Psychol Rec (2016) 66:599–609
DOI 10.1007/s40732-016-0195-y
ORIGINAL ARTICLE
The Effects of Analyses of Contingencies on Clinically Relevant
Behaviors and Out-of-session Changes in Functional Analytic
Psychotherapy
Alessandra Villas-Bôas 1 & Sonia Beatriz Meyer 1 & Jonathan William Kanter 2
Published online: 23 August 2016
# Association for Behavior Analysis International 2016
Abstract Functional Analytic Psychotherapy (FAP) is a
behavior-analytic psychotherapy approach that shapes client
behavior through application of behavioral principles in the
therapeutic relationship. Two categories of in-session clinical-
ly relevant behavior (CRB) are recognized: CRB1 (problem
behaviors) and CRB2 (improvements). The therapist watches
for CRBs (Rule 1), evokes (Rule 2) and responds to CRBs
(Rule 3) and observes the effects of his/her own behavior on
CRBs (Rule 4). This sequence constitutes an experiential in-
teraction in FAP. FAP also includes an analytic interaction, in
which the therapist analyzes the client’s behavior, teaches the
client to do so (CRB3) and asks him/her to engage in home-
work, promoting generalization (Rule 5). The goal of this
investigation was to verify if analytic interventions in FAP
are indeed necessary for generalization of in-session to out-
of-session improvements. Two clients were submitted to a
single-case experimental procedure, A-B-BC-B-BC, in which
A corresponded to behavior therapy without systematic FAP;
B corresponded to the introduction of Rules 1 to 4; and BC to
the addition of Rule 5. Improvements in and out of session
were achieved with the experimental procedure and main-
tained until a follow-up session. Instances of Rule 5 in the
BC phases influenced the clients’ analyses of their own
* Alessandra Villas-Bôas
villasboas.alessandra@gmail.com
1
Departamento de Psicologia Clínica, Instituto de Psicologia,
Universidade de São Paulo, Av. Prof. Mello Moraes, 1721,
CEP: 05508-030, Cidade Universitária, São Paulo, SP, Brazil
2
University of Washington, Center for the Science of Social
Connection, Guthrie Hall 119a, Box 351525, Seattle, WA 98195,
USA
behavior, but did not seem to influence rates of CRB1 and
CRB2 or out-of-session problems or improvements. There
was no evidence from this study that analyses made by ther-
apists or clients are necessary in addition to the clear shaping
process conducted by FAP.
Keywords Behavior Therapy . Contingency Analysis .
Generalization . External Measures . Experimental Design .
Coding
For years, behavior therapy has been conducted mainly by
analyzing and discussing with the client the way the client
behaves and could behave in daily life (Guilhardi, 1997;
Meyer, 2004; Zamignani, 2007), without the direct shaping
of behaviors, which is one of the most important learning
processes described in behavior analysis (Meyer et al. 2015).
While direct shaping processes have been demonstrated as
effective in research settings, in working with children and
in controlled settings (Catania, 1998), clinicians have had dif-
ficulties employing these procedures in less controlled, adult,
outpatient settings (Meyer et al. 2015).
Functional Analytic Psychotherapy (FAP; Kohlenberg &
Tsai, 1991; Tsai et al. 2009) is a behavioral therapeutic ap-
proach that targets the client’s interpersonal problems as they
occur in the therapeutic relationship, recovering the direct
shaping process (Meyer et al. 2015). The basic FAP under-
standing is that a client´s in-session behaviors are functionally
similar to out-of-session behaviors, and thus a client´s inter-
personal problematic behavior (CRB1) will occur in the ther-
apeutic relationship. Thus, the therapist should evoke and re-
inforce interpersonal improvements (CRB2) in the client´s
repertoire, promoting clinical changes first in session to be
generalized later to out-of-session contexts. The therapist
works with the client’s CRB1 and CRB2 during the session,
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watching for the client’s CRBs (Rule 1), evoking them (Rule
2) and responding to them in a natural way, especially rein-
forcing CRB2s (Rule 3) and observing the effects of his/her
own behavior on CRBs (Rule 4). This sequence of four rules
describes the direct shaping process occurring during the ses-
sion, changing the client’s interpersonal behavior directly, and
thereby represents FAP’s primary mechanism of change. This
process can be described as experiential, as it primarily in-
volves working within the live flow of experience between
the client and the therapist in session.
A second set of interventions in FAP can be described as
analytic, wherein the therapist functionally analyzes the client´
s behaviors (Rule 5) and also teaches the client to engage in
functional analyses about his/her own behavior. Client func-
tional analyses of their own behavior are known as CRB3 in
FAP. Together, Rule 5 and CRB3 analyses focus on describing
the contingencies related to positive changes in the session,
and should be used as base to develop homework assignments
that entail putting into daily-life action what worked in session
(Rule 5; Villas-Bôas, Meyer, Kanter, & Callaghan, 2015).
This focus on Rule 5 and CRB3 is consistent with how tradi-
tional behavior therapy has approached the analysis, in that
the focus is on analyzing and discussing the client’s behavior,
rather than direct shaping. However, in FAP, this analysis and
discussion typically occurs in the context of, and is directly
linked to, the direct shaping process that is described by Rules
1 to 4.
The main experiential interaction in FAP focuses on what
Skinner (1966, 1969, 1974) described as contingency shaped
behavior, while the analytic interaction focuses on rule-
governed behavior. When considering the rule-following pro-
cess as a way of changing behavior in therapy, it is important
to consider the different kinds of rule-following behavior de-
scribed by Hayes, Zettle and Rosenfarb (1989) and Törneke
(2010) as pliance, tracking and augmenting. As discussed by
Villas-Bôas et al. (2015), it seems important that client rule-
governed behavior is consistent with tracking and augmenting
functions, which would put the client in contact with the direct
environmental contingencies of his/her behavior, rather than
pliance functions, which only put the client in contact with
therapist approval. In this sense, the analytic interaction in
FAP, because it flows directly from the experiential interac-
tion, seems likely to promote tracking and augmenting func-
tions, and, therefore, should be helpful to therapy, at least in
theory.
The experiential interaction of FAP has been discussed as
extremely important to client improvement and most major
FAP publications focus on it (Kohlenberg & Tsai, 1991; Tsai
et al. 2009). The analytic interaction, in turn, has been
discussed as important to the generalization of a client’s in-
session improvements to other contexts (for more distinctions
between the experiential and analytic interactions in FAP and
