The challenge of understanding process in clinical behavior analysis: the case of functional analytic psychotherapy

Whether explicitly acknowledged or not, behavior-analytic principles are at the heart of most, if not all, empirically supported therapies. However, the change process in psychotherapy is only now being rigorously studied. Functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009) explicitly identifies behavioral-change principles used to bring about therapeutic improvements in adult outpatients whose clinical problems stem from ineffective interpersonal repertoires. These principles include contingent responding to behavioral excesses and deficits by a therapist who has established him- or herself as a salient source of social reinforcement. Empirical support for FAP is emerging, but a variety of pragmatic and theoretical questions warrant investigation. Among the issues described in this paper are the training and dissemination of procedures for how to conduct a functional analysis, how to train therapists to identify functional stimulus classes, how to best address decreasing problem behavior without creating an aversive environment, how to enhance generalization, and how to account for the principle of equifinality when trying to specify therapeutic procedures. These and other issues stem largely from trying to disseminate a behavioral principle-based intervention rather than a topographically specified intervention. These issues present challenges and research opportunities for applied clinical behavior analysts if they wish to extend their science to address clinical issues important to the treatment of adult outpatients with normal intellectual functioning.