fap act presentation for handouts.ppt - what's new · 6/21/2011 1 jonathan kanter, ph.d....

6/21/2011

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Jonathan Kanter, Ph.D.

University of Wisconsin-Milwaukee,

USA

[email protected]

Functional

Analytic Psychotherapy

(FAP) and ACT

“Often the real work can be done by

focusing on the present therapy process. There is no need to talk about experiential

avoidance or cognitive fusion, for

example, when it is usually quite easy to find it then and there…in the room… in

the relationship.”

(Pierson and Hayes, 2007)

Today’s Goals

FAP ACT

Process that

maximizes the impact of therapeutic work in

the present moment

Behavior Analysis

Self asContext

Contact with the Present Moment

Defusion

Acceptance

Committed Action

Values

Instructions?

Practice and feedback?

What is the best way to learn how

to dance?

consequences

real work in the present momentinvolves providing

What kinds of natural

consequences can happen in the therapy

relationship?

What client problems are sensitive to these

consequences?

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CRB’s occur in session and can be

addressed on the spot

CRB: Clinically Relevant Behavior

CRB-1: Client problems occurring in session

(a step backward)

CRB-2: Client improvements that occur in session

(a step forward)

FAP’s 5 Rules

1. Watch for CRBs (awareness)

2. Evoke CRBs (courage)

3. Reinforce CRBs (love)

4. Observe your effect on your client

(awareness)

5. Generalize (behaviorism)

Identify reinforcers (Rule 4) and reinforce CRB2s (Rule 3)

Watch for (Rule 1) and evoke (Rule 2) CRBs

Daily-Life Problems Daily-Life Goals

Provide rules and generalization strategies (Rule 5)

In-vivo occurrences of problems(CRB 1’s)

In-vivo occurrences of improvements(CRB 2’s)

RULE 1: Watch for CRBs

Rule 1 is about awareness

� Your mindfulness in the session is crucial

� Add CRBs to your ACT case conceptualization

� Draw parallels between present moment and outside experiences


In-to-out parallels:

“I am having a reaction to what you just did. I’m wondering if you are aware of other people who

have reacted similarly. I’m trying to determine if my reaction is unique to me or not, or if it would be helpful for us to talk about it in more detail.”


Out-to-in parallels:

� “Does what happens between you and your partner ever occur between us in here?”

� “Is that the same as when you and I had that disagreement and you got really quiet?”

� “Do I make you feel that way as well?”

� “Do you see me as similar to your husband in any of these ways?”

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Define ACT targets as CRBs


Self asContext

Contact with the Present Moment

Defusion

Acceptance

Committed Action

Values

The problem is

verbal contingencies give rise toverbal

Behavior isa function of and contingencies

which leads to dysfunctional behavior

PRESENT

Fusion Avoidance

PAST

Behavior

ChangeWhat is the goal of behavior therapy?

According to ACT:

Defusion AcceptanceDefusing Accepting

PRESENT

Mindfulness

PAST

Values Clarification

Committed

Action

Paying attention

while defusing and

accepting

Acting mindfully, according to one’s

values

Defining values, while defusing

and accepting

What is the goal of ACT?

ACT target Behavioral definition CRB

Fusion

Defusion

Fusing

Defusing

Fusing with thoughts about

therapy or the therapist

Avoidance

Acceptance

Avoiding

Accepting

Avoiding feelings about

therapy or the therapist

Mindfulness Paying attention while

defusing and accepting

Mindful attention to the

therapist while defusing and accepting

Values Defining values while

defusing and accepting

Defining values in terms of

the therapy relationship

Committed

Action

Acting mindfully

according to one’s values

Acting in session towards the

therapist according to one’s values

Defining values and actions relevant to the

therapy relationship and therapist:

[After discussing values regarding significant relationships]

“I would like those values to apply to us as well. My value with respect to you is to foster a genuine, safe, loving, connected, trusting, open, sacred,

accepting, unique…relationship that serves as a model for what you can achieve outside of here.”

RULE 2: Evoke CRBs

Rule 2 is about courage

…courage to have a real, genuine, live,

emotional human relationship with your client

Your acceptance in the session is crucial

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RULE 2: Evoke CRBs

Typical FAP questions:

� What are you thinking or feeling right now?

� What’s going through your mind right now?

� What’s your reaction to what I just said? What were you thinking/feeling on your way to therapy today?

� What were you thinking/feeling while you were waiting for me out in the waiting room?

� What were your reactions to our last session?

RULE 2: Evoke CRBs

Typical FAP questions:

� What are your feelings/reactions to our session today?

� What’s hard for you to say to me?

� How are you feeling about our therapy relationship? What are you avoiding? What are

you accepting?

� What do you wish I would have done more of?

� What do you think I’m thinking about you/ what you said?

