Atlas›Domain II · Behavioural & cognitive›Guide 168
Guide II-168

Functional analytic psychotherapy

Kohlenberg, Tsai1991
A 35 · L 51 · M 1421 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the Kohlenberg and Tsai five-rules model (Kohlenberg & Tsai, 1991, reissued 2007), as taught in Tsai, Kohlenberg et al., A Guide to FAP (2009) and in the Tsai and Kohlenberg ACBS workshop handouts (2012, 2013, 2015), where the rules are mapped onto Awareness, Courage and Love (ACL). Case formulation uses the 12-domain FAP Case Conceptualization Form and Callaghan's FIAT (2006). Cognitive-therapy add-on procedures follow FECT (Kohlenberg et al., 2002). The later stand-alone "ACL model" (Maitland et al., 2017) is mentioned only where it differs. [source: 2012/2013/2015 workshop handouts; Wikipedia]

Functional analytic psychotherapy (FAP) is a behaviour-analytic therapy grounded in radical behaviourism. It uses the therapist–client relationship as the main vehicle of change. It rests on one idea: the client's daily-life interpersonal problems show up, in functionally equivalent form, inside the session as clinically relevant behaviours (CRBs). When the therapist notices them as they happen and responds contingently and naturally, in-session problems (CRB1) decrease and in-session improvements (CRB2) are strengthened. Those improvements are then carried over to daily life through functional interpretation and generalisation work. FAP is principle-driven rather than protocol-driven. It can be used on its own or to "enhance" another therapy such as CBT, ACT or behavioural activation. [source: Tsai & Kohlenberg 2012, 2013 handouts; Kohlenberg et al. 2002; Wikipedia]

Key terms [source: 2012/2013 handouts; Ferro García et al. 2009]

  • CRB1: a client problem occurring in session, such as avoidance, withdrawal, vagueness, attacking the therapist or excessive deference. These behaviours are usually under aversive control and serve an escape or avoidance function.
  • CRB2: a client improvement occurring in session, such as stating a need, giving the therapist feedback, staying with closeness or tolerating emotion.
  • CRB3: the client's own descriptions and explanations of their behaviour and its causes. A CRB3 can itself be problematic or improved. The goal is accurate functional description.
  • T1 / T2: the therapist's own in-session problem behaviours (T1, such as avoiding expressing care) and the therapist's target behaviours (T2).
  • The same behaviour can be a CRB1 for one client and a CRB2 for another. The case conceptualization decides which.

2. Framework

FAP has no fixed manualised phase sequence or session count. Its authors describe it as a set of principles (the five rules) applied in every session, plus a recognisable arc: starting therapy, in-vivo work, and termination. Distinctive Features (Tsai et al., 2012) has practical chapters on starting therapy and the rationale, case conceptualization, the rules, self-disclosure, homework, a typical session, integrating other techniques, termination, supervision and ethics. That book is not drawn on here, so the arc below is assembled from the workshop handouts and articles. [source: 2012/2013/2015 handouts; library TOC of Tsai et al. 2012] [uncertain: exact chapter content of the 2009 and 2012 books]

Format and dose

  • Format: individual outpatient therapy, weekly. Group and workshop formats (ACL/"FAP-based" groups) exist but are not covered here.
  • Session count:
    • Open-ended in FAP proper. The published cases run from months to more than two years (Ferro García et al., 2009).
    • In FECT, cognitive therapy's 20-session structure is retained (agenda, goals, end-of-session feedback), and FAP work is layered on top (Kohlenberg et al., 2002).
    • A weekly target of about five in-vivo turns per session is used as a dose marker. In the FECT study, each extra five turns per session predicted better client-reported progress and relationships the following week. [source: 2012/2013/2015 handouts]

Phase A: Starting therapy (roughly sessions 1–4) [source: Callaghan 2006; Kohlenberg et al. 2002; Tsai et al. 2013] [phase boundaries: synthesis]

  • Goals:
    • Assess daily-life problems functionally.
    • Hypothesise how they will appear in the room.
    • Give the in-vivo rationale ("FAP rap") and establish the session as a dedicated, protected ("sacred") space.
    • Begin the case conceptualization.
  • Typical contents:
    • Intake and history.
    • Life-history written assignment.
    • FIAT-Q and FIAT interview.
    • Rationale.
    • First tentative CRB1/CRB2 list, shared with the client.
  • Move on when: you have a working conceptualization with at least a few specific predicted CRB1s and CRB2s, and the client has heard and broadly accepted the rationale. Acceptance can be tentative, and reactions to the rationale are themselves CRBs. [synthesis]

Phase B: In-vivo work (bulk of therapy) [source: all handouts; Tsai et al. 2013]

  • Goals: the five rules cycle repeatedly within each session:
    1. Watch for CRBs.
    2. Evoke them.
    3. Reinforce CRB2s naturally.
    4. Notice your effect.
    5. Interpret functionally and generalise.
  • Typical contents:
    • The client's daily-life material, with deliberate turns into the here-and-now relationship.
    • Bridging forms between sessions.
    • Generalisation homework.
    • Revising the conceptualization as hypotheses are tested.
  • Progress criteria (Rule 4):
    • Micro level: does the client's behaviour shift right after your response?
    • Macro level: do CRB2s become more frequent and robust over weeks, and do outside improvements follow?
    • Tracking tools: FIAT-DA diary card, repeated FIAT-Q, bridging-form ratings.

