FAP and Empirical Support

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FAP involves the application of known behavioral principles to the interactions that occur during the course of psychotherapy. The behavioral principles that FAP draws upon are the same principles that are the cornerstone of all behavioral interventions that characterize applied behavior analysis or behavior therapy.

Research findings suggest that FAP can improve interpersonal functioning (Callahan, Summers, & Weidman, 2003; Kohlenberg, Kanter, Bolling, Parker, & Tsai, 2002). Kohlenberg et al. (2002) compared FAP-enhanced cognitive therapy (FECT) with cognitive therapy (CT) for the treatment of depression. Their findings suggested that FECT was more effective than CT

alone in reducing depression, and that FECT was more effective than CT alone in helping patients perform well on measures of interpersonal functioning. Client ratings, interviewer ratings, and blind observers determined that clients who had participated in FECT spontaneously described significantly more relationship improvements than did CT clients at the end of therapy.

Callahan et al. (2003) used FAP in a single-case design to treat a client with features of histrionic and narcissistic personality disorders. According to FAP principles, in-session instances of client problematic behavior and improvements were responded to in a contingent manner. This single case study demonstrated both in-session and daily life improvements in interpersonal functioning. Specifically, behaviors defined as narcissistic and histrionic decreased over treatment, and behaviors in the areas of emotional responding, noticing one's impact on others, and being able to assert one's needs improved. Both of these studies provide evidence that FAP can be an efficacious treatment for interpersonal difficulties, even when these behaviors are part of a constellation of other treatment considerations.

Although the strength of the therapeutic relationship has been appreciated as an important predictor of therapy outcome (Horvath & Symonds, 1991) and has been regarded as a critical factor in therapy for abuse survivors (Briere, 2002; Herman, 1992b), only recently have studies empirically examined the role that the therapeutic alliance plays in trauma therapy with adults abused as children (e.g., Cloitre, Chase Stovall-McClough, Miranda, & Chemtob, 2004; Paivio, Holowaty, & Hall 2004). Paivio et al. (2004) demonstrated that, in a population of adults abused as children, therapist relationship skills independently contributed to outcome, and both therapeutic relationship and emotional processing were identified as being important mechanisms of change. Cloitre, Stovall-McClough, Miranda, and Chemtob (2004) noted that the strength of the therapeutic alliance predicted improvement in symptoms at the end of treatment, and that the effect size of this relationship was much larger (0.47) than what has traditionally been found in previous meta-analyses. Cloitre et al. (2004) further suggests:

The potent role that the positive therapeutic alliance plays in treatment success may reflect a reversal or reparation of interpersonal disturbances, which undermine success in a variety of tasks including psychotherapy. The results underscore the idea that the therapeutic relationship may be an especially "active" ingredient in the remediation of childhood abuse-related PTSD and a component of treatment that should be highlighted, better understood, and carefully developed for this population. (p. 414)

These findings provide compelling support for the rationale offered by FAP that there is particular value in addressing the interpersonal struggles of trauma survivors, as they occur, in session.

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