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Robert J. Kohlenberg
This document is copyrighted by the American Psychological Association or one of its allied publishers.
University of Washington
Functional analytic psychotherapy (FAP) promotes client growth by shaping clients daily life problems
that also show up in session with their therapists. FAP therapists create evocative contexts within therapy
that afford clients the opportunity to practice, refine, and be reinforced for new, more adaptive behaviors
which then can be generalized into their outside lives. In FAP, the termination process will vary from
client to client depending on the nature of the clients problems and targets. For many clients, the process
can be a rich, multifaceted, final opportunity to evoke, reinforce, and promote generalization of clients
in-session improvements, particularly improvements related to vulnerable self-expression in the service
of intimate and close relationships. By making explicit agreements at the outset of therapy to participate
in an intentional termination process, and by later providing an evocative structure for ending therapy
with vulnerable emotional expression, clients have the opportunity to develop more adaptive behaviors
in the context of relationship endings which can be a painful part of the human experience. Equipped with
the skills of open-hearted communication developed from an authentic relationship with their therapist,
clients can leave therapy on a trajectory of further growth in interpersonal connection and living more
boldly.
Meaningful, reciprocal, and intentional goodbyes are rare in the creation of a therapy relationship that parallels the clients daily
relationships that populate our everyday lives. Often people inad- life relationships such that the therapeutic connection can be a
vertently slip apart without saying goodbye. Sometimes they part vehicle of growth and transformation in the clients daily life. For
ways with unspoken anger or with misunderstandings, leaving the many FAP clients, the termination process becomes a final, mem-
relationship incomplete. Except perhaps when a death is being orable moment of an intense, caring, and evocative therapy rela-
prepared for, rarely is the ending of a relationship fully realized as tionship where the hearts of both therapists and clients have been
a distinct opportunity to share deeper levels of vulnerability, ex- touched from the beginning (Tsai et al., 2009). FAP therapists
change heartfelt feedback, and acknowledge the gifts and lessons strive for meaningful endings with clients and see termination as
received. Functional analytic psychotherapy (FAP), a contempo- an opportunity to help clients end a relationship well, in the hopes
rary contextual behavioral therapy grounded in empirically sup- that this experience will help them with vulnerable self-expression
ported principles (Kohlenberg & Tsai, 1991), emphasizes the around difficult emotions in general, and with ending relationships
with authenticity in particular.
1
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seen as relevant cross-diagnostically (Wetterneck & Hart, 2012), intensity and content depending on the nature of the clients targets
and targeting them may have positive impacts on both mental and and the reasons for termination, in this article we describe a fairly
physical health (Cacioppo & Patrick, 2008; Holt-Lunstad, Smith, intense, emotionally evocative termination procedure. This prac-
& Layton, 2010). tice does not apply to all FAP clients but does reflect how a FAP
Given its conceptual framework, FAPs unique contributions termination may be unique, challenging for both therapists and
stem from the application of behavioral concepts that suggest clients, and potentially powerful. We discuss how for some clients
novel and more precise interventions based on FAPs five rules. the termination process may evoke CRB1s related to inauthenticity
These rules are not rigid prescriptions, but are guidelines that and avoidance of vulnerability, and may present a unique and
specify therapist behaviors aimed at maximizing therapeutic op- powerful opportunity to work on CRB2s of fully opening to the
portunities which may otherwise go unnoticed, and which typically experience of loss as part of life, and the vulnerable and authentic
lead to clinical improvement. Very briefly, they involve: (a) being expression of caring and appreciation, one final time.
aware of clients clinically relevant behaviors (CRBs)problem
behaviors (CRB1s) and target behaviors (CRB2s) occurring within Initiating Discussion of the Termination Process
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
in their outside relationships, (b) evoking CRBs, (c) naturally In FAP, attention is paid to the therapeutic relationship from the
reinforcing CRB2s, (d) noticing the impact of interventions, and beginning. An explanation of the therapy rationale may include:
(e) using behavioral interpretations and assigning homework to
Our connection provides an opportunity for you to explore how you
help clients generalize target behaviors to daily life (Kanter, Tsai,
are in a relationship and to experiment with different ways of relating.
