Acceptance and Commitment Therapy: Advanced Workshop

1. Acceptance and Commitment Therapy: Advanced Workshop • Julian McNally

2. Program Outline • Review Of ACT Model • Getting Stuck Into ‘Getting Stuck’ • 7 Frequent Problems And How To Respond • Sweet Spot And Client Descending • Matrix For Case Formulation • Developing Mastery In ACT

3. Contact with the Present Moment Values, Purpose & Meaning Acceptance & Willingness Psychological Flexibility Defusion Committed Actions Transcendent Sense of Self/ Self As Context “Hexaflex” • ACT Model of Effective Living

4. Dominance of Conceptualised Past or Feared Future Lack of Values Clarity or Contact Experiential Avoidance Inaction or Disorganised Activity Fusion Attachment to “Storied” or Conceptualised Self “InFlexaHex” • ACT Model of Psychopathology

5. Mindfulness & Acceptance Processes Behaviour Change Processes Contact with the Present Moment Acceptance & Willingness Values, Purpose & Meaning Defusion Committed Actions Transcendent Sense of Self/ Self As Context “Hexaflex” • ACT Model of Effective Living

6. Your turn! Pair up - one is “A” the other is “B” • Decide who will be client first • Brief your partner on presenting problem, but not what’s ‘tricky’ about this client • Counsellor: Notice yourself getting stuck. Observe thoughts and feelings • Client: observe and resist urge to be agreeable or make it easy for counsellor • If counsellor is not getting stuck, brief “client” on what the actual client does that’s ‘tricky’ and try again. Switch.

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

8. Bennet and Cari • Notice your reactions and make peace with them • Provide an ACT-consistent response • Where is the client on the Hexaflex? • Where are you on the Hexaflex?

9. 7 Frequent Problems • What do I do if I get stuck? • Do I need to cover all 6 processes? • What if they say “it didn’t work”? • What if they don’t know/can’t say what their values are or don’t have any? • What do I do with clients who are sceptical/concrete/psychotic? • What if they (or I!) don’t “get” Self-As-Context? • What do I do with clients who are fused with their beliefs or a ‘sick’ or ‘victim’ role?

10. What do I do if I get stuck? General principles: • Slow down! • Be willing and accepting • Hold your formulation and treatment trajectory lightly • Stick closely to principles and loosely to techniques • Listen to client’s experience before yours • Listen to experience before models and ideas • Invite a change in action rather than in understanding or feeling

11. Do I need to cover all 6 processes? • No!

12. What if they say “it didn’t work”? • Is there a control agenda in place? • Try another part of the model • Try a different technique from the same part

13. What if they don’t know/can’t say what their values are or don’t have any? • How do they know they don’t know? • When was the earliest (last) time they remember having values? • Make the therapy about discovering/creating values? • Check for semantic problems • Detect values in the present

14. What do I do with clients who are sceptical/concrete/psychotic? • “Trust your experience, not my words or your thoughts” • Workability of scepticism • Sideline “beliefs” and “being right” for a while • You don’t have to do “mindfulness” – just pay attention • Psychosis – ACT is not an EST – other treatments • Metaphor-imperviousness? Present-moment defusion and willingness with Self-As-Context

15. What if they (or I!) don’t “get” Self-As-Context? Let’s practise!

16. Indicators Of Increased Capacity For Self-As-Context • Detecting and defusing from rules and stories • Increased perspective taking and noticing • Noticing own processes of fusion and unwillingness • Naming or joking about own scripts and stories • Able to dispassionately examine value-contradictory behaviours and thoughts • Recognising current choices and history as separate phenomena • Relating to multiple conceptualisations of self as determined by context and values-in-the-moment

17. What if they are fused with their beliefs or a ‘sick’ or ‘victim’ role? • Try Self-As-Context • Be curious and empathic • Appeal to workability

18. Template for Experiential Exercises • Recognise your mind will interfere, so slow down and accept • Contact with present moment – sounds and touch • Locate the moment of choice or ‘stuckness’ • Immerse in the moment (file cabinet or movie screen) • Open eyes and express it • Hold the moment silently and appreciate

19. Sensory Experience Valued Living SwS Mental Experience The Grid - Kevin Polk • Even Simpler Model of ACT Processes

20. “I think that...” “I’m having the thought that...” “I notice I’m having the thought that...” This is unbearable I notice those thoughts are there again

21. What I want my life to stand for Depressed Unmotivated Unemployed Indecisive Overweight Unloveable Need therapy! Depressed Unmotivated Unemployed Indecisive Overweight Unloveable Need therapy! Recontextualising the Problem The Life I’m left with