1 社会联系与治疗关系中的改变背景

PA R T 1 The IdeasCHAPTER 1 Social Connection and the Therapeutic Relationship as Contexts for Change There is no such thing as a “self-made” [person]. We are made up of thousands of others. Everyone who has ever done a kind deed for us, or spoken one word of encouragement to us, has entered into the make-up of our character and of our thoughts, as well as our success. —George Matthews Adams Think for a moment about the most important interactions and relationships you’ve had in your life. Think about the ones that were the most connected, joyful, and inspiring. Also think about the interactions that were the most painful and heartbreaking, ending in betrayal or disappointment. How did all of these experiences shape you? What lessons did you carry forward? What words from another person will you never forget? What habits, shaped in the past, do you repeat today? Consider Tom, the client mentioned in the introduction, who grew up in a family that felt distant yet also stifling at times. His mother—an executive who worked long hours—taught him that emotions were to be mastered, problems to be solved. He felt anxiety about his emotions. He felt ashamed about his ongoing inability to succeed the way she had. In middle school, a teacher encouraged his writing ability, giving him an experience of pride. From that time forward he prized his literary skill, but he also struggled because his mother doubted its value. A small group of friends in college solidified for him a vision of how society—especially the business world—is oppressive and unethical. He felt close to them, and he felt a righteous indignation about much of the world. Tom, like all people, is a sum of his relationships and experiences. Both affect how he sees himself, others, and the world, as well as how he feels about these things. Take five to ten minutes to write some things down. What have you experienced and learned from relationships? Functional analytic psychotherapy (FAP) is about creating therapeutic relationships in which you skillfully and strategically relate to clients in order to create a context for change. While many relationships change lives, therapeutic relationships aim to change lives therapeutically. Before we get into the specifics of FAP and its approach to therapeutic change, let’s start at the beginning, with the perspective that informs each moment of FAP. FAP is grounded in a view of psychology and social influence that integrates contextual behavioral science (CBS) with the growing science of social connection, including how social connections affect psychological func- tioning. This foundation shapes FAP’s conceptualization of the therapeutic relationship and the therapist’s stance in each moment with clients. In this first chapter, as a way of building toward the more experiential and applied clinical aspects of FAP, we lay out this foundation. SOCIAL CONNECTIONS MATTER Human beings need social connection to thrive, and problems with social connection may create profound suffering. This statement is based on a well-established set of scientific findings that speaks to the fundamental importance of social connection. Here are a few of these findings: • Having poor or extremely limited social relationships has an effect on mortality com- parable to smoking and double the effect of obesity (Holt-Lunstad, Smith, & Layton, 2010). In other words, social connections keep people healthy and help them live longer. Researchers have estimated that the negative health impacts of having poor or limited social relationships is equivalent to smoking fifteen cigarettes a day (Holt-Lunstad & Smith, 2012). • Both poor relationships (characterized by conflict) and limited social relationships (loneliness) negatively impact stress hormones, immune functioning, and cardiovascu- lar functioning, among many other factors (Kiecolt-Glaser et al., 2005; Cacioppo et al., 2002). In fact, social support is a key influence on outcomes for a range of health prob- lems, from cardiovascular disease to tuberculosis to schizophrenia (House, Landis, & Umberson, 1988). • Humans have considerable neural real estate dedicated to processing social signals, and this attunement to social signals emerges in the first moments following birth, as babies orient toward faces and mimic facial expressions (Meltzoff & Moore, 1977). • Social relationships are one of the primary mechanisms that drove evolution of the complex human brain, and they’re deeply interconnected with biological systems that regulate human physiology and emotion (Cacioppo & Patrick, 2008; Porges, 2001). Surveying all these findings, evolutionary science tells us that social functioning has been fun- damental to our species’ survival and has shaped who we are—genetically, physiologically, and behaviorally. We are the ancestors of the humans who related effectively to others, not just in terms of social mechanisms with obvious evolutionary significance, such as sexual interactions and par- enting, but in terms of a host of prosocial relational behaviors that function at the level of groups and promote group well-being, such as friendship, altruism, and cooperative learning and problem solving (Bugental, 2000; Sober & Wilson, 1998). We spread to cover the globe not because of our physical strength or individual smarts, but because collectively our abilities to connect and cooper- ate make us mighty. (For captivating reviews of this perspective, see Harari, 2015, and Henrich, 2016). There are four ideas that are central to understanding how evolution has shaped us and the social challenges we face today:

We evolved to attune to and operate in small groups.
