引言

引言

没有知识的爱，或是没有爱的知识，都无法产生美好的生活。 ——伯特兰·罗素

你来到办公室，并且带着自己。但你还带了些什么？

也许你带来了糟糕的一夜睡眠或周一早晨的压力。你可能带来了好咖啡和做好事的决心。你在职业生涯中处于高点还是低谷？你是否在学习一种新方法，或者与出色的同事进行咨询？又或者你最近几周感到“平淡无奇”，正在思考下一步该做什么？你是否在努力喜欢本周将要见到的一些人？

你带来了什么快乐？什么恐惧？什么希望？什么脆弱之处？你带来了什么羞耻感？周五那次痛苦的会话是否仍然让你有些刺痛？周末发生的事情是否让你与朋友疏远？你是否对某些事情感到畏惧？

当你开始新的一天时，你作为治疗师所坚持的原则有多坚定？你在哪些方面有所保留？你是否真正审视了自己作为治疗师的弱点？你在哪些方面过于努力？

你现在生活中正在回避面对什么？你的脆弱之处在哪里？上述所有变量将如何影响你今天作为治疗师的表现？它们将如何影响你的客户？

你的客户——或许他是一个新客户，我们假设他的名字叫汤姆——也带着他自己和他的历史来到会话中。汤姆醒来时对你即将进行的预约感到焦虑。他倒咖啡时手在颤抖。

他想象着你会坐在他对面，安静而专业地评估着他。他想象自己会坐立不安。他排练着要说的话，以便至少听起来连贯一些。他感到胸中恐慌上升。

他回忆起一连串不知名的医生对他提出的问题。尽管他们都是出于善意，但他们每个人都让他感到紧张不安。

于是你和汤姆相遇了。当你们的历史、脆弱性和观点相互作用时会发生什么？他会从你们的互动中带走什么？你会如何鼓励他？你会如何微妙地阻止他？羞辱他？你会如何邀请他敞开心扉？反过来，他又会如何羞辱你？让你失望？你会如何服务他？或者，如果你为了维护自己的专业知识和能力而行动，是否会微妙地或不那么微妙地忽视汤姆并忽略需要关注的关键问题？

每个客户不仅仅是一个案例，而你也不仅仅是一个治疗师。你和你的客户是两个参与连接（并希望治愈）之舞的人，这种连接基于数万年的人类进化。对于一个周一早上来说，这可真不少！

本书的主题——功能分析心理治疗（FAP），是在与每位客户互动时保持觉知、勇气和技巧。它关乎站在你自己历史的前沿，以觉知的态度与站在她历史前沿的客户互动。随着互动的展开，FAP则关乎共同看到，以勇气和同情心，当前这一时刻在治疗中可能包含着客户寻求帮助的问题——然后抓住机会，在当下立即、体验性地、关系性地成长和改变。当这种情况发生时，互动不仅充满同情和连接，而且还能创造变化。

我们在本书中有两个主要目的：

• 首先，通过情境行为科学的视角，我们希望帮助你认识到，治疗会话中的每一刻都是一种行为，这种行为在每个人的学习历史背景下是有意义的，并且这种行为现在是对当前情况的反应。功能分析（FA）是这种看待会话中每一刻的核心评估过程。这是一种既富有同情心又原则明确的行为处理方式。在FAP中，我们应用FA来理解客户的问题——特别是这个治疗时刻如何唤起这些问题。FA是我们“瞄准”FAP变革过程的方式。它也是我们理解这一刻对这个独特个体意味着什么的方式。

• 其次，我们向你展示如何将FA与诚实、勇敢、富有同情心和个人参与的治疗过程相结合。真实、真诚的治疗关系服务于FA，因为这是人类可以互相“了解”的自然媒介——通过披露和回应的脆弱舞蹈，找到共同的语言和视角。

FA与关系的交集定义了FAP。为什么你应该关心？

首先，广泛接受的是，治疗关系的质量对治疗结果至关重要（Horvath, Del Re, Flückiger, & Symonds, 2011）。FAP基于研究和分析，这些研究和分析着眼于什么创造了强大而紧密的关系，并提供了创建良好治疗关系的具体指导方针。

其次，FAP提供了一种高度个性化但又精确的思考治疗过程的框架。FAP坚定地站在情境行为科学（Hayes, Barnes-Holmes, & Wilson, 2012; Hayes, Levin, Plumb-Vilardaga, Villatte, & Pistorello, 2013）以及更广泛的行为疗法运动之中。FAP基于行为疗法的核心实践，即定义具体行为并通过特定的治疗过程针对这些行为进行干预。反过来，治疗师对行为的响应不是基于它们看起来的样子，而是基于它们在客户不断展开的生活背景中实际对客户意味着什么（即它们的功能）。

内容翻译

说FAP是一种行为疗法，与几十年前的意义大不相同。最新一波的行为疗法（以及其他类型的疗法）已经缩小了行为治疗师的原则性距离和人本主义心理学家的敏感调谐之间的差距。作为治疗师，我们不再需要在结构化的、基于证据的评估框架与在与客户互动中保持完全人性化和敏感之间做出选择。FAP及其同行——接纳与承诺疗法（ACT；Hayes, Strosahl, & Wilson, 1999）、慈悲聚焦疗法（CFT；Gilbert, 2010）以及辩证行为疗法（DBT；Linehan, 1993）——整合了这些观点。如果你有更多体验式疗法的背景，FAP可以帮助你提高评估的精确度。如果你有行为疗法的背景，FAP可以帮助你改进工作的体验流和即时性。

