#5: Season 1, Ep 5 - Process-based Behavior Therapy (PBBT) with Dr. Yvonne Barnes-Holmes

anything connected the shame is going to be avoided because again because it's part of the the me bad me disgusting but so you're going to have negative relating the variations in complexity etc derivation is going to be low you're going to have avoidance of shame or anything connected that because it connects to you being bad and you're probably going to have and this is what I think is quite different about pbt you're going to have a lot of approach behavior you're going to be approaching like you know being good getting other people to like you working too hard you know being the perfect parent you're going to get a lot of approach behavior that's a bit like proving I'm good because it's proof that I'm not bad so for us it isn't just avoidance welcome everyone to another episode of act and perspective podcast i'm your host you ciminic today i'll be sitting down with dr. evan barn's homes a pioneer in relational frame theory or rft a world trainer in acceptance and commitment therapy a researcher clinician an academic who has published over 150 articles in book chapters provided over 500 international workshops and trainings has been a behavior therapist for over 22 years she's a co-founder of process based behavioral therapy or pbt and co-director of perspectives irland with dr. kira mcinteggert she breaks down what pbt is its application wise different and how to get training please help welcome dr. evan barn's homes how's everything in arland by the way uh up here it's we've got a lot of snow which is very lovely it doesn't normally lie in arland but it's lying today and it's it's just gorgeous well it's fine but we're in a very severe lockdown for a very long time so yeah yeah i know i know i'm in danigal which is in the north of the country it still belongs to the republic but it's up in the north wing so dear to the United States it's it's pretty crazy it's pretty crazy yeah i don't know if you heard when we had a minor insurrection it was unbelievable to think that happened in america you turn on the tv and you think that can't be america it's just so shocking the events have been so shocking i just yeah i mean i hope you're on the right path now yeah me too are you ready do you have any questions no i'm all set not okay uh talking a little bit about process behavioral therapy you know there's there's a great website that i found information on on case anybody is lacking that rft background is go-rft.com that your team created at a university against in belgim when you were doing research and if you scroll down to the bottom that page there is i found plenty of research articles but one research article in particular that i found helpful was updating rft more field than frame implications for process based therapy and that seemed to give a really good context of history and what this is exactly yeah it does from for me that really is the article that that springboards rft developments in rft and why they can make such a clinical difference how you can actually stay rooted to the basic research floor and actually just layer your clinical work feeding dine into that all the time so and i think you can only really do that with the updates or do it really well or the best way to do it is with the updates in rft we could do it before but not at this level of groundedness and the concepts and not with this level of precision and i think that article really i think fills that bridge really nicely right right yeah it's certainly dead um you know i want to mention here too i think it's important you you're dedicated to bring greater precision to understanding and applying psychology from a behavioral and functional analytic perspective that i think is important to know because this is not just another clinical approach it this is a precise science that about understanding and intervening on complex psychological issues right yeah i mean it wasn't i mean we never wanted and i don't think psychology needs just another approach i think it actually needs to revert back to its beginnings and i mean all the approaches have a lot of the approaches have been built on the same foundations and i frankly believe those foundations are shaky i think a much more workable place to work off is the behavioral functional analytic tradition is very very solid scientific foundations and i think if you work off them we won't end up going down one slightly blind application alley over another many if you look at the way that the behavioral tradition have used those foundations for the purposes of developing applied behavior analysis a b a it's it's just absolutely second to none and working with populations with limited verbal ability and with overt behavioral issues and in a way why i think what we've done is analogous to that except unfortunately that groin needed to be updated and rft was the update because what we are dealing with with adults is complex verbal behavior and so i think we've taken you know the same strategy that they be a folks have taken and and gosh in terms of application what they have done is absolutely second to none and it has lasted and carried you right up to a pretty verbal level so this is the like step after that i think what the strategy was the same rather than the generic mainstream psychology strategy which is often go looking and forget that the groin jaron is marshy and muddy and it's not stable yeah yeah yeah i've always been curious by a b a lag behind the curve you know great opportunity back um i you know apparently late nineties to really engage with relational frame theory move into the post-scanarian approach um to working with more complex uh verbally sophisticated individuals but we it seems like we're just catching up now why is that yeah i mean i think it's definitely fair to say they're just catching up now that is true um i think in my view there are a couple of factors i'm not sure the hierarchy were really supportive of rft i think partly because it was post-scanarian i think they felt it that it was a little bit anti-scanarian of course it wasn't you wouldn't have rft with that scanner and it's a very hierarchical organization or certainly was historically and it's very patriarchal organization to be honest and i think what was really happening at the top was a lot of stagnation in terms of the core concepts and in terms of the individuals who i think weren't supportive i mean think about aba young people are very very fresh they're very smart they're very progressive but i think they were getting suffocated by a rather stagnated leadership and i think the leadership to be fair absolutely is not supportive of rft and has changed but i think in part that has happened because young people have said listen we're going this way we want to know this new stuff we are dealing with complexity we are dealing with storytelling and perspective taking and they wanted i think to be broader clinicians rather than just low verbal ability clinicians they got more and more interested in the higher end of things i think there have been changes top on bottom but and you know there are changes of foot that's for sure it is rather late but better late than never i suppose yeah i agree and you know even if you know i find like even if you work with a nonverbal individuals knowing this helps give clarity absolutely right i mean yeah that's very true and i think we knew that from very early on but i think for political and optics reasons we didn't really say that too loudly because i think what when we early on tried to say but