Psychotherapy © 2016 American Psychological Association

2017, Vol. 54, No. 1, 22–28 0033-3204/17/$12.00 http://dx.doi.org/10.1037/pst0000091

Saying Good Goodbyes to Your Clients: A Functional Analytic

Psychotherapy (FAP) Perspective

Mavis Tsai Tore Gustafsson

University of Washington Helsa Vårdutveckling Primary Care Unit, Norrköping, Sweden

Jonathan Kanter Mary Plummer Loudon

University of Washington The Seattle Clinic, Seattle, Washington
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Robert J. Kohlenberg
This document is copyrighted by the American Psychological Association or one of its allied publishers.

University of Washington

Functional analytic psychotherapy (FAP) promotes client growth by shaping clients’ daily life problems
that also show up in session with their therapists. FAP therapists create evocative contexts within therapy
that afford clients the opportunity to practice, refine, and be reinforced for new, more adaptive behaviors
which then can be generalized into their outside lives. In FAP, the termination process will vary from
client to client depending on the nature of the client’s problems and targets. For many clients, the process
can be a rich, multifaceted, final opportunity to evoke, reinforce, and promote generalization of clients’
in-session improvements, particularly improvements related to vulnerable self-expression in the service
of intimate and close relationships. By making explicit agreements at the outset of therapy to participate
in an intentional termination process, and by later providing an evocative structure for ending therapy
with vulnerable emotional expression, clients have the opportunity to develop more adaptive behaviors
in the context of relationship endings which can be a painful part of the human experience. Equipped with
the skills of open-hearted communication developed from an authentic relationship with their therapist,
clients can leave therapy on a trajectory of further growth in interpersonal connection and living more
boldly.

Keywords: functional analytic psychotherapy, termination, therapeutic relationship, therapist self-

disclosure

Meaningful, reciprocal, and intentional goodbyes are rare in the
relationships that populate our everyday lives. Often people inad-
vertently slip apart without saying goodbye. Sometimes they part
ways with unspoken anger or with misunderstandings, leaving the
relationship incomplete. Except perhaps when a death is being
prepared for, rarely is the ending of a relationship fully realized as
a distinct opportunity to share deeper levels of vulnerability, ex-
change heartfelt feedback, and acknowledge the gifts and lessons
received. Functional analytic psychotherapy (FAP), a contempo-
rary contextual behavioral therapy grounded in empirically sup-
ported principles (Kohlenberg & Tsai, 1991), emphasizes the
creation of a therapy relationship that parallels the client’s daily
life relationships such that the therapeutic connection can be a
vehicle of growth and transformation in the client’s daily life. For
many FAP clients, the termination process becomes a final, mem-
orable moment of an intense, caring, and evocative therapy rela-
tionship where the hearts of both therapists and clients have been
touched from the beginning (Tsai et al., 2009). FAP therapists
strive for meaningful endings with clients and see termination as
an opportunity to help clients end a relationship well, in the hopes
that this experience will help them with vulnerable self-expression
around difficult emotions in general, and with ending relationships
with authenticity in particular.

Theoretical Basis and Mechanism of Change

This article was published Online First November 21, 2016.
Mavis Tsai, Department of Psychology, University of Washington; Tore
Gustafsson, Helsa Vårdutveckling Primary Care Unit, Norrköping, Swe-
den; Jonathan Kanter, Department of Psychology, University of Washing-
ton; Mary Plummer Loudon, The Seattle Clinic, Seattle, Washington;
Robert J. Kohlenberg, Department of Psychology, University of Washing-
ton.
Correspondence concerning this article should be addressed to Mavis
Tsai, Department of Psychology 351525, Center for the Science of Social
Connection, University of Washington Seattle, WA 98195. E-mail:
mavist@gmail.com
Similar to other relational approaches, a fundamental assertion
of FAP is that the therapeutic relationship is the primary curative
aspect of treatment. FAP often is used to enhance the impact of
other therapeutic approaches by increasing emotional intensity,
interpersonal focus, and the quality of the therapeutic alliance
(Tsai, Kohlenberg, & Kanter, 2010). It also is used as a stand-alone
approach targeting ideographically defined variables, often within
the context of client goals related to improving intimate relating
and social connectedness. In FAP, these interpersonal goals are

