What is Parallel Process?

Introduction

Parallel process is a phenomenon noted between therapist and supervisor, whereby the therapist recreates, or parallels, the client’s problems by way of relating to the supervisor.

The individual’s transference and the therapist’s countertransference thus re-appear in the mirror of the therapist/supervisor relationship.

Background

Attention to parallel process first emerged in the nineteen-fifties (1950s). The process was termed reflection by Harold Searles in 1955, and two years later T. Hora (1957) first used the actual term parallel process – emphasising that it was rooted in an unconscious identification with the client/patient which could extend to tone of voice and behaviour. The supervisee thus enacts the central problem of the therapy in the supervision, potentially opening up a process of containment and solution, first by the supervisor and then by the therapist.

Alternatively, the supervisor’s own countertransference may be activated in the parallel process, to be reflected in turn between supervisor and consultant, or back into the original patient/helper dyad. Even then, however, careful examination of the material may still illuminate the original therapeutic difficulty, as reflected in the parallel situation.

What is a Mental Health Care Navigator?

Introduction

A mental health care navigator is an individual who assists patients and families to find appropriate mental health caregivers, facilities and services. Individuals who are care navigators are often also trained therapists and doctors.

Overview

The need for mental health care navigators arises from the fragmentation of the mental health industry, which can often leave patients with more questions than answers. Care navigators work closely with patients and families through discussion and collaboration to provide information on best options and referrals to healthcare professionals, facilities, and organisations specialising in the patients’ needs. The difference between other mental health professionals and a care navigator is that a care navigator provides information and directs a patient to the best help rather than offering treatment. Still, care navigators may provide diagnosis and treatment planning.

Mental health care navigation is also sometimes provided by self-help books. Lloyd I. Sederer, M.D.’s The Family Guide to Mental Healthcare (W.W. Norton & Company, 2013) is a resource for patients and families searching for guidance in the mental health industry. Publishers Weekly called it a “thoughtful, compassionate, and fact-packed guide for recognizing illness and getting help.” It provides information to patients and families about recognising symptoms of mental illness, how to get diagnosis and how to choose the right therapists and treatments.

Terminology

Many mental health organisations use “navigator” and “navigation” to describe the service of providing guidance through the health care industry. Care navigators are also sometimes referred to as “system navigators.” One type of care navigator is an “educational consultant.”

Models

Models for mental health care navigation can involve many scenarios from a brief consultation to an extended process with follow-up. They offer referrals, assistance with insurance and other financial matters and general support. A highly detailed method of care navigation with long-term follow up was developed in 2011 by San Francisco-based psychiatrist and mental health expert Eli Merritt, M.D. His model involves what he calls the “3 R’s” of mental health care: “Research, Resources, and Referrals.”

It involves four steps:

Assessment & Needs IdentificationIn this preliminary, exploratory phase, care navigators meet with the individual or family seeking help. Patient history and needs are identified. Both the patient and the care navigator think through short- and long-term goals and levels of treatment sought.
Dialogue & Plan FormationThrough discussion and collaboration, both the patient and care navigator brainstorm next steps, establishing a plan that is specific to the patient’s needs.
Care CoordinationAfter information gathering and brainstorming, doctors, therapists, and other mental health options are provided to the patient. Questions of affordability arise, and patients are advised toward the best solutions for their conditions and circumstances.
ContinuityAfter guiding patients to healthcare providers, care navigators maintain communication and continuity with patients, offering assistance with any future obstacles that might arise.

What is Acting In?

Introduction

“Acting in” is a psychological term which has been given various meanings over the years, but which is most generally used in opposition to acting out to cover conflicts which are brought to life inside therapy, as opposed to outside.

One commentator, noting the variety of usages, points out that it is often “unclear whether ‘in’ refers to the internalisation into the personality, to the growth in insight, or to the acting within the session”.

Patients

With respect to patients, the term ‘acting in’ has been used to refer to the process of a client/patient bringing an issue from outside the therapy into the analytic situation, and acting upon it there.

The therapist is advised to respond to the issue immediately to prevent further and more disruptive acting in.

Hanna Segal distinguished positive acting in from destructive acting in – both being aimed however at affecting the analyst’s state of mind, whether to communicate or to confuse.

