5 依据FAP五原则塑造过程

第五章

使用FAP的五个规则塑造过程

很容易认为这是关于他们，关于他或她，但其实这是关于你。还有我。 建立连接。就在此刻，在这次对话中。不是那一次。是这一次。 ——苏珊·斯科特

“每次我妻子批评我的行为时，我当然会变得防御性很强。”

你停顿了一下，让这些点连在一起。“有可能这种——批评、变得防御性强——的行为在我们之前的会谈中也出现过吗？”

她的眉头微微皱起。“不，在这里感觉很不一样。你为什么这么问？”

“嗯，我之所以这么问是因为当时你看起来有点防御性。而且……你现在看起来也有点防御性。你明白我的意思吗？”

她耸了耸肩，显得有些恼火。“好吧，既然你指出来了，是的。”

“你现在可以尝试什么来显得不那么防御性呢？”

“我想……”她停下来，似乎在望向远方。“我觉得当我受到批评时，我的情绪变化非常快，感觉自己自尊心受到了打击。然后我的防备心就上来了。”突然间，她似乎快要哭了。

你对她的语气变化感到惊讶。“你知道吗，这听起来和刚才完全不同。感觉也不同。对你来说是什么样的感受？”

“脆弱。我很焦虑。”她抿了抿嘴唇，看向别处。“总之……”

“我们可以在这里暂停一下吗？”你停顿了几拍。“我知道我们之前讨论过这一点……只是让我觉得，稍微停顿一下，表现出一点脆弱——甚至是对你感到防备的事实，这都起到了很大的作用。我知道她也希望你能给她这个，并且也给自己。这意义重大。”

“对我来说太难了……”这次她真的哭了。

“我知道。这对你的意义是什么呢？”

“我只是希望能够放松下来，信任她。很多时候我就像一只野猫。”她轻声哭泣着。

“我也希望你能这样。能够停下来，被看见……让你自己存在。让她看见你。如果你能和她做到这一点会怎么样？”

当来访将她的人际关系斗争——与她的心理斗争交织在一起——带入治疗关系中，当你看到导致她人际关系冲突的问题正在此时此刻的治疗中发生时，你既承担着责任也拥有机会。你们的关系，此时此刻，将会留下印记。责任在于不要重复她以往的经验：脆弱是危险的；最好保持距离和防御。然而，如果你已经做了工作去了解她的人际关系——例如，看到她不愿意提出自己的需求如何部分地维持了她的抑郁，并使她感到无话可说——那么你可能会看到这种行为的本质：这是一种学来的、曾经适应但现在不再适应的行为；一种代价高昂且回避的行为，同时既舒适又不舒服。如果你已经做了同理心的工作，能够了解她内心的感受，你就能敏感地暂停。你能够打破通常发生的事情，创造出不同的东西。这就是你的机会，你可以陪伴她进入改变的新奇和焦虑之中。

FAP关注的是治疗关系中的这些时刻，当同情（且功能性的）理解对方使你能够看到并引发和强化一种不同的互动方式。在本书的前半部分，我们主要关注这一公式的前半部分：从情境行为科学或功能的角度看待行为。虽然这种观察是FAP的基础，但FAP过程的核心在于你如何利用这种观察来创造改变。

FAP中的改变过程本质上是在治疗过程中影响CRB的过程，以减少CRB1的频率并增加CRB2的频率。在本章中，我们将介绍五个规则（最初发表于Kohlenberg & Tsai, 1991）来指导这一过程。请注意，我们使用的“规则”一词具有特定含义，意味着“尝试一下；你可能会喜欢它，因为好的事情会发生。”这与更为严格的处方相反：“规则是你必须做的事情，否则会有不好的事情发生。”

这五个规则是一种学习工具，帮助你掌握FAP过程。本章主要讨论每个规则。对于每个规则，我们都包括了自我反思或咨询的问题。在书的第二部分，我们将详细说明如何实践这些规则。

以下是这些规则：

• 规则1：注意CRB
• 规则2：引发CRB
• 规则3：强化CRB2
• 规则4：注意你的影响
• 规则5：支持泛化

规则1：注意CRB

多年来，Bob Kohlenberg经常说规则1是FAP中最重要的规则。原因在第二章中我们讨论卡尔·罗杰斯时有所提及：当你理解哪些行为对来访有益，代表成长和灵活性，哪些行为代表停滞且对来访无益时，你会自然倾向于以培养和支持更有效行为的方式回应。因此，规则1主要是关于觉察：理解在治疗过程中来访被唤起的行为以及这些行为与临床问题的关系。它还涉及同理心，因为在那一刻需要对来访的体验、她理想中的样子以及她在每一刻离这个理想有多近有极高的敏感度。

规则1：注意CRB

因为这种觉察是通过功能分析来构建的，规则1涵盖了FAP的大部分内容，并为其他所有规则奠定了基础。更具体地说，注意CRB是指区分哪些行为是CRB1（临床相关行为1，即无效行为）和哪些是CRB2（临床相关行为2，即有效行为），以及这些行为是如何在当下被唤起和塑造的。正如第三章中关于功能分析所讨论的，这要求理解来访生活的大背景，并了解她可能经历的情绪和其他内在体验。

这个观察各种情境和行为功能的过程——以及所有与之相关的关于什么有效、什么无效的判断——是持续进行的、协作性的且复杂的。我们将在本书的第二部分详细讨论如何将这一规则付诸实践。现在，我们将提供几个即时注意CRB的例子。你会看到，这些观察只有在更广泛的功能分析背景下才有明确的意义：

• 一位来访在安排时间时显得过于迁就，尽管这对治疗师来说很方便，但你也知道她在表达需求方面有困难。
• 当你触及某个特定话题时，一位来访的肢体语言显示出羞耻感，似乎在很大程度上封闭自己。
• 一位人际关系中充满回避和冲突的来访在会谈中显得不够投入，似乎治疗没有满足他的需求。
• 一位在日常生活中难以表达情感的来访在一次会谈中哭泣，而在下一次会谈中她显得退缩。
• 尽管在披露时看起来非常诚实和直接，但一位来访让你感到困惑，因为他似乎在对自己的看法和对世界的看法之间摇摆不定，并且他还抱怨没有人理解他或愿意接近他。

自我反思或咨询问题：规则1

• 来访在日常生活中的人际交往模式是什么？哪些模式是有问题的？
• 来访与你的互动过程中有哪些模式？
• 会话外的人际关系和会话过程之间是否存在功能性相似点？
• 与这些模式相关的来访的具体行为是什么？
• 你的哪些行为助长了这些模式？
• 治疗关系中是否有难以概念化的显著模式，例如来访令人困惑、恼人或不安？
• 你是否有一些盲点、混淆区域或脆弱性，可能与你的个人历史有关，影响你清晰地看到来访的CRB？

规则2：引发CRB

一旦你在当下以极其敏感的方式与来访调谐，并能清楚地看到当前发生的事情的功能，你可以更有策略性和明确地创建一个能够引发CRB的情境。换句话说，你可以直接谈论治疗关系中正在发生的事情，它与临床问题的关系，以及如何练习不同而更有效的反应。规则2就是以这种方式战略性地、故意地引发CRB。

换言之，一旦你清楚地看到了来访最挣扎的情境，因此也是通过改善她的行为最有可能获得收益的情境，你就有了机会。除了按照规则1被动地注意到自然发生的CRB之外，你还可以邀请来访注意到这些时刻的发生，并直接鼓励不同的反应。这就是成为来访积极变革力量变得更加刻意、战略性和合作性的勇气和同情心的表现。

至关重要的是，创建这种刻意引发的情境不应导致一种更加人为、操纵感的互动，因为这会破坏一切赖以建立的社会连接的基础。规则2的精神在于关注治疗过程中自然发生的事情，并以大胆、灵活和同情的态度去处理这些事情。因此，规则2通常需要治疗师具备勇气，因为在为了促使新事物出现而引发行为时，可能会打破来访和治疗师都习惯的现状路径。然而，如果你避免引发新的行为，就有风险让功能失调的模式继续存在，甚至可能强化这些模式。

引发不仅是为了促使CRB。引发的互动还会从来访和治疗师双方引出一系列情绪、想法和其他反应。通常，这些反应在为什么期望的CRB2如此难以实现中扮演了重要角色。例如，提出自己的需求可能伴随着强烈的羞耻感或焦虑，或者与他人分享悲伤的经历可能伴随着深深的恐惧。当你引发CRB并开始塑造CRB2（规则3）时，你不仅仅是要求来访回应你当时呈现的内容；你还在邀请他们以接纳和同情的态度回应那一刻的感受。因此，在引发CRB时，你的责任是对整个时刻保持调谐和响应，并在挑战来访的同时支持他们。