在很多方面，治疗是一个过程：两个人之间发生的一系列事件，他们以极其微妙的方式相互影响。一个呼吸、一声叹息或眼神的回避可以传达比长篇大论更多的信息，尤其是在治疗师或客户最脆弱或情绪化的时候。由于这种相互影响的过程通常是微妙、快速、自动且短暂的——或者随着时间的推移而变得难以连贯——很容易错过当下真正发生的事情。很容易忽视治疗发生在当下，并在不断展开的当前时刻序列中进行。也很容易忽略在会话中发生的挣扎通常也是客户生活中其他情境中的问题。同样容易被忽视的是那些微小而试探性的新可能性时刻，在这些时刻中更深层次的变化可能会扎根。

FAP是关于放慢速度并调谐到这个过程中，意识到互动是你和你的客户之间的。FAP是通过学习的一般原则来审视个人和人际交往，同时承认没有任何一套原则能够完全适应现实生活。FAP的立场是在治疗过程中尽职尽责也需要认识到我们的盲点，穿越脆弱，承担风险，并表达我们的感受——不是鲁莽地，而是策略性地。

在一个疗程中，FAP治疗师可能会在白板上绘制功能分析图，然后引发客户对她在此功能分析过程中所做评论的真实愤怒表达。对于另一位客户，FAP治疗师可能会花四十分钟帮助客户在当下表达脆弱的想法和感受，然后在疗程的最后十分钟定义具体的行动作业。在FAP中，行为疗法和人际过程的工具故意交织在一起。

FAP强调一种强烈、投入和个性化的治疗关系，反映了社会关系是塑造人类福祉和成就的关键这一持续发展的科学共识。心理治疗只是社会联系力量的一种表现。并不是魔法、巧合或科学心理学的技巧使得关系（即治疗）具有极强的治疗效果。人类进化的方式使得亲密关系对我们有着巨大的影响。因此，我们人类对彼此来说是极其敏感的改变工具。

由于FAP专注于治疗关系中的真诚参与，而且从人际距离来做治疗违背了这一原则，可以说FAP对治疗师的要求很高。它要求你做好自己的工作，以便能够在客户面前承认错误，展现脆弱，承担风险，感受情感等。我们和我们的客户处于同样的境况：我们都作为人类在奋斗。

这种偏爱真诚参与的态度并非偶然或随意的；这不是个人喜好的问题。它是全球日益增长的认识的一部分——这是情境行为科学（CBS）的核心——人类的福祉由我们生活的环境培养或削弱，而这些环境主要涉及其他人。正如预防科学家和行为分析师Tony Biglan所展示的，总结了超过五十年的行为科学研究，包括育儿、教育、公共卫生和临床科学，“养育环境”极大地支持了人类健康和福祉（2015）。

有几种不同的方式来聚焦FAP（Bonow, Maragakis, & Follette, 2012）。然而，由于FAP在CBS社区中的重要地位以及支持CBS干预措施的不断增长的证据基础（Hooper & Larsson, 2015），本书大量借鉴了关于人类繁荣的情境的基本CBS原则。像CBS一样，FAP旨在创造一个支持灵活、坚定行动的同情环境——在治疗关系中。

证据支持FAP

本书是一本基于行为原则的临床指南，而不是一个直接提出实证主张的治疗手册。原因很简单：对于FAP原则的具体应用——即需要做出实证支持声明的内容——其证据基础还有相当长的一段路要走。

尽管如此，自FAP成立以来的一个优先事项就是建立一种高度灵活且体验性的治疗方法，同时又扎根于严谨的行为科学原则。FAP基于情境行为科学（Hayes等人，2012），并试图将CBS的原则应用于心理治疗，特别关注创建、维持和改善治疗关系的本质和挑战。

虽然FAP的研究还需要进一步扩展，但在这一部分我们将简要概述迄今为止已完成的研究。从诊断角度来看，FAP是一种跨诊断的方法：FAP强调对各种诊断治疗都重要的治疗关系过程。早期关于FAP的研究采取了这种广泛的态度，进行了一系列案例研究、FAP描述以及涉及多种问题的小型试点研究，包括抑郁症、表演型人格障碍、边缘型人格障碍、强迫症、品行障碍、物质滥用、人际关系问题、性虐待、慢性疼痛、学业焦虑、广场恐惧症、暴露癖、无性高潮症、非特异性人格障碍和非特异性焦虑障碍（Mangabeira, Kanter, & Del Prette, 2012年综述）。

一系列更受控制的单个案例研究也已发表（Esparza Lizarazo, Muñoz-Martínez, Santos, & Kanter, 2015; Landes, Kanter, Weeks, & Busch, 2013; Kanter等人, 2006）。这些研究共涉及九名患者，患有抑郁、焦虑和人格障碍。这些研究的独特性和与本书的相关性在于它们展示了FAP核心的功能分析个体化方法，并且在个别客户层面而非群体平均层面上展示了显著的、具有临床意义的变化。

其他大量的FAP研究集中在抑郁症上。1996年，Bob Kohlenberg获得了国家心理健康研究所的资助，以研究FAP培训是否能改善专家提供的认知疗法治疗抑郁症的结果（Kohlenberg, Kanter, Bolling, Parker, & Tsai, 2002）。他的团队认为，当时被认可为抑郁症金标准实证验证治疗的认知疗法是一个很好的方法，但仍然可以从FAP的关键特征中受益：功能分析、关注治疗关系和专注于社会功能的改善。首先，专家治疗师完成了对十六名客户的常规治疗。然后他们参与了一个FAP培训协议，之后完成了对二十四名客户的治疗。研究发现，第一组的客户表现良好，约48%的人经历了临床上显著的改善。然而，FAP客户的表现更好，约70%的人经历了改善。有趣的是，第一组的客户在一项经过验证的社会功能测量——关系满意度上没有表现出任何改善。而FAP客户则在关系满意度上显示出了显著的改善。

最近的研究提供了更多关于早期研究中发现的FAP益处机制的理解。例如，我们现在有证据表明，FAP在会话中强化改进的策略（我们将在本书中讨论）是上述单个案例研究中客户改善的关键机制（Busch等人, 2009; Oshiro, Kanter, & Meyer, 2012），并且FAP过程在刚刚描述的认知疗法研究中的改善是独特的责任因素（Kanter, Schildcrout, & Kohlenberg, 2005）。