We also evolved to compete with other groups.
In any relationship we work to find a balance between close and far.
The world today—perhaps unlike the one we experienced in our evolutionary history— involves navigating between and across lots of “in groups” and “out groups,” close and far. The world today requires that we become skilled at forming and sustaining relation- ships across change and at balancing our own needs against the needs of the various groups to which we belong. We evolved to attune to and operate in small groups. Although today we function in a broad array of social groups—from families to communities (virtual and otherwise) to larger units, such as cities, states, and nations—the key groups in which we evolved and flourished for tens of thou- sands of years tended to be small. At the large end of size spectrum, they typically reached the famous Dunbar number of 150 (Dunbar, 2010). Even in a world of seven billion people, groups at or below the Dunbar number tend to be the ones that shape us the most. As the science of attach- ment shows, this shaping starts early, with our primary caregivers (Cassidy & Shaver, 1999). It continues through childhood with adolescent friends and classrooms and into adulthood with roommates and romantic partners. Our emotions, behaviors, and sense of self and purpose are fine- tuned to the subtleties of the relationships and bonding that develop within these relatively small groups. Our ability to coordinate our actions with others depends on a robust capacity for making sense of the minds of others. The flexible connectedness model (Levin et al., 2016; Vilardaga, Estévez, Levin, & Hayes, 2012)—a CBS framework that is gathering empirical support—argues that our ability to connect with others depends on three distinct capacities: perspective taking (the ability to understand the perspective of another), empathy (the ability to feel what it feels like to be in that perspective), and acceptance (the willingness to experience the feelings that come from being in that perspective). These capacities are the psychological mechanisms of connection. We are so immersed in the water of connection that it’s easy to forget that our ability to understand others is a marvelously complex psychological task. In turn, effective engagement in relationships supports optimal well-being. Across the thou- sands of research studies on this topic (in addition to the findings cited above), three main themes arise. The first is that close relationships and intimacy are highly beneficial (here, “intimacy” means sharing thoughts and feelings that you don’t share with just anyone). Even when we have just one or two close relationships, we tend to be happier and healthier, both physically and mentally. The second theme is that perceived social support matters. Again, it isn’t how many friends we have, it’s whether we feel that there are people who will support us when we need it. The third theme involves social participation—feeling that we’re part of a larger community. This could be an extended family, a group of friends, a network of colleagues, a church or other religious group, a club or sports team, or a volunteer organization. What seems to matter is that we feel like we belong to a group—one that’s larger than ourselves and our one-on-one intimate relationships. We evolved to compete with other groups. The flip side of bonding closely with others, of course, is our tendency to relate with caution, guardedness, competitiveness, and aggression. This ten- dency has a clear role in our dealings with those outside our social groups, especially with people in competitive or aggressive relations with our groups. In fact, evolution science argues that we bond within groups because a highly cooperative group can outcompete other individuals and groups. In other words, the formation of powerful groups is a key human competitive advantage (the same is true for other social creatures). When in competition, we seem to have a capacity to turn off the machinery that supports con- nection. We can dehumanize and disconnect in order to not feel the pain of those we harm or ignore. This ability underlies prejudice, avoidance (of the problems of others), a capacity for vio- lence, and so on (Levin et al. 2016). We have a capacity to disconnect as well as to connect. All relationships involve balancing close and far. In general, we bond within our groups and compete with others who belong to out groups, but we’re sensitive to harm and exploitation even within our closest relationships and the small groups we belong to. Therefore we constantly balance closeness with distance, connection with disconnection, opening up with keeping boundaries, and giving to others with serving ourselves. Interacting with or being influenced by others is a double- edged sword: it might do us good, or it might do us harm. Being close to another person always leaves us a little bit vulnerable and requires a leap of faith. This is the tension of being a socially attuned human being, one with social needs and social vulnerabilities. We have a host of social emotions that steer us through this tension. Anger when our needs aren’t met. Guilt or shame when we’ve violated the needs of another, or the group as a whole. Love and gratitude when