The ACT Matrix K. Polk B.Schoendorff PDF

I love the matrix.
Sometimes you need a way of thinking about ACT that

isso focused on what is critical andsosimplethat you cannot forget it. Thats
the matrix. The numberof situations that call for it is stunning:as atoolfordifficult clients;when you feel lost in therapy; foran elevator speech with a business person; to doa thirty-minutetalk with a lay group; to guidea chat with
a school principal; and on and on. This is the firstbookonthe matrix and
how to use it.Let me simplify it for you:Get it.Read it. Use it.
Steven C. Hayes, PhD, cofounder of ACT and professor of
psychology at the University of Nevada
This book is a must-have for anyone interested in practicing or teaching
ACT.
JoAnne Dahl, PhD, professor of psychology at Uppsala
University, Sweden, and coauthor of ACT and RFT in
Relationships
The matrix method of delivering ACT has experienced a rapid increase in
popularity in the last few years. The ACT Matrix provides a simple, mindful
framework for delivering ACT in a wide number of contexts, including areas
involving emotional disorders, eating disorders, addiction, pain, post-traumatic stress disorder (PTSD), and pro-social behavior.It can be used in the
clinic, in schools, in organizations, or any setting [where someone] would
benefit from increased psychological flexibility and resilience. If you would
like a quick, accessible way to learn and start practicing ACT, this book is for
you.
Joseph Ciarrochi, PhD, author of the best-selling teen book,
Get Out of Your Mind and Into Your Life for Teens
The matrix is transparent and user-friendly for both mental health and
medical providers working in brief treatment settings. As a matrix practitioner, you will help many people, including those with addictions, chronic pain,
and relationship problems. Add The ACT Matrix to your bookshelf now and
benefit from Polk and Schoendorffs numerous examples of how to use this
highly accessible tool.
Patricia J. Robinson, PhD, author of Real Behavior Change in
Primary Care and Brief Interventions for Radical Change
In The ACT Matrix, editors Kevin Polk and Benjamin Schoendorff simplify the entire ACT model into two basic distinctions. The first two chapters of the book, written by the editors and collaborators, summarize the
matrix diagram by discriminating between sensory and mental experiencing and between moving toward versus away from your values. These are
well-written and entertaining. I was unfamiliar with the matrix, and after
reading these introductory paragraphs, I had a good feel for what the work
would look and feel like with a client in the therapy room.
The remaining chapters of the book apply to specific settings, presenting problems and populations. I believe that you could skip to whatever
work you most commonly do, or read straight througheither would be
useful! These chapters are written by practitioners who are experts in each
of the areas, and the subtle details of how the matrix can be used differently
with each issue really shine through. I believe this will be a great addition
to many office bookshelves, and I would say to pick up a copy right away!
Amy R. Murrell, PhD, associate professor at the University
of North Texas
AC
T
m Atr i x
The
A New Approach to Building

Psychological Flexibility
Across Settings & Populations
Edited by
KEviN L.
PoLK, PhD
BENjAmiN
SchoENDorFF,
mA, mSc
Context Press
An Imprint of New Harbinger Publications, Inc.
Publishers Note
This publication is designed to provide accurate and authoritative information in regard to the
subject matter covered. It is sold with the understanding that the publisher is not engaged in
rendering psychological, financial, legal, or other professional services. If expert assistance or
counseling is needed, the services of a competent professional should be sought.
The Bulls Eye and Join the DOTS from ACT MADE SIMPLE by Russ Harris,
copyright 2009 Russ Harris. Used by permission of New Harbinger Publications, Inc.
Distributed in Canada by Raincoast Books
Copyright 2014 by Kevin L. Polk and Benjamin Schoendorff
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
All Rights Reserved
Acquired by Tesilya Hanauer; Cover design by Sara Christian;
Edited by Jasmine Star; Text design by Tracy Marie Carlson;
Indexed by James Minkin
Library of Congress Cataloging-in-Publication Data

The ACT matrix : a new approach to building psychological flexibility across settings
and populations / edited by Kevin L. Polk, PhD, and Benjamin Schoendorf, MSc, MPs.
pages cm
Includes bibliographical references and index.
ISBN 978-1-60882-923-1 (pbk. : alk. paper) -- ISBN 978-1-60882-924-8 (pdf e-book)
-- ISBN 978-1-60882-925-5 (epub) 1. Acceptance and commitment therapy. 2. Mental
illness--Psychological aspects. 3. Adaptability (Psychology) I. Polk, Kevin L., 1955- II.
Schoendorf, Benjamin. III. Title: Acceptance and commitment therapy matrix.
RC489.A32A28 2014
616.891425--dc23
2013050528
The love of my life, Mary Alyce Burkhart, PhD. Her love,

support, and collaboration lift me each and every day.
Kevin Polk
To all the people who have made it their lifes mission to ferry
others through the dark straits of their suffering over into a
life worth living. Ours is a sacred calling, and my fervent hope
is that youll find within these pages a seaworthy vessel in
which to safely steer through the waters of this scary,
wondrous, and ultimately beautiful life.
Benjamin Schoendorff
CONT ENTS
Introduction: What the Matrix Is All About 1
Kevin Polk
PART 1
Understanding the Matrix
1 The Psychological Flexibility Warm-Up 7
Kevin Polk
2 Under the Hood: Basic Processes Underlying
the Matrix 15
Benjamin Schoendorff, Mark Webster, and Kevin Polk
PART 2
Populations and Settings
3 ACT for the Masses: Using the Matrix with the
General Public41
Aisling Curtin
4 You, Me, and the Matrix: A Guide to
Relationship-Oriented ACT57
Benjamin Schoendorff and Marie-France Bolduc
5 Rolling Out the Matrix, Rolling Back Addiction 77

Mark Webster
6 The Pain Matrix 93

Amanda Adcock Vander Lugt
7 ACT in Digestible Bites: The Matrix and
Eating Disorders 109

Florian Saffer
The ACT Matrix
8 Out of the Hole: The Matrix with Chronic
and Severe Symptoms129

Rob Purssey
9 Something You Can Never Forget: The Matrix
and PTSD147
Kevin Polk and Mary Alyce Burkhart
10 Spot the Matrix: Psychological Flexibility in
Private Psychiatric Practice163

Jean-Michel Vincent
11 Casing the Matrix: A Tool for Case
Conceptualization181
PART 3
The Matrix Outside the Box
12 The Matrix Goes to School: Promoting
Psychological Flexibility in Education 207

Phil Tenaglia
13 In Business: The Matrix for Team Building
and Professional Stress221

Annick Seys
14 The Matrix, Evolution, and Improving Work-
roup Functioning with Ostroms Eight Design

G
Principles235
Kevin Polk
Conclusion: Going Viral 251

Kevin Polk and Benjamin Schoendorff
Index257
vi
Foreword
Since I arrived at the University of Mississippi in 2000, I have run an

acceptance and commitment therapy seminar every other spring. The
seminars are odd. I host them at my home. They are typically composed
of seven or eight graduate students. I use what one might generously
describe as a fluid syllabus. (That is, it can really only be written after the
class has happened.) Ole Miss has allowed me considerable latitude to
use these seminars as a place for intellectual and experiential play. We
pursue interesting topics. And, if we see something new and interesting,
we drop everything and chase it.
In the spring of 2007, I had just placed one of my graduate students
at the Togus Veterans Administration Medical Center. Kevin Polk, who
would be my students supervisor, was traveling to Mississippi and asked
about stopping in Oxford. The timing was right, so it was a natural fit to
have Kevin come and talk to my grad students about the ways he was
using ACT in groups of veterans suffering with post-traumatic stress
disorder.
I am not quite sure what Kevin thought when he arrived at my house.
He found a living room full of students, a couple of press pots of dangerously strong coffee brewing in the kitchen, a six-month-old baby, and
nursing grad-student mom. We were all there, interested and ready to
learn. I am sure it seemed odd to someone who thought he was visiting a
class, but it was entirely typical for my little training group.
I briefly introduced Kevin and gave him the floor. What followed
was a description of ACT in groups that was unlike anything Id ever
The ACT Matrix
seen. It was active, it was vital, and, to my delight, it was intently focused
on growing rich and meaningful lives. PTSD treatment can be pretty
grim, but there was nothing grim about this treatment. Hard thoughts,
emotions, and memories were all things to be sorted and noticed on the
way to a richer and more meaningful life. It was simple, and it was brilliant. The students loved it. One of them called it ACT Gone Wild,
and the name stuck.
Riding with Kevin back to his hotel, I knew that I wanted to see
these ideas loosed on the ACT community of scientists and practitioners. I asked Kevin what he was doing in July. When he gave the slightest
indication that July might be open, I told him that he had to come to the
upcoming Association for Contextual Behavioral Science (ACBS) World
Conference in Houston. This work had to be moved beyond the VA
Medical Center to the broader treatment development community.
Clinicians needed simple, useful tools that could help them understand
and assist clients. With the right audience, I knew that this work would
spur wonderful innovations and applications.
Back in those days, the assembly of the conference program was far
less formal than it is now. I recall putting some early programs together
in a hotel room, a couple of months before the conference, with paper
submissions spread all across the floor. I think it had become a bit more
organized by 2007, but not a lot. I called the ACBS office, while sitting
in the car with Kevin, and told Emily Rodriguez, the executive director,
that we just had to get this guy on the program.
Kevin hesitated. From my living room to the world conference in a
couple hours time was quite a leap! However, I am not easily dissuaded.
I poked, prodded, begged, told him how important it could be, and
pointed out how many people could be helped. We need you! was my
message. Loud and clear! As I recall, I got a tentative yes that day and a
definite yes soon after.
As fate would have it, some other things were canceled during
Kevins first ACBS conference presentation, so he ended up with a big
room for his international unveiling of ACT Gone Wild. People loved it.
In the intervening years, Kevin and his partner in the development of
this work, Jerold Hambright, along with other colleagues, continued to
innovate and refine. ACT Gone Wild became the iView and then,
eventually, the matrix. What was created was quickly given away. The
result has been an explosion of work with the matrix all over the planet.
viii
Foreword
I currently use the matrix in treatment, in supervision, and in case

presentations. While the six-process psychological flexibility model has
proven an incredibly useful tool in treatment development and research,
I have always found it to be a cumbersome tool to use while doing therapy.
The matrix spans the gap between clinical practice and the more complex
psychological flexibility model. Clients and clinicians can, within
minutes, understand the thrust of case conceptualization and
treatment.
I am a researcher and treatment developer, and I recommend the
matrix for use in every protocol.
I am a trainer, and I introduce the matrix at every workshop.
I am a clinical supervisor, and all of my supervisees use the matrix.
I am a clinician, and I use the matrix with my own clients.
I am a person, and I use the matrix to look at the ways my own life
is working.
If you are any of the above, I cannot recommend this book highly
enough. Kevin Polk and Benji Schoendorff have assembled a wonderful
resource. You need this book.
Namaste yall, from Oxford, Mississippi.
Kelly G. Wilson, PhD
Professor of Psychology
University of Mississippi
ix
I NT RODUC T ION
What the Matrix Is

All About
Kevin Polk
The matrix is an interactive diagram for increasing psychological flexibility in almost any context at any time. It is a diagram of the process of
acceptance and commitment therapy (ACT), referred to as acceptance
and commitment training when working with the general public. People
interact with the diagram and experience having thoughts, feelings, and
urges that they would rather not have while choosing to take action
toward who or what is important. You, the reader, will discover that
while using the matrix to influence others, you have only one agenda:
increasing psychological flexibility and valued living. The matrix is for
sharing, and its best learned with the notion that you will teach others
how to share it with others. The matrix works best if its paid forward.
How the Matrix Came to Be

The diagram was first called the grid, but later a friend suggested we
call it the matrix because The matrix has Keanu Reeves sexyattached
to it. The name stuck.
The matrix is a result of over ten thousand hours of work beginning
in 2004. At that time there werent so many ACT books, and publications on the philosophy and theory behind ACT were even more sparse.
The ACT Matrix
So after going to one conference and reading what we could about ACT,
my colleagues Jerold Hambright and Mark Websterand I began to use
the approach. By 2009 I had read pretty much every book and article
about ACT, participated in well over one thousand sessions of ACT, and
engaged in hundreds of in-depth conversations. I love to create simple
diagrams, and I worked the diagrams all the while.
Finally, in 2009, I was almost finished reading the latest ACT book
when, in my minds eye, I could see that ACT boiled down to two sorting
tasks: noticing the difference between sensory and mental experiencing;
and noticing the difference between how it feels to move toward important stuff and how it feels to move away from unwanted mental experiencing. I stood up, walked over to one of my whiteboards, and drew the
two lines of the diagram, with Five-Senses Experiencing at the top,
Mental Experiencing at the bottom, Toward to the right, and Away
to the left. Noticing the differences is where the lines cross.
Five-Senses
Experiencing
Away
Noticing the
differences
Mental
Experiencing
Toward
What the Matrix Is All About
How the Matrix Travels

It wasnt long before I was on the Internet showing the matrix to others.
Word spread, and people began to use the matrix in a variety of contexts
and settings, first in hospitals and mental health clinics, and then in
schools. Prisons were one of the next stops, but sadly, we couldnt find
anyone to write a chapter about using the matrix with prison populations
at this time. Then the matrix found its way into boardrooms and meeting
rooms. All of this travel with no formal publication to its nameuntil
now.
In this book youll see the matrix diagram at work in a variety of
contexts, beginning with a basic matrix warm-up routine to get you
started. Its probably best if you read that chapter first. As a matter of
fact, if you want to use the matrix, memorize the warm-up and show it to
others. Learn to introduce people to the psychological flexibility point of
view by having them notice the difference between sensory experiencing
and mental experiencing; and then notice the difference between how it
feels to move toward important stuff and how it feels to move away from
unwanted mental experiencing, such as fear. You might notice interest
showing up on peoples faces as you have them notice those differences.
You might also notice some people giggling just a bit while noticing the
differences.
Whether you choose to learn how to do the matrix routine or not,
after reading chapter 1, feel free to skip around the book, perusing the
topics that are most important to you. You can always come back later to
read other chapters and find new ways of using the matrix diagram.
Whatever approach you take in your reading, youll quickly start to discover your own uses for the diagram. Such is the nature of the psychological flexibility promoted by the matrix. As you share the matrix with
others, your psychological flexibility will increase, and youll dream up
new ways to use it, taking the matrix to cool new places.
PA RT 1
Understanding the Matrix
CH A P T ER 1
The Psychological Flexibility

Warm-Up
Kevin Polk
This short chapter introduces the matrix diagram. Its a warm-up for
psychological flexibility and presents the skills that can help you become
a great matrix practitioner.
The ACT Matrix
Five-Senses Experiencing
Figure 1.1. The basic matrix diagram. Try drawing it on a piece of paper
for clients.
Five-Senses Experiencing vs. Mental

Experiencing
Take out a pen and notice it using your senses. See it, touch it, hear it (by
tapping or clicking), and smell it. Ill omit taste because that wouldnt be
sanitaryunless youre really intimate with your pen.
Now remove the pen from your five senses and recall experiencing
the pen, this time using your mind. See the pen, touch the pen, hear the
8
The Psychological Flexibility Warm-Up
pen, smell the pen, and, now that youre in your mind, taste the pen all
you want.
Now notice if theres a difference between your five-senses experiencing of the pen and your mental experiencing of it. Just notice if theres
a difference.
Toward and Away

Now recall moving toward someone or something thats important to
you. You might have moved toward a loved one or some sports event.
Simply recall moving toward someone or something thats important to
you.
Next, recall moving away from some unwanted thought or feeling
inside you. The most common one is fear. We all move away from the
feeling of fear. Recall how you moved away to avoid the fear.
Now notice if theres a difference between how it feels to move
toward and how it feels to move away.
Youve now completed your warm-up. Well done!
Noticing Differences
Throughout this book, in one way or another youll practice noticing
these two differences: the difference between your sensory and mental
experiencing, and the difference between how it feels to move toward
and move away.
All of us move within the matrix all of the time.
Sometimes were in our heads, toward the bottom of the diagram.
Sometimes were more connected with the five senses. Sometimes were
moving toward, and sometimes were moving away. Knowing where you
are on the diagram at any moment is sort of coolsomething youll
experience for yourself as you read on.
The ACT Matrix
Stretching Toward Psychological

Flexibility
The basic idea of the matrix diagram is to take the essence of psychological flexibility and grow it. Think of it as stretching exercises to promote
psychological flexibility. First notice the differences a few times per day,
then a dozen times per day, and finally many times per day. To get to the
point of noticing the differences many times per day requires some training, and thats what much of this book is about.
Who or What Is Important

To know when were making a toward move, we need to have a good idea
of who or what is important to us. Further, we need to know the actions
that can help us move toward who or what is important. In acceptance
and commitment therapy lingo, this is called values and committed
action. Youll find a great deal of values work throughout this book.
Unwanted Inner Experience

To know when were making an away move, we need to have a good idea
of the unwanted thoughts, feelings, urges, and bodily sensations that
commonly show up for us. (In matrix work, bodily sensations are often
regarded as mental or inner experiencing because they occur inside the
skin.)
Again, youll find many exercises in this book devoted to clarifying
and identifying the stuff that shows up inside that can sometimes be a
barrier to moving toward values. Above all, we need to be aware of the
actions we take too often to move away from unwanted inner
experiencing.
While many away moves, such as getting out of the way of a bus, are
highly functional, others are not. We all do things to move away from
unwanted feelings when the better move would be to take the feelings
with us as we move toward who or what is important.
10
How We Get Stuck

The basic idea of acceptance and commitment therapy is that people get
stuck in their head (mental experiencing) and need to do some exercises
to get out of their head. The title of Steve Hayess book Get Out of Your
Mind and Into Your Life (2005) sums this process up nicely. The problem
is that we swim in a sea of words, and those words take us into our
mental experiencing. Sometimes we get stuck there and forget to smell
the roses. Whether were stuck moving toward or away from mental
experiencing doesnt matter; neither is life.
Getting Unstuck
Getting unstuck from mental experiencing is the purpose of the matrix
diagram and noticing the two differences.
The primary reason for noticing the two differences is that noticing
requires no language, and language is the stuff of mental experiencing.
Of course we cant completely free ourselves from languagenor should
we. Its useful, and wed lose our way in a hurry if we completely disconnected from it. Instead, we notice the difference between mental and
sensory experiencing and learn to have a choice.
Learning to have that choice is the essence of psychological
flexibility.
Noticing the Differences

As you read this book, every once in a while you might pause and notice
the difference between your five senses and mental experiencing, then
notice if youre moving toward or away, and then get back to your reading.
Youll soon start to notice a difference.
Training the Noticing

When youre teaching others to notice these differences, there are a
couple of things to keep in mind. You can accelerate learning by inviting
11
The ACT Matrix
people to do sorting, and this sorting will help them notice the
differences.
Essentially, we all tell stories. Those stories may be about what we
had for breakfast, where we went on vacation last year, or what we plan
to do this weekend. Each is a story that can be sorted into the matrix.
Part of each story includes the five senses: what was seen, heard, felt,
smelled, and tasted. If you go to a restaurant, there will be elements of
each of the five senses in the story of the trip to the restaurant. Each
story also has mental aspects: thoughts, emotions, and urges. The story
will also include actions taken both toward and away. As people tell a
storyany storythey can be invited to sort the elements of the story
into the matrix.
We have people do the sorting so they can practice noticing the differences. In other words, to do the sorting, the person steps back and
notices the differences between elements of the story, sort of like diagramming the story. Every act of sorting requires noticing the
differences.
Yes, And?
Sometimes people get hooked into telling their story and forget to do the
sorting. At these times, we use the gentle art of Yes, and? to draw them
back into sorting and noticing the differences. For example, someone
might be excitedly telling you about an emotionally charged event that
happened last week. You can see and hear that shes stuck in her mental
processing of the story and could probably use a break toward flexibility.
You simply say something like, Yes, and where would you sort that last
bit you were talking about?
Obviously, you dont interrupt every story this way, but if it seems
someone needs a little nudge toward psychological flexibility, a quick
Yes, and? can get the job done nicely.
Verbal Aikido
With Yes, and? we enter the world of what some call verbal aikido. If
you arent familiar with physical aikido, its a martial art that involves
12
redirecting physical energy. When someone strikes out, the energy is

redirected.
Some aikido masters say theyre showing the other person the way to
peace. Yes, and? is verbal aikido, taking the energy of words and directing it, even spinning it, into the matrix. The energy that the person was
just about to spend on being stuck in the story is now being used to sort
the story, get free of some of the bonds of the story, and move toward
psychological flexibility.
Like physical aikido, verbal aikido takes repeated and deliberate
practice, so dont get hooked and discouraged if you dont always succeed
in redirecting someones energy toward the matrix. Keep at it and youll
soon start noticing a difference.
Noticing Hooks
To move the verbal aikido practice into life, the matrix practitioner often
uses a simple homework assignment that involves noticing hooks. Hooks
are those moments we all have when we quickly get emotionally charged.
Maybe a car cuts you off, maybe someone says something unkind, maybe
you see a beautiful person. There are all kinds of emotional hooks that
we each have every day, and each provides an opportunity to practice a
touch of verbal aikido.
The hook gets noticed, and then the next action is noticed. Inherent
in noticing the hook and noticing what is done next is noticing the effect
of the hook. Did the person expend much energy? Did the person fight
against the hook or carry it along? What came next, a toward move or an
away move? These questions are not necessarily asked directly; theyre
inherent in the noticing.
Conclusion
If the only thing you learn from this book is the following summary and
you practice what it teaches you, youll probably become a great matrix
practitioner:
1. Notice the difference
experiencing.
between
sensory
and
mental
13
The ACT Matrix
2. Notice the difference between how it feels to move toward and

away.
3. When teaching others, invite them to sort stuck stories into the
matrix.
4. When teaching others, if they get stuck, use Yes, and? to get
them back to sorting.
5. And maybe think about this stuff being verbal aikido
6. Practice 1 to 5 again and again.
Now that you have the basic matrix moves down, I and the other
authors of this book hope youll join us on a journey through the many
facets and applications of this deceptively simple tool for psychological
flexibility we call the matrix.
References
Hayes, S. (with Smith, S.). (2005). Get out of your mind and into your life: The
new acceptance and commitment therapy. Oakland, CA: New Harbinger.
14
CH A P T ER 2
Under the Hood: Basic