最近，也是最值得注意的是，Daniel Maitland及其同事（即将出版）进行了首个针对人际困难的FAP治疗的随机对照试验。在一组表现出人际问题的焦虑客户样本中，FAP在社交联系、焦虑和回避方面产生了优于最小活动控制条件（观察等待）的结果。在交替治疗设计中，Maitland & Gaynor（2016）先前证明了FAP在改善人际功能方面优于支持性倾听。在这两项研究中，FAP治疗的治疗联盟评分也更高。

仍需更多的研究。我们希望这本书能够进一步激励研究人员。

如何使用本书

这是一本体验式的、实践为基础的书。虽然我们使用技术语言并更广泛地依赖你对心理治疗的知识，但我们的文字只是指向特定体验和行为的路标。我们希望你能充分参与并拥有这些体验，以便找到自己运用FAP的方式。因此，请在阅读过程中暂停并实践我们要求你实践的内容。正如你可能已经知道的那样，主要基于智力内容的培训对实际技能的改变作用甚微（见Beidas & Kendall, 2010）。当你完全实践FAP时，音乐就会响起，如果你只阅读文字，你是听不到它的。

我们提供既实用又有趣的练习，涵盖了FAP原则的全部范围，以促进你的FAP实践。你可以在日常生活中或在心理治疗实践中练习这些练习，或者两者兼而有之。如你所见，我们不仅会将你视为一名治疗师，而是作为一个完整的人来对待。我们有几个理由要求你参与FAP原则的个人实践。

你并非置身于心理治疗过程之外

实际上，你是这一过程的核心。这包括你说的每一句话、你的表情、你在治疗舞蹈中前进和后退的地方，以及所有其他影响你在治疗过程中表现的因素。这一切都受到你个人历史的影响——不仅仅是你的专业训练，还有你的爱与联系、归属感与孤独、痛苦与奋斗的历史，以及你当前的生活状况。你不必总是揭示自己，可能有些部分在治疗中永远不会被揭示。但鉴于治疗过程是两个人之间极其微妙的影响之舞，即使是你最细微的态度和脆弱也可能有时会起作用。

作为FAP治疗师，我们不会要求客户去做我们自己也不做的事情。为了成为一个敏感的工具并有效地引导客户，治疗师必须熟悉这条路。同理心通常由个人经历所塑造。也就是说，你也必须足够了解自己走过的特定路径，以便能够区分它与其他人的路径。

治疗是一项要求自我意识的工作。治疗师需要持续进行自我关怀和同情的自我反思。你会对你的客户做出反应。有时候，这些反应更多地受到你自己历史的影响，而不是客户本身，因此你必须能够识别哪些反应主要是关于你和你的历史，并且不提供关于涉及客户的广泛有用信息。

以上几点概述了我们要求你作为FAP治疗师采取的立场。另一组略有不同的点定义了我们在阅读本书学习FAP时邀请你采取的立场。以下是一些具体的建议，帮助你最大限度地利用这本书。

• 寻找实践伙伴：考虑到FAP对人际互动的关注，书中的某些练习将涉及到与其他人的互动并不令人惊讶。许多练习可以与客户一起完成，但也有用非客户的人来完成某些练习是有益的。现在，在开始时，尝试找到一些愿意与你进行深刻心灵对话或玩一些有趣的体验心理学游戏的人。这些人可能是同事，也可能是朋友或家人。

• 放下完美主义，拥抱不适：在参与本书中的许多练习时，以及在学习功能分析（如果这是新的）和一般练习FAP时，期望感到不舒服。感到笨拙和焦虑是可以的。你正在练习新事物。即使作者们有丰富的经验，在练习FAP或培训FAP治疗师时也会时常感到焦虑。你可以这样想自己的不适：它实际上代表了你对向另一个人开放的过程的调谐和敏感性，从而让你能够从共享人性的基础上与客户建立联系，而不是以孤立的专业知识为基础。我们将在书中深入讨论这个想法。目前，只需专注于接受这种不适，并提醒自己这是一个表明你走在正确道路上的迹象。

• 信任自己的专长：记住，心理治疗是一种强大的药物，如果管理不当，其危害可能与好处一样大。这意味着要通过使用多年的培训来培养能力，以实现胜任力。由于我们无法知道你和你的客户面临的具体情况，请不要将本书中的任何内容视为绝对推荐。如果某事对你来说感觉不对劲，相信你的直觉并跟随你的专长——或者寻求专家咨询。我们会在整本书中要求你承担计算过的风险，但请不要鲁莽行事或盲目信任我们。

• 如果你需要帮助，请伸出援手：如果你对FAP有任何疑问或担忧，不要认为这是因为作为治疗师的某种不足。请让我们负责有效地教授FAP，并通过告诉我们你需要什么来给我们机会这样做。我们非常关心这项工作，并对其保持谦逊。如果你向FAP社区求助，你会得到答案。你可以通过发送电子邮件给其中一位成员（联系方式请访问http://www.functionalanalyticpsychotherapy.com/find-a-fap-supervisor）来访问FAP社区。如果你使用Facebook，可以请求加入私密的FAP Facebook小组，或者如果你认识已经是成员的人，可以请求那个人添加你。

• 参与正式培训或咨询：如果你想加强FAP原则的实践，发现FAP的部分难以付诸实践，或者只是想强烈体验FAP的实际操作，考虑参加面对面或在线培训，或报名参加全球越来越多的FAP培训师之一的咨询。查看http://www.faptherapy.com获取即将举行的培训列表及可用的顾问和培训师名单。尽管本书提供了重要的观点供你悠闲思考，以及可以在自己的节奏下参与的练习和过程，但研讨会、在线培训和个人咨询将以超越书籍范围的方式提供有关FAP的深度体验学习。

