What are contextual therapies?

Cognitive therapy is a type of psychotherapy that suggests that people's feelings and behaviors are affected by the way they organize ideas and beliefs through a framework of interpretation of reality, and by analyzing them in terms of meaning.

Now, within this premise there is a lot of room to develop different therapeutic strategies, and integrative cognitive models of thought for the treatment of mental disorders have advanced widely since their creation. During the last 20 years, it has become clear that therapeutic models cannot remain static. People require treatments that respond to the new demands of society; therefore, context-specific therapies are necessary.

Within this scenario, contextual -or third generation- therapies offer a new perspective on the representation and treatment of mental disorders, or rather, of psychological problems in general. In this article we analyze in detail contextual therapy, its origins and main types.

What are contextual therapies?

Contextual therapies, also called third-generation therapies, examine people's behavior in the context in which they find themselves rather than separate from it. This means examining what a person values, what they say, and how they say it, and also includes analyzing one's verbal behavior when interacting with others.

By understanding how context affects behavior, psychotherapists can better predict patient behavior and provide more effective treatment therapies.

Contextual therapy seeks an understanding of the meaning behind people's emotions, actions, and thoughts, including context as a parameter . It also studies the evolution of behavior with interaction.

Third generation therapies provide a new perspective to understand psychological disorders and their treatment. Some authors claim that these therapies are direct descendants of BF Skinner 's radical behaviorism , according to which human behavior does not respond directly to the stimulus-response association, but that the origin of all behavior lies in the effect that acts have on the subject itself , and this includes the notion of context.

However, to agree with this statement would be too reductionist because it would imply that the postulates of third generation therapies are the same as those of Skinner. Instead, it is more accurate to say that contextual therapies derive from Skinner's ideas, although they present certain important divergences.

Third-generation therapies include findings from basic science, which have shown results in the psychotherapeutic field, in order to determine the effect of the context and its elements on behavior. Psychotherapeutic interventions examine the differences between "reality" and "reality constructed" by each person. Therapies that include this approach are part of a new way of thinking and allow us to consider many other therapeutic lines other than the classic ones.

Contextual therapy is highly philosophically charged : it focuses heavily on issues such as justice, forgiveness, morality, and ethics. It also includes healing across generations, reconciliation, and recognition. The objective of contextual therapy is to reconcile these aspects that are in dissonance and direct them towards a cure, either of the emotional pain they cause, or to improve the patient's relationship with others and the world around him.

The term “contextual” refers to all the people and things involved in the process. In addition to the patient, these include all relevant parties and their interactions . Four aspects of contextual interaction are considered in therapy: the facts, individual psychology, behavioral interactions, and ethical considerations related to relationships.

There are many exponents of contextual or third generation therapies, but below we present the most widespread. The main therapeutic models include:

• Acceptance and Commitment Therapy (ACT)
• Dialectical-behavioral therapy (DBT).
• Functional Analytic Psychotherapy (FAP)
• Mindfulness-based therapy

The origins of contextual therapy

In order to provide a scientific and objective solution to mental disorders, psychotherapy based on the positivist logical model appeared. This method of treatment aimed to cure mental disorders by applying the scientific method.

This way of understanding mental problems breaks with the accepted idea -until then- that these were formed only in the minds of "sick" individuals. Psychology begins to be interested not only in the individual, but also in the relational, including the context . The work of Martin Buber -inspired the greatest advances in this belief system-, introduced in the field of philosophy the idea that reality is made up of relationships.

Due to the growing belief in the relational nature of life, in the 1950s, a series of joint therapies with psychotic children with the participation of the close family were initiated. Before this, individual therapies were common. However, its limits had already been recognized, particularly in psychotic patients.

In 1957, the Philadelphia Institute of Psychiatry launched a research project on family therapies led by Boszormenyi-Nagy and his team . Boszormenyi-Nagy is considered the father of contextual therapy. His work emphasizes the essential union of generations, the processes of the psyche and interpersonal relationships.

The main contextual therapies

Contextual or third generation therapy is the most common form of applied therapy. His science-based knowledge applies to almost every aspect of life. There are many types of models; Below we collect the main exponents, due to their effectiveness and their widespread application within the therapeutic community.

1. Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) is the most widespread model within relational examples . It is a form of intervention that seeks to define the personal values ​​of the person and accept the events. This approach is supported by a broad philosophical theory that serves as the basis for this type of psychotherapy and its theoretical framework.

Humans have the ability to be aware of our thoughts, emotions, memories and images in the present moment. From the acceptance in the present moment, we can decide to act according to our values. Acknowledging ability and choosing to act in the now are the goals of acceptance and commitment therapy. By submitting to our values ​​and accepting what happens to us, acceptance and commitment therapy allows us to increase our psychological flexibility. This includes engaging in or stopping actions that are uncomfortable without added stress.

In acceptance and commitment therapy, language plays a fundamental role . Most psychological problems originate in language, this approach is used to recontextualize events, and to understand the meaning and reason for the lives of patients. It seeks to discover what each individual considers important and encourage commitments to the necessary behavioral changes.

In short, acceptance and commitment therapy suggests accepting the circumstances of the human condition and connecting with the present moment. Through this, we can take actions that lead to a better life in a way that satisfies us.

2. Dialectical Behavioral Therapy (DBT)

Dialectical-behavioral therapy is primarily aimed at reducing patients' self-destructive thoughts and behaviors, and was developed to treat mostly borderline personality disorder . This method teaches psychosocial skills and uses elements of cognitive behavioral theory to relieve emotional pain, perform reality checks, and maintain mindfulness, while promoting tolerance.

Dialectical-behavioral therapies have proven to be the most effective treatment for chronic patients with suicidal thoughts, mood disorders, drug addicts and victims of abuse.

3. Functional Analytical Psychotherapy (FAP)

Functional analytic psychotherapy focuses on the psychotherapeutic relationship. Within the clinical context, this therapy focuses on the patient's relationship with his therapist and the learning opportunities that arise within the sessions . Where the behavioral progress related to the patient's problem is identified along with the clinical variables related to her individual relationship with the problem.

In the framework of this model of therapy, changing certain behaviors depends on the close relationship that is created between patient and therapist. This link also allows patients to increase or decrease their behaviors during the course of treatment.

4. Mindfulness-based therapy

The concept of witnessing the present moment is at the center of one of the most widespread recent therapies. Mindfulness consists of becoming a simple spectator of what is happening, accepting and not trying to control events.

The theory suggests that we need to radically accept the present moment. It emphasizes that we must actively select our experiences, even if they are unsatisfactory or painful, this allows us to operate in the here and now. It also helps us prevent thoughts about the past or the future from taking over us and our minds so that we can decide at the present time.