you really it would really be a good idea to do this from the beginning once they start getting generalized operands like imitation i think we think it would really help if you start to program these and but that was not a popular move because it ab a and ab a i i i think they they were more comfortable what's led us to our stuff and when we need the complex stuff we'll call on you guys and in a way look we just had to let that be so but for us conceptually and unable to apply then it always made sense to go in early in the verbal trajectory and and start getting a generalized performances but i mean it's just it's just not where the community was at at the time yeah yeah you know do you think that it's actually hurt the science with therapists, uh, psychologists who don't have that analytic behavioral analytic background, now practicing accessibility without really understanding RFT. - I think, in my experience, at clinicians who are behaviorally trained, I think do better therapy, to be honest, that's my, of course, I would say at some behaviorally trained, but I think act is very functional analytic at its roots. And I mean, we've trained a lot of people in 20 years, and I certainly see a very big difference in those who have exposure to behavioral science and functional houses and those who don't, because it's learning to think functionally is a real hurdle, it's a real skill. It, I suppose it depends on the way you want to do act, but if you want to do the way act, I think it was conceived in line with its roots and functional thinking and behavior analysis, then I think if you bring that to the table, it's quite an easy sell after that and a relatively easy training that, but is very, very difficult. - Yeah, yeah, yeah. Well, let's get into process-based behavioral therapy is if you can explain that a little bit. - Process-based behavior therapy is the application, the clinical application of the unit of analysis, as we now see at the RO, the ROE, the relating-orienting and evoking, and we see it as the basic unit of the basic unit of complex psychology, the basic unit of language, a cognition complex, thinking whatever you want to call it. And what PBBT does is that it puts that row at the center and basically says that all behavior, pivots around rows, and our job is to, and I had to simplify a little bit to make sense, but our job is to identify the way in which rows are problematic, then shift them so that they contain relating relational patents and they contain functional patents that are actually progressive and adaptive and healthy for the person's life, rather than the rows that form or seem to exist or that emerge, that are just full of functionality that's not helpful for the client and they're full of patents of relating that are painful and horrible and suffocate in the negative and judgmental, etc. So our job is to identify rows and basically turn them around so that they are working for the person, not against the person, so PBBT is the process and the skills and the exercises and the techniques that identify rows and that teach you how to move them. - Yeah. And is it fair to say, when you're talking about the row that the behavior analytic or the functional analytic side of that is the organic and evoking side, right? - Absolutely, right, except that I think it's quite hard for folks, I think for me, you really get them to appreciate that that is only glued together because of the relating because the relating is where the meanings are at. And it's like, you know, the relating patents, patent dictates what the functions will be, of course, functions affect relating to, but it's almost like the functions are they add on or the sort of ring around the planet, but the planet is the meaning is where the relating is at. That's why those particular functions are the way they are because the system coheres together. - Right, right, right, yeah. The relating is the narrative story. - It's exactly. - Read it, yeah. And the great thing about this is there is a HTML, the hyper-dimensional multi-level framework. - Exactly, so it puts the levels of relational skill, for example, on the left hand side, it puts at any one example of any one of those levels, it says, well, how strong is this particular response at that level, and then inside each cell, you have a row, which says, well, okay, if I understand the response, I know what it looks like, I know what's level is at, I know how strong it is, but what's the functionality that's tied to that patent of relating, and so the dimensions in the top end, the levels on the left and the rows sitting in the middle, and that essentially is the HTML framework. - Okay, all right. You know, let's talk a little bit about functional analysis. You know, I think, you know, I'm a behavior analyst, what I had learned in graduate school, is that relevant anymore, these four functions of behavior? Is that at all, you know, usable? - I think for me, that's a $6 million question, because I think it isn't, I think it isn't to the extent that I don't think the complex behavior we're talking about is maintained through the three-term contingency. I don't think even most of it's acquired that way, to be honest. So that was an analysis that was built around the three-term contingency view, and if the three-term contingency no longer applies, then that would probably be no longer useful, at least not in the same way, to the same extent. But at the same time, it is still the case for us that all behaviors have functions, and the functions are essentially approach, and approach avoid or neutral with the row. So that bit of it, I think, is still very similar. You know, people are still seeking attention, people are still moving away from pain. I mean, a lot of that still applies, but I think you have to be super careful now with the underpinning view that this is contingency-based, just like when it was before. And it isn't, it just doesn't look like it is. The row gets you as close to understanding the dynamical interaction between relating and evoking, but how a contingency sensitive that is, and certain terms of the row is, we would still need a lot more data on that. Because we're still nearly days of the row, but I think you really have to take quite a few steps back from the three-term contingency view, because look, that fell short, and that's why RFT came about. You've got to get your head around the generalized operand. You really have to take that leap of faith, and that is a leap of the contingency operation that just is. Yeah, yeah, yeah. What does the new model look like for a verbally sophisticated individual? I think the new model gives you two things. I think it really allows you to embrace that multifunctionality, that, you know, a behavior that you can see a cluster of behaviors that are all part of a relating, and they will move you towards some things and move you away from other things. And they're all part of the same row, and that's, it's really hard to get multifunctionality in the old way of thinking. The row also, and RFT generally, tells you that they, that those functions they coherent around a certain meaning, they don't just stack up together, why that function and not another, especially if you've moved out the concept of direct reinforcement, and you're a work on a generalized operance, that, well, because if you, this person has a narrative about themselves, and it may be a relatively limited narrative, but there is a narrative that connects those functions together. So it's, it's not a, the, the all way of thinking was very one-dimensional. It was almost as if