their implications, see Villas-Bôas, et al. 2015) but has not
Psychol Rec (2016) 66:599–609
been specifically investigated, as mentioned by Maitland and
Gaynor (2012). Currently, only two publications describe the
analytic interaction in more depth (Abreu, Hübner &
Lucchese, 2012; Villas-Bôas et al. 2015) and no experimental
work focusing on it has been published.
There is some support for FAP’s efficacy and its proposed
mechanism of action provided by single-case descriptive and
experimental studies. Callaghan et al. (2003, 2008) and Busch
et al. (2010) analyzed in-session therapist and client behavior
in successful FAP cases and demonstrated that the use of
FAP’s experiential elements led to in-session improvements.
Kanter et al. (2006) published a successful case in which FAP
was added to CBT and out-of-session improvements were
only observed after the addition of FAP, and Busch et al.
(2009) analyzed the in-session therapist and client behaviors
in this case and demonstrated that FAP’s mechanism and im-
provements in CRBs also only occurred in the FAP phase.
Oshiro, Kanter and Meyer (2012), Geremias (2014) and
Mangabeira (2014) conducted reversal designs comparing be-
havior therapy to FAP. These authors showed better in-session
results when FAP was applied. In all of these studies, detailed
observations of in-session therapist and client behavior were
conducted and results indicated that the main mechanism of
action was probably the therapist’s contingent responding to
CRBs (Rule 3).
These studies collectively suggest that FAP is beneficial
but lacks specificity with respect to how important specific
FAP rules and therapeutic strategies are to the successful
process. As suggested by several authors (Maitland and
Gaynor, 2012; Mangabeira, Kanter & Del Prette, 2012;
Weeks et al., 2012), this specificity of research design is
important because the precision with which FAP’s behav-
ioral mechanism has been described allows for research to
identify with equal precision what the therapist should or
shouldn’t do, thereby maximizing the benefits of the re-
search for clinical practice. Several recent studies, howev-
er, have shed some light on the relative importance of spe-
cific interventions within FAP. Popovitz (2013) conducted
FAP, also in a reversal procedure, isolating therapist re-
sponses to CRB2 and CRB3 versus responses to CRB1
and demonstrated the importance of responding specifical-
ly to CRB2 for in-session improvements. Mangabeira
(2014) analyzed two ways to evoke and respond to CRBs
in session, one that emphasized the personal involvement
of the therapist and one that did not, and observed no
differences in frequencies of CRBs depending of the two
forms of therapeutic responses. Landes et al. (2013) com-
pared FAP to a non-specific relationship-oriented therapy
in which the therapist did Rule 1 and the results showed
that Rule 1 is not crucial to out-of-session improvements.
Finally, Lizarazo et al. (2015) manipulated the use of FAP
rules, showing that Rule 2 was not crucial to in- or out-of-
session improvements when isolated from Rule 3.
Psychol Rec (2016) 66:599–609
To date, no studies have isolated the analytic interventions
of FAP (including Rule 5 and focusing on CRB3) to verify
how necessary they are, over and above the experiential inter-
ventions. This is especially relevant to out-of-session im-
provements, as the analytic interventions are theoretically hy-
pothesized to facilitate generalization of in-session gains to
out-of-session contexts. From the studies that obtained data
on improvements in daily life, only Lizarazo et al. (2015)
published data on Rule 5 frequency, showing that it was emit-
ted with low frequency, precluding any analyses of the poten-
tial benefits of Rule 5 and suggesting that it may not be essen-
tial to the generalization process.
Thus, although theoretically coherent, there is yet no evi-
dence that the analytic interventions of FAP are necessary to
produce outcomes in daily life or are at least helpful to max-
imize the effects of the experiential interventions. To this end,
two cases are presented, each of which employed an A-B-BC-
B-BC design. In this design, A consisted of a behavior therapy
baseline in which no systematic FAP was conducted; B in-
cluded the systematic introduction of the experiential inter-
ventions of FAP (Rules 1 to 4); and BC was the maintenance
of the experiential interventions plus the addition of analytic
interventions (Rules 1 to 5). The hypothesis was that in-
session frequencies of CRB3 as well as out-of-session out-
comes would improve in the BC phases, showing that the
analytic interventions facilitate the generalization of in-
session improvements to out-of-session contexts.
Method
Participants
Client 1, BDora^, was a 38-year-old single woman with two
children and part-time employment as a teacher. No psychiat-
ric diagnosis was detected. Dora’s presenting problems were
defined as aggressive behavior towards others when in con-
flict, and indirect aggression. Examples of aggressive behav-
ior included screaming at others or being extremely inflexible
about her wishes and ideas, temporarily reducing anger but
not effectively solving conflict situations. Examples of indi-
rect aggression included acting aggressively with others not
involved in the conflict, such as yelling at her children after a
stressful day at work, avoiding new requests from others and
reducing temporally chances of new conflict situations. Goal
behaviors included expressing her feelings and needs asser-
tively without aggression or hostility. Dora’s defined CRB1s
were aggressiveness against the therapist, such as strongly
complaining about a small part of something that was said in
a previous session without considering the context, or being
inflexible about the therapist’s suggestions or requests.
CRB2s were being assertive with the therapist in conflict
601
situations and emitting responses showing the recognition
and acceptance of different ideas, opinions and suggestions.
Client 2, BSol^, was a divorced 32-year-old woman, work-
ing during the day in accounting and completing her under-
graduate degree at night. She had no children and lived with a
relative. No psychiatric diagnosis was detected. Sol’s present-
ing problems were responses emitted as conflict avoidance
strategies when others made abusive or excessive requests,
doing what they wanted, instead of saying no to these re-
quests. She also remained passive in situations when she could
reach out to friends and share important interpersonal topics.
Goal behaviors included being assertive with others, saying
Bno^ to abusive and excessive requests and also reaching out
to friends and increasing the connection with them. Sol’s de-
fined CRB1s were described as passive behaviors, avoiding
personal contact with the therapist and lack of in-session crit-
icism of abusive people in her life. CRB2s were defined as
requesting what she needed, more personal and intimate inter-
