AskDwightHow.org 365/24/7
14m 24s
Welcome to...
Start exploring the treasures you'll find in every one
of the 1262 plus different rooms in this Guest House.
"I know that you believe you understand what you think I said, but I'm not sure you realize that what you heard is not what I meant."
We'll get your problem solved one way or the other. Open this door
"Don't you think I'm great?!
I love creating these images for you."
Acceptance and Commitment Therapy, Second Edition: The Process and Practice of Mindful Change
by Steven C. Hayes, Kirk D. Strosahl, and Kelly G. Wilson
After finishing this book in September of 2021, I wrote,
"It is rare for me to find a whole new discipline that's been in development for more than two decades that I didn't know about before...especially one in my field. ACT (Acceptance and Commitment Therapy), although not denying the benefits of other therapies, especially CBT, breaks some fundamentally new groundwork both in theory and practice. I learned much from the book, some of which I have already adapted for my own use. I've bought another book to continue my exploration into this theory and discipline."
My clippings below collapse a 417-page book into 22 pages, measured by using 12-point type in Microsoft Word.
​
See all my book recommendations.
​
Here are the selections I made:
​
The Dilemma of Human Suffering Nothing external ensures freedom from suffering. Even when we human beings possess all the things we typically use to gauge external success—great looks, loving parents, terrific children, financial security, a caring spouse—it may not be enough. Humans can be warm, well fed, dry, physically well—and still be miserable. Humans can enjoy forms of excitement and entertainment unknown in the nonhuman world and out of reach for all but a fraction of the population—high-definition TVs, sports cars, exotic trips to the Caribbean—and still be in excruciating psychological pain.
The Example of Suicide There is no more dramatic example of the degree to which suffering is part of the human condition than suicide. Death by deliberate choice is obviously the least desirable outcome one can imagine in life; yet, a surprisingly sizable proportion of the human family at one time or another seriously considers killing themselves, and a shockingly large number of them actually attempt to do so. Suicide is the conscious, deliberate, and purposeful taking of one’s own life. Two facts are starkly evident about suicide: (1) it is ubiquitous in human societies, and (2) it is arguably absent among all other living organisms. Existing theories of suicide are hard-pressed to logically account for both of these facts. Suicide is reported in every human society, both now and in the past. Approximately 11.5 per 100,000 persons in the United States actually commit suicide every year (Xu, Kochanek, Murphy, & Tejada-Vera, 2010), accounting for nearly 35,000 deaths in 2007.
In humans, self-elimination can fulfill a variety of purposes, but its stated purposes are usually drawn from the everyday lexicon of emotion, memory and thought. For example, when suicide notes are examined, they tend to be messages emphasizing the immense burdens of living and conceptualizing a future state of existence (or nonexistence) in which those burdens will be lifted (Joiner et al., 2002). Although suicide notes frequently express love for others and a sense of shame for the act, they also commonly express that life is just too painful to bear (Foster, 2003). The emotions and most common states of mind generally associated with suicide include guilt, anxiety, loneliness, and sadness (Baumeister, 1990).
The Origins of Suffering, according to the Judeo-Christian Tradition The Bible is very clear about the original source of human suffering. In the Genesis story, “God said, ‘Let us make man in our image, in our likeness’ ” (Gen. 1:26 [New International Version]), and Adam and Eve were placed in an idyllic garden. The first humans were innocent and happy: “The man and his wife were both naked, and they felt no shame” (Gen. 2:25). They are given only one command: “You must not eat from the tree of the knowledge of good and evil, for when you eat of it you will surely die” (Gen. 2:17). The serpent tells Eve that she will not die if she eats from that tree, but rather that “God knows that when you eat of it your eyes will be opened, and you will be like God, knowing good and evil” (Gen. 3:5). The serpent turns out to be correct, to a degree, because when the fruit is eaten, “The eyes of both of them were opened, and they realized they were naked” (Gen. 3:7).
Each new human life retraces this ancient story. Young children are the very essence of human innocence. They run, play, and feel—and, as in Genesis, when they are naked they are not ashamed. Children provide a model for the assumption of healthy normality, and their innocence and vitality are part of why the assumption seems so obviously true. But that vision begins to fade as children acquire language and become more and more like the creatures adults see reflected every day in their mirrors. Adults unavoidably drag their children from the Garden with each word, conversation, or story they relate to them. We teach children to talk, think, compare, plan, and analyze. And as we do, their innocence falls away like petals from a flower, to be replaced by the thorns and stiff branches of fear, self-criticism, and pretense. We cannot prevent this gradual transformation, nor can we fully soften it. Our children must enter into the terrifying world of verbal knowledge. They must become like us.
The core of the ACT approach is built upon the idea that human language gives rise to both human achievement and human misery.
The resulting progress is astounding, outstripping our ability to appreciate the multifarious changes. Some 200 years ago the average human lifespan in the United States was 37 years; it now approaches 88! About 100 years ago, an American farmer could feed on average just four others; today, it is 200! Fifty years ago the Oxford English Dictionary weighed 300 pounds and took up 4 feet of shelf space; today, it fits on a 1-ounce flash drive or can be accessed via the Web from virtually anywhere!
You cannot be a good ACT therapist if you take words to be right, correct, and true rather than asking “How effectual are they?”
Suffering occurs when people so strongly believe the literal contents of their mind that they become fused with their cognitions. In this fused state, the person cannot distinguish awareness from cognitive narratives since each thought and its referents are so tightly bound together. This combination means that the person is more likely to follow blindly the instructions that are socially transmitted through language. In some circumstances, this result can be adaptive; but in other cases, people may engage repeatedly in ineffective sets of strategies because to them they appear to be “right” or “fair” despite negative real-world consequences.
People whose cognitions fuse are likely to ignore direct experience and become relatively oblivious to environmental influences.
The problem is that we are not trained to discriminate when the mind is useful and when it is not, and we have not developed the skills to shift out of a fused problem-solving mode of mind into a descriptively engaged mode of mind.
Minds are great when it comes to inventing new devices, constructing business plans, or organizing daily schedules. But, by themselves, minds are far less useful in learning to be present, learning to love, or discovering how best to carry the complexities of a personal history. Verbal knowledge is not the only kind of knowledge there is. We must learn to use our analytical and evaluative skills when doing so promotes workability and to use other forms of knowledge when they best serve our interests. In effect, the ultimate goal of ACT is to teach clients to make such distinctions in the service of promoting a more workable life.
Another key process in the cycle of suffering is experiential avoidance. It is an immediate consequence of fusing with mental instructions that encourage the suppression, control, or elimination of experiences expected to be distressing.