the organism was just moving around with arms and legs, and there wasn't actually anything happening. Yeah. And, you know, I don't mean in an ontological sense, or in a purposeful sense, but it was almost like the human being in there didn't matter. They were just some sort of vehicle for behavioral performance. This actually digs much deeper and says, none of the behavioral performances are all part of a pattern that is emerged, and that self-story is that pattern. And when you look at matchmaking the pattern to the, the behavior, the, the evoking, it matches absolutely perfectly. Every time the behavior's not random or chaotic at all. The behavior seems to pivot. The functions pivot and spin around the relating. Time and time and time again, and it's never not so. Right. Those are the two pieces that I think it adds that makes a really big difference. Multi-functionality was always a struggle. Yeah. Behavioral thinking. Even with relatively limited verbally sophisticated individuals. Right, right. And you give a couple examples in the, and there's a couple examples in the paper that are really good. But, you know, take an individual that is experiencing a lot of shame. And so they have a very strong and very complex shame network. And it's pretty inflexible. And, you know, they've been at it for a long time. So there's low derivation. So you're sitting down with them, and you're getting to know them beyond the rapport. How would you then? Well, what kinds of things would you look for to know that this is what they're oriented to? This is what is a vote. So they tend to give you little bits and pieces here and there they tend to tell you a little bit about the relating along the lines of, you know, that's typical of me as nature. I'm always getting it wrong. So you get these little bits and negative relating coming at you. And in the relating end of it, we're sort of, I'm going to simplify, but we tend to be on the lookout for me equals bad in some way because it tends to be a lot of that about. They also give you little hints on the functional and like, you know, when the paint shows up, I just can't bear it. Or, you know, if I don't change it, this is never going to, I'm never going to go anywhere, you know, or someone's going to leave me or whatever. So you get hints of the functions and you get hints of the relating. We tend to focus on relating first because it tends to guide you very clearly towards what functions are likely to be predicted. What's going to be a move toward what's going to be a move away. So we start to very gently set our sights on, you know, you know, you said you had a lot of negative thoughts about your shuffle. And you could you tell me something about them. So it's like we take these story layers and we build the layers up and then we sort of set them right there and then we look at the layers and we say, okay, if you added that layer and that layer and that layer that cake would look like this. And then that would be the icing on the top would be deep down. I think I'm disgusting. And so we sort of very gently nods up towards, well, in a sense, I think we nodged down towards the bottom layer. And that signs and looks like a dynamic and feeling it is in many ways it is, but there are layers of relating that form across time. And they tend to I think sort of layer up from what is a pretty core area that that boils on is some sort of self hatred, self loathing and validation fear of ejection. I mean, the role, the things that you see in therapy all the time. But they do all buy a boil down to, you know, I'm bad in some way. I'm not good enough. I'm not smart enough. I'm not have the game or that is. And then we sort of keep an eye on the functions that go with that when, you know, what is it that they can't say? What is it that they experientially avoid? I mean, shame is one that people they very rarely talk about at the very beginning of therapy. They start talking about mistakes, guilt, failures. Yeah, you know, can they feel shame? No, because it's just too painful. It's too highly avoidant. Of course, some stage we're going to have to bring that into the room because that that they avoidance of shame is a key part of that narrative. Yeah. And there are certain you're looking for certain words that they use or they don't necessarily. Yeah, words and phrases, and it could just be movements as well that, you know, you could put, you know, say, got that sounds like, you know, I think if I thought that about myself, I think I would, I think I'd really be struggling with shame and they might just, you can just see them pull back or, you know, they might not not definitely not James more like you're thinking that's probably is actually, you know, because it's just working within the limits of what they can cope with at the time that they can cope with it. So our job is to always nudge them to draw white what's there to nudge them towards a more articulate more experiential way of talking about what they really do feel if they can let it in. And then we glue that package together and then we find a way of deconstructing it. Right. And when you're talking about getting down analysis of why they feel the way they feel right or why they're doing what they do, are you you're not talking about getting down to exploring childhood history of, well, this is where it started. Are you or it could be, I mean, you know, we very rarely get to this is where it started because it is always a series of events in the end of what we're looking the same because they give rise to the same perception with very few exceptions. So we, we tend to build up a history that makes the way you are makes sense to you that you realize it isn't you because if I was in that history, I'd come out just the same. It's really about anchoring what I have now in the history that gave rise to it. Now that's a really validating thing to do. It's also just very helpful because it allows you to see, okay, so there are things about this that I can and things about this that I can't change. So where do I go from here? So it's about anchoring what I have now in how it evolved across time and it very rarely comes down to singular events, it's using a pattern, it's like different ingredients produce cake. Yeah, because I was thinking too, how, how trustworthy is their network, when they so you know you can ask someone, so where did this all start? They're prone to tell you a narrative that leads you down a road that they may think is valid, but it's, it's more avoidance than anything else. Because they're operating, they're telling you from inside the story, and you're never going to hear from outside the story, but your job is to piece it together, your job is to listen to any details that that look like they were accurate and true, but that created the story just the way it is, which is just the way they're, they're telling it to you, but behavior comes and patterns, it's, it's very rarely random and never chaotic. So once you've heard a couple of versions of the same story, you become very adept at thinking that's actually a bit like that, and the likelihood is that that, I mean, I'll give you an example, some people have very traumatic experiences that have a heinous impact on their behavior, very specific bits of it. Some people, that's in their story, but it isn't having the same effect. There's another bit of the story that formed because something slightly different about those events was perceived to take an on board. So, I mean, you know, everybody, history gives rise to all these, these outcomes, but in these subtle, nuanced ways that are