RFT for clinical use: The example of metaphor

https://doi.org/10.1016/j.jcbs.2014.08.001Get rights and content

Highlights

  • RFT approach to metaphor as coordination relations.

  • Empirical evidence in support of this account.

  • Understanding metaphors commonly used in ACT.

  • Illustrate how RFT integrates conceptually and pragmatically with ACT.

  • Illustrate how RFT research constructively guides clinical practice.

Abstract

The current article argues that the conceptual analysis of metaphor as offered by relational frame theory (RFT) illustrates one way in which the theory may be integrated with, and have a constructive influence on, acceptance and commitment therapy (ACT). The article walks through the basic account of metaphor as the relating of relations and summarises the empirical evidence in support of this conceptualization. This understanding is then applied to a number of metaphors that are common to ACT in an attempt to illustrate how the RFT account of metaphor may be useful in aiding ACT practitioners to construct and deconstruct clinical metaphors.

Introduction

Contextual Behavioral Science (CBS) is a broad church that encompasses three core areas of knowledge. First, functional contextualism provides clear and pragmatic assumptions about the scientific agenda such that behavior can be understood, predicted, and influenced with precision, scope, and depth (Gifford & Hayes, 1999). Second, Relational Frame Theory (RFT) identifies basic contextual elements (i.e., relating stimuli) that permit the prediction and influence of complex verbal behavior (Hayes, Barnes-Holmes, & Roche, 2001). Third, Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) facilitates an empirically effective approach to psychological health and well-being, thus directly addressing the “challenge of the human condition” (Hayes, Barnes-Holmes, & Wilson, 2012). The challenge now faced by the CBS community is to draw these three strands into a broad, scientific, and coherent agenda. This is not an easy feat, and has rarely, if ever, been successfully achieved in the history of psychology. But as a starting point, Hayes et al. (2012) suggested the following:

…a reticulated (that is, web-like) model of scientific and practical development, in which theoretical and technological progress occurs at multiple levels but in an interconnected way, with differing standards of progress appropriate to the particular level of the work” (p. 6).

Section snippets

Integrating RFT and ACT

The integration of RFT and ACT is central to the CBS reticulated model and the program of research it promotes and relies upon. Accordingly, RFT scholars are often asked by ACT clinicians for RFT-based definitions of fusion, for example. Because the concept of cognitive fusion is pivotal to ACT assumptions and practices, and RFT is after all, an account of language and cognition, it might seem straightforward to be able to provide this. However, an RFT translation of fusion is still a long way

An RFT account of analogy

Naturally, the RFT approach to analogy has the core concept of arbitrarily applicable relational responding (AARR) at its root. But what broadens AARR out and makes it specifically applicable to analogy is the more complex or higher order concept of relating relations. The first detailed analysis of this was provided by Barnes, Hegarty, and Smeets (1997). An example illustrating their basic account is provided in Fig. 1.

Consider the simple analogy in Fig. 1 that might be described as ‘peach is

Distinguishing between analogies and metaphors

The terms ‘analogy’ and ‘metaphor’ are often used interchangeably, and it is difficult to find distinct or concise definitions that separate one term from the other in the language of RFT. Critically, the current paper does not adhere to the traditional English language distinctions between metaphor and analogy (easily distinguished from each other by the use of “like” or “as”) because this is not a working distinction for RFT. To clarify, in terms of RFT, we would define analogy as a

The role of metaphor in ACT

Metaphors have a long-established history as therapeutic tools (for a review see McCurry and Hayes (1992)). Their common purpose in clinical settings appears to be two-fold. First, they are designed to validate the client׳s experience. Second, they aim to enhance the client׳s awareness of her situation. For example, in Cognitive Behavioral Therapy (CBT) metaphors are used to link different areas of thought and thus challenge unhelpful styles of thinking (Blenkiron, 2005, Stott et al., 2010).

Using RFT to enhance metaphor in ACT

From the outset, we acknowledge that the therapeutic pieces outlined subsequently appear, in some ways, to be out of context. For example, we do not focus on the client–therapist relationship, although we believe that this is central to all therapeutic change. Similarly, the client validation that invariably occurs within a good client–therapist relationship clearly impacts on the potential utility of individual techniques, including metaphor.

Perhaps the simplest place to start in an attempt to

Perspective-taking (deictic relations)

For RFT, perspective-taking comprises three types of deictic relations: I–YOU; HERE–THERE; and NOW–THEN.1

Using RFT to construct clinical metaphors

From the perspectives of both RFT and ACT, metaphors should be used to identify and change functional processes. For example, clinical metaphors are used in part to create changes in the deictic relations and particularly the coordination between the I and the client׳s behavior. If metaphors do not achieve this, they are not maximally effective and may need to be modified or replaced. Put another way, the verbal behavior of the therapist, such as in providing a metaphor, changes the context in

Can RFT enhance the use of metaphors in ACT?

There is an on-going debate within the CBS community about whether ACT therapists ‘need’ to learn RFT to better support their clinical work. For example, one might argue that ACT is a functional therapy based on core components (e.g., the hexaflex) and all therapists using this model are going to follow the model (i.e., do some defusion, acceptance, values, etc.) with practically all clients. Addressing this debate is an empirical issue. For example, you would need to compare outcomes and

Future research

There is a great deal of research that is needed to make tracks into the fourth generation of RFT work, and thus to articulate more fully the functional overlap between it and ACT, where this is possible. We have created a short list below of topics that emanate directly from the issues discussed within the current paper. This is not a definitive list even of the issues encountered here, but is simply offered as a guide to those who may be struggling to see exactly what implications RFT has for

Concluding comments

Psychological content and its hold on behavior is an ultimately verbal and uniquely human experience. So too, are our metaphorical and analogical reasoning skills. But there appears to be little empirical study of how these two matters overlap. For the community of CBS, it will become increasingly important to establish functional links between our approach to psychological suffering and our approach to its alleviation. It is thus imperative that fourth generation explorations in RFT begin to

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