规则2：引发CRB

以下是一些在当下引发CRB的例子：

• 如果你知道一位来访在表达自己的需求方面有困难，你可以邀请她在每次会谈开始时明确陈述她的需求。
• 如果一位来访害怕亲密关系，你可以勇敢地要求他练习分享那些他想要避免讨论的内容，并鼓励他向你提出能够建立治疗关系的个人问题。
• 如果你知道一位来访难以接受来自他人的爱，你可以在她进入房间时让她注意到你的温暖表情。
• 如果一位来访请求你在家庭成员因家庭中某位成员去世而产生的悲痛情绪上给予更多回应，你可以花几分钟时间与他谈论你母亲去世的经历，为他提供一个对你的情感作出回应的机会（注意确保互动仍然聚焦于来访的目标）。

自我反思或咨询问题：规则2

• 在治疗过程中，哪些情境或你的哪些行为会引发来访的CRB？
• 你因为来访的CRB让你感到不适而避免做哪些事情？你是否回避了某些话题，无论是关于治疗关系还是治疗过程？这种回避在治疗中有效吗？
• 你是否在会谈中提出了你发现的问题？你是否承认了自己在你们之间循环出现的行为模式中的作用？
• 当引发CRB2时，你是否对来访所需的勇气和爱的平衡保持敏感？你在引发CRB时是否有足够的勇气？你是否有足够的爱心？
• 如果你要用最清晰、大胆且富有同情心的方式描述来访的挣扎，你会怎么说？将这种表述呈现给来访会有帮助吗？如果会，为什么？如果不会，为什么？
• 你的个人经历如何影响你挑战来访或引发CRB的方式？

规则3：强化CRB2

在注意到并引发CRB之后，FAP的下一步是塑造CRB2，使其持续存在。从情境行为的角度来看，实现这一点最重要的是后果：你在当下如何回应CRB。一旦你观察到更有效的行为（通过规则1）或直接引发它（通过规则2），就应该提供关注并以一种希望具有强化作用的方式来回应。

FAP专注于强化CRB2，因为支持性社会连接的积极功能比惩罚CRB1更能有力且有效地塑造行为。毕竟，想想在一个关系中，你的成长步骤被邀请、赞扬和支持，与另一个关系中你的错误被仔细审查和批评的感觉有何不同。前者创造了一个更有利于成长和福祉的滋养环境。

在这种情况下，对CRB2的响应（对应于爱）在功能上等同于规则3。在很多方面，规则3处于FAP的核心，因为它具体化了一种改变机制：CRB2的强化。可以说，其他规则只是为了应用规则3提供了支持性的背景。规则3的主要挑战在于确定你的哪些回应实际上会对特定情境下的特定来访起到强化作用。以下部分提供了一些一般性的指导原则。

• 以自然但强烈的方式回应：你的回应需要让来访觉得有意义，并且与治疗之外的世界相关，因此重要的是要显得自然。这不同于通常的社会规范或适当性，因为这些类型的回应往往不够强烈。理想情况下，你应该识别出你的自然反应，然后将其放大到超出社会规范所规定的程度。这样，你的回应就会明确并且引起注意和反思。最有影响力的回应很可能会打破常规或礼仪的界限，这也是它们令人难忘且有益的原因之一。需要注意的是，这些回应之所以打破社会惯例是因为它们异常强烈或大声，而不是因为它们奇怪或难以理解。它们通常传达并表达了其他人可能感受但不说出来的情绪。

• 强调安全和接纳：从高处俯瞰，治疗的核心是在社交互动的背景下与正在体验脆弱性和情感的来访合作。来访最基本的需求是你提供的安全和接纳。治疗师很容易陷入解决问题或想要“修复”来访的误区，从而忘记这种基本的脆弱性。明确并真诚地向来访表达他们完全安全且被你接纳。这样做要明确，真实。

• 充满信念地说话：像所有人一样，来访在围绕他们的CRB2的脆弱时刻会有疑虑。因此，当你回应CRB2时，你的声音应该清晰、坚定且真诚。最好的回应是大胆且非常明确的，尤其是在100%接纳来访方面，无论他们多么情绪化。当来访非常情绪化时，这一点尤为重要，因为在这些时候，他们可能会抓住任何模糊或沉默之处，并将其视为判断或不安全的迹象。找到一种方式，清晰且富有同情心地表达你的接纳：“我想让你知道，在你与我分享这些的时候，我对你是100%接纳和关爱的，我非常有信心你在我这里是安全的。”

• 了解什么对特定来访有效：对于一些人来说，强烈的、情绪化的感激之情可能是令人厌恶的，会引起羞耻感或担心必须回报或达到新的标准。而对于另一些人来说，高度情绪化的感激是非常肯定的。一如既往，回应的功能才是最重要的——而不是形式。这就使得关注个别来访并发现对他们有效的方法变得很重要。

规则3：强化CRB2

保持真实。最重要的是，不要虚伪。人类非常善于辨别虚假，尤其是那些过去曾被他人伤害过的人。不真诚会阻止或破坏连接和影响力。当你以自己独特的声音和情感回应时，而不是遵循剧本、像专业人士那样说话或提供典型的治疗师回应（如“我为你感到骄傲”或“你真勇敢”），响应才会最有效。通过语调、眼神接触和面部表情传达真诚同样非常重要——有时甚至比你的言语更重要。

以下是一些在当下强化CRB2的例子：

• 通过同意来访请求延长会谈时间来认可这一请求。
• 对来访的生活经历给予真心的回应，例如表达你对她勇气和坚持的启发和感动，并解释为什么你会有这种感觉。
• 说一些类似“这对你来说是一个很棒的2！”的话，并伸出你的手给来访一个击掌。
• 告诉来访他的CRB2让你对工作重新燃起了热情。
• 在来访描述她感到羞愧的事情后，分享你也有过类似的经历，从而与她的脆弱性产生共鸣。

自我反思或咨询问题：规则3

• 你能看到来访的进步时刻吗？你是否投入到来访改变的过程中？
• 来访是否意识到你对她脆弱性、改进和成长的回应？
• 你是否以开放且真诚的方式回应来访？
• 你是否会抑制你的真实情感反应，或将它们隐藏在大量的其他信息中，比如免责声明、心理教育或案例分析？
• 你珍视来访的哪些方面？这位来访如何影响了你？你是否已经让来访知道这些事情？

规则4：注意你的效果

记住，强化的效果不是立即显现的。相反，这是一个过程，在这个过程中，行为随着时间的推移因后果而增加频率。因此，为了确保你有效地强化了来访的CRB2并帮助他们朝着治疗目标前进，你不仅需要注意你在当下的回应，还要注意他们的行为随时间的变化。事实上，随着时间的推移发生的事情远比任何单一时刻的事件重要得多。（而且鉴于治疗中的错误是不可避免的，感谢上帝有这一点。）

我们唯一能了解任何单一互动时刻的影响的方法是注意到治疗过程随时间如何展开。当CRB2变得更强更频繁，而CRB1减少时，治疗就在起作用。当然，如果这种情况没有发生，你也需要知道这一点。治疗总是在进行中。

以下是一些你可以确定你在治疗互动中行为效果的方法：

• 在一次充满情感的交流之后，来访表达了大量情绪，而你也以真心回应，你可以询问她对这次互动的感受。
• 如果你和来访似乎一直在重复类似的模式，比如一次非常情绪化的会谈之后是一次更加封闭的会谈，你可以问来访他是否有同样的印象，以及这种模式可能代表什么。
• 在你尝试为来访的脆弱性提供安全之后，你可以直接询问她是否感到更安全。
• 当来访在治疗中遇到停滞期时，你可以问他是否认为你做的某些事情没有帮助。
• 在每次会谈结束时，你可以问来访：“今天我对你的回应怎么样？”
• 你还可以使用各种监测工具或标准化测量方法，例如要求来访使用日记卡记录日常生活中CRB1和CRB2的频率。

自我反思或咨询问题：规则4

• 来访在治疗关系中是否随着时间发生变化？你是否看到更多的CRB2和更少的CRB1？
• 你们两人是否在重复相同的循环和模式？
• 你是否与来访讨论治疗关系和治疗过程中事物是如何演变的？
• 你和来访是否讨论你们彼此之间的影响？
• 你是否承认并讨论你在当下看到的变化？
• 你是否正在处理可能阻碍来访进展的任何个人问题或局限？

规则5：支持泛化

当然，治疗的目的不仅仅是改变来访在治疗室内的行为；目标是在治疗之外的行为变化足够持久和稳固，从而使治疗最终可以结束。泛化是一个行为术语，指的是一种情境下的行为转移到其他情境的过程。因此，规则5要求关注和支持从治疗情境到所有相关外部情境的改善转移。在FAP中，这种泛化通过两种方式实现：讨论功能分析和案例分析，以及分配CRB2的家庭练习。

