9 迎接成长的挑战

第九章

回应成长 爱……除了是正向强化的另一个名字之外，还能是什么呢？ ——B. F. 斯金纳

“我在想，现在这一刻是不是一个例子，说明你没有……我们上次是怎么说的？没有隐藏自己。”

“嗯。”

“换句话说，我们现在可以有另一种互动方式，而不是我偶尔幸运地猜到你是谁。我想我的问题是：你需要什么才能在这里更自在地毫无保留地表达真实的自己和感受？”

“嗯，嗯。”

“我的意思是，我们怎么才能达到那个状态？”瑞安笑着说，“你现在需要我做些什么，才能让你更自在地做到这一点？”

他又笑了。“嗯。好吧，我的生活其实挺无聊的。没什么特别的。”

“事情是这样的，我真的希望你能在我面前有所不同。你的生活对我来说并不无聊；它很重要。”

“好的。”

“那么，你怎么能在我这里冒险呢？有什么是你没有说出来的吗？有没有一种方式，你可以更完全地展现自己，包括所有的恐惧、担忧、顾虑、愤怒和其他我不知道的情绪？我的意思是，你现在真正想要从我这里得到什么？”

“嗯，我在想，我现在应该说出来吗？”

“直接说吧。”

“听起来有点俗气。”

“这是真实的你吗？”

“是的。”

“那就说出来。”

瑞安停止了笑，挺直身子，带着很多情感和颤抖的声音说：“我真的需要你的支持。你知道，我没有人在支持我和我的努力。我知道这很奇怪，但这是真的。”

在互动的最后阶段，治疗师一直在试图唤起瑞安的CRB2，但他主要得到的是简短的回答和笑声（CRB1）。当瑞安在对话结束时转向CRB2——做了不同的事情——治疗师的坚持得到了回报。

从功能性行为分析（FAP）的角度来看，瑞安最后那句充满感情的话反映了一个关键时刻。对于其他来访来说，这种陈述可能不是什么大事，但对于瑞安来说却意义重大。这是他与治疗师合作期间——甚至可能是他整个成年生活中——第一次明确说出自己的需求并如此直接地提出要求。虽然这不是一个完美的请求，事实上，他具体的意思并不十分清楚，但这对瑞安来说是一个巨大的进步。由于他们在一起度过的时光，来访和治疗师都理解了这个时刻的重要性。

用FAP术语来说，瑞安的陈述是纯粹、明显且完美不完美的CRB2。它直接关系到他与治疗师的关系，也直接关系到他在生活中所面临的困境以及他希望如何改变。有时候，CRB2会更小、更不明显或更不戏剧化。有时候它们不需要太多的唤起，而有时候则需要更多。有时CRB2会与CRB1混合。但在所有情况下，关键问题是如何回应。你如何利用你的回应来最大化这一关键步骤的治疗效果？用行为学的术语来说，我们如何回应才能最大限度地增加这一进步被强化的机会？

本章讨论如何回应CRB2。

什么是强化？

让我们先快速回顾一下。“强化”是指由于行为产生的后果，使得该行为在类似情况下更有可能被重复的过程。

治疗师的以下回应是否具有强化作用？ 来访： 我很难过。 治疗师：啊……我很高兴你说了出来！

如果你对背景行为科学（CBS）有一些了解，你可能会说不。用快乐来回应悲伤的情绪是不一致的。这位治疗师陷入了试图通过轻松、积极的回应来强化情绪表达的陷阱。她将积极情感或赞美与强化混淆了。她还不如给来访一颗M&M巧克力豆。

你可以提醒自己，强化并不是做些好事或让来访感觉良好。强化是一个过程，通过这个过程，某种行为在未来更有可能再次发生。无论你的回应是什么，只要它产生了这种结果，就是强化。强化与你的回应形式无关。

但是，请稍等一下。如果回应的形式——其情感基调、意义等等——与它是否具有强化作用无关，那么你怎么能说上面的回应没有强化作用呢？

你不能。如果你已经意识到这一点，恭喜你。对于“治疗师的回应是否具有强化作用？”这个问题的最佳答案是“我们无法判断。这取决于具体情况。”换句话说，我们不能仅凭回应的形式来判断它是否具有强化作用。真正重要的是回应对于来访的功能——即该回应实际上对来访有什么影响。这就是功能性思维的本质。（请原谅我们提出了一个棘手的问题。希望你通过了这个小测试。）

我们可以通过看到更多关于回应的情境信息，来做出有根据的猜测，判断回应是否会具有强化作用。例如，考虑以下情境中的来访，她正在工作上经历职业倦怠，她的CRB1主要围绕隐藏和脱离自己的需求和情感：

来访：我只是感到迷茫。我不想前进；每天都很拖沓。我喜欢这个项目，但……

治疗师：好像缺少了什么。还是不太合理。你觉得还有什么别的原因吗？

来访：我很难过。

治疗师：啊……我很高兴你说了出来！是的，现在明白了。因为失去了Rod，失去了你的团队。当然。抱歉我之前没有理解到这一点。

来访：是的，我认为悲伤是其中很大的一部分。我不愿意承认这一点。

或者考虑同一个来访的另一个例子：

来访：我只是感到迷茫。我不想前进；每天都很拖沓。我喜欢这个项目，但……

治疗师：你还感受到了什么？

来访：嗯……我很难过。

治疗师：啊……我很高兴你说了出来！谢谢你表达了自己的情感。

来访：嗯。好吧。

在这两个例子中，哪一个来访更可能因为向治疗师表达情感而得到强化？换句话说，在哪个例子中，来访更可能继续分享她的感受？

在第一个例子中，治疗师更紧密地跟踪了来访所说的内容的意义。她的唤起（“你觉得还有什么别的原因吗？”）伴随着一些解释，说明为什么她会问这个问题。她还解释了自己对来访披露内容的反应，并将其与披露内容的背景联系起来：治疗师努力理解来访的倦怠体验。这次互动感觉自然、同理且连贯。特别是，治疗师传达了她对来访所说内容的理解。她传达出这种感觉是有道理的，她接受了这种感觉。

相比之下，在第二个例子中，治疗师似乎更加疏离。唤起（“你还感受到了什么？”）仍然可能是有意义的，但在这种情境下，尝试进行规则3（“谢谢你表达了自己的情感。”）似乎显得随意且难以理解——甚至有些社交尴尬。反过来，来访表达了困惑。

因此，看起来来访更有可能在第一个例子中继续敞开心扉。然而，所有这些解释都只是关于哪些行为更可能具有强化作用的猜测，我们只能通过观察来访随时间的行为变化来真正知道治疗师的回应是否具有强化作用。但我们分享的这些直觉——哪些互动看起来更自然、同理且连贯，以及更可能具有强化作用——是我们用来追踪和调整我们强化CRB2努力的关键代理指标。

具体来说，我们在评估你的强化行为时建议遵循以下指导原则：

• 你不能仅凭回应的形式来判断它是否具有强化作用。
• 看到更多的情境信息可以让你更全面地解读行为的功能，但你的结论仍然是一个猜测。
• 涉及理解和接受的互动更有可能具有强化作用，尤其是在脆弱的情感披露时。
• 你可能从第4章中认识到了最后一点，即意识、勇气和爱的框架。我们将在本章后面回到这一点。现在，我们将更详细地探讨如何基于对情境的敏感性和与来访的调谐来进行具有强化作用的回应。

平衡真实性和策略

功能性行为分析（FAP）要求你有意识地注意CRB2，并以强化的方式作出回应。同时，它也要求你在这样做的过程中保持自然和调谐。

你可能会注意到，在自然（真实）回应与有意识（策略性）回应之间可能存在潜在的紧张关系。具体来说，如果你是有意识的，你就必须选择你的回应。如果你是自然的，你的回应应该是自发的。但如果你的自然回应不太可能强化来访的CRB2，该怎么办呢？

例如，考虑一个来访，其CRB2是变得更加自信： 来访： 这周我们能多安排一次会面吗？ 治疗师：（想着自己已经排满了日程，感到压力上升……）

如果治疗师机械地遵循FAP规则，他可能会回答：“当然可以。我很高兴你能提出你需要的东西。”如果他是人之常情，无法掩饰他对增加会面次数的犹豫，那么这个回应可能会显得勉强或不真诚。来访可能会察觉到这种不一致，这可能会影响互动的强化效果。在极端情况下，来访可能会认为：“原来变得自信就是让别人去做他们不想做的事情？”然而，如果治疗师完全根据自己的反应来回应：“这周我不能增加会面，我的日程已经排满了。” 这似乎也是反治疗的。

幸运的是，正如你所知，对话并不止于一次互动。有许多方法可以应对这种情况，即使治疗师不额外安排会面，也有很大的机会强化来访的自信。以同情和同理心平衡竞争利益是人类社交技能的核心。在这种情况下，治疗师必须平衡对来访需求的关注、请求在治疗背景下的重要性以及自己的需求。情感一致的回应能够平衡这些考量。例如，如果治疗师真的无法安排另一次会面，他可以说：

“哦，天哪……这周我真的不能增加会面了。我的日程已经排满了。我不愿意这么说，因为我明白你提出这个请求时的感受。如果是其他任何一周，我会说好的。但这周我真的非常忙。我们可以讨论一下如何以其他方式为你提供支持吗？或者我们可以安排下周早些时候见面？”

在这个陈述中，治疗师认可了请求的意图、脆弱性和有效性，并以自己的需求回应了这种脆弱性。很容易想象，听到这个陈述的来访仍然愿意向治疗师提出请求。现在想象一下，来访真的处于危机之中，而治疗师稍微更愿意安排会面：

“我犹豫只是因为我确实已经排满了。但是你知道吗，趁热打铁处理这个问题很重要。我很高兴你能提出这个请求。让我们找出周四下午的时间。”