& Kohlenberg, 2010; Kohlenberg & Tsai, 1991; Tsai, Callaghan, Together, we will consider how your interactions with me reflect your
& Kohlenberg, 2013; Tsai, Kohlenberg, Kanter, Holman, & Plum- interactions with others in your life, how problems that may arise with
mer Loudon, 2012; Tsai, Yard, & Kohlenberg, 2014). me may parallel those that come up with others, and likewise, how the
At the core of FAP is its hypothesized mechanism of clinical positive behaviors you develop with me can translate into your rela-
change contingent and effective therapist responding to client tionships with other people.
problematic behaviors and behavioral improvements as they occur
here and now in session. In other words, rather than just talking In that vein, initial queries include not only the typical assessment
about daily life problems that occur elsewhere, FAP focuses on of treatment goals ubiquitous to early therapy sessions, but also
how these problems (CRB1s) show up in the therapy relationship, questions such as,
and how clients can emit more effective target behaviors (CRB2s) How do you usually begin relationships (e.g., do you jump in quickly,
with the therapist. Then, the therapist works to facilitate general- try to make a good impression, start with high hopes then get disap-
ization of these in-session improvements to the clients daily life. pointed, or quickly become critical?) and what are the similarities and
While FAP is rooted in a functional contextual philosophy, our differences between your usual style of beginning relationships and
goal in this paper is to offer a framework that enables therapists, how you are starting this one with me?
regardless of theoretical orientation, to increase the impact of the
termination process. This discussion at the outset of the relationship is a good time to
Consistent with the contextual nature of FAP, CRB1s and raise how it could end. Here is a typical interaction that can take
CRB2s are functionally defined. That is, a CRB1 for one client, place in a first FAP session:
given their history and case conceptualization, might be a CRB2 T: Youve talked about how a primary goal for you is to
for another. For example, asking to end therapy in one case might learn how to connect more deeply with others, but that
be a CRB1 (e.g., engaging in a pattern of avoiding going deeper you tend to give up on your relationships when your
into painful topics) and in another case might be a CRB2 (e.g., needs arent being met, and you leave without talking
being assertive in expressing ones needs when one has a history about it. What are the chances that will happen with me?
of doing what others want).
Overall, FAP assumes that clients patterns of intra- and inter- C: Thats possible.
personal functioning which keep them stuck in their daily lives
likely will play out in the therapy relationship. Applied to rela- T: I hope you will give us the chance to have a good ending.
tionship endings, there may be a tendency for clients to dodge the The building of trust is really important in any relation-
reality of termination until the final moments of contact, to side- ship, and that involves honest communication and the
step direct communication about the mutual meaning and impact honoring of agreements. Ill be checking in with you
of an impending termination, to assume and behave as though their regularly via session bridging questions (see Tsai et al.,
departure is of little consequence to the therapist, to avoid conflict 2009, Appendix D) and in session about how youre
and just drop out if they are unhappy, or to taper so gradually that reacting to the therapy and to me, and whats hard for
an intentional final session never occurs. you to say. Ill be creating a safe place for you to express
This article focuses on how to increase the likelihood of a good yourself honestly. Will you do your best to show up fully?
ending through employment of FAP principles and techniques. C: Yes, Ill try my best.
First, we suggest it is useful to obtain an agreement at the begin-
ning of therapy from clients that they will end the relationship in T: Since endings and loss are a part of life, our therapeutic
a thoughtful, intentional way. Then, we describe steps that we have relationship affords us a unique opportunity to end an
found useful in creating meaningful and healing termination pro- important relationship thoughtfully by discussing the im-
cesses with clients. Although termination in FAP will vary in pact we have had on each other. Will you make an
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agreement with me that we will take at least two sessions throughout therapy, termination presents a potentially powerful
to process the ending of our therapy in a way that final opportunity to work on these targets.
acknowledges what its meant to both of us, that gives us Part of reinforcing CRB2s in our clients is to evoke and shape
a sense of closure? their target behaviors, in this case, by initiating a reciprocally
vulnerable exchange of heart-felt emotional expression as we say
C: That sounds kind of anxiety-provoking, but yes, Im
goodbye. Therapists are invited to address the following questions
game.
as they say a good goodbye to their clients:
How has your client impacted or moved you in memorable
Key Steps in Processing the Ending of Therapy ways?
As in any good termination process, it is important to review Any regrets?
with our clients their progress, what they have learned, what they How have you grown as a result of the work you have done
are taking away from our work together, and the skills they want with this client?
to keep implementing to prevent relapse and to maintain their Has your work together inspired or motivated you? Healed
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
gains. In this section, however, we would like to emphasize a more something inside you? Renewed your enthusiasm for your
This document is copyrighted by the American Psychological Association or one of its allied publishers.
FAP-specific termination that: (a) focuses clients reactions to the work or your relationships?
end of the therapy relationship by exploring and tying in the losses What are your clients unique and special qualities? What
they have experienced in life and related CRBs, and (b) empha- will you always remember about this client? What will you
sizes the therapist being courageous and vulnerable in evoking and miss?
reinforcing client CRB2s related to vulnerability and authentic What do you want your client to remember about you and
expression one final time. your therapy?
