A Review of Peter Sturmey's
Functional Analysis in Clinical Psychology

Reviewed by Joseph Cautilli
and Beth Rosenwasser

Functional Analysis in Clinical Psychology.
Sturmey, P. New York: Wiley, 1996 (254 pages).

However, as the book points out, “functional analysis” has come to mean many things to many people. There are several behavioral methods and even an “eclectic” version of a functional analysis. To help potential readers fully appreciate the merit of Sturmey’s (1996) book, this review will trace the origins of functionalist thinking and how it has changed since its initial inception. A detailed chapter-by-chapter review follows. Finally a summary of the ways that the text may be used in the graduate school classroom or clinic will be presented for those considering it as a primary text.

Historical Roots: From functionalism to behavioral functional analysis

One of the dominant modes of theorizing in the social disciplines is functionalism (Bernstein, 1976; Rorty, 1979). Historically, functionalism began in the late 1800’s and was seen as a reaction to the structuralism of Wundt. Functionalism had many proponents including William James and James Angell. Its basic tenets were: (a) psychology should study mental operations rather than mental structures; (b) these psychological processes were to be studied as the activity of the whole organism in context rather than as isolated and independent events; (c) study of these operations must be understood as a relational response to the environment; (d) conceptual dualism (between mind and body) is unhelpful to the study of human behavior. In contrast, a structuralist approaches of the time emphasized sensation as the content of consciousness, detailed description of consciousness based on careful introspection with a focus on description and prediction. Structuralists were more concerned with the question of what occurs, rather than the how and why questions of functionalists (Hilgard, 1987).

As a movement, functionalism was not originally a concept from psychology. It grew from the work of evolutionary biologist, Charles Darwin. Applied to behavior, functionalism addressed some unique questions not directly answerable by structuralist approaches. Questions generally approached by functionalists sound familiar to modern behaviorists, but terminology is used somewhat differently: (a)What precisely are the actions for which this behavior is used? (b) How does the pattern of behavior relate to each function of use? (c) Do different environmental factors exist that might account for the differences in form of behavior and use? To answer these questions, the concept of natural selection was applied to show how distal (molar) consequences effect the survivability and lineage (proportion of off spring) for the development of particular behavior patterns. For instance, a functionalist approach to understanding squirrels would emphasize that those squirrels who save nuts in the fall will survive and produce more offspring than those who do not.

With these philosophical tenets, the emphasis of the movement stressed the purpose of the behavior in the natural environment. To do this functionalism highlighted (as causal variables) overt, observable behaviors in lieu of private events (the sensations and cognitions of structuralism). In addition, proponents focused on the rationality of the behavior for a given context. Darwin’s theory of natural selection suggested that behavior (and biological structures) could be understood by looking at their role in the adaptation of the organism to the environment. Many of functionalism’s major tenets were absorbed into behaviorism, especially in the writings of B. F. Skinner, although with some modification.

Skinner (1938, 1953) endeavored to move experimental analysis from the molar level, beyond selection across generations, to look at learning within a lifetime. He replaced functionalism’s concept of the rationality of behavior with lawfulness. Modern behaviorism has incorporated this translation in two major ways. The lawfulness of behavior was demonstrated through the application of Thorndike’s law of effect. Skinner emphasized the process of reinforcement whereby the consequences of behavior ‘act back upon the organism,’ effecting the likelihood that behavior will occur again. This reconceptualization can explain situations where long-term consequences can be drastically different from the immediate results. For instance, consider a person with alcohol dependence. At a proximal level of analysis, his drinking is explained by the pleasurable consequences or avoidance of side effects. At a more distal level of analysis, excessive alcohol damages organs in the human body and can lead to social and job dysfunction.

The replacement of lawfulness for functionalism’s rationality is also apparent in Skinner’s approach to verbal behavior. The concept of rationality carries the baggage of intentionality; the term rational holds this implication. Skinner broke from this tradition by clarifying that learning can occur without awareness. Rationality is described instead as a moment-to-moment lawful reinforcement process. Although behaviorism can indeed address learning with awareness, the point is that it need not occur with awareness. While Skinner would later champion an integration of very molar (evolutionary) and molecular (reinforcement) analysis, his early writings focused more on the latter to the exclusion of the former.

