An important distinction was made in Chapter 1 between natural reinforcement (which resembles and functions similarly to genuine and caring relationships in the client’s community) and contrived reinforcement (the ‘reward’ most
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commonly associated with behaviorism, including purposely smiling, saying
‘‘that’s good’’, and giving tokens or monetary reinforcers). Rule 3 is somewhat enigmatic in that FAP is based on the assertion that reinforcement is the primary mechanism of change, yet deliberate efforts to reinforce run the risk of producing contrived or arbitrary, rather than natural reinforcement. The following recommendations seek to resolve this conundrum by suggesting approaches therapists can use to be more naturally reinforcing and avoid using contrived reinforcement. Such naturally reinforcing behaviors are described as
‘therapeutically loving.’ Therapeutic love is ethical, is always in the client’s best interests, and is genuine. Loving clients does not necessarily mean using the word ‘love’ with them, but it does mean fostering an exquisite sensitivity and benevolent concern for the needs and feelings of clients, and caring deeply.
Factors that determine whether therapists’ reactions are likely to be thera-peutically loving and naturally reinforcing include: responding to CRB1s effectively; being governed by clients’ best interests and reinforced by their improvements; having clients’ goal repertoires; matching one’s expectations with clients’ current repertoires; and amplifying one’s feelings to increase their salience. Because the blocking of CRB1s is so closely tied to the evoking and reinforcing of CRB2s, this discussion begins by describing the best ways for therapists to respond to CRB1s.
Responding to CRB1s Effectively
Addressing CRB1s often involves making therapeutic use of negative personal reactions representative of the client’s community. One such example is pro-vided in Kanter, Tsai, and Kohlenberg (in press), in which the FAP therapist let his client know that he was coming across rather ominously. It is important to underscore, however, that CRB1s are addressed in the context of therapist care and concern for the client, and a conceptualization of the client’s problems in terms of historical and environmental factors rather than as something
‘inside’ or inherent in the client. It is also vital that the client concurs that certain behaviors are in-session problems connected with daily life problems, and that the therapist has a belief in the client’s ability to produce more adaptive behavior in response to a CRB1 being pointed out.
It is best to address CRB1s after the client has experienced sufficient natural positive reinforcement and a solid therapeutic relationship has formed, and after a client has given permission for the therapist to do so (e.g., ‘‘We’ve talked about how it’s a problem for people to track you when you go off on tangents. Is it okay for me to interrupt you when you do that with me?’’). If possible, it is best to address or block a CRB1 after the client already has emitted a CRB2 counterpart. For example, a therapist can say, ‘‘You know how sometimes you are really able to let yourself feel your sadness with me? What’s stopping you from doing that right now?’’ Tone of voice and other non-verbal cues (e.g.,
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leaning forward, moving the chair closer) also act as reinforcers. In gene-ral, compassionately toned responses to CRB1 are appropriate unless that approach has not been effective in the past. Simply punishing CRB1s is almost never encouraged, except in the most extreme situations involving life-threaten-ing behavior. In addition, punishment carries risks. In particular, it is well known that punishment in the absence of positive reinforcement for alternative behavior generally yields only temporary decreases in the targeted behavior.
Further, the punisher, in this case the therapist, may elicit fear and frustration resulting in avoidance or termination of treatment. For more on how to work with client avoidance refer to Chapter 7, The Course of Therapy.
Being Governed by Clients’ Best Interests and Reinforced by Their Improvements
Caring for clients means being governed by what is in their best interests and being reinforced by their improvements and successes. The characteristics of a naturally reinforcing therapist are reminiscent of what Carl Rogers called for in his client-centered therapy, namely genuineness, empathy, and caring. Known for his opposition to ‘using reinforcement’ to control others, Rogers would certainly not deliberately use it. Yet a careful analysis of his reactions to clients (Truax, 1966) indicates that Rogers reacted differentially to certain classes of client behavior. His caring and genuineness probably manifested as interest, concern, distress and involvement that naturally punished CRB1s and rein-forced CRB2s. Thus we would suggest that Roger’s call for genuineness and caring is an indirect method of enhancing the occurrence of naturally reinfor-cing contingencies.
The therapy relationship is one of unequal power, and thus it is important to focus on the question, ‘‘What is best for my client at the moment and in the long run?’’ Keeping this question at the forefront of treatment minimizes the like-lihood of exploiting or harming clients through a host of situations that can be harmful to them, such as an unhealthy dependence on the therapist, sexual involvement, or interminable treatments where both parties are gratified by a relationship that is more like friendship than therapy.