在这里，治疗师对他犹豫的情感表现得一致。但他随后也转向解决来访请求的意义。

正如我们在本书第一章中所声称的，当你真正理解和关心来访的进步和成长时，你的反应自然会倾向于服务于来访的福祉。平衡我们的各种反应和回应是一种人际心理灵活性的表现，其中观察和接受多种因素和经验流，但最重要的考虑因素指导行动。

事实上，这种表述允许我们为“真实性”提出一个工作定义：以一种与所有相关情境方面（包括它们的相对重要性）相一致且具有沟通性的方式作出回应。

变化的响应性

接下来我们谈谈另一种真实性与策略（例如，强化CRB2的策略）之间可能冲突的方式。冲突在于理想的强化回应可能与你的自然、自发的回应不符。理想的强化回应由这一行为原则定义：产生强化的后果取决于它们所强化的行为。换句话说，只有当行为发生时（或几乎只在行为发生时），强化后果才会出现，并且它标志着行为发生前的情况发生了偏离。但你的自然回应可能不会自然地以这种方式依赖于行为。

这个例子可能使原则——以及冲突——更加具体化。想象一只鸽子在一个操作学习室里。当按钮被快速连续啄击三次时，鸽子会得到一块美味的食物。然而，如果无论鸽子是否啄击按钮都能得到很多食物，那么就没有激励去啄击按钮。如你所见，只有当食物仅在按钮被按下时才出现时，食物才会导致更多的按钮啄击。这个例子说明了结果（食物）必须依赖于行为（啄击）才能实现强化（啄击频率的增加）。"依赖"意味着"取决于"。

在治疗中，理解、接纳和响应是你所能提供的主要强化物。考虑到上面的鸽子例子，这是否意味着你应该等到CRB2发生时才提供这些？幸运的是，成人社交互动比鸽子的简化情况更为复杂，不是非黑即白的。依存关系更加灵活；存在多重行为流和依存关系。尽管如此，在治疗关系中，改变你对CRB2的回应，使其在某种程度上与众不同，是有帮助的。换句话说，如果你以同样的语调、同样的情感、同样的姿势等做规则3，就像你在治疗中的其他事情一样，你可能会削弱你的回应的强化价值。

幸运的是，变化是亲密关系中自然且真实的响应的一部分。

当你理解和关心另一个人时

当你理解和关心另一个人时，你会自然地以不同的方式回应那些你认为重要的时刻。在这些时刻，仅仅以一种调谐和同理心的方式表达你的反应，通常就能提供足够的变化来强化行为。毕竟，你的情绪反应自然是根据你所反应的行为而定的。

同时，自然响应的一部分也涉及以微妙或不那么微妙的方式修改、扩展或抑制自然反应，以便我们的响应在当下以最有效的方式发挥作用。一个非常明显的例子是成年人在与儿童交谈时如何调整他们的情感表达。我们使用更简单的情感词汇，并可能夸大某些面部表情。这是一种亲社会、具有同理心的行为（至少在某些时候是这样）。

当我们知道其他成年人情绪化或处于某种心态时，我们也可能会这样做，使得更为保留或狂喜的回应无法触及他们。当朋友害怕迈出职业生涯中的重大风险（而你相信这个风险是正确的一步，且恐惧是不合理的高）时，你可能不会说：“嗯，你可能会没事的。去试试吧。”这种回应是理性的，但不符合朋友的需求。如果你花时间思考朋友正在经历的事情以及他需要从你这里得到什么，你可能会意识到你的回应需要非常明确且更加强烈，才能穿透情感的噪音。你可能更有可能说：“你为了这个机会付出了很多努力。所有你能看到的迹象都表明现在是正确的时机。我相信你。勇敢地迈出这一步。”

换句话说，即使你不自然地感受到那种强度，通过理解对方的需求，表达这种强度也会变得自然。我们自然而然地根据他人需要的不同来调整我们的回应。这是响应性的一个重要部分。我们旨在提供他人所需要的东西，而不仅仅是对我们自己来说一致和真实的东西。事实上，与他人的需求保持联系直接塑造了我们自己的情感反应。

在FAP中，基于对他人的需求和体验的同理心的可变响应性，加上对行为原则的关注，是我们遵循规则3（强化CRB2）的重要指导原则。

识别假设

我们发现，在为有脆弱CRB2的来访生成所需的同理心时，问自己这个问题很有帮助： 我带入这次互动的假设有哪些是由于来访的个人历史而没有被来访持有的？

例如，你可能持有以下假设：

• 反馈是健康且无威胁的。
• 表达赞美或喜爱是真诚的，没有隐藏的动机。
• 情感表达是健康的，并能建立关系。
• 请求满足需求是合理且重要的。

然而，有痛苦人际历史的来访可能在理智上理解这些假设，但在情绪和脆弱的时刻却无法真正体验到它们的意义。来访甚至可能持有相反的假设：

• 反馈是为了控制。
• 表达赞美或喜爱是操纵性的。
• 情感表达是软弱和危险的。
• 请求满足需求是不合理且徒劳的。

当你能够识别来访持有的（情感上的而非理性上的）假设或不持有的假设时，你可以以更有效的方式作出响应。例如，你可以明确你在治疗互动中的亲社会假设。想象一下，要求额外会面的来访在过去生活中，她的关键人物总是嘲笑或忽视她的请求。你的回应可以考虑到她过去提出请求的经历，并明确表达你的愿望：“对我来说，当你有这样的请求时，你提出它们是很重要的。鉴于你的历史，你对此感到焦虑在我这里是完全说得通的。”

减少响应

上述关于响应性和可变性的指南有一个例外。有时候，对来访脆弱性的最强化的回应方式是几乎不做任何事情（至少从你的角度来看）。

想象一个来访，由于家人在她表达情感时嘲笑和忽视她，她采取了一种情感疏离的态度。别人觉得她是疏远的、冷漠的，有时甚至是令人不安的。经过几个月的时间，她逐渐开始信任你，能够在描述最近一次让她不安的与父母的经历时表达悲伤和失望。设想即使她不能对你这么说，她对自己情绪的困惑并不亚于她对那次经历的感受。

如果你在那一刻过于响应，过于强烈地关注或用你自己的情绪回应，你可能会破坏使她的情感得以浮现的安全感和信任感。相反，如果你记得过去表达情感的行为经常受到惩罚，并以更加克制的方式回应这次互动，仅仅是缺乏预期的负面后果就可能极其重要。通过简单地保持温暖、开放、同理心的姿态，来访会体验到历史后果与当前发生的事情之间的差异。就好像来访打开了一扇她以为里面藏着怪物的门，却发现房间是空的。许多FAP治疗师都有来访告诉他们，在某些治疗关系中，最小化的回应是如何帮助他们的：“并不是你特别做了什么让我在这里感到受欢迎。而是你倾听的方式。是你没有做的事情。那对我来说意义重大。”

最后一点评论

确保你在回应CRB2时具有变化性的另一个重要方面是确保你不会对CRB1过于响应。如果你习惯于对每个来访的请求都以微笑或点头回应，以至于你的响应范围相对较小（你已经处于高度响应的状态），那么你可能需要考虑找到一个稍微更中立的基线姿态。

用爱强化勇气

你不会发放M&M巧克力豆或为治疗进展给来访现金奖励。你能提供的唯一东西就是在那一刻作为一个人的自然反应。在治疗时间之外，在现实世界中，外界会接续你的反应继续影响。希望是在治疗过程中形成的新行为方式能够在治疗之外得到巩固和滋养（强化）。例如，你希望在你面前变得更加自信的来访也能在他的妻子面前表现得更加自信，并且她会对他的自信做出积极的回应（即，他的自信导致了好的结果）。但在治疗的过程中，作为一个人的反应是你唯一能提供的东西。

现在让我们回到意识、勇气和爱（ACL）模型，进一步阐述我们认为在治疗关系中响应性和强化作用的关键方面。正如我们在本书开头提到的，响应性对行为有非常重要的影响。这些响应性的要素在治疗关系中有普遍的价值，但当您所响应的行为是勇敢的表现时，它们尤为重要。

在接下来的部分中，我们将集中讨论治疗师对三种可以归类为“勇气”的行为的响应：选择体验脆弱和情感、自我披露以及提出需求。我们假设ACL模型中指定的响应类型自然地强化了这些勇敢的行为。这些响应可以用三个句子来概括，这三个句子也描述了ACL治疗立场：

• 我看到你了。
• 在这里你是安全的。
• 我会尽我所能给你想要的。

选择体验脆弱和情感

当我们与之交流的人提供安全和接纳时，我们通常更愿意保持脆弱并体验情感。这样，安全和接纳可以作为一种CRB2来强化脆弱性。“安全”和“接纳”是模糊的概念，基本上是比喻性的。缺乏安全并不意味着实际的危险。我们谈论的是更广泛的社会安全感：即没有评判并且有同情心的关注。

想象一下你在工作中犯了一个错误。你向主管报告了这个错误，而他这样回应：“你在想什么？看在上帝的份上，我不能相信你们这些人能做好任何事情。朋友，你会为此感到痛苦的。”哎呀。虽然没有身体上的威胁，但这种脆弱、羞耻、内疚或愤怒的体验可能是强烈的。你不太可能再向这位主管报告未来的错误。

相比之下，想象这样的回应：“哦，天哪。我很高兴你来找我。我们来谈谈发生了什么。首先，你还好吗？”注意这里有适当的关切表达和学习导向，语气完全不同。你更有可能在未来向这位主管报告错误。（这个例子还强调了强化的回应不一定是快乐或正面情绪的回应。）