22
 SAYING GOOD GOODBYES
seen as relevant cross-diagnostically (Wetterneck & Hart, 2012),
and targeting them may have positive impacts on both mental and
physical health (Cacioppo & Patrick, 2008; Holt-Lunstad, Smith,
& Layton, 2010).
Given its conceptual framework, FAP’s unique contributions
stem from the application of behavioral concepts that suggest
novel and more precise interventions based on FAP’s five rules.
These rules are not rigid prescriptions, but are guidelines that
specify therapist behaviors aimed at maximizing therapeutic op-
portunities which may otherwise go unnoticed, and which typically
lead to clinical improvement. Very briefly, they involve: (a) being
aware of clients’ clinically relevant behaviors (CRBs)—problem
behaviors (CRB1s) and target behaviors (CRB2s) occurring within
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
the client–therapist relationship that correspond to those happening
This document is copyrighted by the American Psychological Association or one of its allied publishers.
in their outside relationships, (b) evoking CRBs, (c) naturally
reinforcing CRB2s, (d) noticing the impact of interventions, and
(e) using behavioral interpretations and assigning homework to
help clients generalize target behaviors to daily life (Kanter, Tsai,
& Kohlenberg, 2010; Kohlenberg & Tsai, 1991; Tsai, Callaghan,
& Kohlenberg, 2013; Tsai, Kohlenberg, Kanter, Holman, & Plum-
mer Loudon, 2012; Tsai, Yard, & Kohlenberg, 2014).
At the core of FAP is its hypothesized mechanism of clinical
change— contingent and effective therapist responding to client
problematic behaviors and behavioral improvements as they occur
here and now in session. In other words, rather than just talking
about daily life problems that occur elsewhere, FAP focuses on
how these problems (CRB1s) show up in the therapy relationship,
and how clients can emit more effective target behaviors (CRB2s)
with the therapist. Then, the therapist works to facilitate general-
ization of these in-session improvements to the client’s daily life.
While FAP is rooted in a functional contextual philosophy, our
goal in this paper is to offer a framework that enables therapists,
regardless of theoretical orientation, to increase the impact of the
termination process.
Consistent with the contextual nature of FAP, CRB1s and
CRB2s are functionally defined. That is, a CRB1 for one client,
given their history and case conceptualization, might be a CRB2
for another. For example, asking to end therapy in one case might
be a CRB1 (e.g., engaging in a pattern of avoiding going deeper
into painful topics) and in another case might be a CRB2 (e.g.,
being assertive in expressing one’s needs when one has a history
of doing what others want).
Overall, FAP assumes that clients’ patterns of intra- and inter-
personal functioning which keep them stuck in their daily lives
likely will play out in the therapy relationship. Applied to rela-
tionship endings, there may be a tendency for clients to dodge the
reality of termination until the final moments of contact, to side-
step direct communication about the mutual meaning and impact
of an impending termination, to assume and behave as though their
departure is of little consequence to the therapist, to avoid conflict
and just drop out if they are unhappy, or to taper so gradually that
an intentional final session never occurs.
This article focuses on how to increase the likelihood of a good
ending through employment of FAP principles and techniques.
First, we suggest it is useful to obtain an agreement at the begin-
ning of therapy from clients that they will end the relationship in
a thoughtful, intentional way. Then, we describe steps that we have
found useful in creating meaningful and healing termination pro-
cesses with clients. Although termination in FAP will vary in
23
intensity and content depending on the nature of the client’s targets
and the reasons for termination, in this article we describe a fairly
intense, emotionally evocative termination procedure. This prac-
tice does not apply to all FAP clients but does reflect how a FAP
termination may be unique, challenging for both therapists and
clients, and potentially powerful. We discuss how for some clients
the termination process may evoke CRB1s related to inauthenticity
and avoidance of vulnerability, and may present a unique and
powerful opportunity to work on CRB2s of fully opening to the
experience of loss as part of life, and the vulnerable and authentic
expression of caring and appreciation, one final time.
Initiating Discussion of the Termination Process
In FAP, attention is paid to the therapeutic relationship from the
beginning. An explanation of the therapy rationale may include:
Our connection provides an opportunity for you to explore how you
are in a relationship and to experiment with different ways of relating.
Together, we will consider how your interactions with me reflect your
interactions with others in your life, how problems that may arise with
me may parallel those that come up with others, and likewise, how the
positive behaviors you develop with me can translate into your rela-
tionships with other people.
In that vein, initial queries include not only the typical assessment
of treatment goals ubiquitous to early therapy sessions, but also