Processes Underlying the
Matrix
Benjamin Schoendorff,
Mark Webster, and Kevin Polk
The matrix is a simple way to help people to adopt a point of view that
enhances psychological flexibility. Well briefly show you that point of
view and then give you our understanding of some of whats going on
behind the scenes of the matrix. Its the stuff of basic human learning,
including the learning of language and thinking. Along the way, well
ease into some technical language to sketch out what we believe goes on
under the hood of this deceptively simple vehicle for getting people on
track to psychological flexibility and a valued life. The matrix is a tool of
human liberation that rests on recent advances in the understanding of
learning and cognition, which underlie acceptance and commitment
training and therapy.
At its essence the matrix is a diagram that prompts the noticing of
two differences: the difference between five-senses experiencing and
mental experiencing (the vertical line of the matrix), and the difference
between how it feels to move toward stuff thats important and how it
feels to move away from stuff inside, like anxiety or guilt (the horizontal
line of the matrix). People are simply invited to notice these two
The ACT Matrix
differences. Most people can readily notice these differences, but for
some folks its more difficult. Why someone would have trouble noticing
the differences goes to the heart of whats going on behind the scenes of
the matrix. In this chapter well lift the curtain and give you a quick run-
through of what science currently has to say about human learning and
cognition. We wont be going deep into the science because that isnt the
purpose of the chapter or this book. Rather, well give you some understandable highlights that might help you use the matrix more effectively.
Along the way, we hope to give you a better sense of what makes the
matrix an effective tool in promoting psychological flexibility.
Basic Assumptions
All science stands upon basic assumptions. For example, we can look at
life and the universe as being like a machine, and a set of mathematical
equations can describe that machine and how its component parts interact. Many of our Western notions of science are built on some variation
of the view that the universe is like a machine. However, theres more
than one way to look at things, and the scientific foundation of the
matrix is built on a completely different set of basic assumptions. Put
simply, humans (and living organisms in general) are not machines.
Mathematic equations dont fully do the trick when it comes to explaining behaviorsthe things that make up a life.
So instead of basing our science on a mechanistic view, we look at
how a person behaves in the situation the person is in at the time. We
look at the whole picture, rather than simply at how the constituent parts
interact. You can do this right now. Simply observe yourself reading these
words in whatever situation you find yourself. Maybe youre on a bus,
maybe in a library, maybe in your house. You can look at the act (reading)
in context (the situation youre in).
The matrix is an application of functional contextualism (Hayes,
1993), an approach that seeks to identify what works in particular contexts. In functional contextualism, the concern isnt about how things
are in themselves or whats true independent of what works to attain
particular goals. Whats true isnt how things really are, but what works
in a given situation. This makes functional contextualism particularly
16
Under the Hood: Basic Processes Underlying the Matrix
well adapted to interventions in which whats important isnt what people

think is true, but what works for them in their varied life situations.
An alternative to functional contextualism is seeking to identify the
mechanisms linking separate parts of reality. Newtonian physics is an
example of that. Applied to health, this gives us the standard model of
disease, in which an underlying cause is seen as the root of a symptom.
Treatment is about removing the cause to remove the symptom. For
instance, in diabetes, lack of insulin is seen as the cause of the symptoms,
so treatment implies supplementing with insulin to achieve levels sufficient to remove symptoms and restore health.
Though we rarely think about them, the basic assumptionsor, as
the philosopher of science Pepper (1961) referred to them, root metaphorsthat underlie our worldviews condition how we go about understanding things and treating people. Therefore, they are important to
examine. Functional contextualism was developed to provide a framework for a psychology that doesnt limit itself to identifying parts and
instead takes into account how whole individuals function in their varied
life contexts. Its an extension of Skinners radical behaviorism, and its
basic assumptions are derived from Darwins view of evolution, rather
than Newtonian physics. The focus is on selection by consequences.
This is different from the standard model to the point of perhaps seeming
counterintuitive. The matrix helps people easily operate in and navigate
this seemingly counterintuitive functional contextual mode.
A functional contextual perspective conditions a different model of
healthone in which how people interact with their life situations
determines the consequences of their behavior and whether their behaviors are workable in moving them toward whats important to them.
Trying to change ones feelings or thoughts may or, more often, may not
work to move a person toward whats important. From this perspective,
diabetes is a condition that generally appears with certain behavioral
patterns and that, over time, can best be treated by changing eating and
exercise patternsthough at times supplementation with insulin can
also help, and with type 1 diabetes its essential. In this model of health,
the target for treatment is long-term quality of life, not short-term fixes.
In the rest of this chapter, well look at the processes the matrix
brings into play to help orient people toward and within a functional
contextual model of mental healthone in which whats important and
how to move toward it organizes the work and becomes the criteria for
17
The ACT Matrix
whats true for each person; in other words, a model that puts psychological flexibility center stage.
Setting Up the Point of View

Work with the matrix always starts with setting up the point of view.
This essential first step allows people to observe what theyre doing in the
context of their whole lifeincluding what they want to move toward.
This is the first step toward psychological flexibility. Its a departure from
the traditional health model, as the matrix doesnt seek to identify what
parts (whether feelings, thoughts, behaviors, or chemical imbalances) are
malfunctioning or problematic and should be changed.
There are many ways to set up the matrix point of view, a number of
which are illustrated in this book. As long as they work in the situations in
which theyre used, all of these different ways are good. As with everything
in this model, flexibility is key. One way to introduce the point of view is
simply to introduce the two discriminations: between five-senses experiencing and mental experiencing (discrimination 1, or D1), and between
actions to move toward whats important and actions to move away from
what people dont want to think or feel (discrimination 2, or D2).
FIVE-SENSES EXPERIENCING
<- D1 ->
AWAY
<- D2 ->
MENTAL EXPERIENCING
Figure 2.1. The two basic discriminations.

18
TOWARD
Heres an exercise to introduce D1. If you didnt try it in chapter 1,

try it for yourself right now. Grab a pen and see if you can experience it
through each of your five senses in turn (or four; tasting is optional!).
Now put the pen away, close your eyes, and see if you can experience
the pen once more, this time mentally running through each of the
senses.
Did you notice a difference between five-senses experiencing and
mental experiencing? Sometimes people dont notice a difference. Thats
okay. They can notice that they dont notice a difference.
Heres a way to introduce D2: Bring to mind some recent action
(well define action as something others could have seen you do) that was
a move toward someone or something important to you.
Next, bring to mind some recent action that was a move away or
attempt to escape from something you didnt want to think or feel.
Did you notice a difference between how the toward move and away
move felt? Sometimes people dont notice a difference. Again, thats okay.
Toward Psychological Flexibility

By setting up the point of view (reflected in figure 2.1), we have taken the
first steps toward psychological flexibility. From this point of view, people
can more readily make distinctions that will make a difference in their
life. We call these discriminations. Making these discriminations leads
to a greater ability to observe each act in context. As people notice
broader aspects of the context than they typically had, they become
better able to notice whether their behavior is in line with whats important to them and whether its workable in their varied life situations.
They become more flexible.
Getting Stuck
When people enter therapy, theyre stuck, which is another way of
saying inflexible. People can get stuck in all sorts of ways: They get stuck
because they cant imagine options other than moving away from
unwanted inner stuff. They get stuck because whats important to them
is obscured by their struggle against unwanted inner stuff. They get stuck
because they focus exclusively on unwanted inner stuff. They get stuck
19
The ACT Matrix
because they have trouble contacting their five-senses experience and

cant notice how their actions affect other people and their own life.
Here are some examples of people who got stuck: Jack gets so hooked
by dark thoughts and feelings of despair that he barely gets out of bed.
When Amy meets new people, she feels so anxious that she seems to
forget that making friends is important to her. Mike cant imagine going
out when his back pain flares up, so hes missed many of his sons ball
games. When Bob feels angry and disappointed with his life, he stops
going to his AA meetings and relapses into drinking. John and Jill are
unable to recognize that when theyre in conflict, they could choose to
engage in an openhearted exchange about whats important in their
marriage and what they could do to improve things.
Getting Unstuck
Consistent practice of the matrix point of view gets people noticing
the discriminations that will make a difference in their lives. Think of it
as stretching exercises that will gradually build flexibilitya yoga of the
mindthat requires deliberate, repeated practice. People get unstuck by
practicing noticing the two basic discriminations across their varied life
situations. As a result, they become increasingly able to choose actions
that move them toward whats important to them in life, rather than
remaining stuck in trying to move away from unwanted inner stuff. They
become more psychologically flexible, and their actions move them
toward better relationships and more satisfying integration into their
community. This ensures that their toward moves continue over time. In
this way, the gains of treatment are consolidated over the long term.
How Derived Relational Responding

Gets Us Hooked
As the scary heading of this section might have alerted you, our
language is about to get somewhat more technical. Weve tried to write
in such a way that you can easily follow the discussion even if you arent
familiar with the technical terms well be using. We hope that the preceding pages gave you enough of a taste for what the matrix does that
youll stick with us through this next section.
20
Jack, Amy, Mike, Bob, and John and Jill all get hooked by internal
stuff they dont want. When their hooks show up, they bite and engage
in away moves. Technically speaking, theyre behaving under the control
of aversive antecedents. Aversives are things that people (and organisms
in general) move away from. For Jack and the others, these thoughts,
feelings, and sensations have (in certain contexts) acquired controlling
functions over their behavior through a process known as derived relational responding. According to relational frame theory (RFT; Hayes,
Barnes-Holmes, & Roche, 2001), derived relational responding is the
result of the way our minds transform five-senses experience into mental
experience. In this transformation, mental experience can acquire some
of the functions of five-senses experience. For example, a five-senses
experience of a charging bear naturally makes people run away. Through
derived relational responding, the mere thought of a charging bear can
make people run away or engage in other actions meant to move them
away from that thought and the fear it elicits. Because of derived relational responding, people react to the derived functions of things rather
than simply responding to the direct functions. Thats what we call
getting hooked by mental experience. When hooked, people have a hard
time noticing the difference between five-
senses and mental
experience.
Derived relational responding is a very complex process, and one
thats largely involuntary. It gets going as children learn language, and as
it does so, it not only relates five-senses experience to mental experience,
but also relates all types of inner experience among themselves: thoughts,
feelings, sensations, images, and memories. Thats why people try to
move away from the feeling of fear, even absent the thought of a charging
bear. Worse, an action or a comforting thought that serves to move away
from the initial thoughts and fears may come to evoke these thoughts
and fears. Derived relational responding can produce so many hooks that
people can easily get lost. Once people learn to speak, mental experience
largely dominates over five-senses experience. As a result, we live mostly
in our heads.
When people get hooked by the inside stuff they dont want, they
naturally try to move away from it. What they do to move away often
works in the short term. For example, Amy feels relief when she moves
away from a person she wanted to meet. This makes it likely that shell
do it againat the cost of her long-term life goals. In technical terms,
21
The ACT Matrix
Amys away moves could be seen as negatively reinforced experientially

avoidant actions under the control of aversive antecedents. In plain language, shes stuck.
Moving Toward Appetitives

Thankfully, theres another kind of mental experience beyond the
inside stuff that we dont want to experience: the things we can notice as
being important to us. We call these things appetitives. Appetitives are
simply things that people (and organisms) move toward.
Once children learn to speak, they can start noticing inside stuff
thats important to them, called values in ACT. Because people easily get
stuck in the struggle to move away from aversives, the matrix sets up a
context that includes appetitives. Thats the right side of the diagram.
This makes it more likely that people will notice appetitives, even when
theyre stuck. Once they start noticing, they naturally derive things they
could do to move toward these appetitives. And when they do these
things, new consequences appear. Inside, they start noticing that theyre
doing what the person they want to be would do. Outside, through five-
senses experiencing, they start noticing the differences their actions are
making.
After three sessions with the matrix, Amy initiated a few conversations to move toward friendship. She noticed people responding. The
inner consequences (feeling proud of acting in line with her values) and
the outer consequences (people responding to her) of her toward moves
made it more likely shed do something similar again, and she did. In
technical terms, Amys toward moves could be seen as positively reinforced valued actions under the control of appetitive consequences. In
plain language, Amy was getting unstuck.
The goal of the matrix is to help people choose to move toward
appetitives. Most people enter treatment to move away from aversives
(primarily mental aversives). They come in asking to get rid of their
depressive feelings, shyness, pain, drinking problem, doubts about their
marriage, and so on.
Traditional therapy seeks to help people move away from these aversives. In so doing, it unwittingly reinforces getting hooked by aversives
and responding to them by moving away. Once the aversives are removed,
people still havent learned to move toward appetitives, so they remain
22
vulnerable to getting stuck again. This is most clearly seen in people with
addictive behaviors (see chapter 5), but it occurs much more broadly.
People who have been reinforced for moving away in this fashion are
liable to get stuck againeither in the same place or in some other
placewhenever aversives show up again.
The matrix orients toward a different kind of treatment. The goal
isnt removing aversives; its training the ability to choose toward moves
in the presence of these aversives and to notice what happens. This is
quite close to the definition of psychological flexibility youll find in ACT
books. Psychological flexibility is key to long-
term change and, we
believe, to improving the effectiveness of therapy and reducing the high
relapse rates that stand witness to the failure of the traditional model.
Actions under appetitive control are long-term patterns of behavior
that are, for the most part, reinforced by the social community. This has
two benefits for the therapist. First, peoples toward behavior stabilizes
over time, and they engage in fewer of the away moves that can lead to
impulsivity and a chaotic lifestyle. Second, the gains of treatment are
maintained in the community after clients stop attending sessions, drastically reducing the probability of relapse.
Using Derived Relational Responding to

Move Toward Flexibility
Now well look at the specific processes likely to be activated by use of
the matrix diagram. Things get a tad more technical from here on. From
the point of view of relational frame theory, when Amy responds to the
anxiety and self-defeating thoughts that appear when she meets new
people by moving away, shes responding to the derived verbal functions
of these experiences. She gets hooked and essentially responds as if these
experiences were bears she must flee. These verbal functions promote
narrow and inflexible behavior. Its the dark side of derived relational
responding.
Thankfully, like the force in Star Wars, derived relational responding
also has a side that can move toward the light. Derived relational
responding can help people choose to move toward whats important,
even in the presence of unwanted inside stuff. The matrix stokes this
23
The ACT Matrix
power. It promotes the deriving of new relations and the transformation

of verbal functions to bring behavior under the control of appetitive consequences. Some consequences are verbal, as people notice that they act
like the person they want to be. Some consequences are noticed through
the five senses, as circumstances and relationships change in new ways.
Its less that the content of what people experience changes; rather, the
functions of their experience are transformed.
As the functions of her experience are transformed, Amy may still
feel anxious and choose to engage in a conversation with someone new.
Mike may see some of his painful sensations as reminders to attend his
sons ball game. Jack may come to see his despairing thoughts and feelings as signs of the importance of engaging in activities outside his home.
Shifting to the Observer Perspective

From the moment its first introduced, the matrix retrains people by
shifting their perspective to an observer position. From that point of
view, people can notice the stuff they dont want and the stuff thats
important. They can notice both aversive and appetitive verbal functions
and the actions that derive from them. The matrix therefore provides a
visual cue for derived relational responding under appetitive control. Its
visual format is generic and minimally verbal. It trains a (functional contextual) point of view that can be applied across multiple contexts.
At its simplest, training clients in the two discriminations is all it
takes to get them unstuck. Technically, they start deriving new relational
responses that gradually promote behavior under the control of appetitive consequences. The sorting can only be done from a position removed
from the content of experience. This is known as the observer position.
Thus, sorting on the matrix trains the observer perspective as learned
behavior.
With practice, use of the matrix point of view itself comes under the
control of consequences as people experience a decrease in the long-term
consequences of (negatively reinforced) away moves, an increase in (positively reinforced) toward moves, or both. Practicing an observer perspective through multiple sortings gradually promotes an increased ability to
maintain behavior under appetitive control and to contact positive reinforcement in the presence of more difficult aversive experiences. This is
freedom as B. F. Skinner (1972) defined it.
24
Using Learning Principles to Train Broader

Derived Relational Responding
Matrix practitioners invite clients to practice the sorting tasks cued
by the diagram. They first invite clients to perform crude discriminations
by helping them identify differences between high-contrast taskssay,
between not going to a party to move away from feelings of inadequacy
versus accepting an invitation to move toward making new friends. Then
gradually finer discriminations will be trained, sometimes in the same
behavior. For example, calling a friend could be both a move away from
loneliness and a move toward friendship. In such cases clients can be
asked to ascribe percentages to the toward and away aspects of the
behavior. Practitioners use successive approximations to guide clients to
more effective sorting, gradually increasing the difficulty.
Sorting by Successive Approximations

Using learning principles, the matrix cues shaping by successive
approximations through multiple exemplar training. The principle is for
practitioners to reinforce successive approximations of sorting behavior
until sorting itself comes under the control of its appetitive
consequences.
At first we want people to simply engage in the sorting tasks. At this
point it doesnt matter whether people sort well. One of the mistakes
beginning matrix practitioners can easily make is trying to get clients to
sort correctly. This runs the risk of getting stuck in arguments or trying
to convince clients where a particular experience should go on the
matrix. At first Jack sorted ruminating into the upper left quadrant of
the matrix. Yet if ruminating cant be observed through the five senses,
does it not belong under mental experiencing? However, the practitioner
just said, Good. You noticed ruminating as an away move. Clients with
addictive behaviors often start sorting in ways that may seem incorrect.
They might sort drinking as a toward movesay toward leisure or socializing. In that case, the practitioner might simply say, Yes. You noticed
drinking as a toward move, perhaps adding, after a pause, And, did you
ever notice drinking as an away move?
As clients get better at sorting, the observer perspective, from which
the sorting is done, emerges. The practitioner can help by asking who is
25
The ACT Matrix
sorting or noticing the differences between moving away and moving

toward, and between five-senses and mental experiencing. Gradually, the
client will start noticing the me who notices, thus establishing contact
with a sense of self thats distinct from any content or process of experience. This is the perspective of me noticing, or self-as-contextthe
behavior of the observer self.
Once clients are engaged in sorting, matrix practitioners coach them
in a systematic practice of the discriminations, always orienting to
experience.
A Word of Warning
Some clients may give the answers they think the practitioner wants
to hear. This is known as pliance. Be on the lookout for it, as it will get
people even more hooked and keep them from responding from the perspective of their sorting. Reinforce the behavior of sorting rather than
particular responses or ways of sorting. The matrix practitioner seeks to
systematically reinforce noticing behavior while avoiding punishing any
kind of sorting. Gently nudging toward broader noticing is as simple as
saying, Yes, and, with the sentence being completed by an invitation
to further discriminate. This is done by training the clients attention to
a different aspect of the matrix than the one theyre currently noticingor hooked by. So in the example discussed in the previous section,
the practitioner was in effect saying, Yes, you noticed drinking as a
toward move, and did you ever notice drinking as an away move?
Hooks
The matrix practitioner invites the client to discriminate and track
verbal behavior and its consequences by asking if a particular verbal
experience works as a hook for the client and inviting her to notice what
she does next. This move involves two steps. First, a practice of D1 is
contained in the invitation to notice the hook because the client will
then notice mental experience as distinct from five-senses experience.
The second part of the question in turn is an invitation to track the
consequences of behavior (including verbal behavior). This move contains two important moments of what is known in ACT as defusion:
distancing from content (antecedents), and noticing the functions
26
(consequences) of acting upon that content in a given context. With this

training, clients notice that biting hooks works in the short term but not
in the long term. In this way, new aversive functions accrue to getting
hooked and engaging in away moves.
Whats Important
The practitioner can also invite clients to discriminate what the
person they want to be would do. This allows clients to contact their
values and identify actions congruent with those values. When clients
practice noticing toward moves in the moment, they increase their ability
to interact with values as ongoing patterns of behavior, rather than as
purely verbal statements. Furthermore, the link between values and
actions helps derive reinforcing functions for their toward moves. This
promotes derived relational responses under appetitive control, making it
more probable that clients will derive further toward moves.
For example, if John invited Jill to go out for a weekly date night, that
would be a move toward being the husband he wants to be. Jill might
identify being empathic and listening to John as moves toward being the
wife she wants to be. The practitioner reinforces the derivation of these
reinforcing functions by asking clients to link toward moves with the
values they serve. The practitioner also encourages clients to notice,
through their five senses, the effect of their toward moves on their relationships and their lives.
Summary of the Process

Through the training of noticing behavior by means of multiple
exemplar training and successive approximations, client behavior gradually transforms from experiential avoidance under negatively reinforced
aversive control (of antecedents, both verbal and direct) to behavior
under positively reinforced appetitive control (of consequences, both
verbal and direct). This is achieved through the continual practice of
noticing or discriminating in the present moment. In this approach, the
role of the practitioner is to orient clients attention toward greater flexibility, using the matrix as a cue to train attention toward those aspects
of their life context (including verbal aspects) that they arent presently
noticing or arent in the habit of noticing.
27
The ACT Matrix
Forms of Derived Relational Responding

Cued by the Matrix
For the interested reader who has followed us this far (congratulations!),
we now provide an even more technical account of how relational
framing is put to use with the matrix diagram. We are moving even
deeper into the language of relational frame theory, so beware: some
technical language lies ahead, but its still manageable, or so we hope.
Derived relational responding is a result of relational framing, the
(largely involuntary) behavior of placing sensory or mental stimuli in
frames of preestablished relations that condition the transformation of
functions between the framed stimuli. Types of frames include equivalence, coordination, opposition, hierarchy, temporal, and perspective
taking (Hayes et al., 2001). The matrix diagram promotes particular
types of relational framing (some of which are involuntary) that gradually help client behavior come under appetitive control. The matrix
diagram dynamically cues movement from psychological inflexibility
(the left side of the diagram) to flexibility (the right side).
The matrix increases derived relational responding by providing a
visual environment that serves as an overarching network of relations
between clinically significant aspects of the clients experience, as represented by the four quadrants and two main discriminations. With
repeated practice of the matrix point of view, that network of relations
can become largely automatic and come to control forms of relational
framing and transformation of stimulus functions that help people come
under appetitive control.
Left Side Work

Lets start by the left side of the diagram. By making apparent the
dynamic links between aversive private experience and experientially
avoidant action (away moves), the matrix diagram helps transfer some of
the aversive functions of these private experiences to experientially
avoidant actions. This is achieved by putting aversive private experience
28
and away moves in temporal frames through asking questions related to

the effectiveness of avoidant action in the short term (typically effective,
and bringing into focus its negatively reinforcing functions), and in the
long term (usually ineffective, and helping derive aversive functions to
those away moves). These temporal frames are also hierarchic, as long
term is higher hierarchically than short term.
The practitioner can present possible frames of opposition between
the away moves and verbal appetitives by asking if these actions have
helped clients move toward who or what is important to them. The practitioner can also present frames of opposition between away and toward
moves by asking clients if these actions have stopped them from engaging in toward moves. When the answer is yes, further aversive functions
can derive to the away moves.
In some cases, away moves will have allowed the client to move
toward something important, even if in the long run they proved ineffective in moving him or her away from aversive private experience. In such
cases, new appetitive functions can derive to actions that had previously
been engaged under aversive control, bringing them under appetitive
control. For example, a client with OCD who went running to fight his
obsessions noticed that running was also a move toward health and
started to run as a move toward, rather than as compulsive response to
his obsessions. The behavior remained the same, but its function changed
and it came under appetitive control. (The moves described above are
illustrated in figure 2.2.)
29
The ACT Matrix

-
Figure 2.2. Some possible derived functions working the left side. Arrows
in boxes represent the direction of derived functions.
Right Side Work

On the right side of the diagram, by linking verbal behavior under
appetitive control (whats important) to overt actions, the reinforcing
functions of toward moves are strengthened, appetitive functions are
transferred to actions that were previously under aversive control, or
both. As an example of the former, the practitioner could ask what
actions would constitute a move toward something important or, conversely, ask what or who is important in engaging a particular action. In
the example of the client with OCD, by deriving that running was a
move toward health (itself important), functions derived that served to
put running under appetitive control. In another example of a similar
derivation, Jill reported feeling oppressed by having to prepare her childrens lunch boxes every evening. When asked what the mother she
wanted to be would do, she responded that she valued having time with
her children in the morning to share the dreams theyd had the night
before. Preparing their lunch boxes in the evening made time for that.
30
After being invited to notice whether she made the lunches on the right
side (a toward move) or on the left (an away move) over the coming
week, Jill reported noticing that she prepared them on the right side
three nights out of five. In other words, verbal appetitive functions had
transferred to behavior previously under verbal aversive control.
By putting suffering and values (the lower quadrants) in a frame of
coordination and creating a frame of hierarchy with values at the top,
the matrix can help the appetitive functions of values transform the
functions of aversive private experience, enhancing acceptance and
establishing aversive private experience as a possible antecedent of committed action. For example, after some matrix work, Amys uncomfortable feelings and self-doubting thoughts in social situations served to
alert her to the importance of relationships and became cues for striking
up conversations. Derivation had transferred new functions to her private
experience of shyness. The practitioner can actively promote such
framing by asking who or what is important behind the clients suffering.
ACT manuals provide numerous examples of how to link suffering with
values in effective ways. (The two derivations described here are illustrated in figure 2.3.)
Figure 2.3. Some possible derived functions working the right side.
Arrows in boxes represent the direction of derived functions.
31
The ACT Matrix
Promoting Involuntary Derivations

Once familiar with the diagram, clients are invited to see if they can
spot the matrix in their everyday lives. Some practitioners even tell
clients that they cant unsee the matrix anymore, so no matter how
stuck on the left they may feel, they will inevitably see that a part of their
context lies on the right side, and this will function as a cue pulling them
toward appetitives. This is one of several moves that can serve to promote
involuntary derived relational responding that moves clients toward
flexibility.
An Experiential Way of Training Self-as-