安全和接纳通过语调、身体姿势、眼神接触和面部表情传达的程度与通过言语传达的一样多。如果你不相信这是真的，下次当来访说一些脆弱的事情时，试着坐得笔直，面无表情。

对于治疗师来说，当来访的脆弱性涉及CRB2时，向来访传达安全和接纳是很重要的。这很容易被忘记。有时治疗师会被聪明或想要做一些复杂、主动或“有帮助”的事情所吸引。当你发现自己在做这些事情时，请放慢速度，明确地传达安全和接纳，无论是非言语还是言语。通过稳定的目光、开放放松的姿势以及努力理解来访的经验和需求来非言语地传达接纳。判断和评价应该不存在。言语上，如果合适的话，你可以明确使用“安全”和“接纳”这两个词；例如，“我想让你知道，当你这样做时，你在我这里是完全安全和被接受的。”或者在来访害怕评判并感到最脆弱的时候，反映一个积极的观点：“我在这件事中看到的是——这对你来说可能有点反直觉——你的力量和诚实的承诺。你所有的感受对我来说都是合理的，我想让你知道我看到你在努力践行你的价值观。”

让我们考虑一个以明显的脆弱性陈述结束披露的来访：

你知道吗，我以前没注意到，但你的台灯和我祖母过去用的一模一样。我记得是因为我们总是坐在那张桌子旁一起拼图。我甚至不知道为什么我要和你分享这个；我只是分享而已。我觉得分享这件事很奇怪。不知怎的，这让我紧张。

针对Madelaine的自我披露

鉴于Madelaine在自我披露方面的困难，以及她在这样做时感受到的脆弱性（可以说她避免自我披露的部分原因是为了避免脆弱），治疗师的目标是双重的：一是认识到分享这样的信息是一种选择体验脆弱和情感的行为，也是一种自我披露；二是以安全、接纳、理解和同理心来回应。

以下是Madelaine的治疗师可能在此刻作出的一些回应示例：

• 治疗师：Madelaine，让我在这里暂停一下。首先我想让你知道，你正在做我们一直在谈论的事情，我喜欢你用的词：“只是分享”。这正是我们一直在讨论的内容。所以我想让你知道，当你这样分享时，在我这里你是完全安全且被接受的。我很喜欢听这个小故事，还想听更多。我能想象你和你的祖母坐在那里，灯光照耀着你们一起拼图的情景。真的很美好。
• 治疗师：Madelaine，当我听到你分享这个故事时，我感到一种温暖，甚至是爱意在我脸上蔓延。你能从我的脸上看到吗？你能从我的眼中看出我有多喜欢你的故事，以及你在与我交谈时是多么安全吗？
• 治疗师：这真是太酷了。我觉得这可以成为一个很棒的拼图灯。我也喜欢听你讲关于你祖母的事。和她在一起是什么感觉？

当然，“最佳”回应是在情境中真实且策略性的。

自我披露的重要性

自我披露可能是社会交流的基础。我们谈论自己，并希望别人倾听。我们希望被听见、被看见、被理解。

自我披露也是心理治疗的基础。这是来访在每次会谈中大部分时间所做的。如果他们在自我披露方面有困难，治疗通常会首先关注这一点。反过来，提供理解、同理心和验证是治疗师回应来访自我披露的基础。也就是说——根据意识、勇气和爱的模型——我们认为理解、同理心和验证的作用是强化自我披露。这种自我披露与理解之间的自然关系深深交织在所有运作良好的社交互动和治疗过程中。为了注意到它的重要性，想象一次你觉得被严重误解的对话。它导致了什么结果？

尽管自我披露对于社会关系和治疗至关重要，但我们经常遇到在这方面有困难的来访。例如，有些来访难以以他人能理解的方式表达感受、事件或态度。这些困难可能出于多种原因（例如，焦虑的脆弱感）。在FAP术语中，我们可以将自我披露的困难视为CRB1。相应地，对于与自我披露相关的CRB2，重要的是清晰地传达理解和同理心作为我们自然响应的一部分。

再考虑Madelaine——她自发地说：“你知道吗，我以前没注意到，但你的台灯和我祖母过去用的一模一样。我记得是因为我们总是坐在那张桌子旁一起拼图。我甚至不知道为什么我要和你分享这个；我只是分享而已。”

治疗师认识到这是一种与自我披露相关的CRB2，特别是因为它自发且Madelaine承认她不知道为什么要分享。这种“只是分享”的自由对Madelaine很重要，因为她之前对自己分享的内容非常拘谨。作为回应，治疗师以简单的方式传达了理解：“听到你说这些对我来说很温馨。我小时候也常和祖母一起玩拼图，那种感觉总是很平静。对你来说也是这样吗？”这些话向Madelaine对她记忆的感受延伸了同理心。

如果这一点看起来显而易见，那是因为同理心是治疗师的基本且熟练掌握的技能。相比之下，想象一个完全错失Madelaine披露重点的回应：“也许你觉得谈论家具比我们在这里讨论的问题更有趣？”

请求满足需求

勇气的第三个子类别是请求满足需求。从FAP的角度来看，这一类别很有趣，因为在最简单的层面上，当有人请求某事时，最自然的强化回应通常是给他们所要求的东西。但显然这并不总是可能的。那么该如何回应呢？

考虑Yolanda，一个在请求他人支持和满足任何需求方面有很大困难的来访。在治疗过程中，她问她的治疗师：“治疗结束后，我们能不能偶尔一起喝杯咖啡？”虽然这类请求通常是有问题的，但Yolanda的治疗师认识到，对于Yolanda来说，这是一个CRB2。这对治疗师来说当然是一个伦理问题，但这并不意味着来访的请求就是CRB1。（尽管可能有一种CRB1的因素在于没有意识到邀请治疗师喝咖啡的尴尬。）这种紧张造成了一个两难的局面，因为治疗师认识到无法给予Yolanda所要求的东西。你会如何回应？以下是一个示例回应：

• 治疗师：你提出这个问题对我来说意义重大，因为我明白这对你的意义。你知道，即使治疗结束，我对你的关心也不会停止。我会很期待收到你的消息并保持联系，如果我们能够通过喝咖啡的形式见面，那就太好了。

关于与前来访喝咖啡的一些复杂性

有一些关于与前来访喝咖啡的复杂性，我想稍后与你分享，但目前最重要的是让你知道，我对你的关心不会因为治疗结束而终止。

也许这不是一个完美的回应，但在当下已经足够好，并且符合这位治疗师的界限。我们想要指出的关键是，治疗师推迟了在那一刻讨论伦理和治疗后的友谊。这是一个与Yolanda需要进行的重要对话，但治疗师认识到，在那一刻进行这样的对话可能会对脆弱请求的CRB2起到惩罚作用。此外，推迟这个讨论并不会带来任何伤害或伦理困境。

大多数时候，满足来访的需求并不那么复杂。来访经常会对治疗过程、治疗安排等方面提出要求，而在这些请求中（包括避免提出这些请求）可能会出现CRB。考虑Zoreh，一位在自我披露和提出请求方面有很大困难的来访。有一天她来参加会话时说：“我今天感觉非常疲惫。我们可以有一个不那么激烈的会话吗？”对于任何特定的来访来说，这可能不是CRB2，但由于Zoreh在自我披露方面的困难，对她来说，说“我今天感觉非常疲惫”是CRB2。同样，由于她在提出请求方面的困难，问“我们可以有一个不那么激烈的会话吗？”也是CRB2。一如既往，一个潜在的强化回应可以采取多种形式：

• 是的，我们可以有一个不那么激烈的会话。我想让你知道，当你提出你需要什么时，无论是什么需求，我都非常尊重，并承诺尽我所能来满足它们。我的心与你的心同在。
• 当然可以！没问题。

当然，“最佳”回应是在情境中真实且策略性的。理解与接纳是我们对来访的自我披露和脆弱性所提出的未言明请求的基本回应。

注意你的影响

想象自己在足球比赛中带球。你不仅仅是踢或轻推球。你会观察球并不断调整自己的动作以保持球的移动，响应对手和队友的动作，并以此来判断你的动作和球的运动是否朝着更大的目标前进。没有这种持续的监控，就不可能有带球。

同样地，作为治疗师，我们不仅仅是对我们认为的CRB做出反应。我们还要观察行为如何随着我们的回应而变化。例如，你只有通过观察你试图强化的行为发生了什么，才能知道你在规则3中的尝试是否有效。反过来，你也只有通过观察这一过程，才能知道那些CRB2的增加是否让来访朝着他的临床目标前进。

这种对过程如何发展的多层次意识——超越我们在治疗关系中要求你带来的基本人际调谐——是FAP的基础。特别是，规则3（强化CRB2）和规则4（注意你的影响）之间存在着深刻的相互依赖，因为你只有通过注意到你的影响，才能知道你是否在强化CRB2。

这种注意主要采取两种形式：

1. 在当下和一段时间内口头检查
2. 观察来访的行为

口头检查

检查你的影响的一种方式是问：“那是什么感觉？”

例如，你可以询问来访在某个互动中的体验（设定治疗议程、回顾一周、处理你们之间的分歧）在一个会话中。当然，你不能期望来访用FAP术语回答：“嗯，你刚才非常有效地强化了我的CRB2。”但来访的回应会给你一些指示，说明互动是否在正确的轨道上。

你也可以检查更广泛的治疗部分。第7章介绍的会话过渡表格的问题可以帮助你逐个会话进行检查。你还可以检查治疗的某个阶段：

• 我们这几周一直在努力让你向我提出坚定的要求。从你的角度来看，进展如何？这有效吗？ 或者你可以整体检查治疗：
• 让我们退一步看看我们的工作进展如何。在你看来，我们是否在正确的轨道上？有没有我们不够关注的事情？

观察来访的行为

观察来访的行为当然是注意你影响的一个更广泛的类别；与来访进行口头检查也涉及观察他们对你回应的行为。如果治疗的总体目标是增加CRB2以及与呈现问题相关的进展，那么有多种迹象表明这些事情正在发生：

