“RussHarrisisanopen,centered,andengagedteacherofacceptanceand commitment therapy (ACT), and, in ACT Made Simple, hesucceeds in delivering a transparent account of a complex andpowerful treatment. I recommend this book to mental health andmedicalprovidersandtotheirteachers.”

—Patricia J. Robinson, Ph.D., coauthor ofBehavioral Consultation and Primary Careand The Mindfulness and AcceptanceWorkbookforDepression

“ACTMadeSimpleissimplythemostaccessiblebookwrittentodatefor therapists interested in learningACT.RussHarris explainsACTconcepts in a style that is both engaging and straightforward. Hisadvice on overcoming therapy roadblocks is invaluable and will beusefultobothnoviceandexperiencedACTpractitioners.”

—Jason B. Luoma, Ph.D., psychologist atPortlandPsychotherapyClinic,Research,andTrainingCenter

“Perhaps the most elegant, easily digestible book on using theprinciplesofmindfulnessandacceptancetoimproveyourownlifeandthe lives of others. Inside are a litany of creative exercises andstrategies that are ready for immediate use.But none of the benefitswouldbepossiblewithout the supportive, entertainingvoiceofRussHarris.Thereissomethingnewtobelearnedwitheachreading.”

—Todd B. Kashdan, Ph.D., professor ofpsychologyatGeorgeMasonUniversity andauthor of Curious? Discover the MissingIngredienttoaFulfillingLife

“ACTaimstoincreasepsychologicalflexibility.Learnfromthisbookand you’ll bedoing ACT rather than just talking about doing ACT.Andyou’llbedoingitwithgreaterflexibility.”

—HankRobb,Ph.D.,ABPP

“Let’sfaceit:psychologicalconcernsarecomplex.Ifmodernbehaviortherapyis torise to theoccasionofreducinghumansuffering, itwillrequire a similarly intricate and comprehensive approach. ACTattempts to provide amultifaceted treatmentmodel to address thesecomplexities, and ACT Made Simple has risen to the occasion byreducing the difficulties in understanding the uniqueACT approach.Harris’s expressive style is matchless. Comprehensive scientific andclinicalliteraturerarelyreadsthiswell.Thisisaclear,understandableintroduction to a powerful intervention approach.Many practitionerswhoarenewtoACTwillwanttostartwithACTMadeSimple.”

—Daniel J.Moran, Ph.D., BCBA, coauthor ofACTinPractice

“This much-needed book is a must for mental health cliniciansinterested in learning ACT. True to his physician roots, Harris hastaken a very practical approach to understanding ACT. He does awonderfuljoboftakingcomplicatedACTconceptsandmakingthemeasy to understand. His writing is full of wit, self-disclosure, anddown-to-earthcommunication.Readersofthisbookwillfinishitwitha much better understanding of core ACT principles andinterventions.”

—Kirk D. Strosahl, Ph.D., coauthor of TheMindfulness and Acceptance Workbook forDepression

“FornewcomerstoACT,thereisnobetterplacetostartthanwiththisbook. Russ Harris masterfully makes ACT come alive with anaccessiblewritingstyleand illustrativeexamplesof itsapplication inalleviatingawiderangeoftypesofhumansuffering.Practicaltipsandhomework assignments throughout will actively engage you to gobeyondmerelyreadingaboutACTandbegintoapplyit toyourownlife and in your work with clients. For those who may have beenholdingout forACTforDummies, thewait is over.This book is foryou!”

—RobertZettle,Ph.D.,professorofpsychologyatWichitaStateUniversityandauthorofACT

forDepression

“For those of you who train or supervise nurses, physicians, socialworkers, or other professionals unfamiliar with psychological lingo,ACT Made Simple is a must. Russ Harris has succeeded in thechallengeof translatingdifficultpsychologicalconceptsembedded inACT into plain, colorful, diverse language that anyone workingclinicallywill understand. Each section is simply organized, easy tofollow,anduser-friendly.HarrishasincludedhighlyusefulsectionsofpracticaltipsandcommonpitfallsthateventhetrainedACTtherapistwillfinduseful.IhighlyrecommendACTMadeSimpleasaprimerforACTtraining.”

—JoAnne Dahl, Ph.D., author of The Art andScienceofValuinginPsychotherapy

“ACTMadeSimple is just that.Dr.Harris has, once again,written averyaccessiblebook that shouldbe readbyall clinicianswanting tolearn,engageorotherwiseimplementACTintheirpractice.ThisbookisamustforACTreaders.MythankstoDr.HarrisformakingACTsouser-friendlyandunderstandable.”

—Robyn D. Walser, Ph.D., author of TheMindfulCouple

Publisher’sNoteThispublicationisdesignedtoprovideaccurateandauthoritativeinformationinregardtothesubjectmattercovered.Itissoldwiththeunderstandingthatthepublisherisnotengagedinrenderingpsychological,financial,legal,orotherprofessionalservices.Ifexpertassistanceorcounselingisneeded,theservicesofacompetentprofessionalshouldbesought.DistributedinCanadabyRaincoastBooksCopyright©2009byRussHarrisNewHarbingerPublications,Inc.5674ShattuckAvenueOakland,CA94609www.newharbinger.comAllRightsReserved

epubISBN9781608821747TheLibraryofCongresshascatalogedtheprinteditionas:AcquiredbyCatharineSutker;CoverdesignbyAmyShoup;EditedbyCaroleHoneychurch;TextdesignbyTracyCarlson

LibraryofCongressCataloging-in-PublicationDataHarris,Russ,1938-

ACTmadesimple:aneasy-to-readprimeronacceptanceandcommitmenttherapy/RussHarris;forewordbyStevenC.Hayes.

p.cm.Includesbibliographicalreferencesandindex.ISBN-13:978-1-57224-705-5(pbk.:alk.paper)ISBN-10:1-57224-705-3(pbk.:alk.paper)1.Acceptanceandcommitmenttherapy.I.Title.RC489.A32H372009616.89’1425--dc22

2009023487

DedicationTomybrotherGenghis:forallyourlove,support,inspiration,andencouragementoverthe

years;forpushingmewhenIneededpushing;foranchoringmewhenIneededstability;forshowingmethewaywhenIgotlost;andforbringingsomuchlight,love,andlaughterintomylife.

ContentsForewordAcknowledgmentsIntroduction

What’sItAllAbout?1.ACTinaNutshell2.Stuck,NotBroken3.TheHouseofACT4.GettingExperiential5.OpeningACT6.CreativeWhat??!!7.WatchYourThinking8.OpenUp9.BeHereNow10.PureAwareness11.KnowWhatMatters12.DoWhatItTakes13.GettingUnstuck14.IandThou15.TheTherapist’sJourneyAppendix1.CaseConceptualizationMadeSimpleAppendix2.ResourcesReferences

ForewordAcceptanceandcommitmenttherapy(ACT)isoddlycounterintuitive.Themindfights it. Even experienced ACT therapists and successful ACT clients canconnect with something in the work, move forward, and then weeks latersuddenly find that thevitality is gone from that connectionbecause theyhavesubtly reformulated it mentally into somethingmore “normal” but also muchlessuseful.ACTisnotabouttrainingthenormalmodeofthemind.Itisaboutgettingout

ofyourmindandintoyourlife.Mindsdon’tlikethatagenda.ThisveryphenomenonpartiallyexplainswhyACTisanewtherapyformost

clinicians,eventhoughitwasdevelopedalmostthirtyyearsago.Wedeliberatelyspenta long timeworkingout theunderlyingprocessesand

theory in hopes that thesewould serve as a guidewhenwe lost ourway.Wecouldsay,inprecisebehaviorallanguage,whatwasmeantby“mind.”Wecouldresearch,inprecisebehavioralexperiments,howdefusionalteredtheimpactofcognitionorhowacceptancechangedtheroleofemotion.This strategy did indeed help keep thework focused, but it greatly delayed

thoroughpresentationsofthework.(ThefirstbookonACTwascompletedonlyten years ago, nearly twenty years afterACTbegan.) It alsomade earlyACTwritingsverycomplex.Clientshaveahardtimeshiftingfromaproblem-solvingmodeintoamindfulappreciationmode.Theunderlyingtheoryexplainswhyandwhat to do about it—and we were ready with these detailed geek-scienceexplanationsevenifattimestheywerevirtuallyunreadabletothosenotversedinbehavioranalysis.Fortunately, theheart of thework shone through for someat least.Creative

cliniciansandauthors,includingtheauthorofthisbeautifulnewbook,begantofindsimplerandclearerwaystohelpothersconnectwiththework.TheadventofACTself-helpbooksacceleratedthatprocessevenfurtherasauthorslearnedhowtowriteinwaysthatpeoplecanunderstand.NowtheACTliteratureisvast,withscoresofbooksandhundredsofarticles.

Cliniciansneedaplace tobegin toexplore that territory.Myprediction is thattheyhavejustfoundit.Russ Harris is brilliant in his ability to sniff out needless complexity and

presentcomplexclinicalideasinanaccessibleway.ACTMadeSimpleisACT.

Unquestionably.Thisbookringswithaclearnoteoneverypage.Russhasputinthe years to understand the work deeply (even the geek science underlyingrelational frame theory) and learn toapplyandextend itwith integrity. In thisbook,hehasbroughthis considerable talents tobearon the clearpresentationandformulationoftheACTmodel,andhehasbroughthisclinicalcreativitytonewmethodsandnewwaysofgettingtotheheartoftheseissueswithclients.Thatisagreatcombinationandasignificantcontribution.Particularlyifyou

arenewto thework, thisbookwilldoamasterful jobofopeninguptheACTmodelforyoutoexplore.Itisjustasthetitlesays:ACTMadeSimple.—StevenC.Hayes,Ph.D.UniversityofNevada

AcknowledgmentsFirst,ahumongousthankyoutomywife,Carmel,forallherloveandsupport;forputtingupwithmyobsessive-compulsivewritingdisorder; forencouragingmetokeepwritingduringallthosedarkpatcheswhereIthoughtIwaswritingnothingbutcrap;andforbeingmy“soundingboard”andactivelyhelpingmetodevelopmyideas.Thanksalsotoallthosefriendsandcolleagueswhoreadearlydraftsandgave

me invaluable feedback: Julian McNally, Georg Eifert, Hank Robb, and RosLethbridge.Asusual,I’dliketodumpazilliontruckloadsofgratitudeonSteveHayes,the

originator of ACT—and that gratitude also extends to Kelly Wilson, KirkStrosahl,RobynWalser,andHankRobb,allhugesourcesofinspirationforme.Ialso amvery thankful to the entireACTcommunity,which is very supportiveandinspirational;manyideaswithinthesepageshavearisenfromdiscussionsontheworldwideACTListserv.NextI’dliketothankmyagent,SammieJustesen,forallhergoodwork;and

a heap of thanks to the entire team atNewHarbinger—including JessBeebe,CatherineSutker, andMattMcKay—for all thehardwork, care, and attentiontheyhaveinvestedinthisbook.Editorsaretheunsungheroesofsuccessfulbooks,andsoI’dliketosingmy

thankstotheheroiceffortsofmyeditor,JeanBlomquist,whotrulyhadherworkcutoutforherinknockingthisbookintoshape.AndfinallyIwant to thankmyson,Max.Whileheisfar tooyoungtohelp

mewiththebookdirectly,hehashelpedenormouslyinamoreindirectmanner,simplybybeinginmylifeandfillingitwithsomuchlove.

Introduction.What’sItAllAbout?

LifeisspeltH.A.S.S.L.E.—AlbertEllis

Lifeisdifficult.—M.ScottPeck

Lifeissuffering.—Buddha

Shithappens!—Anonymous

Why,Why,Why?Whyisitsohardtobehappy?Whyislifesodifficult?Whydohumanssuffersomuch?Andwhatcanwerealisticallydoaboutit?Acceptanceandcommitmenttherapy(ACT)hassomeprofoundandlife-changinganswerstothesequestions.This book aims to take the complex theory and practice ofACT andmake itaccessible and enjoyable. If, like me, you’ve got a bookcase full of mostlyunfinishedacademictextbooks,you’llappreciatethefactthatACTisengagingandplayful.I’vedeliberatelykepttechnicaljargontoanabsoluteminimumandoptedforeverydaylanguagewhereverpossible.IhopetomakeACTaccessibleto thebroadestpossible rangeofprofessionals—fromcoaches,counselors,andmental health nurses, to social workers, psychologists, psychiatrists, and allhealthprofessionals.

SoWhatIsACT?WeofficiallysayACTastheword“act”andnotastheinitialsA-C-T.There’sagoodreasonforthis.Atitscore,ACTisabehavioraltherapy:it’sabouttakingaction. But it’s not about just any old action. First, it’s about values-guidedaction.There’sabigexistentialcomponenttothismodel:Whatdoyouwanttostandforinlife?Whatreallymatters,deepinyourheart?Whatdoyouwanttobe remembered for at your funeral? ACT gets you in touch with what reallymattersinthebigpicture:yourheart’sdeepestdesiresforwhomyouwanttobeandwhat youwant to do during your brief time on this planet.You then usethesecorevaluestoguide,motivate,andinspirebehavioralchange.Second,it’sabout“mindful”action:actionthatyoutakeconsciously,withfullawareness—opentoyourexperienceandfullyengagedinwhateveryou’redoing.ACTgetsitsnamefromoneofitscoremessages:acceptwhatisoutofyour

personalcontrol,andcommittotakingactionthatenrichesyourlife.TheaimofACT is to help us create a rich, full, andmeaningful life,while accepting thepainthatlifeinevitablybrings.ACTdoesthisby

teachinguspsychologicalskillstohandlepainfulthoughtsandfeelings effectively, in such a way that they have much lessimpact and influence—these are knownasmindfulness skills;andhelpingustoclarifywhat’strulyimportantandmeaningful tous—that is, clarify our values—and use that knowledge toguide,inspire,andmotivateustosetgoalsandtakeactionthatenrichesourlife.

ACT restsonanunderlying theoryofhuman languageandcognitioncalledrelationalframetheory(RFT),atheorythatnowhasoveronehundredandfiftypublishedpeer-reviewedarticlessupportingitsprinciples.Wewon’tcoverRFTin this book because it’s quite technical and takes a fair bit of work tounderstand,whereastheaimofthisbookistowelcomeyouintoACT,simplifythemainconcepts,andgetyouofftoaquickstart.The good news is you can be an effective ACT therapist without knowing

anythingaboutRFT.IfACTislikedrivingyourcar,RFTislikeknowinghowthe engine works: you can be an excellent driver while knowing absolutelynothingabout themechanics. (Having said that,manyACT therapists say thatwhentheyunderstandRFT,itimprovestheirclinicaleffectiveness.Therefore,ifyou’reinterested,appendix2willtellyouwheretogoformoreinformation.)

WhoIsThisBookFor?I’ve aimed this book primarily at newcomers to ACTwho want a quick andsimple introduction to themodel. It will also be useful formore experiencedpractitionerswhowantaquickrefreshercourse:anACTprimer,ifyoulike.I’vedesignedittocomplementotherACTtextbooksthatoffermoretheoryormorein-depth discussions of the ACT processes and their clinical applications. I’llmention some of these textbooks as we go along and others in the resourcessection(appendix2)attheend.

HowtoUseThisBookIf you’re brand-new toACT, I strongly recommend you read this entire bookfromcovertocoverbeforeyoustartusinganyofit.ThisisbecausethesixcoreprocessesofACTareallinterdependent,sounlessyouhaveagoodsenseoftheentiremodeland theway thesedifferent strands interweave,youmaywellgetconfusedandheadoffinthewrongdirection.And,ofcourse,readingitisnotenough;you’llalsoneedtoactivelypractice

the exercises as you go.After all, you can’t learn to drivemerely by readingaboutit;youhavetoactuallygetinacar,putyourhandsonthewheel,andtakeit foraspin.Whenyou’reready tostartusingACTwithyourclients,youcaneitherusethisbooktolooselyguideyou,oryoumightprefertouseaprotocol-basedACTtextbookthatwillcoachyoualongindetail,session-by-session.Firstoff,inchapters1through3,we’regoingtozipthroughanoverviewof

themodelandthetheoryunderlyingit.Theninchapters4and5,we’llcoverthebasics of getting started, including how to do experiential therapy, obtaininformedconsent,andstructureyourongoingsessions.Inchapters6through12,we’llgostep-by-step throughthesixcoreprocessesofACTandhowtoapplythemtoawiderangeofclinicalissues.Theemphasisineachchapterwillbeonsimplicity and practicality so you can start using this approach straight away.(Butpleasekeepinmind:newcomersshouldfirstreadthewholebook,covertocover,beforeapplyingit.)In the last section of the book, chapters 13 through 15,we’ll cover awide

range of important topics including common therapist pitfalls, overcomingbarriers to change, enhancing the client-therapist relationship, dancing aroundthesixcoreprocesses,embodyingACTineverydaylife,mixingandmatchingACT with other models, and where to go next on your journey as an ACT

therapist.Fromchapter 5onward, you’ll find these “practical tip” text boxespopping

up:

PracticalTip In these sections, you’ll find practical tips to help yourclinicalpracticeandcommonpitfallstowatchoutfor.

YourRoleinAllThisI heard a great saying recently: “Be yourself: everyone else is already taken.”YourroleinlearningandpracticingACTistobeyourself.IwastedalotoftimeandeffortinmyearlyACTworktryingtodoACTword-for-wordaswritteninthetextbooks.Andthen,afterIsawSteveHayesandKellyWilson—twoofthefounders of ACT—in action, I tried very hard to copy their unique styles ofdoingtherapy.Thisdidn’tworkverywellforme.ItallwentmuchbetterwhenIallowed myself to be me and developed my own style and my own way ofspeaking,amannerthatfeltnaturalandalsosuitedtheclientsIworkwith.I’msureyou’llfindthesame.Soasyougothroughthisbook,useyourcreativity.Feelfreetoadapt,modify,

and reinvent the tools and techniques within these pages (provided you’reremaining true to theACTmodel) tosuityourownpersonalstyle.WhereverIpresentmetaphors,scripts,worksheets,orexercises,changethewordstofityourwayofspeaking.Andifyouhavebetterordifferentmetaphorsthataccomplishthesameends, thenpleaseuseyoursratherthantheonesinthisbook.There’senormousroomforcreativityand innovationwithin theACTmodel,sopleasedotakeeveryadvantageofit.

GettingStartedFewpeoplecometoACTanddiveinheadfirst.You,likemost,maystartoffbydippingatoeinthewater.Next,youputawholefootin.Thenaknee.Thenanentireleg.Nowyoufindyourselfinthisoddposition,withoneleginthewaterandonelegout.Andgenerallyyoustaythereforquiteawhile,halfin,halfout,notquitesureifACTisforyou.Finally,oneday,youtaketheplunge.Andwhen

youdo so, youdiscover thewater iswarm,welcoming, and invigorating; youfeelliberated,buoyant,andresourceful;andyouwanttospendalotmoretimein it. Once this happens, there’s generally no going back to your old way ofworking.(Soifthishasn’talreadyhappenedtoyou,Ihopeitwillbytheendofthisbook.)One reason for this initial uncertainty about ACT is that it challenges

conventional wisdom and overturns the ground rules of most Westernpsychology. For example, most models of therapy are extremely focused onsymptom reduction. Their assumption is that clients need to reduce theirsymptoms before they can lead a better life. ACT takes a radically differentstance. ACT assumes that (a) quality of life is primarily dependent uponmindful,values-guidedaction,and (b) this ispossible regardlessofhowmanysymptoms you have—provided that you respond to your symptoms withmindfulness.Toputitanotherway,mindful,values-congruentlivingisthedesiredoutcome

inACT,notsymptomreduction.SoalthoughACTtypicallyreducessymptoms,this is never the goal. (By theway, as “values-congruent living” is a bit of amouthful, for themost of the book I’ll shorten it to “valued living.” Sorry, Iknowit’snotgreatEnglish.)Thus in ACT,whenwe teach a clientmindfulness skills, the aim is not to

reduce his symptoms but to fundamentally change his relationship with hissymptomssothattheynolongerholdhimbackfromvaluedliving.Thefactthathis symptoms reduce is considered a “bonus” rather than the main point oftherapy.Ofcourse,wedon’tsaytoourclients,“We’renotgoingtotrytoreduceyour

symptoms!”Why not? Because (a) this would set up all sorts of unnecessarytherapeutic barriers, and (b) we know that symptom reduction is extremelylikely. (Even thoughwe never aim for it, in almost every trial and study everdone onACT, there is significant symptom reduction—although sometimes itoccursmoreslowlythaninothermodels.)Sowhatthismeansis,ifyoucometoACTfrommodelsthatareveryfocused

on trying to reduce symptoms, it’s truly amassiveparadigm shift. Fortunatelymost people—therapists and clients alike—find it a liberating one. However,becauseACT is so different frommost other psychological approaches,manypractitioners initially feel awkward, anxious, vulnerable, confused, orinadequate.Icertainlydid.(AndIstilldoattimes!)ThegoodnewsisACTgivesyou the means to effectively handle those perfectly natural feelings. And the

moreyoupracticeACTonyourselftoenrichandenhanceyourownlifeandtoresolveyourownpainfulissues,themoreeffectiveyou’llbeinapplyingitwithyour clients. (How’s that for a bonus?) So, enough of the preamble: let’s getstarted!

Chapter1.ACTinaNutshellWhatIsa“Mind”?

This is toohard. I can’tdo this.Why isn’t thisworking? Itall seemedsoeasywhenIreadit inthetextbook.Iwishtherewasarealtherapistheretotellmewhattodo.MaybeI’mnotcutoutforthissortofwork.I’msodumb.MaybeIshouldreferthisclienttosomeoneelsewhoknowswhatthey’redoing.Doesyourmindeversaythingslikethistoyou?Minecertainlydoes.Andso

doesthemindofeverytherapistI’veeverknown.Nowtakeamomenttoreflectonwhatelseyourminddoesthat’sunhelpful.Forexample,doesitevercompareyouharshlytoothers,orcriticizeyourefforts,ortellyouthatyoucan’tdothethings youwant to do?Does it ever dredge up unpleasantmemories from thepast?Does it find faultwithyour life as it is todayandconjureupalternativeliveswhere you’d be ever somuch happier?Does it ever drag you into scaryscenariosaboutthefutureandwarnyouaboutallthepossiblethingsthatmightgowrong? If so, it sounds as if you have a normal humanmind.You see, inACT,westartfromtheassumptionthatthenormalpsychologicalprocessesofanormalhumanmindreadilybecomedestructive,andsoonerorlater,theycreatepsychological suffering for all ofus.AndACTspeculates that the rootof thissufferingishumanlanguageitself.

LanguageandtheMind

Humanlanguageisahighlycomplexsystemofsymbolsthatincludeswords,images,sounds,facialexpressions,andphysicalgestures.Humansuselanguagein two domains: public and private. The public use of language includesspeaking, talking, miming, gesturing, writing, painting, sculpting, singing,dancing, acting, and so on. The private use of language includes thinking,imagining,daydreaming,planning,visualizing,analyzing,worrying,fantasizing,andsoon.(Acommonlyusedtermfortheprivateuseoflanguageiscognition.)Nowclearlythemindisnota“thing”oran“object.”Weusetheword“mind”

todescribeanincrediblycomplexsetofinteractivecognitiveprocesses,suchasanalyzing, comparing, evaluating, planning, remembering, visualizing, and soon. And all of these complex processes rely on the sophisticated system ofsymbolswecallhumanlanguage.ThusinACT,whenweusetheword“mind,”

we’reusingitasametaphorfor“humanlanguage.”

YourMindIsNotYourFriend—orYourEnemy

ACTregardsthemindasadouble-edgedsword.It’sveryusefulforallsortsofpurposes,butifwedon’tlearnhowtohandleiteffectively,itwillhurtus.Onthebrightside,languagehelpsusmakemapsandmodelsoftheworld;predictandplan for the future; share knowledge; learn from the past; imagine things thathave never existed and go on to create them; develop rules that guide ourbehavior effectively and help us to thrive as a community; communicatewithpeoplewhoarefaraway;andlearnfrompeoplewhoarenolongeralive.Thedarksideoflanguageisthatweuseittolie,manipulate,anddeceive;to

spreadlibel,slander,andignorance;toincitehatred,prejudice,andviolence;tomakeweaponsofmassdestructionandindustriesofmasspollution;todwellonand “relive” painful events from the past; to scare ourselves by imaginingunpleasantfutures;tocompare,judge,criticize,andcondemnbothourselvesandothers; and to create rules for ourselves that can often be life constricting ordestructive. Because language is both a blessing and a curse,we often say inACT,“Yourmind isnotyour friend—and it’snotyourenemyeither.”Sonowthatweknowwhata“mind”is,let’sturntoaveryimportantquestion.

WhatIstheAimofACT?TheaimofACT,inlayterms,istocreatearich,full,andmeaningfullifewhileacceptingthepainthatinevitablygoeswithit.Laterthischapter,we’lllookatamore technical definition of ACT, but first take a moment to consider thisquestion:whydoeslifeinevitablyinvolvepain?Clearly there are many, many reasons. We’ll all experience frustration,

disappointment, rejection, loss, and failure.We’ll all experience illness, injury,andaging.We’llallfaceourowndeathandthedeathofourlovedones.Ontopof that,manybasichumanemotions—normalfeelings thateachandeveryoneof us will repeatedly experience throughout our lives—are inherently painful:fear,sadness,guilt,anger,shock,anddisgust,tonamebutafew.Andasifallthatwerenotenough,weeachhaveamindthatcanconjureup

painatanymoment.Thankstohumanlanguage,whereverwego,whateverwedo,we can experience pain instantly. In anymoment,we can relive a painful

memoryorgetlostinafearfulpredictionofthefuture.Orwecangetcaughtupin unfavorable comparisons (“Her job is better than mine”) or negative self-judgments(“I’mtoofat,”“I’mnotsmartenough,”andsoon).Thankstohumanlanguage,wecanevenexperiencepainonthehappiestdays

of our lives. For example, suppose it’s Susan’s wedding day, and all of herfriendsandfamilyaregathered together tohonorher joyfulnewunion.She isblissfullyhappy.ButthenshehasthethoughtIwishmyfatherwerehere—andsheremembershowhecommittedsuicidewhenshewasonlysixteenyearsold.Now,ononeofthehappiestdaysofherlife,she’sinpain.Andwe’reallinthesameboatasSusan.Nomatterhowgoodourqualityof

life,nomatterhowprivilegedoursituation,allweneeddoisrememberatimewhen something bad happened, or imagine a future where something badhappens,orjudgeourselvesharshly,orcompareourlifetosomeoneelse’sthatseemsbetter,andinstantlywe’rehurting.Thus, thanks to the sophistication of themind, even themost privileged of

human lives inevitably involves significant pain.Unfortunately, typical humanbeings commonly handle their pain ineffectively. All too often when weexperiencepainful thoughts, feelings, and sensations,we respond inways thatareself-defeatingorself-destructiveinthelongrun.Becauseofthis,onemajorelementofACTisteachingpeoplehowtohandlepainmoreeffectivelythroughtheuseofmindfulnessskills.

WhatIsMindfulness?“Mindfulness”isanancientconcept,foundinawiderangeofancientspiritualandreligioustraditions,includingBuddhism,Taoism,Hinduism,Judaism,Islam,andChristianity.Westernpsychologyhasonlyrecentlystartedtorecognizethemanybenefitsofdevelopingmindfulnessskills.Ifyoureadafewbooksonthesubject,you’llfind“mindfulness”definedinavarietyofdifferentways,buttheyallbasicallyboildowntothis:

Mindfulnessmeanspayingattentionwithflexibility,openness,andcuriosity.Thissimpledefinitiontellsusthreeimportantthings.First,mindfulnessisan

awareness process, not a thinking process. It involves bringing awareness orpayingattentiontoyourexperienceinthismomentasopposedtobeing“caughtup”inyourthoughts.Second,mindfulnessinvolvesaparticularattitude:oneofopenness and curiosity. Even if your experience in this moment is difficult,

painful, or unpleasant, you can be open to it and curious about it instead ofrunning from it or fighting with it. Third, mindfulness involves flexibility ofattention: the ability to consciouslydirect, broaden, or focusyour attentionondifferentaspectsofyourexperience.Wecanusemindfulnessto“wakeup,”connectwithourselves,andappreciate

thefullnessofeachmomentoflife.Wecanuseittoimproveourself-knowledge—tolearnmoreabouthowwefeelandthinkandreact.Wecanuseittoconnectdeeplyand intimatelywith thepeoplewecareabout, includingourselves.Andwecanuseittoconsciouslyinfluenceourownbehaviorandincreaseourrangeof responses to the world we live in. It is the art of living consciously—aprofoundwaytoenhancepsychologicalresilienceandincreaselifesatisfaction.Of course there’s a lot more to ACT than just mindfulness. It’s also about

valuedliving:takingaction,onanongoingbasis,thatisguidedbyandalignedwithcorevalues. Indeed,we teachmindfulnessskills inACTwith theexpresspurposeoffacilitatingvaluedaction:tohelppeoplelivebytheirvalues.Inotherwords, the outcome we aim for in ACT is mindful, valued living. This willbecomeclearer in thenextsection,wherewe lookat thesixcoreprocessesofACT.

TheSixCoreTherapeuticProcessesofACTThesixcore therapeuticprocesses inACTarecontacting thepresentmoment,defusion, acceptance, self-as-context,values, andcommittedaction.Beforewegothroughthemonebyone,takealookatthediagraminfigure1.1,whichislight-heartedly known as the ACT “hexaflex.” (This diagram differs from thestandard version you’ll find in most ACT textbooks in that underneath eachtechnical term I’vewritten a short catchphrase to help you rememberwhat itmeans.)Let’stakealooknowateachofthesixcoreprocessesofACT.

ContactingthePresentMoment(BeHereNow)

Contacting the present moment means being psychologically present:consciously connecting with and engaging in whatever is happening in thismoment.Humansfinditveryhardtostaypresent.Likeotherhumans,weknowhoweasy it is toget caughtup inour thoughts and lose touchwith theworldaroundus.Wemayspendalotoftimeabsorbedinthoughtsaboutthepastorthefuture.Orinsteadofbeingfullyconsciousofourexperience,wemayoperateonautomatic pilot, merely “going through the motions.” Contacting the presentmoment means flexibly bringing our awareness to either the physical worldaroundusorthepsychologicalworldwithinus,ortobothsimultaneously.Italsomeans consciouslypaying attention toourhere-and-nowexperience insteadofdriftingoffintoourthoughtsoroperatingon“automaticpilot.”

Defusion(WatchYourThinking)

Defusion means learning to “step back” and separate or detach from ourthoughts, images, and memories. (The full term is “cognitive defusion,” butusuallywejustcallit“defusion.”)Insteadofgettingcaughtupinourthoughtsorbeingpushedaroundbythem,weletthemcomeandgoasiftheywerejustcarsdrivingpastoutsideourhouse.Westepbackandwatchourthinkinginsteadofgettingtangledupinit.Weseeourthoughtsforwhattheyare—nothingmoreorless than words or pictures. We hold them lightly instead of clutching themtightly.

Acceptance(OpenUp)

Acceptance means opening up and making room for painful feelings,sensations, urges, and emotions. We drop the struggle with them, give themsomebreathingspace,andallowthemtobeastheyare.Insteadoffightingthem,resistingthem,runningfromthem,orgettingoverwhelmedbythem,weopenuptothemandletthembe.(Note:Thisdoesn’tmeanlikingthemorwantingthem.Itsimplymeansmakingroomforthem!)

Self-as-Context(PureAwareness)

Ineverydaylanguage,wetalkaboutthe“mind”withoutrecognizingthattherearetwodistinctelementstoit:thethinkingselfandtheobservingself.We’reallveryfamiliarwith the thinkingself: thatpartofuswhich isalways thinking—generating thoughts, beliefs,memories, judgments, fantasies, plans, and soon.Butmostpeopleareunfamiliarwiththeobservingself: theaspectofusthat isaware of whatever we’re thinking, feeling, sensing, or doing in anymoment.Another term for it is “pureawareness.” InACT, the technical term isself-as-context.Forexample,asyougothroughlife,yourbodychanges,yourthoughtschange, your feelings change, your roles change, but the “you” that’s able tonoticeorobserveallthosethingsneverchanges.It’sthesame“you”that’sbeenthere yourwhole life.With clients, we generally refer to it as “the observingself”ratherthanusethetechnicalterm“self-as-context.”

Values(KnowWhatMatters)

Deep in your heart,what do youwant your life to be about?What do you

want to stand for?What youwant to dowith your brief time on this planet?What truly matters to you in the big picture? Values are desired qualities ofongoing action. In other words, they describe how we want to behave on anongoingbasis.Clarifyingvaluesisanessentialstepincreatingameaningfullife.In ACT, we often refer to values as “chosen life directions.” We commonlycompare values to a compass because they give us direction and guide ourongoingjourney.

CommittedAction(DoWhatItTakes)

Committedactionmeanstakingeffectiveaction,guidedbyourvalues.It’sallwell andgood to knowour values, but it’s onlyvia ongoingvalues-congruentaction that life becomes rich, full, andmeaningful. In other words, wewon’thavemuch of a journey if we simply stare at the compass; our journey onlyhappens when we move our arms and legs in our chosen direction. Values-guidedactiongivesrisetoawiderangeofthoughtsandfeelings,bothpleasantandunpleasant,bothpleasurableandpainful.Socommittedactionmeans“doingwhat it takes”tolivebyourvaluesevenif thatbringsuppainanddiscomfort.Anyandalltraditionalbehavioralinterventions—suchasgoalsetting,exposure,behavioralactivation,andskillstraining—canbeusedinthispartofthemodel.And any skill that enhances and enriches life—from negotiation to timemanagement,fromassertivenesstoproblemsolving,fromself-soothingtocrisiscoping—canbetaughtunderthissectionofthehexaflex(providedthatit’sintheserviceofvaluedlivingandnotintheserviceofexperientialavoidance,whichwe’lltalkaboutinchapter2).

PsychologicalFlexibility:ASix-FacetedDiamond

Keep inmind that the six core processes ofACT aren’t separate processes.Although we talk about them that way for pragmatic purposes—to helptherapistsandclientslearnandapplytheACTmodel—it’smoreusefultothinkof themassix facetsofonediamond.And thediamond itself ispsychologicalflexibility.Psychological flexibility is the ability to be in the presentmomentwith full

awareness and openness to our experience, and to take action guided by ourvalues. Putmore simply, it’s the ability to “be present, open up, and dowhatmatters.” Technically speaking, the primary aim of ACT is to increase

psychologicalflexibility.Thegreaterourabilitytobefullyconscious,tobeopentoourexperience,andtoactonourvalues,thegreaterourqualityoflifebecausewe can respond far more effectively to the problems and challenges lifeinevitablybrings.Furthermore, throughengagingfully inour lifeandallowingour values to guide us, we develop a sense ofmeaning and purpose, andweexperienceasenseofvitality.Weusetheword“vitality”alotinACT,andit’simportant to recognize thatvitality isnot a feeling; it is a senseofbeing fullyaliveandembracingthehereandnow,regardlessofhowwemaybefeelinginthismoment.Wecanevenexperiencevitalityonourdeathbedorduringextremegriefbecause“Thereisasmuchlivinginamomentofpainasinamomentofjoy”(Strosahl,2004,p.43).

THEACTTRIFLEX

Thesixcoreprocessescanbe“lumpedtogether”intothreefunctionalunits,asin figure 1.2 below. Both defusion and acceptance are about separating fromthoughts and feelings, seeing them for what they truly are, making room forthem,andallowing them tocomeandgoof theirownaccord. Inotherwords:“Openingup.”Self-as-context (aka the observing self) and contacting the present moment

both involvemaking contact with verbal and nonverbal aspects of your here-and-nowexperience.Inotherwords:“Beingpresent.”Valuesandcommittedactioninvolvetheeffectiveuseoflanguagetofacilitate

life-enhancingaction.Inotherwords:“Doingwhatmatters.”Thus psychological flexibility is the ability to “be present, open up, and do

whatmatters.”

THEACTACRONYM

There’s a simple acronym that encapsulates the entiremodel, and it’s oftenusefultosharethiswithclients.Theacronymis—surprise,surprise!—ACT:

A=Acceptyourthoughtsandfeelings,andbepresent.C=Chooseavalueddirection.T=Takeaction.

(Andonthatnote,Ishouldmentionthatthroughoutthisbook,Iusethephrase“thoughts and feelings” as a form of shorthand. By “thoughts,” I mean all

mannerofcognitions, includingmemoriesandimages,andthe term“feelings”includesemotions,sensations,andurges.)

TheACTinaNutshellMetaphorThe following transcript describes a physical metaphor that I originally puttogethertoquicklysummarizetheACTmodeltoclients.(ManyACTtextbookscautionagainstdidacticallyexplainingthemodeltoclients:thedangeriswecangetboggeddownin long-windedexplanations,or theclientwill intellectualizethemodel.However,therearesituationsinwhichit’susefultometaphorically—asopposedtodidactically—explainthemodel,andwecanadapttheACTinaNutshellMetaphorinmanyways.Indeed,asyoureadthroughthebook,you’llnoticehowwecanuseandmodifypiecesofitformultiplepurposes,especiallywork with defusion and acceptance. The transcript that follows takes placetoward theendof a first session, aspartof informedconsent. (Toget abettersenseofhowthisexerciseisdone,youcanwatchafreeYouTubevideooftheexerciseonwww.actmadesimple.com/free_resources).Therearefivesectionstoit,whichI’venumberedforfuturereference.

SECTION1

Therapist:It’shardtoexplainwhatACTisaboutsimplybydescribingit,anditprobablywouldn’tmakemuch sense even if I tried. Sowould it be

okayifIshowedyouwhatit’saboutbyusingametaphor?

Client:Sure.

Therapist:Great.(Thetherapistpicksupaclipboardoralargehardbackbookandshows it to theclient.) Iwantyou to imagine that thisclipboardrepresentsallthedifficultthoughtsandfeelingsandmemoriesthatyouhavebeenstrugglingwithforsolong.AndI’dlikeyoutotakeholdofitandgripitastightlyasyoucansothatIcan’tpullitawayfromyou.(Clientgripsittightly.)NowI’dlikeyoutoholditupinfrontofyourface soyoucan’t seemeanymore—andbring it up so close toyourface that it’s almost touching your nose. (The client holds theclipboarddirectly in front of her face, blockingher viewof both thetherapistandthesurroundingroom.)

Therapist:Nowwhat’sitliketryingtohaveaconversationwithmewhileyou’reallcaughtupinyourthoughtsandfeelings?

Client:Verydifficult.

Therapist:Doyoufeelconnectedwithme,engagedwithme?Areyouable toread the expressions onmy face? If I were doing a song-and-danceroutinenow,wouldyoubeabletoseeit?

Client:(chuckling)No.

Therapist:Andwhat’syourviewoftheroomlike,whileyou’reallcaughtupinthisstuff?

Client:Ican’tseeanythingexcepttheclipboard.

Therapist:Sowhileyou’recompletelyabsorbedinallthisstuff,you’remissingout on a lot. You’re disconnected from the world around you, andyou’re disconnected fromme.Notice, too, thatwhile you’re holdingon tightly to this stuff, you can’t do the things that make your lifework.Checkitout—griptheclipboardastightlyasyoupossiblycan.(Theclienttightenshergrip.)NowifIaskedyoutocuddleababy,orhug thepersonyou love,ordriveacar,orcookdinner,or typeonacomputerwhileyou’reholdingontightlytothis,couldyoudoit?

Client:No.

Therapist: So while you’re all caught up in this stuff, not only do you losecontact with the world around you and disconnect from yourrelationships,butalsoyoubecomeincapableofdoing the things that

makeyourlifework.

Client:(nodding)Okay.

SECTION2

Therapist: Is italright if I justdragmychairacrosssoI’msittingbesideyou?There’ssomethingelseIwanttodemonstratehere.

Client:Sure.

Therapist: (pulls his chair alongside that of the client) Could I have theclipboard back for amoment? (Therapist takes the clipboard back.)Can I justcheck—youdon’thaveanyneckor shoulderproblemsdoyou?

Client:No.

Therapist: Okay. I’m just checking because this involves a bit of physicalexertion.WhatI’dlikeyoutodoisplacebothyourhandsflatononesideoftheclipboardhere,andI’mgoingtoputmyhandsontheotherside, and I’d like you to push the clipboard away from you. Pushfirmly,butdon’tpushsohardyouknockmeover.(Astheclienttriestopushtheclipboardaway,thetherapistpushesback.Thehardertheclient pushes, the more the therapist leans into it.) And just keeppushing. You hate this stuff, right? You hate these thoughts andfeelings.Sopushashardasyoucan—trytomakethemgoaway.(Thetherapistmaintainsthestrugglesothattheclientkeepspushingwhilethetherapistpushesback.)Sohereyouare, tryingveryhard topushawayall thesepainful thoughts and feelings.You’vebeendoing thisforyears,andaretheygoinganywhere?Sure,you’rekeepingthematarm’s length, but what’s the cost to you? How does it feel in yourshoulders?

Client:(chuckling)Nottoobadactually.It’sagoodworkout.

Therapist:(pushingharder)Okay,thisisfinefornow,we’veonlybeengoingafewseconds,buthowwillyoubefeelingafterawholedayofthis?

Client:I’dbeprettytired.

Therapist: (still pushing theclipboardbackand forthwith the client)And if Iaskedyounowtotypeonacomputer,ordriveacar,orcuddleababy,

orhugsomebodyyoulovewhileyou’redoingthis,couldyoudoit?

Client:No.

Therapist:Andwhat’sitliketryingtohaveaconversationwithmewhileyou’redoingthis?

Client:Verydistracting.

Therapist:Doyoufeelabitclosedinorcutoff?

Client:Yes.

SECTION3

The therapist now stops resisting. He eases off the pressure, and takes theclipboardback.

Therapist: Okay, now let’s try something else. Is it okay if I just place theclipboard on your lap, andwe just let it sit there? (Client nods. Thetherapistplacestheclipboardontheclient’slap.)Nowisn’tthatalotlesseffort?Howareyourshouldersnow?

Client:Alotbetter.

Therapistdragshischairbackacrosstheroom.

Therapist:Noticethatyouarenowfreetoinvestyourenergyindoingsomethingconstructive.IfIaskedyounowtocookameal,orplaythepiano,orcuddleababy,orhugsomebodyyoulove—nowyoucoulddoit,right?

Client:(chuckling)Yes.

Therapist:Andwhat’sitliketohaveaconversationwithmenowasopposedtodoingthis(mimespushingtheclipboardaway)orthis(mimesholdingtheclipboardupinfrontofhisface)?

Client:Easier.

Therapist:Doyoufeelmoreengagedwithme?Canyoureadmyfacenow?

Client:Yes.

Therapist:Notice,too,younowhaveaclearviewoftheroomaroundyou.Youcantakeitallin.IfIstarteddoingasong-and-danceroutine,you’dbeabletoseeit.

Client: (smiles)Yes. (Shegesturesdownat theclipboard.)But it’s still here. Idon’twantit.

SECTION4

Therapist: Absolutely. It’s still there. And of course you don’t want it; whowould all these painful thoughts and feelings? But notice, now thisstuff is havingmuch less impact on you.Now I’m sure in the idealworldyou’d like todo this. (Therapistmimes throwing theclipboardon the floor.)But here’s the thing: you’ve been trying to do that foryears. Let’s do a brief recap. You’ve tried drugs, alcohol, self-helpbooks, therapy, withdrawing from the world, lying in bed, avoidingchallenging situations, beating yourself up, blaming your parents,distractingyourself,rehashingthepast,tryingtofigureoutwhyyou’relikethis,beingbusy,doingself-developmentcourses,andlotsofotherthings too, I’mwilling to bet. So no one can call you lazy!You’veclearly put a lot of time, effort, andmoney into trying to get rid ofthesethoughtsandfeelings.Andyet,despiteallthateffort,they’restillshowing up. They’re still here today. (The therapist points to theclipboard in theclient’s lap.)Someof these thingsyoudomake thisstuffgoawayforashortwhile,butitsooncomesbackagain,doesn’tit?Andisn’titthecasethatthisisnowbiggerandheavierthanitwasall those years agowhen you first started strugglingwith this stuff?There are more painful feelings, thoughts, and memories here thantherewerefiveyearsago,right?

Client:Yes.

Therapist:Soeventhoughthisiswhateveryinstinctinyourbodytellsyoutodo(mimes throwing the clipboard onto the floor), that strategy clearlyisn’thavingtheeffectsyouwant.It’sreallyjustmakingthingsworse.Sowedon’twanttodomoreofwhatdoesn’twork,right?

Client:Iguessnot.

SECTION5

Therapist: So here’swhatACT is all about.We’re going to learn some skillscalled mindfulness skills that will enable you to handle painfulthoughts and feelings farmore effectively—in such away that they

havemuchlessimpactandinfluenceoveryou.Soinsteadofdoingthis(picks up clipboard and holds it in front of his face) or this (mimespushingclipboardaway),youcandothis(dropstheclipboardintohislap and lets go of it.) And notice, this not only allows you to beconnectedwith theworld around you and to engage inwhat you’redoing,butitalsofreesyouuptotakeeffectiveaction.Whenyou’renolongerstrugglingwiththisstuff,orabsorbedinit,orholdingontoit,youarefree.(Thetherapistholdshisarmsupinagestureoffreedom.)So nowyou can put your energy into doing the things that improveyourqualityoflife—likehuggingpeopleyouloveorridingyourbikeorplayingtheguitar.(Thetherapistmimestheseactivities.)Howdoesthatsoundtoyou?

Client:(smiling)Okay.

Obviously it doesn’t always go that smoothly—when does therapy ever go assmoothlyasinthetextbooks?—buthopefullythismetaphorgivesyouasenseofwhatACTisallabout:creatinga richandmeaningful lifewhileaccepting thepainthatgoeswithit.Italsodemonstratesthatweteachmindfulnessskillsnotas some spiritual pathway to enlightenment but in order to facilitate effectiveaction. (Unfortunately, we don’t have the space here to describe some of thewaysclientsmayoccasionallyobjecttothismetaphor,andhowwecanrespondeffectively to those objections. However you can download a description ofthese objections and responses at:www.actmadesimple.com/nutshell_metaphor_objections_and_responses)

DissectingtheMetaphor

ACTspeculates that thereare twocorepsychologicalprocesses—“cognitivefusion” and “experiential avoidance”—that are responsible for mostpsychological suffering.Section1of the transcript is ametaphor forcognitivefusion: getting caught up or entangled in our thoughts, or holding on to themtightly.Section2isametaphorforexperientialavoidance:theongoingstruggleto avoid, suppress, or get rid of unwanted thoughts, feelings, memories, andother “private experiences.” (A private experience means any experience youhavethatnooneelsecanknowaboutunlessyoutellthem:emotions,sensations,memories,thoughts,andsoon.)N.B.Youdon’twanttoturnthisexerciseintoastrength test or a pushing competition. If you suspect your client may pushaggressivelyagainst theclipboard, thenpreempthim.Say,“WhenIaskyouto

push,pleasedon’tpushtoohard.Don’ttrytopushmeover,justpushgently!”Also,modifyyourowncounterpressure;afterafewsecondsyoucouldeaseoffand just leave the clipboard resting gently in midair, gently sandwiched inbetweenyourhandsandtheclient’shands.Section3 isametaphor foracceptance,defusion,andcontacting thepresent

moment. Instead of the term “acceptance,”we often talk about “dropping thestruggle,” “sitting with the feeling,” “letting it be,” “making room for it,” or“willingness to have it.” You can see how these terms nicely fit the physicalmetaphor of letting the clipboard sit on the client’s lap. Instead of the term“defusion,”weoftentalkabout“lettinggo”or“steppingback”or“distancing,”“separating,”“disentangling,”or“droppingthestory”—andagain,astheclientseparatesfromtheclipboardandletsgoofit,themetaphortiesinwellwithsuchwaysoftalking.Section 4 highlights the ineffectiveness and the costs of experiential

avoidance; in ACT, this process is referred to as creative hopelessness orconfrontingtheagenda.Whysuchoddnames?Becausewe’retryingtocreateasense of hopelessness in the client’s agenda of controlling her thoughts andfeelings. This paves the way for the alternate agenda of mindfulness andacceptance,whichistheveryoppositeofcontrol.Finally, section 5 highlights the link between mindfulness, values, and

committed action. Presenting the entire ACT in a Nutshell Metaphor as anexercisegenerallytakesnomorethanaboutfiveminutes.

What’sNext?

Inthenextchapter,we’lllookatcognitivefusionandexperientialavoidanceinmoredetailandseehowtheyreadilyleadtosixcorepathologicalprocessesthatarethe“flipsides”ofthesixcoretherapeuticprocesses.Butbeforereadingon,whynottrytheACTinaNutshellExerciseonafriendorcolleaguetoseeifyoucansummarizewhatACTisabout?First, I recommendthatyouact itoutloud a couple of times: run through each step with an imaginary client, as ifyou’reanactorrehearsingforaplay.Thengiveitagoforreal.Isuspectyoumaybesomewhatreluctanttodothis;youmaybethinkingit’s

silly,orunimportant,orjustnotyourstyle.However,evenifyouneverdothiswitharealclient, running throughthemetaphor in thiswaywillbeavaluablelearningexperience.Notonlywillithelpyoutograspthemodel,it’llalsohelpyou enormously if you ever want to explain it to curious friends, colleagues,

relatives, or guests at your next dinner party. So even thoughyou’re probablyfeelingreluctant,whynotgive itago?Youmaybepleasantlysurprisedat theresults.

Chapter2.Stuck,NotBrokenWhereThere’sPain,There’sLife

TheACTmodelisinherentlyoptimistic.ACTassumesthateveninthemidstoftremendouspainandsuffering,there’sanopportunitytofindmeaning,purpose,andvitality.Wecanfindawe-inspiringexamplesofthisinbookssuchasMan’sSearch for Meaning by Victor Frankl (1959), which chronicles Frankl’sexperiencesasaninmateintheAuschwitzconcentrationcamp,orLongWalktoFreedom, the autobiographyofNelsonMandela. InACT,we’re not aiming tomerelyreducehumansuffering;we’realsoaimingtohelppeoplelearnandgrowasaresultoftheirsuffering,andtousetheirpainasaspringboardintocreatingrichandmeaningfullives.ThisoptimisticattitudeisevidentintheACTsaying:“Ourclientsarenotbroken,theyarejuststuck.”Andwhatisitthatgetsordinarypeople so stuck that they end up depressed, addicted, isolated, phobic, orsuicidal?Twonormalprocessesofthenormalhumanmind:cognitivefusionandexperientialavoidance.

CognitiveFusionWhytheterm“fusion”?Well,thinkoftwosheetsofmetalfusedtogether.Ifyoucouldn’tusetheterm“fused,”howwouldyoudescribethem?Welded?Melded?Bonded? Joined?Attached?Stuck?All these termspoint to the same idea: noseparation. Inastateofcognitive fusion,we’re inseparable fromour thoughts:we’reweldedtothem,bondedtothem,socaughtupinthemthatwearen’tevenaware that we are thinking. Thus defusion means separating, detaching, ordistancingfromourthoughts:takingastepbackandseeingthemforwhattheyare:nothingmoreorlessthanwordsandpictures.Cognitive fusion basically means that our thoughts dominate our behavior.

Thus in ACT, we may talk with clients of being “pushed around by yourthoughts” or “allowing thoughts to tell you what to do,” or we may talk ofthoughtsasbullies,orwemaycomparethemindtoafascistdictator,orwemayask, “Whathappenswhenyou let that thought runyour life?”Similarly,whenour thoughts dominate our attention, we often talk about being “hooked,”“entangled,”“caughtup,”or“carriedoff”bythem.(Aquickreminder:whenweuse the terms“thinking,”“thoughts,”“cognition,”and“mind” inACT,weusethem all as metaphors for “human language,” which includes beliefs,

assumptions, thoughts, attitudes,memories, images,words, gestures, fantasies,andsomeaspectsofemotions.)Humanbeingsdwell in twodifferentworlds.Atbirth,wedwellonly in the

“worldofdirectexperience,”theworldasweknowitdirectlythroughthefivesenses:theworldthatwecansee,hear,touch,taste,andsmell.Butaswegrowolder,we learn to think, andas that abilitygrows,we start to spendmoreandmoretimeinasecondworld,the“worldoflanguage.”Fusionmeanswe’restuckin theworld of language:we’re so caught up in all thosewords and picturesrunning through our head that we lose contact with the world of directexperience.Mindfulnessislikeashuttlebetweenthesetwoworlds:ittransportsusfromtheworldoflanguageintotheworldofdirectexperience.

HandsAsThoughtsMetaphor

Imagineforamomentthatyourhandsareyourthoughts.Whenyoureachtheendof thisparagraph, I’d likeyou toput thisbookdownandholdyourhandstogether,palmsopen,asifthey’rethepagesofanopenbook.ThenI’dlikeyouto slowlyandsteadily raiseyourhandsup towardyour face.Keepgoinguntilthey’recoveringyoureyes.Thentakeafewsecondstolookattheworldaroundyou through thegaps inbetweenyour fingersandnoticehowthisaffectsyourviewoftheworld.Pleasedothisexercisenow,beforereadingon.

***Sowhatwoulditbelikegoingaroundalldaywithyourhandscoveringyour

eyesinthismanner?Howmuchwoulditlimityou?Howmuchwouldyoumissouton?Howwoulditreduceyourabilitytorespondtotheworldaroundyou?Thisislikefusion:webecomesocaughtupinourthoughtsthatwelosecontactwithmanyaspectsofourhere-and-nowexperience,andourthoughtshavesucha huge influence over our behavior that our ability to act effectively issignificantlyreduced.Nowonce again,whenyou reach the endof this paragraph, I’d likeyou to

coveryoureyeswithyourhands,butthistime,lowerthemfromyourfacevery,veryslowly.Asthedistancebetweenyourhandsandyourfaceincreases,noticehowmucheasieritistoconnectwiththeworldaroundyou.Pleasedothisnowbeforereadingon.

***What you just did is like defusion.Howmuch easier is it to take effective

actionwithoutyourhandscoveringyoureyes?Howmuchmoreinformationcanyoutakein?Howmuchmoreconnectedareyouwiththeworldaroundyou?Thismetaphor(Harris,2009),whichyoucanusewithclientstoexplainfusion

and defusion, demonstrates the purposes of defusion: to engage fully in ourexperience and facilitate effective action. People often feel better when theydefuse from painful thoughts and memories, but in ACT we consider this abonusorby-product;it’snottheintentionorgoal.(Remember,we’renottryingto reduceoreliminateoursymptoms.We’re trying to fundamentally transformour relationship with painful thoughts and feelings so we no longer perceivethemas“symptoms.”)Thusdefusionisnotsomeclevertooltocontrolfeelings:it’sameanstobecomepresentandtakeeffectiveaction.Weneedtomakethisclear to our clients, because if they start using defusion techniques to try andcontroltheirfeelings,they’llsoonbedisappointed.We facilitate defusion through experiential exercises. Ifwe try to explain it

conceptuallybeforedoing itexperientially,we’llprobablygetboggeddown inall sorts of time-wasting intellectual discussions. However, after we’ve takenclients experientially through defusion, we may then like to explain itdidactically,asbelow.

SimpleSummaryofFusionvs.Defusion

Inastateoffusion,athoughtcanseemlike

theabsolutetruth;acommandyouhavetoobeyoraruleyouhavetofollow;athreatyouneedtogetridofassoonaspossible;somethingthat’shappeningrighthereandnoweventhoughit’saboutthepastorthefuture;somethingveryimportantthatrequiresallyourattention;somethingyouwon’tletgoofevenifitworsensyourlife.

Inastateofdefusion,youcanseea thought forwhat it is:nothingmoreorless than a bunch of words or pictures “inside your head.” In a state ofdefusion,yourecognizethatathought

mayormaynotbetrue;is definitely not a command you have to obey or a rule you

havetofollow;isdefinitelynotathreattoyou;isnotsomethinghappeninginthephysicalworld—it’smerelywordsorpicturesinsideyourhead;may ormay not be important—you have a choice as to howmuchattentionyoupayit;canbeallowedtocomeandgoofitsownaccordwithoutanyneedforyoutoholdontoitorpushitaway.

Workability

ThewholeACTmodelrestsonakeyconcept:“workability.”Pleaseengravethatword—workability—intoyourcerebralcortex,becauseit’sattheveryheartofeveryinterventionwedo.Todetermineworkability,weaskthisquestion:“Iswhatyou’redoingworkingtomakeyourliferich,full,andmeaningful?”Iftheanswerisyes,thenwesayit’s“workable,”sothere’snoneedtochangeit.Andif the answer is no, then we say it’s “unworkable,” in which case we canconsideralternativesthatworkbetter.ThusinACTwedon’tfocusonwhetherathoughtistrueorfalse,butwhether

itisworkable.Inotherwords,wewanttoknowifathoughthelpsaclientmovetowardaricher,fuller,andmoremeaningfullife.Todeterminethis,wemayaskquestionslikethese:“Ifyouletthisthoughtguideyourbehavior,willthathelpyou create a richer, fuller, and more meaningful life? If you hold on to thisthought tightly, does it help you to be the person youwant to be and do thethingsyouwanttodo?”Here’satranscriptthatexemplifiesthisapproach:

Client:But it’s true. I reallyamfat.Lookatme. (Shegrabsholdof two largerollsoffatfromaroundherabdomenandsqueezesthemtoemphasizethepoint.)

Therapist:One thing I can guarantee you: in this room,we’re never going tohave a debate about what’s true and what’s false. What we’reinterestedinhereiswhat’shelpfulorwhat’susefulorwhathelpsyouto live a better life. Sowhen yourmind starts telling you “I’m fat,”whathappenswhenyougetallcaughtupinthosethoughts?

Client:Ifeeldisgustedwithmyself.

Therapist:Andthenwhat?

Client:ThenIgetdepressed.

Therapist:AndifIwerewatchingavideoofyou,whatwouldIseeyoudoingwhenyou’refeelingdepressedanddisgustedwithyourself?

Client:I’dprobablybesittinginfrontoftheTVandeatingicecream.

Therapist:Sogettingallcaughtupin“I’mfat,”doesn’tseemtoohelpful,doesit?

Client:No,butit’strue!

Therapist:Well,letmesaythisagain:withthisapproach,whatwe’reinterestedin is notwhether a thought is true or false, butwhether it’s helpful.When that thought pops into your head, does it help you to get allcaughtupinit?Doesitmotivateyoutoexercise,oreatwell,orspendtimedoingthethingsthatmakeliferichandrewarding?

Client:No.

Therapist: So what about if we could do something here that could make adifference;whatifyoucouldlearnaskillsothatnexttimeyourmindstartstellingyouthe“I’mfat”story,youdon’thavetogetallabsorbedinit?

Whenweusethebasicframeworkof“workability,”weneverneedtojudgeaclient’s behavior as “good” or “bad,” “right” or “wrong”; insteadwe can ask,nonjudgmentallyandcompassionately,“Isthisworkingtogiveyouthelifeyouwant?”Likewise,weneverneedtojudgethoughtsasirrationalordysfunctional,or get into debates aboutwhether they’re true or false. Insteadwe can simplyask,“Doesholdingontightlytothosethoughtshelpyoutolivethelifeyoutrulywant?”or“Howdoesitworkinthelongrun,ifyouletthatbeliefbeinchargeofyourlife?”or“Ifyougetallcaughtupinthosethoughts,doesithelpyoutodothethingsyouwant?”or“Ifyoulet thosethoughtspushyouaround,doesthathelpyoutobethepersonyouwanttobe?”Notethatinthetranscriptabove,thetherapistmakesnoattempttochangethe

content of the thoughts. In ACT, the content of a thought is not consideredproblematic;it’sonlyfusionwiththethoughtthatcreatestheproblem.Inmanypsychologytextbooks,you’lldiscoverthisquotationfromtheworksofWilliamShakespeare: “There is nothing either good or bad, but thinkingmakes it so.”The ACT stance would be fundamentally different: “Thinking does not make

anything good or bad. But if you fuse with your thinking, that can createproblems.”

ExperientialAvoidanceExperiential avoidance means trying to avoid, get rid of, suppress, or escapefrom unwanted “private experiences.” (As I mentioned earlier, ACT uses thetermprivateexperiencetomeananyexperienceyouhavethatnooneelseknowsaboutunlessyou tell them:forexample, thoughts, feelings,memories, images,urges,andsensations.)Experientialavoidanceissomethingthatcomesnaturallytoallhumans.Why?Well,here’showwedescribeittoclients…

TheProblem-SolvingMachine:AClassicACTMetaphor

Therapist:Ifwehadtopickoneabilityofthehumanmindthathasenabledustobe so resourceful thatwe’venotonly changed the faceof theplanetbut also traveledoutside it, it’d have to beour capacity for problemsolving. The essence of problem solving is this: A problem meanssomething unwanted.And a solutionmeans avoid it or get rid of it.Nowinthephysicalworld,problemsolvingoftenworksverywell.Awolf outsideyour door?Get rid of it: throw rocksor spears at it, orshoot it.Snow,rain,hail?Well,youcan’tgetridof thosethings,butyoucanavoidthembyhidinginacave,buildingashelter,orwearingprotectiveclothes.Dry,aridground?Youcangetridofitbyirrigationandfertilization,oryoucanavoiditbymovingtoabetterlocation.Soourmindis likeaproblem-solvingmachine,and it’sverygoodat itsjob. And given that problem-solving works so well in the materialworld, it’s only natural that ourmind tries to do the samewith ourinnerworld:theworldofthoughts,feelings,memories,sensations,andurges.Unfortunatelyall toooftenwhenwe try toavoidorget ridofunwantedthoughtsorfeelings,itdoesn’twork—orifitdoes,weendupcreatingalotofextrapainforourselvesintheprocess.

