act ‘boot camp’ - russ harris, 2014 · act ‘boot camp’ - russ harris, 2014 psychological...

ACT ‘Boot Camp’

- Russ Harris, 2014

Psychological

Flexibility

Contact with the

Present Moment

Defusion

Acceptance Values

Committed

Action

Self-as-context

1

Be Present

Open Up Do What Matters

3

Workshop Aims

1. Technique <=> Process

2. Fluidity & flexibility

3. Interpersonal focus

4

Workshop Content

S.L.O.W.

The 4 IMPACT Questions

The Triflex

The Choice Point

‘Function-Spotting’ => Ubs & Wubs

The 4 Horsemen Of Rigidity

Self-as-context & Problems With Self

What Is Confidence?

• ‘Com fides’

How To Build Confidence

• Leave your comfort zone

• Make mistakes

• Make room for anxiety & self-doubt

• Competence precedes confidence

• Actions of confidence come first,

feelings of confidence come later

‘TOWARDS’acting effectively, getting closer to

behaving like the person you want to be

‘AWAY’ acting ineffectively, moving away from


Challenging Situation

CHOICE

POINT

‘HOOKS’

Thoughts, feelings, emotions

memories, urges, sensations

‘HELPERS’

Values, strengths, skills

‘Unhooking’ skills (mindfulness)

S.L.O.W.

• Slow down

• Lean in

• Open up

• Warmly illuminate

29

In every session, be on the

lookout for ….

30

Gating Skating Baiting Stating

The 4 Horsemen: Gating

=> barring/holding back emotions

Biting lip, clenching teeth, breathing heavily, looking

away, going silent, shifting position in chair,

changing body posture (e.g. folding arms, putting

hands over eyes), leaving the room, reaching for

tissues, rituals, shrugging, fidgeting, digging nils

into palms, forced or inappropriate laughter, etc.

31

The 4 Horsemen: Skating

=> Gliding over painful events

Nothing much happened, can’t recall, it was okay,

that’s old news, don’t go there, fine, no worries,

next, moving on, oh you know what it’s like, why

dwell on it, it’s over and done, who cares?

Rapidly changing the topic

32

The 4 Horsemen: Baiting

=> Behaviours that ‘hook’ us and pull us ‘off-track’

Aggression, blaming, interrogating, insulting,

undermining, accusing, going silent, etc.

You don’t understand/care/know what it’s like!

You’re only here for the paycheck!

Why won’t you help me? You don’t believe me!

You’re just like all the others!

33

The 4 Horsemen: Stating

Stating rules, reasons and judgements as if they are

absolute facts or immutable lawsShould/ Shouldn’t/Have To/Must/Ought/Right/Wrong/Can’t Because/ Won’t Until/

Shouldn’t Unless/ Always or Never/ Everyone or No one/ All or Nothing/

Black or White

A = B; If C then D; No E unless F, Never do G, Always do H

If he does L, then I will do M

I can’t do P because I feel Q

I shouldn’t have to R unless S

Life is W, Men are X, Women are Y, You can’t trust Z, He never does F, She

always does G, The Universe is R

AND THAT’S HOW IT IS!

34

‘TOWARDS’acting effectively, getting closer to


‘AWAY’ acting ineffectively, moving away from


Challenging Situation

CHOICE

POINT

‘HOOKS’

Thoughts, feelings, emotions

memories, urges, sensations

‘HELPERS’

Values, strengths, skills

‘Unhooking’ skills (mindfulness)

Exercise in Pairs: 5 mins Case

Conceptualisation – Version 1• One person briefly summarises a current client.

• Jointly fill in the choice point for that client - a broad,

general, overview

• Any of the 4 horsemen – gating, skating, baiting, stating

- showing up in session?

38

Exercise in Pairs: 5 mins Case

Conceptualisation – Version 2• This time, the other person in the pair summarises a

specific behaviour, e.g. an addiction, aggression, a

compulsion, procrastination, social withdrawal

• Jointly fill in the choice point for that specific behaviour

• Any of the 4 horsemen – gating, skating, baiting, stating

- showing up in session?

