2 从情境行为角度出发

CHAPTER 2 Take a Contextual Behavioral Perspective To understand all is to forgive all. oasis-ebl|Rsalles|1490374048 —­Anne Louise Germaine de Staël C arl Rogers rose to fame in the United States and worldwide by expressing clearly and pas- sionately that what matters most in the process of psychotherapy is not the expert knowledge of therapists, but rather their personal qualities and how they bring those qualities to their relation- ships with clients. His work promoted a sea change in the helping professions and influenced the way clinicians are trained to this day. The treatment approach he developed remains the bench- mark against which many others are compared. Of particular note, Rogers stood against efforts to control or change clients; he was the voice of nurturance and unwavering support, in opposition to those who advocated manipulation and control. What is less well-­known is that Rogers was also interested in the scientific study of the process of therapy. To that end, he allowed a number of researchers to have access to recordings of his psychotherapy sessions. One resulting study is particularly relevant to FAP. In 1966, Charles Truax published his findings regarding Rogers’s responses to clients. His expressions of warmth and regard for his clients were not, in fact, unconditional; his responsiveness was not the same regard- less of a client’s behavior. Rogers responded more warmly or with more encouragement to some kinds of remarks, particularly those that represented client growth, and responded in a more reserved way to others. The result of this pattern was that, over the course of therapy, the client remarks that Rogers responded to in a nurturing way increased in frequency, whereas the other types of remarks decreased in frequency. How could it be that the man who preached unconditional support was actually responding conditionally? The answer is simple: in keeping with the science and principles reviewed in chapter 1, the therapeutic relationship (or any relationship, with intimate relationships often being more influential) may exert more or less subtle influence on the client and therefore function as a process for behavior change. This influence happens quite naturally in a social connection that feels com- pletely accepting and supportive. Today, such processes are deliberately harnessed—­and linked to other established processes of behavior change—­in a range of evidence-­based therapies, including motivational interviewing, acceptance and commitment therapy, and dialectical behavior therapy. FAP focuses directly on shaping interpersonal behaviors that affect social functioning and psychological well-­being and on cultivating caring therapeutic relationships that deliberately and authentically shape these behav- iors. This stance represents an alignment of the perspective of behavioral science, Rogers’s per- spective, and caring relationships and principles of learning. A key aspect of this alignment is thinking about therapy relationships in terms of qualities (such as warmth and genuineness) as well as processes of behavior, learning, and influence. Contextual behavioral science (CBS) is the contemporary field of study that best represents FAP’s perspective on learning principles and how to put them to use clinically in a therapeutic relationship. In this chapter we introduce you to that theoretical perspective. Our stance is that using CBS clinically doesn’t require a massive investment in the study of its theory or philosophy. Instead it requires understanding a relatively small set of core principles or assumptions. Think of this approach as the 80–­20 rule for clinical CBS: 20 percent of the CBS principles and assumptions account for 80 percent of the approach’s clinical utility. If you want to spend time reading about and exploring the other 80 percent, you can do that. (We enthusiastically recommend The ABCs of Human Behavior, by Jonas Ramnero and Niklas Törneke for this purpose.) In outline form, here is the 20 percent that you need to know: • Everything people do is behavior. • Behaviors are events. • All behavior happens in the moment. • Behaviors are steered by consequences. • Learning by consequences sometimes creates less than optimal results. • You can’t understand all the ways behavior is influenced, but partial, iterative under- standing can lead to useful results. • These ways of understanding people and behavior are fundamentally empathic and compassionate. We discuss each point in greater detail below. EVERYTHING PEOPLE DO IS BEHAVIOR Let’s start with the term at the center of this discussion: “behavior.” Behavior is what we study, understand, and influence. Behavior is what people do; it’s action. It’s how we move through the world, transition from one situation to the next, and exert influence. Many of us are used to making a distinction between thinking and behavior, in which behavior means outwardly observable actions like walking or talking. But in CBS we include in the same bundle everything that people do: speaking, thinking, imagining, hearing, perceiving, feeling, doubting, knowing, believing, intuiting, hearing, and on and on. If a live person can do it, it’s behav- ior. Right now as you read this, that’s behavior. Right now as you think about whether what you’re reading makes sense, that’s behavior too. And right now as you notice yourself thinking, that’s behavior too. Being aware of your behavior is behavior. It’s all part of the same stream of behavior, interacting with the world, within itself, and with the behavior of others. Bundling all actions together in this way becomes useful, as we will explain. By the way, when you speak with clients, you don’t have to use the clunky term “behavior.” You can use whatever word makes sense in the context: action, thinking, choosing, movement of spirit, or whatever. It doesn’t matter, as long as you keep track of the concept at the center of this word cloud: there are many things people do that can be looked at through the principles of learning.