• 你可能会注意到来访与你互动的方式或会话的基调发生了微妙的变化。例如，会话可能感觉冲突较少，更加有益。
• 你可能会注意到旧问题的完全消失。例如，家庭作业可能可靠地完成（而在过去很少完成）。来访可能会为每次会话提出并重申明确的议程（而过去则非常模糊）。
• 你也可能会注意到关键转折点时刻，在这些时刻，来访对特定情况的反应明显且戏剧性地不同于他们过去的反应。例如，Gareth永远不会忘记那个抱怨了数周、坚持要求他提供更好的工具来立即缓解痛苦的来访。有一天晚上，同一个来访——在极度痛苦中寻求支持时——深呼吸后叹了口气说：“你知道吗，我意识到你们这个领域其实并不先进。你们实际上没有工具来帮助我。我理解这一点。而且我很感激你能在这里听我说，并尽你所能帮助我。”在那一刻，斗争突然转向接受，并在接下来的几个月里持续并深刻地发展。

总结

• 回应CRB2的目标是强化——即增加未来重复该行为的可能性。
• 你的回应是否具有强化作用不能仅凭其形式或外观来确定。你只能通过观察来访行为随时间的变化来知道你的回应是否具有强化作用。
• 也就是说，具有同理心、接纳性和响应性的回应更有可能起到强化作用。
• 确保你对来访CRB的回应是真实的，建立在真诚的同理心之上，并符合来访的需求、目标和价值观。

知识点阐述

1. 正向强化与爱

   • 定义：正向强化是指通过奖励来增加某种行为在未来发生的可能性。B.F.斯金纳认为，爱可以被视为一种正向强化的形式。
   • 重要性：在治疗过程中，通过提供支持和鼓励，治疗师可以帮助来访建立积极的行为模式，从而促进个人成长和发展。
   • 具体实践：
     • 识别积极行为：注意并认可来访的积极行为和进步。
     • 提供反馈：及时给予正面反馈，增强来访的行为动机。
     • 建立信任：通过持续的支持和理解，建立稳固的信任关系。

2. CRB2的识别与响应

   • 定义：CRB2是指来访在治疗过程中展现出的具有治疗价值的行为，这些行为有助于来访的发展和成长。
   • 重要性：正确识别和响应CRB2能够推动治疗进程，帮助来访实现个人目标。
   • 具体实践：
     • 敏锐观察：仔细观察来访的行为，识别出那些具有治疗价值的行为。
     • 即时响应：在来访表现出CRB2时，立即给予积极的反馈和支持。
     • 深化理解：了解来访行为背后的动机和意义，以更有效地引导其发展。

3. 创造安全的环境

   • 定义：创造一个让来访感到安全和支持的环境，使他们能够自由地表达真实的自我和感受。
   • 重要性：安全的环境有助于来访敞开心扉，更容易展示出真实的自我，从而促进治疗效果。
   • 具体实践：
     • 无条件接纳：接受来访的所有情绪和行为，不加以评判。
     • 倾听与理解：认真倾听来访的感受和需求，表现出理解和同情。
     • 保密原则：确保来访的信息保密，保护其隐私。

4. 逐步引导与支持

   • 定义：通过逐步引导和支持，帮助来访逐渐克服障碍，实现个人成长。
   • 重要性：逐步引导能够帮助来访建立信心，逐步面对和解决问题。
   • 具体实践：
     • 设定小目标：设定可实现的小目标，逐步推进治疗进程。
     • 鼓励尝试：鼓励来访尝试新的行为模式，即使失败也不失为一次学习的机会。
     • 持续跟进：定期检查进展，并根据需要调整策略。

通过这些知识点，我们可以更好地理解如何在治疗过程中有效识别和响应来访的CRB2，创造一个支持性的环境，并通过逐步引导和支持帮助来访实现个人成长。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 强化的概念

   • 定义：强化是指通过行为的结果使该行为在未来更有可能再次发生的心理过程。
   • 重要性：正确理解和应用强化原理可以帮助治疗师有效地引导来访的行为，促进治疗进程。
   • 具体实践：
     • 识别行为结果：注意来访行为的结果，判断这些结果是否增加了行为的未来可能性。
     • 选择适当的强化物：根据来访的具体情况选择合适的强化物，确保它们能够有效增加目标行为的发生。

2. 功能分析的重要性

   • 定义：功能分析是指通过观察行为及其结果，理解行为背后的功能和动机。
   • 重要性：功能分析有助于治疗师更好地理解来访的行为模式，从而制定有效的干预策略。
   • 具体实践：
     • 全面观察：不仅关注行为本身，还要关注行为发生的背景和结果。
     • 假设检验：通过实验性的干预来验证对行为功能的假设。

3. 理解和接受的作用

   • 定义：理解和接受是指治疗师对来访的情感和经历表示理解和接纳的态度。
   • 重要性：理解和接受能够建立信任关系，使来访感到安全和支持，从而更愿意开放和表达。
   • 具体实践：
     • 倾听与共情：认真倾听来访的情感表达，并表现出同情和理解。
     • 非评判性态度：保持开放和非评判性的态度，避免对来访的情感和行为进行负面评价。

4. 情境敏感性与调谐

   • 定义：情境敏感性是指治疗师对当前情境的敏锐感知，调谐则是指治疗师与来访的情感状态相匹配。
   • 重要性：情境敏感性和调谐能够帮助治疗师更准确地把握来访的需求，提供更有效的支持。
   • 具体实践：
     • 观察细节：注意来访语言、表情和身体语言中的细微变化。
     • 灵活调整：根据来访的情感状态灵活调整自己的回应方式，以更好地满足来访的需求。

通过这些知识点，我们可以更好地理解如何在治疗过程中有效地应用强化原理，通过功能分析来理解来访的行为，并通过理解和接受的态度建立信任关系。此外，通过情境敏感性和调谐，治疗师能够更准确地把握来访的需求，提供更有效的支持。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 真实性和策略之间的平衡

   • 定义：真实性和策略之间的平衡是指在治疗过程中，治疗师需要在保持真实自然的同时，采取有意识的策略来强化来访的行为。
   • 重要性：这种平衡有助于建立信任关系，同时确保治疗的有效性。
   • 具体实践：
     • 自我反思：治疗师应定期反思自己的反应，确保它们既真实又有效。
     • 灵活调整：根据具体情况灵活调整回应方式，确保回应既符合情境又具有强化作用。
     • 情感一致性：即使在表达拒绝或犹豫时，也要保持情感的一致性和真诚性。

2. 强化的原则

   • 定义：强化是指通过特定的结果使某种行为在未来更有可能再次发生的心理过程。
   • 重要性：正确应用强化原理可以帮助治疗师有效地引导来访的行为，促进治疗进程。
   • 具体实践：
     • 识别行为结果：注意来访行为的结果，判断这些结果是否增加了行为的未来可能性。
     • 选择适当的强化物：根据来访的具体情况选择合适的强化物，确保它们能够有效增加目标行为的发生。
     • 灵活应用：即使在复杂的社交互动中，也要灵活应用强化原理，确保强化物与目标行为紧密相关。

3. 变化的响应性

   • 定义：变化的响应性是指治疗师在不同情境下以不同的方式回应来访，以保持回应的新鲜感和强化作用。
   • 重要性：变化的响应性有助于维持来访的兴趣和参与度，增强治疗的效果。
   • 具体实践：
     • 多样化回应：使用不同的语调、情感和姿势来回应来访，避免单调和习惯化。
     • 适时调整：根据来访的行为和情感状态适时调整回应方式，确保回应始终具有强化作用。
     • 自然变化：在保持真实性的前提下，自然地引入变化，使回应更具吸引力和有效性。

4. 情感一致性和共情

   • 定义：情感一致性是指治疗师在回应来访时保持情感的真实性和一致性，共情则是指治疗师理解和感受来访的情感。
   • 重要性：情感一致性和共情有助于建立深厚的治疗关系，使来访感到被理解和接纳。
   • 具体实践：
     • 倾听与理解：认真倾听来访的情感表达，并表现出同情和理解。
     • 非评判性态度：保持开放和非评判性的态度，避免对来访的情感和行为进行负面评价。
     • 情感共鸣：通过情感共鸣，治疗师能够更好地与来访建立联系，增强治疗效果。

通过这些知识点，我们可以更好地理解如何在治疗过程中平衡真实性和策略，通过变化的响应性来保持回应的新鲜感和强化作用，以及如何通过情感一致性和共情建立深厚的治疗关系。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 自然响应与可变性

   • 定义：自然响应是指治疗师根据情境和来访的需求自发地调整自己的回应方式；可变性则指在不同情况下采用不同的回应策略。
   • 重要性：自然响应和可变性有助于增强治疗效果，因为它们确保了治疗师的回应既符合情境又具有针对性。
   • 具体实践：
     • 调谐与共情：通过调谐和共情来理解来访的需求，从而自然地调整自己的回应方式。
     • 情感一致性：即使在调整回应方式时，也要保持情感的一致性，确保回应的真实性和有效性。
     • 灵活应用：根据不同的情境和来访的具体情况，灵活地调整回应策略，以达到最佳效果。

2. 识别来访假设

   • 定义：识别来访假设是指治疗师意识到来访可能持有的信念或假设，尤其是那些由于过去的经历而形成的信念。
   • 重要性：了解来访的假设可以帮助治疗师更好地理解来访的行为和情感，从而提供更有效的支持。
   • 具体实践：
     • 自我反思：治疗师应定期反思自己的假设，并与来访的假设进行对比。
     • 沟通与澄清：通过与来访的沟通，明确来访持有的假设，并探讨这些假设如何影响他们的行为和情感。
     • 个性化干预：根据来访的假设制定个性化的干预措施，以帮助他们重新评估和调整这些假设。

