Interview with Adrián Muñoz Pozo, expert in contextual therapies

Psychologist Adrián Muñoz Pozo answers our questions about what these therapies consist of.

Psychotherapy is sometimes spoken of as a process in which the psychologist simply limits himself to eliminating the specific symptom, without taking into account the discomfort responsible for the appearance of this phenomenon.

However, this criticism does not correspond well with reality. In fact, there is a set of psychotherapeutic approaches designed precisely to put the general well-being of patients above all else: These are contextual therapies, also called third-generation therapies..

Third-generation therapies go beyond the symptom and focus on the overall well-being of the person.

However, this explanation is no more than a simplification, and in reality there are many more interesting characteristics that make this psychotherapeutic approach a very interesting option to consider when seeking psychological assistance. For this reason, it is best to have an expert's point of view.

Interview with Adrián Muñoz Pozo, psychologist expert in contextual therapies

To learn more about third-generation therapies, we talked to Adrián Muñoz Pozo, a psychologist who offers psychological assistance in Malaga and Fuengirola, so that he could explain this area of mental health work to us.

If you had to summarize what third-generation therapies consist of in a single sentence, how would you do it?

It is a difficult task to summarize a whole paradigm shift in a single sentence. But here we go.

In a sentence: understanding human behavior (verbal or nonverbal) within the context in which it is generated, analyzing the functions that maintain behaviors in order to employ intervention strategies aimed at creating a more flexible behavioral repertoire that allows people to reach a horizon full of vital purposes.

What are the differences between this new proposal for psychological intervention and classical cognitive-behavioral therapy? Do you think that they totally break with the pillars on which the latter is based?

Yes, totally. Third-generation therapies constitute a contextual rethinking of clinical psychology, a new way of understanding psychological problems and their approach.

Second generation or cognitive-behavioral therapies understand that the cause of 'mental disorders' lies in alterations of cognitions (thoughts, beliefs, attributions, expectations). Consequently, the treatment of these problems will consist in the development of specific techniques to reverse this situation.

Therefore, we are faced with a model based on the Input-Output (I-O) schema of cognitivism, which is internalist, nosological, nomothetic, biomedical and focused on the elimination of the symptom as the clinical purpose.

In contrast, third generation therapies are based on an ideographic, holistic and contextualist model to understand the origin and maintenance of psychological problems, based on Skinner's radical behaviorism and the return to the use of functional analysis of behavior.

From this perspective, symptomatology is not understood as something dysfunctional and to be eliminated, but rather all the emphasis is placed on the construction of treatments that go in the direction of abandoning the struggle against the elimination of symptoms and the construction of fuller personal lives.

Among all the third generation therapies, you specialize in one called Acceptance and Commitment Therapy. What does it consist of?

In Acceptance and Commitment Therapy, ACT, psychological discomfort is seen as part of life. Suffering is intrinsic to the fact of living. However, people try to avoid being in contact with all those internal events (thoughts, emotions, sensations) that cause us discomfort. These attempts to eliminate, reduce or modify the "negative" private events is what is known as "Experiential Avoidance Disorder".

In ACT, the goal is for clients to learn to become aware of their control agenda (avoidance behaviors) and to abandon these behaviors that have not helped them to let go of their discomfort.

At the same time, clients are trained to generate a state of acceptance of private events that cause them discomfort as an alternative to avoidance through exercises and metaphors that aim to generate a state of cognitive de-fusion. That is, learning to observe private events as they are: mere thoughts and emotions that we have at a given moment due to the circumstances and history that surrounds us. That is, learning to see private events with perspectives and not through them.

But ACT is not about exposing the client to his or her suffering for the sake of it. Exposing yourself to your private annoying events is a means to a greater end: to lead the life you want, in accordance with your values, understanding values as all those things we do that bring meaning to our life.

Usually, people think that we can only and only lead the life we want if we eliminate discomfort and find ourselves in an ideal state of well-being. However, as many of you, the readers, have already seen that we do not have much control in selecting what thoughts or feelings we want to have or not have at a given time to perform any type of activity.

Therefore, at ACT we teach clients that they do not have to eliminate or modify their discomfort as a premise to lead the life they want. We teach them to focus and put their time and effort into what really matters to them (being a better parent, being a better employee, having better health, being closer to friends, etc.) and to take committed actions to achieve it, regardless of the private events we have.

Working on focusing on your values, learning to accept and take distance from the private events that generate discomfort and are interpreted as incapacitating is what promotes psychological flexibility and with it the subsequent fruit of leading a life that, despite your private events, you qualify as satisfactory and meaningful, since you are dedicating your time, your life, to the things that really matter to you, and not to trying to control something that is uncontrollable.

One of the keys to this type of psychological intervention is that it helps you not to create additional problems for yourself by feeling responsible for your discomfort. How is this achieved?

That's true. Many of my clients, especially after doing the creative hopelessness exercise, tend to think that they are to blame for feeling the way they feel. To which I always allude to the metaphor of digging:

"Imagine you've fallen into a hole, a very very deep hole, and you want to get out of it to continue on your way. Then you reach into your backpack and take out the tool you are carrying: a shovel. And you start digging and digging... after a while, you realize that you are still in the hole. What's more, now you're deeper."

The problem is not that you have fallen (as you feel), nor the person who has fallen, but the only problem is that you have been using a tool that is not indicated, that is ineffective, to solve the problem of getting out of a hole.