questions such as,
How do you usually begin relationships (e.g., do you jump in quickly,
try to make a good impression, start with high hopes then get disap-
pointed, or quickly become critical?) and what are the similarities and
differences between your usual style of beginning relationships and
how you are starting this one with me?
This discussion at the outset of the relationship is a good time to
raise how it could end. Here is a typical interaction that can take
place in a first FAP session:
T: You’ve talked about how a primary goal for you is to
learn how to connect more deeply with others, but that
you tend to give up on your relationships when your
needs aren’t being met, and you leave without talking
about it. What are the chances that will happen with me?
C: That’s possible.
T: I hope you will give us the chance to have a good ending.
The building of trust is really important in any relation-
ship, and that involves honest communication and the
honoring of agreements. I’ll be checking in with you
regularly via session bridging questions (see Tsai et al.,
2009, Appendix D) and in session about how you’re
reacting to the therapy and to me, and what’s hard for
you to say. I’ll be creating a safe place for you to express
yourself honestly. Will you do your best to show up fully?
C: Yes, I’ll try my best.
T: Since endings and loss are a part of life, our therapeutic
relationship affords us a unique opportunity to end an
important relationship thoughtfully by discussing the im-
pact we have had on each other. Will you make an
 24 TSAI ET AL.
agreement with me that we will take at least two sessions
to process the ending of our therapy in a way that
acknowledges what it’s meant to both of us, that gives us
a sense of closure?
C: That sounds kind of anxiety-provoking, but yes, I’m
game.
Key Steps in Processing the Ending of Therapy
As in any good termination process, it is important to review
with our clients their progress, what they have learned, what they
are taking away from our work together, and the skills they want
to keep implementing to prevent relapse and to maintain their
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
gains. In this section, however, we would like to emphasize a more
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FAP-specific termination that: (a) focuses clients’ reactions to the
end of the therapy relationship by exploring and tying in the losses
they have experienced in life and related CRBs, and (b) empha-
sizes the therapist being courageous and vulnerable in evoking and
reinforcing client CRB2s related to vulnerability and authentic
expression one final time.
Loss of the Therapy Relationship in the Context of
Previous Loss Experiences and Related CRBs
Termination will bring up different CRBs for clients depending
on their previous loss experiences. For example, a client who
suffered an early maternal loss may cling and have a very difficult
time saying goodbye, whereas someone who has been hurt by
unreliable partners may want to shut down and avoid saying
anything meaningful. In addressing previous experiences of loss
and related CRBs, clients are asked questions such as these:
• Since the end of therapy often brings up feelings and
memories of previous transitions and losses, what is com-
ing up for you from the past as we prepare for our good-
bye?
• What are the losses you have endured in your life that stand
out to you from earliest memories to the present? What has
made you sad, what has broken your heart, what has left a
gap in your life?
• How do you usually handle loss, endings, and grief? Do
you have particular trouble with this?
• What thoughts and feelings are you having about the end-
ing of our therapy relationship?
This final phase of therapy may take several weeks to many
months, depending on the degree to which the client’s previous
experiences of loss are extensive and related to the primary prob-
lems targeted throughout therapy.
Evoking and Reinforcing CRB2s Related to
Vulnerability and Authentic Expression
As clients discuss topics related to termination, we want to focus
on a typical FAP process of shaping CRB2s related to vulnerability
and authentic expression. Particularly if these targets are part of the
case conceptualization and something we have been working on
throughout therapy, termination presents a potentially powerful
final opportunity to work on these targets.
Part of reinforcing CRB2s in our clients is to evoke and shape
their target behaviors, in this case, by initiating a reciprocally
vulnerable exchange of heart-felt emotional expression as we say
goodbye. Therapists are invited to address the following questions
as they say a good goodbye to their clients:
• How has your client impacted or moved you in memorable
ways?
• Any regrets?
• How have you grown as a result of the work you have done
with this client?
• Has your work together inspired or motivated you? Healed
something inside you? Renewed your enthusiasm for your
work or your relationships?
• What are your client’s unique and special qualities? What
will you always remember about this client? What will you
miss?
• What do you want your client to remember about you and
your therapy?
• What are your hopes for your client?