与来访讨论功能分析和案例构建

在FAP中，治疗师会与来访讨论他们的功能分析和案例构建，并尽可能让来访参与到构建过程中。这有助于来访开始看到各种功能如何在治疗室外的生活中体现出来。当来访意识到他们在会谈内外的行为之间的相似性，并且能够在当下注意到他们的CRB时，他们可以看到自己在治疗中的进步以及这些进步在其他情境中的意义和实用性。

为此，我们建议你回顾第2章和第3章关于观察功能和进行功能分析的内容，并思考如何与来访分享这些原则：他们如何与你合作开发功能分析？然后在适当的时候采取这种方法，尤其是在你强化了CRB2之后。这是关键时刻，通过言语学习可以促进新行为向其他情境的泛化。谈论刚刚发生的事情，让来访能够看到她作为CRB2所做的事情与你的回应之间的联系，以及这一切对她生活的重要性。

我们有一个术语来描述这种类型的总结：从内到外的平行。这指的是将会谈中刚刚发生的事情与来访关心的会谈外的情境进行类比。以下是一些从内到外平行的例子：

• 当你在会谈中向我展示脆弱时，你可以看到我是多么开放和安全地对待你。实际上，这给了我空间并激励我去支持你。我认为你的伴侣也希望你这样做。你觉得呢？
• 当你向我提出你需要什么时，我会尽力满足你——就像现在这样。所以猜猜看？我认为这对你的朋友也适用。也许不是所有的朋友，但根据你告诉我的，玛丽真的很想支持你，对吗？
• 我打赌如果你尝试对你妈妈这样做，她的表情会和我现在一样。

分配CRB2的家庭练习

实施规则5的第二种方法是分配家庭作业——通常是与他人一起练习在会谈中发展出的新CRB2。再看看我们刚才提供的那些从内到外平行的例子。你能看出每个例子如何引导出一个具体的家庭作业任务吗？最好的任务直接且立即来源于强有力的会谈互动。例如，考虑一个难以建立亲密关系并且在表达情感时很少与你进行眼神交流的来访。在识别出少眼神交流作为CRB1后，你可以将增加眼神交流设定为相关的CRB2，并将其作为明确的会谈目标。在强化了这一CRB2之后，你可以要求来访尝试与其他人增加眼神交流。所有这些可能会以如下方式表述：“当我们刚开始治疗时，你倾向于避免表达情感并通过转移视线来减少我们的连接。这造成了我们之间的距离。当你意识到这个问题并更愿意与我进行眼神交流和表达情感后，我们的关系变得更加亲密。我建议你试着对你的朋友卡罗尔做同样的事情，看看你们的关系亲密程度会发生什么变化。”然后你可以为来访安排一个非常具体的任务，让她在特定情境下与卡罗尔进行这个练习。你也可以讨论这样做可能带来的风险，因为我们无法保证他人的反应，以及为什么尽管如此，来访仍然需要承担这个风险。

以下是几个促进新CRB2泛化的例子：

• 与来访合作进行功能分析，并识别CRB1和CRB2。
• 获取来访的反馈，了解会谈中的时刻与重要的会谈外情境有何相似或不同之处。
• 指出来访在会谈中与你一起做的事情与他人交往的相关性，并提供一些指导，说明如何与他人练习CRB2。
• 对于难以识别自己需求的来访，在她在会谈中成功做到这一点后，分配家庭作业，每天都要接触自己的需求。
• 帮助来访安排特定的活动，以便在会谈中出现新的CRB2后立即练习。

自我反思或咨询问题：规则5

• 来访是否同意你对他会谈内外CRB的功能相似性的概念化？
• 如果不同意，你们是否讨论过分歧所在？
• 你是否在讨论来访如何将在你这里体验到的东西带入他的生活中？
• CRB2向日常生活的转移效果如何？有什么可以改进泛化过程的地方？

在情境中体验FAP的五条规则

我们将以本章开头的对话结束这一章节，同时也是本书第一部分的结尾，但这一次我们会注解这个对话，展示FAP的五条规则如何在实际操作中应用，以及治疗师正在回应的CRB。虽然这段对话很简短，但它传达了FAP所特有的关系焦点、灵活性和个性化。需要注意的是，这只是FAP在一个特定治疗师与一个特定来访之间的具体例子。FAP并不局限于某种风格；它关注的是过程。我们将在本书的第二部分强化这一重要观点，通过提供大量对话示例来说明FAP技能的实际应用——这些示例展示了多种治疗风格。

“每次我妻子批评我的行为时，我当然会变得防御。” [描述了一个会谈外的问题。] 你停顿了一下，连接起点。“是否有可能这种情况——批评和防御——在之前的会谈中也发生过？” [注意到会谈早期可能存在的CRB（规则1），并进行类比。]

她的眉头微微皱起。“不，在这里是很不同的。你为什么这么问？” [CRB1。]

“嗯，我之所以问是因为当时我觉得你有点防御性。而且……你现在似乎也有点防御性。你明白我的意思吗？” [规则1和2：注意并引发CRB。]

她耸了耸肩，显得有些恼火。“好吧，既然你指出来了，是的。” [出现CRB2。]

“你现在可以尝试什么，让你看起来不那么防御？” [规则2：引发CRB。]

“我想……”她停下来，似乎凝视着远方。“当我受到批评时，我的情绪变化很快，感觉自尊心受到了打击。然后我就变得戒备起来。” 突然间，她几乎要哭了。[CRB2：脆弱的自我披露。]

你对她语气的变化感到惊讶。“你知道吗？这听起来完全不同。感觉也不同。” [规则3：强化CRB2。] “对你来说是什么感觉？” [规则4：检查治疗师对来访CRB2的反应效果。]

“脆弱。我很焦虑。” [CRB2。] 她抿紧嘴唇，看向别处。“不管怎样……” [CRB1。]

“我们可以在这里暂停一下吗？” 你停顿了几秒钟。[规则2：引发CRB。] “我知道我们以前谈过……只是让我觉得，这种短暂的停顿，这种脆弱——即使是你感到戒备的事实，都会带来很大的不同。” [规则3：强化CRB2。] “我知道她也希望你能给她这样的感觉，也给自己。这意义重大。” [规则5：支持泛化，通过描述会谈中行为的功能——即她的脆弱性导致了连接。]

“对我来说真的很难……” 这次她泪流满面。[CRB2。]

“我知道。” [规则3：强化CRB2。] “这对你的意义是什么？” [规则2：引发CRB。]

“就是我可以放松下来，信任她。很多时候我就像一只野猫。” 她轻声哭泣。[CRB2。]

“我也希望你能这样。能够暂停一下，被看见……让自己存在。” [规则3：强化CRB2。] “让她看到你。如果你能和她这样做呢？” [规则5：通过建议家庭作业来支持泛化。]

第二部分

实践

我扎根于此，但我流动。 ——弗吉尼亚·伍尔夫

当尼克来接受治疗时，他陷入了痛苦和苦涩的深渊。他在答录机上的留言很简短：“住院部推荐我来找你进行治疗。这怎么运作？请回电。”

在第一次会面时，他紧张地坐在厚重的大衣里，穿着一件旧了的布鲁克斯兄弟衬衫。他的头发和胡子都修剪得很整齐。他的身体紧绷而沉重，下巴紧闭。他的眼睛四处游移，透露出焦虑，但也显示出思维敏捷。他经常似乎快要翻白眼，预期着接下来可能会说的令人厌烦或平庸的话。

鉴于转介的模糊性和之前的治疗记录，最初的几次会谈集中在诊断评估和建立关系上。让治疗师印象深刻的是尼克的绝望之深以及他所感受到的空虚。他还感到很多愤怒，甚至是仇恨。他们讨论了他是否喜欢任何事物。有时他会喜欢歌剧或古典音乐，但这些也让他感到痛苦，只是稍微提升了他痛苦的程度。

到了第三周，尼克冒了一个大风险。他描述了去参加系里的活动时，感受到来自教员和其他研究生的一系列小轻视和侮辱；感到恐惧逐渐上升，然后是恐怖，最后是偏执——他们一定都在想我是个傻瓜。这样的互动让他内心深处感到灼烧般的疼痛。“这是正常的吗？”他喘着气问道，“我需要知道这是否正常。我没有其他地方可以求助。要么和你一起工作，要么我就完了。我会自杀。”

这一刻——当他愿意分享一个深深困扰他的经历，这个经历削弱了他对所有人的信任——真正的治疗关系开始了。他提出了一个真诚而脆弱的问题，并依赖于治疗师的回应。

最终，治疗师和尼克决定，有效的诊断是边缘型人格障碍。随后的治疗结合了辩证行为疗法、接纳与承诺疗法和FAP（功能性分析心理治疗）。治疗持续了几年，并且取得了成功。

事后回想起来，尼克认为有帮助的是他和治疗师年龄相同，共享世界观，而且“他感觉像我”。他们共同开发了一个框架来思考他所经历的事情，以及他如何在当下发生变化。他认为最有帮助的核心是：深刻的共情。这体现在多种形式中，包括共同体验、理解、命名，然后要求改变——即使改变困难也要邀请改变。他们庆祝胜利，也解决了许多分歧。他们审视了尼克在当下的隐藏，以及治疗师的隐藏。他们把各种情绪都摆在桌面上。治疗师不得不多次道歉，接受反馈，甚至分享自己的渴望和抱负，以描绘作为人类的意义。