actions with the therapist and making critical judgments about
abusive people in her life.
The therapist-researcher (AVB) was a behavior-analytic
therapist with 10 years of clinical experience, trained in FAP
by the second (SM) and third authors (JWK). She received
individual supervision for both cases during the experiment.
Data Collection Instruments
For in-session analyses, sessions were audio recorded and the
Functional Analytic Psychotherapy Rating Scale (FAPRS;
Callaghan & Follette, 2008) was used in an adapted version
to code the therapist and client talk on a turn-by-turn basis. At
least five sessions were coded for each experimental phase
and most sessions were coded before the occurrence of the
next one. The analyzed client codes were CRB1, CRB2 (as
defined previously) and CRB3. CRB3s were defined for this
research as client descriptions of CRB1s and CRB2s, restrict-
ed to the in-session interaction and therapeutic relationship
and its parallels with outside session behaviors; analyses ex-
clusively about external behavior were not considered CRB3
in this code. Other verbalizations not related to FAP were
coded but not analyzed in this report.
The therapist behavior was coded as Rule 1 when the ther-
apist explicitly checked the occurrence of CRB, and described
possible parallels between out-of-session behavior and CRB.
Rule 2 was coded when the therapist directly evoked CRBs.
Rule 3 was coded when the therapist responded to the client’s
CRB1 hopefully not in a reinforcing way, such as changing
the subject or punishing it more directly. Therapist Rule 3
responses to CRB2 also were coded when the therapist
attempted to reinforce the CRB2 in an explicit way or even
in a more indirect way, such as responding with an encour-
agement for the client to keep emitting the CRB2. Rule 4 was
coded when the therapist explicitly checked with the client on
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the impact of previous responses to her behavior. Rule 5 was
coded when the therapist requested or reinforced the clients’
analyses of in-session interactions or analyzed the therapeutic
interaction herself (related to CRBs), including requesting and
discussing parallels to outside problems and improvements
(consistent with how CRB3 was coded, analyses only about
external behavior isolated from the therapeutic relationship
were not included in this code). Examples of codes for each
rule with each client can be seen in Table 1 (translated from
Portuguese).
The primary coder was the therapist-researcher. Although
this introduced possible bias, the therapist’s detailed knowl-
edge of the case conceptualization was seen as helpful to the
functional CRB identification, as proposed by Oshiro, Kanter
and Meyer (2012). Inter-rater agreement coding was conduct-
ed by three experienced FAP therapist/researchers who were
not independent from the therapist. They used the therapist’s
case conceptualization and the therapist’s provided codes
when reading the transcribed sessions to check the therapist’s
codes and provide gold-standard (Bbest available^) ratings
(Versi, 1992). A strength of the gold-standard procedure is
that the agreement evaluators had available to them as much
information as possible to produce the most valid ratings. The
weakness is that because they had the primary coder’s ratings
as part of their information, their ratings were not independent
and may be biased in favor of high agreement. To produce
agreement ratings, each evaluator coded three sessions, each
from a different phase of the research, with some overlap
between the sessions coded. Kappa was calculated separately
for client and therapist codes and all checked sessions provid-
ed a kappa agreement higher than 0.73 for therapist codes and
higher than 0.85 for client codes. These results indicate high
agreement between evaluators and the primary coder with
respect to both therapist codes and client codes.
Out-of-session behavior was monitored by clients using
self-report diary card tracking, as per Kanter et al. (2006),
Landes et al. (2013) and Lizarazo et al. (2015) with some
modifications. The client and the therapist collaboratively de-
termined the specific daily life problems (DLPs) to monitor
over the course of the initial sessions of the study based on a
FAP case conceptualization. Once the DLPs were defined, the
therapist trained the client to track the frequency of the DLPs
and clients were asked to record DLPs as close to the time of
occurrence as possible, at least on a daily basis. The therapist
did not look at the diary cards until the end of the experiment.
Because the therapist was also the primary researcher who
knew the experimental hypotheses, this precaution was imple-
mented to avoid any possible influence of the therapist-
researcher on the DLP data. Dora had a friend collect addi-
tional data about her out-of-session behavior, the same DLPs
that the client coded. Sol demonstrated repeated difficulties in
recording behavior accurately; her data is therefore not
reported.
Psychol Rec (2016) 66:599–609
Table 1 Examples of coded FAP rules employed with each client
Dora
Rule 1
T: So, I will ask you something. If you think I am being invasive or
tendentious, let me know. The way you told me this now was similar to
the way you would talk to your friend if she were being invasive or
tendentious?
Rule 2
(Client had an aggressive tone of voice and talked about something that
happened during the week which irritated her)
T: And how irritated are you with me right now?
Rule 3
(Therapist requested Dora to complete some paperwork).
C: Let’s leave this for later. (CRB1)
T: Sorry, but I need you to complete this before we start the session.
C: I think it will be important for me to see your research after you finish
it. No, I don’t think so, I’m sure it will be important. (CRB2)
T: I really respect the clarity with which you are telling me this, and your
wish to see it. And, sure, I will show you, I have no objections to this.
C: Now, I don’t have an answer for everything, but then I ask you… are
you going to talk with them? Are you going to discuss this with them?
(CRB2)
T: You are asking me to talk to them, right? (Rule 1)
C: Yes, I’m asking you. (CRB2)
T: So, I will. And you can ask me how it was next week and I will tell you.
Rule 4
T: And did you leave here feeling better? I was wondering how you were
after our interaction.
Rule 5
T: Can you understand what was good for you in the last session, what
made you feel so good?
C: I believe it was the possibility to talk to you about my uncomfortable
feelings without arguing. (CRB3)
T: It is good to hear this answer. Because I believe this was the biggest
gain from last week.
T: And how does this work? Why is it that you can talk to me and not to
others?
C: Well, because I believe you know me a little. So, I don’t know, if I say
BI don’t want to talk about this^ I believe you understand a little bit and
respect me. My friend does know me and, even so, she frequently