Phase C: Termination [source: Yates, Sanida, Tsai & Kohlenberg 2017]

  • Goals:
    • Use the ending itself as an evocative event, since it can stir old losses.
    • Practise ending a relationship well.
    • Consolidate and generalise gains.
  • Typical contents: ending structured around Awareness, Courage and Love (see 4.21), often with a written letter or narrative from the therapist.
  • Criterion for entering termination: not specified in the sources. Reasonable markers [synthesis]:
    • CRB2s are occurring reliably in session without prompting.
    • The client reports matching outside improvements.
    • Goals on the conceptualization form have been reached.
    • Or treatment is not helping. The 2015 handout lists not continuing non-beneficial treatment as a precaution.

Variants [source: Kohlenberg et al. 2002; 2012 handout; Wikipedia; Maitland 2021]

  • FAP as stand-alone therapy.
  • FAP-enhanced therapies: FECT for depression; FAP-enhanced ACT, for example in a smoking-cessation RCT.
  • The simplified ACL model: a brief, often group, format built on Awareness, Courage and Love. Maitland notes it may sacrifice FAP's idiographic precision.

3. Guiding principles

[source: 2012/2013/2015 handouts; Tsai et al. 2013; Callaghan 2006; Ferro García et al. 2009. One-line practical meanings are synthesis unless quoted.]

  1. The relationship is the vehicle of change. Treat what happens between you and the client as the main treatment material, not as background to it.
  2. Functional equivalence. Assume the client's outside problems will appear with you. Ask "how would this show up here?" for every daily-life problem.
  3. Function over form. Classify behaviour by what it does (for example, escapes closeness), not by how it looks. Joking, crying, lateness and silence can all be the same CRB1.
  4. Idiographic formulation. No behaviour is a CRB1 or CRB2 in itself; decide by this client's conceptualization. Speaking up more is a CRB2 for one client and a CRB1 for another.
  5. Contingent responding, close in time and space. Respond to the CRB as it happens. Reinforcement is strongest immediately and in person.
  6. Natural, not arbitrary, reinforcement. Respond the way a caring person in the client's life naturally would (closer, more engaged, more open). Avoid praise tokens such as "good job", which please the therapist but generalise poorly.
  7. The reinforcement conundrum. Deliberately trying to reinforce tends to come out arbitrary. Instead:
    • Let yourself genuinely be affected.
    • Notice how your reactions parallel those of others in the client's life.
    • Amplify and disclose real reactions when helpful.
  8. Shape; match the client's current repertoire. Reinforce small approximations. Do not demand more than the client can currently do, but keep encouraging growth (Tsai et al. 2013).
  9. Reinforcement is defined by its effect (Rule 4). Your response counts as reinforcing only if the behaviour strengthens. Check, then adjust.
  10. Therapist reactions are data. Use your own pull toward or away from the client as a CRB detector. Check whether the reaction is idiosyncratic by asking how important others react.
  11. Awareness, Courage, Love (ACL). These map onto the therapist's skills:
    • Rules 1 and 4: awareness.
    • Rule 2: courage, meaning taking tolerable risks to evoke.
    • Rule 3: therapeutic love, meaning caring enough to notice and respond to small improvements.
  12. Therapeutic love is caring, not attachment. It means being reinforced by the client's growth and attuned to small changes, with different boundaries and responsibilities from everyday intimacy.
  13. Sacred space. Set the session apart as dedicated and protected, and don't let it be casually intruded on. This makes risk-taking possible.
  14. Authenticity and strategic self-disclosure. Share your true reactions when doing so serves the client's growth. Disclosure is deliberate, never unrestricted, and monitored for its effect.
  15. Principle-driven, technique-flexible. Any technique, from your own school or borrowed, is acceptable if it functions to evoke CRBs (Tsai et al. 2013).
  16. Interpretations as rules. Functional interpretations help the client contact the contingencies already operating. Make them functional ("this protects you from…"), not trait labels.
  17. Teach discrimination before response. If the client can't yet tell when a need, feeling or conflict is present, train noticing before training new responses. Otherwise change won't generalise (Callaghan 2006).
  18. Therapist's own work (T1/T2). Your avoidances limit what you can evoke and reinforce. Target behaviours should be in your own repertoire, so do your own ACL work.
  19. Ethical precautions (2015 handout):
    • Stay aware of cultural bias.
    • Don't continue non-beneficial treatment.
    • Be governed by reinforcers that benefit the client, not you.
    • Update the conceptualization continually.

4. Intervention inventory

All example language is illustrative (my wording) unless it is in quotation marks with a citation. Short quotations are taken from the cited handouts and articles. Check them against the originals before quoting in training materials [uncertain]. Forms are described, not reproduced.