Context and Perspective Taking
By engaging in the sorting tasks, people necessarily gain distance from
their content. Thus, sorting undermines the credibility of stories about
oneself based on the content of ones experience, known as self-as-content.
When Jack buys into his mind saying, Im a depressive, thats self-as-content.
In practicing the discriminations, people experience the process of five-
senses versus mental experiencing, which is akin to self-as-process. Finally,
through sorting, people get to adopt an observer perspective toward their
content; in other words, self-as-context, or the observer self. Those three
senses of self, which are commonly presented in ACT, are represented as
they appear in the matrix diagram in figure 2.4.
32

(PROCESS)
CONTENT:
what I can see, touch, hear, taste, or smell
AWAY MOVES
(PROCESS)
TOWARD MOVES
(PROCESS)
ME
AWAY
WHAT I DONT WANT
TO THINK OR FEEL
TOWARD
NOTICING
CONTENT:
thoughts, memories,
emotions, images, stories,
bodily sensations,
feelings, urges
WHO OR WHAT IS
IMPORTANT TO ME
CONTENT:
who and what
I choose to hold
as important
in my life
MENTAL EXPERIENCING
(PROCESS)
Figure 2.4. The matrix and the three senses of self. Self-as-content is
coded in gray, self-as-process in black, and self-as-context lies in the
center (Me Noticing).
When Amy meets new people, she gets hooked by the thought People
wont talk to me. The fundamental move in the matrix, which is always
implicit in the D2 discrimination (toward versus away moves), is to take
the person out of the experience and establish a point of view thats
external to the situation being describedthat is, unhooked. The discrimination between hooked and unhooked is D1, and its implicit in D2.
Making a discrimination is the act of an observer. In such moves,
perspective-taking framing is at work: people are taking perspective on
their experience and behavior from the point of view of I-here-now
noticing me-there-then, even when just noticing that their experience
of the moment, as verbal behavior, always lags a few milliseconds behind
their direct sensory experience.
33
The ACT Matrix
Perspective taking (or deictic framing, as its also known) is key in a

number of applications, for example, in helping children with autistic
spectrum disorders acquire broader social repertoires (McHugh, Barnes-
Holmes, & Barnes-Holmes, 2009). The matrix represents an application
of perspective taking for the purpose of general interventions. Perhaps it
could help operationalize self-as-context through the process of noticing
at any given time the different quadrants and discriminations cued by
the matrix diagram.
Put simply, in using the matrix with clients, were shifting their perspective from one rooted inside the content of the experience being
reported (hooked), to one that looks from outside, like an observer
looking in (unhooked). By repeatedly training this capacity, people
become better able to stay with difficult experiences, rather than engaging in away moves under aversive control. In this way, they learn to
derive new responses that will lead toward behavior under appetitive
control. Its a capacity developed through practice, trained through multiple exemplars, and made gradually increasingly difficult until a new
repertoire is established.
Matrix and Hexaflex

The matrix constitutes a new way of presenting the processes underlying
acceptance and commitment therapy. Another way to present the processes is the hexaflex diagram (Hayes, Strosahl, Bunting, Twohig, &
Wilson, 2004). The hexaflex is a great conceptual presentation of the
psychological flexibility processes. The matrix diagram is a dynamic representation that cues movement from psychological inflexibility (the left
side of the diagram) to psychological flexibility (the right side). The correspondence between the two diagrams is illustrated in figure 2.5. On
the left side of the matrix diagram is behavior under aversive control of
derived relations (cognitive fusion), when these induce behavior that is
under the control of these derived antecedents (nonacceptance) and
negatively reinforced. On the right side, verbally constructed appetitives
and consequences (values) can bring behavior under appetitive control
(committed action). The central hexaflex processes of contact with the
present moment and self-as-context correspond to the behavior of noticing and performing the discrimination tasks, as discussed above.
34

PRESENT MOMENT
COMMITTED
ACTION
NONACCEPTANCE
AWAY
TOWARD
FUSION
VALUES
SELF-AS-CONTEXT
MENTAL EXPERIENCING
Figure 2.5. The matrix (in black) and hexaflex (in gray).
The six hexaflex processes are commonly presented as middle-level
terms that dont precisely map out onto basic behavioral processes. They
are shorthand, offered as tools to orient practitioners within a seemingly
complex and counterintuitive model: functional contextualism. Yet
committing to terms such as acceptance, defusion, contact with the
present moment, and values can cause difficulties. For example, it can be
challenging to give basic process accounts of the terms, leading to a
potential disconnect between basic science and intervention procedures.
A related difficulty concerns research design. It can be exceedingly challenging to tease out, for example, defusion from acceptance, especially
based on behavioral signs. As an example of the problem, defused talk,
a measure used in some studies, may not be a reliable indicator of
defusion.
35
The ACT Matrix
We may also become wedded to our terms and thus lose flexibility.
There are a number of social contexts in which the terms of the hexaflex
carry undesirable functions for the purpose of promoting derived relational responding under appetitive control. In some countries and cultures, the term values has a socially conservative connotation; in
others, acceptance carries functions of resignation. We may not be at
our most effective if, right after mentioning values or acceptance, we
have to specify what these terms dont mean.
The strength of the matrix diagram doesnt reside in the terms used
to establish the point of view. These are largely interchangeable. This
book contains numerous examples of practitioners in various settings
changing the terms associated with the quadrants or the discriminations. Its strength is that from the get-go it frames the work of both practitioners and clients in a functional contextual worldview, thereby
potentially preventing one of the dangers that come with the growing
popularity of ACT: the use of its exercises and procedures as borrowed
technological fixes in the absence of a functional contextual approach.
From Explicit to Implicit Sorting?

We believe that consistent training of the matrix-cued discriminations
through multiple exemplars could lead to a form of rapid and implicit
discrimination. In particular, learning to discriminate the felt experience
of behavior under appetitive control might gradually orient people toward
implicitly recognizing and moving to such behavior without needing to
look explicitly through the matrix point of view.
Consistent use of the matrix viewpoint might thus lead from
extended and elaborated relational responses to brief and immediate
relational responses (Hughes, Barnes-Holmes, & Vahey, 2012). Indeed, it
is our experience that clients who get the matrix and consistently train
with it move from explicit or controlled sorting to naturally or spontaneously choosing toward moves, even in what had previously seemed intractable situations eliciting away moves.
Matrix training could be a bridge from valued living through
extended and elaborated relational responding to valued living via brief
and immediate relational responses, returning people to a more automatic and functional discriminative behavior. In this way, bypassing the
36
traps of experientially avoidant behavior might restore to our species

some of the simplicity of discriminative behavior observed in other living
organisms.
Conclusion
As practitioners, we offer this chapter as our current understanding of
the basic processes underlying the use and effectiveness of the matrix
diagram as a tool to promote behavior under appetitive control, also
known as psychological flexibility or valued living. We believe that one
of the central modes of action of the matrix is rooted in the way it promotes specific forms of derived relational responding through relational
framing, particularly perspective taking, or deictic framing. Through the
new derived relational responses the matrix affords, behavior that has
been largely under the control of aversive antecedents can gradually
move under the control of appetitive consequences.
Multiple exemplar training and shaping are at the heart of using the
matrix effectively. Adopting the matrix point of view provides practice in
perspective taking through the behavior of sorting. The matrix puts the
behaviors of noticing and taking perspective at the heart of clinical work,
thereby facilitating new and more workable derived relational responses.
It is our hope that this chapter will be of use to practitioners, and
that it might inspire basic researchers to start playing around with the
matrix diagram to illuminate it more fully at the basic process level.
References
Hayes, S. C. (1993). Analytic goals and the variety of scientific contextualism.
In S. C. Hayes, L. Hayes, H. W. Reese, & T. R. Sarbin (Eds.), Varieties of
scientific contextualism (pp. 1127). Reno: Context Press.
Hayes, S. C., Barnes-Holmes, D., & Roche, B. (Eds.). (2001). Relational frame
theory: A post-Skinnerian account of human language and cognition. New
York: Kluwer Academic/Plenum.
Hayes, S. C., Strosahl, K. D., Bunting, K., Twohig, M., & Wilson, K. G. (2004).
What is acceptance and commitment therapy? In S. C. Hayes & K. D.
Strosahl (Eds.), A practical guide to acceptance and commitment therapy (pp.
329). New York: Springer.
37
The ACT Matrix

Hughes, S., Barnes-Holmes, D., & Vahey, N. (2012). Holding on to our functional roots when exploring new intellectual islands: A voyage through
implicit cognition research. Journal of Contextual Behavioral Science, 1(12),
1738.
McHugh, L., Barnes-Holmes, Y., & Barnes-Holmes, D. (2009). Under- standing
and training perspective taking as relational responding. In R. A. Rehfeldt
& Y. Barnes-Holmes (Eds.), Derived relational responding applications for
learners with autism and other developmental disabilities: A progressive guide to
change (pp. 281300). Oakland, CA: New Harbinger.
Pepper, S. C. (1961). World hypotheses: A study in evidence. Berkeley: University
of California Press.
Skinner, B. F. (1972). Beyond freedom and dignity. New York: Springer.
38
PA RT 2
Populations and Settings
CH A P T ER 3
ACT for the Masses: Using

the Matrix with the
General Public
Aisling Curtin
The matrix can be a very powerful and accessible tool for introducing
the general public to functional contextual frameworks. This chapter
aims to provide guidance to clinicians, coaches, educators, and facilitators on how to use the matrix as a means of introducing the general
public to key elements of acceptance and commitment therapyor
acceptance and commitment training, as it is referred to when working
with the general public.
A key element of using the matrix with the general public (hereafter
referred to as people) is to become aware of our own toward and away
moves in communicating these concepts. One of my away moves is to
overly complicate the conceptual framework, and one of my toward
moves is to speak about this approach in a way thats readily accessible to
people with no preexisting knowledge of functional contextual concepts.
So my commitment to you in this chapter is to speak to you, as much as
possible, in the same way that I would speak to the general public. I hope
this will best inspire you to get out there and do this much-needed and
meaningful work.
The ACT Matrix
Introducing the Matrix to the General

Public
The matrix can be introduced to people in five steps, which I describe
below:
1. Making the two primary discriminations in terms of form and
function of experience
2. Using the Bulls-
Eye Worksheet to establish a baseline and
primary focus
3. Identifying unwanted mental experiences
4. Identifying strategies used to avoid pain
5. Checking workability with three questions
1. Making the Two Primary

Discriminations in Terms of Form
and Function of Experience
Initially, our job is to help people notice just how much time we spend
in our heads compared to the time we spend actively engaged in our lives.
The exact words you use to make the distinctionmental experiencing
versus five-senses experiencing, inside your skin versus outside your skin,
in your head versus in your lifearent that important. What counts is
that your audience can begin to notice this important discrimination.
It can be helpful to use humorous personal examples that people can
relate to, demonstrating the difference between being caught up in their
head and actively participating in life. I give everyday examples until
each participant fully gets this distinction, and I find sharing personal
examples to be most effective. Once the distinction is clear, I ask people
to self-assess how theyre doing on this continuum. I usually ask them to
assign a ratio or percentage to how much time they spend in their head
compared to how much time they spend actively engaged in the moment
and their life. The most common answers range between 90 to 10 and
99.99 to 0.01. At this point, I generally say, Wow, thats amazing that
you spend 99.99 percent of your time in the moment! After sharing a
42
ACT for the Masses: Using the Matrix with the General Public
good laugh, we look at how universal it is to spend the majority of our

time in our head. I always give personal examples to illustrate that Im in
the same boat. The Path Up the Mountain metaphor (Hayes, Strosahl,
& Wilson, 1999) can be particularly useful during this initial phase.
Next, I turn to highlighting the primary motivations behind engaging in an activity: aiming to get away from something we dont want to
have or move toward something we do want. A PowerPoint slide with the
acronym WTF comes on screen at this point. Once participants get past
the shock of this not meaning what they expect it to mean, I invite them
to notice whats the function (WTF) behind their actions. For example,
at this moment Im writing a chapter about the matrix for the public.
The function of this action might be not letting down my dear colleagues
Kevin Polk and Benjamin Schoendorff or not experiencing the feelings
that would come with that. Or it could be that I engage in this action
because, fundamentally, I care about making the matrix more accessible
to people. The action may look the same either way. However, it will feel
quite different if its an away move (primarily under aversive control) or
a toward move (primarily under appetitive control). I find that the more
personal, humorous, current, and relatable my examples are, the more
quickly and effectively people can understand this distinction.
2. Using the Bulls-Eye Worksheet to

Establish a Baseline and Primary Focus
I use Russ Harriss adaptation of the Bulls-Eye Worksheet (Harris,
2009; Dahl & Lundgren, 2006) to help people rate how much theyre
living in congruence with their values in four main life domains: relationships, work or education, health and personal growth, and recreation
(figure 3.1). To clarify what that means, I say, If a video camera were
following you around, how much would the actions it recorded you doing
be in line with what the ideal you would do? How are you measuring up
to how you want to be in this area of your life? Dont consider how you
think I think you should be or how you think your family, partner, or
friends think you should be. The only gauge is how youre doing in relation to how you truly want to be.
43
The ACT Matrix
The Bulls-Eye Worksheet

Read through your values, then mark an X in each area of the dartboard to represent
where you stand today. An X in the bulls-eye (the center of the dartboard) means that
you are living fully by your values in that area of life. An X far from the bulls-eye means
that you are way off the mark in terms of living by your values.
Since there are four areas of valued living, you should mark four Xs on the dartboard.
I am living fully
by my values.
Work/
Education
Health/
Personal growth
I have lost touch

with my values.
Recreation
Relationships
Figure 3.1. The Bulls-Eye Worksheet.

Then I ask participants to select one valued area in which theyd like
to move closer to the bulls-eye right now. The Values as a Cube metaphor (McKay, Forsyth, & Eifert, 2010) can help establish focus while also
allowing for flexibility. It likens our choice of which value to pursue in
any given moment to seeing one side of a cube. Through life events or
change of context, another side of the cube might come to the
forefront.
44
3. Identifying Unwanted Mental Experiences

Next, I walk participants through a worksheet I created based on the
matrix (figure 3.2).
Outer World
Five-Senses
Experiencing
Join the DOTS

Distraction:
Opting out:
Valued
Domains:
Thinking:
Family
Intimate
relationships
Substances/self-harm/other:
Parenting
Away
Unwanted Mental or Inner Experiences
Troublesome thoughts:
Toward
Work/
Education
Recreation
Friends
Education
Work
Recreation
Spirituality
Uncomfortable bodily sensations:
Citizenship
Health/
Personal growth
Health
Relationships
Mental
Experiencing
Inner World
Figure 3.2. The Prompted Bulls-Eye Matrix Worksheet.

Encouraging participants to remain focused on the main valued
domain theyve chosen, I invite them to identify the top three thoughts
they struggle with in that area. I provide examples of common thoughts
people struggle with, such as Im not good enough, Theres no point in trying,
and Things dont work out well for me. Then I elicit further examples from
participants. When I ask participants to write their three thoughts, I
provide a simple definition: Thoughts are often strings of words that
generally involve judgments, evaluations, or comparisons of ourselves,
others, or the world. Our minds are rarely politically correct and can
often give us a hard time. Write down as many of your thoughts as possible, exactly as they would appear in your mind. Again humor and personal examples help normalize this experience. For example, while
writing this chapter, the top three thoughts Im struggling with are I have
no idea how to write this, I bet most of the other contributors will have PhDs,
45
The ACT Matrix
and My chapter will probably be the one that needs the most editingif they
even accept it. The key is to model awareness of and willingness to share
whatever my experience is, even when its difficult.
Next, I ask participants to look for the top three emotions that they
get hooked by or entangled in trying to avoid in the valued domain
theyre working with. I use a simple definition of emotions: Emotions
are generally words that can sum up how were feeling overall and arent
tied to a particular part of the body. Examples would be sad or anxious.
Finally, I ask participants to identify the top three bodily sensations they
most want to get rid of in that same valued domain, since these are often
regarded as inner experiencing in matrix work.
Initially, people often get thoughts, emotions, and bodily sensations
mixed up. Our job is to reinforce their willingness to share and then help
them more accurately label what they shared as a thought, emotion, or
bodily sensation. Labeling accurately is important because participants
will later learn different ACT strategies they can apply depending on
whether theyre struggling with a thought, a feeling, or a bodily sensation. I always allow enough time for participants to jot down their top
three unwanted experiences in each category. Parsing in this way keeps
people from getting thoughts, emotions, and bodily sensations mixed up.
Time permitting, we might look at unwanted urges and memories. It can
be helpful to use different colors of pens for each category of unwanted
mental experiencing to underscore the differences.
4. Identifying Strategies Used to Avoid Pain

Next, using Russ Harriss Join the DOTS approach (Harris, 2009),
we look at participants top three away moves in four categories:
Distraction
Opting out
Thinking
Substances, self-harm, and other strategies
The DOTS are outlined in the top left quadrant of my matrix
worksheet.
46
For distraction, I mention common distraction strategies such as the

Internet, TV, food, and so on. I define distraction as any activity we
engage in to try to get away from an unwanted mental experience. I use
empathy and humor to help people feel more comfortable in identifying
their top three strategies in this area.
I define opting out as avoiding people, activities, or situations in
order to minimize or avoid feeling pain. I give common examples, such as
avoiding calls, text messages, e-mails, particular people, or job applications
or other opportunities. I then elicit three examples from participants.
At this point, I draw a distinction between thoughts and the category thinking. Whereas thoughts are generally strings of words that
appear in our mind that we have little or no control over, such as the
thought Im not good enough, thinking is how we respond to such
thoughtsfor example, by ruminating, challenging them, suppressing
them, or engaging in positive thinking.
I explain that in ACT, we look at the category substances, self-
harm, and other strategies from a functional point of view. Therefore,
food, caffeine, and prescription medications may be included as substances if used in an attempt to avoid some internal experience. Similarly,
self-harm includes any activity that causes the person harm or damage in
the long term; therefore, it may include behaviors like ignoring people or
lashing out. I try to help participants become aware of the difference
between having a piece of chocolate or a glass of wine to savor it and the
company we keep in those moments, versus mindlessly consuming in an
attempt to numb or distract ourselves. Giving personal examples can be
extremely useful here.
5. Checking Workability with

Three Questions
Next, I help participants assess workability using three key
questions:
1. Have any of the strategies in the top left quadrant permanently gotten
rid of any of the unwanted experiences in the bottom left quadrant?
The answer is inevitably no. Normalizing this experience is
important. I often say, It seems like all the people in this room
have tried many, many, many things. Nobody could accuse you
47
The ACT Matrix
guys of being lazy. Maybe its just that youre playing a rigged
game.
2. In general, when you use these strategies rigidly or excessively, do
they make your unwanted mental experiences better or worse? The
answer is usually worse.
3. In general, when you use these strategies rigidly or excessively, do you
move closer to the bulls-eye or farther away? The answer is typically farther away.
At this point, we look at the importance of recognizing that these
strategies arent workable, and I explain that the matrix is a tool to help
us check in with our current strategies and assess their relative effectiveness. This is a means of using the matrix to illustrate the ACT process of
creative hopelessness (Hayes, Strosahl, & Wilson, 2011).
I also explain that the matrix and various ACT strategies are tools
to help us accomplish two things: to learn strategies to manage unwanted
mental experiences and unworkable strategies more effectively (the left
side of the matrix); and to identify the people, relationships, and things
that matter most to us as well as to take action to move toward the bulls-
eye in the areas that matter most (the right side of the matrix).
Integrating ACT with the Matrix

ACT is about connecting with the here and now and the things that
matter most to us, taking meaningful action in our lives, and accepting
what lies outside of our personal control. Physical metaphors can be quite
helpful in illustrating that avoidance is the opposite of acceptance.
I introduce the six core processes of ACT that the matrix can target.
For the purposes of public workshops, I generally refer to the six processes as follows (adapted from Harris, 2009), adjusting my descriptions
to meet participants needs:
Connection, or being here now
Expansion and compassion, or opening up
Defusion and unhooking, or watching your thinking
48
Observing self and perspective taking, or seeing the bigger

picture
Values, or knowing what matters
Committed action, or doing what it takes
I developed and sometimes use the Matrix Mindfulness Exercise to
connect with ACT processes through the matrix. A transcript of the
exercise is downloadable on the books website: http://www.newharbin
ger.com/29231.
Cultivating Mindfulness
At this point, I generally introduce mindfulness exercises, as I find
them a useful means of helping people connect to the principles of ACT
and the matrix. Participants become more aware of their habitual
thoughts, emotions, bodily sensations, and behavioral patterns in both
their internal and external worlds. This allows us to check in on these
processes from a vantage of workability. The underlying question is
Does engaging in this pattern and acting in this way help me move
toward the bulls-eye, or does it take me farther away? Here are some
suggestions for guided mindfulness exercises that can fulfill this
function.
Watching reactions to thoughts. Gently become aware of any thoughts
that might arise in the form of judgments, evaluations, and comparisons in
your daily life. Imagine that youre watching a video of yourself as you become
hooked by these thoughts, and simply notice whether you engage in actions
that help bring you closer to who and where you want to be or whether you
engage in actions that take you further away.
Watching reactions to emotions. Notice any difficult or unwanted emotions that might arise within you. When these emotions arise, we generally go
into one of two modes: avoidance mode, or an allowing, compassionate mode.
If youre willing and choose to do so, Id like to invite you to connect to the
actions you engage in when youre in avoidance mode. Are these actions that
help bring you closer to who and where you want to be, or do they take you
further away? Rest in the knowledge that the vast majority of us engage in
actions that take us further away when were in the midst of avoidance mode.
49
The ACT Matrix
Now notice any moments, no matter how brief, when you brought a more
compassionate and allowing approach to your experience. Simply notice
whether, in these moments, you were moving closer to or further away from
who and where you want to be.
Cultivating self-compassion. Id like to invite the you that is right here right
now to imagine looking into your eyes in a moment of vulnerability earlier in
your life. Simply notice what you can see. Do you see sadness, fear, regret,
disappointment, guilt, resentment, or some other emotion? From the vantage
point of the you that is right here right now, looking back to that you in that
moment of difficulty, do you see yourself doing things that brought you closer
to who and where you want to be, or do you see yourself doing things that took
you further away? Rest in the knowledge that the vast majority of us, myself
included, see ourselves doing things that take us further away, that this is part
of being human, and we are still worthy of love and connection.
Cultivating committed action. Often, when we feel strong unwanted or
difficult emotions, theres a reality gapa discrepancy between what we want
and what we have in our lives. As best you can, bring to mind a moment
when you felt a reality gap. Choose a moment that feels okay for you to look
at in this context. (You can repeat this exercise with more painful reality gaps
as you learn and integrate these skills.) In this moment, Id like to invite the
you that is right here right now to imagine asking the you in that reality gap
What is it that you need? Simply listen and breathe (Pause and repeat
the question twice.) See if you can extend some small gift of kindness and
compassion to yourself exactly as you are. Now connect to one small thing
that you can do in the next couple of days to help you move closer to who and
where you want to be. Notice what difference this small action might make for
you and the people, relationships, and things that matter most to you.
Cultivating Defusion
The matrix and its primary functional discriminations can also aid in
gaining a functional understanding of how each of the six core ACT processes work. Here again, the key is using examples and illustrations that
are personally relevant, humorous, and memorable. For example, with
regard to defusion, I ask participants to come up with a couple of examples
of thoughts they might get hooked by and what their toward and away
moves might look like on a video camera. Once we have two examples, I
50
offer to demonstrate a defusion strategy for each example and invite participants to choose which ones Ill demonstrate. Generally, participants
choose to have me sing one of the thoughts to the tune of Happy
Birthday and to say the other in the voice of a cartoon character.
Common thoughts that people get hooked by include Im too anxious,
I might panic, and Im not confident enough to do that. For each unhelpful
thought, the toward move would be engaging in the feared action if
doing so is consistent with the persons values, and the away move would
be distracting by doing an activity not guided by values or opting out of
a values-consistent activity.
I demonstrate this by role-playing Ann, whose anxiety is a barrier to
going out, and Mary, whose lack of confidence is a barrier to going out.
As Ann, I might pretend to be the Roadrunner and bleat, Im too
anxious; I might panic! in a high-pitched voice while running across the
room and saying, Beep beep! This generally gets people laughing. I
then say that using this defusion strategy makes Ann laugh too, and she
feels so much better that she decides not to go out. Instead, she stays at
home and spends the evening surfing the Internet.
As Mary, I might sing the thought Im not confident enough to do that
to the tune of Happy Birthday. I then say that after using this defusion
strategy Mary feels even worse and less confident than she did before.
However, this strategy gives her a chance to connect to her values, and
she decides to go out anyway because its a move toward her values.
I then ask who did defusion from an ACT perspective. Was it Ann,
who felt much better but didnt engage in a toward move, or was it Mary,
who felt worse but engaged in a toward move anyway? People almost
always get this and realize that from an ACT perspective, its all about
living betterengaging in more toward movesrather than feeling better
by numbing or moving away from unwanted thoughts and feelings.
Although I might give people handouts with a variety of strategies for
each of the six ACT processes, I find that demonstrating defusion in this
way often stays in peoples minds because these strategies are a bit on the
wacky side.
51
The ACT Matrix
Back to the Functional Contextual

