Art Therapy

History of Art Therapy

For centuries, art and drawing have been used all over the world as tools for
communication, storytelling, self-expression, and social interaction. As far back as there
have been humans, there has been art. Just think of the original cave drawings. Art as a
therapy practice was only accepted more recently. The term ‘Art Therapy’ was coined in
1942 by Adrian Hill, a British artist, who attributed painting and drawing to his recovery
from tuberculosis. However, the benefits of the practice of art for emotional health go
back further than this.
In 1915, Margaret Naumburg, often referred to as the Mother of Art Therapy, established
the Walden School in New York. Naumburg believed that children should be allowed
creative freedom and that allowing them to pursue subjects that interested them would
enable healthy development.

Concept of Art Therapy

One of the strengths of the arts therapies, is the diversity of ways the art-form can be used
within relationships to bring about therapeutic change. Art therapy is a blended field of
therapeutic practice that combines art and psychology, utilizing the creative process,
artistic techniques, and external artwork to support individuals to develop self-awareness,
explore emotions, and address unresolved conflict or trauma.
Art therapy has also been used to help individuals, particularly young children, develop
social skills and raise self-confidence. It’s a fantastic addition to positive psychology, as
at its core, it seeks to help individuals overcome emotional or psychological challenges to
achieve a greater sense of personal wellbeing.
Art therapy is an integrative mental health and human services profession that enriches
the lives of individuals, families, and communities through active art-making, creative
process, applied psychological theory, and human experience within a psychotherapeutic
relationship.
To participate in art therapy, you do not need any prior experience with art or a ‘natural’
artistic ability. The process itself is one of exploration with no ‘wrongs’ and no ‘rights.’
The practice allows each individual to use creative activities in ways that support them
best without judgment.
Contribution of the arts in therapy

Inclusion of an active and creative arts-based process provides opportunities for self-
expression, creativity and a nonverbal means of relating with other people. The art-form
brings a third object concrete (such as a recording or piece of art work), or experienced
(such as movement or heard sound)- into the matrix of relations within the group. Each
person brings their own unique creative and cultural identity. This can be explored as part
of the therapy with the potential to link this and expand their personal relationship and
use of the art-form as a ‘helping resource’ in their day-to-day lives. Arts therapies are
therefore well placed to help patients identify difficulties and strengths through the use of
the art-form in the varying interactions in the group. Use of the art-form can facilitate
exploration and expression of emotions and discovery of personal meaning in creative
activities, allowing experiences and learning through non-verbal and verbal
communication. Through creativity, imagination and play, patients are helped to explore
new or different emotional and cognitive experiences with support of both the group and
the therapist. The production of a piece of art is often cited as a means of strengthening
self-esteem by clients and can provide access to personal and interpersonal resources
which may be continued into wider daily and creative life in the community.

So far most of the reasons and purposes given apply to any kind of group. It is worth
drawing out the aspects of groupwork which are particularly enhanced by using art as the
group activity:
1. Everyone can join in at the same time, at their own level. The process of the
activity is important, and a scribble can be as much of a contribution as a finished
painting.
2. Art can be another important avenue of communication and expression, especially
when words fail. The spatial character of pictures can describe many aspects of
experience simultaneously.
3. Art facilitates creativity.
4. Art is useful in working with fantasy and unconscious.
5. Art products are tangible and can be examined at a later time.
6. Art can be enjoyable, and in a group this can lead to shared pleasure.
What Size of Group is Best?

Most art therapy and personal art groups, in common with other ‘small groups’, have a
membership of between six and twelve, although larger groups are occasionally
manageable. This size is important to ensure the following factors:
1. Members can maintain visual and verbal contact with all other members.
2. Group cohesiveness can be achieved.
3. There is an opportunity for each person to have an adequate share of time in
discussion.
4. There are enough people to encourage interaction and a free flow of ideas, and to
undertake group projects.