In the ACT approach, a goal of healthy living is not so much to feel good as to feel good. It is psychologically healthy to have unpleasant thoughts and feelings as well as pleasant ones, and doing so gives us full access to the richness of our unique personal histories.
The constructive alternative to fusion is defusion, and the preferred alternative to experiential avoidance is acceptance.
These skills involve consciously experiencing feelings as feelings, thoughts as thoughts, memories as memories, and so on.
The Zen master Seng-Ts’an was fond of saying “If you work on your mind with your mind, how can you avoid great confusion?”
It is based on a pragmatic philosophy of science called functional contextualism
Once there is a verbally stated goal, however, we can assess the degree to which analytic practices help us achieve it. This option allows successful working toward a goal to function as a useful guide for science.
“Is there something you hope will happen by telling me that thought?”).
“Hmmm. Let’s do this and see what happens. Say out loud, ‘I can’t stand up or I will have a panic attack,’ and then while doing that, slowly stand up”).
The key verbal relations in the development of perspective taking are “deictic,” which means “by demonstration.”
This relationship is learned over hundreds if not thousands of examples; what is consistent across examples is not the content of the answer but rather the context, or perspective, from which the answer occurs. That is the case with all other deictic frames, such as I/you, we/they, and now/then.
Deictic framing can be successfully taught, however, and when it is, perspective-taking and theory-of-mind skills improve
Conscious content now is known in the context of a consistent locus or point of view that can integrate that knowledge. Infantile amnesia begins to drop away. Events are held in memory in a verbal temporal order. A conscious person shows up—not as the object of reflection but as a perspective from which knowing can occur.
I begin to experience myself as a conscious human being at the precise point at which I begin to experience you as a conscious human being. I see from a perspective only because I also see that you see from a perspective. Consciousness is shared. Moreover, you cannot be fully conscious here and now without sensing your interconnection with others in other places and other times. Consciousness expands across times, places, and persons. In the deepest sense, consciousness itself contains the psychological quality that we are conscious—timelessly and everywhere.
Compassion and acceptance; stigma and defusion. As described thus far, acceptance and defusion seem, superficially, to be intrapsychic issues, but self-as-context expands their nature. Because perspective taking is social, it is not possible to take a loving, open, accepting, and active perspective on yourself without doing likewise for others.
“Vision without action is a daydream; action without vision is a nightmare.”
“In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself”
Psychological flexibility can be defined as contacting the present moment as a conscious human being, fully and without needless defense—as it is and not as what it says it is—and persisting with or changing a behavior in the service of chosen values.
ACT uses acceptance and mindfulness processes and commitment and behavioral activation processes to produce psychological flexibility. It seeks to bring human language and cognition under better contextual control so as to overcome the repertoire-narrowing effects of an excessive reliance on a problem-solving mode of mind as well as to promote a more open, centered, and engaged approach to living.
It is the breadth of problems addressed in these studies that is perhaps most startling. Such breadth is one of the main scientific requirements of a model that claims to be unified and transdiagnostic.
There are controlled ACT studies on work stress, pain, smoking, anxiety, depression, diabetes management, substance use, stigma toward substance users in recovery, adjustment to cancer, epilepsy, coping with psychosis, borderline personality disorder, trichotillomania, obsessive–compulsive disorder, marijuana dependence, skin picking, racial prejudice, prejudice toward people with mental health problems, whiplash-associated disorders, generalized anxiety disorder, chronic pediatric pain, weight maintenance and self-stigma, clinicians’ adoption of evidence-based pharmacotherapy, and training clinicians in psychotherapy methods other than ACT. The only sour notes so far are the use of ACT for more minor problems, where existing technology exceeded ACT outcomes on some measures (e.g., Zettle, 2003).
The classic self-problem seen in clinical settings is fusion with the content of verbal self-knowledge—such as “I am depressed” where “depressed” has the quality of a personal identity. This aspect of self—the conceptualized self—can be “positive” or “negative” or both, but its most dominant features are that it is rigid, evaluative, and evocative.
Another aspect of self is contact with the ongoing stream of private experience, or “self-as-process.” This contact has to do with the ability to observe and describe experiences in the present moment. Statements such as “I am feeling angry right now” reveal that the client is both aware of the content of ongoing awareness and aware of the distinct process of observing that content. This aspect of self-relatedness is a crucial part of “contact with the present moment.”
The “I/here/nowness” of consciousness itself is an aspect of self that transcends any particular content of awareness—it is the context of verbal knowing itself.
A good way to assess for self-as-context is to examine the flexibility of perspective taking via the interview itself.
To what extent does the client live in a world of “musts” and “shoulds” and “can’ts”? To what extent does the client live in a world of well-rehearsed excuses for why things are as they are—a world in which change is either impossible or for a time other than right now?
These include the Self-Compassion Scale (Neff, 2003); White Bear Suppression Inventory (Wegner & Zanakos, 1994); Cognitive-Behavioral Avoidance Scale (Ottenbreit & Dobson, 2004); Thought Control Questionnaire (Wells & Davies, 1994), Distress Tolerance Scale (Simons & Gaher, 2005), the Emotional Nonacceptance subscale of the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), or similar subscales on various mindfulness measures such as the Kentucky Inventory of Mindfulness Skills (Baer, Smith, & Allen, 2004) or the Five Facets of Mindfulness Questionnaire (Baer et al., 2008), among several others. The definitions of acceptance vary in all of these approaches.
Comparison and Evaluation. Listen for excessive comparison and evaluation in the client’s speech, as contrasted with description. The clinician can probe the strength of such patterns of fusion by asking the client to simply describe the troublesome situation and what it evokes without injecting evaluations. Clients with high levels of fusion may not be able respond at all or may quickly lapse, injecting personal evaluations into the ongoing narrative.
Does the client experience life as merely imposed or rather as something he or she can author in a meaningful and ongoing way?
For example, the client who values education might be asked, “What if you received the education, but no one knew. Would that still be of importance?”
All printed forms and tools in this book are readily downloadable at www.contextualpsychology.org/clinical_tools.
The goal is not to “fix” people but rather to empower them. What the psychological flexibility model provides is a characterization of key features that can be changed, but it does not specify how to link history to those features, nor precisely how to intervene in a step-by-step fashion.
The process of living is like taking a very long road trip. The destination may be important, but the journey experienced day to day and week to week is what is invaluable.
“We are in this stew together. We are caught in the same traps. With a small twist of fate, I could be sitting across from you, and you could be sitting across from me—both of us in opposite roles. Your problems are a special opportunity for you to learn and for me to learn. We are not cut from different cloths, but rather from the same cloth.”
One of the most important attributes of an ACT therapist is his or her posture of radical respect, in which the basic ability of the individual to seek valued ends is protected. In essence, ACT is inherently client-centered.