This shovel is a tool that we all carry as standard in our backpack and the only mistake has been to use it where it is not effective. That said, we have no choice but to let go of the shovel, later we will discover what to do to get out. But now, the main thing is to stop using something that does not help us to solve the problem.

With this metaphor we help our clients not to generate these feelings of guilt towards themselves. Instead, they should take responsibility for the actions they have been taking to eliminate their discomfort. How these actions have not been fruitful and thus propel them to undertake new actions in the direction of values.

In what type of patients do you think the advantages of Acceptance and Commitment Therapy are most noticeable?

In general, all patients who end up contacting ACT notice a great improvement in the quality of their lives.

But, in particular, those people whose problem is chronic, or who have been struggling for many years to solve their discomfort, are the ones in whom improvements are most quickly observed. Contrary to what one might think.

Clients who have been immersed in their discomfort for a long time are the ones who have developed the most avoidance behaviors with the purpose of eliminating, reducing or modifying their discomfort.

This facilitates a more rapid change in the abandonment of the struggle to control their internal events, since their experience tells them that it has been impossible to get rid of their discomfort no matter how many things they have tried throughout their history. This is what is known in ACT as generating a state of creative hopelessness.

How do psychotherapy sessions based on this paradigm usually develop?

In general, in contextual therapies and in particular in ACT, sessions usually take place in a relaxed and warm atmosphere, where psychotherapist and client are seated facing each other, as equals, person to person.

From this position, the psychotherapist shows his client that, like him, we too are exposed to human suffering and therefore understand them and share the same experience.

When approaching the reason for consultation, this is done from the functional analysis of behavior. That is to say, we analyze together with the client the behavioral repertoire that he/she deploys in the face of his/her discomfort so that he/she can glimpse his/her own control agenda and see the ineffectiveness of his/her avoidance behavior.

In addition, ACT sessions are dynamic sessions, in which many experiential exercises are practiced to expose the client to his or her feared private events; as well as the use of metaphors, adapted to the client, with the purpose of generating acceptance and de-fusion with the mental content. And there is also the use of activities aimed at the clarification of values and the commitment to action directed towards them.

Finally... could you tell us about a case of improvement of a patient that you feel particularly satisfied and proud of?

Of course. I remember one of my cases that best exemplifies the change that ACT produces in the lives of clients who ask for help, and at the same time one of those cases that make you learn.

I still remember this client, a woman, about 38 years old, with a degree in chemistry, with a steady partner, although she lived with her parents in the family home. We will call her Ana.

She came to the consultation requesting assistance because she was going through a stage in her life in which she was experiencing symptoms of anxiety and uncontrolled stress.

Exploring her background, we could see that she had grown up in a very protective family environment in which achievements were not reinforced. In addition, throughout her life, whenever she was exposed to a feared situation, she abandoned it. She was afraid to look for a job outside of her hometown because she was away from her parents. She was afraid of becoming independent and not being able to support herself financially. Fear of leaving and losing the friends and hobbies she had in her environment, etc.

We began to work following the ACT guidelines that I explained in the previous question, and very early on we began to explore problems, since she was very focused on trying to eliminate her private events that caused her discomfort. Even so, we continued with a lot of effort, dynamics and various exercises.

I remember that as the sessions went by, we worked on making this type of behavior and her values more flexible, but she kept insisting on the condition of eliminating her private events as a condition to lead the life she wanted to lead. Despite this complaint, I insisted that she open up to her experience, and we worked on many exercises of acceptance and cognitive de-fusion coupled with taking actions in the direction of her values.

Ana had a teaching career, and it was her true vocation. However, she had only worked as a teacher on a few occasions, covering the summer vacations at her local school.

Throughout the sessions, Ana realized that the job she was in was not to her liking (it was not linked to education) and she took a very brave step. Which, until then, was unthinkable. She left her job, despite the uncertainty and fear that this new situation created in her. We were beginning to observe changes in her: she was more open to change, to her discomfort, and above all, she was taking more action in the direction of her values.

Once this step was taken, we set out to get her to look for new career goals in the direction of her vocation as a teacher. She began to prepare for the competitive examinations and started to apply for job vacancies. After a few weeks, she got a call from a job bank in Melilla to fill a position. And she accepted.

She packed her bags and went to undertake this new adventure in Melilla with her partner. I remember that she lived it with a lot of fear and that we had to work a lot on living in the present moment, since she was very anxious and anxious about the fear of failure. Even so, she persisted.

Today, a year and a half has passed since Ana set foot in Melilla. She continues to work there, lives with her partner, practices sports and has created a circle of friends with whom she goes on getaways. Everything she desired and that, in her opinion, her fears prevented her from achieving. And best of all, she has achieved it without having to stop her life to eliminate her fear and anxiety.

When I ask her how she is doing, she always reminds me that there are days when she feels anxious, when her fear returns, when she gets tangled up with her mind... but I always remind her of the same thing: "look at where you are, is that the life you want to lead?" Yes. "Then make room for that discomfort and keep building a rich and satisfying life".

However, when I ask her how satisfied she is with her life, she says something along the lines of, "It's the best I've been able to do. She may feel fear and anxiety but she is comfortable with what she is doing and feels that she is a real teacher, something she had always dreamed of."

This is a case that I like very much because it exemplifies very well how ACT works. At ACT, we want people to build valuable lives, lives that they want to be lived. And for this, we use techniques that help people to stop controlling their emotions or thoughts, developing a spectator attitude towards them.

Instead, we encourage and reinforce all those actions that go in the direction of achieving a fuller life, a life oriented towards their values.