Joan Rullan: "More and more people are starting to train in ACT".

We interviewed Joan Rullan, promoter of Activital's Acceptance and Commitment Therapy course.

Third generation therapies are part of a wave of recent therapeutic proposals increasingly used by psychologists.

Among all of them, Acceptance and Commitment Therapy (ACT) is possibly the best known, both in terms of research and in terms of the effectiveness of its therapies.It is possibly the best known, both in terms of research on its forms of application and effects and in terms of the degree of familiarity that psychologists have with it. And this popularity is increasing.

However, in Spain there is still not a wide variety of training programs specialized in ACT. Today we interviewed one of the psychologists who are making sure that this changes, Joan Rullan, from Activital Psicólogos..

Interview with Joan Rullan: training psychologists in Acceptance and Commitment Therapy

Joan Rullan is a psychologist and trainer member of Activital Psicólogos. In this interview he talks about the initiative that has led his team and himself to offer training for psychologists and psychiatrists through Activital's "Acceptance and Commitment Therapy Online Course", one of the few ambitious online training programs on ACT in Spain.

What are some of the myths that exist about Acceptance and Commitment Therapy?

I believe that both Acceptance and Commitment Therapy and Contextual Therapies as a whole are awakening the interest and respect of a good part of the psychologists who come to know them. I believe that the scientific rigor of the main developers of ACT and the empirical evidence on which it is based have a lot to do with this.

It is true that there are certain myths and criticisms of ACT, which from our point of view are the result of ignorance, or biased information. I have heard it said, for example, that ACT is practically synonymous with Mindfulness. In ACT we apply certain Mindfulness practices with certain objectives, but it is neither necessary, much less a theoretical pillar on which it is based.

In our culture the term "acceptance" can be confused with "resignation", which can often lead to misinterpretations of what we do in Acceptance and Commitment Therapy.

I have heard other critical opinions that are curiously opposed to each other: from the fact that it does not contribute anything new with respect to Skinner's radical behaviorism, to the fact that in ACT emotions and thoughts are considered as causes of behavior. I don't think that neither position fits with what is exposed in the main texts and trainings in ACT.

What made you decide to launch the ACT course that you offer at Activital?

The idea came after the ACBS (Association for Contextual Behavioral Science) World Congress in 2017. Talking with other colleagues we were surprised to learn that in Spain we were very lucky to have masters exclusively on Contextual Therapies such as the one directed by Carmen Luciano. We saw that as her students, we had a broad and deep training.

In many countries the training offer is scarce, and certainly much shorter. They usually take place in one-off seminars, or occupy a few hours within clinical training in general.

In spite of this, we realized that there were practically only two ways to learn ACT in Spain. The first is by reading manuals in a self-taught way, and the second in masters like the one I mentioned above, but which require a high time and economic commitment. It is true that in some universities some time is being dedicated to Acceptance and Commitment Therapy, but in an introductory way.

Our idea was to create an intermediate step, an online course with which to learn ACT in a complete way from the theoretical and philosophical bases to the applied part. It could be useful for those who want to start from scratch, or who have been training for some time in short seminars or on their own.

What are the most important aspects to take into account if, as psychologists, we want to train in Acceptance and Commitment Therapy?

The main thing is that the training emphasizes the theoretical foundations. ACT is a way of putting into practice a series of specific scientific and philosophical principles. Without a good knowledge of functional contextualism and learning principles, we will hardly be doing ACT, no matter how many metaphors we know.

To use a metaphor since I mention them, if we want to learn to play the guitar really well and flexibly in many contexts, we cannot do it by learning the chords of our favorite song. We need to know the instrument well, to know about basic musical principles, harmony, rhythm, and so on.

I also see that since ACT is a relatively new therapy, there are many trainings on "modern therapies", in which ACT is taught one day and the next day another therapy with which it shares practically nothing in its foundations. From my point of view a good training in ACT should be exclusive of ACT or together with Contextual Therapies with which it shares fundamentals, otherwise we will hardly learn well the underlying model.

