Recontextualising the ProblemThe Life Im left with
For Sweet Spot & Client Descending, add a template for How
to develop these kinds of exercisesCan use GUIDE FOR AN INITIAL ACT
SESSION If this helps you get startedRogers quote: Nothing to do
with getting stuck.
Value of getting stuck: Committed action is not about not
falling down on the climb up the mountain, its about continually
getting up again
The expertise literature (more to come about that in the
afternoon) says you learn by exposing your mistakes to
correction
Bike-riding metaphor. How do you keep your balance when youre
riding a bike? Trick question you dont!Notice your own cognitive
and emotional response to what the client says. Take a moment to
accept and make peace with these feelings and to observe these
thoughtsProvide a response that acknowledges the client's position
and provides a bridge to one of the Hexaflex pointsWhat ACT process
is going on with the client (that warrants your attention)?What ACT
process is going on with you?Demonstrate with a volunteer if there
is time or offer to come back to this.Respect the context in which
you are working and the clients treatment goals. To some extent the
latter are negotiable anyway who doesnt want a richer, more vital
and meaningful life? Clients are only stuck in how theyre trying to
achieve that (get fixed first and the EA agenda). From the research
lit on ACT it seems as though the approach is robust enough that
leaving bits of the Hexaflex out doesnt prevent good
outcomes.Invite participants to give examples. Who has had clients
say this? What did they say? What were your therapeutic goals?
CONTROL AGENDA: You or the client are trying to change or avoid
an experience/feeling?ANOTHER PART: Sometimes what your formulation
is off and they will respond to a different part of the model
better. The main thing is to keep things flowing, not get
stuckDIFFERENT TECHNIQUE: Some people just dont respond to certain
exercises. Or maybe the exercise doesnt suit you.
IF YOU SAY IT DIDNT WORK: What was your agenda? And why arent
you just moving on?How do they know they dont know? Where do they
go to determine the answer to this problem? Check that its not into
their feelings or comparisons with others/idealised self/ rules
etc.
Semantic problems? E.g. they think of values as something given
by society, parents, scripture, or other rule source. i.e. theyre
not the author and chooser of them.
Detect values in the present: What purpose do they have in being
in therapy here with you today? There is so much else you could be
doing, why this? What matters? Who will be positively affected if
they change?
ALL of this with an invitational attitude.
Workability of scepticism: What is it costing you? How is life
working when you follow the rules of a sceptic?
Psychosis: What ACT does have to offer increasing clients
capacity to tolerate the distress occasioned by the symptoms
Emphasise small steps and relational shifts: to the symptoms and
small steps = behavioral change
Metaphor problems? Perspective-taking challenges from ABI/
developmental difficulties/ psychosis but present moment is always
there, so what can client practise willingness in the presence
of?
Don't get Self-As-Context
"I'm not that" exercise - whole group"Observer Self" exercise -
demo with s.o. who doesn't get it"Who are you?" exercise pairsIf
time, Conversational demo - "Who is noticing that? Who is saying
that? Who answered that question?"The ability to see rules and
stories about one's life as just verbal formulations, not as
determinative of one's choices
Increased ability to take or notice the perspective of
others
Increased ability to notice the appearance of old rules or the
process of being 'hooked' by one's own thoughts
*Naming and joking about scripts and stories
Able to examine patterns of thinking and behaviour that have
been contrary to one's values
Recognising that while one's history may bring difficulties, it
doesnt define one or one's choices and that valued choices are
always possible
Relating flexibly to multiple conceptualisations of self
depending on context and on values being lived
Curious and empathic: Help me understand. Can we just dwell in
the space of this conflict or choice without rushing to either
conclusion? Demonstrate if a volunteer and there is time.
Workability: How is it going with the belief and getting a life
that you love? "Gee, that all sounds reasonable, and yet there's
this difficulty you keep encountering...
And if theres time do Demonstrate with a volunteer if there is
time or offer to come back to this from Slide 10 How do you get
stuck and what do you do?
Promise that after lunch youll get to experience staying with
being stuck.
Recognise your mind will interfere, so slow down and accept
Contact with present moment sounds and touch
Locate the moment of choice or stuckness
Immerse in the moment (file cabinet or movie screen)
Open eyes and express it. SLOW RIGHT DOWN YOU FIRST AND THEN THE
CLIENT
Hold the moment silently and appreciate TRAIN THE CLIENT TO
DEFUSE DURING THIS
Healthy living = Acceptance of and response to sensory
experience, with actions guided by values.Pathology = Fusion and
overinvolvement with Mental Experience and actions directed into
struggling with suffering
If time - do this:Simply draw The Grid for your client and
explain that to the right are behaviors or actions toward values,
important things like health, relationships, etc. To the left are
behaviors away from unwanted mental experiences like anxiety and
depression. Explain that all humans do both kinds of behaviors.
Above the left line write the following:I ________ for ___________.
I ________ for _________. action suffering action valueHave the
person fill in the action blanks with the same action, but the
suffering and value blanks are filled with an unwanted mental
experience (suffering) and value. For example, one might sleep for
depression or sleep for health. One might walk for anxiety or walk
for health. One might talk for anger or one might talk for
friendship. Once the person has filled in the blanks ask, "Is there
a difference between doing that action to move away from suffering
and doing that action to move toward a value?" Most people will
immediately notice the difference between moving toward and moving
away. If not, keep training until the difference is noticed.3 Step
defusion of troublesome thoughts1. I think that this suffering is
unbearable2. You could say though, that im having the thought that
this suffering is unbearable.3. You could also NOTICE that you are
there having the thought.4. It looks like the thought appears out
of nowhere. Just like when you open your eyes, there is the
world.5. As soon as that unbearable thought appears, so does
everything else associated with it. [RFs]6. But there is a mind
there having the thoughts. In a sense you contain them, so you are
not them...7. ...and can observe your mind having them. [Then go on
to choose value-consistent actions in their presence.]