39

INFORMED CONSENT (see page 16)

• ACT is a very active form of therapy/coaching – not just talking about problems.

• Learning skills to handle difficult thoughts and feelings more effectively, so they

have less impact and influence over you

• Clarifying your ‘values’: what kind of person you want to be, how you want to

treat yourself and others, what you want to stand for in life, what gives you a

sense of meaning or purpose

• Taking action: to solve problems, and do things that make life better

• I want you to leave here at the end of each session with a plan of action –

something you can do in between sessions that will make a difference

• NB Modify this as needs – e.g. in grief work, this would sound very different

40

IMPACT – Interpersonal

Mindfulness Processes in ACT

FAP = Functional Analytic Psychotherapy

ACT & FAP => Massive overlap

Biggest difference: FAP = Purely Interpersonal

Also, FAP ‘sits on’ the underlying model => sits

equally well on top of traditional CBT as on ACT

41

ACT & FAP

Disclaimer: I don’t know much about FAP!

I have only attended a 1-day workshop, where I spent much of the

day protesting to the trainer, ‘This is just ACT!’.

And vice-versa: whenever I suggested an ACT move, the trainer

would say, ‘That’s FAP!’.

Based on that limited experience, my opinion is that the FAP model

is already a component of ACT.

My apologies to any FAP enthusiasts who are offended by that.

After this workshop, if you read enough transcripts of ACT therapy

sessions from virtually any ACT textbook, you will see these

interpersonal processes are all there –especially in Mindfulness For

Two and Getting Unstuck In ACT

With IMPACT my aim is to make these interpersonal ACT processes

much more explicit and practical.

42

Setting Up Sessions #1 – Pressing

Pause

Can I have permission to press pause from time to time - so if I see you

doing something that looks like it might be contributing to your

problems or making them worse, I can pause you and point it out,

and we can address it?

And can I also press pause if I see you doing something that looks like it

might be really helpful or useful, in terms of dealing with your

problems and improving your life? So you can reflect on it, and

think about how to do more of it?

43

Setting Up Sessions #2 – Trying

New Things

I mentioned already that part of this approach includes learning new skills

to handle thoughts and feelings more effectively. Is it okay if at times

ask you to try some of these things in session?

At times I might ask you to do an exercise that seems a bit weird or

strange, and you are always free to say no. I’m only going to suggest

these things if I think they’ll be helpful to you, but you certainly don’t

have to do them.

.

44

Setting Up Sessions #3 – Setting

An Agenda

Are you okay if we take a couple of minutes at the start of each session to

establish a focus or an agenda for the session? To pick one important

problem or area of life that we can hone in on, and make the main

focus of the session, in order to improve it?

The reason for this, is it makes our work much more efficient. If we are

talking about several different problems at once, it’s very hard to deal

effectively with any of them.

Once client agrees, set an agenda – e.g. use the ‘bull’s eye’ and pick a

quadrant – or ask the client to nominate a single problem, goal, or

aspect of life to focus on

45

Setting Up Sessions #4 – Team

BuildingBring in at any point where the session becomes about relationship issues

Very often the problems that show up in relationships outside this room,

tend to show up here in our sessions too. Is it okay if I press pause at

times and get us look at what’s happening here in the room, in the way

that you and I are interacting with each other?

To get you to notice things that you’re doing that seem helpful and things

that seem unhelpful, in terms of us building a strong team/alliance?

And can I ask you at times to try out new skills or strategies here in the

room with me, so that you can then take them and use them in your

relationships with other people outside this room?

46

Setting Up Sessions #5 – Being

Real

Can we make this a place where we can both be real with each other? I

want you to be real with me – and give me honest feedback about

whether what I am doing is helpful or not etc. And I want to be real

with you, too. Am I allowed to give you honest feedback?

Sometimes that can be confronting – but there are very few people in

the world that will give you honest feedback. One of the most

powerful things abut a coaching/counselling relationship is that you

will, if you allow it, get honest feedback from someone with no other

agenda than to help you build a better life

47

IMPACT: Interpersonal

Mindfulness Skills In ACTThe 4 questions:

• What’s going on?

• What’s showing up?

• How’s this working?

• How can you use this?

