The air we breathe in contextual therapies

In the last few days I have been reading materials about the content of the table that I will be part of at the CEFI Congress, and an excerpt from a book caught my attention:

“I aim to demonstrate how philosophical assumptions are similar to the air we breathe: typically invisible, integral to our daily functioning, and yet often taken for granted (…) your worldview silently shapes the way you think and act, influencing the theories, therapies, techniques, and data that you find convincing or valid.”, (Hofmann & Hayes, 2018. p. 24)

In Acceptance and Commitment Therapy (ACT), the air we breathe is Functional Contextualism. Its root metaphor is the “act in context”: behavior can only be understood by analyzing the individual and the contingencies of their historical and current environment. Within this philosophy, truth is that which works to influence behavior with precision and usefulness. Thus, the function of behavior becomes more important than its form.

The worldview silently shapes our way of acting in session, so it is essential to be clear about the philosophy that underpins the approach with which we work. It is what influences the way we observe, understand and respond to the customer. Without this clarity, we run the risk of conducting the therapeutic process in a confusing and inconsistent manner.

If, in Functional Contextualism, truth is what works, and if the objective of ACT is to develop psychological flexibility through processes, then the therapist also needs to experience this experience. Reading about ACT and taking classes is important, but that's just the beginning. It is experience that makes this “air” more fluid, natural and almost invisible in clinical practice.

We can read about how to ride a bike, understand the theory of balance and memorize each necessary movement. But we only really learn when we get on the bike and start pedaling. In the first attempts, we lost our balance, fell and, sometimes, even injured ourselves. It is repeated exposure to practice that allows the skill to be built little by little.

In the clinic, learning also happens like this. But there is an important difference: our mistakes, falls and imbalances impact another person: the patient. That's why skills training becomes so important.

Traditionally, we are more accustomed to the supervision model, in which a more experienced professional suggests possible paths for the therapist in training. This practice is extremely valuable, but it has limits. Often, we understand intellectually what should be done before we can actually do it in session.

A tool widely used in different areas of knowledge is Deliberate Practice, currently considered the gold standard for skill development. It involves five main pillars: observation, feedback, incremental goals, repetitive rehearsal and continuous assessment. Adapted to the context of ACT, it allows therapists to experience their own processes of psychological flexibility in peer training contexts.

Without feedback, it's easy to keep repeating what we already know how to do, and difficult to understand what we still need to develop. Experience alone does not guarantee expertise. We often automate ways of acting without necessarily becoming more effective. Feedback helps us identify where we're falling short, what we're avoiding, and which skills still need refining.

But to do so, you need to be open to exposing yourself, making mistakes, falling and experiencing different emotions. Because, in the end, learning therapy is also a process of exposure. And perhaps good therapists are not those who never lose their balance, but those who continue to refine their skills along the way.

Reference:
Hofmann, S. G., & Hayes, S. C. (Eds.). (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. Context Press.


By Viviane Grafitti