Clinically Relevant Behaviors and The Five Rules of Functional Analytic Psychotherapy

Functional analytic psychotherapy (FAP) focuses largely on the therapeutic relationship and the interpersonal behaviors that occur in sessions. FAP therapists pay special attention to identifying clinical relevant behaviors — behaviors that take place in sessions and exemplify the client’s real-life problematic behavior (termed CRB1), and the client’s real-life improved behavior (termed CRB2). These are the “away moves” and “toward moves” clients engage in during sessions.

What makes CRBs relevant to clinical work is that they share the same functions as the targeted real-life behavior. For instance, if a client describes how she avoided asking her boss for a raise, avoiding asking her boss for a raise isn’t clinically relevant behavior, as it didn’t take place in session. If she is avoiding talking to you about her financial difficulties and how they might impact her ability to pay for therapy, this would be clinically relevant behavior; it exemplifies the real-life behavior of not asking her boss for a raise.

A behavior is clinically relevant when it serves the same function both in and out of session; the form of behavior will not necessarily look the same. And it’s not the subject of the discussion (money) that makes the in-session avoidance an instance of CRB; rather, it is the underlying issue that she’s having a hard time asking for her needs to be met, both in and out of session.

The Matrix tool, which was developed by clinical psychologists Benjamin Schoendorff, MA and Kevin Polk, PhD, aims to help clients notice their problematic behavior (away moves) and improved behavior (toward moves), along with the inner experiences that can drive these behaviors. Identifying these moves as they occur in sessions creates an opportunity to provide present moment instances of the problem behavior, that can then be worked with in real time.

The following five rules (Tsai et al., 2009) delineate a stepwise process for working with CRBs using courage, awareness, and love.

Rule 1: Notice CRB.

This is an awareness rule. By becoming aware of clients’ CRBs, you can help them notice these behaviors. Clinicians using the matrix would take a similar approach by asking clients and clinicians whether a given behavior is more of a toward or away move, and whether that behavior also shows up outside of a session.

Rule 2: Evoke CRB.

This is a courage rule. You can help bring CRB into the room by inviting clients to engage in a behavior that’s difficult for them. This seldom requires a stretch, as CRB can be evoked by the very nature of therapy: the fee structure, setting an agenda, recommending home practice exercises, ending therapy, and so on.

Rule 3: Respond contingently to CRB and naturally reinforce CRB2, or improved real-life behaviors.

This is a love rule, because reinforcing people when they move toward their goals (and being reinforced by the fact that they’re doing this) is part of what love is. When clients produce problematic behaviors, you can respond by blocking it or by seeking to shape the part of their behavior that could become a toward move.

Blocking these behaviors can be aversive to clients, so make sure you ask for permission, and then be as gentle as you can and offer an alternative toward move your client could engage in instead.

When clients produce improved behaviors, you can reinforce them by responding appropriately and letting them know how you feel when you see them make progress.

Rule 4: Notice the effects of your behavior on clients.

This is an awareness rule, as it involves being aware of your impacts. Everyone responds differently, and what may be reinforcing for one client may be punishing for another. You’ll know whether your behavior has been reinforcing if a client does more of the behavior you’ve tried to reinforce—not just in the short term, but also in the long term. Technically, you can only know if reinforcement is effective by observing whether the target behavior increases. It’s also a good idea to ask clients how things went for them.

Another way to work with this rule is to ask clients to share appreciations at the end of a session. Your appreciations can further reinforce improved behaviors, and the client’s appreciations can give you insight into whether your behavior is achieving the desired effect. Plus, by asking clients how things went for them, you also model being aware of one’s impact, a skill that can only help your clients in their interpersonal interactions.

Rule 5: Provide functional explanations and promote generalization.

This is an awareness and courage rule. The matrix is an ideal tool for practicing functional analysis: the identification of antecedents, behavior, and consequence. It’s flexibility allows you to choose whether the relevant antecedent to a behavior is an event in the world of the five senses, as in traditional behavior analysis, or a private event, like a thought of emotion. Similarly, the behavior can be either an observable toward or away move or a covert behavior, such as ruminating. The consequence can be either the actual toward or away behavior, or what happens in the world after clients engage in either a toward or away move.

For more about Functional Analytic Psychotherapy and the matrix, check out The Essential Guide to the ACT Matrix.

References

Tsai, M., Kohlenberg, R. J., Kanter, J. W., Kohlenberg, B., Follette, W. C., & Callaghan, G. M. (Eds.). (2009). A Guide to functional analytic psychotherapy: Awareness, courage, love, and behaviorism. New York: Springer.