49

IMPACT Questions go both ways

What’s going on: What are you doing right now?

What am I doing right now?

What’s showing up for you? What’s showing up for

me?

How’s this working? Are you doing a ‘towards’ or

an ‘away’ move? Am I doing a ‘towards’ or an

‘away’ move?’

How can you use this? How can I use this?

50

Exercise in pairs: play around with

the first 2 IMPACT questions –p6What’s going on?

What’s showing up?

51

Exercise in pairs: play around with

the other 2 IMPACT questions –p6How’s this working?

How can you use this?

52

53

Psychological

Flexibility

Contact With The Present Moment

Defusion

Acceptance Values

Committed Action

Self-as-context

What’s going on?


What’s going on?


What’s going on?


up?

There’s a part of you

noticing everything that’s

going on and showing up,

and all your towards &

away moves

How’s this working?

Towards or away?

How can you use this?

Notice it, name it

Notice it, name it

Open up/make room

THE WHOLE ACT MODEL RESTS ON .....?

IMPACT: interpersonal level

IMPACT: Interpersonal

Mindfulness Skills In ACT‘Ubs’, ‘Wubs’, and ‘Rubs’

Ubs - Unworkable Behaviours happening in session

Wubs – Workable Behaviours happening in session

Rubs – Reports of Behaviours, happening elsewhere

56

Common Ubs & Wubs

What are common unworkable behaviours in session?

What are common workable behaviours in session?

Almost any behaviour could be workable or unworkable,

depending on the context

57

For each of the following client

behaviours, come up with:a) context where it functions as a Wub, we want to reinforce

b) context where it functions as an Ub, we want to redirect

client cries

client says ‘You’re an idiot’

client says, ‘Yes, I’ll definitely do that. I feel so inspired’

client says, ‘You’re a great therapist. This is really helping’

client says, ‘I feel like punching you’

client goes silent

client says ‘This is a waste of time’

client says ‘Aha! There’s my not good enough story again!’

58

Our Aim

To instigate, model and reinforce psychological

flexibility

“Redirect Ubs & Reinforce Wubs”

Can’t know for certain, in advance, what will be

reinforcing.

You make an educated guess & observe what

happens.

59

Reinforce Wubs, Redirect Ubs

How might we intentionally reinforce a Wub?

How might we intentionally redirect an Ub?

How might we unwittingly reinforce an Ub?

How might we unwittingly redirect a Wub?

60

Redirect an Ub => any combo or

variant of …• Can I press pause, shine a light on what’s happening here?

• Do you notice what you’re doing right now?

• Here’s what I notice ….

• What’s showing up for me right now is ….

• I’m wondering what’s showing up for you?

• For you, is this a towards move or an away move?

• How do you think this is affecting us as a team?

62

Reinforce a Wub => any combo or

variant of …• Would you be willing to try doing something different here?

• Do you notice how/what you are doing differently, now?

• What’s that like for you? Here’s what I notice.

• Thank you. I appreciate your willingness. That means a lot

to me

• How do you think this is affecting us as a team?

• For you, is this a towards move or an away move?

• I notice this is affecting me like this…

• How could you use this, outside of this room – when and

where, with whom, doing what?

• Is it okay if we do more of this sort of work in our sessions?63

65

Psychological

Flexibility

Contact With The Present Moment

Defusion

Acceptance Values

Committed Action

Self-as-context

I’m noticing something problematic

here and I’d like to share it with you

I’m feeling pretty

anxious about it.

My heart’s racing.

My mind’s telling me

you’ll be upset or angry

or think I’m rude, or this

will damage our

relationship

So even though I’m

feeling really nervous,

I’m going to tell you what

I’ve noticed

But my aim in here is to

help people live better lives

– so if I ignore this, I’m not

being true to myself and I’m

doing you a disservice

No ‘one size fits all’ responses

In what context might you disclose you’re feeling anxious?

In what context might you NOT do so?

In what context might you disclose your thoughts are very

similar to the client’s thoughts?


In what context might you tell your personally relevant story?


In what context might you apologise for making a mistake?