3. 减少响应的重要性

   • 定义：减少响应是指在某些情况下，治疗师选择不做出过多的回应，以避免干扰来访的情感体验。
   • 重要性：在特定情境下，减少响应可以为来访创造一个安全的空间，让他们能够自由地表达情感。
   • 具体实践：
     • 观察与等待：在来访表达情感时，治疗师可以选择观察并等待，而不是立即做出回应。
     • 保持平静：保持冷静和平静的态度，避免过度介入或表达强烈的情绪。
     • 非言语支持：通过非言语的方式（如眼神接触、点头等）传达支持和理解，而不是通过言语干预。

4. 情感调谐与同理心

   • 定义：情感调谐是指治疗师在回应来访时，能够准确地捕捉和反映来访的情感状态；同理心则是指治疗师能够理解和感受来访的情感。
   • 重要性：情感调谐和同理心有助于建立深厚的治疗关系，使来访感到被理解和接纳。
   • 具体实践：
     • 倾听与理解：认真倾听来访的情感表达，并表现出同情和理解。
     • 非评判性态度：保持开放和非评判性的态度，避免对来访的情感和行为进行负面评价。
     • 情感共鸣：通过情感共鸣，治疗师能够更好地与来访建立联系，增强治疗效果。

通过这些知识点，我们可以更好地理解如何在治疗过程中自然地调整回应方式，识别和处理来访的假设，以及在适当的情况下减少响应以支持来访的情感表达。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 避免过度响应CRB1

   • 定义：避免过度响应CRB1是指治疗师不应总是以相同的方式（如微笑或点头）对所有来访请求作出反应，以免失去响应的变化性。
   • 重要性：保持响应的变化性有助于增强治疗效果，因为不同的情况需要不同的处理方式。
   • 具体实践：
     • 建立中立基线：找到一个中立的基线姿态，以便能够根据具体情况灵活调整响应。
     • 自我反思：定期反思自己的响应模式，确保不会陷入机械式的回应。
     • 多样化回应：尝试采用多种方式回应来访，以适应不同的情境和需求。

2. 用爱强化勇气

   • 定义：用爱强化勇气是指治疗师通过关爱和支持来强化来访表现出的勇敢行为。
   • 重要性：这种强化方式有助于来访在治疗过程中建立起新的行为模式，并在治疗之外继续巩固这些模式。
   • 具体实践：
     • 意识、勇气和爱（ACL）模型：通过ACL模型中的三个核心元素（我看到你、在这里你是安全的、我会尽我所能给你想要的）来指导治疗师的响应。
     • 非言语沟通：通过语调、身体语言和面部表情传达安全和接纳。
     • 言语确认：用言语明确表达对来访的理解和接纳，特别是在他们感到脆弱时。

3. 选择体验脆弱和情感

   • 定义：选择体验脆弱和情感是指来访在感到安全和被接纳的情况下，愿意展示自己的脆弱并表达真实的情感。
   • 重要性：这种行为有助于建立信任关系，促进治疗过程中的深层次沟通。
   • 具体实践：
     • 创造安全环境：通过非言语和言语的方式传达安全和接纳，让来访感到被理解和接纳。
     • 避免评判：保持无评判的态度，避免对来访的情感和行为进行负面评价。
     • 积极反馈：在适当的时候给予积极的反馈，鼓励来访继续表达自己的脆弱和情感。

4. 非言语沟通的重要性

   • 定义：非言语沟通是指通过身体语言、面部表情、语调等方式传达信息。
   • 重要性：非言语沟通在治疗过程中起着至关重要的作用，因为它可以传达出言语无法表达的信息。
   • 具体实践：
     • 稳定的目光：通过稳定的目光传达关注和理解。
     • 开放的身体姿态：采用开放和放松的身体姿态，表明自己是可接近的。
     • 一致的语调：使用温暖和接纳的语调，避免冷漠或批评的语调。

通过这些知识点，我们可以更好地理解如何在治疗过程中避免过度响应CRB1，用爱强化来访的勇气，以及如何通过非言语和言语的方式传达安全和接纳。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 针对Madelaine的自我披露

   • 定义：自我披露是指个体愿意分享个人经历、感受和想法，尤其是在面对脆弱性时。
   • 重要性：自我披露有助于建立信任和亲密关系，促进深层次的沟通和理解。
   • 具体实践：
     • 认可和鼓励：治疗师应明确认可来访的自我披露行为，并鼓励他们继续分享。
     • 安全和接纳：通过非言语和言语的方式传达安全和接纳，让来访感到他们的分享是受欢迎的。
     • 理解和同理心：展示对来访分享内容的理解和同理心，帮助他们感到被看见和被理解。

2. 自我披露的重要性

   • 定义：自我披露是个体在社交互动中分享个人信息的过程，是建立人际关系的基础。
   • 重要性：自我披露有助于增强人际间的信任和亲密感，促进更深层次的情感连接。
   • 具体实践：
     • 倾听和理解：治疗师应认真倾听来访的自我披露，并通过反馈表明理解。
     • 同理心和支持：展示同理心，让来访感到他们的感受被理解和接纳。
     • 处理误解：在出现误解时，及时澄清和调整，确保沟通的有效性。

3. 请求满足需求

   • 定义：请求满足需求是指个体主动提出自己的需求，并期望得到他人的响应和支持。
   • 重要性：请求满足需求是建立健康人际关系的关键，有助于提升个体的自尊和自信。
   • 具体实践：
     • 识别和尊重：治疗师应识别来访的需求，并尊重他们的请求。
     • 灵活应对：在不能直接满足来访需求的情况下，寻找替代方案或提供其他形式的支持。
     • 伦理考量：在处理涉及伦理问题的请求时，要谨慎处理，确保符合专业标准和伦理规范。

通过这些知识点，我们可以更好地理解如何在治疗过程中有效处理来访的自我披露和请求满足需求。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 与前来访喝咖啡的复杂性

   • 定义：与前来访喝咖啡涉及伦理和专业边界问题，需要谨慎处理。
   • 重要性：正确处理这类请求有助于维护治疗师的专业性和来访的安全感。
   • 具体实践：
     • 推迟讨论：在当下避免立即讨论伦理问题，以免对来访的脆弱请求产生负面效果。
     • 明确界限：确保来访明白治疗结束后的关系界限，同时传达持续的关心和支持。
     • 后续讨论：在适当的时候，与来访详细讨论伦理问题和治疗后的友谊。

2. 满足来访需求

   • 定义：满足来访需求是指治疗师在治疗过程中响应来访的合理请求，特别是在他们表达自我披露和脆弱性时。
   • 重要性：满足来访需求有助于建立信任，促进治疗的有效性。
   • 具体实践：
     • 灵活应对：根据来访的具体情况，灵活调整治疗计划，以适应他们的需求。
     • 积极反馈：通过正面的语言和态度，鼓励来访继续表达自己的需求。
     • 尊重和理解：展示对来访感受的理解和尊重，让他们感到被重视和支持。

3. 注意你的影响

   • 定义：注意你的影响是指治疗师在治疗过程中持续监控自己的行为对来访的影响。
   • 重要性：这种意识有助于治疗师及时调整方法，确保治疗朝着既定目标前进。
   • 具体实践：
     • 口头检查：通过提问等方式，直接了解来访对治疗过程的感受。
     • 观察行为：密切关注来访的行为变化，评估治疗的效果。
     • 多层意识：不仅关注当前的互动，还要关注整个治疗过程的发展，确保各环节的连贯性和有效性。

通过这些知识点，我们可以更好地理解如何在治疗过程中处理复杂的伦理问题，满足来访的需求，并持续监控治疗的效果。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 观察来访的行为

   • 定义：观察来访的行为是指治疗师在治疗过程中持续关注来访的言行举止，以评估治疗效果。
   • 重要性：通过观察来访的行为变化，治疗师可以了解治疗措施的有效性，并及时调整策略。
   • 具体实践：
     • 注意细微变化：留意来访在互动方式、会话基调等方面的微妙变化，如会话变得更加和谐、更有成效。
     • 识别旧问题的消失：观察来访是否不再表现出过去存在的问题，如家庭作业完成情况的改善、会话议程的明确性增强。
     • 发现关键转折点：识别来访在特定情境下的显著变化，这些变化可能标志着他们在接受度、自我认识等方面的重要进步。

2. 强化CRB2的行为

   • 定义：强化CRB2是指通过治疗师的回应来增加来访在未来重复某些积极行为的可能性。
   • 重要性：强化CRB2有助于促进来访的个人成长和问题解决能力。
   • 具体实践：
     • 评估行为变化：通过观察来访行为随时间的变化，判断治疗师的回应是否起到了强化作用。
     • 采用同理心和接纳：确保回应是基于同理心和接纳的，这样更容易被来访接受并产生积极影响。
     • 真实性与调谐：保持回应的真实性和针对性，确保它们符合来访的具体需求、目标和价值观。

3. 有效回应的特点

   • 定义：有效的回应是指能够促进来访积极行为的治疗师反馈。
   • 重要性：有效的回应可以帮助来访建立信心，增强治疗效果。
   • 具体实践：
     • 真实性和同理心：确保回应是真诚的，并基于对来访情感和经历的理解。
     • 适应来访需求：根据来访的具体情况和需求调整回应，使其更具针对性。
     • 持续监测：定期评估来访的反应，确保回应始终有效并适时调整。

通过这些知识点，我们可以更好地理解如何在治疗过程中观察来访的行为变化，以及如何通过有效的回应来强化来访的积极行为。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