书籍结构

本书分为两部分。第一部分（第1章至第5章）涵盖了FAP的基本原则，第二部分（第6章至第13章）则关注临床实践。第一章介绍了一种情境行为视角下的社会连接，并从这一视角描述了社会功能如何影响心理问题以及治疗关系如何运作。第二章更深入地探讨了构成FAP基础的情境行为视角。第三章介绍了应用于FAP的功能分析核心原则。第四章描述了意识、勇气和爱模型——一个可用于治疗关系以及其他社交情境的功能分析框架。第五章将前面的所有线索联系起来，根据FAP的五个规则描述了FAP核心的治疗过程。

第二部分的感觉与第一部分略有不同，原因很简单：虽然理论是FAP的支柱，但仅仅掌握理论还不足以成为一名有效的FAP临床医生。需要一套特定的技能——个人的、人际的和临床的——来运用这些理论。第六章将从更广泛的角度开始，介绍一些治疗师可以做的练习，以发展自我意识和支持FAP技能的人际灵活性。第七章展示了在治疗开始时发挥作用的FAP元素，并阐述了如何在这个早期阶段为FAP工作打下坚实的基础。第八章进一步探讨了在会话中激发和探索你与客户之间发生的事情的过程。第九章讨论了会话过程中的下一个重要部分：如何以强化的方式回应客户的改进。第十章再次回顾了所有五个FAP规则，并讨论了一个单次互动中使用它们的框架：逻辑互动。同时讨论了实际的FAP实践可能会偏离逻辑性和线性。第十一章涵盖了FAP中的案例概念化。第十二章讨论了家庭作业和体验练习及其在FAP中的使用。第十三章讨论了治疗的结束，这是FAP特别关注的话题。

本章知识点阐述

知识点阐述

1. 治疗师的自我觉察：

   • 治疗师应当对自己的状态有清晰的认识，包括个人的情感、压力和期望。这些因素会影响治疗过程和与客户的互动。

2. 客户的历史和脆弱性：

   • 客户带来的不仅仅是症状，还有他们的历史、情感和经历。治疗师需要理解和尊重这些背景，以便更好地与客户建立联系。

3. 治疗关系的重要性：

   • 治疗关系的质量对治疗效果至关重要。良好的治疗关系能够促进信任、开放和合作，从而提高治疗的成功率。

4. 功能分析心理治疗（FAP）：

   • FAP强调在治疗过程中保持觉知、勇气和技巧。它关注治疗关系中的互动，并通过功能分析（FA）来理解客户的行为及其背后的意义。

5. 功能分析（FA）：

   • FA是一种评估过程，用于理解客户行为的功能。它帮助治疗师识别和理解客户在治疗中的行为模式，并据此制定干预措施。

6. 个性化和精确的治疗：

   • FAP提供了一种高度个性化但又精确的治疗框架。它基于客户的具体行为和需求，通过具体的治疗过程来实现行为改变。

7. 情境行为科学：

   • FAP属于情境行为科学的一部分，强调行为在特定情境中的功能。这种方法结合了行为疗法的原则和现代心理学理论。

8. 治疗师的响应：

   • 治疗师应当根据客户行为的实际功能来响应，而不是仅仅基于行为的表面现象。这种响应方式有助于更有效地解决问题。

9. 治疗关系的构建：

   • 真实、真诚的治疗关系是FAP的核心。治疗师需要通过诚实、勇敢、富有同情心和个人参与的方式来建立这种关系。

10. 治疗过程中的互动：

    • 治疗过程中的互动不仅是信息交流，也是情感和经验的共享。治疗师和客户之间的互动可以成为治疗的重要组成部分，促进双方的成长和改变。

知识点阐述

1. 现代行为疗法的发展：

   • 当代行为疗法如FAP、ACT、CFT和DBT等，已经将传统行为疗法的原则性和人本主义心理学的敏感性结合在一起。这使得治疗师可以在保持结构化和基于证据的同时，更加人性化和敏感地对待客户。