70

Be Present

Open UpDo What Matters

‘The ACT Bicycle’

Center to balance

Right to moveLeft to loosen

Gentler ways to get clients

present?

What are you noticing now?

What’s showing up for you?

What are you aware of?

And what else? And what else? And what else?

Can I get you to notice ….

Can you notice what your mind is saying?

72


present?

What are you noticing in your body?

Let’s come back to what we’re doing here, right

now; to what this work is about

I’ve lost you; you’re back

You seem distant/disengaged/distracted

I feel disconnected from you

73


present?

Let’s come back to what we’re doing here, right

now; to what this work is about

Can we take a moment just to notice what is

happening here, between you and me?

I’m noticing X, Y, Z … and I wonder if you are,

too?

74


present?

Do you notice how:

- Your mind keeps hooking you

- Your attention keeps wondering

- Whenever I ABC, you tend to DEF

75


present?

Can we just pause for a moment, and

- Take stock

- Notice what’s going on

- Let the dust settle

- Take a moment to center ourselves

- Drop anchor

76

I NOTICE …

I Feel X When You Do YI notice I feel anxious when you clench your fists and raise your voice like

that

I notice I feel under pressure, and nervous, and uncomfortable, when you

say things like ‘I fired my last therapist’

I notice feel really awkward when you go silent like and stare out of the

window like that; and sad, too; because I really want us to be a team

here, and when you won’t speak, it’s virtually impossible to do that.

---- and I’m wondering if this is the effect you want to have?

---- what effect do you think this has, in terms of us being a team?

---- is this a towards or away move?

77

Addressing Verbal Baiting

You don’t understand/care/know what it’s like!


Why won’t you help me? You don’t believe me!


78

YES, BUT => YES, AND

Hayes, Strosahl, Wilson, 1999

‘Yes, but’ conversations => change the ‘but’ to

‘and’

79

YES, AND ….

You don’t understand what it’s like!

Yes, I can never know exactly what it’s like to be you – and

I’m committed to doing my best to help you .. and it’s fine if

you don’t believe that … and I don’t want to waste our time

together trying to convince you it’s true

Other options?

80

YES, AND …. Exercise


Yes, I do like to get paid – and …

You don’t care about me

Yes, at times I am not as caring as I’d like to be – and …

.


Yes, in some ways I am like those others – and …

Why won’t you help me?

Yes, I would like to help you more than I currently am – and81

YES, AND …. Exercise

Client tries to verbally bait the therapist

Therapist responds with SLOW =>

Slow down, lean in, open up

A warm ‘Yes’ ….. then some sort of ‘And’

Generic ‘cacth-all’ version: Yes I hear what you’re saying …

and I really want us to work together here, as a team, to help

you build a better life … so what can we right now to help

that?.

NB – you don’t have to use the word ‘yes’ – any

acknowledgement is fin82

Disclosing Inner Conflict

I’m a bit torn right now/ being pulled in two directions/ noticing some

conflict within myself

Part of me wants to do A, and part of me wants to do B

On the one hand I want to C, and on the other hand I want to D

I’m debating with myself whether or not to share with you how I feel about

this.

Part of me says I should hold back, and part of me says I should speak up

I’m having mixed feelings right now. Part of me feels A and part of me

feels B

I’m noticing some confusion in myself because I’m getting conflicting

messages from you: I hear you say A - and yet, at the same time I

notice B/ on the one hand X, on the other hand Y

83

Inner Conflict Exercise

Client says something provocative to ‘bait’, e.g. you don’t

care about me

Therapist: I’m noticing some conflict within myself. Part of me

wants to address what you just said – reassure you, or try

to convince you that’s not true, etc. And another part of

me wants to stay focused on the main issue here/ on

doing this exercise/ on exploring this questions, and not

get side-tracked. Is it okay with you if we stay on track

here for now, and come back to what you just said a bit

later?

84

Inner Conflict Exercise

Client is frustrated when therapist keeps refocusing on an

exercise or process or question

Therapist: I can see you’re frustrated. And there’s a part of

me that just wants to please you here – answer your

questions/change the topic/address your concerns, to

ease your frustration. And there’s another part of me that

really wants us to stay with this exercise/question/process

for a bit longer, before addressing that

question/concern/issue. Is it okay if we just persist with

this a bit longer, and then we can address the other stuff?