similar across individuals, but it doesn't lend you to, okay, so that happened, so everybody who experienced that then that must have turned out to be the same. Because, for example, experientially, there's a, there's a very big difference between, you know, the Elf hatred and self-disgust, they're not exactly the same thing, they have different functions and different relational patterns. So our job is to listen to what seems outside the story, so you can understand that, to explain to you, but how did the story form just the way they're telling me now? Yeah, I mean, you know, there are variations. I mean, if someone has, you know, talked about something lighter in a way than discussed, like, you know, I just don't like myself, don't know who I am, stuff like that. And as the, as the relationships unfolding, you can feel it, the sense of hatred coming out, because they're just more comfortable in dealing and saying it to you, you've built a context where they feel safer in terms of approaching painful content and painful words like that. And so it's a bit like, you know, you've seen discussed brothers and sisters, and then you can feel them coming into the room, and then he comes into the room, and it's a really pivotal moment because they've now started to go to a place that they just couldn't go to before and you're there with them. So you don't get big surprises very often like that, if, you know, discussed is coming out, it's probably, if it's been really avoided, it's going to come out rather slowly. And your job is to get sort of, it's a bit, I was thinking of it's a bit like shaping, get an approximation closer and closer, but you're not prodding into them, they're coming with you. You know, I mean, you've talked about, you've talked about hating yourself, that's, you know, that's a really strong way of talking about yourself. I mean, how negative does it go? So you're setting up a context where if discussed, the feeling of disgust has been avoided, then you're gently nudging that to come into the room at the pace that suits them. It's not too painful, you'd never say like a question. So do you think it's discussed? I mean, that would be horrible. It wouldn't, it just wouldn't work. Our job is to nudge, to nudge the close and closer to the things that they, that you guess they've been avoiding. And that's a guess, because you know, no, because it's been avoided. Right, right. And to always start with the relation, the Arctic eye, and so does it always contain what is the, what is the self relating to, and what alliances can I establish with that eye? Yes, it is. It's always, for us, it is always that the core question for us is that I is in a relational pattern with whatever negative stimuli, right? And our job is to absolutely find that, get experiential approach on the stimuli in the room, look at the functions that have been surrounding that, but that is what PVPT does, it goes after me negative what? And what are the functions around that? That in our experience and, of course, an experience of lots of other therapies, not just us, but it makes total sense is that they under the core, underpinning of your behavior is the, is the deep knowing sense of who you are. Whether that's correct or not, whether it's good or not, that's, that is forming all of the time as behaviors becoming increasingly selective and complex. And our job is to get to that, rearrange it if we need to, and in doing so, rearrange the functions so that they are more adaptive than. and non-adaptive or however you want to describe that. Yeah, and just to clarify too, when you're talking about the functions, so if a person comes in, they have a very coherent shane network, what would then the function be defined with that? Like how? You will see two sets, you will see a lot of avoidant functions. For example, if someone, if there's a shameys you're going on, you're going to have something like "I'm bad," because if you have shame as a function, right, you could have "I'm shameful." Like I'm a bad human being, and that makes me feel shame. Anything connected, the shame is going to be avoided because, again, because it's part of the me bad, me disgusting, but so you're going to have negative relating to variations and complexity, etc. Derivation is going to be low. You're going to have avoidance of shame or anything connected, because it connects to you being bad. And you're probably going to have, and this is what I think is quite different about PVBT. You're going to have a lot of approach behavior. You're going to be approaching, like, you know, being good, getting other people to like you, working too hard, you know, being the perfect parent. You're going to get a lot of approach behavior that's a bit like proving I'm good, because it's proof that I'm not bad. So for us, it isn't just the avoidance. That's a big part of it, and act is very focused on that. But I think what differentiates PVBT from other regimes, we're very focused on the approach behavior, because it's a bit like the approach behavior sets on top, and the avoidance just all seems to flourish and underneath. Right, right, right. You get a lot of like clean behavior, like an awful lot of "I need to care for other people. I can't make any more mistakes." You know, if you have someone, for example, with a history of being sexual victimization, and they carry a lot of self-disgust, then, and if they have shame about that, which of course is awful, because it's not their shame, but they carry it as if it was. That's very often the way abuse like that leaves you. Then what you tend to see, I'd word, is you tend to see very much a lot of proving that's about, you know, bad stuff didn't happen to me. I could never do bad stuff to another person. I must look good all the time. My body must be perfect. I can't look. I mean, you see a lot more approach behavior than you see. Avoid behavior and approach behavior tends to look like the opposite of the thing that's being avoided, because, you know, deep down, I'm disgusting, on the surface of it, I have to look like I'm perfect, and you see a lot of people like that. Yeah, and so then take that example, where she, you know, a client is saying, they have to look perfect, you know, they have perfectionism, and those approach behavior, how do you address that? How do you, how do you possibly address those approach behaviors? The first thing we do is really validate them, because they have a legitimate place in that person's life. It's just that they have a legitimate place in the story. That's a two-part story. The front part that says, "Look at me, I'm perfect." In the back part that says, "Look at me, I'm not perfect." So we start really validating and getting that approach behavior on the table, and connecting that approach behavior to the part of the narrative that says, "When I do this, I'm good." And then, of course, people have contexts where they can't do it, and it all just gets too much for them. And then we say, "Okay, so what about the days, what about those days when you can't get out of bed?" So, well, of course, perfect then. Oh, no, that was. So in some contexts, it's this, in other contexts, it's the opposite. That's like being on a pendulum of a clock. That's like, is it like that? Is it like swinging? But I've always got to make sure the pendulum swings to the clean end. Yeah, it's very often what clients will say. So then we start to what's the client build up the picture of the pendulum? Okay, you're talking about approach behaviors like obsessive cleaning, you know, perfect grades. Yeah, exactly, right, and perfectly. Do you