A. Assessment and set-up

4.1 FAP case conceptualization form

  • Purpose / when:
    • From the first sessions onward, link daily-life problems to predicted in-session CRBs, and set the therapist's own targets.
    • Revise it throughout therapy.
    • [source: 2012/2013/2015 handouts; Kohlenberg et al. 2002; Ferro García et al. 2009]
  • Steps:
    1. Work through the 12 domains:
      • relevant history
      • daily-life problems
      • problematic beliefs and thoughts
      • variables maintaining the problems
      • assets and strengths
      • in-session problems (CRB1)
      • in-session targets (CRB2)
      • daily-life goals
      • therapy goals
      • planned interventions
      • therapist in-session problems (T1)
      • therapist targets (T2)
    2. Group problems by function, such as distancing others, blurring feelings or avoiding conflict, rather than by symptom (Tsai et al. 2013).
    3. For each daily-life problem, write a specific prediction of how it will look with you, for example "will change the subject when I express warmth". Then write the matching CRB2, for example "stays with it and says what it's like to hear".
    4. FECT uses a shorter six-column version: daily-life problems, history, in-session interpersonal CRB1s, cognitive CRB1s, daily-life goals and CRB2s. It is shared with the client and revised collaboratively (Kohlenberg et al. 2002).
    5. Update the form after any session where a prediction was confirmed or disconfirmed.
  • Example language (illustrative): "You've described pulling back whenever someone gets close. If that happens in here too, it gives us a chance to work on it live. Can we write that down as something to watch for together?"
  • Watch for:
    • CRB lists that are topographical ("cries a lot") rather than functional.
    • An empty T1/T2 section.
    • Predictions never being tested.
    • Working: the predictions start to come true in session, which gives you material to use.

4.2 FIAT assessment and diary card

  • Purpose / when: structured idiographic assessment of interpersonal repertoires across five overlapping classes, at intake and repeated to track change. [source: Callaghan 2006]
    • A: Assertion of needs, including seeking social support.
    • B: Bidirectional communication, meaning noticing your impact on others and giving and receiving feedback.
    • C: Conflict, covering recognising, resolving, over-acquiescing, withdrawing or escalating.
    • D: Disclosure and interpersonal closeness.
    • E: Emotional experience and expression.
    • Each class splits into discrimination problems (noticing the relevant cue and context) and response repertoire problems (avoidance, excess, deficit, unclear responding).
  • Steps:
    1. Preface it: explain that the assessment is idiographic and why you are asking. Build rapport; don't march through classes.
    2. Give the FIAT-Q before session 1 or 2. You can use the whole questionnaire or selected subscales. It is a published instrument; obtain it from the author's materials and do not reproduce its items in client handouts.
    3. Follow up elevated or interesting areas by asking for concrete recent examples, frequency, and whether the client sees the behaviour as a problem. Clients under-report what they cannot discriminate, so use judgement.
    4. Ask for a recent success and a recent failure in each relevant class, and place the client on a continuum between them.
    5. Deliver the FAP rationale (see 4.5). Explain that you expect these problems to show up between you, and why that is useful.
    6. After sessions, rate the presence of each class from your in-session observations together with the client's self-report.
    7. Track daily with the FIAT-DA diary card.
      • Pick the level to suit the client's ability: whole class per day, one salient instance per week, or one instance per day.
      • The client marks Problem, Improvement, both, or No change, and adds when, where and with whom.
  • Example language (illustrative): "When you need something from someone, what usually happens? Can you give me last week's example, and a time it went better?"
  • Watch for:
    • Definitions: clients define "feedback" or "asking" differently, so define terms explicitly.
    • Conflict and violence: distinguish conflict from physical violence, and never normalise violence.
    • Scores: a "no problem" score does not settle anything.
    • Not a full analysis: the FIAT is a shared vocabulary, not a full functional analysis.

4.3 Life-history assignment

  • Purpose / when: early homework that builds the history column and also functions as an evoker. How the client approaches it is CRB data. [source: Kohlenberg et al. 2002]
  • Steps:
    1. Ask the client to write an outline, timeline or short autobiography of major events and relationships.
    2. Read it with the client.
    3. Equally, attend to the process of doing it: procrastination, sparse entries, refusal, over-production.
    4. Discuss that process as possible CRB, non-judgementally.
  • Example language (illustrative): "I noticed this was hard to start. Is that like what happens when you're asked to show people who you are?"
  • Watch for:
    • Shame or flooding when writing about trauma. Allow outline form and pacing [synthesis].
    • Working: it yields predicted CRBs and openings for in-vivo turns.

4.4 Therapist pre-session preparation (greeting meditation)

  • Purpose / when: before each session, prime the therapist's awareness and intention to evoke and reinforce CRB2s. [source: 2012 handout; 2015 handout]
  • Steps: take a few minutes before the client arrives to bring to mind:
    1. Your own history and how it may shape your reactions to this client.
    2. The client's suffering, history and hopes.
    3. The case conceptualization: the likely CRB1s and CRB2s today, and your own T1/T2.
    4. How you will create a space that evokes CRB2s.
    5. Vary the wording regularly so it stays mindful rather than rote (the handout cites Langer, 1989).
  • Example language: internal; not scripted in the sources.
  • Watch for:
    • It becoming a ritual without content.
    • Working: you notice and act on more CRBs in the session.

4.5 Structuring the environment: rationale ("FAP rap") and sacred space

  • Purpose / when: at the outset, and again whenever the client is puzzled by the relationship focus. It makes in-vivo work expected and consented to, and evokes CRBs from the start. [source: Tsai et al. 2013; Callaghan 2006; 2012/2015 handouts]
  • Steps:
    1. Explain that problems people have with others usually show up in therapy too.
    2. Explain that working on them as they happen between you is the most direct way to change.
    3. Explain that you will sometimes ask about what is happening between you, and share your own reactions.
    4. Describe the session as a protected space where taking risks is welcome, and where the client can decline any exercise.
    5. Invite questions.
    6. Treat reactions to the rationale as CRBs. Polite agreement, skepticism and enthusiasm are all data (Kohlenberg et al. 2002).
    7. Re-explain whenever needed (Callaghan 2006).
    8. FECT adds a written brochure listing extra possible foci beyond thoughts: strengths, grief, relationship skills, acceptance and mastery.
  • Example language: Tsai et al. (2013) describe telling the client that the most effective way to change is to "start right here, right now with me." Illustrative: "If the way you shut down with your partner shows up here, I'd like us to notice it together, gently, so you can try something different with someone who's on your side."
  • Watch for:
    • The exact FAP-rap wording in the 2009 Guide is not drawn on [uncertain].
    • Informed consent: make it explicit that therapy may feel more emotionally intense and personal than the client expects [synthesis; the 2015 handout says FAP pushes both parties to take risks].
    • Working: the client starts bringing reactions to you spontaneously.