….One of the most useful skills you can learn here is how to

have difficult emotions like frustration without letting them

control what you do 85

Speed Therapy - courtesy of

Emily SandozOnly two people sitting – Client 1 &Therapist

Third person is standing – Client 2

Bell rings => T works with C1 for 1 minute

Bell rings => C1 stands up (and gets ready to return as C3)

C2 sits down => T works with C2 for 1 minute

Bell rings

C2 stands up (and gets ready to return as C4)

C3 sits down, & T works with C3 for 1 minute etc.

90

Feedback

Compassionate & respectful; Start with something positive!!!

A=> B 1min

A => C 1 min

A= > my experience, 1 min

B=> C 1 min

B => A 1 min

B= > my experience, 1 min

C => A 1 min

C= > B 1min

C = > my experience, 1 min

91

Mindful, Values-Guided Problem-

SolvingMindful: Drop anchor/ grounding/ centering

Values: What do you want to stand for?

The Resilience Formula – 4 options

1. Leave

2. Stay & change what can be changed, guided by values

3. Stay & accept what can’t be changed, and live by your

values

4. Stay, give up and do stuff that makes it worse

Locus of control: what can you do with your arms, legs and

mouth to influence the situation constructively?92

94

PAIN

SMELL

TASTE

TOUCH

HEAR

SEE

FEELINGS

THOUGHTS

SELF-COMPASSION

VALUES & ACTION

“I” “You”

“Here” “There”

“Now” “Then”

“What are you doing here?”

“What am I doing here?”

“ What were you doing there?”

“What was he doing there?”

“What are you doing now?”

“What are they doing now?”

“What was she doing then?”

“What were you doing then?”

The only constants?

I

Here

Now

THEN

NOW

YOU

I

HERE

THERE

Perspective Taking Skills

Slide Courtesy of Steve Hayes

Self-as-Context

The ‘locus’ of

consciousness:

everything is

noticed from a

perspective of ‘I,

here, now’

Slide Courtesy of Steve Hayes

‘Flexible Perspective Taking’

Self-as-context

Two definitions:

‘Outcome definition’ => SAC => the experience of the

observing self or transcendent self

=> an ‘outcome’ of noticing your own noticing

- Outcome definition = most common

- Less commonly, the process definition:

‘Process definition’ => SAC => the process of flexible

perspective taking

underlies all ACT processes

100

CONTACTING THE PRESENT MOMENTI, here, now notice WHAT I see, hear, touch, taste, smell, think, feel, do

DEFUSIONI, here, now notice and name my thoughts and feelings

ACCEPTANCEI, here, now notice my thoughts and feelings and make room for them

TRANSCENDENT or OBSERVING SELF => ‘SELF-AS-CONTEXT’I, here, now notice THAT I am continuous, unchanging, distinct from, & more than WHAT I see, hear, touch, taste, smell, think, feel, do

VALUESI, here, now notice what is important and meaningful to me and put it into words

COMMITTED ACTIONI, here, now notice my actions and take control of them

EMPATHYI, here, now notice what someone else is feeling and feel it too

COMPASSIONI, here, now notice suffering and respond

with kindness

SELF-AS-PROCESSI, here, now notice THATI see, hear, touch, taste, smell, think, feel, do

TEAWATER ……… plus tea leaves

MILKWATER………. plus various fats, proteins & sugars

BEERWATER ……. plus beery stuff

COFFEEWATER…….. plus coffee bean extracts

ORANGE JUICEWATER …….. plusbits of orange

103

3 Senses of Self in ACT

The conceptualised self – the narrative about

who I am – self-story

(Textbook term: ‘Self-as-content’)

Self-awareness – the ongoing process of

noticing what I see, hear, feel, think etc

(Textbook term: ‘Self-as-process’)

The observing self – noticing my noticing –

awareness of my awareness

(Textbook term: ‘Self-as-context’)

104

4 Common Self Problems

The Labelled Self

=> I am good/bad; I am this/that

The Unstable Self

=> Self-story rapidly & dramatically fluctuates

The Underdeveloped Self

I don’t know who I am or what matters to me

The Disconnected Self

=> I can’t connect/empathise/understand others

105


In many DSM disorders, a combination of these.