Point of View
Essentially, the matrix helps us and the people we serve come back
to the functional contextual basis of ACT again and again. We are ultimately trying to help others, and ourselves, live more in the top right
quadrant of the matrix.
With the matrix, ACT exercises are augmented by continuously
looking at toward and away moves and increasing awareness of how
certain contexts (both internal and external) may shift the likelihood of
engaging in particular actions. However, we can choose to act in a different way in any context, and what constitutes a toward move in one
context might be an away move in another. In this way, we help people
move away from rigid rule following, or pliance, to become conscious,
empowered choosers, creating lives that matter through ongoing
trackingnoticing whether applying a particular rule is effective or not.
Using tracking over time, people can become aware that, even in the
face of unexpected or undesired life events, they can still choose to live
in a values-consistent way. This approach has helped many people, me
included, redefine what a bad day (week, or month) is. The challenge
within the Serenity Prayer, outside of a religious context (to accept the
things we cannot change, to have the courage to change the things we
can, and to have the wisdom to know the difference), becomes increasingly workable as the matrix helps us see exactly what is and isnt within
our control.
Relational Frame Theory Through the

Lens of the Matrix
Through experiential exercises augmented by including matrix components, people (ourselves included) become increasingly aware of how language is a double-edged sword. We learn that it is not mental experiences
that are fundamentally problematic. We learn about the nature of the
mind and shift the primary focus of our attention to our actionsthat
which is within our control. The fact that we can relate anything to anything else becomes more apparent with repeated use of the matrix and
52
also when the matrix is used in a large group. Verbal processes such as
judgment, reason giving, evaluations, and comparisons become evident.
Supplementary metaphorical and experiential exercises can be used
in conjunction with the matrix to illustrate relational frame theory (RFT;
Hayes, Barnes-Holmes, & Roche, 2001). I generally do this work by
looking at how words have the capacity to make both our past and our
future very much alive in the present. I find it important to look at both
the ways in which language works well (e.g., we are able to read directions and understand warnings whether in written or auditory form) and
the ways in which it leads to suffering (e.g., constant comparisons and
how a single aspect of our context can remind us of a time when we felt
incredibly sad or anxious). I give personal examples of comparisons that
Im making in that moment. In any given room, I can notice people who
I believe to be more intelligent or attractive than I am, or who probably
have a better relationship history. In fact, Im willing to bet that you,
reading this chapter now, fit into at least one of those categories.
Unfortunately, youre probably so busy comparing yourself unfavorably to
others that you cant fully connect with that. We know from RFT that
values and vulnerabilities are two sides of the same coin. So with language we have the ability to make contact with both incredibly painful
and extremely pleasant elements simultaneously.
To show how randomly applicable language can be and how anything can become bad, I often share a personal story. Its about how Im
not married, and if I ever were to get married, even to someone I deeply
care about and could see myself spending my life with, I know for certain
that on that day I would think of my brother Shane, who died tragically
almost fifteen years ago. Id think about what age he would be, whether
he would have a partner, and how he would have felt on that day. And I
know that in that moment, I would feel his loss afresh and experience a
wave of sadness.
Even though I have the capacity to read directions, follow instructions, and book flights for conferences (and occasionally, but not always,
do this well), I have the capacity to suffer in a way that animals and
preverbal children dont. Something seemingly minute in my environment or context, something that might not even be noticeable to someone
else, can trigger an internal experience within me that can make a reality
gap in my life very evident and very painful. I believe that the matrix
normalizes this experience and shows it clearly. And with this awareness
53
The ACT Matrix
comes an opportunity for choice. Do I get sucked into these verbal processes and let them push me around? Or do I compassionately notice
how these processes impact me and mindfully choose an action that
brings me one step closer to the bulls-eye? In this way, the matrix puts
the principles of RFT into action.
Functional Analytic Psychotherapy from

the Matrix Perspective
One of the things I love about functional analytic psychotherapy (FAP)
is that it sees nothing as absolute or fixed. In the opening chapter of
A Guide to Functional Analytic Psychotherapy (Tsai, Kohlenberg, &
Kanter, 2009), which I highly recommend to anyone wanting to delve a
little deeper into the world of FAP, the authors give a number of descriptions of FAP from different sources. So I feel liberated to give my own
definition of FAP and share what it means to me and how I feel its relevant to people.
For me, FAP is about looking deeply at the ways in which we relate
to others and honestly reflecting on whether those are in alignment with
how we want to relate to others and ourselves in the world. Personally,
FAP has helped me be more authentic, genuine, caring, and loving in my
most important relationships.
Fellow practitioners have asked me about the differences between
ACT and FAP. I believe that some people who are extremely functionally
sensitive and courageous both in their lives and in the way they interact
with others or clients may not need FAP. For the rest of us, however, I
firmly believe that FAP supercharges any intervention we lead. The
matrix is a powerful tool to help people become aware of their clinically
relevant behaviors (CRBs), which are divided into CRB1s (problematic,
or away actions) and CRB2s (improvement, or toward actions). (See
chapter 4 for more on FAP.) With the general public, I stick to the matrix
terms away and toward, as ACT in a public context is always considered acceptance and commitment training, rather than as therapy, and
the words clinically relevant, while extremely useful in clinical settings,
may seem somewhat daunting to a lay audience.
54
I include this brief discussion of FAP because I believe that this

approach will greatly accelerate the changes you can promote in your
own life and in the lives of people with whom you share this approach. It
has been my experience that the more I model, eat, live, and breathe this
approach in my own life, the more people get it and implement it in their
own lives. This is far more effective than any particular strategy Ive
developed, no matter how many hours I may have spent on it. FAP can
help you maintain an overall functional contextual perspective thats
sensitive to the most minute changes in interpersonal contexts, and it
constantly challenges and encourages you to go one step further outside
your comfort zoneand thats where the magic happens. In my opinion,
any ACT or matrix exercise that looks deeply into how we relate to
others and the impact this has on relationships is informed by FAP.
Conclusion
This chapter will hopefully serve as a reference point on how to integrate
the matrix into work with the general public. At a time when people feel
that theyre doing more and more while enjoying less and less, an
approach that helps them learn strategies to manage thoughts and emotions more effectively while moving toward a life that really matters is
infectious.
This chapter isnt about knowing everything you need to know to
bring the matrix to the general public. The first thing and most important thing isnt something that can be taught. Its a willingness to look at
the barriers to bringing this work to the public that you might face, and
finding a reason for doing so thats big enough that you would choose to
take one step closer toward shining brightlynot because you have to,
should, or must, but because this work is worth having all of that stuff on
the bottom left side of the matrix if maybe, just maybe, you can help
people make meaningful changes in their lives.
References
Dahl, J., & Lundgren, T. (2006). Living beyond your pain: Using acceptance and
commitment therapy to ease chronic pain. Oakland, CA: New Harbinger.
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The ACT Matrix

Harris, R. (2009). ACT made simple: An easy-to-read primer on acceptance and
commitment therapy. Oakland, CA: New Harbinger.
Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2001). Relational frame theory: A
post-Skinnerian account of human language and cognition. New York: Kluwer
Academic/Plenum.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York:
Guilford.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy, second edition: The process and practice of mindful change. New
York: Guilford.
McKay, M., Forsyth, J. P., & Eifert, G. H. (2010). Your life on purpose: How to find
what matters and create the life you want. Oakland, CA: New Harbinger.
Tsai, M., Kohlenberg, R. J., & Kanter, J. W. (2009). A guide to functional analytic
psychotherapy: Awareness, courage, love, and behaviorism. New York:
Springer.
56
CH A P T ER 4
You, Me, and the Matrix: A

Guide to Relationship-
Oriented ACT
Benjamin Schoendorff and
Marie-France Bolduc
The matrix diagram, used as a tool to present and train individuals in a

functional contextual viewpoint, can also serve to integrate contextual
therapies other than acceptance and commitment therapy. In this
chapter, we describe how the matrix can serve as a powerful tool for
integrating a relationship-centered therapyfunctional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai, Kohlenberg, Kanter,
Kohlenberg, et al., 2009; Tsai, Kohlenberg, Kanter, Holman, & Loudon,
2012)into ACT-based individual and couples clinical work.
Weve been using the matrix diagram in our clinical and therapist
training practice since it was first devised by Kevin Polk, Jerold
Hambright, and Mark Webster. Weve found it incredibly helpful in
getting our clients and trainees to adopt a functional contextual viewpoint, which in turn has promoted broader psychological flexibility and
values-driven behavior.
In our ACT practice, we noticed occasionally getting stuck in a very
mind-y place, especially when doing defusion or values work. Wed get
lost in our heads (and our clients in theirs) and find ourselves moving
The ACT Matrix
away from a deeper connection with our clients and their suffering,
hopes, and aspirations. Although ACT, as presented in the classic
manuals, is a powerful intervention to help clients develop a more accepting relationship with their personal experience, we also noticed that it
didnt always get at the roots of our clients interpersonal difficulties, at
least as we practiced it then. Though clients came to struggle less with
inner experience and engage in more valued actions, progress in interpersonal effectiveness didnt always follow.
FAP is a relationship-centered contextual therapy that focuses on
the therapeutic relationship as the vehicle of clinical change by means of
reinforcement of improved in-the-moment behavior. FAP alerted us to
the importance of noticing interpersonal functions in the room. It helped
us better track and make use of the effects of our behavior on clients, as
well as the effects client behavior had on us. FAP offers the therapeutic
relationship as a training ground for improved interpersonal behavior
for both clients and therapists.
A Tool for Integrating ACT and FAP

Wed already started integrating FAP into our ACT practice when we
adopted the matrix diagram. Soon we discovered that it could serve as a
tool to integrate ACT and FAP.
The Importance of Interpersonal Processes

Difficulties in close relationships are implicated in many psychological disorders (see, for example, Whisman, Sheldon, & Goering, 2000).
Struggling against unwanted inner experience isolates people, whether
through the resulting avoidance of relationships or because it leads them
to pursue ineffective ways of seeking support. The outward forms of the
inner struggle often make others move away. For example, Jack, who is
depressed and expresses only dark thoughts, has seen his friends gradually distance themselves and lose touch. This is unfortunate, as poor
quality of relationships is a major risk factor for depression (Teo, Choi, &
Valenstein, 2013), is correlated with depression severity (Vittengl, Clark,
& Jarrett, 2004), and is a predictor of recurrence (Vittengl, Clark, &
Jarrett, 2009), whereas social support offers protection against depression
58
You, Me, and the Matrix: A Guide to Relationship-Oriented ACT
(Peirce, Frone, Russell, Cooper, & Mudar, 2000) and is a predictor of

recovery from depression (Lara, Leader, & Klein, 1997).
Furthermore, for a highly social species such as the human, relational values are at the center of most peoples lives. When the question
Whats important to you in life? draws blanks, the question Whos
important? nearly always works.
Modeling Intrapersonal and

Interpersonal Processes
The matrix is first and foremost a way to establish a functional contextual viewpoint. It enlarges the context of interest to include inner
experience, both aversive (suffering) and appetitive (values), and puts
workability center stage because it helps sort behavior in terms of its
effectiveness in moving toward whats important. The matrix draws
attention to the clinically relevant aspects of the context: those that play
a role in maintaining problematic behavior and those that can contribute to flexible values-driven behavior.
The matrix invites people to discriminate between actions engaged
to move toward whats important and actions engaged to move away
from inner suffering. It helps discriminate between experientially avoidant behavior, which according to the ACT model is one of the main
sources of psychopathology (Boulanger, Hayes, & Pistorello, 2010), and
valued actions, which in ACT are key to a meaningful life (Wilson &
Murrell, 2004).
The matrix is also an effective tool for helping clients notice in
session their inner experience and whether they respond to it (again, in
session) by moving toward values or away from unwanted inner experience. In therapy as in real life, there is rarely just one matrix in play. In
real life, peoples matrices interact with others matrices. In therapy, there
is the clients matrix, the therapists matrix, and how they interact. The
matrix is thus ideally suited to helping both client and therapist notice
interpersonal processes.
59
The ACT Matrix
The Matrix and Functional

Analytic Psychotherapy
FAP focuses on discriminating between in-session instances of problematic day-to-day client behaviors (in FAP called clinically relevant
behavior 1, or CRB1) and in-session instances of improved behaviors
that could make a positive difference when generalized to the clients life
(clinically relevant behavior 2, or CRB2). The two types of CRB map out
neatly onto the horizontal axis of the matrix, with CRB1s on the left
(away moves) and CRB2s on the right (toward moves).
Promoting Generalization
The relevance of the matrix to FAP work extends outside sessions to
problematic or improved daily-life behaviors. The matrix point of view
helps clients sort their behavior between sessions and, by increasing the
functional similarity between in-session toward moves and away moves,
promotes generalization of matrix sorting to clients everyday lives.
In-the-Moment Functional Analysis

FAP sees clients ability to identify the antecedents and consequences of their behavior as key to progress. Clients are encouraged to
perform three-term ABC (antecedent-behavior-consequence) analyses of
their behavior (FAP terms such analyses CRB3). Lets consider a client
named Rosa, who might identify feeling misunderstood (A) as an antecedent to the behavior of withdrawing (B), with the consequence that
her relationships feel unsatisfying (C).
As clients identify the three-term contingencies evoking their behavior, they open the door to responding to the antecedents in new ways and
moving toward desired consequences. So Rosa might identify the familiar antecedent of feeling misunderstood and instead respond to it by
sharing her feelings (improved B), leading to a stronger sense of connection with others (desired C).
Using the matrix can be of great help to clients in performing CRB3s.
The matrix is flexible enough to allow either outside events or inner
experience to be identified as either antecedents or consequences of
target behavior, whether away moves (CRB1s) or toward moves (CRB2s).
60
Thus, neither client nor therapist needs to get stuck on a given model of
causality and argue about whether feelings and thoughts or outside
events cause behavior. Depending on the context, either form of analysis can be helpful. The therapist helps clients gain flexibility in their
functional accounts by orienting them either to outside events or to
inner experience.
For FAP, CRB3s are also a way to promote generalization. The same
holds true when using the matrix. It promotes generalization of CRB by
inviting clients to notice away moves and toward moves in daily life and,
more generally, to spot the matrix in everyday experiences.
Using the Matrix in Relationship-

Centered Clinical Practice
Clinicians wishing to concentrate on present-moment processes can
invite clients to focus on matrix sorting tasks in the moment, especially
as they relate to the therapeutic relationship.
The FAP Rap

From the first session, we give clients a rationale for relationship-
centered work: The difficulties and unpleasant thoughts and feelings
you struggle with might show up in here, between us, about our work or
our relationship. This is not only normal and acceptable; it also represents an opportunity to work in the moment with whats showing up so
that you can learn ways of dealing with it that will help you go where you
want to go and get whats important for you in life and in your relationships. So it will be important for us to pay attention and share when
these things show up in here. Are you willing to work in this way? This
rationale, known as the FAP rap (Tsai, Kohlenberg, Kanter, & Waltz,
2009), is central to setting the stage. Its also an opportunity for clients to
give informed consent to relationship-centered work. In addition, we
spell it out in a letter. Beyond allowing clients to practice more effective
interpersonal behavior and get reinforced for it, the therapeutic relationship is thus established as a model of how an intimate relationship that
works looks and feels.
61
The ACT Matrix
Introducing the Matrix

Next, we introduce the matrix. There are a number of ways this can
be done. A quick and effective way is to show clients a matrix diagram
and say, We all have things that are important to us and things that
make us suffer in life. What these are and how we function with them is
unique to each of us. If youd like, we can look at how this works for you.
Next, we ask clients to name someone or something important to them,
or some inner difficulty or suffering that has been troublesome. Then we
may invite them to identify at least one action they do to move away
from their suffering and one action they could do to move toward what
or who is important. We also ask clients to name one away move and one
toward move we could see them doing in therapy (CRBs). We conclude
by asking for permission to ask if particular in-session behaviors constitute an away move or a toward move.
Spiky and Flexi

Playing around with the matrix, we derived cartoon characters
embodying moving away and moving toward: Spiky and Flexi
(Schoendorff, Grand, & Bolduc, 2011; see figure 4.1). When people move
away, they often become like Spiky, who tries his damnedest not to feel
what hes feeling. He tenses up and gets all rigid and spiky, making it
hard for him to notice who or what is importantexcept as rigid rules
full of have-tos. Spikys struggle makes others move away. It also makes
him more vulnerable and easily entangled with spiky people and spiky
things. When we notice ourselves getting spiky, we can choose to slow
down and make room for whatever were feeling, allowing us to contact
who or what is important and choose to move toward it. This is what
Flexi does. Flexi feels the same difficult stuff as Spiky. Hes just more
flexible around it and makes space in the service of moving toward who
or what is important to him.
62
Figure 4.1. Spiky and Flexi. The spikes represent suffering as well as moves
away from suffering. Whereas Spiky seeks to contract his experience of
what he doesnt want to think or feel, thus creating further spikes by struggling, Flexi makes room for what he doesnt want to think or feel, allowing
him to contact whats important in the situation and choose toward moves.
Weve found that these characters offer an intuitive way for clients to
get a sense of the felt difference between away moves and toward moves.
They also nicely illustrate the interpersonal functions of struggling,
which makes others move away or enables only connection in superficial
ways, and the functions of acceptance and valued living, which make
others more inclined to move closer and seek deeper connection.
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The ACT Matrix
Letting Clients See Your Matrix

When clinicians are willing to be open about their own matrix and
to authentically reflect the effects of client behavior on them, this can
help clients better evaluate the impacts they have on others. Bearing in
mind the potential aversive effects of revealing too directly the aversive
functions of clients CRB1s, or away moves, clinicians will carefully
choose how to titrate such reflections. One effective strategy when
addressing client CRB1s is to distance somewhat from the emotional
reaction the clients behavior elicits and immediately present an alternative (CRB2, or toward move) that can be reinforced. Well illustrate this
technique (and many others in this chapter, with a dialogue. In these
dialogues, the therapist is a woman, and the client is a man.
Client: I dont think therapy can help. I dont believe anything
can help, and I dont believe youd care if I werent
paying you.
hen you say that nothing will work, Im noticing some
Therapist: W
tension in my throat, and also some sadness, shame, and
irritability. I have the thought that I dont know how I
can help you. Do you think something similar might
show up for other people in your life?
Client: Sure. Everybodys dropped me. And now you want to
drop me too?
Therapist: No, its important to me to be there for you. I can see
that its because things are so painful for you right now
that youre being like Spiky. I wonder if youd be willing
to let your mind say, Nothing will ever work, and let me
know that you too are committed to our work.
Client: Its nice to hear you say that youre committed to being
there for me.
Therapist: When you say this, it makes me feel hopeful that I can
help you.
In this dialogue, the client was first moving away from despair by
voicing disbelief and pushing the therapist away. The therapist let him
see the interpersonal functions of that statement and offered a possible
64
parallel to problems in day-to-day life, thus orienting him to a possible

CRB1, which he validated. Stating her values, the therapist then suggested a possible toward move (CRB2). When the client produced a
toward move approximating the suggested CRB2, the therapist sought to
reinforce it by letting the client see how she felt (i.e., the interpersonal
functions of the toward move).
In this way, the therapeutic relationship and what happens moment
to moment between client and therapist can become an effective training ground for more workable relational behavior based on authentic
reactions by both client and clinician.
Using the Clinical Relationship for

In-the-Moment Sorting
Broadly speaking, clinicians can help clients pay attention to CRBs
showing up in the room and the clinical relationship by asking if an in-
session behavior is a toward move or an away move. Well illustrate this
with a continuation of the previous dialogue.
Therapist: Would you say that what you said just now, that it felt
nice to hear that I was committed to helping you, was
an away move or a toward move?
Client: I guess a toward move.
Therapist: What was important to you there?
Client: Well, its actually really hard for me to accept other
peoples help. I guess I wish I could do it more so I didnt
push people away.
Therapist: I felt like you were letting me come closer when you said
that. I know that, for you, asking for helpand then
accepting itis a toward move, and a courageous one.
I want to support you in doing more toward moves if
thats your choice. So what further toward move could
you do right now?
Client: I guess I could ask you to give me some clues as to what I can
do when I feel so down that I just want to curl up and die.
65
The ACT Matrix
Therapist: I do want to help, and heres something thats known

to be effective for depression. (Presents an activity
record sheet that invites clients to note if an action was a
toward or an away move; the worksheet can be downloaded
at http://www.newharbinger.com/29231.)
The client has identified asking for help and accepting it as a toward
move (CRB2), and the therapist seeks to reinforce it by responding in a
natural way to the clients request. Note that for a different client, or for
the same client in a different context, asking for help might be an away
move, which the therapist may not want to reinforce.
Defusion
The matrix also helps promote defusion and can easily be blended
with traditional ACT exercises. We commonly use the Hook metaphor.
Clients are invited to notice if some aspect of their inner experience,
whether its a thought, an emotion, or a bodily sensation, is a hook for
them. If it is, theyre asked to notice what do they typically do next: a
toward move or an away move.
Therapist: So thats what hooks are. What do you think your
hooks were earlier?
Client: A big hook for me is that nothings ever going to
change.
Therapist: You noticed that hook. Good! And when this hook
shows up, what do you do next?
Client: I become sad and angry, and I just want to shut the
whole world out.
Therapist: You notice what you do next. Good! For me, the hook is
that Im not a good enough therapist. If I dont notice
the hook, I may just shut down or propose an exercise
right away. Noticing the hook helps me notice what I
tend to do next, and notice if I can see what the person
I want to be would do next, which is generally a toward
move. How about you?
66
Client: Hmm. I think the hook doesnt come alone. There are
many others on the line. Like People dont care about
me, and Im all alone anyway.
Therapist: Ouch! Painful hooks. And what do you do next when
these show up?
Client:
The same. I withdrawget crabby.
Therapist: Okay, you noticed that. And what would the person you
want to be do when these hooks show up?
Client: Not push people away, so
Therapist: Seems to me youre biting less right now.
Client:
(Laughs.) Yeah, but thats only because youre helping
me. I dont know if I could do it out there.
Therapist: How about seeing if you can notice hooks and what you
do next between now and next week?
Client: Sure.
The Hook metaphor contains the two important steps of defusion:
noticing thoughts or emotions as thoughts or emotions, thereby affording
some distance from them, and getting at the function of individual
thoughts or emotions in their particular context, using the question What
do you do next? This highlights the behaviors that follow from biting the
hook of that particular content and thus effectively promotes CRB3.
Acceptance
Inviting clients to describe what shows up in the lower left quadrant
of their matrix is an effective way of promoting acceptance. The character Flexi is also a versatile image for promoting and discriminating acceptance in the moment.
Therapist: When you talk about noticing your hooks and not
biting, would you say thats more like Spiky or Flexi?
Client:
Like Flexi. Its when I bite that I become like Spiky.
Therapist: Its great to see you make space for these hooks without
biting. See if you can notice how you do that, and
67
The ACT Matrix
perhaps explore doing it between now and next week

when thoughts and feelings of despair show up and
entice you to bite.
When asked to describe their feelings or bodily sensations in an
aversive situation, some clients are initially unable to respond. Some
locate all sensations in their head, as if cut off from the rest of their body.
It may look like a phobia of inner experience or an inability to name
inner experience. Many such clients suffer from an unstable sense of self
and may find contact with their bodily experience threatening. In
working with this population, one of us (Marie-France Bolduc) thought
of adding a layer of experience around the matrix (see figure 4.2). In the
upper part of the matrix, this layer comprises five-senses experiencing,
and in the lower part it extends beyond mental experiencing to inner
experiencing. Inner experiencing points to how having a particular
thought or image feels and where in the body it shows up.
FIVE-SENSES
EXPERIENCING
AWAY
AWAY MOVES
TOWARD MOVES
WHAT I DONT WANT

TO THINK OR FEEL
WHO OR WHAT IS
IMPORTANT TO ME
MENTAL
EXPERIENCING
INNER
EXPERIENCING
TOWARD
POTENTIALLY
VALUED
LIFE DOMAINS
INTIMATE RELATIONS
FAMILY
PARENTING
FRIENDSHIP
SOCIAL RELATIONSHIPS
LEISURE
WORK
TRAINING/LEARNING
COMMUNITY
SPIRITUALITY
SELF-CARE/HEALTH
Figure 4.2. The matrix with an added layer of experiencing. The inner
experiencing layer allows clients to discriminate between bodily sensations and thoughts and images and can help them contact how it feels to
have a particular mental experience.
68
Therapist: So when this thought that nothing will work shows up,
you become sad and angry. Whats that like?
Client:
I dont know. I just get really mad and I despair.
Therapist: Where does this go in your matrix?