知识点阐述

1. FAP的五个规则

   • 定义：FAP（功能性分析心理治疗）通过五个规则来指导治疗师在治疗过程中如何影响来访的行为，以减少无效行为（CRB1）并增加有效行为（CRB2）。
   • 重要性：这些规则为治疗师提供了具体的指导，帮助他们在治疗过程中更加有效地引导来访进行行为改变。
   • 具体实践：
     • 规则1：注意CRB：治疗师应密切注意来访在治疗过程中表现出来的行为，特别是那些与临床问题相关的行为。
     • 规则2：引发CRB：治疗师应通过提问或其他方式引发来访展现某些行为，以便更好地理解和处理它们。
     • 规则3：强化CRB2：当来访展现出有效行为时，治疗师应及时给予正向反馈，以增强这些行为。
     • 规则4：注意你的影响：治疗师应持续关注自己的行为对来访的影响，确保自己的干预是有效的。
     • 规则5：支持泛化：治疗师应帮助来访将治疗中学习到的有效行为应用到日常生活中，实现泛化。

2. 规则1：注意CRB

   • 定义：规则1要求治疗师在治疗过程中注意来访的行为，尤其是那些与临床问题相关的行为。
   • 重要性：觉察是FAP的基础，只有充分了解来访的行为及其背景，治疗师才能制定出有效的干预策略。
   • 具体实践：
     • 觉察：治疗师应具备高度的敏感性和洞察力，能够识别来访在治疗过程中展现的各种行为。
     • 同理心：治疗师应深入理解来访的内心体验，包括他们的需求、目标和情感状态。
     • 功能性分析：治疗师应从功能的角度分析来访的行为，理解这些行为背后的原因和目的。

3. FAP的应用

   • 定义：FAP强调在治疗过程中即时观察和干预来访的行为，通过改变行为模式来促进心理健康。
   • 重要性：FAP提供了一种动态的、灵活的方法，帮助治疗师在治疗过程中不断调整策略，以达到最佳效果。
   • 具体实践：
     • 即时反馈：治疗师应在治疗过程中及时给予来访反馈，帮助他们意识到自己的行为模式。
     • 行为实验：通过设计和实施行为实验，治疗师可以帮助来访尝试新的行为模式，体验其带来的变化。
     • 持续评估：治疗师应持续评估治疗效果，根据实际情况调整干预策略。

通过这些知识点，治疗师可以更好地理解和应用FAP的原则，不仅在与来访的互动中，也在个人成长和自我关爱中。同时，治疗师自身的自我反思和持续改进也是提高治疗质量的关键。

知识点阐述

1. 规则1：注意CRB

   • 定义：规则1要求治疗师密切注意来访的行为，特别是那些与临床问题相关的CRB1和CRB2行为。
   • 重要性：这是FAP的基础，因为它帮助治疗师理解来访的行为模式及其背后的功能，从而制定有效的干预策略。
   • 具体实践：
     • 识别行为：治疗师应学会区分哪些行为是无效的（CRB1）和哪些是有效的（CRB2）。
     • 功能分析：治疗师应从来访的生活背景出发，理解其行为背后的情感和内在体验。
     • 持续观察：治疗师应持续观察来访的行为模式，并结合功能分析来理解这些模式的意义。
     • 自我反思：治疗师应定期反思自己的行为，看看是否无意中助长了来访的某些不良模式。

2. 规则2：引发CRB

   • 定义：规则2要求治疗师在治疗过程中有意识地创造情境，以引发来访的CRB，特别是那些有助于改变的行为。
   • 重要性：通过有意识地引发CRB，治疗师可以更有效地引导来访尝试新的、更有效的行为模式。
   • 具体实践：
     • 调谐与敏感：治疗师应在当下与来访保持高度敏感的调谐，理解当前情境的功能。
     • 直接讨论：治疗师可以直接讨论治疗关系中正在发生的事情，以及这些事情与临床问题的关系。
     • 鼓励新行为：治疗师应鼓励来访尝试新的、更有效的行为模式，即使这些行为可能超出他们的舒适区。
     • 勇气与同情：治疗师应以勇气和同情心来面对来访的情绪反应，支持他们在尝试新行为时的感受。
     • 避免操纵：治疗师应确保引发过程自然流畅，避免给来访带来人为或操纵的感觉。

3. 综合应用

   • 定义：规则1和规则2共同构成了FAP的核心，它们相互补充，帮助治疗师在治疗过程中更有效地引导来访。
   • 重要性：通过结合这两个规则，治疗师可以更好地理解来访的行为模式，并有意识地创造情境来促进改变。
   • 具体实践：
     • 持续观察与反馈：治疗师应持续观察来访的行为，并及时给予反馈，帮助他们意识到自己的行为模式。
     • 行为实验：通过设计和实施行为实验，治疗师可以帮助来访尝试新的行为模式，体验其带来的变化。
     • 同理心与支持：治疗师应始终以同理心和支持的态度对待来访，帮助他们在尝试新行为时感到安全和被理解。

通过这些知识点，治疗师可以更好地理解和应用FAP的原则，不仅在与来访的互动中，也在个人成长和自我关爱中。同时，治疗师自身的自我反思和持续改进也是提高治疗质量的关键。

知识点阐述

1. 规则2：引发CRB

   • 定义：规则2要求治疗师在治疗过程中有意识地创建情境，以引发来访的临床相关行为（CRB），特别是有助于改变的有效行为（CRB2）。
   • 重要性：通过有意识地引发CRB，治疗师可以更有效地引导来访尝试新的、更有效的行为模式，从而促进其心理成长。
   • 具体实践：
     • 主动邀请：治疗师应主动邀请来访表达需求、分享恐惧或进行情感交流，以激发CRB。
     • 勇敢提问：治疗师应勇敢地提出问题，尤其是那些可能引发来访情感反应的问题，以促进深层次的沟通。
     • 关注细节：治疗师应关注来访进入房间时的表情和身体语言，以捕捉细微的情感变化。
     • 自我暴露：治疗师可以通过分享自己的经历来建立共鸣，使来访感到更加安全和被理解。

2. 规则3：强化CRB2

   • 定义：规则3要求治疗师在观察到或引发CRB2后，通过正面反馈和强化来增强这些有效行为，使其持久。
   • 重要性：强化CRB2有助于巩固来访的新行为模式，促进其长期的心理健康和福祉。
   • 具体实践：
     • 自然但强烈：治疗师的回应应自然且强烈，以确保来访能够感受到回应的真实性和强度。
     • 强调安全和接纳：治疗师应明确表达对来访的接纳和支持，确保来访感到安全和被理解。
     • 充满信念：治疗师在回应时应表现出坚定和真诚的态度，特别是在来访情绪波动较大时。
     • 个性化：治疗师应根据每个来访的具体情况调整回应方式，找出最有效的强化方法。

3. 综合应用

   • 定义：规则2和规则3共同构成了FAP的核心，它们相互补充，帮助治疗师在治疗过程中更有效地引导来访。
   • 重要性：通过结合这两个规则，治疗师可以更好地理解来访的行为模式，并有意识地创造情境来促进改变，同时通过强化来巩固新行为。
   • 具体实践：
     • 持续观察与反馈：治疗师应持续观察来访的行为，并及时给予反馈，帮助他们意识到自己的行为模式。
     • 行为实验：通过设计和实施行为实验，治疗师可以帮助来访尝试新的行为模式，体验其带来的变化。
     • 同理心与支持：治疗师应始终以同理心和支持的态度对待来访，帮助他们在尝试新行为时感到安全和被理解。
     • 个性化强化：治疗师应根据每个来访的具体情况，选择最合适的强化方法，以确保行为改变的持久性。

通过这些知识点，治疗师可以更好地理解和应用FAP的原则，不仅在与来访的互动中，也在个人成长和自我关爱中。同时，治疗师自身的自我反思和持续改进也是提高治疗质量的关键。

知识点阐述

1. 规则3：强化CRB2

   • 定义：规则3要求治疗师通过正面反馈和强化来增强来访的有效行为（CRB2），使其持久。
   • 重要性：强化CRB2有助于巩固来访的新行为模式，促进其长期的心理健康和福祉。
   • 具体实践：
     • 保持真实：治疗师应避免虚伪，以真实的情感和声音回应来访，而不是遵循固定的脚本或典型的专业语言。
     • 自然表达：通过语调、眼神接触和面部表情传达真诚，使来访感受到治疗师的诚意。
     • 个性化回应：根据具体情况给出个性化的反馈，例如通过分享自己的感受或体验来加强情感联系。
     • 明确肯定：用明确的语言肯定来访的行为，例如通过肢体动作（如击掌）来庆祝来访的进步。