With these modifications to functionalism made, Skinner (1953) defined a functional analysis as follows:

The external variables of which behavior is a function provide for what may be called a causal or functional analysis. We undertake to predict and control the behavior of the individual organism. This is our dependent variable – the effect of which we are to find the cause. Our independent variables – the causes of behavior – are the external conditions of which behavior is a function. Relations between the two – the cause-and-effect relationships in behavior – are the laws of a science. A synthesis of these laws expressed in quantitative terms yields a comprehensive picture of the organism as a behaving system. (p. 35)

Since Skinner wrote this, behaviorism’s emphasis on functional analysis for both experimental and clinical purposes has waxed and waned. An early focus on functional analysis can be seen in the work of Patterson, Forehand, Goldiamond, Bijou, Kanfer and Saslow, and others. In the 1970’s applied behavior analysis became enamored with the powerful technology that it created leading to more structural treatment designs (although theoretically rooted in functionalism). More recently, there has been a renewed emphasis on functional analysis. As Sturmey (1996) points out, the last fifteen years have seen changes in technique and conceptual refinements in functional analytic practices. This is the context from which Sturmey’s book has entered the scene.

Functional Analysis in Clinical Psychology

Sturmey (1996) opens his book with a brief history of the differences between a structural analytic and a functional analytic approach. He reviews the differences between descriptive and experimental functional analysis and between behavioral and what has come to be called eclectic or cognitive-behavioral approaches to such methodology.

In Chapter 2 Sturmey reviews several conceptual areas of functional analysis research. In particular, he looks at school refusal, anorexia nervosa, delusional speech, suicidal threats in persons with disabilities, and tic disorders among others. In addition he provides a referenced summary table of current diagnostic categories that have been subject to functional analysis. He then reviews examples of functional analyses of systems such as a correctional facility, doctor-patient relations, and classrooms. This chapter gives readers a sense of the wide scope of the psychology literature that functional analysis has addressed.

Chapter 3 reviews the literature and growth in the area of behavioral assessment. The movement is tracked from its beginning focus on the calculation of frequency, intensity and duration to advances relating the rate of behavior of the person to the rate of reinforcement in the environment. The emphasis here is on how hypothesis testing of functional relations has been advanced, using many specific examples. This type of assessment allows for direct linking of research and assessment to treatment, rather than cook-book applications of so-called behavioral methods. Interestingly, the point is made that functional assessment may lead to interventions that are not considered traditionally behavioral if these treatments address the function of the target behavior – e.g., talk therapy with a focus on the treatment relationship in order to develop a more realistic self-concept and adaptive responses to intimate others may be an effective treatment for a person whose depression is functionally related to subtle maladaptive interpersonal repertoires (Kohlenberg & Tsai, 1991). This chapter might be used as a stand-alone chapter to an introduction to functional analysis within the context of a clinical practicum class or introduction to assessment class or training.

Chapter 4 covers behavioral interviewing. Sturmey holds that behavioral interviewing is a critical but often underrepresented part of functional analysis research. Learning how to conduct a behavioral interview is quickly becoming important to many domains, not just in psychology but also in management and human resource departments. This chapter presents specific interview techniques in easy-to read table format with examples (e.g., rapport-building, open- and closed-ended questions, paraphrasing, etc.). It goes on to demonstrate how these are used in functional hypothesis testing and picking behaviors for treatment target. This chapter could stand on its own for a wide range of training purposes in both behavioral and cognitive oriented settings. The text is useful for organizing training activities. For example, it provides a list of articles containing annotated behavioral interviews that teachers, clinical supervisors and trainers can use in teaching behavioral interviewing as well as presenting a hypothesis testing “game” that looks like a lot of fun!

Chapter 5 focuses on the importance of behavioral observation. The author points out that self-report data are subject to the bias of the client-subject who may lack accurate awareness of their own behavior and its various functions. Additionally, clients may wish to appear better or worse than in actuality for a variety of reasons. Instead, behavioral observation data allow the clinician to base target goals on actual samples of behavior in context. As in other chapters, after presenting a theoretical discussion, the practice is outlined. This chapter covers a range of topics from creating observation forms to methods of checking reliability; several examples and forms are given. Finally, Sturmey addresses the complexity of behavioral observation, pointing out that observational data are not without their own form of bias including sampling and interpretive errors.

