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Mastering the Clinical Conversation: Q & A with Matthieu Villatte

Atypicals: Do They Work for Depression?Matthieu Villatte, Ph.D, is a scientific researcher, clinical trainer at the Evidence-Based Practice Institute in Seattle and co-author of Mastering the Clinical Conversation : Language as Intervention , the first book based in relational frame theory (RFT) that teaches clinicians to harness the power of language to free clients from life-constricting patterns and promote psychological flourishing.

 You co-authored a book last year—along with acceptance and commitment therapy (ACT) co-founder Steven Hayes, Ph.D, and clinical psychologist Jennifer Villatte, Ph.D—called Mastering the Clinical Conversation: Language as Intervention. It was the first book about the clinical applications of relational frame theory (RFT). So, what is relational frame theory?

 RFT is a theory of language and cognition that has emerged from contextual behavioral science. It approaches language and cognition as behaviors, more specifically, as building and responding to symbolic relations among things (events, experiences, people, etc.).

 In other words, RFT studies how we conceptualize our experiences and how this conceptualization influences the way we respond to these experiences. For example, a person suffering from depression might find a compliment aversive because for this person, being complimented is the sign that others are feeling sorry for her. As a result, she might dismiss compliments and avoid engaging in positive actions in front of others.

 Or a person with social anxiety might find other people’s gazes threatening and smiles as signs of sarcastic judgments, which makes social interactions less satisfying.

So, RFT tries to understand how we build symbolic networks and how these networks help us adjust to the world to live meaningful lives or instead lead us to disconnect from important experiences and engage in ineffective actions.

 Why is it so important for clinicians to have this level of understanding regarding the power and limitations of language?

 Language is the main tool of psychotherapy. Clinicians ask questions to gather information. They make statements that help clients make sense of confusing experiences. They use instructions in exercises to develop self-compassion. They use metaphors to enhance awareness. They take postures and display facial expression to build a warm relationship and so on.

From an RFT perspective, all these moves are part of language because they are symbolic interactions and they carry meaning that can impact the client’s behavior. Even a silence can convey an important message!

 So, understanding how language functions can help clinicians use this tool most effectively, which is why we wrote this book. We wanted to provide clinicians with an RFT framework to use language more intentionally and more precisely, and to increase the impact of their interventions.

 But using RFT in clinical practice doesn’t necessarily mean knowing everything about RFT. Just as behavior therapists have learned for decades the basics of reinforcement principles to guide their interventions, therapists can learn to use RFT principles to guide their use of language in session.

 What is functional contextualism, and how does helping a client become more oriented toward this way of seeing things enhance the therapeutic process, or even, life in general?

 Functional contextualism is a pragmatic philosophy of science proposing that behavior can only be understood in functional relation to its context. This philosophical stance influences the work of clinicians who adopt it because they always approach their clients’ issues through the influence that the context exerts on these issues. In order to help clients change their behaviors, functional contextual clinicians need to identify what parts of the context can be altered.

 As we saw earlier, language is a key part of what influences our behaviors and so, in therapy based on functional contextualism, clinicians can use language as part of the context shaping their clients’ behaviors.

 Clients themselves can benefit from approaching the world through functional contextualism because it helps them develop a more pragmatic perspective on their lives. Instead of wondering what is objectively true, they can focus on what works to meet their goals.

 At first, it’s often difficult to do this shift, but once people are able to look at what they are doing pragmatically, it’s a true liberation. The therapeutic process can then focus on identifying the contextual variables that need to change in order to shape more effective behaviors.

Given the importance of language, it makes sense that the clinical conversation becomes such an important space from which to work with language in a way that instigates healing and behavior change. Are there any introductory techniques, exercises that someone could do in-session to begin to orient more toward this way of using the conversation? If not, what’s the best way for someone to start to learn to use the clinical conversation in this way? 

 First, it is important to become aware of the impact that what we say can have on clients. Generally speaking, most therapists are probably aware that what they say, ask and even express non-verbally, influence their clients’ behavior, but what we suggest with applying RFT to the clinical conversation is to become more aware and intentional moment-by-moment in session.

 Potentially, each word can make a difference, and so, a first thing therapists can do is to approach their language as an intervention tool, not just as a background of the intervention. Approaching language as intervention requires identifying your therapeutic goals and how your language can help you reach these goals.

 For example, if you are asking a client to observe and describe an emotion, you need to know what you are trying to accomplish. Is it greater awareness of internal experiences and their influence on behaviors? Is it more behavioral flexibility toward internal experiences? Is it greater connection with meaningful experiences? And if the client is having a hard time observing and describing this emotion, you can use language moves such as metaphors and perspective taking shifts that will make this process easier.