HowExperientialAvoidanceIncreasesSuffering

We’llreturntotheProblem-SolvingMachineMetaphorinlaterchapters.For

now, let’s consider how experiential avoidance increases suffering.Addictionsprovideanobviousexample.Manyaddictionsbeginas anattempt to avoidorgetridofunwantedthoughtsandfeelingssuchasboredom,loneliness,anxiety,guilt,anger,sadness,andsoon.Intheshortrun,gambling,drugs,alcohol,andcigaretteswilloftenhelppeopletoavoidorgetridofthesefeelingstemporarily,butinthelongrun,ahugeamountofpainandsufferingresults.Themore timeandenergywe spend trying to avoidorget ridof unwanted

privateexperiences, themorewe’relikelytosufferpsychologicallyinthelongrun.Anxietydisordersprovideagoodexample.It’snotthepresenceofanxietythatcomprisestheessenceofananxietydisorder.Afterall,anxietyisanormalhumanemotionthatweallexperience.Atthecoreofanyanxietydisorderliesexcessiveexperientialavoidance:alifedominatedbytryingveryhardtoavoidorgetridofanxiety.Forexample,supposeIfeelanxiousinsocialsituations,andinordertoavoidthosefeelingsofanxiety,Istopsocializing.NowIhave“socialphobia.” The short-term benefit is obvious—I get to avoid some anxiousthoughtsandfeelings—butthelong-termcostishuge:Ibecomeisolatedandmylife“getssmaller.”Alternatively I may try to reducemy anxiety by playing the role of “good

listener.” I become very empathic and caring toward others, and in socialinteractions, I discover lots of information about their thoughts, feelings, anddesires, but I reveal little or nothing ofmyself. This helps in the short run toreducemy fear of being judged or rejected, but in the long run, itmeansmyrelationshipslackintimacy,openness,andauthenticity.Now suppose I take Valium, or some other benzodiazepine, to reduce my

anxiety. Again, the short-term benefit is obvious: less anxiety. But long-termcosts of relying on benzodiazepines, antidepressants, marijuana, or alcohol toreduce my anxiety could include (a) psychological dependence on mymedication,(b)possiblephysicaladdiction,(c)otherphysicalandemotionalsideeffects, (d) financial costs, and (e) failure to learnmore effective responses toanxiety,which thereforemaintains or exacerbates the issue.Still anotherway Imightrespondtosocialanxietywouldbetogritmyteethandsocializedespitemyanxiety—thatis,totoleratethefeelingseventhoughI’mdistressedbythem.From an ACT perspective, this too would be experiential avoidance. Why?Because, although I’mnot avoiding the situation, I’m still strugglingwithmyfeelings and desperately hoping they’ll go away. This is tolerance, notacceptance. If I truly acceptmy feelings, then even though theymay be veryunpleasantanduncomfortable,I’mnotdistressedbythem.Togetthedistinctionbetweentoleranceandacceptance,considerthis:Would

youwantthepeopleyoulovetotolerateyouwhileyou’represent,hopingyou’llsoongoawayandfrequentlycheckingtoseeifyou’vegoneyet?Orwouldyoupreferthemtocompletelyandtotallyacceptyouasyouarewithallyourflawsandfoibles,andtobewillingtohaveyouaroundforas longasyouchoosetostay?The cost of toleratingmy anxiety (that is, grittingmy teeth and putting up

withit)isthatittakesahugeamountofeffortandenergy,anditmakesithardtoremainfullyengagedinanysocialinteraction.Asaconsequence,Imissoutonmuch of the pleasure and fulfillment that commonly accompanies socialinteraction. And this in turn increases my anxiety about future social eventsbecause“Iwon’tenjoyit”or“I’llfeelawful”or“It’stoomucheffort.”Sadly the more importance we place on avoiding anxiety, the more we

developanxietyaboutouranxiety.It’saviciouscycle,foundatthecenterofanyanxietydisorder. (Afterall,what isat thecoreofapanicattack, ifnotanxietyabout anxiety?) A large body of research shows that higher experientialavoidanceisassociatedwithanxietydisorders,excessiveworrying,depression,poorerworkperformance,higherlevelsofsubstanceabuse,lowerqualityoflife,high-risk sexual behavior, borderline personality disorder, greater severity ofPTSD, long-term disability, and higher degrees of overall psychopathology(Hayes,Masuda,Bissett,Luoma,&Guerrero, 2004). Indeed, it’s arguably thesinglebiggestfactorinpsychopathology.So now you can see one reason why ACT doesn’t focus on symptom

reduction:todosoislikelytoreinforceexperientialavoidance,theveryprocessthat fuels most clinical issues. Another reason is that attempts to reducesymptoms can paradoxically increase them. For example, research shows thatsuppressionof unwanted thoughts can lead to a rebound effect: an increase inboth intensity and frequency of the unwanted thoughts (Wenzlaff &Wegner,2000).Otherstudiesshowthattryingtosuppressamoodcanactuallyintensifyitin a self-amplifying loop (Feldner, Zvolensky, Eifert, & Spira, 2003;Wegner,Erber,&Zanakos,1993).One core component of most ACT protocols involves getting the client in

touch with the costs and futility of experiential avoidance. This is done toundermine theagenda of control (that is, the agenda of trying to control ourthoughtsandfeelings)andtocreatespaceforthealternativeagenda:acceptance.However,althoughwewanttofacilitatemindful,valuedliving,wedon’twanttoturninto…

“MindfulnessFascists”

Wearenot “mindfulness fascists” inACT;wedon’t insist that peoplemustalwaysbe in thepresentmoment, alwaysdefused, always accepting.Not onlywouldthatberidiculous,itwouldalsobeself-defeating.We’reallexperientiallyavoidant to some degree. And we all fuse with our thoughts at times. Andexperiential avoidance and cognitive fusion in and of themselves are notinherently “bad” or “pathological”; we only target themwhen they get in thewayoflivingarich,full,andmeaningfullife.Inotherwords,it’sallaboutworkability.Ifwetakeaspirinfromtimetotime

inordertogetridofaheadache,that’sexperientialavoidance,butit’slikelytobeworkable—thatis,itimprovesourqualityoflifeinthelongrun.Ifwedrinkoneglassofredwineatnightprimarilytogetridoftensionandstress,thattooisexperientialavoidance—butunlesswehavecertainmedicalconditions, it’snotlikelytobeharmful,toxic,orlifedistorting.Onthecontrary,itwillactuallydoour heart some good. However, if we drink two entire bottles each night,obviouslythat’sadifferentstory.Thesameholdstrueforfusion.Therearecertaincontexts—althoughfewand

far between—where fusion is actually life enhancing, such aswhenwe allowourselvesto“getlost”inanoveloramovie.Andthereareothercontextswherewefusewithourthoughts,andalthoughit’snotlifeenhancing,it’snotusuallyproblematic either—for example,whenwe’re daydreamingwhilewaiting in asupermarket line. But generally speaking, we’re better off defusing from ourthoughtsatleastalittle.(Toclarifythis,recalltheHandsAsThoughtsExerciseyoudidearlier.Evenasmallgapbetweenyourfaceandyourhandsallowsalotmoreinformationabouttheworldtogetthroughtoyou.)

AVeryImportantPointaboutAcceptancevs.Control

InACT,wedonotadvocateacceptanceofallthoughtsandfeelingsunderallcircumstances. That would not only be very rigid but also quite unnecessary.ACTadvocatesacceptanceundertwocircumstances:

1. Whencontrolofthoughtsandfeelingsislimitedorimpossible.2. When control of thoughts and feelings is possible, but the

methodsusedreducequalityoflife.

If control is possible and assists valued living, then go for it. Please do

remember this point. It is often forgotten or misunderstood by new ACTpractitioners,andrememberingitwillsaveyoualotofconfusion.

TheSixCorePathologicalProcessesCognitive fusion and experiential avoidance together give rise to six corepathologicalprocesses,asshowninfigure2.1below.(Youcanthinkoftheseasthe“flipsides”ofthesixcoretherapeuticprocesses.)AsItakeyouthrougheachprocess,I’lluseclinicaldepressiontoprovideexamples.

Fusion

Asdescribedabove,fusionmeansentanglement inour thoughtsso that theydominateourawarenessandhaveahugeinfluenceoverourbehavior.Depressedclients fusewith all sorts of unhelpful thoughts: I’m bad, I don’t deserve anybetter, I can’t change, I’ve always been thisway, Life sucks, It’s all too hard,Therapywon’twork,It’llnevergetanybetter,Ican’tgetoutofbedwhenIfeelthis way, I’m too tired to do anything. They also often fuse with painfulmemories involving thingssuchas rejection,disappointment, failure,orabuse.(Extremefusionwithamemory—tosuchanextentthatitseemstobeactuallyhappening right here and now—is commonly referred to as a flashback.) Inclinical depression, fusion often manifests as worrying, ruminating, trying tofigureout“whyI’mlikethis”oranongoingnegativecommentary:“Thispartysucks. I’d rather be in bed.What’s the point of even being here? They’re allhavingsuchagoodtime.Noonereallywantsmehere.”

ExperientialAvoidance

AsI’vementionedbefore,experientialavoidancemeans trying toget ridof,avoid,orescapefromunwantedprivateexperiencessuchasthoughts,feelings,andmemories.It’sthepolaroppositeofacceptance(whichisanabbreviationof“experientialacceptance”).Asanexample, let’s lookat theroleofexperientialavoidance in depression. Your depressed clients commonly try very hard toavoid or get rid of painful emotions and feelings such as anxiety, sadness,fatigue, anger, guilt, loneliness, lethargy, and so on. For example, they oftenwithdraw from socializing in order to avoid uncomfortable thoughts andfeelings.Thismaynotbeapparentatfirstglance,solet’sthinkitthrough.Asasocialengagementdrawsnearerandnearer,they’relikelytofusewithallsortsofthoughtssuchasI’mboring,I’maburden,I’vegotnothingtosay,Iwon’tenjoyit,I’mtootired,orIcan’tbebothered,aswellasmemoriesofprevioussocialeventsthathavebeenunsatisfactory.Atthesametime,theirfeelingsofanxietyincrease and they often report a sense of anticipatory “dread.” However, themoment theycancel theengagement, there’s instant relief:all thoseunpleasantthoughts and feelings instantly disappear. And even though that relief doesn’tlast for long, it’s very reinforcing,which increases the chance of future socialwithdrawal.Fusion and avoidance generally go hand in hand. For example, depressed

clientsoften tryhard topushaway thevery thoughtsandmemories theykeepfusing with—for example, painful thoughts such as I’mworthless orNobodylikesme,orunpleasantmemoriesofrejection,disappointment,andfailure.Theymaytryanythingfromdrugs,alcohol,orcigarettestowatchingTVorsleepingexcessivelyinvainattemptstoavoidthesepainfulthoughts.

DominanceoftheConceptualizedPastandFuture/LimitedSelf-Knowledge

Fusionandavoidancereadilyleadtoalossofcontactwithourhere-and-nowexperience.Weallreadilygetcaughtupinaconceptualizedpastandfuture:wedwellonpainfulmemoriesandruminateoverwhythingshappenedthatway;wefantasize about the future, worry about things that haven’t yet happened, andfocusonallthethingswehavetodonext.Andintheprocess,wemissoutonlifeinthehereandnow.Contactingthepresentmomentincludestheworldaroundusandinsideus.If

welosecontactwithourinnerpsychologicalworld—ifwe’reoutoftouchwithourownthoughtsandfeelings—thenwelackself-knowledge.Andwithoutself-knowledge,it’smuchhardertochangeourbehaviorinadaptiveways.

Depressedclientscommonlyspendalotoftimefusedwithaconceptualizedpast:ruminatingonpainfulpastevents,oftenhavingtodowithrejection, loss,andfailure.Theyalsofusewithaconceptualizedfuture:worryingaboutallthe“badstuff”thatmightlieahead.

LackofValuesClarity/Contact

As our behavior becomes increasingly driven by fusion with unhelpfulthoughts,orattempts toavoidunpleasantprivateexperiences,ourvaluesoftenget lost, neglected, or forgotten. Ifwe’re not clear about our values or not inpsychological contactwith them, thenwecan’tuse themasaneffectiveguidefor our actions. Depressed clients often lose touch with their values aroundconnectingwith and contributing to others, being productive, nurturing healthandwell-being,havingfun,orengaginginchallengingactivitiessuchassports,work,andhobbies.Our aim in ACT is to bring behavior increasingly under the influence of

valuesratherthanfusionoravoidance.(Note:Evenvaluesshouldbeheldlightlyrather than fusedwith. Ifwefusewithvalues, theyeasilybecomerigid rules.)Considerthedifferencesbetweengoingtoworkunderthesethreeconditions:

1. Mainlymotivatedbyfusionwithself-limitingbeliefssuchas“Ihavetodothisjob.It’sallI’mcapableof.”

2. Mainly motivated by avoidance: going in to work to avoid“feelinglikealoser”ortogetridoffeelingsofanxietyrelatedtotensionathome.

3. Mainlymotivatedbyvalues:doingthisworkguidedbyvaluesaround contribution, self-development, being active, orconnectingwithothers.

Which form of motivation is likely to bring the greatest sense of vitality,meaning,andpurpose?

UnworkableAction

Unworkable action means patterns of behavior that pull us away frommindful, valued living; patterns of action that do not work tomake our livesricherandfuller,butrathergetusstuckorincreaseourstruggles.Thisincludes

actionthat’simpulsive,reactive,orautomaticasopposedtomindful,considered,purposeful; action persistentlymotivated by experiential avoidance rather thanvalues; and inaction or procrastination where effective action is required toimprovequalityof life.Commonexamplesofunworkableactionindepressioninclude using drugs or alcohol excessively, withdrawing socially, beingphysically inactive, ceasing previously enjoyable activities, avoiding work,sleeping or watching TV excessively, attempting suicide, excessiveprocrastinationonimportanttasks,andthelistgoesonandon.

AttachmenttotheConceptualizedSelf

Weallhaveastoryaboutwhoweare.Thisstoryiscomplexandmultilayered.Itincludessomeobjectivefactssuchasourname,age,sex,culturalbackground,marital status, occupation, and so on. It also includes descriptions andevaluations of the roleswe play, the relationshipswe have, our strengths andweaknesses,ourlikesanddislikes,andourhopes,dreams,andaspirations.Ifweholdthisstorylightly,itcangiveusasenseofselfthathelpstodefinewhoweareandwhatwewantinlife.However,ifwefusewiththisstory—ifwestarttothink we are the story—it readily creates all sorts of problems. Most ACTtextbooksrefertothisstoryastheconceptualizedselforself-as-content.Ipreferthe term self-as-description, a phrase coined by psychologist Patty Bach,becausethat’sessentiallywhatitis:awayofdescribingourselves.Andwhenwefusewithourself-description,itseemsasifwearethatdescription,thatallthosethoughtsaretheveryessenceofwhoweare:self-as-description.Note that even fusion with a very positive self-description is likely to be

problematic.Forexample,whatmightbethedangeroffusingwith“Iamstrongand independent?” That will undoubtedly giveme high self-esteem, but whathappens when I really need help and I’m so fused with my positive self-descriptionthatI’munwillingtoaskforitoracceptit?Andwhat’sthepotentialdangerof fusingwith“Iamabrilliantcardriver. IcandriveexceedinglywellevenwhenIamdrunk!”?Again,thisgivesmeverypositiveself-esteem,butitcaneasilyleadtodisaster.Indepression,clientsgenerallyfusewithavery“negative”self-description:“I

am (bad/worthless/hopeless/unlovable/dumb/ugly/fat/incompetent/a loser/afailure/damagedgoods/disgusting/boring/unlikeable),”andsoon.However,youmayalsoget“positive”elementsinthere—forexample,“I’mastrongperson;Ishouldn’tbereactinglikethis,”or“I’magoodperson;whyisthishappeningto

me?”oreven“Idon’tneedanyhelp.Icangetthroughthisonmyown.”

OverlapamongPathologicalProcesses

You’ll notice that there’s considerable overlap among these pathologicalprocesses; as with psychological flexibility, they’re all interconnected. Forexample,ifyourclientruminateson“WhyamIsuchafailure?”youcouldclassthatasfusionorself-as-description.Andifhespendstheeveningpacingupanddownruminatinginsteadofdoingsomethinglifeenhancing,youcouldclassitasunworkableaction.Andifhe’slostinhisthoughtswhilespendingtimewithhiswifeandkids,thennotonlyishelosingcontactwiththepresentmoment,he’sprobably losing contact with his values around connecting and engagingwithothers.Ruminationcouldevenserveasexperientialavoidance, ifhe’sdoing itprimarily to avoid thinking about or dealing with other painful issues, or todistracthimselffromfeelingsinhisbody.

SoWhoIsACTSuitableFor?ACThasbeenscientificallystudiedandshowntobeeffectivewithawiderangeof conditions including anxiety, depression, obsessive-compulsive disorder,socialphobia,generalizedanxietydisorder,schizophrenia,borderlinepersonalitydisorder,workplace stress, chronicpain,druguse,psychologicaladjustment tocancer, epilepsy, weight control, smoking cessation, and self-management ofdiabetes (Bach & Hayes, 2002; Bond & Bunce, 2000; Brown et al., 2008;Branstetter, Wilson, Hildebrandt & Mutch, 2004; Dahl, Wilson, & Nilsson,2004;Dalrymple&Herbert, 2007;Gaudiano&Herbert, 2006.;Gifford et al.,2004;Gratz&Gunderson, 2006;Gregg,Callaghan,Hayes,&Glenn-Lawson,2007;Hayes,Masuda,Bissett,Luoma,&Guerrero,2004;Hayes,Bissett,etal.,2004; Tapper et al., 2009; Lundgren,Dahl,Yardi,&Melin, 2008;Ossman&Wilson,2006;Twohig,Hayes,&Masuda,2006;Zettle,2003).When therapistsaskme,“WhoisACTsuitablefor?”myreplyis“CanyouthinkofanyonewhoACT is not suitable for?” Who wouldn’t benefit from being morepsychologically present; more in touch with their values; more able to makeroomfortheinevitablepainoflife;moreabletodefusefromunhelpfulthoughts,beliefs,andmemories;moreabletotakeeffectiveactioninthefaceofemotionaldiscomfort;moreable toengage fully inwhat they’redoing;andmoreable toappreciate each moment of their life, no matter how they’re feeling?

Psychological flexibility brings all these benefits, and more. ACT thereforeseemsrelevanttojustabouteveryone.(Ofcourse,ifhumanshavesignificantdeficitsintheirabilitytouselanguage,

suchassomepeoplewithautism,acquiredbraininjury,orotherdisabilities,thenACTmaybeoflimiteduse.However,RFT(relationalframetheory)hasallsortsofusefulapplicationsforthesepopulations.)To help you start thinking in terms of this model, I’m going to close this

chapterwith an exercise in case conceptualization. I’d likeyou topickoneofyourclientsandfindexamplesofthesixcorepathologicalprocessesoutlinedinthis chapter. To help you with this task, please use the worksheet AssessingPsychologicalInflexibility:SixCoreProcesses.(You’llfinditattheendofthischapter.It’salsodownloadablefromwww.actmadesimple.com.)Ifyougetstuckonanyheading,don’t fretabout it, justmoveon to thenextone.Andkeep inmind, there’sa lotofoverlapbetweentheseprocesses,soifyou’rewondering,“Is thisfusionoravoidance?”thentheanswerisprobablyyes—inwhichcase,write it down under both headings. This exercise is purely to get you started.Lateronin thebook,we’ll focusoncaseconceptualizationinmoredetail.Fornow,justgiveitashot,andseehowyoudo.Better still, run through this exercise for two or three clients because (like

prettymucheverything)withpractice,itgetseasier.Andevenbetterstill:ifyoureallywanttogetyourheadaroundthisapproach

tohumanpsychopathology,picktwoorthreeDSM-IVdisordersandidentifythefusion,avoidance,andunworkableactiongoingon:Whatkindofmentalcontentdo sufferers fusewith (in termsofworrying, ruminating, self-image, and self-defeatingbeliefsandattitudes)?Whatfeelings,urges,sensations,thoughts,andmemories are sufferers unwilling to have or actively trying to avoid? Whatunworkable actionsdo sufferers typically take?What corevaluesdo they losetouchwith?Lastbutnotleast:runthroughthisexerciseonyourself.Ifyouwanttolearn

ACT, the best person to practice on is you. So take some time to do thisseriously: identifywhat you fusewith,what you avoid,what values you losetouch with, and what ineffective actions you take. The more you apply thismodel toyourown issuesandnoticehow itworks inyourown life, themoreexperienceyoucandrawoninthetherapyroom.

Chapter3.TheHouseofACTWhatTookYouSoLong,ACT?

WhydidittakeACTsolongtobecomepopular,giventhataslongagoas1986therewererandomizedcontrolledtrialsshowingittobeequivalentorsuperiortotraditional cognitive behavioral therapy (CBT) for treatment of depression?SteveHayes,thecreatorofACT,answersthatquestionlikethis:“If ACT had been popular twenty years ago it could not have withstood

scrutiny.Themodelwasnotwelldevelopedanditsfoundationwasweak…Wewerewillingtospendyearsonphilosophy,basictheory,measures,andappliedtheory before even publishing the approach in book form (in 1999) … Butbecausewewaitedandworkedon thefoundation,nowwhenpeoplepeelbackthe layers they seehowmuchhas beendoneon the foundationsof thework”(Harris,2008b)Asaresultofall thisfoundationalwork,ACTisnowlike the topfloorofa

three-storymansion.Onthenextfloordown,you’llfindrelationalframetheory(RFT),whichisabehavioraltheoryofhumanlanguageandcognition.Thenonthe ground floor you’ll find applied behavioral analysis (ABA), a powerfulmodel for the prediction and influence of behavior that has had an enormousimpactonalmosteverybranchofmodernpsychology.Andthegroundonwhichtheentiremansionrestsisaphilosophycalledfunctionalcontextualism(FC).WhiletherestofthisbookisprimarilyfocusedonACT,inthischapterwe’re

goingtotakeaquicklookatfunctionalcontextualism.Youdon’thavetoknowthisstuff—youcanskipthischapterifyouwish—butIencourageyoutoreadonbecause it will help your understanding of ACT. (Originally this chapter alsoincludedanintroductiontoABAandRFT,butunfortunatelywehadtocutitforlack of space. However, you can download that introduction fromwww.actmadesimple.com/the_house_of_ACT.)

FunctionalContextualismandtheThree-leggedChairI’dlikeyoutoimagineachairthathasfourlegs,butthemomentanyonesitsonit,oneofthelegsdropsoff.Wouldyoudescribethischairas“broken,”“faulty,”or“damaged”?Wouldyoucallita“dysfunctionalchair”orevena“maladaptivechair”?I’veaskedthisquestionofmanyhundredsoftherapists,andtheyalways

answer yes to at least one of the above descriptions. The problem is that thisinstinctive answer—“Yes, there is something wrong, faulty, or flawed in thechair”—forgetstotakeintoaccounttheall-importantroleofcontext.SoIinviteyounowto think laterally: thinkofat least threeorfourcontexts inwhichwecouldsaythischairfunctionsveryeffectivelytoserveourpurposes.

***

Didyoucomeupwithsome?HereareafewIthoughtof:

Playingapracticaljoke.Creatinganartexhibitionofbrokenfurniture.Findingpropsforaclown’sactoracomedyshow.Demonstratingdesignflawsinafurniture-makingclass.Improvingbalance,coordination,andmusclestrength(that is,youtrysittingdownwithoutmakingthelegfalloff).Hopingtoinjureyourselfatworktogetacompensationclaim.

In all of these contexts, this chair functions very effectively to serve ourpurposes.Thisexampleillustrateshowfunctionalcontextualismgetsitsname:itlooksathowthingsfunctioninspecificcontexts.FromtheviewpointofFC,nothoughtorfeelingisinherentlyproblematic,dysfunctional,orpathological.Inacontextthatincludescognitivefusionandexperientialavoidance,ourthoughts,feelings,andmemoriesoftenfunctioninamannerthatistoxic,harmful,orlifedistorting. However, in a context of defusion and acceptance (that is,mindfulness), those very same thoughts, feelings, andmemories function verydifferently:theyhavemuchlessimpactandinfluenceoverus.Theymaystillbepainful, but they’re no longer toxic, harmful, or life distorting—and moreimportantly,theydon’tholdusbackfromvaluedliving.Most models of psychology are based on a philosophy calledmechanism.

Mechanistic models treat the mind as if it’s a machine made up of lots ofseparateparts.“Problematic”thoughtsandfeelingsareseenasfaultypartsofthemachineorerrorsinthestructureofthemachine.Theaiminsuchmodelsistorepair, replace, or remove these faulty parts so the machine can functionnormally.Mechanisticmodelsofpsychologyassume that therearesuch thingsas inherently “dysfunctional,” “maladaptive,” or “pathological” thoughts,feelings,andmemories.Inotherwords,therearememories, thoughts,feelings,emotions,urges,schemas,narratives,egostates,corebeliefs,andsoonthatarefundamentally problematic, dysfunctional, or pathological, and much like a

“faultychair,”theyneedtobeeitherfixed,replaced,orremoved.Mechanism has been the most successful philosophy of science in most

scientificfields,soit’snotsurprisingthatmostmodelsinpsychologyarebasedonsomesortofmechanisticphilosophy.Andthereisnothing“wrong”or“bad”or “inferior” or “basic” about mechanism. I’m merely emphasizing thatfunctional contextualism is a radically different philosophical approach to themainstream,anditnaturallyleadstoadifferentwayofdoingtherapy.

AreClients“DamagedGoods”?

Ourclientsoftencome to therapywithmechanistic ideas.Theybelieve thatthey’re faulty, damaged, or flawed, and they need to be fixed up or repaired.Sometimes they even refer to themselves as “damaged goods.” They oftenbelieve they’re lacking important components such as “confidence” or “self-esteem.” Or they believe they have faulty parts—such as feelings of anxiety,negative thoughts, or painful memories—that need to be removed. Mostmechanisticmodelsreadilyreinforcethesenotionsthroughtwoprocesses:

1. Theyusewords—forexample, termssuchas“dysfunctional,”“maladaptive,”“irrational,”or“negative”—thatimplywehavefaultyordamagedcomponentsinourminds.

2. They use a wide variety of tools and techniques designed todirectly reduce, replace, or remove these unwanted thoughtsandfeelings(usuallyontheassumptionthatthisisanessentialstepforimprovingqualityoflife).

InACT,ourattitudeisverydifferent.Wedon’tsetouttoreduceoreliminate“symptoms”;insteadweaimtofundamentallytransformtheclient’srelationshipwith her thoughts and feelings so that she no longer perceives them as“symptoms.” After all, the moment we label a thought or feeling as a“symptom,” that implies that it’s “bad,” “harmful,” “abnormal,” and thereforesomethingweneedtogetridofinordertobenormalandhealthy.Thisattitudereadilysetsusuptostrugglewithourownthoughtsandfeelings—astrugglethatoftenhasdisastrousconsequences.Supposethere’saplantthatyoujudgeas“ugly,”growingrightinthecenterof

your front garden. And suppose that there’s no way to get rid of it withoutdestroying your entire garden. (Youmay be thinking,But theremust be someway togetridof it. If so, just stepback foraminuteandmakeahypothetical

leap:imagine,forthepurposesofthisexercise,thatyoucan’tgetridofthisplantwithoutdestroyingyourgarden.)Nowifyouviewthisplantasa“weed,”whatislikelytohappentoyourrelationshipwithit?Chancesareyouwon’tlikeitandyouwon’t want it there. And youmaywell get upset or angry about it. Youcould easily waste lots of time thinking about how much better your gardenwouldbewithoutit.Youmightevenhesitatetoletpeopleintoyourfrontgarden,forfearthey’lljudgeyouonaccountofit.Perhapsyoumightevenstartleavingbythebackofyourhousesoyoudon’thavetolookatthis“uglyweed.”Inotherwords,this“uglyweed”hasbecomeAVERYIMPORTANTTHINGINYOURLIFE—somuchso,thatitnowhasasignificantimpactonyourbehavior.Butwhat happens if, instead of viewing that plant as an “uglyweed,” you

view it as just an unfortunate fact of life: a natural part of the nativeenvironment, a common example ofAmerican indigenous flora?Now it’s thesameplant,inthesamelocation,butyourrelationshipwithithasfundamentallychanged.Nowyounolongerhavetostrugglewithit.Nowyouneednolongerbeupsetorembarrassedaboutit,orwastesomuchtimethinkingaboutit.Nowyoucanletpeopleintoyourgardenwithouthesitation,andyoucanleavebythefrontof thehouse.Theplant itselfhasnotchanged,butyounolongermakeitinto A VERY IMPORTANT THING IN YOUR LIFE. It now has much lessimpactorinfluenceoveryou.Mindfulness enables us to make a similar attitude shift toward all those

thoughts, feelings, sensations, and memories that we so readily judge as“problematic”; it enablesus tochoose the relationshipwehavewith them.Bychanging thecontextfromoneoffusionandavoidance tooneofdefusionandacceptance (that is, mindfulness), we alter the function of those thoughts andfeelings so theyhavemuch less impact and influenceover us. In a context ofmindfulness,they’renolonger“symptoms”or“problems”or“thingsthatstopusfrom living a rich and full life”; they’re nothing more or less than thoughts,feelings,sensations,memories,andsoon.In one sense,mindfulness is the ultimate reframing tool: itmoves all these

painful thoughts and feelings from the old frame of “abnormal pathologicalsymptomsthatareobstaclestoarichandmeaningfullife”intothenewframeof“normalhumanexperiencesthatarenaturalpartsofarichandmeaningfullife.”

WhatIstheGoalofFunctionalContextualism?

ThegoalofFCistopredictandinfluencebehavioraccuratelyandeffectively,

using empirically supported principles.Andwhat is the purpose of predictingand influencing behavior? InACT, the purpose is specifically to help humanscreaterich,full,andmeaningfullives—thatis,toenablemindful,valuedliving.Thus ACT teaches people to increase awareness of their own behavior (bothpublic andprivate), and to notice how it functions in the context of their life:doesitimprovetheirqualityoflife,orlowerit?YoumayrecallthatinACT,werefertothisconceptas“workability.”Nowlet’stakeamomenttoconsidertheword“function.”It’satechnicalterm

(not one that you’d usewith clients) that you’ll find inmostACT textbooks.Whenweask“What is the functionof thisbehavior?”wemean“Whateffectsdoes this behavior have?What are the consequences?” In other words, we’reasking, “What purpose does this behavior serve? What is it intended toachieve?”Toclarifythis,imaginefivedifferentpeople,infivedifferentsituations,each

makingcutsacrosstheirforearmwithasharpknife.Nowseeifyoucancomeupwithfivepossiblefunctionsforthisbehavior.

***

Herearesomepossibilities:

GettingattentionSelf-punishmentReleaseoftensionDistractionfrompainfulemotionsCreatingbodyartTryingtofeelsomethingifyouare“totallynumb”Attemptingtogetadmittedtoahospital

Notice in all these scenarios the form of the behavior is the same—cuttingone’sarm—butthefunctionofthebehavior—thepurposeitserves—isdifferent.Nowlet’ssupposeyourpartnerislostinthought,andyourpurposeistogain

hisattention.Thinkoffivedifferentformsofbehaviorthatmightachievethis.***

Hereareafewideas:

Waveathim.Shout“Hello,isthereanybodyinthere?”

Pouracupofwateroverhishead.Bangloudlyonsomefurniture.Say,“Darling,canIhaveyourattentionforamoment,please?”

Inthisexample,youcanseethatmanydifferentformsofbehaviorallhavethesame function: they serve the purpose of getting attention. In functionalcontextualism,we’reinterestedinthefunctionofabehaviorratherthantheformof it.Butnotice,wecanonlyknowthefunctionofabehavior ifweknowthecontext inwhich it occurs. If someone raises an arm up high in the air,whatpurposedoesthatserve?Isheinalecturehall,askingaquestion?Isshepointingupataplaneinthesky?Orisheperhapstryingtohailataxi?Withoutknowingthecontext,wecan’tknowthefunctionofthebehaviorandviceversa.Andthatbrings up another important question:What dowemean by “behavior”—and“behaviorism”?

“Behaviorism”:AMisunderstoodWordWhenIfirstdiscoveredACT,Icouldn’tbelievethatsuchaspiritual,humanisticmodel came out of behaviorism. I thought behaviorists treated humans likerobotsorrats,thattheyhadnointerestinthoughtsandfeelings,andconsideredthemunimportantor irrelevant.Boy,was Iwrong! I soondiscovered thereareseveral different schools of behaviorism, and some of them have ideas thatdirectly contradict essential elements of ACT and RFT. ACT comes from abranchknown,somewhatunfortunately,as“radicalbehaviorism.”Butdon’tletthenameputyouoff.Radicalbehaviorists do not run around in combat gear,armed with assault rifles—they get their name because of their radicalviewpoint:theyconsidereverythingthatanorganismdoesisbehavior.Yes,youread that correctly: everything that an organism does is behavior. Thus, to aradicalbehaviorist,processessuchasthinking,feeling,andrememberingareallconsideredtobeformsofbehavior—andallareconsideredveryimportant.Radical behaviorists talk of two broad realms of behavior. One realm is

“public” behavior—that is, behavior that can directly be observed by others(provided they are present towitness it).Thus, ifwewatched a videoof you,whateverwecouldseeyoudoingorhearyousayingwouldbepublicbehavior.Ineverydaylanguage,wecommonlyrefertothesepublicbehaviorsas“actions.”Theotherrealmis“private”behavior—thatis,behaviorthatcanonlybedirectlyobserved by the person doing it: thinking, feeling, remembering, fantasizing,worrying,tasting,smelling,andsoon.Radicalbehavioristsareveryinterestedin

boththeserealms.Behaviorism has had a profound impact on clinical psychology. Through

rigorous scientific study, thebehavioristsdiscovered awide rangeofpowerfulmethods for reliably and effectively influencing human behavior (both publicandprivate):methodsthatincludeexposure,reinforcement,shaping,extinction,and classical and operant conditioning. Many models of therapy have beenextremely influenced by these ideas, althoughmany fail to acknowledge it oreven realize it. Indeed, it’shard to imagineaneffective therapistorcoach thatdoesnotutilizeatleastsomeofthesebasicprinciples,giventheyhaveprovensoeffectiveforfacilitatingbehavioralchange.Many of these ideas are hugely influential in everyday life. For example,

business leadershipprogramsadvisemanagers tocatch theircoworkers“doingsomething right” and sincerelypraise them for it.Likewise, positiveparentingprogramsadviseparentstoactivelynoticewhentheirchildrenarebehavingwelland reward them for it. All this excellent advice is based on the powerfulbehavioralprincipleof“positivereinforcement.”

TheThreeWavesofBehaviorism

Nowlet’stakeaquicktourofbehaviorismtoseehowwegottowherewearetoday.Therehavebeenthree“waves”ofbehavioraltherapiesinthelastcentury.The “first wave,”which reached its peak of popularity in the 1950s and 60s,focusedprimarilyonovertbehavioralchangeandutilized techniques linked tooperant and classical conditioning principles. Many practitioners in this firstwaveplacedlittleimportanceonthoughtsandfeelings.Unfortunatelythisledtoallbehavioristsbeingpaintedwiththesamebrush:thattheytreatedhumanslikeratsorrobots.The “second wave” of behaviorism, which took off in the 1970s, included

cognitive interventions as a key strategy in behavior change. In particular, the“secondwave”placedamajoremphasisonchallengingordisputing irrational,dysfunctional, negative, or erroneous thoughts, and replacing themwithmorerational,functional,positive,orrealisticthoughts.Cognitivebehavioraltherapy(CBT) eventually came to dominate this “second wave,” closely followed byrationalemotivebehaviortherapy(REBT).ACTispartoftheso-called“thirdwave”ofbehavioraltherapies—alongwith

dialectical behavior therapy (DBT), mindfulness-based cognitive therapy(MBCT), functional analytic psychotherapy (FAP), and several others—all of

which place a major emphasis on acceptance and mindfulness, in addition totraditionalbehavioralinterventions.

AndtheRestoftheTour?Ifyou’d like to tour therestof thehouseofACT, thenI recommendyoureadThe ABCs of Human Behavior: Behavioral Principles for the PracticingClinicianbyJonasRamneröandNiklasTörneke.Thisisanexcellentbookthattakesyoustep-by-step,simplyandclearly, throughall thedetailsofFC,ABA,andRFT,tyingthemalltogetherwithACTvianumerousclinicalexamplesandannotated transcripts of therapy. There’s also a free online tutorial on RFT,availableatwww.contextualpsychology.org/rft_tutorial.But that’s enough of this intellectual talk. Now it’s time to start getting

experiential…

Chapter4.GettingExperientialLessTalk,MoreAction:ACTasExperientialTherapy

ACT is a very active therapy. We take clients through a wide array ofexperientialexercises,whichrangeindurationfromtensecondstohalfanhour.Now,ifyou’realreadywell-versedinexperientialtherapy,youmaytakethisinstride.However,formanypractitioners,theideaofleadingsuchexercisesisnotonlychallenging,butit’salsodaunting.Sointhischapter,we’lllookathowtoacclimatizeclients to theexperientialnatureofACT,andhowtodevelopyourabilitytoleadtheseexercises.

TheProofofthePudding

There’sanold saying, “Theproofof thepudding is in theeating.”Youcantalkuntil thecowscomehome, tryingtodescribe thepuddingyouwantmetotaste,butuntilIactuallyplaceitinmymouth,Iwon’tknowwhatittasteslike.Oneofthemostcommonpitfallswhenwe’renewtoACTistryingtodescribeorexplainACTprocesses insteadofactuallydoing them. Ifwe’renotcareful,it’seasytogetboggeddowninwordyconversationsandwastealotoftimeonintellectualdiscussioninsteadofdoingsomethingthat’spracticalanduseful.Becauseof this,you’rebetteroff togo throughaprocessexperientiallyand

thentalkaboutitlater,ratherthantheotherwayaround.Andifyoudochoosetoexplainanexercise inadvance, thenpreferablydosoviaametaphor; I’llgiveyouplentyofexamplesaswego.

AQuickNoteontheTherapeuticRelationship

Throughout this book, you’ll encounter a lot of techniques, metaphors,worksheets,strategies,andotherinterventions.Noneofthiswillbeeffectiveifyoudon’thaveagoodrelationshipwithyourclient.InACT,weaimtobefullypresentwithourclients:open,authentic,mindful,compassionate,respectful,andin touchwithourowncorevalues. Inotherwords,weaimto liveandbreatheACT ourselves, and to deliver it with heart and soul rather than coldly andmechanicallyusingitlikeafancytoolkit.KellyWilson,oneofthepioneersofACT,putsthisverysimply.Headvisesus

toseeourclientsassunsets,notasmathproblems.Andheremindsusthatwedon’t do interventions to clients—we do interventionswith clients.As part ofthis respectful stance towardourclients,we repeatedlyask theirpermission tobeginand/orpersistwithexperientialexercises.Forexample,wemightsay,“I’mjustwondering—there’sanexercisethatIthinkcouldbereallyusefulforyouindealingwiththisissue.Wouldyoubewillingtogiveitago?”Similarly, in the midst of some exercise where our client is in touch with

strongemotions,youmightask,“I’mjustchecking—isitokayifwekeepgoingwith this? I don’t want you to feel in any way coerced.We can stop at anypoint.”Andifweshouldnoticewe’vespentalongtimediscussingACTprocessesas

opposedtoactuallydoingthem,wemightsay,“I’vejustnoticedsomethinghere.We’ve been doing a lot of talking in this session but not much practice.Obviously you can’t learn to play a guitar by talking about it; you have toactuallypickitupandstrumthestrings.Andit’sthesamewiththistherapy.Sowould itbeokay ifwestopped talking forawhile,and insteadcouldwedoalittleexerciserelatedtothisissue?”

RelevanceandRationale

Wewanttomakeourmetaphorsandexercisesdirectlyrelevanttotheissueswe’redealingwith in thesessionrather than trottingoutsomeexercisesimplybecausewelikeit,it’sfreshinourmemory,oritworkedwellwithourpreviousclient.Forlongerexercises,it’softenusefultoprovidearationale.Forexample:

Therapist:So,insummary,itseemslikeyouspendalotoftimecaughtupinalltheseworryingthoughts,andit’smakingyouprettymiserable.

Client:Yes.Iknowit’sstupid,butIcan’thelpit.That’sthewayIam.We’reallworriersinmyfamily.Mymom’stheworst.

Therapist: What if you could learn a new skill so that when these worryingthoughtspop intoyourhead,youcould let themcomeandgo—as iftheywerejustcars,drivingpastoutsideyourhouse—insteadofgettingallcaughtupinthem.Wouldthatbesomethingyou’dbeinterestedin?

Client:Iknowwhatyou’resaying,but(laughing)Ireallydon’tthinkIcoulddothat.

Therapist:Well,would itbeokay togive itago,andseehowitworks?It’sa

very simple exercise—you can do with your eyes open, or closed,whicheveryouprefer.

Client:Icantry,Iguess.

EstablishingStructure

In the very first session,we generally say something like this: “One of thethings thatmakesACTdifferent frommany other therapies is that during oursessions,wespenda lotof timepracticingskillssuchas learningnewwaystohandledifficultthoughtsandfeelingsmoreeffectively.Andyoucan’tlearntheseskills simply by talking about them—you have to actually practice them. Soquiteoften,ifit’sokaywithyou,I’llbeaskingyouduringthesessiontodosomesimpleexercises.Wouldyoubeokaywiththat?”(Note:Not all clientswill answer yes; somewillwant to knowmore about

theseexercises.We’llcoverhowtodealwiththisinthenextchapter.)Usuallywithin the first sessionor two,we’ll takeourclient throughat least

one mindfulness exercise that lasts five minutes or more. Until clients knowwhattoexpect,Igenerallyintroduceallexerciseswithashortspiel,suchasthis:“Thisexercisewilltake[estimateduration].Youcandoitwithyoureyesopenorclosed,whicheveryouprefer.Andthere’snoneed tospeak tomeduring it,butyoucantalkatanytimeifyouwish,andstopmewheneveryoulike.”Once we’ve done a couple of mindfulness exercises, we could say, “If it’s

okaywithyou,I’dliketostarteachsessionwithashortmindfulnessexercise,abitliketheonewe’vejustdone.Wouldthatbeokay?”Ifyourclientagrees—asmostwill—younowhavealovelywaytoopeneachsessionthatgetsbothyouandyour client into the spaceofmindfulness.Of course, if youdon’twant tostructure your sessions this way, it’s by no means essential; this is merely asuggestion,notacommandment.Andofcourse,someclientswillhatethisidea.So ifyourclient’snotkeen,whateveryoudo,don’tpush it!Remember: ifweever find oursevles pushing, persuading, coercing, convincing, debating, orarguingwithourclients,thenwe’renotdoingACT.

Flexibility,Creativity,andSpontaneity

Whenleadingexercises,beflexible.Makethemlongerorshorter,asrequired.Changethewordstosuityourownstyle,andadaptthemfortheclientsyou’re

dealingwith.Andfeelfreetointerruptanyexerciseatanypointtocheckinwithyour client and ask how he’s doing. Also use your creativity to incorporatethoughts, feelings, comments, or metaphors that your client has made in thissessionorpreviousones.

ImprovingDelivery

As youwork through this book, don’t just read the exercises to yourself. Istronglyurgeyoutoreadthemoutloudandpretendthatyou’reactuallyworkingwithaclient.Thismayseemodd,but it’s a simpleandeffectiveway tobuildyourskillsandconfidence.Whenyourehearsebyyourself, itpreparesyouforthetherapyroom:yourwordswillflowmoresmoothly,andyou’llhavetoexertlessconsciouseffort.(Betterstill,findacolleaguetopracticewith.)Iusedtopracticemindfulnessscriptsintoataperecorder(andastechnology

advanced,intoanMP3recorder).ThenIplayedthembackandanalyzedthem.Ithenworked on the bits thatwere shaky until I knewwhat Iwas doing. ThismeantthatevenifIwasreadingfromascriptinsession,thescriptbecamejustaguidetoimprovisearoundratherthansomethingIhadtoslavishlyfollowwordfor word. This allows for a fluidity and spontaneity that brings scripts to liferatherthanmakingthemsoundstilted,awkward,andunnatural.Thesameholdstruefor themanymetaphorsACTutilizes.Somepeopleare

natural-bornstorytellers.They’llhearametaphoronce,andthenretellitintheirown way, and it will come out wonderfully. They’re very lucky!Most of usaren’tsotalented.Weneedpractice.Isuggestthatyoutrysayingametaphoroutloudafewtimes.Thenonceyouhaveitdownpat,trytellingittosomeoneelse.As a general rule, mindfulness exercises are best delivered at a slow,

deliberatepaceandinacalm,stillvoice.Generallyit’sbettertogotooslowthantoofast. Inmanyof thescripts in thisbook, I’ve indicatedpausesof five, ten,fifteen,or twentyseconds,but theseareonlyroughguidelines,sopleasedon’ttry toslavishlyfollowthem—findyourownnaturalrateandrhythm.Formostpeople, one slow deep breath all theway in and all theway out is about tenseconds.IhaverecordedsomeCDsandMP3sthatyoucanuseforguidance,ifyouwish(seeappendix2).If you wish to read from a script during a session, it’s a good idea to say

something to your client like “There’s an exercise I’d really like to take youthrough,butIhaven’tyetmemorizedthewholething,sodoyoumindifIreaditfrom thisbook?”However, don’t read the textword forword aswritten, or it

willsoundstiltedandunnatural;improvisearoundit.Finally, remember to be yourself. I encourage you to alter the words and

phrasesineveryexerciseandmetaphorwithinthisbooktosuityourownstyle,yourownwayofspeaking,andtheclienteleyouworkwith.

TheHexaflexerciseWe’renowgoingtolookattheHexaflexercise,whichcoversallelementsofthehexaflex (see chapter 1)in “one hit.” I use it in all myworkshops, talks, andlectures;atthestartofgroupsessions;andasabrief“refreshercourse”inlatersessionswithmyindividualclients.Aswrittenhere,ittakesfromtentofifteenminutes, depending on how fast you talk and how long you pause. Pleasepractice it a few times before continuing onwith the book because (a) itwillhelpyoutounderstandthemodel,and(b)itwillgiveyouafoundationformanyoftheexercisestocome.

Thisexercise,usedinitsentiretyisundoubtedlytoolongforsomeclients.Butyoucaneasilydoabbreviatedversionsoruse “chunks”of it. I’venumbereddifferentsectionsof theexercisesowecandissect itand referback to it inlaterchapters.

Now… please read the exercise out loud. Read it in a slow, calm, steadyvoice,andpretendthatyou’resayingittoaclient.

SECTION1

Therapist:Iinviteyounowtositupstraight,letyourshouldersdropandgentlypushyourfeetintothefloor…andgetasenseofthegroundbeneathyou… and you can either fix your eyes on a spot, or close them,whicheveryouprefer.Nowjusttakeamomenttonoticehowyouaresitting.(Pause5seconds.)Andnoticehowyouarebreathing.(Pause5seconds.) Notice what you can see. (Pause 5 seconds.) And noticewhat you can hear. (Pause 5 seconds.) Notice what you can feelagainstyourskin.(Pause5seconds.)Andnoticewhatyoucantasteor

senseinyourmouth.(Pause5seconds.)Noticewhatyoucansmellorsense in your nostrils. (Pause 5 seconds.) And notice what you arefeeling. (Pause 5 seconds.) Notice what you are thinking. (Pause 5seconds.)Noticewhatyouaredoing.(Pause5seconds.)

SECTION2

Therapist:So there’sapartofyou in there thatcannoticeeverything thatyousee, hear, touch, taste, smell, think, and feel. (Pause5 seconds.)Wedon’thaveagoodwordforthispartofyouineverydaylanguage.I’mgoingtocallit“theobservingself,”butyoudon’thavetocallitthat.You can call it whatever you like. (Pause 5 seconds.) Life is like astage show. And on that stage are all your thoughts, and all yourfeelings,andeverythingthatyoucansee,hear,touch,taste,andsmell.Theobservingselfisthatpartofyouthatcanstepbackandwatchthestageshow:focusinonanypartofit,orstepbackandtakeitallinatonce.(Pause5seconds.)

SECTION3

Therapist:Nowtakeamomenttoreflectonwhyyoucameheretoday.Thereissomething that matters to you, something that is important deep inyourheart thatmotivatedyou tocomehere…Is it about improvingyour life?…Personal growth?…Learning new skills?…Buildingbetter relationships?…Is itabout improving thingsatwork,orwithyour family, or your friends?… Or perhaps it’s about your health:nurturing your body or enhancing your well-being? … Just do asearch, deep inside your heart, to clarify what values led you heretoday.(Pause15seconds.)

SECTION4

Therapist:Andnowtakeamoment to reflectonhowyougothere today.Youdidn’t get here by magic. You are only here because of committedaction.You had to organize the appointment.You had to reschedulethings.Youhadtoinvesttimeandeffortandenergytogethere.Andchances are that getting here today brought up some uncomfortablethoughts and feelings for you. And yet… here you are. (Pause 10

seconds.)Andrecognizethatrightnow,inthismoment,youaretakingaction.Youaresittinghereinachair,doinganexercisethatprobablyseems a bit odd or unusual… and you probably have all sorts ofthoughts whizzing through your head… and all sorts of feelingspassingthroughyourbody.(Pause5seconds.)Andthereareallsortsof thingsyoucouldbedoing right thataremuchmore fun than this,and yet here you are, taking action to improve and enrich your life.(Pause10seconds.)

SECTION5

Therapist:Nowforthenextfewbreaths,I’dlikeyoutofocusonemptyingoutyourlungs:pushalltheairoutofthemuntilthere’snomoreleft,andthen allow them togently fill, all by themselves. (Pause 5 seconds.)Really notice the breath—notice it flowing in and out. (Pause 10seconds.) Observe it as if you’re a curious scientist who has neverencountered breathing before. (Pause 10 seconds.)Notice how oncethe lungs are empty, they automatically refill, all by themselves.(Pause5seconds.)Youcan takeadeepbreath in ifyouwant to,butnoticehowthere’sreallynoneedto:thebreathjusthappensbyitself.(Pause10 seconds.)And I invite younow to undertake a challenge:for the next couple of minutes, keep your attention on your breath,observingitasitflowsinandout.(Pause10seconds.)

SECTION6

Therapist:Youwillfindthishard,becauseyourmindisamasterfulstoryteller.Itwill tellyouall sortsof interestingstories tograbyourattentionandpullyouawayfromwhatyou’redoing.(Pause5seconds.)Seeifyoucanletthosethoughtscomeandgo,asiftheyaremerelypassingcars—justcarsdrivingpast,outsideyourhouse—andkeepyourattentiononthebreath.(Pause10seconds.)Noticeyourbreathflowinginandout. (Pause 10 seconds.) Notice your abdomen, rising and falling.(Pause10seconds.)Notice theriseandfallofyourchest. (Pause10seconds.)Letyourmindchatterawayasifit’sjustaradioplayinginthe background.Don’t try to turn the radio off; it’s impossible—notevenZenmasterscandothat.Justletitplayoninthebackground,andkeep your attention on the breath. (Pause 10 seconds.)From time to

time, yourmindwill succeed in distracting you: itwill hook you inwith a good story, and you’ll lose track of your breathing. This isnormal and natural, and it will happen repeatedly. Themoment yourealizethishashappened,takeamomenttonotewhathookedyou,andthengentlyrefocusonyourbreathing.(Pause10seconds.)Againandagainandagain,youwilldriftoff intoyour thoughts.This isnormalandnatural. Ithappens toeveryone.Assoonasyourealize it,gentlyacknowledgeitandrefocusonyourbreath.(Pause10seconds.)

SECTION7

Therapist:As thisexercisecontinues, thefeelingsandsensations inyourbodywill change. There may be pleasant feelings showing up—such asrelaxation, calm, peacefulness—and theremay be unpleasant ones—such as boredom, frustration, anxiety, or backache. See if you canallowthosefeelingstobeexactlyas theyare in thismoment.(Pause10seconds.)Don’ttrytocontrolyourfeelings,justletthembeastheyare—regardlessofwhethertheyarepleasantorunpleasant—andkeepyour attention on your breathing. (Pause 10 seconds.) Again andagain, you’ll drift off into your thoughts. As soon as you realize it,acknowledgeitandrefocusonyourbreath.(Pause10seconds.)Thisisnotarelaxationtechnique.Youarenottryingtorelax.Theaimistolet your feelings be as they are, to feelwhatever you feelwithout astruggle.So ifyou’renoticingadifficult feeling, then silently say toyourself,Here’safeelingoffrustrationorHere’safeelingofanxietyorHere’s a feeling of boredom. Acknowledge it’s there, and keep yourattentiononthebreath.(Pause20seconds.)

SECTION8

Therapist:So life is likeastageshow.Andon thatstageareallyour thoughtsand all your feelings, and everything that you can see, hear, touch,taste,andsmell. In thisexercise,youdimmed the lightson thestageandyou focuseda spotlightonyourbreathing.Andnow it’s time tobring up the rest of the lights. This breathing is happening inside abody,sonowbringupthelightsonyourbody:situpinthechair,andnoticeyourarmsandlegs,head,neck,chest,andabdomen.(Pause5seconds.)Andyourbodyisinsidearoom,sonowbringupthelights

on the roomaroundyou.Look around, andnoticewhat you can seeand hear, and smell and taste and touch. (Pause 10 seconds.) Andnoticewhatyou’refeeling.(Pause5seconds.)Andnoticewhatyou’rethinking.(Pause5seconds.)Sothere’sapartofyouintherethatcannotice everything:whatever you see, hear, touch, taste, smell, think,feel,ordoinanymoment.Andthatbasicallybringstheexercisetoanend.Solet’stakeagoodstretch,andthenwecantalkaboutit.

PullingItAllApart

Wewillnowanalyze theHexaflexercise, sectionby section.Pleasegobackandrereadeachsectionoftheexerciseoutloudbeforereadingtheexplanationbelow.

SECTION1:BEHERENOW

Section1coverscontactwiththepresentmoment.Thissectionconsistsofthebasicinstructionatthecoreofallmindfulnessexercises:“noticeX.”“X”canbeanythingthatishere,rightnow,inthismoment.Itcouldbeyourbreathing,thesoundsintheroom,thetensioninyourbody,thethoughtsinyourhead,thetasteinyourmouth, theviewfrom thewindow,andsoon.Commonalternatives totheword“notice”include“payattentionto,”“bringyourawarenessto,”“focuson,”or“observe.”Notethatthepausesatthispointarebrief—onlyfiveseconds.Lateronin theexercise, theyincrease.Youcaneasilyadapt thissectionintoabriefmindfulnessexercise,suitableforanysessionasagroundingorcenteringtechnique.

SECTION2:PUREAWARENESS

Section2covers self-as-context.Herewe refer to it as the“observingself”:the part of you that does all the noticing. I originally came upwith theStageShowMetaphor specifically to facilitate self-as-context, but aswe’ll see later,youcanuseittoenhanceanyothermindfulnessprocess:acceptance,defusion,orcontactwiththepresentmoment.

Before you take clients through this section, it’s a good idea to give a brief

explanation about the two parts of the mind—the thinking self and theobservingself—sotheterm“observingself”won’ttakethembysurprise.Thefollowingtranscriptexemplifiesthis.

THETHINKINGSELFANDTHEOBSERVINGSELF

Therapist:Sooneofthethingsthat’simportantinourworkhereistorecognizethat there are two very distinct parts of the mind. There’s the partwe’re all very familiar with—the part that thinks, imagines,remembers, analyzes, plans, fantasizes, and so on.Let’s call that the“thinking self.” But there’s another part of the mind that virtuallynevergetstalkedabout—wedon’tevenhaveawordforitincommoneveryday language. It’s a part of yourmind that doesn’t think, can’tthink—it justnotices. Itnoticeswhateveryou’re thinkingandfeelinganddoingandseeingandhearingand tastingandsoon.Theclosestwordswehavetoitineverydaylanguageare“awareness,”“attention,”or“focus.”InACT,wecall it the“observingself”becauseitdoesn’tthink—it merely observes. To give you an example, have you everencounteredamagnificentsunsetandforamoment,yourthinkingselfgoesquiet.Therearenothoughts—you’rejustsilentlyobservingthisamazing sunset. That’s your observing self in action—silentlynoticing. But the silence doesn’t last long. Within seconds, thethinkingselfpipesup:“Oh,lookatallthoselovelycolors.IwishIhadmycamera.Thisremindsmeof that trip toHawaii.”Andasyougetmore and more caught up in your thoughts, you start to disconnectfromthesunset.

SECTION3:KNOWWHATMATTERS

Section 3 covers values: what matters enough to this client that he hasbothered to come and see you? (Even if he wasmandated by a court of lawunderthreatofgoingtoprison,hestilldidn’thavetocome:hecamebecausehevaluedbeingfree.)Ideallyweindividualizethissectiontospecificallymentionany core values already identified—for example, “Is it about being a bettermothertoyourkids?”

SECTION4:DOWHATITTAKES

Section4coverscommittedaction:takingtheactionnecessarytolivebyyourvaluesevenwhen it’sdifficult andpainful.Hereweacknowledgeandvalidatethattheclienthascommittedtoactioneventhoughithasbroughtupdiscomfort.This is a message we’ll reinforce throughout therapy: the actions we take tomakeourlivesmeaningfuloftengiverisetopain.Attimes,we’llfeelgoodasaresultof them,andatother times,wewon’t.Thequestion life repeatedlyaskseachoneofusisthis:“AmIwillingtomakeroomforthesefeelingsinordertodowhatmatterstome?”

SECTION5:BEHERENOW(AGAIN!)

Herewe’re back to the basicmindfulness instruction of “noticeX.” In thiscase, “X” is the sensations of breathing. Sections 5 and 6 taken togetherconstituteaquickandsimplemindfulbreathingexercisethatyoucanuseinanysession.

SECTION6:WATCHYOURTHINKING

Section 6 covers defusion: putting some distance between you and yourthoughts so you can let themcome andgowithout getting entangled in them.We’reusingthreedifferentmetaphorsheretofacilitatedefusion:(1)thenotionof themind as a storyteller and thoughts as stories; (2) treating your thoughtslike passing cars; and (3) treating your mind as if it’s a radio playing in thebackground. Any and all of these metaphors can be usefully added into anymindfulnessexerciseyoudo.Wealsoemphasizeoverandoverthatit’s“normalandnatural”torepeatedly

driftoffintoyourthoughts(thatis,tofusewiththem).Thisisimportantbecausemanyclients(likemanytherapists)haveastrongperfectioniststreak,andthey’llbedisappointediftheyexpecttomaintaintotalfocus.Indeed,manyclients(andtherapists)areshockedatjusthowharditistostayfocusedformorethanafewseconds.

SECTION7:OPENUP

Section 7 covers acceptance: opening up to and making room for painfulprivateexperiences.(Note:Acceptanceisshortfor“experientialacceptance,”theopposite of experiential avoidance.)Herewe introduce the notion of allowingyourfeelingsandsensationstobeastheyarewithouttryingtochangethemor

getridofthem.Whenyousilentlynameandacknowledgeapainfulfeeling,thisoften facilitates acceptance, so it’s a useful little technique to slip into thissection.Andyoucaneasilyassignitasasimpletechniquetopracticeinbetweensessions.You’ll notice too that we emphasize that this is not a relaxation technique.

This is important becausemany clientswill find this experience calming, andthey’lloftenmistakerelaxationas thepurposeof theexercisewheninfact it’smerelyabeneficialby-product.

SECTION8:WRAPPINGITUP

Section8wrapsup the exercisewith theStageShowMetaphor to facilitatecontactwiththepresentmomentandbrieflyrevisitself-as-context.

Practice,PracticePractice

Nowbeforereadingon,Istronglyencourageyoutogobackandreadthroughevery transcript in this chapter—but this time, read the words out loud, as ifyou’re actually speaking to a client. This is especially important for theHexaflexercise. I ask you to do this because only through practice will youmaster thismodel. Sowhywait until you’reworkingwith your clients? Startrightnow!

Chapter5.OpeningACTTheFirstSession

Therapistscome toACTfromavastarrayofbackgroundsand thereforeoftenhavewidelydifferingideasaboutthefirstsession.Forexample,manytherapistsliketodoan“intakesession”or“pretreatmentsession”beforethefirstsessionof“active” therapy. This could involve some or all of the following: taking adetailedhistory,fillinginassessmentforms,conductingspecializedassessmentssuch as a mental status examination, obtaining informed consent, and/oragreeingtoatherapeuticcontract.SomeACTtextbooksactivelyrecommendapretreatmentsession,andothers

implicitlyassumeit.However,practitionerswithabackgroundinbrieftherapyoften prefernot to do a pretreatment session; instead they actively jump intotherapyontheveryfirstencounter.Thereareprosandconstobothapproaches,andthisbookisn’ttheplacetodiscussthem;presumablyyoualreadyhaveyourownapproach,andifit’sworking,there’snoneedforyoutochangeit.Forthesake of clarity, throughout this book I treat session 1 as the very first client-therapistencounter (that is, there’snopretreatmentsession). Ifyoudon’tworkthisway, just add a pretreatment session or “stretch out” the first session intotwo.Ideallyinsession1,weaimto

establishrapport;takeahistory;obtaininformedconsent;agreeoninitialtreatmentgoals;andagreeonthenumberofsessions.

Inaddition,iftimeallows,wemayalsobeableto

doabriefexperientialexercise,andgivesomesimple“homework.”

Withhigh-functioningclientsorthosewhohaveaveryspecificproblem,youcan often accomplish all of the above in one session. However, for low-functioningclientsor thosewithmultipleproblemsandcomplexhistories, this

couldeasilyspilloverintotwosessions,especiallyifyouwantyourclienttofillinabatteryofassessmentforms.Also keep inmind, if your client has a long history of trauma or repeated

experiences of abuse and betrayal in intimate relationships, theremaywell besignificant trust issues. If so, you may want to spend two or three sessionsprimarily takingahistoryandbuilding rapport—going slowlyand takingyourtimeinordertograduallyestablishatrustingrelationship.

EstablishRapport

All models of therapy place importance on the therapeutic relationship; inACT, this is especially so.MostACT textbooks ask readers to applyACT tothemselves.Why?BecauseACTisfarmoreeffectivewhenwe,thepractitioners,actually embody it in the therapy room. When we’re fully present with ourclients, open to whatever emotional content arises, defused from our ownjudgments, and in touchwith our core values around connection, compassion,and contribution, then we’ll naturally facilitate a warm, resonant, open, andauthenticrelationship.Indeed,whenwegiveourfullattentiontoanotherhumanbeingwithopenness,compassion,andcuriosity—thatinitselfistherapeutic.TheACTstanceisthatweastherapistsareinthesameboatasourclients:we

bothreadilygetentangledinourminds,losetouchwiththepresent,andengageinfutilebattleswithourownthoughtsandfeelings;repeatedlylosetouchwithourcorevaluesandactinself-defeatingways;andwebothwillencountermanysimilar struggles in our lives, including disappointment, rejection, failure,betrayal, loss, loneliness,sickness, injury,grief, resentment,anxiety, insecurity,and death. This is all part of the human experience. So given that client andtherapistarefellowtravelersonthesamehumanjourney,wecanbothlearnalotfromeachother.InACT,a compassionate,open, and respectful therapeutic relationship isof

utmost importance. Without it, many of our tools, techniques, strategies, andinterventionswillfail,backfire,orcomeacrossasinsensitiveorinvalidating.Inparticular,weneedtobealertforanytraceof“one-upmanship”or“superiority”inourselves; thiswouldbe inconsistentwith theACTstance that the therapistandclientareequals.TheTwoMountainsMetaphor(Hayes,Strosahl,&Wilson,1999)effectivelyconveys thisstance,andIgenerallyshare thiswith theclientabouthalf-waythroughthefirstsession.

THETWOMOUNTAINSMETAPHOR

Therapist:Youknow,alotofpeoplecometotherapybelievingthatthetherapistissomesortofenlightenedbeing,thathe’sresolvedallhisissues,he’sgotitalltogether—butactually,that’snotthewayitis.It’smorelikeyou’re climbing your mountain over there, and I’m climbing mymountainoverhere.AndfromwhereIamonmymountain,Icanseethingsonyourmountainthatyoucan’tsee—likethere’sanavalancheabout tohappen,or there’sanalternativepathwayyoucould take,oryou’renotusingyourpickaxeffectively.ButI’dhateforyoutothinkthatI’vereachedthetopofmymountain,andI’msittingback,takingit easy. Fact is, I’m still climbing, still making mistakes, and stilllearning from them. And basically, we’re all the same. We’re allclimbingourmountainuntilthedaywedie.Buthere’sthething:youcangetbetterandbetteratclimbing,andbetterandbetteratlearningtoappreciate the journey.Andthat’swhat theworkwedohere isallabout.

TakeaHistory

Gatheringaclienthistorycan takeanything froma fewminutes toanhour,depending upon the situation. For example, the excellent textbook ACT inPractice(Bach&Moran,2008)recommendsanentiresessiontotakeadetailedhistoryandcarefullyconceptualizeyourclient’sissues.Ontheotherhand,ACTisincreasinglyusedinprimarycaresettingswherethetherapistmayhaveonlytwo or three sessions of fifteen to thirty minutes each, and this obviouslynecessitatesabriefhistory(Robinson,2008).Soonceagain,themessageisthis:adaptACTtoyourownwayofworking,

yourownstyle, andyourownclientele.Andaspartof taking thehistory,youcan use whatever standardized assessment tools you like. A word of cautionthough: many popular assessment tools measure changes in the number orseverity of symptoms (that is, changes in symptom form) but fail tomeasurechangesinthepsychologicalimpactorinfluenceofsymptoms(thatis,changesin symptom function).However, inACT, our interest is in changing symptomfunctionratherthanform.Sowhilethere’snoabsolutenecessityforyoutouseACT-specific assessment tools, such as the AAQ (Acceptance and ActionQuestionnaire),theycanbeveryhelpful.Iwon’tdiscusssuchtoolsinthisbook,but you can download a wide variety at www.contextualpsychology.org/act-

specific_measures.Before we move on to the nuts and bolts of history taking, take a look at

figure 5.1 below. This figure summarizes the essence of most clinical issuesfromanACTperspective.

ThisfigureremindsusthattheoutcomewewantfromACTismindful,valuedliving. In otherwords,wewant to reduce struggle and suffering (via defusionandacceptance)andcreatearich,full,andmeaningfullife(viamindful,values-guidedaction).Whenwetakeahistory,ourclientsgenerallyfinditfareasiertodescribetheirsufferingandtheirstrugglesthantodescribewhatarich,full,andmeaningful life would look like. However, we need to know both sets ofinformation.Fortunatelythereareallsortsoftoolsandtechniquestohelppeopleclarifytheirvalues,asweshallseelater.

CASECONCEPTUALIZATION:TWOKEYQUESTIONS

Withregardtoanyclient’sproblem,wewanttofindtheanswerstotwokeyquestions:

1. Whatvalueddirectiondoestheclientwanttomovein?2. Whatstandsintheclient’sway?

ThesetwoquestionsallowustoquicklyconceptualizeanyissuefromanACTperspective.Let’slookattheminmoredetail.

