Interview with Adrián Muñoz Pozo, expert in contextual therapies

Sometimes psychotherapy is spoken of as a process in which the psychologist simply limits himself to eliminate the specific symptom, without taking into account the discomfort responsible for the appearance of this freak.

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: It is about contextual therapies, also called third generation therapies.

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

However, this explanation is still an oversimplification, and there are actually many more features. interesting facts that make this psychotherapeutic approach an option to take into account when seeking assistance psychological. Therefore, it is best to have the point of view of an expert.

Interview with Adrián Muñoz Pozo, psychologist expert in contextual therapies

To learn more about third-generation therapies, we talked to

Adrian Munoz Pozo, a psychologist who offers psychological assistance in Malaga and Fuengirola, so that he explains this area of ​​work in mental health to us.

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

Complicated task, to summarize a whole paradigm shift in a single sentence. But let's go there.

In a sentence: understanding human behavior (verbal or non-verbal) within the context in which it is generated, analyzing the functions that maintain behaviors to employ intervention strategies aimed at creating a more flexible behavioral repertoire that enables people to achieve a purposeful horizon vital.

What are the differences between this new proposal for psychological intervention and classical cognitive-behavioral therapy? Do you think they completely 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 'disorders mental’ is found in alterations of cognitions (thoughts, beliefs, attributions, expectations). And, therefore, the treatment of these problems will consist of the elaboration of specific techniques to revert this situation.

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

In contrast, third-generation therapies are based on an ideographic, holistic, and contextual 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 conduct.

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

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 distress is seen as a 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 "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 (behaviors of avoidance) and that they abandon these behaviors that have not served them to get rid of their discomfort.

In turn, clients are trained to generate a state of acceptance in the face of private events that cause them discomfort such as alternative to avoidance through exercises and metaphors that have the objective that people generate a state of de-fusion cognitive. 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 in ACT it is not about exposing the client to their suffering for the sake of it. Exposing yourself to their annoying private events is a means to a greater end: leading the life you want, accordingly. with your values, understanding values ​​as all those things we do that give meaning to our life.

Usually, people think that we can only lead the life we ​​want if we eliminate discomfort and find ourselves in an ideal state of well-being. However, like many of you, the readers, you will have been able to verify that we do not have much control regarding select what thoughts or sensations we want to have or not have at a certain moment to carry out any type of activity.

For this reason, 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 father or mother, being a better employee, having a better health, be closer to friends, etc.) and take committed actions to achieve it, regardless of the private events that let's have.

Working on focusing on your values, learning to accept and distance yourself from private events that cause you discomfort and that 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 as fulfilling 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 not to create additional problems for yourself by feeling responsible for your discomfort. How is this achieved?

TRUE. Many of my clients, and 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 refer to the metaphor of digging:

“Imagine that you have 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're still in the hole. What's more, now you're more sunk."

The problem is not that you fell (how 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 that the only mistake has been to use it where it is not effective. That said, we have no choice but to drop the shovel, later we will discover what to do to get out. But now, the main thing is to stop using something that doesn't help us solve the problem.

With this metaphor we help our clients not to generate those feelings of guilt towards themselves. If not, that they take responsibility for the actions they have been carrying out 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 in whom their problem is chronic, or who have spent many years struggling to solve their discomfort, are the ones in whom improvements are best observed quickly. Contrary to what you might think.

Clients who have been submerged 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 faster change in the abandonment of the fight to control its internal events, since its Experience tells you that it has been impossible to get rid of your discomfort no matter how many things you have tried throughout your life. history. It is what is known in ACT how to generate 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, the sessions tend to take place in an environment relaxed and warm, where psychotherapist and client are seated facing each other, on an equal footing, as a person to person.

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

When addressing the reason for consultation, this is done from the functional analysis of behavior. In other words, we analyze together with the client the behavioral repertoire that she displays when faced with her discomfort so that he himself is the one who catches a glimpse of his own control agenda and sees the ineffectiveness of his behavior avoidance.

In addition, ACT sessions are dynamic sessions, in which many experiential exercises are practiced to expose the client to 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 we must also take into account the use of activities aimed at clarifying values ​​and the commitment to action directed towards them.

Finally... could you tell us about a case of improvement in 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 demand help, and in turn 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 stable partner, although she lived with her parents in her family home. We'll call her Anna.

She came to the office demanding assistance because she was going through a stage in her life in which she experienced symptoms of anxiety and uncontrolled stress.

Exploring her background, we could see how she had grown up in a very protective family bosom and in which her achievements were not reinforced. Furthermore, throughout her life, whenever she exposed herself to a feared situation, she would abandon her. She was afraid of looking for a job outside of her city 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 that they had around them, etc.

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

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

Ana had a teaching career, and it was her true vocation. However, she had only practiced as such on a few occasions, covering the summer vacations at the school in her city.

Throughout the sessions, Ana realized that the job she was in was not to her liking (she was not tied 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 for her. We began to observe changes in her: she was more open to changes, to her discomfort, and above all, she took more actions towards her values.

Once this step was taken, we set out so that she could look for new work objectives in the direction of her vocation as a teacher. She began to prepare for the oppositions and began to register on job boards. After a few weeks, she was called from a stock exchange in Melilla to fill a position. And she accepted it.

She packed her bags and went to undertake this new adventure in Melilla with her partner. I remember that he lived it with great fear and that we had to work hard to live in the present moment, since he had a lot of anguish and anxiety due to the fear of failing. Still, she persisted.

To this day, a year and a half has passed since Ana set foot in Melilla. She continues to work there, she lives with her partner, practices sports and has created a circle of friendship with which she goes on trips. Everything she wanted and that, in her opinion, her fears prevented her from getting. And best of all, he has achieved it without having to stop his life to eliminate his fear and anxiety.

When I ask him how he is, he always reminds me that there are days when he feels anxious, when fear returns, when those who get entangled with his mind... but I always remind him of the same thing: "look at yourself where you are, is this the life you want to lead?" Yeah. "Well, make room for that discomfort and continue building a rich and satisfying life."

However, when I ask her how satisfied she is with her life, she answers something along the lines of: “it's the best I could do. She may feel fear and anxiety but she is comfortable with what she does and feels that she is a real teacher, something she had always dreamed of ”.

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

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