What are your hopes for your client?
We encourage therapists to consider writing a letter that answers
Loss of the Therapy Relationship in the Context of
these questions in written form as a final gift and remembrance of
Previous Loss Experiences and Related CRBs the special interactions they have had with their client. We aim to
Termination will bring up different CRBs for clients depending write letters that the client will treasure as a summary of their
on their previous loss experiences. For example, a client who growth, their strengths, and their personal impact on the therapist.
suffered an early maternal loss may cling and have a very difficult Typically, the therapist will read the letter aloud in the next to last
time saying goodbye, whereas someone who has been hurt by session with the client, giving the client a chance to absorb it,
unreliable partners may want to shut down and avoid saying discuss it in the last session, and write a letter in return.
anything meaningful. In addressing previous experiences of loss Here is an example of a FAP termination process which repre-
and related CRBs, clients are asked questions such as these: sents the authors experiences and work. The client, Thomas, is
a composite of several depressed clients, the therapist client dia-
Since the end of therapy often brings up feelings and logue is based on an amalgam of our clinical work, and material
memories of previous transitions and losses, what is com- has been de-identified to maintain confidentiality.
ing up for you from the past as we prepare for our good-
T: Its important for us to say goodbye as if we will not see
bye?
each other again so that you can experience a real
What are the losses you have endured in your life that stand ending. The reality is that anyone can go at any time, and
out to you from earliest memories to the present? What has we never know if an encounter will be the last time. So Id
made you sad, what has broken your heart, what has left a like us to act as if these last two sessions will truly be the
gap in your life? last time we will see each other, so that we can say
goodbye in the fullest way possible emotionally, and
How do you usually handle loss, endings, and grief? Do leave nothing unsaid. After weve done that, then we can
you have particular trouble with this? talk about what kind of contact would be helpful to you in
the future. How does that sound?
What thoughts and feelings are you having about the end-
ing of our therapy relationship? C: Im not sure. Ive never done this before. How will this
help me?
This final phase of therapy may take several weeks to many T: Most people avoid being real when they say goodbye.
months, depending on the degree to which the clients previous They avoid meeting each other with the pain of loss and
experiences of loss are extensive and related to the primary prob- the joy of moving on to the next chapter in life. Youve
lems targeted throughout therapy. grown so much in your work with me that I know you can
meet me in this place of being real about what saying
Evoking and Reinforcing CRB2s Related to goodbye means. This is a final chance for you to practice
Vulnerability and Authentic Expression being in touch with your feelings in a deep way and
expressing them to me, and receiving what I have to say
As clients discuss topics related to termination, we want to focus
to you. And you know how much this ability has improved
on a typical FAP process of shaping CRB2s related to vulnerability
your relationships and will continue to do so.
and authentic expression. Particularly if these targets are part of the
case conceptualization and something we have been working on C: Youre right. Ok, I will try my best.
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T: I wrote this letter for you, and I want to read it out loud. What regrets do you have about our therapy or what would
May I read it to you now? you like to have gone differently?
C: Ok. What stands out to you most about your interactions with
T: Thank you for giving me one of the best gifts a client has me? What will you always remember?
ever given meyour promise not to commit suicide. That
Can you use this experience with me to identify how you
gift from you means so much to me because Ive wit-
want to be in other relationships?
nessed numerous times the devastation that my col-
leagues endure when their clients kill themselves. You If it is a good idea to treat every moment in a relationship
taught me that I needed to trust my instincts, and to trust as if it were the last, how do you want to be in this last
you, that hospitalizing you when you were suicidal would moment with me? What can you take from this into your
have pushed you over the edge. Even though you came other relationships?
close so many times to committing suicide, I know that it
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
was an act of love on your part for me that you didnt do Some clients will come to their final session prepared with a
This document is copyrighted by the American Psychological Association or one of its allied publishers.
it. I will be forever grateful to you that you made the written letter for their therapist. Often, this letter demonstrates the
decision to live. transformation the client has undergone in therapy. FAP empha-
You are one of the most generous people Ive ever had sizes that how a therapist responds to CRB2s expressed in the
the privilege to knowwith ALL of your resourcesyour termination letter or conversation is critical insofar as client im-
love, your time, your money, your thoughtfulness, your provements only will be strengthened to the extent they are rein-
possessions to anyone in need, whether they are close forced. For this reason, FAP therapists try to maximize their
family members, or homeless strangers on the street reinforcing value by open-heartedly receiving their clients senti-
sleeping in the cold. Your generosity was incredibly ments and authentically self-disclosing the impact of the exchange.
