Original post to angela.cathey.com June, 2016

First, I must confess here that I am a geek. I love theory, research, tech, philosophy, cultural anthropology, and quantum physics. I’m also a bit of a social activist. (So, imagine me in person as something in between a female Sheldon from Big Bang Theory and a card carrying hippy [Sorry, Dad but it’s still true].)

I’ve always had a need to understand how things work, straight down to reality (for reference see movie collection with worn out copies of The Matrix, Inception, and Fight Club). To some extent there’s always been a part of me screaming, “you’re not your f$%#$ing khakis!”… “so, what are you?; what are we?; and, why?!?”

I carried that into an interest in process and outcomes research. When I found RFT the first time I can’t say it drew my interest. Reading the original Acceptance and Commitment Therapy text I’m sure I fell asleep with the book on my face chapters 1-3.

Some 10 years later I was doing Prolonged Exposure, ACT, and FAP with those who’d experienced severe and complex trauma and treating severe OCD. Here, more clinically aware then I’d been as a noob therapist, I kept running across quirks in treatment and assessment that weren’t well explained in the literature. One of those phenomena was that what tended to most amp up or dampen exposure intensity within OCD and PTSD wasn’t what you’d expect. I found that often the stimuli or experiences that were most painful for people were linked to their values or their sense of themselves/others. I also noticed that sometimes hierarchies needed to include exposure to stimuli that just didn’t fit into normal models of fear conditioning (see exposures to milk shakes, umbrellas, The Doors, and emotions themselves). And, weirder yet… that a change in context could sometimes seemingly result in immediate ‘habituation’.

So, what’s the deal with RFT? Isn’t this just another theory to add to your dusty reading stack? No. Put it on top, like yesterday.

RFT is a theory of how relating becomes a part of our processing of the world. We are richly hooked into our very verbal sense-making of the world. Our internal verbal-ish history can become a more predominate shaper of perception in the moment than even previous classical or operant conditioning. Move over Bandura and those ridiculous Bobo dolls… we’re onto something big.

Yes, it’s a big deal. HUGE. The most coherent, expansive, and useful theories we have in psychology that allow us to predict and influence behavior are operant and classical conditioning-based. Functional Analysis (FA) is a corner stone of modern behaviorist therapies and yet we’re saying that even if you account for all the ‘external’ context you could be missing the most important variable in the room.

Our ideographic and collective history of verbal relating influences our perception. Note: this is not the same as ‘language’. What we’re talking about is a hodgepodge mix of learning history, language, internal rules, sensations, etc. that people often hear as “language”). It’s not about language its about relational history that gets heavily influenced by language because that’s the framework we see the world from. Just think… when is the last time that voice in your head actually shut up? Never. We are verbal and that verbal-ness is often key in high-jacking a human’s response to the contingencies in the room.

Further, we understand that the specific ways and frequencies in which we relate things can influence our perception, behavior, emotion in predictable ways.

So, this verbal relational soup of history is on-going and influencing our contact with the world. This is pretty profound, but in itself, esoteric at best. Like a knowledge of quantum mechanics and M-theory (hey, I warned you…) it’s cool but what can we DO with it?

That’s where we really start getting to the sexiness inherent in RFT. RFT describes properties of relating such that you can walk back and forth with empirical logic from observation, to assessment, to intervention strategy.

If we head back to the exposure therapy examples I provided there’s a logic to pin under what otherwise might not make sense. Take the example of values intensifying exposure via values. Yes, that might be covered by ACT mid-level terms but it doesn’t give you a full picture. If we consider properties inherent in various types of ‘framing’ that might be at hand in values we not only know what to do to move this material with the client but we also have indications of other, less intuitive things that might also beamply or de-amplify an exposure (outside of valued outcomes). We can reasonably say that hierarchical framing is likely at hand with a value or some form of comparison framing. Knowing that we might also be able to find other material that move exposures up and down the hierarchy or alter intensity of anxiety within exposure simply by relation (hypothetically other concepts that my amplify or de-amplify intensity might then be self-concept, concept of the world, of others, identification to one’s race, social status, etc.) All of these of course are ideographically determined yet likely areas to check. All of them allowing for, potentially, more flexible ways to promote context generalization… without even leaving the office. I could go on about the usefulness and precision of RFT with regard to exposure therapy but I’ll save that for another post.

What’s more you can do this underneath the level of therapeutic orientation and diagnosis. Everything becomes about relations that we can influence without clinging to our own preferred tools that ALL work in some ways. (Yes, that’s right. I’m a behaviorist and I believe those psychoanalytic folks may be getting it right too. Just differently. None of us has a total lock-down on effective treatment.)

I see this as the real beauty of RFT; unification of psychology (across all areas influenced by human thought, across levels of analysis, across basic and applied, across therapeutic orientation, and across diagnoses). Psychology is currently an elaborated mess of opposing theories, big egos, and lack of cooperation.

Can’t we all just get along? Didn’t we get in this to help people?!?! Then have the cojones to put down your tenure track research plan of further and further narrowing and get enough RFT to rip the hood off of your own orientation biases.

If you aren’t yet convinced of the benefits of this way of thinking you’re in luck. If you’re a CBS clinician you’ll surely encounter more RFT track in the future conferences and the reading on RFT has become infinitely less snooze worth over the last few years.

If you’re interested in getting a bit more acquainted with RFT I’d recommend starting with Villatte, Villatte, & Hayes (2015) Mastering the Clinical Conversation: Language as intervention.


Angela Cathey, MA

Angela Cathey, MA

Founder, Partner, Consultant, Data Scientist

Angela is experienced in leading and coordinating the operations of research and intervention teams. She has a master’s in Clinical Psychology from the University of Houston – Clear Lake. She has specialty training in measurement, intervention, People Analytics, natural language processing, and data science. Angela was the entrepreneurial lead in the National Science Foundation i-Corps customer validation program for Enso’s key products. She has a background in innovative technology problem solving, technology development, and resulting market-ready product development.

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