Whatvalueddirectiondoestheclientwanttomovein?Hereweseektoclarify

values:Howdoestheclientwanttogrowanddevelop?Whatpersonalstrengthsorqualitiesdoeshewanttocultivate?Howdoesshewanttobehave?Howdoeshewant to treat himself?What sorts of relationships does shewant to build?Howdoeshewanttotreatothersinthoserelationships?Whatdoesshewanttostand for in life?What does hewant to stand for in the face of this crisis orchallenging situation?What domains of life aremost important to her?Whatvalues-congruentgoalsdoeshecurrentlyhave?Oncewecananswerthequestion“Whatvalueddirectiondoestheclientwant

to move in?” we can use that knowledge to set valued goals and to guide,inspire,andsustainongoingvaluedaction.Andifwecan’tanswerthisquestion,thattellsuswe’llneedtodosomevalues-clarificationwork.

Whatstandsintheclient’sway?Thisquestionisaboutthethreemainbarrierstomindful,valuedliving:fusion,avoidance,andunworkableaction.Wecanbreakitdownintothreesmallerquestions:

1. Whatunhelpfulthoughtsistheclientfusingwith?2. What private experiences—thoughts, feelings, memories,

urges,andsoon—istheclienttryingtoavoidorgetridof?3. Whatistheclientdoingthatrestrictsorworsensherlifeinthe

longrun?

Putmoresimply:

Whatistheclientfusedwith?Whatprivateexperiencesisheavoiding?Whatunworkableactionisshetaking?

These three questions reveal the essence of any clinical problem: fusion,experiential avoidance, and unworkable action. (A quick reminder:“unworkable”means itdoesn’twork tomake life rich, full, andmeaningful inthe long run; it interferes with vital, valued living. When action is stronglyinfluencedbyfusionandavoidance,it’slikelytobeunworkable.)

ABASICGUIDETOTAKINGAHISTORY

Formanyofus,takingahistoryisnotaneat,orderly,linearprocess(andit’simportant to remember, we don’t need to gather all our information in onesession;wecanalwaysgetmorehistory later, asneeded).Personally, tomake

thisprocessquickerandeasier,Iaskmyclientstofilloutacoupleofworksheetsbeforethefirstsession.(Ieithermailore-mailtheformsout,orasktheclienttoarrivetwentyminutesearlyandcompletetheminthewaitingroom.)IgivethemDissecting theProblem,andeither theBull’sEyeor theLifeCompass.You’llfindtheseworksheetsattheendofthechapter.Pleasetakeaquicklookatthemnow, then come back to this point. If we want to broadly assess values indifferentdomainsoflife,thequickestandeasiestformistheBull’sEye,whichdivides life into four domains: work/education, health/personal growth,relationships,and leisure.Morecomplexbutstillveryuser-friendly is theLifeCompass,whichdivideslifeintotendomains.Youmightliketoexperimentwithbothandseewhichworksbestinyourpractice.IpersonallyusetheBull’sEyeinitially with lower-functioning clients, and the Life Compass initially withhigher-functioningclients.TheDissecting theProblemworksheetbreaksdowntheclient’s“struggleandsuffering”intoitskeycomponents:fusion,avoidance,andunworkableaction.Iaskmyclientstocompletetheseworksheetstothebestof their abilityandbring themalong to the first session. I explain that even iftheyonlywriteafewwords,that’sagoodstart.Alternatively,youcanfilltheseworksheetsinduringthesessionorgivethemas“homework”tocompleteafterthesession.Now let’s go on to the history itself.What follows is a very basic guide to

takingahistory.Eachofthenumberedsectionscanbebrieflycoveredinafewminutesorexploredindepthoveramuchlongertimeframe,dependingonyourneeds.There’snoneedtoaskallthequestionsineachsection:theyaremerelyguides. (Note: The term “thoughts and feelings” is short for “thoughts,memories, images, emotions, sensations, and urges.”) You can download asimplified version of this history guide from www.actmadesimple.com. Readthroughtheguidenow,andthenwe’llexploreitinmoredetail.

AFEWNOTESONTAKINGAHISTORY

Notes on section 1: The Presenting Complaint In this section, you may alsoinclude a question such as this: what do you hope to get from therapy? Theanswerwill usually tell you a lot about the client’s emotional control agenda.

She’slikelytotellyouhowshewantstofeel(happy,moreconfident,moreself-esteem,andsoon)orwhatfeelingshewantstogetridof(anxiety,depression,badmemories,andsoon).Thequestions in1bareveryuseful:Howdoesthis issueinterferewithyour

life?Whatdoes it stopyou fromdoingorbeing?Clients’ answersusually fallintothreecategories;theissueisproblematicbecause:

1. “I can’t stand feeling this way.” This answer points to theexperiential avoidance agenda.Youmay followup by askingwhich thoughts/feelings/memories and so on are hardest tofeel,ormostunwanted,orhavethegreatestimpact.

2. “Ijustwanttobenormal.”Thisanswerpoints tofusionwiththe conceptualized self. The client is likely fusedwith “I amabnormal/weird/weak [or others].” You may follow up byasking,“Sowhatdoesyourmindsaythisproblemmeansaboutyou?”

3. “It stopsme frombeingordoingX,Y,Z.”Thisansweroftenpoints to values andgoals.Youmay followupby asking formoreinformationaboutX,Y,Z.

Notesonsection2:InitialValuesAssessmentI’veincludedlotsofquestionsinthis section togiveyouavarietyofoptions for elicitingvalues.Youwouldn’taskallofthesequestionsofoneclient;youcanpickandchoosewhicharemostrelevantorlikelytobeusefulforagivenclient.(Ifyougetanswerslike“Idon’tknow”toeverysinglequestionyouask,andyourclientisunwillingorunabletofill in theBull’sEyeorLifeCompassworksheets, that’suseful information; ittells you you’re almost certainly dealingwith a client at the upper end of theexperientialavoidancespectrum,andyou’llprobablyneed todevelopdefusionandacceptanceskillsbeforeyoucangettovaluesindepth.)TheBull’sEyeisasimpler assessment tool than theLifeCompass and is a better initial choice ifyoususpectyourclientishighlyexperientiallyavoidant.

Notes on section3:TheCurrentLifeContext, FamilyHistory,SocialHistory,OtherAssessmentToolsCurrentlifecontextincludeshealth,medications,work,finances, relationships, family, culture, and so on. Also look for factors thatreinforce the problem—for example, getting attention, manipulating others,obtaining disability benefits, avoiding fears of rejection/intimacy/failure,adheringtoculturalbeliefs,andsoon.Identifythesefactorsassoonaspossibleastheywilllikelyprovidebarrierstomovingforward.Keepyoureyesandears

openfor“secondarygains.”Forexample,ifDadonlyhelpsoutwiththeirthreeyoungkidswhenMomisinbedfeeling“toodepressedtodoanything,”thenthissecondarygaincouldactasabarriertoMom’srecovery.Familyhistoryandsocialhistoryalso includessignificantrelationshipsfrom

thepastandpresent,andhowtheclientperceiveshehasbeenimpactedbythishistory.Herewe’relookingatthebroadcontextoftheclient’slifeasitistoday,aswellaskeyeventsfromthepastthathaveshapedtheclient’scurrentbehaviorandcontributedtotheproblematicthoughts,feelings,memories,andsoonthatareshowingup inher life today. Inparticular,notesocialandfinancial factorsplayingaroleintheclient’scurrentproblems.PersonallyItendtozipthroughthisquiterapidlywithmostclients,knowingI

cangathermoreinformationwheneverIneedto.However,aswitheverythinginACT, modify this to your own preferences and needs. Thus, if you want toconceptualizeindepthhowcurrentbehaviorhasbeenshapedbypastexperience,thenyou’llobviouslytakemuchlongertoexploretheclient’spasthistory.

Notesonsection4:PsychologicalInflexibilityThissectionisprettymuchself-explanatory: we are on the lookout for core pathological processes that we’lllatertargetwithmindfulnessandvaluedaction.

Notes on section 5: Motivational Factors Hopefully you will already havegatheredalotofthisinformationviasections1,2,and3.Ofcourse,withsomeclients you’ll initially have little or no helpful responses to questions aboutvalues and goals.But that’s okay: it just tells you this client is likely to needworkarounddefusionandacceptancebeforehecanreadilydovalueswork.Theveryfactthatsuchclientshavecometotherapypointsinthedirectionofvalues.Forexample,inanextremecasesuchasaclientmandatedbythecourttoeitherattendtherapyorgotoprison,theveryfactthatshehascometoseeyoupointsto values around freedom. (You can also use the FEAR acronym to identifybarrierstochange:seechapter12.)

Notesonsection6:PsychologicalFlexibilityandClientStrengthsAssessareasof life in which the client already exhibits psychological flexibility throughdefusion,acceptance,asenseofself-as-context,contactingthepresentmoment,connectionwithvalues,andtakingcommittedaction.Thisisavitallyimportantpartofthehistory.Ifweimaginepsychologicalflexibilityasascaleof0to100,presumablytherewouldbenosuchthingasaclientwhoratedzero.Solet’sfindwhatelementsofpsychologicalflexibilityheisalreadyusing,inwhatcontexts,withwhatresults.Youmaywanttoaskdirectquestions,suchasthese:

Doyoueverfindyou’reabletodetachfromyourthoughtsornottakethemsoseriously?Doyoueverfindyourmindstartscriticizingyou,butyoudon’tbuyintoit?Do you ever find you can tolerate your feelings even thoughthey’reveryunpleasant?Doyouevergetasenseofbeingabletostepbackandobservepainfulthoughtsandfeelingsratherthanstrugglingwiththem?Do you have any spiritual, religious, ormeditative practices?(Youmightspecificallyinquireaboutyoga,taichi,martialarts,meditation,prayer,andsoon.)Whendoyoufeelconnectedwithlife,yourself,ortheworld?Whendoyougetasenseofmeaning,purpose,vitality?Doingwhatsortsofactivities?Where?When?Withwhom?Whendoyou get a sense that you’remaking themost of your life, orcontributing to something important, or connecting withsomethingthat“pullsyououtofyourself”?Whendoyoupushonanddowhatyouneedtodoregardlessofhowyou’refeeling?When are you fully present—that is, conscious, aware, andengaged in what you’re doing instead of being “off in yourhead”? Doing what sorts of activities?With whom?Where?Andwhen?

ObtainInformedConsentIdeallyinformedconsentincludessomediscussionof

theACTmodel:whatACTisandwhatitinvolves;the importance of experiential exercises and practicing skills;andpossibleadverseexperiences.

Tomovefromtakingahistorytoinformedconsent,youcouldsaysomethinglike, “There’s a lotmore I could ask you about all this, but you’ve givenmeenoughforustomakeastart.WhatI’dliketodoatthispointistellyouabitabout the sort of therapy I do, what it involves, and how long it takes, andbasicallymakesureit’stherightapproachforyou.Isthatokay?”

THEACTMODEL:WHATACTISANDWHATITINVOLVES

Next you can provide a brief summary of the ACT approach, as detailedbelow. (I suggest you take this “spiel,” rewrite it or modify it into your ownwords,andthenpracticeituntilitrollsoffthetipofyourtonguesothatyoucanquickly summarize ACT to colleagues, allied health professionals, clients,friends,relatives,andpeopleyoumeetatdinnerparties.)

Therapist:DoyouknowanythingatallaboutthemodelIworkwith?

Client:No.

Therapist: Well, it’s a scientifically based therapy that has a rather unusualname. It’s called acceptance and commitment therapy—or ACT, forshort. And it gets its name from one of its core messages: acceptwhat’soutofyourpersonal control andcommit to takingaction thatimprovesyour life.And theaimofACT isbasicallyvery simple: tohelp you create a rich, full, and meaningful life while effectivelyhandlingthepainandstressthatgoeswithit.AndACTachievesthisin twomainways.First, it helpsyoudeveloppsychological skills todealwithyourpainfulthoughtsandfeelingsmoreeffectively,insuchawaythattheyhavemuchlessimpactandinfluenceoveryou.Wecallthese“mindfulnessskills.”Second,ACThelpsyou toclarifywhat istrulyimportantandmeaningfultoyou—whatwecallyour“values”—andthenusethatknowledgetoguide,inspire,andmotivateyouwhenmakingchangesinyourlife.

Notice the italicized phrase: deal with your painful thoughts and feelingseffectively, in such away that they havemuch less impact and influence overyou.Thiswordingisveryimportant.ACTisnotabouttryingtoreduce,avoid,eliminate, or control these thoughts and feelings—it’s about reducing theirimpactandinfluenceoverbehavior(inordertofacilitatevaluedliving).

Practical Tip You don’t have to use the word “mindfulness.” Mostclientsarefinewithit,butsomepeopleassociatemindfulnesswithhypnosis,religion, or the New Age movement. So you could talk instead about“psychologicalskills”or“newwaystohandlethoughtsandfeelings”;andyoucould use alternative terms such as “noticing,” “observing,” “opening up,”“centering,” “being present,” “focusing,” “paying attention,” “awareness,” andsoon.

THEIMPORTANCEOFEXPERIENTIALEXERCISESANDPRACTICINGSKILLS

Afterthespielabove,youcouldsaysomethinglikethis:

Therapist:As I justmentioned,ACT is a scientifically basedmodel. It’s beenproven to be effectivewith awide range of issues from depression,anxiety,andworkstresstodrugaddictionandschizophrenia.Andit’saveryactivemodeloftherapy.Wedon’tjusttalkinthesesessions;weactuallypracticepsychological skills soyoucan learnhowtohandleallthosedifficultthoughtsandfeelingsmoreeffectively.Andlikeanyskill, the more you practice, the better you’ll get. So what we doduring these sessions will be useful, but what really makes thedifferenceispracticingthesenewskillsinbetweensessions.Afterall,ifyouwanted to learn theguitar,youwouldn’texpect tohavea fewlessons and thenbecomeagreat guitarist—you’d expect to do somepractice.

If clientswantmoredetailAt this point, someclientswill ask formoredetailabout what’s involved. If so, you could say something like the following(tailoringyourresponse tospecificallyaddress theclient’s issues):“Well,whatwedovariesenormouslyfromsessiontosession.Insomesessions,we’llfocuson how you can let go of painful thoughts or memories or worries, or freeyourself up from self-limiting beliefs. Sometimes we’ll look at new ways tohandlestrongfeelingslikefearorangerorsadnessorguilt.Attimes,we’llfocusongettingin touchwithwhat’s important toyou,settinggoals,orconstructinganeffectiveplanofaction.Itvariesenormously,dependinguponwhattheissueis,andhowyou’regoingalong,andwhatyou’vefoundhelpful.”Asmallnumberofclientswillstillaskyouformoreinformationatthispoint

aboutwhatsortofskillsthey’llbelearningorwhatexercisesthey’llbedoing.Ifso, you could answer, “I think it’s great that you’re eager to knowmore, buttryingtodescribeexactlywhatwedoinACTisliketryingtodescribeskiingorscubadivingorhorseriding:youcantalkaboutthosethingsuntilthecowscomehome, but you’ll never know what they’re really like until you actually startdoingthem.Inthesameway,Ican’tdojusticetoACTinwords.ButwhatI’dliketodoabit later is takeyouthroughashortexercise togiveyoua tasteofwhat’s involved.And ifwedon’thave time today, thenwe’ll leave it fornextsession.Wouldthatbeokay?”(Alternatively, you could take the client through the ACT in a Nutshell

Metaphorfromchapter1.However,beforeyoudothis,thereareseveralthings

you need to consider. First, is the metaphor appropriate for this client at thispointintherapy?I’mwaryofusingitforverylow-functioningclientsorthosethat I suspect are extremely experientially avoidant because they maymisinterpret it, criticize it, or insist it won’twork for them. In contrast, high-functioning clients typically warm to it. Second, do you have time in thesession?Youshouldallowseveralminutestorunthroughthemetaphorandalsoensure you have at least another five minutes to address any questions orconcerns.Andlastbutnotleast,Iwouldn’tadvocatetheuseofthismetaphoraspart of informed consent until you have quite a bit of practice at ACT and asoundgraspofthemodelsoyoucanaddressanyconcernsorqueriesthatariseinaneffective,ACT-consistentmanner.)

IftheclientisdoubtfulSupposeyourclientsays,“Idon’tthinkthiswillworkforme.”Thoughtslikethisareperfectlynatural,andthey’reonlyproblematiciftheclient fuses with them. So here you have a perfect opportunity to establish acontext of acceptance and defusion. For example, you might say, “That’s aperfectlynaturalthought.Manypeoplefeeldoubtfulatfirst.Andthefactisthereis no known treatment that is guaranteed to work for everyone. So I can’tpromisethatthiswillworkforyou.Icouldtellyouit’sworkedforlotsofotherpeople,andIcouldpulloutallthepublishedstudiesandtheresearchpapers,andso on, but that still wouldn’t guarantee it will work for you.However, here’ssomethingIcanguarantee:ifwestopthesessionwheneveryouhavethethoughtThiswon’twork,thenIcanabsolutelyguaranteethatweWON’Tgetanywhere.Soeventhoughyou’rehavingthethoughtthatthiswon’twork,areyouwillingtogiveitagoanyway?”Noticethatwe’renotchallengingtheclient’sthought.Ratherwe’revalidating

itasnaturalandnormal.Andwe’reestablishingacontextwhere(a)it’sokayfortheclienttohavethatthought(acceptance),and(b)thethoughtisjustathoughtanddoesn’tcontroltheclient’sactions(defusion).

POSSIBLEADVERSEEXPERIENCES

Nextwemoveon todiscussingpossible adverse consequencesof therapy. Iliketousearoller-coastermetaphor:“ThereareacouplemorethingsIwanttodiscusswithyou.Onethingis,inordertolearnnewskillsforhandlingpainfulthoughtsandfeelings,we’regoing tohave tobringupsomeof those thoughtsandfeelingsinsessionsothatyouhavesomethingtopracticewith.Thismeansthatattimestherapymightseemlikeabitofaroller-coasterride.Buthere’smyguarantee: Iwill be there in the roller-coaster car alongside you.”If you know

thatyourclientishighlyexperientiallyavoidantorhasatendencytodropoutoftherapy,thenit’susefultosaysomethinglikethis:“Youmayfindthatattimesyou feel a strong urge to drop out of therapy. This is completely normal andnatural,andifithappens,thenit’salmostalwayswhenyou’refacinguptosomevery important issue—usually something that canhaveahuge impactonyourlife.Soifyoueverdostartfeelingthatway,Ihopeyou’llbewillingtoshareitwithmesowecanworkwiththosefeelingsduringoursessions.”

AgreeonTreatmentGoals

Agreeingongoalsandformulatingatreatmentplanmaynotcomenaturallytoyou, but it is important; otherwise how do you know where to go in yoursessions?Ofcourse,whileobtaininginformedconsent,you’vealreadyagreedonsomebasictreatmentgoals:thatduringsessionstheclientwilllearnmindfulnessskills, clarify values, and use values to guide behavioral change, and betweensessions,she’llpracticeandapplythesenewskills.Forsomeclients,thismaybeaboutasspecificasyoucangetduringafirstsession.Ifyou’vehadyourclient fill in theBull’sEyeorLifeCompassworksheets,

you can ask him, “If you had to pick just one of these life domains to startworkingon,whichonewoulditbe?Whatsortofchangesdoyouwanttomakeinthatareaofyourlife?Howdoyouwanttoimproveit?”Ifyou’relucky,thiswill giveyou someuseful values-guidedgoals to agreeon as treatment goals.However,manyclientswillinitiallygiveyou“emotionalgoals,”“deadperson’sgoals,”or“insightgoals.”Let’stakeaquicklookateachofthese.

EMOTIONALGOALS

“I just want to be happy,” “I don’t want to be depressed,” “I want to stopfeelinganxious,”“Iwantmoreself-confidence,”“Ineedmoreself-esteem,”“Iwanttomoveon,”“Iwanttofeelcalm,”or“Iwanttostopworrying.”InACT,wecallthese“emotionalgoals”becauseineachcase,thegoalistocontrolhowonefeels:togetridof“bad”thoughtsandfeelingsandreplacethemwith“good”ones.If we agree to these goals, we’ll reinforce experiential avoidance, a core

pathological process that is the very opposite ofmindfulness.However, ifwebluntlyannouncethistotheclient,itwillprobablybecounterproductive.Soit’sbettertosaysomethinglike,“Okay.SocanIputitthisway?Therearepainful

thoughtsandfeelingsthatyou’vebeenstrugglingwith,andonegoaloftherapyistolearnbetterwaysofhandlingthem.”Having said all that, there are a few special circumstances in which it’s

probably better to be crystal clear from the outset that our agenda is not toeliminate unwanted thoughts and feelings. For example, suppose you have aclientwithPTSDwhosays,“Ijustwanttogetridofthesememories.”AusefulresponsetothismightincludetheHorrorMovieMetaphor.

THEHORRORMOVIEMETAPHOR

Therapist: You know, there are quite a few scientifically proven models fortreatingPTSD—wecallthem“empiricallysupported”treatments—butnotoneofthemworksbyeliminatingbadmemories.Whattheyalldoishelpyoutorespondtoyourmemoriesdifferentlysotheyhavelessimpactandinfluenceoveryou.IfIcangiveyouananalogy:rightnowwhen thesememories showup, it’s likewatching a terrifying horrormovielateatnight,allalonebyyourself,inaricketyoldhouse,withall the lights off. Now suppose you have exactly the same movieplaying, but this time theTV’s in the corner of the room, it’s broaddaylight, sunlight’s streaming in through thewindows,yourhouse isfulloffriendsandfamily,andyou’reallinteractingtogether—talking,laughing,eating,having fun.Themoviehasn’tchangedonebit—it’sstillplayingontheTVinthecorneroftheroom—butnowit’shavingmuchlesseffectonyou.Mindfulnessskillswillenableyoutodothissort of thing. I don’t know any way to permanently delete thesememories,butwecanchangeyourrelationshipwiththemsoyoucangetonwithyourlifeanddothethingsyoureallywanttodo.

DEADPERSON’SGOALS

Oftenyourclient’sgoalswillbetostopfeelingorbehavingacertainway—forexample,“Iwanttostopusingdrugs,”“Iwanttostopyellingatmykids,”“Idon’twanttohaveanymorepanicattacks,”or“Idon’twanttofeeldepressed.”In ACT, these are called a “dead person’s goals” (Lindsley, 1968). A deadperson’sgoalisanythingthatacorpsecandobetterthanalivehumanbeing.Forexample,acorpsewillneverusedrugs,neveryellatthekids,neverhaveapanicattack,andneverfeeldepressed.In ACT, we want to set “living person’s goals”—things that a live human

beingcandobetterthanacorpse.Tomovefromadeadperson’sgoaltoalivingperson’sgoal,youcanasksimplequestionslikethese:

“So let’s suppose that happens. Then what would you dodifferently?What would you start or do more of? And howwouldyoubehavedifferentlywithfriendsorfamily?”“If you weren’t using drugs, what would you be doinginstead?”“If you weren’t yelling at your kids, how would you beinteractingwiththem?”“Ifyouweren’thavingpanicattacksorfeelingdepressed,whatwouldyoubedoingdifferentlywithyourlife?”

Two useful questions to turn emotional goals and dead person’s goals intovalues-congruent goals are the magic wand question and the seven-daydocumentaryquestion.Let’stakeaquicklookateachofthesenow.

The magic wand question This is a good question for cutting through theemotional control agenda.Note thephrase “areno longer aproblem foryou”;thisisverydifferenttosaying“havealldisappeared.”

Therapist: Suppose I had a magic wand here. I wave this wand, and all thethoughts and feelings you’ve been struggling with are no longer aproblem for you.Whatwould you then do differently?What sort ofthingswouldyoustartdoingorperhapsdomoreof?Howwouldyoubehave differently toward others?What would you do differently atwork,athome,onweekends?

TheSeven-DayDocumentaryQuestionThis isagoodquestionforhelpingtheclientbecomemorespecificaboutthechangesshewantstomakeinherlife.

Therapist: Supposewe followed you aroundwith a camera crew for a week,filmedeverythingyoudid,andediteditintoadocumentary.Andthensupposewedid the sameat somepoint in the future, afterourworktogether has finished.Whatwouldwe see or hear on the new videothatwould show that therapyhadbeenhelpful?Whatwouldwe seeyoudoingorhearyousaying?Whatwouldwenoticedifferentlyaboutthe way you interact with other people or the way you spend yourtime?

INSIGHTGOALS

“Iwant to understandwhy I’m like this,” “I need to figure outwhy I keepdoingthis,”or“IwanttodiscoverwhoIreallyam.”Treatmentgoalsliketheseeasily lead to “analysis paralysis”—to session after session ofintellectual/theoretical/conceptualdiscussionsandendlessreflectionsonthepastinsteadoftothedevelopmentofnewskillsformindful,valuedliving.As it happens during ACT, clientswill develop a lot of understanding and

insight into their own behavior, thoughts, feelings, personality, and identity.Theywillgenerallyhavepowerfulrealizationsaroundwhotheyare,howtheirmindworks,whattheyreallywantinlife,howthepasthasinfluencedthem,andwhy they do the things they do. But in ACT, they develop this insight viaexperientialwork,notthroughlengthyanalyticaldiscussions.Furthermore, thisinsightisnotanendinitself:it’ssimplysomethingthathappensonthejourneytowardthedesiredoutcomeofmindful,valuedliving.Thustomovetoamoreusefultreatmentgoal,Isay,“Aspartoftheworkwe

dotogether,you’llcertainlygeta lotmoreinsight intowhoyouare,howyourmindworks,whyyoudothethingsyoudo,andwhatyoureallywantinlife.Allofthatisalreadyagiven;ithappensaspartoftheprocessinACT.WhenIaskwhatyouwantoutof therapy,what Imean is,onceyouhave that insight andunderstanding,whatdoyouwanttododifferently?Ifyouhadthatknowledge,what would you do that you’re not doing now? How would you behavedifferently?Whatwouldothersnoticethatwasdifferentaboutyou?”

TREATMENTGOALS:AFEWEXAMPLES

Herearesomeexamplesoftreatmentgoals,assummarizedbythetherapist.

TreatmentGoals forDepression In response to themagicwand question, thisclientrepliedthatwhatshe’ddodifferentlyisgetbacktowork,startexercisingagain,andspendmoretimewithherfriendsandfamily.

Therapist:Socanwesayitlikethis:Itseemsthatwhatyoumeanbydepressionispartlythatyou’regettingcaughtupinalotofunpleasantthoughts—negative self-judgments, a sense of hopelessness, and thoughts andmemoriesaboutpainfuleventsfromthepast.Andanotherpartofitisthatyou’restrugglingwithsomereallypainfulfeelingsincludingguilt,sadness, anxiety, and physical tiredness. And a third part of it is,you’redoingthingsthatmakeyourlifeworse,suchasspendingalot

of time inbed, socially isolatingyourself, staying indoors,givingupexercise,avoidinggoingtowork,andsoon.Sowemaywellchangethegoalsaswego,butfornowcanweagreethatwhatwe’reaimingforis(a)tolearnsomenewskillstohandleallthosedifficultthoughtsand feelings, and (b) to get you back into doing things that used tomatter toyou,suchassocializing,working,exercising,andgenerallydoingthingsthatfulfillyou?Isthataboutright?

Noticehowthetherapistbreakstheissuedownintothreeelements:(1)gettingcaughtupinthoughts,(2)strugglingwithfeelings,and(3)unworkableactions.Thisisintentional.Rightfromtheword“go,”wecansubtlylaythegroundworkfortwokeyinsights:

1. Ourthoughtsandfeelingsarenotthemainproblem;it’sgettingcaught up in them (fusion) and struggling with them(avoidance)thatcreatesourproblems.

2. Ourthoughtsandfeelingsdonotcontrolouractions.

This second key insight often takes therapists by surprise, so let’s take amomenttoexploreit.Ourthoughtsandfeelingscertainlyinfluenceouractions,but they don’t control our actions. Our behavior in anymoment is under theinfluenceofmultiplestreamsofstimuli,comingbothfromtheworldinsideourskinandfromtheworldoutsideus.ThinkbacktotheStageShowMetaphor:ouractionsare influencedbyeverythingon the stage—whateverwecan see,hear,smell,touch,taste,sense,feel,andthink.Sowhendothoughtsandfeelingshavethemostinfluenceoverouractions?

Youguessedit: inacontextoffusionandavoidance.However, inacontextofdefusionandacceptance(thatis,mindfulness),thosesamethoughtsandfeelingshavemuch less influence over our behavior, which frees us up to act on ourvalues.What thismeans is thegreaterourpsychological flexibility, thegreaterour capacity to choose the actions we take regardless of the thoughts andfeelings we’re having. With this in mind, we want to repeatedly draw adistinctionbetween(a)theclient’sthoughtsandfeelings,and(b)theactionstheclient takeswhen those thoughtsand feelings showup.Ultimatelywewant toshattertheillusionthattheformercontrolsthelatter.(Andthisapproachisonlylikelytosucceedwhenwedoitexperientially,notdidactically.)

Treatment goals for alcohol addiction This client wanted to quit drinkingbecause (a)hiswifewas threatening to leavehim, and (b) at a recentmedical

checkuphisliverwasinbadshape.Inresponsetothemagicwandquestion,hewantedtobea“betterhusband”and“fixup”hisliver.

Therapist: So to summarize:whenyou’ve tried to quit drinking in the past, itnever lasted long because you’d get strong cravings or you’d havefeelings of anxiety and depression, and then you’d start drinking tomakethemgoaway.Soourgoalshereintherapyare(a)tolearnsomenew skills so you can handle these cravings and feelings moreeffectively,(b)tobuildabetterrelationshipyourwife,and(c)tostartlooking after your liver and make it as healthy as possible. Is thataboutright?

Noticehowthetherapisthasmovedfromadeadperson’sgoal—stopdrinking—toseverallivingperson’sgoals.

Practical Tip Some clients have so many issues, they don’t knowwheretostart,ortheyfeeloverwhelmed.HeretheBull’sEyeorLifeCompassworksheetsareveryuseful:youcansay,“Justpickoneofthesedomains,andwe’llstartthere.Whatwouldyouliketododifferentlyinthisareaofyourlife?”

GenerictreatmentgoalsSometimes,despiteallyourbestefforts,yourclientwillbeunableorunwillingtogiveyouanyspecificvalues-orientedtreatmentgoals.Shemayjustkeepanswering,“Idon’tknow,”“Nothingmatters,”or“Ijustwanttostopfeelinglikethis,”or“Ijustwanttofeelhappy.”Insuchcases,don’ttrytoforcethepoint;justacceptthatfornowyourtreatmentgoalswillbevagueandgeneric.Belowaretwoalternativesyoucoulduseinthesecases.

Therapist:Sohowaboutweagreetothis?Theworkwedoherewillbeabouttwo things. First, learning new ways to handle your thoughts andfeelingsmoreeffectivelysotheycan’tholdyoubackfromlivingthelifeyouwant.Second,eventhoughrightnowyouhavenoideawhatyou want and you feel like nothingmatters, let’s make this a placewhereyougettodiscoverwhatdoesmattertoyouandwhatsortoflifeyoudowanttohave.Andoncewe’vediscoveredthat, let’ssetaboutmakingithappen.

***

Therapist: So for now, let’s just say that the work we do here will be aboutgivingyoualifethatgrabsyou,alifethatyoufeelisworthliving.Atthis point, you don’t knowwhat that life looks like, but that’s okay.We’llfindoutaswegoalong.Sooneaimofourworkherewillbetodiscoverwhat’simportanttoyouandwhatsortoflifeyouwanttolive.Andanotheraimwillbetolearnbetterwaystodealwiththepainthatlife iscurrentlygivingyou.Andbothof thoseaimsareultimately toserveonepurpose:creatingarichandmeaningfullife.

PracticalTip Notice inall of theseexampleshow the therapistusesterms like “handle” or “deal with” pain as opposed to “manage,” “control,”“reduce,”or“eliminate.”Mindfulnessisnotawaytocontrol,manage,reduce,or eliminate thoughts and feelings; it’s a way of “handling them gently” or“dealingwiththemcompassionately”or“holdingthemlightly.”Othertermsyoucould use include “stepping out of the battle,” or “dropping the struggle,” or“changingyourrelationship”withyourthoughtsandfeelings.

AgreeontheNumberofSessions

HowmanysessionsofACTdoesaclientneed?Well,howlongisapieceofstring?I’veseenamazingthingshappenfromasinglesessionofACT,andI’vealsohadclientsthatIworkedwithonaregularbasisforthreeorfouryears!Asageneralrule,thegreateryourclients’problemsinnumber,duration,severity,andimpactontheirqualityoflife,thelongerthedurationoftherapy.Howeverthisisnotnecessarily so;ACTcanbedelivered inmanydifferent formats, includingthese:

Long-termtherapy: forexample,oneprotocolforACTwithborderline personality disorder goes for forty group sessions,each two-hours long (Brann, Gopold, Guymer, Morton, &Snowdon,2007).Brieftherapy: forexample,apopularprotocol forACTwithanxietydisorders isbasedontwelveone-hoursessions(Eifert& Forsyth, 2005) and one published study for ACT with

chronic stress and pain is based on an eight-hour protocol(Dahletal.,2004).Verybrieftherapy:forexample,onepublishedstudyonACTforchronicschizophreniaconsistedofonly threeor fourone-hoursessions.Thatverybriefinterventionleadtoanalmost50percentreductioninhospitalreadmissionrates(Bach&Hayes,2002).

(Obviouslywith these very briefACT interventions, it’s not as if the clientfullyandcompletelyembracesmindful,valuedlivingandneverhasanyissueseveragain.It’smorethecasethatwecandeliverthecoreelementsofACT—bepresent,openup,dowhatmatters—quitequicklyandwithsignificantbenefits.TheclientthenbecomeshisownACTtherapist,andlifethrowsupallsortsofproblems and challenges, which provide opportunities to further develop hisskills.)QuiteafewACTtextbookssuggestyouagreetotwelvesessionsinitially,but

there is nothing magical about this number, so you can adjust it to suit yourclientele.Forexample,inAustralia,thecountrywhereIliveandpractice,there’snot the same degree of openness to therapy as there is in the United States;thereforeItypicallycontractforonlysixsessionsinitially.At this juncture, we tell the client that therapy isn’t a smooth journey but

involves ups and downs. For example, you might say, “One thing I shouldmentionisthattherapydoesn’talwaysprogresssmoothly.Sometimesyoumakeahugeleapforward;andsometimesyoutakeabigstepbackward.Sobecauseitcanbeabitupanddown,Iwonderifyouwouldcommittosixsessionsinitially—andat theendof that time,we’ll assesshow it’sgoingand see ifyouneedmore.Andyou’llbe theonewhomakes thecallon that,notme.You’ll judgewhetherwe’remakingprogressornot.Nowobviously,somepeopledon’tneedafullsixsessions,andothersendupneedingmorethanthat.Atthispoint,it’shardformetopredicthowmanyyou’llneed,sowouldyoubewillingtoinitiallycommittosix?”

DoaBriefExperientialExercise

If time permits, I like to do a brief experiential exercise during the firstsession.Anymindfulnessexercisewillsuffice—ideallyonethatgoesforaboutfiveminutes.Forexample,youmightrunthroughachunkoftheHexaflexercise

(seechapter4),orexercisessuchasDroppinganAnchororTenMindfulBreaths(see chapter 9). Then once you’ve done this exercise at the first session, youcouldaskpermissiontostarteachsessionwithasimilarone.

GiveHomework

Askyourclients todoa littlebitofhomeworkbetween thissessionand thenext.This reinforces thenotion thatACTinvolvesactiveworkboth insessionand between sessions. For example, if you took your client through a simplemindfulnessexercise,thenforhomeworkyoucouldaskhertopracticeitonceaday.Alternativelyyoumightaskhertokeepadiaryorfillinaworksheet,suchasthoseattheendofthischapter.

Practical Tip Many people don’t like the sound of “homework.” Itcarries all sorts of negative connotations. I prefer the term “practice” or“experiment.”Forexample, youmight say, “Wouldyoubewilling topracticesomething between now and next session?” or “Would you be willing toexperimentwithdoingthisandseewhathappens?”

WORKSHEETS

Thisbookcontainsa lotofclientworksheets.They’reoftenhelpfulbecausetheyact as a reminderof the session, increase the chance thatyour clientwillfollowthrough,andprovidegoodmaterialforthenextsession.(Buttheyaren’tessential,andyoucancertainlydoACTeffectivelywithoutusingworksheets,ifyouprefernotto.)At the end of the first session, if you didn’t get much information about

values, and you didn’t get the client to fill out a LifeCompass orBull’s Eyeworksheet,thenyoucouldnowaskthemtodosoforhomework.Forexample,you might say, “We’ve talked quite a lot about your problems today—thethoughtsandfeelingsyoustrugglewith,and the thingsyoudo thatmakeyourlifeworse—butwehaven’ttalkedmuchaboutwhatsortoflifeyouwanttolive,what reallymatters toyou in thebigpicture.So I’mwondering,betweennowandnextsession,wouldyoubewillingtofillinthisworksheet,whichasksyouto think about these things?” Other worksheets you might give out are the

Vitality vs. Suffering Diary or the Problems and ValuesWorksheet. You canexplain that these worksheets help gather more information to guide therapy.(Worksheetsarelocatedattheendofthechapter,ortheycanbedownloadedatnocostfromwww.actmadesimple.com.)

ALTERNATIVESTOWORKSHEETS

Someclients—and some therapists—don’t likeusingworksheets and forms.This is not too surprising. Try filling in a few yourself, especially those thatrequire daily completion, and you’ll soon see how challenging it is. If clientsstronglyopposefillinginforms,or ifyouasa therapist intenselydislikeusingthem, then you don’t have to use them. They are simply aids to ACT, notessentials.So instead of giving her a worksheet, you could ask your client simply to

noticeoverthenextweek(a)whatshedoesthatdrainsorrestrictsherlife,and(b)whatshedoesthatenrichesandexpandsherlife.Alternativelyyoucouldaskyourclienttothinkabitmoreabouthisvaluesor

practicea simplemindfulness techniquesuchasmindfulbreathing.Youmightevenaskhimtonoticesomeofthemostdistressingthoughtsthathehas,andtonoticewhathappenswhenhegetscaughtupinthem.

HomeworkforYouIf you’re anything like me, you have a tendency to read textbooks and hopeeverything“sinksin”soyoucanreadilytrotitoutinthetherapyroom.Ifonly!!There’snotwowaysaboutit:youwon’tlearnACTsimplybyreadingabook.Sofromnowonat theendofeachchapter,you’llfindahomeworksection.Ifyoudotheseexercises,they’llhelpyoutolearnACTinawaythatfarsurpassesmerereading.Andbecauseyou’rethebestpersontopracticeon,manyoftheseexercisesaskyoutoworkonyourownissues.SohereareafewthingsIrecommend:

1. Readout loudandparaphraseallof the therapist’s“spiels” inthetranscriptsabove—especiallyoninformedconsent—togetyourselfusedtoACT-speak.

2. Doacoupleofquickcaseconceptualizations.Picktwoclientsandwrite brief answers to these four questions:What valued

directiondoes the clientwant tomove in?What is she fusedwith? What is he avoiding? What unworkable action is shetaking?

3. Practice summarizing treatment goals. Pick two clients andimaginehowyouwouldsummarizethetreatmentgoals,usingthesuggestionsinthischapter.

As you do these exercises, and all the other ones in this book, please giveyourselfpermissiontodothempoorly.You’relearninganewmodeloftherapy,soallowyourselftobeabeginner,anovice,alearner.Beginnersmakemistakes(and so do experts). It’s an essential part of the learning process.And if yourmindstartsbeatingyouup, thenmakeanoteofwhat itsays,soyoucanworkwiththosethoughtsinchapter7.

SubsequentSessionsOneof thehardestdecisionsfornewACTpractitioners is this:aftersession1,whereonthehexaflexdoIstart?Thereisno“correct”answertothisquestion.There’s reallynosuch thingas the“right”or“wrong”startingpoint,asall sixcoreprocessesareinterconnectedandoverlapping.(Ifyou’rebrand-newtoACT,thisinterconnectednessmaynotbecomeclearuntiltheendofthisbook.)Indeed,asyoubecomemorefamiliarwithACT,you’lltypicallyfindyourselfcoveringmostorallpointsonthehexaflexinmostorallsessions.Asyoudothis,someprocesseswillbeexplicit—that is,youdirectlyfocuson themin thesession—whiletheothersremainimplicit—thatis,presentbut“inthebackground.”Intermsofsubsequentsessions,traditionalACTprotocolsfollowaparticular

sequence:

1. Defusionandacceptance2. Contactingthepresentmoment3. Self-as-context4. Valuesandcommittedaction

A less common sequence but one that I recommend for coaching, coupleswork,high-functioningclients,mandatedclients,orclientslackinginmotivationisthis:

1. Valuesandcommittedaction

2. Defusionandacceptance3. Contactingthepresentmoment4. Self-as-context

There is also an optional component of ACT called creative hopelessness,which means getting in touch with the costs and futility of experientialavoidance. Creative hopelessness is only essential if and when clients are sodeeply attached to the agenda of emotional control that they aren’t open tomindfulnessandacceptance.Youcanbringcreativehopelessnessinatanypointin therapy where it becomes necessary—however, traditional ACT protocolsstartwithitinordertolaythefoundationforacceptance.As I’m a traditional kind of guy (did you notice my conceptualized self

there?),inthenextsevenchapters,I’mgoingtotakeyouthroughthetraditionalsequence, starting with creative hopelessness. However, please keep in mindthere are no clean-cut divisions between different components of the model:when we talk about the “sequence of components,” it’s a convenient way ofdescribingthemajoremphasisineachofthosesessions.Forexample,it’shardtoimagineasessionfocusedpurelyonacceptancewithoutanelementofvaluesorasessionpurelyonvalueswithoutsomedefusion.Alsorememberthatonceyouknowwhatyou’redoing,youcandancearound

thehexaflexinanysequencethat’slikelytobeclinicallyeffective.Forexample,ifyouhaveaclientwhodissociateseasily,youmightstartactive therapywithcontacting thepresentmoment: teachinghim simplemindfulness exercises forgroundingandcenteringhimself.

WhatDoWeDoinEachSession?

RecallthattheaimofACTistocultivatepsychologicalflexibility:theabilitytobefullyconsciousandopentoyourexperiencewhileactingonyourvalues—or,saidmoresimply,theabilityto“bepresent,openup,anddowhatmatters.”The outcomewe’re looking for ismindful, valued living,whichmeans doingwhatismeaningfulwhileembracingeachmomentoflife.Asfigure5.2(below)illustrates,weaimtohelpclientsmovefrommindless,

fused, avoidant, ineffective action—which leads to suffering—to mindful,valued,willing,effectiveaction—whichleadstovitality.AndwhenweusethetermvitalityinACT,we’renotreferringtoafeelingoranemotion;wemeanasenseofbeingfullyaliveandembracingeachmomentevenifit’spainful.

Ineachsession,weaim to increasepsychological flexibility: that is, tohelpthe client move from the left (suffering) to the right (vitality). Behavior thattakestheclientfromlefttorightis“workable”—andbehaviorthattakesherinthe opposite direction is “unworkable.”Whether the session is fifteenminuteslongoranhourlong,weaimtomakeashiftinanyorallofthedimensionsinthisdiagram:

Where unworkable behavior is mindless (that is, doneimpulsively or on autopilot), we can work on mindfulness:helping the client become fully conscious of and engaged inwhatheisdoing.Where unworkable behavior is heavily influenced by fusionwith unhelpful beliefs, we can work on both defusion fromthosebeliefsandvaluesclarificationasanalternativesourceofmotivation.Where unworkable behavior is heavily influenced byavoidance of unwanted private experiences, we can work onwillingnesstohavethoseprivateexperiences.Whereunworkablebehaviorisduetoineffectiveness—thatis,duetodeficitsinskillsorfailuretouseappropriateskills—wecanworkonbuildingandapplyingnecessaryskills.

WhatInterventionsDoWeUse?

Anyinterventionthathelpstheclienttomovefromthelefttotherightinthefigureaboveisuseful.Nomatterhowtinythemoveis,iftheclientmovesinthedirection of “workability,” the intervention can be said to be “effective.” Ofcoursethisisn’talwaysasmoothlinearprocess.Oftenyourclientswillgetstuckor“backslide,”andwillstartmovingintheoppositedirection.Youraimisthentocompassionatelyandnonjudgmentallyhelp theclientconnectwith thecosts

ofdoingsoandtohelphergetback“ontrack”asfastaspossible.

StructuringYourSessions

Here’sagoodgeneralstructureforyoursessions:

1. Mindfulnessexercise2. Reviewofprevioussession3. Maininterventions4. Homework

Let’stakeaquicklookateachofthesenow.

Mindfulness exercise It’s often helpful to start each session with a briefmindfulnessexercisesuchasmindfulbreathing.(Thisisnotessential,justoftenhelpful!)

ReviewofprevioussessionReviewtheprevioussession,includingkeycontentcovered, exercises practiced, and any thoughts or reactions the client has hadsince. If your client followed through on his homework, what happened, andwhatdifferencediditmake?Andifnot,whatgotintheway?In later sessions, once values work has been done, specifically ask about

valued living.Forexample,“Sohowhaveyoudone livingbyyourvalues thisweek?”or“Whatvaluedactionshaveyoubeentaking?”

Main interventions. If you’re following a protocol, you’ll have a good idea inadvance of what you wish to cover in session. It’s important though to beflexible—to respond to what’s happening in session. Be willing to let go ofeverythingyouhadpreplanned,ifneedsbe.(Youcanalwayscomebacktoitinalater session.) Ifyou’renot followingaprotocol,youwill eitherpickup fromwhereveryouleftoffintheprevioussessionoraddressanewissuethathasjustarisen.

HomeworkIt’simportanttorepeatedlyemphasizetoclientsthatwhattheydoinbetween sessions is what will really make all the difference in their lives.Mindfulness skills require practice.Valued action requires effort.You need tocollaborativelyagreebefore theendofeachsessionwhat theclient isgoingtopractice,do,orexperimentwithinbetweensessions.(Butbecareful—don’tgettoopushyorusevaluescoercively.)

SummaryTo sum it all up, themain tasks for a first session are tobuild rapport, obtaininformed consent, and make a basic assessment. When assessing the currentproblems, look for fusion, avoidance, and unworkable action. And whenassessing desired outcomes of therapy, look for values and values-congruentgoals. And that’s basically it; that’s themain information you’ll need to helpyourclientmovefromsufferingtovitality.Of course, it’s not as easy as it sounds in a four-sentence summary. To do

ACTeffectivelyrequirespractice—andplentyofit.Andthefactis,there’salotof information in thischapter;most readerswillnot take itall in thefirst timearound. So I strongly suggest that as soon as you’ve finished the book, comeback and read through this chapter again.And I guarantee it’ll all seemmuchsimplerthen.Theworksheets for clientsmentioned in this chapter arepresentedbelow in

alphabeticalorder:

TheBull’sEyeDissectingtheProblemTheLifeCompassTheProblemsandValuesWorksheetVitalityvs.SufferingDiary

Chapter6.CreativeWhat??!!CreativeHopelessnessinaNutshell

InPlainLanguage:Creative hopelessnessmeans fully opening to the realitythattryingtoohardtocontrolhowwefeelgetsinthewayoflivingarich,fulllife.

Aim:Toincreaseawarenessoftheemotionalcontrolagenda;toexperiencethatit’sbasicallyunworkable,anddiscoverwhythisisso.

Synonym:Confrontingtheagenda.

Method: Look at what the client has done to try to control how he feels,examinewhetherit’smadehislifebetterorworse,andgethimintouchwiththeunworkability of his actions. This creates openness to an alternative way ofhandlingthoughtsandfeelings.

WhentoUse:When theclient is stronglyattached toanagendaof emotionalcontrol.InmanyACTprotocols,it’saprecursortotherestofthework.

ConfrontingtheAgendaCreativehopelessness(whichisnotatermweusewithclients)or“CH”isalsoknownas“confrontingtheagenda,”whichisshortfor“confrontingtheagendaofemotionalcontrol.”Theemotionalcontrol agenda isbasedon this idea: themoreyoucancontrolhowyoufeel,thebetteryourlifewillbe.Inanysessionwemay,attimes,needtoconfrontthecontrolagendaofourclient.

WhatDoWeMeanby“Control”?

Whenclients come in to therapy, theyusuallywant to feelbetter.This isn’tsurprising. Everyone likes to feel good. No one likes to feel bad. So quitenaturallywe try hard to avoid or get rid of “bad” or “negative” thoughts andfeelings.Thisistheagendaofemotionalcontrol.Our culture strongly reinforces this agenda with the popular notion that

happiness is thesameas feelinggood. Ifyoubuy into thatnotion, thenyou’re

goingtoinvestalotoftimeandenergyinemotionalcontrolstrategies—thatis,trying toreduce the“bad”feelingsand increase the“good”ones. (InACT,westayawayfromtheword“happiness”asitissuchaloadedterm.Butifweweretodefineit,we’dsay,“Happinessmeanslivingarich,full,andmeaningfullifein which you willingly feel the full range of human emotions.” This is verydifferent thanHappiness=FeelingGood. Indeed,weoftensay toclients,“It’snot about feelinggood; it’s about feelingwhatyou feelwithout a struggle”or“It’snotaboutfeelinggood;it’saboutfeelingalive.”)Acontrolstrategythereforemeansanythingwedoprimarilytotrytogetrid

of“bad” thoughtsand feelings: it isactionmotivatedprimarilybyexperientialavoidance.Controlstrategiescanincludeeverythingfromexercise,prayer,andmeditation to alcohol, heroin, and suicide attempts. In creative hopelessnesswork,we ask the client to look openly and nonjudgmentally at all the controlstrategiesshe’susing.Butwedon’tjudgethesestrategiesasgoodorbad,rightorwrong,positiveornegative;our aim ispurely and simply to seehow thesestrategiesareworkingintermsofcreatingabetterlife.

DoesACTTargetAllControlStrategies?

In a word: no! Recall that the whole ACT model rests on the concept ofworkability: is this behaviorworking to improve quality of life? So if controlstrategiesareworkingtoenrichandenhancelife,itmakessensetokeepdoingthem!However,therealityismost,ifnotall,humanbeingsover-relyoncontrolstrategies;andwhenweusethemexcessivelyorinappropriately,ourqualityoflifesuffers.Take eating chocolate, for example. When we eat a piece of good-quality

chocolate,we feel good (assumingwe like chocolate, that is).Use this simplecontrolstrategyinmoderation,anditenrichesour life: it’sworkable.Butdoitexcessively, and itmaywell start to have costs to our health, such asweightgain.Exerciseisanotherexample.Whenweexercise,weoftenfeelbetter(atleast,

afterward, if not at the time). And exercise also improves our quality of life.Therefore, as a control strategy, it’s generally workable. But if it becomesexcessive—liketheanorexicclientwhospendsthreehoursinthegymeachdaytokeepherbodyinastateofwastedthinness—thenevensomethingaspositiveasexercisecanhavecosts.Furthermore, ACT postulates that even life-enhancing activities (such as

exercise, prayer, meditation, healthy eating) will be more satisfying andrewardingwhen they’remotivatedbyvalues (such as looking after health andwell-beingandbuildingrichrelationships)ratherthanmotivatedbyexperientialavoidance.Forexample,haveyouevereatenfoodprimarilytopushaway“bad”feelings

such as boredom, stress, or anxiety? Was it a deeply satisfying experience?Contrastthatwithoccasionswhenyoureatingwasmotivatedbyvaluesaroundsavoringyour food,orsharingwith friends,or tryingoutanewrecipe.Whichwasmorerewarding?Similarly,ifyoudocharityworkmotivatedbyvaluesaroundsharing,giving,

and contributing to the community, you’ll likely find that farmore rewardingthan if you’re mainly motivated by trying to avoid feelings of guilt orworthlessness.Thereforeweaimtohelpclientstakeactionguidedbytheirvaluesratherthan

byexperientialavoidance:wewanttogetthemconsciouslymovingtowardwhatismeaningfulratherthansimplyrunningfromwhatisunwanted.Toreallyhammerthispointhome:Supposeyouexerciseprimarilymotivated

by values such as looking after health and fitness, or you pray motivated byvalues around connecting with God. We wouldn’t class those as controlstrategies because your primary aim isn’t to control how you feel.Wewouldonlycallthemcontrolstrategiesifyourmainpurposeindoingthemistogetridofunwantedthoughtsandfeelings.Creative hopelessness is an intervention based on workability. We ask the

clienttotakeagood,long,honest,andmindfullookatwhathe’sdoingtoavoidorgetridofunwantedthoughtsandfeelings,andtoseewhatthatiscostinghim.Wewanthimtoconnectwiththerealitythatwhathe’sdoingoftenworksintheshortruntomakehimfeelbetter,butitdoesnotworkinthelongruntomakehisliferich,full,andmeaningful.

IsCHNecessaryforEveryone?

Again, the answer is no.Our aim is to loosen the client’s attachment to theagenda of emotional control (that is, trying to get rid of “bad” thoughts andfeelings).Wehopetherebytoopenhertoanalternativeagendaofacceptanceorwillingness. However, if she’s highly motivated to change and not deeplyattached to an agenda of emotional control, or if she’s already familiar withmindfulnessorACTandopentotheapproach,thenthere’snoneedforCH,and

wecanthereforeskipit.However,ifwedoskipit,wemaystillusesomeoftheexercises and metaphors that traditionally follow immediately after CH,especiallythoseabouttheillusionofcontrol.

HowLongDoesItTake?

CH interventionsvary enormously in length. InZettle’s sampleprotocol fordepression (Zettle, 2007), CH lasts for 20 minutes. In Walser’s protocol forPTSD,itlastsforonetotwosessions(Walser&Westrup,2007).WecanalsodoCHveryquickly,inthespaceofafewminutes(Strosahl,2005).Ideally we’ll “titrate” the intervention to suit our client’s issues. A high-

functioningclientwithplentyofself-awarenessandopennesstonewideasisaverydifferentstorythantheclientwithalifelonghistoryofsubstanceabusewhoclingsdesperately to thecontrolagenda.The latterwill likelyneeda farmoreextensiveCHinterventionthantheformer.

THREESIMPLEQUESTIONS

Creative hopelessness interventions are constructed around three simplequestions:

1. Whathaveyoutried?2. Howhasitworked?3. Whathasitcost?

Firstweask,“Whathaveyoutrieddoingtogetridofthesedifficultthoughtsandfeelings?”Weasktheclienttocomeupwitheverysinglecontrolstrategyhehaseverused.Nextweask,“Howhasitworkedinthelongrun?”Weasktheclienttoassess

whetherinthelongrunithasactuallyworked:Hasitreducedherpain?Hasitenrichedhislife?Finallywe ask, “What has it cost youwhen you have over-relied on these

methods?”Weasktheclienttonoticethecosts—whenthesemethodsareusedexcessively or inappropriately—in terms of health, well-being, relationships,work,leisure,energy,money,andwastedtime.

JointheDOTS

The Join the DOTS worksheet given below simplifies CH. It is self-explanatory.You can fill this inwith the client in session, prompting her andgivingfeedback.Oryoucandrawituponawhiteboard(especiallyusefulwithgroups). Or you can simply talk through it with the client without using theworksheet.

Alternatively, you might just use the DOTS acronym as a memory aid foryourself.Becausemostclientscan’t readily reeloffa listofcontrol strategies,you’ll generally need to prompt them. DOTS helps you remember the mostcommonstrategiesused:

D–DistractionO–OptingoutT–ThinkingstrategiesS–Substances,self-harm,otherstrategies

There’s considerable overlap between these elements: eating junk food and

drinking wine could come under distraction or substances. Under “otherstrategies,”youcanputanythingfromsleepingalldaylongtopunchingthewalltoyogaor therapy.With thisacronymin thebackofyourmind,youcankeepasking the client, “Have you ever tried doing this?” Make sure to ask aboutprevioustherapiestried.As an alternative to Join the DOTS, you might prefer the worksheet

AttemptedSolutions andTheirLong-TermEffects (adapted fromHayes et al.,1999; see below).You can download free copies of both of these forms fromwww.actmadesimple.com.

Question1:Whathaveyoutried?

Herethetherapisthelpstheclientidentifycontrolstrategies,usingtheDOTSacronym.

Therapist: So far, we’ve identified quite a few thoughts and feelings that areproblematic for you. Now, by the time most folks get to therapy,they’vealreadytrieddoingalotofdifferentthingstofeelbetterornotfeelsobad.AndoneofthethingsIwanttoensureisthatwedon’tdomoreofwhatdoesn’twork.SoI’dliketospendabitoftimerecapping

allthethingsyou’vetriedtoavoidorgetridofthesepainfulthoughtsandfeelings.Isthatokay?

Client:Tobehonest,Ican’treallythinkofanything.

Therapist: Well, let me help you out here. One of the most common thingspeopledois try todistract themselves to taketheirmindoff it.Whatsortofthingsdoyoudotodistractyourselffromhowyou’refeeling?

Client:IwatchTV.Listentomusic.Read.Smokedope.

Therapist:Computers?

Client:Yeah—computergames,surfingtheNet,alotoftimeonYouTube,justwatchingcrap.

Therapist:Whatelse?

Client:(pauses,shakeshishead)

Therapist:Well,anotherthingpeopleoftendoistheystartoptingoutofthingsthatbringuppainfulfeelings.Arethereanypeople,places,situations,activitiesthatyou’vewithdrawnfromorarestayingawayfrom?

Thetherapistcontinuesinthismanner,workingthroughtheDOTSacronym.Oncecomplete,shemovestothenextquestion.

Question2:HowHasItWorked?

Wenowaimtovalidatethattheclienthasinvestedalotoftimeandeffortinthecontrolagenda—andclearlyithasnotworked.

Therapist:Soyou’veputa lotof timeandeffort into tryingtogetridof thesethoughts and feelings.No one can call you lazy.Andmost of thosestrategies are things that all of us commonly do. We all avoiduncomfortablesituations,putstuff intoourbodies,oruseallsortsofdifferentwaystodistractourselves.Andintheshortrun,thesethingsoftenmakeusfeelbetterforalittlewhile.Butletmeaskyouthis:inthe long run, did these things get rid of your painful thoughts andfeelingssothattheynevercamebackagain?

Client:(hesitates)No.That’swhyI’mhere.

Therapist:Right.You’vecomeheretotryandgetridofthemonceandforall.

Client:Yeah.Ihatefeelingthisway.

Therapist:Okay,socanIaddthattothelist—thinkingabouthowmuchyouhatethesefeelings?

Client:Well,wouldn’tyou?

Therapist: I have to say, I don’t knowanyonewho likespainful feelings.Thequestionwe’reinterestedinhereisthis:what’sthebestwayofdealingwiththem?Haveyoureffortstogetridofthesefeelingstakenyouinthedirectionofarich,full,andmeaningfullife,orhavetheytakenyouinthedirectionofstruggleandsuffering?

Question3:WhatHasItCost?

Wenowmoveontoaskingwhatallthecostshavebeen,andwe’lloftenhaveto prompt our client to think about different areas of life: health, well-being,relationships,work,money,wasted time,missedopportunities, andsoon.Youcan do this through conversation alone—but if you’re up for somethingmoreadventurous,youcandothisusingtheinteractivephysicalmetaphorofPushingAgainsttheClipboard.Note:theclipboardmetaphorisveryeffective,butdon’tever use it with people who have neck/shoulder/arm issues, and always becarefulyoudon’tpushtoohard!

PUSHINGAGAINSTTHECLIPBOARD:ANINTERACTIVEMETAPHOR

Therapist: Can I stand up and demonstrate something to you? (Client nods.Therapist picks up a clipboard, stands up, and walks over to theclient.)Youdon’t have shoulder or neck problems?Good, because Iwant you to imagine that this clipboard is all those painful thoughtsand feelingsyou’vebeen trying toget ridof for so long,and Iwantyoutoplacebothyourhandsflatonthisclipboardandpushagainstit,tryingtogetridofit.Don’tpushsohardthatyouknockmeover,butdopushfirmly.(Clientpushes;therapistpushesback.)That’sit—keeppushing.Youhatethisstuff.Youwantittogoaway.(Astheclienttrieshardtopushtheclipboardaway,thetherapistpushesback.Theharderthe client pushes, the more the therapist leans into it.) Notice howmuch effort and energy it requires—trying to make them go away.(The therapist eases off on the pushing, but retains enough gentle

counterpressure to keep the clipboard suspended in midair, restingbetweentheclient’shandsandthetherapist’shands.)Sohereyouare,tryingveryhardtopushawayallthesepainfulthoughtsandfeelings.You’ve tried distracting yourself with TV, music, computers, books,avoiding friends and family, staying home all by yourself, avoidingwork, beating yourself up, analyzing why you’re like this, tellingyourself life sucks, smoking dope, drinking beer, punching thewall,jogging,readingself-helpbooks—thelistgoesonandon.You’vebeendoingthisforyears:pushingandpushingandpushing.Andarethosepainful thoughts and feelings going anywhere? Sure, you’re keepingthematarm’slength,butwhat’s thecost toyou?Howdoesitfeel inyour shoulders? (Therapist pushes a bit harder.) We’ve only beendoing this for aminute or two, but you’ve been doing this for overtwentyyears.Thisistiring,isn’tit?

Client:Yes.I’mtired.

Therapist:(easingoffthepressure)Okay,wellI’measingoffthepressurehere,but just for a while longer, would you be willing to keep gentlypressing?(Clientpressesverygentlyagainst theboard.)Now Iwantyoutonotice—whileyou’redoingthis—ifIaskedyoutodoyourjobeffectively,orsocializewithyourfriends,orcookdinner,couldyoudoit?

Client:Noway.

Therapist:Andwhat’sitliketryingtohaveaconversationwithmewhileyou’redoingthis?

Client:Annoying.

Therapist: Annoying. Frustrating. Exhausting. Right? And do you feel a bitclosedinorcutofffromtheworldaroundyou?

Client:Yes.

Therapist:So trying topushall thesefeelingsaway iseatingupa lotofeffortand energy. Now let me take the clipboard back for a moment.(Therapist takes the clipboard back and sits down.) So this is whatyou’ve been doing for soooo long now—trying to get rid of thesethoughtsandfeelings.Andyet, they’restillshowingup,stillpushingyouaround,stillhavinganimpactonyourlife.

Client:Yes.Iknowthat.SohowdoIgetridofthem?

Therapist:Well,we’regoingcometo thatshortly.But first let’s takea lookatwhat it’scostyou, tryingsohard toget ridof this stuff.Whathas itcost you in termsof health, relationships,money,wasted time? (Thetherapistnowprompts theclient throughall thedifferentcostsofhiscontrolstrategies.)

Therapist:Sotryingtogetridofallthisstuff(holdstheclipboardattheedgesand pushes it out in front of her as far away as she can possiblystretch) is not only tiring, not only costly, but it doesn’t evenwork.Thesethoughtsandfeelingsarestillshowingup!Andeachtimeyouaskmehowtogetridofit,you’reaskingmetohelpyoudomoreofthis.Doyoureallywanttodomoreofwhatdoesn’twork?

Client:No.Butthen—whatareyousaying?Ijusthavetoputupwithit?

Therapist: Not at all. Putting up with it is doing more of the same. It’s likeyou’restilltryingtopushitaway,butyou’resotired,youstoppushingsohard.Puttingupwithit islikedoingthis.(Therapistagainpushestheclipboardout in frontofher,but this timeherarmsarehalfbentinstead of fully outstretched.) It’s still tiring, still costing you, stillgettinginthewayofyourlife.

Client:SowhatdoIdothen?

Therapist:Goodquestion.I’llcomebacktothat.Butlet’sjustacknowledgeyouhavealreadytriedveryhardtosortthisout.Youcertainlyhaven’tbeenlazy.And you haven’t been stupid either;most of the things you’vetriedarecommonsensestrategiesthatalmosteveryoneuses.Andsomeof them, such as distraction techniques, are frequently recommendedbydoctorsandpsychologists.Andyetitdoesn’tseemtobeworking.You’retryingveryhard,butit’snothavingtheeffectthatyouwant.

PracticalTip For thiswork tobeeffective,weneed to come fromaspace of compassion, equality, and respect.We aim to validate the client’sexperience—thatshe’stryingveryhard,butwhatshe’sdoingisn’tworking.Ifwecomefromaspaceofone-upmanshiporarrogance,ifwecomeacrossascriticalorjudgmental,ifweadopttheroleoftheexpertwith“alltheanswers,”thenourclientwillfeelirritated,demeaned,orbelittled.

PLEASE,TELLMEWHATTODO!