4.6 Therapist self-assessment and supervision (T1/T2 work)

  • Purpose / when: ongoing. Identify your own avoidance so it doesn't block evoking or reinforcing. [source: 2012 handout; Tsai et al. 2013; Kohlenberg et al. 2002]
  • Steps: answer in writing or with a supervisor:
    1. What do I avoid addressing with clients, and with this client?
    2. How does that avoidance affect the work?
    3. What do I avoid in my own life: tasks, people, memories, needs, grief, anger, fear?
    4. How do those avoidances reach my clients?
    5. What specific skills (T2s) do I need to develop with this client?
    6. What does this client stir up in me? Does it help or hinder? What does it say about the client, and about me?
    7. Record the T1s and T2s on the conceptualization form, then track them.
    8. Workshop materials add experiential practice for therapists. These include non-dominant-hand writing, a loss inventory, closeness-generating questions, role-plays and "good goodbye" exercises, presented as therapist training rather than client protocol.
  • Watch for:
    • T1 examples from the sources include deflecting compliments and changing the subject after client warmth.
    • Working: fewer missed CRB2s, and more turns per session.

4.7 Watching for CRBs (Rule 1, Awareness)

  • Purpose / when: continuously. All other rules depend on it. [source: all handouts; Tsai et al. 2013]
  • Steps:
    1. Hold the predicted CRB list in mind.
    2. Monitor the client's moment-to-moment behaviour toward you and toward the therapy (agenda, homework, scheduling, fees, cancellations, lateness).
    3. Monitor your own reactions. Do you feel drawn in, bored, pushed away, irritated or protective?
    4. Ask whether that reaction is idiosyncratic. Check by asking how others react to the client.
    5. Classify the behaviour as CRB1, CRB2 or both, guided by the conceptualization.
    6. Common disguised avoidance includes joking, excessive crying, intellectualising, "I don't know", unfinished sentences, agreeing without following through, smiling at painful content, and waiting for you to lead (Ferro García et al. 2009).
    7. Watch also for multiple-function requests, such as an oversleeping story that may signal avoiding the session.
  • Example language: Tsai et al. (2013) suggest naming your reaction and asking how a partner, boss or friend would react. Illustrative: "I just felt myself getting a bit lost in the detail. Do people in your life ever tell you they lose you like that?"
  • Watch for:
    • Over-interpreting everything as CRB.
    • Ambiguous cases: the 2012 handout's example is a request that the therapist phone a prescriber, which could be a CRB2 (asking for help) or a CRB1 (dependence) depending on the client.
    • Working: you detect CRB2s that would previously have passed unnoticed.

B. Evoking CRBs (Rule 2, Courage)

4.8 In-vivo turn (out-to-in parallel)

  • Purpose / when: the core FAP move. When the client describes a daily-life problem, turn to whether and how it happens between the two of you. The target is about five turns per session. [source: 2012/2013/2015 handouts; Kohlenberg et al. 2002]
  • Steps:
    1. Listen for a daily-life problem that is on the conceptualization.
    2. At a natural pause, ask whether it shows up in one of the three levels of in-vivo interaction:
      • the therapy: agenda, homework, progress, scheduling, rationale, metaphors
      • the therapy relationship
      • the therapist as a person
    3. Use a soft evoke first: a general prompt about present feelings or body sensations. Use a hard evoke when ready: a direct, relationship-specific question (2015 handout).
    4. If the client says yes, slow down and stay with it in the present.
    5. If the client says no, accept it and stay curious. Note it as a hypothesis to revisit.
    6. Reverse direction too (in-to-out): when something happens with you, ask where else it happens (Tsai et al. 2013).
  • Example language:
    • The 2012 handout gives "Does this happen in our relationship?" and "Do you feel the same way about me?". It also turns a client's helplessness with her husband into a question about whether it appears with the therapist.
    • Illustrative: "You said you never know if your friends actually want you around. I'm curious whether you ever wonder that about me."
  • Watch for:
    • Turns that feel like an ambush; pace them by the client's repertoire.
    • Working: the client engages with the here-and-now, and CRBs appear while you are both present.

4.9 Evocative questions about the therapy and its structure

  • Purpose / when: structure itself evokes CRBs; use it deliberately. This includes the rationale, agenda-setting, homework, time limits, the waiting room, holidays, fees, ending, silences, and therapist errors. [source: Kohlenberg et al. 2002, Table 3 themes; Ferro García et al. 2009]
  • Steps:
    1. At predictable evocative moments, ask about the client's reaction. These moments include setting the agenda, reviewing homework, announcing a break, the last minutes of a session, and after a silence.
    2. Ask about the way to the session and the time in the waiting room: what were you thinking and feeling?
    3. Ask which behaviours bring you closer and which create distance today.
    4. Use the client's answers as CRBs: respond per Rule 3 or 4.13.
  • Example language (illustrative):
    • "When I said I'll be away for two weeks, what happened inside?"
    • "What was it like sitting out there waiting for me today?"
  • Watch for:
    • Formulaic over-use.
    • Working: brief, specific, honest answers that you can respond to.