Ten core principles

On the basis of this, we suggest ten core principles for the arts therapies groups:
1. The arts therapies groups are fully explained with information and video material
so that patients can make an informed choice as to their preference
2. Attendance is encouraged and supported through maintaining active contact with
patients throughout the treatment phase
3. The therapists ensure communication is maintained and held with the multi-
disciplinary care team throughout.
4. Group structure always contains: a) an opening warm-up b) use of the art-form,
with space for verbal reflection, c) a closing circle to reflect upon the group
experience.
5. Active participation, exploration and use of the art-form is encouraged.
6. Therapists always offer structure within the art-form to promote group cohesion
and only let this become free when there is space and safety to do so.
7. Within the early phase of therapy (weeks 1-5), the therapist focuses upon building
trust and active engagement with the art-form, allowing plenty of time for this to
happen.
8. Middle to late sessions (weeks 6-17): Developing content and arts-based activities
in collaboration with service users to build variety (as opposed to doing the same
arts-activity each session).
9. End phase (weeks 18-20): The group reflects on the process as a whole and review
to prepare for ending. Therapists signpost patients to wider arts-based
opportunities in the community.
 10. Sessions are recovery-oriented: Therapists work collaboratively with patients so
that their strengths and preferences in using the art-form are acknowledged to
support their future recovery and signposting.

Art and Play

There is now a vast literature on play, and it is impossible to do justice to it in a few
paragraphs. These comments are meant to stimulate thought and ideas, which can be
followed up by consulting the titles on play.
Piaget has classified play into three types:
1. Sensori-motor play, in which a child seeks to master a skill, and then repeats it for
the sheer enjoyment (ages 0–2yrs).
2. Symbolic play, in which a child plays ‘pretend’ games using objects to hand as
symbols for other things, e.g. she/he may pick up a stone and pretend it is an ice-
cream, saying ‘Here is an ice-cream for you. Eat it!’ (ages 2–6yrs).
3. Games with rules, in which a change of rules changes the nature of the game.
These may often involve groups (age 6+).

Although the classification above refers to stages of development, all three types of play
may be involved in the use of art. The first type will be part of exploring the use of art
materials, and the activities concerned with ‘media exploration’ will encourage this kind
of play, for both children and adults (who often wish they could recapture children’s play
capacity). The second type is part of the nature of art, which is a symbolic medium; any
painted image stands for something in the artist’s mind.
The third type of play can be involved in some of the art communication group games.
Many artists have used these elements of play to explore and experiment with media to
produce new forms and unexpected results.
However, this classification of types of play only goes so far. Play can never be defined
as one particular activity; rather, it comprises many kinds of activity, linked by an attitude
of non-literalness and enjoyment, known as ‘playfulness’. For instance, the same activity
may be playful or non-playful: two people chasing each other may be involved in a
serious situation, but if at the same time they are laughing it is usually safe to assume
they are playing. The characteristics of play may be summarized as follows:
 Play is pleasurable and enjoyable.
 Play is spontaneous and voluntary, and freely chosen.
 Play involves active engagement on the part of the player.

Thus, play is a free, joyful activity—but also needs the limits outlined above in order to
be play. It is also usually a social activity.

The other quality on the list of characteristics is one which engages many teachers and
therapists. It is well known that children’s play is linked to their learning of language and
other cognitive skills, and to their practising of social roles. At another level, children
also re-enact problems and conflicts in a condensed form in their play. The non-literal
quality of play means that this can be done in safety, without fear of real consequences.
By representing a difficult experience symbolically, and going through it again, perhaps
changing the outcome, a child becomes more able to deal with the problem in real life.

Adults too need to develop or rediscover a sense of play, which can give them a much
needed ‘space’ away from the constraints of normal living, and help them to renew their
capacities for tackling life’s problems and opportunities. In Winnicott’s words: ‘It is play
that is the universal, and that belongs to health: playing facilitates growth and therefore
health; playing leads into group relations; playing can be a form of communication in
psychotherapy.

Games
Games can be seen as play activities which have become institutionalized. They belong to
Piaget’s third stage of play, involving explicit rules, which make up the very essence of
the game. Games are social activities, and the participants need to agree on the rules
before they can take part in the game. However, there need be nothing sacrosanct about
the rules—they can be changed at will to produce an entirely new game. In a worthwhile
game the rules will be flexible enough to allow for many levels of response, resulting in
an enjoyable playful activity.

Many group leaders have found that games can stimulate enjoyable learning
experiences, and there has been a burgeoning of literature on ‘growth games’, ‘new
games’, ‘co-operative games’—to mention just a few. Leaders in informal settings often
use games to start sessions, or to help people to make contact with each other.
Of course, a ‘games’ approach does not suit everyone: some people feel it would take
away from the seriousness of their work, and the respect of other professionals for them.
This depends to some extent on the ethos of the setting in which the activities take
place.

However, many group art activities can be seen as games, in the sense that they are
based on certain simple rules contained within the theme, which is usually flexible
enough to allow for many levels of response. Then, starting with a particular theme, we
could change the rules and see how this changes the activity. It is easier to see how this
might work if we look at a practical example.

