Functional Assessment of Skills for Interpersonal Therapists:: The FASIT System: For the Assessment of Therapist Behavior for Interpersonally-Based Interventions Including Functional Analytic Psychotherapy or FAP-Enhanced Treatments
Callaghan, Glenn M., The Behavior Analyst Today
Several contemporary behavior therapies exist that espouse the importance of the therapeutic relationship including Functional Analytic Psychotherapy (FAP), Dialectical Behavior Therapy (DBT), and Acceptance Commitment Therapy (ACT). Each of these therapies has described the importance of focusing on the process of what occurs in session between the client and therapist in an effort to change client behavior. This interpersonal aspect is shared not only by behavior therapies but by numerous other paradigmatically driven interventions. Functional Analytic Psychotherapy posits that the mechanism of clinical change is therapist contingent responding to client problem and improved behaviors in-session. This suggests that the therapists conducting these types of interpersonally-oriented psychotherapies possess a corresponding set of interpersonal skills to be effective. The Functional Assessment of Skills for Interpersonal Therapists (FASIT) manual presents an approach to assessment and classification of behavioral repertoire problems that can prevent effective delivery of interpersonally-oriented psychotherapies such as FAP. The manual begins with a discussion of its purpose, the selection of target therapist behaviors for improvement, therapist self-assessment questions, questions used by the supervisor to assess the therapist, and a discussion of idiographically based tracking devices that can be developed using the FASIT system. The bulk of the FASIT manual presents definitions and examples of particular therapist problems in five domains or classes of interpersonal functioning. These classes include: Assertion of needs; bi-directional communication (providing and receiving feedback); problems with conflict resolution; disclosure skills related to developing interpersonally close relationships; and difficulties with the experience and expression of emotions. There is a repeated emphasis throughout the manual on the purpose of identifying and targeting therapist skills for change. It is highlighted for the reader that therapist skills which directly impact his or her ability to conduct interpersonally-oriented psychotherapies can be reasonable behaviors targeted for change by a supervisor. The FASIT manual provides a basic behavioral approach to assessing these therapist responses in order to assist with the identification, documentation, and amelioration of such problems in the context of supervision and training. Developing more effective interpersonally-oriented psychotherapy therapy skills should continue to be driven by its direct impact on alleviating client distress with these clinical interventions.
Key Words: Functional Analysis, Analytic, Psychotherapy, Assessment, Therapist, Skills, Interpersonal, Behavior, Interpersonal, Therapy
This system is used to assist therapists in learning interpersonally-based behavioral and cognitive behavioral interventions including Functional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1991) or FAP-enhanced treatments such as FAP Enhanced Cognitive Therapy (FECT; Kohlenberg, Kanter, Bolling, Parker, & Tsai, 2002) and FACT (Callaghan, Gregg, Marx, Kohlenberg, & Gifford, 2004). The Functional Assessment of Skills for Interpersonal Therapists (FASIT; pronounced "facet") system is designed to target therapist problem and improved behaviors relevant to effectively conducting FAP. This manual is designed to be used with the Functional Idiographic Assessment Template (FIAT) system (Callaghan, in press). The FIAT manual specifies the classes of behaviors used with the Client Forms (FIAT-C pre and FIAT-C post) and Therapist Forms (FIAT-T pre and FIAT-T post) of the assessment template. The FIAT system is more expansive than this counterpart focusing on therapist skills. However, there are both parallels and important differences between the two systems. There are many similar impersonal skills deficits that can appear with clients and with therapists alike. However, there will be some important differences, particularly with how these behaviors may occur, that make the FASIT system unique.
There are several essential skills for therapists to be able to be effective in FAP and other interpersonally-based psychotherapies. These skills include discriminating the impact of both client behaviors on them and their impact on the client. Responding effectively to clients remains imperative, including making requests for different client behaviors and disclosing the impact the client has on the therapist in the moment. Another fundamental skill required by therapists conducting FAP and other contemporary behavior therapies (including Acceptance Commitment Therapy; Hayes, Strosahl, & Wilson, 1999) is the therapist's ability to identify, experience, and then respond to his or her own emotional experience. Therapists in training may show difficulties in any of these areas; all of these skills are addressed in the FASIT manual.
The FASIT manual specifies classes of therapist problem behaviors seen in interpersonally focused interventions. These descriptions are based on the function of behaviors as they affect the therapist's ability to conduct FAP and other interpersonal interventions. Some of these behaviors are experiential or intrapersonally focused; however, the impact of those behaviors ultimately resides in an interpersonal context.