We encourage therapists to consider writing a letter that answers
these questions in written form as a final gift and remembrance of
the special interactions they have had with their client. We aim to
write letters that the client will treasure as a summary of their
growth, their strengths, and their personal impact on the therapist.
Typically, the therapist will read the letter aloud in the next to last
session with the client, giving the client a chance to absorb it,
discuss it in the last session, and write a letter in return.
Here is an example of a FAP termination process which repre-
sents the authors’ experiences and work. The client, “Thomas,” is
a composite of several depressed clients, the therapist– client dia-
logue is based on an amalgam of our clinical work, and material
has been de-identified to maintain confidentiality.
T: It’s important for us to say goodbye as if we will not see
each other again so that you can experience a real
ending. The reality is that anyone can go at any time, and
we never know if an encounter will be the last time. So I’d
like us to act as if these last two sessions will truly be the
last time we will see each other, so that we can say
goodbye in the fullest way possible emotionally, and
leave nothing unsaid. After we’ve done that, then we can
talk about what kind of contact would be helpful to you in
the future. How does that sound?
C: I’m not sure. I’ve never done this before. How will this
help me?
T: Most people avoid being real when they say goodbye.
They avoid meeting each other with the pain of loss and
the joy of moving on to the next chapter in life. You’ve
grown so much in your work with me that I know you can
meet me in this place of being real about what saying
goodbye means. This is a final chance for you to practice
being in touch with your feelings in a deep way and
expressing them to me, and receiving what I have to say
to you. And you know how much this ability has improved
your relationships and will continue to do so.
C: You’re right. Ok, I will try my best.
 SAYING GOOD GOODBYES
T: I wrote this letter for you, and I want to read it out loud.
May I read it to you now?
C: Ok.
T: Thank you for giving me one of the best gifts a client has
ever given me—your promise not to commit suicide. That
gift from you means so much to me because I’ve wit-
nessed numerous times the devastation that my col-
leagues endure when their clients kill themselves. You
taught me that I needed to trust my instincts, and to trust
you, that hospitalizing you when you were suicidal would
have pushed you over the edge. Even though you came
close so many times to committing suicide, I know that it
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was an act of love on your part for me that you didn’t do
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it. I will be forever grateful to you that you made the
decision to live.
You are one of the most generous people I’ve ever had
the privilege to know—with ALL of your resources—your
love, your time, your money, your thoughtfulness, your
possessions to anyone in need, whether they are close
family members, or homeless strangers on the street
sleeping in the cold. Your generosity was incredibly
inspiring to me, and has made me a bigger person in
terms of how I give to others. Because of you, I have a
regular habit of dropping off items at Union Gospel
Mission for the homeless, and I will always think of you
whenever I drop things off. I will never forget you—you
will always have a special place in my heart. I love you
as deeply as a therapist can love a client.
C: I do not know what to say (tearing up).
T: I’m touched by your emotion. It seems you’re really
getting how important you are to me?
C: Yes, I cannot believe you took the time to write this letter.
I’m always going to treasure it.
T: I took the time to write it because I want to honor how
memorable our relationship has been by saying goodbye
in a powerful way.
C: I’m not that good at writing letters, but I’m going to do
my best to answer the questions in writing that you gave
me for next week.
As alluded to in the dialogue above, clients for whom this
process is appropriate are asked to prepare for the final session by
responding to a list of questions (see below) aimed at helping them
to expand their repertoire around loss and endings, and to increase
the likelihood of an impactful closing. They are invited to write a
letter back to the therapist if they want to, but if not, to at least be
prepared to respond to the questions in session.
Key Aspects of the Process During a Final Session
These are the questions that clients are invited to address in the
final session, either orally, or in writing if they choose.
• What is hard for you to express to me as we say goodbye?
• What have you appreciated about me and our therapy?
25
• What regrets do you have about our therapy or what would
you like to have gone differently?
• What stands out to you most about your interactions with
me? What will you always remember?
• Can you use this experience with me to identify how you
want to be in other relationships?
• If it is a good idea to treat every moment in a relationship
as if it were the last, how do you want to be in this last
moment with me? What can you take from this into your