4.10 Intimacy questionnaires (beginning, middle, end)

  • Purpose / when: a FECT procedure. Short written prompts at three points in therapy invite disclosures about the client and the therapy relationship that might not be said aloud. [source: Kohlenberg et al. 2002, Table 2]
  • Steps:
    1. Give a few open sentence-completion or open questions early, mid-therapy and at the end. Examples of themes: what would be hard for me to face, and what stands out about my interactions with the therapist.
    2. Read the answers together in session.
    3. Reinforce disclosures (Rule 3).
    4. Turn any relationship content into in-vivo work.
  • Example language (illustrative): "Thank you for writing that you worry I'll get tired of you. Can we talk about it now, while it's here?"
  • Watch for:
    • The original item wording was not reproduced here. Write your own prompts [uncertain re exact items].

4.11 Experiential evocative exercises

  • Purpose / when: to evoke emotion, need-statements and vulnerability when talking about them stays abstract. The sources treat any technique as usable for this, if it functions to evoke CRBs. [source: Tsai et al. 2013; 2012/2013/2015 handouts]
  • Steps (non-dominant-hand writing, from the workshop materials):
    1. Explain that writing with the non-dominant hand slows things down and often lets less-filtered material through.
    2. Offer sentence stems. The 2013 handout lists stems such as "I feel", "I'm scared", "It's hard for me to tell you" and "If I had the courage I would".
    3. Give the client a few minutes. Then invite them to read aloud what they choose to share, ideally directly to you.
    4. Respond naturally to the disclosure (Rule 3), and ask what it was like to say it to you.
  • Other evocative techniques the sources list (use with your own training in them): empty-chair work, free association, writing exercises, dream work, mindfulness and acceptance exercises, cognitive restructuring, focusing on bodily sensations, and hypnotherapy. Ferro García et al. (2009) add "prompts" (when you know the likely response) and "probes" (when you don't), including thematic material such as describing another (anonymised) case.
  • Example language (illustrative): "Would you be willing to read me the one that feels riskiest? You can choose not to."
  • Watch for:
    • Overwhelm or dissociation. Offer opt-outs, grounding and pacing [synthesis].
    • Working: the client says something to you that they haven't said before, and stays present while saying it.

4.12 Strategic therapist self-disclosure

  • Purpose / when:
    • Evoke CRBs.
    • Naturally reinforce CRB2s.
    • Model intimacy.
    • Normalise experience.
    • Show genuineness.
    • Equalise power.
    • Use it when it serves the client's growth.
    • [source: Tsai et al. 2013; 2012/2013/2015 handouts]
  • Steps:
    1. Choose the type: your in-the-moment reaction to the client (the most common), relevant history, or a similarity.
    2. Check function first: will this evoke, reinforce, or risk punishing a CRB? Is it for the client or for me?
    3. Disclose briefly and specifically, linked to the client's behaviour.
    4. Observe the effect (Rule 4) and ask about it.
  • Example language:
    • The 2013 handout gives a disclosure beginning "I feel especially close to you right now", tied to the client's vulnerability.
    • Tsai et al. (2013) give "It's really hard to stay connected to you when you pull away" as part of a longer, caring statement in response to a CRB1.
    • Illustrative: "I'm aware I felt a bit nervous asking you that, and I'm glad I did."
  • Watch for:
    • The 2015 handout flags therapist caretaking, dissociation and emotional unsafety as disclosure cautions.
    • Disclosure must not be unrestricted or shift the focus to you.
    • Working: the client moves closer and responds in kind.

4.13 Using therapist mistakes and session events as evokers

  • Purpose / when: ruptures, your errors, lateness, schedule changes and endings are natural evokers of conflict, feedback and needs CRBs. [source: 2015 handout; Ferro García et al. 2009]
  • Steps:
    1. Name the event, such as your mistake or the change.
    2. Ask directly for the client's reaction, including negative feedback.
    3. Treat any honest feedback, need statement or anger expressed without escalation as a CRB2 and reinforce it (4.14).
    4. Take responsibility where appropriate.
  • Example language (illustrative): "I started ten minutes late today. If that annoyed you, I'd really like to hear it. That's exactly the kind of thing we said you swallow."
  • Watch for:
    • Manufacturing errors deliberately is not described in the sources; don't do it [synthesis].
    • Working: the client voices a complaint, and the relationship survives it.

C. Responding (Rules 3 and 4, Love and Awareness)

4.14 Natural reinforcement of CRB2s

  • Purpose / when: the moment a CRB2 occurs, even a small approximation. This is the main change mechanism. [source: all handouts; Tsai et al. 2013; Maitland 2021]
  • Steps:
    1. Recognise the CRB2 against the conceptualization.
    2. Respond immediately, in the way a caring person would naturally respond to that behaviour:
      • If the client asks for something, give it where reasonable, or engage seriously with the request.
      • If the client discloses, move closer and share your genuine reaction.
      • If the client gives feedback, take it in and change something.
    3. Make your response specific to what they did. Amplify a genuine feeling so it is salient; don't manufacture one.
    4. Avoid arbitrary tokens such as "great job" or praise for eye contact.
    5. Optionally, name what just happened and how it affected you.
    6. Then go to Rule 4.
  • Example language:
    • In Tsai et al. (2013), the therapist answers a client's flat claim of being unlovable with "What if that doesn't match my experience?", then expresses caring and sadness.
    • Illustrative: "You just told me straight out that you needed me to slow down. I really appreciate that. It makes it so much easier to be with you. Let's slow down."
  • Watch for:
    • The reinforcement conundrum: effortful reinforcement tends to come out arbitrary. If it does, ground it in your real reaction.
    • Working: the CRB2 recurs and grows within the session and across weeks.

