Contextual Approach in Therapy
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ScribdTranslationsContextual Approach in Therapy
Translated by
ScribdTranslationsContextual approach
In the interventions derived from the cognitive approach, such as Ellis's rational-emotive therapy.
(1977) and Beck's cognitive therapy (Beck, Rush, Shaw, and Emery, 1979), the thoughts
negatives, irrational beliefs, pathological cognitive schemas, and errors in the
Information processing constitutes variables that mediate between the stimulus context and
the emotional and behavioral response that the individual shows. The processing of information
it is the underlying metaphor behind cognitive therapy, characterized by the existence of mechanisms
dysfunctional interns that need to be modified through intervention. This new approach
it fit well with the stimulus-response (S-R) framework of behaviorism, and soon it was
incorporated into behavior therapy, leading to cognitive-behavioral therapy. The therapy
cognitive-behavioral has been the dominant paradigm in recent decades and has established itself as
one of the cornerstones of evidence-based therapies, enjoying prestige and support among
researchers and clinicians. However, despite their success, some members of the discipline
they started to question some of their basic assumptions and began the search for new ones
formulations that will enjoy greater consensus.
According to Hayes (2004), some of the limitations of cognitive-behavioral therapy could
considered a consequence of the same incorporation of cognitive aspects into therapy of
behavior. The combination of both approaches led to an emphasis on cognitive aspects in
detriment of contextual aspects and the idiographic approach. The causes of the problem
they shifted from being environmental to being due to a cognitive deficit or dysfunction, with therapy
cognitive-behavioral adopted the internalist and nomothetic medical model. On the other hand, the
standardization of intervention procedures and the publication of some studies that
they indicate that the addition of cognitive aspects to the treatment does not significantly increase
its effectiveness are other limitations attributed to cognitive-behavioral therapy. The therapies
Third generation emerged in the last decade of the 20th century and solidified during the first.
década del siglo XXI como respuesta a las limitaciones mostradas por las terapias cognitivo-
behavioral and thanks to the development of radical behaviorism and the functional analysis of behavior.
In fact, as Pérez (2006) points out, third generation therapies represent a return to
the origins, that is, a return to the contextual roots of behavioral therapy.
The contextual approach revisits Skinner's proposals on verbal behavior.
verbal behaviors are defined as operant functional classes that can have
verbal and non-verbal consequences. The term functional class refers to those stimuli or
responses that have the same function. Behavior is understood in terms of its function, not
of its form. Behaviors that have the same effect on the environment in a given situation
they are treated as equivalents, regardless of whether they are similar in form
(topographically). Another key concept is that of 'rule', understood as a class of
verbal conduct consisting of instructions that are matched with contingencies
environmental. In this sense, behavior may be controlled by environmental contingencies or
by rules (instructional control serves the function of environmental contingencies). The rules
they have a discriminatory character, although some are capable of producing operations
instrumental, for example reinforcement, punishment, or extinction. The behaviors controlled by
rules, unlike the others, have functional autonomy, in the sense that they
contingencies do not exert any control over them. There are behaviors, such as in the case of the
social demands, which are unlikely to be met by natural contingencies,
Rather, what is reinforced is to follow the rule (Luciano, 1993).
Third-generation therapies share a contextual model of psychotherapy that recovers
the basic principles of the original behavioral approach, but at the same time incorporates assumptions and
procedures specific to other approaches such as the phenomenological, humanistic-existential and the
sociocultural. These therapies are explicitly proposed as alternatives to the medical approach.
characterized by an internal psychological explanation of mental disorders (the problem is
inside the individual, whether in their dysfunctional thoughts or in alterations
neurochemicals). This internal explanation is based on the existence of a dysfunction or deficit in the
psychological functioning and, therefore, treatment involves the use of specific techniques
intended to remedy the existing dysfunction or deficit. The effectiveness of the treatment is measured by
based on the reduction of the symptoms that characterize the treated disorder.
In contrast to the medical model, the contextual model explains the disorder that an individual presents.
attending to their circumstances, that is, to interactive, functional and contextual aspects. For
thus, the problem is a consequence of the relationships that the person establishes with others and
himself, that is, with his thoughts, feelings, and experiences, and not from a deficiency or
psychological dysfunction. Thus, for example, depression would not be explained by a disturbance of the
levels of serotonin nor by the presence of negative thoughts but by the decrease
drastic change in activity and interpersonal relationships that the person suffers and the consequent loss
of reinforcements that perpetuate the state of depressive mood.