another meets our needs. Sadness and grief when another betrays us. The story of our social relationships is, in many ways, one of finding balance between closeness and distance—between getting our needs met and shielding ourselves from harm and vulnerability. As such, it’s the story of how we’ve been hurt and nurtured and, as a result, how we’ve learned to relate to others. We all carry this tension, because evolution required groups to struggle with this balancing act in order to function. For survival, we needed to weave delicate threads of connection, yet we also needed to be able to sever them when the cost of keeping them became too high. In fact, sometimes it seems that the very ability to step back and disconnect—so that we can come back and reconnect when the time is right—is part of what makes relationships resilient and flexible. The world today is different. Not only do we all experience this double-edged sword of human connection, we also live in a world that is quite different from the world of our ancestors, the one that shaped and optimized our mechanisms for social connection. That world was often small and relatively stable with a reasonably well-defined worldview and set of social rules. For example, a child born into a hunter-gatherer tribe in south-central Africa in the 1940s lived a life very similar to a child born in the 1840s or 1540s or even AD 40. This child mainly interacted with the same twenty to thirty people over the course of his or her life. This sort of (from the perspective of

stable social arrangement was the norm rather than the exception for most of human history. The social scale of the world today is much larger. Many groups—defined by differences, for instance, in religious beliefs, politics, career focus, cultural practices, hobbies, as well as school or sports affiliations—intermingle and live together, and this places many more demands on our ability to adapt and cooperate socially. For example, we experience social transition after social transition, in which we enter new groups, build new alliances, and decide whom to trust and ally with. These transitions might continue across our life span, and we may never settle down in a stable community. Our worldview might differ so markedly from that of our own parents that we have difficulty relating to them. At the same time, we are also the children of parents who faced similar disruptions to their social fabric, similar conflicts and negotiations. Today we face chal- lenges that strain our ability to socially adapt as a normal part of life. oasis-ebl|Rsalles|1490374036 SOCIAL CONTEXT MATTERS The legacy of this evolutionary history is reflected deeply in our psychology. It’s not just that we’re sensitive and feel better or worse depending on how people interact with us; in all of our human interactions we are working to balance closeness and distance, learning the lessons of our relation- ships, and carrying the scars and the victories. Because navigating the social world is so important to our species, social relationships shape us. They leave lasting marks, influencing our behavior and well-being. The links between difficulties with social connection and psychological problems are profound and exist across almost all major psychiatric disorders (Barnett & Gotlib, 1988; Beck, 2010; Horowitz, 2004; Leach & Kranzler, 2013; McEvoy, Burgess, Page, Nathan, & Fursland, 2013; Pettit & Joiner, 2006; Pincus, 2005). The causal arrow probably goes in both directions: social stressors cause psychological stress, and psychological stress, in turn, creates social stress. As a result, many clients who seek psychotherapy aren’t just struggling with themselves, they’re struggling in relation to others and often have a long and painful history of doing so. Consider Mark, a client who descended into depression after losing his job eight months ago and is now almost entirely isolated. Although he might seem self-absorbed and cut off, his isolation is actually intensely interpersonal. He grew up in a household in which he was typically ignored or criticized, and given this context, he developed an abiding sense that something was wrong with him. He experiences low-level anxiety and reticence that settle into his body whenever he’s around people whom he fears will evaluate him negatively. He has coped with his sense of inadequacy by becoming very oriented toward pleasing others, and most people find him to be a nice guy. Yet, just as if he were asked to speak a language he’d never learned, he has few words for expressing his own needs or feelings; he just knows that he feels “bad.” As his depression deepened, he became increas- ingly overwhelmed by phone calls and e-mails from friends and family members. For him, it was easier to avoid their outreach than to experience the pain of speaking to them. Now he’s frozen in excruciating isolation, alternating between various aversive states: harsh self-criticism and despair; guilt about his continued withdrawal, which he knows worries his family profoundly; and numb detachment revolving around sleep, television, and pornography, which only reinforce his belief that he’s worthless. Or consider Joan, who suffers with chronic pain related to a work injury that occurred several years ago. While the more obvious