insists. And keeps questioning. And sometimes I say Bstop it! Do
whatever you want!^ (CRB3)
T: And do you think you talk openly with her as you talk to me?
T: Yes, and you are doing a lot in session, right? You are asking me things,
you are delineating the limits with me, as you did several times today.
(…) And I believe that somehow you are learning how to do it with
others, too. You are letting me know the limits and I have tried to
respect them as much as I can. And you told me you also did it with
your friend.
Sol
Rule 1
T: And is it difficult to tell me this?
Rule 2
T: What do you think about what she said? Was it really an apology or
not…? (Therapist is trying to evoke some more critical judgment about
abusive people.)
T: Yes, and I’m going to travel next week. So, actually this is our last
session before my trip. And I will be back only next month. How do
you feel about this, that for one month we are not going to see each
other?
Rule 3
(Therapist talked about how she feels about the client)
Psychol Rec (2016) 66:599–609
Table 1 (continued)
C: I believe I can’t accept this… or act this way. (CRB1)
T: Right now, I just talked about how much I admire you, right? How did
you feel listening about my admiration?
C: Yes. A big issue of mine is this difficulty to accept wrong things. And I
know I’m getting better. And the fact that I would have our session
today, made me much calmer, so, I thought a lot about how grateful I
am to you. A lot… (CRB2)
T: Yes, I see all this difference… and to be able to be part of this is a
pleasure to me, it is very important, and it is really good to see you
feeling that you are getting better. And to see you talking, expressing
this is even more special! Because I know this is difficult for you! And
to see that you are able to talk this in such a beautiful way… wow!
C: Yeah… and I was thinking, wondering, what a big difference would be
to me to tell you this (…).(CRB2)
T: It is very special for me that you are talking about it. I believe it is
important for you to tell me this, and to hear you expressing yourself
this way. To see you interacting so at ease is very special for me. Thank
you for letting me know that you are feeling this way. (…)
C: I know I will miss the sessions, but I can write to you, as you told me.
(CRB2)
T: I really want to keep in touch if this suits you, but I don’t want you
feeling that you need to write to me. You can use this help, I am willing
to give it to you. I will be far away, but I’m close, you know?
Rule 4
(Therapist made some self-disclosure in response to the client’s risk to get
emotionally closer to the therapist)
T: I want to ask you how it was to hear about my own battles. Does it
make any difference?
Rule 5
T: Yes, I’m very happy with this. That there is no script. This certainty that
there is no disappointment here in session. And maybe with your
mother and your boyfriend this process would be much more difficult.
As I said, I believe that the more you try not to worry about them, the
more they will complain. It is probably going to be difficult at first.
And I am wondering with whom it would be easier to do something
similar to what you do with me, not to worry, to be yourself.
T: And what do you think helped you to talk? I mean, what is missing in
your daily life to help you to express yourself there the way you do
here? What do you have here that you don’t have there?
Procedure
During an initial period of therapy, a therapeutic relationship
was established, a case conceptualization was developed and
CRBs and DLPs were defined. This period was longer for
Dora due to some difficulties in defining behaviorally the
problem behaviors; it lasted 24 sessions, while for Sol it lasted
10 sessions. After this period, the experimental period was
initiated.
A single-case experimental design was used in this research
that can be described as A-B1-BC1-B2-BC2. During phase A
(baseline condition), five sessions of behavior therapy were
conducted, without systematic FAP interventions. CRBs were
not directly evoked or responded to, although they could oc-
cur naturally.
In phase B (experiential interactions condition), FAP inter-
ventions were employed in a consistent way, with the therapist
engaging in FAP Rules 1 to 4. Rule 5 was not presented as per
603
Villas-Bôas et al. (2015). In other words, analyses about out-
of-session behaviors could happen, but analyses about the
therapeutic relationship and parallels between this and out-
of-session behaviors were directly avoided.
In phase BC (full FAP condition), the whole experiential
interaction of FAP was maintained and analyses about the
therapeutic relationship and its parallels with out-of-session
behavior were added. In addition, the therapist encouraged
and evoked the client to engage in these kinds of analyses
(CRB3) and reinforced the occurrences of these analyses.
Providing homework was directly avoided, as the analytic
interaction studied here was the functional analysis of the
therapeutic relationship and not the direct request to try to
apply the new behavior in other contexts.
Phases B and BC each had eight sessions for Dora and
seven for Sol. The end of the phase could be postponed in
case of big increases or decreases of CRBs or in cases of some
critical moments in the client’s life, as happened at the end of
phase BC1 for Dora. As mentioned before, at least five ses-
sions of each phase were coded.
Around 6 months after the end of the procedure, a follow-
up session was conducted, consistent with phase A. That way,
it was possible to verify the maintenance of the in-session
gains of therapy without systematic FAP interventions.
During these 6 months, therapy was still being conducted,
although without following systematic procedures.
Results
Implementation of FAP in B and BC Phases
Table 2 presents specific FAPRS codes as a percentage of total
therapist codes, summarized across each experimental phase.
Figure 1 presents these percentages, session-by-session, for
the key codes of Rule 3 and Rule 5 only. Because the percent-
age of Rule 3 is considerably higher than the percentage of
Rule 5, each of them has a different scale, so that the right
scale represents Rule 3 and the left one represents Rule 5.
Figure 1 shows that the percentage of Rule 3 was higher
overall in all phases after phase A, especially for Dora. For
her, the percentage of Rule 3 did not reach 30 % in any base-
line session, and was higher than 30 % throughout phases B
and BC (except for session 6 in phase BC2). For Sol, phase A
occurrences of Rule 3 were more frequent than with Dora
already, but it was lower than 45 % in most session of this
first phase and higher than that in most sessions of phases B
and BC. Regarding Rule 5, there were almost no occurrences
of it in phases A and B (except for session 2 of phase A for
Dora — 0.4 % — and session 3 of phase B1 for both clients —
around 1 %). Moreover, during phases BC it is possible to see
a higher frequency of Rule 5 in most of the sessions.
604 Psychol Rec (2016) 66:599–609