Chapter 6 focuses on the role of psychometric measures in functional analysis. Since behaviorists frequently go on to practice in environments or universities that are non-behavioral, this text does a good job of educating readers as to the central differences between behavioral and “non-behavioral” approaches. In doing so, Sturmey shows the overlap areas, including discussions of the difficulties or limitations with some behavioral approaches. Although this runs through the text, this chapter emphasizes the gray overlap area. He discusses the burden for clinicians of a completely idiographic approach and presents formulaic approaches to functional assessments. This is a practical book. Sturmey reviews the validity, reliability and robustness of several measures including the Functional Analysis Checklist, The Functional Analysis Interview Scale, The Motivational Assessment Scale, and others.

Following the history and methods sections of the book, chapter 7 begins the process issue section. Chapter 7 is the highlight of the book in that it really shows the scope and depth of functional assessment. Sturmey correctly emphasizes that functional analysis is more than just questionnaires: it is a process of understanding how clients’ problems are related to the world around them. This chapter begins by discussing the difficulty in operationally defining and identifying target behaviors. An important issue in the field has been the relative lack of research on operationalism. In addition, Sturmey deals with the complexity of determining if responses belong to a particular response class, are part of a chained response, or belong to a response hierarchy is very difficult to determine. The text makes several suggestions that are helpful in teasing out these areas.

Sturmey does not shy away from difficult theoretical and practical topics! He reviews the literature on response-response relations and eliciting functionally equivalent alternatives. The chapter ends with a return to the old antecedent-behavior-consequence event recording. However, event recording and analysis is now strengthened with the concept of the establishing operation. Establishing operation research is reviewed. One small area of disappointment with the book is its failure to review the literature on interventions for establishing operations, which have come to be known as neutralizing routines. The chapter ends with how functional analyses can be helpful in the treatment of problematic private events such as depression and anxiety.

Chapter 8 deals with how to write up functional analysis protocols. It presents a standard methodology for case presentation. Practice exercises for students and clinicians are included. Finally Sturmey reviews how to evaluate antecedent, consequence, and history based strategies.

Chapter 9 deals with critical issues in functional analysis. He underscores the way that functional approaches emphasize that clinical behaviorists are practicing scientists and need to stay connected to our experimental roots. This is a movement away from the manualized treatments of the 1970’s and back to a point of being more analytic and theoretical in our work. This chapter includes a literature summary of studies comparing functional with other approaches.

Ways to use this text

We highly recommend this text for use as an introduction to functional analysis, perhaps within the context of an introductory clinical class such as a second year practicum course. It is appropriate for masters or doctoral level students. In order to appreciate this book, students will need prior exposure to basic behavioral procedures and terminology such as “multi-element design,” “graded exposure,” or “chaining.” Alternatively, as noted in the detailed review above, several chapters could be used independently for various training purposes. We found several training references and procedures, as well as interesting clinical examples, which enhance our current work as instructors/supervisors.

In using this text for a class, it is set up so that the professor can supplement chapter overviews with the actual rating scales, direct observation measures, articles with the cases described for more detailed discussion. There are some sections that would need more extensive supplementation; for example, for those interested in behavior analytic discussions of verbal behavior, there is little analysis of client talk from this perspective. However, the case descriptions, which come from a functionalist perspective, are set up in a way that make them easy-to-use for this purpose. He really addresses the subtleties of functional analysis in a way that books covering classic behavioral direct observation measures do not. This is particularly important in working with adult outpatients and caretakers of those with developmental disabilities where precision in experimental control becomes more difficult to arrange since self-report and self-editing are both more common.

In conclusion, Sturmey’s (1996) book is well worth your time. The process chapters are loaded with plenty of case examples to give even a novice a good feel for the subject matter. Overall the book gives basic exposure to the current research and literature in functional analysis and would make an excellent graduate text.

References

Bernstein, R. J. (1976). The reconstructing of social and political theory. Philadelphia: University of Pennsylvania Press.

Bijou, S. (1966). A functional analysis of retarded behavior. In R. Ellis (Ed.) International Review of Research in Mental Retardation, Volume 1 (pp. 1-19). New York: Academic Press

Hilgard, E.R. (1987). Psychology in America: A historical survey. New York: Harcourt Brace Jovanovich.

Kohlenberg, R.J. & Tsai, M. (1991). Functional analytic psychotherapy: Creating intense and curative treatment relationships. New York: Plenum Press.

Rorty, R.(1979). Philosophy and the mirror of nature. Princeton, NJ: Princeton University Press.

Skinner, B.F. (1938). The behavior of organisms. New York: Applton-Century-Crofts.

Skinner, B. F. (1953). Science and human behavior. New York: Macmillan.

Sturmey, P.(1996). Functional analysis in clinical psychology. New York: Wiley.

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