cause of her pain is the injury itself, Joan’s suffering in the current context involves many other people. She feels guilty for being a burden to her husband, who is not only carrying the family financially but also handling all of the household chores. Driven by guilt, she periodically overexerts herself at home, exacerbating her pain. When her physical therapist prescribed exercises that were too difficult, she was too ashamed to let him know and instead canceled several sessions in a row. In general, she avoids reaching out to friends or former coworkers because she’s embarrassed and frustrated and doesn’t want people to see her “like this.” Occasionally, she expresses her frustration through hostile comments to her children or husband. Over several months, she came to meet the criteria for depression. In both of these cases, while it might be possible to imagine a version of the person’s problem occurring outside the social context, we can only appreciate the full story of suffering—and the challenges involved in changing—by looking at the social contexts in which Mark and Joan live. Similarly, it may be possible to provide therapeutic relief to Mark or Joan by focusing on a narrower band of psychological functioning, such as activity scheduling or acceptance of pain and other feel- ings. But these apparently intrapersonal processes necessarily play out across interpersonal con- texts, starting with the interpersonal context of accepting help from a therapist. The point is so important, we repeat it: social context has an ongoing and pervasive impact not only on satisfaction with relationships but on functioning in general—mood; stress levels; general well-being; pursuit of goals; health-related behaviors such as exercise and nutrition; sense of safety; and sense of self, meaning, and purpose. In the language of CBS, social interactions are a major context in which all of these other aspects of our psychology are shaped, both developmentally and in the present. Even how we relate to ourselves is shaped by interpersonal contexts, such as how our parents and others have related to us, how they treat us now, and, in turn, how we relate to them. (Of course, there are myriad other nonsocial causes of pain and suffering, such as genetics, cognitive factors, and all sorts of nonsocial traumas and stressors. We are not suggesting replacing the full biopsychosocial model of suffering with a solely social model; rather, we seek to understand the importance of the social piece of the puzzle and to devote adequate attention to it.) This relationship between social context and overall satisfaction and functioning makes it inter- esting to look more closely at the metaphor of connection, as in social connection. We often describe our most influential relationships using metaphorical terms like “close” or “deep.” In fact, one of the most popular methods for measuring the closeness of relationships asks people to describe, visually, how much their own self overlaps with others—how much of the other’s self is, metaphorically, included in one’s own self (Aron, Aron, & Smollan, 1992). These metaphors about the closeness or depth of connection reveal a simple truth: that closer or more intimate relation- ships involve higher degrees of psychological contact. In these intimate relationships we reveal more of ourselves and open up more of ourselves to influence. We are able to give and receive influence and—ideally—this influence is supportive and beneficial. At the same time, if this influ- ence has been painful, or if we’ve not been taught how to accept and benefit from connection with others, our suffering may be compounded. A painful history of relationships shapes how we exist in our current network of social relations. And psychological suffering in the present tends to impact how we relate as well. The challenge of the interpersonal process of therapy is amplified, then, when clients’ problems interfere with their effective participation in the process of interpersonal influence that lies at the heart of psychotherapy. For example, when Mark avoids giving his therapist the feedback that their sessions feel too abstract because he is afraid of disappointing the therapist (and the therapist doesn’t pick up on this misalignment), or when Joan avoids sharing the extent of her distress with her therapist because she is ashamed, the progress of therapy is likely impaired. And it often seems that this kind of challenge is the rule, not the exception, when working with clients who have sub- stantial or long-standing suffering. As therapists, we encounter the whole person through the social interaction of therapy—and of course they bring their social history to that interaction. SOCIAL LEARNING Now, from a contextual behavioral science (CBS) standpoint, let’s consider a little more closely how social interactions shape behavior. The CBS perspective makes up the foundation of the therapeu- tic stance in FAP, and there are some general CBS principles that apply to our social relationships. Here we’ll only introduce some basic concepts. We’ll go deeper in the next chapter—again, not for the sake of theory per se, but because the CBS perspective is a key element in FAP’s practical clinical tools. All Behavior Is Learned The general perspective