allow them to, you know, you're validating? Do you allow them the room to see what that network is for themselves, or do you point that out? Not till quite a bit later, we let it be as it is. And, you know, just say, for example, if people are out to be the perfect mom, which is very common of the perfect colleague, and that's part of that approach behavior, we will validate it by saying, you know, you're an incredible trial, and I even see you really try and in here, and you know what, I think that's absolutely the right ingredient. I think that's really fantastic. It's just part of me breaks my heart because you're trying never seems to go somewhere. It's almost like you're coming in underneath it around the back of it. And listen, you're absolutely amazing. But there does appear to be a cost to you here. Where are you in all of this? It's like this, it's like this big clean hand has got you in its clutches. So, so, so very slowly, it's, it's where are you in this? And that, that tends not to invalidate or not to have a feel like you shouldn't be doing that, you're making some sort of mistake. This is a rational, there's a none of the things that we want. Yeah, yeah, you know, I see where you're you're building, you're building the alliance there, and you're getting their trust, but you're allowing them to turn on the light bulb. Absolutely right. You know what, I never really saw it that way. Absolutely right. As an experience, and we will very often reflect the experience of the therapist by saying, you know, when I watch you do that, I mean, I totally get it. It just breaks my heart because, you know, of what costs to you. So, we tend to, the therapist tends to stay very grounded and say, from the position that I look at, I, as at my experiences this, and that really does help the experience of the client go in the direction that you want, you know, does, you know, does it really look painful? Yeah, it really does look painful over here. What's it like for you? So, we do an awful lot of that sort of looking in, but normalizing at the same time, because if we swap places and you're over here looking in, I'd be doing exactly what you're doing. Yeah, yeah, and working with children are very vulnerable, right? And that light comes on, when they go home, you know, they're, they're being fed those same contingencies of, you know, the parent is not understanding the child's behavior and it's adding to the shame and blame network. How in the world do you get out of that cycle? You know, a psychologist aren't social workers, right? That's a social work context, and we've just got to be very aware that it's there. And what we, what you don't want is that you don't want to increase the punitive behavior by a parent, by, you know, oh yeah, now you're a smart ally. I mean, that's just, that's frankly just very dangerous. So, I mean, we always know what we can't change. We would really try to encourage holistic treatment where the parents are also in treatment because they're, you know, they're part of the problem, I'm part of the solution. I mean, we don't want children being taken from home because there are many contexts where that doesn't work either. So, knowing absolutely every second of every moment that we're constrained by the rules of the house and the dynamics at home. But our job in a situation like that is very often A, to keep the child alive and B, to keep whatever sense they have about themselves that's strong, keep that alive and keep it going until we get them out of there. That could be years, but I've had many 14-year-olds and my job, you know, in a funny sort of a way, is to be like a parallel parent holding their hand, giving them guidance, just to align them, be strong where you can and cope with being weak where you can and someday this this will all be different. And sometimes to be honest, just keeping them alive and standing, that's all you can actually do. Is it fair to say that good clinical psychologist is already doing all of this without even any awareness of RFT? Yeah, I mean, I've met a lot of really brilliant therapists over the years in acting and all sorts of other traditions. And you could translate very, very easily what they're doing into this language. And when you do that with them, they'll say, yes, that fits exactly. That language does really affect what I think I'm actually doing. So you're not rewriting anything, you're not, you're not trying to teach them anything, they're actually already doing it, but I would say two things. Even those brilliant therapists, they struggle with a language for what they do, they get frustrated even when they're trying to teach it in supervision, they get frustrated with themselves because they know what they're doing, they just don't have the language to do it. And the second thing is even really good clinicians will regularly come across a very, very difficult case. And if you don't have the language or a system to describe what you're doing, it's quite hard to get yourself when all of your normal tools and analytic strategies fail you. Because this is a way of understanding complex human behavior. There should, in principle, be no case, we can't understand. Of course, there are many cases we can't fix, to be honest, because sometimes the odds are stacked against people, or we can get them quite a bit better, but not, I mean, that's totally understandable. So if you have an analytic system that is built out of understanding complex human language and cognition, there is absolutely no reason why it could not be applied to every case. We've certainly never come across a case that this analysis couldn't understand and give you direction how to fix it as much as that was humanly possible, so that's the difference. And how long does it take to become skilled? Wow, that's one of those pieces, strange questions. It really depends on what you bring to the table, skill wise, it does depend on, I mean, if you've a lot of clinical experience, you've already honed your skills. If you have been functional analytically trained, your eyes are already trained to see functions, and if you're reasonably proficient at RFT, your eyes are reasonably trained to look for relating. If you're trained in something like act, you're very familiar with acceptance, you're very familiar with approaching avoid, so a lot of the pieces are already there. I would also say, and we often say this, for us too, a big hurdle is your own experiential work. If you've not done a lot of experiential work, certainly not in an ongoing basis, you will struggle with PBBT because it is about getting functions in the rim, and it is about supporting them, and it is a really hard job to be a grounded therapist, like it's a bit like I think being a parent, being really grounded, like the example you gave, that can also be a real obstacle, and it's very often we have to take people sort of out the back door of supervision and bring them in through experiential training, because it's just proven to soar for them, not too hard, just to soar to go with the pace with the client. So if those pieces were in place, you know, for the most part, people will come in this supervision and be in probably a couple of years, I would say, because they're working through this type of client, and then their supervision with somebody and they're working through different types of clients, and it's just a skill, it's just like learning to do surgery, and it's just how many hours you've done with the scalpel. So, without putting anybody off or making it sound like it's impossible, but isn't impossible, we have trained people to