Posture

The term was used in 1957 by Meyer A. Zeligs to refer specifically to the postures taken by analysts in a psychoanalytic session.

Therapists

Psychoanalysis also describes as ‘acting in’ the process whereby the analyst brings his or her personal countertransference into the analytic situation – as opposed to the converse, the acting out of the patient’s transference.

The result is generally agreed to produce a chaotic analytic situation which hampers therapeutic progress.

The term was used rather differently however by Carl Whitaker in the 60’s, so as to refer to the technique whereby therapists increase their involvement in a session in such a way as to ramp up the patient’s anxiety for therapeutic ends.

What is Body-Centred Countertransference?

Introduction

Body-centred countertransference involves a psychotherapist‘s experiencing the physical state of the patient in a clinical context.

Also known as somatic countertransference, it can incorporate the therapist’s gut feelings, as well as changes to breathing, to heart rate and to tension in muscles.

Refer to Countertransference.

Various Approaches

Dance therapy has understandably given much weight to the concept of somatic countertransference. Jungian James Hillman also emphasised the importance of the therapist using the body as a sounding-board in the clinical context.

Post-Reichian therapies like bioenergetic analysis have also stressed the role of the body-centred countertransference.

There is some evidence that narcissistic patients and those suffering from borderline personality disorder create more intense embodied countertransferences in their therapists, their personalities favouring such non-verbal communication by impact over more verbalised, less somatic interactions.

Orbach

Susie Orbach has written emotively of what she described as “wildcat sensations in my own body…a wildcat countertransference” in the context of body countertransference. She details her role responsiveness to one patient who evoked in her what she called “an unfamiliar body experience…this purring, reliable and solid body” to counterbalance the fragmented body image of the patient herself.

The Irish Experience

In Female Trauma Therapists

Irish psychologists at NUI Galway and University College Dublin have recently begun to measure body-centred countertransference in female trauma therapists using their recently developed ‘Egan and Carr Body-Centred Countertransference Scale’ (2005), a sixteen symptom measure.

Their research was influenced by developments in the psychotherapy world which was beginning to see a therapist’s role in a therapeutic dyad as reflexive; that a therapist uses their bodies and ‘self’ as a tuning fork to understand their client’s internal experience and to use this attunement as another way of being empathic with a client’s internal world. Pearlman and Saakvitne’s seminal book on vicarious traumatisation and the effect of trauma work on therapists has also been an important directional model for all researchers studying the physical effects of trauma work on a therapist.

High levels of body-centred countertransference have since been found in both Irish female trauma therapists and clinical psychologists.[16] This phenomenon is also known as ‘somatic countertransference’ or ’embodied countertransference’ and it links to how mirror neurons might lead to ‘unconscious automatic somatic countertransference’ as a result of postural mirroring by the therapist. Hamilton et al (2020) revisited BCT in a larger sample of 175 therapists (122 females) and that the a similar pattern of body-centred countertransference was reported as in the previous two studies. The most common being:

  • Muscle Tension: 81%;
  • Tearfulness: 78%;
  • Sleepiness: 72%;
  • Yawning: 69%;
  • Throat constriction: 46%;
  • Headache: 43%;
  • Stomach disturbance: 43%;
  • Unexpectedly shifting in body: 29%;
  • Sexual arousal: 29%;
  • Raised voice: 28%;
  • Aches in joints: 26%;
  • Nausea: 24%;
  • Dizziness: 20%; and
  • Genital pain: 7.5%.

The authors reported how previous researchers did not find BCT because surveys have previously failed to ask specifically about it, and have focused on emotional and cognitive and relational CT. The authors finally called for larger longitudinal studies and also larger sample sizes to allow a comparison of gender and orientation effects as well as whether higher levels affect levels of burnout and therapeutic engagement and treatment outcomes 26. Hamilton, L., Hannigan, B., Egan, J., Trimble, T., Donaghey, C., & Osborn, K. (2020). An exploration of body-centred countertransference in Irish Therapists. Clinical Psychology Today, 4(2), 26-38.