 Learning RFT principles will help you gain precision and flexibility in your use of these different moves, but at the core, the process will remain the same: using your language to create a context that enables change in the client’s behavior.

So, the first step is to approach your language as a tool and to track how what you say impacts your clients in session.

 In the book, you emphasize the use of experiential language for psychological assessment. Can you explain a little bit about what that means and how a focus on language can make assessment more effective? 

 Creating an experiential context can be helpful for assessment and for intervention. The stance we take in clinical RFT is to encourage clients to produce their own observations and analyses as much as possible, rather than telling them what to see and think, which is more typical of didactic approaches. Didactic techniques like psycho-education have their utility, but experiential techniques help clients gain more autonomy. Instead of being given a fish, they learn to fish, so to speak.

 Experiential work has often been opposed to using language, but from an RFT perspective, it’s not talking per se that is the issue, but what we say. A conversation can be rich in words and still experiential if the therapist uses her language to help the client observe what he is doing and feeling, what happens as a result of his actions and if it matches his goals.

 In the process of assessment, using an experiential language means taking a truly collaborative perspective on evaluating the client’s strengths and difficulties. Of course, an experiential therapist has clinical expertise and can make hypotheses and case conceptualizations that her clients wouldn’t be able to make alone. But, as much as possible, the therapist includes the client in the assessment process by encouraging him to identify his own goals and what actions would help him reach these goals and to observe what gets in the way of these actions.

 So, in this approach, most elements that end up in the case conceptualization are observations made by the client. And because we give the client’s experience such a central place in clinical work, assessment remains an ongoing process throughout therapy.

 At the core of each session based on RFT and contextual behavioral science principles, you will find exchanges aiming to encourage the client to observe his experience and assess the effectiveness of what he is doing.

The use of metaphor in psychotherapy is widely understood as effective and useful within the psychology community. You recently wrote a blog post on your website about using clients’ own metaphors. How is this done and why is it useful?

In clinical RFT, metaphors are helpful because they provide a concrete situation in which the client can experiment and observe. They bring knowledge from a situation the client understands experientially to a clinical issue with which he struggles.

Therapists can use metaphors in various ways but research shows that they are most helpful when client and therapist elaborate them together (on this topic, I highly recommend Niklas Törneke’s new RFT book on clinical metaphors , which will be published in English later this year).

 If you use clients’ own metaphors or include them in the elaboration process after initiating a metaphor, there is a greater chance that the metaphor will talk to the client. If the client has direct experience with the metaphorical situation, it becomes easier for him to draw conclusions based on actual observations.

In order to use clients’ own metaphors, you need to pay attention to the language they use to describe their experiences. Sometimes the metaphor stands out: the client might say, “I felt like I was pushed under the water.” Sometimes it is more subtle: the client might say, “I felt really heavy.”

 In any case, there is a high chance that the client will eventually use some metaphorical language to describe his experience. When it happens, you can follow up with experiential questions aiming to evoke observation and description that include the client’s metaphor.

For example, you might ask, “How heavy was it? What kind of weight was it?” or “Did you stay under the water? Did you try to come back to the surface? What was the temperature of the water like?” Progressively, the metaphor will help the client learn something he can use to approach his difficulties differently.

 If the metaphor is built collaboratively, it can become a kind of common language between the client and the therapist who might use it to communicate more concretely about abstract experiences (e.g. “How deep in the water were you during this conversation?”).

 For more about clinical RFT and using language as intervention, visit Dr. Villatte online at www.languageasintervention.com or check out his book, Mastering the Clinical Conversation: Language as Intervention.

Mastering the Clinical Conversation: Q & A with Matthieu Villatte


Jessica Dore

Jessica Dore is a behavioral science and spirituality writer with several years of experience in clinical psychology publishing. She blogs weekly about tarot cards and psychology on her website www.jessicadore.com. In her free time, she is a devoted ashtanga yoga practitioner, food enthusiast, and DJ. Follow her on twitter @realJessicaDore.

 

APA Reference
Dore, J. (2017). Mastering the Clinical Conversation: Q & A with Matthieu Villatte. Psych Central. Retrieved on December 12, 2019, from https://pro.psychcentral.com/mastering-the-clinical-conversation-q-a-with-matthieu-villatte/

 

Scientifically Reviewed
Last updated: 27 Jan 2017
Last reviewed: By John M. Grohol, Psy.D. on 27 Jan 2017
Published on PsychCentral.com. All rights reserved.