Client: Bottom left, for sure.
Therapist: Yes, thats stuff you dont want. But is it mentalthe
thoughts or images themselvesor is it also what it feels
like to have them in that moment?
Client: Its both I guess. Its how they make me feel. It grips me
here (pointing at his chest), and I feel this weight there
(pointing to his upper belly). I cant stand it!
Therapist: So thats your inner experience of feeling sad and angry?
Client:
Yes. So it goes there? (Points to inner experiencing.)
Therapist: Yes. Often thats the biggie. Thats what we really try to
move away from. Not so much the words or images, but
how they make us feel inside. Thats how we become
like Spiky, by contracting our inner experience so as to
not feel it.
Client:
Yep, thats what I do.
In our clinical practice, weve also noticed that when clients have
difficulty or refuse to contact inner experience, training their attention
toward five-senses experiencing can help them gradually open up to their
bodily sensations. In this manner, clients can progressively learn to recognize their feelings and develop a more stable sense of self.
Values
Values work in ACT, particularly values clarification, can become a
verbal minefield. Traditionally, values work gets pushed back toward the
end of therapy, when progress with defusion and acceptance make it less
likely that client and therapist will get stuck. The matrix can help simplify values work by recasting it in terms of discriminating between
69
The ACT Matrix
toward moves and away moves, allowing values to take center stage from
the get-go. Using the word important rather than values can protect
both client and clinician from falling into wordy confusion. A question
as deceptively simple as What would the person you want to be do in
this situation? can lead to the immediate derivation of valued action.
Here too, the therapeutic relationship provides a privileged context for
in-
the-
moment derivation and engagement in moves toward whats
important (CRB2). As the most important values often involve relationships, this can be evoked by the therapeutic relationship itself.
Therapist: I noticed that when I told you I cared about you and
was wondering how you had been doing over the week,
you changed the subject.
Client: It makes me feel uncomfortable when you say that you
care about me.
Therapist: I appreciate you sharing what you genuinely feel. Weve
seen how receiving other peoples care is difficult for
you. But would you like to be able to open up to other
peoples care and affection?
Client: Well, my ex-wife complained I always made jokes when
she tried to say she loved me.
Therapist: And what would you like to be able to do?
Client: I wish I could be warmer, not so distant.
Therapist: Okay, how about now? Can you open up to the fact that
I care about you and wonder how youre doing during
the week?
Client: Thats nice (Pauses and chuckles.) Its a little hard to
open up to it.
Therapist: And when you do, what do you notice?
Client:
Fear, and also a warm feeling in my chest.
In that exchange, the client is moving toward his relational value of

opening up to other peoples affectionnot through elaborate values clarification, but through in-the-moment embodiment of his relational values.
70
Perspective Taking
The matrix trains flexible perspective-taking skills. We do this work
by inviting clients to adopt the matrix perspective (discussed in chapter
2). In the therapeutic relationship, we invite clients to take our perspective and describe what they would experience if they were the therapist
and we were the client. Once the skill has been trained in the therapeutic relationship, it can generalize to the client taking the perspective of
significant others by taking the perspective of their matrices.
Another effective way to train flexible perspective taking is inviting
clients as they are here and now, in contact with their matrix, to imagine
being teleported to a difficult situation and noticing their matrix in that
situation. Being aware of what shows up in the situation, is there something they, as they are here and now, could tell themselves, as they will
be there and then, that could help? This dialogue can lead to an exploration of self-validation strategies, gently returning attention to whats
important and choosing action. The therapist can conclude the exchange
by asking clients how probable they think it is that they, as they are here
and now, will be able to go and assist themselves there and then.
Special Clinical Skills

This section briefly outlines a few clinical skills that weve found useful
in our clinical and training work.
Noticing the Toward in Away Moves

At first, some clients will see everything they do as away moves, and
their minds will beat them up for it. Clinicians can help clients notice
toward moves within away moves. Because few behaviors are purely away
or toward moves, we can point, for example, to the self-care dimension
within many away moves. For example, a client may see not accepting an
invitation to Friday night drinks as an away move. However, it may also
be a move toward resting at the end of an intense week. Framed as a move
toward self-care, the behavior is thus pulled to the right and starts acquiring appetitive functions that make it more probable that clients will start
choosing additional behaviors on the right. In our example, this may lead
71
The ACT Matrix
to a broader repertoire of self-care moves, which could now extend to

exercising more regularly or more readily accepting invitations.
Clinician Self-Disclosure
Through the matrix, clinicians may choose to self-disclose if this is
done in the interest of helping clients better identify the interpersonal
functions of their own behavior or as a way to model processes and let
clients contact their shared humanity with the therapist. A clinician
could thus choose to disclose that shes feeling anxious because shes
awaiting news of the outcome of an operation a sick relative is undergoing. She could also choose to disclose that when the client rejects her
praise, she notices feeling pushed away.
Sharing Therapist Toward and Away Moves

When feeling stuck, in addition to disclosing their inner experience,
therapists can share what their hooks are and what an away or toward
move could be in the situation. Not infrequently, therapy gets stuck after
therapists engage in away moves. Candidly admitting what the away
move was and inviting the client to share how this move impacted him
can get therapy moving again and engage the client in a conversation
aimed at defining more effective therapist behavior. This conversation
can be part of a joint case conceptualization (see chapter 11) and also
gives the therapist a chance to model engaging in a functional exchange
around getting, receiving, and acting upon interpersonal feedback.
Matrix Spotting
An effective way to promote generalization of behavior practiced in
session is inviting clients to see if they can spot the matrix in their life
outside of sessions, and especially in interpersonal relationships. We
sometimes tell clients that now that theyve started looking through the
matrix, they wont be able to unsee it no matter how hard they try, and
that it will start popping up in many life situations.
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Homework
When using the matrix, homework isnt called homework; instead,
its home practice. Its simply about noticing, not about having to do anything in particular. In addition to ensuring client compliance with
homework (as long as they commit to noticing), its also an excellent
way of working through pliance and counterpliance issues.
Couples Work
Space precludes a thorough discussion of how to use the matrix for
couples work. However, many of the strategies outlined above can be
used with couples; therefore, we will briefly sketch how they can be
adapted to couples work.
Setting Up
As we introduce the matrix, we get each partner to fill out an individual matrix, while we often fill in their matrix as a couple. Each partner
writes his or her own values, suffering, and away and toward moves as
theyre identified, and those they have in common are recorded on the
couples matrix. (See also the Second Loop Around the Matrix, in
chapter 14, for a discussion of shared matrix work.)
Combining Personal and Couple Values

The goal of therapy can then be set as combining whats important
to each partner into whats important to both as a couple, and supporting
both partners in their ability to choose to engage in both individual and
couple-related toward moves even in the presence of unwanted inner
experience. An effective way to tease out relational values is the Cereal
Box metaphor.
Therapist: Imagine youre in the shop of all possible relationships.
Theyre lined up on shelves like so many cereal boxes.
You can read the ingredients on the boxes and pick your
ideal relationship. There are two columns for the
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The ACT Matrix
ingredients: one for what each person brings to the

relationshipwhat each would do. Which ingredients
would you choose?
Noticing Workable and Unworkable

Behaviors
The therapist gently invites each partner to identify his or her toward
and away moves, taking care to encourage each partner to link to both
whats important and what he or she doesnt want to think or feel, and
then asking the other partner how that behavior works for him or her.
Guided by the therapist, both partners can then discuss more effective
behaviors that would better take into account workability, and the
impact of their behaviors on each other.
Perspective Taking and Couple

Communication
The matrix is well suited to helping partners become more aware of
each others perspective. The Fence metaphor can help.
Therapist: When we discuss the content of our matrices, its easy
to lose perspective and waste time looking for the
truth. When were in conflict, its a bit as if there was
a fence dividing two gardens. We can lose precious time
arguing about the color of the fence: Its green! No,
its blue! Only when we look from inside the other
persons matrix can we see that it looks different
depending on which side of the fence were standing on.
When each partner describes his or her own inner experience in
terms of the matrix, this also has a distancing quality for both partners
that makes it easier to create space for the other partners perspective.
Both partners can then be invited to describe how things might appear
from the perspective of the other persons matrix.
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Couples Home Practice

The matrix provides an effective framework for setting couples
home practice. Partners are invited to see their relationship as a garden
in which they can choose what they tend to. In session they can start
practicing ways of watering what they want to see grow, and then between
sessions they can explore watering these seeds. Here again, the main task
is noticing when the matrix shows up in each partners experience, and
whether they choose to move away from discomfort or toward whats
important to them in the relationship.
Conclusion
In this chapter, we illustrated how the matrix could be used to integrate
relationship-centered strategies from FAP into ACT-based interventions,
and as a tool in couples work. We believe that the matrix is ideally suited
to integrating exercises and procedures from other approaches with
ACT-based interventions, as long as this is done in the service of moving
toward whats important (i.e., under appetitive control, rather than aversive control of moving away from discomfort). We hope this chapter has
given you a taste for using the matrix as a flexible cue for therapists
engaged in relationship-focused work, helping clients move toward the
life and relationships they want.
References
Boulanger, J. L., Hayes, S. C., & Pistorello, J. (2010). Experiential avoidance as
a functional contextual concept. In A. M. Kring & D. M. Sloan (Eds.),
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of Abnormal Psychology, 106(3), 478482.
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Peirce, R. S., Frone, M. R., Russell, M., Cooper, M. L., & Mudar, P. (2000). A
longitudinal model of social contact, social support, depression, and alcohol
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CH A P T ER 5
Rolling Out the Matrix,

Rolling Back Addiction
Mark Webster
This chapter is mainly a story about the development of a systematic

group approach to addiction treatment based on the matrix. The matrix
was coinvented during the development of a new approach to addiction
treatment in the city of Portsmouth, UK. The process took place over
five years, starting in 2007, during which time the addiction services in
Portsmouth evolved to become firmly based on the matrix model. What
follows is an anecdotal account of the journey we undertook and the
cultural change in addiction services provided by the city.
At this point, I need to acknowledge the vision of the commissioners
who were willing to support the groundbreaking development of a new
approach to treatment. Id also like to take this opportunity to thank the
many workers and clients who contributed to the development of the
model and the services in Portsmouth. You are too many to name, and I
am grateful for all your contributions.
What Is Addiction?
The term addiction is increasingly applied to widely different situations, ranging from substance misuse to gambling or sex to shopping and
even to ice cream consumption. What this tells us is that addiction is not
The ACT Matrix
a single condition that can be defined in the way that a disorder like
depression might be. Therefore, we need to look at addiction more as a
category of disorders that can have widely ranging differences in presentation and underlying cause. There is extensive comorbidity with traditional mental health conditions and overlap with serious mental illness,
often referred to as dual diagnosis. It is a kaleidoscope, and a principle-
based model seems the only realistic approach.
Since this is not a chapter on addictions per se, I am going to limit
the use of the term addiction to describe typical behaviors that are
involved in maintaining a strong physical dependency on a chemical substance. Typically, this involves substances that are illegal in the UK at
this time, such as opiates, cocaine, and amphetamines. However, substance dependency in the UK more often involves legal substances,
including alcohol, nicotine, and prescription drugs, such as the benzodiazepine family, and such addictions are also addressed here. (I will leave
caffeine out of the discussion!)
As mentioned, the term addiction is often applied more widely to
describe behavior that does not involve ingesting a mood-altering substance, for instance gambling or sex. It can be taken even further to
describe engaging in a variety of behaviors compulsively, such as shopping or spending, and even to describe our Western culture, as in the
label addictive society. The matrix will work equally well with these
compulsive addictions, as it does not require the focus on physical
dependence that is so heavily emphasized in the treatment of substance
misuse.
The Context of Addiction Treatment in

the UK
At this time, there is a model of treatment provision in the UK based
around specialized treatment facilities purchased locally, with services
provided free of charge at the point of delivery under the National Health
Service ethos. In 1998 a specialized regional health authority was set up
within the National Health Service to coordinate the overall approach
to addiction, which was becoming a more widely recognized social
problem, especially as regarded criminal activity.
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Rolling Out the Matrix, Rolling Back Addiction
Access to treatment operates under a system of referral whereby the

client receives a comprehensive assessment from a specialist in substance
misuse and a treatment plan is drawn up. The client then attends a specialized treatment center, usually some form of community drug team,
where another assessment takes place that is more specific to the intervention. These teams are usually centralized, and waiting times can vary.
Treatment itself has mainly focused on prescribing the heroin substitute methadone, and more recently buprenorphine, both of which work
on opiate receptors. It has been mainly a harm-reduction strategy in
which people are encouraged to taper off the methadone and undergo
detoxification or attend residential care. Once people are substance-free,
their treatment is regarded as complete and they are discharged with
very little aftercare. Previously, the main community treatments available have been through 12-step fellowships, such as Narcotics Anonymous
(NA) and Alcoholics Anonymous (AA). Additionally, there have been
community day programs or centers that can be freely accessed, as well
as counseling. Level and quality of services provided varies widely across
different regions.
Initially, treatment was focused on drug problems, with alcohol
treatment being more systematically addressed only since 2008. The two
streams arent yet fully integrated across the country, contributing to a
system of treatment that is fragmented and made up of multiple modalities. Accessing treatment can be a minefield for the client.
Client Group
People presenting to the system have usually reached a fairly desperate
situation in life, often referred to as rock bottom. This is a specific incident or moment that shocks people into action, such as a hospital admission, or having children removed by social services, or loss of a job.
Circumstances vary widely, and for many people these events just fuel
further substance use. For each individual, the rock bottom is personal
and comes after many, many years of sliding into an increasingly worse
condition. Clearly, such people need a model of treatment that is simple
and well organized.
What this means when considering a treatment model is that the
system is usually dealing with people whose physical and mental health
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are at an extremely low ebb. In most cases, their lives are chaotic and
filled with all sorts of difficult problems, and their support systems have
disappeared. People who present for help usually have a high level of life
difficulty and low access to resources. It is a very tough starting point,
and we can expect many relapses as people progress through the journey
of recovery.
This places an emphasis on engagement, and particularly the use of
the Yes, and? skill (discussed in chapter 1). People who enter treatment
are typically feeling unsafe and out of control in daily life, and they also
belong to a social group that is heavily stigmatized. For that reason, it is
particularly important to create an environment that is safe and interesting for new clients. In fact, clients often report that having a safe place
really matters, and that being with a group of similar people is a relief
from the stigma experienced elsewhere in the course of their recovery.
First Attempts in Portsmouth

It was against this background that the initial work in Portsmouth began
in an effort to provide an alternative for people who had been through
the existing services many times and kept reappearing for treatment.
Unfortunately, this type of revolving door phenomenon is an all-too-
common problem in addiction treatment. Our task was to help people
move on, creating some lasting gains for the services.
The initial projects were located in the detoxification unit and the
community drug team, which had mainly prescribed methadone and
prepared people for detox. Since clients in these locations had usually
been through the system many times, most were initially skeptical about
attending another group. Often they attended just to comply with the
requirements of their treatment plan, so initially they would not put a lot
of energy into participating.
The format of the new groups required every member to process
examples on the matrix. Seeing examples being processed by others
allowed new people to identify with common, shared problems, and the
focus on values helped them quickly realize how different the matrix
model is, leading to greater engagement.
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A System Based on Values

From the beginning, we were sure that the new intervention needed to
be focused on recovery, and that basing the system on the values component of acceptance and commitment therapy could be a way to do that.
We understood that it was not enough to get people to stop using drugs
and practice relapse prevention. To recover from addiction, they needed to
build a life worth living, and values are the perfect basis for that.
It was also clear that resources were limited and that financial pressure in the public sector meant any growth in budgets was unlikely. In
fact, it was far more likely that budgets would be cut. Therefore, we had
to create a financially efficient group model of treatment. Since there
was no group model of ACT at the time, we had to innovate.
Group Treatment
My own background was ten years of experience with dialectical
behavior therapy (DBT), which is where my interest in behaviorism
started, as well as an interest in ACT fueled by my dissatisfaction with
the symptom-first approach of DBT. I had already run a few ACT-like
groups focused on the traditional six components of the hexaflex, but
with limited success. I was ready for something more effective and went
over to visit Kevin Polk, at the Togus VA Medical Center in Maine. I
brought the iView format, as it was then called, back over to the UK and
started using it in groups, but it proved to be confusing for clients.
Early on, we understood that the model needed to be simple and
visual because clients are in such a state of disarray when they enter the
treatment setting. The elements of noticing were there in iView, along
with acceptance and defusion, but the tool was not clear enough. We
could see that we were on to somethingand that it was not yet the
finished article. Fortunately, enough clients started engaging with the
approach and making strides to recovery that we were able to maintain
funding for the project.
The Grid
When I was at Togus, we improvised a role-play in which the client
was visually presented with two choices. This was the first time I had
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The ACT Matrix
clearly observed a client faced with a discrimination task, and I was

struck by how effective it was. I remember christening this the hingeaflex. When I got back to the UK, we started using it in supervision under
the name the grid, which looked exactly as the matrix does today, but
with different labels. Kevin Polk and I were Skyping regularly during this
phase, and somehow the diagram evolved to use the discriminations that
exist today. Kevin called his diagram the matrix, and I called mine the
grid. Later we settled on one name.
Once I started using the grid with clients, there was a visible lift in
their levels of engagement and progress. People were responding to a
values-based approach, and we were clearly on to something. It was so
popular that we started producing a number of graduates who needed
more of an aftercare approach. Happily, we were able to conduct a group
in a community center, and it became the template for our current group
format.
Group Format
By this point, we were using the standard matrix diagram with the
two discrimination lines and four quadrants and getting clients to sort
their experiences onto the diagram. Next, we built a structure for the
group that allowed us to focus more clearly on some of the individual
components of ACT, such as values and acceptance. A structure for the
groups emerged in which we began with mindfulness, then sorted examples on the matrix, and then did an activity around one of the components. We still use this standard structure today, though we leave out
formal mindfulness with drop-in groups. We use the standard homework
statement at the end, inviting people to either notice where they are on
the matrix or not to bother with the homework, as people often dont like
homework and its all the same to us. These are all written up in the
manual 60 Ways to Use the Matrix, which is unpublished but available
from me by e-mail. (Please send requests to mark_swest@yahoo.ie.)
Group Guidelines
As the approach gained popularity, we started to diversify the locations where we ran groups, so we needed to have a clear set of guidelines
for groups that were independent of the setting. These guidelines were
82
developed by the service users using a toward and away approach until
we arrived at a set that seemed to work (which is included in the manual
60 Ways to Use the Matrix).
Decentralized Groups
The number of groups we were running continued to grow, and we
were running more and more groups in the community. One of the
groups we started was in the local general hospital working in conjunction with the Alcohol Specialist Nurse Service, only the second such
service in the UK at the time. We set up an integrated psychosocial
interventions service offered in the wardthe first program of its kind in
the UK.
This was another pivotal moment. Although it had been a chance
decision to set up the groups in the hospital, we immediately started to
notice how popular this was with patients. When we asked them about
their experience, they tended to give similar responses. They liked
coming to the hospital because it was perceived as a normal environment, allowing them to avoid the stigma associated with specialized
addiction centers. Furthermore, many patients with alcohol problems
preferred not to be treated in the same groups as people with drug problems. We were also able to bypass the lengthy referral system so people
could self-refer after a relapse. We were surprised by how successful this
was, as we had all worked in addiction services for a long time, and this
didnt conform to the usual pattern.
Excluded Clients
Because the first ward-based program was a pilot project, it underwent an external audit. When we looked at the results, we had 100
percent satisfaction from those attending the matrix groups. This got us
thinking about the basic assumptions in the existing model of
provision.
Another group we were running, in a community center, had also
started attracting people who were in recovery but not attending specialized services. They were in differing stages of recovery and did not want
to be associating with people who were still involved in using. We realized that there was a large group of people who wanted recovery-based
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The ACT Matrix
treatment but did not want to be involved in traditional services that

focus on the substance rather than on the person. Some were from 12-
step fellowships and some were not.
Diversified Locations
The success of the hospital program allowed us to expand the alcohol
service, and we decided to base groups in community locations. We
wanted to see if we could expand the service and include clients who
wanted the recovery aspect of treatment rather than the drug or alcohol
aspect.
This meant working with other agencies and running groups on
their premises with a direct referral pathway. The first agencies we looked
at were Probation, Social Services, Mental Health, Primary Care, and
Housing. In each instance we met with the local managers and staff to
identify the needs of the client group and set up times for groups to be
run.
Generally, these groups flourished, and like the hospital groups they
were well attended and valued. The few groups that didnt succeed were
closed down, and for those, we went back to the drawing board, did a
toward and away analysis, and tried again. Numbers of people attending
the groups continued to grow, and there was a demand for different levels
of groups so the work could be progressively more challenging.
Stages and Barriers

We found that participants naturally progressed through stages. In the
first stage, people would present with the consequences of their addiction
being the main factor. Early treatment involved learning to be in a group
(maybe for the first time), understanding the values-based approach of
the model, and starting to engage in some early progress toward what is
important.
Once people had engaged with the work and settled in, there seemed
to be a second stage in which obstacles and barriers to progress started to
show up. As stated earlier, there is so much variety in clients with addiction that just about anything could be an obstacle or barrier, and most
people had several.
84
Additionally, the intermediate-level groups were usually held in a

different location than the one in which the home group met, where
people first presented, creating another set of difficulties. This is one of
the areas that we are still working to improve. We have noticed a tendency for people to become comfortable in their home group and not
move on to the higher levels. Our hypothesis is that a lot of the early
issues that bring people to treatment are moves away from the consequences of their addiction.
Treatment as Aversive Control