At somepoint toward the endofCH,your client is likely to say somethinglike,“AreyousayingIshould justputupwith it?”As in the transcriptabove,we’d reply, “Putting upwith it/tolerating it/giving up/resignation is just doingmoreof thesame.Youragenda isstill toget ridof it—you’re justputting lesseffort into it. It’s still tiring, stilldrainingawayyourhealthandvitality.”Yourclientislikelytothenaskyouforasolution:“SowhatdoIdo?”At that point, you have to make a judgment call. Has the client really

acknowledged the unworkability of the control agenda? If so, you could gostraight intoactiveworkon thehexaflex, typicallymovingon todefusionandacceptance. (In chapter 8, we’ll look at how you can revisit the clipboardmetaphoranduseittoillustratethemovefromavoidancetoacceptance.)Morecommonly at this point, you’d move on to identifying that control is theproblem,notthesolution,andthengoontotwopsychoeducationalcomponents:normalizingcontrolandtheillusionofcontrol.Here’sanexampleofhowthatmightgo:

Client:SowhatdoIdothen?

Therapist:Goodquestion.Youalreadyknowwe’regoing tobe learning somenewskillshereforhandlingthoughtsandfeelings.Butthisapproachisso different from everything else you’ve tried, from everything oursocietytellsus,fromalmosteverythingyoureadinpoppsychology,itwouldprobablybackfireifwejustleapedstraightintoit.Soifyou’rewillingtobearwithmealittlelonger,whatI’dliketodoislayabitofgroundworkforwhatcomesnext.Perhapsyoucouldthinkaboutitthisway… (The therapist now uses metaphor of choice to convey thatcontrolistheproblem.)

ControlIstheProblem,NottheSolution

In this phase, we use a metaphor to increase our client’s awareness thatemotionalcontrolstrategiesarelargelyresponsibleforherproblems;thataslongas she’s fixated on trying to control how she feels, she’s trapped in a viciouscycleofincreasingsuffering.TwopopularmetaphorsaretheTugofWarwithaMonsterandStrugglinginQuicksand(Hayesetal.,1999).

STRUGGLINGINQUICKSANDMETAPHOR

Therapist:Remember thoseoldmovieswhere thebadguy falls intoapoolofquicksand,andthemorehestruggles,thefasteritsuckshimunder?Inquicksand,theworstthingyoucanpossiblydoisstruggle.Thewaytosurviveistolieback,spreadoutyourarmsandlegs,andfloatonthesurface.This isvery tricky,becauseevery instinct inyourbody tellsyoutostruggle,butifyoudowhatcomesnaturallyandinstinctively,you’ll drown.Andnotice, lyingback and floating is psychologicallytricky—it doesn’t come naturally—but it’s a lot less physical effortthanstruggling.”

TUGOFWARWITHAMONSTERMETAPHOR

Therapist: Imagine you’re in a tug-of-war with some huge anxiety monster.(Alter the name the monster to suit the issue, for example, thedepressionmonster.)You’vegotoneendoftherope,andthemonsterhastheotherend.Andinbetweenyou,there’sahugebottomlesspit.And you’re pulling backward as hard as you can, but the monsterkeepsonpullingyoueverclosertothepit.What’sthebestthingtodointhatsituation?

Client:Pullharder.

Therapist:Well,that’swhatcomesnaturally,buttheharderyoupull,theharderthemonsterpulls.You’restuck.Whatdoyouneedtodo?

Client:Droptherope?

Therapist:That’sit.Whenyoudroptherope,themonster’sstillthere,butnowyou’re no longer tied up in a struggle with it. Now you can dosomethingmoreuseful.

PracticalTip It’seffective—andfun—toactthismetaphoroutwiththeclient,usingabeltorarope.(Thetherapistshouldplaythemonsterandholdoneendofthebelttightly,whiletheclienttugsontheotherend.)

OTHERMETAPHORS

There are numerous othermetaphors you could use. Basically you can useanythingthatconveysthismessage:themoreyoudowhatcomesnaturallyandinstinctively in this problematic situation, the worse the situation gets. Well-known examples include slamming on the brakes when your car skids,swimmingagainstariptide,tryingtodigyourwayoutofahole,andscratchinganastyrash.

ISTHISTHEENDOFTHESESSION?

In more traditional protocols, you end the session at this point, and forhomeworkyouasktheclienttonotice(a)allthedifferentwayshetriestoavoidor get rid of unwanted feelings, (b) how thatworks, and (c)what it costs.Ofcourse,aswithanythinginACT,youdon’thavetodoitthetraditionalway,soifyouhavetimeinthesession,youmayprefertomovestraightontothenexttwocomponents—thenormalityofcontrolandtheillusionofcontrol. (Andevenifyou skip CH altogether, these components are often useful to bring into latersessions.)

TheNormalityofControl

Inthiscomponent,weaddresswhycontrolcomesnaturally.

Therapist: I’d hate for you to get the wrong impression here—that I’mcriticizingyou inanywayforwhatyou’vebeendoing. If that’showI’vecomeacross,Isincerelyapologizebecausethetruthiswe’reallinthesameboat.Mostof the thingsonyour list are things that Idoattimes;almosteveryonedoes.Weallgetcaughtupinthesameagenda.We live in a feel-good society: everyone likes to feel good, no onelikestofeelbad.Sowetryhardtogetridofunpleasantfeelings.Andweallkeepondoingit—doingwhateverwecantoavoidorgetridofunpleasantthoughtsandfeelings—eventhoughitdoesn’tworkinthelong run andweoften endup suffering as a result.And there are atleastfourreasonswhywedothat.One,becausewe’veallfalleninto“the happiness trap”; we’ve bought into the myth that humans arenaturally happy, and we should feel good most of the time. Two,because the thingswedo tocontrolour feelingsoftendoworkquitewell in theshort run.Three,becausewebelieve thesemethodsworkfor other people. And four—and this is the one reason above and

beyond all the others: it’s the way our mind has evolved to solveproblems. (At this point, the therapist launches into the Problem-SolvingMachineMetaphorfromchapter1.)

TheIllusionofControl

In this component,we shatter themyth or illusion that humans can controlhow they feel.You could lead into it like this: “Sowe’re allwalking around,tryingtocontrolhowwefeel,anditjustdoesn’twork.It’snotthatwe’vegotnocontrolatall,butwe’vegotalotlessthanwe’dliketohave.AndwhatI’dliketodo,ifyou’reokaywithit,isjusttakeyouthroughafewlittleexercisessoyoucan check this out for yourself and seehowmuch control you actuallyhave.”Youcouldthentaketheclient throughanyorallof thefollowingexercises, inanycombinationororder.(Exceptforthefirsttwo,theyallcomefromHayesetal.,1999.)

DELETEAMEMORY

Therapist:Justtakeamomenttorememberhowyougotheretoday.Donethat?Okay,nowdelete thatmemory.Justget ridof it. (pause)How’dyoudo?

NUMBYOURLEG

Therapist:Nowmakeyourleftleggocompletelynumb.Sonumb,thatIcouldcutitoffwithahacksawandyouwouldn’tfeelathing.(pause)How’dyoudo?

DON’TTHINKABOUT…

Therapist:Forthenextexercise,youmustnotthinkaboutwhatIsay.Notevenfor one microsecond. Don’t think about … ice cream. Don’t thinkabout your favorite flavor. Don’t think about how it melts in yourmouthonawarmhotsummer’sday.(pause)How’reyoudoing?

THEPOLYGRAPHMETAPHOR

Therapist: Imagine I’m a mad scientist and I’ve kidnapped you for anexperiment.And I’vewiredyouup toa supersensitivepolygraph,orliedetector.Thismachinewilldetectthetiniestbitofanxietyinyourbody.Youcan’tkidit.Eventhetiniesthintofanxietyandallthealarmbellswill ring.And in this experiment I’m about to do on you, youmustnotfeelanyanxietyatall.Andifyoudo,thenI’llpullthislever,whichwillelectrocuteyou.(Pause.)Whatwouldhappen?

Client:I’dbefried.

Therapist: Right. Even though your life depends on it, you can’t control theanxiety.

FALLINGINLOVE

Therapist:NowsupposeIweretoofferyouonebilliondollars—onebillion—ifyoucandowhatIask.I’mgoingtobringsomeoneinto thisroom—someoneyou’venevermetbefore—andifyoucaninstantlyfallheadover heels in love with that person, then I’ll give you the money.Couldyoudoit?

Client:IfitwereBradPitt,Icould.

Therapist:It’salittleoldmaninawheelchair,andhehasn’thadabathforthreemonths.

Client:No.

Therapist:Notevenforonebilliondollars?

Client:Icouldtry.

Therapist:Sure.Youcouldputonanact.Hughimandkisshimandsay,“Iloveyou, I love you!” Because you’ve got a lot of control over youractions,butcouldyoucontrolyourfeelings?

Client:No.

BriefCreativeHopelessness

Asmentionedearlier,wedon’thavetodoCHwithallclients.Withmotivatedhigh-functioning clients who are not overly attached to control, wemay wellskip itordoabriefversion. In thebriefversion,weask,“Soall thesepainful

feelingsareshowingup.Whathaveyoutrieddoingtogetridofthem?”Nextweelicit a fewof themain control strategies.Thenwe say, “Okay, so seems likeyou’ve tried quite a few things to get rid of these thoughts and feelings, andthat’snotworkingtoowell,sohowaboutwetrysomethingdifferent?”Andifwetakethisapproachinitially,butdownthelineitturnsoutourclient

ismore attached to the control agenda thanwe thought—no problem:we cansimplyreturntoCHanddoamoreextensiveintervention.

HomeworkandtheNextSessionAtthispoint,yourclientwillhopefullybecuriousabout thealternativeyou’reoffering. She may even ask again, “So what do I do?” If you have timeremaininginthissession,youcanthenmoveontothenextphase.Ifnot,explainthat you’ll move on to it in the next session. Traditionally, after creativehopelessness and naming control as the problem, you would move on todefusionandacceptance.Asmentionedbefore,forhomeworkyoucouldasktheclienttonoticeallthe

differentways he tries to avoid or get rid of unwanted feelings, and how thatworks, and what it costs. Either of the worksheets above—Join the Dots orAttemptedSolutionsandTheirLong-TermEffects—canfacilitatethis.Alternatively, depending on the metaphor you’ve used, you may ask your

client to notice when she’s “tugging on the rope” or “struggling in thequicksand”andwhen,ifever,shestopstuggingorstruggling.Better still, if she’s willing, have her keep a daily journal:When does the

strugglehappen?Whattriggersit?Whataretheconsequences?And if you started this sessionwith a simplemindfulness exercise, you can

alsoaskyourclienttopracticeitonadailybasis.

HomeworkforYou

Pick some thoughts and feelings you’ve been strugglingwithandcompleteboththeworksheetsonyourownissues.Read throughall theexercises andmetaphorsout aloud, as iftakingaclientthroughthem.Reflect on your current client caseload. Do you have any

clients who are clinging to the control agenda? MentallyrehearserunningthroughaCHinterventionwiththem.

SummaryCreative hopelessness is an optional component of ACT that we use when aclientseemsoverlyattachedtotheemotionalcontrolagenda.Webasicallywanttheclienttotakeagoodhonestlookathowthecontrolagendaisworking:isittakingherinthedirectionofarich,full,andmeaningfullife,orisittakingherinthe direction of struggle and suffering? We can do this as an extensiveintervention takingupawholesession,orasabrief intervention takingonlyafew minutes. It boils down to asking three simple questions:What have youtried?Howhasitworked?Whathasitcost?Andpleasekeepinmind:inallcreativehopelessnesswork,brieforlong,we

donottrytoconvincetheclientofunworkability.Ultimatelyit isuptohimtojudge for himself, based on his own experience, whether or not control isenrichinghislife.

Chapter7.WatchYourThinkingDefusioninaNutshell

In Plain Language: Fusion means getting caught up in our thoughts andallowing them to dominate our behavior. Defusion means separating ordistancingfromourthoughts,lettingthemcomeandgoinsteadofbeingcaughtupinthem.Inotherwords,defusionmeans

lookingatthoughtsratherthanfromthoughts;noticingthoughtsratherthanbeingcaughtupinthoughts;andlettingthoughtscomeandgoratherthanholdingontothem.

Synonym:Deliteralization(thistermisrarelyusednowadays).

Aim: To see the true nature of thoughts: they are nothing more or less thanwords and pictures; and to respond to thoughts in terms ofworkability ratherthanliterality(thatis,intermsofhowhelpfultheyareratherthanhowtruetheyare).

Method:Notice theprocessof thinking; learn experientially that our thoughtsdonotcontrolouractions.

WhentoUse:Whenthoughtsfunctionasbarrierstovaluedliving.

GettingtoDefusionWefacilitatedefusionthroughouteverysinglesessioninACT.Insomesessions,defusionisthecentralfocus,andweformallytakeourclientsthroughavarietyof metaphors and experiential exercises to help them develop defusion skills.Mostof thischapterfocusesonsuchinterventions.However,wealsofacilitatedefusion informally in every session, evenwhen the session is predominantlyfocusedonothercoreprocessessuchasvaluesclarification.Wedothisinthreemainways:

1. Weaskclientstonoticetheirthoughts:1. “Sowhat’syourmindtellingyounow?”

“Andwhatdoesyourthinkingselfhave

tosayaboutthat?”“Can you notice what you’re thinkingrightnow?”

2. “Noticewhatyourmindisdoing.”2. Weaskclientstolookattheworkabilityoftheirthoughts:

1. “Sois thatahelpful thought?Ifyouholdontightly to it, does it help you deal with thesituationeffectively?”“Ifyoulet that thought tellyouwhat todo,willittakeyouinthedirectionofarich,full,andmeaningfullife,orinthedirectionofbeingstuckandsuffering?”“IfwestopthesessionjustbecauseyourmindsaysThiswon’tworkorIcan’tdoit,willthathelpyouchangeyourlife—orwillitjustkeepyoustuck?”

2. Weaskclients tonoticewhentheyarefusedwithordefusedfromtheirthoughts:

1. “Sorightnow,howcaughtupareyouinthatthought?”

2. “Didyounoticehowyourmind just hookedyouthen?”

Ifwewanttomakedefusionthemainfocusofasession,wecanleadintoitinmany ways. For example, if we’ve started therapy by identifying values andsetting specific goals, then we could ask questions such as these: “So what’sgettinginthewayofyoutakingaction?”“What’sstoppingyoufromactingonthesevalues/achievingthesegoals/beingthepersonyouwanttobe/buildingtherelationships you want?” “What’s your mind telling you that holds youback/keepsyoustuck/makeslifedifficultforyou?”Alternatively,ifwefindinthefirstsessionthateveryattempttoclarifyvalues

meetswith a block, then defusion is a good choice for the first step in activetherapy.(Onceourclienthasdevelopedgooddefusionandacceptanceskills,wecanthenreturntoworkonvaluesandgoals.)Yetanotheroption,ifwesuspectorknowthatourclientisdeeplyattachedto

the control agenda, is to do creative hopelessness before actively focusing ondefusion. In this case, after a creative hopelessness intervention,we could say

somethinglikethis:“Soyou’reprobablywonderingiftryingtogetridofthesethoughtsdoesn’twork,what’sthealternative?”

IdentifyingFusion

Whenwetakeahistory,wewatchforfusioninsixkeyareas:rules,reasons,judgments,past, future,andself.Let’s takeaquick lookateachof theseareasnow.

RulesWhatsortofrigidrulesdoestheclienthaveaboutlife,work,relationships,andsoon?Inparticular,lookforrulesabouthowsomeoneneedstofeelbeforeshecantakeaction.Watchforkeywordslikeshould,must,haveto,ought,right,wrong,can’t,don’t,andkeyphrasessuchasshouldn’thaveto;ifIfeelX,thenIcan’tdoY;ifIdoA,thenyoushoulddoB.Thesewordsandphrasesoftenalertyou to rigid ideas about how life should operate or what’s necessary beforechangecanhappen.Theserulesusuallycreatealotofsufferingiftheclientfuseswiththem.Herearesomecommonexamples:“Ishouldn’tbefeelingthisway,”“Ican’tgothepartywhenIfeelanxious,”“IfIcan’tdoitperfectly,there’snopointintrying,”“Thisshouldn’tbesodifficult,”“MykidsshoulddowhatItellthem,”and“Normalpeopledon’tfeelthisway.”

ReasonsWhat reasonsdoes the client giveyou forwhy change is impossible,undesirable, or impractical? Humans are excellent at coming up with reasonswhytheycan’torshouldn’tchange:“I’mtoobusy/tired/anxious/depressed,”“Imight fail,” “I shouldn’t have to,” “It’s too hard,” “It’s genetic,” “We’re allalcoholics in my family,” “It’s a chemical imbalance,” “I’ll get hurt,” “I’vealwaysbeenlikethis,”“Ican’tcopewithloneliness,”“It’llallgowrong,”“I’lldoitwhenIhavemoretime/energy/money,”andsoon.Ifweorourclientsfusewiththesethoughts,theyoftenholdusbackfrommakingchanges.

JudgmentsHumansjudge.Andmanyofthejudgmentswemakeareusefulandimportant:Isthispersontrustworthyoruntrustworthy?Isthiscargoodvalueformoney?Isthisfruitripeornot?Unfortunately,though,manyofourjudgmentsare unhelpful. Of course, if we hold our judgments lightly, they present noproblem. But if we fuse with those judgments—“I’m bad,” “You’re mean,”“Anxiety is awful,” “I’m too fat,” “Being rejected is unbearable,” “He’s soselfish,” “Life sucks,” “Men are liars”—we readily end up struggling andsuffering.What sort of judgmental or evaluative thinking is your client fusingwith?

PastHowisyourclientfusingwith thepast?Ruminatingonoldhurts, failures,mistakes,missedopportunities?Relivingthe“goodolddays”beforelifeturnedbad?Havingflashbacks?(Aflashbackisextremefusionwithamemory.)

FutureHowisyourclientfusingwiththefuture?Worrying?Fantasizingaboutabetter life?Constantly caught up in thinking about all the things he has to dolater?

Self What sort of self-description is your client fusing with? Here are somecommon ones: “I am weak/useless/unlovable,” “I don’t need help,” “I amnothingwithoutmyjob,”“Ican’tcope,”“Idon’ttoleratefoolsgladly,”“Idon’tneedhelp,” “I’m right and they arewrong,” and soon. Is she fusingwithherdiagnosisorherbodyimage—“Iambipolar,”“Iamfat”?Isheperhapsfusingwithhisjobtitleorhisroleinthefamily?Obviouslywe could describemany different categories of thinking—black-

and-white thinking, catastrophizing, overgeneralization, and so on—but theabove six help to keep it simple. (We’ll look in detail at fusionwith past andfuture in chapter9, fusionwith self-description in chapter10, and fusionwithreason-givinginchapter13.)

“SettingtheMood”

To“setthemood”fordefusion,Iinitiallyrecapsomeofthepainfulthoughtsormemories the clienthasbeengettingcaughtup inor strugglingwith, and Icompassionatelyacknowledgehowdifficultthishasbeenforher,andhowmuchpainandsufferingshehasexperienced.ThenIsaysomethinglikethis:“Asyouknow,oneofouraims in thiswork is todeveloppsychologicalskills thatwillhelpyou tohandleyourmindmoreeffectivelywhen it startsdoing things thatholdyoubackfromlivingafulllife.Andthat’swhatI’dliketofocusontoday.Wouldthatbeokaywithyou?”Atthispoint, it’suseful todosomepsychoeducationabout thenatureof the

mind.TypicallyIstartwithabriefdiscussionofthetwopartsofthemind:thethinkingselfandtheobservingself,asdescribedinchapter4.Uponconclusion,I say something like, “So in the work we do here, whenever I use the word“mind,”I’mtalkingabout“thethinkingself”—thepartofyouthatchattersawayinside your head, never shuts up, and always has something to say. Can younoticeitchatteringaway,rightnow?”Theclientusuallysaysyes,andIthenask,“Sowhat’syourmindsayingtoyou?”Whatevertheanswer,Ireply,“SeewhatI

mean?It’salwaysgotsomethingtosay.Sometimesit’shelpful to imaginethattherearefourofusintheroomhere:there’syouandme,andyourmindandmymind.Mymind’sgoingtochatterawaytome,andyourmind’sgoingtochatterawaytoyou.What’sreallyimportanthereiswhathappensbetweenyouandmeratherthanwhatourmindshavetosay.”Typically we next do a bit of psychoeducation about how our minds have

evolved to think negatively, as in the transcript below.This sets the scene foractivedefusioninterventions.

ManyACTtherapistsdon’t introduce theobservingselfuntil later in therapy,following work on defusion and acceptance, but some therapists prefer tointroduceitupfront. Ipreferthelatterapproach,but ifyouprefertheformer,thensimplyskipintroducingtheobservingselffornowandbringit in later intherapy.

HOWOURMINDSHAVEEVOLVEDTOTHINKNEGATIVELY

Therapist:Soyou’vetoldmesomeofthepainfulorunhelpfulthoughtsthatholdyoubackormakeyourlifeharder.AndI’mwillingtobetwe’veonlyjust scratched thesurface—because ifyourmind isanything likemymind, then it’s got no shortage of negative thoughts. And there’sactuallyaverygoodreasonforthat,andI’dliketotakeafewminutestoexplainit.Wouldthatbeokaywithyou?(Waitforclient’sresponse.)You see, the human mind has evolved to think negatively. Ourprimitiveancestors lived inaworldofconstantdanger—biganimalswith big teeth lurked around every corner. So back then, yourmindhad toconstantlybeon the lookout fordanger, anticipatinganythingthatcouldhurtyouorharmyouinanyway:“Watchout.Therecouldbeabear in thatcave.Therecouldbeawolf in thosebushes.Is thatpersoninthedistanceafriendoranenemy?”Ifyouwereacavemanandyourminddidn’tdothisjobwell,you’dsoonbedead.Andthat’swhatwe’veinheritedfromourancestors:ourmodernmindisbasicallya “don’t get killed” machine. It’s constantly trying to warn you ofanythingthatcouldpossiblygowrong:“You’llgetfat,”“You’llscrewuptheexam,”“Hemightrejectyou.”Thisisnormal.Everyone’sminddoesthis.Ourmindhasevolvedtothinknegatively.It’sjusttryingto

doitsnumberonejob,whichistoprotectusandkeepusalive.

There’s no absolute necessity to use the above spiel (or any othermetaphor/exerciseinthisbook),butitdoesmakesagoodtransitionintolearningdefusion skills. The next step is to recap some of the client’s problematicthoughts,clarifywhatitcostshimwhenhegetsentangledinorpushedaroundbythesethoughts,andtheninvitehimtolearnanewwayofhandlingthem.Thetranscript that follows illustrates only oneway ofmany that you can do this;whenyoureadotherACTtextbooks,you’lldiscovermanyothermethods.

IntroducingDefusion:Part1

The client in this transcript is a twenty-four-year-old single, femalechiropractor.Weareabout fifteenminutes intosession2, following (1)abriefmindful breathing exercise (see chapter 9), (2) a quick reviewof the previoussession, and (3) a quick discussion of the two parts of themind and how themindevolvedtothinknegatively.

Therapist:Soonethingweidentifiedlastweek,abigpartoftheproblem,isthatyouhavealotofthoughtsaboutbeingworthlessoruseless.

Client: Yeah, I do. I feel like I’m a waste of space. I don’t even know whyyou’rewastingyourtimewithme.

Therapist: And I notice that as you’re saying that, you’re slumping down—almostasifyou’resinkingintothechair.I’mgettingasensethatthesethoughts really drag you down. (Client nods.) That must hurt. (Theclient nods again, and her eyes tear up.)What’re you feeling rightnow?

Client:(shakingherhead)It’ssilly.

Therapist:What’ssilly?

Client:Iam.Thisis.(wipinghereyes)Idon’tthinkyoucanhelpme.

Therapist:Well, that’saperfectlynatural thought tohave.Lotsofpeoplehavethoughtslikethat,especiallyatthestartoftherapy.AndthetruthisIcan’tactuallyguaranteethat itwillhelp.ButIcanguaranteethatI’lldomyverybesttohelpyoucreateabetterlife.So,howaboutwegiveitago,eventhoughyou’rehavingthethought that it’shopeless,and

let’sseewhathappens?

Client:Okay.

Therapist:Okay,well,weagreed last session thatoneofyourgoalshere is tolearnnewways tohandledifficult thoughts and feelings. Is that stillimportanttoyou?

Client:Yeah.

At this point, the therapist could move on to pretty much any defusioninterventionheprefers.

Therapist:Okay.(Hepullsoutawhiteindexcard.)Well,whatI’dliketodo,ifit’sokaywithyou,isjotdownsomeofyourthoughtsonthiscardsowe’vegotsomethingtoworkwith.Wouldthatbeokaywithyou?

Client:Sure.

Therapist:Thanks.So,whenyourmindisreallybeatingyouup,reallygettingstuck intoyouaboutwhat’swrongwithyou, andwhat’swrongwithyour life—if I could listen in at those times, sort of plug into yourmindandlistenintowhatit’ssaying,whatit’stellingyou,whatwouldIhear?

Client:Oh.Um.Just reallynegativestuff, like,um,you’restupid,you’re lazy,nobodylikesyou.

Therapist:Okay.Soletmegetthisdown.(Hestartswritingthethoughtsdownon the index card.) Your mind says, “I’m stupid … I’m lazy …Nobodylikesme.”Whatelse?

Client:Idon’tknow.

Therapist: Well, you mentioned “silly” and “waste of space” today, and“worthless”and“useless”lastweek.Arethosenamesyourmindoftencallsyou?

Client:Yeah.

Therapist:(writingthemdown)Okay.Soyourmindtellsyou“I’msilly…I’mworthless…I’museless…I’mawasteofspace.”Whatelse?

Client:(chuckles)Isn’tthatenough?

Therapist:Yes,itis—butIwasjustwonderingifyourmindtellsyouanyreallydarkorscarystoriesaboutthefuture?Youknow,whenitreallywantstomakeyoufeelhopeless,whatarethescariestthingsitsaystoyou?

Client:Um.JustthatI’mf****ed.Thereisnofuture.Lifeisf****edandthenyoudie.

Therapist:Okay, so yourmind likes to swear a bit. Let’s get that down. “I’mf****ed…Thereisnofuture…Lifeisf****edandthenyoudie!”

NowLet’sUnpackThat:Part1

Before continuing this chapter, read through the above transcript again andidentify thevariousways the therapistsubtlyestablishesacontextofdefusion,includingnormalizing and allowing thoughts, treating the mind as an “entity,”listening to the mind, writing thoughts down, and describing thoughts as“stories.”Let’stakeaquicklookateachofthese.

NORMALIZINGANDALLOWINGTHOUGHTS

Notice how the therapist responds to “I don’t think you can help me” bysaying“Well,that’saperfectlynaturalthought.”Wefacilitatedefusionwhenwedescribeathoughtasnormal,natural,typical,orcommon,andmakenoattempttojudgeit,challengeit,orgetridofit.

TREATINGTHEMINDASAN“ENTITY”

Defusioninvolvesseparatingfromyourthoughts,soweoftenfinditusefulinACT to talk, playfully andmetaphorically, about themind as if it’s a separateentity.Forexample,wemayaskquestionslike,“Whatdoesyourmindtellyouaboutthat?”or“Who’stalkinghere—youoryourmind?”(Hayesetal.,1999).Inthetranscriptabove,thetherapistalsotalksaboutthemind“gettingstuckintoyou,” “beating you up,” “calling you names,” and also notes that it “likes toswear.”

LISTENINGTOTHEMIND

Many defusion techniques involve noticing or playing with the auditory

propertiesofthoughts.Herethetherapisttalksabout“listeningintothemind,”“hearingwhatitissaying,”and“whatitsoundslike.”

WRITINGTHOUGHTSDOWN

Oneofthesimplestwaysofseparatingfromthoughtsistowritethemdown.Thishelpsyoutotakeastepbackandseethethoughtsforwhattheyare:stringsofwords.Thetherapistcandothewritingandthenpassitontotheclient,ortheclientcanwritethethoughtsdown.

THOUGHTSASSTORIES

In ACT, we often talk about thoughts as “stories.” This ties in nicely tometaphors about the mind as a storyteller (more on this below) and gettingabsorbedorlostinthestory.Thetherapistspecificallyasksaboutany“darkorscarystories”aboutthefuture.

PracticalTip Once in a blue moon, a client will object to the term“stories.”Ifso,immediatelyapologizeandexplain,“Nooffenseintended.AllImeant by the term “story” is that it’s a bunch of words that conveysinformation.Ifthetermbothersyou,I’mmorethanhappytocallthesewords‘thoughts,’‘beliefs,’or‘cognitions.’”

Nowbeforereadingpart2,Iencourageyoutogobacktochapter1andrereadtheACT in a NutshellMetaphor. In the transcript below, the therapist adaptssections1and3ofthatmetaphor.

IntroducingDefusion:Part2

Thetranscriptbelowcontinuesimmediatelyfromwherepart1leftoff.

Therapist:(handingthecardtotheclient)Sothisisthesortofstuffyourmindsaystoyouwhenit’sbeatingyouup?

Client:(lookingdownatthecard)Yeah.

Therapist: I’mgoing to askyou todoa coupleof thingswith this card.Theymay seem a bit odd, but I think you’ll get a lot out of them. Is thatokay?

Client:Whatsortofthings?

Therapist:Well,firstI’dlikeyoutoholdittightly,withbothhands,andholditrightupinfrontofyourfacelikethissoyoucan’tseeme,soallyoucanseearethosethoughtsonthecard.(Clientholdsthecardinfrontof her face.) That’s right—and hold it up so close that it’s almosttouchingyournose.(Theclientdoesso.)Nowwhat’sit liketryingtohave a conversation with me while you’re all caught up in thosethoughts?

Thetherapistisnowdoingsection1oftheACTinaNutshellMetaphor.

Client:Bloodyhard.

Therapist:Doyoufeelconnectedwithme?

Client:Icanhearyouokay.

Therapist:Sure,butcanyoureadtheexpressionsonmyface?Doyoufeeltrulyengagedwithme?IfIwasjugglingballsrightnow,ordoingamimeact,wouldyoubeabletoseewhatIwasdoing?

Client:Iguessnot.

Therapist:Andwhat’syourviewoftheroomlikewhileyou’reallwrappedupinthosethoughts?”

Client:(grinning)Whatroom?

Therapist:Sonoticewhat’sgoingonhere.Here’syourmindtellingyouallthesenasty stories, and the more absorbed you become, the more you’remissingouton.You’recutofffromtheworldaroundyou;you’recutofffromme;you’recutofffromeverythingexceptthesethoughts.

Client:Yeah.That’swhatit’slike.

Therapist: Notice, too, that while you’re clutching this stuff, it’s hard to doanythingthatenrichesyourlife.Checkitout:holdthecardastightly

asyoupossiblycanwithbothhandssoIcan’tpull itfromyou.(Theclientholds thecard tightlywithbothhands.)Now if Iaskedyou totakeanexamorgoforaninterview,orgoforaswimorhugsomeoneyoulove,orrideabike,engagewithyourfriendsandfamily,orhaveadeep and meaningful conversation with a close friend while you’reholdingontightlytothis,couldyoudoit?”

Client:Icouldgiveitashot.

Therapist:Okay,youcouldtry.Andwoulddoingit thisway—allcaughtupinthosethoughts—makeiteasierorharderforyou?

Client:Yeah,it’dbebloodydifficult.

Therapist:Right.Sowhenyourmindhooksyouwiththesethoughts,notonlydoyou get cut off from the world around you and disconnected fromother people, but it’s also much, much harder to do the things thatmakeyourlifework.

Client:(nodding)Igetthepoint.

Therapist:Okay,nowlet’strysomethingelse.CanItakethecardback?(Clienthands it over.)Now, is it okay if I just place this card on your lap?(Clientnods.The therapist leans forwardandplaces thecardon theclient’slap.)Andcanyoujustletitsitthereforamoment?

Thetherapistisnowdoingsection3oftheACTinaNutshellMetaphor.

Therapist:Nowhow’sthat,comparedtohavingitrightinfrontofyourface?Doyoufeelmoreconnectedwithme?Moreengagedintheworldaroundyou?

Client:Yes.

Therapist:Nownoticethosethoughtshaven’tgoneanyway.They’restillthere.Andifyouwantto,youcanstillgetallabsorbedinthem.Checkitoutfor yourself. Look down at the card and give it all your attention.(Client looks down at the card in her lap.) Notice how as you getabsorbed in those thoughts, you get cut off fromme—and you losetouchwiththeworldaroundyou.(Clientnods.)Nowlookbackatme.

(Client looks up at the therapist.) And notice the room around you.(Client looks around the room.) Now which do you prefer—to getsucked intoyour thoughtsdown thereor tobeouthere in theworldinteractingwithme?

Client:(smiling)Ipreferthis.

Therapist:Metoo.

Client:ButIkeepwantingtolookatit.

Therapist:Ofcourseyoudo.Ourmindstrainustobelievethateverythingtheysay to us is very important andwemust pay attention. The thing isthere’snothingwrittenonthatcardthat’snew,isthere?Imeanyou’vehadthosethoughts,whathundreds,thousandsoftimes?

Client:Trymillions.

Therapist:Sonotice,youhaveachoicehere.Youcaneitherlookdownandgetallabsorbedinthisstuff,inallthesethoughtsthatyou’vehadzillionsof times,oryoucan just let it sit thereandyoucanengagewith theworld.Thechoiceisyours.Whichdoyouchoose?

Client:Um…(Sheseemsunsure.Sheglancesdownatthecard.)

Therapist:(warmly,humorously)Oh,I’velostyou.(Clientlooksupagainatthetherapist.) Ahh, you’re back again. See how easily those thoughtshookyou?

Client:Yeah.Iknow.Thathappensallthetime.

Therapist:Yeah—toyou,me,andeveryoneelseontheplanet.That’swhatwe’reup against. That’s what minds do. They hook you. But notice howdifferent it iswhenyouunhookyourself.Notice that if now I askedyoutotakeanexam,orgoforaninterview,orgoforaswim,orhugsomeone you love—nowyou could do it somuchmore easily.Andnow you can also take in the room and appreciate all this fantasticfurnitureandwonderfuldecorfromIKEA.AndifIstartjugglingballsordoingamimeshow—nowyou’llbeabletoseeit.

Client:Well,thatsoundsgood,butI—Idon’tknowifIcoulddothat.

Therapist:Well,there’sreallyonlyonewaytofindout,andthat’stogiveitago.We have a fancy name for this process.We call it “defusion.” AndwhatI’dliketodo,ifyou’rewilling,istakeyouthroughacoupleof

simple defusion techniques, and let’s just see what happens.Wouldyoubewillingtodothat?Justgiveitago?

Client:Okay.

NowLet’sUnpackThat:Part2

Whenwewritethoughtsdownonacardandthenturnthecardintoaphysicalmetaphor, that is a defusion technique in itself: the client is probably alreadystartingtodefusealittlefromsomeofthethoughtsonthatcard.There is some psychoeducation here too: the metaphor illustrates the

differencebetweenfusionanddefusion,andshowshowfusionhinderseffectiveaction. It also draws out the connection between defusion and contacting thepresent moment: defusion enables the client to contact and engage with thetherapistandtheroom,whereasfusioninterfereswiththis.At theendof the transcript, the therapistasks,“Wouldyoubewilling todo

that?” and the client answers, “Okay.” The therapist can now take the clientthroughanydefusiontechnique(s)heprefers.Asageneralrule,it’sbesttostartwith some quick and easy techniques rather than the longer, moremeditativeones.Butsupposetheclientisnotsowilling.Supposeshesaysshedoesn’twantto

letthethoughtsjustsitthere—shewantstogetridofthem!Orsupposeshesaysokay,buthertoneofvoiceandbodylanguagesuggestthatshe’sreallynotkeenontheidea.Whatcoulddowedothen?You got it. In both cases, we would confront the agenda: run through

everythingshe’striedtogetridofthesethoughts,assesshowwellitworked,andlookatwhat it cost.Thenwe’dcomebackandask something like, “Sogiventhatyou’vebeentryingforyearstogetridofthesethoughts,andclearlyithasn’tworked,areyouopentoexploringadifferentapproach?”Pleasekeep inmind,youdon’thave touse the thoughts-on-cards technique

above.I’veuseditpurelyasanexamplebecauseIfinditsoeffective.However,wecouldrunthroughtheprocessconversationally.First,we’daskourclienttoidentifythethoughtsshefuseswith.Thenwe’dclarifywhathappenswhenshegetscaughtupinthosethoughts.Finallywe’daskabouthowherlifewouldbedifferentifthosethoughtslostalltheirimpact;ifshecouldletthemcomeandgowithoutgettingcaughtupinthem.

DEFUSIONINEVERYDAYLANGUAGE

In the transcript above, the therapist uses the term “defusion.” However,shouldyouforanyreasonprefernot touse the technical term, therearemanyways to talk about fusion and defusion in everyday language. To convey theconceptoffusion,youmighttalkaboutbeinghookedorreeledinbythoughts,getting entangled or caught up in thoughts, or getting lost or swept away bythem.Oryoumighttalkaboutholdingontightlytoyourthoughts,refusingtoletthem go, dwelling on them, stewing on them, buying into them, or beingabsorbed by them. Or you could speak of struggling with thoughts, gettingboggeddowninthem,orallowingthemtopushyouaround.Andthelistgoeson.Thesemetaphoricalwaysof speaking all convey the same theme: that ourthoughts have amajor impact on us, andwe invest a lot of time, energy, andeffortinrespondingtothem.To convey the concept of defusion, you could talk about noticing thoughts,

observing thoughts, taking a step back andwatching your thoughts; or lettingthoughtscomeandgo,holdingthemlightly,orlooseningyourgriponthem;orunhookingyourself,disentanglingyourself,droppingthestory,andsoon.Theseall convey the ideaof separating fromyour thoughts and allowing them todotheir own thing instead of investing your time and energy and effort inrespondingtothem.

TheDefusionSmorgasbordOnceyouhavepermissionfromtheclienttodoanexperientialexercise,there’sasmorgasbordofoptionsavailable toyou.However,asyoureadon, therearetwothingstokeepinmind:

1. Defusion is not a technique. There are well over a hundred defusiontechniques transcribed inACTtextbooksandarticles,andscoresofothers thathave never been written up. But remember: defusion is a process, not atechnique.Allthosedifferingtechniquesaretheretohelplearntheprocess.

2.Bewaryofinvalidation.Whenwedoworkarounddefusion,weneedtostayin touchwithourcompassionand respect for theclient,and toensure thatwedon’t get into a position of one-upmanship. When a client shares painfulthoughtswithus, there’sapotentialdanger in referring to themas“stories”ordoing someof themore zanydefusion techniques (such as saying thoughts insillyvoicesorsingingthem—moreonthisbelow).Ifwedothisworkcarelessly,

itcancomeacrossasinvalidating,uncaring,trivializing,ordemeaning.So it’s important that we compassionately join with the client: we connect

with his suffering, and we validate howmuch pain he’s experienced. From astanceofcompassion,equality,andrespect,weformanalliancewiththeclient.Weworktogetherasateamtofindanewwayofrespondingtothesethoughtsandtodevelopanewattitudethatenablesmindful,valuedliving.Whenwedoourworkwith thisattitude, theriskof invalidatingaclient is low.Butwithoutthis attitude, the risk is high—especially with the zanier techniques.Compassionate, respectful playfulness is the quality we aim for in all theseexchanges.

ATasteofDefusion

I’mnowgoingtotakeyouthroughseveraldefusiontechniquesasifyouwereaclientsoyoucangeta tasteof them.Sopulloutascrapofpaper,andwritedowntwoorthreenegative,self-judgmentalthoughtsyourmindthrowsupfromtimetotimetogiveyouagoodthrashing.You’llneedthesetoworkwithduringthe exercises. (If you need any help coming up with some, consider thesequestions:What does yourmind say about your bodywhen you see yourselfnaked in the mirror?What does your mind tell you about your abilities as atherapistwhenyou’vejusthadareallychallengingsessionwherenothingwentright?Whatdoesyourmindtellyouwhenitreallywantstobeatyouupandtellyouyou’renotgoodenough?)Haveyoudone that?Okay,nowpick the thought thatbothersyou themost

anduseittoworkthroughthefollowingexercises.(Atthestartofeachexercise,I’llaskyoutofusewithyourthoughtfortenseconds.Yougenerallywon’tneedtoaskyourclientstodothatasthey’llalreadybefused!)

I’MHAVINGTHETHOUGHTTHAT…

Putyournegative self-judgment into a short sentence—in theform “I am X.” For example, I’m a loser or I’m not smartenoughNowfusewiththisthoughtfortenseconds.Inotherwords,getallcaughtupinitandbelieveitasmuchasyoupossiblycan.Nowsilentlyreplaythethoughtwiththisphraseinfrontofit:“I’mhaving the thought that…”For example, I’mhaving the

thoughtthatI’maloser.Nowreplay itonemore time,but this timeadd thisphrase“Inotice I’mhaving the thought that…”For example, I noticeI’mhavingthethoughtthatI’maloser.

What happened?Did you notice a sense of separation or distance from thethought?Ifnot,runthroughtheexerciseagainwithadifferentthought.Thisisanicesimpleexercise(adaptedfromHayesetal.,1999)thatgivesanexperienceofdefusiontoalmosteveryone.Inatherapysession,youcouldfollowupasbelow:

Therapist:Sowhathappenedtothethought?

Client:Itsortoflostsomeofitssting.

Therapist:Didyougetsomesenseofseparationordistancefromit?

Client:Yeah.Itsortofbackedoffabit.

Therapist:Couldyou just showmewithyourhandsandyourarmswhere thethoughtseemedtomoveto?

Client:Outhere.(Theclientstretcheshisarmsoutinfrontofhischest.)

Therapist:Sothat’spartofwhatwemeanbydefusion:youstarttoseparatefromyourthoughtsandgivethemsomespacetomovearoundin.

Youcouldfollowupinotherwaystoo.Forexample,youcouldasktheclient,“Iwonder if you’dbewilling to try talking thisway inour sessions.Supposeyouhavesomesortofdistressing,painful,orunhelpfulthoughtlikeThis isalltoohard.Whenyouhaveathoughtlikethat,couldyousaytome,“I’mhavingthethoughtthatthisisalltoohard?”Oncethisconventionisestablished,youcancomebacktoitagainandagain

andplaywithitasabriefintervention.Herearetwoexamples:

Client:Ican’thandlethis.

Therapist:Soyou’rehavingthethoughtthatyoucan’thandlethis.

***

Therapist:Couldyousay thatagain,but this time,preface itwith“I’mhavingthethoughtthat…”

Client:I’mhavingthethoughtthatI’mastupididiot.

Therapist:Didyounoticeanydifference?

Client:Yes,itdidn’tbothermesomuchthesecondtime.

Ofcourse,youcanusethistechniquewithfeelingsandurgestoo:“I’mhavingafeelingofanxiety”or“I’mhavingtheurgetorunaway.”

SINGINGANDSILLYVOICES

Forthesetwoexercises(takenfromHayesetal.,1999),usethesamenegativeself-judgment as you used above, or try a new one if the old one has lost itsimpact:

Putyournegative self-judgment into a short sentence—in theform“IamX”—andfusewithitfortenseconds.Now, inside your head, silently sing the thought to the tune“HappyBirthday.”Now, inside your head, hear it in the voice of a cartooncharacter,moviecharacter,orsportscommentator.

What happened that time?Did you notice a sense of separation or distancefromthethought?Ifnot,runthroughtheexerciseagainwithadifferentthought.Variationsonthethemeincludesingingthethoughtsoutloud,sayingthemout

loudinasillyvoice,orsayingtheminexaggeratedslowmotion(forexample,“I’mmmmmm stuuuuuuupiiiddddddddd”). Keep in mind that in the rightcontext, zany techniques like these can be very powerful, but in the wrongcontext, they can be invalidating or demeaning. For example, you probablywouldn’taskaclientwithterminalcancertosingherthoughtsaboutdyingtothetune“HappyBirthday.”

PracticalTip Often with these zany defusion techniques your clientwillchuckleorlaugh.We’renotspecificallyaimingforthatoutcome,butwhenit happens, it’s usually a signof significant defusion, and it’s oftenuseful tohighlight it: “You’resmiling.What’sgoingon?This isa reallynastynegativethought, isn’t it? How come you’re laughing?” However, if your client startsjudgingthethoughtharshly—“Itseemssosilly”or“It’sstupid, isn’t it?”—thenwewanttodefusethosejudgmentstoo.Forexample,wemaysay,“Well,the

pointistonoticeit’sjustabunchofwords.Wedon’tneedtojudgeit.Let’sjustseeitforwhatitis:abunchofwordsthatpoppedintoyourhead.”

TITCHENER’SREPETITION:LEMONS,LEMONS,LEMONS

Thisexercise(Titchener,1916)involvesthreesteps:

1. Pickasimplenoun,suchas“lemon.”Say itout loudonceortwice, and notice what shows up psychologically—whatthoughts,images,smells,tastes,ormemoriescometomind.

2. Nowrepeatthewordoverandoveroutloudasfastaspossibleforthirtyseconds—untilitbecomesjustameaninglesssound.Pleasetrythisnowwiththeword“lemon,”beforereadingon.Youmustdoitoutloudforittobeeffective.

3. Now run through the exercise again with an evocativejudgmentalword—awordthatyoutendtousewhenyoujudgeyourself harshly, for example, “bad,” “fat,” “idiot,” “selfish,”“loser,” “incompetent,”—or a two-word phrase such as “badmother.”

Please try this nowandnoticewhat happens.Most people find thewordorphrase becomes meaningless within about thirty seconds. Then we see it forwhatittrulyis:anoddsound,avibration,amovementofmouthandtongue.Butwhenthatverysamewordpopsintoourheadandwefusewithit,ithasalotofimpactonus.

COMPUTERSCREEN

Thisexercise(Harris,2006)isparticularlyusefulforpeoplewhoaregoodatvisualizing.Youcanalsoconvertitintoawrittenexercise,usingsheetsofpaperanddifferentcoloredpens:

Fusewithyournegativeself-judgmentfortenseconds.Now imagine a computer screen and imagine your thoughtwrittenupthereasplainblacktext.Now in your mind’s eye, play around with the color. See itwritteningreen,thenblue,thenyellow.Now in your imagination, play around with the font. See it

writteninitalics,theninstylishgraphics,theninoneofthosebigplayfulfontsyouseeinchildren’sbooks.Nowputitbackasplainblacktext,andthistimeplayaroundwiththeformat.Runthewordstogether.Thenspacethemoutfarapart.Thenrunthemverticallydownthescreen.Now put it back as plain black text, and this time, in yourmind’s eye, animate thewords like thosecartoonsonSesameStreet.Have thewords jump up and down, orwriggle like acaterpillar,orspininacircle.Now put it back as plain black text, and this time imagine akaraokeballbouncingfromwordtoword.(Andifyoulike,atthesametime,hearitsungto“HappyBirthday.”)

“Meditative”Techniques

You’ll notice in this book I talk about mindfulness skills, not mindfulnessmeditation.That’sbecause,fromanACTperspective,formalmeditationisonlyonewayamonghundredsof learning thebasicmindfulness skillsofdefusion,acceptance, and contact with the present moment. If clients want to take upmeditationorotherformalmindfulnesspracticessuchasyogaor taichi, that’sgreat—when itcomes to learningnewskills, themorepractice thebetter—butit’sdefinitelynotsomethingweexpectoraskfor.Having said that, some defusion techniques, such as the two that follow—

LeavesonaStream(Hayesetal.,1999)andWatchYourThinking—dohaveameditative feel to them. In these exercises, we observe our thoughts withopennessandcuriosity;wewatchthemcomeandgowithoutreactingtothem—withoutjudgingthem,holdingontothem,orpushingthemaway.

LEAVESONASTREAM

1. Findacomfortableposition,andeithercloseyoureyesor fixyoureyesonaspot,whicheveryouprefer.

2. Imagineyou’resittingby thesideofagentlyflowingstream,andthereareleavesflowingpastonthesurfaceofthestream.Imagineithoweveryoulike—it’syourimagination.(Pause10seconds.)

3. Now, for the next fewminutes, take every thought that pops

intoyourhead,placeitonaleaf,andletitfloatonby.Dothisregardless of whether the thoughts are positive or negative,pleasurable or painful. Even if they’re the most wonderfulthoughts, place them on the leaf and let them float on by.(Pause10seconds.)

4. If your thoughts stop, just watch the stream. Sooner or lateryourthoughtswillstartupagain.(Pause20seconds.)

5. Allow the stream to flow at its own rate. Don’t speed it up.You’re not trying to wash the leaves away—you’re allowingthem to come and go in their own good time. (Pause 20seconds.)

6. If yourmind says,This is stupid or I can’t do it, place thosethoughtsonaleaf.(Pause20seconds.)

7. If a leaf gets stuck, let it hang around.Don’t force it to floataway.(Pause20seconds.)

8. If a difficult feeling arises, such as boredom or impatience,simply acknowledge it. Say to yourself, “Here’s a feeling ofboredom” or “Here’s a feeling of impatience.” Then placethosewordsonaleaf,andlettheleaffloatonby.

9. From time to time, your thoughts will hook you, and you’lllosetrackoftheexercise.Thisisnormalandnatural,anditwillkeephappening.As soon as you realize it’s happened, gentlyacknowledgeitandthenstarttheexerciseagain.

After instruction 9, continue the exercise for several minutes or so,periodicallypunctuatingthesilencewiththisreminder:“Againandagain,yourthoughts will hook you. This is normal. As soon as you realize it, start theexerciseagainfromthebeginning.”Afterwarddebrieftheexercisewiththeclient:Whatsortofthoughtshooked

her?Whatwas it like to let thoughtscomeandgowithoutholdingon?Was ithard to let goof any thoughts in particular? (Clients oftenwant to hold on topositivethoughts,butthatdefeatsthepurposeoftheexercise;theaimistolearnhow to let thoughts come and go.) What feelings showed up? Wasacknowledging the feeling (as in instruction 8) useful? (This is an acceptancetechnique.)Didshespeedup thestream, trying towash the thoughtsaway? If so, she’s

probablyturningitintoacontroltechnique,tryingtogetridofthoughts.Thisisnottheaim.Theaimistoobservethenatural“flowofthoughts,”allowingthem

to come and go in their own good time. That’swhy I’ve put instruction 5 inthere.You can end the exercisewith a simple instruction such as this: “Andnow,

bringtheexercisetoanend…andsitupinyourchair….andopenyoureyes.Lookaroundtheroom…andnoticewhatyoucanseeandhear…andtakeastretch.Welcomeback!”

Practical Tip Some people find visualization very hard. I’m one ofthem.Soit’sagoodideaatthestartofanyexerciserequiringimaginationtosay,“Differentpeopleimagineindifferentways.Someseeveryvividpicturesas on a TV screen. Other people imagine with words, sounds, feelings, orideas.However you imagine isabsolutely fine.”For theLeavesonaStreamexercise,Ialwaysofferthealternativeofimagininga“movingblackness”ora“movingblackstrip”—justasenseofsomethingblackandexpansivethatjustkeepsonrollinggentlyby.Youplaceyourthoughtsonthemovingblacknessratherthanontheleaves.

WATCHYOURTHINKING

1. Iinviteyounowtositupstraight,andletyourshouldersdrop.Gently push your feet into the floor and get a sense of thegroundbeneathyou.Youcaneitherfixyoureyesonaspotorclosethem.

2. Nowjusttakeamomenttonoticehowyou’resitting.(Pause5seconds.)Andnoticehowyou’rebreathing.(Pause5seconds.)Andforthenextfewbreaths,reallyobservethebreath—studyit—noticeitflowinginandout.(Pause10seconds.)Observeitas if you’re a curious scientist who has never encounteredbreathingbefore.(Pause10seconds.)

3. Nowshiftyourattentionfromyourbreathingtoyourthoughts,and see if you can notice your thoughts: Where are yourthoughts?Wheredotheyseemtobelocatedinspace?(Pause10 seconds.) If your thoughts are like a voice, where is thatvoice located? Is it in thecenterofyourheador tooneside?(Pause10seconds.)

4. Noticetheformofyourthoughts:Aretheymorelikepictures,

words,orsounds?(Pause10seconds.)5. Are your thoughtsmoving or still? Ifmoving, atwhat speed

andinwhatdirection?Ifstill,wherearetheyhovering?6. Whatisaboveandbelowyourthoughts?Arethereanygapsin

betweenthem?7. For the next fewminutes, observe your thoughts coming and

going as if you’re a curious scientist who has neverencounteredanythinglikethisbefore.

8. Fromtimetotime,you’llgetcaughtupinyourthoughts,andyou’ll lose track of the exercise. This is normal and natural,and it will keep happening. As soon as you realize it’shappened,gentlyacknowledgeit,thenstarttheexerciseagain.

You could continue this for severalminutes,with periodic reminders of thelastinstruction—orifyouonlywanttodoaquickexercise,youcouldbringittoan end at this point, as suggested in the last exercise. Debrief the exerciseafterward,aswithLeavesonaStream.

AccentuatingDefusion:“LettingGo”Metaphors

Defusion is implicit in any mindfulness exercise or practice: the more weenterintotheworldofdirectexperience,themoreweleavebehindtheworldoflanguage.However,asyou’ll see in thenext threechapters, somemindfulnessexercises are more heavily geared toward acceptance, contacting the presentmoment,or theobservingself.Wecanaccentuatedefusion inanymindfulnessexercisebyaddingametaphorortwoabout“lettinggo.”Afewexamplesfollow.Allowyourthoughtstocomeandgolike

passingcars,drivingpastoutsideyourhouse;cloudsdriftingacrossthesky;peoplewalkingbyontheothersideofthestreet;suitcasesonaconveyorbelt;bubblesrisingtothesurfaceofapond;waveswashinggentlyontothebeach;birdsflyingacrossthesky;trainspullinginandoutofthestation;orleavesblowinggentlyinthewind.

CommonClientMisconceptions

Clients often have misconceptions about defusion (as do many newtherapists).Theymaythinkthepointofdefusionistogetridofpainfulthoughts,images,ormemories,ortoreducethepainfulfeelingsassociatedwiththem.Butitisnot.Pleaseremember:

The aim of defusion isNOT to feel better or to get rid ofunwantedthoughts.The aim of defusion IS to reduce the influence of unhelpfulcognitive processes upon behavior and to facilitate beingpsychologicallypresentandengagedinexperience.Inotherwords,theaimofdefusionistoenablemindful,valuedliving.

Clientsoftenfindthatwhentheydefusefromapainfulthought,itdisappears,ortheyfeelbetter,orboth.Whenthishappens,thetherapistneedstoclarifythat(1) this is merely a bonus, not the primary purpose, and (2) it won’t alwayshappen,sodon’texpectit.Ifthetherapistdoesn’tdothis,clientswillstartusingdefusiontotrytocontroltheirthoughtsandfeelings.Andthen,ofcourse,itnolongerfunctionsasamindfulnesstechniquebutasacontroltechnique.Andthenit’sonlyamatterof timebefore theclientbecomes frustratedordisappointed.Herearetwoexamplesofhowthetherapistmayhandlethis:

Client:Thatwasgreat.Thethoughtjustwentaway.

Therapist:Well,sometimesthathappens,andsometimesitdoesn’t.Sometimesathoughtjustkeepsonhangingaround.Ouraimisnottotryandmakeitgoaway;ouraimistostopgettingcaughtupinit,makesomeroomfor it, allow it tobe therewithout struggling—so that if andwhen itdoes hang around for a while, it doesn’t stop you from doing whatmattersandengagingfullyinyourlife.

***

Client:That’sgood.Ifeellessanxiousnow.

Therapist:Yes,wellthatquiteoftenhappenswithdefusion,butcertainlynotallthe time.Defusion isnotsomemagicalway tocontrolyour feelings.Theaimof is todisentangleyourself fromyour thoughtsso thatyoucan be in the present moment and do the things you consider

important. So if you feel better, by all means enjoy it. But please,consider it a bonus, not the main intention. If you start using thesetechniques to control how you feel, I guarantee you’ll soon bedisappointed.

Ifyourclientseemsdisappointedorsurprisedwhenyousaythis,itmeansshehasmisunderstoodthepurposeofdefusion,inwhichcaseyou’llneedtorecapit—andyoumayneedtovisit(orrevisit)creativehopelessness.Onewaytodoaquickrecapisto“replay”theACTinaNutshellMetaphorfromchapter1ortheHandsAsThoughtsMetaphorfromchapter2.

IT’SNOTWORKING!

Sometimesyouwon’trealizethatyourclienthasmissedthepointofdefusion.That’sokay;he’llsooncomebackandtellyou.He’llsaysomething like,“It’snotworking!”Inwhichcase,weask,“Whatdoyoumeanit’snotworking?”Hesays,“Well,Itriedallthosedefusiontechniques,butIstillfeltreallyanxious.”And hey, presto! There we have the control agenda. We can now recap thepurposeofdefusionandclarifythat it isnota tool tocontrolourfeelings.Thefact is our emotions may or may not change when we defuse from painfulthoughts. (If this seems odd to you, keep in mind that it’s a myth that ourthoughts create our emotions. Our emotions are under multiple sources ofinfluenceatanytime,andourthoughtsareonlyoneinfluenceamongmany,sodefusingfromthemmayhavelittleornoimpactonouremotionalstate.)

BUTIT’STRUE!

Fromtimetotime,aclientwillresistorcriticizeadefusiontechniqueonthegroundsthatthethoughtistrue.It’sgenerallyeasiesttorespondtothisintermsofworkability:“Thethingis,inACT,we’renotsomuchinterestedinwhetheryour thoughts are true or false, but whether they’re helpful. If you hold thisthoughttightly,willithelpyoutolivethelifeyouwant?Willithelpyouachieveyourgoals,improveyourrelationships,oractlikethepersonyouwanttobe?”Belowisanexamplefromatherapysession:

Client:Butit’strue.Iamabadmother.

Therapist:Well, one thing I never intend to do here is debatewith you aboutwhat’s true and what’s false. What we’re interested in is, is this

thoughthelpful?Whenyougetallcaughtupinit,doesithelpyoutobethesortofmotheryou’dliketobe?

Client:Sometimesitkicksmybuttintoaction.

Therapist:Sometimes,yes.Butmostofthetimeitjustdragsyoudown,doesn’tit?

Client:Yes.

Therapist:Andonceit’sdraggedyoudownintothedepths,that’swhenyou’remost likely to neglect the kids, right? So most of the time, gettingcaughtupinthisthoughtdoesn’thelpyoutobethemotheryouwanttobe.

Client:No.

Therapist: Suppose you’re in themiddle of the sea, your boat’s capsized, andyou’reholdingontightlytoaheavysuitcase.Youdon’twanttoletgobecause it’s fullofpreciousbelongings.But it’sdraggingyoudown,pullingyouunderthewater.Whatwouldyoudo?

Client:Letgoofit.

Therapist: Right.And once you let go, you could put your energy into doingsomething useful—like swimming toward the shore. So how aboutdoingthesameforthe“badmother”story?Regardlessofwhetherit’strueorfalse,letgoofitsoyoucanputyourenergyintobeingthesortofmotheryoureallywanttobe.

At this point, the therapist might well choose to change tack and explorevaluesalittle:tofindoutwhatsortofmothertheclientwouldliketobe.

TheSuitcaseintheSeaMetaphor,asgiveninthetranscriptabove,isusefulforbothdefusionandacceptance.

WhenDefusionBackfires

Occasionallyyou’lltakeaclientthroughadefusiontechnique,andit’llhavethe opposite effect to what you intended: your client will become evenmorefusedthanbefore.Luckilythiswon’thappenoften,butifandwhenitdoes,it’s

really not a problem. Simply turn it into an opportunity to help your clientdiscriminatebetweenfusionanddefusion—forexample:

Therapist:Oh,I’msorry.Thatdidn’t turnout thewayIexpected.Usually thatexercise helps people step back and get some distance from theirthoughts,butinthiscaseitseemstohavehadtheoppositeeffect.Sogiven that this has happened, let’s learn from it. Notice how you’reevenmorecaughtupinthatthoughtthanbefore.Noticetheimpactit’shavingonyou.Thisiswhatwemeanby“fusion.”

Then,afterdebriefing,youcansuggestadifferentdefusionexercise.

TechniquesGalore

There are currentlywell over ahundreddefusion techniquesdocumented inACTtextbooksandself-helpbooks,andmanymorethathaveneverbeenwrittenup. And there’s plenty of opportunity for you or your clients to modify oldtechniquesorcreatenewones.Youcandoanythingthatputsthethoughtintoanewcontext,whereyoucanseeitforwhatitis:nothingmoreorlessthanwordsorpictures;nothingyouneedtofightwith,clingto,orrunfrom.Forexample,youmightvisualizethethoughtasacaptiononagreetingcard,

writteninfrostingonabirthdaycake,orpoppingupinsidethespeechbubbleofacomicbookcharacter.Oryoumightimaginethethoughtcomingfromaradio,orhearitinthevoiceofawell-knownpoliticianorsportscommentator.Oryoumightimagineyourselfdancingwiththethought,walkinghand-in-handwithitdownthestreet,orbouncingitupanddownlikeaball.Youmightdraworpaintthe thought, write it out in different colors, or sculpt it in clay. You mightvisualizeitontheT-shirtofajogger,imagineitasatextmessageonyourcellphone, or see it as a pop-up on your computer.Youmight sing it in differentmusical styles (for example, opera, jazz, rock ’n’ roll), say it in anoutrageousforeignaccent,orhaveahandpuppetsayitoutloud.Theoptionsareendless.Sobefore readingon,see ifyoucan thinkupa fewtechniquesofyourown.Andhavesomefunwithit.(Howoftendoyouhearthatinatextbook?!)

MetaphorsGalore

Youcanalsouseallsortsofmetaphorstohelpwithdefusion.Oneofthemost

useful iscomparingthemindto“amasterstoryteller”becausethis ties inverynicelywithtalkingofthoughtsas“stories.”

THEMASTERSTORYTELLERMETAPHOR

Therapist:Ourmindisliketheworld’sgreateststoryteller.Itnevershutsup.It’salwaysgotastorytotellandguesswhatitwantsmorethananythingelse?

Client:(shrugs,thenshakeshishead)

Therapist: It wants what any good storyteller wants. It wants us to listen. Itwants our full attention. And it’ll say whatever it can to get ourattention.Evenifit’spainfulornastyorscary.Andsomeofthestoriesittellsusaretrue.Wecallthose“facts.”Butmostofthestoriesittellsus, we can’t really call “facts.” They’remore like opinions, beliefs,ideas, attitudes, assumptions, judgments, predictions, and so forth.They’restoriesabouthowweseetheworld,andwhatwewanttodo,andwhatwethinkisrightandwrongorfairandunfair,andsoon.Andoneofthethingswewanttodohereislearnhowtorecognizewhenastory is helpful, and when it isn’t. So if you’re willing to do anexercisehere,I’dlikeyoutojustcloseyoureyes—don’tsayanythingfor about thirty seconds—and just listen to the story your mind istellingyourightnow.

OTHERMETAPHORS

Youcanalsousefullycomparethemindto

a word machine: it manufactures a never-ending stream ofwords;radio “doomandgloom”: it likes tobroadcast a lotofgloomabout the past, a lot of doom about the future, and a lot ofdissatisfactionwiththepresent;a spoiled brat: it makes all sorts of demands and throws atantrumifitdoesn’tgetitsway;a reason-givingmachine: it churns out a never-ending list ofreasonswhyyoucan’torshouldn’tchange;a fascistdictator: it constantlyordersyouabout and tellsyouwhatyoucanandcan’tdo;or

ajudgmentfactory:itspendsalldaylongmakingjudgments.

Andsoonandsoforth.Onceyou’veusedthesemetaphorswithaclient—andassumingtheclienthasembracedthem—youcancomebacktothemagainandagain in subsequent sessions as brief defusion interventions. For example, inresponse to a client who comes out with a whole stream of negative self-judgments youmight say, “There goes the judgment factory again; it’s reallypumpingthemouttoday.”Orinresponsetoaclientwhokeepssaying,“Ishoulddo X, I have to do Y!” you might say, “Wow! Seems like that little fascistdictatorinsideyourheadisreallylayingdownthelawtoday.”Youprobablyalreadyknowquiteafewmetaphorsforthemind:forexample,

the “chatterbox” and the “inner critic” are both in common usage. Beforereading on, why not take a few moments to see if you can come up with ametaphorortwoofyourown.

Don’tForgetAbouttheClient

WhenIwasnewtoACT,thereweretimeswhenIgotsocaughtupinplayingaroundwithallthesewonderfulnewdefusiontechniquesthatIforgotaboutthehumanbeing in frontofme.Soweneed to remember:wedo techniqueswithclients, noton clients.AndACT is not about delivering techniques: it’s aboutbuildingavital,valuedlife.Soamindful,attunedconnectionwiththeclient isessential inall thiswork.