2. 规则4：注意你的效果

   • 定义：规则4要求治疗师注意其行为在治疗过程中的长期效果，而不仅仅是当下的互动。
   • 重要性：通过观察来访行为随时间的变化，治疗师可以评估治疗的有效性，并作出相应的调整。
   • 具体实践：
     • 定期反馈：定期向来访询问他们对治疗过程的感受，特别是关键的互动时刻。
     • 识别模式：注意治疗过程中反复出现的模式，并与来访讨论这些模式的意义。
     • 直接询问：直接询问来访是否感到更安全，或者是否认为某些治疗方法无效。
     • 使用工具：利用监测工具或标准化测量方法，如日记卡，来跟踪来访的行为变化。

3. 规则5：支持泛化

   • 定义：规则5要求治疗师关注和支持将治疗室内的行为改变推广到治疗之外的情境中。
   • 重要性：泛化是确保治疗效果持久的关键步骤，它帮助来访在现实生活中应用所学的技能。
   • 具体实践：
     • 功能分析：与来访讨论功能分析和案例分析，帮助他们理解行为背后的功能。
     • 家庭练习：分配CRB2的家庭练习，鼓励来访在日常生活中实践新的行为模式。
     • 持续支持：在治疗过程中不断提供支持，确保来访能够将新行为成功地应用到不同的生活情境中。

通过这些知识点，治疗师可以更好地理解和应用FAP的原则，不仅在与来访的互动中，也在个人成长和自我关爱中。同时，治疗师自身的自我反思和持续改进也是提高治疗质量的关键。

知识点阐述

1. 与来访讨论功能分析和案例构建

   • 定义：在FAP中，治疗师与来访共同讨论功能分析和案例构建，帮助来访理解其行为在不同情境下的功能。
   • 重要性：通过参与功能分析，来访可以更好地理解自己在治疗室内外的行为模式，从而更容易将治疗中的进步应用到现实生活中。
   • 具体实践：
     • 合作分析：治疗师应鼓励来访参与到功能分析的过程中，共同探讨行为背后的原因和功能。
     • 识别CRB：帮助来访识别CRB1（无效行为）和CRB2（有效行为），并理解它们在不同情境下的表现。
     • 从内到外的平行：利用会谈中的互动作为桥梁，将治疗中的经验与现实生活中的情境联系起来，帮助来访看到行为改变的意义。

2. 分配CRB2的家庭练习

   • 定义：通过分配家庭作业，让来访在治疗室外练习新学到的有效行为（CRB2），以促进行为的泛化。
   • 重要性：家庭练习是确保治疗效果持久的关键步骤，它帮助来访在实际生活中应用新行为，增强其在不同情境下的适应能力。
   • 具体实践：
     • 具体任务：基于会谈中的互动，设计具体的任务，让来访在特定情境下练习新的CRB2。
     • 风险管理：讨论家庭练习可能带来的风险，并解释为什么尽管存在不确定性，仍然值得尝试。
     • 持续支持：提供持续的支持和反馈，帮助来访应对挑战，确保新行为的成功泛化。

3. 促进CRB2泛化的策略

   • 定义：通过多种策略，帮助来访将治疗中的有效行为推广到日常生活中的不同情境。
   • 重要性：泛化是确保治疗效果持久的关键步骤，它帮助来访在现实生活中应用新行为，提高生活质量。
   • 具体实践：
     • 合作分析：与来访合作进行功能分析，识别CRB1和CRB2，并讨论它们在不同情境下的表现。
     • 反馈与讨论：获取来访对会谈内外情境相似性和差异性的反馈，讨论如何将治疗中的经验应用到现实生活中。
     • 具体指导：提供具体的指导，帮助来访在与他人交往时练习新的CRB2。
     • 日程安排：帮助来访安排特定的活动，以便在会谈中出现新的CRB2后立即进行练习。

通过这些知识点，治疗师可以更好地理解和应用FAP的原则，不仅在与来访的互动中，也在个人成长和自我关爱中。同时，治疗师自身的自我反思和持续改进也是提高治疗质量的关键。

知识点阐述

1. FAP的五条规则概述

   • 定义：FAP的五条规则指导了治疗过程中的每一步，强调功能性思考。
   • 重要性：这些规则帮助治疗师识别、引发、强化来访的临床相关行为（CRB），并在治疗过程中持续评估效果，最终促进行为的泛化。
   • 具体实践：
     • 规则1：注意CRB：治疗师需要敏锐地观察来访的行为模式，并在会谈中识别出相关的CRB。
     • 规则2：引发CRB：通过提问或引导，治疗师可以帮助来访在当下表现出CRB，从而更好地理解其行为模式。
     • 规则3：强化CRB2：当来访表现出有效行为（CRB2）时，治疗师应给予积极的反馈和支持，以巩固这些行为。
     • 规则4：注意你的效果：治疗师需要持续关注自己的回应对来访的影响，确保治疗的有效性。
     • 规则5：支持泛化：治疗师应帮助来访将治疗中的有效行为推广到日常生活中的其他情境，以实现持久的改变。

2. 具体对话示例分析

   • 背景：来访提到他在面对妻子批评时会有防御性反应。
   • 规则1：注意CRB：治疗师注意到来访在会谈中表现出类似的防御性行为，并将其与会谈外的情境联系起来。
   • 规则2：引发CRB：治疗师通过提问，促使来访意识到自己在会谈中的防御性行为，并进一步探讨这种行为。
   • 规则3：强化CRB2：当来访开始表现出脆弱性时，治疗师立即给予正面反馈，强化这种有效行为。
   • 规则4：注意你的效果：治疗师询问来访对自己反应的感受，以评估自己的回应是否有效。
   • 规则5：支持泛化：治疗师鼓励来访在日常生活中尝试类似的行为，如与妻子互动时表现出更多的脆弱性，从而促进行为的泛化。

通过这个具体的对话示例，可以看到FAP的五条规则如何在实际治疗过程中应用，帮助来访识别和改变行为模式。这些规则不仅适用于特定的治疗风格，而是通过功能性思考和灵活的方法，帮助治疗师和来访共同实现治疗目标。此外，通过不断反思和调整，治疗师可以更好地理解和应用这些规则，提高治疗效果。

知识点阐述

1. 治疗关系的建立

   • 定义：治疗关系是指治疗师与来访之间建立的一种专业关系，这种关系基于信任、理解和合作。
   • 重要性：良好的治疗关系是治疗成功的关键因素之一。它能够为来访提供一个安全的空间，让他们能够自由表达自己的感受和经历。
   • 具体实践：
     • 建立信任：通过倾听、理解和尊重来访，逐步建立起信任感。
     • 共情：治疗师需要展示深刻的理解和共情，让来访感受到被理解和接纳。
     • 透明度：治疗师应保持开放的态度，必要时向来访道歉并接受反馈，增强治疗关系的透明度。

2. 诊断与治疗计划

   • 定义：诊断是确定来访问题性质的过程，而治疗计划是根据诊断结果制定的具体干预措施。
   • 重要性：准确的诊断有助于制定有效的治疗计划，从而提高治疗效果。
   • 具体实践：
     • 综合评估：通过详细的评估，了解来访的症状、背景和需求。
     • 多方法结合：根据来访的具体情况，采用多种治疗方法，如辩证行为疗法、接纳与承诺疗法和FAP。
     • 个性化方案：制定个性化的治疗计划，确保治疗措施符合来访的具体需求。

3. 共情与情感支持

   • 定义：共情是指治疗师能够理解和感受来访的情感状态，提供情感支持。
   • 重要性：共情可以帮助来访感到被理解和接纳，从而增强治疗效果。
   • 具体实践：
     • 倾听与理解：认真倾听来访的故事，理解他们的感受和经历。
     • 情感表达：允许来访表达各种情感，并给予适当的反馈和支持。
     • 情感共鸣：治疗师可以通过分享自己的情感体验，与来访建立更深层次的情感联系。

4. 治疗过程中的变化与成长

   • 定义：治疗过程中，来访会经历各种变化，包括情感、认知和行为的变化。
   • 重要性：这些变化是治疗成功的标志，也是来访个人成长的重要部分。
   • 具体实践：
     • 识别变化：定期评估来访的变化，包括积极的变化和面临的挑战。
     • 鼓励进步：庆祝来访的每一点进步，无论大小，增强他们的信心。
     • 应对挑战：面对治疗中的挑战，如分歧和冲突，通过对话和协商解决。

通过这些知识点，我们可以更好地理解治疗过程中的关键要素，以及如何通过有效的治疗关系、准确的诊断、共情支持和促进来访的成长，实现治疗目标。同时，治疗师自身的反思和调整也是提高治疗质量的重要环节。