do it, you know, and they're absolutely brilliant at it, but it does take an awful long time, and there are many of those, I think, foundational skills, that if you don't have them, it will take a lot longer, that that's just the honest answer. Is that what then perspectives are is it trains clinicians on the use of PBBT? Yeah, it's one of the things that perspective does, and that's one of the reasons why perspectives has owns a trademark on PBBT, so that we can we can control, he delivers the training, because it is very precise and transformative, and you do not want the scalpel in everybody's hands, because people's lives are at risk. Yeah, is there then a vacation process? At the moment, the way it's trademarked is that if you attend trainings of ours, you are certified to do PBBT with your clients, because we want to train people to do it with the clients, because they, for us, are the guys who really matter the most. The way the trademark is located at the minute, or works, is that no one apart from my self-incare perspectives can deliver training, and just because one, we just need to get it out there, we just need to do trademark to control who's doing what. Down the line, we will possibly consider looking at levels of certification, but the trademark is only new, I'm going to trademark is only new, you got to let this thing settle, and you got to get people to a place where they can get confidence doing with this with their clients. There's no need right now for anybody to be delivering training, because they need to be doing with their clients. So once we get over that hurdle, then we'll look at, okay, we're at a place now, where we think quite a few folks are at training level, then what are we going to do with that? But remember, we've been doing this, you know, I'm working in this area for over 20 years. It would be quite a while before someone would catch up with us, it don't mean that they signed arrogant, but I'm just being honest in terms of the skill sets. So, you know, people want and to be trainers right now, that's not the most important question. The most important question is how do we get people trained to deliver this with the clients, and that is our immediate hurdle. So, perspectives does a lot of work with the public as well, but that's one of the strands, that's the PBBT strand of it, is to train people to do it. Okay, and I know you've spent a lot of time, you know, this was out of, this was kind of created directly if I'm wrong, out of a large grant at a university in Belgium, and working with people or clients around in Europe is the United States Canada, are they lagging behind? Are there people who are well trained in PBBT here? No, I would say, yeah, to be honest, there's a big lag. It's mostly European because those were the guys that our training was available directly too. In the grant, we very often did a lot of our trainings for free because we were getting a salary from the grant. So, it was whoever we were already connected to in Ireland, UK and Europe, and we just kept extending our connections even before, in the days before it was called PBBT. I mean, that's what the group of people that we were working with. So, obviously, it's been nurtured and fed and through that group and developed as part and part with our experiences in training those folks. So, it is probably fair to say, yeah, that American Canada and that West Wing is nerve-racking there that I would say that have been a lot of our training, you know. I mean, people like yourself and other people in Brazil, for example, have started coming to our recent training. So, I mean, you know, we're getting there and it's time and money for folks and things we appreciate that too. But there are quite, you know, I mean, we've you know, closed our online training once because it was full and the recent thing I did with Robin Walzer, it was full. So, I mean, you know, the numbers are there. People are interested, but it's a big group. You don't really need other certification. To be honest, we haven't really wanted to play that game where the salt club in here responds the most gets ended. I mean, we really want to devoid that at the same time, we have to be careful because it's such a precise tool. You know, if people, you know, if people are willing to jump the hurdles in terms of learning what they need to learn and that's how they come in and then they say, okay, I sort of think I've got the basics. Now I would like to, like we started doing clinics for that reason because clinics are for people who are sort of familiar with it, but you feel like they aren't ready for supervision. So, clinics is like a sort of slightly silent group where you can suggest the case where you can just sit back while I'm working through a case with somebody else. So, clinics was just a nice way of getting the guys who'd maybe done the training, but who really aren't ready for supervision yet. We had a group of people there that that was what they wanted in between and then when the people are in clinics and they say, okay, I think I'm sort of ready for supervision. Then we do blocks of supervision, but we try to match the three or four people in the group so that they're reasonably coherent in terms of skill or same types of clients or whatever, they're going to learn from each other. So, we have staggered it in terms of the things that we provide. For everybody who comes into any of our training events, we always try to engage with them very fully and say, look, what is it you want us to do here? Where do you think you're at? And if you say, oh, I think I'm really at supervision and we think, well, you're not, we'll just tell you and just say, listen, please don't waste your money on supervision. What we think you really need to do is we think you sort of need to do a bit more of this. You need to end the clinical or whatever. So, it's just trying to really genuinely match what you need with what's going to develop you and the next step and just trying to be as honest with people and create just for us trainings or products that are going to like meet the needs like, you know, training videos and stuff like that. Just things that people say, like, would really help me know if you did this and we're just trying to develop that. Yeah, I mean, look, I have complete respect for the ACBS training committee and I've been on the committee a couple of times and they really are trying to get it right. I think, yeah, I think something they got handed and it definitely is not reflection on the individuals there. I think they got handed a very clumsy system that really didn't ask questions about people's therapeutic competence and for me, that is always a stickler. I want to know how much experience you have. I want to know what you've been doing. So, the fact that anyone can call themselves an act there but that bothers me enormously and that was one of our key things about PBBT. You won't get to call yourself a PBT until we've seen you directly and we know the deal. We can't police you afterwards, but we've policed you of the system that's reasonably tight. So, if you're in the AC community a long time and you can call yourself an act therapist, whatever you want, you then have to engage at a different level to call yourself an act trainer but it is about act training and again because it's somewhat empty of this Qualification as a therapist in that sense in terms of your experience. It's getting better, but it's still a little empty of it I think that's I think that's potentially risky and it certainly is something that has put a lot of people off I think