Psychosexual Therapy

Overview of Psychosexual Therapy

Sex can be a highly pleasurable, connecting and motivating experience for many people.
There are many reasons for moving towards sex, including procreation, pleasure, to gain
power or to express love for someone (e.g. Meston & Buss, 2007). Whatever the case
may be, sex can be rewarding, affirming and fun. However, sex can also be source of
significant difficulty and distress for others. Sexual difficulties such as pain with
penetration, erectile difficulties, low desire, early ejaculation and difficulties with
orgasm are fairly common (Mitchell et al., 2016). As well as impacting sexual pleasure,
sexual difficulties can affect many aspects of people’s lives and can contribute to
difficulties in relationships (Christopher & Sprecher, 2000), shame, embarrassment, low
self-confidence, anxiety and depression (Ayling & Ussher, 2008; Laumann et al., 2005;
Sotomayor, 2005). There is also considerable shame and stigma related to sexual
difficulties, which can inhibit professional support seeking (Gott & Hinchliff, 2003;
Sheppard et al., 2008).

Historical Evolution
The most well-known and widely used form of psychosexual therapy was initially
proposed by Masters and Johnson (Linschoten et al., 2016; Weiner & Avery-Clark,
2014). They introduced a behavioural approach to psychosexual therapy in which various
behavioural strategies are practiced to reduce avoidance of sex and re-introduce sexual
and sensual touch in a graded way. Examples of the behavioural interventions include
sensate focus (where couples progressively introduce or re-introduce sensual touch) and
vaginal trainers for pain with penetration.
Sigmund Freud proposed that personality development in childhood takes place during
five psychosexual stages, which are the oral, anal, phallic, latency, and genital stages.
During each stage, sexual energy (libido) is expressed in different ways and through
different body parts.
Psychosexual stages of development
These are an innately determined stages of sexual development through which,
presumably, we all pass, and which strongly shape the nature of our personality. Before
turning to the stages themselves, however, we must first consider two important concepts
relating to them: libido and fixation .

Libido.
It refers to the instinctual life force that energizes the id. Release of libido is closely
related to pleasure, but the focus of such pleasure and the expression of libido changes as
we develop. In each stage of development, we obtain different kinds of pleasure and
leave behind a small amount of our libido, this is the normal course of events. If an
excessive amount of libido energy is tied to a particular stage, however, fixation results.

Fixation
Fixation is an excessive investment of psychic energy in a particular stage of
psychosexual development which results in various types of psychological disorders.
It can stem from either too little or too much gratification during a stage, and in either
case the result is harmful. Since, the individual has left too much “psychic
energy” behind, less is available for full adult development. The outcome may be an adult
personality reflecting the stage or stages at which fixation has occurred. To put it another
way, if too much energy is drained away by fixation at earlier stages of development, the
amount remaining may be insufficient to power movement to full adult development.
Then an individual may show an immature personality and several psychological
disorders.

Psychosexual stages
Psychosexual Therapy
Psychosexual issues are sexual problems that have a psychological or emotional basis
rather than a physical one. There may be psychological or emotional blocks that affect
your ability to be intimate, for example. These sorts of issues are the focus of
psychosexual therapy.
The body and mind are inextricably linked. While psychosexual issues have emotional or
psychological roots, they can also lead to or be caused by physical issues. So, while
sexual problems can lead to feelings of guilt, stress, anxiety and depression, they may
also be caused by them. Many sexual problems are caused by anxiety, lack of confidence,
lack of knowledge, poor body image or communication and/or emotional problems.

And while physical issues can make your sex life problematic, these can lead to
psychological problems too. For example, an illness, condition or surgical procedure may
leave you feeling less desirable. Which makes you feel depressed. And depression can
affect your desire for sex. It’s a complicated two-way relationship.
Psychosexual therapy involves a brief type of psychoanalytic therapy which involves
exploring and understanding how emotional factors, not always experienced at the
conscious level, interfere with sexual performance and enjoyment. Often this involves
physical examination. Psychosexual therapy focuses on the experiences an individual and
their partner(s) have with sexual function/dysfunction, commonly referred to as sexual
difficulties.
The referral criteria include sexual problems such as:
 Pain with sexual intercourse or altered sensation
 Erectile dysfunction
 Problems with orgasm
 Ejaculation disorders
 Loss of libido
 body image issues related to sexual intimacy
 compulsive sexual behaviours (sex and porn addictions)
 Mismatched sex drives in a relationship, and/or differences in sexual preferences.