Having Clients’ Goal Repertoires
Therapists are more able to discriminate client CRB1s and foster CRB2s when they have client goal behaviors in their own repertoires. For example, if a client is feeling invalidated by something the therapist said and shuts down, a thera-pist who is avoidant of conflict and negative feedback is unlikely to discriminate that the client is upset and is engaging in a CRB1 of pulling away. This therapist also is unlikely to encourage a CRB2 involving an open discussion of what just
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occurred between them to help the client do the same in daily life relationships.
Similarly, if a therapist is disdainful or afraid of client attachment and depen-dence (e.g., frequent emailing of the therapist, announcing feelings of dread at the therapist’s upcoming vacation), he or she will find it difficult to use these as therapeutic opportunities. Helpful discourse may include exploring how a client’s dependency behaviors play out in current relationships, and creating healthier ways of expressing attachment and dependency in both the therapeu-tic relationship and in daily life relationships.
Matching One’s Expectations with Clients’ Current Repertoires
Being aware of clients’ current repertoires will help therapists to have reason-able expectations and to be tuned to nuances of improvement. Continuing with the example of the client who felt extremely dependent on her therapist, it is not helpful to expect her to cheerfully say, ‘‘Have a great vacation’’ given that she felt suicidal upon thinking about her therapist going away. Rather her behavior was shaped so that each step of the way, while difficult for her, the therapeutic task matched what she was capable of in terms of her current repertoire: (1) going into the hospital while her therapist was on vacation; (2) meeting with a back-up therapist while having telephone sessions with the primary therapist who was on vacation; (3) asking for a transition object (e.g., teddy bear) from the therapist and having sessions with a back-up therapist without having phone sessions with the primary therapist; (4) asking for a little object from where the therapist was going to let her know the therapist was keeping her in mind; (5) not needing contact while her therapist was away by arranging to have lots of get-togethers with friends. While challenging, these therapeutic tasks did not feel impossible to her because they took place over a period of ten years. The client has now reached a point in her therapy where she has a full social support network and sees her therapist once every two months.
Technically, the above strategy incorporates the principle of shaping succes-sive approximations to a desired target behavior, and CRB1s and CRB2s should be defined with shaping in mind. For example, although the ultimate goal for the above client was dependency on the therapist, if strict non-dependency were seen as the CRB2, the client never would have emitted any behavior that could have been reinforced. The therapist’s task is to identify graded improvements within the client’s capability. What is an incremental improvement in terms of the client’s current level of functioning? What would be a small, but real, stretch for this client?
The issue of shaping raises a certain complication for FAP. Specifically, although the therapist may be reinforcing CRB2s that are successive approx-imations to the target behavior, these CRB2s may not be reinforced by outside others. Thus behaviors that are occurring in the therapy relationship will not be maintained by others in daily life. For example, a very shy client’s first attempt
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at assertiveness may be reinforced by the therapist, even though it was awkward and unlikely to meet with success in the outside world. Or a male client’s first attempt at spending more time with his wife may be explained away by his wife as ‘‘You just want to get me off your back.’’ This may be discussed directly with the client. The therapist may explain that the therapy relationship is an opportunity to practice and improve important interpersonal behaviors before ‘going on the road’ with them. The therapist may also explain that clinicians are probably more sensitive to subtle changes, and more reinforced by them, because their only purpose in the relationship is to help the client.
Daily life relationships are more complicated, and relationship partners may require time and patience before they change as well. The therapist, by being sensitive to the client’s progress and being naturally reinforced by small improvements over current functioning, may foster the client’s appreciation for these small changes as well, such that they become self-reinforcing enough to allow the time needed for further growth even in the absence of positive responses from others.
Amplifying One’s Feelings to Increase Their Salience
Sometimes it is helpful for therapists to add other verbal behavior to a basic reaction in order to increase therapeutic effectiveness. Amplification can help clients discern and be reinforced by subtle manifestations of therapists’ private reactions that may not be noticeable otherwise. To illustrate, consider a male client who has difficulty in forming intimate relationships and who has taken a risk in revealing vulnerable feelings during the session. His disclosure results in mostly private and subtly observable spontaneous reactions of the therapist, including predispositions to act in caring ways and private respondent beha-viors that correspond to ‘feeling close.’ If the client’s CRB1, however, is a lack of sensitivity to the subtleties, such reactions will not be discriminated and will have weak reinforcing effects. In this case the therapist can describe private reactions by saying, for example, ‘‘I feel really moved by what you just said.’’
Without this amplification, the therapist’s reactions would have little or no reinforcing effects on the client’s CRB2. With that statement the therapist may also be taking a risk, and may evoke additional intimacy-related CRBs in the client.