Loughran (2002) found that 38 therapists out of 40 who had responded to a questionnaire (which was distributed to a sample of 124 therapists) on a therapist’s use of body as a medium for transference and countertransference communication reported that they had experienced bodily sensations (nausea or churning stomach, sleepiness, shakiness, heart palpitations, sexual excitement, etc.) while in session with patients.

Frequency of Symptom Occurrence

A list of the frequency of occurrence of body-centred countertransference symptoms reported by trauma therapists (Sample A: 35 Female Irish Trauma therapists[20]) and Irish clinical psychologists (Sample B: 87 Irish Clinical Psychologists[21]) in the previous six months ‘when in-session with a client’ is given below in order of frequency:

  • Sleepiness (A; 92%, B; 76%).
  • Muscle Tension (A; 83%, B; 79%).
  • Yawning (A; 65%, B; 77%).
  • Unexpected shift in body (A; 77%, B; 57%).
  • Tearfulness (A; 71%, B; 61%).
  • Headache (A; 54%, B; 53%).
  • Stomach Disturbance (A; 41%, B; 46%).
  • Throat Constriction (A; 34%, B; 36%).
  • Raised Voice (A; 29%, B; 33%).
  • Dizziness (A; 26%, B; 19%).
  • Loss of voice (A; 32%, B; 18%).
  • Aches in joints (A; 37%, B; 18%).
  • Nausea (A; 23%, B; 18%).
  • Numbness (A; 29%, B; 15%).
  • Sexual Arousal (A; 26%, B; 11%).
  • Genital pain (A; 6%, B; 2%).

Somatisation

A small but significant relationship was found between female trauma therapists’ level of body-centred countertransference and number of sick leave days taken, suggesting a possible relationship between uncensored body-centred countertransference and somatization. This relationship was not however found in clinical psychologists who were working mainly with a non-trauma population. Therapists have noted the connection between a tendency for some clients to express emotional discomfort by focusing on bodily symptoms rather than being able to put their emotional distress into words. It is thought that such processes are more common in people who have experienced childhood abuse and trauma.

Recent research which measured female genital arousal in response to rape cues found that women when listening to rape, consent or violence developed genital arousal more frequently than men. It also might explain the relatively frequent reported experience of sexual arousal amongst Irish female trauma therapists. Further validation of body-centred countertransference in psychologists and therapists is on-going in both NUI Galway and Trinity College Dublin.

Cautions

Therapists have been warned against assuming too automatically that their body-feelings always involve somatic resonance to the client, as opposed to being produced from their own feelings/experiences – the same problem appearing with countertransference generally.

What is Countertransference?

Introduction

Countertransference is defined as redirection of a psychotherapist‘s feelings toward a client – or, more generally, as a therapist’s emotional entanglement with a client.

Refer to Body-Centred Countertransference.

Early Formulations

The phenomenon of countertransference (German: Gegenübertragung) was first defined publicly by Sigmund Freud in 1910 (The Future Prospects of Psycho-Analytic Therapy) as being “a result of the patient’s influence on [the physician’s] unconscious feelings”; although Freud had been aware of it privately for some time, writing to Carl Jung for example in 1909 of the need “to dominate ‘counter-transference’, which is after all a permanent problem for us”. Freud stated that since an analyst is a human himself he can easily let his emotions into the client. Because Freud saw the countertransference as a purely personal problem for the analyst, he rarely referred to it publicly, and did so almost invariably in terms of a “warning against any countertransference lying in wait” for the analyst, who “must recognize this countertransference in himself and master it”. However, analysis of Freud’s letters shows that he was intrigued by countertransference and did not see it as purely a problem.

The potential danger of the analyst’s countertransference – “In such cases, the patient represents for the analyst an object of the past on to whom past feelings and wishes are projected” – became widely accepted in psychodynamic circles, both within and without the psychoanalytic mainstream. Thus, for example, Jung warned against “cases of counter-transference when the analyst really cannot let go of the patient…both fall into the same dark hole of unconsciousness”. Similarly Eric Berne stressed that “Countertransference means that not only does the analyst play a role in the patient’s script, but she plays a part in his…the result is the ‘chaotic situation’ which analysts speak of”. Lacan acknowledged of the analyst’s “countertransference…if he is re-animated the game will proceed without anyone knowing who is leading”.