Causes Of Sexual Difficulties Physical/Organic Issues

 Hormonal issues/imbalances
 Side effects of prescribed and non prescribed medication
 Long term alcohol & drug abuse
 Childbirth trauma/injury
 Damage to the blood supply to sexual organs which could be due to diabetes, high
blood pressure, disease of the arteries, surgery to sexual organs
 Damage to the nerves of sexual organs caused by spinal injury, + neurological
issues e.g. Parkinson’s, stroke and MS
 Cancer treatment
 Recurrent Sexually Transmitted Infections and their treatment

Most Common Causes Of Sexual Difficulties Emotional Issues:

 False or unhelpful/frightening beliefs about sex
 Myths and taboos
 Relationship issues which include: poor communication, transmission of inter-
generational trauma, fear of closeness, intimacy, commitment, isolation,
resentment
 Performance anxiety
 Low self esteem/negative self worth
  Guilt, anger, fear
 Shame based issues/embarrassment
 Jealousy, rivalry, frustration, competition
 Issues of loss
 Depression, anxiety, stress
 Fear of pregnancy, fear of Sexually Transmitted Infections
 Survivors of abuse
 Survivors of sexual violence

Efficient therapeutic forms

Freud was the first to talk about sexuality in a psychotherapeutic framework, though
nowadays the majority of sex therapies are based on cognitive behavioural therapy. When
assessing the efficiency of the therapy in clinical treatment, we need to consider that the
primary aim of sex therapies in practice is not the attainment of some kind of results (e.g.
strong erection exceeding a certain level, a minimum frequency of weekly orgasms etc.),
but a sexual relationship which gives mutual pleasure.

1. Psycho-education: It is essential to provide accurate information to the clients

regarding the anatomy and functioning of the genital organs. In instances when the
client is not in possession of certain basic facts, and is not acquainted with the
changes concomitant with ageing or with the normal variations of anatomy, not to
mention the genital anatomy of the opposite sex, a thorough education and a
dissipation of misconceptions may, at the same time, serve as a solution for the
sexual disorder. If we have insufficient time at our disposal or the client is not
open enough yet Important for a talk, we may recommend him books or other
educational literature, nevertheless it is good to provide him an opportunity, so
that later, should it prove necessary, he may put questions to us in connection with
his readings.

2. Communicational training: In a significant part of the sex therapeutic cases

communicational problems between the two members of the couple may be
revealed. Among the reasons for the lack of communication we may find sexuality
connected attitudes, social taboos, shame, and an absence of the ability of self-
assertion. Clients are often unable to indicate their needs to their partners, because
they feel their needs are not justifiable, or they are not in the possession of a
satisfactory vocabulary, or they do not want to offend their partner by indicating
that something does not give them pleasure. In case the sex therapy takes place in
 the form of pair sessions, the couple, even during the sessions, may get to know
things about each other that they might have not uttered in front of each other
before. In the course of discussing individual problems, both partners get the
chance to disclose their feelings, thoughts and desires regarding that problem, and
this way may dissipate the misconceptions that might have remained in the other
party. Sensate focusing, one of the essential techniques of sex therapy, also
attributes a significant role to the open dialogue between the participators.

3. Sensate focusing exercises: Sensory-focus, or sensate-focusing exercises have

been developed by Masters and Johnson (Masters and Johnson 1966). Its aim is to
increase the attention paid to one’s own and the partner’s needs during intimacy.
Participants are encouraged to direct their attention towards the diversified
sensation, and towards their experiences felt during sexual relations, and not to
deem orgasm as the sole aim of sexuality. The basis of the programme is
constituted by a temporary prohibition of coitus, which lasts until partners develop
a loose, pressure and anxiety free trust, the ability of directing attention towards
bodily sensations, and efficient communication.

4. Cognitive restructuring: Cognitive restructuring is a fundamental element of

cognitive behavioural therapy. Its aim is the identification and transformation of
negative automatic thoughts occurring in problematic situations, and the
substitution of them with positive thoughts. The first step of cognitive
restructuring is the assessment of negative attitudes feeding on sexuality related
general, and often childhood, experiences or the prejudices of the particular
cultural circle, as well as the negative automatic thoughts currently emerging in
sexual situations.
Mindfulness Therapy

The term ‘mindfulness’ was originally derived from Pali (the language used in original
teachings of Buddha) word, sati and sampajan ̃ña that can be translated as consciousness,
memory, or judgement (Wallace & Bodhi, 2006). Although often associated with
Buddhist tradition, or even yogic tradition in Hindu (Miller, Fletcher, & Kabat-Zinn,
1995), the phenomenological nature of mindfulness can be found in most religious
traditions, for example, Tafakkur in Islam, Kabala in Judaism and the rosary in
Christianity (K. W. Brown & Cordon, 2009; Manikam, 2014).