There is a great deal of implicit social influence lodged in therapy. Social influence harnessed to the goals of the client is one thing, whereas social influence as a substitute for the client’s values and choices is entirely something else. Many therapists who use such words as choice and values subtly direct the client toward outcomes the therapist believes will benefit him or her. This tendency often occurs explicitly when therapists are working with clients engaged in such socially unacceptable behavior as domestic assault, chronic intoxication, or the like. Often the goal of the therapist with such clients is to eliminate the behavior, regardless of the goals the client may bring into treatment. The therapist, in response to a new episode of binge drinking by a client, might say, “Well, if it’s your choice to go out and drink again, I hope you are willing to endure the consequences that are sure to follow.” Here the therapist is basically saying, “Your choice is not the right choice—your choice should be to stop drinking. You deserve what is going to happen next because you made the wrong choice!” Using choice in this way may shame the client into temporarily achieving the goal of sobriety, but it is really a form of coercive social control, not a values-based “choice” that emanates spontaneously from the client.
This experiential truth usually involves understanding that the formula for successful living is unique to each individual. There is no single right or wrong way to live one’s life. There are only consequences that follow from specific human behaviors.
Irreverence is not the same thing as being condescending to the client. The therapist’s irreverence derives from appreciating the craziness and verbal entanglements that surround all human beings.
Many ACT concepts, techniques, or sayings are inherently irreverent. For example, an ACT therapist might say: “The problem here is not that you have problems ... it’s that they continue to be the same problems. You need some new ones!”
The clinical use of the word why is almost always a mistake. It is an invitation to reason giving or storytelling, and it generally leads both the client and therapist to a dead end. It is generally more productive to ask the client to describe the internal events (including thoughts about one’s history) that show up in association with the difficult material. The agenda is to see what is there—not to solve it, as though the person’s life is a problem.
The private events the ACT therapist is most interested in are those that surface once the client initiates valued actions. As the client moves toward establishing a process of vital living, negative avoided feelings, thoughts, and memories will in fact surface.
In ACT, therapeutic relationships are strong, open, accepting, mutual, respectful, and loving. In short, the ideal ACT relationship is the epitome of psychological flexibility.
How to foster a creative sense of hopelessness, such that the client is willing to begin trusting his or her own experience rather than blaming him- or herself for any shortcomings.
Basically, the client is trying to find a way to feel better. Like pulling your hand off a red-hot burner immediately makes you feel better, clients carry this same definition of better into their psychological world. Better is being free from the actively painful emotion, thought, memory, or sensation the client is experiencing.
If a person has exerted so much effort to reduce emotional distress and yet is still seeking help, one of two things must apply: either (1) the person has not found the right way to fix the problem, or (2) the “desired outcome” originated in a flawed and unworkable approach to the problem situation in the first place. Almost without exception, clients believe that it is the first circumstance that applies. ACT, however, starts from the viewpoint of the second alternative.
What does the client desire as the optimum outcome? 2. What strategy (or strategies) has the client already tried? 3. How has that worked? 4. What has been the personal cost of following this strategy (or these strategies)?
In ACT, the client might be asked, “What would tell you that your life was working better? What would you be doing differently?” or “If a miracle were to happen and this situation were resolved, what would you notice that would tell you things are going better?”
THERAPIST: So, waking up and feeling depressed is one problem that you haven’t been able to get on top of—is that correct? What happens next when you wake up and notice that you’re depressed? CLIENT: Well, I have to decide whether I’m going to go to work or not. If I’m really depressed, I just call in sick and go back to bed and try to disappear. THERAPIST: So, one strategy you use to control your depression is to opt out of going to work to save your energy—is that correct?
THERAPIST: What would you be doing differently if you didn’t experience flashbacks and anxiety attacks when you and your boyfriend are about to be intimate?” CLIENT: I could relax, enjoy the moment of intimacy, and be responsive to his needs. I would be able to share with him how much I love him. THERAPIST: It sounds like you have a very deep investment in making this relationship a reflection of what you want to be about as a life partner. That’s very cool. It sounds like the impact of having flashbacks and anxiety is that they are trying to block you from realizing your dreams for this relationship. In this case, the therapist is simply acknowledging the client’s values and pointing to the fact that there is a conflict between what she wants and what she has to deal with in the way of emotional obstacles. This strategy is a kind of “thumbtacking.” The therapist simply notes this important value and associated obstacles, and puts it on the bulletin board to be addressed later in therapy.
Up to this point, the therapist has revealed how attempts at control and avoidance don’t work in terms of what is promised by the client’s mind. However, it is important that the client also understand that these strategies actually make matters worse because deliberate attempts to suppress or control emotions, thoughts, memories, images, or sensations actually create the opposite effect.
So we’ve solved the problems nonverbal critters face. Yet we can be miserable when they would be happy. What if there is a relationship between those two things?
In the world inside the skin, the rule actually is: if you aren’t willing to have it, you’ve got it.
Taking an open, accepting, present moment–focused posture and allowing thoughts, emotions, memories, and bodily sensations to come and go without having to do anything about them leads to the emergence of a sense of self that is distinct from the contents of consciousness—self-as-context or a transcendent sense of self.
In some cases, clients have so little contact with other forms of self that they don’t know what they are feeling or experiencing and can’t separate themselves from the contents of their minding. In ACT, entanglement with the conceptualized self is largely seen as problematic because it narrows our repertoire of actions needlessly. Fusion with the conceptualized self can lead to distortion or reinterpretation of events that are inconsistent with the conceptualized self.
Ironically, most people come into therapy wanting to defend their particular self-conceptualization even if it is loathsome, harmful, or the apparent reason for seeking treatment in the first place. Familiar repeated ideas about oneself—both positive and negative—are treated as things to be right about. Initially, most clients are so thoroughly trapped in this conceptual prison that they do not know that—and won’t believe that—they are imprisoned. The conceptual world in which they live is a given, and within that world certain thoughts are rational and others are irrational; certain emotions are good, and others are bad; certain beliefs show high self-esteem, while others show low self-esteem; and so on.
The ACT therapist introduces the idea that the goodness or badness of beliefs may not be a problem, per se, but that the problem may consist of one’s attachment to the beliefs.
“We will help with that as we go forward. But right now, just notice that it is impossible not to struggle with thoughts and feelings if you treat them as defining who you are.”
The objective is to be present with what life gives us at any given point in time and to more toward valued behavior.
As mentioned earlier, ACT therapists often suggest that clients “kill themselves everyday,” but it is the conceptualized self, not self-as-perspective, that needs to be continuously killed off (only to reemerge and be killed off again).