other relationships?
Some clients will come to their final session prepared with a
written letter for their therapist. Often, this letter demonstrates the
transformation the client has undergone in therapy. FAP empha-
sizes that how a therapist responds to CRB2s expressed in the
termination letter or conversation is critical insofar as client im-
provements only will be strengthened to the extent they are rein-
forced. For this reason, FAP therapists try to maximize their
reinforcing value by open-heartedly receiving their client’s senti-
ments and authentically self-disclosing the impact of the exchange.
This may lead to intense emotions felt and expressed on both sides,
with teary eyes and sometimes hearty laughter filling the room.
Following is additional dialogue between the composite client
“Thomas” and the first author in their last session, including parts
of the letter he wrote to his therapist:
C: Here’s what I wrote: “The most important thing that I
learned in this therapy is that someone can really care
about me. Your obvious concern and caring really stand
out to me, and I learned that I can alter my actions
despite how stubborn I am. Because of your enormous
help, and how much you became a part of my life, I came
to see that I would harm you and other people I’m close
to if I killed myself. I learned that there are other solu-
tions, like focusing on how much I can help others who
are less fortunate than me. Your love for me was a
therapeutic love that helped me re-ignite my passion for
my wife. I love you and saying good-bye to you hurts.”
T: It means a lot to me that you took the time to write this
letter, to tell me how important my caring has been in
helping you choose life. Do you see how this letter really
shows how much you have grown?
C: Yes. I never would have been able to express myself so
clearly.
T: I do not think so either. It is really amazing to me. What
I see is this really perfect example of you, feeling a lot of
pain, the hurt of saying goodbye to me, but moving
toward this generous spirit of yours in this moment of
pain instead of choosing less functional options like
suicide. In your pain, you help me feel more connected to
you by expressing it so beautifully and letting me know
how I have touched you. This is exactly what I hope you
can take from our work and bring with passion into your
relationship with your wife.
 26 TSAI ET AL.
C: It’s still hard to be this vulnerable with my wife, but we
are a lot closer and I know I need to keep trying . . . I do
not need to see you anymore right now, but what if that
changes in the future? What are your rules about staying
in touch?
T: You can always contact me if you want more therapy in
the future. If anything big happens in your life, I’d
appreciate an email update from you. I promise I will
write back. You know that our connection continues for
me even if we aren’t seeing each other, and I hope you
will carry with you all that you’ve learned in this rela-
tionship with me.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
In sum, the termination process represented in the example
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above was the ending exchange of an intense therapy experience
for Thomas. The personal, mutually emotional, and reciprocally
vulnerable nature of the interaction was similar to many other
moments in Thomas’s FAP experience, in which the therapist
involved herself fully and strategically in the relationship in the
service of his growth (evoking and reinforcing his CRB2s). Al-
though we do not recommend this level of authenticity and emo-
tional intensity with all clients, with Thomas it made sense in the
context of the values and goals that he had committed his life to
over the course of this therapy experience. For Thomas, termina-
tion was a unique opportunity for emotional intimacy in terms of
an intense form of giving and receiving, expanding the client’s
repertoire to engage deeply with important others in all stages of
relationship— beginning, building, maintaining, and ending.
Empirical Support
While the FAP termination process has not been isolated for
research, studies with a full FAP protocol that involved termina-
tion procedures consistent with those discussed above include the
following: (a) a small randomized clinical trial in a college coun-
seling context showed significant reductions in depression and
anxiety, and significant increases in social connectedness, in FAP
compared to a watchful waiting condition (Maitland Petts, Knott,
Briggs, Moore, & Gaynor, 2016); (b) an alternating treatments
design comparing FAP to supportive listening showed a statisti-
cally stronger therapeutic alliance in the FAP sessions (Maitland &
Gaynor, 2016); (c) a small open trial indicated the positive impact
of FAP on smoking cessation and alleviating depression (Holman
et al., 2012); and (d) a group design study showed the effectiveness
of FAP-enhanced cognitive therapy depression compared with
pure cognitive therapy (Kohlenberg, Kanter, Bolling, Parker, &
Tsai, 2002).
Additional research on FAP processes, including single-subject
designs and microprocess research, has provided support for
FAP’s mechanism of action— effective contingent responding by
therapists to client problems (CRB1s) and improved behaviors
