Processes, procedures and outcomes in therapy

When it comes to delivering therapy, precision is key. We strive to be as precise as possible in our interventions to have a greater impact and help individuals in distress as quickly as possible. However, changing human behaviour is far from a straightforward process, unlike say getting a new fuel pump from your local car mechanic. It involves navigating and managing various reinforcement pathways that influence a particular behaviour. This complexity makes motivation for change an intricate and multifaceted phenomenon. While a behaviour may cause significant harm, it can also serve as a protective mechanism against other sources of pain or discomfort. Therefore, it is crucial to have clarity regarding our procedural interventions, the specific processes we are targeting, and the desired outcomes we are aiming for.

However, there are instances in therapy where it may not be clear what our intervention actually is, which process we are truly targeting, and the specific outcome we hope to achieve. In such situations, it can be tempting to adopt a “throw it at the wall and see if it sticks” approach to therapy. While this approach may have some merit and can be helpful in certain cases, it becomes less effective or even potentially harmful when we encounter client resistance. Client resistance occurs when there are other positive reinforcers for behaviour that we may not be aware of, or when we are dealing with high levels of complexity.

In these situations, it becomes crucial to take a step back and reassess our approach. We need to delve deeper into understanding the underlying factors contributing to client resistance or the complexity of the presenting issue. This requires a more nuanced and tailored approach to therapy. Rather than relying on a one-size-fits-all solution, we need to explore and adapt our procedures and interventions to suit the unique needs and circumstances of each individual.

By taking a more thoughtful and precise approach, we can better identify the specific processes at play, target them directly, and work towards the desired outcomes. This may involve exploring and addressing the protective functions of certain behaviours, understanding the reinforcing factors that maintain them, and gradually introducing alternative coping mechanisms or strategies.

So, while precision is crucial in therapy, there are instances where the complexity of client resistance or the multifaceted nature of the presenting issue requires a more thoughtful and tailored approach. By understanding the underlying factors at play and adapting our interventions accordingly, we can navigate these challenges more effectively and work towards positive change and growth for our clients.

If you are interested in finding out more about this topic, and want to dive deeper, you might want to come along to Richard Bennett’s FREE talk, ACT in focus navigating processes, procedures in future directions on the 23rd of November, 2023. In this talk, Richard will explore three key areas:

1. A review of the claims made about ACT’s core processes, procedures, and outcomes, providing insight into the foundations of this transformative therapy

2. An examination of how ACT established itself as a ground-breaking “third wave” cognitive-behavioural therapy, including the introduction of the Hexaflex and its practical implications for your practice.

3. An appraisal of the current state of the evidence base and offering ideas for where ACT and its practitioners should focus their efforts in this era of process-based therapy.