“Seeing someone’s behavior in context is simply another way of describing empathy and understanding,” write Gareth Holman, Jonathan Kanter, Mavis Tsai and Robert Kohlenberg in their book Functional Analytic Psychotherapy Made Simple.
Without getting into technical details, this simple statement is enough to get the point across about why it is necessary to dig around in sessions for the reasons why patients do what they do. To some extent, it involves being able to take the perspective of the patient in order to better understand what drove them to a particular behavior and what’s kept it going.
To begin utilizing this approach in your sessions, you can start by simply looking at everything a client does (including language) as behavior, and seeking to understand the context within which that behavior occurs. Ask questions about what precludes it, what follows it, what seems to trigger it—both in terms of the individual’s inner and external experience.
The following four steps, which have been loosely adapted from “Functional Analytic Psychotherapy Made Simple,” can be practiced in order to better understand the function of any behavior, whether it be your client’s or your own.
Tips to Practice
1. Identify the reason that the behavior continues to happen.
Let’s say that a patient is struggling with letting go of an unhealthy relationship. Each time she breaks up with her boyfriend, she winds up reaching out to him again after just a few days. Why is she doing this?
A small amount of investigation will likely get to the crux of why the client is engaging in the behavior of going back to a relationship that she knows is unhealthy. Upon being asked, she may share that she experiences thoughts of worthlessness of inadequacy—teachings that she carried with her from childhood. She may also share that she finds it difficult—if not impossible—to tolerate her feelings of grief over the relationship not turning out the way she’d hoped.
Understanding why she continues to go back is the first step in helping her create change.
2. Investigate whether or not the behavior may be related to avoiding something aversive or unpleasant.
From the first step, it’s a short leap to knowing whether or not the whys of the behavior are at all related to avoiding something unpleasant or seemingly intolerable. In both of the hypothetical reasons for the behavior mentioned above, the client is using the behavior of going back to her boyfriend to avoid sitting with her feelings of inadequacy and/or grief.
From there, it might make sense to target treatment accordingly; interventions could target building self-compassion for the client who struggles with letting of of the learned behavior of intense self-criticism or building distress tolerance skills for the client who never learned to regulate her emotions.
3. Examine the patient’s history and her history of using that particular behavior.
With the client mentioned above, it’s important not only to investigate the history of the behavior of going back to an unhealthy relationship, but also to investigate the underlying behaviors of intense self-criticism and emotional avoidance.
The client may have learned to berate and criticize herself from an early age through watching the behaviors of parents or from being berated or criticized by them or others directly. She may have learned to criticize herself as a way of regaining control over a situation that felt out of control such as after making a mistake, which she’d also learned somewhere along the way was unacceptable.
Or perhaps the patient was taught early on that “negative” emotions like grief or sadness were inherently “bad,” therefore she learned to reject them and never acquired the tools to deal with them effectively. As an adult, it only makes sense that when difficult feelings emerge, she now engages in behaviors that reject and push them away.
4. Identify potential longterm consequences.
While projecting into the future about what might happen if the client continues to engage in unhealthy behaviors—such as compulsively returning to an unhealthy relationship, harsh self-criticism and emotional avoidance—may well be a difficult process, it can often help to solidify the person’s understanding of exactly why it’s in her best interest to work toward change.
If the patient does, in fact, struggle with distress tolerance, keep in mind that any pain that may emerge while doing this exercise may be an opportunity to help her learn to better tolerate distress within the safety of the therapy room.
“The flip side of this pain is to get in contact with what might be gained—what purpose, what meaning, what goals, what freedom—if one were to let go of the constricted problem behavior,” write the authors of Functional Analytical Psychotherapy Made Simple.
There are many, many ways that we learn to use behaviors and then learn to continue using them. Getting to the heart of why each client does what he or she does requires radical openness and a willingness to listen. You may have a hunch about why patients do what they do, but it’s a good idea to approach each client with the intention to have your mind changed or be proven wrong. In many ways we are all in the same boat as humans, but the variations on experience are vastly different. Always stay open.
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