Table 2 Percentage (of total therapist and client codes, respectively) of ding at the follow-up session, without any evident or
each rule and each CRB per experimental phase, for Dora and Sol (F =
systematic differences between phases B and BC.
follow-up)
Figure 3 presents the Rule 5 and CRB3 percentages for
Dora Sol all sessions. It is possible to see that there is an increase in
the clients’ analyses about therapeutic relationship at the
A B1 BC1 B2 BC2 F A B1 BC1 B2 BC2 F
moments when the therapist invested more in in-session
Rule 1 0 0.2 0 0.1 0.1 0 0 0.8 0.5 0.5 1.1 0 analyses, in the BC phases. In Dora’s case, it is possible
Rule 2 1.8 2 2.7 1.6 1.6 2 5.2 9.3 5.9 7.6 7.5 2.6 to observe small increases in CRB3 during these phases,
Rule 3 19 40 43 48 42 32 39 52 44 55 45 44 with higher frequency than most phase B sessions, where
Rule 4 0.1 0.2 0.1 0 0.1 0 0 0.1 0.3 0.2 1.5 0 no analyses were emitted in most sessions. In Sol´s case,
Rule 5 0.1 0.2 1.6 0 2.7 0 0 0.1 4.8 0 3 1.1 there is a bigger increase in CRB3s in the BC phases than
CRB1 17 18 14 15 11 4 31 16 5.6 11 12 2.1 observed for Dora, when a higher percentage of Rule 5 was
CRB2 13 26 34 35 35 31 15 37 42 44 35 42 presented.
CRB3 0.2 0.2 0.4 0 1.9 0 0 0.3 2.1 0 2.2 0.5
Frequency of Out-of-Session Behavior