of CBS practitioners is that the behaviors we work with in psycho- therapy are learned. In other words, behaviors have been shaped into their current form by experi- ences in the world. If you do something, there is a reason why you do it: you learned to behave that way in previous situations. This general perspective leads to a very accepting stance: behavior always makes sense in its context. Just as we don’t fault the billiard ball for going where physics dictates, we don’t fault clients for how their behaviors unfold. (This does not mean that behaviors can’t be changed, because we are always able to evolve—that is what learning is about. Nor does it mean that behavior is always optimal. Making sense is not the same as being optimal.) For instance, if a client describes feeling dread when you tell her that you’re going on vacation, you might discover that she has a history of painful things happening when others leave her alone. Her feelings reflect that history, as do her efforts to convince you to stay in contact. Likewise, a client reporting daily panic attacks probably learned to fear the signs of fear in his own body, even though this fear of fear paradoxically leads to exactly the experience he doesn’t want. As you have no doubt experienced, clients can find it illuminating to gain such perspectives on how experience has shaped their behaviors. The Profound Influence of Social Interactions in Shaping Behavior Social interactions have such a profound impact on us for two major reasons: other people constantly deliver experiences that shape our behavior, and, as human beings, we come into this world prepared to be deeply shaped by our social experiences. As we move through the social world, the path we’re on is largely a result of our history of interactions with others, which shape a whole range of behaviors related to our psychological well-being, including how we express emo- tions, express our needs, find safety and security, make important decisions, and solve problems. Momentum from the past carries us forward, and we’re nudged in one direction or another by our present interactions with others. Each of us is also nudging others in the process; the influence is reciprocal. Over time, the effects of this shaping can be positive, resulting in the capacity to effectively seek support from others, process emotions, solve problems, and build shared identity and meaning. If this is the case, we can be thankful that our efforts to connect with others have generally met with enough success that we’ve continued to reach out and increase our skills for doing so. We can be grateful for the reasonably nurturing social environment that we have drawn upon to process painful experiences; make big life decisions; cope with change; or simply enjoy a quiet, connected time with someone. Unfortunately, the influence of others over time can also be negative, leading to limitations in our ability to engage socially and benefit from social connections in the ways just mentioned (pro- cessing emotions, making decisions, and so on). Specifically, we might end up with patterns of relating to others that are constrained by the past. These patterns may help us feel some degree of comfort or invulnerability in the short term, but they usually have long-term costs. As you’ve prob- ably seen with some of your deeply suffering clients, these patterns can result in a vicious cycle in which suffering becomes a barrier to connecting with others, and lack of connection with others perpetuates suffering. Of course, these are broad generalizations for the purpose of illustrating how social interac- tions influence behavior. The reality isn’t so black-and-white. For many of us, it might be more accurate to say that we have ways of relating that more or less work well, and that some of our ways of relating have downsides and bear improvement. And when we’re under stress or feeling vulner- able, these limitations may be more costly and may be linked directly to our suffering. USING THE THERAPEUTIC RELATIONSHIP AS THE CONTEXT FOR CHANGE Understanding the relationship between social connection and psychological problems, and how improved social connection can lead to improved well-being, leads to a very particular conceptual- ization of the function and significance of the therapeutic relationship. The therapeutic relation- ship is a source of influence on the client’s behavior—an influence exerted in the here and now. When clients seek therapy, and especially when their psychological problems involve difficulties relating to other people, the therapeutic relationship presents both an opportunity and a liability. Imagine that Tom, from earlier in this chapter, has come to see you. His responses to you seem stilted. He struggles to articulate his thoughts. He can’t seem to find a path forward through life’s difficulties. If you become anxious about his uncertainty, or too eager to help, you might bite the same hook his mother bit: completing his sentences, offering solutions, rushing to solve problems. With the best of intentions, you risk perpetuating an insidious interaction in which Tom receives the message that he is deficient and less capable than others. He may comply and yet remain demoralized. Let us put it more explicitly: in the therapy