Weneedtobewatchfulofourclients,respectfulofwheretheyareat,andopentotheirresponses.Andifwegetsocaughtupindeliveringtechniquesthatweneglect the relationship, then as soon as we notice it, we should apologize:“Whoa!I’msosorry.IjustrealizedwhatI’vebeendoinghere.Igotsocaughtupinmyownenthusiasm,Ilosttouchwithyou.Canwejustpauseandrewindalittle,backtobeforeIstartedbombardingyouwithallthisstuff?”Thesesortsofinteractionsnotonlybuildatrustingandopenrelationship;they

also allow us to model self-awareness and self-acceptance. And theydemonstratethatwe’reinthesameboatasourclients:thatwetoocangetcaughtup in our heads and lose touch with the present moment—and we can bringourselvesbacktothepresentandacteffectively!

Psychoeducation

ManyACTprotocolsincludesignificantamountsofpsychoeducation.Whereverpossible, this is done via experiential exercises or metaphors rather thandidactically. Metaphors are particularly useful for teaching because (a) theyconveya lotof information ina short spaceof time; (b)clients tend toacceptthembecausetheyaretruisms;and(c)clientstendtorememberthem.Two psychoeducational components commonly linked to defusion were

covered in the last chapter: “the illusion of control” and “the normality ofcontrol.” Two other components often used are “the normality of negativethinking”and“theillusionthatthoughtscontrolactions.”

TheNormalityofNegativeThinking

Normalizing negative thinking often facilitates acceptance and defusion.Clientsbecomemorewillingtohavetheirthoughtsandlessintentongettingridof them. As a bonus, clients often feel a sense of relief to know that they’re“normal.” We’re sending them a powerful message: “Your mind’s notdysfunctional; it’s just doingwhat allminds do.Ourminds evolved to judge,compare,andpredict theworst.Yourmind’s justdoing its job.”The transcriptthatfollows,ontheinevitabilityofcomparison,canalsousefullybetaggedontoacreativehopelessnessintervention.Itiswrittenbelowaswemightdeliverittoclients,exceptinreallifewewouldpausefromtimetotimeandcheckinwiththeclient:“Doesthissoundabitlikeyourmind?”

THEINEVITABILITYOFCOMPARISON

Therapist:We’vealreadytalkedabitabouthowourmindhasevolvedtothinknegatively, but there’smore to it. You see, in prehistoric times, oneabsoluteessentialforsurvivalwasbelongingtothegroup.Ifthegroupkickedyouout,itwouldn’tbelongbeforethewolvesateyou.Sohowdoes the mind prevent that happening? It compares you to everymemberofthetribe:“AmIfittingin?AmIdoingtherightthing?AmIdoingitwellenough?AmIdoinganythingthatcouldgetmethrownout?”Asaresult,ourmodern-daymindalwayscomparesustoothers.Butnow,there’snotjustasmallgrouportribe.Nowwecancompareourselves toeveryoneon theplanet—therich, famous,andbeautiful,movie stars, top athletes, even fictitious superheroes. And we don’thave to look far beforewe find someonewho is “better” than us in

someway—richer, taller,older,younger,morehair,betterskin,morestatus, smarter clothes, bigger car, and so on. As a result of all thiscomparing,we’re allwalking aroundwith some version of the “I’mnotgoodenough”story.Formostofus,itstartsinchildhood;forafewpeople, it doesn’t start until the teenageyears.And it’s thebest-keptsecret on the planet. Everyone’s got multiple versions of this story—“I’m too old/fat/stupid/boring/fake/unlikeable/lazy/incompetent,blah,blah,blah”or“I’mnot smartenough/richenough/slimenough,andsoon.”We’veallgotthisstory,butalmostnoonetalksaboutit.

TheIllusionThatOurThoughtsControlOurActions

Oneofthekeyinsightsthatwewantourclientstounderstandexperientiallyisthatourthoughtsdonotcontrolouractions.Thoughtshavealotofinfluenceonour actionswhenwe fusewith them; theyhavemuch less influencewhenwedefuse.Onceclientsunderstandthis,itenablesustodobriefinterventionssuchasthese:

Client:Idon’tthinkIcandoit.

Therapist:Canyouhavethatthoughtanddoitanyway?

***

Client:Ijustknowthisisgoingtoturnoutbadly.

Therapist:Well, that’s what your mind’s going to tell you. Can you let yourmindtellyouthat,andstillgoaheadwithit?

Thetranscriptsthatfollowhighlightamorerealisticviewoftherelationshipamongthoughts,feelings,andactions.They’rewrittenaswemightdeliverthemtoourclients.

IFOURTHOUGHTSANDFEELINGSCONTROLLEDOURACTIONS

Therapist: If our thoughts and feelings really controlled our actions, wherewouldwe be? Think of all those angry, resentful, vengeful thoughtsandfeelingsyou’vehad.Rememberallthosenastythingsyouthoughtaboutsayingordoing to thepeopleyouwereangrywith. Imagine if

those thoughts and feelings had controlled your actions—if you hadactuallygoneanddoneallthosethings.Wherewouldweallbeifourthoughts and feelings controlled our actions? (Wait for the client toanswer.Shewillusuallysay“inprison,”“inthehospital,”or“dead.”Ifshedoesn’t,youcansupplytheseanswersforher.)

HAVEYOUEVERHADTHOUGHTSANDFEELINGSYOUDIDN’TACTON?

Therapist: Have you ever had thoughts and feelings you didn’t act on? Forexample,didyoueverhavethethought“Ican’tdothis,”butyouwentaheadanddiditanyway?(Afterthisandeachsubsequentquestion,tryto elicit answers from the client.)Did you ever have thoughts aboutyelling at someone or leaving your partner or quitting your job orcallinginsick,butyoudidn’tactonthem?Didyoueverfeelangrybutactcalmly?Didyoueverfeelfrightenedbutactconfidently?Didyouever feel sad but act as if you were happy? Did you ever feel likerunningawayfromanawkwardorstressfulsituation,butyoustayed?Whatdoesthisshowyou?Doyourthoughtsandfeelingstrulycontrolyouractions,ordoyouhavesomechoiceinhowyouact?

ICAN’TLIFTMYARM

Therapist: I’d likeyoutosilentlyrepeat toyourself,Ican’t liftmyarm.Say itoverandover inyourheadandasyou’resaying it, liftyourarmup.(Waituntiltheclientliftshisarmup.Usuallytherewillbeapauseofasecondor two.)Soyoucan lift your armupeven thoughyourmindsays you can’t.Did you notice how you hesitated though?We’re sousedtobelievingwhateverourmindstellus,foramomentthereyouactuallybelievedit.Nowrepeattoyourself,“Ihavetostandup,”and,asyousayit,remainseated.

SummaryofDefusionTechniquesThe diagram below (see figure 7.1) encapsulates many common defusiontechniques (but not even close to all of them). The box at the very bottom isentitled“TheClassics”becausetheseallcomefromtheveryfirstACTtextbookeverwritten,AcceptanceandCommitmentTherapy:AnExperientialApproach

toBehaviorChange(Hayesetal.,1999),andtheyrepresentsomeoftheoldestACT techniques inuse.Mostof theboxes are self-explanatory,but I’d like toquicklytouchonafewofthem.

ProblemSolving

Aclientwilloftenfeelveryguiltyifshehasthoughtsaboutkillingherself,orwishingsheweredead,or leavingherpartner,or runningawayfromherkids.Thesearecommonthoughts thatmanypeoplehavewhenunderstress,andwecan normalize, validate, and reframe them by pointing out, “This is just yourmindproblemsolving.This iswhat itevolved todo.”Defusionhappenswhenthe client can recognize the thought as merely an automatic product of thatamazing“problem-solvingmachine”wecallthemind.(Youcanlinkthistothe

Problem-SolvingMachineMetaphorinchapter2.)

Workability/Pragmatism

Thequestionsintheseboxeslookatthefunctionofthoughtsasopposedtothecontent.Theyallaskthesamequestion:howdoesitworkforyou,intermsoflivingarichandfulllife,ifyoufusewithathought—thatis,ifyouallowittohave a major influence over your actions? This neatly sidesteps the issue ofwhether thoughts are trueor false.Beloware a fewmoreuseful questions forclientstoaskthemselves.HelpfulQuestionsforUnhelpfulThoughts

Isthisthoughtinanywayusefulorhelpful?Isthisanoldstory?HaveIheardthisonebefore?WhatwouldIgetforbuyingintothisstory?Couldthisbehelpful,orismymindjustbabblingon?Doesthisthoughthelpmetakeeffectiveaction?If I let this thought guidemy actions,which directionwill ittake me? Towards vital, valued living, or struggle andsuffering?DoesthisthoughthelpmetobewhoIwanttobe?

Insight/SecondaryGains

Thequestionsintheseboxesalsolookatthefunctionofthoughts.Theclientdevelops insight into howher behavior changeswhen she fuseswith thoughtsand becomes aware of the costs and benefits of allowing this to happen.Thisapproachtothoughtsalsosidestepsthetrue/falseissue.

TheObservingSelf

Althoughwe’vealreadytouchedonself-as-context,commonlyknownasthe“observingself,”severaltimesinpreviouschapters,wewon’tcoveritindepthuntil chapter 10. I just want to mention here that once we’ve introduced theobserving self and run through some of the brief exercises in chapter 10, wehaveawayofinstantlyfacilitatingdefusion:“Canyoulookatthisthoughtfrom

theperspectiveoftheobservingself?”“Takeastepbackandseeifyoucanlookatyourthoughtsfromtheviewpointofyourobservingself,”“Notice,thisisyourmind in full flight—it desperatelywants you to get all caught up inwhat it’stellingyou.Seeifyoucangointothepsychologicalspaceofyourobservingselfand, fromthatspace,noticewhatyour thoughtsaredoing.”Orsimplestofall:“Let’slookatthatthoughtfromtheobservingself.”

KeepingDefusionSimple

Aswe’veseen,thereareallsortsofdefusiontechniquesandyoucancertainlyhave a lot of fun inventing your own, and/or getting your clients to do so.However,Ifindthereareplentyoftimeswhere,foronereasonoranother,Ijustlike to keep it all very simple. So here are a few of the simplest defusioninterventionsIknow:

“Noticewhatyourmind is tellingyou rightnow.”This simplephrase—or theshorterversion,“Noticethatthought”—isusuallyinstantlydefusing.Itinstantlygetsyourclienttonoticehisthoughtsratherthanbeingcaughtupinthem.Sure,it may not give him a huge degree of defusion, but it rapidly creates a littledistancefromhisthoughts.Thiscanthenbeincreasedbyaddinginanynumberofbriefdefusiontechniques.Forexample,youcanaskquestionslikethese:“Isthis a helpful thought?” “Howold is this story?” “Whatwould happen if youallowedyourselftogetallcaughtupinthis?Woulditbeagooduseofyourtimeand energy?” Alternatively you might go for responses in which the clientnoticestheform(seebelow).

Noticetheform.Youcanaskyourclienttonoticetheformofthethought:“Isitmadeupofwords,sounds,orpictures?Doyouseeitorhearitorjustsenseit?”Youmaychoose tofocuson thesound:“Whatdoes that thoughtsoundlike inyour head? Is it your ownvoice or somebody else’s? Is it loud or soft?Whatemotion can you hear in that voice?” Or you may focus on location andmovement: “Just close your eyes for amoment and noticewhere that thoughtseemstobe:Isitinfrontofyou,aboveyou,behindyou,insideyourhead,insideyourbody?Isitmovingorstill?Ifmoving,inwhatdirectionandatwhatspeedisitmoving?”

HandsAsThoughtsMetaphor.You’llfindthislittleexerciseinchapter2.It’sasimplemetaphorforfusionanddefusion,and,onceestablished,youcanuseittohelpclientsgagehowfusedtheyare,asinthistranscript:

Client:Idon’tdeserveanybetter.

Therapist:Soyourmind’stellingyoudon’tdeserveanybetter.Rightnow,howcaughtupinthatthoughtareyou?Areyoulikethis(holdsherhandsoverhereyes)orlikethis(restsherhandsinherlap),orsomewhereinbetween?

“That’san interesting thought.”This iswhat I saywhen Idon’tknowwhat tosay.Whenaclientsayssomethingthatthrowsme,triggersastrongreaction,orsetsmymind in a frenzy trying to figureouthow to respond, I find this littlephrase stops me from rushing in and getting caught up in the content. It’s asimplephrase that remindsbothmeand theclient thatnomatterwhatshehasjustsaid,whatwe’redealingwithisathought.Anditinvitesusbothtostopandlookatthethoughtratherthanleapingstraightintothecontentofthethought.Ioftenfollowthisstatementwithalongpause,whichallowsmetocentermyselfsoIcanrespondeffectivelyandmindfully.

ThankYourMind.Encourageyourclienttothankhismindforitsinput(Hayesetal.,1999).Youmightsay,“Whateveryourmindsaystoyou,nomatterhownastyorscary,seeifyoucansimplyreply,‘Thanks,mind!’”Dothiswithasenseofhumorandanappreciationofyourmind’samazingcapacityforgrabbingyourattentionwithanymeansatitsdisposal.”

Short phrases.When your client expresses a particularly negative, critical, orunhelpful thought, you could say “Nice one!” with a sort of nonchalant,humorous openness. Or you can use other words such as “lovely,” “neat,”“beautiful,”or“verycreative.”Oncetheclient“gets”theconcept,purpose,andexperience of defusion—and provided there is a good therapeutic rapport sothere’snochanceoftheclientfeelinginvalidatedorbelittled—thenyoucansaythese words in response to a wide variety of harsh criticisms, judgments,catastrophicthoughts,orother“nastystories.”Accompaniedbyacompassionategrimace,saying“Ouch!”canalsoworkwell.

IntroducingDefusion:Part3

Thethirdandfinalpartofthistranscriptpicksupabouttwentyminutesaftertheendofpart2.Duringthattime,thetherapisttooktheclientthroughseveralbriefdefusiontechniques,askinghertoworkwithsomeofthethoughtswrittenonthecard.Onceshecoulddiscriminatefusionanddefusionexperientially,he

thendidacticallyexplaineditasintheSimpleSummaryofFusionvs.Defusionfromchapter2.Duringallthattime,theclienthadthecardsittingonherlap,anongoing metaphor for defusion and acceptance. Occasionally she would lookdownatthecard,andthetherapistwouldask,“Hasithookedyou?”Whentheclient lookedupagain, the therapistwouldmakea light-heartedcomment like,“Ah.You’rebackagain.”Now, in part 3, the therapist ties the whole session together with another

defusion technique calledNaming theStory (Harris, 2007) that neatlydoublesupashomework.

Therapist:Solet’scomebacktoallthesethoughtsonthecardthere.I’mgoingtoaskyousomethinganditmayseemabitodd.

Client:I’mgettingusedtoit.

Therapist:Supposewetookall these thoughts,andall thepainful feelingsandmemoriesthatgowiththem,andweputthemallintoadocumentaryofyour life,oranautobiography.Andsupposeyouweretogivethatfilm or book a short title—the something something story, forexample,the“I’mnogood”storyorthe“lifesucks”story—thenwhatwouldyou call it?Andpleasemake sure the title acknowledges andhonors just how much you have suffered; don’t pick a title thattrivializesormakeslightofit.

Client:Um.Howaboutthe“uselessJane”story.

Therapist:Okay.And you’re quite sure that title acknowledges your sufferinganddoesn’ttrivializeit?

Client:Yeah.

Therapist:Okay.CanIhavethecardbackforamoment?(Theclientpassesitover.)I’mgoingtowritethattitleonthebackhere.(Thetherapistflipsthe card over and writes, AHA! HERE IT IS AGAIN! THE“USELESSJANE”STORY!)Okay,nowhere’swhat I’d likeyou todo,ifyou’rewilling.First,I’mgoingtoaskyoutoreadthroughallofthesenegativethoughtsonthisside.Thenflipthecardoverandreadwhat’swrittenontheback,andjustnoticewhathappens.

Client:Doyoumeanreaditoutloud?

Therapist: No. Just do it in your head. And I honestly don’t knowwhat willhappen.Areyouwillingtojustdoitasanexperiment?

Client: Sure. (The therapist passes the card to the client. She silently readsthroughallthenegativethoughts,afrownonherface.Thensheflipsthecardoverandreadsthestatementontheback.Thenshegrins.)

Therapist:You’resmiling.Howcome?

Client: It’s sort of amusing, I think. It’s like you said. I can see it as a story.That’swhatitis.It’sthe“uselessJane”story.

Therapist:Andareyoucaughtupinthisstory?

Client:No.It’s—thiscardsortofcontainsit.

Therapist:Soletmeaskyou,isitokaytohavethatstory?Haveyougotroomforit?

Client:Whenit’slikethis.

Therapist:Whenyou’redefusedfromit?

Client:Yeah.

Therapist:Well,that’swhatwe’reaimingfor.Youcan’tgetridofthestory—notwithout major brain surgery anyway—but you can learn to hold itlightly.

Client:Well,Icandoitinhere.ButIdon’tknowaboutoutside.

Therapist: I’m glad you said that. Because defusion is a skill, and it needspractice.LikeIsaidtoyoulastsession,ifyouwanttobecomeagoodguitarist,youneedtopracticeinbetweenyourguitarlessons.Soifyouwant to get better at doing this, would you be willing to practice acoupleofthingsbetweenthissessionandthenext?

Client:Likewhat?

Therapist:Well,thefirstthingistopracticenamingthestory.Forthenextweek,anytimeathoughtorafeelingoramemorythatislinkedtothisstoryshowsup, themoment younotice it, I’d like you to say to yourself,“Aha! There’s the ‘useless Jane’ story” or something like that. Butthat’sallyoudo.Justnameit.Sometimesit’llhookyoubeforeyou’reaware of it. That’s normal.We expect it.As soon as you realize it’shappened,saytoyourself,“Oh.Justgothookedbythe‘uselessJane’story.”Doesthatsounddoable?

Client:Yeah.I’llgiveitago.

Therapist:There’sanotherthingtoo.Andthismayseemabitodd,sopleasefeelfreetosaynoifyoudon’twanttodoit.

Client:Okay.

Therapist:Okay.Well,whatI’dlikeyoutodoiscarrythiscardaroundinyourpurseforthenextweekandpullitoutatleastfourorfivetimesaday.Read throughall thesenegative thoughts,and then flip thecardoverandreadwhat’swrittenontheback.

Client:Ihopenoonegetsintomypurse.

Therapist:(chuckles)Wouldyoubewillingtodothat?It’sfineifyoudon’twantto.ThereareplentyofotherthingsIcansuggest.

Client:No.That’sfine.

Therapist:Great.

NowLet’sUnpackThat:Part3

Okay,beforewewrapup,hereareafewthingstoconsider:

1. It doesn’t always go that smoothly. This client readilyembraced defusion. A few may find it difficult or miss thepoint. Others may return to the control agenda. If the latter,yourbestbetistojumpbacktocreativehopelessness.

2. The therapist could have used any number of defusiontechniques in this session. There’s nothing essential aboutwriting thoughts on a card or naming the story. However, asyou’veprobablyguessed,thetherapistisme—andthisdouble-combo is my personal favorite. I particularly like using anindexcardbecause(a)itprovidesagreatphysicalmetaphortowork with in session; (b) when your client takes it away, itreminds him of the session and jogs his memory abouthomework;(c)carryingthecardaroundinapurseorwalletisanongoingmetaphorfordefusionandacceptance;and(d)youcanwriteseveraldefusiontechniquesonthebackofthecard,ifyoulike,tojogtheclient’smemory.

3. Supposetheclient isreluctant totakethecardaway.Supposeshesays,“No,Idon’twantit.”Thatwouldindicatebothfusion

and experiential avoidance. In this case, you wouldn’t try tocoerceher.Insteadputthecardinherfileandkeepitformoreworkinthenextsession.

Fusionvs.BelievabilityFusion isn’t the same as believability.You can fusewith a thought you don’tbelieve, and you can defuse from a thought that you do believe. A couple ofyearsagoIgaveaworkshopandoneof theattendees—let’scallherNaomi—cameuptomeatthemorningcoffeebreakandtoldmethatshehadamalignantbrain tumor.The tumorwasuntreatable,andNaomihadonlya fewmonths tolive.Shewasattendingtheworkshopforpersonalreasons:tohelpcopewithherfear,andcometotermswithherimpendingdeath.Naomisaiditwashardtostayfocusedintheworkshop.Shekeptthinkingaboutdying:losingherlovedones,the tumor spreading throughherbrain, the inevitabledeterioration toparalysisandcoma,thendeath.Nowclearlyifyouhaveaterminalillnessthere’satimeandaplacewhenit’s

usefultothinkaboutdying:ifyou’rewritingawill,planningafuneral,makingmedicalcarearrangements,orsharingyourfearswithalovedone.Butifyou’reattending aworkshop for personal growth, it’s not useful to be so fusedwithyour thoughts about dying that you’remissing out on theworkshop. So afterlistening compassionately, I talked to Naomi about naming the story, and shechosethistitle:the“scarydeath”story.I asked her to practice naming the “scary death” story throughout the

workshop. By midway through the second day, she had significantly defusedfromthosethoughtsaboutdeathanddying.Theyhadnotalteredinbelievabilityone tiny bit, but she was now able to let them come and go without gettingcaughtupinthem.When we defuse from thoughts, they often do reduce in believability—but

fromanACTperspective, it’snot that important.Afterall,believinga thoughtsimplymeans taking it to be true. In ACT, we’re interested not in whether athoughtistrueorfalse,butwhetheritcanhelpuswithvaluedliving.

HomeworkandtheNextSessionHomeworkisessential.Defusion,likeanyskill,requirespractice.Notallclients

willdoit,ofcourse,butweshouldatleastaskthem.Homeworkcouldinvolveaquicktechniquetopracticeintermittentlythroughouttheday—likeNamingtheStory. Alternatively, if you took the client through Leaves on a Stream or amindful breathing exercise, you could ask him to practice that each day. Youmight like to record these exerciseswhile you’re doing them in session, thenburn them onto a CD and give them to your clients to assist their practice athome.Mostclientsfindthisveryhelpful. (ThesedaysIhaveprerecordedCDsthatIgivetoallmyclientsonthefirstsession.TheCDsareimaginativelytitledMindfulnessSkillsVolume1andMindfulnessSkillsVolume2,and,ifinterested,youcanpurchasethemfromwww.actmadesimple.com.)Anothertypeofhomeworkinvolvesaskingclientstofillinaworksheetsuch

asGettingHooked,whichyou’llfindattheendofthischapter.Foramoreinformalhomework,youmightsaysomethingasbelow:

Therapist: Between now and next session, I wonder if you’d be willing topracticeafewthings.First,I’dlikeyoutolearnmoreabouthowyourmindhooksyouand reelsyou in. Inwhat situationsdoes ithappen?What sort of things does it say to you?And as soon as you realizeyou’ve been hooked, just acknowledge it: “Aha! Hooked again.”Second, I’d like you to play around with one of those defusiontechniqueswecovered.(Selectoneorasktheclienttopickone.)Thenwhenever you’re feeling wound up, stressed, anxious, or whatever,identifythe“hot”thought—theonethatburnsyouthemost—andtrydefusingfromit.Third,I’dlikeyoutonoticeanytimesthatyourmindtriestohookyou,butyoudon’ttakethebait—youjustlettheminddoitsthing,butyoudon’tgetcaughtupinit.

PracticalTip You canmake homework a win-win experience. First,whenyouintroducethehomework,youcouldsay,“Dothisasanexperimenttoseewhathappens,”or“Dothistolearnmoreabouthowyourmindworks,”or “Do this to discovermoreabout yourself andhowyouoperate.”Second,saysomething like, “Let’smake thisawin-winproposition. Ihopeyou followthroughbecause,asIsaidearlier,practiceisimportant.However,ifyoudon’tdo it, I’d like you to notice what stopped you. What thoughts did you getcaughtup in,what feelingsdid youget intoa strugglewith, orwhat kindofthingsdidyoudo thatgot in theway?”During thenextsession, if theclienthasn’tfollowedthrough,youwouldaddressthesebarriersasinchapter13.

Thefirstthingtodoonthenextsession—preferablyafterabriefcheck-inandmindfulnessexercise—isreviewthehomeworkandseewhathappened.Wemayneedtodomoreworkarounddefusion,oriftheclienthasfallenintothecontrolagenda,wemayneedtomovetocreativehopelessness.Ifhe’smakingprogress(thatis,he’sfindingiteasiertodefusefromunhelpfulthoughts),wetraditionallymoveontoacceptanceandcontactingthepresentmoment—butwecouldmovetoanyotherpartofthehexaflex.Ofcourse,it’snotasifdefusioniscoveredentirelyinoneortwosessionsand

thennevermentionedagain.Asmentionedat thestartof thischapter, ineverysinglesession,wehelpourclientsdefusefromunhelpfulcognitionswithsimpleinterventions like these: “Noticewhat yourmind is telling you. Is this an oldstoryoranewone?”or“Soifyoulet that thoughtdictatewhatyoudo,will itleadyoutovitalityorsuffering?”

HomeworkforYouIsthistheendofdefusion?Noway.We’llberevisitingitthroughoutthebook.Butbeforereadingon,let’stalkaboutyourhomeworkforthischapter.Hereareafewsuggestions:

1. Tryoutallthedefusiontechniquesonyourself.You’rethebestpersontopracticeon!

2. Read all the exercises, metaphors, and psychoeducationalcomponentsoutloud,asiftakingaclientthroughthem.

3. Review the cases of two or three clients, and identify keythoughts that they’re fusing with. Especially look for fusionwith past, future, self, rules, reasons, and judgments. Thenconsiderwhichdefusiontechniquesyoumighttrywiththem.

And if you don’t do any of this, identify what’s stopping you, in terms offusion, experiential avoidance, and ineffective action. What thoughts are youfusingwith?(Forexample,“Ican’tbebothered”or“I’lldoitlater”or“Idon’tneed to do this stuff; reading is enough.”)What feelings are you avoiding—reluctance,impatience,apathy,anxiety?Whatineffectiveactionsareyoutaking—procrastinating,distractingyourself,skimreading?

SummaryTheabilitytothinkisvery,veryuseful,butthegreaterthedegreeoffusionwithourthoughts,themoreinflexibleourbehaviorbecomes.Wefacilitatedefusioninevery session of ACT by repeatedly asking clients to notice what they’rethinking,discriminatefusionfromdefusion,andlookattheirthoughtsintermsofworkability.Andweneverneedtodebatewhetherathoughtistrueorfalse—allweneedtoaskissomethinglikethis:“Ifyouholdontightlytothisthought,willithelpyoutolivethelifeyouwant?”

Chapter8.OpenUpAcceptanceinaNutshell

InPlainLanguage:Acceptancemeansallowingourthoughtsandfeelingstobeas theyare, regardlessofwhether theyarepleasantorpainful;openingupandmakingroomforthem;droppingthestrugglewiththem;andlettingthemcomeandgoastheynaturallydo.

Aim:Toallowourselvestohavepainfulprivateexperiencesifandwhendoingsoenablesustoactonourvalues.

Synonyms:Willingness,expansion.

Method: Make full, open, undefended psychological contact with unwantedprivateexperiences.

When to Use: When experiential avoidance becomes a barrier to values-congruentaction.

AFewWordsonAcceptanceClients often don’t understand what acceptance is; they commonly think itmeansresignation,tolerance,“grittingyourteethandputtingupwithit,”orevenlikingit.Therefore,earlyonintherapy,it’sbesttoavoidtheword.Traditionally“willingness” is used as an alternative—that is, the willingness to have yourthoughtsandfeelingsastheyare,inthismoment.Anothertermyoucanuseis“expansion”; this fitsnicelywith themetaphorical talkofopeningup,creatingspace,andmakingroom.Hereareafewotherstoplayaroundwith:

Allowittobethere.Openupandmakeroomforit.Expandaroundit.Giveitpermissiontobewhereitalreadyis.Letgoofstrugglingwithit.Stopfightingwithit.Makepeacewithit.Giveitsomespace.Softenuparoundit.

Letitbe.Breatheintoit.Stopwastingyourenergyonpushingitaway.

AQuickReminder

Sorry to keep harping about this, but it’s very important, and many newpractitioners get the wrong idea: for the third (and final) time, we’re notmindfulness fascists in ACT. We don’t advocate acceptance of every singlethoughtandfeeling.Weadvocateacceptanceifandwhenitenablesustoactonourvalues.Also, acceptance is short for “experiential acceptance.” It’s about actively

acceptingourprivateexperiences:thoughts,feelings,memories,andsoon.Itisnot about passively accepting our life situation. ACT advocates that we takeaction to improve our life situation as much as possible: acceptance andcommitment! For example, if you were in an abusive relationship, we’dadvocatethatyoumakeroomforallthepainfulthoughtsandfeelingsshowingup(insteadofdoingself-defeatingthingssuchasdrinking,smoking,overeating,ruminating, worrying, and so on)—and simultaneously act on your values toeitherimprovetherelationshiporleaveit.

GettingtoAcceptanceIn many protocols, and in the original 1999 ACT textbook,acceptance/willingnessfollowscreativehopelessness/confrontingtheagenda.Ifthat’swhereyou’recomingfrom,youcouldsegueintoitlikethis:“Okay,soiftrying to control how you feel doesn’t work too well, then what’s thealternative?” The Pushing Against the Clipboard Metaphor (chapter 6) lendsitselfverynicelytothistransition:

Therapist: So let’s just do a quick recap. (The therapist quickly recaps theclipboardmetaphorandgetstheclientpushingagainstitoncemore.)Soyou’repushingandpushingandpushing,andit’stakingupallyourtimeandyourenergy.Yourshouldersaretired,andyou’rehemmedin,andyoucan’tdoanythingusefullikedriveacarorcookdinnerorhugsomeoneyou lovewhileyou’redoing this.Now(pulls theclipboardaway) let it just sit there on your lap. (Therapist lays the clipboard

gentlyontheclient’slap.)Nowhow’sthat?Isn’tthatalotlesseffort?

Client:Well…yes.It’slesseffort.Butit’sstillthere.

Therapist: Absolutely. Not only is it still there, it’s even closer to you thanbefore.Butnoticethedifference:nowyou’refreetodothethingsthatmakeyourlifework.Youcanhugsomeoneyoulove,cookdinner,ordriveacar.It’snotdrainingyou,tiringyou,tyingyouup,closingyouoff.Isn’tthateasierthanthis?(Therapistmimespushingtheclipboardaway.) Now suppose you learned how to do this with your feelingsinsteadoffightingwiththemororganizingyourlifearoundtryingtoavoidthem.Howdoyouthinkthatmightbenefityou?

To lead into acceptance from defusion, you could say, “So far we’ve beenlookingatpainful thoughts,butwhatabout feelings?”or“Yourmindsays thisfeelingisunbearable.Howaboutwecheckitoutandseeifthat’sthecase?”Fromvalues: “Soasyou talkabout thesevalues,what feelings showup for

you?”Fromcommittedaction:“What feelingsare likely to showup foryouwhen

you take this action?” or “So as you think about doing this, what’re youfeeling?”or“Whatfeelingswillyouneedtomakeroomforinordertodothis?”Fromself-as-context:“Sofromtheperspectiveoftheobservingself,let’snow

takealookatsomeofthesefeelingsyou’vebeenstrugglingwith.”One of our challenges is making acceptance acceptable to our clients. The

moreexperientiallyavoidantourclients,themorereluctantthey’llbetoacceptunpleasant private experiences. So we’ll need to go more slowly and moregently.We’llgenerallyneedtodomoreworkaroundcreativehopelessness,andwemaywellhavetogobacktoitrepeatedly.Workaroundvaluesisalsoveryimportanthere.Weneedtomakeaclearlink

between acceptance and vitality—that accepting this pain is in the service ofsomethingimportant,meaningful,andlifeenhancing.Themagicwandquestionis oftenveryuseful: “If Iwaved amagicwand so that these feelings couldn’tholdyoubackinanyway,whatwouldyoudodifferentlyinyourlife?”Onceweknowtheanswer,wecansay,“Okay.Soifthat’swhatyouwanttodowithyourlife, let’smake itpossible. Idon’thaveamagicwand,butwecan learn someskillsheresothatthesefeelingsnolongerholdyouback.”Ofcoursewealsoneedtokeepthisworksafe.Wewanttobemindfulthatwe

don’tlectureorcoerceourclients;wealwaysaskpermission,alwaysgivethem

achoice,andletthemknowtheycanstopatanypoint.

TheAcceptanceToolKitAs with all six core ACT processes, there’s a wide variety of techniquesavailabletoyou.Sometakeonlyafewseconds,andotherstakeuptofifteenortwentyminutes.So,giventhatI’mabouttoopenupawholenewtoolkit,Ifeelthe need to give you a gentle reminder (sorry): acceptance is a process, not atechnique.Thetoolsandtechniquesareusedtolearntheprocess.

AcceptanceofEmotions

Now we’re going to kick off with a long mindfulness exercise, which isconstructed from eight different techniques strung together: observe, breathe,expand, allow, objectify, normalize, show self-compassion, and expandawareness.AfterwardI’llunpackit.Asusual,I’dlikeyoutoreaditoutloudasiftalkingtoaclient.(However,Irecognizeyoumaynotwishtodothisifyou’rein a library!)The ellipses indicate brief pauses of one to three seconds. (Alsoplease note: with my clients, and throughout this book, I use the words“feelings”and“emotions”interchangeably.)

OBSERVE

Therapist: I inviteyou to situpright inyourchairwithyourbackstraightandyour feet flaton the floor.Mostpeople find they feelmorealertandawake sitting thisway, so check it out and see if this is the case foryou.Andeithercloseyoureyesorfixthemonaspot,whicheveryouprefer.Andtakeafewslow,deepbreaths,andreallynoticethebreathflowing in and out of your lungs. (Pause10 seconds.)Now quicklyscan your body from head to toe, starting at your scalp andmovingdownward. And notice the sensations you can feel in your head…throat…neck…shoulders…chest…abdomen…arms…hands…legs…andfeet.Nowzoominonthepartofyourbodywhereyou’refeelingthisfeelingmostintensely.Andobservethefeelingclosely,asifyou’reacuriousscientistwhohasneverencounteredanything likethisbefore.(Pause5seconds.)Observethesensationcarefully…Letyourthoughtscomeandgolikepassingcars,andkeepyourattention

onthefeeling…Noticewhereitstartsandwhereitstops…Learnasmuch about it as you can… If you drew an outline around it,whatshapewouldithave?…Isitonthesurfaceofthebodyorinsideyou,or both? … How far inside you does it go? … Where is it mostintense?…Where is itweakest? (Pause5 seconds.) If you drift offintoyourthoughts,assoonasyourealizeit,comebackandfocusonthesensation…Observeitwithcuriosity…Howisitdifferentinthecenterthanaroundtheedges?Isthereanypulsationorvibrationwithinit? … Is it light or heavy? … Moving or still? …What is itstemperature? … Are there hot spots or cold spots? … Notice thedifferentelementswithinit…Noticethatit’snotjustonesensation—there are sensationswithin sensations…Notice the different layers.(Pause5seconds.)

BREATHE

Therapist: As you’re observing this feeling, breathe into it … Imagine yourbreath flowing into and around this feeling … Breathing into andaroundit…

EXPAND

Therapist:Andasyou’rebreathingintoit,it’sasif,insomemagicalway,allthisspace opens up inside you… You open up around this feeling …Makespaceforit…Expandaroundit…Howeveryoumakesenseofthat…Breathingintoitandopeninguparoundit…

ALLOW

Therapist:Andseeifyoucanjustallowthisfeelingtobethere.Youdon’thaveto like it orwant it… Just allow it… Just let it be…Observe it,breatheintoit,openuparoundit,andallowittobeasitis.(Pause10seconds.)Youmayfeelastrongurgetofightwithitorpushitaway.Ifso, just acknowledge the urge is there without acting on it. Andcontinueobservingthesensation.(Pause5seconds.)Don’t try togetrid of it or alter it. If it changes by itself, that’s okay. If it doesn’tchange, that’sokay too.Changingorgetting ridof it isnot thegoal.Youraimissimplytoallowit…toletittobe.(Pause5seconds.)

OBJECTIFY

Therapist:Imaginethisfeelingisanobject…Asanobject,whatshapedoesithave?… Is it liquid, solid, or gaseous?… Is itmoving or still?…Whatcolorisit?…Transparentoropaque?…Ifyoucouldtouchthesurface,whatwoulditfeellike?…Wetordry?…Roughorsmooth?…Hot or cold?… Soft or hard? (Pause 10 seconds.) Observe thisobject curiously,breathe into it, andopenuparound it…Youdon’thavetolikeitorwantit.Justallowit…andnoticethatyouarebiggerthanthisobject,…nomatterhowbigitgets, itcannevergetbiggerthanyou.(Pause10seconds.)

NORMALIZE

Therapist:Thisfeelingtellsyousomevaluable information…It tellsyouthatyou’reanormalhumanbeingwithaheart…ittellsyouthatyoucare…that therearethingsinlife thatmatter toyou…Andthis iswhathumans feel when there’s a gap between what we want and whatwe’ve got … The bigger the gap, the bigger the feeling. (Pause 5seconds.)

SHOWSELF-COMPASSION

Therapist: Take one of your hands and place it on this part of your body…imagine that this is ahealinghand… thehandof a loving friendorparentornurse…and feel thewarmth flowing fromyourhand intoyourbody…nottogetridofthefeelingbuttomakeroomforit…tosoftenupandloosenuparoundit.(Pause10seconds.)Holditgently,asifit’sacryingbabyorafrightenedpuppy.(Pause10seconds.)Andlettingyourhandfall,onceagainbreatheintothefeelingandexpandaroundit.(Pause10seconds.)

EXPANDAWARENESS

Therapist:Life is likeastageshow…andonthatstageareallyour thoughts,and all your feelings, and everything that you can see, hear, touch,taste,andsmell…andforthelastfewminutes,wedimmedthelightsonthestage,andweshinedaspotlightonthisfeeling…andnowit’s

timetobringuptherestofthelights…Sobringupthelightsonyourbody…noticeyourarmsand legsandheadandneck…andnoticethatyou’reincontrolofyourarmsandlegs,regardlessofwhatyou’refeeling…Justmovethemaroundalittletocheckthatoutforyourself…andnowtakeastretch,andnoticeyourselfstretching…andbringupthelightsontheroomaroundyou…Openyoureyes,lookaround,andnoticewhatyoucansee…andnoticewhatyoucanhear…andnotice that there’snot justafeelinghere…there’safeeling insideabody,insidearoom,insideaworldfullofopportunity…andwelcomeback!

PracticalTip Keepyourowneyesopenwhendoinganymindfulnessexercise andmindfully observe the client. Look out for signs of distress ornoddingoff,and interveneasrequired.Whenyoudo these longerexerciseswithclients,it’sagoodideatokeepcheckinginwithsimplequestionssuchas“Howareyoudoing?Areweokaytokeepgoingwiththis?”

You can mix and match these eight techniques—observe, breathe, expand,allow, objectify, normalize, show self-compassion, expand awareness—in anywayyoulike.Youcanstretchthemoutorcutthemdown,useanyoneofthemalone,oranynumberincombination.Intheabovescript,wefocusedonjustonesensation—the most intense one. Often this is enough so that acceptance“spreads” through the whole body. But sometimes there may be other strongsensations in different parts of the body, in which case, we can repeat theprocedurewitheachone.Aswe take the client through this exercise, one of two thingswill happen:

eitherherfeelingswillchange—ortheywon’t.Itdoesn’tmattereitherway.Theaimisnottochangeorreducefeelingsbuttoacceptthem—toallowthemtobetherewithoutastruggle.Why?Becausewhenwearen’tinvestingsomuchtime,energy, andeffort in trying tocontrolhowwe feel,wecan invest it instead inactingonourvalues.Ourclientsoftenfindthatwhentheyacceptapainfulemotionorsensation,it

reducessignificantlyorevendisappears.Whenthishappens,weneedtoclarifythat (1) this is abonus,not thegoal, and (2) itwon’t alwayshappen, sodon’texpect it.Wecouldsay,“Here’s thereality.Whenweacceptourfeelings, they

mayormaynotreduceinintensity.Wecan’tpredictit.Butwecanpredictthis:whenwetrytocontroloravoidourfeelings,it’sverylikelythatthey’llincreaseinintensityandcauseusmoredistress.”Ifwedon’texplicitlyaddressthisissue,then,aswithdefusion,ourclientswill

startusingacceptancetechniquestotrytocontroltheirfeelings.And,ofcourse,thatwillsoonbackfire.Theclientwillthenbedisappointed,andcomebackandcomplain, “It isn’tworking.”We respond to this aswith similar issues arounddefusion(seechapter7,It’sNotWorking!).

Practical Tip Suppose your client reports something like, “Thefeeling’sgone”or“Icanhardlyfeelitnow”or“Ifeelsomuchbetternow.”Ifyousmileandsay,“That’sgreat!”,thenyou’vejustreinforcedthecontrolagenda,andthechancesaretheclientwillnowtrytoturnthisintoacontroltechnique.So instead, aim for nonchalance: “Enjoy that when it happens. But pleasedon’t think this isamagicwandtocontrolyour feelings. It’snot.Whatwe’reaiming for is to let go of the struggle with our feelings so we can put ourenergy intodoing the things thatmake lifemeaningful.” If yourclient seemsconfusedorambivalent,youcangobackand revisit creativehopelessness.ThePushingAgainsttheClipboardMetaphorisafastandeffectivewaytodothis.

UnpackingtheAcceptanceofEmotions

Section1:ObserveInordertoacceptafeelingorsensation,wemustfirstnoticeit.(Thisiswhere

contacting the present moment overlaps with acceptance.) The metaphor of“observing like a curious scientist” helps to encourage openness and curiositytowardthefeeling:approach,insteadofavoidance.Simplyobservingornoticingafeelingwithcuriosityoftenleadstoacceptance—andifnot,it’satleastastepintherightdirection.TheTen-SecondVersion

Therapist:Noticethatfeeling.Noticewhereitis.Noticewhereit’smostintense.

SECTION2.BREATHE

Manyclients—butnotall—findbreathingintoafeelingenablesthemtomakeroomforit.Slow,diaphragmaticbreathingseemsparticularlyusefulforalotofpeople.TheTen-SecondVersion

Therapist:Noticethatfeelingandgentlybreatheintoit.

SECTION3.EXPAND

Metaphorical talk around making room, creating space, opening up, orexpandingisoftenhelpful.TheTen-SecondVersion

Therapist:Noticethatfeeling,andseeifyoucanjustopenuparounditalittle—giveitsomespace.

SECTION4.ALLOW

Again and again and again,we remind our clients that acceptance does notmeanliking,wanting,orapprovingofathoughtorfeeling:itmeansallowingit.TheTen-SecondVersion

Therapist: I knowyou don’t like this feeling, but see if you can just let it sitthereforamoment.Youdon’thavetolikeit—justallowittobethere.

SECTION5.OBJECTIFY

Quite often our clients, especially those who are very visual, willspontaneouslydothiswhenweasktothemobservetheirfeelings.Whenweturnafeelingintoanobject,ithelpsusexperiencethatthisfeelingisnotbiggerthanweare;wehaveplentyofroomforit.In somemodels of therapy, youmight try dissolving the object with white

lightorshrinkingitinvariousways.InACTwewouldnotdothis,asthatwouldreinforcetheagendaofcontrol.However,asithappens,theobjectalmostalwaysspontaneouslychanges.Typicallyitgetssmallerorsofter,butsometimesitgetsbigger.Ifthelatter,wemightsay,“Nomatterhowbigthisfeelinggets,itcan’tgetbiggerthanyou.Soobserveit,breatheintoit,andmakemoreroomforit.”The point iswe don’t need to shrink or remove the object;we just need to

makeroomforit.Withacutegriefwork,Ioftenhaveclientsleavingmyofficewithaheavyblackrockinsidetheirstomachorathickplankofwoodontheirchest.That’sonlytobeexpected.Majorlossesgiverisetopainfulfeelings.Let’shelpourclientstocarrythosefeelingswillingly,insteadofgettingboggeddowninastrugglewiththem,sotheycanengagefullyinlifeanddowhatmatters.TheTen-SecondVersion

Therapist:Ifthisfeelingwasanobject,whatwoulditlooklike?

SECTION6.NORMALIZE

Ifwecanrecognizethatit’snormalandnaturaltohavepainfulfeelings—thatthisisaninevitablepartofbeinghuman—we’remorelikelytoacceptthem.Incontrast,supposeyourclientisfusedwithastorylikethis:“Normalpeopledon’tfeel thisway.Theremustbesomethingwrongwithme.”Whateffectwill thathaveonhisattitudetowardhisfeelings?Instead of a ten-second version, here are two longer interventions that can

helpestablishamorerealisticviewofhumanemotion.NineBasicEmotions

Therapist: I’m going to run through a list of the nine basic human emotions.There’s debate about this, butmost “experts” tend to agree on thesebasics.AsIcallthemout,Iwantyoutogivemethethumbsuporthethumbsdown.Thumbsupmeansit’sa“good”or“positive”emotion.Thumbsdownmeansit’sa“bad”or“negative”emotion.Nohesitationallowed—just thumbs up or thumbs down. Ready? Love… Joy…Curiosity…Anger…Fear…Sadness…Guilt…Shock…Disgust.Nowisn’tthatinteresting?Youdidathumbs-downforsixoutofnineofthenormalhumanemotions.Getthat:sixoutofnine.Thistellsyousomething about what it is to be human. Two-thirds of the normalhuman emotions that every human being will repeatedly experiencethroughout lifedonot feel good!We live in a feel-good society thattellsusweshouldfeelgoodallthetime,buthowrealisticisthat?

TheRealityGapIcoinedthephrase“realitygap”inreferencetothegapbetweentherealitywe

haveandtherealitywedesire:thebiggerthatgap,themorepainwefeel.

Therapist:There’sagapherebetweentherealityyouwantandtherealityyouhave.Andit’snotjustasmallgap—it’shuge.Soletmeaskyouthis:Whatwouldyouexpectanyhumanbeingtofeelwhenthere’ssuchabig gap between what you want and what you have? (Usually theclientwillnameemotionssimilartoherown.Ifnot,youcannametheemotions yourself.) That’s right. Sowhat you’re feeling is a normalhumanemotion.Thisiswhatwefeelwhenthere’sarealitygap.Andthebiggerthegap,thebiggerandmorepainfulthefeeling.

SECTION7.SELF-COMPASSION

Self-compassion—being kind and caring toward yourself—adds an extraelement toacceptance.You’lloftennoticethisclinically:you’llseeyourclient“softeningup”faciallyandeasingthetensioninhisbody.Whentheclientlayshis hand on a painful feeling, it often promotes acceptance very powerfully.Presumablythewarmsensationsofthehandandtherichmetaphorof“healinghands”contributetotheeffectiveness.TheTen-SecondVersion

Therapist:Justplaceahandwhereyoufeelthismostintensely—andseeifyoucanopenuparoundit…Holditgently.

SECTION8.EXPANDAWARENESS

At times, we may want to focus on our emotions—such as when we’relearningamindfulnessskillorgrievingforalovedone.However,muchofthetime, if we’re too intently focused on our feelings, they’ll get in the way ofliving life. At times, clients will leave your session with strong unpleasantfeelings or sensations in their body. For example, this is very likely whenworkingwithchronicpainsyndrome,acutegriefduetoasuddenloss,oranxietyaboutsomeimpendingmajorcrisisorchallenge.Wewantclients tobeable tomake room for their feelingsand engagewith theworld around themand dowhatevertheyneedtodotomaketheirlifework.The Stage Show Metaphor assists the concept of narrowing attention and

expandingawareness.Asweexpandawareness, thefeeling isno longer in thespotlight; it’s simply one of many actors on a well-lit stage. This in itselffacilitatesacceptance:whenit’sjust“onepartofthewholeshow,”thefeelingnolongerseemssobigandthreatening.

TheTen-SecondVersion

Therapist:Noticethefeeling.Andalsonoticeyourbreathing…andnoticeyourbody.Alsonoticetheroomaroundyou.Noticethere’salotgoingon.

EnhancingAcceptance

Acceptance is implicit inmindfulness, but you can enhance the acceptance“element”ofanymindfulnessexercisebyaddinginsimpleinstructionssuchasthese:

“Allow your feelings to be as they are. Don’t try to changethemorcontrolthem.”“If a difficult feeling shows up for you, such as anxiety orbackache, simply acknowledge it. Silently say to yourself,‘Here’safeelingofbackache’or‘Here’safeelingofanxiety.’”

Also remember thatacceptance isalways in theserviceofvaluedaction, sowecanenhance itbyexplicitly linking it tovalues: “Areyouwilling tomakeroomfor thisfeelingif thiswillenableyoutodowhatreallymatters toyou?”From an ACT perspective, there’s no point in making room for our painfulprivate experiences unless that enables us to take meaningful, life-enrichingaction.TheWadeThroughtheSwampMetaphor(Hayesetal.,1999)illustratesthis.

WADETHROUGHTHESWAMPMETAPHOR

Therapist: Suppose you love mountain climbing. It’s something you’reabsolutely passionate about. And one day you set out to climb thismountainthatyou’veheardgreatthingsabout.Butwhenyougetclosetothemountain,youdiscoverthataswamprunsallthewayaroundit.It’s a big surprise.No one told you about it. But now the onlywayyou’ll get to climb thatmountain is towade through the swamp.Sothat’swhatyoudo.Youwadethroughtheswamp.Youdon’twallowinit,justforthesakeit.Youwadethroughtheswampbecauseclimbingthatmountainmatters.

DEFUSIONANDACCEPTANCE:HANDINHAND

Defusionandacceptancearebothaboutopeningupandmakingroom.Whenwe accept a thought—notice it andmake room for it—that involves defusion.Whenwedefuse froma thought—see it forwhat it is (wordsorpictures) andallow it to be there—that involves acceptance. We tend to reserve the term“defusion”fordealingwiththoughts,images,andmemories,andwetendtotalkabout acceptance when dealing with emotions, sensations, and urges.Colloquiallywecanlumpthembothtogetheras“openingup”.You’ll generally find it much easier to facilitate acceptance if you’ve

previouslydonesomeworkarounddefusion.Forexample,supposeyourclient,whilebreathing into feelingsof anxiety, protests, “It’s toohard. I can’t do it.”Youmightsay,“Okay,soyourmind’stellingyouit’stoohard.Isitokayifweletyourmindsaythat,andwestickwiththeexercisealittlelonger?”

PSYCHOEDUCATION

Psychoeducationaboutemotionscanplayabigroleinacceptance.Weoftentalktoclientsabouttheevolutionaryoriginsofemotions,andhowtheymaybebeneficialinsomecontextsandanuisanceinothers.Forexample,weoftentalkabout the fight-or-flight response: how it’s triggered by perceived threats orchallenges; how that leads to fear, anxiety, and stress; and how, in somesituations,anxietycanenhanceperformanceorprovideusefulmotivation.Almost every client we see is likely to be somewhat avoidant of anxiety.

(Aren’tyou?IknowIam!)Soone thingwewant toemphasize is thatchangealmostalwaysbringsanxiety,andifwe’renotwillingtomakeroomforit,we’regoingtohavedifficultymakingchanges.Thequestionweaskisthis:“Areyouwilling tomake room for this anxiety in order tomake the changes that willenrichyourlife?”Wecanaccentuatethisbyaskingtheclienttokeepajournalofeverythingshegivesupormissesoutonbecauseshe’sunwillingtomakeroomforanxiety.Anotherimportantinsightforallourclientsisthatourfeelingsdonotcontrol

our actions. Influence, yes—control, no. For this, we can use the exercisesmentioned inchapter7: IfOurThoughtsandFeelingsControlledOurActionsandHaveYouEverHadThoughtsandFeelingsYouDidn’tActOn?Farmorepowerful, though, is to workwith strong feelings in session. If your client isfeeling strong anger, fear, sadness, or other emotions, youmight say, “Noticethese emotions showing up—and notice that even though they’re intense, youhavecontrolofyourarmsandlegsandmouth.Don’ttakemywordforit—check

it out.Move your arms and legs around, play aroundwith your hands, makesomegestures.Noticethatyoucan’tcontrolyourfeelings,butyoucancontrolyouractions.”Ifaclientisfeelingstronganger,youmightaskhimtotellyouinawhisperhowangryheis—toshowhimhehascontroloverwhetherheyellsornot.Ifaclienthasstronganxiety,youmightaskhertowalktodifferentpartsoftheroom,andeventoleaveandreturn,todemonstrateshecancontrolwhereshegoesandwhatshedoes.Andonelastcomponenttoconsiderhere:ifaclienthaslimitedawarenessof

his own emotions, we can teach him to recognize and label them. This is anessentialskillforemotionalintelligence.

CommonAcceptanceTechniquesFigure 8.1 below encapsulates many common acceptance techniques. We’vecovered most of them already. In finishing off this chapter, I want to brieflytouchonthreeboxes(fromfigure8.1): theObservingSelf, theChoicetoFeel,andMetaphors.

TheObservingSelf

Once we’ve done some work around self-as-context—we’ll look at this indetailinchapter10—wehaveyetanotherpathwaytoacceptance.Wecouldsay,“See if you can go into the psychological space of your observing self—andfromthatspaciousawareness, lookat this feeling,noticewhere it is,andwhatit’smadeof.”Ormoresimply,“Lookatthisfeelingfromtheobservingself.”

TheChoicetoFeel

This is a very powerful question, adapted from the workshops of KellyWilson:“SupposeIcouldgiveyouachoice.OptionA:youneverhavetofeelthispainfulfeelingeveragain—ever.Butitmeansyouloseallcapacitytoloveandcare.Youcareaboutnothingandnoone.Nothingmatters.Noonematters.Life becomesmeaningless because you don’t care about anythingwhatsoever.OptionB:Yougettoloveandcare.Peoplemattertoyou.Lifematters.Youcareaboutwhatyoudo,andwhathappens.Youcareaboutfriendsandfamily.You

gettobuildlovingrelationships.Lifebecomesmeaningful.Andwhenthere’sagapbetweenwhatyouwantandwhatyou’vegot,painfulfeelingslikethisonewillshowup.Whichoptiondoyouchoose?”Thisquestionconfrontsuswith thehumancondition: ifwe’regoing to love

and care, then we’re going to feel pain. Love and pain are intimate dancepartners; theyalwaysgohandinhand.Inordertoavoidpain,somepeopletrydesperatelyhardnottocareorloveorwant.Theymaytrytodothisinamyriadof differentways, fromdrugs and alcohol to socialwithdrawal to proclaiming“Nothingmatters”or“Idon’tcareaboutanything.”Obviouslysuchattemptsaredoomedtofailure:theyparadoxicallyendupcreatingmorepain,notless.Almost all clients choose optionB, but once in a bluemoon, someonewill

pickoptionA.Ifso,youcouldreply,“Ofcourse,that’swhatyouwouldchoosenow because your pain seems so unbearable. But in the ideal world, whichoption would you like to choose?” At that point, the client almost alwayschoosesoptionB,andthentherapybecomesaboutmakingthatchoicepossible.Thisquestionisparticularlyusefulingriefworkandnaturallyflowsintovalues,aswe’llseeinchapter11.If the client still chooses option A, we can turn this into a brief creative

hopelessness intervention.We could say, “I completely understandwhy you’dchoosethat.Lifeissopainfulrightnow,you’ddoanythingtostopthepain,nomatterwhatthecost.Soletmeaskyou:isn’tthiswhatyou’vebeentryingtodo?Whenyou takedrugs/get drunk/take anoverdose/stay in bed all day/withdrawfromyourfriends/cutyourselfwithaknife—aren’tthosealljustwaysoftryingtostop thepain?Andhow is thatactuallyworking? In the long run,are thesestrategiesactuallymakingyourlifelesspainfulormorepainful?”

Metaphors

There are a huge number ofmetaphors for acceptance, and the ones in thisbox are a mere sprinkling. Passengers on the Bus (Hayes et al., 1999) andDemonsontheBoat(Harris,2007)areveryversatileinthattheyencapsulatetheentire hexaflex in onemetaphor, and can therefore be used to accentuate anyprocess in any session. Both metaphors are essentially the same. I changedPassengersontheBustoDemonsontheBoatforthreereasons:(1)demonsandboats have amuch richer cultural heritage than passengers and buses; (2) justabouteverysinglebookonACThasPassengersontheBusasakeymetaphorandIfeltlikeachange;and(3)that’sjustthekindofguyIam.

DEMONSONTHEBOATMETAPHOR

Therapist:Imagineyou’resteeringaboatoutatsea.Andthereareallthesebig,scary, ugly demons that live beneath the deck. And they’vemade adealwithyou.As longasyoudrift aimlesslyout at sea, they’ll staybeneaththedecksoyoudon’thavetolookatthem.Sothisisokayfora while. But then you see all these other boats, heading toward theshore.Andyouknowthat’swhereyoureallywant togo.You’vegotmaps andplans—there are places youwant to see. So youpluck upcourage and you turn the tiller and head toward the shore. But theinstanttheboatchangesdirection,allthedemonsrushupfrombelowthedecksandthreatentotearyoutopieces.Andtheylookmean.Andthey’rehuge.Razor-sharpteeth.Massivehorns.Enormousclaws.Andtheysay,“We’regoingtotearyoutoshreds.We’regoingtoripyoutopieces.”Soyou’reterrified.Andyougo,“Whoa!Sorry,demons!”Andyouturntheboataroundandheadbackouttosea.Assoonastheboatis drifting aimlessly once more, the demons disappear. You go“Phew!” and breathe a sigh of relief. And for a while, it’s okay—driftingwithoutanydirection.But thenyouseeall thoseotherboatsheadingtowardtheshore.Andyoulookdownatyourmapsandyourplans.Andyouknowwhereyou reallywant togo.Soyoupluckupcourage,turnthetiller,andtheinstanttheboatchangesdirection,thedemons are back. Huge teeth, huge claws: “We’re gonna kill you!”Nowhere’sthething:althoughthesedemonshavebeenthreateningtokill you your whole life, they’ve never actually harmed you. That’sbecausetheycan’t.Theyhavenocapacity toharmyou.All theycandoisthreatenyou.Andaslongasyoubelievethatthey’regoingtodothethingstheysaythey’regoingtodo,they’vegotcontroloftheboat.So—armedwith this knowledge—if heading toward the shore reallymatters, what do you need to do? (Elicit response from the client.)That’s right; you need to keep your hands on the tiller and keepheadingtowardtheshore.Thedemonswillthengatherroundandtryto intimidate you. But that’s all they can do. And as you let themgather around, you’ll be able to get a good look at them in directsunlight.Andyou’llrealizethatthey’renowherenearasbigandnastyastheyappeared; theywereusingspecialeffects tomakethemselvesseem ten times their real size. And as you keep your hands on thattiller,headingtowardtheshore,younoticethat there’sanentireboathere.Andthere’sthesky,andthesea,andthesun,andthewind—and

fish, and birds, and other ships; there’s a whole world out there toexplore and appreciate, not just these demons. And notice that nomatterhowfaryouarefromtheshore,theinstantyouturnthattiller,you’reonanadventure;you’re instantlymoving in thedirectionyouwanttogo,insteadofdriftingaimlessly.

Iftheclientsuggeststhrowingthedemonsoverboard,wereply:

Therapist:Butthere’saninfinitenumberofdemons.Nomatterhowmanyyouthrowoverboard,morewillcome.Andwhileyou’retryingtogetridof them, who’s steering the boat? It could crash on the rocks orcapsize.

Iftheclientsuggestsjumpingoverboard,wereply:

Therapist:Unfortunatelyyoucan’t.Theseaisfullofkillersharks.

Youcannowusethismetaphortoassistwithcreativehopelessness(tryingtothrow the demons overboard); acceptance (allowing the demons to gatheraround); defusion (seeing them in broad daylight, seeing through the specialeffects); valued directions (heading to shore); committed action (keeping yourhandsonthetiller);contactingthepresentmoment(noticingthesea,sky,wind,sun, and so on); and even the observing self (you are not the boat or thedemons).Thus, for a defusion technique, youmight name the demons—for example,

the“Ican’tdoit”demon,the“I’vewastedmylife,andnowit’stoolate”demon,or the“youwon’t like itwhenyouget there”demon.Foracceptance,youcanasktheclient,“Ifheadingtowardtheshoreiswhatmatters,areyouwillingtoletthedemonsgatheraround?”Oryoumightsay,“Whichdemoniscontrollingtheboatnow?”Once ithasbeennamed,youcould say,“Sohowaboutwe takealook at this demon in broad daylight?” and then lead into a defusion oracceptanceexercise.

THESTRUGGLESWITCH

The Struggle Switch (Harris, 2007, adapted fromTwo Scales,Hayes et al.,1999) is an extended metaphor that covers both creative hopelessness andacceptance; once introduced, it becomes a powerful interactive tool foracceptancework.

Therapist:Imaginethatatthebackofourmindisa“struggleswitch.”Whenit’sswitchedon,itmeanswe’regoingtostruggleagainstanyphysicaloremotional pain that comes our way; whatever discomfort shows up,we’lltryourbesttogetridofitoravoidit.Supposewhatshowsupisanxiety. (This isadapted to theclient’s issue:anger, sadness,painfulmemories,urgestodrink,andsoon.)Ifmystruggleswitchison,thenI absolutely have to get rid of that feeling! It’s like, “Ohno!Here’sthathorriblefeelingagain.Whydoesitkeepcomingback?HowdoIget rid of it?” So now I’ve got anxiety about my anxiety. In otherwords,my anxiety just gotworse. “Oh, no! It’s gettingworse!Whydoesitdothat?”NowI’mevenmoreanxious.ThenImightgetangryaboutmyanxiety:“It’snotfair.Whydoesthiskeephappening?”OrImightgetdepressedaboutmyanxiety:“Notagain.WhydoIalwaysfeel like this?” And all these secondary emotions are useless,unpleasant,unhelpful,andadrainonmyenergyandvitality.Andthen—guesswhat?Igetanxiousordepressedaboutthat!Spottheviciouscycle? But now suppose my struggle switch is off. In that case,whateverfeelingshowsup,nomatterhowunpleasant,Idon’tstrugglewith it.Soanxiety showsup,but this time Idon’t struggle. It’s like,“Okay, here’s a knot in my stomach. Here’s tightness in my chest.Here’s sweaty palms and shaking legs.Here’smymind tellingme abunchof scarystories.”And it’snot that I like itorwant it. It’s stillunpleasant.ButI’mnotgoingtowastemytimeandenergystrugglingwithit.InsteadI’mgoingtotakecontrolofmyarmsandlegsandputmyenergyintodoingsomethingthat’smeaningfulandlifeenhancing.Sowiththestruggleswitchoff,ouranxietylevelsarefreetoriseandfall as the situation dictates. Sometimes they’ll be high, sometimeslow, and sometimes there will be no anxiety at all. Far moreimportantly,we’renotwastingourtimeandenergystrugglingwithit.But switch it on, and it’s like an emotional amplifier—we can haveangeraboutouranger,anxietyaboutouranxiety,depressionaboutourdepression, or guilt about our guilt. (At this point, check inwith theclient: “Can you relate to this?”)Without struggle, we get a naturallevelofphysicalandemotionaldiscomfort,whichdependsonwhoweare andwhatwe’re doing. InACT,we call this “clean discomfort.”There’snoavoiding“cleandiscomfort.”Lifeservesituptoallofusinone way or another. However, once we start struggling with it, ourdiscomfort levels increase rapidly. We call this additional suffering“dirtydiscomfort.”Wecan’tdoanythingabout thecleandiscomfort,

butwecanreducethedirtydiscomfort.Guesshow?(Waitforclient’sreply.)That’sright:welearnhowtoturnoffthestruggleswitch.Andwhat I’d like todonext, ifyou’rewilling, is toshowyouhowtodothat.

Thenextstep is toworkwithapainfulemotionandpractice turningoff thestruggleswitch.Thefollowingtranscriptillustratesthis.

WORKINGWITHTHESTRUGGLESWITCH

Thetherapisthasjustfinishedaskingtheclienttoscanherbodyandidentifywhereshe’sfeelingheranxietymostintensely.

Therapist: (summarizing) Okay, so there’s a lump in your throat, tightness inyourchest,andchurninginyourstomach.Andwhichofthesebothersyouthemost?

Client:Here.(Theclienttouchesherthroat.)

Therapist:Okay.Andona scaleof0 to10, if0 isnoanxietyat all and10 issheerterror,howwouldyouratethis?

Client:Aboutan8.

Therapist: Okay. So remember that struggle switch we talked about? (Clientnods.)Well,rightnowwouldyousayit’sonoroff?

Client:On!