CHAPTER 5 Shape Process with the Five Rules of FAP It’s easy to think it’s about them, about him or her, but it’s about you. And me. Connecting. Right now, in this conversation. Not that one. This one. —­Susan Scott “Every time my wife criticizes my behavior, of course, I get defensive.” You pause as the dots connect. “Is it possible that this—­criticism, getting defensive—­occurred between us earlier in session?” There’s a flickering frown. “No, it’s pretty different here. Why would you ask that?” “Well, I asked because it seemed like you were a little defensive then. And…you seem a little defensive now. Do you see what I mean?” She shrugs, irritated. “Okay, well now that you point it out, yes.” “What could you try right now that would appear less defensive?” “I guess…” She stops and appears to stare off into the distance. “I feel like when I receive criticism, my mood changes very quickly and I feel as though my self-­esteem has deflated. And my guard goes up.” Suddenly, she seems on the verge of being tearful. You are surprised at the change in her tone. “You know. It’s amazing how different that sounds. How different it feels. What is it like for you?” “Vulnerable. I’m anxious.” She purses her lips and looks away. “Anyway…” “Is it okay if we just pause in this?” You pause a few beats. “I know we’ve talked about it before…it just strikes me how that bit of pause, that bit of vulnerability—­even about the fact that you feel guarded, it makes all the difference. I know she wants you to give her this as well. And give it to yourself. It means so much.” “It’s so hard for me…” She is tearful this time. “I know. What does it mean for you?” “Just that I could relax and be…trust her. I’m like a feral cat so much of the time.” She weeps softly. “I want that for you too. To be able to take that pause and be seen…to let yourself be. Let her see you. What if you could do this with her?” When a client brings her interpersonal struggle—­bound up with her psychological strug- gle—­to the therapy relationship, when you see the very issue that is causing strife in her relationships occurring here and now, in therapy, you have a liability and an opportunity. Your relationship, here and now, will leave a mark. The liability rests in replicating what experience has shown her: that vulnerability is dangerous; that it’s better to remain distanced and defended. If, however, you have done the work to know her interpersonally—­to see, for instance, how resistance to asking for what she needs, in part, maintains her depression and leaves her feeling voiceless—­then you may see the behavior for what it is: something learned and once adaptive but now maladaptive; a costly and avoidant behavior that is both comfortable and uncomfortable at the same time. If you have done the work to know her empathically, so you can know what this moment feels like for her on the inside, you will be able to pause sensitively. You will be able to disrupt what normally happens in order to create something different. This is your opportunity, in which you will be able to walk with her into the novelty and anxiety of change. FAP is about these moments in the therapy relationship, when a compassionate (and functional) understanding of the other person allows you to see and evoke and reinforce a different way of relating. In the first half of this book, we have mainly focused on the first part of this formula: seeing behavior from a contextual behavioral science, or functional, perspective. While this seeing is foundational to FAP, the heart of the FAP process lies in how you use that seeing to create change. The process of change in FAP is essentially the process of influencing CRBs, as they happen in the therapy process, in such a way that you decrease the frequency of CRB1 and increase the fre- quency of CRB2. In this chapter, we present five rules (originally published in Kohlenberg & Tsai, 1991) to guide you in the process. Note that we use the term “rule” in a specific sense, meaning “Try it; you’ll probably like it because good things will happen.” This is in opposition to a more rigid prescription: “The rules are something you must do or something bad will happen.” The five rules are a learning tool to help you get your head around the FAP process. This chapter is primarily devoted to discussing each rule. For each, we’ve included questions for self-­ reflection or consultation. In part 2 of the book, we’ll detail how to practice with these rules. Here, then, are the rules: Rule 1: Notice CRB. Rule 2: Evoke CRB. Rule 3: Reinforce CRB2. Rule 4: Notice your effect. Rule 5: Support generalization. RULE 1: NOTICE CRB Over the years, Bob Kohlenberg has often said that rule 1 is the most important rule in FAP. The reason is captured somewhat in our discussion of Carl Rogers in chapter 2: when you understand which behaviors serve a client and represent growth and flexibility and which represent being stuck and don’t serve the client, you’ll naturally tend to respond in ways that nurture and support the more effective behaviors. Broadly, then, rule 1 is about awareness: understanding what is evoked in the client during the work of therapy and how that behavior relates to the clinical problem. It also involves empathy, as what’s needed in the moment is an exquisite sensitivity to the client’s experi- ence, who she ideally wants to be, and how close she is to that ideal in each moment. Because this awareness is structured by functional analysis, rule 1 encompasses much of FAP and is the foundation for all the other rules. More technically, noticing CRB is about discriminating which behaviors are CRB1 and which are CRB2, as well as how these are being evoked and shaped in the moment. As discussed in chapter 3, on functional analysis, this requires appreciating the larger context in which the client lives and understanding the emotions and other internal experi- ences she may be experiencing. This process of seeing various contexts and functions in the stream of behavior—­and all of the associated judgments about what’s effective and what isn’t—­is ongoing, collaborative, and complex. We’ll address the specifics of how to put this rule into practice in part 2 of the book. For now, we’ll offer a few examples of noticing CRB in the moment. As you’ll see, these observations only take on a definite meaning in the context of a broader functional analysis: • A client seems overly accommodating when it comes to scheduling, and despite this being convenient for you, you also know that she struggles with asserting her needs. • A client seems to close up in a big way, with body language indicating shame, when you touch upon a particular topic. • A client whose relationships are characterized by a lot of avoidance and conflict seems underengaged in session, and it seems the therapy isn’t meeting his needs. • A client who struggles to express emotion in her daily life cries in one session, and at the next she seems withdrawn. • Despite appearing to be quite honest and direct in his disclosures, a client confuses you by seeming to shift between radically different views of himself and the world, and he also complains that nobody understands him or wants to get close to him. Questions for Self-­Reflection or Consultation: Rule 1 •What are the client’s patterns in interpersonal relationships in daily life? Which patterns are problematic? •What are the patterns in the client’s process with you? •Are there any points of functional similarity between outside-­of-­session relationships and in-­ session processes? •What are the client’s specific behaviors related to these patterns? •Which of your behaviors contribute to these patterns? •Are there any noteworthy patterns in the therapy relationship that are difficult to conceptual- ize, such as the client being confusing, annoying, or unsettling? •Do you have any blind spots, areas of confusion, or vulnerabilities, perhaps related to your life history, that affect your ability to see the client’s CRBs clearly? RULE 2: EVOKE CRB Once you attune with exquisite sensitivity to the client in the moment and can see the functions of what’s happening in the here and now, you can be more strategic and explicit about creating a context in which CRBs are evoked. In other words, you can talk directly about what’s happening in the therapy relationship, how it relates to clinical problems, and how different, more effective responses can be practiced. Rule 2 is about being strategically and deliberately evocative in this way. Said another way, once you clearly see the contexts in which a client struggles most and there- fore has the most to gain by improving her behavior, you have an opportunity. Beyond passively noticing CRBs when they happen naturally, in keeping with rule 1, you can invite the client to notice these moments as they happen and directly encourage a different response. This is where becoming a positive disruptive force for clients becomes a more deliberate, strategic, and collab- orative act of courage and compassion. It’s crucial that creating this kind of deliberate, evocative context doesn’t result in a more arti- ficial, manipulative-­feeling interaction, as this would undermine the foundation of social connec- tion on which everything else stands. The spirit of rule 2 is to attend to what happens naturally in the therapeutic process and approach what’s happening boldly, flexibly, and compassionately. In this way, rule 2 often requires courage from the therapist because evoking in order to prompt something new, outside the comfort zone, can disrupt behaviors that are the status quo path of least resistance for client and therapist alike. Yet if you avoid being evocative, you risk allowing dysfunctional patterns to continue and may even reinforce those patterns. Evoking has functions beyond prompting CRB. An evocative interaction also elicits a range of emotions, thoughts, and other reactions from both client and therapist. Often these reactions play a large role in why the desired CRB2 is so difficult. For instance, the prospect of asking for what one needs can be bundled with intense shame or anxiety, or sharing the experience of sadness with someone may be accompanied by a deep fear of humiliation. When you evoke CRB and begin to shape CRB2 (rule 3), you aren’t just asking clients to respond to what you’re presenting in the moment; you’re also inviting them to respond with acceptance and compassion to whatever they’re feeling in that moment. Therefore, when you evoke CRB, your responsibility is to be attuned and responsive to the entire moment and to support clients as much as you’re challenging them. Here are a few examples of evoking CRB in the moment: • If you know a client who struggles with asserting her needs, you can invite her to begin each session with a clear statement of her needs. • If a client fears intimacy, you could courageously ask him to practice sharing what he wants to avoid discussing and encourage him to ask personal questions of you that could build connection in the therapy relationship. • If you know a client has difficulty accepting love from others, you might ask her to notice your warm expression as she enters the room. • If a client has asked you for help in being more responsive to the emotions of his family members about a death in the family, you could spend a few minutes talking to him about your own mother’s death, providing him the opportunity to respond to your emo- tions (taking care to ensure that the interaction remains focused on the client’s goals). Questions for Self-­Reflection or Consultation: Rule 2 86 •Which situations in therapy or behaviors from you evoke CRB from the client? •What do you avoid doing because the client’s CRB is aversive to you? Are there any topics you’re avoiding, in regard to either the therapy relationship or the therapeutic process? Is that avoidance effective in therapy? •Have you brought up the issues you’ve identified in session? And have you owned your part in the cycles unfolding between you and the client? •When evoking CRB2, are you sensitive to the balance of courage and love the client needs? Are you courageous enough when evoking CRB? Are you loving enough? •If you were to describe the client’s struggle in the most clear, bold, and compassionate way, what would you say? Would it work to present this statement to the client? If yes, why? If not, why not? •How does your history affect the way you challenge the client or evoke CRB? RULE 3: REINFORCE CRB2 After noticing and evoking CRB, the next step in FAP is to shape CRB2 so it persists. From the contextual behavioral viewpoint, what matters most in accomplishing this is consequences: how you respond to CRB in the moment as it happens. Once you observe a more effective behavior (via rule 1) or directly evoke it (via rule 2), provide attention and respond in a way that will hopefully be reinforcing. FAP focuses on reinforcing CRB2 because aligning with the positive function of supportive social connection is a more potent and effective way to shape behavior than punishing CRB1. After all, think about how it feels to be in a relationship in which your steps toward growth are invited, praised, and supported, versus one in which your missteps are scrutinized and criticized. The former creates a more nurturing context for growth and well-­being. In this way, responsiveness to CRB2 (corresponding to love) is functionally equivalent to rule 3. In many ways, rule 3 lies at the heart of FAP because it instantiates a specific mechanism of change: reinforcement of CRB2. One could argue that the other rules only provide a supportive context for applying rule 3. The big challenge with rule 3 lies in determining which of your responses will actually function as reinforcing for a particular client in a particular context. The following sections provide some general guidelines in this regard. Respond in a way that’s socially natural but intense. Your responses need to make sense to the client and come across as relevant to the world outside of therapy, so it’s important to be socially natural. This is different from being socially typical or appropriate, as these kinds of responses often aren’t strong enough. Therefore, you would ideally identify your natural response and then amplify it beyond what social norms would dictate. This way, your response will be explicit and command attention and reflection. The most influential responses are likely to break the bounds of convention or propriety in this way, which is part of what makes them memorable and beneficially disruptive. To be clear, these responses break social conventions because they’re unusually strong or loud, not because they’re weird or hard to make sense of. They typically channel and express what other people might feel but not say. Emphasize safety and acceptance. When seen from an eagle’s-­eye view, high above and with good perspective, therapy is centered around working with a client who’s experiencing vulnerability and emotion in the context of a social interaction. What that client needs from you at a very basic level is safety and acceptance. It’s all too easy for therapists to get caught up in problem solving or wanting to “fix” clients and forget this basic vulnerability. Express to clients that they’re fully safe and accepted by you. Do this explicitly, with authenticity. Speak with conviction. Like everyone, clients have doubts, especially in the moments of vulnera- bility surrounding their CRB2s. So when you respond to CRB2, your voice should be clear, strong, and authentic. The best responses are bold and crystal clear, especially in terms of being 100 percent accepting of clients, no matter how emotional they get. This is especially important when clients are very emotional, because at these times they may latch onto ambiguities or silences and view them as indicators of judgments or lack of safety. Find a way to clearly and compassionately state your acceptance: “I want you to know that as you’re sharing this with me, I’m feeling 100 percent accepting and loving toward you, and I feel really confident that you’re safe with me.” Learn what works for a given client. For some people, intense, emotional outbursts of appreciation can be aversive, causing shame or raising fears that the person must now reciprocate or live up to a new standard. For others, highly emotional appreciation is extremely validating. As always, the function of the response is what matters—­not the form. This makes it important to attend to indi- vidual clients and discover what works for each. Be authentic. Most of all, don’t be phony. Humans are very skilled bullshit detectors, especially those who have been harmed by others in the past. Inauthenticity prevents or destroys connection and influence. Responsiveness is most effective when you bring your unique voice and emotion to it, rather than following a script, talking like a professional, or offering typical therapist responses such as “I’m so proud of you” or “You’re so courageous.” Conveying genuineness through tone of voice, eye contact, and facial expressions is also extremely important—­sometimes more important than your words. Here are few examples of reinforcing CRB2 in the moment: • Acknowledging a request for more session time by granting it. • Sharing a heartfelt response to the client’s life history, such as expressing how inspired and moved you are by her courage and persistence, and why you feel that way. • Saying something like “This is an awesome 2 for you!” while offering your hand for a high five. • Telling a client that his CRB2 has renewed your enthusiasm for your work. • Joining a client in her vulnerability after she describes something she feels ashamed about by sharing that you’ve had a similar experience. Questions for Self-­Reflection or Consultation: Rule 3 88 •Can you see the client’s moments of improvement? Do you feel engaged in the client’s process of change? •Is the client aware of your responses to her vulnerability, improvements, and growth? •Do you respond to the client in openhearted ways that feel genuine to you? •Do you hold back your authentic emotional responses or conceal them within a lot of other information, such as disclaimers, psychoeducation, or case formulation? •What do you value and cherish about the client? How has this client affected you? Have you let the client know these things?