relationship there is the liability that you may recre- ate and reinforce the interpersonal problems that are causing your client’s suffering. Here are a few other examples: • A client who tends to criticize others harshly does so with the therapist. The therapist withdraws or responds defensively. The client in turn ramps up his criticism and even- tually stops coming to therapy. • A client typically avoids asking for what she needs. The therapist doesn’t know how to help her and makes suggestions that aren’t helpful. The client doesn’t follow through on these unhelpful suggestions, so the therapist deems her lazy or unmotivated. Consequently, the client feels shame and is even less likely to ask for what she needs, creating a cycle that persists for weeks. • A client has an internal process of endless rumination and tends to talk with other people in a similar way, moving through tedious, complaining loops. The therapist feels competing urges to listen attentively and recognize the client’s pain and to interrupt in impatient frustration. When the therapist finally does make an effort to focus on behav- ior change, the client perceives the therapist’s judgment and feels even more anxious. This liability, however, is also an opportunity. In essence, the therapeutic relationship gives the therapist an opportunity to be an agent for disrupting dysfunctional social patterns and nurturing more effective ones. You have an opportunity to clearly see the interpersonal issues that clients bring to therapy. You can choose to engage with these issues therapeutically, rather than merely recapitulating what clients experience with others outside of session. The result can be a virtuous circle in which clients improve their relationship with you and thus their relationships with others, contributing to improved overall well-being. For instance, with Tom you might recognize that his social history has shaped his reticence and anxiety about pleasing others. You might then gently and persistently present opportunities for Tom to voice his own needs and find his own way forward. You might challenge Tom to take those opportunities. Let’s look at a few other ways to create a virtuous cycle using the previous examples: • You might point out to the client, compassionately, that his criticisms are painful and gently link your experience to the experience of other people the client has pushed away. You might challenge the client to collaborate with you to find other ways to voice his needs. • You might notice the client’s passivity and shame and work closely with her to notice moments when she pulls back, suggesting that she instead find the language to articu- late what she wants in therapy and in life. • You might explain to the client the tension you feel between a wish to listen attentively and a concern that the client’s storytelling is not the most efficient use of time in session. Then you could come up with a balanced solution that meets the needs of the client in order to make progress in therapy. The two fundamental pillars of FAP—functional analysis and genuine connection—balance each other and help you pursue the opportunity to create a relationship that is uniquely therapeutic for each client. Genuine, Authentic Therapeutic Relationships Are Essential To experience a different way of relating is a more potent vehicle for shaping relational behavior than merely talking about it. Again, this is a statement about how people learn; we often learn more effectively through experience, also called experiential learning, than through passively receiving infor- mation. This is not to say that talking is not important—much of our relating consists of talking— but instead that experiencing a challenge and practicing a different behavior can be a potent context for change. Let’s again consider Tom. He may only come to fully appreciate his experiences with his mother, the effects of his history, and the degree to which he is oriented toward pleasing other people through his experience of relating to you and the challenges you offer. More importantly, with you he might begin to find the courage to step through the sense of anxiety that has pre- vented him from making clear requests and statements of need to others. Experiential learning in a therapy relationship is a type of work that requires us, as therapists, to be open and direct about what is happening in the relationship, which is a level of genuineness or self-disclosure that many therapists find challenging. This directness might simply manifest as an observation about how the client engages in therapy; for example, “I notice that I find myself uncertain about what exactly you want to achieve here.” Or, “I notice that you tend to acquiesce to whatever I suggest we put on the agenda.” Or, “I notice you seem quite skeptical about many of the things I say.” Experiential learning might also mean disclosing more vulnerable aspects of ourselves or our reactions to clients. For instance, we might express our frustration to a client who is persistently late, knowing that he tends to avoid contact with the negative consequences of his actions. We might ask him to make contact with our reaction. We might invite him to notice what emotions or sensations come up for him as a result. Because such