4.15 Responding to CRB1s: blocking, prompting and gently discouraging

  • Purpose / when: when a CRB1 occurs. The aim is to reduce it and create room for a CRB2, without punishment that teaches more avoidance. [source: 2015 handout; Kohlenberg et al. 2002; Tsai et al. 2013]
  • Steps: the options listed in the sources are:
    1. Notice and name the behaviour, compassionately and tentatively.
    2. Gently block avoidance: return to the topic or moment the client left.
    3. Re-present the evoking question or situation.
    4. Prompt the alternative: ask for the CRB2 directly.
    5. Ignore minor CRB1s (extinction) when naming them would derail the session.
    6. Share the natural impact of the CRB1 on you, caringly.
    7. As soon as any CRB2 appears, switch to 4.14.
  • Example language:
    • Kohlenberg et al. (2002) describe treating a dismissive "nothing important" after a pause as a CRB1 to explore gently.
    • Illustrative: "You said 'nothing important', and something crossed your face. I'd rather hear the unimportant thing. What was it?"
  • Watch for:
    • Responses that feel like criticism. Clients with a history of punishment may hear naming as attack.
    • Working: the client tries the alternative, even partially.

4.16 Noticing your effect (Rule 4)

  • Purpose / when: right after each contingent response (micro level), and across weeks (macro level). Reinforcement is defined by its effect. [source: all handouts; Tsai et al. 2013]
  • Steps:
    1. Micro level: watch the client's next behaviour. Did they continue, deepen, or withdraw?
    2. Ask directly how your response landed.
    3. If the CRB2 weakened, your response may have been aversive, arbitrary or mistimed. Try a different natural response next time.
    4. Macro level: review the bridging forms, the FIAT-DA card and the CRB tally monthly. Ask whether the target is strengthening and generalising.
    5. Watch for overshoot. The 2012 handout's example is a client who, months later, seeks the therapist's advice on everything.
  • Example language (illustrative): "When I said I felt moved just now, what was that like to hear?"
  • Watch for:
    • Taking the client's politeness as evidence.
    • Working: you can point to specific behaviours that have changed.

D. Interpretation and generalisation (Rule 5)

4.17 Functional interpretation

  • Purpose / when: after an in-vivo sequence, or when the client offers a problematic explanation (a CRB3). Build an accurate account of what controls the behaviour. Interpretations work as rules that help the client contact real contingencies. [source: 2012 handout; Tsai et al. 2013; Ferro García et al. 2009]
  • Steps:
    1. Describe the sequence in plain behavioural terms: situation, what the client did, what it achieved in the short term, and what it cost.
    2. Link it to history, meaning how it made sense in past relationships, so it is less blaming (Kohlenberg et al. 2002).
    3. Link it to the present relationship and daily life, in both directions.
    4. Invite the client to build the description themselves: shape their CRB3s toward accurate functional statements.
  • Example language:
    • The 2012 handout asks "How has this change in our relationship mirrored your relationships with others?"
    • Illustrative: "When I got close, you made a joke, and the moment passed. That kept you safe from being hurt, like it did growing up, but it also leaves you lonely."
  • Watch for:
    • Intellectualised interpretation replacing experience.
    • Working: the client starts spotting the function spontaneously.

4.18 Generalisation homework ("take it on the road")

  • Purpose / when: after a CRB2 in session. Assign the same improved behaviour with a significant other. [source: Tsai et al. 2013; Kohlenberg et al. 2002; 2015 handout]
  • Steps:
    1. Name the CRB2 that just occurred.
    2. Agree on one specific person and situation to try it with this week.
    3. Anticipate obstacles.
    4. Ask the client to log what they did and how the other person responded.
    5. Review it next session.
    6. Workshop variants:
      • an interpersonal risk assignment, such as expressing gratitude, an apology or a longing to someone, then reporting back
      • a daily "towards-moves" log of small relationship-enhancing actions
    7. FECT variant: after testing a belief with the therapist, test the same belief with someone in daily life.
  • Example language (illustrative): "You just asked me directly for what you needed. Who's one person you could ask like that before we meet again?"
  • Watch for:
    • Unsafe targets: don't send a client to be vulnerable with an abusive person [synthesis].
    • Non-completion is itself a CRB (see section 5).
    • Working: outside improvements are recorded.