2. 治疗过程中的微妙互动：

   • 治疗过程中的细微非言语信号（如呼吸、眼神接触）可能比言语传达更多信息，特别是在情感高度波动的情况下。治疗师需要注意这些微妙的交流，以更好地理解客户的状态。

3. 功能分析心理治疗（FAP）的特点：

   • FAP强调在治疗过程中放慢节奏，关注当下的互动，并通过一般的学习原则来理解和处理个人及人际问题。FAP认为，真实参与和面对脆弱是治疗过程中的关键要素。

4. FAP在治疗中的应用：

   • FAP治疗师会在治疗过程中使用功能分析工具，同时鼓励客户表达真实的情感和想法。这种方法结合了行为疗法的技术和人际过程的深入探索。

5. 治疗关系的重要性：

   • FAP强调治疗关系的质量，认为良好的治疗关系能够促进客户的成长和变化。这种关系建立在真诚、投入和个性化的基础上。

6. 社会关系对人类福祉的影响：

   • 社会关系对人类的福祉和成就至关重要。FAP和其他现代疗法都认识到这一点，并努力在治疗过程中创建支持性的社交环境。

7. 治疗师的自我反思：

   • FAP要求治疗师进行自我反思，勇于承认错误，展现脆弱，并承担风险。这种态度有助于治疗师与客户建立更加真实的连接。

8. 情境行为科学（CBS）：

   • CBS强调人类福祉受生活环境的影响，尤其是人际关系。FAP借鉴了CBS的原则，旨在创造一个支持灵活和坚定行动的同情环境。

9. FAP的灵活性：

   • FAP可以根据不同客户的需求进行调整，既可以用于精确的行为评估，也可以用于增强治疗过程中的体验流和即时性。

10. FAP与其他疗法的整合：

    • FAP不仅独立作为一种治疗方法有效，还可以与其他疗法结合使用，提供更为全面和个性化的治疗方案。

知识点阐述

1. FAP的证据基础：

   • FAP作为一种治疗方法，其证据基础正在逐步建立。目前已有多个案例研究和小规模实验研究支持FAP的有效性，尤其是在处理抑郁、焦虑和人格障碍方面。

2. FAP的灵活性和体验性：

   • FAP强调治疗的高度灵活性和体验性，同时基于严谨的行为科学原则。这种方法旨在适应不同客户的需求，并通过功能分析和治疗关系的改善来实现变化。

3. FAP的跨诊断特性：

   • FAP是一种跨诊断的方法，它关注治疗关系的过程，这些过程对于各种诊断的治疗都是重要的。这意味着FAP可以应用于多种不同的心理问题。

4. FAP与认知疗法的结合：

   • 有研究表明，FAP与认知疗法结合使用时，可以提高治疗效果，特别是在改善社会功能方面。这表明FAP可以增强传统治疗方法的效果。

5. FAP的实证研究：

   • 虽然FAP的研究还在进行中，但已有初步的随机对照试验表明，FAP在处理人际困难方面比传统的支持性倾听更为有效。这些研究还显示了FAP在改善治疗联盟方面的优势。

