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Learning to Relate: ACT + FAP for Clients with Intimacy Issues

Learning to Relate: ACT + FAP for Clients with Intimacy Issues

Inclusion in tribes was a condition of survival in earlier eras of human history. As a result, our ancestors grew extremely sensitive to the threat of rejection from the group, and we retain sensitivity to social exclusion to this day. But most of us no longer have strong group bonds akin to those that exist in tribes, and we are also potentially able to be in contact with cast numbers of other humans. Thus each and every individual we encounter can represent either a source of great comfort and safety or a looming threat of social exclusion.

Deep bonds are a necessary part of well-being that are dependent on our ability to relate intimately with others. Healthy intimate relationships are based on authenticity, caring for another person, and mutual validation of another’s experience.

In their book, The Essential Guide to the ACT Matrix: A Step-By-Step Approach to Using the ACT Matrix Model in Clinical Practice, clinical psychologists Benjamin Schoendorff, MA, MSc, and Kevin Polk, PhD define an intimate relationship as “one in which you are mostly reinforced and rarely punished for sharing what you think and feel and in turn mostly reinforce and rarely punish the other person for doing the same (Cordova and Scott, 2001).”

Even for clients with severe intimacy issues, psychotherapy is an inherently intimate process that gravitates around the personal details of our clients’ lives. It provides an opportunity to establish a bond in which clients feel safe to share their deepest thoughts and feelings without fear of rejection, even for those who may have never before experienced such a thing. This sense of safety is one of the conditions that allows humans to bond deeply with one another, and can serve as a foundation for healthy human connection outside of the therapy room.

The following tips—which have been adapted from Schonedorff and Polk’s book—provide guidelines for working with clients who struggle with intimate relating.

Create an explicitly intimate context

Remember that the focus of an intimate relationship is on reinforcing and rarely punishing others for sharing what they think and feel. Creating an explicitly intimate context in the therapy room involves embodying this focus in your interactions with clients. Making a commitment to reinforce and rarely punish clients for what they think and feel is an immensely powerful way to help them learn to relate intimately. Intimate relating with a client will also require that she learn to mostly reinforce and rarely punish you for sharing what you think and feel, as well. This will also be a powerful way for her to learn the skills needed to build healthy, intimate relationships.

You may wish to start out by telling clients that in the service of helping them create and nurture the kinds of relationships they want, you’re committed to making space for everything they think and feel. Remind them that the difficulties they experience in day-to-day life will likely also show up in sessions, and that these events will present them valuable opportunities to notice and authentically share what they think and feel. In doing so, they will be learning the skills to build the kinds of relationships they want from within the safety of the therapeutic relationship. As they begin to forge and nurture the relationships they long for outside of therapy, they’ll draw from the skills they learned through their experiences with intimate relating in sessions.

Get better at noticing the process of intimate relating

As you engage in relationship-focused work in sessions, stay attentive to the experience and processes of intimate relating. Hone your ability to notice and maximize opportunities to encourage clients to practice intimate relating.

Doing this work means that as clinicians we must also have the courage to engage in intimate relating, and be aware of any of your own internal obstacles that may emerge and stand in the way of caring and loving the client enough to create a deeply authentic and supportive relationship with them. This approach reflects the stance of functional analytic psychotherapy (FAP), which holds that awareness, courage, and love are central processes in both intimate relating and therapeutic change (Tsai et al., 2009).

Focus your work in sessions toward learning through present moment experiences

There’s a huge distinction between talking about doing something and actually doing it, which is why therapy that focuses on clients’ lives outside of sessions may be limited in terms of helping clients learn new skills for things like intimate relationships.

Therapy is a learning environment. Learning new behavior can only be done in the present moment, and it also requires practice. Without a focus on the learning in the present moment inside the therapy session, therapy runs the risk of being just an exercise in talking about stuff, rather than training new behavior that can help clients get unstuck in other contexts.

People generally seek therapy because they want to learn how to better handle things. In the service of helping clients learn new skills for living, it’s tremendously useful to present instructions and invite clients to practice new behaviors during sessions. However, not everyone who enters therapy is apt to take instructions and try out new behaviors. In fact, for some, rules may be downright aversive. Some clients’ difficulties may be rooted in the way they react to instructions. Be aware that this may be keeping clients stuck and curtailing therapeutic progress. Seek further guidance from an advisor, mentor, or consultant if necessary.

For more about ACT, FAP, the matrix, and helping client with intimacy issues, check out The Essential Guide to the ACT Matrix.

References

Cordova, J. V., & Scott, R. L. (2001). Intimacy: A behavioral interpretation. Behavior Analyst 24(1): 75–86.

Tsai, M., Kohlenberg, R. J., Kanter, J. W., Kohlenberg, B., Follette, W. C., & Callaghan, G. M. (Eds.). (2009). A Guide to functional analytic psychotherapy: Awareness, courage, love, and behaviorism. New York: Springer.