In the ward-based program, we figured out what some of the relapse patterns were about. People coming into the program had been admitted to
the hospital with serious health problems as a result of their alcohol use.
Typically, these were problems with the liver, heart, or stomach, which
could lead to an expensive stay in intensive care.
We noticed that people would come into the program and work hard
in the early days, but then their engagement would taper off. When we
analyzed this, we realized that moving toward health was, in fact, moving
away from the symptoms of bad health. Therefore, as soon as peoples
symptoms went away, so did the contingencies for engaging in treatment,
leaving no appetitive control.
This allowed us to better understand the extent to which aversive
control dominates in this client group. You might even say they are
addicted to it. We realized that there are three main aversive control
hurdles that have to be overcome in the journey of recovery:
Movement away from the consequences of using, which tapers
off after engagement in treatment
Resumption of negative emotions suppressed by drug or alcohol
use, which emerge as treatment progresses
The difficulties of change, developing new behavior, or entering
unfamiliar environments (for example, going back to college), as
people develop a life worth living
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The ACT Matrix
This helped explain the high rates of relapse and low rates of success
in the harm-reduction approach, a result of people switching from one
form of aversive control to another as treatment progressed.
Our analysis is that harm reduction helps people move away from
the consequences of their addictions. For example, these might be health
consequences in the hospital, family consequences in social services, or
criminal justice consequences in probation. In fact, hospitals, social services, and the criminal justice system define good outcomes by the
absence of those very consequences, so the dominance of aversive control
is perpetuated by the institutional culture of these agencies and the government bodies that fund them. Government outcomes normally represent a successful use of aversive control, without any appetitive element.
And, of course, standard mental health outcomes are defined in a similar
fashion.
What we observed in stage one is that people would participate in
treatment and successfully escape the consequences of whatever got
them to engage with services in the first place. Then the services would
typically be withdrawn as if treatment were a success. However, once
people had engaged in treatment and reduced the frequency of their
initial presenting behaviors, they were left with the same unwanted
thoughts, feelings, and physical sensations that their addiction had
helped suppress. So as the aversive control of engaging in treatment
started to fade, a new set of aversive stimuli that would drive people back
into addiction emerged. No wonder people relapse
its a double
whammy. I call this the relapse shuffle.
Those who stayed with treatment, perhaps because some form of
appetitive control had been established, were then faced with the third
set of obstacles to recovery: the challenges of meeting new people, going
to new places, and trying new things in a community that stigmatizes
addiction. It became clear to us why people were not progressing into
stage-two and then stage-three work, which is about reintegrating into
the community. People would instinctively want to move away from that
and stay in the home group, which is more comfortable and safe. This
corresponded with another observation: that people typically stay in
their treatment settings and do not move on and reintegrate into the
community. Usually, clients were blamed for the failure, whereas in fact
we were not providing the necessary tools to help people overcome these
weighty obstacles.
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An Unrelenting Focus on What Is

Important
From this insight, we developed an unrelenting focus on appetitive
control and made sure that all the groups we conducted were training
clients to develop new repertoires that were under the control of positive
reinforcement. We changed the structure of the groups so that we started
with a round of introductions in which clients stated what was important
to them, and then we did a second round of introductions in which we
asked each client to talk about what is in your heart right now. This
allowed us to tap into the most effective streams of appetitive control for
each individual and also created a group culture that was more focused.
We also changed the way in which we worked with positive reinforcement by breaking it down into three parts of a powerful toward
statement, using the acronym WILD:
WIWho or What Is Important. Finding the deepest connections
of meaning and purpose in an individuals life is crucial to
cultivating appetitive control.
LLiving. This is the opposite of the corpse test or dead mans
rule, which states that any objective that could be achieved by a
dead person cannot be a workable therapeutic objective for a living
person. An example of an objective that doesnt pass the test is not
feeling bad. We ask people to express their statement as an activity
or behavior so it can be used to build new behavioral patterns that
are not under aversive control.
DDirection. Instead of goals, which are short-term and disappear
when reached, we use the idea of directions and the metaphor of a
compass to support long-term changes that create stability.
Focusing on appetitive control became the truth criterion for the
project. Now we are able to monitor our own behavior in terms of toward
and away moves in setting up appetitive control contingencies for our
clients. This allowed me to develop a system of measurement that assesses
how individuals are progressing in their recovery, whether they are in the
correct level of group, and whether the groups are being run effectively.
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The ACT Matrix
iGro
The Individualized Generic Recovery Outcomes (iGro) is a system
of measurement I developed based on the D1 (sensory vs. mental experiencing) and D2 (toward vs. away) structure of the matrix. Each dimension is based on a simple scale of 1 to 5 scored each time there is contact
with a client. The information is then entered into a database that allows
client progress through recovery to be charted at a push of a button. It
allows group leaders to make systematic assessments of clients progress,
rather than relying on feel or opinion. When we started to apply the
system, we discovered that our opinions were not very accurate, compared to the scales!
Challenges
We developed challenges as one of the key components of the
program because this effectively tells us about the level of aversive control
being maintained. Including challenges allows us to monitor each client
to ensure that everyone is learning to overcome barriers and obstacles.
The term challenges is very intuitive for group members.
Challenges are set monthly in community programs and weekly or
biweekly in residential programs. The challenges are individualized
behavioral tasks that require each person to confront a higher level of
aversive control than previously, like raising the bar on a high jump a
notch at a time. Through the systematic application of challenges, each
person both develops new behavior under appetitive control and engages
in exposure work around the internal aversive stimuli that had previously
been generating away behaviors. Common challenges involve dealing
with difficult interpersonal situations, sorting out money issues, enrolling
in courses, applying for a job, or engaging in a new leisure activity.
Activities
We realized that we had to carry the focus on what is important
through to group activities. We now provide many more activities that
are focused on developing appetitive control, and have even created an
activities book called Take a Walk on the Wild Side that contains thirty
ways to work experientially in groups with the ACT components. We
88
also noticed that people did not like talking about their away behaviors,
as doing so is also under aversive control due to the high levels of stigma
and shame that surround addiction. Consequently, we have increased
the level of aversive stimuli in group activities to provide another opportunity for exposure work and progress in facing aversives. For example,
not talking about away behaviors is an away move, so we include an
activity in which we put clients into small groups and get them to generate lists of away behaviors and think about which ones apply to them.
Then we ask them to think about and list the aversive stimuli that underpin these behaviors (known as not wants) and to think about and list
the long-term negative consequences of each. This is then processed in
the larger group using the whiteboard. In this way, all participants talk
about their own aversive stimuli, but they do so in a safe environment
that normalizes much of the experience.
Most of the activities follow a similar pattern. In another activity we
use laminated pictures that we spread on the floor. Clients are invited to
select one that represents an area of their life that is difficult. Each then
talks about why he or she chose that picture, thereby contacting some of
the aversive stimuli while talking and engaging in new behavior in the
presence of those stimuli.
From this work emerged a second overall direction for the project:
maintaining as high a level of exposure practice as is appropriate.
Community
In Portsmouth we are fortunate to have a strong 12-step community and
now a strong community of people in recovery who operate as a service
user group called PUSH (Portsmouth User Self Help) funded by the
commissioners. Over time, we have come to work more closely with
people who are in recovery, as they are in a better position to provide the
individual support and encouragement that clients need to overcome
their obstacles and barriers. PUSH members act as recovery brokers
and receive training and supervision. This community (PUSH) is reinforcing to belong to and provides opportunities for others in recovery to
safely learn new skills and try new activities. PUSH members follow the
same format of focusing on what is important, and they use their experience to help people along the road to a better life.
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The ACT Matrix
Training
As the system has grown, weve needed to train more people to deliver
the groups. This is another area where we have innovated and made a
considerable change in the culture. I created a system of training people
that involves learning three main competencies: sorting to appetitive
control, using the Yes, and? skill, which is a relationship-building tool,
and understanding how to run activities and conduct exposure work.
Training is delivered through workshops and observing a more experienced leader. All feedback is against the three competency areas and
the standard group structure. We have been able to train all manner of
nonspecialist workers in this way. This allowed us to make another paradigm shift in the way we approach treatment; in addition to delivering
treatment away from specialized addiction centers, we can also deliver
treatment through nonspecialist workers.
Task Shifting
The matrix has allowed the development of a completely new paradigm
in addiction treatment. Although it is an extremely obvious statement,
addiction is a condition that affects all corners of society. People with
addictions turn up in all agencies and, up until now, the frontline workers
in these agencies have had to refer to specialized substance misuse services. Most people referred never make it to those programs.
Using the matrix, we have not only been able to locate services
where clients are but have also created an integrated pathway that is
holistic and addresses the full range of client needs. In fact, the model is
so simple and straightforward that it can be taught to almost anyone.
This means we can teach people in many agencies, such as Housing,
Social Services, Probation, and Education, how to deal with the substance misuse element of the situation.
Through the matrix, we can transfer skills out to workers in all agencies and equip them to deal with not only addiction problems but also
other behavior change problems. Behavior change is no longer just the
province of specialists; and, by shifting this task out into the community,
we can reach many more people and reach them much sooner, before
their lives get so bad that they need a specialized service. Through this
90
work, we are now seeing changing attitudes toward substance misuse and
treatment across many agencies in the city.
Standards
Over the past two years, we have worked with the commissioners, service
providers, and service users to create a set of standards for practice based
on a recovery model. These standards are behavioral and based on the
idea of working on who or what is important for the client. The next
phase of the work is to reach the point where the whole system develops
appetitive control at every opportunity, and is monitored. The system is
becoming a functional contextual one, but it will take at least another
five years to change the wider culture.
Conclusion
While this has been the story of the journey toward a new model of
addiction treatment in Portsmouth, it is also a story of how the matrix
can be used to broaden the reach of the functional contextual approach
to the places where it is needed. The model is simple and universal, so it
is suitable for all people, whether they present in crisis or are simply
struggling with life. It can be taken outside the walls of traditional specialized centers and made available in a more timely fashion where and
when it is needed. It can also be delivered by anyone who has a sincere
wish to help others. These are all essential in addiction because it is a
condition that knows no limits, and affects the whole of society.
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CH A P T ER 6
The Pain Matrix

Amanda Adcock Vander Lugt
Human beings experience many types of pain in the course of a lifetime.

When physical pain complaints last longer than expectedsay, longer
than three monthsthe medical community may determine the pain to
be chronic and diagnose chronic pain syndromes like fibromyalgia, back
pain, stenosis, or post-laminectomy syndrome, to name a few. Chronic
pain is a broad term that can encompass a wide variety of medical diagnoses. Research suggests that anywhere from 20 to 70 percent of patients
in primary care settings present for chronic pain (McBeth, Macfarlane,
Hunt, & Silman, 2001). Complicating the diagnosis and treatment
process, chronic pain frequently co-occurs with mental health concerns
at rates of 10 to 50 percent (Asmundson, Norton, & Norton, 1999;
Gibson, 2012; Morasco, Corson, Turk, & Dobscha, 2011; Wetherell et
al., 2011). Because of the associated complexities, many clients with
chronic pain get shuffled around from provider to provider without a
consistent treatment plan. Acceptance and commitment therapy and its
underlying assumptions provide a useful orientation for assessment and
treatment of complex chronic pain. There is an excellent book-length
description of ACT in chronic pain treatment (Dahl, Luciano, & Wilson,
2005). In this chapter, Ill outline how the matrix can be used to assess
and treat patients with chronic pain in the hopes of improving their
quality of life.
The ACT Matrix
ACT Assessment and Case

Conceptualization
A thorough ACT-based assessment will be grounded in some basic
assumptions of case conceptualization. First and foremost is the belief
that all people have the capacity to choose things that are important to
them. Valued living drives the assessment, case conceptualization, and
treatment processes.
ACT is inherently client centered, relying on the client to both set
the course for treatment and determine if the treatment is necessary.
The therapist communicates to clients that they will be in charge of
deciding if they will continue with treatment beyond the first assessment
appointment, even if they have been referred by another provider.
Assessment starts with a brief description of the format of the session.
I inform clients that Ill ask questions to better understand their treatment goals, then assess the available options, briefly describe the premise
of ACT, and complete written assessment measures. The first question I
ask clients is What is important to you? With this I express to clients
that I view them as whole people with things they care about out in the
world. I point out that pain and suffering are only a part of their whole
life and use follow-up questions to gain a fuller sense of what drives them
and who is central to their life. These first assessment questions set the
tone for the entire treatment.
Within the first few moments with a new client, I explain that the
work I do with people with chronic pain conditions aims to help them
find ways to improve their quality of life, and then I ask if the client is
interested in improving his or her overall quality of life. Many people
living with chronic pain may feel that this is impossible or that nothing
can be done. Dont let this discourage you or the client. Given the myriad
of doctors they have likely visited up to this point, it is understandable
that they would feel this way.
A second basic underlying assumption of ACT case conceptualization is that either there is a solution to the problem at hand or there isnt.
With chronic pain, this idea can be tricky to get across. Many people
believe that having pain means something is wrong. Without debating
this point, its important to lead clients toward exploring their own experiences with pain, being careful to include information from their medical
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The Pain Matrix
treatment providers. The idea that the pain may have a biological cause
is only partially relevant to this conversation. The driving factor should
be that either there is a solution to the current pain problemsuch as
surgery or any other treatment that can resolve itor there isnt. If there
is no medical solution, we may need to approach the pain from a different perspective. The perspective I suggest can be represented using a
version of the matrix with some slight variations specific to this population (see figure 6.1). The matrix places the person in the center, where
pain is a partand only a partof a full life.
External Experiencing
(Five Senses)
Values:
Family
Intimate Relationships
Parenting
Away
Toward
Friends
Education
Work
Recreation
Spirituality
Citizenship
Health
Internal Experiencing
(Inside the Skin)
Figure 6.1. The matrix for chronic pain.

The guiding assessment question is In a situation where pain is
inevitable, what would you choose to live for? Once we answer that
question, we can get to work.
Objective assessment tools can be useful both for setting the course
of treatment and for indicating changes as a result of treatment. The
Valued Living Questionnaire (VLQ; Wilson, Sandoz, Kitchens, &
Roberts, 2010) is a measure of valued living. Its as useful in session as it
is to measure treatment progress. The Chronic Pain Acceptance
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The ACT Matrix
Questionnaire (CPAQ; McCracken, Vowles, & Eccleston, 2004) assesses

the clients current relationship to pain. Other measures of ACT-relevant
constructs that may be useful include the Acceptance and Action
Questionnaire2 (AAQ-2; Bond et al., 2011) and the Psychological
Inflexibility in Pain Scale (PIPS; Wicksell, Lekander, Sorjonen, &
Olsson, 2010). A key component of the assessment is determining
whether clients are willing to explore the idea that there are ways to
move forward with life other than attempting to control pain. Even if
clients are hesitant, exploration or flexibility is an important seed to sow
early, in order to move forward with presenting and working with the
matrix. A basic willingness on the part of the client to listen and attempt
to apply the model to life is key and can be gradually shaped over time.
ACT for Chronic Pain Using the

Matrix
Setting up the matrix is important in preparing people to hear the perspective that it offers and adopt it. And carefully listening to what people
say during the assessment process is essential. People like to be heard and
usually respond more rapidly to the process of becoming contextual
behavioral scientistswhich is what doing ACT effectively leads toif
they feel that the person giving them the information cares about them
and believes that they can experience improved quality of life. Another
thing humans appreciate is the idea that they are the experts on their
own lives, experiences, and bodies. This can be used as a way to invite
them to let their experiences be the guide to what worksin other
words, to become contextual behavioral scientists.
In order to further the process, clients need to grasp a few things and
consent to treatment. Informed consent can be accomplished by asking
clients how people learn things to gauge their understanding of the
matter, and then explaining that we learn either through doing or
through being told. In other words, we learn through our own direct
experience or indirectly through rules and words about how the world
works. Many things are learned very effectively through instructions and
how-to descriptions, but some are not. Here, I ask, Can you tell me how
to ride a bike? In explaining, people eventually get to the concept of
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The Pain Matrix
balance. Then I ask, What is balance? Of course, you have to experience it to know. Then I outline the ACT approach: At times in our
work, much like for balance, we simply will not have the words to adequately describe the experience. When this happens, we will try exercises designed to create an experience. This is all to help you develop
psychological flexibility so you can better engage with things you care
about. This is our treatment contract: we will continue to gain perspective for the purpose of moving toward a valued life. If the patient says yes
to the contract, we move into exploring the new perspective.
Matrix Overview
Please refer to figure 6.1 for the perspective described in the rest of this
chapter. The self, or me, is the center of the model, because human
beings perspective has them at the center of their own universe. I will
usually write Me in a circle at the center and then ask, How do you
experience or take in information about the world? This begins the
exploration of the vertical axis, which represents the two ways that
humans experience things. At the top is the way that people take in
information about the world around them: through the five senses.
Through a mindfulness-based exercise, I invite people to experience an
object and describe their experience of it with each of their five senses.
People usually report that they havent paid attention to their direct
experience in that way in a long time. This slowing down is both useful
and unusual. Then I ask them to put the object aside and experience it
through the other way of experiencing: internal, represented at the
bottom of the vertical line. Here it may be useful to discuss everything
that can occur inside the skin, such as memories, thoughts, feelings, and
sensations, including pain. The horizontal line can be described as the
skin barrier, with things that happen inside the skin falling below the
line and things that happen outside the skin falling above the line
because they are experienced through the five senses.
The horizontal axis is the behavior line. It represents the two major
functions, or purposes, of behavior. I use a series of questions to create a
context that makes this distinction come alive. I begin with a trick question: Have you ever experienced pain? This both highlights clients
experience, and normalizes it, as all human beings experience pain. Pain
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The ACT Matrix
gets placed in the lower left quadrant of the matrix, because its inside
the skin. The next question really begins the discussion of the behavior
line: Have you ever done anything to move away from something
uncomfortable inside your skin, like pain? If this question is unclear, I
clarify by asking about the present moment, for example, Are you doing
that now? We then contact the moving toward side through similar
questions. Sometimes it may be helpful to ask, Who or what is important to you? and Have you ever done anything to move toward something or someone important to you? The key distinction is the difference
between moving toward something thats important to the individual
and moving away from things inside the skin that are uncomfortable.
The bulk of the treatment can be mapped directly onto the two lines
and the circle at the center. Sometimes, just showing clients this model
is helpful enough to allow them to make a significant start in moving
toward a valued life; but often, more is needed. If a client is particularly
inflexible or focused on removal of pain as the goal of treatment, highlighting each piece of the model becomes necessary. The purpose of the
model and use of the diagram is to help create perspective on where the
client is placing attention and what is motivating behavior in the
moment. This is in keeping with the traditional ACT question What
are you willing to do and experience in this moment to move toward the
things that are important to you?
Walking Around the Matrix to Create

Psychological Flexibility
The rest of this chapter is focused on the use of the matrix in a group
format because Ive found that having multiple people learning the
process together is an awesome, inspiring, loving, and kind process. I
prefer it to individual therapy, but any of these pieces can be done in
individual sessions with a little creativity or a mindfulness exercise. Ive
indicated session numbers in which various concepts are typically
covered, but these are just rough guidelines, to be used flexibly depending on the clients and the context.
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The Pain Matrix
Creative Hopelessness
In the first group session, the goal is to uncover the unworkable
change agenda by bringing attention to the pain story. Session 1 is
focused on the left side of the matrix diagram. During the initial assessment, clients describe their pain problems, the location of the pain, its
intensity or severity, and the many things they try, possibly daily, to
manage or control the pain. In the first group session, we look at all of
this in a special way. First, we note how long the pain problem has
existed. In groups, it isnt uncommon to find totals of well over one
hundred years of experience among all members in dealing and living
with pain. Who could argue with one hundred years of experience of
anything? I sure wouldnt, and I tell them that. I let clients know that
their experience is what will be the guide. The point of this session is to
slow down and really look at what is. As clients work with individual
matrix worksheets, I invite them to list the problems they suffer in the
bottom left quadrant and the solutions theyve tried in the upper left
quadrant.
They can then map out a real-life example on their individual matrices. I ask for an example of pain showing up inside the skin, as illustrated
in this dialogue.
Therapist: Pain shows up. What do you do? What happens next?
Client:
I go to the doctor.
Therapist: Okay, so you go to the doctor to find out whats causing

the pain or to do something about it, right?
Client:
Yes. I want to make it stop.
Therapist: And how does going to the doctor help?

Client: Sometimes it does. Sometimes theres an answer or a
new medication I can take to help.
Therapist: How long does that work?
These solutions may work for a few minutes or hours, but usually
they fall into the category of short-term solutions to the pain problem.
Most medical answers (aside from surgery, when it works) are temporary
in that they dont resolve the underlying problem. There are many things
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The ACT Matrix
that alleviate pain in the short term, and some that work in the longer
term, but nothing that works to remove the pain for life. If it sometimes
goes away, it continues to show up. The goal of this session is for clients
to experience that the process of outlining the problems, solutions, and
how theyre linked frequently creates a circle that just keeps going around
and around, getting thicker and darker in some areas. This realization
can feel heavy and depressing. Its supposed tonot for the sake of creating depression, but for the purpose of looking at what truly is. The process
of trying to control things inside the skin leads to feeling hopeless. It
looks like a downward spiral and feels like being stuck in a rut.
The matrix is helpful here to help initiate part of the ACT process
known as creative hopelessness (Hayes, Strosahl, & Wilson, 1999). If
there is a whole other side of the model, that must then mean theres an
alternative. What might that alternative be? This is the creative part of
the hopelessness. The middle and right side of the model allow for experiencing that the self, in the center, is not wrapped up in the downward
spiral of attempts to control inner experiencing. Frequently, I end the
creative hopelessness session with the Man in the Hole metaphor (Hayes
et al., 1999), which illustrates the process of the session and can lead to
a thoughtful summary of the experience.
Identifying Values
Session 2 is focused on the right side of the matrix: values and committed action. Values are defined as setting the course for treatment,
based on the important things in life. Establishing that values are individual decisions already present inside each person and personal to each
person is of utmost importance in this session. Each individual is asked
what is important to him or her, and these values are recorded on the
right side of the matrix. Because some people have great difficulty stating
something important to them, the worksheet includes a list of life
domains that people often say are important, to help them explore whats
important to them. This list is by no means exhaustive; its just one set of
possible domains.
In this session, I introduce committed action using the distinction
between choosing and deciding in the following riddle: Three frogs sat
on a log. One decided to jump off. How many frogs are left on the log?
The answer is three, because as long as the frog has only decided but not
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jumped, it hasnt made a choice. Deciding is a mental activity that doesnt