RULE 4: NOTICE YOUR EFFECT Remember that reinforcement doesn’t exert its effects immediately. Rather, it’s a process in which behavior increases in frequency as a result of its consequences over time. Therefore, to ensure that you’re effectively reinforcing your clients’ CRB2s and helping them move toward their therapy goals, you need to attend not only to how you respond in the moment but also to how their behav- ior evolves over time. In fact, what happens over time is much more important than the events comprising any single moment. (And given that mistakes are inevitable in therapy, thank goodness for this fact.) The only way we can know the impact of any single moment of interaction is by noticing how the process of therapy unfolds over time. When CRB2s are increasing in strength and frequency and CRB1s are decreasing, then therapy is working. Of course, if this isn’t happening, you want to know that too. Therapy is always a work in progress. Here are a few examples of ways in which you can determine the effect of your actions in the therapeutic interaction: • After an intense exchange in which a client expressed a lot of emotion and you recipro- cated in a heartfelt way, you might inquire about how she experienced the interaction. • If you and the client seem to keep repeating a similar pattern, such as a session that’s more intensely emotional followed by a session that’s more withdrawn, you could ask the client whether he has the same impression and what that pattern might represent. • After you’ve tried to provide safety in response to a client’s vulnerability, you can directly ask whether she feels safer. • When a client is going through a stuck period in therapy, you could ask him whether he thinks anything you’re doing isn’t helpful. • At the end of each session, you might ask the client, “How was I in responding to you today?” • You can also use various monitoring tools or standardized measures, such as asking clients to use a diary card to record the frequency of their CRB1s and CRB2s in daily life. Questions for Self-­Reflection or Consultation: Rule 4 •Is the client changing within the therapeutic relationship over time? Are you seeing more CRB2 and less CRB1? •Are the two of you repeating the same cycles and patterns? •Are you talking with the client about how things are evolving in the therapeutic relationship and in the therapy? •Do you and the client discuss the effects you have on each other? •Do you acknowledge and discuss the changes you’re seeing in the moment? •Are you working with any issues or limitations of your own that could impede the client’s progress? RULE 5: SUPPORT GENERALIZATION Of course, the point of therapy is not just to change client behaviors in the therapy room; the goal is behavior change outside of therapy that’s sufficiently sustained and durable so that therapy can eventually end. Generalization is a behavioral term for the process by which behavior in one context transfers to other contexts. Thus, rule 5 calls for attending to and supporting the transfer of improvements from the context of therapy to all of the relevant contexts outside of therapy. In FAP, this generalization is achieved in two ways: by discussing functional analyses and case formu- lations, and by assigning home practice of CRB2. Discussing Functional Analyses and Case Formulations with Clients In FAP, therapists discuss their functional analyses and case formulation with clients and include them in developing the formulation as much as possible. This helps clients to start seeing how various functions show up in life outside of session. When clients are aware of the parallels between their in-­session and outside-­of-­session behaviors and can notice their CRBs in the moment, they can see the progress they’re making in therapy and how it can be meaningful and useful in other contexts. To this end, we recommend that you reflect on chapters 2 and 3, about seeing function and doing functional analysis, and think about how you can share those principles with clients: How can they collaborate with you in developing a functional analysis? Then take this approach whenever it makes sense, especially after you’ve reinforced CRB2. That’s the key moment when verbal learning will promote generalization of the new behavior to other contexts. Talk about what just happened so the client can see the connections between what she did as CRB2 and what you did in response, and how all of this matters and applies to her life. We have a term for this kind of debriefing: in-­to-­out parallels. This refers to taking what just hap- pened in session and making a parallel with a situation the client cares about outside of session. Here are a few examples of in-­to-­out parallels: • When you show vulnerability to me in here, you see how I can be really open and safe for you. It actually gives me space and motivates me to be there for you. I think your partner wants this from you too. What do you think? • When you ask me for what you need, I’ll always try to give it to you—­like right now. So guess what? I think this is true for your friends too. Maybe not every one of them, but from what I’ve heard from you, Mary really wants to support you, no? • I bet your mom would have the exact same look on her face as I do right now if you tried this with her. Assigning Home Practice of CRB2 The second way to implement rule 5 is by assigning homework—­typically working to practice new CRB2s, developed in session, with others. Take another look at those examples of in-­to-­out parallels we just provided. Can you see how each could lead to a specific homework assignment? The best assignments flow directly and immediately from powerful in-­session interactions. For example, consider a client who has difficulty forming close relationships and makes minimal eye contact with you when she’s struggling with expressing feelings. After identifying minimal eye contact as CRB1, you can establish increased eye contact as the relevant CRB2 and make this an explicit in-­session target. After an instance of reinforcing this CRB2 in the here and now, you could then ask the client to try to increase eye contact with others. All of this might be stated in the fol- lowing way: “When we first started therapy, you tended to avoid expressing your feelings and to reduce our connection by diverting your eyes. That created distance between us. After you became aware of this issue and were more willing to have eye contact with me and express your feelings, our relationship became closer. I’m going to suggest that you try to do the same thing with your friend Carol and see what happens to the closeness in your relationship with her.” You could then schedule a very specific homework assignment for the client to do this with Carol in a certain context. You might also discuss how this might feel risky, given that we can’t guarantee how others will respond, and why it might be important for the client to take the risk anyway. Here are a few examples of how you can promote generalization of new CRB2s: • Collaborate with the client in functional analysis and the identification of CRB1 and CRB2. • Get the client’s feedback about how in-­session moments are similar to or different from important out-­of-­session contexts. • Point out how what the client did in session with you is relevant to relating to others, and offer some guidance on how to practice the CRB2 with others. • For a client who has difficulty identifying her needs, after she’s successfully done so in session, assign homework that involves getting in touch with her needs each day. • Help the client schedule particular activities that offer opportunities to practice a new CRB2 immediately after that CRB2 shows up in session. Questions for Self-­Reflection or Consultation: Rule 5 •Does the client agree with your conceptualization of how his in-­session CRBs are functionally similar to relevant out-­of-­session behaviors? •If not, have you discussed where the two of you disagree? •Are you discussing the ways in which the client is taking what he’s experiencing with you out into his life? •How well is this transfer of CRB2 into daily life working? What might improve the process of generalization? EXPERIENCING THE FIVE RULES OF FAP IN CONTEXT We’ll close this chapter, and part 1 of the book, with the same dialogue that opened this chapter, but this time annotated to show the five rules of FAP in action and the CRB the therapist is responding to. Although it’s brief, the transcript also conveys the kind of relational focus, flexibil- ity, and individualization that’s characteristic of FAP. Note, however, that this is just one example of FAP as it plays out between one particular therapist and one particular client. FAP isn’t about a particular style; it’s about process. We’ll reinforce this important point in part 2 of the book, where we provide numerous dialogues illustrating FAP skills in action—­examples that demonstrate a range of therapeutic styles. “Every time my wife criticizes my behavior, of course, I get defensive.” [Description of an out-­of-­session problem.] You pause as the dots connect. “Is it possible that this—­criticism, getting defensive—­ occurred between us earlier in session?” [Noticing a potential CRB earlier in session (rule