In this sense, the term includes unconscious reactions to a patient that are determined by the psychoanalyst’s own life history and unconscious content; it was later expanded to include unconscious hostile and/or erotic feelings toward a patient that interfere with objectivity and limit the therapist’s effectiveness. For example, a therapist might have a strong desire for a client to get good grades in university because the client reminds her of her children at that stage in life, and the anxieties that the therapist experienced during that time. Even in its most benign form, such an attitude could lead at best to “a ‘countertransference cure’…achieved through compliance and a ‘false self’ suppression of the patient’s more difficult feelings”.

Another example would be a therapist who did not receive enough attention from her father perceiving her client as being too distant and resenting him for it. In essence, this describes the transference of the treater to the patient, which is referred to as the “narrow perspective”.

Middle Years

As the 20th century progressed, however, other, more positive views of countertransference began to emerge, approaching a definition of countertransference as the entire body of feelings that the therapist has toward the patient. Jung explored the importance of the therapist’s reaction to the patient through the image of the wounded physician: “it is his own hurt that gives the measure of his power to heal”. Heinrich Racker emphasised the threat that “the repression of countertransference…is prolonged in the mythology of the analytic situation”. Paula Heimann highlighted how the “analyst’s countertransference is not only part and parcel of the analytic relationship, but it is the patient’s creation, it is part of the patient’s personality”. As a result, “counter-transference was thus reversed from being an interference to becoming a potential source of vital confirmation”. The change of fortune “was highly controversial. Melanie Klein disapproved on the grounds that poorly analysed psycho-analysts could excuse their own emotional difficulties” thereby; but among her younger followers “the trend within the Kleinian group was to take seriously the new view of counter-transference” – Hanna Segal warning in typically pragmatic fashion however that “Countertransference can be the best of servants but is the most awful of masters”.

Late Twentieth-Century Paradigm

By the last third of the century, a growing consensus appeared on the importance of “a distinction between ‘personal countertransference’ (which has to do with the therapist) and ‘diagnostic response’ – that indicates something about the patient…diagnostic countertransference”. A new belief had come into being that “countertransference can be of such enormous clinical usefulness….You have to distinguish between what your reactions to the patient are telling you about his psychology and what they are merely expressing about your own”. A distinction between “neurotic countertransference” (or “illusory countertransference”) and “countertransference proper” had come (despite a wide range of terminological variation) to transcend individual schools. The main exception is that for “most psychoanalysts who follow Lacan’s teaching…counter-transference is not simply one form of resistance, it is the ultimate resistance of the analyst”.

The contemporary understanding of countertransference is thus generally to regard countertransference as a “jointly created” phenomenon between the treater and the patient. The patient pressures the treater through transference into playing a role congruent with the patient’s internal world. However, the specific dimensions of that role are coloured by treater’s own personality. Countertransference can be a therapeutic tool when examined by the treater to sort out who is doing what, and the meaning behind those interpersonal roles (The differentiation of the object’s interpersonal world between self and other). Nothing in the new understanding alters of course the need for continuing awareness of the dangers in the narrow perspective – of “serious risks of unresolved countertransference difficulties being acted out within what is meant to be a therapeutic relationship”; but “from that point on, transference and counter-transference were looked upon as an inseparable couple…’total situation'”.

Twenty-First-Century Developments

Further developments in the current century might be said to be the increased recognition that “Most countertransference reactions are a blend of the two aspects”, personal and diagnostic, which require careful disentanglement in their interaction; and the possibility that nowadays psychodynamic counsellors use countertransference much more than transference – “another interesting shift in perspective over the years”. One explanation of the latter point might be that because “in object relations therapy…the relationship is so central, ‘countertransference’ reactions are considered key in helping the therapist to understand the transference”, something appearing in “the post-Kleinian perspective…[as] Indivisible transferencecountertransference”.

Body-Centred Countertransference

Psychologists at NUI Galway and University College Dublin have recently begun to measure body-centred countertransference in female trauma therapists using their recently developed “Egan and Carr Body Centred Countertransference Scale”, a sixteen symptom measure. High levels of body-centred countertransference have since been found in both Irish female trauma therapists and clinical psychologists. This phenomenon is also known as “somatic countertransference” or “embodied countertransference” and links to mirror neurons and automatic somatic empathy for others due to the actions of these neurons have been hypothesised.