Figure 4 shows DLP data from diary cards recorded by

Frequency of In-Session CRBs Dora and the external observer. It is possible to see an
increase in both behaviors recorded by Dora when FAP
Table 2 also presents specific FAPRS codes for client was implemented (phase B1), but this may be due to in-
behavior (CRB1, CRB2, and CRB3) as a percentage creased awareness about these behaviors after she started
of total client codes, summarized across each experi- to record them. The external observer’s records, showing
mental phase, and Fig. 2 presents CRB1s and CRB2s that both behaviors became stable from A to B1 phase, also
at the session-by-session level. support this. It is also possible to see that both problem
It is possible to see that for both clients CRB1 was behaviors recorded by Dora and the observer decreased
predominant over CRB2 during the baseline sessions. during the FAP phases. There is a reduction of all behav-
When FAP was introduced, at phase B1, the total iors from phase B1 to phase BC1, except for indirect ag-
amount of CRB2s increased. For Dora, at session 4 gression recorded by the external observer, but there is no
of phase B1, CRB2 became more frequent than evidence of increases in these behaviors in phase B2 or
CRB1, while for Sol CRB2s become more prominent decreases in phase BC2. Thus, there is no evidence that
at the first B1 phase session. CRB2 remained higher there are systematic differences between the B and BC
for both clients for the rest of the experiment, inclu phases.

Fig. 1 Percentage Rule 3 (scale Dora

8 80
Rule 5 percentage

Rule 3 percentage
on the right) and Rule 5 (scale on 7 70
6 60
the left) codes for all sessions 5 50
rated for Dora and Sol 4 40
(F = follow-up) 3 30
2 20
1 10
0 0
1 2 3 4 5 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
A B1 BC1 B2 BC2 F
Experimental phases
Rule 5 Rule 3

Sol
12 100
Rule 5 percentage

Rule 3 percentage

10 80
8
60
6
40
4
2 20
0 0
1 2 3 4 5 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7
A B1 BC1 B2 BC2 F
Experimental phases
Rule 5 Rule 3
Psychol Rec (2016) 66:599–609 605

Fig. 2 Percentage of CRB1 and Dora

50
CRB2 codes through 40

Percentage
experimental sessions, for Dora 30
and Sol (F = follow-up)
20
10
0
1 2 3 4 5 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
A B1 BC1 B2 BC2 F
Experimental phases
CRB1 CRB2

Sol
70
60

Percentage
50
40
30
20
10
0
1 2 3 4 5 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7
A B1 BC1 B2 BC2 F
Experimental phases
CRB1 CRB2

Clinical Impressions of Improvement
Dora: Both the therapist and Dora reported strongly
that her life improved during the procedure, describ-
ing that Dora’s aggressive behaviors decreased and
assertive behaviors increased. Consistent with the di-
ary cards, the therapist did not believe that Dora’s
improvements behaviors were related to changes in
the experimental phase.
Sol: Both the therapist and Sol described that she be-
came more assertive with others and better at not com-
plying with abusive and excessive requests. Sol reported
that this effectively resulted in a decrease in the requests
made by others. The client also started to reach out for
friends, inviting them sometimes to go out and
accepting more invitations. Sol did not appear to under-
stand the whole functional class seen by the therapist,
recording only specific topographies (like saying Bno"
to abusive requests) and not others which changed more
rapidly (like doing things for herself instead of offering

Fig. 3 Percentage of Rule 5 and Dora

10
CRB3 codes, throughout 8
Percentage

experimental sessions, for Dora 6

and Sol (F = follow-up)
4
2
0
1 2 3 4 5 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
A B1 BC1 B2 BC2 F
Experimental phases