BEHAVIORS ARE EVENTS A key characteristic of a behavior is that it is an event, occurring at a particular time and place with a particular person. Think for a moment about how many behaviors have occurred for you so far today. Think of all the overt actions you have made—­those we could see if we were watching you via a camera. Think as well of all the covert psychological behaviors that have happened: each thought, each sensation, each decision, and so on. Think of the discrete fleeting behaviors that make up a moment. Think as well of the extended, complex behaviors that make up the meaning of our days and our lives—reading this book, getting a graduate degree, and so on. Watch the flow of behavior inside you in this moment: Now I am thinking this… Now I am feeling this… Now I am going here… And thinking this… As you might expect, there’s no shortage of behaviors to work with. Behavior is a continuous, complex stream that moves through each of the seven billion people on the planet (sleep is a behav- ior too). In fact, so much behavior is occurring in any given moment that there’s simply no way any of us can maintain conscious awareness of all of our behaviors, let alone all of the influences on our behavior. The result is a kind of chaos—­not in the sense of disorder, but in the sense of complexity to such a degree that it often defies mechanistic understanding. This is the medium of psychology. ALL BEHAVIOR HAPPENS IN THE MOMENT A feature of behavior is how often we slip away from contact with or awareness of the behavior that is happening in the moment. Here’s an example that will be familiar to most psychotherapists: you ask a client what he’s feeling, meaning what’s happening in his body right now, and he simply says “bad,” or “I feel like I can’t get anything right.” These are, of course, conventional, sensible responses. Yet notice that they put the client at a distance from what’s actually happening: that his body is feeling a certain way, that he isn’t breathing very much, that he isn’t noticing the tension in his shoulders or the way he’s clasped his hands around his knees. In particular, he isn’t noticing that he’s having the thought I can’t get anything right or I feel bad, which is quite distinct from the sensations he is actually experienc- ing. He might live much of his life in this way, wrapped up in generalized thoughts about what is happening, yet rarely in contact with the momentary play of events flowing through him and how this behavior is shaped and shapes itself. In a similar way, as therapists we might talk about clients having a personality disorder, being resistant, having a transference reaction, being psychopathic, being depressed, or having a certain attachment style. Yet if we stop at such terms or labels, it’s difficult if not impossible to locate, in time and space, the concrete behaviors we’re referring to. Unless we provide more information, we’re obligating others to guess what we mean or, worse, to make blind assumptions that they know exactly what we mean. If another therapist tells you, clinician to clinician, that a client she’s refer- ring to you is depressed, you might have some general ideas about what’s happening, and you might know what sorts of questions to ask to get more specific information about the client, but you don’t know any of the specifics. This person might be an insomniac who obsesses about suicide but has no notable feelings of sadness, only a ringing emptiness. Or this person might spend eighteen hours a day in bed consumed by grief and bouts of crying. At best, the other therapist’s description orients you toward what sorts of questions could be helpful to ask the client. That’s very useful indeed, but it’s only the beginning of an assessment. Of course general labels aren’t inert. They shape how we relate to the person we’re labeling. The client who labels himself a failure stays at a distance from himself and treats himself unkindly. We react with distrust or disgust to the client labeled a psychopath. Labels form a basis for judg- ments and discriminations. And insidiously, these labels can steer our behavior even when we aren’t deliberately being pernicious or judgmental. Because the flow of behavior is the medium of psychology, and because we often lose track of that flow in ways that distance us from ourselves and what matters, the first and most basic step in the CBS perspective is to orient ourselves to seeing behavior as the flow of events it really is. Relating to the flow of events in this way is