You’ve probably heard a lot about process-based therapy. Today I wanted to provide a quick orientation to it, and then some follow-up readings. I hope that a process-based approach will help empower you to be a more flexible, creative, and effective practitioner.
Process-based therapy is not a replacement for other therapies.
It’s a shift in focus.
For example, you might do psychodynamic therapy, schema based therapy, or cognitive behaviour therapy ALL in a process-based way.
Process-based therapy helps you shift from thinking in terms of evidence-based packages to evidence-based processes inside those packages. So instead of saying this CBT protocol is evidence-based and you have to use the whole protocol with every single person, you can identify the evidence-based processes within the protocol.
This gives you a lot more flexibility and creativity, because you don’t have to use the whole protocol with every single client, and you can cross therapeutic islands and use techniques from different approaches together, within the same coherent framework. Pretty cool huh?
The above example illustrates what we’re up to here. We often evaluate therapeutic packages like a black box. We don’t know what ingredients are inside, and which ingredients we need for each client. A process-based approach lets us open the box, and examine what are the evidence-based processes. I’ve given a few examples here, such as those targeting cognition, affect, and overt behaviour. Once we break the package down into evidence-based processes, we’re now free to use components of the package that, based on our case conceptualisation, are most relevant to our client. For example, not every client needs to be taught how to think of problems as challenges rather than threats. Not every client will need an emphasis on goal setting.
The process-based metatheory underpinning process-based therapy is called the extended evolutionary metamodel (EEMM). I know that’s a mouthful, but don’t worry, you can read about it on the links below if you’d like to know more. Here are a couple of important points about the EEMM.
We can use the EEMM to understand other theories. It’s not restricted to one therapeutic approach. Rather, It’s based on the one theory that every single therapeutic island accepts: evolution. Thus we hope it will allow us to create a shared language that everybody can use, in every therapeutic orientation, to communicate their amazing insights.
The key drivers of change in this model are: variation, selection, and retention, in a particular context. For example, if someone is struggling and seeking help, that means they need a change. You’ll need to support them to try something new (variation). Then they’ll discover if that new behaviour builds value, meaning and health (selection). Finally, when they find what works, they need to make sure the new behaviour “stick” (retention). Maybe they’ll develop habits, or morning rituals, or change their environment so that it’s easier to engage in value consistent behaviour.
The evolutionary meta-model attempts to provide a kind of common language for all therapies, a periodic table of evidence-based processes. All processes can be classified as involving the dimensions of cognition, attention, affect, motivation, self, and overt behaviour. The figure below presents an example of the process and how it might be linked to the hexaflex and DNA-V models of ACT.
The extended evolutionary meta-model doesn’t replace the hexaflex or DNA-V framework. Rather, it let’s y put the two frameworks side-by-side and understand how they relate.
The process-based approach will help you understand what you emphasise in your own practice and what you may want to do more of. It’ll also allow you to explore other therapeutic orientations, knowing that you can always classify the process within that orientation inside the extended evolutionary metamodel. Finally, it gives you flexibility with clients. You can use different processes, in different orderings, with different clients, depending on what they need. For example, with a mandated client you may emphasise value clarification and building a relationship. In contrast, if you have a fully engaged client who already has a high level of emotional awareness, but is not engaging in helpful behaviour, you might emphasise activating overt behaviour. In this way, process-based approaches help you personalise your interventions.
Follow this new journey of process-based therapy with these follow-up readings.
Ciarrochi, J., Hayes, S., C., Oades, L.G., & Hofmann, S.G. (2022). Toward a unified framework for positive psychology interventions: Evidence-based processes of change in coaching, prevention, and training. Frontiers in Psychology, 12.
Hayes, S.C., Hofmann, S.G., Ciarrochi, J. (2020). A process-based approach to psychological diagnosis and treatment: The conceptual and treatment utility of an extended evolutionary model. Clinical Psychology Review, 82.