necessarily involve action. Choices are decisions empowered by willingness and actionany action, no matter how small. A quick exercise
using the values recorded on the worksheet can help put values together
with choices and decisions by demonstrating that any behavior can
establish a valued action or choice.
Therapist: Can you draw a circle?
Client:
Yes.
Therapist: Great, thats all you need to do for this exercise. The
instructions are simple: making a circle represents
making a choice. Im going to say something, and I just
want you to draw a circle to make a choice, okay?
Client:
Okay.
Therapist: On your matrix, draw a circle around a value youd like
to work toward this year. (Pause for one second.) Now
draw a circle around a value youd like to work toward
this month. (Pause for one second.) Now draw a circle
around a value youd like to work toward this week.
(Pause for one second.) Okay, great. Does everyone have
three circles on their matrix?
Inevitably, someone doesnt make three circles around values on the
worksheet. Why? It has to do with the difference between choosing and
deciding. If people get stuck in their head deciding, how quickly this exercise moves can become overwhelming. It forces them to make a choice or
get stuck. This can highlight that decisions are internal, and by now its
established that internal experiences can be tricky and get us stuck.
Returning to the goal of this sessionsetting a course for treatmentwe revisit individual values by preparing homework. The homework assigned in this session is for clients to identify a value that they
can work toward between this session and the next. Next, I have participants plan an action: a single behavior to move in the direction of that
value, the simpler, the better. Its helpful to think about movement
toward values as baby steps at first, choosing a behavior thats attainable
to demonstrate the point of valued action. The value is like a guiding
star, with the behavior chosen for homework moving clients slightly in
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that direction and serving as a goal along the path. The homework is
then simply to do the planned action and notice what happens.
The Mind
In session 3, mindfulness comes to the forefront. The purpose of the
session is to set up for defusion or mindfulness exercises. I begin by
describing the mind as a tool for humans to use and outline the minds
job. This session focuses on the lower half of the matrix: things inside the
skin and our reactions to them. In order to communicate mindfulness as
conceived in ACT and as relevant to the matrix, Ill use your own experience to demonstrate, just as I would with clients.
The mind is a useful tool that lives inside the skin. It helps us learn
things, usually quite quickly. It does many things automatically. A short
mindfulness exercise can provide a vivid illustration of the automatic
nature of the minds functioning. Visualize a piece of fruit. See yourself
cutting up that ripe, delicious-looking fruit. Now imagine putting the
first piece up to your lips and taking a bite of that big juicylemon! What
happened? Did the words on this page perhaps make you salivate a bit?
Human minds evolved to turn words into responses so we could
learn by indirect means. If each of us had to learn from direct experience
that lions and bears are dangerous, we all would have been eaten before
the first book was ever written. However, at times this amazing function
of the mind can cause problems. For instance, sometimes when pain
shows up, the mind may say that something cant be done. Has this ever
happened to you? Assuming it did, what happened next? Sometimes the
thought that we cant do something hooks our attention, drawing the
mind further inward. When this occurs, were hooked. Have you ever
walked down a hallway and bumped into someone or something? How
did it happen? Usually folks say, I wasnt paying attention or I was lost
in my thoughts. This is the essence of being hooked: attending to internal experiences to the exclusion of external experiences without noticing
that this is happening.
The story of Sid and Fido is a great representation of the power of the
mind. One Saturday, Sid gets tired of listening to his daughters radio and
decides to take his dog, Fido, out for a walk. By the time he gets to the
farthest point on his walk, thunder breaks out and rain begins to fall. He
returns home soaked and shivering to find that he accidentally locked
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The Pain Matrix
himself out of the house. He can still hear his daughters music blaring
inside. He pounds on the door and checks every window to no avail.
Finally, the radio stops briefly and his daughter hears him banging at the
door. She lets them in. Fido shakes himself off quickly at the door, walks
over to his food dish, has a snack, curls up on the rug, and takes a nap.
What does Sid do? He grumbles to his daughter, stomps around, tells his
wife what happened when she arrives home, and may even tell this story
to his friends at work on Monday. This is the difference between animals
and humans who are focused on indirect experience. Humans get hooked
on mental content and experience stress in the absence of the stressor.
Who would you rather be, Sid or Fido?
Willingness
Willingness is balancing between the left and right sides of the
matrix. It has to do with how we treat the right side. Are we struggling
with internal experiences, or are we doing something differently? Session
4 focuses on willingness as a physical posture of acceptance toward internal experiences. Its achieved through practice in noticing the struggle
and choosing to do something different. To illustrate this physical
posture, I use a rope to pull a client or a hand to push a clients hand to
demonstrate what happens when something is touching us. An automatic response is to tense muscles or push or pull back. Try this sometime if you havent. Its impressive what your body does, almost without
you thinking about it, when someone pushes against your hand or runs a
rope through your hand.
Reactions to pain are often similar: muscles tense automatically.
Pain hooks us, and then we struggle. This struggling usually lands us
back in hopelessness. However, at that point we can begin to physically
practice a new posture toward hooks and the struggle: acceptance.
Acceptance is like relaxed muscles creating a space inside us that allows
us to move forward, toward our values.
A further way of describing the posture of acceptance is to imagine
the difference between experiencing a sunset versus solving a math problem
(Wilson & DuFrene, 2009). Again, Ill engage your own experience for the
purpose of illustrating how to bring these concepts to life for clients. Have
you ever seen a sunset? How did you respond to it? Think about how your
body was as you watched it. Actually pause here and experience that for a
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moment. Then contrast that experience with how youve felt while solving
a math problem. Which of these is more like how you treat pain or other
uncomfortable internal experiences? Do you treat those experiences like
sunsets or math problems? Could you watch your internal experiences
somewhat like a sunset, with that body posture? Could you do that if it
meant being able to have the life you want for yourself?
Self-as-Context
People can become lost in the patient role, as Dahl and colleagues
eloquently describe (2005). They become welded to their pain, and its as
if it defines them so completely that they cant imagine a perspective or
life beyond it. They are stuck in self-as-contentin defining themselves
by the content of their experience. Their mind has reduced them to their
pain and the limitations it imposes. To pull people from this stuck place,
the intervention described above may begin the task but still fall short.
Clients need to adopt a new perspective from which they arent reduced
to their pain. Describing this perspective, known in ACT as self-as-
context, is one of those places where words fail us. Describing it to clients
isnt helpful; what is needed is the ability to experience this perspective.
Mindfulness exercises can help clients contact a sense of self that remains
stable and consistent through the constant changes in all aspects of their
experiencephysical, mental, sensory, and emotionaland through
their different roles and ages. When initiating this work, usually in
session 5, I warn clients, Please notice your experience and dont simply
trust everything I say. Then we explore the self that experiences things
by finding the self that is consistent and has both changed over time and
remained the same.
Practicing sorting with the matrix is in itself an exercise in self-as-
context as clients gradually understand that the perspective from which
they observe their matrix remains constant over time and cannot be
reduced to their pain or their other experiences, or to their behavior or
roles. The Chessboard metaphor (Hayes et al., 1999) can be helpful at
this stage. Clients are encouraged to see the content of their experience
as a set of warring pieces on an infinite chessboard, and to contact the
sense of having always been there, like the board, throughout all the
changes in positions of the pieces and regardless of which side won a
particular round. To the chessboard, it matters little who wins. It remains
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The Pain Matrix
unchanged; its always present and able to notice each piece without
needing to get involved. Contacting a perspective that fosters the experience of remaining the same through whatever changes may come can
greatly help people commit to bold moves toward values. When commitments are made from this perspective, it often brings a genuineness to
values that feels intensely vital.
Putting It All Together: Passengers on

the Bus
At this point, all of the pieces of the ACT model are present and
accounted for, but something is still missing: action. The Passengers on
the Bus metaphor (Hayes et al., 1999) is an ACT classic, with video versions available on YouTube (for example, Oliver, Christodoulou, &
Whitfield, 2012). Acting out this metaphor in groups can be an effective
way to directly experience valued action. In session 6, I ask for a volunteer whos willing to share a valued direction and a problematic move.
This volunteer is the driver of the bus. I then ask what passengers
(thoughts, emotions, bodily sensations, memories, etc.) show up to stop
him or her from moving in the valued direction. I coach the other group
members in acting out the passengers as realistically as they can. Then
we explore the different ways the driver might deal with the passengers.
First I ask the driver to drive while dealing with them as usual. Next, I
invite the driver to acknowledge each passenger in turn, without struggling with any of them and while continuing to drive in the valued direction. Finally, we debrief and discuss differences the driver noticed
between the two experiences. It brings up some important questions:
Whos driving your busyou or your internal experiences?
What direction are you driving your bustoward your values or
away from pain or discomfort?
What passengers show up?
How are you treating your passengers? Do you struggle against them?
Are you hooked by them? Or can you accept them, treating them like
old friends that you invite along for the ride?
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The ACT Matrix
Terminating Therapy
Sending clients off to enjoy a full, valued life is an excellent ending to
this type of work. Of course, there will be setbacks, relapses, and so on.
These are expected. Life is full of highs and lows, including pain and suffering. I prepare clients for this eventuality with the question Would you
be willing to receive your setbacks and relapses as youve learned to
receive other experiences in this group, so you can move toward enjoying
a full life with all of this and so much more?
Conclusion
When working with patients with chronic pain, the matrix can offer a
useful perspective. The specific perspective presented by the matrix is
functional contextualism: the ability to base behavioral decisions on
what workswhat moves people toward their valuesusing acceptance
of internal experiences to allow for flexible responding. This work is a
combination of difficult emotions, fun and energetic metaphors, and
exploration of internal and external experiences. This chapter simply
presents some examples of metaphors and exercises that I have found to
work well in groups. It isnt a treatment manual; rather, its an outline of
some things I typically do in treatment that you may find helpful when
working with clients with chronic pain. The matrix has been useful for
me and my clients, and I hope that youll find this to be the case for your
practice as well. The matrix offers guidance in asking effective functional questions, making it broadly useful in working with clients, in
supervising and consulting with other professionals, and in life more
generally.
References
Asmundson, G. J. G., Norton, P. J., & Norton, G. R. (1999). Beyond pain: The
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97119.
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt,
H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of
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psychological flexibility and experiential avoidance. Behavior Therapy,
42(4), 676688.
Dahl, J., Luciano, C., & Wilson, K. G. (2005). Acceptance and commitment
therapy for chronic pain. Reno: Context Press.
Gibson, C. (2012). Review of posttraumatic stress disorder and chronic pain:
The path to integrated care. Journal of Rehabilitation Research and
Development, 49(5), 753776.
Guilford.
McBeth, J., Macfarlane, G. J., Hunt, I. M., & Silman, A. (2001). Risk factors for
persistent chronic widespread pain: A community-
based study.
Rheumatology, 40(1), 95101.
McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of
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Morasco, B. J., Corson, K., Turk, D. C., & Dobscha, S. K. (2011). Association
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Oliver, J., Christodoulou, V., & Whitfield, H. (Producers). (2012). Passengers on
a Bus: An Acceptance and Commitment Therapy (ACT) Metaphor [Video].
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Wetherell, J. L., Afari, N., Rutledge, T., Sorrell, J. T., Stoddard, J. A., Petkus, A.
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Wicksell, R., Lekander, M., Sorjonen, K., & Olsson, G. (2010). The psychological inflexibility in pain scale (PIPS): Statistical properties and model fit of
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Wilson, K. G., and DuFrene, T. (2009). Mindfulness for two: An acceptance and
commitment therapy approach to mindfulness in psychotherapy. Oakland, CA:
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CH A P T ER 7
ACT in Digestible Bites: The

Matrix and Eating Disorders
Florian Saffer
I work as a dietitian-nutritionist in private practice. My office is part of a

medical clinic that includes physicians, psychologists, and other health
professionals. General practitioners or psychiatrists generally refer clients
who struggle with eating to me. This kind of outpatient care is usually
multidisciplinary and coordinated by a physician.
I see my job as helping my clients move toward a diet that is in line
with their physiological needs and also respects their emotional needs.
Rather than adhering to a standardized protocol, I prefer to help my
clients become better aware of what happens when they move toward a
diet more respectful of their needs. The main obstacles to their progress
are generally emotional: fear of putting on weight, strict dietary rules,
and so on. I have found that acceptance and commitment therapy, and
especially the matrix, is perfectly suited to this task.
My Matrix
While doing ACT with eating-disordered clients, a strong therapeutic
relationship is invaluable. As a therapist, I can be assailed by aversive
thoughts and emotions just as often as my clients. I may be visited by the
fear of not being up to the task or the shame of not providing effective
The ACT Matrix
help, or even feel irritation in the presence of an uncooperative client.

When I get hooked by these thoughts and emotions, I feel the pull of
away moves. At times, I can even disengage from the therapeutic relationship, which flies in the face of my therapeutic values. Using the
matrix around my own experience effectively helps me become conscious
of my inner experience and behaviors in session, and also helps me
refocus on whats meaningful to me.
Becoming aloof
Showing impatience
Actively listening
Remaining open
ME
noticing
Fear of not being

up to the task
Shame that I could
be unhelpful
Being an empathic
and present
therapist
Figure 7.1. My matrix as a therapist.

I find it useful to share my own matrix with clients. It allows clients
to see the similarities in our experiences. My fear of not being good
enough and how the shame that comes with it can make me withdraw
could resonate with a clients experience. Clients also get that this self-
revelation is a move toward a more authentic and solid therapeutic relationship. Sharing my own matrix also helps clients understand what the
noticing work is about and get a sense of the use of the discriminations
between inner and five-senses experiencing on the one hand, and toward
and away moves on the other. Finally, sharing my own matrix allows me
to let clients see the consequences of their behavior on our relationship,
and thus better notice the consequences of their behaviors on their significant relationships in life (see chapter 4 for more on this type of
relationship-oriented application of the matrix and ACT).
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ACT in Digestible Bites: The Matrix and Eating Disorders
Using the Matrix with Eating-

Disordered Clients
Folks who have a conflicted relationship with their weight or with food
often experience strongly aversive emotions such as shame, anxiety, or
anger. In addition, they are often entangled in inflexible rules about
eating, weight management, happiness, and so on. These make up the
steel from which their hooks are cast.
Getting hooked by inflexible rules and difficulties in being with discomfort can pull people with eating disorders into actions to move away
from what they dont want to think or feel. The away moves that keep
them stuck can take many forms: bingeing, mindlessly nibbling, restricting, obsessively counting calories ingested or burned, extreme exercising,
isolating, avoiding contacts, and so on. With eating, away moves are
often cyclical. The cycles may be short or long, but they invariably leave
clients feeling stuck and hopeless.
Interestingly, the hooks that eating-disordered clients bite often take
the form of talk about whats important. Being slim, looking like impossibly thin magazine models, or regaining self-esteem is seen as important.
Yet coming to see a dietician with the goal of changing eating behaviors
or losing weight is commonly an away move. Most of these clients first
come knocking at my door under aversive control, aiming to move away
from aversive feelings or conform to punitive standards.
Therefore, it isnt surprising that, when expressing their therapeutic
objectives, these clients often say they want to feel good, stop obsessing
about food, or lose weight so they can be happy. As long as they stay
stuck on the left side of their matrix, they remain highly vulnerable to
the struggle spiral and to relapse at some point in the future, no matter
what short-term progress they may make toward their (left side) goalsa
dynamic discussed in greater detail in chapter 5.
Meanwhile, their lives narrow down to their experiences of what
they dont want to think or feel and their struggles against that.
Overinvestment in the left side drains their lives of meaning and vitality,
leaving little time and energy to engage in actions that would move them
toward who or what is really important to them: loved ones, relationships, personal development, self-care, and so on.
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The ACT Matrix
The matrix can help these clients better notice their hooks and
where they might get pulled when they bitewhether these hooks seemingly appear on the left, as suffering; or on the right, as things their mind
claims are important, but which are really inflexible rules. The matrix
can also help them differentiate between mental experiencing and inner
or bodily experiencing, which in turn can help them reconnect with and
better recognize sensations of hunger and satiety.
Annie
I have chosen to illustrate how I work with the matrix through the case
of Annie. This case will help you see how I use the matrix from the first
session to help clients increase their psychological flexibility. Annies
case will also help you see how well suited the matrix is to treating clients
with eating disorders and how it can be used to train the different ACT
processes with this population.
First Session
Annie is a twenty-two-year-old law student. She comes with the goal
of getting her eating behavior under control. She binges about four or
five times a week, then purges by vomiting or using laxatives. When not
bingeing, she follows strict dietary restrictions. She describes herself as
impulsive and a perfectionist who dislikes the unexpected.
Early in our first interview, she confesses to being obsessed by food.
Her mind bombards her with rules about what, when, and how to eat
often contradictory: Eat a hearty breakfast and a frugal dinner, No carbohydrates if youre not exercising, Eat your fill but not a bite more, Skip
breakfast When these show up, she easily gets hooked. When hooked,
she becomes unable to fully engage with her experience of the moment.
She also has difficulties contacting her inner experience. She says she
has too much on her plate and is generally too stressed to know when
shes hungry or tired. Shes constantly striving to silence her food-related
thoughts through sports, excessive studying, relaxation, and more, but
nothing really works.
When I asked Annie what she expected from our work, she answered
without hesitation: I want to feel better.
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Seeing how highly fused with her thoughts Annie was and how stuck
she was in struggling against them, I chose to start working on her fusion
with rigid dietary verbal rules right away, using the matrix. Rather than
performing a comprehensive functional analysis, I invited Annie to work
with me on a recent situation illustrative of her difficulties. I thought it
might be interesting to start with the right side of her matrix so that from
the get-go our work would focus on ACTs central goal: commitment to
a meaningful life.
Therapist: Wow, it seems your mind never stops. Minds rarely do.
They love creating rules and telling us stuff. Its quite
normal. Problems arise when these rules prevent us
from doing whats meaningful to us. Could you
describe to me a situation where these rules prevented
you from having fun?
Client: Yes, last week my best friend, Marieshes passionate
about cuisineinvited me to this swanky restaurant.
The whole evening I could only think of how much
fat might be in the food, what I shouldnt be eating,
how much exercise Id have to do to burn those
calories I just wanted the meal to be over! I was
barely there. I think Marie sensed something was up.
Therapist: How important is her friendship to you?
Client: Shes one of the people I love the most in this world.
Shes my best friend and my confidant.
Therapist: Does Friendship with Marie go to the right of your
matrix, with the important things?
Client: Yes, of course!
Therapist: Go ahead and write it there.
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The ACT Matrix

FIVE-SENSES
EXPERIENCING
AWAY
ME
noticing
TOWARD
My friendship
with Marie
MENTAL OR INNER
EXPERIENCING
Figure 7.2. Whats important to Annie in the situation.
Therapist: Lets get back to the restaurant. If you didnt have all
these rules and all this pain, how would you have
imagined that night? Tell me about the best possible
restaurant evening with Marie.
Client: Id really be therelisten to her. Wed talk about
clothes, our studies, our future, what comes after
graduation
Therapist: And if a camera were there, what would we see?
Client: Two girls sharing a good meal, joking, and enjoying
a delicious dessert full of cream while chatting about
fashion and stuff.
Therapist: Could you place this on the matrix?
Client:
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(Points to the top right and fills it in.)

FIVE-SENSES
EXPERIENCING
Discussing fashion
Appreciating a delicious
dessert
Sharing pleasantries
Being present for Marie
AWAY
ME
noticing
TOWARD
My friendship
with Marie
MENTAL OR INNER
EXPERIENCING
Figure 7.3. Annies possible toward moves.
Therapist: Great! So you noticed these as possible toward moves.

For a few seconds, would you be willing to stay in
contact with the physical sensations you experience just
thinking about sharing such moments with your friend?
Client: Its kind of a warm feeling. As if I was surrounded by a
gentle energy.
Therapist: Cool. Well, our work together will be in the service of
giving you a chance to choose to spend more moments
like this one. Would you be interested in that?
Client: Sure. Thats what I want.
The foregoing exchange allowed Annies therapeutic objectives to
evolve somewhat. Her emotional objective of wanting to feel better
now transformed into a more behavioral one: increasing her ability to
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The ACT Matrix
engage in committed action (toward moves). Shed already started

opening up and becoming more flexible.
At this point, we moved to the left side of the matrix.
Therapist: So, last Friday at the swanky restaurant with Marie,
what prevented you from being fully present and
spending the moment as you just described?
Client: My anxiety. My fear of piling on the pounds.
Thinking about what to eat.
Therapist: Where would you put these on the matrix?
Client:
(Points to the bottom left and fills it in.)

FIVE-SENSES
EXPERIENCING
Discussing fashion
dessert
AWAY
ME
noticing
Anxiety
Thoughts:
Dont touch the fatty
stuff
Turn dessert down
Youll have to make up
for all these excesses
Youll put on at least
5 pounds!
TOWARD
My friendship
with Marie
MENTAL OR INNER
EXPERIENCING
Figure 7.4. What Annie doesnt want to think or feel.
Therapist: Okay, there it goes. And what influence did these

thoughts have on what you did that day?
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Client: I lied. I pretended I had an upset stomach and only

ordered a salad. I drank lots of water to fill up. Oh,
and I spent my time counting calories.
Therapist: Okay, so this goes in the upper left of your matrix.
Client:
(Writes.)
FIVE-SENSES
EXPERIENCING
AWAY
Counting calories
Ordering only a salad
Filling up with water
to eat less
Pretending I cant eat
because of a tummy
upset
Discussing fashion
dessert
ME
noticing
Anxiety
Thoughts:
stuff
Turn dessert down
5 pounds!
TOWARD
My friendship
with Marie
MENTAL OR INNER
EXPERIENCING
Figure 7.5. Annies completed matrix with her away moves in the
situation.
Therapist: What feelings came along with these things you did?
Client:
I felt on edgeoverwhelmedfrustrated
Therapist: So complying with these rules didnt help you feel
better? It sounds as though it might even have made it
worse.
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The ACT Matrix
Client:
Yes. I felt so frustrated and sad!
Therapist: So it kind of went around like this? (Draws the arrows on
the left side in figure 7.6.)
Client:
Yes, exactly.
Therapist: And, turning toward what you wrote on the right side of
your matrix, would you say that struggling in this way
helped you choose to move toward the important stuff?
Client:
I guess not. Just the opposite!

Moving further
from this!
FIVE-SENSES
EXPERIENCING
AWAY
Counting calories
Ordering only a salad
Filling up with water
to eat less
Pretending I cant eat
because of a tummy
upset
ME
noticing
Anxiety
Thoughts:
stuff
Turn dessert down
5 pounds!
Im frustrated
and sad
Discussing fashion
dessert
TOWARD
My friendship
with Marie
MENTAL OR INNER
EXPERIENCING
Figure 7.6. Annies away moves create more frustration and sadness and
further distance her from whats important.
Therapist: Okay. Could you describe the bodily sensations you

experienced when you became entangled in either
challenging or obeying these thoughts?
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Client:
Tense!
Therapist: Do you notice a difference between how it feels to

engage in toward moves versus away moves?
Client: Hmm, yes. Id rather feel the stuff on the right.
Therapist: Cool. See if you can notice this difference in your daily
life. Now lets get back to your thoughts. These thoughts
usually come and go in your head. Does it make a
difference to see them written in black-and-white on the
matrix?
Client: Im not sure. Maybe it feels like they somehow
reached me less?
Therapist: Seeing our thoughts as natural phenomena can help us
not become their slaves.
At this point in our work with the matrix, Annie noticed two consequences of getting entangled with rigid eating rules:
It didnt allow her, in this specific context, to effectively control
her pain.
It kept her away from her friend.
Finally, I asked Annie to write her thoughts and feelings regarding
our first session on a new matrix.
Client: Well, Im afraid of failure, and hopeful that I can get
my life back to normal.
Therapist: Could you give me an example of what youd do
differently in a normal life?
Client: I dont know. I guess Id just be able to eat when
Im hungry.
Therapist: Could you put all of this on the matrix?
Client: Eating when hungry goes in the upper right, and the
fear that this wont work goes in the bottom left.
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The ACT Matrix
Therapist: Its normal for stuff to show up on the right and on the
left. Moving toward whats meaningful can often give
rise to feelings that arent always pleasant, such as fear
or shame. For example, during our consultation I
wanted to help you, and at the same time I could notice
a fear of not being up to it. To be totally honest, this
fear sometimes prevents me from being effective for my
clients. If you want, in our next consultation we could
look at these feelings that can prevent us from moving
toward whats important.
Client: Yes. My emotions often paralyze me.
I invited Annie to consider her food-related thoughts as natural phenomena and suggested the classical ACT exercise of prefacing her
thoughts with I have the thought that I then invited her to differentiate, in her private experience, the thoughts that invited her to engage
in toward moves and those that told her to stick to away moves. Finally,
I told Annie that the goal of our work was not to modify her thoughts so
much as it was to help her detach from unhelpful thoughts. I concluded
our first consultation by inviting Annie to notice where some of her
experiences went on her matrix over the coming week.
Thanks to the versatility of the matrix, this first session helped
increase Annies psychological flexibility by helping her cultivate defusion (gaining some distance from food-related thoughts), and initiate
work on values (friendship), committed action (spending quality time
with Marie), acceptance of unwanted emotions (anxiety), mindfulness
(of bodily sensations), and the observing self (adopting the matrix
perspective).
Second Session
By our second session, Annie had noticed some changes in her
eating behavior. Twice, shed added carbs to her lunch, which she identified as a toward move, yet shed also felt guilty for doing so. Because she
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mentioned that, I chose to orient our second session toward training a

different way to receive her discomfortacceptance.
We explored a number of experiential noticing exercises, which she
appreciated. In an exercise inspired by one in a workshop given by Kelly
Wilson, I invited Annie to recall a situation in which suffering was
present and notice without judgment the emotions and sensations that
had showed up. Next, I invited her to imagine her suffering leaving her
body in a physicalized form. Third, I invited her to imagine carrying her
suffering with kindness and compassion, as she would a crying baby.
Then I debriefed the exercise using the Spiky and Flexi characters (see
figure 7.7 and chapter 4) to help Annie notice how she was receiving her
suffering from moment to moment.
Therapist: Would you like to share what you felt during this
exercise? Okay if we use the matrix?
Client: Sure. At first it was really hard for me to contact the
situation. I didnt want to think about it. I just wanted
to stop the exercise.
Therapist: Thats perfectly natural. We all want to avoid suffering.
And where would you place that on your matrix?
Client: There, on the left It was like a gray ball of dust.
I wanted to push it away, but each time I tried to
push it away it would just regroup.
Therapist: Would you say you were more like Flexi or Spiky?
Client:
The spiky one.
Therapist: So where would you place struggling with suffering on

your matrix?
Client: To the left.
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The ACT Matrix
Figure 7.7. Spiky and Flexi and the matrix.
Client: When you invited me to carry my suffering as I would

a small child, I appreciated that you didnt force me
because, to be honest, I didnt want to do it. Its weird
because this gray cloud somehow looked like a soft and
smiley monster. Does that even make sense?
Therapist: More Spiky or Flexi?
Client:
Flexi.
Therapist: So would you say that when you struggle against what
you dont want to feel, suffering increases and you
become spiky, whereas when you treat your suffering
with kindness you dont feel so stuck?
Client: My brother is always going on about letting go.
Thats what that last part was about, wasnt it?
Annie found this exercise particularly useful. Previously, she had
thought of letting go as getting rid of all feelings and thoughts so as not
to feel anythingsomething she could never do.
Messages that the frequency and intensity of emotions can or must
be controlled are pervasive. Friends, family, the health care system, and
more generally the culture all convey these messages in some form.
Emptying ones mind, thinking of something else, chilling out, chasing
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the blues away, and so onall can be hooks that would seem to be on
the right side and thus are commonly reported as being important. By
helping people identify the function of these verbal rules, the matrix
gradually helps them sort between the hooks that appear as a function of
suffering and those that contact what is truly important and vital.
By the end of the exercise, Annies face looked more serene. I invited
her to notice, over the next week, experiences of suffering and whether
she could receive them in a similarly kind fashion.
Values Clarification and Behavioral