Yet, language itself claims to know how to do virtually everything, from reaching for a pen to developing a relationship. Verbal knowing rests atop nonverbal knowing so completely that an illusion is created that all knowledge is verbal knowledge. If we suddenly had all nonverbal knowledge removed from our repertoires, we would fall to the floor quite helpless!
For example, the sentence “I’m bad” can be said as rapidly as possible over and over for at least 45 seconds. Several studies have demonstrated that this word repetition exercise rapidly reduces the believability of negative self-referential thoughts and the psychological distress associated with
The Passengers on the Bus exercise is a core ACT intervention aimed at deliteralizing provocative psychological content through objectification. It contains within it the entire psychological flexibility model. “It’s as if there is a bus and you’re the driver. On this bus we’ve got a bunch of passengers. The passengers are thoughts, feelings, bodily states, memories, and other aspects of experience. Some of them are scary, and they’re dressed up in black leather jackets and they’ve got switchblade knives. What happens is, you’re driving along and the passengers start threatening you, telling you what you have to do, where you have to go. ‘You’ve got to turn left,’ ‘You’ve got to go right,’ etc. The threat that they have over you is that, if you don’t do what they say, they’re going to come up from the back of the bus.
“It’s as if you’ve made deals with these passengers, and the deal is, ‘You sit in the back of the bus and scrunch down so that I can’t see you very often, and I’ll do what you say, pretty much.’ Now, what if one day you get tired of that and say, ‘I don’t like this! I’m going to throw those people off the bus!’ You stop the bus, and you go back to deal with the mean-looking passengers. Notice that the very first thing you had to do was stop. Notice now, you’re not driving anywhere, you’re just dealing with these passengers. Plus, they’re real strong. They don’t intend to leave, and you wrestle with them, but it just doesn’t turn out very successfully. “Eventually you go back to placating the passengers, to try and get them to sit way in the back again where you can’t see them. The problem with that deal is that you have to do what they ask. Pretty soon, they don’t even have to tell you to ‘Turn left’—you know as soon as you get near a left turn that certain passengers are going to crawl all over you. Eventually you may get good enough that you can almost pretend that they’re not on the bus at all. You just tell yourself that left is the only direction in which you want to turn! However, when they eventually do show up, it’s with the added power of the deals that you’ve made with them in the past.
“Now, the trick about the whole thing is the following. The power that the passengers have over you is 100% based on this: ‘If you don’t do what we say, we’re coming up and we’re making you look at us.’ That’s it! It’s true that when they come up they look like they could do a whole lot more. They’ve got knives, chains, etc. It looks like you could be destroyed. The deal you make is to do what they say so they won’t come up and stand next to you and make you look at them. The driver (you) has control of the bus, but you trade away the control in these secret deals with the passengers. In other words, by trying to get control, you’ve actually given up control! Now notice that, ...
The therapist can continue to allude to the bus metaphor during therapy. Questions such as “Which passenger is threatening you now?” can help reorient the client who is practicing emotional avoidance during the session.
This time the driver puts a hand on each passenger’s shoulder (as a symbol of connection to one’s own history), hears each one out, and is asked to invite each one on board as an expression of willingness (“Is there room for this passenger?”). If that choice can be negotiated with each passenger, the driver then grasps an imaginary steering wheel and begins driving while the “passengers” begins threatening the client with feared obstacles. The goal of the passengers in this game is to get the client to let go of the steering wheel and begin to talk back or argue with one or more of them; the driver is asked to experience what it is like to drive with the chatter and with an eye on the road instead of fighting the chatter.
Having Thoughts, Holding Thoughts, Buying Thoughts
Having a thought is simply being aware of the presence of a psychological event (primarily thoughts, but also emotions, memories, images, sensations and so on, since all have verbal functions in an RFT sense). Holding a thought is the action of withholding judgment and evaluation while not attempting to manipulate the form of the verbal product. Buying a thought is moving into overidentification with the thought or fusing with it.
The notion of buying thoughts highlights the basic conundrum the client must face. The “problem” is not in the content of private events; the issue is not what the feeling is, what the thought says or what the memory is about. These verbal processes are conditioned, arbitrarily applicable, historically determined events. The problem is that overidentification with the content of the product creates behavioral rigidity and inflexible attention.
“So, what happened when you bought that thought (feeling, memory)?”
CLIENT: So, how do I stop myself from being pulled in like you are talking about? THERAPIST: Well, what would you do if you were being phished on the Internet? Slow down. Step back. Don’t impulsively dive in on what your mind is feeding you. And, just like these Internet messages, see if you can notice the common qualities of these lures. They are often black-and-white, negative, provocative, urgent. They encourage you to avoid or drop out of your life in some way. You will often receive this bogus information in the form of ‘I’ statements, which create the impression that these are thoughts you’ve already bought into, when in fact this is just your mind speaking to you. The mind is not the same as you. You are the human being. Your mind is a verbal tool, not your master. But it is a very noisy servant and tricky to deal with at times.
THERAPIST: What did you observe? CLIENT: Well, at first it was easy. I was watching them go by. Then I suddenly noticed that I was lost and had been gone for about 15 seconds. THERAPIST: As if you were off the reviewing stand entirely. CLIENT: Right. The whole exercise had stopped. THERAPIST: Did you notice what had been happening right before everything stopped? CLIENT: Well, I was thinking thoughts about how my body was feeling, and these were being written on the cards. And then I started thinking about my work situation and the meeting with the boss I have on Friday. I was thinking about how I might be anxious telling him some of the negative things that have been going on, and next thing you know it’s a while later and I’m still thinking about it. THERAPIST: So, when the thought first showed up—“I’m going to be meeting with the boss next Friday”—was that thought written on a placard? CLIENT: At first it was, for a split second. Then it wasn’t. THERAPIST: Where was it instead? CLIENT: Nowhere in particular. I was just thinking it. THERAPIST: Or it was just thinking you. Can we say it that way? At some point you had a thought that hooked you. You bought it and started looking at the world from that thought. You let it structure the world. So, you started actually working out what might happen, what you will do, and so on, and at that point the parade has absolutely stopped. There is now no perspective on it—you can’t even see the thought clearly. Instead, you are dealing with the meeting with the boss. CLIENT: It was like that. It was. THERAPIST: Did you get that thought back on the placard?
CLIENT: Well, at some point I remembered I was supposed to let the thoughts flow, so I wrote the thought out and let a soldier carry it by. Then things went OK for a while until I started thinking that this whole exercise is kind of silly. THERAPIST: And did you just notice that thought, or did it think you? CLIENT: I bought it, I guess. THERAPIST: What happened to the parade? CLIENT: It stopped. THERAPIST: Right. And check and see if this isn’t so. Every time the parade stopped, it was because you bought a thought. CLIENT: It fits. THERAPIST: I haven’t met anyone who can let the parade go by 100% of the time. That is not realistic. The point is just to get a feel for what it is like to be hooked by your thoughts and what it is like to step back once you’re hooked.