What is a Mental Health Care Navigator?

Introduction

A mental health care navigator is an individual who assists patients and families to find appropriate mental health caregivers, facilities and services. Individuals who are care navigators are often also trained therapists and doctors.

Background

The need for mental health care navigators arises from the fragmentation of the mental health industry, which can often leave patients with more questions than answers. Care navigators work closely with patients and families through discussion and collaboration to provide information on best options and referrals to healthcare professionals, facilities, and organisations specialising in the patients’ needs. The difference between other mental health professionals and a care navigator is that a care navigator provides information and directs a patient to the best help rather than offering treatment. Still, care navigators may provide diagnosis and treatment planning.

Mental health care navigation is also sometimes provided by self-help books. Lloyd I. Sederer, M.D.’s The Family Guide to Mental Healthcare (W. W. Norton & Company, 2013) is a resource for patients and families searching for guidance in the mental health industry. Publishers Weekly called it a “thoughtful, compassionate, and fact-packed guide for recognizing illness and getting help.” It provides information to patients and families about recognising symptoms of mental illness, how to get diagnosis and how to choose the right therapists and treatments.

Terminology

Many mental health organisations use “navigator” and “navigation” to describe the service of providing guidance through the health care industry. Care navigators are also sometimes referred to as “system navigators.”. One type of care navigator is an “educational consultant.”

Models

Models for mental health care navigation can involve many scenarios from a brief consultation to an extended process with follow-up. They offer referrals, assistance with insurance and other financial matters and general support. A highly detailed method of care navigation with long-term follow up was developed in 2011 by San Francisco-based psychiatrist and mental health expert Eli Merritt, M.D. His model involves what he calls the “3 R’s” of mental health care: “Research, Resources, and Referrals.” It involves four steps:

  • Assessment & Needs Identification:
    • In this preliminary, exploratory phase, care navigators meet with the individual or family seeking help. Patient history and needs are identified.
    • Both the patient and the care navigator think through short- and long-term goals and levels of treatment sought.
  • Dialogue & Plan Formation:
    • Through discussion and collaboration, both the patient and care navigator brainstorm next steps, establishing a plan that is specific to the patient’s needs.
  • Care Coordination:
    • After information gathering and brainstorming, doctors, therapists, and other mental health options are provided to the patient.
    • Questions of affordability arise, and patients are advised toward the best solutions for their conditions and circumstances.
  • Continuity:
    • After guiding patients to healthcare providers, care navigators maintain communication and continuity with patients, offering assistance with any future obstacles that might arise.

What is a Therapeutic Relationship?

Introduction

The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client.

In psychoanalysis the therapeutic relationship has been theorised to consist of three parts: the working alliance, transference/countertransference, and the real relationship. Evidence on each component’s unique contribution to the outcome has been gathered, as well as evidence on the interaction between components. In contrast to a social relationship, the focus of the therapeutic relationship is on the client’s needs and goals.

Therapeutic/Working Alliance

The therapeutic alliance, or the working alliance may be defined as the joining of a client’s reasonable side with a therapist’s working or analysing side. Bordin (1979) conceptualised the working alliance as consisting of three parts: tasks, goals and bond. Tasks are what the therapist and client agree need to be done to reach the client’s goals. Goals are what the client hopes to gain from therapy, based on their presenting concerns. The bond forms from trust and confidence that the tasks will bring the client closer to their goals.

Research on the working alliance suggests that it is a strong predictor of psychotherapy or counselling client outcome. Also, the way in which the working alliance unfolds has been found to be related to client outcomes. Generally, an alliance that experiences a rupture that is repaired is related to better outcomes than an alliance with no ruptures, or an alliance with a rupture that is not repaired. Also, in successful cases of brief therapy, the working alliance has been found to follow a high-low-high pattern over the course of the therapy. Therapeutic alliance has been found to be effective in treating adolescents suffering from PTSD, with the strongest alliances were associated with the greatest improvement in PTSD symptoms. Regardless of other treatment procedures, studies have shown that the degree to which traumatised adolescents feel a connection with their therapist greatly affects how well they do during treatment.