The next case material is from a session about six months into MT’s work with her client SJ, a 41-year-old male who entered therapy seeking to work through the effects of childhood physical and emotional abuse and to develop intimate relationships in his daily life.
Therapist: So you are telling me that because of our interactions, your aware-ness of your impact on other people is really dramatically increas-ing. [MT has been reinforcing this awareness as CRB2.]
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Client: Yes, Very much. I am more aware of how I interact with other people. But am I interacting in a healthy way? Is my neediness coming through, is my self confidence coming through?
T: What feels healthy to you about how you and I interact?
C: The only thing that’s coming into my mind, I’m just going to throw the answers out, is that you see me for me. It’s sort of like you’re in an airplane. I’m sorry, but this is the mental image that’s coming to mind. SJ is a lot like Safeco Field (Seattle’s baseball stadium), okay, hang in with me, this is good. The roof is closed on Safeco field, but for Mavis I’ve opened up that rolling retracting roof and you are in an airplane flying around. You see SJ in the whole picture, you see the whole vision, the good, the awkward, the clumsy, everything. But you also see center field, you see the baseball diamond, the good stuff in baseball. And you have binoculars and you sort of look over here and you see all the good stuff but then again you see over in the stands, you see the rowdy face painted side, you see the reserved bleachers and the box seats. You see the entire picture of me. And you go ‘Yeah, I want to hang out in my sunglasses with my little helicopter, I may even land and hang out with SJ.’ It’s a unique metaphor but it’s true. You accept me for who and what I am–the good, the awkward, and the not so good. There’s a comfort and a safety within you, within our dynamic, and that’s how I feel. I feel safe when I’m here with you.
T: SJ, you’re right. It’s really a great metaphor, and I feel really moved by what you’re saying. [Rule 3, Although MT felt she displayed subtle signs of being moved, she amplified expression of feelings with the intention of facilitating natural reinforcement and the evocation of CRBs. Rule 2.]
C: And I’m not going detract from what I just said, but I am going to ask you a question related to FAP. To the best of your ability you are supposed to represent in a general way the world outside so I can interact with you the same way that I interact out in the world.
How do I get to that level of safety and that comfort in feeling okay with other people, other safe people who see SJ for who and what he is. [SJ is asking an important and relevant question, but is not acknowledging MT’s response of feeling moved. This is a CRB1 and will be responded to later as shown below.]
T: Do you expect some kind of deep philosophical answer that’s going to solve your problems?
C: Yes, immediately, right on the nose, within 30 seconds. Boom.
T: You already know the answer.
C: I have to take the personal risks. I’ve got to get out there and engage. [CRB3.]
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T: SJ, having done it with me increases the possibility that you’ll be able to do it with other people. I have every belief that you’ll be able to do it with other people. You think this has been an easy ride for you? You’ve been really scared at times. You’ve really pushed yourself to take risks with me, and I know you can do the same with others. [Rule 3, natural reinforcement; Rule 5, facilitate generalization.]
C: Right.
T: Can we now sit with what transpired today. . . what stands out to you about today? Please give short answers. [MT is prompting the CRB2 of succinct responding.]
C: Quiet empowerment, that in fact I am doing what I need to do, that it may not be as big or bad or ugly as I think.. I feel encour-aged by you.
T: What stands out to me is that I loved your metaphor, I was really moved by it, and I wonder if you sensed how moved I was. And you didn’t create space for that. I told you I felt moved, I started getting teary, and you moved in with your talking. That’s some-thing I want you to watch, especially outside of here, especially when you’re with your girlfriend, that there’s a way you use your language to be in charge. Just be aware of that, to create more space for the other person, to be tuned into what’s happening.
How aware were you of what was going on? [Calling attention to the CRB1s of limited discrimination of MT’s positive emotional responses, his lack of reinforcing intimacy building, and prompt-ing O2s.]
C: Not very aware, but yet it triggers memories and things like that that have happened in the past.
T: What triggers things?
C: When you complimented me last week, and I didn’t, I sort of rolled past it, like Paul at work..
T: Don’t give me any examples right now, we’re talking about you and me. [Blocking SJ’s CRB1 of intimacy avoidance, but said with a gentle tone.]
C: You complimented me in the past and I had a hard time letting it in. Last week, it was like, okay, Mavis complimented me.
T: Before you couldn’t take it in and you’ve started taking it in. You were talking about your awareness of other people and how it’s skyrocketed. Keep working on that. That also increases your connection with me and others. [Rule 5, facilitate generalization.]
C: It does. Being with the silence. In other words, somebody says something that I’ve moved them or touched them, be with the stillness, be with the silence, accept what they’ve said. I can be that way with my girlfriend.
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