The Soldiers in the Parade exercise can be recorded and practiced nightly. Clients can make daily ratings of the degree to which they were “mind watching” and write down what they noticed, much like the bird watcher who keeps a log of each new species observed. These will help establish a posture of dispassionate curiosity—one of the hallmarks of defusion.
Some therapists whimsically ask clients to give it a name, which is then used for the rest of therapy (e.g., “What does Bob have to say about that?” or “So, has Bob been throwing a tantrum since you’ve taken these steps forward?”). Treating the mind almost as though it were a separate entity is a very powerful defusion strategy.
The Take Your Mind for a Walk exercise can provide a powerful experience of how busy, evaluative, and obstructionistic the mind can be. In this exercise, the therapist goes for a walk with the client. The goal is for the client to simply walk at whatever speed and in whatever direction the client desires. There is no destination set; it is just an exercise in random walking. The client is to play the “human,” and the therapist will play “the mind.” While walking, the therapist verbalizes the sort of evaluative second-guessing chatter that the client gets from his or her mind on a daily basis. Often, it is helpful for the therapist to use provocative content or distressing themes that have arisen in therapy. The goal for the client is to keep walking despite this steady stream of negative chatter. If the client stops or tries to talk back to the mind, the therapist immediately says, “Never mind your mind!” This is a signal that the client has been pulled into the distressing content and needs to defuse from this content and just keep walking.
It is helpful to sensitize the client to the pernicious effect of verbal reason giving. It is one thing to deliteralize single words and play interesting games with the client’s verbal operating system, but it is quite another to step back from well-worn, treasured stories of how life has removed all opportunity for the client’s living a vital, meaningful life. Defusing “reasons” and self-stories are particularly important for clients who continually use insight into, and understanding of, past history in ways that are self-defeating.
“And what is that story in the service of?” • “And does that description of your past help you move ahead?” • “Is this helpful, or is this what your mind does to you?” • “Are you doing a solution, or is this just your way of digging?” • “Have you said these kinds of things to yourself or to others before? Is this old?” • “If you’ve said this before, what do you think will be different now by saying it again?” • “If God told you that your explanation is 100% correct, how would this help you?” • “OK, let’s all have a vote and vote that you are correct. Now, what?”
THERAPIST: I would like for us to try something different when we are talking together. I’m going to ask you to use the word and instead of the word but when you form a sentence. This may seem a bit awkward at first, and you may notice that you have to slow your thinking down to make sure you are not slipping in a but. Don’t worry, though, if one does slip through—I’ll stop you and have you use the word and in its place. CLIENT: Why are you doing this? It seems kind of weird. THERAPIST: Most of the time, we don’t even think about the words we are using. But is a good example. We just throw it in the mix whenever there is a pause or we don’t quite know whether we are willing to go somewhere or do something. I’m interested in hearing how changing from but to and affects the feel of our conversation for you. At another level, I guess we could say that I’m going to help you get off your buts.
“I love my husband, but I get so angry with him” can make anger a very dangerous feeling for someone committed to a marriage. “I love my husband, and I get angry with him” carries little such threat, and in fact, implies an acceptance of the experience of anger within the experience of love.
The most provocative evaluations, and the ones clients are most likely to fuse with, involve four polarities: good versus bad, right versus wrong, fair versus unfair, and responsibility versus blame.
Acceptance We can’t control the wind; we can only adjust the sails. —POPULAR SAYING
Acceptance, as we mean it, is the voluntary adoption of an intentionally open, receptive, flexible, and nonjudgmental posture with respect to moment-to-moment experience. Acceptance is supported by a “willingness” to make contact with distressing private experiences or situations, events, or interactions that will likely trigger them.
Acceptance can sometimes have an unhealthy connotation. Indeed, the term is sometimes used as a kind of weapon against others (“You just have to grow up and accept it!”). Used in that way, acceptance means bucking up, tolerating, resigning oneself, or putting up with a situation—a passive form of acceptance does not necessarily predict positive health outcomes (Cook & Hayes, 2010). Acceptance also does not mean wanting or liking something, wishing it were here, or judging it to be fair, right, or proper. It does not mean leaving changeable situations unchanged—it means to embrace experiences as they are, by choice, and in the moment.
It means to stand with your self psychologically and embrace what is present at the level of experience.
Acceptance Is an Ongoing Process An important feature of acceptance is that it is an ongoing voluntary process; it never remains constant. Acceptance is part of an open stance taken toward life, but that general stance needs to be lived out moment by moment. Thus, acceptance includes acceptance of the rise and fall of acceptance itself. We can get better at it, but we will never be perfect at it.
Acceptance Is Not Giving In One unfortunate connotation of the word acceptance is resignation or defeat. In fact, the opposite is true: change is empowered by embracing the present moment and accepting what will occur in the process of change. Consider a wife in a domestic violence situation. Acceptance is very relevant, but it does not mean acceptance of the abuse. Instead, it might mean accepting the painful fact that if nothing is done the abuse will most likely continue. It may mean acknowledging the toxic emotional impact of the abuse and the painful gap between valued intimacy and what is present. It might mean facing the fearful thoughts as part of the process of terminating or fundamentally changing an unworkable relationship. But it does not mean giving in.
Acceptance Is Not Toleration Acceptance is not merely tolerating the status quo. Toleration is a conditional stance in which a certain amount of distress is allowed for a period of time, usually in exchange for something else of value—but without real openness to the experience itself. Most of us practice this type of toleration when we go to the dentist. Acceptance is active, not passive. It suggests that there is something meaningful in feeling what is there to be felt.
Willingness as an Alternative to Control Clients need an alternative to their control-and-eliminate agenda. Willingness and acceptance are that alternative. Willingness is a values-based choice to expose oneself to an unpleasant thought, emotion, memory, or sensation or to feared situations or feared content. Clients become willing to make this choice as they become aware of their values and of how avoidance has blocked valued actions. Willingness is a prerequisite for acceptance. In other words, willingness is what gets you in front of unwanted experience; acceptance is what you do with that experience.
An ACT client once said it this way: “I used to hold back willingness as if my life depended on it. I figured God or someone would rescue me if I held out long enough. It was as if reality or some force would care that I was in pain and would come and take it away. Finally, I saw that only one thing could happen if I was unwilling and that lots of things could happen if I was willing. So, now I’m willing as if my life depends on it—because actually my experience tells me that it does!”