about humane, connected, and empathetic understanding—­staying close to the story of what is actually happening rather than our stories and labels about those events. It’s about getting in touch with what is actually happening here and now—­and whatever we wish to change. Here are some of the fundamental behaviors we orient ourselves to in psychotherapy: • Actions • Thoughts • Utterances • Images • Urges • Sensations • Feelings • Questions BEHAVIORS ARE STEERED BY CONSEQUENCES The experiential foundation of CBS is noticing what’s happening in the moment. We aim to notice, with some level of precision and mindfulness, how judgments may cloud our view of what’s happen- ing. In turn, that in-­the-­moment awareness allows us to begin to notice how our behavior is shaped—­ steered this way or that way—­by the consequences it creates. In other words, the CBS perspective is about making sense of the flow of experience in terms of some basic principles of learning. Again, there are really only a few principles that are especially useful to understand: • Some behavior functions to increase contact with certain things. • Some behavior functions to reduce contact with certain things. • When a behavior functions to get a payoff, a person will be more likely to repeat that behavior in the context where he or she received that payoff. • When a behavior doesn’t get a payoff, or it incurs a cost, a person will be less likely to repeat that behavior in the context where he or she didn’t receive that payoff or incurred a cost. In the sections that follow, we’ll take a closer look at each of these ideas. Some Behaviors Function to Move Us Toward Things There are certain things or states or situations in the world that we tend to move toward. When we are thirsty, we drink water. When we are lonely, we seek social contact. Often we move toward things that feel good or meet some biological need or give meaning. The things that we move toward are referred to as appetitive. It’s important to not assume that the thing itself is intrinsically appetitive, because what is appe- titive for us depends on the situation we are in (for example, whether we are thirsty or lonely) and, to some greater or lesser extent, who we are and our particular history. Many people like donuts and will move toward them, but after a few donuts, the donuts are no longer appetitive. In turn, in any large crowd of people, there will be a variety of different purposes, sets of values, tastes, and so on—­in other words, different things that are appetitive. The flow of behavior tends to move us toward what we find appetitive. What were the things your behavior functioned to move you toward today? As you read this book, what does your behavior move you toward? Some Behaviors Function to Move Us Away Conversely, sometimes the function of our behavior is to reduce contact with or move away from something. Things that we move away from are referred to as aversive. The first three donuts were appetitive. The fourth donut—­the one that makes us sick—­becomes aversive. We push away certain thoughts or feelings because they are painful. We react against certain statements from others. The Payoffs of a Behavior Can Reinforce That Behavior Sometimes behavior gets a payoff: it moves us toward an appetitive thing that we enjoy or away from an aversive thing that causes us harm or distress. When we have these experiences, learning happens: When our behavior successfully moves us toward an appetitive thing or moves us away from an aversive thing, we become more likely to repeat the behavior in the same or similar situations in the future. This is called reinforcement, the process by which the probability of behavior in a given setting increases. The Costs of a Behavior Can Decrease That Behavior At other times, behaviors have costs: they take us farther away from the appetitive thing or bring us closer to the aversive thing. When this happens, another type of learning, called punishment, occurs: those behaviors become less likely to recur in similar circumstances in the future. As with aversive and appetitive stimuli, whether a given consequence will actually be reinforc- ing or punishing can’t be determined in advance. You have to wait and see how the consequences affect the behavior. When you stand back and observe the flow of behavior, you can begin to see more clearly the different ways that consequences influence behaviors. For example: • When there is a strong payoff coming, or you have a strong sense of the payoff for a behavior in the moment, it is easier to endure the aversive things that might happen along the way. • When there is no sense of payoff, it is more difficult to persist in the face of aversive things. • One of the most desperate places to get stuck is when you know that a behavior is important because of its long-­term consequences, yet you constantly get derailed while pursuing it because of the pain involved, or because numerous other appetitive “shiny gold objects” draw you away. Function Is Active CBS doesn’t take the view that humans are passive agents or automatons who are pushed around by the world and are at the mercy of their environment. Central to the principles we’ve just outlined—­about how behavior functions—­is the notion that humans are actively