4.19 Session bridging form

  • Purpose / when: between every session. It extends the session, evokes CRBs in writing, and gives Rule 4 feedback. Reprinted from the 2009 Guide. [source: Tsai et al. 2009, via ACBS handout]
  • Steps:
    1. Part A, soon after the session:
      • what stood out (thoughts, feelings, insights)
      • 1–10 ratings of helpfulness (and what did or didn't help), connection with the therapist, engagement and presence
      • what would have helped more, and anything the client held back from saying or asking
      • how session events or the therapist mirror daily-life problems
      • risks taken and progress that can be carried outside
    2. Part B, just before the next session:
      • the week's high and low points
      • what to address next time
      • a percentage rating of how open they were in completing the form
      • anything else
    3. Read the form at the start of the session.
    4. Treat what the client held back as an evocative opening, and reinforce candid answers.
  • Example language (illustrative): "You wrote that you almost asked me something last time. Want to ask it now?"
  • Watch for:
    • Low openness percentages and blank "held back" boxes are useful CRB data.
    • Write your own form; don't copy the Guide's.

E. FAP-enhanced cognitive therapy (FECT) procedures

4.20 Expanded cognitive model and in-vivo thought work

  • Purpose / when: when FAP is added to CBT for depression. Retain CT structure and add in-vivo focus. [source: Kohlenberg et al. 2002]
  • Steps:
    1. Assess the sequence: ask which came first, the thought or the feeling.
      • If it follows A-B-C (the belief drives the reaction), standard CT methods fit.
      • If it follows A-C, B-not-causal or A-C-B, drop the cognitive-causation hypothesis and use the expanded rationale.
    2. Modified thought record:
      • Record whether thinking, feeling or doing came first.
      • Add an "in vivo" column: how might this thought or feeling show up with the therapist?
      • Add a column for alternative, more effective actions.
      • Add a commitment rating: unwilling, willing to try, or willing to act effectively while still having the thoughts and feelings.
    3. Cognitive CRBs: when a core belief appears in session about the therapist (defective, failure, helpless, loser in relationships), test it there and then. Examples: "you must be bored with me", or feeling unable to influence the therapist.
    4. Assign homework from in-session work.
    5. Keep agenda, goals and end-of-session feedback, and treat reactions to them as CRBs.
  • Example language (illustrative): "You think I see you as a failure for not doing the homework. Would you be willing to check that with me right now?"
  • Watch for:
    • Persisting with A-B-C when it doesn't fit the client, which Kohlenberg et al. note can damage the alliance.

F. Ending

4.21 ACL termination and the therapist's goodbye letter

  • Purpose / when: the termination phase. The ending is a chance to practise a healthy goodbye and consolidate gains. [source: Yates, Sanida, Tsai & Kohlenberg 2017]
  • Steps:
    1. Awareness: explore what past transitions and losses the ending stirs up, how the client usually handles loss and grief, and how to end well together.
    2. Courage: say, in your own voice, what has been unique about working with this client: what was most vulnerable to say, how they touched or inspired you, what you'll remember. A written letter or card the client can keep is preferred; spoken is acceptable.
    3. Love: reflect back the client's progress and best self. One option is a personalised narrative (short story, metaphor, poem, fairytale) weaving in their history, challenges, strengths, hopes and key session moments.
    4. Invite the client's own goodbye. Reinforce honest expression of sadness, gratitude or anger as CRB2s [synthesis].
  • Example language: Yates et al. suggest asking "How can we say goodbye in a way that would be healing and memorable?"
  • Watch for:
    • Letters that over-promise availability or blur boundaries [synthesis].
    • Termination timing is not specified in the source [uncertain].

5. Handling problems

In FAP most "problems" are themselves CRBs, to be watched for, evoked and responded to rather than managed around. Source-based guidance is tagged with its source. Guidance marked [synthesis] is my own, consistent with FAP principles but not given in the sources.

Client finds the relationship focus strange, intrusive or "not what I came for"

  • Re-deliver the rationale, as often as needed (Callaghan 2006).
  • Ask about the reaction itself: polite compliance, irritation and confusion are all possible CRBs (Kohlenberg et al. 2002).
  • Reduce the intensity: use soft evokes and more daily-life work with occasional turns, and build up as trust grows [synthesis].
  • If the client clearly declines in-vivo work after informed discussion, respect it. Use FAP principles quietly within another approach (FECT shows FAP layered on standard CT), and don't push [synthesis].

Avoidance and "resistance" in session

  • Treat these as CRB1s and explore them gently: "That's fine, whatever", "nothing important", "I don't know", smiling at painful material, unfinished sentences, waiting for you to lead, refusing questionnaires (Kohlenberg et al. 2002; Ferro García et al. 2009).
  • Respond with 4.15. Never argue a client out of avoidance. Make a small step easier and reinforce it.
  • Check that the avoidance isn't a reasonable response to something you did (4.13).

Stuck: no CRBs appearing, or sessions stay at the daily-life level

  • Revisit the conceptualization. The predicted CRBs may be wrong, or too topographical (2015 handout lists continual updating).
  • Count your in-vivo turns; if far below about five per session, increase them (2012/2013 handouts).
  • Check your T1s: are you avoiding closeness, conflict or emotion yourself? Take it to supervision (4.6).
  • Use structured evokers: bridging forms, intimacy questionnaires, non-dominant-hand writing.
  • Ask directly what the client hasn't said to you [synthesis drawn from the bridging-form content].

Non-adherence to homework, forms or tasks

  • Treat it first as a CRB, not a compliance problem (Ferro García et al. 2009; Kohlenberg et al. 2002 note how the client approaches the history assignment).
    • What function does not doing it serve? Avoiding evaluation, protest, overwhelm?
    • Does it mirror outside patterns?
  • Reinforce honest disclosure about not doing it as a CRB2.
  • Then shape: smaller assignment, co-designed in session [synthesis].