RULE 2: Evoke CRBs

Rule 2 ACT Dilemma

ACT naturally is evocative

but

some ACT relationships are not natural

The goal is for the therapy relationship to temporarily disrupt the context of literality that

dominates outside relationships

RULE 2: Evoke CRBs

“Thank your mind for that thought”

“Don’t believe a word I am saying”

“Instead of me answering you directly, let me launch into this 20-minute metaphor

about monsters or this 20-minute

experiential exercise about shapes and colors”

RULE 2: Evoke CRBs

When behaving abnormally in session:

Ask for permission

Acknowledge the weirdness

Be compassionateDon’t be jargony

Don’t be mindy

RULE 2: Evoke CRBs

Try ACT without ANY metaphors

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RULE 3: Reinforce CRB2s

Rule 3 is about love and acceptance

Love and acceptance are extremely reinforcing the most people


Rule 3 is about love and acceptance

CRB2 Rule 3 response

General Amplify your natural emotional reaction, show interest

Assertiveness Give client what s/he wants

Disclosure, approaching intimacy

Disclosure, approaching intimacy


Be careful of…

technique

trying to be reinforcing

being a therapist

Let yourself be a genuine human being

Work on this with yourself, your loved ones, your clients

When a CRB occurs, the best responses

are…

accepting,

natural,

honest,

focused on value-based committed actions that can occur in the therapy relationship


Typical ACT moves:

Natural consequences:

FAP moves:

CRB1: “I’m not getting any better in here. This just seems like psychobabble to me.”

Typical ACT moves:

Natural consequences:

FAP moves:


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� Are the following responses to CRB1s

and CRB2s punishing or reinforcing?

� How could they be improved?

� How could they be more natural, genuine,

direct and focused on committed action?


Treat as experiential avoidance:

“I’m guessing you’ve felt like this before with other therapies. Yes? OK, so could I you ask this: what did you do in the past when you felt like this and how did that work for you?”

Very indirect. Seems not completely honest. How about, “I want to take that seriously but at the same time, I’m thinking you are really stuck at this moment. Can I really gently shift you a little bit right now? Can you talk with me directly about these feelings rather than have them push you into this sort of judgment?”

“Are you feeling afraid that I will disappoint you and let you down?”

Nice - brings up and blocks the avoidance directly.

CRB1: “I’m not getting any better in here. This just seems like psychobabble to me.”Treat as fusion:

“Could I ask you this: how close is that thought to you right now? Does it feel like it is right on top of you, or does it feel like it is floating out here in the space between us a bit? Like if this piece of paper is the thought ‘I’m not getting any better’ can you show me how far away it is from you right now?”

“Interesting. Well if we take that thought literally I suppose we would need to deal with whether you are in fact progressing. And we can do that if your gut level sense is that it would really have value. But I wonder if another area would be to look at our relationship and what we plan to do when we have thoughts about the process itself that are scary or difficult.”

Second quote better because it is more direct and natural.


Treat as lack of contact with present moment (mindfulness):

[moving chair over next to the client so that they both look back in the same direction]. Would it be possible for us both to get into contact with what it feels like to think that therapy is going no where, right here right now? And let’s put that thought out there on the floor in front of us and both of us watch in more detail what then comes up as we look at it.”

Good except for putting thought on floor. How about, “Can you and I right now, get a little distance from that thought and really connect in this moment on that issue?”

“Cut this b**sh**. We’re going to waste our session if you keep this up. I want to connect with you.”


The best response to a CRB1 like this may be to ignore it and prompt a CRB2.

“Listen – what do you really value, right now, in this relationship, with me? I really want to connect with you and these sorts of comments from you don’t help with that. Let’s come together on this.”


Treat as acceptance:

“Thanks for telling me that. … What do you feel as you put that into this room?”

How about, “When you say that, it hurts a bit to be called out on it, but I have to say, you are so right. I’m scared you are not getting better too, and when I get scared I tend to psychobabble, but I am 100% committed to you and this process. I will try to do better and not psychobabble, but if I do, will you call me on it again?

Treat as defusion:

“Ouch. That must be a painful thought to have.”

How is “ouch” reinforcing?

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Treat as mindfulness:

“Let’s both just take a second to get present with what it feels like to be here with that in the room.”

Treat as values:

“I hear you. And before we even unpack that let me just say that what I’m in here for is you and what you really want in your life, not me getting applause for saying clever things.”

Both of these seem pretty good to me.


The best response to a CRB2 may be to amplify your natural emotional reactions to the client:

“You know, on the one hand, that is kind of harsh, but on the other hand, it is the kind of thing I really appreciate about you. Your honesty, your ability to tell it like it is. I really take what you say seriously and when you’re honest with me like this it actually makes you more human to me as a person, but like a full, real, living breathing human being. So I know that is difficult to say but, wow, fantastic. I’m right here with you now on this. Let’s make some changes, ok?”

RULE 4: Notice your effect on

the client

Rule 4 is about awareness

Micro-level: What is the client’s immediate response to your intervention?

Macro-level: Are CRB2s increasing in strength and frequency over time?

RULE 4: Notice your effect on

the client

� How am I doing in response to you right now, am I making this easier or harder?

� What was it like to tell me that? Did I respond in a helpful way? How?

� Do you think you are more likely or less likely to do this again?

RULE 5: Generalize

� Weave together in-session and daily-life

material and content.

� Provide homework relevant to in-session interactions

“Now that you’ve done this with me, are you willing to try it with…”

Summary

Rule 1: Watch for CRBs

Define ACT CRBs and define the therapy relationship in terms of your client’s stated values and committed actions

Rule 2: Evoke CRBs Develop a natural relationship that is a model for other relationships

Rule 3: ReinforceCRBs

Be loving, emotional and accepting in session

Rule 4: Notice your effect on client

Ask for feedback

Rule 5: Generalize Provide homework assignments based on intense live interactions

fap act presentation for handouts.ppt - what's new · 6/21/2011 1 jonathan kanter, ph.d....

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