Acceptance and Commitment Therapy: Advanced Workshop
Acceptance and Commitment Therapy: Advanced Workshop
Julian McNallyJulian McNally
Program Outline
Review Of ACT Model
Getting Stuck Into ‘Getting Stuck’
7 Frequent Problems And How To Respond
Sweet Spot And Client Descending
Matrix For Case Formulation
Developing Mastery In ACT
“Hexaflex”“Hexaflex”ACT Model of Effective LivingACT Model of Effective Living
Values, Purpose & Meaning
Defusion Committed Actions
Contact with the Present Moment
Acceptance & Willingness
Transcendent Sense of Self/ Self As
Context
PsychologicalFlexibility
“InFlexaHex”“InFlexaHex”ACT Model of PsychopathologyACT Model of Psychopathology
Lack of Values Clarity or Contact
Fusion Inaction or Disorganised Activity
Dominance of Conceptualised Past
or Feared Future
Experiential Avoidance
Attachment to “Storied” or
Conceptualised Self
“Hexaflex”“Hexaflex”ACT Model of Effective LivingACT Model of Effective Living
Values, Purpose & Meaning
DefusionCommitted Actions
Contact with the Present Moment
Acceptance & Willingness
Transcendent Sense of Self/ Self As
Context
Mindfulness & Acceptance Processes
Behaviour Change Processes
Your turn!
Decide who will be client first
Brief your partner on presenting problem, but not what’s ‘tricky’ about this client
Counsellor: Notice yourself getting stuck. Observe thoughts and feelings
Client: observe and resist urge to be agreeable or make it easy for counsellor
If counsellor is not getting stuck, brief “client” on what the actual client does that’s ‘tricky’ and try again. Switch.
Pair up - one is “A” the other is “B”
Getting Stuck Into “Getting Stuck”
My experience is not authoritative because it is infallible. It is the basis of authority because it can always be checked in new primary ways. In this way its frequent error or fallibility is always open to correction. Carl Rogers, On Becoming a Person
Bennet and Cari
• Notice your reactions and make peace with them
• Provide an ACT-consistent response
• Where is the client on the Hexaflex?
• Where are you on the Hexaflex?
7 Frequent Problems
1 What do I do if I get stuck?2 Do I need to cover all 6 processes?3 What if they say “it didn’t work”?4 What if they don’t know/can’t say what their
values are or don’t have any?5 What do I do with clients who are
sceptical/concrete/psychotic?6 What if they (or I!) don’t “get” Self-As-Context?7 What do I do with clients who are fused with
their beliefs or a ‘sick’ or ‘victim’ role?
What do I do if I get stuck?
General principles:
Slow down!
Be willing and accepting
Hold your formulation and treatment trajectory lightly
Stick closely to principles and loosely to techniques
Listen to client’s experience before yours
Listen to experience before models and ideas
Invite a change in action rather than in understanding or feeling
Do I need to cover all 6 processes?
No!
What if they say “it didn’t work”?
Is there a control agenda in place?
Try another part of the model
Try a different technique from the same part
What if they don’t know/can’t say what their values are or
don’t have any? How do they know they don’t know?
When was the earliest (last) time they remember having values?
Make the therapy about discovering/creating values?
Check for semantic problems
Detect values in the present
What do I do with clients who are
sceptical/concrete/psychotic?
“Trust your experience, not my words or your thoughts”
Workability of scepticism
Sideline “beliefs” and “being right” for a while
You don’t have to do “mindfulness” – just pay attention
Psychosis – ACT is not an EST – other treatments
Metaphor-imperviousness? Present-moment defusion and willingness with Self-As-Context
What if they (or I!) don’t “get” Self-As-Context?
Let’s practise!
Indicators Of Increased Capacity For Self-As-
Context Detecting and defusing from rules and stories
Increased perspective taking and noticing
Noticing own processes of fusion and unwillingness
Naming or joking about own scripts and stories
Able to dispassionately examine value-contradictory behaviours and thoughts
Recognising current choices and history as separate phenomena
Relating to multiple conceptualisations of self as determined by context and values-in-the-moment
What if they are fused with their beliefs or a ‘sick’ or
‘victim’ role? Try Self-As-Context
Be curious and empathic
Appeal to workability
Template for Experiential Exercises
1 Recognise your mind will interfere, so slow down and accept
2 Contact with present moment – sounds and touch
3 Locate the moment of choice or ‘stuckness’
4 Immerse in the moment (file cabinet or movie screen)
5 Open eyes and express it
6 Hold the moment silently and appreciate
The Grid - Kevin PolkThe Grid - Kevin PolkEven Simpler Model of ACT ProcessesEven Simpler Model of ACT Processes
SwS Valued Living
Sensory Experience
Mental Experience
“I think that...”“I think that...”
“I’m having the thought that...”“I’m having the thought that...”
“I notice I’m having the thought that...”“I notice I’m having the thought that...”
This is This is unbearableunbearable
I notice those I notice those thoughts are there thoughts are there
againagain
Recontextualising the ProblemRecontextualising the Problem
DepressedDepressedUnmotivatedUnmotivatedUnemployedUnemployedIndecisiveIndecisive
OverweightOverweightUnloveableUnloveable
Need therapy!Need therapy!
What I want What I want my life to my life to stand for stand for
DepressedDepressedUnmotivatedUnmotivatedUnemployedUnemployedIndecisiveIndecisive
OverweightOverweightUnloveableUnloveable
Need therapy!Need therapy!
The Life I’m left withThe Life I’m left with
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