Academic journal article The Behavior Analyst Today

The Functional Analytic Psychotherapy Rating Scale (FAPRS): A Behavioral Psychotherapy Coding System

Academic journal article The Behavior Analyst Today

The Functional Analytic Psychotherapy Rating Scale (FAPRS): A Behavioral Psychotherapy Coding System

Article excerpt

Psychotherapy is a set of circumstances that can produce meaningful, lasting and positive behavior change. It is unclear, however, which aspects of many treatments actually cause change. Most therapies assume that the manipulation of certain critical variables in psychotherapy, called mechanisms of change, will reduce client problem behaviors and increase adaptive behaviors. Although mechanisms of change are assumed to operate in the day-to-day practice of psychotherapy, they are rarely studied empirically, and are often left either unspecified or defined in a way that makes detection and measurement of their operation difficult. The client-therapist relationship is one such potential mechanism of change in need of further specification and study.

Psychotherapy has been described as the "systematic use of a human relationship for therapeutic purposes" (Butler and Strupp, 1986, p. 36). Many other therapists and researchers also regard the therapeutic relationship as essential to the process of client change (Beck, Rush, Shaw, & Emery, 1979; Fiedler, 1950; Greenberg, 1994; Hentschel & Bijleveld, 1995; Horvath & Luborsky, 1993; Krasner, 1962, 1963; Lazarus, 1972; Morganstern, 1988; Rimm & Masters, 1974; Rogers, 1957; Rosenfarb, 1992; Schaap, Bennun, Schindler, & Hoodguin, 1993; Wright & Davis, 1994). There is an important gap, however, between assumptions about the importance of the therapeutic relationship and empirical documentation of the events that change client behavior.

To empirically establish a link between the therapeutic relationship and client behavior change, psychotherapy researchers must accomplish several tasks. First, a treatment must be identified and described. Second, the hypothesized mechanism of change for that treatment must be specified in a way that is clear and measurable. Third, the dimensions of behavior that are hypothesized to change following the manipulation of the mechanism must be defined. Fourth, a measurement system that allows reliable observation of behavior occurring within that treatment must be designed. Fifth, the validity of the hypothesized mechanism of change must be tested by empirically linking the manipulation of that mechanism to client improvement. This improvement should be documented within the therapeutic relationship, and ultimately it should be shown to generalize to other relationships the client has outside of therapy.

This article presents a method for accomplishing the goals described above for Functional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1991) an interpersonally oriented, behavioral psychotherapy. It defines FAP's mechanism of change (therapist contingent responding; discussed below) and the dimensions of client behavior that are impacted by the therapist's contingent responses in-session. It describes the development of and presents data on a reliable coding system for FAP (the Functional Analytic Psychotherapy Rating Scale; FAPRS; Callaghan, 1998). Finally, it presents initial data testing the validity of FAP's hypothesized mechanism of change.

The primary purpose of this study was to create and evaluate a coding system that could reliably demonstrate FAP's mechanism of change (and the client behaviors hypothesized to be impacted by it). In the next section, the important dimensions of the therapeutic relationship in FAP will be introduced and FAP's mechanism of change, therapist contingent responding, will be defined.

Functional Analytic Psychotherapy

Functional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1991; see also Kohlenberg, Hayes & Tsai, 1993) is used primarily to treat psychological disorders that are interpersonally based, such as those with pervasive repertoire deficits including generalized anxiety disorder, dysthymia, social phobia, and the Axis-II personality disorders (American Psychiatric Association, 1994). …

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