Necessary and Sufficient Conditions

In the Humanistic approach, Carl Rogers identified a number of necessary and sufficient conditions that are required for therapeutic change to take place. These include the three core conditions: congruence, unconditional positive regard, and empathy. Rogers (1957; 1959) stated that there are six necessary and sufficient conditions required for therapeutic change:

  1. Therapist–client psychological contact: a relationship between client and therapist must exist, and it must be a relationship in which each person’s perception of the other is important.
  2. Client incongruence: that incongruence exists between the client’s experience and awareness.
  3. Therapist congruence, or genuineness: the therapist is congruent within the therapeutic relationship. The therapist is deeply involved, they are not ‘acting’ and they can draw on their own experiences (self-disclosure) to facilitate the relationship.
  4. Therapist unconditional positive regard: the therapist accepts the client unconditionally, without judgment, disapproval or approval. This facilitates increased self-regard in the client, as they can begin to become aware of experiences in which their view of self-worth was distorted or denied.
  5. Therapist empathic understanding: the therapist experiences an empathic understanding of the client’s internal frame of reference. Accurate empathy on the part of the therapist helps the client believe the therapist’s unconditional regard for them.
  6. Client perception: that the client perceives, to at least a minimal degree, the therapist’s unconditional positive regard and empathic understanding.

Transference and Counter-Transference

The concept of therapeutic relationship was described by Freud (1912) as “friendly affectionate feeling” in the form of a positive transference. However, transferences, or more correctly here, the therapist’s ‘counter-transferences’ can also be negative. Today transference (from the client) and counter-transference (from the therapist), is understood as subconsciously associating a person in the present, with a person from a past relationship. For example, you meet a new client who reminds you of a former lover. This would be a counter-transference, in that the therapist is responding to the client with thoughts and feelings attached to a person in a past relationship. Ideally, the therapeutic relationship will start with a positive transference for the therapy to have a good chance of effecting positive therapeutic change.

Operationalisation and Measurement

Several scales have been developed to assess the patient-professional relationship in therapy, including:

Reference

Bordin, E.S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice. 16(3), pp.252-260.

On This Day … 24 April

People (Births)

People (Deaths)

  • 1924 – G. Stanley Hall, American psychologist and academic (b. 1844).
  • 1983 – Erol Güngör, Turkish sociologist, psychologist, and academic (b. 1938).

Eliana Gil

Eliana Gil RPT-S, ATR (born 24 April 1948), is a lecturer, writer, and clinician of marriage, family and child. She is on the board of a number of professional counselling organisations that use play and art therapies, and she is the former president of the Association for Play Therapy (APT).

Dr. Gil is the senior partner of the Gil Institute for Trauma Recovery and Education in Fairfax, Virginia. She is also the director of Starbright Training Institute for Child and Family Play Therapy based in northern Virginia.

G. Stanley Hall

Granville Stanley Hall (01 February 1846 to 24 April 1924) was a pioneering American psychologist and educator. His interests focused on childhood development and evolutionary theory.

Hall was the first president of the American Psychological Association and the first president of Clark University.

Review of General Psychology survey, published in 2002, ranked Hall as the 72nd most cited psychologist of the 20th century, in a tie with Lewis Terman.

Erol Gungor

Erol Güngör (25 November 1938 to 24 April 1983) was a Turkish sociologist, psychologist, and writer.

After spending a period in the Faculty of Law, Güngör graduated from the Faculty of Literature and Social Sciences of Istanbul University in 1961. He received his Ph.D. in 1965 with a thesis titled “Kelâmî (Verbal) Yapılarda Estetik Organizasyon”. Kenneth Hammond invited him to visit the University of Colorado. He became an associate professor with his thesis titled “Şahıslar arası Ihtilafların Çözümünde Lisanın Rolü” in 1970. He became an academic in the Faculty of Literature and Social Sciences of Istanbul University in 1975. He eventually became the president of Selçuk University in 1982.

He mostly studied culture, personality, customs, people and religion. He focused on the identity and cultural problems which Turkish people have faced in the last 150 years.