E.g. think of a range of your clients labelled with

the diagnosis of ‘depression’. Consider how all

these self problems may show up at times:

106


The Labelled Self

=> I am good/bad; I am this/that

The Unstable Self

=> I am unstable/fragile


I don’t know who I am or what matters


=> I cant connect/empathise/understand others

107

The Labelled Self

I’m noticing the thought that …

I notice thoughts/ judgments about …

I notice my mind saying/ I notice the story that

I notice I’m getting hooked by …

I notice my values, always available in any moment

A part of me is unchanging; always there, always

available.

There’s much more to me than this story.

108

The Unstable Self

I’m noticing my thought and feelings, changing

I notice my roles, actions, patterns, changing

I notice my self-story, always changing

I notice my values, always available in any moment

And I notice myself noticing

A part of me is unchanging; always there, always

available. A calm center.

There is much more to me than any of these

stories.

109


I notice what matters to me, what I care about

I notice my emotions, and what they tell me

I notice what I do that feels self-respectful, self-

caring, being true to myself

I notice the roles I play & my ‘towards’ & ‘away’

moves in those roles

I notice what nurtures me and what drains me

I notice my values, always available in any moment.

And I notice myself noticing. A part of me is

unchanging; always there, always available.

110


I notice when and how I am disconnected from

you, and when and how I am more connected with

you

I notice you with curiosity and openness

I notice what you look like and sound like and do,

and how you react, and what you react to

I notice my away and towards moves in this

relationship

Flexible perspective taking: If I were you, what

would I be thinking and feeling?

Use self-as-process/self-as-context

to defuse from self-story

Client: fused with self-story – e.g. I’m bad

Therapist: instigate defusion from self-story

#1 – Noticing and naming (self-as-process) – 3 min

# 2 – Observing self (self-as-context) – 2 min

# 3 – Move to values/committed action – 2min

.111

#1 Self-awareness (Self-as-

process): Noticing and NamingNotice:

Hooked vs unhooked

Connected/engaged vs disconnected/disengaged

Vitality vs ‘life drain’

I’m noticing the thought that …

Name: The story, your mind, the thought, the

judgment, the not-good-enough-story, the

emotional storm

Note the difference: ‘What does your mind say to

you?’ Versus ‘What are you telling yourself?’112

#2 Self-as-context/ Observing self:

There’s a part of you noticing every thought, every

story, every feeling linked to it

There’s a part of you in there noticing everything

else

Notice your thoughts, feelings, body, actions –and

notice there’s a part of you n there noticing

everything else. Use that part now, to step back

and notice your mind doing its thing.

If you can step back and notice this story, there

must be more to you than this story113

#3 Values/Committed Action

If I could wave a magic wand so this story was like

water of a duck’s back – it loses all its impact – it

has no effect on you any more ….

What would you do differently? How would you

behave differently? What would you say

differently? How would you interact differently

with others? What would you start or stop doing?

If these ‘unhooking’/defusion skills could help you

to do that, would you be willing to practice them?

114

Use self-as-process/self-as-context

to defuse from self-story

Client: fused with self-story – e.g. I’m bad

Therapist: instigate defusion from self-story

#1 – Noticing and naming (self-as-process) – 3 min

# 2 – Observing self (self-as-context) – 2 min

# 3 – Move to values/committed action – 2 min

.115

Committed Action

Situation: mid-therapy – therapist has been working with a

client on an ACT process – e.g. dropping anchor,

defusion, making room, self-compassion, getting present,

Therapist: So we’ve been practicing this skill (name it). How

can you use it outside this room?

Specify when, where, with whom, in what situation - what

will it sound and look like -who will notice? – how

realistic, 0-10?

What times and places you can practice this?

How will your mind try to talk you out of this? Can you do it

anyway, even though your mind will try to hook you with

all those reasons not to?116

act ‘boot camp’ - russ harris, 2014 · act ‘boot camp’ - russ harris, 2014 psychological...

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