“Willingness is like jumping. You can jump off lots of things. [The therapist takes a book and places it on the floor and stands on it, then jumps off.] Notice that the quality of jumping is to put yourself in space and then let gravity do the rest. You don’t jump in two steps. You can put your toe over the edge and touch the floor, but that’s not jumping! [The therapist puts one toe on the floor while standing on the book.] So, jumping from this little book is still jumping. And it is the same action as jumping from higher places. [The therapist gets up on the chair and jumps off.] Now this is jumping too, right? Same quality? I put myself out into space, and gravity does the rest. But notice, from here I can’t really put my toe down very well. [The therapist tries awkwardly to touch the ground with his toe after getting back up on the chair.] Now if I jumped off the top of this building, it would be the same thing. The jump would be identical. Only the context would have changed. But from there it would be impossible to try to step down. There is a Zen saying, ‘You can’t cross a canyon in two steps.’ Willingness is like that. You can limit willingness by limiting context or situation. You get to choose the magnitude of your jump. What you can’t do is limit the nature of your action and yet still have it work. Reaching down with your toe is simply not jumping. What we need to do here is to learn how to jump: we can start small, but it has to be jumping from the very beginning or else we won’t be doing anything fundamentally useful. So, this is not about learning to be comfortable, or gritting your teeth, or gradually changing habits. This is about learning how to be willing.”
The Costs of Unwillingness: Clean and Dirty Pain There is an important distinction to be made between pain that is clean and pain that is dirty. Clean pain is the original discomfort we feel in response to a real-life problem. It doesn’t feel good necessarily, but ultimately it is a normal, natural, and healthy experience. In contrast, dirty pain is the pain we get when we needlessly struggle to control, eliminate, or avoid clean pain.
THERAPIST: Now, I want you to imagine yourself placing this depression outside of you, putting it 4 or 5 feet in front of you. Later we’ll let you take it back, so if it objects to being put outside let it know that you will soon be taking it back. See if you can set it out in front of you on the floor in this room, and let me know when you have it out there. CLIENT: OK. It’s out there. THERAPIST: So, if this feeling of depression had a size, how big would it be? CLIENT: (pause) Almost as big as this room. THERAPIST: And if it had a color, what color would it be? CLIENT: Dark black. THERAPIST: And if it had a speed, how fast would it go? CLIENT: It would be slow and lumbering. This process continues with questions about power, surface texture, internal consistency, shape, density, weight, flexibility, and any other physical dimensions the therapist wishes to choose. Have the client verbalize each response, but do not get into a conversation. After getting a fairly large sample, go back to a few earlier items and see if anything is changing (e.g., what was big may now be small). Especially if the psychological situation hasn’t changed much, ask the client whether she or he has any reactions to this thing that is big, black, slow, and so forth. Often, the client will report being angry with it, repulsed by it, will not want it, will be afraid of it, will hate it, or something of that kind. Get the core strong reaction, and then ask the client to move the first object slightly to the side and to put this second reaction out in front, right next to the initial object. Repeat the entire Physicalizing exercise with the second reaction. Now take a look back at the first. Usually, when the second reaction is physicalized, the first will be thinner, lighter, less powerful, and so on. Sometimes these attributes can be turned on and off like a switch: whenever the second reaction is taken literally and used as a perspective from which to examine the first reaction, the first becomes more powerful. When the second reaction is deliteralized by being viewed as an object, the initial reaction diminishes in intensity. If the items do not change, the therapist can either look for another core reaction that is holding the system in place or simply stop the exercise. The therapist should never suggest that any particular outcome was expected if it did not occur. Just commenting on a reaction as though it were a physical object—without struggling with it—changes its qualities profoundly. This simple experience can change the context of that reaction when it occurs again in real life. It may be the same reaction, but it is seen differently, even if the client still struggles with it.
Connecting with Values If we don’t decide where we’re going, we’re bound to end up where we’re headed. —CHINESE SAYING
How values can be used to create a sense of life’s meaning and direction.
How values differ from but are linked to life goals.
The distinction between the act of choosing and the act of deciding.
How to support the client’s construction of valued directions.
How to help clients distinguish between valuing as behavior and valuing as a feeling.
How to separate values from unfulfilling social and community pressures.
In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself”
Perhaps the things to most remember in clinical work are, first, that even though values are socialized, they have a quality of being freely chosen rather than appearing forced by other people or by emotions that need to be avoided; and, second, that they establish intrinsic appetitive consequences. Values are not off in the distant future. They have an appetitive nonavoidant quality in the now despite their temporal extension; it is as if meaning in the present stretches out through time.
Among the most important is distinguishing values as feelings from valuing as actions. These two aspects are often thoroughly confused for the client. The example of valuing a loving relationship with one’s spouse is instructive. One’s feelings of love may wax and wane across time and situations. To behave lovingly (i.e., respectfully, thoughtfully, etc.) only when one has feelings of love (and to behave in the opposite way when negative feelings show up) has problematic effects on a marriage. Yet, this is precisely the difficulty we find ourselves in when values are confused with feelings, since feelings are not fully under voluntary control and tend to come and go.
Often our clients will find that the purposes they are serving are relatively ineffectual and provide, at best, only short-term relief from some type of aversive consequence. For example, a client involved in a unfulfilling marriage might dutifully do “all the right things” around the home so as to maintain a peaceful, albeit distant, relationship with the spouse. This temporary relief is purchased at an expensive price because there is little if any chance that the relationship will evolve into anything more gratifying so long as the most painful issues remain closeted. In ACT, we try to turn the discussion to the question, If you could choose a purpose here, what purpose would you choose?
THERAPIST: This is what I call the What Do You Want Your Life to Stand For? exercise. I want you to close your eyes and relax for a few minutes and put all the other stuff we’ve been talking about out of your mind. (Assists the client with relaxation for 2–3 minutes.) Now, I want you to imagine that through some twist of fate you have died, but you are able to attend your funeral in spirit. You are watching and listening to the eulogies offered by your wife, your children, your friends, the people you have worked with, and so on. Imagine just being in that situation, and get yourself into the room emotionally. (Pauses) OK, now I want you to visualize what you would like these people who were part of your life to remember you for. What would you like your wife to say about you as a husband? Have her say that. Really be bold here! Let her say exactly what you would most want her to say if you had totally free choice about what that would be. (Pauses and allows the client to speak.) Now what would you like your children to remember you for as a father? Again, don’t hold back. If you could have them say anything, what would it be? Even if you have not actually lived up to what you would want, let them say it as you would most want it to be. (Pauses and allows the client to speak.) Now what would you like your friends to say about you as a friend. What would you like to be remembered for by your friends? Let them say all these things—and don’t withhold anything! Have it be said as you would most want it. And just make a mental note of these things as you hear them spoken. [The therapist may continue with this until it is quite clear the client has entered into the exercise. Then the therapist helps the client to reorient back to the session, e.g., “Just picture what the room will look like when you come back and when you are ready just open your eyes.”]