CRB3 Rule 5

Sol
12
10
Percentage

8
6
4
2
0
1 2 3 4 5 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7
A B1 BC1 B2 BC2 F
Experimental phases
CRB3 Rule 5
606
Fig. 4 Weekly average
Weekly average occurrence
occurrence of responses recorded
by Dora per experimental phase
(continuous line — scale on left);
and observations of the external
observer (dashed line — scale on
right)
unnecessary help for others). Even so, the clinical im-
pressions were that the client’s out-of-session behaviors
improved during the experiment, but with no evidence
of differences between the B and BC phases.
Discussion
The results suggest that the experiment was conducted as
planned for each experimental phase, with higher rates of
Rule 3 after the A phase, and rates of Rule 5 increasing and
decreasing in the appropriate phases for both clients. Results
indicate that the introduction of FAP had a positive impact on
CRBs, which was maintained at the follow-up session, and the
introduction of FAP had a positive impact on out-of-session
behavior (for Dora), corresponding to observed clinical im-
provements. The addition of analytic techniques increased the
frequency of CRB3s in the BC phases. However, the change
in frequency of therapist Rule 5 behavior and client CRB3
behavior did not seem to have a differential impact on
CRB1s or CRB2s or on out-of-session behaviors (per client
self-report and diary cards).
The changes in the percentages of CRB1 and CRB2
(Fig. 2) after the A phase, combined with the high rates of
Rule 3 (much higher than any other FAP rule percentage) in
these phases, suggest the importance of Rule 3 and the expe-
riential interaction, rather than Rule 5 and the analytic inter-
action, to the in-session changes. Rule 3 is seen as the primary
mechanism of in-session behavior change in FAP, both in
terms of the theoretical literature (Follette & Bonow, 2009;
Follette, Naugle & Calaghan, 1996; Kohlenberg & Tsai,
1991; Tsai et al. 2009, 2012) and the existing empirical evi-
dence (Callaghan et al. 2003; Busch et al. 2009, 2010;
Geremias, 2014; Kanter et al. 2006; Lizarazo et al. 2015;
Mangabeira, 2014; Meurer, 2011; Oshiro et al. 2012;
Popovitz, 2013; Xavier et al. 2012). The present results add
more evidence suggesting the power of the experiential inter-
action in FAP, with Rule 3 at the center of this interaction, to
produce in-session clinical change (and out-of-session
Psychol Rec (2016) 66:599–609
1.6 3.5
1.4 3
1.2 2.5
1
Score
2
0.8
0.6
1.5
0.4 1
0.2 0.5
0 0
A B1 BC1 B2 BC2
Experimental phases
Dora Agression Dora Indirect agression
External Observer Agression External Observer Indirect agression
change, for Dora). In addition, the data presented from the
BC1 and BC2 phases did not provide evidence of a consistent
effect of Rule 5 or CRB3 on client behavior. In that sense,
there is no evidence from this data that the analytic interaction
maximized the gains produced by the experiential interaction.
Although the current findings do not find evidence for the
impact of the analytic interaction on outcomes, it is important
to note that this design did not evaluate the role of analytic
interactions in a therapy focused on teaching the client to
analyze their behavior and the environmental contingencies
as the primary focus. Rather, this design explored if the ana-
lytic interaction of FAP complements and adds to the experi-
ential interaction of FAP, as per theoretical writings on FAP
and the role of Rule 5 as part of the larger intervention. The
role of such analyses in improvements in FAP therapy process
is still unsubstantiated, at least with respect to how the analysis
was implemented in this research and in the way the improve-
ments were recorded.
As per the current findings, it is possible to consider that
when FAP is consistently and systematically implemented,
analyses about this process are secondary and add little to
the experiential interaction. As suggested by others
(Abreu-Rodrigues & Sanabio-Heck, 2004; Matos, 2001;
Meyer, 2005), when there are clear contingencies present
during the experiential interaction, the supplementation by
rules may not make a big impact on the behavior. Simple
schedules of reinforcement, like continuous reinforcement
schedules, present a higher discriminability level than in-
termittent and mixed schedules, showing that there are dis-
criminative properties in reinforcement schedules that fa-
cilitate contingency discrimination (Cerutti, 1991; Abreu-
Rodrigues and Sanabio-Heck, 2004; Meyer, 2005). This is
consistent with the hypothesis of Follette, Naugle and
Callaghan (1996) about this process in FAP, who argued
that very high frequencies of contingent responses to the
client’s behavior in therapy increase the chance of learning
more effective responses than when the feedback happens
at random intervals (very intermittent schedules of rein-
forcement). These higher frequency schedules may be
more likely at the beginning of therapy.
Psychol Rec (2016) 66:599–609
In this research, CRB2s were reinforced with high frequen-
cy and CRB1s were systematically punished or not reinforced
(extinction). In-session contingencies were probably clear to
the clients and easily discriminable even when not explicitly
described. As the shaping process was constantly conducted
in session and the environmental contingencies were clear,
perhaps the need for supplemental control by rules was
minimal.
Considering the small amount of data collected in this re-
search and the limitations of the methodology, it may be that
the experiential interaction in FAP is enough to produce
changes in some cases, and the analytic interaction may be
only a needed supplementation in some cases, but not neces-
sary for the expected changes. But more data are needed to
confirm these hypotheses.
Another issue is that functional analysis of the client´s in-
session improvements can be helpful in creating clear and
objective homework assignments, which is another element
of Rule 5 (Tsai et al, 2009); but this was not included in the
current research. The current research measured the effects of
explicit functional analyses of behavior in session, seen as a
central mechanism of change within behavior analysis and
consistent with how Rule 5 was originally defined in FAP
(which did not include homework; Kohlenberg & Tsai,
1991), versus homework which is common in behavior ther-
apy and cognitive-behavioral approaches. Perhaps, therefore,
the addition of concrete homework as part of Rule 5 would
have resulted in observable improvements during the analytic
phases.
One last issue to be addressed is that, although the therapist
