May 28, 2018

[Interview] The Challenge of being a therapist and a FAP trainer

Comporte-se: Functional Analytic Therapy, a Behavioral approach in which the therapeutic relationship itself is used as a form of intervention, is of growing  interest to many members of the Behavioral Analysts community. To talk about the subject, we invite Priscila Rolim, who is a Certified FAP Trainer since 2017, to share with us a bit about the FAP work as a Psychotherapist and also to explain about her certification process.

Priscila Rolim de Moura is a Psychologist (CRP 06/85737), with a Master in Clinical Psychology from Leiden University (Netherlands), where she Specialized in Cognitive Behavioral Therapy at the Anxiety Clinic of the Institute of Psychiatry, Hospital das Clínicas (FMUSP). She is the founder of iMind – Psychology and Mindfulness, and one of the Translators of the book FAP Made Simple (Holman et al., 2017), in Brazil. She works as a Clinical Psychotherapist, teacher, supervisor and has a Trainer Certification in Functional Analytical Psychotherapy (FAP), granted by the University of Washington, USA in 2017. She participates continuously in FAP training directly with the founders of the methodology as well as other important names in Contextual Behavioral Therapies. Priscila also gained experience working as a psychotherapist at a Specialized Clinic in Intercultural Psychiatry (iPsy – The Netherlands), helping immigrants and people who have suffered trauma in countries living in armed conflict, such as Afghanistan, Angola, Iraq and Pakistan. She is a member of the Brazilian Association of Psychology and Behavioral Medicine (ABPMC) and the Association of Contextual Behavioral Sciences (ACBS). E-mail to contact: pri_rolim@me.com – http://www.priscilarolim.com

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Priscila: First of all I would like to thank you for the invitation to give an interview to the Comporte-sePortal. It was an extremely enriching and a challenging experience!

“FAP HAS THE PURPOSE OF GUIDING THE THERAPIST TO CONDUCT A GENUINE, ENGAGING, SENSITIVE AND CAREFUL RELATIONSHIP WITH THE CLIENT, AND, AT THE SAME TIME, USING THE CLEAR, LOGICAL AND ACCURATE DEFINITIONS OF THE BEHAVIORAL PRINCIPLES. CONCLUDING, THE ESSENCE OF BEING A FAP THERAPIST IS TO HAVE THE ABILITY TO LIVE IN THE RELATIONSHIP FUNCTIONALLY, MOMENT BY MOMENT.”

Comporte-se: Many people say they “use” FAP, but FAP seems like a complete Behavioral Approach. Faced with this, there is a question: what defines a FAP therapist? What characteristics should your practice have in order for it to be considered a FAP Therapy?

Priscila: Although functional analytic psychotherapy (FAP, Kohlenberg & Tsai, 1991) is a type of behavioral therapy, it is quite different from traditional behavioral therapies such as social skills training, cognitive restructuring, or behavioral activation.

FAP is about creating therapeutic relationships with the strategic target of promoting changes in client’s behavior. The major difference from FAP to other approaches is that it understands that the process of transformation during therapy occurs through the therapeutic relationship, using it as the primary vehicle during the process of change. This understanding about FAP is what distinguishes it from other behavioral therapies.

I understand that in order to be considered a FAP Therapist, the person conducting the session is encouraged to pay special attention to what is happening in the interpersonal process between the client and the therapist while the psychotherapy session unfolds, assessing the improvement’s behaviors of the client or how the therapist should respond contingently to promote change. FAP has the purpose of conducting the therapist to a genuine, engaging, sensitive and careful relationship with the client, and, at the same time, enjoying the clear, logical and accurate definitions of the behavioral principles. In conclusion, the essence of being a FAP therapist is to have the ability to live in the relationship functionally, moment by moment.

Comporte-se: Still about the “use” of FAP, what does a professional need to have to incorporate FAP tools into their practice while still acting as a Behavioral Therapist from another approach, such as Acceptance and Commitment Therapy, Analytical-Behavioral Therapy, Dialectical Behavioral Therapy or others?

Priscila: I’m trying to figure out what you mean by FAP tools, but let me take a stab at it!

One of the things we do in FAP is the identification of CRB1 (named as clinically relevant behaviors 1, or problem behavior) and CRB2 (named as clinically relevant behaviors 2, or improvement behavior), with the focus on shaping CRB2. So if the therapist only uses shaping in any other type of therapy it does not mean that he is doing FAP, but rather, shaping behavior in session. For me, shaping is part of a process or procedure and can be used in any other therapy, but FAP goes far beyond shaping behavior in session, which is to live the relationship intimately and genuinely.

Many people have the impression that FAP means being intense and to behave in a “sugary” way. The  great risk is that trying to be aware, courageous and loving in an intense way in session may lead to be unauthentic. When FAP suggests three major functional classes for the behavior of the therapist and the client in session (being aware, courageous and loving), it makes it very clear that the relationship will be based on the transparent manifestation of these behaviors by both members of the dyad. Being genuine in how we show up is essential for FAP therapy.