THERAPIST: So, notice that I’ve drawn a target on this piece of paper. Are you familiar with a target like this? CLIENT: Yeah, I used to play darts as a kid, and we used a target similar to this. THERAPIST: Well, we are going to use the target to measure a different kind of marksmanship here—basically, the degree to which you are aiming your life in the direction you want it to go. You’ve discovered that one of your main life values is to feel like you are participating in life and also helping others who are in need. Remember that the center of the target is called the “bull’s eye”; that is what you want to hit when you play darts, right? CLIENT: Right, and it didn’t happen very often for me, but it was very cool when it did! THERAPIST: And the rings continue outward, and you get fewer points for putting the dart in those rings, remember? Right now, what I want you to do is to think about this value you’ve expressed, and I want you to place a mark on this target that reflects the degree to which you are living your values at this point in time. A mark in the center means you have hit the bull’s eye; you are participating in your life to the fullest extent possible, and you are living out the value to help others in need. A mark away from the center means you might be living your values sometimes or maybe not at all, depending on where you put your mark.
So, right now, I want you to think about where you are in your life at this exact moment and put a mark on the target for me. [The therapist hands a sheet of paper to the client, and the client makes a mark in the outermost ring and hands the paper back to the therapist.] So, it looks like you have marked yourself pretty far from the bull’s eye, meaning that you don’t feel you are living consistent with your values right now—is that correct? CLIENT: Yeah, this is pretty upsetting because I feel I’m capable of more than this. I’m just not doing it! Putting a mark on the target is like going on record as saying I’m failing at this. THERAPIST: Thank your mind for those rosy, warm thoughts. There is a much more important purpose here than declaring yourself a winner or a loser. It is to figure out where you actually are in your life. You can only start from where you are, not where you’d like to be. So, as unpleasant as this might be, it is a vital first step in the process of choosing to do something different, if that is what you choose to do. CLIENT: OK, so I’m out here in this ring, and I want to be in here in this ring. How do I get there? THERAPIST: Maybe think of this as an ongoing process. You don’t stay in one ring forever; even if you hit bull’s eye, you don’t get a certificate from life that says “Bingo! You are at the center, and you don’t have to ever do anything else to stay there!” So, just notice that your location on the target will fluctuate all the time; this is just a way of checking in and seeing where you are. Nothing more, nothing less. If you don’t like your location, you might choose to do just one thing differently that might move you one ring closer to the bull’s eye. It’s kind of like steering an ocean liner: you can’t turn on a dime, but you can nudge the rudder slightly and over time it will make a big difference in the ship’s direction.
Family relations (other than marriage or parenting). In this section, describe the type of brother/sister, son/daughter, father/mother you want to be. Describe the qualities you would want to have in those relationships. Describe how you would treat these people if you were the ideal you in these various relationships. 2. Marriage/couples/intimate relations. In this section, write down a description of the person you would like to be with in an intimate relationship. Write down the type of relationship you would want to have. Try to focus on your role in that relationship. 3. Parenting. What sort of parent would you like to be, either now or in the future? 4. Friendships/social life. In this section, write down what it means to you to be a good friend. If you were able to be the best friend possible, how would you behave toward your friends? Try to describe an ideal friendship.
Career/employment. In this section, describe what type of work you would like to do. This description can be very specific or very general. (Remember, this is in an ideal world.) After writing about the type of work you would like to do, write about why it appeals to you. Next, discuss what kind of worker you would like to be with respect to your employer and coworkers. What would you want your work relations to be like? 6. Education/training/personal growth and development. If you would like to pursue an education, formally or informally, or undertake some specialized training, write about that. Write about why this sort of training or education appeals to you. 7. Recreation/fun. Discuss the type of recreational life you would like to have, including hobbies, sports, and leisure activities. 8. Spirituality. We are not necessarily referring to organized religion in this section. What we mean by spirituality is whatever that means to you, whether it is as simple as communing with nature or as formal as participation in an organized religious group. Whatever spirituality means to you is fine. If this is an important area of life, write about what you would want it to be. As with all of the other areas, if this is not an important part of your values, skip to the next section.
Community life. For some people, participating in community affairs is an important part of life. For instance, some people feel that it is important to volunteer for work with the homeless or older adults, to lobby government policymakers at the federal, state, or local level, to become a member of a group committed to conserving wildlife, or to participate in the service structure of a self-help group, such as Alcoholics Anonymous. If these sorts of community-oriented activities are important to you, write about what direction you would like to take in these areas. Write about what appeals to you about this area. 10. Health/physical self-care. In this section, include your values related to maintaining your physical well-being. Write about such health-related issues as sleep, diet, exercise, smoking, and the like. 11. The environment/sustainability. In this section, include your values related to values you might have in the area of sustainability and caring for the planet and especially the natural environment. 12. Art/aesthetics. In this section, include your values related to such pursuits as art, music, literature, craftsmanship, or any other form of beauty in the world that is meaningful to you—whether considering things that you make yourself or things that others make and that you mainly appreciate.
Ask yourself the following questions when you make ratings in each area. Not everyone will value all of these areas, or value all areas the same. Rate each area according to your own personal view. Possibility: How possible is it that something very meaningful could happen in this area of your life? Rate how possible you think it is on a scale of 1–10. 1 means that it is not at all possible and 10 means that it is very possible. Current Importance: How important is this area at this time in your life? Rate the importance on a scale of 1–10. 1 means the area is not at all important and 10 means that the area is very important. Overall Importance: How important is this area as a whole? Rate the importance on a scale of 1–10. 1 means the area is not at all important and 10 means that the area is very important. Action: How much have you acted in the service of this area during the past week? Rate your level of action on a scale of 1–10. 1 means you have not been active at all with this value and 10 means you have been very active with this value. Satisfied with Level of Action: How satisfied are you with your level of action in this area during the past week? Rate your satisfaction with your level of action on a scale of 1–10. 1 means you are not at all satisfied and 10 means you are completely satisfied with your level of action in this area. Concern: How concerned are you that this area will not progress as you want? Rate your level of concern on a scale of 1–10. 1 means that you are not at all concerned and 10 means that you are very concerned.
The therapist should be on the lookout for, among other indicators, the following signs that pliance or counterpliance might be influencing the process: •. Values statements controlled by the presence of the therapist, in conjunction with the client’s assumptions about what might please the therapist. Relevant consequences would be signs indicating the therapist’s approval and/or the absence of the therapist’s disapproval. •. Values statements controlled by the presence of the culture more generally. Relevant indicators would include the absence of cultural sanctions and broad social approval or widespread prestige. •. Values statements controlled by the stated or assumed values of the client’s parents. Relevant consequences would be parental approval—either actually recorded and/or verbally constructed. •. Values statements that have a “have to” quality that might indicate either fusion or avoidance. •. Values statements that are heavily laden with rumination about the past and/or worry about the future.