the other issue is the struggle and I totally recognize the struggle that people who already have the Qualification what are they asked to then do in order to maintain that and I think that is an ongoing issue as it is for many of those Organized and there's are not these are not easy things to solve but I think the system has a diverged NA CBS was designed to be very horizontal But that doesn't always work because you can get massive variability and you can get people who will play that to their advantage Right, and you know that's that for me is risky. That's all there's none of these systems are foolproof But that's that bit of it's risky. Yeah, and but that's I think that's a problem with act doesn't it? I think it's a problem that exactly the same thing we're talking about We've just got this massive variability. You've got some people do you act and it looks nothing like behavior therapy at all And you've got other folks do you enact I think and as an example people who are trained to do act is very beginning And it is clearly functional analytic in orientation the way they do it. So you've got this Really tightly functional end of it and you've got this I can only call very very loose end of it and one wonder So they both act is everything and I mean that look that's been I think that's been you know a bug for act For a very long time and there is no solid well It is what it is some people do it in a very very loose Non-functional analytic non-behavioral way and some folks did you look at anything that's behavior analysis red large I mean that's pretty obvious what it is So unfortunately if you don't certify And you make it really horizontal and you you let anybody call themselves an act there But you're going to get this massive variability and It's just not a move. We wanted to make them PBBT Yeah, and and just to draw Between what what a behavioral therapy is in a psychotherapy Very different, right? It is for us. Yeah. Yeah, it is for us. Right. So we're dealing with For us everything is behavior. It's all behavior. Yeah. Yeah. There's nothing. It's not behavior for us In psychotherapy, I mean, I'm simplifying a little bit, but there is a mentalism wing of that that says There is a psychological thing that's not to find this behavior and that's just not what we do for every for us everything behavior and it's behavior is understood in a scanarian and in an RFT way Right, right, okay, and I got you and and then also to clarify a really important point I am not Clear on this at all The practice of ABA in the practice of clinical behavior analysis and PBBT fall under clinical behavior analysis and are there special qualifications or special things that one must do to move in that direction I I like we like to think about PBBT as as clinical behavior analysis because if your behavior analysis is RFT It is clinical behavior analysis. It is the clinical application of behavior analysis. Don't three RFT don't through the developments Right, okay, so it just depends on I mean how loose you want to make your term clinical behavior analysis But but I keep it reasonably tightly defined it is the clinical application of behavior and let it concepts and the concepts are Effect to the row in our case. So it's definitely but is it also applied behavior analysis? Yes, if you're behavior analysis is RFT. Yes, it is Okay, all right So now just kind of shifting gears Thank you so much for clarifying that So shifting gears Is there anything now around the corner? In the future of this is This is going to continue to expand or are we kind of Working still working within this model I think on the scientific and and it's not that's not my job anymore But I think on the scientific and I would like to see more proof of principle type work Yeah, I think on the application and I think You know what PBBT has used the road to do. I think that bit's done But we've already been developing an awful lot of I think over the years we've modified a lot of the techniques and exercises and metaphors That we that I originally drew from act that we were using and They have developed and changed. I mean so dramatically we use analogy so much more than metaphor for example And so what Kieran I've been working on is is developing those Techniques developing those exercises developing those analogies and and really Putting writing a dime like we've been working on a book writing a dime so that people can can Go and see what it looks like and make and videos and things and see what do these guys look like when they're When they're actually in therapy and you can just see the way that we've developed the analogies and the exercises and And things and we do a lot of physicalizing exercises and things so for us. It's just really Writing a dime all of those changes that we've been making if we didn't just create an analytic sister We've actually changed the techniques and awful lot Yeah, yeah as well I thought now that you mentioned using analogy is I thought at the Brilliant part of the second example in the paper I cannot remember it was a mention of a stream. Oh, yeah, let's see once the functional properties of the word stream had been Established as a way to talk about her cyclical struggle. Yeah, the therapist then validated the stream By highlighting the coherence And how the therapists herself would react if someone's stream. Okay, so that was a lion's building, but then Um, am I getting this right that the therapist use a stream as a network to create a That sought to undermine the behavioral control. So basically you created a metaphor. So you use that term to describe something that was um Uh, I guess they avoided right and use a term to distance herself not only that But then built a metaphor Yeah, we did now she's sitting on a rock that's safe and Dipping her toe in stream. Yeah, we do that. Wow. That's really brilliant. That's a great very specific Use of metaphor. Yeah, it really is we tend to put in like a little mutually entailed relation first like you know what? That's wow. I mean, that's a real that's real badly got going on there And then we'll add debattled by you know, see that bad old you know, you must really feel like you're underneath it like you're stuck inside and then Then you know as the system is tilting We then use that relation that will build up complexity and those new derivations and then we'll start to to reshape the functions when they're in there So we'll start off with like a one word it'll become a bit of analogy and then it will be built up in the amount of for that directly captures all the functions And just dump some all inside it and you do that a lot it is incredibly powerful, but you have to have done your homework Yeah, and the brilliant thing is they have no idea Right, so it's really a backdoor action which leads me to like a really important question because you know We're dealing with in this country, right? We're um, I can I had mentioned before you know, you can sit down with a person on the old spectrum and Is not only a difference of opinion, but it's a different of how they How we view facts, so I could say you know the sky's blue. They would say the sky's pink, right? We can never agree on anything there There when you're talking about those dimensions of endurance and rigidity um, all that kind of is is there to get it through the front door is nearly impossible um, and this seems like a backdoor action where Yeah, it really is. I mean like for example if you look at political situations like that where the the ideologies are just completely opposite You're not going to change the relating you may just