(CRB2s) as they occur in the session (Busch et al., 2009; Cal-
laghan, Summers, & Weidman, 2003; Lizarazo, Munoz-Martinez,
Santos, & Kanter, 2015; Kanter et al., 2006; Kanter, Schildcrout,
& Kohlenberg, 2005; Landes, Kanter, Weeks, & Busch, 2013).
This research, however, has not specifically explored the benefits
of responding to CRBs that occur during the termination process,
as discussed in this paper.
Broadly speaking, the termination phase is seen as essential in
psychodynamic and interpersonal approaches, which may view the
process as a corrective emotional experience (Craige, 2002; Joyce,
Piper, Ogrodniczuk, & Klein, 2007). The cognitive– behavioral
literature, in contrast, is primarily concerned with “premature”
termination (Goldfried, 2002) and places less emphasis on the
termination process. Although FAP is generally viewed as a be-
havioral or contextual behavioral approach (Hayes, Barnes-
Holmes, & Wilson, 2012), it clearly falls into the camp of focusing
on endings as providing opportunities for growth that can gener-
alize to daily life.
Although some may find the suggestion that therapists write a
letter to their clients as part of the termination process to be
difficult to accept, there is research to support it (O’Keefe & Berk,
2009). SmithBattle, Leander, Westhus, Freed, and McLaughlin
(2010) reported that therapeutic letter writing improved rapport
building and relational skills on the part of nursing students with
their patients. These letters provided summaries of the patient’s
accomplishments, and consistent with our suggestions for the
content of the closing letter, included what the nursing students
had learned from their patients. These patients expressed appreci-
ation for the reciprocal nature of their relationship with their
caretakers. Similarly, Kerr and Ryle (2006) recommended the use
of “goodbye” letters in cognitive analytic therapy, a treatment that
integrates cognitive behavioral therapy and psychodynamic ap-
proaches, as a means of facilitating the termination process, and
suggested that the letter include what therapists had learned from
the experience for themselves. To be clear, our suggestion to write
a termination letter is not meant as a directive that should be used
in all cases. Consistent with our functional analytic approach, the
use of such a letter would be appropriate when it is consistent with
serving the client’s daily goals related to interpersonal closeness.
The extent of therapist disclosure required in writing a FAP
termination letter and more generally in facilitating an in-depth
and emotional ending can be controversial depending on the the-
oretical orientation of the therapist. A strong parallel exists be-
tween FAP’s view of therapeutic opportunities presented by the
occurrence of client clinically relevant behaviors in session and the
psychodynamic notion of the “real relationship,” as discussed by
Schachter and Kächele (2013). Although early psychoanalytic
approaches discouraged therapist disclosure of information about
themselves, later humanistic and psychodynamic therapies argued
for such disclosures. This shift was based on the notion that
therapist disclosure modeled openness, strength, and vulnerability,
which can facilitate positive outcomes (Farber, 2006). Further-
more, research has indicated that strategic therapist disclosures can
enhance the therapeutic relationship (Tsai, Plummer, Kanter, Ne-
wring, & Kohlenberg, 2010), normalize clients’ experiences,
model adaptive and intimacy building behavior (Goldfried, Burck-
ell, & Eubanks-Carter, 2003; Vandenberghe, Coppede, & Kohlen-
berg, 2006), demonstrate genuineness and positive regard for
clients (Robitschek & McCarthy, 1991), and equalize power in the
therapeutic relationship (Mahalik, VanOrmer, & Simi, 2000).
Conclusion
While therapists tend to get focused on having good endings
with their clients, having no regrets, and making sure that they and
their clients say what is important to say, we believe that what
 SAYING GOOD GOODBYES
happens over the course of the entire relationship is what really
matters. Cocreating a deep, authentic, open-hearted relationship
throughout the course of therapy is what facilitates a memorable
ending. And in the words of poet Ralph Waldo Emerson (n.d.),
endings always lead to new beginnings: Our life is an apprentice-
ship to the truth that around every circle another can be drawn;
that there is no end in nature, but every end is a beginning . . . As
our clients end with us, our wish is that the skills they have
developed in vulnerable emotional expression will create begin-
nings in deepening current relationships and in developing new
and more meaningful interpersonal connections. We hope that
FAP offers a conceptually clear framework that crosses theoretical
boundaries and provides inspiring ways for scientist-practitioners
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to examine the impact of therapist-client reciprocal vulnerability in
This document is copyrighted by the American Psychological Association or one of its allied publishers.
the psychotherapy termination process.
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Received July 5, 2016
Revision received August 1, 2016
Accepted August 12, 2016 䡲