6. FAP的实践导向：

   • 本书强调实践的重要性，鼓励读者通过具体的练习来体验和掌握FAP的原则。只有通过实际操作，才能真正理解和应用FAP的方法。

7. FAP的个性化方法：

   • FAP强调个体化的功能分析，关注每个客户的具体情况和需求。这种方法有助于识别和解决客户独特的问题，从而实现更有效的治疗。

8. FAP与治疗关系：

   • FAP特别重视治疗关系的质量，认为良好的治疗关系是治疗成功的关键。FAP通过功能分析和即时反馈来加强治疗关系，从而促进客户的成长和改变。

9. FAP的未来研究方向：

   • 尽管已有初步的研究支持FAP的有效性，但仍需要更多的研究来进一步验证和完善FAP的方法。本书希望能够激发更多研究者对FAP的兴趣。

10. FAP的广泛应用：

    • FAP不仅可以用于心理治疗，还可以应用于日常生活中的个人实践。通过在日常生活中应用FAP的原则，人们可以更好地理解和管理自己的情绪和行为。

知识点阐述

1. FAP治疗师的角色：

   • FAP治疗师不仅是治疗过程的参与者，而且是整个过程的核心。他们需要对自己的言行举止高度敏感，认识到自己的个人历史和经历会对治疗产生影响。

2. 自我意识的重要性：

   • 治疗师需要具备高度的自我意识，以便能够区分自己的反应和客户的实际需求。这包括对自身情感和历史的认识，以及对这些因素如何影响治疗过程的理解。

3. FAP的实践性质：

   • FAP强调实践而非仅仅是理论。治疗师应当通过实践来发展必要的技能，包括自我意识、人际灵活性等，这些都是FAP成功的关键。

4. 面对不适：

   • 在FAP的学习和实践中，治疗师应该准备好面对不适。这种不适实际上反映了治疗师对人际关系的敏感度，以及与客户建立基于共同人性联系的能力。

5. 信任自己的判断：

   • 治疗师应信任自己的专业知识和直觉。当遇到不确定的情况时，他们可以根据自己的经验和判断行事，必要时还可以寻求同行的支持。

6. 积极参与FAP社区：

   • 加入FAP社区可以为治疗师提供支持和资源。无论是通过邮件联系还是加入社交媒体群组，都能帮助治疗师获得指导、分享经验并保持最新知识。

7. 持续学习和发展：

   • 通过参与正式培训、咨询以及不断学习，治疗师可以深化对FAP的理解和应用。这些活动提供了超越单纯阅读书籍所能提供的深度体验学习机会。

8. FAP的临床实践：

   • 第二部分详细探讨了FAP在临床实践中的具体应用，包括如何开展治疗、如何处理治疗过程中的关键环节，以及如何有效结束治疗。

Introduction Neither love without knowledge, nor knowledge without love can produce a good life. —­Bertrand Russell You arrive at your office, and you bring yourself with you. But what else do you bring? Perhaps you bring a bad night’s sleep or the stress of Monday morning. You might bring good coffee and a commitment to do good. Are you at a high or low point in your career? Are you learning a new method, or consulting with fantastic colleagues? Or are you wondering what you’ll do next because too many weeks have felt “blah” lately? Are you struggling to like some of the people you will see this week? What joy have you brought with you? What fears? What hopes? What vulnerabilities? What shame have you brought with you? Are you still stinging a bit from a painful session on Friday? Are you feeling disconnected from a friend because of something that happened over the weekend? Are you dreading something? As you start your day, how firmly do you hold on to what you stand for as a therapist? How are you holding back? Are you truly looking at your weaknesses as a therapist? How are you trying too hard? What are you avoiding facing in your life right now? Where are you vulnerable? And how will all of the variables above affect how you perform as a therapist today? How will they affect your clients? Your client—­maybe he is a new client, let’s say his name is Tom—­also brings himself and his history to the session. Tom wakes up feeling anxious about his appointment with you. His hands shake as he pours his coffee. He imagines you will be sitting across from him, quietly professional yet full of assessment. He imagines himself squirming. He rehearses what he’ll say so he can sound at least semicoherent. He feels panic rising in his chest. He recalls a string of nameless doctors questioning him. Though well-­intentioned, they all set him on edge. And so you and Tom meet. What happens as your histories and vulnerabilities and perspectives interact? What will he take away from your interaction? How will you encourage him? How will you subtly discourage him? Shame him? How will you invite him to open up? In turn, how will he shame you? Disappoint you? How will you serve him? Or, if you act to preserve your sense of expertise and competence, will you subtly or not so subtly miss Tom and overlook key issues that need attention? Each client is not just a case, and you are not just a therapist. You and your client are two people engaging in a dance of connection (and hopefully healing) with a foundation that involves hundreds of thousands of years of human evolution. That’s a lot for a Monday morning! Functional analytic psychotherapy (FAP), the subject of this book, is about being aware, coura- geous, and skillful in the moment when interacting with each client. It’s about standing at the head of your own history, with awareness, and engaging with a client who stands at the head of her history. As the interaction unfolds, FAP is then about seeing together, with courage and compas- sion, how this present moment in therapy may contain the very problem for which your client is seeking help—­and then taking the opportunity to grow and change right here and right now in a way that is immediate and experiential and relational. When this happens, the interaction is not only compassionate and connected, but it also creates change. We have two main purposes in this book: • First, through the lens of contextual behavioral science, we want to help you recognize that what happens in each moment in a therapy session is a behavior that makes sense in the context of each person’s learning history, and that behavior is unfolding now in response to the present. Functional analysis (FA) is the assessment process at the heart of this way of seeing each moment in session. It’s a way of relating to behavior that is empathic and compassionate and also principled and precise. In FAP we apply FA to understand the client’s problems—­in particular, how this moment in therapy may evoke these problems. FA is how we “aim” the change processes of FAP. It’s also how we understand what this moment means for this unique person. • Second, we show you how to weave FA with honest, courageous, compassionate, and personally involved engagement in the therapeutic process. A real, authentic therapeu- tic relationship serves FA because that’s the natural medium in which human beings can become “known” to each other—­through the vulnerable dance of disclosure and response, by finding a common language and perspective. The intersection of FA and relationship defines FAP. Why should you care? First, it’s widely accepted that the quality of the therapeutic relationship is important to therapy outcomes (Horvath, Del Re, Flückiger, & Symonds, 2011). FAP is based on research and analysis that looks at what creates strong, connected relationships, and it offers concrete guidelines for creating good therapeutic relationships. Second, FAP provides a framework for thinking about the therapy process in a highly indi- vidualized yet precise way. FAP stands firmly inside the growing movement of contextual behav- ioral science (Hayes, Barnes-­Holmes, & Wilson, 2012; Hayes, Levin, Plumb-­Vilardaga, Villatte, & Pistorello, 2013) and behavior therapy more generally, and FAP is based on the central practice of behavior therapy, which is defining specific behaviors and then targeting those behaviors through specific change processes in therapy. In turn, the therapist responds to behaviors not based on what they look like but on what they actually mean for the client (that is, how they function) in the context of his or her unfolding life. To say that FAP is a behavior therapy means something quite different than it did several decades ago. The newest wave of behavior therapies (and therapies of other types) has closed the gap between the principled distance of the behavior therapist and the sensitive attunement of the humanistic psychologist. As therapists, we no longer have to choose between a structured, evidence-­based assessment framework and being fully human and sensitive in our interactions with clients. FAP and its fellow travelers—­acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999), compassion-­focused therapy (CFT; Gilbert, 2010), and dialectical behavior therapy (DBT; Linehan, 1993), in particular—­integrate these viewpoints. If you have a background in more experiential therapies, FAP can help you improve the precision of your assessments. If you have a background in behavior therapies, FAP can help you improve the experiential flow and immediacy of your work. In so many ways, therapy is a process: a series of events unfolding between two people who influence each other in exquisitely subtle ways. A breath, a sigh, or an averting of the eyes can com- municate more than a long stream of words, especially when therapists or clients are most vulner- able or emotional. And because this process of mutual influence is often subtle, fast, automatic, and ephemeral—­or so extended over time that it’s hard to connect the dots—­it’s easy to miss what’s really happening in the moment. It’s easy to miss that therapy happens in the here and now and unfolds in the ongoing sequence of present moments. It’s easy to overlook that the struggle hap- pening in the here and now, in session, is often what happens in other situations in a client’s life. It’s also easy to overlook the tiny, tentative moments