Therapist:Okay.Supposeweturneditintoadial.Onascaleof0to10if10isfull on, out and out struggle—“I have to get rid of this feeling nomatterwhat”—and0 is no struggle at all—“I don’t like this feeling,but I’m not going to struggle with it”—and 5 is the halfway point,whatwemightcalltoleranceorputtingupwithit.Onthatscale,howmuchareyoustrugglingwiththisfeelingrightnow?

Client:Abouta9.

Therapist:Okay. So a lot of struggle going on right now.Let’s see ifwe canbringitdownacoupleofnotches.Wemayormaynotbeableto,butlet’sgiveitago.

Thetherapistnowtakestheclient throughsections1–4of theAcceptanceofEmotionsExercise:observe,breathe,expand,allow.Thenhechecksinwiththe

clienttoseewhat’shappening.

Therapist:Sowhat’shappeningnowwiththestruggleswitch?

Client:Well,Ifeellessanxious.

Therapist:Okay,wellwe’ll come to that in amoment.What I’m interested innow is the struggle. On a scale of 0 to 10, how much are youstrugglingwiththisfeeling?

Client:Oh,abouta3.

Therapist:Abouta3.Okay.Nowyoumentionedthatyouranxietyisless.Onascaleof0to10,whatisitnow?

Client:Abouta6.

Therapist: Okay, so enjoy thatwhen it happens; at times,when you drop thestrugglewithanxiety,itwillreduce,butthat’snotwhatwe’retryingtoachievehere.Ouraimistodropthestruggle.Wouldyoubewillingtokeepgoing?Let’sseeifwecangetthestruggleswitchdownanothernotchortwo?

PracticalTip Beonthealertforpseudoacceptance.Whenyourclientexperiences a reduction in the intensity of his feelings, he often ignores ormisunderstands that “it’s a bonus, not the goal.” He leaves the sessionthinking, Now I know a way to reduce my anxiety, and starts practicing“acceptance”inordertogetridofhisunpleasantfeelings.However,thatisnottrue acceptance. True acceptance is willingness to have the feelings,regardless of whether they increase or decrease. This one of the mostcommonplacesyouandyourclientswillgetstuck.

CommonPitfallsforTherapists

Inworkingwithdefusionandacceptance,bealertforseveralcommonpitfalls:toomuchtalk,notenoughaction;reinforcingavoidance;insensitivity;failingtolinkacceptancetovalues;andbeingtoopushy.Let’stakeaquicklookateachofthesenow.

Toomuch talk, not enough action. Trying to explain defusion and acceptancedidacticallyislargelyawasteoftime,sodoitexperientially.Wecaneasilyfeed

fusion and avoidance by getting into “analysis paralysis”—that is, discussing,analyzing,andintellectualizinginsteadofdoingexperientialwork.

Reinforcing avoidance. As mentioned already, if we get excited wheneverpainfulfeelingsreduceandthoughtsdisappear,thenwereinforceavoidance(orpseudoacceptance).

Insensitivity. If we don’t validate and empathize with our clients, if weinsensitivelyrushinwithallourclever toolsandtechniques,we’lldamagethetherapeuticrelationship.

Failingto linkacceptancetovalues.Ifwefail todrawtheconnectionbetweenvalued-livingandacceptance,ourclientsarelikelytoresist.

Beingtoopushy.Ifwepushourclientsintointenseexperientialexercisesbeforethey’re ready,we’redoing themamajordisservice, and theymaydropout oftherapy.

HomeworkandtheNextSessionOneformofhomeworkistoformallypracticeamindfulnessexercisecenteredaroundacceptanceofemotions.Thisisparticularlyusefulforanxietydisordersand grief work. The ideal thing is to do such exercises in session and recordthemasyougo,andthengiveyourclienttherecordingtotakehome.Oryoucangive them a prerecorded CD to practice with—your own or a commerciallyavailableone.(MyCDMindfulnessSkills:Volume1hasarecordingontrack3verysimilar tothemainexerciseinthischapter.)Atwww.actmadesimple.com,youcanalsodownloadtheExpansionPracticeSheet(atendofthischapter)anduseitasanadjuncttoencouragepractice.Asecondthingyoucandoisaskyourclientthisquestion:“Betweennowand

next session, I wonder if you’d be willing to practice making room for yourfeelings,aswe’vedonetoday.Assoonasyourealizeyou’restruggling,justrunthroughtheexercise.”Then,soshedoesn’tforget,writedownthekeystepsyouwanthertopractice—forexample,“observe,breathe,expand”or“makeitintoanobjectandbreatheintoit.”A third option is this: “Over the next week, notice when you’re struggling

with your feelings, and noticewhen you’re opening up andmaking room forthem.Andnoticewhateffectsithaswhenyourespondineachway.”Youcouldalso download from www.actmadesimple.com a copy of the Struggling vs.

OpeningUpWorksheet(attheendofthischapter)andasktheclienttofillitin.Traditionally after defusion and acceptance, we move on to contacting the

presentmomentandself-as-context—butofcoursewecanmovetoanypartofthehexaflexwithanyclientinanysession.So,inthenextsession,ideallyafterabriefcheck-inandmindfulnessexercise,wereviewthehomeworkandseewhathappened.Ifourclientisopentotheideaofacceptancebutisstrugglingtoputitintopractice,wecoulddomoreworkonacceptanceskillsandperhapsbringindefusion or self-as-context interventions to assist. If he’s fallen back into thecontrol agenda,we can either revisit creative hopelessness (What is it costingyoutostrugglewiththesefeelings?Howisitworkingforyou?)orturntovalues(What’s important to you in life? Are you willing to make room for thesefeelingsinordertodowhatmatters?).

HomeworkforYouTry these techniques and worksheets on yourself. Pick some painful issue inyourliferightnow.

Practice openingup andmaking room for those feelings.Trythis when you have a difficult therapy session—both duringand after—because one of the abilities of a good therapist isbeingabletoacceptyourownemotionalreactions.Read all the exercises, metaphors, and psychoeducationcomponentsoutloud,asifyou’retakingaclientthroughthem.Review the cases of two or three clients, and identify keyfeelings that they are fighting with or trying to avoid. Thenconsiderwhichacceptancetechniquesyoumighttrywiththem.

SummaryAcceptance is the process of actively making room for unwanted privateexperiences (including thoughts, memories, feelings, urges, and sensations).Acceptance and defusion go hand in hand: in acceptance, as we make directcontactwithourprivateexperiences,wedefusefromour thoughtsabout them.Defusion and acceptance also go hand in hand: defusion, as we notice ourthoughtsandallowthemtobeastheyare,isanactofacceptance.Sohopefullynowyou’re starting to seewhat Imeantwhen I said the different parts of the

hexaflexareallinterconnectedlikesixfacetsofadiamond.Thediamonditselfis psychological flexibility: the capacity to “be present, open up, and dowhatmatters.”Andthus,whenwetalkof“openingup,” that includesbothdefusionandacceptance.Inthenexttwochapters,wewillfocuson“beingpresent.”

Chapter9.BeHereNowContactwiththePresentMomentinaNutshell

InPlainLanguage:Contactwiththepresentmomentmeansbeinginthehereandnow,fullyconsciousofourexperience,insteadofbeinglostinourthoughts.Itinvolvesflexiblypayingattentiontoboththeinnerpsychologicalworldandtheoutermaterialworld.

Aim:Toenhanceconsciousawarenessofourexperienceinthepresentmoment,so we can perceive accurately what’s happening, and gather importantinformationaboutwhether tochangeorpersist inbehavior.Toengage fully inwhateverwe’redoingforincreasedeffectivenessandfulfillment.

Synonyms: Being psychologically present, consciousness, awareness, flexibleattention.

Method:Noticewhatishappeninghereandnow;discriminatebetweennoticingandthinking;payattentionflexiblytoboththeinnerworldandtheouterworld.

WhentoUse:Whenclientsareoverlypreoccupiedwiththepastorfuture,actingimpulsivelyormindlessly,“disconnected”intheirrelationships,lackinginself-awareness,orotherwiseoutofcontactwiththeirhereandnowexperience.

TheOnlyTimeIsNow

AsLeoTolstoyonceputit,“Thereisonlyonetimethatisimportant—NOW!Itisthemostimportanttimebecauseitistheonlytimethatwehaveanypower.”Tolstoy’sfamousquoteremindsusthatlifehappensnow—inthismoment.Thepastandfutureonlyexistasthoughtsoccurringinthepresent.Wecanplanforthefuture,butthatplanninghappenshereandnow.Wecanreflectonandlearnfromthepast,butthatreflectionhappensinthepresent.Thismomentisallweeverhave.In popular usage, the word “mindfulness” has become synonymous with

“beinginthemoment,”“beingpresent,”or“livinginthenow.”Why?Becausecontactingthepresentmomentliesattheheartofallmindfulness.Forexample,the starting point for all defusion and acceptance techniques is to consciouslynoticethethoughtsandfeelingsthatarepresentinthismoment.

Beingpresentplaysamajorrole invalues-congruent living. Ifyou’reactingonyourvaluesbutnotfullyengagedinwhatyou’redoing,thenyou’re“missingout.”Beingpresentaddsrichnessandfullnesstoyourexperience.Italsoenableseffectiveaction:it’shardtoacteffectivelywhenyoudon’tpayattentiontowhatyou’redoing.Whendoingvalueswork,manyclientswillmentionsomethinglike“livingin

themoment,”“appreciatingwhatI’vegot,”or“stoppingandsmellingtheroses,”and almost everyone will talk about wanting to cultivate loving or caringrelationships. These activities all require us to be present. And, of course, toknowwhether or notwe’re living by our values, andwhether our behavior isworkable or not, we need to be aware of what we’re doing and notice theconsequencesofouractions.Contacting thepresentmoment is also essential for self-awareness and self-

knowledge.Themore in touchwearewithourownthoughtsandfeelings, thebetterwe’reable toregulateourbehaviorandmakewisechoices that takeourlifeinthedirectionwewanttogo.

GettingtoContactwiththePresentMomentAttimesineverysession,we’llasktheclienttonoticewhat’shappeninginthismoment: “Notice what your mind is telling you right now,” “Notice what’shappeninginyourbodyrightnow,”“Whatareyoufeeling?Wheredoyounoticethat feelingmost intensely?”,“Asyoumake thatcommitment,what’sshowingupforyou?”,andsoon.InsomeACTprotocols,rightfromtheveryfirstsession,evenbeforecreative

hopelessness,clientsareaskedtodoshortexercisesaroundnoticingtheirbreathornoticingthesoundsintheroom,andareaskedtopracticetheseforhomework(for example, seeWalser &Westrup, 2007). However, typically it’s not untilafterdefusionandacceptancethattherapistsstartexplicitlytalkingaboutlivinginthemomentandmakingthatthecentralfocusofasession.On the other hand, if you’ve started therapy with work around values and

committed action, you can segue into this by drawing the link between beingpresent and building resonant relationships, acting effectively, performingskillfully,orgettingthemostfulfillmentoutofwhateveritisyou’redoing.At times,youmayevenstart therapybyexplicitly focusingon thisprocess,

especiallywithclientswhodissociateeasilyorwhogetsosweptawaybytheir

emotionsthatit’sdifficulttodoanyconstructivework.

TheMindfulTherapist

Obviously in order to do effective therapy, we ourselves need to be fullypresent:attunedtoourclients,noticingboththeirphysicalandverbalresponses.(Indeed, this is essential for any relationship we wish to enhance. Buildingresonant relationships requires emotional intelligence: awareness of our ownemotional reactionsaswellas thoseof thepeoplewithwhomwe interact.)Ofcourse,beingfullypresentasatherapistiseasiersaidthandone.Haveyoueverbeen in a session and suddenly realized that you haven’t heard a word yourclient’sbeensayingforthelasttwominutes?Andthenyoutriedtohidethefactbysayingsomethinglike,“Hmmm.Canyoutellmeabitmoreaboutthat?”Agutsierandmoreusefulresponseatthoseembarrassingmomentsissimply

tocomeclean:“I’mverysorryaboutthis.Ijustgotallcaughtupinmymindfora moment there, and I wasn’t really listening to you. If we were at a socialfunction,I’dtrytocoverthatupandpretendithadn’thappened,buthereit’sagoodopportunitytodemonstratethatwe’reallinthesameboat.Ourmindsjustpullusoutofourexperience.SoIhopeyou’llforgiveme,andcouldyoupleaserepeatwhatyoujustsaid?”While responding in thisway is likely to bring up some anxiety for you, it

builds a more open, honest, and equal relationship, and it powerfully modelsbothself-acceptanceandbeingpresent.Italsobringshometherealitythatbeingpresentissimplebutnoteasy.Whileitiseasytogetpresent—wesimplynoticeourexperience—it’sverydifficulttostaypresent.Ourmindalltooeasilycarriesusoff.Weneedtobeupfrontwithourclientsonthisissue.Weneedtoletthemknow that we can get better at being present—like any skill, the more wepractice, the better we get—but we can’t get perfect. Even Zen masters gethookedbytheirmindsattimes.

IntroducingthePresentMoment

When explicitly introducing this element, it’s often good to start with ametaphor that conveys the difficulties of beingpresent. For example, ifwe’veintroducedthemindasaproblem-solvingmachine(asinchapter1),wecanreferbacktoit:“We’vetalkedbeforeabouthowourmindis likeaproblem-solving

machine. And it’s very, very good at its job. It’s always looking out forproblems. And unfortunately when we get caught up in problem solving, weoftenmissoutonenjoyingorappreciatinglife.It’shardtoappreciatewhatwehaverightnowwhenwe’refocusedonall the things thatarebadorwrong,ornotquiteright,orneedtobefixedandsorted.Sooneimportantpartofourworkhere is learning how to do that—to shift from problem-solving mode toappreciatingwhat’shere andnow.”Othergoodcandidates for introducing thisnotionincludethesemetaphors:HandsAsThoughts(seechapter2),section1ofACT in a Nutshell (see chapter 1), or the Time Machine (see below). Withdepressedoranxiousclients,youcandirectlyandexplicitlylinkthesemetaphorstodwellingonthepastorworryingaboutthefuture.

THETIMEMACHINEMETAPHOR

Therapist: It’s lucky for us that our mind can conceptualize the past and thefuture.It’sahugelyusefulability.Itallowsustoreflectonandlearnfromthepast,andtopredictandplanforthefuture.Aswegrowolder,ourmindgetsbetterandbetteratdoingthesetricks:conjuringupthepastandthefuture.Butunfortunately,thisstartstocreateproblems.Aschildren,wecaneasilyliveinthepresent,butbyadulthoodourmindis like an out-of-control time machine that constantly pulls us backintothepastorforwardintothefuture.Asaresult,wespendalotoftimeinthepastrelivingoldhurts,failures,rejections,andmistakes,ora lot of time in the future, worrying about everything that could gowrong.Andmeanwhilewe’remissingout on life in the present. It’shardtogetanysatisfactionorfulfillmentfromyourlifeifyou’renotactuallypresenttoappreciateit.

Onceyou’veusedametaphor to introduce thisprocessandconveywhy it’srelevanttotheclient,thereareavastnumberofexercisesyoucanturnto—andtheyallboildowntoonebasicinstruction.

TheBasicMindfulnessInstructionThe basic instruction that you’ll find at the core of every single mindfulnessexercise—from a ten-second ACT technique to a ten-day silent meditationretreat—isthis:“NoticeX.”(Commonalternativesto“notice”includeobserve,

payattentionto,focuson,beawareof,orbringyourawarenessto.)The“X”thatwe’re noticing can be anything that’s present in this moment: a thought, afeeling,asensation,amemory—oranythingthatwecansee,hear,touch,taste,orsmell.Xmightbe theviewfromawindow, theexpressionon thefaceofalovedone,thesensationsofahotshower,thetasteofapieceofchocolateinourmouth, the action of tying our shoelaces, the movement of our lungs, or thesoundswecanhearintheroomaroundus.Attimes,wemaywantaverybroadawarenessofthepresent:forexample,if

we’rewalkinginthecountrysideandwewanttotakeinallthesightsandsoundsand smells. At other times, we may want a much more focused attention: ifwe’redrivinginpouringrain,wewanttobeabsolutelyfocusedontheroad,nottuningintotheradioorchattingwiththepassengers.Attimes,wemaywanttodirectourattentioninwardtotheworldofthoughts,feelings,andsensations;atother times, outward to the world around us; and much of the time, to bothworlds at once—freelymoving from one event to another, as required by thedemandsofthesituation.Ausefultermforthisabilityisflexibleattention.

ConstructYourOwnMindfulnessExercises

In this and every other book on ACT, you’ll find plenty of scripts formindfulnessexercises,butonceyouknow the“basic formula,”youcaneasilyconstructyourown.All exercisesbasicallyboildown to somecombinationofthesethreeinstructions:

1. NoticeX.2. Letgoofyourthoughts.3. Letyourfeelingsbe.

Allmindfulness exercises include instruction 1: noticing your experience istheverycoreofmindfulness.Mostexercisesalsoincludeinstruction2,defusion.Instruction3,acceptance,islesscommonlygiven(butalwaysimplied).Readthroughsomeofthelongerscriptsinthisbookoranyothermindfulness

book you may have, and you’ll see they’re all constructed around somecombination of these basic instructions. For example, the first section of theAcceptanceofEmotionsExercise(seechapter8) issimplyanextendedriffon“noticeX,”whereXisanintensesensationinthebody.TheLeavesonaStreamExercise (see chapter 7) is built around both “notice X” and “let go of yourthoughts,” as is the common mindfulness instruction, “When you notice that

you’ve drifted off into your thoughts, gently acknowledge it and bring yourattentionbacktoX.”Toconstructanexercisearoundcontactingthepresentmomentissimple.All

you need to do is direct your client’s attention to “X”—for example, breath,body posture, feelings, sounds in the room, and so on—and then ask hertoobserve “X” with openness and curiosity. If you wish to add in elements ofdefusionoracceptancethensimplyaddinstructions2or3fromabove.One of the most popular exercises to start off with is Mindfulness of the

Breath (below). I ask clients initially to practice this for fiveminutes once ortwiceaday,thenincreasethedurationbytwoorthreeminuteseveryfewdaysuntiltheycandothisforfifteentotwentyminutesatatime.(Ofcourse,notallclients will agree to this or follow through with it, but those who do usuallyderivesignificantbenefits.)

MINDFULNESSOFTHEBREATH

Therapist: I invite you to sit with your feet flat on the floor and your backstraight,andeither fixyoureyesona spotorcloseyoureyes.Bringyourattentiontoyourbreathing,andobserveitasifyou’reacuriousscientist who has never encountered breathing before. (Pause 5seconds.)Notice the air as it comes in through your nostrils… andgoesdowntothebottomofyourlungs.(Pause5seconds.)Andnoticeitasitflowsbackoutagain.(Pause5seconds.)Noticetheairmovinginandoutofyournostrils…howit’sslightlywarmerasitcomesout…andslightlycooleras itgoes in.Notice thesubtle riseandfallofyour shoulders… (Pause5 seconds.) and the gentle rise and fall ofyour rib cage…(Pause5 seconds.) and the soothing rise and fall ofyourabdomen.(Pause5seconds.)Fixyourattentionononeof theseareas,whichever youprefer: on thebreathmoving in andout of thenostrils, on the rising and falling of the rib cage, or the abdomen.(Pause 5 seconds.)Keep your attention on this spot, noticing themovement—inandout—ofthebreath.(Pause20seconds.)Whateverfeelings, urges, or sensations arise, whether pleasant or unpleasant,gentlyacknowledge them,as ifnoddingyourheadatpeoplepassingby you on the street. (Pause 5 seconds.) Gently acknowledge theirpresenceandletthembe.(Pause5seconds.)Allowthemtocomeandgo as they please, and keep your attention on the breath. (Pause 20seconds.) Whatever thoughts, images, or memories arise, whether

comfortable or uncomfortable, simply acknowledge them and allowthem to be…Let them come and go as they please, and keep yourattentionon thebreath. (Pause20seconds.)From time to time,yourattentionwillwanderasyougetcaughtupinyourthoughts.Eachtimethis happens, notice what distracted you, then bring your attentionbacktothebreath.(Pause20seconds.)Nomatterhowoftenyoudriftoff, whether a hundred times or a thousand—your aim is simply tonote what distracted you and to refocus on your breath. (Pause 10seconds.) Again and again and again, you’ll drift off into yourthoughts. This is normal and natural and happens to everyone. Ourmindsnaturallydistractusfromwhatwe’redoing.Soeachtimeyourealize your attention has wandered, gently acknowledge it, noticewhatdistractedyou,andreturnyourattentiontothebreath.(Pause20seconds.)Iffrustration,boredom,anxiety,impatience,orotherfeelingsarise, simply acknowledge them, and maintain your focus on thebreath. (Pause 20 seconds.) No matter how often your attentionwanders, gently acknowledge it, note what distracted you, and thenrefocusonyourbreath.(Pause10seconds.)Andwhenyouareready,bringyourselfbacktotheroomandopenyoureyes.

MINDFULNESSOFYOURHAND

Theexercisethatfollowsismypersonalfavorite,andwasinspiredbymyson,Max.Once,whenMaxwasabouttenmonthsold,Iwatchedhimdiscoveringhishands.Heheldonetinylittlehandupinfrontofhisface,wigglinghistinylittlefingersaround,utterlyfascinatedbytheirmovements—aswasI!AndIthought,“Wow.Thatwouldmakeagoodmindfulnessexercise.”(Idon’tmeanlookingatMax’s hands—Imean looking at your own!) It’s impossible to appreciate thebeauty and simplicity of this exercise purely through reading, so I’ve alsorecorded a version as an MP3, which you can download for free fromwww.actmadesimple.com.

Therapist:Inamoment,I’mgoingtoaskyoutonoticeyourhand.AndImean,really notice it. In fact, I’m going to ask you to look at it for fiveminutes. But beforewe do that, I’d like to know,what’s yourmindpredictingaboutthenextfiveminutes?

Client:Seemslikealongtime.

Therapist:Yeah.And—justguessinghere—isyourmindpredictingit’sgoingto

beboring,tedious,difficult—somethinglikethat?

Client:(laughs)Yeah,itsoundsprettyboring.

Therapist:Okay.Solet’scheckitoutandseeifthat’sthecase.Sometimesourmindisrightonatpredictingthings.Getsitabsolutelyright.Butveryoften,itspredictionsareabitoffmark.Solet’sseewhathappens—seeifitreallyisslow,tedious,andboooooring.

Inthefollowingtranscript,theellipsesindicatepausesofaboutthreeseconds.

Therapist: I inviteyoutoget intoacomfortableposition.Andjust turnoneofyourhandspalmupward,andholditacomfortabledistancefromyourface.Forthenextfewminutes,I’dlikeyoutoobserveyourhandasifyou’reacuriousscientistwhohasneverseenahandbefore.Andfromthatperspective, firstnotice theoutline.Mentally trace theoutlineofyourhand,startingatthebaseofthethumb,andtracingaroundallthefingers…andnotice theshapesof thespaces inbetweenthefingers…andnoticewhereyourhandtapersinatthewrist.Andnow,noticethe color of your skin… notice it’s not just one color… there aredifferent tonesand shades, anddappledareas…andever so slowly,stretchyourfingersout,andpushthemasfarbackastheywillgo,andnoticehowthecolorchangesinyourskin…andthenslowlyreleasethetension,andnoticehowthecolorreturns…anddothatoncemore,eversoslowly,noticingthecolordisappear…andthenreturn…andnow notice the large lines on your palm… notice the shapes theymakewheretheycometogetherordivergeorintersect…andzoominoneofthoselinesandnoticehowtherearemany,smallerlinesfeedingintoitandbranchingoutofit…andnowshiftyourattentiontooneofyourfingertips…andnoticethespiralpatternthere…thepatternthatyoualwaysseeonfingerprints…andnoticehowthepatterndoesn’tstopinyourfingertip…itcarriesondownyourfinger…andtraceitrightondownandnoticehowitcontinuesintoyourpalm…andnowever so slowly, bring your little finger toward your thumb … andnoticethefleshinyourpalmscrunchesup…andnowslowlyrelease… and notice the flesh resume its normal contours…and now turnyour hand to the karate-chop position … and notice the differencebetweentheskinonthepalmandtheskinontheback…andlookatyour index finger, and notice there’s a sort of dividing line, wherethosetwotypesofskinmeeteachother…andeversoslowlyturnyourhand over … and notice the skin on the back … and notice any

criticisms or judgments your mind makes … notice any scars,sunspots, blemishes…andnotice the different colors in the skin…where itpassesoveravein…oroveryourknuckles…andeversoslowly,curlyyourhandintoagentlefist…andnoticehowthetextureofyour skin changes…andnotice anycommentsyourmindmakesaboutthat…andfocusinonyourknuckles…andgentlyrotateyourfist,andnoticethecontoursandvalleysofyourknuckles…andnowtightenyourfist,andnoticewhathappenstotheknuckles…totheircolorandtheirprominence…andtheneversoslowlyopenyourhandup, straighten your fingers, and notice how your knuckles justdisappear…andnowbringyourattention tooneofyour fingernails… and notice the texture of the nail… and the different shades ofcolor … and notice where it disappears under the skin … and thecuticlethatsealsitinthere…andnoweversoslowly,eversogently,wiggle your fingers up and down…and notice the tendonsmovingundertheskin…pumpingupanddownlikepistonsandrods…andthatbringsustojustoverfiveminutes.

Client:(Amazed)You’rekidding?Thatwasfiveminutes?

Therapist:Surewas.Andwasitslow,tedious,boring?

Client:No.Itwasreallyinteresting.

Almosteverybodywhodoesthatexerciseisamazednotonlyathowquicklytimepasses—itseemsliketheblinkofaneye—butalsoatjusthowfascinatingtheir hand is. We now debrief the exercise: “What did you discover? Whatinterested you most?” Then we can ask, “So what is the relevance of thisexercise to your life?” Through questioning our client—and providing theanswers if he doesn’t come upwith any—we now draw out (a) howwe takethingsforgrantedandfailtoappreciatethem,and(b)how,whenwereallypayattention,lifeissomuchmoreinterestingandfulfilling.Useful questions to ask include these: “Whatmight happen in your closest

relationshipsifyoupaidattentiontoyourlovedonesinthesamewayyoujustdid to your hand?Would you be willing to give it a go?” “Next time you’refeelingbored,stressed,anxious,orotherwisecaughtupinyourhead,wouldyoubewillingtoreallyengageinwhateveritisyou’redoing,likeyoujustdidwithyourhand,andnoticewhathappens?”

BEINGPRESENTANDLIFESATISFACTION

We like to draw the connection between being entangled in yourmind andmissingoutonyourlife.Wecanaskclientsquestionssuchasthese:“What’sitlikeforyou,spendingsomuchtimecaughtupinworriesaboutthefutureorpainfromthepast?”“Is thatreallywhereyouwanttospendyourtime?”“Whatdoyoumissouton,whenyou’retrappedinsideyourmind?”Wecanpointoutthatalthoughwecan’tstopourmindfrombringinguppainfulmemoriesortellingusscary stories about the future,wecan learn to let those thoughts comeandgoinstead of latching on to them (that is, instead of worrying or ruminating).LeavesonaStream(seechapter7)isanexcellentexerciseforthispurpose.Also establish that fully engaging in your experience leads to increased

satisfactionandfulfillment.Theexercisethatfollows,MindfullyEatingaRaisin(Kabat-Zinn,1990),makesthispointverypowerfully.(Ifyourclientdoesn’tlikeraisins,apeanutorasmallpieceofchocolatewilldonicely.)

MINDFULLYEATINGARAISIN

Theellipsesrepresentpausesoffiveseconds.

Therapist:Throughoutthisexercise,allsortsofthoughtsandfeelingswillarise.Let themcomeandgo,andkeepyourattentionon theexercise.Andwhenever you notice that your attention has wandered, briefly notewhatdistractedyou,and thenbringyourattentionback to the raisin.Now take hold of the raisin, and observe it as if you’re a curiousscientistwhohasnever seena raisinbefore…Notice theshape, thecolors, the contours…Notice that it’s not just one color—there aremanydifferentshadestoit…Noticetheweightofitinyourhand…and the feel of its skin against your fingers…Gently squish it andnoticeitstexture…Holdituptothelight,andnoticehowitglows…Nowraiseittoyournoseandsmellit…andreallynoticethearoma…Andnowraiseittoyourmouth,restitagainstyourlips,andpausefor a moment before biting into it…And notice what’s happeninginsideyourmouth…Noticethesalivation…Noticetheurgetobite…Andinamoment—don’tdoityet—I’mgoingtoaskyoutobiteitinhalf,keepingholdofonehalf and letting theotherhalfdropontoyourtongue…Andsonow,inultraslowmotion,bitetheraisininhalf,andnoticewhatyour teethdo…and let the raisin sit thereonyourtongue for amoment…and I inviteyou to closeyour eyesnow, toenhance theexperience…And justnoticeanyurgesarising…Andthengentlyexploretheraisinwithyourtongue,noticingthetasteand

thetexture…Andnow,inultraslowmotion,eattheraisinandnoticewhatyourteethdo…andyourtongue…andyourjaws…andnoticethe changing taste and texture of the raisin … and the sounds ofchewing… and notice where you can taste the sweetness on yourtongue… and when the urge to swallow arises, just notice it for amomentbeforeactingon it…andwhenyoudo swallow,notice themovementandthesoundinyourgullet…andthennoticewhereyourtonguegoesandwhatitdoes…andafteryou’veswallowed,pause…andnoticethewaythetastegraduallyfades…butstillfaintlyremains…andthen,inyourowntime,eattheotherhalfinthesameway.

Afterward debrief the exercise much as for theMindfulness of Your HandExercise.Clientscommonlycommentwithamazementonhowmuchtasteandflavorthereis inoneraisin,andhowmuchactivitygoesoninthemouth.Askyour client how she usually eats raisins, and she’ll usually mime chucking awhole handful into her mouth. Use this exercise as a metaphor for life: howmuch richer it is when we’re mindful. This exercise can be very useful fordepressed or dysphoric clients who complain they get no pleasure frompreviously enjoyable activities; it’s hard to get pleasure or enjoyment from anactivity if youarenotpsychologicallypresent (that is, if you’re fusedwith anongoingstreamofnegativethoughts).

NOTICINGSELF-DEFEATINGBEHAVIOR

Mostimpulsive,self-defeating,orself-destructivebehaviorsaremotivatedbyfusion and avoidance.Mindfulness exercises can be designed to enhance yourclient’sself-awarenessaroundwhatthey’refusingwithandwhatthey’retryingto avoid. For example, you can ask your clients to notice their thoughts andfeelingsbefore theyactually startdoing theproblembehavior (drinking,bingeeating, self-harming, gambling, and so on).Youmight say, “Next time you’reabout to start [doing the problem behavior], stop for a moment, take a deepbreath, and notice your thoughts/feelings/sensations. Notice any thoughts orfeelings you’re trying to push away/escape from/get rid of. Notice any urges.Noticewhatyourmindistellingyoutodo.”Mindfulnessexercisescanalsodisruptproblematicbehaviors.Clientscanbe

assigned to mindfully observe the way they do the problematic behavior, tonoticeeveryaspectofitingreatdetail,and,inparticular,tonoticewhatthoughtsand feelings are present while they’re doing so. Often simply bringing fullawarenesstothebehaviordisruptsit.

NARROWFOCUSVS.BROADFOCUS

Think about whether the clinical problem warrants a broader focus or anarrowerfocusformindfulness.Forexample, ifclientsarepronetoworryandrumination,youmaywanttoencourageanarrowerfocus:havethemengageinsome valued activity and focus their attention primarily on that activity. Theycanletthoughtscomeandgoinperipheralawarenesswhilerepeatedlybringingtheir attention back to the activity itself. In contrast, if the problem is chronicpain,youmaywanttoencourageabroaderfocus.Whilepainisacknowledgedand accepted, awareness is broadened to encompass the five senses, thesurroundingenvironment,andthecurrentactivity.Thuspainbecomesonlyoneaspectofamuchbroaderexperience.In session, we often ask clients to focus primarily on one aspect of their

privateexperience—forexample,on their thoughts, feelings,orsensations. It’simportant that they realize this is simply to teach themaskill. In theworldofeveryday living, the idea is that when distressing thoughts and feelings arise,they can be accepted as just one aspect of awareness (one performer amongmany on a well-lit stage) rather than completely dominating awareness (oneperformerstandinginaspotlightonadarkenedstage).

KeepingClientsPresent

Whenworkingwithpeoplethatdissociateeasily,orthoseattheextremeendof the experiential avoidance spectrum (for example, clients with borderlinepersonalitydisorderoreatingdisorders),it’sgenerallybesttostartwithexercisesfocusedontheexternalworld:weaskthemtonoticewhattheycanseeandhearandtouch.Andifourclientisverydrowsyordissociateseasily,wekeeptheseexercisesshort,andtheydothemwiththeireyesopen.Ifourclient“driftsoff”inasession,webringhimback:“Iseemtohavelost

you.Where are you?” or “I may be wrong about this, but I get a sense thatyou’renot fullypresent rightnow.Youseemabitdistantorpreoccupied.”Or“CanIjustcheckinwithyouforamoment?Inoticeyou’restaringdownatthefloorandIthinkyoumayhavegottencaughtupinastory.AmIright?”Onceour client is present again,we could ask “Where did yourmind take you justthen?”or“Sohowdidithookyou?”Wecantaketheseopportunitiestopointout—compassionately and respectfully—how easily ourmind pulls us out of our

experience.Whenourclientkeepsdriftinginto thepastor thefuture—rehashingastory

we’ve already heard several times—we can respectfully point out what’shappeningandinterruptit.Ifwejustsitback,saynothing,allowhimtorambleon,we’renothelpinghim,orourselves;he’suselesslyfusedwithhisworriesormemories, and he’s missing out on the present—plus we’re getting bored orfrustrated, and we’re missing the opportunity to help him develop a usefulmindfulnessskill.Here’sanexample:

Client: That bitch! I’m tellin’ ya. I still can’t believe it. I can’t believe—tenf****ing years, there I amworking like a dog, morning, noon, andnight—whileshe’sathomef****ingthenext-doorneighbor.Andthen—thenshehastheballstoaskforhalfthehouse.

Therapist:I’msorrytointerruptyou.Icanseehowpainfulthisisforyou,andIcanonlybegintoimaginewhatthatmustfeellike.Atthesametime,I’m wondering if you’ve noticed what’s happening here. You’vealready toldmeabout this several timesnow inquite somedetail. Isthereanythinghelpfulorusefulingoingoveritagain?

Client:(longpause)Notreally.No.

Therapist:Canyounoticehowyourmindkeepshookingyouhere?Pullingyoubackintothepast,backintoallthatpain.Isthatreallywhereyouwanttoberightnow?

Client:No.But—Ican’tstopthinkingaboutit.

Therapist: I’mnotsurprised.Thisisverypainfulforyou.It’snot likeyoucanjustputonahappyfaceandpretenditneverhappened.

Client:That’sright.MyfriendssayIshouldgetoverit,butI’dliketoseethemtryit.

Therapist:Sohowaboutthis:ratherthantryingtostopthethoughts,howaboutwepracticelettingthemcomeandgoinsteadofholdingontothem?

DROPPINGANCHOR

Atanypointinasessionwhereourclientseemstobeexperiencingemotionaldistress, it’suseful tobringher intocontactwith thepresent.Forexample,wecouldsay,“Icanseeyou’redistressed.Whatareyoufeelingrightnow?Where

areyoufeelingit?”Wecouldthengointoherphysicalsensationsanddosomeworkwith acceptance.Orwe couldmove to defusion: ask her to noticewhatshe’s thinking. Orwe could ask him to contact the external world: “Can youhave this feeling and also stay present in the room? See if you can allow thefeelingtobethere,andalsonoticewhatyoucanseeandheararoundyou.Seeifyou can really be present with me—fully here with me—even while you’rehavingthisfeeling.”Ausefulmetaphor/mindfulnesstechnique/exerciseforworkingwithdistressed

clients isDroppingAnchor. In the transcriptbelow, theclienthasbeen talkingfeverishly about her partner’s intention to leave her, and is clearly verydistressed.

Therapist:Thisisclearlyaverystressfulsituation,soit’shardlysurprisingthatyou’refeelingdistraught.Thethingis,rightnowyou’recaughtinanemotional storm.All these thoughtsand feelingsarewhirlingaroundyourbody,draggingyouhere, there, andeverywhere.Andyoucan’tdoanythingusefuluntilyoudropananchor.

Client: (talking very fast)What d’you mean? There’s nothing I can do. He’sgoing to leaveme.He’snotgoing tochangehismindnow.He’sgotsomeoneelse.He’salreadytakenmostofhisstuff.Andthere’snowayIcanpaytherentbymyself.Pluseverything’sinhisname—thegas,theelectricity,thephone,the…

Therapist: Please excuseme for interrupting you, but it’s important to noticewhat’s happening here. Your mind’s pulling you all over the place.You’re being tossed around in a storm of thoughts and feelings andwhile that’s going on, you can’t think effectively or act effectively.There’s one thing you need to do before anything else: you need todropananchor.

Client:Whatdoyoumean?

Therapist:Okay.Pushyourfeethardintothefloor.Feelthegroundbeneathyou.Now sit up in your chair, and notice how you’re sitting. And lookaround the room,andnoticewhatyoucan see.Noticewhatyoucanhear.Noticewhatyou’redoingrightnow—noticethatyouandIareinthisroom,talkingtoeachother.Nowtakeafewdeepbreaths,andseeifyoucanbreathedownintoyourfeet.Andkeepthemfirmlypressedinto the floor. And notice how your mind keeps trying to pull yousomewhere else, and see if you can stay present. Notice the room

aroundyou.Noticewhatwe’redoinghere,rightnow.

Whenaclientattendsincrisismodeorbecomeshighlyemotionallyarousedduring a session, these are valuable opportunities for teaching him how togroundhimself:anessentialfirststepinrespondingeffectivelytothechallengeathand.

HomeworkandtheNextSessionHomeworkistopracticebeingpresent.Youcanaskyourclienttomindfullydoanyactivity:washthedishes,playwithherkids,drivethecar,dothegardening,workoutatthegym,takeashower,ironshirts,brushteeth,putthegarbageout,cook dinner, listen to music, stretch, walk, run, dance, sing, eat, drink, talk,shave,makelove,makeacupoftea,andsoon.HereareafewofthethingsIoftenaskclientstodo:

Practice ten to twentyminutesofmindfulbreathingeachday.(ThisismucheasierforyourclientifhehasaCDtopracticewith.NaturallyIrecommendmyownCDs,buttherearemanyothers out there. In fact, you can easily record your own: asimpleMP3recorderandaCDburneronyourcomputerareallyou need. It may not have the same sound quality as aprofessionally recordedCD,butyourclientswon’tcareabit.The sound of your voice will have special significance forthem.)Practice five to ten mindful, slow, deep breaths at everyopportunitythroughouttheday(forexample,attrafficlights,insupermarketlines,duringcommercialbreaksonTV).Practice a brief centering technique (a) whenever you feelyourself starting to “zone out”/ dissociate/“flip out”; (b)wheneveryou’reenteringastressfulsituation;(c)themomentyou realize that you have been “zoning out”/“flippingout”/dissociating, and so on; (d) at every opportunitythroughout the day (for example, at traffic lights, insupermarketlines,duringcommercialbreaksonTV).

You could also give your clients a copy of InformalMindfulness Practice,SimpleWays to Get Present, or theMindful Breathing Practice Sheet, which

you’llfindattheendofthischapter.Theseworksheetscanalsobedownloadedfromwww.actmadesimple.com.Intraditionalprotocols,workaroundbeingpresentseguesintoself-as-context.

Inothers,itseguesintomoreexplicitworkaroundvaluesandcommittedaction.Beingpresentis,ofcourse,essentialforvaluedactionssuchasconnectingandcaring,lovingandnurturing,appreciationandgratitude,andpeakperformance.

HomeworkforYou

Read all the exercises, metaphors, and psychoeducationcomponentsoutloudasiftakingaclientthroughthem.Reviewthecasesoftwoorthreeclients,andidentifywhenandhow they’re losing touchwith thepresentmoment:worrying,ruminating, dissociating, using drugs and alcohol, and so on.Then do the same for yourself. In particular, notice how you“driftoff”duringyourtherapysessions:Howdoesyourmindpullyouawayfromyourclient?Howoftendoyougetcaughtupinthinkingaboutwhattodonextorinjudgingyourselforyourclient?Practice the activities described in Informal MindfulnessPractice (below) and noticewhat happens. This is invaluableinformationforyoubecausewhateveryoustrugglewith,yourclients will also struggle with. And if you don’t do theexercises,noticehowyourmindstoppedyou:Whatstoriesdiditgetyoutobuyinto?Wasitperhapsoneofthese—toobusy,too tired, can’t be bothered, not important, do it later, whyshouldI,it’stoohard,Ialreadyknowthisstuff?Inventafewmindfulnesspracticesofyourown.Whatdoyouhaveinyourtherapyroomthatcouldbecomean“X”tonotice?

SummaryContactwiththepresentmomentisattheverycoreofmindfulnessandnaturallyplaysan important role ineverysessionofACT.To facilitate thisprocess, thebasicinstructionwegivetoourclientsis“noticeX,”whereXisanythingthatishere in this moment. Contact with the present moment is implicit in both

defusionandacceptance:thefirststepindefusingfromathoughtoracceptingafeelingistonoticeit.Of course, at times we find it life enhancing to “escape from the present

moment” through daydreams, fantasies, novels, and movies. However, ingeneral, themore fullywecancontactourhereandnowexperience, themoreeffectivelywecanactandthemorefulfillinglifebecomes.

Chapter10.PureAwarenessSelf-as-ContextinaNutshell

In Plain Language: Self-as-context is not a thought or a feeling but a“viewpoint”fromwhichwecanobservethoughtsandfeelings,anda“space”inwhich those thoughts and feelings can move. We access this “psychologicalspace”throughnoticingthatwearenoticing,orbecomingconsciousofourownconsciousness.Itisa“place”fromwhichwecanobserveourexperiencewithoutbeingcaughtupinit.“Pureawareness”isagoodalternativetermbecausethat’sallitis:awarenessofourownawareness.

Aim:Toconnectwithatranscendentsenseofselfthatisseparatefromthoughtsand feelings, and that provides a safe and constant viewpoint from which toobserveandacceptthem.Tohelppeoplestoprunningfromtheirpain,wehelpthemexperience that there is a “place inside”where, nomatter howgreat thepainis,itcannotharmthem.

Synonyms: Self-as-perspective, the observing self, the noticing self, the silentself,pureconsciousness,pureawareness,thetranscendentself.

Method:Anyongoingmindfulnesspracticegenerallyleadstoasenseofself-as-context. This is enhanced by exercises that explicitly direct attention to one’sownconsciousness.

WhentoUse:Tofacilitateacceptance,whentheclientisafraidofbeingharmedby his own inner experiences; to facilitate defusion when the client is overlyattached to the conceptualized self; to facilitate conscious choice andeffectiveactionbyprovidingaspaceinwhichthoughtsandfeelingsdon’tcontrolactions.

ThreeSensesofSelf

Whiletherearemanywaysinwhichwecantalkaboutself,ACTtraditionallyfocuseson three sensesof self: the conceptualized self, self-as-awareness, andself-as-context. (Thesearenot termsweusewithclients.WhenyoureadACTtextbooks, you may become a bit confused as different authors use differentterminology,sohereI’vestuckwiththemostcommonlyusedterms.)

Theconceptualizedself:allthebeliefs,thoughts,ideas,facts,

images, judgments, memories, and so on that form my self-concept, that describe “who I am” as a person: my self-description.Fusionwiththesethoughtsleadstoasenseofself-as-description:Iammythoughts!Self-as-awareness: the ongoing process of noticing ourexperience,contactingthepresentmoment.Self-as-context:thelocus/spacefromwherenoticinghappens;theperspective/viewpointfromwhichnoticinghappens;the“I”thatnoticeswhateverisbeingnoticedinanymoment.

THESLITLAMPMETAPHOR

Ametaphor adapted from Buddhism illuminates these three senses of self.Imaginewalkingintoapitch-blackroom.Inyourhandsisaslitlamp.Youopenthe slit, and a beam of light shoots out and illuminates part of the room,revealing a chair, a bed, and a table.The furniture is likeyour conceptualizedself. The beam of light is like the ongoing process of noticing (self-as-awareness).Whenthelightshinesondifferentpartsoftheroom,differentpiecesoffurniturearerevealed:adesk,awardrobe,achestofdrawers.Butwhereverthe light shines, whatever it illuminates and reveals, the light beam is alwayscomingfromthesamesource,thesamelocus:thelampitself.Thelampislikeself-as-context.

TheObservingSelfIsImplicitinMindfulness

RenéDescartes,inhisfamousdeclaration,said,“Ithink,thereforeIam,”butwhoisthe“I”thatnoticesallthatthinking?InACT,weoftenrefertothis“I”asthe“observingself,”andtheobservingselfisimplicitinallmindfulness.Ifthebasic mindfulness instruction is “notice X,” that implies there’s a locus orperspective from which X is noticed. And this locus or perspective neverchanges.Inoticemythoughts, Inoticemyfeelings,Inoticemybody,Inoticetheworldoutsidemybody—andIevennoticemyownnoticing.Sothatwhichis being noticed—X—changes continually. But the locus or perspective fromwhich the noticing happens, in and of itself, never changes: throughout life,everythingisalwaysnoticedfromalocusorperspectiveofI/here/now.If you’re struggling to make sense of this, it’s not surprising, because the

observing self is an experience beyond all words.Whatever wordswe use todescribe it, whatever imageswe create of it, whatever beliefs or conceptswe

formulateabout it—they’renot it! It’s theaspectofus thatnoticesorobservesallthosewords,images,beliefs,andconceptsthatweusetotryanddescribeit.Evencallingit“it”isaproblem,becausewhenyoulabelsomething“it,”you’retreating“it”asanobject.Andyetthisobservingselfcannotbeanobjectas“it”hasnophysicalproperties.The closest we can get to this experience in language is via metaphor.

Metaphorsusuallyrefertoitasa“space”inwhichthoughtsandfeelingsmove,ora“perspective”fromwhichthoughtsandfeelingsareobserved.Oneexcellentmetaphor(whichcanbefoundinBuddhism,Taoism,andHinduism)comparestheobserving self to the sky.Youcanuse thismetaphorconversationallywithyour clients, but I prefer to deliver it at the end of amindfulness exercise, aswrittenbelow:

THESKYANDTHEWEATHERMETAPHOR

Therapist:Yourobservingselfislikethesky.Thoughtsandfeelingsareliketheweather. Theweather changes continually, but nomatter how bad itgets, itcannotharmthesky inanyway.Themightiest thunderstorm,themost turbulent hurricane, themost severewinter blizzard—thesethings cannot hurt or harm the sky. And no matter how bad theweather, the sky always has room for it—and sooner or later theweatheralwayschanges.Nowsometimesweforgettheskyisthere,butit’sstill there.Andsometimeswecan’tseethesky—it’sobscuredbyclouds. But if we rise high enough above those clouds—even thethickest,darkest,thunderclouds—soonerorlaterwe’llreachclearsky,stretching in all directions, boundless andpure.More andmore, youcanlearntoaccessthispartofyou:asafespaceinsidefromwhichtoobserveandmakeroomfordifficultthoughtsandfeelings.

GettingtoSelf-as-ContextIn traditional ACT protocols, the observing self is introduced after severalsessionsondefusion,acceptance,andthepresentmoment.However,aswithallsixcoreprocesses,wecanbringself-as-contextintoanysession.Inrecentyears,I’veincreasinglyintroducedthisconceptrightfromtheverybeginningofactivetherapy, using the concept of the thinking self and the observing self (Harris,2007).Beforereadingon,pleaserefreshyourmemoryofthisconceptbyturning

back tochapter4andrereading thesectionentitledTheThinkingSelfand theObservingSelf.IfwefollowatraditionalACTprotocol,thenwebringinself-as-contextafter

severalsessionsfocusedondefusion,acceptance,andbeingpresent.Wemightsay,“Soyou’vebeendoingallthesemindfulnessexercises—noticingthoughts,noticingfeelings,noticingyourbreath,andsoon.Whatisthispartofyouthatdoesallthenoticing?Wedon’thaveanameforitineverydaylanguage.InACT,wecallitthenoticingselfortheobservingself.Andifyou’reopentoit,I’dliketotakeyouthroughanexercisenowtohaveadeeperconnectionwiththispartofyou.”Another useful metaphor for introducing self-as-context is the Chessboard

(Hayesetal.,1999).

THECHESSBOARDMETAPHOR

Therapist: Imagine a chessboard,where thewhite pieces are all your positivethoughtsandfeelings,andtheblackpiecesareallyournegativeones.Wegothroughlifedesperatelytryingtomoveourwhitepiecesacrossand wipe off all the black pieces. But the problem is—there are aninfinitenumberofwhiteandblackpieces.Nomatterhowmanyblackpiecesyouwipeoff,morewill appear.Also, thewhitepieces attractblackpieces.Youmoveforwardthewhitepiece,“I’magoodparent,”and it immediately attracts the black piece, “No, you’re not. Whatabout the way you yelled at your kids last night.” So we can gothroughlife,wastingalotoftimeandenergy,tryingtowinthisbattlethat can never be won. Or we can learn how to be more like thechessboard.Theboardisinintimatecontactwithallthepieces,butit’snot involved in thebattle.There’s apartofus thatoperates like thischessboard.InACT,wecallittheobservingself.Itenablesustostepout of the battle with our thoughts and feelings while giving themplentyofspacetomovearound.

ExperientialExercises

Once we’ve introduced self-as-context by metaphor, there are manyexperientialexerciseswecanuse.Remember thebasicmindfulness instruction—“noticeX”?To facilitate self-as-context,Xbecomesyourownawarenessor

consciousness—that is, you notice your noticing, or notice your awareness, ornoticeyourconsciousness.Wecanfacilitatethisbyaddingsimpleinstructionstoany mindfulness exercise such as “notice who is noticing” or “be aware thatyou’renoticing.”Thefollowingexerciseillustratesthis.

THEREGOYOURTHOUGHTS…

This exercise is simply an extension of Watch Your Thoughts, the defusiontechniqueintroducedinchapter7.

Therapist:Findacomfortableposition,andcloseyoureyes.Nownotice:whereareyourthoughts?…Wheredotheyseemtobelocated:aboveyou,behindyou,infrontofyou,tooneside?(Pause5seconds.)Andnoticetheformofthosethoughts:aretheypictures,words,orsounds?(Pause5seconds.)Andnotice—aretheymovingorstill?…Andifmoving,whatspeedandwhatdirection?(Pause10seconds.)Notice therearetwoseparateprocessesgoingonhere:there’saprocessofthinking—yourthinkingselfisthrowingupallsortsofwordsandpictures—andthere’saprocessofnoticing—yourobservingselfisnoticingallthosethoughts. (Pause 5 seconds.) Now this gets your mind whirring,debating, and analyzing, so let’s do it again.Notice:where are yourthoughts?…Are theypicturesorwords,movingor still? (Pause10seconds.) There go your thoughts—and there “you” are, observingthosethoughts.Yourthoughtskeepchanging.The“you”thatobservesthemdoesnotchange.Nowonceagain,thisgetsyourmindwhirring,debating, and analyzing, so let’s just do that one last time. Notice:where are your thoughts?…Are they pictures orwords,moving orstill?…(Pause10seconds.)Theregoyourthoughts—andthere“you”are,observingthem.Yourthoughtschange;youdon’t.

NOTICINGTHESTAGESHOW

AnotherusefulexerciseisNoticingtheStageShow.Iwon’treproduceithereas it is comprised of sections 1 and 2 of the Hexaflexercise, exactly astranscribedinchapter4.Pleasegobackandrereaditnowbeforecontinuing.YoucanuseNoticingtheStageShowastheintroductiontoanymindfulness

exercise,suchasMindfulnessof theBreath,LeavesonaStream,orMindfullyEatingaRaisin.Thislaysthegroundworkfordeeperexplorationlater.TheStageShowMetaphoralsoprovidesausefulconclusiontoanymindfulnessexercise,

asinsection8of theAcceptanceofEmotionsExercise(seechapter8).Again,pleasegobackandrereaditnowbeforecontinuing.You can also tie this metaphor into earlier defusion and acceptance work:

thoughtsandfeelingsarelikeperformersintheshow,tryingtheirhardesttogetyourfullattention—andifyou’renotcareful,theygrabholdofyouandpullyouupontothestage(fusion).Defusionandacceptancearelikesteppingbackfromthestagesoyoucantakeinthewholeshow.

NOTICEWHO’SNOTICING

Asimplewayofbringingself-as-context intoanymindfulnessexerciseis toslipinaninstructionsuchas“Andasyounoticeyourbreath/yourthoughts/thissensationinyourchest/thetasteoftheraisinonyourtongue,takeamomenttonoticewhoisnoticing.”Variantsonthisinclude“Beawarethatyou’renoticing”or “Recognize that there’s a ‘you’ in there—a ‘you’ behind your eyeswho isnoticingallthis”or“ThereisX,andthereyouare,noticingX.”

TALKINGANDLISTENING

Here’sanotherultraquickexercise.

Therapist: For the next thirty seconds, silently listen in towhat yourmind issaying.And ifyour thoughts stop, justkeep listeninguntil they startagain.(Pause30seconds.)Sothereyouhaveit:there’sapartofyourmindthattalks—thethinkingself—andapartofyourmindthatlistens—theobservingself.

PracticalTip Supposeyourclientsays,“Idon’tgetit.Idon’tseemtohave an observing self. I just keep thinking.” You can reply (with suitablepauses in between each question):, “So can you notice yourself telling methis?…Can you notice your feelings of confusion?…Can you notice thesensations of that frown upon your forehead? … Can you notice all yourthoughtsaboutnotgetting it?…Canyounoticeme talking toyou?…Canyounoticewhatyou’rethinkingnowaboutmyreplies?Okay,sothere’sapartofyouintherethatnoticeseverything.That’sit—that’stheobservingself.”

THECONTINUOUSYOU

Whatfollows isamuch-shortenedversionof the“classic”observerexercisefrom Hayes and colleagues (1999), often known as the “continuous you”exercise(forreasonsthatwillsoonbeobvious).Theexercisemayatfirstseemcomplex,butit’sbasicallycomprisedofonlyfourinstructions:

1. NoticeX.2. There’sX—andthereyouarenoticingX.3. IfyoucannoticeX,youcannotbeX.4. Xchangescontinually;theyouwhonoticesXdoesnotchange.

Xcanincludesomeorallofthefollowing:yourbreath,yourthoughts,yourfeelings,yourphysicalbody,therolesyouplay.Withmostclients,Irunthroughthe entire exercise in one go, which takes about fifteenminutes, but you canbreakitupintosmallersectionsanddebriefthemasyougo.IalwaysconcludethisexercisewiththeSkyandtheWeatherMetaphor,whichusuallyhasastrongimpact.

Therapist: I invite you to sit up straight,with your feet flat on the floor, andeither fix your eyes on a spot or close them … Notice the breathflowing in and out of your lungs…notice it coming in through thenostrils…downintothelungs…andbackoutagain…Andasyoudo that, be aware you’re noticing… there goes your breath… andthere you are noticing it. (Pause 5 seconds.) If you can notice yourbreath, you cannot be your breath. (Pause 5 seconds.) Your breathchanges continually … sometimes shallow, sometimes deep …sometimes fast, sometimes slow… but the part of you that noticesyourbreathdoesnotchange.(Pause5seconds.)Andwhenyouwereachild, your lungs were so much smaller… but the you who couldnoticeyourbreathingasachildisthesameyouwhocannoticeitasanadult.Now that gets your mind whirring, analyzing, philosophizing,debating…Sotakeastepbackandnotice,whereareyourthoughts?…Wheredotheyseemtobelocated?….Aretheymovingorstill?…Are they pictures or words?… (Pause 5 seconds.) And as you donotice your thoughts, be aware you’re noticing … there go yourthoughts…andthereyouarenoticingthem.(Pause5seconds.)Ifyoucan notice your thoughts, you cannot be your thoughts. (Pause 5seconds.) Your thoughts change continually … sometimes true,sometimes false … sometimes positive, sometimes negative …

sometimes happy, sometimes sad…but the part of you that noticesyour thoughts does not change. (Pause 5 seconds.) And when youwereachild,yourthoughtsweresoverydifferentthantheyaretoday…buttheyouwhocouldnoticeyourthoughtsasachildisthesameyouwho notices them as an adult. (Pause 5 seconds.) Now I don’texpectyourmindtoagreetothis.Infact,Iexpectthroughouttherestof this exercise your mind will debate, analyze, attack, orintellectualizewhateverIsay,soseeifyoucanletthosethoughtscomeand go like passing cars, and engage in the exercise nomatter howhardyourmindtriestopullyouaway.(Pause5seconds.)Nownoticeyourbody in thechair…(Pause5seconds.)Andasyoudo that,beaware you’re noticing … there is your body … and there you arenoticing it. (Pause 5 seconds.) It’s not the same body you had as ababy,asachild,orasateenager…Youmayhavehadbitsputintoitorbits cutoutof it…Youhave scars, andwrinkles, andmoles andblemishes, and sunspots… it’s not the same skin you had in youryouth,that’sforsure…Butthepartofyouthatcannoticeyourbodyneverchanges.(Pause5seconds.)Asachild,whenyoulookedinthemirror, your reflectionwas very different than it is today…but theyouwhocouldnoticeyourreflectionisthesameyouthatnoticesyourreflectiontoday.(Pause5seconds.)Nowquicklyscanyourbodyfromhead to toe, and notice the different feelings and sensations… andpickanyfeelingorsensationthatcapturesyourinterest…andobserveitwithcuriosity…noticingwhereitstartsandstops…andhowdeepin itgoes…andwhat its shape is…and its temperature…Andasyounoticethisfeelingorsensation…justbeawareyou’renoticing…thereisthefeeling…andthereyouarenoticingit.(Pause5seconds.)Ifyoucannoticethisfeelingorsensation,youcannotbethisfeelingorsensation. (Pause 5 seconds.) Your feelings and sensations changecontinually…sometimesyoufeelhappy,sometimesyoufeelsad…sometimes you feel healthy, sometimes you feel sick… sometimesyoufeelstressed,sometimesrelaxed…butthepartofyouthatnoticesyour feelingsdoesnot change. (Pause5 seconds.)Andwhen you’refrightened,angry,orsadinyourlifetoday…theyouwhocannoticethose feelings is the same you that could notice your feelings as achild.Nownoticetheroleyou’replayinginthismoment…andasyoudothat,beawareyou’renoticing…rightnow,you’replayingtheroleofaclient…butyourroleschangecontinuously…attimes,you’reintheroleofamother/father,son/daughter,brother/sister,friend,enemy,

neighbor, rival, student, teacher, citizen, customer,worker, employer,employee,andsoon.(Pause5seconds.)Ifyoucannoticethoseroles,youcannotbethoseroles.(Pause5seconds.)Andtherearesomerolesthat youwill never have again… like the role of a young child…(Pause5seconds.)Buttheyouwhonoticesyourrolesdoesnotchange…It’sthesameyouthatcouldnoticeyourrolesevenwhenyouwereveryyoung.Wedon’thaveagoodnameineverydaylanguageforthispart of you… I’mgoing to call it the observing self, but you don’thave to call it that… you can call itwhatever you like… and thisobservingselfislikethesky.(FinishtheexercisewiththeSkyandtheWeatherMetaphor.)

Longerversionsoftheexercisetaketheclientbackthroughseveralmemoriesfromdifferentperiodsofher lifeandhaveher recognize that ineachcase, theobservingselfwaspresentwhenthememorywas“recorded.”Manyclientsfindthisexerciseaprofoundlymovingspiritualexperience.It’s

betternottoanalyzeitafterwardoryouruntheriskofintellectualizingit.

AccentuatingDefusionandAcceptance

Asmentionedinchapters7and8,onceyou’veintroducedtheobservingself,you can bring it into sessions as a brief intervention to enhance defusion andacceptance: “See if you can take a step back and look at this thought/feelingfromtheobservingself.”Youcansee thisplayout in the following transcript,from a fourth session, following work on defusion, acceptance, and self-as-context.Theclient,amiddle-agedwoman,wantstotellhertwenty-six-year-oldsontomoveoutofherhome.

Client:(lookingpale,tense,agitated,andanxious)Idon’tknowifIcandoit.Iwantto,Imean,Iwanthimtogo…I’vehadenoughofhim…but…Ifeelso…well,I’mhismother,aren’tI?Oh,God.Ican’tstandthisfeeling.

Therapist:Takeastepbackforamomentandseeifyoucanlookatthisfromtheobserving self … Notice all those thoughts whizzing through yourhead… and all those feelingswhirling around in your body… andnotice your body sitting in the chair… and notice the room aroundyou…whatyou can see andhear… including little oldme, sitting

overhere…There’sawholestageshowgoingonhere—andthere’sapartofyou,anobservingself,that’sabletonoticethatshow…Fromthatperspective,noticethisfeelinginyourbody…andrecognizethatit’sonlyoneactoronthestage.Nowyourmindsaysyoucan’tstandthis feeling, butwhen you look at it from the observing self, is thatreallythecase?

Client:No.It’s—whenIlookatitlikethat,it’sabiteasier.

Therapist:Easiertomakeroomfor?

Client:Yeah.

Thesessionnowturns toanexplorationof themother’svalues.Thisrevealsthat asking her son to leave home is in the service of encouraging hisindependence, helping him to “grow up,” and creating a home atmosphereconducive to greater intimacy with her husband. About ten minutes later, thetherapistreturnstotheobservingself.

Therapist: For just a moment, can I get you back into contact with yourobserving self? (Client nods yes.) Then once again from thatperspective,justnoticethethoughtspassingthoughyourmind…andnotice the feelings surging throughyourbody…andnotice that thestageshowhaschangedfromafewminutesago…but theyouwhonoticesthestageshowhasnotchanged.

Thetherapistgoes throughthisbriefexerciseonemoretimeneartheendofthesessionthenaskstheclient:

Therapist:Iwonderifyou’dbewillingtodothisexercisetwoorthreetimesaday—just take a moment to step back and notice the stage show.Noticethatitchangesallthetime—there’sanever-endingprocessionofnewthoughtsandfeelingsstruttingtheirstuffonthestage.Andasyou do that, notice that the part of you noticing the show—theobservingself—neverchanges.

LetYourSelfGoClients will often say, “I have no self-esteem” or “I want more self-esteem.”While there are different constructs of self-esteem, far and away the mostpopular concept is this: Self-Esteem = Thinking Positively About Yourself.

Certainlythemajorityofself-esteemprogramsplacehugeemphasisontryingtojudgeyourselfpositively,focusingonyourstrongpoints,andtryingtoreduceoreliminate negative self-judgments.However, from anACT perspective, fusionwith a self-description is likely to create problems whether it is positive ornegative.Thefollowingtranscriptmakesthisclear.

THEGOODSELF/BADSELFEXERCISE

Client:Buthighself-esteemisgood,isn’tit?

Therapist:Well,youhavethreeyoungkids,right?

Client:Yeah.

Therapist: So suppose you have the thought I am awonderfulmother. I do abrilliant job. Now if you hold on tightly to that thought, there’s nodoubtitwillgiveyouverypositiveself-esteem.Butwhatmightbethedangeroffusingwithit?Goingthroughyourdayconvincedyou’reawonderfulmom,doingabrilliantjobwithnoneedforimprovement?

Client:(chuckles)Well,it’snottrueforastart.

Therapist: Okay, so one cost is you lose touchwith reality.What else?Whatmight happen toyour relationshipwithyourkids if you100percentbelievedthateverythingyoudidwaswonderful?

Client:IguessImightnotrealizewhenIwasdoingthingswrong.

Therapist: Sure. You would lack self-awareness, and you’d probably becomeinsensitive. And then you wouldn’t grow and develop into a bettermombecausethatonlyhappenswhenyoucanseeyourmistakesandlearnfromthem.Nowletmeaskyou:atyourfuneral,whichofthesedoyouwantyourkidstobesaying,“Momhadareallyhighopinionofherself”or“MomwasreallythereformewhenIneededher?”

Client:(laughs)Thesecondone.(confused)Butcan’tself-esteemhelpmetobeabettermom?

Therapist:Okay.Let’scheckthisout.(Therapistpullsoutanindexcard.)Whenyourmindwantstobeatyouup,whataresomeofthenastiestthingsitsaystoyou?

Client:(sighs)Sameoldstuff.I’mfat.AndI’mdumb.

Therapist:Okay.Sothisisthe“badself”:“I’mfat”and“I’mdumb.”(Therapist

writes“I’mfat”and“I’mdumb”ononesideoftheindexcard,thenturnsthecardover.)Nowonthoserareoccasionswhenyourmindisbeingnicetoyou,whataresomeofthenicethingsitsaysaboutyou?