inspiring to me, and has made me a bigger person in This may lead to intense emotions felt and expressed on both sides,
terms of how I give to others. Because of you, I have a with teary eyes and sometimes hearty laughter filling the room.
regular habit of dropping off items at Union Gospel Following is additional dialogue between the composite client
Mission for the homeless, and I will always think of you Thomas and the first author in their last session, including parts
whenever I drop things off. I will never forget youyou of the letter he wrote to his therapist:
will always have a special place in my heart. I love you
as deeply as a therapist can love a client. C: Heres what I wrote: The most important thing that I
C: I do not know what to say (tearing up). learned in this therapy is that someone can really care
about me. Your obvious concern and caring really stand
T: Im touched by your emotion. It seems youre really out to me, and I learned that I can alter my actions
getting how important you are to me? despite how stubborn I am. Because of your enormous
help, and how much you became a part of my life, I came
C: Yes, I cannot believe you took the time to write this letter.
to see that I would harm you and other people Im close
Im always going to treasure it.
to if I killed myself. I learned that there are other solu-
T: I took the time to write it because I want to honor how tions, like focusing on how much I can help others who
memorable our relationship has been by saying goodbye are less fortunate than me. Your love for me was a
in a powerful way. therapeutic love that helped me re-ignite my passion for
my wife. I love you and saying good-bye to you hurts.
C: Im not that good at writing letters, but Im going to do
my best to answer the questions in writing that you gave T: It means a lot to me that you took the time to write this
me for next week. letter, to tell me how important my caring has been in
As alluded to in the dialogue above, clients for whom this helping you choose life. Do you see how this letter really
process is appropriate are asked to prepare for the final session by shows how much you have grown?
responding to a list of questions (see below) aimed at helping them
C: Yes. I never would have been able to express myself so
to expand their repertoire around loss and endings, and to increase
clearly.
the likelihood of an impactful closing. They are invited to write a
letter back to the therapist if they want to, but if not, to at least be T: I do not think so either. It is really amazing to me. What
prepared to respond to the questions in session. I see is this really perfect example of you, feeling a lot of
pain, the hurt of saying goodbye to me, but moving
Key Aspects of the Process During a Final Session toward this generous spirit of yours in this moment of
pain instead of choosing less functional options like
These are the questions that clients are invited to address in the
final session, either orally, or in writing if they choose. suicide. In your pain you help me connected with me
more by expressing it so beautifully and letting me know
What is hard for you to express to me as we say goodbye? how I have touched you. This is exactly what I hope you
can take from our work and bring with passion into your
What have you appreciated about me and our therapy? relationship with your wife.
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C: Its still hard to be this vulnerable with my wife, but we Broadly speaking, the termination phase is seen as essential in
are a lot closer and I know I need to keep trying . . . I do psychodynamic and interpersonal approaches, which may view the
not need to see you anymore right now, but what if that process as a corrective emotional experience (Craige, 2002; Joyce,
changes in the future? What are your rules about staying Piper, Ogrodniczuk, & Klein, 2007). The cognitive behavioral
in touch? literature, in contrast, is primarily concerned with premature
termination (Goldfried, 2002) and places less emphasis on the
T: You can always contact me if you want more therapy in termination process. Although FAP is generally viewed as a be-
the future. If anything big happens in your life, Id havioral or contextual behavioral approach (Hayes, Barnes-
appreciate an email update from you. I promise I will Holmes, & Wilson, 2012), it clearly falls into the camp of focusing
write back. You know that our connection continues for on endings as providing opportunities for growth that can gener-
me even if we arent seeing each other, and I hope you alize to daily life.
will carry with you all that youve learned in this rela- Although some may find the suggestion that therapists write a
tionship with me. letter to their clients as part of the termination process to be
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
6 TSAI ET AL.
happens over the course of the entire relationship is what really pression: A successful and unsuccessful case using functional analytic
matters. Cocreating a deep, authentic, open-hearted relationship psychotherapy. Journal of Applied Behavior Analysis, 39, 463 467.
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boundaries and provides inspiring ways for scientist-practitioners Enhancing cognitive therapy for depression with Functional Analytic
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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This document is copyrighted by the American Psychological Association or one of its allied publishers.
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apy, 40, 110. http://dx.doi.org/10.1007/s10879-009-9116-6 Received July 5, 2016
Tsai, M., Yard, S., & Kohlenberg, R. J. (2014). Functional analytic psy- Revision received August 1, 2016
chotherapy: A behavioral relational approach to treatment. Psychother- Accepted August 12, 2016
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.