of new possibility in which deeper change might take root. FAP is about slowing down and tuning into this process and realizing that the interaction is about you and your client. FAP is about examining the personal and interpersonal through the general principles of learning while acknowledging that no set of principles entirely survives contact with real life. FAP’s stance is that doing due diligence in the therapeutic process also requires knowing our blind spots, passing through vulnerability, taking risks, and expressing what we feel—­ not recklessly, but strategically. In the course of a session, a FAP therapist might plot a functional analysis on a white board and then evoke the client’s honest expression of anger related to a comment she made during the func- tional analysis. With a different client, a FAP therapist might spend forty minutes working with the client to express vulnerable thoughts and feelings in the moment, and then spend the last ten minutes of the session defining a concrete behavioral homework assignment. In FAP, the tools of behavior therapy and interpersonal process deliberately mingle. With its emphasis on an intense, engaged, and individualized therapy relationship, FAP reflects the ongoing and evolving scientific consensus that social relationships are key to shaping human well-­being and achievement. Psychotherapy is simply one expression of the power of social connec- tion. It isn’t magic, a coincidence, or a trick of scientific psychology that a relationship (which is what therapy is) can be incredibly therapeutic. Human evolution has proceeded in such a way that close relationships can influence us tremendously. As a result, we humans are exquisitely sensitive instru- ments of change for one another. Because of FAP’s focus on genuine engagement in the therapy relationship, and because doing therapy from an interpersonal distance is a violation of this principle, it’s fair to say that FAP demands a lot from therapists. It requires you to do your own work so you can own your mistakes with clients, be vulnerable, take risks, feel emotion, and so on. We are in the same situation as our clients: we struggle as human beings. This stance of favoring genuine engagement is not incidental or arbitrary; it’s not a matter of personal preference. It is part of a growing worldwide recognition—­core to contextual behavioral science (CBS)—­that human well-­being is nurtured or undermined by the contexts in which we live, and those contexts are overwhelmingly about other people. As prevention scientist and behav- ior analyst Tony Biglan shows, summarizing more than five decades of behavioral science in the areas of parenting, education, public health, and clinical science, “nurturing environments” pro- foundly support human health and well-­being (2015). There are several different ways to focus FAP (Bonow, Maragakis, & Follette, 2012). However, because of FAP’s important place in the CBS community and the growing evidence base support- ing CBS interventions (Hooper & Larsson, 2015), this book draws heavily on the foundational CBS principles concerning the contexts in which human beings flourish. Like CBS, FAP is about creat- ing a compassionate context for change—­one that supports flexible, committed action—­in the therapeutic relationship. EVIDENCE FOR FAP This book is a clinical guide based on behavioral principles rather than a treatment manual with direct empirical claims. The reason for this is simple: the evidence base for specific applications of FAP principles—­what is needed to make empirically supported claims—­has quite some distance to go. That said, one of the priorities of FAP since its inception has been to build a treatment approach that is highly flexible and experiential yet grounded in rigorous principles of behavioral science. FAP is grounded in contextual behavioral science (Hayes et al., 2012) and seeks to apply CBS’s principles to psychotherapy, with a particular focus on the nature and challenges of creating, main- taining, and improving therapeutic relationships. While FAP research has some ground to cover, in this section we provide a brief overview of the research that has been done so far. In diagnostic terms, FAP is a transdiagnostic approach: FAP emphasizes therapeutic relationship processes that are important to treatment across diagnoses. Early research on FAP pursued this broad stance with a series of case studies, descriptions of FAP, and small pilot studies with clients experiencing a diverse range of problems, including depression, histrionic personality disorder, borderline personality disorder, obsessive-­compulsive disorder, conduct disorder, substance abuse, problems in interpersonal relationships, sexual abuse, chronic pain, academic anxiety, agoraphobia, exhibitionism, anorgasmia, nonspecific personality disorder, and nonspecific anxiety disorder (reviewed in Mangabeira, Kanter, & Del Prette, 2012). A series of more controlled single-­case studies on FAP has also been published (Esparza Lizarazo, Muñoz-­Martínez, Santos, & Kanter, 2015; Landes, Kanter, Weeks, & Busch, 2013; Kanter et al., 2006). A total of nine clients were involved in these studies, with a range of depressive, anxiety, and personality disorders. These studies are unique and particularly relevant to this book because they demonstrate the individualized approach to functional analysis that’s at the heart of FAP, and they also demonstrate large, clinically relevant changes at the level of the individual client rather than a group average. Other substantial FAP research has been done with depression. In 1996, Bob Kohlenberg received a grant from the National Institute of Mental Health to study whether FAP training would improve the outcomes of cognitive therapy treatment for depression delivered by experts (Kohlenberg, Kanter, Bolling, Parker, & Tsai, 2002). His team reasoned that cognitive therapy, then recognized as the gold-­standard empirically validated treatment for depression, was a great approach but could still benefit from key features of FAP: functional analysis, attention to the therapy relationship, and a focus on improvements in social functioning. The expert therapists first completed their typical therapy with sixteen clients. Then they participated in a FAP training pro- tocol, after which they completed therapy with twenty-­four clients. The study found that clients in the first group did well, with about 48 percent experiencing clinically significant improvement. The FAP clients, however, did even better, with about 70 percent experiencing improvements. And interestingly, clients in the first group didn’t demonstrate any improvements on a well-­validated measure of social functioning: relationship satisfaction. FAP clients, however, demonstrated signifi- cant improvements in relationship satisfaction. Recent research has provided more understanding of the mechanisms responsible for the ben- efits of FAP found in earlier studies. For example, we now have evidence that FAP’s strategy of reinforcing improvements in session (which we’ll discuss throughout this book) is a key mechanism responsible for clients’ improvements in the single-­case studies discussed above (Busch et al., 2009; Oshiro, Kanter, & Meyer, 2012), and that FAP processes were uniquely responsible for the improve- ments in the cognitive therapy study just described (Kanter, Schildcrout, & Kohlenberg, 2005). Most recently, and most notably, Daniel Maitland and colleagues (in press) produced the first randomized controlled trial of a FAP treatment for interpersonal difficulties. FAP produced supe- rior outcomes for social connection, anxiety, and avoidance compared to a minimal active control condition (watchful waiting) in a sample of anxious clients presenting with interpersonal problems. In an alternating-­treatments design, Maitland & Gaynor (2016) previously demonstrated the supe- riority of FAP compared to supportive listening for improving interpersonal functioning. In both of these studies, the ratings of therapeutic alliance were also superior for the FAP treatments. More research is needed. We hope this book might further inspire researchers. HOW TO USE THIS BOOK This is an experiential, practice-­based book. While we use technical language and rely more gener- ally on your knowledge of psychotherapy, our words are only signposts meant to lead you toward particular experiences and behaviors. We hope you’ll fully participate and own those experiences so that you can find your own way of working with FAP. So