interactions are complex, nuanced, and individual, it’s important that they are genuine, meaning the therapist is operating in the context of his or her actual experiences and reac- tions to the situation. Why? First, because any or all of the reactions brought to bear may be rel- evant to therapy, a therapeutic relationship shouldn’t be simpler than a real relationship. Second, human beings are equipped with a fine capacity to detect lack of genuineness—that is, when others are withholding responses or reactions. When lack of genuineness is detected, it is not a neutral fact. Though it may not trigger a primordial sense of threat, it will at least trigger caution, and this can undermine the quality of the therapy relationship. This reaction is especially likely for clients who have been harmed or betrayed by others. Functional Analysis Keeps Us on Track Because genuine, authentic relationships are complex, we use functional analysis (FA) to stay on track regarding therapeutic goals. FA is an assessment process in which we use learning princi- ples to understand what a particular behavior represents for the client in the context of his or her own history and life situation. To that end, we consider questions along these lines: How was this behavior shaped in the past? How did it function in the past? How does it function now? What costs are associated with it? In this way, we get a handle on which behaviors represent problems in the client’s life, and which—despite seeming clumsy or imperfect—actually represent important steps toward growth. (A third class of behaviors includes those that might grab our attention—for example, a client who is a conspicuous name-dropper—but do not represent any clinically significant issue. It’s important to discriminate these behaviors from the other two classes so that we don’t try to “treat” what doesn’t need to be treated.) In turn, FA helps ensure that we respond strategically and therapeutically to clients in the moment based on our understanding of their problems and the growth or behavior change they need. For instance, with Tom, we might notice that some clumsy assertions of his needs are actually an important step toward assertiveness. You might notice that there is a potential contradiction in this process: What if FA dictates that we should see a given behavior as growth (for example, Tom should be more assertive), yet we genuinely find the growth behavior unpleasant (for example, we experience Tom as demanding in ways we are reluctant to support)? Should we suppress our personal reaction in order to nurture Tom’s growth? Luckily, this contradiction rarely arises in reality. First, when we take the time to really under- stand a client, whether through FA or other means, our responses to the client tend to naturally line up with FA: we feel satisfaction and happiness about the client’s steps toward growth because we understand the meaning and the struggle behind those steps. Similarly, we feel some level of genuine frustration or disappointment (balanced of course with compassion and understanding) when we see clients stuck in self-defeating patterns. Second, if you can’t naturally respond posi- tively to the client’s growth, then this behavior is likely something important to address. For instance, you might say to Tom, “Something is coming up for me. You know I’m supportive of you being more assertive. And I notice there’s a way that you’re erring on the side of being blunt, even harsh. Have you noticed that too?” Because authentic relationships involve two people, in the process of FAP our own reactions and perceptions are as important as those of the client. Accordingly, we also continuously aim FA at ourselves, refining our self-knowledge as therapists, asking how we’re contributing to the thera- peutic moment, and ensuring that our approach serves clients and not our own ends. The assump- tion is that therapists are also human and therefore susceptible to the influence of clients, just as they are susceptible to ours. When we relate to clients in their suffering, especially if things are happening quickly or with a great deal of emotion, complexity, or struggle, we can lose our footing. Again, FA helps keep us on target. In the next chapter, we’ll lay out the essential, practical principles of the contextual behavioral science perspective that lies at the heart of FAP and similar treatments (most notably, acceptance and commitment therapy). SUMMARY • Poor social connection poses as much mortality risk as smoking cigarettes. • From a CBS perspective, social relationships are a key context for shaping psychologi- cal functioning—mood, motivation, emotion, and achievement—and therefore well- being across one’s life span. • Psychotherapy involves processes of social connection and influence, through the ther- apeutic relationship, that can shape change in the client’s psychological and social functioning. • FAP asks you to balance a genuine, authentic way of relating to your client with under- standing based on functional analysis—a way of assessing the function of what is hap- pening in the therapy relationship for each individual client. By doing so, you can ensure that your response to the client is therapeutic and does not perpetuate the client’s problems in relationships.