Mara McGraw, MSW - Relational Mindfulness for individuals, couples & moresomes

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Chain Analysis

The Behavioral Chain Analysis (BCA) is the backbone of DBT informed treatment. If consists of 1-define the problem; 2-explore factors that influenced the behavior; 3-define solutions; 4-troubleshoot solutions; and 5-commit to practicing the solutions. 

There are many factors that influence the effectiveness of the chain process. Beyond the basics (lets assume the client is willing and has the capacity to recall the events, and the therapist is actively practicing nonjudgemental stance) many of my clients report a sense of shame arising during the description of the event (defining the problem). It's paramount that the therapist attend to this response and highlight it to the client in the moment; early in treatment some clients aren't aware this is happening they only know they feel uncomfortable and might state feeling judged. Blocking a shame response by checking the facts of the current moment, identifying the emotion that fits the facts and using verbal and nonverbal behaviors to rehearse the emotion that fits the current facts ("I'm in my therapist's office and s/he is here to support and teach me, not reject me") allows the client to learn a new behavior and "primes the pump" in their brain for a more effective emotional response that, if practiced during each chain, will result in a changed emotional response while revisiting less skillful moments in their life. Ultimately this is the skill that will enhance the client's ability to conduct an effective chain on their own, outside of treatment, so they can ideally become their own therapist for life.

Factors that influence behavior happen on two ends of the chain: immediately before and immediately after the targeted behavior. I'll take a moment to define "behavior" as any body sensation, verbal or nonverbal action, thought, or emotion. A "target" is any behavior the client wants to change. The behavior that happened immediately before the target, is the precipitating factor (PF): e.g., feeling lonely and a desire for connection, feeling anger and a sense of rejection, etc. The behavior that occurs immediately after the target is the controlling variable (CV) is the reinforcer or what happens to keep the target in place: e.g., flirting with someone and having anonymous sex that satiates the desire for connection, arguing with someone and rejecting them before they reject you to prevent feeling vulnerable, etc. At this stage in the chain it's important to get excruciating detail in order to intervene at the right moment. If therapist and client pick the wrong PF and CV we won't see the desired change. This sometimes happens and we can recover by retrospectively chaining, in the next session, the solution rehearsal to figure out why our experiment wasn't as effective as intended. 

In defining solutions we need to be confident the new behaviors to rehearse are clearly defined, attainable and measurable. Again, excruciating detail on what exactly the client is to do differently, that they have the capacity to do it, and that we've set it up in a way that we can return and notice before and after effects. 

Effectiveness of solutions can be thought through by troubleshooting the following roadblocks: 1-Is there a skill deficit? If yes, teach/learn the skills. 2-Are there emotions that could get in the way? If yes. add emotion regulation skills prior to the new behavior solution. 3-Are there worry thoughts that may block effectiveness? If yes, review the common thinking errors and align thinking with desired outcome and identify possible invalidation of self or others and correct it. 4-Is indecision a factor? If the client hasn't decided to change or doubts the solution or isn't sure in some way, re-evaluate and firmly enter into a choice to resolve or postpone solution rehearsal. 5-Is the environment too strong? If our solution is dependent on someone else changing first or engaging in a specific behavior, or if the environment will simply deny or is inflexible, we need to re-evaluate our solution. 

Finally, and most often a hiccup in the process, is the client has agreed to rehearse the new behavior solution in the office (to please the therapist, because they initially do agree and later change their mind, because they want to avoid the conflict of disagreeing, etc) and isn't 100% committed to working on this change. The client and therapist need to asses commitment and link this new behavior rehearsal to the clients overall, long term, quality of life, ultimate goals. This is big stuff! To use the examples above, this small change could be a paving stone on the path to the client finding true connection with a life time partner or eliminating a sense of perceived rejection that results in maintaining friendships over the course of a life time.

There are, likely, many factors that influence the effectiveness of the behavioral chain analysis process that are individual to each client and therapist; here I've highlighted a few known pitfalls and troubleshooting options in creating lasting change. More information on BCA can be found in Dr. Marsha Linehan's skills training manual, in other DBT informed skills books and online by searching for "behavioral chain analysis" or some combination of those words.            

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