The purpose of this manual is to create highly individualized or idiographic assessment materials for each individual therapist in an effort to help the therapist improve in his or her ability to conduct an intervention. Examples of these assessments are included in the appendix of this manual. For a more thorough description of the types of assessments that can be created and examples of assessments of client assessment, the reader is referred to the FIAT manual. There is no one right way to create these idiographic assessment devices; they should each be tailored the needs of the therapist, the supervisor, and even the particular on-going intervention with a client.
As with any nomenclature, the language used here is specific not only to the paradigm employed but also the author. The main idea for the FASIT system was to create a common language for frequently observed therapist behaviors that impede their ability to conduct an interpersonally-based behavioral intervention. This vernacular is intended to aid communication, assessment, and research in the community. With a new system employing a new vocabulary, it will take therapists and supervisors time and effort to become familiar and facile with the terms used here. As with systems of diagnosing or assessment, the more practice with the FASIT and its terminology, the greater its utility for the user.
The use of the manual assumes that therapists have a working knowledge of the principles of FAP and have an understanding of the administration of assessment devices in accordance with the ethical principles of test administration, or are receiving training in one or both of these areas.
Understanding of Response Classes. Users are also expected to have an understanding of behavior analysis, particularly of functional response classes of behavior. Briefly, a response class is a group of operant behaviors that have a particular effect regardless of the form the response might take (i.e., its topographical features). The distinction of form or topography versus function requires therapists and supervisors differentiate the effect or impact that the therapist's behavior is having rather than merely watching what the therapist is doing in one moment. For example, a therapist may make a humorous remark to a client. This will only be understood as effective or ineffective depending on the impact of that statement has on the client. The humorous remark may serve to make the client feel more at ease and more willing to disclose or the client could also feel distanced by this comment or even disrespected. Of course this will depend some on the content of the humorous remark, but it will ultimately depend on what function the remark has on the client in that situation. (It should be noted that simply because the therapist makes one bad joke, this does not mean the therapist has important problems; this will be determined by a much broader sample of behavior.
Functional classes are understood idiographically and are based on the analysis of each particular therapist's problem and effective behaviors. For example, a therapist may be silent, overly familiar, especially formal, and so on. If each of these behaviors functions to allow the therapist to avoid talking about the emotional experience he or she is having in response to the client or in supervision, even though the behaviors have different topographies, they could all be instances of the same response class. It is the supervisor's and therapist's task to recognize the function of a response rather than identifying a behavior based merely on its topography.
Response classes in this manual are grouped into five main categories. Each of the classes is defined by a basic function served by the behaviors in the class. The classes described below are non-orthogonal. Each of the classes may overlap with other behavioral problems or deficits that the therapist exhibits. If the therapist shows problems in one class, it should not be assumed that the therapist does not show problems in another class. The choice of determining which class the behavior is a member of (e.g., problems with assertion of needs versus difficulties with conflict) is given to the supervisor in coordination with the therapist. The FASIT is designed primarily for clinical utility with respect to supervision and training goals. If the assessment serves the therapist and the supervisor to categorize the behavior one way over another, they would be encouraged to make that choice. The choice of classification of responses is made in as much as it serves the assessment and training of the therapist's skills in the service of the intervention for their clients.
Criteria for Inclusion of Class as Problem Behavior
It is essential that the user understand that these classes define different repertoires that may be a source of attention in the process of supervision and training therapists. It would be expected that most individuals express some instances of each of the classes during their lives. Engaging in many of these behaviors periodically as determined by contextual variables would be very effective (e.g., escape behaviors, acquiescing to others' needs, etc.). To be assessed as a problem area, behaviors in each class need to problematic for that therapist. The therapist with problem behaviors engages in these strategies inflexibly or with such salience that the behaviors interfere with their ability to effectively conduct the intervention. Problem behaviors are defined as ineffective or effective relative to the goals of training in FAP or other interpersonally based interventions through the shaping of a repertoire with social contingencies (Follette, Naugle, & Callaghan, 1996).