The core of FAP is the contingent response of the therapist to the CRBs present in the session, and therefore FAP will provide rules for therapists who will direct attention to the occurrences of the behavior within the session and its function, and for this to be done in a contingent and contiguous way, one needs to be attentive, sensitive and in tune with what the client really needs to be able to evoke improvement behaviors (CRB2).

The therapist who uses FAP as a technique may also be at risk of strengthening a CRB1 and/or ignoring or punishing a CRB2 if he is not aware of case conceptualization, thus, producing a counterproductive effect on client improvements. For example, if the client has difficulty getting in touch with some private events (connecting with his/her own experience), during a meditation, an avoidance response may be evoked; or if the person has difficulty trusting other people, the client may have difficulty closing his eyes in the same situation. Just remember, CRB1 is not inherently bad, and CRB2 is not inherently good.

What can be a CRB1 for a client can be a CCR2 for another; similarly, what can be a CRB1 for a client in one context can be a CRB2 for that same client in a different context; and what can be a CRB2 for a client at one point in time may be a CRB1 for the same client at a later time (Holman et al., 2017).

Comporte-se: In the context of evidence-based practice, some psychotherapies are more recommended for some populations or diagnoses than for others. Which populations benefit the most from FAP Therapy? And, of course, are there restrictions or populations for which FAP is not recommended?

Priscila: The application of FAP is to create and enhance an intimate interpersonal process between the client and the therapist and directly directs the interpersonal functioning of the client, specifically with respect to the relationship.

The original FAP text (Kohlenberg & Tsai, 1991) suggested that FAP was well suited for clients “who have difficulties in establishing intimate relationships, and/or who have diffuse, pervasive interpersonal problems” (p. 2).

Therefore, within a broader and more flexible structure, FAP can be applied in several contexts and interpersonal functioning has been the prototypical target of the therapeutic process in this approach. This fluid, idiographic, context-dependent view of CRBs is consistent with clinical thinking within contextual behavioral science that emphasizes the understanding of single-person actions in context, rather than generalizing from groups or statistics.

This is a very interesting question, and the idea is that the FAP is flexible, but I think there may be a population that is not recommended for each therapist. I believe that maybe it is not just about using FAP in certain populations, but about having interpersonal skills to use FAP with certain clients. In order for you to implement FAP skillfully, you have to be actively developing yourself, as well as your ability to relate to functional analysis, that is, a therapist who is willing to develop both intellectually (clinical reasoning, case conceptualization, functional analyzes), as well as interpersonal skills in and out of session. The question that resonates is “what are you able to do with the use of FAP”?

Comporte-se: You have recently completed the procedure for obtaining FAP Certification. How was the process?

Priscila: Challenging, painful, intimate, flourishing … So many adjectives! I have learned that I am strong, that I am able to deal with many adversities and give life a new meaning. It takes a lot of strength and wisdom to turn difficult experiences into growth and choices. Many of our clients face these challenges, and our personal learning can and should enhance our clinical practice. What are our choices to meet these challenges and learn how much we can grow?

What I know about FAP is that if you really challenge yourself (you have to during the course to get the Certificate) you will be able to challenge yourself that way during sessions with your clients.

Comporte-se: What changes in your career and practice from the moment you receive the certificate?

Priscila: In my experience, receiving the certificate was the recognition of many years of dedication and love for FAP. The biggest change was during the course. Today, my goal is to balance reflection, awareness and action. I learned that it was very important to work on developing my personal style, to be genuine, courageous and compassionate, while enhancing my analytical and interpersonal skills, faithful to evidence-based treatments.

While FAP lacks robust experimental data to place it currently within the evidence based treatment perspective, all therapists from time to time go through training and acquisitions of skills in an area to refine skills and hone clinical and professional ability, which is essential to evidence based practices. The best theoretical knowledge with the nuances and individuality of the client, along with the best technical expertise of the therapist.

Comporte-se: What recommendations can you give to those who are interested in becoming FAP therapists? Where can they begin to qualify?

Priscila: My recommendation is that you start to expose yourself more to FAP’s experiential trainings, this includes supervisions, experiential workshops and therapy in the same approach. One of the requirements is to do at least 20 supervised sessionswith both a male and a female Certified Trainer. Through supervision, the therapist will learn to be more aware of one’s own repertoires and stimuli control, thus, to have more mastery and wisdom in doing an intervention. The workshop aims at conducting experiential exercises in order to directly modeling and shaping the skills and repertoire of the therapist, integrating with the application of the five rules of FAP.

REFERENCES:

Holman, G., Kanter, J., Tsai, M., Kohlenberg, R.J., & Hayes, S.C. (2017). Functional Analytic Psychotherapy Made Simple (1st ed). Oakland, CA: New Harbinger Publications.

Kohlenberg, R.J., & Tsai, M. (1991). Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Rel

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