Practice Review
This is an open invitation for authors to submit what Charlie Gelso developed and termed a Practice Review for possible
publication in Psychotherapy. I want to continue this series as a step toward enhancing the value and relevance of scientific research
on psychotherapy and related processes to practice.
The general aim of the Practice Review is to clarify, as much as the current state of knowledge permits, what empirically-derived
findings in a given area imply for practice in that and related areas. In this type of review article, the reviewer begins the process
with the intent of deriving implications for practice from the research and theory that is examined. Much like program evaluation
research, the central question for the writer of a Practice Review may be phrased as: “Despite the near inevitability of at least
somewhat mixed findings on virtually any topic, what is the most likely relationship between these variables, and what does that
relationship imply for the practitioner?”
The above kind of question is based on an awareness that the practitioner must do his or her practice, despite the general lack
of fully consistent research findings; and it will be useful in that practice if the best available knowledge were used. This, of course,
is not to say that the reviewer may take a cavalier attitude toward drawing implications for practice. The reviewer needs to derive
such implications with great care. At the same time, the Practice Review does not convey the same degree of scientific skepticism
that is typical of the classical scholarly review. For example, in the traditional scholarly review, as in classical scholarly inquiry
in general, one takes a very conservative attitude toward accepting results. Substantial evidence must accumulate before we may
safely say a given finding is confirmed and valid. In the Practice Review, on the other hand, the investigator searches for the most
likely conclusion, when all evidence is weighed, and then seeks to place that conclusion within the context of practice.
The process of relating a “most likely conclusion” or finding to practice is rarely if ever a straightforward or linear process. As
but one example, the most likely conclusions about the role of duration of treatment in outcome is that, other things being equal,
the longer the therapy (at least up to a certain point), the more positive the outcomes. What implications does this have for the
practitioner? For implications to be drawn, this finding needs to be placed within the context of related findings, existing theory,
and other factors (e.g., pragmatic ones) that help the practitioner conceptualize duration factors in his or her practice. Placing
findings within contexts such as these may well modify the findings.
With these considerations in mind, the following guidelines are offered for those who write Practice Reviews:
1. Your set from the beginning should be to find out what are the most likely conclusions about the relationships under
investigation.
2. In doing so, consider how particular findings may be integrated with related findings in your area of review.
3. Once the most likely conclusions are arrived at and placed in the context of related knowledge, discuss what these findings
imply for the practitioner.
4. In relating findings to practice, show an appreciation of the likelihood that the findings-to-practice links will not be direct and
clear cut. Rather, given findings (“facts”) may relate to practice through their connection to theories, clinical wisdom, practical
and political concerns, etc.
5. Although the refrain, “more research is needed,” is virtually always valid, the practice review must not hide behind scientific
equivocation. Rather, the approach ought to be that, although more research is surely needed, here is our best available
knowledge and what it implies for practice.
Although the length of practice reviews should be dictated by the subject matter, such reviews generally should be limited to
about 25 pages of text. Reviews of relatively narrow topics should naturally be much briefer. Authors are invited to contact me if
they are considering writing such a review but have questions about the process. Email me at Psychotherapy@adelphi.edu.