did not explicitly generate or teach rules about in-session im-
provements and their out-of-session parallels during the B
phases, the clients still could have abstracted rules from the
in-session experiences without an explicit focus on doing so.
However, if this was the case and if these abstracted rules had
an impact on behavior, it possibly would be expected that
client would emit more CRB2 in the B2 phase, compared to
the B1 phase. Even so, it is possible that the clients had ab-
stracted these rules in both B phases as a rationale was pro-
vided at the beginning of therapy, suggesting that in session
improvements would be generated, presumably in the service
of out-of-session improvements. Regardless, whether or not
this process occurred within the client does not speak to the
issue of whether it is required to specifically and explicitly
engage in Rule 5 behavior.
Research Limitations
Both participants of this study were similar in terms of gender,
presenting problems, cultural context and education levels. It
is possible that analytic interventions would function dif
ferently with clients with different difficulties or contexts.
Also, it needs to be considered that as a single-case expe
607
riment, it is not possible to generalize these results to the larger
population; only principles can be derived.
One may argue that Rule 5 should have occurred at a higher
frequency; thus, the analytic interaction was not adequately
tested in this research. It is difficult to determine what an ideal
percentage of Rule 5 would be in a FAP session. Only two
empirical studies on FAP have described the amount of Rule 5
in FAP sessions (Geremias, 2014; Lizarazo et al. 2015). Both
reported a percentage or frequency of Rule 5 similar to or
lower than those presented in this investigation. Thus, there
is no evidence in the literature that FAP sessions have been or
should be conducted with a higher amount of Rule 5 than was
done in this study. It also was expected that Rules 1 to 4 would
be similar in the B and BC phases, as the experiential interac-
tion of FAP should not suffer from the addition of the analytic
interaction; thus, it would be difficult to produce rates of Rule
5 much higher than they were. These results indicate that FAP
was conducted in a natural way in the BC phases, exceeding in
some sessions the percentage presented in other studies.
However, it may be the case that, if FAP can be conducted
appropriately and with higher rates of Rule 5 emissions, these
analyses may show a greater impact on client behavior.
The low frequency of DLPs could make it difficult to see an
impact of Rule 5 and CRB3 interventions. The diary cards
included only DLPs and did not include daily life improve-
ments, because Dora had difficulties discriminating her im-
provements when they were only starting to happen. The re-
cording of those improvements would help to clarify the re-
sults found in this research. The fact that Sol did not provide
reliable diary card data is also a shortcoming of this study.
Unlike studies by Kanter et al. (2006), Landes et al. (2013)
and Lizarazo et al. (2015), during this study, the therapist did
not influence the diary card reporting during the experimental
procedure, decreasing the influence that the therapist can have
on the data, but losing the chance to correct possible inaccu-
racies that may have happened in Sol’s or even Dora’s report.
The client had also completed the diary cards for a long peri-
od, without any pauses, contrary to what was recommended
by Bohm and Gimenes (2008).
Other limitations of the current study were that the therapist
was the primary rater, and also how inter-rater agreement was
calculated. Although very high levels of agreement were
reached, the coders were not blind to the codes provided by
the therapist, such that they only checked them instead of
coding it independently. This introduces the possibility that
the coding was biased by the therapist-researcher coder and
this bias was not sufficiently checked by the reliability proce-
dure, obscuring the true nature of the data and reflecting ther-
apist biases instead. The fact that the findings run counter to
the unique hypotheses of this study (i.e., that there was no
evidence for the impact of the analytic interventions of FAP
on CRBs) but are consistent with the previous research (i.e.,
that there is evidence for the impact of the experiential
608
interactions of FAP) mitigates, but does not eliminate, con-
cerns about possible bias due to unblinded coders significant-
ly. It is strongly suggested that blinded coders be employed in
future research.
Conclusion
In summary, the current study found that across two success-
ful FAP cases, the introduction of experiential interventions
produced observable improvements in CRBs and correspond-
ing out-of-session behavior (in one case). The introduction of
analytic interventions produced observable increases in the
frequencies of the clients’ CRB3s, suggesting that clients pro-
duce more analyses about the therapeutic relationship when
the therapist evokes this behavior and engages in it as well.
There was no evidence, however, that analytic interventions in
FAP made an impact on problems or improvements in or out
of session. Possibly, when contingencies are clear, the addition
of analytic interventions is not important to outside improve-
ments. Overall, this research presents more evidence that FAP
has a positive impact and Rule 3 matters. The current conclu-
sion is that Rule 5 does not have an additional effect on clin-
ical improvements, but this conclusion is tentative. Future
research may address current limitations by implementing
the analytic interventions at higher rates, addressing home-
work requests based on these analyses, by improving the qual-
ity of out-of-session data collection, and by obtaining more
independent observations of CRBs and FAP rules.
Acknowledgments Research was funded by São Paulo Research
Foundation (FAPESP), grant #2010/19816-2.
Compliance with Ethical Standards The paper has not been pre-
viously published and has not been and will not be submitted elsewhere.
Research was funded by the São Paulo Research Foundation
(FAPESP), grant #2010/19816-2.The authors declare that they have no
conflicts of interest.
All procedures performed in studies involving human participants
were in accordance with the ethical standards of the institutional and/or
national research committee and with the 1964 Helsinki Declaration and
its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants inclu-
ded in the study.
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