have to change the functions Our job and that's strange matter for was to get the functions to shift so that when the client started to look for germs or whatever it was she realized This the detail doesn't matter. I'm already drawing but but the life has already just gotten sucked out of me in this very moment So that was really do wrestle with the functions and and in a situation like that where the two relational patterns are the opposite sometimes All you can do is say listen, you know, you may be Protestant. I may be Catholic. We are never going to agree But what about we have a common purpose? What about we have a common function What is it that we can actually do together if you can change the relating then you you've got no option But to start to work on the functions. There's just no other option open to you Yeah, yeah, that's something definitely think about has this been brought in or tried to be brought in out in I mean, I think it has, but not in a explicit way. I mean, if I look at, if I have my sister-in-law, who's an incredible participant in the women's movement here in Northern Ireland, and she works from very, very hard core Republican women in those areas, along with women in very hard core loyalist areas. And they couldn't agree on politics. Look, it's, you know, but they are mothers. They are struggling financially. They're trying to do charitable works, and they formed a group around common purposes. So now they help other women, and the Catholic women, they represent Catholic women, but they help everybody in that because they represent the views of them absolutely, and Protestant women, they of course they represent their own communities views. That's absolutely fine. But the common function is to, is to, is to represent their own community. It's to, is to help the other women around us. And that dominates any political narrative or relational patterns. So I think communities have been doing this forever, where communities have been divided. They, they really stopped talking and started working together. And then, I mean, they never talk about politics because it, it's, it's not, it doesn't matter functionally. Right, right, right, yeah. And, you know, it just brings me back to, I'm old enough to remember when I could have a disagreement with someone, but we could actually be friends. And now we've moved into a, a point in history where my wife and her father, as he is on the other side of the political spectrum, he's on the other side of the religious spectrum. And that is so now a boy, that's, that's part of, that's defining his character, right. And it's like, well, you know, there's got to be a work around as opposed to instead of avoiding any conversations and walking on glass. There, there's got to be a part of language that we can use to soften the approach. I think there always is an principle, but the thing is, you know, you can take a horse to the well, but you can't make a drink. I mean, with all due respect to each party's, each party's view, there are probably two things that really happened. I mean, one is their views are not respected one way or another. And the other thing, I think, is there are needs that aren't met on either side. And if needs aren't met for long enough, you will get into this very entrenched position. And it's, it's like the end of the slope and really not the beginning of it. So if you combine needs not being met with being disrespected, you, I mean, when people, when that happens to people, they self harm, let alone other people. So, I mean, in principle, there's always a solution, but an organism isn't always ready for it for those reasons, because they can't see how it's going to meet any needs and they can't see how they're going to be respected. It's, I mean, that, that is one thing, I think, is, and it's very strong. And I was very unique to PVBT. We will take the horse to the well and we completely respect his views, not the drink. It's, yeah, it really, sometimes if you live in a world where genuinely is a white choice, you'll often be disappointed in people's choices. Yeah, yeah, I find that we would mention that in another podcast, there is a, the fundamental around surrounding choice, right? Yeah, understanding context to an extent of fundamentally underneath that person has a choice. And because they chose what they did there to blame and you still have that blame network. Logs didn't are, is conceptually go for to understand. It is, and it's experientially difficult because you look around and you think it would be better for them, it would be better for all, why don't they, and maybe all that's true. It's just that I think in PVBT, we put respect up along with choice. And when you put respect along with choice, sometimes you could just, you know, you really get very frustrated. Yeah, yeah, well then you have all the sheds and odds. Yeah, you do. And, you know, they don't help either. So like, you know, you and that organism are just at a different place. You've done everything you can to bring that person to a workable place. And then, then you set them free. It's difficult, it's difficult experientially to do, but I think you learn to, you learn to get patient across the years. Is there anything that we haven't talked about? Just for us. No, no, I mean, we've, you know, just tried to explain to people why we felt the need for PVBT to be a thing. And why in, in many ways, it's, it seems different. It's a different analytic model and it allows you to use whatever techniques you want to use, some will fit that better than others, but it's ultimately a model for analyzing complex human action. And that gives you direction on how to change it. And, and that's, I just wanted a basic science to do that. I really did. Yeah, yeah. And it's, it's easier to like RFT like it's, it's conceptually easy to understand. It's much, much harder to put in the application. Yeah, I mean, it is a very, very fine precision tool, base piece of work, but sometimes people's difficulties are just the width of a hair. Yeah. And your job is to is, is to get in there with your, with your tool and cut through it's best you can. Yeah. Wow. Thank you so much for being with me. I learned an incredible amount. And I hope that, um, yeah, I, I plan to learn more about PVBT myself, you know, grow from here. I think our website is growing, we're starting to really fill their shells with the things the products that people have asked us for. And so if there's something that you think would really help you and other people, then just email us and say, listen, this is where I'm at. This is, you know, do you provide this sort of training or what? And we will, of course, we'll look at it. Our job is to get it out there. Yeah, you know, and I took my training through behavioral connections. Are you offering another PB PBT training soon? Yeah, we have just recorded an online training that we did. Okay. Okay. That's not everybody given the time zones or whatever could, could do lives. So we literally just recorded it and should be on the shelf for people to buy. So it's like multiple pieces is like four modules divided into clips. And so that should be available possibly next week of the week after. And the comics are running. Yeah. On the perspective Ireland website. Oh, fantastic. Okay. Yeah. Great. Thank you so much for being here. And stay safe in Ireland. Like this. Yeah. And we're all watching the situation in America. And don't forget us. Our fingers crossed that you. Yeah. We get it better. We get it better dancing. We need to all up. We need all the allies we can get. Thank you. [Music]