What are contextual therapies and what types exist?

Contextual or third generation therapies provide new perspective on what we understand about psychological disorders and their treatment. Although some authors point out that these therapies are a direct descendant of Skinner’s radical behaviorism, even accepting the idea as valid, we would be too simplistic if we reduced the postulates of the daughters -third generation therapies- to those of the “father” -Skinner-.

Relational frame theory (RMT) is one of the main commonalities of all these therapies. This theory is based on the theoretical precepts of functional behavior analysis (FBA) focused on language and cognition.

Another of their common points would be do not consider private and unpleasant events as phenomena to be eliminated, since it entails a high experiential avoidance, with the price that this dynamic imposes. The importance of the person’s values ​​as the axis that guides the therapy intervention varies from one therapy to another.

As main exponents of contextual or third generation therapies would be:

Acceptance and commitment therapy (ACT). Dialectical-behavioral therapy (DBT). Functional analytical psychotherapy (FAP). Behavioral activation (AC).

Although there are other approaches, they are currently the main ones today. Let’s see what each of them consists of.

Contextual therapies: behavioral activation

Behavioral activation (BA) is a new therapy for depression developed on the basis of contextual and functional therapies. The AC maintains that the context explains depression more efficiently.

Maintains that the behaviors that characterize depressed people play a significant role in the evolution of depression. They are not merely symptoms of a condition.

Good part of the behavior of depressed people actually functions as behavioral avoidance of important areas of life. Behavioral activation tries to restore the person to life, putting him or her in contact with the conditions that could reorder the “disorders” or given disorder.

We can say that Therapy is a procedure to increase behaviors that make contact with reinforcing environmental contingencies probable. These behaviors will produce changes in thoughts, mood and quality of life. It involves activating the person to the extent of their current possibilities and in accordance with their interests and values.

In this regard, the functional analysis of behavior is essential, from which to put into play the activities that could be relevant.

Contextual therapies: comprehensive couples therapy

Comprehensive couples therapy understands that relationship problems not only require first-order changes (modifying one behavior or another). Second-order changes must also occur, that is, the person making the complaint tries to accept the other’s behavior.

TIP does not promote behavior change, but instead encourages change in oneself rather than in others. A change, therefore, in the context of the problem rather than in the problematic behavior.

Fundamental aspects

Comprehensive couples therapy places its emphasis on three fundamental aspects:

Returns to functional analysis as a way to evaluate relationship problems. Emphasis on natural reinforcement using fewer rules.More importance to context in which problems arise, that is, much more attention is paid to the role of the individual’s history in current problems.

In comprehensive couples therapy Careful consideration is given to the antecedents and consequences that maintain a given behavior. As Jacobson and Christensen (1996) point out, this is not without difficulties, since it is impossible for the therapist to be present in each of the conflicts of a given couple, so it becomes inevitable to trust their judgment.

Contextual therapies: acceptance and commitment therapy

Acceptance and commitment therapy deals, like behavioral activation, with clarify the patient’s values ​​and promote the development of behaviors in line with these values. By doing just this, the therapist will already have a lot to gain.

The main objectives of ACT would be to treat the so-called experiential avoidance disorder, promote acceptance and take into account the client’s personal values ​​at all times during therapy.

experiential avoidance

This therapy has been conceived as a specific treatment for those psychological problems that can be classified as what is known as experiential avoidance disorder (EED).

TEE occurs when a person is unwilling to make contact with their private experiences (thoughts, feelings, memories, etc.). The person behaves deliberately to alter the form or frequency of such events.

The TEE is conceptualized from an analytical-functional perspective. It is a functional diagnosis in contrast to the topographical and mechanistic conceptions prevailing today, especially those of the DSM. Sometimes, TEE has been related to a lack of cognitive flexibility. In other words, it is a state of “cognitive fusion” with private events.

The therapy has a double objective: On the one hand, it seeks for the patient to come to accept those aspects of his experience (thoughts, emotions, memories, etc.) that he has been trying to modify without success. On the other hand, it is that such private events no longer paralyze the person’s life.

Contextual therapies: functional analytical psychotherapy

Functional analytical psychotherapy (FAP) is a form of behavioral therapy that emphasizes the use of the therapist-client relationship. The goal is to use with all their intensity the learning opportunities that arise in the therapeutic session.

FAP produces change through natural reinforcing and healing contingencies that occur within a therapist-client relationship. emotional, close and with a high degree of involvement.

Kohlenberg and M. Tsai found that some of their clients treated with conventional cognitive-behavioral therapy techniques experienced notable improvements that went beyond the initial treatment goals. They observed that this progress occurred in those patients with whom an intense and committed therapeutic relationship had been established.

The FAP greatly values ​​in vivo learning opportunities, that is, the actual appearance of the patient’s problems in their interaction with the therapist. We can distinguish three types of clinically relevant behaviors within therapy:

Relevant behaviors type 1 (CCR1) They are those behaviors related to the problem that the client presents in the session and whose frequency must be reduced throughout the therapy.Type 2 (CCR2) They are the behaviors that occur in the session and that represent an improvement in relation to the problem for which the patient is consulted.Clinically relevant behaviors type 3 (CCR3) They are the client’s interpretations of their own behavior. Along with these, descriptions of functional equivalence are also included that indicate similarities between what happens in the session and your daily life.

Conclusion

Contextual therapies or third generation therapies represent a break with cognitive or second generation therapies. They focus on accepting and changing the relationship we have with our internal events (thoughts, emotions).

They propose that the goal is not to suppress those negative thoughts that are unpleasant to us, since they appear automatically and the experiential cost is very high. The acceptance of negative thoughts and feelings as something normal in our lives is one of the objectives of these therapies.something that will shock patients at first.

Contextual therapies move away from the traditional way of diagnosis, since they consider that an endless enumeration of symptoms and their treatment will not go to the root of the problem. A functional analysis of behavior will have to be carried out to take into account that it is more important to know what function these symptoms serve than to group them into a label – a defect that many attribute to the DSM.

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