The concept of mindfulness is then re-arranged and adopted by counselling practitioners

as part of their therapies (Hanley, Abell, Osborn, Roehrig, & Canto, 2016). Although
there is a debate amongst theorists in defining mindfulness as a means that is originally
from Eastern spiritual system into Western therapeutic practices, mindfulness is “paying
attention in a particular way: on purpose, in the present moment, and nonjudgmentally”
(Kabat-Zinn, 1994, as cited in Hanley et al., 2016, p. 104). Following this definition,
Shauna L. Shapiro, Carlson, Astin, and Freedman (2006) posit three components of
mindfulness: intention (representing ‘on purpose), attention (representing ‘paying
attention’), and attitude (representing ‘in a particular way’) (IAA). These components
occur simultaneously in a single cyclic process. Intention is related to the outcomes and
reminds the clients why they are practising mindfulness. Attention identifies clients’
surrounding worlds and moment-to-moment internal experiences.
Whereas attitude is needed to include heart qualities to the attention in the mindfulness
process (J Kabat-Zinn, 1990; S. L. Shapiro & Carlson, 2017).

As a part of therapy sessions, mindfulness highlights the urgency of the relationship

between therapists and clients as this factor can strongly predict the therapeutic outcomes
(Weinberger, 2002). Some theorists, such as Lambert and Simon (2008) argue that the
therapeutic relationship is the key aspect of helping clients, regardless of the type of
interventions. The characteristics of the relationship are empathy, trust, warmth,
unconditional positive regard, kindness, congruence, and human wisdom. These
characteristics are essential for clients’ changes (Bohart, Elliott, Greenberg, & Watson,
2002; Lambert, 2005; Rogers, 1961).
In the therapeutic relationship, the therapists must be present with the clients, instead of
being separated individuals (Hick, 2008). This requires the skills in which the therapists
must be able to switch attention to what their experiences in their bodies as well as what
the clients are feeling or saying. No matter how well-trained the therapists are, if they
cannot pay full attention to what occurs during the sessions, they cannot build good
rapport and respond appropriately (S. L. Shapiro & Carlson, 2017).

Mindfulness-based Therapies
Mindfulness-based therapies are therapies that include mindfulness concepts in the
therapies to teach mindful awareness, ranging from formal meditation (e.g., sitting
quietly for 45 minutes) to informal exercises (e.g., bringing mindful awareness to daily
activities) (Baer, 2014). Despite the various types of mindfulness-based therapies, this
section focuses on Mindfulness Based Stress Reduction (MBSR), Mindfulness-Based
Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT), and
Functional Analytic Psychotherapy (FAP).

Mindfulness Based Stress Reduction (MBSR),

MBSR is the first therapy utilising mindfulness as part of the therapy. It was initially
developed to help patients with chronic pain in medicine settings. It comprises eight
weekly groups sessions for 2.5-3 hours each with approximately 30 participants. Apart
from the sessions, participants are required to complete daily home practices (meditation
and yoga) for six days per week for 45 minutes per day during the treatment period (J.
Kabat-Zinn, 1982; J Kabat-Zinn, 1990).
MBSR typically begins with the body scan in which the participants are directed to pay
attention to parts of the body (started from toe to head or otherwise) and feel the
sensations that arise without judging nor changing them for 40-45 minutes. The next
practice is mindful yoga which aims to kindly arouse mindful awareness while observing
the body. Many people report that by practising mindful yoga, they can easily relax and
maintain awareness. Sitting meditation is also included in MBSR. This practice is paying
attention to the flow of breath while sitting.
During the practice, participants are directed to move their attention to other broader
aspects step by step, such as sounds, emotions, and thoughts. The next exercise is walking
meditation which is the same as the other meditation practices. However, in this case,
participants are required to feel the bodily sensations of walking. The last practice is
lovingkindness meditation in which participants purposefully pay attention to different
objects as well as all beings with kindness and compassion. This practice is perceived as
the core element of the adaptations of MBSR programme for other purposes. In addition,
MBSR encourages clients to practice informal mindfulness exercises every day rather
than only depending on formal exercises during the sessions. Mini meditation can also be
practised at any time. For example, when clients are in a queue, in traffic, or any short
period recess (Baer, 2014; S. L. Shapiro & Carlson, 2017).
Mindfulness-Based Cognitive Therapy (MBCT)