In some ways, this presents complications. There is a difficult process of discriminating therapist behaviors that are under the purview of supervision and those that are better addressed in the supervisees own psychotherapy. This manual cannot possibly provide a definitive solution to this challenge, but the following rough guideline is offered. Therapist behaviors that impact the supervisee's ability to conduct the psychotherapy or intervention effectively and are clearly seen to impact their skills development in this domain are reasonable targets for supervision and the use of the FASIT system. Therapist behaviors that are viewed by the supervisor or supervision team as less effective in the therapist's broader functioning but that do not directly impact their ability to effectively conduct the intervention are not necessarily appropriate targets for identification using the FASIT or intervention in supervision. Situations will not typically be so clean cut, and there will of course be overlap between these two areas. The essential issue here is to remind therapists and supervisors that the therapist behaviors that are viewed as requiring amelioration should be those that are clearly tied to the skills being developed for that intervention. It would be important to continue to refer to a conceptualization of the therapist's skills using the FASIT to remind supervisor and therapist which behaviors are being address and the reason.
Organization of the Manual
Each of the classes described below begins with a definition of the class and then explicates each of the instances in the class that may be a focus on attention in supervision and clinical situations. These class and instance descriptors are then followed by specific assessment questions to be asked by the therapist and then by the supervisor. The Manual is organized for each class so that problems with Contextual Cues/Discriminative Stimulus Functions precede the Response Repertoire problem areas.
Contextual Cues/Discriminative Stimulus Functions include Problems with Identification or Specification that are defined as difficulties with identifying, labeling (tacting; Skinner, 1957) or specifying elements of the defined class. It is essential to determine whether or not the therapist has the skills to identify the features required of the targeted class before assessing the therapist's response repertoire. For example, if a therapist demonstrates a lack of ability to respond to feedback given by others, the supervisor or therapist must assess whether the therapist has the skills to discriminate that feedback has been given and the therapist has determined whether this feedback is accurate or inaccurate. If there are deficits in this area, and the supervisor or therapist attempts to alter the Response Repertoire of Lack of response to feedback, it is likely the therapist will still be unable to respond effectively in novel situations.
Problems with Appropriate Contextual Control define other contextual cue problems therapists may have. These behaviors are characterized by a lack of discrimination of situations, times, or other persons with whom to engage in the response. For example, for therapists with Problems with Emotional Experience and Expression, the therapist may be unable to specify the conditions under which emotional expression would be more effective. These conditions include with whom to engage in the response, the time or other setting factors to consider, and the situation where this would be more effective to do.
The Response Repertoire section includes instances of the expression of each response the therapist may engage in for the targeted class. This section includes escape, avoidance, excess, and deficits of behaviors relevant to the class.
A Note on Function, Form, and the FASIT
As described with the FIAT system, the FASIT manual attempts to describe behaviors in terms of function, but it does not provide a precise functional analysis as defined by a detailed specification of stimulus, response, and consequences. The FASIT attempts to detail and give a consistent language to those behaviors that have the general function for the therapist of impeding their ability to effectively conduct FAP or other interpersonally-oriented therapeutic intervention.
The ultimate goal of using the fast should remembered, to aid with the assessment and intervention of therapist problem behaviors and the development of more effective skills with respect to conducting their interventions with clients.
It will be important that supervisors, peer supervisors, and therapists view either live sessions or video tapes of sessions to assess for the problems detailed in this manual. While not required, it may be helpful for therapists to code sessions for client and therapist behaviors using the Functional Analytic Psychotherapy Rating Scale (FAPRS; Callaghan, 1999)
Identifying problem behaviors can occur by watching a live therapy session, viewing video taped sessions, or observing therapist behavior in group on individual supervision. Therapist problem behavior may be observed both while the therapist interacts with a client or during a supervisory interaction. Again, the purpose of using the FASIT to identify therapist responding that is ineffective is to assist in the training of the supervisee to become more effective conducting the intervention. Larger life goals and values not impact the therapist's ability to perform the psychotherapy but that the supervisor has for the therapist are not targeted using the FASIT system.
Each Assessment Questions section begins with a note to help define the class for the therapist and supervisor. Both should be familiar with these specific notes and should be able to convey what the questions are asking. The supervisor cannot assume that the therapist has the same definition for the key terms being assessed (e.g., "asking for something" or "feedback"). The therapist definitions should be sufficiently …
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Publication information: Article title: Functional Assessment of Skills for Interpersonal Therapists:: The FASIT System: For the Assessment of Therapist Behavior for Interpersonally-Based Interventions Including Functional Analytic Psychotherapy or FAP-Enhanced Treatments. Contributors: Callaghan, Glenn M. - Author. Journal title: The Behavior Analyst Today. Volume: 7. Issue: 3 Publication date: Summer 2006. Page number: 399+. © 2007 Behavior Analyst Online. COPYRIGHT 2006 Gale Group.
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