CHAPTER 9 Respond to Growth What is love…except another name for the use of positive reinforcement? —­B. F. Skinner “I’m wondering if this, right now, is an example of you not being… How did we phrase it last time? Not being who you are without hiding.” “Yeah.” “In other words, there’s another way you and I could be interacting right now, instead of me just getting lucky and sometimes figuring out who you are. I guess my question is this: What would it take for you to be more okay in here with truly expressing who you are and how you feel without reservation?” “Yeah, yeah.” “I mean, how could we get there?” Ryan laughs. “What do you need from me, right now, to make that happen more?” He laughs again. “Yeah. Well, my life is pretty boring. Nothing, really.” “So here’s the thing, I really want you to be able to be different with me. Your life isn’t boring to me; it’s important.” “Okay.” “So how can you take a risk with me? Is there anything you’re not saying? Is there a way you can be more fully you, with all of your fears and worries and concerns and anger and hostility and I don’t know exactly what else? I mean, what do you really want from me—­right now?” “Well, I’m thinking, Should I say this right now?” “Just say it.” “It sounds so cheesy.” “Is it who you are?” “Yeah.” “Then say it.” Ryan stops laughing, straightens himself up, and, with a lot of emotion and a shaky tone, says, “I really need you to support me. You know, I don’t have anybody to support me and my endeavors. I know it’s weird, but it’s true.” Up to this final point in the interaction, the therapist had been trying to evoke CRB2 in Ryan, but mostly he was getting CRB1 in the form of brief responses and laughter. When Ryan shifted toward CRB2 at the end of the exchange—­did something different—­the therapist’s persis- tence paid off. From a FAP point of view, that last, heartfelt statement from Ryan reflects a key moment. For another client, that kind of statement might not be a big deal, but for Ryan it was. It was the first time in his work with the therapist—­and perhaps in his entire adult life—­that he specified what he needed and asked for it so directly. It wasn’t a perfect request; in fact, exactly what he meant was unclear, but it was a huge step for Ryan. Because of the time they had spent together, both the client and the therapist understood the significance of the moment. In FAP terms, Ryan’s statement is pure, obvious, and perfectly imperfect CRB2. It is directly about his relationship with the therapist, and it is also directly related to what Ryan was struggling with in life and how he wanted to change. Sometimes CRB2s are smaller, less obvious, or less dra- matic. Sometimes they don’t require so much evoking, and sometimes they require more. And sometimes CRB2 is mixed with CRB1. But in all cases, the key question is how to respond. How can you use your response to maximize the therapeutic impact of this crucial step? In behavioral terms, how do we respond so as to maximize the chances that this step forward will be reinforced? This chapter discusses how to respond to CRB2. WHAT IS REINFORCEMENT? Let’s start with a quick review. “Reinforcement” is the process by which a behavior becomes more likely to be repeated in similar circumstances due to the consequences the behavior produces. Is the therapist’s response below reinforcing? Client: I am sad. Therapist: Ah… I’m so glad you said that! If you know a little bit about contextual behavioral science (CBS), you might say no. It is incon- gruent to respond to an expression of sadness with happiness. This therapist is falling into the trap of offering a glib, positive response in an apparent effort to reinforce the expression of emotion. She is conflating positive affect or praise with reinforcement. She might as well give the client an M&M. Reinforcement, you might remind yourself, is not about doing something nice or making the client feel good. Reinforcement is a process by which a behavior becomes more likely to recur. Whatever response from you produces that result is reinforcing. Reinforcement has nothing to do with the form of your response. But hold on a second. If the form of your response—­its emotional tone, its meaning, and so forth—­has nothing to do with whether or not it is reinforcing, then how can you say that the response above is not reinforcing? You can’t. Congratulations if you realized this already. The best answer to the question “Is the therapist’s response reinforcing?” is “We can’t tell. It depends.” In other words, we can’t tell if the response is reinforcing based only on its form. What matters is the function of the response for the client—­what effect does that response actually have on the client? This is the essence of functional thinking. (Forgive us for the trick question. And we hope you passed that little test.) We might be able to make an informed guess about whether the response will be reinforcing by seeing more of the context around the response. For example, consider the following situation with a client who is struggling with burnout at work and whose CRB1 revolves around hiding and being out of touch with her own needs and emotions: Client: I just feel lost. I don’t want to move forward; I drag every day. I love the project but… Therapist: It’s like there’s something missing. It still doesn’t make sense. What else do you think is there? Client: I am sad. Therapist: Ah…I’m so glad you said that! Yes, now it clicks. Sad about losing Rod, losing your team. Of course. Sorry I didn’t get that before. Client: Yeah, I think the sadness is a big part of it. I’ve not wanted to admit that. Or consider this example, with the same client: Client: I just feel lost. I don’t want to move forward; I drag every day. I love the project but… Therapist: What else are you feeling? Client: Um…I am sad. Therapist: Ah… I’m so glad you said that! Thank you for expressing your emotions. Client: Um. okay. In which of these two examples do you think the client is more likely reinforced for expressing her emotions to the therapist? In other words, in which example is the client more likely to con- tinue to share how she feels? In the first example the therapist more closely tracks the meaning of what the client is saying. Her evoking (“What else do you think is there?”) comes with some explanation of why she is asking. She also explains her own reaction to the client’s disclosure in relation to the disclosure’s context: the therapist makes an effort to make sense of the client’s experience of burnout. The interaction feels natural, empathic, and coherent. In particular, the therapist communicates her understanding of what the client is saying. She communicates that the feeling makes sense, that she accepts it. In contrast, in the second example the therapist seems more disconnected. The evoking (“What else are you feeling?”) still possibly makes sense, but the attempt at rule 3 (“Thank you for express- ing your emotions.”) seems arbitrary and inexplicable—­even socially awkward—­in the context. In turn, the client expresses confusion. It seems more likely, then, that the client will continue to open up in the first example. However, all of this interpretation comprises only guesses about what is likely to be reinforcing, and we can only really know if the therapist’s response is reinforcing by observing the client’s behavior over time. But these intuitions we’re sharing, about which interaction seems more natural, empathic, and coherent—­and more likely to be reinforcing—­are key proxies or indicators that we use to track and moderate our efforts to reinforce CRB2. Specifically, we propose the following guidelines when it comes to evaluating your reinforcing behavior: You can’t tell whether a response is reinforcing based only on its form. Seeing more of the context allows for a fuller interpretation of the function of a behavior, but your conclusion is still only a guess. Interactions that involve understanding and acceptance are more likely to be reinforcing, especially for vulnerable disclosure. You might recognize the last point from chapter 4, on the awareness, courage, and love frame- work. We’ll return to this point later in the chapter. For now, we’ll explore in more detail how to approach the task of responding in reinforcing ways based on sensitivity to context and attuning to the client. BALANCING AUTHENTICITY AND STRATEGY FAP requires you to be deliberate about noticing CRB2 and responding in reinforcing ways. It also requires you to be natural and attuned in the way you do that. You may notice that there’s potentially tension between responding naturally (authentically) versus responding deliberately (strategically). Specifically, if you are deliberate, you have to choose your response. If you are natural, your response should be spontaneous. What if your natural response is not likely to reinforce the client’s CRB2? For example, consider a client whose CRB2 is being more assertive: Client: Can we schedule an extra session this week? Therapist: (Thinking about how he is already overbooked, feeling his stress level rising…) If the therapist follows the FAP rules in a mechanical way, he might reply, “Yes, of course. I’m glad you’re asking for what you need.” If he is understandably human and unable to mask his hesitation to committing to another session, that response might come across as strained or inau- thentic. The client, in turn, may or may not pick up on that incongruence, and this may have an effect on how reinforcing the interaction is. At an extreme, the client could walk away thinking, So, being assertive is about “guilting” people into doing things they don’t really want to do? However, it would seem countertherapeutic if the therapist was completely authentic to his own reaction: “I can’t do an extra session this week. I’m overbooked.” Thankfully, as you well know, the conversation doesn’t stop with one interaction. There are many ways to respond to this situation, many of which stand a good chance of reinforcing the cli- ent’s assertiveness—­even if the therapist doesn’t grant an extra session. Balancing competing inter- ests in compassionate, empathic ways is core to human social skills in general. In this situation the therapist must balance attention to the client’s needs, the significance of her request in the context of what she is working on in therapy, and his own needs. An emotionally congruent response bal- ances these considerations. For example, if the therapist really can’t fathom scheduling another session, he could say something like this: Oh, man…I can’t do an extra session this week. I’m overbooked. I hate to say that to you because I know what you must feel like asking this of me. If it were any other week, I would say yes. I’m just really, genuinely pushed to my edge this week. Can we talk about another way of getting you the support you need? Or maybe we can schedule something for earlier next week? In this statement, the therapist recognizes the intent and vulnerability and validity of the request, and in response he reciprocates that vulnerability with his own statement of needs. It’s easy to imagine that the client hearing this statement would remain willing to make requests of the therapist. Now imagine that the client really is in crisis and the therapist is slightly more willing to schedule: I’m hesitating just because I’m really booked. But, you know what, it’s important that we work on this now while the iron is hot. I’m glad you’re asking for this. Let’s figure out a time for Thursday afternoon. Here the therapist is emotionally congruent about his hesitation. But he also then moves to address the meaning of the request of the client. As we claimed early in the book, way back in chapter 1, when you genuinely understand and care for the client’s progress and growth, your own reactions will tend naturally to align to serve the client’s well-­being. Balancing our various reactions and responses is a form of interpersonal psychological flexibility in which multiple factors and streams of experience are observed and accepted, but the most important considerations guide action. In fact, this formulation allows us to venture a working definition of “authenticity”: responding in a way that is congruent to and communicative about all the different pertinent aspects of a context, including their relative importance. oasis-ebl|Rsalles|1490374217 Variable Responsiveness Let’s talk next about another way that authenticity and strategy (for example, the strategy of reinforcing CRB2) potentially conflict with each other. The conflict is that the ideally reinforcing response may not match your natural, spontaneous response. The ideally reinforcing response is defined by this behavioral principle: consequences that produce reinforcement are contingent on the behavior they reinforce. In other words, the reinforcing consequence only (or nearly only) occurs in response to the behavior, and it marks a deviation from the situation before that behavior occurred. But your natural response may not be naturally contingent in that way. This example may make the principle—­and the conflict—­more concrete. Think about a pigeon in an operant learning chamber. When the button is pecked three times in a row quickly, the pigeon gets a delicious piece of food. However, if the pigeon receives lots of food regardless of whether he pecks the button or not, there is no incentive to peck the button. As you can see, the food only results in a greater frequency of button pecking if the food only arrives when the button is pressed. This example illustrates how consequence (food) has to be contingent upon the behav- ior (pecking) in order for reinforcement (increase in rate of pecking) to occur. “Contingent” means “depends on.” In therapy, understanding, acceptance, and responsiveness are the main offerings you have that are reinforcing. Considering the pigeon example above, does this mean you should withhold these things until a CRB2 occurs in session? Thankfully, adult social interaction is more complex and less black-­and-­white than the simplified situation of the pigeon. The contingencies are more flexible; there are multiples streams of behavior and contingencies. Still, in the therapy relationship, it can be helpful to vary your response to CRB2, marking it as distinct in some way. In other words, if you do rule 3 in much the same way—­with the same voice tone, same affect, same posture, and so forth—­as you do everything else in therapy, you risk diminishing the reinforcing value of your response. Thankfully, variability is a natural, authentic part of responsiveness in a close relationship. When you understand and care about another person, you naturally respond differently, with vari- ability, to moments that you recognize as significant. In those moments, simply expressing your reaction in an attuned, empathic way will often supply enough variability to reinforce behavior. Your emotional response, after all, is naturally contingent on the behavior to which you’re reacting. At the same time, part of being naturally responsive involves modifying, extending, or sup- pressing natural responses in subtle or not so subtle ways so that our response functions in the most effective way in the moment. A very obvious example is how adults modify their expression of emotions when talking to children. We use a simpler emotional vocabulary and may exaggerate certain facial expressions. This is a prosocial, empathic act (at least some of the time). We might also do this with other adults when we know they are emotional or otherwise in a frame of mind such that a more reserved or ecstatic response won’t reach them. When a friend is fearfully on the verge of taking a big career risk (and you believe the risk is the right step, and the fear is irrationally high), you probably won’t say, “Well, you’ll probably be okay. Go for it.” That response is rational but not emotionally attuned to your friend’s needs. If you take the time to think about what your friend is going through and needs from you, you may realize that your response needs to be crystal clear and more intense in order to cut through the emotional noise. You may be more likely to say something like “You’ve worked hard for this opportunity. All the signs you can see say this is the right moment. And I believe in you. Take the leap.” In other words, even if you don’t naturally feel that intensity, by tuning into what the other person needs it becomes natural to express it. We naturally vary our responses based on what other people need from us. This is an essential part of responsiveness. We aim to provide what other people need, not just what would be congruent and authentic for us if we weren’t in touch with their needs. In fact, being in touch with the needs of others directly shapes our own emotional responses. In FAP, variable responsiveness—­based on empathy concerning the needs and experience of others—­supplemented by attention to behavioral principles, is a big part of what guides our adher- ence to rule 3: reinforce CRB2. Recognizing Assumptions We’ve found it useful, when generating the needed empathy for clients with vulnerable CRB2, to ask ourselves this question: What assumptions do I bring to this interaction that the client does not because of his or her history? For example, you might have these assumptions: • Feedback is healthy and nonthreatening. • Expressions of praise or affection are genuine, not loaded with ulterior motives. • Expression of emotion is healthy and builds relationships. • Asking for needs to be met is reasonable and important. Clients