operating on the environment around them. Every aspect of human behavior is an active, ongoing, mutual interac- tion with the world. The CBS perspective considers how behavior is shaped by context and the ways behaviors create or perpetuate context and the situations people find themselves in. This interdependent relationship is the central meaning of the word “function.” How does this behavior produce consequences in the world? What consequences has the behavior produced in the past that have shaped it, making the behavior worth repeating now? PROBLEMS WITH LEARNING The behavior we engage in now, in this situation, reflects the history of consequences we received in similar situations in the past. Because we are always bringing past experience to the present moment (that’s what learning is), the past is always present. At the same time, what worked and was reinforced in the past does not always work well in the present. Said another way, the influence of historic consequences doesn’t always steer us well in the long run. One form of this breakdown involves limited contact with the future. We could call it the problem of “consequences now matter more than consequences later.” For instance, when people are addicted to cigarettes, they are excessively under the influence of the immediate results of smoking (for example, relief from tension and withdrawal symptoms), despite the fact that the long-­ term consequences can be deadly. Or consider how this dynamic plays out for Mark, whom we mentioned earlier. He learned to avoid expressing his needs to the important people in his life because, due to early life experiences, it makes him anxious to do so. In the short term, he avoids the anxiety of making requests, but in the long term he stands a good chance of feeling more disap- pointed or resentful because his needs aren’t met. In these kinds of situations, behavior is too heavily constrained by its short-­term results, despite the fact that being constrained in this way doesn’t work well in the long run. This pattern happens in interpersonal contexts all the time. We avoid raising a difficult issue in the moment because we don’t want to feel uncomfortable in the short term. Yet that avoidance leads to ongoing dissatisfac- tion and a bigger problem later. Or we gossip, complain, or attack because it feels satisfying in the moment, even though a few hours later we feel ashamed, and in the long run we undermine trust and closeness. Another form of the breakdown of learning involves the past. In this case, behavior that func- tioned well in the past can persist into the present even though it no longer functions very well. We could call it the problem of “past learning is out of touch with the present.” Consider Gillian, who avoids expressing her wishes because she was consistently punished for doing so as a child. She may persist in this behavior even though her current partner is eager to understand her and respond compassionately toward her. Behavior that’s been met with such painful consequences in the past can be especially problematic because the person now avoids the situation or behavior that prompted the pain, as is the case for Gillian. In fact, she may feel fear simply at the thought of expressing her wishes. When people avoid such situations, they deprive themselves of opportunities for new learning. As a result, Gillian loses the chance to learn that expressing her wishes will actually produce positive consequences. Because of her avoidance, she remains under the influence of old learning and is less effective in her current context. This kind of avoidance can persist for decades. If psychological problems occur when past learning excessively controls our behavior, more effective behavior often occurs when people balance being guided by the past with being respon- sive to what seems to be working best in the present. In other words, we benefit from past learning but remain able to flexibly adapt our behavior to the present moment. Similarly, if problems occur when short-­term consequences excessively control our behavior, such that we cause long-­term problems, more effective behavior typically occurs when we build a capacity to tolerate whatever short-­term consequences are necessary to achieve our long-­term aims; more effective behavior also occurs when we are able to find a clearer sense of the long-­term value of our actions here and now in the present. Or in other words, when we have a vivid sense of the purpose or goal behind our actions, we become much more able to tolerate frustrations and discomforts and forgo easy dis- tractions in favor of persevering toward what matters to us. CBS terms these capacities, taken together, as psychological flexibility. In turn, taking the CBS stance—­being able to see our behavior clearly and see the ways that it gets stuck—­tends to help us become more psychologically flexible. LANGUAGE: A VERY SPECIAL KIND OF BEHAVIOR Notice how much of the CBS stance is about learning to “see,” that is, observe and label behaviors and how behaviors function. All of this involves language—­and language, like everything else people do, is behavior. Not surprisingly, then, language plays a very special role in the CBS frame- work. In humans, language is an important behavior that