MBCT was initially developed following the fact that Cognitive Behavioural Therapy
(CBT) experts on depression treatment John Teasdale, Mark Williams, and Zindel Segal
were unable to help people suffering from the depressive relapse, a tendency to feel
depressed again after recovered. Since MBSR became familiar, they integrated MBSR
and CBT into one therapy, known as MBCT (Baer, 2014; S. L. Shapiro & Carlson,
2017).
There is a distinction between CBT and MBCT in the mechanisms of behaviour changes.
CBT has three main theories: (1) cognition can affect behaviours, (2) cognition can be
identified and altered, (3) behaviour changes is affected by cognitive changes (Dobson &
Dozois, 2010), suggesting that CBT stresses the role of cognition in changing behaviours.
Clients are encouraged to change their thoughts so that they can change their behaviours.
However, in MBCT, clients are taught to see thoughts without judging. Instead of
replacing negative thoughts, clients are encouraged to create good relationships with
thoughts that arise in their mind (Baer, 2014; S. L. Shapiro & Carlson, 2017).

MBCT comprises eight sessions with 12 participants for two hours per week. Since
MBCT adapts MBSR, the exercises included in the programme are the same as MBSR,
except lovingkindness meditation. One of the unique techniques in MBCT is Three-
Minute Breathing Space. This technique consists of three steps: (1) focus on the internal
experiences of asking “What is my experience right now?” to notice the sensations
currently arising without judging, (2) pay attention to the sensations of the breath process,
(3) broaden awareness to the whole body without judging. Clients are required to practice
this technique every day, particularly when they feel overwhelmed (Baer, 2014; S. L.
Shapiro & Carlson, 2017).

Acceptance and Commitment Therapy (ACT)

Different from MBSR and MBCT, ACT is derived from the behavioural approach and
the relational frame theory (a theory positing that there is a strong relationship between
psychology and language). It includes mindfulness and acceptance to move people’s
awareness from certain feelings and thoughts to behaviours influenced by personal values
(Oliver, Joseph, Byrne, Johns, & Morris, 2013). ACT aims to achieve the ability to be
fully aware of the present moments and determine whether to change or to persevere with
behaviours, also known as psychological flexibility, by learning how to accept the present
experiences. Similar to other mindfulness-based therapies, instead of altering internal
experiences (thoughts or feelings), ACT changes the relationships to these experiences
(S. C. Hayes, Strosahl, & Wilson, 1999; Steven C Hayes et al., 2006).

In practice, ACT is commonly undertaken in individual rather than in group settings. It

has six core processes guiding to the psychological flexibility that is interrelated and
clustered into three response styles: open, aware, and active. Open comprises acceptance
(embracing the experiences without attempting to change, particularly when it causes
psychological pain) and defusion (a process in which clients see language as an active
relational process). Aware comprises self as context (securing the self from occurring
events and differentiating from those events) and present moment (contact with occurring
events without judging). Active comprises values (life directions) and committed action
(agreed steps to achieve certain goals) (Steven C. Hayes, Villatte, Levin, & Hildebrandt,
2011).

Functional Analytic Psychotherapy (FAP).

Another mindfulness-based therapy derived from behavioural philosophy is FAP. It
posits that behaviours are shaped by the reinforcement that occurs during therapy.
Therefore, the therapist and the client influence each other’s behaviours (Kohlenberg et
al., 2004). FAP highlights clients’ interpersonal relationships and posits that the
psychological problems that clients suffer from are caused by a lack of interpersonal
relationships (Horowitz, 2004). Clients are directed to increase awareness by seeing
interpersonal relationships from different perspectives (Bowen, Haworth, Grow, Tsai, &
Kohlenberg, 2012). More importantly, they are encouraged to be open and honest in
interactions with others as this can increase closeness and connection with others, which
is the purpose of FAP (Cordova & Scott, 2001).
In practice, the interaction between therapists and clients are essential to creating love
and intimacy and in turn, increase clients’ relational quality in their own lives. Therefore,
FAP therapists must be able to conduct therapies with acceptance and mindfulness, love,
courage, and compassion (Kanter, Tsai, & Kohlenberg, 2010). AFT can be a stand-alone
approach or combined with other approaches that have similar treatment rationales
(Kohlenberg et al., 2004).