“Dealing with others is dealing with ourselves, dealing with others.”
Creating intense and curative therapeutic relationships is a fundamental skill for meaningful therapy. Strong relationships like this can engage people in ways that challenge and can perhaps even frighten them. This means that therapy can involve exposure to avoided thoughts, emotions and sensations for the client AND the therapist.
“Exposure therapy typically elicits a temporary increase in patients’ negative affect in order to facilitate new learning. This may in turn increase therapist discomfort as therapists interact with the patient and are confronted with their own uncomfortable subjective experiences.” (Scherr, Herbert and Foreman, 2015).
The authors of this study found that therapists with high levels of avoidance tended to avoid doing exposure therapy. Powerful therapy requires us choosing to lean into risking vulnerability instead of leaning back and doing therapy to the client. Easier said than done. Doing therapy can be disturbing and we rarely receive explicit training on what to do when we are struggling. When we find the courage to open up about our challenges in consultation, we might hear solutions, be given articles to read, or have our behaviors analyzed by the other clinician. Rarely do we hear, “Yeah, me too. As a matter of fact, about an hour ago.”
Thankfully, two third wave behavioral therapies (Functional Analytic Psychotherapy and Acceptance and Commitment Therapy) blend quite nicely and give us clear guidance on how to continue to move toward that vulnerable edge of growth. With them, we can accept our own human urge to avoid distress and stay the course, especially when deep pain arises in the therapy.
Functional Analytic Psychotherapy (FAP)
Bob Kohlenberg and Mavis Tsai, at the University of Washington developed FAP. As behavior analysts, they noticed some clients improved much more than others. They found that in sessions where the client experienced great change, the relationship was pivotal. FAP focuses on interpersonal flexibility. The power of FAP is responding to our client’s behaviors moment-to-moment in session. To do this, we need to consider our clients in the context of their lives and their histories. For example, consider a client with a pervasive and persistent pattern of complaining which affects his relationships. Telling us that they don’t like something about the therapy could be an instance of that unworkable behavior. For another client, it might be a risky move toward intimacy. FAP terms these ‘clinically relevant behaviors’ or CRB for short.
FAP gives a framework for how to be most effective with our clients through a set of rules or guidelines. When we follow FAP rules with our clients, we can find ourselves risking and challenging ourselves to engage in an honest and undefended way.
Here’s a simplified version of those rules: Be aware, courageous and loving with our clients. Again, easier said than done.
Acceptance and Commitment Therapy (ACT)
ACT was developed by Steve Hayes at the University of Reno, and focuses on intrapersonal flexibility. Humans don’t like risk, so we need something to help us when we are in that shaky ambiguity of pushing our comfort zones. ACT helps us find our ground as we engage in emotionally vulnerable ways with the people we serve. As human beings with our own histories, it’s certain that we will have painful reactions in the therapy session. Accepting this as normal, staying in the present moment with those reactions, touching into our values and taking action allows us to follow the FAP rules of engagement. ACT helps us hold a stance of open curiosity, so that we can engage in the messy work of human intimacy.
Doing effective and meaningful work as a therapist is not easy. Thankfully, Steve Hayes, Bob Kohlenberg and Mavis Tsai have given us tools that provide a scaffold for us to create transformation with our clients. I’m excited to share how you can get the most out of these two therapies and make your work more powerful. We’ll be working in depth on blending these two powerful therapies and applying them to your most challenging clients. Come join us.
Harnessing the Power of the Therapeutic Ralationship Using ACT & FAP
- 2-day workshop led by Joanne Steinwachs, LCSW
- March 4 – 5, 2016, from 8:30 am – 4:30 pm
- sponsored by Portland Psychotherapy
Joanne Steinwachs LCSW is a social worker in private practice in Denver, CO. She is a peer reviewed ACT trainer and a recognized FAP trainer. To learn more about her training and therapy practice, go to www.joannesteinwachslcsw.com.