What are the practical effects of trying to apply ACT without a good knowledge of its theory and the philosophical foundations on which it is based?

I believe that we will hardly be doing ACT without mastering those bases, given that our social and cultural context when talking about the psychological is very marked by psychoanalysis and the biomedical model.

All of us, psychologists and non-psychologists, have our own philosophy, explicit or not. Either you are a mentalist or you are not, there is no other. You are either mechanistic, or contextualist, structuralist or functionalist, and so on.

One of the great advantages of training in ACT is that it invites you to adopt a concrete vision of how people function, how psychological problems are generated, maintained, and can be modified. The applied part is a way of operationalizing this knowledge.

Without mastering these bases it is very easy for us to fall again and again into that way of talking about psychology that we have inevitably learned and from which we want to get our patients out of.

An example of this would be telling a patient that we are going to help them accept their negative thoughts. Without wanting to or realizing it, talking about negative thoughts already has aversive functions, and how is he going to accept them if they are negative.

Following the example, if we have learned ACT only for its applied part, perhaps we will do an exercise to help him to defuse certain thoughts, and in another moment of the therapy we will seek to reduce or eliminate those thoughts. In short, we can generate a lot of confusion and be counterproductive with our patients.

I think you can be very eclectic in terms of techniques if you have a solid theoretical basis, but being eclectic in terms of fundamentals seems to me to be unstable, it can be chaotic.

What learning strategies and methods did you want to promote, did you consider that they fit well with the purpose and content of the course?

The idea of the online course is that it can be comfortable to learn its contents. That is why we allow each student to go through this learning path at their own pace. All modules have a "notes" document, and a video recorded lecture on the syllabus, which are uploaded to the platform and are accessible at any time.

As you may have deduced from the previous questions, we dedicate an important part of the training to understand the philosophical and theoretical bases of ACT: Functional Contextualism, Behavior Analysis, Relational Frame Theory...

But this is not a theoretical course; the practical part, seeing how ACT is applied to different problems, occupies more than half of the training. In these applied modules, we explain what to do and how to do it, for which we use role-playing videos addressing different problems. So that students can practice, we provide them with a package of 40 experiential exercises, metaphors and other techniques, and 4 fictitious cases with which we raise some practical issues.

What are the elements of the training that you notice that students value the most?

We like to have a fluid communication with our students, and from what they tell us I would highlight two elements. The first is the role-playing videos in which they can observe how to carry out the applied part. This is something we wanted to include because we have found learning by modeling in therapy to be very useful when we have also trained ourselves.

The second is individualized feedback. We propose a series of tasks to see how they would approach one case or another, and then we give it back to them with comments and proposals as to how the interactions they have proposed could be optimized.

Have you noticed any changes in the way Acceptance and Commitment Therapy is perceived and used by psychologists in Spain?

Without a doubt, I think it is a reality that more and more people are starting to train in ACT, and I think it is important to note, that they are staying in ACT. And psychologists look for what works best for us in therapy, so the fact that they "stay" in ACT is a sign that they find it useful to help their patients.

I know that the contextual model is increasingly entering universities around the country, especially in Andalusia. We ourselves, being a small team, have trained more than 200 professionals in the two years we have been offering the course. We have several very complete masters in Spain from which people leave, as far as I know, learning a lot and with a clear model.

I would also like to highlight something interesting that some students have shared with us, and that is how, through their training in ACT, they have learned about behaviorism first hand, reading Skinner, for example, and have been surprised by how different it is from what they were told about behaviorism in their undergraduate studies. That change in perception strikes me as very interesting and promising for the future of our discipline and the development of psychology as a science.

This is something that I think affects both behaviorism and Contextual Therapies. I have the feeling that nowadays there are so many therapies, pseudotherapies and so on, that psychologists have to choose and choose well. And if you investigate currents and models, you see that ACT has the scientific character and commitment to research that I think should be required of any psychological perspective, and that generates confidence.