In the contextual model, the intervention is not based on the use of specific techniques but rather on the
application of two great therapeutic principles: acceptance and activation. It is understood that
acceptance as the cessation of the struggle against the symptom. The goal is no longer to want to eliminate the
symptom, which sometimes becomes very difficult or impossible (think of a chronic disorder), but not
learning to live with it and despite it. And here comes the second principle, activation. Activation
it implies that the person takes an active role, decides what they want to do with their life and what values
wants to be guided. Once these values are clarified, she must act to change the circumstances.
that maintain the problem and prevent him from living according to his values, that is, in one direction
valuable to her (for example, being a good father, being responsible at work, etc.). Not
try to conform rather than accept the situation and act accordingly. According to this model, the
the effectiveness of the treatment is not measured based on symptom reduction but in terms of whether the
the person has managed to modify the context (social, interpersonal, and intrapersonal) that perpetuates
the problem and prevent moving in the desired direction.
Acceptance and Commitment Therapy (Hayes, McCurry, Afari, and Wilson, 1991), along with the
functional analytic psychotherapy (Kohlenberg and Tsai, 1991) and dialectical behavior therapy
(Linehan, 1993) represent the most established third-generation therapies. The therapy of
acceptance and commitment (ACT, Acceptance and Commitment Therapy) focuses on two aspects:
acceptance, understood as the ability to experience, in the here and now, events
private (thoughts, sensations, emotions, etc.) without subjecting them to evaluative judgment and,
joined to her, the commitment to act according to important values and objectives for the
individual. The fact of being verbal beings means that in certain situations it is inevitable
that thoughts or sensations may arise that could be painful. When these arise
unpleasant private events, the person can get caught up in counterproductive struggles that
end up increasing and perpetuating the discomfort. This sort of experiential avoidance,
understood as a broad range of behaviors aimed at avoiding contact with the
negative private events are observable in various disorders. ACT aims to
increase the psychological flexibility of the person, so that they learn to connect with the
private events, both positive and negative, and be able to recontextualize them within the framework of their
values, that is, what really matters in their life.
Functional analytic psychotherapy, for its part, focuses on the interactions that occur between
client and therapist in the clinical context (from the contextual model, the person is not considered)
in treatment as a "patient," since she is not presumed to be sick). From the analysis and
functional classification of these interactions, the therapist detects the relevant behaviors for
the problem and creates the necessary conditions for them to be reproduced during the clinical session. The
the objective of therapy is to recreate an interpersonal context functionally equivalent to the one that is
find the customer in their daily life, so that through positive reinforcement and the
description of the functional relationships between contextual conditions and client behavior,
the therapist can model, increase, or reduce certain behaviors.
Dialectical Behavior Therapy (DBT) was developed by Linehan.
for the treatment of borderline personality disorder, but over time it has been applied
also to other problems, including mood disorders, substance abuse,
suicidal behavior and post-traumatic stress disorder in people who have suffered
sexual abuse. One of the main objectives of the DBT is to create a climate of acceptance.
unconditional and trustworthy in which the client feels that their feelings and behaviors are
validated by the therapist. However, at the same time, the therapist lets him know that some
these feelings and behaviors can be harmful both to him and to the
which there are more adaptive behavioral alternatives. Thus, therapy provides a space in
the one that combines acceptance with the commitment to change through a dialectical progress and
en el que el cliente puede desarrollar las habilidades necesarias que permitan su autorregulación
emotional.
Other examples of increasingly used third-generation therapies are activation therapy.
behavioral (Jacobson et al., 2001), integrated couple behavioral therapy (Jacobson and
Christensen, 1996) and mindfulness-based cognitive therapy (Segal et al., 2002). The therapy of
behavioral activation emerged from a broad study conducted by Jacobson on the
effectiveness of the various components of cognitive-behavioral therapy for depression. The
results evidenced that the addition of the cognitive component to behavior therapy does not
provided no benefit to the treatment. In fact, the behavioral activation component by
yes it was only shown to be as effective as the full therapy. From this study, the
behavioral activation therapy, based on the contextual approach and focused on two issues
Basics: what conditions cause depressive behavior and what are the consequences of it
behavior towards the client. The goal of therapy is to break the pattern of behavioral avoidance, which
it involves the loss of reinforcers and perpetuates the depressive situation in which one finds themselves
the person.
Jacobson also applied the contextual model to couple therapy, developing therapy
integrated couple behavioral therapy, in which the same principles of acceptance are applied
Changes seen so far. Finally, mindfulness-based cognitive therapy is based on the
concept of mindfulness, originating from Buddhist meditation, which refers to the
capacity to focus attention on thoughts, emotions, sensations, and stimuli that
surround us in the here and now, without judging or valuing them. The aim is for the person to
focus on the present and set aside rumination about past or future events that
characterizes the depressive and anxious mood.