The 4 types of Contextual Therapy: what are they and what are they based on?

Contextual therapy perceives the person as a being in constant interaction with his or her environment.

Throughout the history of psychology, therapies have evolved from a predominantly philosophical perspective to a much more empirical approach, thus developing behavioral (first generation therapies) or cognitive-behavioral (second generation) therapies.

However, this trend is on the decline; contextual therapies, or third generation therapies, are becoming increasingly common in clinical practice. The different types of contextual therapy are based on the philosophical current of Functional Contextualism, whose base is based on the results of research in the laboratory; and it has applications in any area of human life.

What is Contextual Therapy?

As already mentioned, contextual therapies receive their name from Functional Contextualism. From this perspective, the person and his/her behavior are studied within their context and not in isolation.

Moreover, these therapies give special importance to the patient's verbal behavior and the values he or she holds.. In other words, what the patient says to himself and to others directly influences his behavior and daily functioning.

Types of Contextual Therapy

Although they are not the only ones, there are four models of contextual therapies that stand out from the others. But all of them have a common goal: to alleviate the patient's mitigation through the development of much more effective, extensive and elastic behavioral patterns.

Mindfulness

Mindfulness has already established itself as a reference therapy within the contextual models. Although there is no specific word to refer to Mindfulness, the most accurate translation would be Mindfulness or Full Awareness, among others.

Although as a general rule, we think we are in control of our attention and thoughts, the reality is that we are constantly attending to intrusive thoughts about the past or the future, or registering only a small part of what is happening to us in the present.

This practice allows us to explore what is happening while it is happening.. Accepting the experience as it is, whether it is positive or negative, and accepting that it is part of our passage through life. This avoids the suffering caused by trying to make the unpleasantness go away.

Although Mindfulness ties in with many aspects of more traditional psychology, such as exposure and self-regulation, it offers a degree of innovation within its own technique:

Focusing on the present moment.

This involves the patient focusing their attention and feeling things as they happen, without exercising any control over them. The benefit of this technique lies in the possibility of living a moment completely.

Radical acceptance

In contrast to the usual procedure in psychology, radical acceptance aims for the patient to focus on his or her experiences without making any kind of evaluation and accepting them as natural.

Choice of experiences

Although it may seem that mindfulness preaches passive living of personal experiences, this is not the case. People actively choose what goals and experiences in their lives to be involved in.

Control

Acceptance of our experiences implies relinquishing direct control over them.. The aim is for the person to experience their feelings and emotions as they happen. It is not a matter of controlling discomfort, fear, sadness, etc., but of experiencing them as such. This point is opposed to the traditional procedures of psychology that pursue the elimination of negative thoughts, or the control of anxiety.

These techniques allow the person to learn to relate directly to whatever is happening in his life at the present moment, becoming aware of his reality and consciously working on the challenges that life poses, such as stress, pain, illness, etc.

Dialectical Behavioral Therapy (DBT)

Dialectical behavioral therapy focuses on learning psychosocial skills.. It combines various cognitive-behavioral techniques for emotional regulation with some of the typical concepts of contextual therapies, such as acceptance and mindfulness or tolerance of distress and stressful events.

In DBT, the practitioner accepts and validates the patient's feelings, but at the same time makes the patient aware that some of the feelings he or she is experiencing are maladaptive. The therapist then points the patient to alternative behaviors that will lead to more pleasant feelings.

It is a reference therapy in the treatment of borderline personality disorder (BPD), as well as in patients presenting symptoms and behaviors typical of mood disorders.

Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy is a type of intervention that uses acceptance, understood as the ability to attend to sensations, thoughts, feelings, etc., together with the commitment to carry out actions consistent with personal values.

ACT is based on the theory that psychological problems are based on language, making thoughts and feelings inevitable.The ACT is based on the theory that psychological problems are based on language, making unavoidable the thoughts and feelings that can be experienced as annoying. Through techniques such as metaphors, paradoxes and experiential exercises, the patient learns to connect with these thoughts or sensations, recontextualizing them and shedding light on what really matters in his or her life. In this way, they acquire the commitment to the necessary changes they need to make.

In addition, acceptance and commitment therapy is linked to strategies to improve psychological flexibility, i.e., the person's ability to be present and adapt to the situations that arise; thus avoiding the psychological suffering produced by constantly avoiding contact with negative thoughts, emotions or memories.

4. Functional Analytic Psychotherapy (FAP)

Besides being considered a contextual or third generation therapy, it is also part of the movement called Clinical Behavior Analysis. What differentiates it from the rest of the therapies of this wave is the use of the therapeutic relationship as a way of promoting change in the patient's behavior.

This therapy utilizes what the patient does and says during the therapeutic sessionor what is referred to as clinically relevant behaviors. These behaviors include thoughts, perceptions, feelings, etc., which should be attempted to occur within the treatment session in order to work with them.

Another category is the behavioral improvements that occur during such sessions and which should be reinforced by the therapist. The objective of this type of therapy is to get the patient to make interpretations of his own behavior and its causes from the analytical-functional perspective.

In order to achieve this, the therapist uses five strategies:

• Identification of clinically significant behaviors that occur during therapy sessions.
• Construction of a therapeutic context conducive to the emergence of conflictive behaviors, in order to allow the patient's positive development.
• Positive reinforcement of the patient's improvements
• Detection of the aspects of the patient's behavior that are reinforcing for him/her.
• Fostering the development of skills and functional analysis of the relationship between their behaviors and other elements.