1. and drawing a parallel.] There’s a flickering frown. “No, it’s pretty different here. Why would you ask that?” [CRB1.] “Well, I asked because it seemed like you were a little defensive then. And…you seem a little defensive now. Do you see what I mean?” [Rules 1 and 2: Noticing and evoking CRB.] She shrugs, irritated. “Okay, well now that you point it out, yes.” [Emerging CRB2.] “What could you try right now that would appear less defensive?” [Rule 2: Evoking CRB.] “I guess…” She stops and appears to stare off into the distance. “I feel like when I receive criticism, my mood changes very quickly and I feel as though my self-­esteem has deflated. And my guard goes up.” Suddenly she is on the verge of being tearful. [CRB2: Vulnerable self-­disclosure.] You are surprised at the change in her tone. “You know. It’s amazing how different that sounds. How different it feels. [Rule 3: Reinforcing CRB2.] What is it like for you?” [Rule 4: Checking on the effect of the therapist’s response to the client’s CRB2.] “Vulnerable. I’m anxious.” [CRB2.] She purses her lips and looks away. “Anyway…” [CRB1.] “Is it okay if we just pause in this?” You pause a few beats. [Rule 2: Evoking CRB.] “I know we’ve talked about it before… It just strikes me how that bit of pause, that bit of vulnerability—­even about the fact that you feel guarded, it makes all the difference. [Rule 3: Reinforcing CRB2.] I know she wants you to give her this as well. And give it to yourself. It means so much.” [Rule 5: Supporting generalization, in this case by describing the func- tion of in-­session behavior—­that her vulnerability leads to connection.] “It’s so hard for me…” She is tearful this time. [CRB2.] “I know. [Rule 3: Reinforcing CRB2.] What does it mean for you?” [Rule 2: Evoking CRB.] “Just that I could relax and be…trust her. I’m like a feral cat so much of the time.” She weeps softly. [CRB2.] “I want that for you too. To be able to take that pause and be seen…let yourself be. [Rule 3: Reinforcing CRB2.] Let her see you. What if you could do this with her?” [Rule 5: Supporting generalization by suggesting homework.] SUMMARY • The moment-­by-­moment process of FAP is guided by functional thinking and proceeds through the five rules of FAP. • Rule 1: Notice CRB. • Rule 2: Evoke CRB. oasis-ebl|Rsalles|1490374125 • Rule 3: Reinforce CRB2. • Rule 4: Notice your effect. • Rule 5: Support generalization. 93PA R T 2 The Practice I am rooted, but I flow. —­Virginia Woolf oasis-ebl|Rsalles|1490374121 When Nick came to therapy he was down a miserable, bitter hole. His voice on the answering machine was clipped: “I’ve been referred to you for treatment by the inpatient unit. How does this work? Call me back please.” Arriving at the first session, he sat tensely in a heavy peacoat and well-­worn Brooks Brothers shirt. His hair and beard were neatly trimmed. His body was tense and heavy, jaw set. His eyes, darting around, betrayed his anxiety but also a quickness of mind. He often seemed on the verge of rolling his eyes, anticipating the next annoying or mundane thing that might be said. Given the vagueness of the referral and the previous treatment notes, the first few sessions centered on diagnostic assessment and rapport building. What stood out to the therapist was the depth of Nick’s despair and the emptiness he felt. He also felt a lot of rage. Hatred, even. They talked about whether there was anything he liked. Sometimes he liked opera or classical music, but these also seemed to make him miserable, just slightly more exalted in his misery. Then in the third week, Nick took a big risk. He described what it felt like to go to a department event and perceive waves of little slights and insults coming at him from faculty and fellow graduate students; to feel a rising sense of fear, then terror, and then paranoia—­they must all be thinking that I’m a fool. Such interactions left him with a burning pain inside of his chest. “Is this normal?” he gasped. “I need to know if this is normal. I don’t have anywhere else to turn. It’s either work with you or I’m done. I will kill myself.” This moment—­when he was willing to share an experience that was deeply disturbing, that undermined his willingness to trust everyone—­was when the real therapeutic relationship started. He asked a genuine, vulnerable question and relied on the therapist’s responsiveness. Together the therapist and Nick eventually decided that the valid diagnosis was borderline personality disorder. The treatment that followed incorporated elements of dialectical behavior therapy, acceptance and commitment therapy, and FAP. The treatment took several years, and it was successful. Afterward, recalling what worked, Nick said it had helped that he and the therapist were the same age, that they shared a worldview, and that “he felt like me.” They developed a framework for thinking about what had happened to him, and how he was changing in the here and now. The core of what he experienced as being helpful was simple: deep empathy. This took many forms, including seeing the experience together, understanding it, naming it, and then asking for change—­inviting change even when it was difficult to change. They responded to victories and hashed out lots of disagreements. They looked at how Nick hid in the moment and how the therapist hid. They put a whole range of emotions onto the table. The therapist had to apologize numerous times, take feedback, and even share longings and aspirations to help paint the picture of what it means to be human.