allows us to operate in and be shaped by social interactions. By and large, therapy is a process of language. On the flip side, sometimes lan- guage can powerfully curtail our flexibility, such as when people decide, based on past experience, that they know exactly what’s going on and, as a result, miss what’s really happening. In our treatment of language in this book, we’re guided by relational frame theory (RFT; Hayes, Barnes-­Holmes, & Roche, 2001), an empirically established CBS account of language and cogni- tion. Briefly, RFT posits that the behavior at the core of language is the behavior of relating. For instance, we relate objects and words to one another, such as when we relate the verbal label “tree” to an actual tree. Similarly, we can relate words to each other; for example, we say, “Blue is a color.” We can relate things in many ways. For instance, “blue is a color” is a relation of hierarchy, given that color is a category that contains several things, one of which is blue. Another type of relation is that of opposition: day is not night. These are very fundamental relations. The analysis of RFT has allowed us to break the operation of language down into these fundamental pieces of behavior. These relations, in turn, influence how we respond to the things we’re relating to. For example, “This apple is good” or “This apple is bad” steers our behavior. As for language operating naturally in a mature human being, that’s what happens when you take these very simple relations, multiply them by a trillion, then put them in a blender, along with other people and massive chunks of the world, and run that blender at high speed for several decades. The result is a very complex soup of relations and influences and an ability to engage in the present-­moment behavior of relating a whole bunch of things that aren’t in the here and now to whatever is present. Again, these relations influence how we respond to the things to which we’re relating. Remember when we warned in chapter 1 that labels are not neutral? For instance, if you relate your child’s teacher and “stupid,” thinking to yourself That teacher is stupid, you’ll respond to him differently than if you relate other words to him. Similarly, some clients may come to therapy with all sorts of thoughts about how they should interact with you—­without having any prior experience with you, or perhaps with therapists in general. Part of what we do carefully in therapy, then, through the process of functional analysis and our therapeutic relationship, is influence how people relate to themselves and their behavior and the world around them. From the CBS perspective, this is no doubt a “common factor” across any form of therapy. If you’re interested in learning more about RFT and this common factor, we encourage you to check out Learning RFT (Törneke, 2010) or Mastering the Clinical Conversation (Villatte, Villatte, & Hayes, 2015). In this book, our presentation of FAP is strongly influenced by RFT; however, we won’t invoke RFT directly beyond this point. THE CLIENT IS RIGHT: DON’T ASSUME, ASSESS If you’re having the thought that learning is incredibly complex, you’re right. When we study behavior, we’re studying something of marvelous complexity. As therapists, we must witness the ongoing flow of this complexity and bring great humility and appreciation to our attempts to influ- ence it. This is of course what we all know as clinicians. CBS echoes this wisdom. As Skinner said, “Behavior is a difficult subject matter, not because it is inaccessible, but because it is extremely complex. Since it is a process, rather than a thing, it cannot easily be held still for observation. It is changing, fluid, and evanescent, and for this reason it makes great technical demands upon the ingenuity and energy of the scientist” (1953, 15). Of course, for mental health therapists, we typi- cally have only one hour per week with a given client, so this difficulty is greatly compounded: it’s like trying to watch a parade through a pinhole. This complexity and inaccessibility of behavior has direct implications for how we must venture to understand it from a CBS perspective. Beware of any tendency to dismiss or distort clients and their experience in service of preserving a case conceptualization or other theory about how things should be. Instead, listen and watch and see what works. An anecdote from the early science of behaviorism illustrates this concept: A famous scientist reached the end of some grueling and fastidi- ous experiments with rats and found that one of his well-­considered hypotheses didn’t seem to hold up to reality. But he accepted this, saying, “The rat is always right.” In other words, clients might not behave as we think they should, but they are nevertheless behaving exactly as they ought to. The good news is that we don’t need to know everything in order to be helpful. The goal is not to be right; it’s to be helpful. We can take a pragmatic approach and focus on knowledge that works. A large component of the art of behavior therapy is knowing how much factual information and specificity is necessary in order to focus treatment without making it unnecessarily compli- cated or inflexible. We don’t need to find the “best” way or the “right” way. After all, there