with painful interpersonal histories, however, might intellectually grasp these assump- tions without experiencing—­especially in a moment of emotion and vulnerability—­their truth in any meaningful way. Clients might even hold conflicting assumptions: • Feedback is about domination. • Expressions of praise or affection are manipulative. • Expression of emotion is weak and risky. • Asking for needs to be met is unreasonable and fruitless. When you can recognize the assumptions that clients hold (emotionally if not rationally) or do not hold, you can be responsive in more effective ways. For example, you can make explicit your prosocial assumptions about the therapeutic interaction. Imagine that the client who is asking for an extra session has a long history of key people in her life ridiculing or dismissing her requests. Your response might take into consideration her past experience of making requests and make clear your wishes: “It’s important to me that you make these requests when you have them. And given your history, your anxiety about doing so absolutely makes sense to me.” oasis-ebl|Rsalles|1490374222 Being Less Responsive There is an exception to the above guidelines about responsiveness and variability. Sometimes the most reinforcing way to respond to a client’s vulnerability is to do very little at all (at least from your perspective). Imagine a client who—­as a result of her family who ridiculed and ignored her when she expressed emotions—­has adopted a stance of emotional disconnection. Others experience her as distant, disconnected, even ominous at times. Gradually, over the course of many months, she comes to trust you enough to express sadness and disappointment when describing a recent and upsetting experience with her parents. And imagine that—­even though she can’t say this to you—­she is as disconcerted by her own emotions as she is by the experience she had with her parents. If you are too responsive in that moment, shining the light of attention too brightly or respond- ing with your own emotions, you might risk disrupting the sense of security and trust that allowed her emotions to emerge in the first place. If instead you remember that this behavior of expressing emotions was routinely punished in the past, and you respond to the interaction in a more reserved manner, the mere absence of the feared consequence might be extremely significant. By simply maintaining your warm, open, empathic stance, the client experiences a discrepancy between historic consequences and what is happening in the moment. It is as though the client opens a door to a room she feared held a monster only to discover the room is empty. Many FAP thera- pists have had clients describe to them how responding minimally in certain therapeutic relation- ships helped them: “It was nothing that you did in particular that made me feel so welcome here. It was simply the way you listened. It was what you didn’t do. That made all the difference for me.” One Last Comment Another important aspect of ensuring variability in your responsiveness to CRB2 is making sure you are not overly responsive to CRB1. If you have a habit of responding with a grin or a nod to every client request, to the extent that there is relatively little natural range in your responsive- ness (you’re already at a high end of responsiveness with grinning and nodding), then you might consider finding a slightly more neutral baseline stance. REINFORCING COURAGE WITH LOVE You don’t dispense M&Ms or offer a client cash for therapeutic progress. You offer the only thing you have to offer in the moment: your natural responsiveness as a human being. Outside the moment, outside the therapy hour, the world picks up where your responsiveness left off. The hope is that the new ways of being that are shaped within therapy take root and are nourished (rein- forced) by natural consequences outside of therapy. For instance, you hope that the client who has become more skillfully assertive with you will become so with his wife, and that she will respond in reinforcing ways to his assertiveness (that is, his assertiveness leads to a good outcome). But, in the moment in therapy, your responsiveness as a human being is the one thing you have to offer. Let’s now return to the awareness, courage, and love (ACL) model to further flesh out what we propose are essential aspects of responsiveness and of being reinforcing in the therapeutic relation- ship. As we mentioned at the beginning of this book, responsiveness has a very significant influence over behavior. These elements of responsiveness are of general value in the therapeutic relation- ship, but they are especially relevant when the behavior you are responding to is courageous. In the following sections, we zero in on and discuss therapist responses to three behaviors that can fit under the umbrella of “courage”: choosing to experience vulnerability and emotion, offering self-­disclosure, and asking for a need to be met. We hypothesize that the types of responses speci- fied by the ACL model tend to naturally reinforce these courageous behaviors. The responses can be summed up in three sentences that, in turn, describe the ACL therapeutic stance: • I see you. • You are safe here. • I will give you, to the best of my ability, what you want to receive. Choosing to Experience Vulnerability and Emotion We tend to be more willing to remain vulnerable and experience emotion when the person we’re communicating with offers safety and acceptance in return. In this way, safety and accep- tance can reinforce vulnerability as a CRB2. “Safety” and “acceptance” are vague terms, essentially metaphorical. A lack of safety does not literally indicate danger. Instead we are talking about a more general sense of social safety: that is, an absence of judgment and the availability of empathic concern. Imagine you make an error at work. You report the error to your supervisor, and he responds this way: “What were you thinking? I can’t trust you people to do anything, for Christ’s sake. You’re going to feel this one, my friend.” Ouch. There’s no physical threat, but the experience of vulnerability, or shame, or guilt, or anger is probably intense. You’re not likely to continue making vulnerable disclosures to this supervisor. In contrast, imagine this response: “Oh, man. I’m glad you came to me. Let’s talk about what happened. First of all, are you okay?” Notice that there’s an appropriate expression of concern and orientation toward learning, and the tone is entirely different. You are much more likely to report future errors to this supervisor. (This example also highlights how a reinforcing response is not necessarily a happy or positive-­affect response.) Safety and acceptance are communicated through voice tone, body posture, eye contact, and facial expressions as much as through words. If you don’t believe this is true, try sitting bolt upright and expressionless the next time a client is saying something vulnerable. For therapists then, when client vulnerability is involved in CRB2, it’s important for us to communicate safety and acceptance. This can be easy to forget. Sometimes therapists get caught up in being clever or wanting to do something sophisticated or active or “helpful.” When you find yourself doing any of these things, slow down and make safety and acceptance crystal clear, both nonverbally and verbally. Communicate acceptance nonverbally through a steady gaze; an open, relaxed posture; and effort to understand the client’s experience and needs. Judgments and evaluations should be absent. Verbally, you can use the words “safety” and “acceptance” explic- itly if they fit the moment; for example, “I want you to know that when you do this, you are totally, 100 percent safe with and accepted by me.” Or you might reflect a positive perspective at a moment when the client fears judgment and feels most vulnerable: “What I see in this—­and it actually might be counterintuitive for you—­is your strength and commitment to being honest. Everything you’re feeling makes sense to me, and I want you to know I see you really fighting to live your values.” Let’s consider a client who ends a disclosure with a clear statement of vulnerability: oasis-ebl|Rsalles|1490374221 You know, I haven’t noticed it before, but your table lamp is exactly like a lamp my grand- mother used to have. I remember it because we would always sit at that table doing puzzles together. I don’t even know why I’m sharing this with you; I am just sharing it. I feel weird about sharing it. It makes me nervous somehow. Given Madelaine’s difficulty with self-­disclosure, and the vulnerability she feels when doing so (such that we could say her avoidance of self-­disclosure likely functions, in part, to avoid vulnerabil- ity), the therapist’s goal is twofold: to recognize that sharing information like this is an instance of choosing to experience vulnerability and emotion, as well as an instance of offering self-­disclosure; and to respond with safety and acceptance as well as with understanding and empathy. Here are several examples of how Madeleine’s therapist might respond in that moment: Therapist: Madelaine, let me pause here for a second. I want you to know, first, that you’re doing the thing we’ve been talking about, and I love the words you used for it: “just sharing.” This is exactly what we’ve been talking about. So I want you to know that when you share like this, you’re totally safe with and accepted by me. I loved hearing this brief story, and I want more. I can imagine you sitting with your grandma, doing a puzzle, with the light of this lamp over you. It’s really nice. Therapist: Madelaine, as I listen to you just share this story, I feel a warmth, love even, spreading across my face. Can you see it on my face? Can you see in my eyes how much I enjoy your story and how safe you are with me to talk about this? Therapist: That’s supercool. I think it would make a great puzzle lamp. I also like hearing about your grandmother. What was it like being with her? As always, the “best” response is authentic and strategic in the context. Offering Self-­Disclosure Self-­disclosure is perhaps the bedrock of social communication. We talk about ourselves, and we want people to listen. We want to be heard, seen, and understood. Self-­disclosure is, of course, also a bedrock of psychotherapy. It’s what clients do for much of the time in every single session. And if they have trouble with self-­disclosure, therapy tends to focus there first. In turn, providing understanding, empathy, and validation is the bedrock for how therapists respond to client self-­disclosure. That is—­in the terms of the awareness, courage, and love model—­we suggest that understanding, empathy, and validation function to reinforce self-­ disclosure. This natural relation between self-­disclosure and understanding is deeply interwoven into all well-­f unctioning social interactions and therapy sessions. To notice how fundamental it is, imagine a conversation in which you felt significantly misunderstood. Where did it lead? Despite the fact that self-­disclosure is fundamental to social relations and therapy, we often encounter clients who have difficulty with it. For example, some clients struggle to express feelings or events or attitudes in ways that are clear to others. These struggles might arise for a variety of reasons (for instance, a sense of anxious vulnerability). In FAP terms, we can treat difficulties with self-­disclosure as CRB1. In turn, with CRB2 related to self-­disclosure, it’s important to communi- cate understanding and empathy clearly as part of our natural responsiveness. Consider Madelaine again—her spontaneous statement that “You know, I haven’t noticed it before, but your table lamp is exactly like a lamp my grandmother used to have. I remember it because we would always sit at that table doing puzzles together. I don’t even know why I’m sharing this with you; I am just sharing it.” The therapist recognized this as CRB2 related to self-­disclosure, specifically because it was spontaneous and Madelaine admitted that she didn’t know why she was sharing it. This freedom of “just sharing” was important for Madelaine because previously she’d been quite constricted about what she shared. In response, the therapist communicated understanding in a simple way: “It’s sweet for me to hear you say that. I used to play puzzles with my grandmother too, and it always felt peaceful. Did it feel like that for you too?” These words extend empathy toward the feelings that Madelaine may have about her memories. If this point seems obvious, it’s because empathy is a fundamental and well-­practiced skill for therapists. For contrast, imagine a response that completely misses the point of Madelaine’s disclosure: “Maybe you find it more interesting to talk about furniture than the stuff we’ve been working on here?” Asking for a Need to Be Met The third subcategory of courage is asking for a need to be met. This category is interesting from a FAP perspective because, at a simple level, the most natural reinforcing response when someone asks for something is generally to give them what they ask for. But obviously this isn’t always possible. So how does one respond? Consider Yolanda, a client who has had great difficulty asking others for support and asking for her needs to be met in any way at all. In the middle of therapy, she asks her therapist, “When therapy ends, could we get together for a cup of coffee every now and then?” Although this type of request is generally problematic, Yolanda’s therapist recognizes that, for Yolanda, it’s CRB2. It’s an ethical issue for the therapist, of course, but that doesn’t mean it’s CRB1 for the client to ask. (Though perhaps there’s an element of CRB1 in not being attuned to the awkwardness of asking your therapist out to coffee.) This tension creates a dilemma, as the therapist recognizes the impossibility of giving Yolanda what she has asked for. How would you respond? Here’s a sample response: It means a lot to me that you’re asking that, because I know what it means to you. You know, when therapy ends, my caring for you won’t end. I will be eager to get updates from you and check in, and if that could take the form of meeting for coffee, that would be great. There are some complications about meeting a former client for coffee, which I’d like to share with you a little later, but the important thing right now is for me to let you know that the caring I have for you won’t end just because therapy ends. Perhaps this isn’t a perfect response, but it works well enough in the moment and fits this thera- pist’s boundaries. The key thing we want to point out is that the therapist delays having a conversa- tion about ethics and post-­therapy friendships in the moment. That’s an important conversation to have with Yolanda, but the therapist recognizes that, in the moment, the conversation could func- tion to punish the CRB2 of a vulnerable request. Further, there is no harm or ethical dilemma associated with waiting to have that discussion. Most of the time, meeting a client’s needs is less complicated. Clients often make requests about the process of therapy, therapy logistics, and so on, and CRB may occur in the context of those requests (including avoidance of making them). Consider Zoreh, a client who has great dif- ficulty with self-­disclosure and making requests. Arriving for her session one day, she says, “I’m feeling really wiped out today. Can we have a less intense session?” For any given client, this may or may not be CRB2, but because of Zoreh’s difficulty with self-­disclosure, for her it’s CRB2 to say, “I’m feeling really wiped out.” And because of her difficulty with making requests, it’s a CRB2 for her to ask, “Can we have a less intense session?” As always, a potentially reinforcing response can take a variety of forms: 185Yes, we can have a less intense session. I want you to know that when you ask for what you need, I really respect your needs, whatever they may be, and promise to do the best I can to meet them. My heart is with your heart in this. Heck yes! Of course. Again, the “best” response is authentic and strategic in context. Of course, understanding and acceptance are fundamental pieces of what we give clients in therapy in response to the unspoken requests of self-­disclosure and vulnerability. NOTICE YOUR EFFECT Imagine yourself dribbling the ball in a soccer game. You don’t just kick or nudge the ball. You watch the ball and constantly adjust your movement to keep the ball moving, to respond to oppo- nents and teammates, and, in turn, to judge at a high level whether your movements and the move- ment of the ball are heading toward the larger goal. There is no dribbling possible without this constant monitoring. Similarly, as therapists, we don’t just respond to what we perceive as CRB. We watch how the behavior shifts and moves in response to our responding. You only know, for instance, whether your attempts at rule 3 are working by observing what happens to the behavior you seek to rein- force. In turn, you only know if increases in those CRB2s move the client toward his clinical goals by observing that process. This multilayered awareness of how processes are moving—­beyond the basic interpersonal attunement we ask you to bring to the therapy relationship—­is fundamental to FAP. There is a deep interdependence, in particular, between rule 3 (reinforce CRB2) and rule 4 (notice your effect) because you only know if you are reinforcing CRB2 by noticing your effect. This noticing takes two primary forms:

1. Checking in verbally, in the moment and over time
2. Observing the client’s behavior Verbal Check-­Ins One way to check in on your effect is to ask, “What was that like?” For example, you might ask about the client’s experience in a particular interaction (setting a therapy agenda, debriefing the week, processing a disagreement between the two of you) in a single session. Of course, you can’t expect the client to reply in FAP terms, “Well, you very effec- tively reinforced my CRB2 just then.” But the client’s response will give you some indication of whether the interaction was on the right track. You can also check in on broader sections of therapy. The questions of the session bridging form, introduced in chapter 7, help you check in on a session-­by-­session basis. You can also check in about a particular phase of therapy: We’ve been working really hard on you making assertive requests from me these last weeks. How is that going from your perspective? Is this productive? Or you can check in about therapy as a whole: Let’s step back and look at how our work’s going. How are we on track in your view? Are there any things that we’re not attending to enough? Observing the Client’s Behavior Observing the client’s behavior is, of course, a broader category of noticing your effect; check- ing in verbally with a client also involves observing their behavior in response to you. If the overarch- ing goals of therapy are increasing CRB2 and the corresponding progress with presenting problems, there are a variety of signs that indicate these things are happening: • You might notice subtle changes in the client’s way of engaging with you or the tone of the sessions. For example, sessions might feel less conflictual and more rewarding. • You might notice the complete absence of old struggles. For example, homework might be completed reliably (whereas in the past it was rarely completed). The client might present and reiterate clear agendas for each session (whereas in the past there was great murkiness). • You might also notice critical turning-­point moments, in which the way a client responds to a given situation strikes you as markedly and dramatically different from how the client would have responded in the past. For example, Gareth will never forget the client who complained and insisted for weeks that he should provide better tools to immediately relieve the client’s suffering. One evening, that same client—­reaching out for support from a moment of excruciating pain—­took a breath and sighed. “You know, what I’ve realized is that your field is just not very advanced. You don’t actually have tools to help me. I get that. And I appreciate you for being here to listen to me and do what you can.” In that moment, the struggle took a drastic turn toward acceptance that persisted and grew profoundly over the months that followed. SUMMARY • The aim of responding to CRB2 is to reinforce—­that is, increase the likelihood that the behavior is repeated in the future. • Whether or not your response is reinforcing cannot be determined by the form or appearance of the response. You can only know if your response is reinforcing by watch- ing how the client’s behavior changes over time. • That said, responses that are empathic, accepting, and responsive are more likely to be reinforcing. • Ensure that your responses to client CRB are authentic, built on genuine empathy, and attuned to your client’s needs and goals and values.