Client:Um.I’magoodperson.I’mkindtoothers.

Therapist:Okay.Sothisisthe“goodself.”“I’magoodperson”and“I’mkind.”(Therapistwritesthesedownontheflipsideofthecard.)Thisisabitlikethatexercisewedidacoupleofsessionsback.Soifyou’rewillingto,I’dlikeyoutoholdthecardupinfrontofyourfacesoyoucanreadall the negative stuff. That’s it—hold it right up in front of you sothat’s all you can see. (Client holds the card in front of her face,cuttingoffthetherapistfromherview.)Holdittightly.Getallcaughtupinyour“badself.”Now,that’sverylowself-esteem,isn’tit?

Client:Yeah.

Therapist:Andnotice—whileyou’reallcaughtupinthis,whathappenstoyourrelationshipwithme?Doyoufeelengaged,connected?

Client:No.Ican’tseeyou.

Therapist:Okay.Nowturnitaround,soyou’relookingatallthepositivestuff.That’sit—andkeepitupthererightinfrontofyou.(Clientturnsthecardaroundandcontinuestoholditupinfrontofherface.)Nowgetall caught up in your “good self.” Hold it tightly—all those lovelypositive thoughts. And now you’ve got really high self-esteem. Butwhat’s your relationship with me like? Do you feel engaged,connected?

Client:(chuckling)No.

Therapist:Okay.Nowput the card down on your lap. (Client does so.)Now,what’syourrelationshiplikewithme?

Client:(Clientlooksatthetherapist.Hegrins,andshegrinsback.)Muchbetter.

Therapist:Engaged?Connected?

Client:Yes.

Therapist:Andnotice,aslongasyouletitsitthereinyourlap,itdoesn’tmatterwhich way up the card is—good self, bad self doesn’t matter—ifyou’renotholdingontoitorgettingabsorbedinit,itdoesn’tstopyoufromdoingwhatyouwant todo.So in termsofbeingagoodmom,

what’s more important? Trying to hold on to tightly to all thesethoughts about how good you are, or engaging and connectingwithyourkidsandreallybeingthereforthem?

Client:Beingthereformykids,ofcourse.

Attheendofthesession,thetherapistgavethecardtotheclient.Heaskedherto(a)writefivemorepositiveself-judgmentsonthe“goodself”side,andfivemore negatives on the “bad self” side; (b) carry the card around in herpurseforaweek;and(c)pullitoutseveraltimesaday,readbothsides,thenputitbackinherpurseagain.Duringthefollowingsession,theclientreportedshe had been much better at defusing from self-judgments (positive andnegative)andhaddevelopedagreatersenseofself-acceptance.

Self-Acceptancevs.Self-Esteem

FromanACTperspective,self-acceptanceisfarmoreempoweringthanself-esteem. Inmostmodels of psychology, self-acceptance is taught as a thinkingprocess—thatis,tellingyourselfthingslikeIacceptmyselfasafalliblehumanbeing;weallmakemistakes.Whilethiscanundoubtedlybeuseful,inACT,theemphasisisondevelopingself-acceptancethroughmindfulnessratherthanself-talk. Self-acceptance develops naturallywhenwe repeatedly defuse from self-judgments(bothpositiveandnegative)andthoughtscomparingustoothers.Amore profound experience of self-acceptance happenswhenwe enter the

psychologicalspaceofself-as-contextandwhen,fromthatspace,werecognizethe conceptualized self forwhat it is: nothingmore or less than an incrediblycomplex construction of thoughts, memories, and images. The figures belowillustratesthisprogression.

Infigure10.1, thepersonisfusedwith(attachedto) theconceptualizedself.Andwhether this conceptualized self is positive or negative, fusionwith it islikelytobeproblematic.Fusionwithapositiveselfcaneasilyleadtoarrogance,narcissism,intoleranceofothers,andrefusaltoacknowledgenegativefeedback;fusion with a negative self can lead to depression, anxiety, feelings ofworthlessness, and so on. In either case, lack of self-awareness andpsychologicalinflexibilityresult.Forexample,considerwhatimpactitmighthaveonamanagerifheisfused

with“IworkhardandIdon’ttoleratefoolsgladly.”Orsupposeapoliceofficerisabsolutelyfusedwith“Iamanofficerof thelaw”—hebaseshiswholeself-worthon this identity,and thenonedayhebecomespermanentlydisabledandunabletowork.Hewillthenstruggletoacceptandadapttothissignificantlifechange,andhisconceptualizedselfmaynowcontainelementssuchas“Withoutmyjob,Iamnobody.”

In figure 10.2, the person is defusing from thoughts that make up herconceptualizedself.Thosethoughtsthenhavelessinfluence;theystillcomeup,but they “take up less space.” She is no longer clinging to her self-description/self-image/self-concept;insteadshe“holdsitlightly.”

Infigure10.3,thepersonisinthepsychologicalspaceofself-as-context;fromthis perspective, there is maximum defusion. The conceptualized self isrecognizedasaconstructionofthoughtsandnot“theessenceofwhoIam.”

WhoAmI?

Attimes,whenyou’vetakensomeonethroughaself-as-contextexperience,aclientwill ask, “Well,whoam I then?” It’s easy toget boggeddown indeep,philosophicalquestionsatthispoint,andforourpurposesinACT,wedon’twishtodothat.We’recoachesandtherapists,notphilosophers,gurus,ormeditationteachers.So I usually reply along these lines: “‘Whoam I?’ is abigquestion.Therearemanydifferentsensesofself.Inoursociety,wetendtofocusontwomain senses of self: the physical self—our body—and the thinking self,morecommonlyknownas ‘themind.’Whatwe’re aiming todohere is recognize athirdsenseofself.The‘observingself’canobservebothour thinkingselfandourphysicalself,butitisdistinctfromthem.Youarecomprisedofallthreeofthese selves, but whereas the thinking self and the physical self changecontinuously, theobserving selfdoesn’t. It’s likea safeplace insideyou that’salways there—a place from where you can observe what’s happening in themindorthebodywithoutbeingharmed.”

ISTHISTHESOUL?

Attimes,clientsmayaskifthisisthesoul.Myresponseissimple:“That’snotawordIwouldpersonallyuse,butyoucancallitwhateveryoulike.Whatever

wordsyouusetodescribeit,thisisthepartofyouthatnoticesallthosewords.”

THERAPYVS.MYSTICISM

Ifyouwere to“stay in the space”of self-as-context foraprolongedperiod,you would have the “mystical experience”: there is no individual self,“everythingisone.”WearenottryingtocreatemysticalexperiencesinACT;itis not some religious or spiritual path to enlightenment. With prolongedmindfulness practice, we can “stay in the space” of self-as-context for longerperiods,butfromanACTperspective,that’snotactuallynecessary.Inpractice,mostpeoplegetonlybrief“glimpses”ofthisspace,andthenthey

quickly get “pulled out of it” by their thoughts. However, that’s more thanenoughtoserveourpurposes.Wesimplywantpeopletoexperiencethatthere’sa powerful psychological resource within us, a resource that is readilyaccessible, a place from which to observe and make room for our painfulthoughts and feelings.Furthermore, it is apsychological space that freesus tomake conscious choices about what we do. How so? Because from thisperspective, we can “clearly see” that our thoughts and feelings are transienteventsthatdon’tdefinewhoweareorcontrolouractions.

ATECHNICALPOINT

InthescriptsofsomeACTexercises,youmayreadcommentslikethis:“Theobservingselfisthereyourwholelife—fromthemomentyou’reborn,untilthemomentyoudie.”Forthepurposesofcoachingortherapy,it’sfinetotalkthisway,howeverpleasekeepinmind,it’snottechnicallyaccurate.RFT(relationalframe theory; the theory of language and cognition on which ACT rests)explains howwe develop this transcendent sense of self, typically around agefour, through a process called “deictic framing.” This is just one of themanyfascinatingthingsyouwilllearnaboutifyoushouldchoosetodelvefurtherintoRFT.

HomeworkandtheNextSessionThere are two ideas for homework already in this chapter: the first involvescontacting self-as-context, and the other involves defusing from theconceptualized self. And, of course, we can make the Good Self/Bad Self

Exercisemorespecific:itcouldbegoodmother/badmother,goodtherapist/badtherapist,orevengoodcop/badcop.Here’s another simple option: we suggest that our client continuewith any

previous mindfulness practice and we add the instruction, “From now on, asyou’redoing that, from time to timecheck inandsee ifyoucannoticewho’snoticing.”Youcouldalsoaskclientstopracticemindfulnessexercisesthatareexplicitly

orientedtowardself-as-context.Thisismoreeffectiveifyouhaverecordedtheexercisesinsession,orifyourclienthasacommercialCD(forexample,track5ofmyCDMindfulnessSkills:Volume1 is a recording of theContinuousYouExercise).As for the next session, traditionally we would move on to values and

committedaction.Wewouldcontinue tobring inself-as-contextexperientiallyas needed as an aid to overcoming any psychological barriers (that is, tofacilitatedefusionoracceptance).

HomeworkforYou

Readall theseexercisesandmetaphorsout loud,andpracticethemasifyouwereworkingwithclients.Pick two or three cases and identify thoughts, beliefs,judgments, and other self-descriptions that comprise theconceptualizedself.Considerhowyoucouldintroduceself-as-contextworkwith these clients—both brief interventions andlongerones.Trytheseexercisesonyourself.Inparticular,pulloutanindexcard and do the Good Self/Bad Self Exercise, and carry thecardaroundwithyouforaweek.Ifpossible,haveafriendorcolleague take you through theContinuousYouExercise—orrecord it yourself and then listen to it. And if you have anongoingmindfulnesspractice,fromtimetotimenoticewhoisnoticing.

SummaryThe observing self (self-as-context) is implicit in allmindfulness exercises or

practices. It is not really a “self” at all: rather it is the locusorperspectiveorpsychologicalspacefromwhichweobserveornoticeeverythingelse.If“NoticeX”is thebasicmindfulness instruction, then inself-as-contextwork, theXwenotice is our own awareness or consciousness. Thus self-as-context can beconceptualizedasawarenessofawareness,orconsciousnessofconsciousness.Many mindfulness-based models of therapy never make self-as-context

explicit; they rely on people to discover “it” for themselves through ongoingmindfulnesspractice.However,inACTweliketomakeself-as-contextexplicitas it enhances defusion and acceptance, and allows us to experience atranscendentsenseofself.

Chapter11.KnowWhatMattersValuesinaNutshell

InPlainLanguage:Valuesarestatementsaboutwhatwewanttobedoingwithour life: aboutwhatwewant to stand for, and howwewant to behave on anongoingbasis.Theyareleadingprinciplesthatcanguideusandmotivateusaswemovethroughlife.

Aim:Toclarifywhatgivesour lifeasenseofmeaningorpurpose,and touseourvaluesasanongoingguideforouractions.

Synonyms:Chosenlifedirections.

Method: Distinguish values from goals; help clients connect with and clarifytheirvaluessotheycanusethemtoinspire,motivate,andguideongoingaction.

When toUse:When looking for guidance fromwithin; whenmotivation foraction is lacking; as a precursor to goal setting and action plans; to facilitateacceptance;toaddrichness,fulfillment,andmeaningtolife.

GettingtoValuesThewholeACTmodelisaimedtowardoneoutcome:mindful,values-congruentliving or, in lay terms, a rich, full, andmeaningful life. It’s this outcome thatmotivateseverythingwedoinACT:wewouldn’twantsomeonetoacceptpain,orpracticedefusion,orexposeherselftochallengingsituationsunlessitservedtomakeherlifericherandfuller.SomeACTprotocolsdonotexplicitlyworkonvalues until they’ve first covered defusion, acceptance, present moment, andself-as-context.However,othersstartwithclarifyingvaluesupfront.Therearepros and cons to both approaches. On one hand, work around values oftentriggersfusionandavoidance;thereforesomeclientswillbeunableorunwillingtoexplorevalues inanydepthuntil theyfirstdevelopdefusionandacceptanceskills.Ontheotherhand,someclientswillnotbemotivatedtodothehardworkoftherapyunlesstheyfirstgetintouchwiththeirvalues.Forasenseofthefirstapproach,youmayliketoreadmyself-helpbook,The

Happiness Trap (Harris, 2007), which takes the reader step-by-step along themore traditional route of creative hopelessness first, followed by mindfulness

skills,andthenvaluesandaction.Forasenseofthesecondapproach,youmightwanttolookatACTwithLove(Harris,2007),myself-helpbookforrelationshipissues(Harris,2009).Personally, wherever possible, I prefer to start therapy or coaching with a

focus on values. That’swhy, in chapter 5, I suggested thatwe start clarifyingvaluesfromourveryfirstencounterwiththeclient.Sobeforereadingon,pleasegobacktochapter5andreadagainthesectionentitledABasicGuidetoTakingaHistory.Of course, sometimes we’ll have a client who initially won’t go anywhere

nearvalues.Ifwegivehimavaluesworksheetonthefirstsession,hemayleaveit blank, put a cross through it, scrunch it into aball, or protest that he “can’tthinkofanything”orit’s“awasteoftime.”Aresponselikethisgivesususefulinformation: it alerts us to a significant lack of contact with or clarity aboutvalues,anditusuallyindicateshighexperientialavoidance.Inthesecases,we’llgenerallyneedtotreadslowlyandgently,anddoplentyofworkarounddefusionandacceptancebeforewecangettocorevalues.

PracticalTip Sometimes wemay be lucky enough to have a clientwhorespondsdramaticallytodiscussionsaboutvaluesandimmediatelystartsmaking significant changes in her life. If so, we don’t need to go diggingaround trying to find psychological barriers or trying to “sell her” onmindfulnessskills.However,inmostcases,asshestartsactingonhervalues,psychologicalbarrierswillstartshowingup.

Regardlessofwhatnumbersessionwe’rein,andwhichpartsofthehexaflexwe’ve covered, ifwehaven’t yet explored the client’svalues, there’s a simplewaytoleadintoit:wecompassionatelyandnonjudgmentallypointoutthatweknowalotaboutwhattheclientdoesn’twant—butlittleornothingaboutwhathedoeswant.Forexample,wecouldsay,“IthinkIknowquitealotaboutwhatyourproblemsare: thepainful feelingsyoustrugglewith, thepainful thoughtsyougetentangledin,thedifficultiesyoufaceindifferentpartsofyourlife,thethingsotherpeopledothatyoudon’tlike,andthethingsthatyoudothateitherdon’thelpor justmake thingsworse. Inotherwords, Iknowa lotaboutwhatyoudon’twant,whatyou’vehadmorethanenoughof.Butthere’sabiggapingholeinmyknowledgehere.Iknowverylittleaboutwhatyoudowant—about

whatsortofpersonyouwanttobe,whatsortofrelationshipsyouwanttobuild,and what you want to do with your life to make it richer, fuller, and moremeaningful.Sothat’swhatI’dlikeustolookatnow.Wouldthatbeokay?”

WhatValuesAre—andWhatTheyAren’t

When Idescribevalues tomyclients, I say something like, “Valuesareourheart’s deepest desires for the way we want to interact with the world, otherpeople,andourselves.They’rewhatwewanttostandforinlife,howwewanttobehave,whatsortofpersonwewanttobe,whatsortofstrengthsandqualitieswewanttodevelop.”AsyoureadafewbooksonACT,you’llencounterseveraldifferenttechnical

definitionsofvalues.Here’stheonethatIthinkismostuser-friendly:valuesare“desired global qualities of ongoing action” (Hayes,Bond,Barnes-Holmes,&Austin,2006,p.16).Let’sbreakthatdownintothreecomponents:

1.Ongoingaction.Valuesareabout“ongoingaction.”Inotherwords,valuesareabouthowyouwant tobehaveor actonanongoingbasis—whatyouwant tokeepondoing.Forexample,yourvaluesmayincludebeinglovingandcaring;giving, sharing, and contributing; being a good friend;maintaining health andfitness;beingopenandhonest.Incontrast,goalsareaboutwhatyouwanttogetorhaveorcomplete.Thus,ifit’snotsomethingyoucandoonanongoingbasis,then it’s not a value. Happiness is not a value—you can’t do it. A sense ofbelongingisnotavalue—youcan’tdoit.Beinglovedandrespectedbyothersisnot a value—you can’t do it. To have a big car, a big house, a great job, awonderful partner, or a thin body: those are not things you can do—they aregoals,notvalues.

2. Global qualities. Values are about “global qualities” of ongoing action. Solet’s suppose you want to play baseball. Now clearly “playing baseball” issomethingyoucandoonanongoingbasis—itisanongoingaction,butit’snotaqualityofaction.Toclarifythis,herearefourpossiblequalitiesofthatongoingaction: playing baseball skillfully, playing baseball clumsily, playing baseballenergetically,playingbaseballhalf-heartedly.Sowhatdowemeanbya“global”quality?Wemeanaqualitythat“unites”

many different patterns of action. For example, if your value is “beingsupportive” to the other players in your team, then there are many differentactionsyoucouldtakewiththequalityof“supportiveness.”Andifyourvalueis

“beingfair,”therearemanydifferentactionsyoucouldtakewiththequalityof“fairness.”So in order to get to your values around playing baseball, I could ask you

questions such as: “How do you want to play baseball?” “What personalqualitiesor strengthsdoyouwant tomodelordemonstrateduring thegame?”“Howdoyouwanttobehaveinyourrelationshipswiththeotherplayers,bothonyourteamandtheopposingteam?”Thesequestionsmayuncovervaluessuchas being focused, being competitive, applying yourself fully, being respectful,being cooperative with your teammates, being fair, “giving it your best,”challengingyourself,andsoon.Notethatthesequalitiesofactionareavailabletoyouinanymoment:evenif

you become paralyzed from thewaist down and unable to ever play baseballagain,youcanstillbefocused,competitive,respectful,cooperative,fair;youcanstillapplyyourselffully towhateveryou’redoingand“giveityourbest”;youcanstillactinwaysthatchallengeyou.

3.Desired.Valuesare“desired”qualitiesofongoingaction.They’restatementsabouthowyouwanttobehave,howyoudesiretoact,whatmatterstoyou,andwhat’simportanttoyou.They’renotaboutwhatyoushoulddoorhavetodo.(Inmany ACT textbooks, you’ll find the word “chosen” rather than the word“desired”; this is to emphasize that younot onlydesire thesequalities inyouractions,butyoualsoconsciouslychoosetoemploythem.)

VALUESVS.GOALS

Useful questions to clarify values include these: “Deep down inside,what’simportant to you?” “What do you want to stand for in life?” “What sort ofpersonalstrengthsandqualitiesdoyouwanttocultivate?”“Howdoyouwanttobehaveinyourrelationships?”Whenclientsanswerthesequestions,they’llusuallygiveusgoalsratherthan

values.Thisishardlysurprising.Oursocietyislargelygoalfocused,notvaluesfocused.Sowe’llneedtodosomepsychoeducation:explainthatvaluesarelikedirections inwhichwewant tomove throughout our lives,whereas goals arethingsthatwewanttoachieveorcomplete.Tohelpourclientsunderstandthis,weoftencomparevaluestoacompass(Hayesetal.,1999).

THECOMPASSMETAPHOR

Therapist:Valuesarelikeacompass.Acompassgivesyoudirectionandkeepsyouon trackwhenyou’re traveling.Andourvaluesdo the same forthejourneyof life.Weusethemtochoosethedirectioninwhichwewanttomoveandtokeepusontrackaswego.Sowhenyouactonavalue, it’s likeheadingwest.Nomatterhowfarwestyoutravel,younever get there; there’s always further to go. But goals are like thethingsyoutrytoachieveonyourjourney:they’relikethesightsyouwant to see or themountains youwant to climbwhile you keep ontravelingwest.

Wecangiveclientsacoupleofexamplestoclarifythedifference.Oneofmyfavoriteexamplesisthecontrastbetween“gettingmarried”and“beingloving”(Hayes et al, 1999). If you want to be loving and caring, that’s a value—it’songoing; you want to behave that way for the rest of your life. And in anymomentyouhaveachoice:youcaneitheractonthatvalueorneglectit.Butifyou want to get married, that’s a goal. It’s something that can be completed,achieved,“crossedoffthelist.”Andyoucanachievethegoalofmarriageevenif you completely neglect your values around being loving and caring. (Ofcourse,yourmarriagemightnotlasttoolong.)Valuesarefarmoreempoweringthangoalsbecausethey’realwaysavailable

tous. Inanymoment,wecanacton themorneglect them; thechoice isours.Notsoforgoals.Wecan’tguaranteewe’lleverachievethegoalofmarriage,butinanymomentwecanactonourvaluesaroundbeinglovingandcaring.Thisispossibleevenifwedon’thaveapartner;wecanbelovingandcaringtowardourfriends, neighbors, family, pets, pot plants, environment—and, of course,ourselves.Here’s another example I oftengive: if youwant abetter job, that’s agoal.

Onceyou’vegot it, it’s“missionaccomplished.”But ifyouwant tobehelpfuland efficient and productive, those are values: desired qualities of ongoingaction.Andinanymoment,youcanactonthosevalues—evenifyoudon’tlikeyourjoboryoudon’tcurrentlyhaveone.Hereareafewmoreexamplestoreallyhammerthispointhome:Toloseten

poundsofweightisagoal;eatinghealthilyisavalue.Togotothegymisagoal;caringforyourbodyisavalue.Tohaveabighouseisagoal;supportingyourfamilyisavalue.Togetloveandrespectfromothersisagoal;tobelovingandrespectful is a value. To feel less anxious is an “emotional goal”; actingcourageouslyisavalue.Tofeelhappyisanemotionalgoal;beingwarm,open,andfriendlytowardothersisavalue.Tostopcriticizingyourpartnerisa“dead

person’sgoal”(adeadpersonwillnevercriticizehispartner);beingaccepting,understanding,andappreciativeisavalue.

VALUESVS.DESIRES,WANTS,NEEDS,FEELINGS,VIRTUES,MORALS,ANDETHICS

At times, both therapists and clients may confuse values with the thingsmentionedintheheadingabove,solet’squicklyclarifythedifferences.

Wants,needs,anddesires.Wemaywantorneedordesireallsortsofthingsfromother people—love, respect, kindness, and so on. But those are not valuesbecausethey’renotwaysthatwewanttobehaveonanongoingbasis.Naturallywevalidate thosewants/needs/desires inour clients.And if a client can fulfillthosewants/needs/desiresinamannerthat’sworkable,thenwehelphertodoso.Likewise,wehelphertoacceptthepainthatariseswhenthere’sagapbetweenwhatshedesiresandwhatshe’sgot.Atthesametime,wehelpourclientstorecognizethatwhilewedohavealot

ofcontroloverhowweact,wedon’thaveanycontroloverwhatweget.Soitmakessensetofocusonwhatismostwithinourcontrol.Themostempoweringresponse to unmet needs and unfulfilled desires is to accept the pain, connectwithourvalues,andtakeaction.

Feelings.Valuesarenotfeelings.Ourvalueswillaffecthowwefeelaboutanygiven event or situation and how we act in response to it, but they are notfeelings.Togettovalues,wecanask,“WhatdoIwanttostandforinthefaceofthis?HowdoIwanttoactinresponsetothiseventorsituation?”

Virtues,morals,andethics.Valuesarebeyondrightorwrong,goodorbad.Theyaresimplyexpressionsofwhatmatterstous.Ofcourse,oursocietyjudgesthosevalues as good and bad, and the “good” ones get called “virtues.” Then oursociety lays down rules about the rightway and thewrongway to act on ourvalues, and it tells us that ifwe don’t act the “rightway”we are “bad.”Thisgivesrisetomorals,ethics,andcodesofconduct.Soifourclientsstarttalkingaboutright,wrong,good,orbad,weknowthey

haveshiftedfromvaluesintotherealmofmorals,ethics,orcodesofconduct.

FiveKeyPointsaboutValues

Aside from the distinction between values and goals, there are at least fiveotherkeypointstodrawoutintherapy:

1. Valuesarehereandnow;goalsareinthefuture.2. Valuesneverneedtobejustified.3. Valuesoftenneedtobeprioritized.4. Valuesarebestheldlightly.5. Valuesarefreelychosen.

Let’squicklyzipthroughtheseonebyone.

VALUESAREHEREANDNOW;GOALSAREINTHEFUTURE.

Valuesarehereandnow: inanymoment,youcanchoose toacton themorneglectthem.Evenifyou’vetotallyneglectedacorevalueforyearsordecades,inthismomentrightnowyoucanactonit.Incontrast,goalsarealwaysinthefuture:agoalissomethingthatyou’reaimingfor,strivingfor,workingtoward.Andthemomentyouachieveit,it’snolongeragoal.Because of this, peoplewho lead a very goal-focused life often find that it

leads to a sense of chronic lack or frustration.Why? Because they’re alwayslookingtothefutureandcontinuallystrivingtoachievethenextgoalundertheillusionitwillbringlastinghappinessorcontentment.Inthevalues-focusedlife,westillhavegoals,buttheemphasisisonlivingbyourvaluesineachmoment;this approach leads to a sense of fulfillment and satisfaction as our values arealways available. Themetaphor of TwoKids in the Car gets this across well(Harris,2007).

TWOKIDSINTHECARMETAPHOR

Therapist: Imagine thereare twokids in thebackofacar,andMom’sdrivingthem toDisneyland. It’s a three-hour trip to get there, and one kid’ssaying,everyfiveminutes,“Arewethereyet?Arewethereyet?Arewe there yet?”Mom’s getting annoyed, the kid’s frustrated, they’resnapping at eachother—it’s a stateof chronic tension.But theotherkid’s looking out of the window, waving at the other cars, noticingwith great interest all the towns and farms and factories that they’redrivingpast.Nowboth kids reachDisneyland at the same time, andbothhaveagreattimewhentheygetthere.Butonlyoneofthesekidshashadarewardingjourney.Why?Becausehewasn’tjustfocusedonthegoal;healsovaluedexploring,traveling,learningabouttheworldoutsidethecar.Andonthewayhome,thefirstkidkeepssaying,“Are

wehomeyet,arewehomeyet,arewehomeyet?”Whereastheotheroneenjoystheridebylookingout thewindowandappreciatinghoweverythinglookssodifferentatnight.

PracticalTip Mostpeoplethinkofsuccessasachievinggoals.Iinviteclients toconsideradifferentdefinition:success is livingbyourvalues.Withthisdefinition,wecanbesuccessfulrightnoweventhoughourgoalsmaybealongwayoff(andeventhoughwemayactuallyneverachievethem).

VALUESNEVERNEEDTOBEJUSTIFIED

Valuesare likeour taste in icecream:wedon’tneed to justifywhywe likestrawberry or chocolate or maple syrup—or whatever our favorite flavor is.Valuesaresimplystatementsaboutwhat’smeaningful tous;weneverneed tojustifythat.However,wemay need to justify the actionswe take. If, for example, you

value connectingwithnature, youdon’t have to justify that—but if youmoveyourfamilyfromthecitytothecountryside,youmayhavealotofexplainingtodo.OurassumptioninACTisthatdestructivebehavior—toselforothers—isnotmotivatedbyvalues.This is apragmaticassumption,becausewhathappens ifwestart fromthealternativeviewpoint—thatyourclient’sdestructivebehaviorreflectswhohereallywantstobeandwhathewantstostandforinlife?Whatsortoftherapeuticrelationshipwillwebuild,ifthat’sourattitude?Therapists sometimesask, “What ifmyclienthasvalues I ethicallyoppose,

such as wanting to rape or torture others?” The short answer is you aren’tobliged to work with any client if doing so compromises your own ethicalstandards. The longer answer is this: even in forensic populations where ourclients have committed awful crimes such as rape, torture, andmurder, if wework hard, build a strong rapport, and dig down under layers and layers ofthickened,hardened,encrustedfusionandavoidance, thenwe’llalmostalwaysdiscover core values similar to our own.When these people committed theircrimes,it’shighlyunlikelytheywereactingmindfullyontheirvalues;theywerealmost certainly acting impulsively or mindlessly, motivated by fusion andavoidance.

VALUESOFTENNEEDTOBEPRIORITIZED

Becauseallourvaluesareavailableineachmoment,we’llneedtoprioritizewhichweacton.Forexample,wemayvaluebeinglovingandcaringtowardourparents,but if they’recontinuallyhostileandabusivetous,wemaycutoffallcontact with them because our values around self-protection and self-nurturetake priority.Our values around being loving and caring haven’t disappeared;they’vejustbeenprioritized.PsychologistJohnForsythhasagoodanalogyfor this:ourvaluesare likea

cube.Inanyposition,somefacesofthecubeareclearlyvisible,andotherfacescan’t be seen at all.The unseen faces haven’t ceased to exist, they’re just notvisible in this position. Andwhenever the cube changes position, some facescometotheforeground,whileothersrecedeintothebackground.

VALUESAREBESTHELDLIGHTLY

InACTwesay, “Pursueyourvaluesvigorously,buthold them lightly.”Wewanttobeawareofourvaluesandincontactwiththem,butwedon’twanttobefusedwith them.Whenwe fusewith them, our values start to feel oppressiveandrestrictive,likecommandmentswehavetoobey.Theyturnintorigidrulesrather than flexible guides. To use the compassmetaphor: when you go on ajourney,youdon’twant toclutch thecompass tightlyeverystepof theway—youwanttocarryitinyourbackpack,knowingthatanytimeyouneedittosteeracourseorfindyourway,youcaninstantlypullitoutanduseit.

VALUESAREFREELYCHOSEN

We consciously choose to bring these desired qualities to our actions. Wedon’thavetoact inthisway;wechoosetosimplybecauseitmatters tous.Tohighlightthis,wemayaskclients,“SupposeIwavedamagicwandsoyoucouldhave any values youwanted;what valueswould you choose?” This is a neatquestion,becausewhatevervaluesyou’dchooseinamagicalworld,youcanactonthoseverysamevaluesrightnowinthismoment;there’snoneedforamagicwand.Thisisoftenausefulinterventionforclientswhosay,“Ihavenovalues.”

BringingValuestoLife

There are two ways of working with values. One way is in a very dry,

theoretical, wordy, conceptual manner: discussing values, analyzing values,theorizing about values—that is, working with them largely at an intellectuallevel. This isn’t particularly satisfying or useful for client or therapist, andusually indicates thatbothare lost in fusionandavoidance.Youcan tellwhenthis ishappeningbecauseyoursessionwillbedull, tiring, intellectual, lifeless,andunsatisfying.Theotherwayofworkingwithvalues isat the levelof“heartandsoul.” In

otherwords,ratherthanjusttalkingorthinkingaboutthem,youfacilitatedeep,intimate,experientialcontactwithvalues.(NoguessesastowhichwayweworkinACT.)Effective conversations about values have a sense of openness, vitality, and

freedom. When a client truly connects with her values, it brings a sense ofliberation andexpansiveness; she realizes that even indesperate situations shehaschoices;thatshecanopenupherlifeandtakeitinmeaningfuldirections.During these conversations, your clientwill be verymuch in the present—

engagingwithyou,sharingwithyou,lettingyouin.You’llseehim“comingtolife”infrontofyoureyes.Thesessionwillbealive,engaging,andfulfilling—andoftenintenseemotionswillarise,runningthefullgamutfromjoyandlovetosadnessand fear.You’lloftenexperienceaprofoundsenseofconnectionasyougettoseedeepintotheheartofafellowhumanbeingandbearwitnesstothepainandthelovethatresideswithin.

WORKINGWITHVALUES

In the transcript that follows, the client is a single, middle-aged woman,strugglingtocopewithherson’sbehavior.Hertwenty-three-year-oldsonhasaheroinaddiction,andevery fewdayshecomeshome tobeg formoney. If shedoesn’tgivehimthemoney,hebecomesaggressive;heoftenscreamsandyellabusively,blamesherforscrewinguphischildhood,accusesherofbeingcoldanduncaring,orinsiststhatshedoesn’treallylovehim.Thishasbeengoingonfor over two years. She constantlyworries about him, and after his visits shefeels hopeless, guilty, and remorseful. She says she knows that giving himmoneyis“wrong”becauseit“justfeedshishabit,”butshefindsit“toohardtosayno.”

Client:Youknow,tobehonest,sometimesIthinkit’dbeeasierifhewouldjust…die.(Sheburstsoutcrying.)

Therapist:(pause)Icanseeyou’reinalotofpainrightnow…andIwonderif

justforamomentwecanslowthisrightdown…andIwonderifyoucouldlookatwhat’shappeningherefromyourobservingself…justkindoftakeastepbackandnoticewhat’sgoingon,howyou’resittingin the chair, the position of your body … and notice the feelingsshowing up inside you…where they are in your body… and alsonoticethethoughtswhizzingaroundinyourhead.(pause)Andwhat’syourmindtellingyourightnow?

Client:(wipinghereyes)I’mamonster.Imean,whatsortofmotheramI?HowcouldIthinksomethinglikethat?

Therapist:Soyourmind’stellingyouthatyou’resomesortofmonsterbecauseyouhavethoughtsthatlifewouldbeeasierifyoursonweredead?

Client:Yeah.Imean,he’smyson.He’smyson!HowcanIthinklikethat?

Therapist: (pause)Rememberwe talkedabouthowyourmind is like a super-duperproblem-solvingmachine?

Client:Yeah.

Therapist:Well,there’sabigproblemhere,isn’tthere?Imean,averybig,verypainful problem. Right? So quite naturally, the problem-solvingmachine goes into action. It starts cranking out solutions. And let’sfaceit:onesolutiontoanyproblematicrelationshipistohavetheotherpersondisappear.Sothatthought,aboutyoursondisappearing,isjustyourminddoingitsjob.Andyouknowwhat?There’snowayyoucanstopitfromdoingthat.

Client:ButmaybeDavid’sright.MaybeIdon’treallylovehim.

Therapist:Well,that’saninterestingthought.(pause)I’llbetyourmindlovestotormentyouwiththatone.

Clien:Yeah.Allthetime.

Therapist:CanIask,what’reyoufeelinginyourbodyrightnow?

Client:Ijustfeelsick.Really,reallysick.

Therapist:Andwheredoyoufeelthatmostintenselyinyourbody?

Client:Rightinhere.(Sheplacesahandonherstomach.)

Therapist:Okay,sojustnoticethatfeelingforamoment…noticewhereitis…andwhatit’sdoing.(pause)Whatwouldyoucallthisemotion?

Client:Oh—it’sguilt.Ihateit.Ifeelitallthetime.

Therapist:Okay.Sonoticethatguiltforamoment…Observeit…Breatheintoit…Closeyoureyes ifyou’d like…andjustbreathe into it…andsee if you can, in someway, just openup around it…give it someroom.…Andatthesametime,I’dlikeyoutotuneintoyourheart…Justtakeamomenttogetintouchwithwhatyoursonmeanstoyou…(pause)Whatdoesthisfeelingtellyouaboutyourson,aboutwhathemeanstoyou?

Client:(crying)Ijustwanthimtobehappy.

Therapist: (pause)Soyourmind says, “Maybe Idon’t really lovehim.”Whatdoesyourheartsay?

Client:OfcourseIdo.

Therapist:Yousaidit.Imean,ifyoudidn’tcareabouthim,you’dhavenoguilt,right?

Client:(tearybutrelieved)Yeah.

Therapist:So tellme,youreallycareaboutDavid…sowhatsortofmomdoyouwanttobetohim?

Client:Ijustwanthimtobehappy.

Therapist: Okay. So let’s suppose I wave a magic wand and David is happyforeverafter.Thenwhatsortofmotherwouldyouwanttobe?

Client:Idon’tknow.Ijustwanttobeagoodmom.

Therapist:Okay.So if youwanted to earn that title—ofbeingagoodmom—howwould you be towardDavid?What sort of qualitieswould youwanttohaveasamother?

Client:Idon’tknow.

Therapist:Well,supposeamiraclehappens,andDavidsortshislifeout,andafewyearsfromnowweinterviewhimonnational television,andweask him, “David, what was your mom like when you were goingthrough theworstof thatheroinaddiction?” In the idealworld,whatwouldyoulikehimtosay?

Client:IguessI’dliketohimtosaythatIwas…um…loving…andkind…and…um…supportive.

Therapist:Anythingelse?

Client:ThatIwasthereforhimwhenheneededme.

Therapist:Sotobeloving,kind,supportive—that’swhatyouwanttostandforasamother?

Client:Yeah.

Therapist: Okay. So just sit with that for a moment. To be loving, kind,supportive:that’swhatmatterstoyouasamom.

Client:Yeah. (She sits upright, noddingher head slowly.) Iwant to dowhat’sbestforhim.Iwanttodotherightthing.AndIknowthatgivinghimmoney—that’snotit.

Therapist:Okay. (pause)Sonext timeyour soncomesover, it seems likeyouhaveachoicetomake.Ontheonehand,youcanletyourmindbullyyou—pushyouaroundandtellyouwhattodo.Andyouknowexactlywhat your mind’s going to tell you—that you have to give him themoney, and if you don’t, you’re a bad mother, and saying no is sostressfulandpainful, it’seasier to justgivehim themoney,and thenhe’llleaveyoualone.That’sonechoice.Ontheotherhand,youcouldchoose to let yourmind saywhatever it likes, but instead of buyinginto it,youcanbe thesortofmotheryou reallywant tobe—loving,kind, supportive, and doing what’s best for David in the long run.Whichwillyouchoose?

Client:Well,I—Iwanttobelovingandsupportive.Iwanttohelphim.

Therapist:So ifyouwere trulyactingon thosevalues insteadofbeingpushedaround by the “can’t say no” story, then howwould you respond toDavid’srequestsformoney?

Client:(smilesthinly)I’dsayno.

Therapist:You’dsayno?

Client:(nods)Uh-huh.

Therapist:Whatareyoufeelingrightnow,asyousaythat?

Client:I’mreallynervous.I’mshaking.

Therapist: Icansee that,andI’msureI’dfeel thesamewayif Iwere inyourshoes. So the question is are you willing to make room for thesefeelingsofnervousnessandshakinessif that’swhatit takestobethe

sortofmomyoutrulywanttobe?

Client:Yes.

Givinghersonmoneyto“feedhishabit”wasactuallyinconsistentwiththisclient’scorevalues.Theactionwasmotivatedbyavoidance(tryingtogetridofguilt and anxiety) and fusion (with thoughts like “It’s too hard to say no,” “Ican’tstandtoseehimlikethis,”or“I’mabadmotherifIdon’thelphim”),notby values. After the intervention above, the conversation turned to the manydifferentways inwhichshecouldactonhervalues:howshecouldbe loving,kind,supportivetoDavidinotherwayswithoutgivinghimmoney(orthingshecouldsellforcash).You can see in that transcript the overlap and interplay between defusion,

acceptance, and values.We call this “dancing around the hexaflex”—movingflexiblyandfluidlyfromoneprocesstoanotherasrequired.

Practical TipClientswill often give you values such as “Iwant to be a goodMom/Dad”or“Iwanttobeagoodfriend.”Thisisagoodstartingpoint,butit’sa bit vague and nonspecific. It’s generally useful to explore further, withquestionssuchas:“SowhatarethequalitiesofagoodMom/Dad/friend?”or“Ifyouwanted toearn that title—goodMom/Dad/friend—howwouldyoubehavetowardyourchildren/friends?”

TECHNIQUESFORCLARIFYINGANDCONTACTINGVALUES

In this chapter, we’re going to cover a lot of techniques. But remember,they’re only a means to an end: to help our clients connect with their ownhumanity, to find their own sense of meaning and purpose in life. So whileapplying these techniques,wealwaysneed tobemindful:attunedtoourclientandwatchfulforthosequalitiesofvitality,openness,andliberation.Figure11.1belowsummarizesmanycommonvaluesclarificationtechniques.

Pleasereadthroughthemalltogetasenseofthemanydifferentwayswecandothiswork.

As you can see, there are techniques galore available to you, andmany ofthem involve asking questions. And if we ask these questions dryly andintellectually,we’llgetdry,intellectualresponses.Sotakeyourtimewiththesequestions;don’trushthem.Askyourclienttoconsiderdeeply,totakehertime.Wecouldsay,“Canyousitwith thisquestion forawhile?Really reflecton itandseewhatcomesup.Takeyourtimewithit.There’snohurry.”Wecouldalsoinvitehertoclosehereyesandcontemplate.Ifananswerseemssuperficial,wecould say, “I couldbewrongabout this, butmy impression iswe’reonly justscratchingthesurfacehere.Seeifyoucangodeeper—reallyexplorethis.Tuneintoyourheart.Deepdown,whatreallymatterstoyou?”Mostof thesetechniquesarefarmorepowerfulwhenwedeliverthemasan

experientialexerciseasopposedtojusthavingaconversation.Forexample,wecan start off with a short mindfulness exercise, such as Mindfulness of theBreath, and then ask our client to close his eyes and silently reflect upon thequestionorimaginethescene.Thetranscriptbelow,whichincludestheImagineYourEightiethBirthdayExercise,illustratesthis.

IMAGINEYOUREIGHTIETHBIRTHDAY

Therapist: So I’m going to ask you to imagine your eightieth birthday and toimagine that three different people stand up tomake speeches aboutyou.Andkeepinmind,thisisafantasy—animaginaryexercise—soitdoesn’t have to follow the rules of logic and science. You can beeighty,butyour friendsmay lookexactlyas theydo today.Andyoucanhavepeopletherewhoarealreadydead,orwho’llbedeadbythetimeyou’reeighty.Andifyouwanttohavechildrenoneday,thenyoucanhaveyourchildrenthere.Alsokeepinmind,youaren’ttryingtorealistically predict the future. You’re creating a fantasy—if magiccould happen so that all your dreams come true—then what wouldyoureightiethbirthdaylooklike?Soifyourmindstartsinterferingandsayingthingslike,Peopledon’tmeanwhattheysayattheseeventsorNo,thatpersonwouldneversaythataboutme,thenjustsay“Thanks,mind”andcomebacktotheexercise.Okay?

Client:Okay.

Therapist:Okay.So I inviteyou toget into a comfortableposition, andeithercloseyoureyesorfixthemonaspot…andforthenextfewbreaths,focus on emptying your lungs … pushing all the air out … andallowing them to fill by themselves…Notice the breath flowing inandflowingout…inthroughthenostrils…downintothelungs….and back out … Notice how, once the lungs are empty, theyautomaticallyrefill…Andnow,allowingyourbreathtofinditsownnatural rateand rhythm…noneed tokeepcontrolling it…I’d likeyou to do an exercise in imagination… to create a fantasy of youridealeightiethbirthday…nottotryandrealisticallypredict itbut tofantasizehow itwouldbe in the idealworld, ifmagic couldhappenandallyourdreamscametrue…Soit’syoureightiethbirthday,andeveryonewhotrulymatterstoyou…friends,family,partner,parents,children, colleagues … anyone and everyone whom you truly care

about,evenifthey’renolongeralive,isgatheredthereinyourhonor…Thismightbea small intimateaffair ina familyhomeorahugeaffair in a classy restaurant… it’s your imagination, so create it theway youwant it…Now imagine that one personwhom you reallycare about—friend, child, partner, parent, you choose—stands up tomakeaspeechaboutyou…ashortspeech,nomorethanthreeorfoursentences…andtheytalkaboutwhatyoustandforinlife…whatyoumeantothem…andtherolethatyouhaveplayedintheirlife…andimaginethemsayingwhateveritisdeepinyourheartyouwouldmostlovetohearthemsay.(Pause40to50seconds.)

The therapist now repeats this for two other people—always allowing theclienttochoosewhowillspeak—andeachtimeallowingfortytofiftysecondsofsilenceforreflection.

Therapist: Most people find that this exercise brings up a whole range offeelings, some warm and loving, and some very painful. So take amoment to notice what you’re feeling … and consider what thesefeelings tell you…aboutwhat trulymatters to you…what sort ofperson you want to be … and what if, anything, you’re currentlyneglecting.(Pause30seconds.)Andnow,bringingtheexercisetoanend…andnoticeyourbreathing…andnoticeyourbodyinthechair… and notice the sounds you can hear… and open your eyes andnoticewhatyoucansee…and takeastretch…andnoticeyourselfstretching…andwelcomeback!

Afterwardwedebrieftheexerciseindetail:Whathappened?Whatdidpeoplesayaboutyou?Whatdoesthistellyouaboutwhatmatterstoyou,whatyouwanttostandfor,andwhatsortofpersonyouwanttobe?Wecan also inquire about fusion and avoidance:Howdidyourmind try to

interfere with the exercise? Did you get hooked at any point? How did youunhook yourself?What feelings showed up for you?Did youmake room forthemorstruggle?Didyouavoiddoingtheexercise?

FORMSANDWORKSHEETS

AlltheformsandworksheetsmentionedintheFormsandWorksheetsboxinfigure11.1abovearedownloadable atnocost fromwww.actmadesimple.com.Togetasenseofhowtheseformswork,pleasestopreading,downloadacopyofeach,andfilltheminforyourself.HopefullyyoualreadydidtheLifeCompass

andtheBull’sEyebackinchapter5;ifnot,pleasedothemnow.Both these forms are quick, simple tools for rapidly gathering some

information about your client’s (or your own) values. You can fill them incollaborativelyduringasessionorgivethemoutashomework.TheBull’sEyeisparticularlyusefulasaquickassessmenttoolontheveryfirstsession.Youcanalsoaskyourclienttoquicklyfilloneinduringthecheck-inatthestartofeachsession;it’sasimpleguidefortrackinghowtherapyisprogressing.TheLifeCompassisalsoveryusefulbecause(a)itgivesavisualoverviewof

the client’s life; (b) it identifies core values that cut through many differentdomainsoflife;and(c)ifyourclientfeelsoverwhelmedbyall thechangeshewantstomake,youcanaskhimto“justpickoneboxtostartwith.”

ProblemsinClarifyingValues

Asageneralrule,it’seasiertodovaluesworkwithhigh-functioning/worried-well/coaching clients than with lower-functioning clients or those with highlevels of experiential avoidance. This is because the more someone’s life isdriven by experiential avoidance, themore he becomes disconnected fromhisvalues. Obvious examples include many clients with borderline personalitydisorderor chronicaddictions toalcoholornarcotics.Often theseclientshaverepeatedlyhurt,abused,orneglectedtheirbody,theirfriends,theirfamilies,theirpartners, and so on.This is the sad consequence of long-standing unworkablebehaviorthatisdrivenbyfusionandavoidance.Notsurprisingly,itgivesrisetoa lot of emotionalpain.To connectwithneglectedvalues, therefore,means toconnectwithallthatpain.So if clients repeatedly resist, avoid, or put up blocks to values—“I don’t

know,”“Nothingmatters,”“Idon’thaveanyvalues,”“Idon’tseethepoint,”“Idon’t deserve to have a life,” “This is so corny”—that usually indicatesexperientialavoidanceandnecessitatesworkwithacceptanceanddefusion.Ofcoursesometimestheclientsimplyhasnoideawhat“values”are;ifshehasledadeprivedorimpoverishedlife,“values”mayseemlikesomethingfromanotherplanet.ThusinoneprogramforACTwithborderlinepersonalitydisorder,theyactuallygivetheclientsalistofthirtycommonvaluesandaskthemtochecktheonesthatpersonallyresonate(Brannetal.,2007–09).

WORKINGFROMGOALSTOVALUES:USEFULQUESTIONS

Whenweaskaclientaboutvalues,shewillcommonlygiveusgoals.Hemaydescribethepartner,job,orbodyhewantstohave,orthethingshewantstogetfromotherssuchasloveorfriendshiporforgiveness.Orshemaysayshewantsfame,wealth,status,respect,orsuccess.Orhemaygiveusanemotionalgoal:tofeelhappyortohavemoreself-confidence.Orshemaygiveusadeadperson’sgoal:tonotuseheroin,tonothavepanicattacks,tonotlosehertemper,tonotfeelself-conscious.Sotogettothevaluesunderlyingagoal,wecanaskanyorallofthefollowingquestions(prefacethemwiththisphrase,“Ifthisgoalwereachieved…”):

Whatwouldyoudodifferently?Howwouldyouactdifferently?Howwouldyoubehavedifferentlyinyourrelationships,worklife,sociallife,familylife,andsoon?Whatpersonalqualitiesorstrengthswoulditdemonstrate?Whatwoulditshowthatyoustandfor?What would it enable you to do that is meaningful and thatmattersinthebigpicture?

Forexample,ifyouhadself-esteem,oryoufelthappy,oryouhadasenseofbelonging,oryouhadabigcar/greatbody/fantasticjob,thenhowwouldyouactdifferently?Whatwouldyoudodifferently?Howwouldyoubehavedifferently?If clientsgiveus anegativegoal—something that theydon’twant—wecan

often quickly transform it into a positive one by asking “What do you wantinstead?”Forexample,iftheclientsays,“Iwanttostopfightingwithmymom,”wecanask,“Sowhatwouldyouliketodoinstead?Howwouldyouliketobewhenyouspendtimewithher?”If clients give you a positive goal, additional useful questions to elicit

underlying values include “What’s that in the service of?” “What’s important/meaningful about that?” “What is it that matters about achieving that goal?”“What’simportantaboutthat?”“Whatwouldhavingthatenableyoutodo?”Forexample, the values underlying a holiday may be about being adventurous,nurturingmentalhealth,orspendingqualitytimewiththefamily,andsoon.

PracticalTip As long as you’re not coming across like the SpanishInquisition,it’sokaytokeepaskingquestions.Clientsrarelygettocorevaluesafteronlyoneortwoquestions.Ifyou’reconcerned,youcouldsay,“Mymind’s

tellingme that you’re going to get annoyedwith all these questions. I keepasking becausewe’re trying to get to something of fundamental importancehere,andmysenseis,sofar,we’rejustscratchingthesurface.Soisitokayifwekeepgoingwiththisabitlonger?”

PLEASINGOTHERS

Someclients are so focusedongaining approval fromothersordoingwhatthey’vebeentoldtodobytheirparents,religion,orculturethattheydisconnectfrom their own core values.To help reconnect them, here’s a useful question:“Suppose I were to wave a magic wand so that you automatically had theapprovalofeverybodywhoseopinionmatterstoyou;sothatwhateveryoudid,they totallyapprovedof it,whetheryoubecameasaintoraserialkiller.Oncethiswandhasbeenwaved,you’dneverhavetoimpressanyoneorpleaseanyoneever again—whateveryoudo, they’dbedelighted.Then—whatwouldyoudowithyourlife?Andhowwouldyouactinyourrelationships?”

WHENTHEGOALISTOCHANGEOTHERS

If a client says, “Iwantmywife/husband/mother/boss/colleague to bemorecheerful/cooperative/friendly/loving/respectful,” and so on—or “lessabusive/lazy”andsoon,wemayask,“Let’sassumeIhaveamagicwand,andIcan instantly change this person to fit your ideal. If you did have that idealrelationship,howwouldyouactdifferently?Whatpersonalqualitiesorstrengthswould you like to develop or bring into that relationship? What sort offriend/relative/colleaguewouldyouliketobe?Howwouldyouideallytreattheotherperson?”After this, we may consider how the client can influence the behavior of

othersbyactingonhisownvalues.Wewouldemphasizethatwecan’tcontrolothers;wecanmerelyinfluencethem.Andthemorewetakecontrolofourownactions,themoreeffectivelywe’llbeabletoinfluenceothers.

HomeworkandNextSessionHomeworkcaninvolvewritingaboutvalues, thinkingaboutvalues,meditatingon values, discussing values with loved ones, or filling in the forms andworksheets named in figure 11.1. A simple homework assignment is this:

“Betweennowandnext session,wouldyoubewilling todo two things?One,noticewhenyou’reactingonyourvalues,andtwo,noticewhatit’sliketodoso,whatdifferenceitmakes.”Inthenextsession,wemightdomoreworkaroundvaluesormoveontogoal

setting and taking action. And if fusion and avoidance get in the way ofclarifying values, then we’d dance across the hexaflex to defusion andacceptance.From time to time,we’ll encounter a high-functioning clientwho’s already

doingallthethingsthatmatter—goingtowork,lookingafterthekids,keepingfit,andsoon—butisdeeplyunfulfilled.Oftenherlackoffulfillmentisbecause,although she’s doing what matters, she’s not psychologically present. Insteadshe’scaughtupinherhead:lostinthoughtsaboutallthethingsonher“todo”list,or immersedinanongoingcommentaryaboutwhat’snotgoodenough,orconsumed by worrying, ruminating, or daydreaming. With these clients, wewouldworkon“beingpresent.”

HomeworkforYouFor this chapter, there’snohomework foryou.Nah, I’m just kidding!There’sactually lots of it. If you haven’t yet completed all the aforementioned valuesforms,pleasedownloadthemanddoso.

Read all the values interventions out loud, as if taking yourclientsthroughthem.Think of other questions youmight ask.Are there any otherexercises you know, or ideas you have, about ways to getclientsintouchwithvalues?Picktwoorthreeclientsandidentifywhatvaluesthey’velosttouch with. Consider what exercises you could do to helpreconnectthemwiththeirvalues.Reflectonyourownvaluesasatherapist:Whatmatterstoyou,deepinyourheart,aboutdoingthiswork?Whatdoyouwantto stand for as a therapist? What personal strengths andqualitiesdoyouwanttobringintothetherapyroom?Over the next week, notice when you’re in touch with yourvalues—andwhat that’s like.Whatdifferencedoes itmakeinyourlife?

SummaryTechnicallyvaluesaredesiredqualitiesofongoingaction.Poeticallythey’reourheart’s deepest desires for how we want spend our brief time on this planet.Metaphorically they’re like a compass: they give us direction and keep us ontrack.Helpingourclients toget in touchwith theirvaluescanbedifficult;weoften encounter all sorts of misconceptions and misunderstandings, mostcommonlyaround thedifferencebetweenvaluesandgoals.Furthermore,we’llfrequentlycomeupagainstbarriers in the formof fusionandavoidance.Thuswe’lloftenbedancingbackandforthbetweenvalues,defusion,andacceptance.However,withpatienceandpersistence,wecanusuallyhelpourclientsget intouchwiththeirhearts—andwhenweseethathappen,it’strulymagical.

Chapter12.DoWhatItTakesCommittedActioninaNutshell

InPlainLanguage:Committedactionmeanstakinglargerandlargerpatternsofeffectiveaction,guidedandmotivatedbyvalues. Italsomeansflexibleaction:readilyadaptingto thechallengesof thesituation,andeitherpersistingwithorchangingbehaviorasrequired;doingwhatittakestolivebyourvalues.

Aim:Totranslatevaluesintoongoing,evolvingpatternsofaction.Toestablishthepatternofrepeatedlyreturningtoourvalues,nomatterhowmanytimeswelosetouchwiththem.

Synonyms:None.

Method: Use values to set goals, and break those goals down into specificactions.Asktheclient tocommit to thisaction.Identifybarriers toaction,andovercomethemusingtheotherfivecoreACTprocesses.

When to Use: Whenever a client needs help with translating values intoworkable action. This includes learning any new skills necessary for values-congruentliving.

GettingtoCommittedActionCommittedactionhappensineverysession.Turningupfortherapyiscommittedaction;doingamindfulnessexerciseordiscussingapainfultopiciscommittedaction;doingACThomeworkiscommittedaction.However,committedactiondoesn’tusuallytakecenterstageuntilwehaveclarifiedvalues.Almost always, as we move from values to goals to taking action, we’ll

encounterpsychologicalbarriers.Soifwe’vealreadycoveredsomeorallofthefour mindfulness processes—defusion, acceptance, contacting the presentmoment,self-as-context—wecannowuse themforovercoming thesebarriers.And ifwehaven’tyetcovered thesecomponentsof thehexaflex, thenwecannowmoveontothem.Under the heading of committed action, we can incorporate any and all

traditional behavioral interventions—skills training, exposure anddesensitization,behavioralactivationfordepression,andsoon.So,forexample,

we may teach crisis coping, problem solving, self-soothing, assertiveness,communication, or conflict resolution skills.As long as these skills are in theservice ofmindful valued living (and they aren’t emotional control strategies,suchasdistractiontechniques),thentheycanbeconsideredapartofACT.

CommittedAction:StepbyStep

Basicallytherearefourstepstocommittedaction:

1. Chooseadomainoflifethatishighpriorityforchange.2. Choosethevaluestopursueinthisdomain.3. Developgoals,guidedbythosevalues.4. Takeactionmindfully.

Ourultimateaimistogeneralizethisapproachintolargerandlargerpatternsofcommittedvalues-guidedaction,creatingadominoeffectthatspillsoverintoalldomainsof life.SettingValues-BasedGoals (below) isaworksheet tohelpyouwiththefirstthreesteps:pickingalifedomain,clarifyingvalues,andsettinggoals.Pleasereadthroughitnow.

SMARTGOALS,LIVE-PERSON’SGOALS

NotetheSMARTacronymforgoalsetting(whichisabitdifferentfromsomeotherversions.)Goalsneedtobe:

S=SpecificM=MeaningfulA=AdaptiveR=RealisticT=Time-framed

(Alsomake sure to avoid emotional goals and dead-person’sgoals.)

Ofcourse,wecandoallthisgoalsettingconversationallyifwe(orourclient)don’tlikeforms.However,writingitdowninsessionmakesitmoretangibleandgivesourclientavaluableremindertotakeaway.Wemaywellfindthatduringthiswork,ourclientstartstofusewithunhelpfulthoughtsaboutitallbeingtoohard, hopeless, pointless, or doomed to failure. This provides an excellentopportunityfordefusion,asyou’llseeinthistranscript:

Client: (frowningat theworksheet)This is awasteof time. (Sheputsherpendown.) I’vedone this before. Iwrite goals down, but I never followthroughonthem.

Therapist:Soyou’rehavingthethoughtthatthisisgoingtobejustlikealltheothertimes?

Client:It’snotjustathought.It’strue.

Therapist:Well, Icould try todebatewithyouhere—try toconvinceyou thatthethought’snottrue.OrIcouldtrytomotivateandinspireyou.OrIcouldlectureyouonhowimportantthisis.Ortellyounottothinkthatway.Ortellyoutothinkpositively.Doyouthinkanyofthosethingswouldbeuseful?

Client:(chuckles)No.

Therapist:Solet’sjusttakealookatthisfromtheobservingself.Justtakeastepbackandnoticewhatyourthinkingselfistellingyou.

Client:(Shepauses,observingherthoughts.)Justthesameasbefore.Thisisn’tgoingtowork.It’sawasteoftime.

Therapist: So if you let those thoughts tell youwhat to do,will that takeyouclosertothelifeyouwanttolive—orfurtheraway?

Client:Furtheraway.

Therapist:Sowhat’reyougoingtodohere?Letthosethoughtsbullyyouaroundandtellyouwhatyoucanandcan’tdo?Ordosomethingthat’slikelytomakeyourlifework?

Client: Hmm.When you put it that way… (She picks up the pen and startswriting.)

Therapist:Nowasyoukeepwriting,justnoticewhatyourmind’sdoing.Noticeallthewaysittriestogetyoutostop.

Client:(Shestopswritingagainand,smiles.)It’ssayingthisisacompletewasteoftime.

Therapist: Good stuff! Now see if you can get your mind to have a full-ontemper tantrum—you know, the full works: screaming, shouting,stampingitsfeet!

Client: (smiling, continuing to write) Oh yeah … It’s having a completemeltdownnow.Arealdoozy.

PracticalTip Youcanreinforcedefusionbyofferingyourclientarangeof alternative responses to a problematic thought: “I can debate with youwhetherit’strueorfalse,tellyounottothinkthatway,lectureyou,tellyoutothinkpositively,giveyouadvice, reassureyou.Doyou think thatwouldstopyourmindfromhavingthesethoughts?”Yourclientwillalmostalwayssayno,and then you can move on to any defusion technique your client haspreviously embraced, for example, “So why not let Radio Doom andGloomkeepbroadcastingandinvestyourenergyindoingsomethingthattrulymatterstoyou?”

PUBLICCOMMITMENTS

People are far more likely to follow through on public commitments thanprivate ones. So we usually ask the client to say out loud exactly what he’scommitting to. Asmany people feel awkwardmaking public commitments, Iliketogivearationale,somethingalongtheselines:

Therapist:WhatI’mabout toaskyoumayseemabitodd,butresearchshowsthatwhenpeoplemakepubliccommitments,they’refarmorelikelytokeepthem.So,ifyou’rewillingto,I’dlikeyoutosayoutloudexactlywhat it is you’re committing to—and as you say it, just notice anythoughtsandfeelingsthatarise.

Client:Youmean,tellyouwhatI’vewritten?

Therapist:Yes,please.Sayitoutloud,likeyoureallymeanit.Andnoticewhatshowsupinyourmindandyourbody.

Client: I commit to taking the kids to the park on Saturday afternoon to playbaseball.

Therapist:Great.Youlookedabituncomfortableasyousaidthat.Whatfeelingsshowedup?

Client:Mystomach.Itknottedup.

Therapist:Anddidyourmindhaveanythingunhelpfultosay?

Client:Youbet.I’mtoobusywithwork.Idon’thavetime.It’sahassle.Leaveittillnextmonth.

Therapist:Soareyouwilling tomakeroomfor those thoughtsandfeelings inordertodowhatmatters?

Client:Yes.

Whenclientsspeaktheircommitmentsoutaloud,theycommonlyexperienceuncomfortable thoughts and feelings. It’s useful to inquire about their privateexperiencesandensurethatthey’rewillingtomakeroomforthem.

THETINIESTSTEP?

Averyusefulquestion,onceyou’ve identifieda lifedomainand somecorevalues,isthis:“What’sthesmallest,tiniest,simplest,easieststepyoucantakeinthenexttwenty-fourhoursthatwilltakeyoualittlebitfurtherinthatdirection?”Learningtotakesmallstepsisimportant.Whenclientsgettoofocusedonbig

long-termgoals,they’repulledoutoflivinginthepresent;theygetsuckedintothemindsetof“I’llbehappyonceI’veachievedthatgoal.”And,ofcourse,theymayneverachieveit,oritmaytakemuchlongerthantheyexpected,oritmaynotmakethemhappyeveniftheydoachieveit.SoIliketoremindclientsofthefamoussayingfromtheTaoTeChing:“The

journeyofathousandmilesbeginswithonestep.”Livingourvaluesisanever-ending journey; it continues until the moment of our final breath. And everylittle stepwe take, nomatter how tiny, is a valid andmeaningful part of thatjourney.(IalsoliketoquoteAesop:“Littlebylittledoesthetrick.”)To show you how values, goals, and actions come together, let’s consider

Sarah—a thirty-eight-year-old nurse, single for four years since her divorce.Sarahverymuchwantedtofindanewpartner,getmarried,andhavechildren,and she was worried that she would soon be too old to conceive. Of course

getting married and having kids are goals—they can be crossed off the list,achieved,done!—notvalues.Sousingtheworksheetabove,Sarahidentifiedtwolifedomainsaspriority:“intimatepartner”and“parenting.”Wethen lookedathervaluesineachdomain.InitiallySarahsaidwhatshewantedwastobelovedandcherished.Nowthese

arecommondesiresthatalmosteveryonehas,buttheyarenotvalues;valuesareabouthowwewanttobehave,notwhatwewanttoget.Withfurtherexploration(and plenty of work around accepting the intense sadness that arose), Sarahidentified her values in the domain of “intimate partner” as connecting, beingcaring, being loving, being supportive, being nurturing, being playful, beingpresent, being emotionally intimate, and being sexually active. Under“parenting” her values were almost identical (except for “being sexuallyactive”).Sarah recognized that “marriage and kids” were not realistic as immediate

goals(nexttwenty-fourhours)orshort-termgoals(nextfewdaysandweeks),soshewrotethemdownasmedium-orlong-termgoals.Nextshelookedatshort-termgoals.Inthedomainof“intimatepartner,”she

setgoalsto(a)joinadatingagencyandgoonsomeblinddates,and(b)attendsomemixed-sexLatindancingclasses.Inthedomainof“parenting,”hergoalswere to (a) take her teenage niece out for a day trip and (b) visit a couple offriendswhohadyoungchildren.In terms of immediate goals, Sarah was stumped. Here’s how the session

went:

Therapist:You’veidentifiedquiteafewimportantvalueshere.Whichseemsthemostimportant?

Sarah:Um.Ithink,morethananythingelse,connectingandbeingintimate.

Therapist:Okay,sowhat’sasmall,simple,easythingyoucoulddointhenexttwenty-fourhours,inlinewiththosevalues?

Sarah:Idon’tknow.

Therapist:Noidea?

Client:No.

Therapist:Well,thekeyhereistothinkoutsidethebox.Ifconnectionmatterstoyou, there are hundreds of different ways to do it; you can connectwithanimals,plants,people,yourbody,your religion.And the same

for being intimate—there are all sorts of different ways you can dothat,includingbeingintimatewithyourself.