What is Functional Analytic Psychotherapy?

Introduction

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

FAP was first conceptualised 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 behavioural psychotherapy based on these concepts. Behavioural principles (e.g. reinforcement, generalisation) form the basis of FAP (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 behaviour instead of the form. The aim is to change a broad class of behaviours 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.

The Basics

FAP posits that client behaviours 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 behaviours, FAP therapists, in collaboration with their client, develop a case formulation that includes classes of behaviours (based on their function not their form) that the client wishes to increase and decrease.

In-session occurrence of a client’s problematic behaviour is called clinically relevant behaviour 1 (CRB1). In-session occurrence of improvements is called clinically relevant behaviour 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” operationalise the FAP therapist’s behaviour 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.

  • Rule 1 – Watch for CRBs:
    • Therapists focus their attention on the occurrence of CRBs that are in-session problems (CRB1s) and improvements (CRB2s).
  • Rule 2 – Evoke CRBs:
    • Therapists set a context which evoke the client’s CRBs.
  • Rule 3 – Reinforce CRB2s naturally:
    • Therapists reinforce the occurrence of CRB2s (in-session improvements), increasing the probability that these behaviours will occur more frequently.
  • Rule 4 – Observe therapist impact in relation to client CRBs:
    • Therapists assess the degree to which they actually reinforced behavioural improvements by noting the client’s behaviour subsequent behaviour after Rule 3.
    • This is similar to the behaviour analytic concept of performing a functional analysis.
  • Rule 5 – Provide functional interpretations and generalise:
    • Therapists work with the client to generalise in-session behavioural improvements to the client’s out-of-session relationships.
    • This can include, but is not limited to, providing homework assignments.

The ACL Model

Researchers at the Centre 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 behaviours relevant to social connection based on decades of scientific research.

  • Awareness (A):
    • Behaviours include paying attention to your own and the other’s needs and values within an interpersonal relationship.
  • Courage (C):
    • Behaviours include experiencing emotion in the presence of another person, asking for what you need, and sharing deep, vulnerable experiences with another person in the service of improving the relationship.
  • Love (L):
    • Behaviours involve responding to another’s courage behaviours with attunement to what that person needs in the moment. These include providing safety and acceptance in response to a client’s vulnerability.

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

Research Support

Radical behaviourism and the field of clinical behaviour analysis have strong scientific support. Additionally, researchers have conducted a number of case studies, component process analyses, a study with non-randomised design on FAP-enhanced cognitive therapy for depression, and a randomised controlled trial on FAP-enhanced acceptance and commitment therapy for smoking cessation.

Third Generation behaviour Therapy

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

Criticism

FAP has been criticised for “being ahead of the data”, i.e. having not enough empirical support to justify its widespread use. Challenges encountered by FAP researchers are widely discussed There is also criticism of using the ACL model as it detracts from the idiographic nature of FAP.

Book: Relaxation and Stress Reduction Workbook

Book Title:

Relaxation and Stress Reduction Workbook.

Author(s): Matthew McKay (PhD).

Year: 2019.

Edition: Seventh (7th).

Publisher: New Harbinger.

Type(s): Paperback and Kindle.

Synopsis:

The Relaxation and Stress Reduction Workbook broke new ground when it was first published in 1980, detailing easy, step-by-step techniques for calming the body and mind in an increasingly overstimulated world. Now in its seventh edition, this fully revised and updated workbook-highly regarded by therapists and their clients-offers the latest stress reduction techniques to combat the effects of stress and integrate healthy relaxation habits into every aspect of daily life.

This new edition also includes powerful self-compassion practices, fully updated chapters on the most effective tools for coping with anxiety, fear, and panic-such as worry delay and diffusion, two techniques grounded in acceptance and commitment therapy (ACT)-as well as a new section focused on body scan.

In the workbook, you will explore your own stress triggers and symptoms, and learn how to create a personal action plan for stress reduction. Each chapter features a different method for relaxation, explains why the method works, and provides on-the-spot exercises you can do when you feel stressed out. The result is a comprehensive yet accessible workbook that will help you to curb stress and cultivate a more peaceful life.