are numerous ways to describe clinical phenomena and a variety of paths to behavior change. Our task as clinicians is to find one path that works. WHY IT’S IMPORTANT TO UNDERSTAND LEARNING AND FOCUS ON FUNCTION Hopefully everything you’ve read in this chapter has underscored that CBS is an intrinsically com- passionate way of understanding and working with clients. At its core, CBS is about seeing behav- ior and seeing the influences of learning in the present so we can become more flexible and effective in the present. Everyone has a history that makes up the meaning of this moment. And yet that history is invis- ible to us, as observers. So it is so easy to misunderstand people, to miss the meaning of their actions. In psychotherapy especially, in which our job is to create change in behaviors, we need ways to see that invisible context of learning and function. Social psychology research on what’s called the fundamental attribution error (Jones & Harris, 1967; Gilbert, 2002) has nicely captured our view on this point. On the one hand, we tend to explain our own mistakes and failings through an appeal to context; for example, “I wasn’t lazy. I had a lot on my plate this week. I was stressed and needed to rest.” We can make these kinds of generous inter- pretations of our own behavior because, in part, we have access to the contexts that shaped us. Furthermore, we tend to provide similarly generous interpretations for the behavior of those we care about. On the other hand, we aren’t as generous with strangers, as we can’t see beyond their appear- ance and their history is invisible to us. The same is true of people whom, for whatever reason, we dislike. We’re much more likely to judge them based on their supposed intrinsic qualities as people. The attribution error we make in these cases is that we blame people’s attributes for their behavior, rather than imagining that, within their context, their behaviors make sense, as we do for ourselves. Another way to say this is that we tend to see people’s behavior in its context when we’re at our most compassionate. In a sense, seeing someone’s behavior in context is simply another way of describing empathy and understanding. And likewise, we are much more likely to feel understood by someone who takes a generous view of our actions and more likely to be open to that person’s influence. CBS is about developing that generous stance of seeing action in context. In fact, CBS researchers (Hooper, Erdogan, Keen, Lawton, & McHugh, 2015) recently showed that training in perspective taking decreases the chance that people will commit the fundamental attribution error. Not surprisingly, for many people seeking psychotherapy, one way they’ve gotten stuck is by failing to see their own actions in context. They’ve become bogged down in negative and general- ized self-­attributions: “I’m a loser,” “I’m unlovable,” and so on. By helping them see their behavior in context, we can help them achieve a more self-­compassionate stance. And as we said in the previ- ous chapter, when you deeply understand someone and care for her, then what’s good for her—­her growth—­will naturally become appetitive for you, so you’ll tend to nurture or reinforce more of that. Perhaps this is what a skilled listener does, even without noticing it. And given how central social connection is to well-­being for humans, as discussed in chapter 1, it should come as no sur- prise that a close relationship can be such a subtle and sensitive instrument for behavior change. CBS helps us get below appearances in order to investigate the deeper functions of behavior and to build a deeper kind of empathy and understanding and, therefore, influence. In turn, we seek to see a client’s problematic behaviors as they happen, respond in ways that evoke new and more effective behaviors, and reinforce those behaviors so they take root, not only in the client’s rela- tionship with us but in other contexts as well. In the next chapter, we turn to more concrete ways in which we put the CBS perspective to work in the therapy relationship using functional analysis. SUMMARY • The psychological perspective at the root of FAP is contextual behavioral science (CBS). • The CBS perspective involves a small set of basic assumptions, including • everything people do is behavior, including thinking, feeling, sensing, and so on; • behaviors are events happening in time and space; and • behavior is steered by its consequences. Some consequences cause the behavior to increase in frequency; other consequences cause the behavior to decrease in fre- quency. “Function” is what a behavior achieves in terms of these consequences. • There are problems that result from learning through consequences. Behavior can become too constrained by past experiences and therefore be out of touch with the present. It can also become too influenced by short-­term consequences, even if it leads to long-­term costs. • The influences on behavior are complex. You won’t be able to gain a definitive under- standing of them, but you can attain a good enough understanding to exert influence. • Understanding function and learning history is a road to empathic, compassionate understanding—­to making sense of the contexts and experiences that lead people to behave as they do.