically and empirically derived from decades of laboratory experimentation. On the other, FAP has yet to be tested in a randomized controlled trial. Our belief is that the basic tenets of FAP—namely the importance of the therapeutic relationship and the use of natural reinforcement to shape client problems when they occur naturally in the therapeutic relationship—are robust, and lines of evidence in support of these principles converge from multiple and diverse areas of research. In this chapter we review these lines of evidence. It should be clear from the outset, however, that this review by no means seeks to justify the paucity of direct empirical evidence in support of FAP. Rather, we believe that the findings of this review strongly suggest that additional empirical research specifically investigating the efficacy of FAP is warranted, as it was developed from a solid foundation of principles and evidence and represents a convergence of some of the most robust findings in psychological research. While FAP is a therapy based on behavior analytic principles, at its heart it is an interpersonal therapy. FAP is based on the assumption that both the causes of, and treatment for, psychopathology are intimately related to interpersonal relationships. This assumption has substantial support in the literature with respect to depressive disorders. It is well established that interpersonal problems, troubled relationships, and lack of social support predict the onset (Stice, Ragan, & Randall, 2004), course (Lara, Leader, & Klein, 1997; Miller et al., 1992), duration (Brown & Moran, 1994) and relapse of depression (Hooley & Teasdale, 1989). Conversely, the presence of social support has protective effects (Peirce, Frone, Russell, Cooper, M Sherboume, Hays, & Wells, 1995). While several alternative therapies focus on the therapeutic relationship and associated processes, FAP utilizes basic learning principles to harness the therapist-client relationship, focusing on the establishment of a more effective

FAP and dialectical behavior therapy (DBT) dialectical behavior therapy (DBT)

This chapter explores the intersections of Functional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009 ) and Dialectical Behavior Therapy (DBT; Linehan, 1993a, 1993b ) with a focus on how training and experience with each model can enhance work with the other.