Acceptance and Commitment Therapy: Advanced Workshop

Acceptance and Commitment Therapy: Advanced Workshop

Julian McNallyJulian McNally

Program Outline

Review Of ACT Model

Getting Stuck Into ‘Getting Stuck’

7 Frequent Problems And How To Respond

Sweet Spot And Client Descending

Matrix For Case Formulation

Developing Mastery In ACT

“Hexaflex”“Hexaflex”ACT Model of Effective LivingACT Model of Effective Living

Values, Purpose & Meaning

Defusion Committed Actions

Contact with the Present Moment

Acceptance & Willingness

Transcendent Sense of Self/ Self As

Context

PsychologicalFlexibility

“InFlexaHex”“InFlexaHex”ACT Model of PsychopathologyACT Model of Psychopathology

Lack of Values Clarity or Contact

Fusion Inaction or Disorganised Activity

Dominance of Conceptualised Past

or Feared Future

Experiential Avoidance

Attachment to “Storied” or

Conceptualised Self

“Hexaflex”“Hexaflex”ACT Model of Effective LivingACT Model of Effective Living

Values, Purpose & Meaning

DefusionCommitted Actions

Contact with the Present Moment

Acceptance & Willingness

Transcendent Sense of Self/ Self As

Context

Mindfulness & Acceptance Processes

Behaviour Change Processes

Your turn!

Decide who will be client first

Brief your partner on presenting problem, but not what’s ‘tricky’ about this client

Counsellor: Notice yourself getting stuck. Observe thoughts and feelings

Client: observe and resist urge to be agreeable or make it easy for counsellor

If counsellor is not getting stuck, brief “client” on what the actual client does that’s ‘tricky’ and try again. Switch.

Pair up - one is “A” the other is “B”

Getting Stuck Into “Getting Stuck”

My experience is not authoritative because it is infallible. It is the basis of authority because it can always be checked in new primary ways. In this way its frequent error or fallibility is always open to correction.     Carl Rogers, On Becoming a Person

Bennet and Cari

• Notice your reactions and make peace with them

• Provide an ACT-consistent response

• Where is the client on the Hexaflex?

• Where are you on the Hexaflex?

7 Frequent Problems

1 What do I do if I get stuck?2 Do I need to cover all 6 processes?3 What if they say “it didn’t work”?4 What if they don’t know/can’t say what their

values are or don’t have any?5 What do I do with clients who are

sceptical/concrete/psychotic?6 What if they (or I!) don’t “get” Self-As-Context?7 What do I do with clients who are fused with

their beliefs or a ‘sick’ or ‘victim’ role?

What do I do if I get stuck?

General principles:

Slow down!

Be willing and accepting

Hold your formulation and treatment trajectory lightly

Stick closely to principles and loosely to techniques

Listen to client’s experience before yours

Listen to experience before models and ideas

Invite a change in action rather than in understanding or feeling

Do I need to cover all 6 processes?

No!

What if they say “it didn’t work”?

Is there a control agenda in place?

Try another part of the model

Try a different technique from the same part

What if they don’t know/can’t say what their values are or

don’t have any? How do they know they don’t know?

When was the earliest (last) time they remember having values?

Make the therapy about discovering/creating values?

Check for semantic problems

Detect values in the present

What do I do with clients who are

sceptical/concrete/psychotic?

“Trust your experience, not my words or your thoughts”

Workability of scepticism

Sideline “beliefs” and “being right” for a while

You don’t have to do “mindfulness” – just pay attention

Psychosis – ACT is not an EST – other treatments

Metaphor-imperviousness? Present-moment defusion and willingness with Self-As-Context

What if they (or I!) don’t “get” Self-As-Context?

Let’s practise!

Indicators Of Increased Capacity For Self-As-

Context Detecting and defusing from rules and stories

Increased perspective taking and noticing

Noticing own processes of fusion and unwillingness

Naming or joking about own scripts and stories

Able to dispassionately examine value-contradictory behaviours and thoughts

Recognising current choices and history as separate phenomena

Relating to multiple conceptualisations of self as determined by context and values-in-the-moment

What if they are fused with their beliefs or a ‘sick’ or

‘victim’ role? Try Self-As-Context

Be curious and empathic

Appeal to workability

Template for Experiential Exercises

1 Recognise your mind will interfere, so slow down and accept

2 Contact with present moment – sounds and touch

3 Locate the moment of choice or ‘stuckness’

4 Immerse in the moment (file cabinet or movie screen)

5 Open eyes and express it

6 Hold the moment silently and appreciate

The Grid - Kevin PolkThe Grid - Kevin PolkEven Simpler Model of ACT ProcessesEven Simpler Model of ACT Processes

SwS Valued Living

Sensory Experience

Mental Experience

“I think that...”“I think that...”

“I’m having the thought that...”“I’m having the thought that...”

“I notice I’m having the thought that...”“I notice I’m having the thought that...”

This is This is unbearableunbearable

I notice those I notice those thoughts are there thoughts are there

againagain

Recontextualising the ProblemRecontextualising the Problem

DepressedDepressedUnmotivatedUnmotivatedUnemployedUnemployedIndecisiveIndecisive

OverweightOverweightUnloveableUnloveable

Need therapy!Need therapy!

What I want What I want my life to my life to stand for stand for

DepressedDepressedUnmotivatedUnmotivatedUnemployedUnemployedIndecisiveIndecisive

OverweightOverweightUnloveableUnloveable

Need therapy!Need therapy!

The Life I’m left withThe Life I’m left with