Sarah:Ineverthoughtaboutitthatway.

Aftersomediscussionalongtheselines,Sarahidentifiedanimmediategoalofhavingalong,hot,soothingbath:thiswasawayofbeingintimatewithherselfandconnectingwithherbody.

IMPOSSIBLEGOALS

Attimes,clientswillhaveimpossiblegoals.Forexample,Alexwasaforty-two-year-old former social worker on long-term disability benefits. He wasreferred with a fifteen-year history of chronic PTSD, major depression, andchronicpain syndrome.Hisproblemshadstarted fifteenyearsearlierwhenhehad been horrifically assaulted, resulting in severe back and neck injuries thatrequiredmultipleoperationstodealwiththoseinjuries.Priortotheassault,Alexhadbeenapassionateamateurfootballplayer;now

hecouldbarelyget aroundwitha cane.Whenwe first startedworkonvaluesandgoals,Alexkept talkingabouthowhewanted toplayfootballagain,eventhough many surgeons had told him it was impossible. I said to him, “Well,here’s the thing,Alex. It’snotmyplace to tellyouwhat’spossibleandwhat’snot. But can we agree that today, right now, in the next twenty-four hours,playingfootballisnotpossible?”Alexagreedwiththat,sowethenexploredhisvaluesunderlyingthegoalof

playingfootballagain.Initiallyhecameupwiththefollowing:winningagainstother teams, getting respect, having a social life. None of these are values:they’renotdesiredqualitiesofongoingaction.SoIaskedhim,“SupposeIwaveamagicwandsoyouinstantlyachieveall thesegoals:youplayfootballagain,youwinallyourgames,yougetlotsofrespect,andyouhaveagreatsociallife.Then,howwouldyouactdifferently…towardyourselfandyourbodyandotherpeople?Asaplayer,whatsortofpersonalqualitieswouldyouliketohave?Howwouldyouliketobehavetowardthepeopleyousocializewith?”Withfurtherexplorationalongtheselines,wewereable toget tosomecore

values: being active, taking care of his health, contributing to a team, beingsociable, being competitive, being a “good friend,” connecting with others. Ithenpointedout thereweremanydifferentwayshecouldacton thesevalues,eventhoughhecouldn’tcurrentlyplayfootball.TowhichAlexprotested,“Butthat’snotthesame.”

Considerforamoment,beforereadingon:HowwouldyouhaverespondedtoAlex’scomment?Whatwe’re dealingwith here is a reality gap: a large gap between current

realityanddesiredreality.Andthebiggerthatgap,themorepainfulthefeelingsthatwillarise.Sonaturallyweneedtovalidateandnormalizethosefeelings,tocompassionately acknowledge how painful they are, and to help our client toacceptthem.ThereforemyresponsetoAlexwasthis:

Therapist:Absolutely.It’snotthesame.It’snotthesamethingatall.Notevenclose.Andwhenthere’sahugegapbetweenwhatyouwantandwhatyou’vegot,thathurts.Icanseehowupsetyouarerightnow,andIcanonlybegintoimaginehowmuchyou’resuffering.(pause)Andinmyexperience,whenpeople arehurting theway thatyouare rightnow,it’s because they’re in touch with something really important;somethingthatmatters.(pause)SosupposeIcouldgiveyouachoicehere.Oneoptionisthatyoulearnhowtomakeroomforthesepainfulfeelingsandhowtodropthestrugglewith themsoyoucanputyourenergy into doing something that’s important, something that trulymatterstoyou,deepinyourheart—soyoucanstandforsomethinginthe face of this painful reality.The other option is to get all boggeddowninthesepainfulfeelingsandjustkindofgiveuptrying,andputyourlifeonhold.Whichoptiondoyouwanttochoose?

Atthatpoint,Alexexperiencedahugewaveofsadness,resentment,andfear,so we worked on acceptance, defusion, and self-compassion. Alex learned toacceptthepainfulfeelingsrelatedtohislosses,andtodefusefromthethoughtsthatkeptdragginghimintobitternessandhopelessness—“IcanneverhavethelifeIwant,”“It’snotfair,”“There’snopointgoingon.”Afteracouplemoresessions,wereturnedtoAlex’svaluesandstartedsetting

small realistic goals. For example, two of his core valueswere “contribution”and “being sociable.” Instead of a sports team, Alex started contributing to ahealthteam:thenursesathislocal“oldfolks’”home.Hestartedgoinginonavoluntarybasistosocializewiththeelderlyresidents.Hewouldmakethemcupsoftea,chataboutthenews,andevenplaychesswiththem(whichwasactingonhis value of being competitive).He found this very satisfying, even though itwasamillionmilesfromplayingfootball.So,tosummarize,here’swhattodowhenagoalisimpossibleoralongway

off:

1. Validatethepainarisingfromtherealitygap.2. Respondtothepainwithacceptanceanddefusion.3. Findthevaluesunderlyingthegoal.4. Setnewgoalsbasedonthoseunderlyingvalues.

BarrierstoAction—andHowtoDealwithThem

Ifclarifyingvaluesandsettinggoalswereenoughtoensurevaluedliving,thetaskofACT therapistswould be a lot easier.Unfortunately,when it comes tomaking positive life changes, we commonly encounter psychological barriers.ThemostcommonofthesearesummarizedbytheacronymFEAR:

F=FusionE=ExcessivegoalsA=AvoidanceofdiscomfortR=Remotenessfromvalues

Let’stakeaquicklookateachofthesebarriers.

F is for fusion.Whenwe set out tomake change, it’s normal for ourmind tothrowup“negative”thoughts:I’mtoobusy,Ican’tdoit,I’ll fail, It’s toohard,andsoon.Thisisn’taproblemifwedefusefromthem,butifwefusewiththosethoughts,theycanpreventusfrommovingforward.

Eisforexcessivegoals.Ifourgoalsexceedourresources,we’lleithergiveupor fail. Necessary resources could include skills, time, money, and physicalhealth.

A is for avoidance of discomfort. Change usually gives rise to uncomfortablefeelings—mostcommonlyanxiety.Ifwe’renotwillingtoacceptthisdiscomfort,wewon’tmoveforward(thatis,westayinour“comfortzone”).

R is for remoteness fromvalues.Whyarewebothering toput in all thishardeffort?Ifwelosetouchwiththevaluesunderlyingthisgoal—ifitdoesn’tseemmeaningful or important—thenwe readily losemotivation. “Remoteness fromvalues”commonlypresentsinfourways:(1)clientscan’torwon’taccesstheirvalues;(2)theyconfuserulesandmoralswithvalues;(3)theypaylipservicetovaluesbutdon’ttrulyconnectwiththem;and/or(4)theygiveyouthevaluesof

theirreligion,culture,orparentsratherthantheirown.(Bytheway:theaboveversionoftheFEARacronymisdifferenttotheone

you’ll find in other ACT textbooks; I changed it to make it morecomprehensive.)Sohowdoweaddressthesebarriers?Well,theantidotetoFEARisDARE:

D=DefusionA=AcceptanceofdiscomfortR=RealisticgoalsE=EmbracingvaluesSolet’stakealookatwhat’sinvolvedinordertoDARE.

Disfordefusion.Weidentifythethoughtsthatholdusbackandwedefusefromthem.

Aisforacceptanceofdiscomfort.Wemakeroomforourpainful thoughtsandfeelings, not becausewe like themorwant them, but so thatwe can dowhatmatters.

Risforrealisticgoals.Ifwelackthenecessaryresources,wehavetwooptions.Option 1: Create a new goal to acquire the necessary resources. If we lacknecessaryskills,ournewgoalistolearnthem.Ifwelackmoney,ournewgoalmaybetoborrowitorsaveitup.Ifwelackphysicalhealth,ournewgoalistoimprove it. And if we lack time, our new goal is to rearrange our schedule(whichmayrequireustogiveupotheractivities).Option2:Ifit’snotpossibletoget therequiredresources, thenweaccept thelimitationsofrealityandchangeourgoaltoadaptinthebestwaypossible.

E is for embracing values. If we’re lacking in motivation, let’s reflect for amoment onwhywe’re doing this.What’s important ormeaningful about thisaction?Doesittrulymatter?Ifso,why?Ifwewritetheseacronymsonabusinesscardforourclientstocarryaround

in a purse or wallet, we provide them with a concrete way to help them toidentify their barriers and respond effectively. These acronyms also help usdecidewhattodointherapy.Ifourclientgetsstuck,wefigureoutthebarriersusingFEAR,andthenwetargetthemwithDARE.Notethatbothoftheseacronymscanaccountforexternalbarriers.Ifthere’s

anexternalbarriertoaction,thenwe’llbedealingwiththeEofFEAR:ourgoalexceedsourresources.AndwerespondwiththeRofDARE:wesetarealistic

new goal, either to overcome the barrier (assuming that’s both possible andworkable)ortoacceptitandadapttoit.

REASON-GIVING

We’reallverygoodatcomingupwithreasonsforwhywecan’torshouldn’tdo things that take us out of our comfort zone. And if we fuse with thesethoughts,they’llholdusback.Therearemanywayswecandefusefromreason-giving (aswith anyother categoryof thinking).One simpleway is toname itandanticipateit,asweseeinthistranscript.

Therapist:Youknowourmindisprettyamazing.It’snotonlyaproblem-solvingmachineandajudgmentfactory,it’salsoareason-givingmachine.Assoon as we have to face any sort of challenge and step out of ourcomfortzone,ourmindwillmanufactureawholelistofreasonsnottodoit:I’mtootired.It’s toohard.I’llfail. It’s tooexpensive. It’ll taketoo long. I’mtoodepressed. Idon’thaveenoughconfidence. I’m tooanxious.Otherswouldn’tapprove.Idon’tdeserveit. It’snot therighttime. I shouldn’t have to do this. It’ll all go wrong. [Modify thesereasonssothey’redirectlyrelevanttoyourclient’sissue.]Themachineneverstops—itkeepsonchurningoutreasonafterreasonafterreason.Your mind, my mind, everybody’s mind produces these sorts ofthoughts.That’sjustwhatmindsdo.Andthisisonlyaproblemifweletthesethoughtsbullyusaround—ifweletthemdictatewhatwecanand can’t do. But if we treat them the same way as all our otherunhelpful thoughts—see them for what they are, hold them lightly,unhook ourselves—then they can’t stop us from doing what trulymatters.Sowhatsortofreasonsisyourmindgivingyourightnowasto why you can’t or shouldn’t do what we’ve been talking about?[Elicitasmanyreasonsaspossible.]Okay,soasfarasIcansee,theseareallperfectlyvalidreasonsnottotakeaction.SonowIinviteyoutotakeagoodhonest lookat thesituationandconsiderthisquestion:ifyoudon’t takeanyactionhere—ifyoujuststop trying,giveup,stayput,domoreofthesame—willthatenrichandenhanceyourlifeinthelongrun?[Elicitananswer;usually theanswerwillbeno.)So then,are youwilling to take action, even though yourmind can andwillgiveyouallsortsofperfectlyvalidreasonsnottodoit?

Ifyourclientsays“yes,”youcannowuseallmannerofdefusiontechniques.

Youcansilentlynametheprocess:“Aha!Here’sreason-giving!”Youcansaytoyourself,“I’mhavingthethoughtthatIcan’tdothisbecauseI’mtootired.”Youcan say to yourself, “Thanks, mind. Good reason-giving.” You can sing thereasons, write them on cards, observe them dispassionately, treat them as aspecialbroadcastfromRadioDoomandGloom,andsoon.Ifyourclientsaysno,youcansay—veryslowly,gently,andcompassionately:

Therapist:Well,here’sthething.Ifyou’rewaitingtillthedayyourmindstopsgivingyoureasons,you’llprobablybewaitingforeverbecausethat’swhat minds do. They give you reasons not to take action. So justimaginecomingbacktoseemeintenyears’time…andyoutellmethat nothing has changed in your life…nothing… that the last tenyearshavebeenjustmoreofthesame.You’vebeenwaitingtenyearsfor the day your mind stopped giving reasons … and nothing haschanged.(pause)Isthatthefutureyoutrulywant?”

Yourclientisalmostcertaintonowsayno,inwhichcaseyouonceagaincanask:

Therapist: So are youwilling to take action, even thoughyourmind cangiveyouallsortsofperfectlyvalidreasonsnottodoso?

OnelaststrategytoconsiderissomethingIcall“thekidnapquestion”:

Therapist:Okay,soyou’vejustgivenmesixorsevenperfectlyvalidreasonsnotto do this. Now, if you’re willing to, I’d like you to imaginesomething.Imagine that thepersonyoulovemoston thisplanetwaskidnapped. And the deal is, unless you take this action we’ve beentalkingabout,you’llneverseethispersonagain.Wouldyoutakethisaction,eventhoughyourmindcangiveyouallsortsofperfectlyvalidreasons not to do it?” [Elicit an answer; your client is bound to sayyes.]Okay.Soat themoment, it’s like this: the rich,meaningful lifethat you would ideally like to have has been kidnapped, and you’llnevergettoseethatlifeunlessyoutakeaction.Areyouwillingtotakethisaction,eventhoughyourmindgivesyouallsortsofreasonsnottodoit?

THEWILLINGNESSANDACTIONPLAN

Wecan reduce the impactofpsychologicalbarriersbyanticipating them.AsimplewaytodothisistousetheWillingnessandActionPlanbelow.(It’salsodownloadablefreefromwww.actmadesimple.com.)Part1of the formspecifiesvalues,goals,andactions.Part2asksclients to

predicttheirownpsychologicalbarriers.Beingforewarnedisforearmed,anditincreasesthechancesthatthey’llrespondwithacceptanceanddefusion.(Besuretoaskyourclienttoincludeasmuchreason-givingaspossibleinthesectiononthoughts.)Part3breaksthegoaldownintosmalldoablesteps,andalsoincludesa section for any useful self-talk—for example, “The journey of a thousandmilesbeginswithonestep”or“It’sokaytomakemistakes.”Oncethisformiscompleted,askyourclienttoreadparts1and2outloudin

session as a public commitment. Again, you can do all this conversationallywithoutusingforms,butawrittenrecordactsasapowerfulreminder.Youcouldalsoprintoutafewcopiesandgivethemtoyourclientforongoinguse.

BREAKINGCOMMITMENTS

Everyonebreaks commitments at times.This is part of beinghuman.Oftenourclientwillbequicktoraisetheissueoffailure:“WhatifIfail?”“I’vetrieddoing thisbefore,but Inever stick to it.” Ifour clientdoesn’t raise this issue,thenwe’llneedtoraiseitourselves.Here’sanexample:

Therapist:It’sagiventhatfromtimetotimeyou’llbreakacommitment.That’scalledbeingarealhuman,notafictitioussuperhero.It’sunrealistictoexpectthatwe’llalwayslivebyourvaluesandfollowthroughonourcommitments.Whatisrealisticistogetbetteratit.Wecangetbetteratstayingon track, fasteratcatchingourselveswhenwegoofftrack,andbetteratgettingbackontrackagain.Andwhenwedogoofftrack,what helps is being kind and accepting toward ourselves:we acceptthepainfulthoughtsandfeelings,thenreconnectwithourvalues,andgetmovingagain.Whatdoesn’thelpisbeatingourselvesup.Imean,ifbeatingyourselfupwasagoodwaytochangeyourbehavior,wouldn’tyoubeperfectbynow?

It’salsousefultotalktoclientsaboutthetwomaincommitmentpatterns:

TheTwoCommitmentPatterns:

Pattern1:Makeacommitment,breakacommitment,giveup.

Pattern 2: Make a commitment, break a commitment, lickyourwounds,pickyourselfup, learnfromtheexperience,getbackontrack,makeanothercommitment.

Thefirstpatternleadstogettingstuck.Thesecondleadstocontinuedgrowth.Youcanaskclients to identify theirpattern—and if it’spattern1, ask them tohonestlyassessitintermsofworkability.Basically we want our client to build bigger and bigger patterns of valued

action,extendingintoeveryareaofherlife.Andintheprocess,wewanthertobecomeherownACTtherapist:identifyingherownFEARandrespondingwithDARE.PracticalTipTherearetwoverycommonpitfallsfortherapistsinthisstageof

thework.Thefirstisbeingtoopushy.Ifwetrytoharangue,coerce,orpushourclients into action, it will probably backfire. The second is being too wishy-washy. Ifwe don’t actively encourage our client to set specific goals,make apubliccommitment,andconfrontherpsychologicalbarriers,thenshemaywellnotfollowthrough.

HomeworkandtheNextSessionForhomework,yourclienttakestheactionthathecommittedtointhesession.It’simportanttoanticipatepossiblebarriersanddiscusseffectiveresponses.TheFEAR/DARE acronyms are very useful, and you can accentuate theireffectivenesswiththeworksheetFromFEARtoDAREbelow.

Chapter13.GettingUnstuckWorkability:OurBestFriend

Here’smyguaranteetoyou.AsyoustartworkingwithACT,bothyouandyourclientswill get stuck.Repeatedly. I guarantee thiswill happenor yourmoneyback!FortunatelyACTprovidesuswithanincrediblypowerfultoolforgettingunstuck:workability.KirkStrosahl,oneofthepioneersofACT,saysitthisway:“When we’re doing ACT, workability is our best friend.” From a stance ofworkability,weneverneedtojudge,criticize,orattackaclient’sself-defeatingbehaviors,nordoweneed toconvinceorpersuadeher tostop. Insteadweaskhertolookhonestlyandopenlyathercurrentbehavioranditslong-termeffectsonherlife,andtoassesswhetherheractionsarehelpinghertogrowasahumanbeingand live avital,meaningful life—ornot.Wemayaskquestions suchasthese:“Iswhatyou’redoingworkinginthelongruntomakeyourlifericherandfuller?”“Is this takingyoucloser to the lifeyoureallywant?”“Is thishelpingyoutobethepersonyouwanttobe?”However,weneedtobeverycarefulhere:it’seasyforustostart“bullying”

ourclients.Bullyingmeansthatwehavealreadydecidedwhatwillworkfortheclientandwhatwon’twork(Strosahl,2004).Whenwefusewithourownideasaboutwhatisbestorrightforourclient,westartimposingourownagenda.Ourclientmaythenstartsayingthethingswewanttohearinordertoappeaseus.Ifthis happens, the exercise is empty because the client is not genuinely takingresponsibilityforhisownlife.Strosahlwarnsus:“Inordertousetheworkabilitystrategy,youhavetoberelentlesslypragmaticandnon-judgmentalandtotrulymean it. This is not a game, a trick or a form of therapeutic manipulation”(Strosahl, 2004, p. 226).Keeping this inmind, let’s look now at some of themanywaysworkabilitycanhelpusout.

HelpingUswithCreativeHopelessness

Workabilityenablesustodo“mini”creativehopelessnessinterventionsatanytimeinanysession.Whatever theproblematicbehavior is,wecanalwaysask,“Sowhenyoudo that,what effect does it haveonyour life in the long run?”Thisismoreeffectiveifwefirstnormalizethebehavior:“It’scompletelynaturalthatyouwoulddothis,givenyourpastlifeexperience.Lotsofpeoplewoulddotheverysamethingundersimilarcircumstances.Thequestionis,ifyoukeepon

doingit,willitmakeyourlifericherandfuller—orwillitdotheopposite?”

PracticalTip When talking of workability, we don’t have to use theterms“rich,full,andmeaningfullife”or“livingbyyourvalues.”Therearemanyways to communicate the concept ofmindful, valued living.We can talk ofvitality,alifeworthliving,alifethatgrabsyou,abetter life,beingthepersonyouwanttobe,doingwhat’simportant/meaningful,doingwhatmatterstoyou,doingwhat you care about, enhancing or enriching life, thriving, flourishing,andsoon.

HelpingUswithDefusion

Workabilityenablesrapiddefusion,andit’sparticularlyusefulwhenaclientinsiststhatathoughtistrue.Wecansay,“Iwon’targuewithyouoverwhetherit’strueornot.WhatI’dlikeyoutodoistotakeagoodlookatwhathappenswhenyougetallcaughtupinthisthought.”Thenwecanask,“Ifyougivethisthoughtallyourattentionand let itdictatewhatyoudo,whathappens toyourlifeinthelongrun?”or“Doesgettingcaughtupinthisthoughthelpyoutobethepersonyouwanttobe?Doesithelpyoutodothethingsyouwanttodo?”This is particularly useful when our client starts insisting change is

impossible.Forexample,aclientwithanaddictionmaysay,“Iknowthiswon’twork forme. I’ve tried before. I’ve got no control over it.”We can respond,“Okay, so yourmind says,Thiswon’twork. I’ve got no control. Fair enough.That’sthesortofstuffthatmindssay.Iwon’targuewiththat.Ijustwantyoutoconsidersomething.Ifwegoalongwiththat—ifweletyourminddictatewhathappensinthisroom—thenwheredowegofromhere?Dowestopthesessionandgiveup?”Wecouldthengoontosay,“Ifullyexpectyourmindwillkeeptellingyouthatthistherapywon’tworkandyouhavenocontrol.Idon’tknowanyway,otherthanmajorbrainsurgery,tostopthatfromhappening.Socanweletyourmindsaywhateveritwantsandgivethisagoanyway?”This strategy is alsoveryusefulwhenclients insist thatnastynegative self-

judgmentsaretrue—forexample,“Butit’strue.Iamfat/ugly/stupid/aloser.”Wecansay,“Whenyourmindsaysthisstufftoyou,doesithelpifyougetallcaughtupinitorholdontoit?Doesbuyingintothesethoughts—givingthemallyourattention,allowingthemtodictatewhatyoudo—doesthatmakeyourlifericher,fuller,andmoremeaningful?Ifnot,howaboutwepracticelearningtoletthem

comeandgowithoutholdingontothem?”

HelpingUswithClientsWhoAreMakingProgress

Ifwhattheclientisdoingis“workable,”thenwecanreinforcethisbehaviorbyincreasingawarenessaroundit.Forexample,wemayaskquestionssuchasthese: “What’s it like when you act in this way?What happens to your life?Whathappenstoyoursenseofvitality?Howcouldyoudomoreofthis?”Itcanalsobeuseful toask,“Howdidyoudo that?Howdidyoumake thathappen?Whatdidyoudodifferently?Whatdidyouhave tomake roomfor?Didyourmindtrytointerfere—andifso,howdidyourespond?Whatdoesthistellyouaboutwhatworksinyourlife?”

HelpingUstoCatchOurselves

Becausewe’refalliblehumanbeings,it’sinevitablethatattimeswe’lltrytopersuade,convince,debate,orarguewithourclients.Andwhenwerespondinthis way, we aren’t doing ACT. So whenever I catch myself doing this, Ipromptly apologize. I say, “I’m really sorry. I just realized I’vebeen trying toconvinceyouhere,andthat’snotwhatIwantthistobeabout.Thisisnotaplaceformetotrytoimposemybeliefsonyouandtellyouwhattodowithyourlife.It’saplaceforustoworktogether,todiscoverwhatworksinyourlife.SocanwepleasejustrewindtobeforeIstarteddebatingwithyou?Let’sjustbringthisbacktoyour lifeandyourexperiencerather thanmybeliefs.AndthequestionI’dlikeyoutoconsideristhis:regardlessofwhatanyoneelsethinks(includingme),ifyoukeepdoingwhatyou’redoing,isitworkinginthelongruntomakeyour life better? If it is, then by all means keep doing it, and let’s focus onsomething else.But if it’s not, how aboutwe take a good honest look at it—exceptthistimewe’lldothatwithoutmetryingtoconvinceyouofanything?”

HelpingUstoFindOurFooting

Whenwe’re“lost”inasessionorwonderingwheretogotonextintherapy,wecanalwayscomeback toworkability.Wecanask, “Ona scaleof0 to10,howwell isyour lifeworking? If10meansthat thewayyou’re spendingeachdaygivesyouarealsenseofvitalityandfulfillmentand0meansthattheway

you’respendingeachdaymakeslifeseempointless,meaningless,andnotworthlivingatall,whereareyouonthatscale?”Ifaclientscoreshighly,thenlet’stalkaboutwhentoendtherapy.Ifaclient

scoreslow—forexample,3or4—wecouldask,“Whatwouldhavetohappentoget to a5?What’sgetting in thewayof that?”His answerwill eithergiveusinformation about further goals or reveal something about psychologicalbarriers.

HelpingUswith“IDon’tKnow!”

At times, we’ll ask clients important questions and they’ll answer, “I don’tknow.”Forexample,thisoftenhappensearlyonwithvalueswork.Ifwesuspectthat the function of “I don’t know” is to avoid the discomfort that discussingvalues often elicits, thenwe can bring inworkability in a variety of differentways:“Howis itworkingforyousofar,going through lifenotknowingwhatmatters to you?” “Ifwe stop the conversation right there,with your very firstanswerof‘Idon’tknow,’thenwherewouldthatleaveyou?”“Ifitcouldmakearealdifference inyour life,wouldyoubewilling to spend some timeon this?Wouldyoubewilling tostickwith thequestionandexplore iteven thoughnoanswerimmediatelycomestomind?”Fromhere,wecandanceintoanynumberof values interventions—from formal worksheets to imagining your eightiethbirthday.Alternatively,wecanmoveintoacceptanceanddefusioninterventionsinordertodealwiththepainfulthoughtsandfeelingswe’veelicited.

HelpingUswith“I’veGotNoChoice!”

Often our most challenging clients will tell us they have no choice or nocontrolovertheiractions.Theywill insist thatwhenstrongurgesshowup—tocommitsuicide,drinkalcohol,takedrugs,andsoon—theyhavenochoicebutto“give in.” Other clients may insist that they’re powerless or hopeless orincapableofmakingchange,ortheymaysaythingssuchas,“WheneverItrytoimprovemylife,italwaysgoeswrong;Ialwaysfailorgethurt.”Wewouldfirstvalidatehowmuch theyhave suffered: “Clearly this issuehas created a lot ofpain and difficulty for you. And you’ve tried hard, and so far nothing hasworked.”Thenwewouldsay,“Andnowyouhaveachoicetomake.OnechoiceistoholdontightlytoIhavenochoice,Ihavenocontrol,There’snothingIcando— and just give up trying, and carry on living theway you are. The other

choiceistotakeactionthatmovesyouinavalueddirection,eventhoughyou’rehavingthethoughtthatit’spointlessandhopeless.Whichofthesetwochoicesisguaranteedtokeepyoustuckandstopyourlifefromimproving?Whichofthesetwochoicesstandsthebestchanceofimprovingyourlife?”

HelpingUswith“ButItWorks!”

Someclientswillinsistthattheirself-defeatingbehaviorworksfortheminthelong run.Here are two classic examples: “Worrying helpsme prepare for theworst” and “I like getting stoned. It’s the only way I can relax.”We need tovalidatethat,yes,thereareindeedsomerealbenefitstothesestrategies,andatthe same time, there are otherways to obtain thosebenefits thatwouldbe farmoreworkable.Iuseametaphoraboutaricketybicycletoconveythis.

THERICKETYBICYCLEMETAPHOR

Therapist: You can cycle fromNewYork toMexico on a rickety old bicyclewithbadsuspensionandaworn-outseat,anditwilleventuallygetyouthere.Butwhatconditionwillyoubeinbythetimeyouarrive?Therearemanymoreeffectivewaystomakethatjourney:cars,buses,trains,planes. When you (Name the client’s issue here: for example, getstoned,doallthisworrying),that’slikeridingaricketybicycle.Wouldyouliketolearnanalternativethatwillgetyoutoyourdestinationinmuchbettercondition?

AfterusingtheRicketyBicycleMetaphor,wethenteachthenecessaryskills(orwehelp theclientaccess resources for learning them).Forexample, ifourclientwantsto“preparefortheworst,”wecanteachhimstrategicplanningandproblemsolving.Ifourclientwantstorelaxandmarijuanaistheonlywaysheknowstodoso,wecanteachherrelaxationskills(whilebeingcleartheyarenotthesameasmindfulnessskills).

OvercomingResistanceResistanceisastate,notatrait.Intherightcontext,anyonewouldberesistanttotherapy.Supposeyouwerebeingtreatedbya“witchdoctor”insomethirdworldcountry.Ifhetoldyoutherewasanevilspiritinyourbodyandtheonlywayto

getridofitwastoeatalivesquid,wouldyouberesistant?Resistance in therapy generally boils down to a few key factors: treatment

mismatch,secondarygains,thetherapeuticrelationship,andFEAR.Let’stakealookateachofthesenow.

TreatmentMismatch

Did you adequately consent with your client? Did you explain what ACTinvolves?Washeexpectingan“easyride”?Didshejustwantsomeonetolistentoherwithout expecting to domuchwork?Washe expecting somethingverydifferent,suchaslong-termpsychoanalysis?NoteverybodyisopentoACT,andwemayneed to refer clients on orworkwith a differentmodel.This issue islargely avoided by giving adequate information when obtaining informedconsent(seechapter5).

SecondaryGains

Are there benefits for the client (whether conscious or unconscious) if she“stays stuck,” such as proceeds from a legal settlement, or care and attentionfromotherswhileshe’sinthesickrole?Toaddresstheissueofsecondarygains,we need to compassionately bring it into the client’s awareness andnonjudgmentallyexploreit.Wemayneedtodoacost-benefitanalysis,framedintermsofworkability—forexample,wemightsay,“ItseemsthatstayingstuckworksintheshortruntogainbenefitsX,Y,andZ,butdoesitworkinthelongruntomakeliferichandfull?”or“I’mwillingtobewrongaboutthis,buthere’showIseeit.Ifyoudon’tmakeanychangeshere,therearesomegenuineshort-termbenefits foryou—suchasA,B,andC.What I’d likeyou todo isweighthesebenefitsupagainstthelong-termcostsofstayingstuck.”

TherapeuticRelationship

A strong therapeutic relationship is essential for effective therapy. Is thereroom for improvement here? Check in with yourself: Have you fused withunhelpfulbeliefs,judgments,orassumptionsaboutthisclient?Areyoumovingtoofastortooslow?Areyoubeingtoopushyortoopassive?Tooseriousortooplayful? Do you need to validate his experience more or show more

compassion?Doyouneedtobemorepresent,open,andaccepting?Doyouneedto provide more rationale for the client as to why you’re encouraging her tomakethesechangesorpracticetheseskills?Areyouyourselffusedandavoidantin session: skating around important issues instead of approaching them orgetting lost in your own internal dialogue? In chapter 14,wewill explore thetherapeuticrelationshipinmoredetail;sufficeittosayfornow,thebestwaytobuildandstrengthenthetherapeuticrelationshipisforustoembodyACTduringoursessions.

FEAR

Inthelastchapter,wediscussedFEAR:fusion,excessivegoals,avoidanceofdiscomfort,andremotenessfromvalues.Allthesefactorscanplayamajorrolein resistance. The key is to identify them and then target them with DARE:defusion,acceptanceofdiscomfort,realisticgoals,andembracingvalues.

ResistanceIsFertile

Whenweencounterresistanceinourclients—orperhapsit’sbettertodescribeit as “avoidance of making changes”—most of us tend to get frustrated orirritated, or we doubt our own abilities, blame the client, or blame ourselves.Whilethisisnormal,itisn’tparticularlyhelpful.AbetteralternativeissimplytoapplyACT to this issue itself. (I often say thatACT reframes your entire lifebecause every problemyou encounter becomes an opportunity to get better atACT.)In other words, whenever a client seems stuck, our first step is to look

mindfullyatwhat’shappening,lookatthesituationwithopennessandcuriosity,andnoticethethoughtsandfeelingsshowingup.Wemightsaysomethinglike,“Whydon’twejust takeastepbackandnoticewhat’shappeninghere?”ThennonjudgmentallyexploretheFEARfactorsthatare(almostcertainly)involved.

Practical Tip Psychological flexibility is the capacity to be present,openup,anddowhatmatters.Soifyourclientstartstocloseofforshutdownwhilethesessionisfocusedonopeningup(defusionandacceptance)orondoingwhatmatters(valuesandcommittedaction),thenyourbestoptionistofocusonbeingpresent.Askyourclienttonoticewhat’shappening;tonotice

herthoughtsandfeelings;andtocomebacktotheroomandgetpresentwithyou.Fusionandavoidance tend to “witherand fade”whenwe’re fully in thepresentmoment.

AcceptanceofBeingStuckThere will be times that nomatter what we try, our client will remain stuck.Haven’tyoueverexperienced this inyourown life?Despiteallyourwisdom,knowledge,resourcefulness,andexperience,yousomehowfoundyourselfstuck:you were unwilling or unable to take the action that would really make adifferenceinyourlife?Atthesetimes,ourdefaultistobeatourselvesup,whichclearlydoesn’thelp.Beatingourselvesupforgettingstuckisaboutasusefulasrubbingsaltintofreshwounds.Amorelife-enhancingresponseistoturnthesepainful situations into opportunities to develop self-acceptance and self-compassion.We can ask our clients questions like these: “Can you accept yourself as a

humanbeingeventhoughyouaretemporarilystuck?”and“Canyoubekindandcaring toward yourself instead of beating yourself up?” Section 7 of theAcceptanceofEmotionsExercise(seechapter8)isalovelyexercisetopracticeherefordevelopingself-compassion.And notice the paradox: if we can use these situations to develop self-

acceptanceandself-compassion,thenwe’restillgrowinganddevelopingusefullifeskillseventhoughwemaybe“stuck”onthisparticularissue.

HomeworkforYou

Play around with the concept of workability. Keep it in theback of yourmind and use it as a resource for innovation inyourwork.Playaroundwithdifferentwaysoftalkingaboutit.Start looking at your own behavior through the lens ofworkabilityandnoticewhateffect thathas.Inparticular, lookatwhatyoudoinyourclosestrelationships.Insteadofgettingcaughtupinright/wrongorshould/shouldn’t(asmostofusdoattimes),startlookinginadefusedandacceptingwayathowworkable your behavior is and whether there’s any way you

canimproveonit.Think of one or two clients who seem stuck or resistant.Identifythefactorsthatmaybecontributingtotheirresistanceandbrainstormwaysthatyoumightrespond.

Practical Tip Whenever our clients seem stuck, resistant, orunmotivated, look forFEAR factorsand respondwithDARE. If asearch forFEARfactorsdoesn’t reveal thebarriers, thenconsider treatmentmismatch,secondarygains,orthetherapeuticrelationship.

SummaryThewholeACTmodelrestsontheconceptofworkability.Againandagain,weask our clients to assess whether their actions are giving them meaning,fulfillment, and vitality—or struggle and suffering? When we rely onworkabilityformotivation,weneverhavetocoerce,persuade,orconvinceourclientstochange;wesimplyopentheireyestotheconsequencesoftheiractionsandallowthemtochoosetheirowndirection.Andsometimes,despiteourbesteffortstohelpthemgetmoving,ourclientswillstaystuck—inwhichcase,wecan at least provide themwith a safe, compassionate space inwhich they canrest.

Chapter14.IandThouTheTherapeuticRelationship

Injustabouteverymodeloftherapyorcoaching,thetherapeuticrelationshipisconsidered important—and rightly so. In ACT, we especially emphasize thisrelationship.Asatherapistorcoach,weaimtoembodytheentireACTmodelinsession: to be mindful, nonjudgmental, respectful, compassionate, centered,open,receptive,engaged,warm,andgenuine.Weregardtheclientasanequal:afellowhumanbeingwho, just likeus,getscaughtup inhismindandendsupstruggling with life. This attitude is very much summarized by the TwoMountainsMetaphor(seechapter5).

BeingMindful

ACT is a very active therapy that placesmuch less emphasis on supportivelisteningthanmostothermodels.However,evenafewminutesoftrulymindful,genuinelycompassionatelisteningcanbeincrediblypowerful—farmoresothananentirehourofdisengagedlistening.Oneofthegreatestgiftswecangiveotherhumansistomakethemthecenter

of our attention in an atmosphere of complete acceptance, openness, andcompassion. So we listen to our clients carefully, kindly, genuinely—with anopenheartandanopenmind.Welistencompassionatelytotheirstruggles.Wenoticeandvalidatetheirpain—andacknowledgehowthey’vesuffered.Weaskthemtobewillinglyvulnerable.Andwecreateacompassionate,nonjudgmentalspacewherethisispossible.Throughthismindful,caringinteraction,astrong,trusting,andopenrelationshipisforged.Ineachandeverysession,wehavetheopportunitytobearwitnesstothepain

andsufferingofourclientinamannerthatperhapsnooneelsehaseverdone.We take the time to listen completely, carefully, and open-mindedly; to noticeour client’s body language and facial expressions; to respond genuinely andempathetically; and to validate her experience in the process. If we catchourselves “tuning out,” not paying full attention, getting caught up in ourthoughts,thenthemomentwerealizeit,wecangentlyacknowledgeitandbringour attention back to our fellow human being. In this way, every sessionbecomesamindfulnesspracticeinandofitself.

AskingPermission

“Is itokay if…?”“Could Iaskyou to…?”“Wouldyoubewilling to…?”—these are all useful ways to ask the client’s permission. This is simplyshowing respect. It’s a key ingredient for building and maintaining rapport,especiallywhenwe’reaskingourclientstodoexercisesthatarelikelytobringuppainfulthoughtsandfeelings.Themorepainfultheexperienceislikelytobe,themore essential it is to knowwehavegenuinepermission—andnot just anautomaticyesresponse.Attimes, it’salsouseful tosay,“Youdon’thavetodothis.Iwouldn’twant

you to go alongwith it just because I’ve suggested it.” It’s important, too, tomakesuretheclientunderstandstherationalebehindtheexercise.Ifhedoesn’t,thentakethetimetoexplainit.

Saying“I’mSorry”

Whenwescrewup,makeamistake,offend,upset,orinvalidateaclient,thenthemomentwerealizeit,let’stakeaction:acknowledgeit,admitit,andgiveagenuine,heartfeltapology.We’remodelingsomethingveryusefuleachtimewedothis;inmanyintimaterelationships,there’sanotablepaucityofapologizing!At times,even themostexperiencedofACT therapistswill find themselves

lecturing,coercing,convincing,debatingwith,ortryingtopersuadetheirclients.Whenwe’redoingthis,wearen’tdoingACT.Sothemomentwecatchourselvesdoingthis,it’susefultoacknowledgeitandtoapologize.Isaysomethinglike,“I’mreallysorry.I’vejustrealizedwhatI’vebeendoinghere.I’vebeentryingtoconvinceyouofsomething.Youdidn’tcomeheresothatIcouldforcemybeliefsystems on you. Can we please rewind here—go back to the point before Istartedtryingtoconvinceyou—andstartagainfromthere?”

BeingPlayful

Playfulness, irreverence,andhumorcanplayan importantpart inenhancingrapport. This often comes into its own when working with defusion. Whenlaughterarisesspontaneouslyinsession,it’sgenerallyagoodsign.Ontheotherhand,watchout for insensitivity and invalidation.When someone is sharing aheartbreaking story of pain and suffering, playfulnesswould be inappropriate.And if our client’s in terrible distress, we certainly wouldn’t be using zany

defusiontechniques.

PracticingSelf-Disclosure

While we don’t have to self-disclose, ACT advocates that we do so if andwhen it’s likely to be beneficial to the client in the service of normalization,validation,promotingself-acceptance,orenhancingthetherapeuticrelationship.TheACT stance is that therapy involves an intimate relationship.However,

intimacy is a two-way street; it requires openness from both parties. If thetherapist is a “blank slate” and the client knowsnothing of her innerworld—nothingaboutwhatshevaluesorcaresabout,orwhatshetrulyfeelsandthinks—thenclearlytheydonothaveanintimaterelationship.Whenourclientscomeinto therapy, they’re in avulnerableposition,whichmakes for averyunequalrelationship.However,ifweastherapistsdeliberatelyandopenlyshareourownvalues and vulnerabilities, that helps to establish a powerful bond with ourclients.Obviously that doesn’t mean we “dump on them” or say, “Hey, you think

you’ve got problems—listen to mine!” We use self-disclosure judiciously—when it’s likely to normalize and validate a client’s experience, deepen thetherapeutic alliance, ormodel something useful.Here are some forms of self-disclosurethatcouldbehelpfulintherightcontext.

“Ihave toconfess, that’s thrownme…”Whenyourclienthassaidsomethingthathasthrownyou,stunnedyou,knockedyouoffyourfeet,it’softenusefultoadmitit.Youmaythenliketosuggestacoupleofminutesofmindfulbreathingorsimilarexercisesoyoucanbothcenteryourselves.

“I feel disconnected from you” or “I feel as if you’re not fully present rightnow.” If you sense your client dissociating, disconnecting, withdrawing,detaching, or wandering off inside her own mind, it’s often helpful to drawattentiontoit—andtohighlightwhathappenstoyourrelationshipwiththeclientduringthesemoments.

“I’m noticing a couple of different thoughts here …” At times, my mindsuggests several different directions I could take the session in—all of themvalid.It’softenusefultosharethesethoughtsandgaugetheclient’sresponse.Atother times, my mind makes several different judgments about the samesituation.Again,intherightcontext,thiscanbeusefultoshare.

“I’mnoticingIfeelabit…”Intherightcontext,itcanbeveryusefultoshareemotionalreactions.

ConfrontingProblematicBehaviors

Fromtimeto time,weallhaveclientswhobehave“problematically”duringthe session—for example, they may endlessly rehash the same old story orcontinuallyblameeveryoneelsefortheirproblemsinlifewithouteverlookingattheirownrole.Whenthishappens,mostofushaveatendencytogritourteethandtryandputupwithitratherthanopenlyaddressit.Why dowe do this? Usually because we either fuse with thoughts like “It

wouldberudeofmetointerrupt”or“IfIsaysomethingaboutit,she’llgetupsetwithme”—orweexperiencefeelingsofanxietythatwe’renotwillingtomakeroomfor.Atthesetimes,it’sveryusefultoexplicitlymodelACT.Wecouldsaysomethinglike,“I’mnoticingsomethinghappeninghere,andIwanttobringittoyourattention.Mymind’stellingmeyou’regoingtobeupsetoroffendedbywhatIsay,andI’mnoticingquitealotofanxietyinmybody,andastrongurgejust to sit here andnot say anything.However, I’mcommitted to helpingyoucreatethebestlifeyoucanpossiblyhave.AndifIsithereandsaynothing,thenI’ll be neglecting those values. So I’m going to do what matters here, eventhoughmyheartisracing—I’mgoingtotellyouwhatI’mnoticing.”Notice how, in doing this, we have explicitly modeled five of the six core

ACTprocesses:defusion,acceptance,values,action,andcontactingthepresent;self-as-context is implicitbutnotexplicit.Andbynow,we’llhaveourclient’sfullattention!Then,withanattitudeofopennessandcuriosity,defusedfromanyjudgmentsorcriticisms,wedescribethebehaviorwe’renoticingandpointtothefactthatit’spreventingusefulworkinthesession.Fromthere,wemayexplorethe function of the behavior—“Can I ask what you’re hoping to achieve bydoingX?”—orwhetheritplaysoutinotherrelationshipsand,ifso,whataretheconsequences.Wemayalso inquire about the client’s thoughts and feelings inresponsetoourobservation—anddosomeworkaroundacceptanceanddefusionifnecessary.

DeclaringOurValues

In thehomework sectionat theendof chapter11, I askedyou to reflecton

yourvaluesasatherapist.Ifyouhaven’tdoneso,pleasegobackandreflectonthosequestions.Whenwegointoasessionconsciouslyguidedandmotivatedbyour core values, we’ll do a different sort of therapy than when we’re onautomatic pilot or fused with thoughts likeHere we go again; another day,anotherdollar!orThisisgoingtobeatoughone.ACTadvocatesthatwedeclareourvaluestoourclients.Forexample,“Iwant

you toknow,I’min this roomworkingwithyouforonesolepurpose: tohelpyoucreateabetterlife,alifethatyoufeelisworthliving”or“I’mcommittedtohelpingyou turnyour lifearoundand take it inadirection thataddsmeaning,purpose,andfulfillment.”Whensaidgenuinely,thisisapowerfulmessagethatunitestherapistandclientinacommon—andincrediblyworthwhile—cause.

SlowingDownandLeaningIn

“Slow down and lean in” is a phrase I picked up from a workshop withpsychologist RobynWalser. When we get stressed or anxious in response towhat’shappeninginsession,mostofustendtospeedup—talkmore,talklouder,giveadvice,startlecturing,andsoon—orweleanback—disengage,tuneout,withdraw.Obviouslythisisn’thelpfulforthetherapeuticrelationship.Soaimtodo the opposite: slow down and lean in! Notice your thoughts and feelings,notice your tendency to speed up and lean out, connectwith your values, andthen lean in (literally) and slow down. Talk less, talk slower, and pausefrequently.

SittingwithIt

AmajorchallengeformostACTtherapistsislettinggooftheneedtofixtheclient’sproblems.Andyet, themorewe takeon the roleofproblemfixer, themore we disempower our client. In ACT, we help clients cultivate enoughpsychological flexibility to effectively contact their own problem-solvingresources—andifproblem-solvingskillsarelacking,we’llteachthem.However,thereareallsortsofproblemsinlifethatcan’tbe“solved”or“fixed”—thelossofa lovedone, thepainof rejectionor failure, theheartacheof loneliness, theinevitabilityof aging, infirmity, and illness. In such situations,wehelp clientsdeveloptheabilitytostepoutofproblem-solvingmodealtogetherandintothepsychologicalspaceofmindfulnessandacceptance.Thisisusefulwhenever(a)problems cannot be solved, or (b)when problem-solving attempts create even

biggerproblems.Therefore,weneedtolearntheabilityto“sitwithit”:toletthesituationbeas

itisandallowourclienttohavehisthoughtsandfeelingswithoutrushinginto“rescue”him.Thismeansthatveryoftenwe’llneedtomakeroomforourownfeelings of anxiety, our own impatience, and our own urges to rush in, fix it,solveit,orsaytherightthing.Of course, that’s not the same as allowing the client to wallow in her

suffering;ratherweaimtocreateaspaceofacceptanceanddefusion—aspacewithinwhich both client and therapist can be present with their thoughts andfeelingswithoutfightingthem,withoutbeingsweptawaybythem,andwithoutneedingtotakeanyimmediateaction.Thisis, ifyoulike,“abreathingspace.”(Nowondersomanymindfulnesspracticesfromdifferenttraditionsarecenteredaround the breath.) From a space of mindfulness, we can then make a wisechoice by taking the entire situation into account, connectingwith our values,andengaginginconsciousaction.Attimes,tohelpmyselfalongwiththis,Imaysaytotheclient,“I’mfeelingastrongurgerightnowtotryandfixthisforyou.Mymind’stellingmeallsortsofthingstosaytoyou—bitsofadvice,thingsyoucoulddo,blah,blah,blah.Thechallengeforbothofushereistoseeifwecanjustsitwiththisstuff—justmakesomeroomforallthesethoughtsandfeelingsandurgesshowingup—withoutrushingintotryandfixit.”(Ofcourse,iftherearepracticalskillsthatclientswouldbenefitfromlearning

—skills thatwill help them to solve those problems in their lives that can besolved through overt action—thenACT advocates thatwe either teach clientsthoseskillsorpointthemintherightdirectiontolearnthem.)

DefusingfromOurOwnJudgments

Ofcourseweall aim tobenonjudgmental, andwemayachieve that—forawhile. But sooner or later, judgments will happen. Our mind is a well-oiledjudgmentmachine;itwon’tstopjudgingforlong.So,whenourjudgmentsaboutourclientsdopopup,thechallengeistorecognizethemanddefusefromthem,andtoletthemcomeandgowithoutgettingcaughtupinthem.Ifwerealizeajudgment has hooked us, we can silently say,Aha! A judgment!, then gentlyrefocusonourclient.

RevealingYourselfasaNovice

When it comes to doing ACT, do you ever feel your heart racing or yourstomachknotting?DoyoueverhavethoughtslikeIdon’tknowifIcandothisorWhatifmyclient“freaksout”?Ormaybeyouthink,I’llfumblemywords,I’llscrewitup,Thisistoohard,orI’lldoitwrong.Ifso,good.Thisshowsyouthatyou’reanormalhumanbeing.Normalhumanstypicallyfeelanxiouswhenevertheymoveoutoftheircomfortzone.However,ifyoustartfusingwithideasthatyou’vegottodothisstuffperfectlyrightfromthewordgoorelseyourclientswill react negatively, you’re going to make life very hard for yourself. So ifyou’reatotalACTnewbie,I’dencourageyoutotakethepressureoffyourselfbysimplyadmitting it.Youcouldsaysomething like,“CanIbe totallyhonestwithyou?I’mabitnervousabouttellingyouthis;mymind’stellingmethatyoumightlosesomerespectforme.ThetruthisI’mstillabitofanewcomertothisACT stuff. I really like themodel, I’ve found it very helpful inmy life, andobviously I think it’s going to be useful for you or Iwouldn’t recommend it.However,becauseI’mrelativelynewtoit,fromtimetotimeImightstumbleorgetabittongue-tied.Andforsomeofthelongerexercises,Imayevenneedtopulloutabookandusethescriptstoreadfrom.Wouldyoubeokaywiththat?”Obviouslyyoudon’thavetodisclosethis(andwhateveryoudo,don’tsayany

partofitthatisn’ttrue),butmanytherapistsfinditgivesthempermissiontobeimperfect or to read from a script if desired. Furthermore, you’re modelingopenness, willingness, and self-acceptance, and your self-disclosure helps toestablishamoreintimatetherapeuticrelationship.

ApplyACTtoYourselfHopefully you can see that everything in this chapter follows quite naturallyfromapplyingACTtoyourselfasatherapistorcoach.Andobviouslythisholdstrue for every relationship in your life: the more you act from a space ofmindfulness andvalues, thehealthieryour relationshipswill be.Sowhy leaveACTfor the therapy room?Whynot spend some timenow reflectingonyourmostmeaningful relationshipsand thinkabouthowACTprinciplescanenrichandenhancethem?Andthenputitintopracticeandseehowitworks.Youmaybesurprised!

Chapter15.TheTherapist’sJourneyFromChunkyandClunkytoFluidandFlexible

WhentherapistsarenewtoACT,wetendtoslicethemodelupandcentereachsessionaroundamajor“chunk”ofit—muchasI’vedoneinchapters6to12ofthisbook.Forexample,wemightdoasessionwithamajorfocusondefusion,thenanothercenteredaroundacceptance,andanotherwithanemphasison theobservingself,andsoon.Typicallyaswebecomefamiliarwiththemodelandrealizehowthesixcoreprocessesall interconnectandcomplementeachother,our therapy becomes less “chunky” and more “blended.”We learn to “dancearoundthehexaflex,”workingexplicitlywithseveralprocessesineachsession(and implicitly with all processes). Our therapy becomes more fluid, moreflexible, more creative. We start to modify and adapt tools, techniques, andmetaphors,creatingnewonesofourown(orborrowingthemfromourclients).Hopefullyyou’vealreadystartedtoappreciatetheinterconnectednessofthis

model.Togetabettersenseofit,spendsometimestudyingtheACThexaflexdiagram(seechapter1)and identifyhoweachof thesixcomponents interactswith all the others. Also, as you reread this book or move on to other ACTtextbooks,noticehowvirtuallyevery interventioncontainsseveraloverlappingcoreprocesses.Forexample,supposeyouaskaclient,“Canyoujustsitwiththisfeelingforamoment?Justnoticewhereit’smostintense.Thentakeastepbackand look at it from the observing self.”Here you have three processes in onebriefintervention:presentmoment,self-as-context,andacceptance.(Ifyoulookmore closely, you’ll see that values, committed action, and defusion are alsoinvolvedinthisexercise,buttheyarelessobvious.Canyouspotthem?First,inACT,acceptanceisalwaysintheserviceofvaluedliving,sothisexerciseisinsomewaylinkedtotheclient’svalues.Second,doingtheexerciseis,initself,acommitted action. Third, as we fully contact our experience in the presentmoment,thereisalwayssomedefusionthathappens.)The journey from “chunky, clunky” ACT to “fluid, flexible” ACT requires

time, practice, patience, persistence, and reflection.We’ll screw up again andagain.We’llgetitwrong.Ourmindswillbeatusupforbeinglousytherapists.But if we each bring an attitude of openness and curiosity to ourmistakes—WhatdidIdothatwasineffective?WhatdidImiss?WhatdidIfusewith?Whatcould I do differently next time?—we can learn valuable lessons from them.(AndwemayliketorecallthewordsofSirWinstonChurchill:“Successisthe

abilitytogofromfailuretofailurewithoutlossofenthusiasm.”)

WhatCanWeBringInfromPreviousTraining?Oneof thebeautiful thingsaboutdoingACTis that itenablesus tobring inavast wealth of experience and knowledge from our previous training in othermodels.Lookoncemoreatthediagraminfigure15.1:

You can basically use anything from any other model that helps the clientmove in thedirectionofworkability.Takea fewmoments to thinkaboutyourprevioustrainingandhowyoucanfruitfullyuseit.Whatdoyouknowthatcanhelpclientsto:

clarify their values and connect with a sense of meaning orpurpose?be present, conscious, aware, open, connected to theirexperience,centered,orgrounded?setgoalsandbreakthemdownintoactions?increase self-awareness around the short-term and long-termeffectsoftheirbehavior?beawareofandaccepttheirthoughtsandfeelings?beawareoftheirthoughts,detachfromtheirthoughts,letgooftheirthoughts,orseetheirthoughtsjustasthoughts?connect with a transcendent sense of self such as “the silentwitness,” “the observing self,” “metacognitive awareness,”“pureconsciousness,”or“the‘I’thatnotices”?becompassionateandacceptingtowardthemselvesorothers?makeeffectivebehavioralchanges,orlearnnewlife-enhancingskills?makelifeasrich,fullandmeaningfulaspossible?

Hopefullyyoucan see that there’s awealthofknowledgeyoualreadyhavethatyoucanbringtoyourACTwork.Whatyouneedtobewaryofisbringingin theories or techniques intended primarily to avoid or get rid of unwantedprivate experiences; these simply do not fit into the ACT model. Examplesinclude the challenging and disputing of cognitions, visualizations to dissolveunwantedfeelings,thoughtstopping,anddistractiontechniques.Askyourselfthesequestions:Whatisthepurposeofthistechnique?Isitsaim

toattack,suppress,avoid,reduce,orgetridofanunwantedprivateexperience?If so, it’snotACT-consistent.Ofcourse, thatdoesn’tmeanyoucan’tuse it intherapy;itjustmeans(a)thatit’snotACT,and(b)ifyou’redoingACTandalsotrying to incorporate this technique,yourisksendingconflictingmessagesandunderminingacceptance.

WheretoNext?ACT is a bigmodel.While you can certainly start using it straight away andimmediatelygetpositiveresultsinyourwork,mosttherapistsfindthatittakesatleastayearofdevotedpractice, reading,and learning togetagoodhandleonbothACTtheoryandpracticeandtoimplementitfluidlyandflexibly.Sotakeyourtime—enjoythejourney,don’trushit.RememberAesop’sfamouswords:“Littlebylittledoesthetrick.”Intermsoffurtherlearning,Irecommendthatassoonaspossibleyouattend

anexperientialACTworkshop.Readingbooks,listeningtoCDs,andwatchingDVDs are valuable, but they can’t compare to actually attending live trainingandapplyingthesesixcoreprocessestoyourself.Inappendix2ofthisbook,I’lltalkaboutwhereyoucanfindtrainingandsupervision,andI’llalsorecommendavarietyofbooks,CDs,andDVDsthatcantakeyouintoACTinmoredepth.

PartingWordsThehardestpartofwritingthisbookwaschoosingwhattoleaveout.ThereissomuchmoreI’dliketosharewithyou,butifIdid,thisbookwouldbetentimesthesizeitisnow!Sowithgreatreluctance,I’llleaveyounowwithafewpartingwords.

Beyourself

If you try to doACT interventions by parroting themword for word frombooks, there’s a good chance they’ll comeout stilted or artificial.Modify andadapt;useyourownwordsandyourownstyle;becreativeandinnovativeifyouwishto.VERYIMPORTANT:ifanythingIsuggestinthisbookdoesn’tsuityou,eithermodifyitorleaveitout.IfyoureadafewACTbooks,and/orattendafewdifferent workshops/demonstrations, you’ll see wildly different ways of doing

ACTaswellasavastarrayofdifferentstylesand techniques.That isbecauseACT is a process-basedmodel, not a technique-basedmodel. So theway thatyou do ACT with your clients will inevitably be different than the way thatothersdoit.(Isn’titgreatwecanallbeindividuals?)Atthesametime,makesureyouattuneandadapttoyourclients’needs.For

example,yourstylemaybetodobrieftherapy,butthere’snovirtueinmovingquickly if your client is not ready for it or feels invalidated by it. Likewise,there’snovirtueinmovingslowlyor“hangingback”whenyourclientisreadyandeagerforchangeandwillingtodowhat’snecessary.

Practice,Practice,Practice

Whoever said“Practicemakesperfect”was lying!Butpracticedoes lead toimprovement.Soifyouhaven’tdoneanyofthehomeworkinthisbook,pleasetakea lookatwhat’sstoppingyou.Haveyoufusedwith thoughtssuchasToohard,Toobusy,Doitlater?Orareyoutryingtoavoidtheinevitablefeelingsofanxiety that come when you take risks, face challenges, or try out newbehaviors?Have a lookat yourbarriers in termsofFEAR—and respondwithDARE.Remember,themoreyouapplyACTinyourownlifetodealwithyourown issues, themore naturally itwill come to you in the therapyor coachingroom.

MakeMistakes

I’vesaiditbeforeandI’llsayitagain:youwillmakemistakesandscrewup.This is an inevitable part of learning. So when it happens, practice ACT onyourself.Thankyourmindforthe“lousytherapist”storyorthe“toohard”story.Breathe into your frustration, anxiety, disappointment, and make room for it.Havecompassionforyourself.Thenreflectonwhatyou’vedoneandlearnfromitsothatyouandotherscan

benefitfromtheexperience.

ComeBacktoYourValues

And again and again, come back to your values. Connect with why youmoved into this profession in the first place: your desire to help others, your

desire tomakeadifference,yourdesire tomake theworldabetterplace.Andtakethetimetoappreciatetheprivilegeofourwork:theuniqueopportunitywehavetoseedeeplyintotheheartsandsoulsofothers,andtohelpthemconnectwiththosehealingplacesinsidethemselves.

Appendix1.CaseConceptualizationMadeSimple

This is a very basic guide to case conceptualization. (There are far moresophisticated tools available; thisone isdesigned togetyou“upand running”quickly.) You can download this sheet from www.actmadesimple.com, and Iencourage you to print out twenty copies and use one for each of your nexttwentysessions.Iguaranteethatdoingsowillgiveyouabigboostintermsofunderstandingandapplyingthismodel.

AQUICKGUIDETOACTCASECONCEPTUALIZATION

1. Whatvalueddirectiondoestheclientwanttomovein?(Whatdomain of life and what values seem most important to thisclient?Doesshehaveanyvalues-congruentgoals?)

2. Whatstandsintheclient’sway?(Identifythebarrierstovaluedliving:fusion,avoidance,andunworkableaction.)

1. Whatishefusingwith?(Identifyproblematicfusion,includingreasons,rules,judgments,past,future,andself-description.)What is she avoiding? (Identify thoughts, feelings,memories, urges, sensations, and emotions that thisclientistryingtoavoidorgetridof.)

2. What unworkable actions is he taking? (What is the clientdoingthatmakeshislifeworseorkeepshimstuck?)

You can use the diagram below to help you plan your next session.Writedown anymetaphors, exercises, questions, techniques, orworksheets that youcoulduseinthenextsessiontohelpyourclientmakeaworkableshift.

Appendix2.ResourcesTherearenowawealthofresourcesforongoinglearningandtraininginACT.Hereareafewideastogetyoustarted.

SectionA:ResourcesbyDr.RussHarris

Books

Harris,Russ,ACTwithLove(Oakland,CA:NewHarbinger,2009)ACTwithLoveisaninspiringandempoweringself-helpbookthatappliesthe

principlesofACTtocommonrelationshipissues,anddetailshowtomovefromconflict, struggle, and disconnection to forgiveness, acceptance, intimacy, andgenuine loving. It also functions as a step-by-step clinical guide for therapistswishingtouseACTforrelationshipproblems,andislinkedtoitsownresource-packedwebsite:www.act-with-love.com.

Harris, Russ, The Happiness Trap (Wollombi, NSW, Australia: ExislePublishing,2007)The Happiness Trap translates ACT into simple everyday language and

practicaluser-friendlyexercises.Itisaself-helpbookwrittenforeveryoneandanyone, applicable to everything from work stress to major depression. It’swidely used by ACT therapists and their clients all around the world, and iscurrently translated into twelve different languages. A website—www.thehappinesstrap.com—offersmanyfreeresourcestousewiththebook.

CDsandMP3s

MindfulnessSkills:Volume1&MindfulnessSkills:Volume2Available as eitherCDs or downloadableMP3 files, these volumes cover a

widerangeofmindfulnessexercisesforusebyyouorwithyourclients.Youcanorder them via www.actmadesimple.com (or if you live in Australia, viawww.actmindfully.com.au).

OnlineResources

This book is linked to the ACT Made Simple website awww.actmadesimple.com. On this site, you’ll find many free resources,includingdownloadablecopiesofallthehandoutsinthisbook.You’llalsofindsomevaluableonlinetrainingintheformofE-coursesandwebinars.

Workshops

RussrunsACTtrainingworkshopsaroundtheworld.FordetailsofAustralianworkshops, visit www.actmindfully.com.au. For workshops in other countries,you’llfindinformationonwww.actmadesimple.com.

Newsletter

TheHappinessTrapNewsletter is a regular, free, e-mail newsletter, packedwithuseful information, tools,and tipsrelating toACT.Youcanregister for itunderthemainmenuatanyofthewebsitesmentionedabove.

SectionB:GeneralResources

ACTTextbooksandSelf-HelpBooks

A wide range of ACT textbooks and self-help books now exists with themajorityofthempublishedbyNewHarbinger.VisittheNewHarbingerwebsiteat www.newharbinger.com, or go to www.amazon.com (or some other largewebsite that sells a wide range of books) and do a search for titles on“acceptanceandcommitment therapy.”These textbooksareallverygood,andtheycovertheapplicationofACTtoawiderangeofissuesandconditions,fromchronicpainandPTSDtodepressionandanxietydisorders.ThesethreebooksstandoutasparticularlyrelevanttonewACTpractitioners:

Hayes,StevenC.,KirkStrosahl,andKellyWilson,AcceptanceandCommitmentTherapy:AnExperientialApproach toBehaviorChange (NewYork:GuilfordPress,1999)

This is the ground-breaking theoretical and philosophical text that firstintroduced ACT to the world, and you’ll find it widely cited in every othertextbookonACT.

Luoma, Jason B., Steven C. Hayes, and Robyn D. Walser, Learning ACT(Oakland,CA:NewHarbinger,2007).This step-by-step, skills-training manual for ACT therapists lives up to its

descriptionas“themostcomprehensiveguidetoutilizingACTinyourclinicalpractice.”

Ramnerö,Jonas,andNiklasTörneke,TheABCsofHumanBehavior:BehavioralPrinciplesforthePracticingClinician(Oakland,CA:NewHarbinger,2008)This is an excellent bookon the science, theory, andphilosophyunderlying

ACT:functionalcontextualism,appliedbehavioralanalysis,andrelationalframetheory(RFT).

DVDs

YoucanalsobuyDVDsshowinghow todoACTwithclients: the series iscollectivelyknownasACTInAction byStevenC.Hayes (Oakland,CA:NewHarbinger,2008).

Professional Organization: ACBS: Association for Contextual BehavioralScience

MembershipinACBSincludesthefollowing:

Opportunities to participate in the online ACT and/or RFTcommunities, where you can share ideas and receive advicefrom ACT therapists and/or RFT researchers all around theworld.Extensive resources for clinicians, including articles, videos,podcasts, handouts, protocols, papers, and even PowerPointpresentationsonACT/RFT.OpportunitytolistyourselfasanACTtherapistontheofficialworldwideACTwebsite.Help in finding anACT therapist or a supervisor, or anACT

workshopnearyou.Andmuchmore…

Consider joining ACBS, which the parent organization of ACT and RFT.ACBSmembership operates on a system called “voluntary dues.”Thatmeansyoupaywhateveryouthinkit’sworth.(Thereisaminimumfeeof$1tojoin.)Ifyou’re not sure you want to join, take a look at what ACBS has to offer atcontextualpsychology.org.

RFTTutorial

If you want to learn about RFT, the post-Skinnerian behavioral theory oflanguageandcognitionthatunderliesACT,thenagoodstartingpointisthefreeonlinetutorialavailableatcontextualpsychology.org/rft_tutorial.

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