Overwhelm, flooding or dissociation

  • The sources say not to require more than the client's current repertoire (Tsai et al. 2013), and to take "tolerable" risks (2013 handout).
  • Concretely [synthesis]:
    • Slow down and shift to a soft evoke or the present-moment body.
    • Name that you pushed too fast and take responsibility.
    • Ask what would help.
    • Agree a signal the client can use to pause. Using that signal is itself a CRB2 (asserting a need).
  • With trauma histories, add standard stabilisation before deep in-vivo intimacy work [synthesis].

Ruptures and the client's anger at you

  • For many clients, direct negative feedback or anger expressed without escalation is a CRB2 (FIAT Classes B and C). Thank them, take it in, and change something visible. That is the natural reinforcer (2015 handout on mistakes as opportunities; Callaghan 2006).
  • Distinguish this from escalation or threats, which are CRB1s. Set clear limits and do not normalise violence (Callaghan 2006).
  • Repair explicitly [synthesis].

Your response didn't work, or the CRB2 dropped off (Rule 4 failure)

  • Your response may have been arbitrary, mistimed or aversive. Ask the client how it landed and try another natural response (2012 handout; Tsai et al. 2013).
  • If you are forcing reinforcement, return to your genuine reaction (the reinforcement conundrum).

Overshoot and dependence

  • The 2012 handout's example: a client who, months on, seeks the therapist's advice about everything.
  • Re-examine whether the original CRB2 (asking for help) is now functioning as a CRB1 (reliance, avoiding self-direction).
  • Shift reinforcement to independent and reciprocal behaviour.
  • Generalise support-seeking to other people (FIAT Class A) [synthesis on specifics].

Therapist self-disclosure goes wrong

  • Signs: the client starts caretaking you, you feel exposed or dissociated, or the focus shifts to your story (2015 handout cautions).
  • Stop, re-centre on the client, name the shift, and take it to supervision.
  • Disclose less and more briefly next time (Tsai et al. 2013: deliberate, not unrestricted).

Boundary and intimacy risks (romantic or erotic feelings, wishes for friendship)

  • The sources state that therapeutic intimacy has different boundaries and responsibilities from everyday intimacy, and that the therapist must be governed by reinforcers that benefit the client (2012, 2015 handouts).
  • Concretely [synthesis]:
    • Treat a client's expressed attraction as possible CRB2 (honest disclosure) or CRB1 (a familiar pattern), and respond with warmth and clear limits.
    • Never act on it.
    • Monitor your own attraction or rescuing as T1s.
    • Seek consultation early.
    • Document.
    • Contact between sessions and the meaning of "love" in FAP should be discussed explicitly in informed consent.

Iatrogenic worsening

  • In a small study, some participants worsened on fear of intimacy and distress (Maitland 2021).
  • Monitor outcomes routinely (FIAT-Q repeats, bridging-form ratings, standard symptom measures).
  • If deterioration persists, reduce intensity, review the formulation, and consider changing or ending treatment; the 2015 handout says not to continue non-beneficial treatment [synthesis on steps].

Suicide and self-harm risk

  • The sources do not give a risk protocol. One published case involved self-harm and hospitalisations, but no procedure is described (Ferro García et al. 2009) [uncertain].
  • [synthesis]:
    • Follow standard practice: structured risk assessment at intake and when indicated, collaborative safety planning, and lethal-means counselling (safe storage and removal).
    • Agree a crisis plan outside the session.
    • Disclosure of suicidal thoughts to you is often a CRB2 (courage); respond with warmth while doing the risk assessment.
    • Never treat risk communication as a CRB1 to be extinguished or ignored.
    • Avoid hard evokes when the client is acutely unsafe.

Cultural mismatch

  • The 2015 handout lists awareness of cultural biases. What counts as appropriate directness, disclosure, eye contact or expression of anger varies across cultures.
  • Define CRB2s with the client, from their values and community norms, not from the therapist's style [synthesis].

Termination stirs grief or anger

  • Expected. Use the Awareness step of 4.21 and treat the client's expression of loss as CRB2 (Yates et al. 2017).
  • If the client drops out abruptly rather than say goodbye, consider a brief written note. It offers a closing session without pressure [synthesis].

FECT-specific: the cognitive model doesn't fit

  • Assess the thought–feeling sequence and drop A-B-C causation when it doesn't fit. Use the expanded rationale (Kohlenberg et al. 2002).

Sources

Sources

Further reading (not drawn on in full) [uncertain: content known only via the handouts, reprints and TOC above]

  • Kohlenberg, R. J., & Tsai, M. (1991; reissued 2007). Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Relationships. Plenum/Springer.
  • Tsai, M., Kohlenberg, R. J., Kanter, J. W., Kohlenberg, B., Follette, W. C., & Callaghan, G. M. (2009). A Guide to Functional Analytic Psychotherapy: Awareness, Courage, Love, and Behaviorism. Springer.
  • Kanter, J. W., Tsai, M., & Kohlenberg, R. J. (Eds.) (2010). The Practice of Functional Analytic Psychotherapy. Springer.
  • Tsai, M., Kohlenberg, R. J., Kanter, J. W., Holman, G. I., & Loudon, M. P. (2012). Functional Analytic Psychotherapy: Distinctive Features. Routledge.
  • Holman, G., Kanter, J., Tsai, M., & Kohlenberg, R. (2017). Functional Analytic Psychotherapy Made Simple. New Harbinger.
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