To illustrate, consider a client who endorses the value of being well educated. The therapist might ask if the level of valuing (or the value itself) would change if it had to be enacted anonymously: “Imagine that you had the opportunity to further your education but you could not tell anyone about the degrees you had achieved. Would you still devote yourself to achieving it?” Or, “What if Mom and Dad would never know you pursued an education—would you still value it?” A different tack might also provide some insight into controlling variables. So, for instance, the therapist might ask: “What if you were to work very hard for a degree, and Mom and Dad knew and were proud, but the day after you received the degree you forgot everything you had learned. Would you still value it to the same extent?” As the client considers various imagined consequences, he or she may be chagrined to find that parental approval is the “straw that stirs the drink.” In this case, “becoming well educated” is not a value at all but rather a goal in the service of some other value (i.e., “being loved by and loving those who are in my life”). Once this value is clarified, it is written down as a desired end. It is not uncommon for some values to change in valence over the course of therapy or even as a function of the initial assessment.
The problem lies in the inflexibility and insensitivity that fusion produces. The high-water mark in values work is defused valuing. A value can be held lightly but yet pursued vigorously.
The advantage of defused valuing is that the client is better able to perceive when letting go of a particular valued act is the best way to serve the same value over the longer term. Sometimes doing something that is, on the surface, contrary to the value functionally serves the value. Allowing children to make some mistakes can be hard on parents but is vital for the children’s learning experience. Inflexible adherence to a rule about keeping your children from any harm can lead to over-protectiveness and stifle children’s need to develop their own autonomy.
Values and Self The most common obstruction to values work in the domain of self is over-attachment to the storyline of the conceptualized self, as with such statements as “It’s too late for me—I have already made too many mistakes that cannot be redeemed” or “There is some flaw that I have that makes achieving anything in this domain impossible” (e.g., “I am not smart enough,” “good enough,” “enthusiastic enough,” or “lovable enough”). Sometimes the flaw is not known but is asserted with great certitude: “I don’t know what is wrong with me, but look at my life!”
Confusing Values and Goals A common problem in values work is the therapist’s failure to detect goals that are presented as values by the client. For example, the client might say, “I want to be happy.” This sounds like a value, but it is not. Being happy is something you can have or not have, like an object. A value is a direction—a quality of action. By definition, values cannot be achieved and maintained in a static state—they must be lived out. When goals are mistakenly taken as values, the inability to achieve a goal seemingly cancels out the value. A practical way to avoid this confusion is to place any goal or value statement produced by the client under the following microscope: “What is this in the service of?” or “What would you be able to do if that was accomplished?” Very often, this exercise will reveal the “hidden value” that has not been stated.
Contemporary society is dominated by a focus on object-like outcomes (i.e., goals that are attained). In most cases, the first time the client completes the values exercise what he or she produces looks more like an exercise in goal definition than an exercise in choosing valued directions. The therapist’s job is to detect this confusion of process and outcome and help the client connect specific behavioral goals to values.
One reason clients get stuck is because they believe attaining goals is the key to happiness and their satisfaction with life. They try to get what they want in order to be happy. This way of living is in some ways oppressive because it is functionally connected to a state of deprivation. Trying to be happy by achieving goals is living in a world where what is important is constantly missing, present only in the hope that it will someday arrive. The thing that you most need (i.e., having what you want) is constantly never present. While this sense of deprivation may create motivation and directed action, it squeezes out any sense of vitality. Little wonder that goals and values are constantly confused with each other!
When the process of living itself actually becomes the primary outcome of interest, we are no longer living in a verbal world of constant deprivation. When the purpose of life becomes truly living, we always have it right here, right now.
“Suppose you go skiing. You take a lift to the top of the hill, and you are just about to ski down the hill when a man comes up and asks where you are going. ‘I’m going to the lodge at the bottom,’ you reply. He says ‘I can help you with that,’ and immediately grabs you, throws you into a helicopter, flies you to the lodge, and then disappears. So, you look around kind of dazed, take a lift to the top of the hill again and are just about to ski down it when that same man grabs you, throws you into a helicopter, and flies you to the lodge again. You’d be pretty upset, right? You’d probably say, ‘Hey, I want to ski!’ “Skiing is not just getting to the lodge. Any number of activities can accomplish that for us. Skiing is a particular process of getting there. But notice that getting to the lodge is important to skiing because it allows us to do that process. Valuing down over up is necessary in downhill skiing. If you try to put on downhill skis and ski uphill instead of down, it just doesn’t work! There is a paradoxical way to express this: outcome is the process through which process can become the outcome. We need outcome goals, but the real point is that we participate fully in the journey.”
Most clients in contemporary society are far too outcome-oriented in that much if not most of their social training consists of simply applying materialistic standards of “success” to themselves almost by rote. They constantly monitor how well they are doing and how successful they are compared to others, and they constantly imagine themselves achieving a better state of mind than their current one or lamenting past instances whenever their actions, or failures to act, play out badly. They often pull up short on potentially invigorating life initiatives whenever the anticipated outcome is not achieved precisely “on time.”
A goal is defined as a specific achievement sought in the service of a particular value.
Taking little steps consistently has a greater impact than heroic steps done inconsistently.
Our clients do not get stuck in life solely by chance. They get stuck because they avoid taking valued actions as a means of avoiding painful emotional barriers.
As barriers are identified and discussed, the therapist helps the client to consider the following: 1. What type of barrier is this? Are negative private events or external consequences in conflict with some other value? Are there issues with pliance or counterpliance? 2. Is this barrier something you could make room for and keep acting? 3. What aspect of this barrier is most capable of reducing your willingness to have the barrier without defense? 4. Are any of these barriers just another form of experiential avoidance?
In the context of commitment, willingness is the choice to act in a values-based way while knowing full well that doing so triggers feared content.
Mental causation is thus viewed as inherently incomplete until the contextual variables are specified that in principle would allow for the goal of “influence” to be met
The grandfather of ACT measures is the Acceptance and Action Questionnaire (AAQ ; Bond et al., in press; Hayes, Strosahl, et al., 2004). The AAQ examines acceptance, defusion, and action. The general measure is not content-free—its components include measures of anxiety and depression—but it assesses experiential avoidance and psychological flexibility fairly broadly and predicts many forms of psychopathology successfully
ACT and RFT development is being encouraged and supported by the Association for Contextual Behavioral Science. Only a few years old, ACBS has 4,000 members, more than half of whom reside outside of the United States.
