Intimacy Is a Transdiagnostic Problem for Cognitive Behavior Therapy: Functional Analytical Psychotherapy Is a Solution

Article excerpt

The purpose of this paper is to highlight some current trends in transdiagnostic approaches to cognitive behavioral therapy (CBT) and how these trends relate to the constructs of intimacy and interpersonal functioning. We will define aspects of intimacy, introduce how Functional Analytic Psychotherapy may aid in developing effective intimacy and interpersonal functioning, and underscore the importance of intimacy across a range of disorders and clinical presentations. We aim to make the case that explicitly addressing intimacy and interpersonal functioning is essential for the holistic long-term well-being of those suffering from psychiatric disorders, and for CBT practitioners, using a behaviorally based treatment such as FAP will enhance these efforts.

The term interpersonal functioning comprises a wide range of topics, such as social skills, social cognition, intimacy, and connectedness. Intimacy is a core part of interpersonal functioning as, broadly speaking, it is the quality of close connection between individuals and the ongoing process of promoting and maintaining this quality. Researchers have conceptualized in a number of different ways. Jamieson (2011) viewed intimacy as something experienced emotionally, cognitively, and behaviorally, and may include sharing feelings of mutual love, sharing a similar worldview and sharing common life experiences. Others have considered intimacy a form of social cognition (i.e., intrapersonal processes such as encoding, storing, and retrieving information about one's own species) that is essentially interpersonal (Sharp, Fonagy, & Goodyer, 2008). Still others have defined intimacy a process of increasing reciprocity of self-disclosure in which individuals experiences their innermost self-validated, understood, and cared for by the other (Reis & Shaver, 1988).

Given the behavioral context of this paper, we chose a definition of intimacy by Cordova and Scott (2001) to use throughout this paper, that lends itself to behavioral analytic theory. In this view intimacy develops from a historical collection of events "in which behavior vulnerable to interpersonal punishment is reinforced by the response of another person" (p. 75). These events consist of a number of types of overt and covert behaviors including: sharing private thoughts and feelings or self-disclosure consisting of either unpleasant feelings (e.g., sadness, embarrassments, failures, etc.) or more "positive" sentiments (e.g., love, attraction, closeness, gratitude, hope, etc.); sharing memories and secrets; physical closeness (e.g., sex, hugging, acts of physical comfort, etc.); and subjective states (e.g., warmth, closeness, and loving). Thus by this definition, intimate behavior incurs risk that may leave one vulnerable to aversive experiences of shame, humiliation, embarrassment, or rejection. The willingness to engage in the process of intimacy as defined by Cordova and Scott promotes accessibility to gains in experiences of feeling validated, understood, and cared for (Reiss & Patrick, 1996).

Although there are therapeutic approaches that target increasing intimate behaviors through individual or couples modalities (e.g., Emotion-Focused Therapy; Greenberg & Watson, 2004; Johnson, 2004), few have roots in the cognitive-behavioral tradition. Integrative behavioral couple therapy is one exception (Christensen, Jacobson, & Babcock, 1995); however it is designed to be of use in couples therapy, leaving somewhat of a void in CBT for working on intimacy in individual therapy. Functional Analytic Psychotherapy (FAP; Tsai, Kohlenberg, Kanter, Kohlenberg, Follette, & Callaghan, 2009) may help address this void, as it is a behaviorally based therapy that works with in-session behavioral change to promote functional interpersonal skills and intimacy outside of the session.

FUNCTIONAL ANALYTIC PSYCHOTHERAPY

FAP is deeply rooted in behavioral principles and will be briefly summarized in the following paragraphs. …