Sunday, October 30, 2011

Creating Intensive and Successful Therapeutic Relationships; Functional Analytic Psychotherapy (FAP)

Will Hunting (Matt Damon) has genius-level intelligence. He works as a janitor at MIT and lives alone in a sparsely furnished apartment in an impoverished South Boston neighborhood. An abused foster child, he blames himself for his unhappy upbringing and turns this self-loathing into a form of self-sabotage in both his professional and emotional lives. Hence, he is unable to maintain either a steady job or a steady romantic relationship.

In the first week of class, Will solves a difficult graduate-level math problem that Professor Gerald Lambeau (Stellan Skarsgård) is hoping someone might solve by the semester's end. Everyone at MIT wonders who solved it, and Lambeau puts another problem on the board -- one that took him and his colleagues two years to prove. Will is discovered in the act of solving the problem, and Lambeau initially thinks that Will is vandalizing the board and chases him away. When Will turns out to have solved it correctly, Lambeau tries to track Will down. 

Meanwhile, Will attacks a youth who had bullied him years ago in kindergarten, and he now faces imprisonment after attacking a police officer who was responding to the fight. Realizing Will might have the potential to be a great mathematician, such as the genius Évariste Galois, Lambeau goes to Will's trial and intervenes on his behalf, offering him a choice: either Will can go to jail, or he can be released into Lambeau's personal supervision, where he must study mathematics and see a psychotherapist. Will chooses the latter even though he seems to believe that he does not need therapy.

Five various mental health professionals fail to connect with Will. Out of sheer desperation, Lambeau finally calls on psychologist Sean Maguire (Robin Williams), an estranged old friend and MIT classmate of his who grew up in the same neighborhood as Will. Sean differs from his five predecessors in that he is from Will's neighborhood and systematically pushes back at Will and is eventually able to get through to Will and his hostile, sarcastic defense mechanisms.

How did Sean, in this fictional work, get through to Will when 5 previous therapists had not?  Through the development of an intense and curative therapeutic relationship.  Often the general public, when faced with trying to understand why or how a therapeutic encounter was successful, will look at the personal characteristics of the client and the theoretical orientation of the therapist and conclude that a good match occurred, the result of which was a successful therapeutic outcome.  Although fictional in nature, the story of Good Will Hunting is a good example of a therapist and client forming a functional therapeutic relationship that allows the client to grow and develop in his personal life.  In psychology we know the basic factors that allow this to happen and well trained therapists can often duplicate this fete with many of their clients.  These basic factors are combined in a fairly simple set of procedures or therapeutic model known as Functional Analytic Psychotherapy; often referred to as FAP for short. 

Who Does FAP work best for?  What type of client benefits most from FAP?  FAP techniques work best with clients who seek an intensive, emotional, in-depth therapy experience.  It is also well suited for individuals who have not improved adequately with traditional behavior therapies, who have difficulties establishing emotionally intimate  or functional relationships, and/or who have diffuse, pervasive, and chronic interpersonal problems typified by one or more axis II disorders in the DSM-IV-TR.

Who developed FAP?  Dr. Robert Kohlenberg of the University of Washington in Seattle and Dr. Mavis Tsai, a Clinical Psychologist in Seattle published their first work on FAP in 1987.  Since that time they have refined it and have written several books about it.  It has been studied extensively and has been shown experimentally to be a highly effective EBP (Experimentally based Procedure) for a variety of psychological disorders.

What is FAP?  How does FAP work?  Outpatient psychotherapy typically takes place one-on-one in a therapist's office and is scheduled for one or more hours per week.  It is relevant to ask how something that occurs inside an office between two people for a few hours per week can generalize to a clients outside world on a daily basis?  The answer lies in the careful identification of behaviors that occur inside the office setting that relate to the clients behavior outside of the office that either increase or decrease functional social relationships.  In FAP we call these "Clinically Relevant Behaviors" or CRB's.  In FAP we can reinforce desirable CRB's and reduce undesirable CRB's.  Everything a therapist can do to help a client can and does occur during a session.  Therapist actions that help clients during a session include identifying, eliciting and reacting to CRB's.  For the well trained and experienced therapist, every therapist action in session has one of these three effects.

OK, what are CRB's specifically?  Are they the same of different for each client?  In a general sense CRB's are different for each client but they do tend to share some common factors.  Three general commonalities include but are not limited to 1) learning to ask for what one wants, 2) trusting, and 3) the acceptance of love or being valued by others.

How can I find a therapist who is trained in and understands FAP? The best way is to ask ahead of time. Do some reading on your own and then ask some questions of your potential therapist.  Competent therapists welcome educated clients and will appreciate your efforts in finding them.  I've taught advanced intervention techniques including FAP to hundreds of graduate students and believe me, nothing would be more welcome to them then a motivated and well read client looking to make successful changes in their life through the development of an intensive and curative therapeutic relationship.

For further reading see; 

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