9 迎接成长的挑战

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.