throughout, please pause and practice what we ask you to practice. As you’re probably well aware, training with primarily intellectual content does little to change actual skills (see Beidas & Kendall, 2010). A music arises when you fully practice FAP, and you won’t hear it if you only read the words. We offer exercises that are both practical and interesting and address the full range of FAP principles in order to facilitate your practice of FAP. You can practice these exercises in your day-­ to-­day personal life, in your psychotherapy practice, or both. As you can see, we will address you not just as a therapist but as a whole person. We have several reasons for asking you to engage in a personal practice of the FAP principles. You are not outside the process of psychotherapy. Indeed, you are at the center of the process. This includes the words you speak, the expressions you show, where you push forward and where you pull back in the dance of therapy, and everything else that contributes to how you appear in therapy. All of this is shaped by your history—­not just your professional training, but also your personal history of love and connection, of belonging and loneliness, of suffering and striving, as well as your current life circumstances. You may not always have to reveal yourself, and there may be parts of yourself that you never reveal in therapy. But given that the process of therapy is an exquisitely nuanced dance of influence between two people, even your most subtle dispositions and vulnerabilities may sometimes matter. As FAP therapists, we don’t ask clients to practice or do what we do not do. To be a sensitive instrument and to guide clients well, therapists must be familiar with the path. Empathy is usually informed by personal experience. That said, you must also have enough awareness about the par- ticular ways you’ve traveled on your own path to discriminate it from the paths of others. Therapy is demanding and requires self-­awareness. Therapists need to engage in ongoing prac- tices of self-­care and compassionate self-­reflection. You will react to your clients. And sometimes those reactions will be influenced more by your own history than by clients themselves, so you must be able to identify which of your reactions are mostly about you and your history and there- fore don’t yield broadly useful information about the client involved. The points above outline the stance we ask you to take as a FAP therapist. A slightly different set of points defines the stance we invite you to take as you go about learning FAP by reading this book. Here are a few specific suggestions about how to get the most out of this book. Find practice partners. Given FAP’s focus on interpersonal interactions, it probably won’t come as a surprise that some of the exercises in this book involve interacting with other people. Many can be done with clients, but it will be useful to do certain exercises with people who are not clients. Here and now, at the outset, try to identify a few people who might be willing to engage in some deeply heartfelt conversations with you or play some fun, experiential psychology games. These people could be colleagues, but they might also be friends or family members. Drop perfectionism and embrace discomfort. Expect to feel uncomfortable while engaging in many of the exercises in this book, as well as while learning functional analysis (if it’s new to you) and while practicing FAP in general. It’s okay to feel clumsy and anxious. You’re practicing some- thing new. Even with all of our experience, the authors of this book continue to feel anxious at times while practicing FAP or training therapists in FAP. You may find it helpful to think of your discomfort this way: it actually represents your attunement and sensitivity to the dance of opening up to another person, and thus your ability to relate to clients from a foundation of shared human- ity rather than disconnected expertise. We discuss this idea in depth later in the book. For now, simply focus on accepting the discomfort and reminding yourself that it’s a sign that you’re on the right track. Trust your own expertise. Bear in mind that psychotherapy is strong medicine and can do as much harm as good if it isn’t managed effectively. That means managing it locally by using the years you’ve devoted to training to develop the capacity to practice competently. Since we cannot know the particulars of the situations you and your clients face, please don’t take anything in this book as an absolute recommendation. If something doesn’t feel right to you, trust your gut and follow your expertise—­or seek expert consultation. We will ask you to take calculated risks throughout this book, but please don’t be reckless or trust us blindly. Reach out if you need help. If you have questions or concerns about FAP, don’t assume it’s because you’re somehow inadequate as a therapist. Hold us accountable to teach FAP effectively, and give us the opportunity to do so by letting us know what you need. We care deeply about this work, and we remain humble about doing it. If you reach out to the FAP community, you will get answers. You can access the FAP community by e-­mailing one of us (for contact information, visit http:// www.functionalanalyticpsychotherapy.com/find-­a-­fap-­supervisor). If you’re on Facebook, you can ask to be added to the private FAP Facebook group, or if you know someone who is already a member, you can ask that person to add you. Participate in formal training or consultation. If you want to intensify your practice of FAP prin- ciples, if you find that parts of FAP remain difficult to put into practice, or if you simply want a powerful experience of FAP in action, consider joining an in-­person or online training or signing up for consultation with one of the growing number of FAP trainers worldwide. Check out http:// www.faptherapy.com for a listing of upcoming trainings and available consultants and trainers. Although this book offers important ideas you can leisurely ponder and exercises and processes that you can engage in at your own pace, workshops, online trainings, and individual consultation will provide in-­depth, experiential learning about FAP in ways that go beyond the scope of what’s possible within a book. ORGANIZATION OF THE BOOK This book is organized in two parts. Part 1 (chapters 1 through 5) covers the essential principles of FAP, and part 2 (chapters 6 through 13) addresses clinical practice. Chapter 1 introduces a contex- tual behavioral view of social connection and describes, from this perspective, how social functioning influences psychological problems and how therapeutic relationships work. Chapter 2 goes deeper into the contextual behavioral perspective at the root of FAP. Chapter 3 introduces the core principles of functional analysis as applied in FAP. Chapter 4 describes the awareness, courage, and love model—­a framework for the functional analysis of social connections that can be applied to therapeutic relationships, as well as other social contexts. Chapter 5 ties all of the previ- ous threads together to describe the therapeutic process at the center of FAP as encapsulated in the five rules of FAP. Part 2 has a slightly different feel than part 1 for a simple reason: although theory is the back- bone of FAP, having a grasp of theory isn’t sufficient to be an effective FAP clinician. A particular set of skills—­personal, interpersonal, and clinical—­is required to put the theory to use. We’ll begin a bit more broadly in chapter 6 with a presentation of some exercises therapists can do to develop self-­awareness and the interpersonal flexibility that supports FAP skills. Chapter 7 presents the ele- ments of FAP at play in the beginning of therapy and sets forth how to strengthen the foundation for FAP work at this early stage. Chapter 8 delves further into the process of evoking and exploring what is happening in session between you and the client. Chapter 9 discusses the next important part of in-­session process: how to respond to a client’s improvements in reinforcing ways. Chapter 10 reviews all five FAP rules again and discusses a framework for using them in a single interaction: the logical interaction. It also discusses how the actual practice of FAP might deviate from the logical and linear. Chapter 11 covers case conceptualization in FAP. Chapter 12 addresses home- work and experiential exercises and how these are used in FAP. Chapter 13 discusses the end of therapy, a topic of special attention in FAP.