Activation
The ultimate goal of receiving ones emotional experience is to facilitate
engaging in committed actions. Because Annies range of toward moves
was narrow and restricted, in the second session I also thought it might
be useful to help her identify small steps that could represent more vital
toward moves.
Therapist: As you struggle less, you may find that you have
more energy for the important stuff. You mentioned
how the shame you feel around your body image can
push you to isolate or spend hours in front of the
computer. But what would the Annie you want to be
do in these situations?
Client:
See people. I hate loneliness.
Therapist: So seeing people is important to you. What would be

some small steps you could take toward connecting
with others?
Client: Marie invited me to her place for drinks with some
friends from her graduate program. It could be an
opportunity to meet people. I always turn her down
if its not just us two. Im always afraid her friends
will judge me.
Therapist: Well, we all know this pull to move away from suffering.
Unfortunately, it can stop us from living the life we
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The ACT Matrix
want. How would you feel about taking a risk in the

direction of connecting with others?
Client: I dont know if Im able to do that.
Therapist: You know, you can choose to do it or not do it.
Whats important is noticing what shows up in your
matrix around doing itor not doing it. As long as
you notice, you cant fail.
Toward the end of our second session, I invited Annie to estimate
how much energy shed spent struggling versus moving toward whats
important to her and then write it on her matrix. This helped her see
that energy invested in struggling against unwanted experience is energy
taken away from toward moves. It also served to underline that life
cannot be reduced to struggle, even when suffering is intense. Many
people who struggle with eating disorders feel as if their lives are reduced
to struggling and suffering. Yet when evaluating the amount of energy
spent on away and toward moves, even the most stuck clients rarely estimate that their proportion of toward moves is much below 20 percent.
This exercise also reinforces the notion that therapeutic work is about
gradually increasing the time and energy the client invests in toward
moves.
Discriminating Inner and Mental

Experience
During our first few sessions, it became clear that Annie was having
trouble noticing and respecting her sensations of hunger. Many people
struggling with disordered eating share this difficulty. Struggling against
feelings of hunger can increase food cravings in proportion to caloric
restriction and often induces strong feelings of frustration. I liken this
phenomenon, which I have dubbed the body-mind conflict, to a tug-of-
war, with the body pulling to one side to get its energy supply and the
mind pulling to the other to gain control. In this respect, bingeing can be
seen as a victory of the body over the mind.
In my experience, most bingeing episodes take place in the late afternoon or evening, usually over four hours after the last meal, when the
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body is in a physiological state of hunger. This physiological state is

marked by disagreeable physical sensations (hunger pangs, a growling
stomach), a tendency to become more irritable (which I well recognize in
my toddlers), and cravings for nutrients that may provide the needed
energy. The physiological stress resulting from struggling against these
sensations combined with other stresses, such as professional or relational stress, can act as a catalyst for bingeing.
The verbal rules that come with the guilt about giving in to the cravings become hooks. Biting those can lead to overeating (As all is lost, I
might as well stuff myself) or renewed efforts at caloric restriction. Both
lead to further turning away from food-related bodily sensations, fueling
an unending struggle between mental and inner experience.
Using a matrix that separates mental and inner experiencing (see
chapter 4, and specifically figure 4.2) can help people gradually reconnect with their bodily sensations. To help Annie better discriminate
inner from mental experiencing, I suggested a body scan exercise. I
invited her to notice how, as she was scanning her bodily sensations, her
mind was continuing to chatter and produce thoughts. This allowed
Annie to more readily discriminate her bodily sensations from her
thoughts and to notice that both inner and mental experiences are
present at any given moment. We then debriefed this exercise with the
matrix.
Therapist: Would you be willing to share your observations with
me and place them on the matrix?
Client: I noticed I was clenching my jaw.
Therapist: Did you notice your mind commenting about this?
Client: Yes. I thought that I wasnt even realizing how stressed
I was, that I should relax.
Therapist: Great! Do you see how both these experiences
coexiston the one hand your experience of your
clenched jaw, and on the other your experience of your
mind telling you should relax? Where would you put the
thought I should relax?
Client: On the right. I think its important.
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The ACT Matrix
Therapist: Interesting to note that our minds also tell us about

important stuff. Did you also notice some thinking on
the left?
Client: When I was scanning the sensations in my thighs,
I thought, Im a fat cow and I have to exercise more.
So I guess that was on the left?
Therapist: Are those thoughts hooks that you readily bite?
Client:
Definitely!
I then invited Annie to continue in this vein by noticing food-related

sensations and the thoughts that coexist with these sensations. I also
invited her to differentiate between thoughts that talk about whats
important and thoughts that tell her to engage in away moves.
In the next session, we once again debriefed some of Annies observations with the matrix over the previous week. One experience had
particularly stood out. Shed felt hunger in the middle of the morning on
the day after our session. Shed also noticed her mind baiting her with
the hook Its not normal to feel hungry at 10 a.m. If you start eating now, you
wont be able to stop. She placed these thoughts on the left side. She chose
to drink a cup of tea as a way to make her hunger go away, which she also
placed on the left. The consequences were strong feelings of frustration.
A few minutes later, she noticed the thought And what about eating a
small snack? Maybe your body needs it. She chose to follow that thought
and ate a piece of fruit and a slice of bread, which she reported as a pleasant experience. Further, Annie noticed that she could choose to not
submit to her rigid eating rules, and that the catastrophic scenario her
mind was envisioning (You wont be able to stop!) didnt occur.
Learning Through Direct Experience

Helping Annie be able to experience the direct consequences of eating
enough to appease her hunger seemed an interesting avenue for the
remainder of our work. Multiple experiences are necessary to gradually
reconnect with food-related bodily sensations before eating can come
under the control of hunger. Noticing the inner experiences of eating to
satiety and of overeating are crucial steps that can provide valuable
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corrective feedback. Learning any new behavior is based on successive

approximations. For example, learning to swim takes getting in the water
and experimenting with several movements. Some will prove useful and
will be built upon; others that are less useful will disappear from the
swimming repertoire. Learning to swim through verbal instructions,
such as reading a manual, can help you orient to the most useful swimming behaviors. However, you obviously cant learn to swim by reading a
manual. The same holds true for learning new eating behaviors.
Over the next several sessions, I gave Annie advice on balancing her
diet and eating rhythms to help her experience eating to satiety and
without excess. Note, however, that dietary advice given to clients can
all too easily be turned into inflexible rules, such as I have to eat some
carbs at every meal. It is thus important to have laid the groundwork that
will help clients notice these rules and how well they work before introducing dietary advice. The matrix is well suited to this groundwork and
is a tool of choice for helping clients notice how the mind will pick up
anything and turn it into rules that pull them toward experiential avoidance. It also helps them notice whats important to them in broader life
contexts.
As work with Annie progressed, the frequency of her bingeing episodes dropped dramatically and her relationship to food became less
conflictual. She still occasionally noticed herself biting hooks such as If
you eat youll become obese or No carbs before 3 p.m., but being aware of her
matrix helped her unhook from the struggle more readily and choose to
move in the direction of respecting her bodily needs.
In addition, Annie became more aware of what was meaningful to
her and increasingly took steps in valued directions. In spite of her fear of
being judged, she started meeting friends more and isolating less. She
also volunteered for an association helping underprivileged students.
Through this work she made new friends and became part of a project
that felt meaningful to her.
Conclusion
The matrix has become essential to my practice and central to my work.
As illustrated in this chapter, its a great tool for helping clients struggle
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The ACT Matrix
less and allowing them to reconnect to both whats important to them in

life and their natural experience of eating.
For me as a clinician, the matrix is a great tool for conducting simple
and effective functional analyses with my clients. I love that this is not
limited to disordered eating behaviors and encompasses whats truly
meaningful to clients. The matrix seamlessly reveals the influence of
hypercontrol not only on clients feelings (increased discomfort), but also
on all life domains (partners, family, friends, health, and more). Analyzing
how they get stuck in the struggle against suffering allows clients to gradually embrace whats important and gives their lives meaning, turning
their lives toward appetitives and freeing them from the struggle.
Instead of focusing on what doesnt work, matrix-led functional analysis plants the seeds of behavior connected to core values. This allows
clients to rapidly take action toward their values, infusing their behavioral change project with rich and deep meaning.
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CH A P T ER 8
Out of the Hole: The Matrix

with Chronic and Severe
Symptoms
Rob Purssey
Im just tired of always having to struggle. Id be better off dead. Clients

with chronic and severe symptoms often cause therapists to feel frustration, anxiety, sadness, and other unwanted experiences. We may struggle
in our work with these clients, at a personal and professional cost. And
yet, when these very clients make small moves toward values, they can
utterly transform their lives, over time. If I asked you to recall some
clients who have really moved you, as a clinician and as a fellow human
being, with their resilience and humanity, I bet those with chronic and
severe struggles would top the bill.
(Note: At times I use the term symptoms instead of problem
behaviors or struggles for the sake of workability and brevity, but this
doesnt imply symptoms in the sense used in the medical model, indicative of an underlying disease or disorder. Here, symptoms simply means
behaviors that are unworkable over the longer term in a particular
contextclients problem behaviors or struggles.)
These clients may face various obstacles: traumatic histories; chronic
struggles with anxiety, depression, or pain; isolated or conflictual lives;
recurrent self-destructive behaviors; marginal living in harsh, unforgiving situations; ongoing psychotic experiences; dependence on substances
The ACT Matrix
or multiple medications; and more. Nevertheless, they create meaning

and purpose in their lives, living out true human courage in small, often
unrecognized ways. Such clients often provide our greatest inspiration.
Yet you may feel that current systems are inadequate for addressing
the severity and apparent complexity of their symptoms. Thankfully, the
matrix provides a simple, pragmatic framework that reveals workability
in context. As a conceptual and clinical tool, it cuts through the surface
appearances of diverse behaviors by clarifying their function. We see
unwanted mental experiences as they are: simply the normal emotional
signals of a human with a heart and a history, living in a particular situation. Chronic does not equal more broken, and severe symptoms do not
equal severe problems. More severe struggles may simply indicate a
greater imbalance between away and toward moves. The specific nature
of those moves might reflect temperament, role models, and cultural
influences more than anything else. Away moves are seen as functional
responses that may entangle the person and persist to excess due to
learned patterns (Strosahl, Robinson, & Gustavsson, 2012).
The functional pragmatism of the matrix gently shapes empathic
change strategies. It allows both therapist and client to gradually let go of
struggling and instead embrace moving toward more valued living. The
matrix liberates us, and our clients, from rigid, unhelpful topographic
diagnostic categories (e.g., personality disorder or treatment resistant).
Softly stepping aside from symptoms, in the medical model, and emotionally defined disorders frees us from culturally promoted yet unworkable emotional control strategies and helps us move toward health and
well-being. This is important in all clinical work, but nowhere more so
than for those we might describe as having chronic and severe
struggles.
In his work with challenging patients, Kirk Strosahl (2004a) succinctly describes patterns of behavior often shown by clients with chronic
and severe struggles of any kind in the following terms [with my matrix
rewording after each]:
Pervasive: Dysfunctional behaviors [excessive away moves]
become the dominant response to almost any stress, setback, or
emotional flare-up.
Persistent: Dysfunctional behaviors [excessive away moves] occur
across time despite negative consequences.
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Out of the Hole: The Matrix with Chronic and Severe Symptoms
Resistant: Dysfunctional behaviors [excessive away moves] are

difficult to extinguish in the response hierarchy because of their
overlearned nature.
Distress producing: Dysfunctional behaviors [struggling with
suffering and engaging in less valued living] cause distressing consequences to the client and others in the context of reduced
self-efficacy and low motivation.
It doesnt matter whether the label is depression, anxiety, psychosis,
substance use, or personality disorder. Ways of struggling with suffering
are more simply and usefully viewed functionally and pragmatically,
rather than through the lens of a label. The matrix point of view lets
both client and clinician step back from struggling and move toward
more flexibility.
In this chapter, Ill explore how clinicians and these challenging
clientsboth of whom are often in sticky situations, personally, clinically, and institutionallycan step back from difficult experiences and
unworkable strategies and move toward more vital lives. Starting with a
therapist matrix, Ill look at whats important for us in clinical work,
unwanted experiences that can show up, how we struggle, and how this
can get in the way. Then Ill explore how presence, self-forgiveness, and
empirical knowledge can be useful in seeing how such struggles may be
harnessed and moved with, resulting in turn in a movement toward
engagement with easing clients struggles and enhancing their lives. At
first, clients valued living, current repertoire of toward moves, and
potential for change may seem minimal. As we tease out their values and
actions in daily life and connect these to larger patterns, we can increase
their awareness and chances of progress in tiny, gradual ways. By increasing our own self-compassionate, in-the-moment awareness, we can instigate, model, and reinforce clients self-
forgiveness, presence, and
movement toward values.
Clinician Matrix
Notice that you are reading these wordswith both your five-senses and
mental experiencing. Who is doing the noticing? Why are you reading
this? What discomfort might show up that could get in the way of moving
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toward the values that brought you to this book? Simply notice what
happens next: an away move or a toward move. Clarifying and remaining aware of our own behavior in clinical work is essential, especially
with challenging clients. The matrix provides a simple and effective orienting tool. As we introduce and use the matrix framework in each
session with clients, simply noticing whats happening for us in each
quadrant of the matrix focuses and amplifies our awareness.
Clinicians Values
The lower right quadrant of the matrix addresses whats important
to us in working with challenging clients. Think for a moment about
what brought you to your training and your daily work as a health care
professional: perhaps helping others, kindness, caring, empowering, connecting, curiosity about the human condition, easing suffering, or social
justicechanging the world one life, one family at a time. Values like
these are probably guiding your toward moves in this very moment. Yet
when working with challenging clients in challenging situations, connecting with these values from moment to moment can often be
challenging!
Its easy to lose contact with what matters during difficult clinical
work or in inadequate, undersupported work environments. An ongoing,
intentional connection with our valuesgently returning to them when
we inevitably driftis essential for nurturing and sustaining ourselves.
From time to time during each session, notice why youre choosing to be
with that client in that moment, and what tiny toward move is possible
in that moment. If what shows up is Im not choosing; I have to, can you
perhaps find a choose-to even in that moment?
Clinicians Unwanted Mental Experiencing

The lower left quadrant of the matrix addresses what gets in the way
of helping clients with chronic and severe struggles. Imagine this scenario: Youre in the closing minutes of a session with your seventh client
on a long day, with one more client to go. This client, who is socially
isolated and chronically suicidal, engages in self-harm, and uses numerous medications and substances, says, If youre asking me to accept the
way I feel, Id rather kill myself. This ACT stuff just isnt helping! What
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I really need is to be admitted, to be put somewhere safe, or I just might

kill myself. Please pause and allow yourself to fully experience the scene,
then notice what unwanted mental experiencing is showing up for you
right now.
If you identified feelings of anxiety, uncertainty, fear, panic, inadequacy, embarrassment, frustration, irritation, sadness, despair, anger,
guilt, or isolation, all of these are, of course, inevitable with clients who
have chronic and severe symptoms. How can we make room for and
gently hold these normal, essential human feelings in the service of our
clients lives?
Too often were highly sensitized to issues of risk. Risk is emphasized
by our clinical setting and broader environment, such as health care
systems, peers, medicolegal settings, and the media. Our systems often
add to our suffering, for example, through symptom control agendas,
paradigms focused on medications and disorders, or lack of peer
support. This is heightened when our personal resources are stretched in
realms such as workload, health, family, and professional support, as is
inevitable at times.
Clinicians Away Moves

The upper left quadrant of the matrix addresses what we do to get
away from the unwanted stuff we dont want to have when helping clients
with chronic and severe struggles. See if you dont recognize some of your
away moves in this quick rundown of things we do to resolve our anxieties, frustrations, and other unwanted emotions when dealing with challenging clients (and remember, all may well be toward moves; it depends
on the context).
Diagnosing away moves: Being hooked by topographic diagnostic
models, such as personality disorder, treatment resistant, comorbidities,
or substance dependence, as separate problems: Its behavioral. Hes
manipulative. Shes acting out.
Therapeutic away moves: Declining referrals; tuning out; blaming the
client; blaming yourself; blaming the clients family, the system, or the
universe; working harder; not working as hard; abusing metaphors;
relying on medications; admitting the client to the hospital; overanalyzing the client and yourself; getting hooked by content, such as the story
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or some other ever-present therapist bait. Whew! But wait, theres

more! Setting more (or less) home practice; being overly rigid or structured; lacking structure; being eclectic in model and approach; making
too many or too few appointments; letting sessions run over or cutting
them short; daydreaming in session; wishfully thinking, If only or
Needs to see a real expert.
Personal away moves: Working harder or longer hours; working less or
shorter hours; overanalyzing or ignoring work issues; letting out frustrations; drinking or using other substances; tuning out family and friends;
forgoing exercise or leisure activities.
Remember, its never about form; its always about the function of
particular behaviorsin a particular moment, and in the particular
context of your therapy work within the context of the clients life and
environment. Any of the moves listed above might be fully toward or
very much away. Keeping an open, aware, engaged view allows for a functional analysis of our clinical behaviors, which leads nicely to the next
topic.
Clinicians Toward Moves

Finally, the upper right quadrant of the matrix addresses behaviors
we can do to move toward whats important to us in helping these challenging clients. Here are some suggestions.
Nurturing Your Professional Self

First and foremost, Id like you to notice that youre doing one of
these behaviors in this very moment: youre reading these words in this
book. This is a move toward lifelong learning and continuing professional development, done in the service of moving your clients toward
their values. Whats more, you are doing this within a conceptual frameworkan important element of contextual behavioral science, the foundation of the matrixthats simple, comprehensive, coherent, and
closely focused on function within a context. Ongoing connection with
a coherent framework is likely to be useful to us as clinicians. The matrix
functionally connects us to the contextual behavioral science point of
view.
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Contextual behavioral science has been defined as a strategy that

seeks the development of basic and applied scientific concepts and
methods that are useful in predicting-and-influencing the contextually
embedded actions of whole organisms, individually and in groups, with
precision, scope, and depth (Hayes, Barnes-Holmes, & Wilson, 2012, p.
2). Examine this definition closely, and see if it doesnt match entirely
what you seek clinically. We are trying to predict and influence the
actions of our clients, within their contexts, with precision (efficiency),
scope (breadth), and depth (in all aspects of their lives). All aspects of
therapy may be viewed from the perspective of contextual behavioral
science. The matrix framework enables this point of view simply, in
action, in the ongoing moment. How is this move working toward this
chosen aspect of valued living?
Maintaining Your Personal and Professional

Well-Being
In order to instigate, model, and reinforce psychological flexibility in
our clients, it may be a good idea to nurture these processes in ourselves.
That means having manageable working hours, taking breaks, exercising, eating healthily, maintaining a broad connection with things we
care about, and making time for personal and professional development
and forgiving ourselves when we fail to keep to these commitments as
often as wed like.
Letting Go of Topographic Diagnosis

For you and, critically, for your clients, its helpful to let go of DSM
and ICD categories except where necessary, such as for reimbursement
and clinical communications (and the latter only with caution, and
holding labels lightly). These diagnoses are simply verbal constructs,
models that may be useful in moving us toward predicting-
and-
influencing the contextually embedded actions of whole organismsor
they may not be. Most have proven to be clinically unhelpful (Kupfer,
First, & Regier, 2002).
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Letting Go of Chemical Imbalance and Other

Biomythologies
Approach the literature about chemical imbalances with a critical
eye. While chemistry, including your neurochemistry, is supporting your
behavior as you read this paragraph (and, after reading this paragraph,
your chemistry may have changed, certain behaviors making more
likely), there is no evidence that chemical imbalances exist or cause dysfunctional behaviors.
Dealing with Risk

Clients with chronic and severe struggles often exhibit pervasive,
persistent, resistant, and distress-
producing suicidal or self-
harming
behaviors. These behaviors acutely raise our anxieties, both for clients
well-being and for our professional liability. These client away moves also
provoke other unwanted mental experiencing in us: frustration, anger,
guilt, and so on.
Therapists often work in settings with demanding risk-management
protocols for addressing suicidality and self-harm. While risk-management
responses to suicidality or self-harm may technically fit protocols, such
moves can be counterproductive with clients who chronically present
these thoughts and behaviors. Although such responses to these thoughts
in a more functional client in the midst of an acute life crisis is warranted
(Strosahl, 2004b), reacting to chronic suicidality with risk-management
hospitalization, medication, and the like is strongly reinforcing of such
behaviors, leading to poor outcomes (see Chiles & Strosahl, 2005, for a
more complete discussion of this topic).
Stepping back to view risk through the lens of the matrix, we can
notice and hold our natural, inevitable reactions to suicidality and self-
harm while responding more flexibly: Ah yes, theres anxiety. Heres frustration. Im feeling hooked. We can notice urges to terminate therapy, to
apply labels such as personality disorder, to refer these clients, to medicate, and so on. And we can identify whether these moves are away from
anxiety or toward values for our clients, and for ourselves in their service.
After a client has engaged in such behaviors in the past, what has been
tried? What were the consequences? How can that history guide our
responses in this moment?
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In this way, we notice and emphasize the normal and natural away
move functions of suicidality in the clientand their consequences,
which are often very effective in the short term yet very life-narrowing in
the longer term. This view reframes such behaviors as attempts at
problem solving, functioning as perfectly understandable moves away
from unwanted mental experiences. Holding these functional analyses
foremost for ourselves and our clients allows us to notice our natural
anxious reactions with less entanglement.
Similarly, while its important to minimize external reinforcers for
clients suicidal behaviors, its equally important to manage our own external reinforcers for therapeutic behaviors that are reactive and risk-averse
(and life narrowing for clients), such as inappropriate hospitalization,
increasing medication, involuntary treatment, contracts, and so on.
Simple measures include clearly documenting chronic rather than acute
suicidality; clarifying our functional, empirically based harm-minimization
approach; giving advice about crisis services; maintaining appropriate professional indemnity insurance; and being aware of the extensive literature
supporting outpatient care of chronic suicidality and self-harming behaviors. There is no unbiased evidence supporting the use of medication to
decrease the incidence or severity of self-harm or of suicidalityquite the
opposite. There is evidence that, for instance, selective serotonin reuptake
inhibitors often increase suicidality (Ferguson et al., 2005). Maintaining
professional support, education, and supervision from within the professional communities you inhabit is critical.
Persevering with Valued Actions, Sensitive to

Contextual Shifts
Because challenging clients may feel stuck and hopeless, we may feel
the same. So how can we nurture our health and flexibility, even in
barren sessions and stuck therapy? We apply the same approach we
encourage for our clients: remaining open, aware, and active; forgiving
ourselves when we struggle; and gently returning to our values, again and
again. We do so by reinforcing our own tiny toward moves in session,
noticing what happens, analyzing these interactions, and setting home
practice for ourselves to take these new behaviors on the road and see
what happens. Both we and our clients may view the smallest valued
action as a meaningful toward move.
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Summary of the Clinicians Matrix

It may be your privilege to choose to work with the most severely
distressed, disturbed, and at times disturbing individuals, gently helping
them move toward their chosen values. This work can bring personal
suffering, yet really making a difference in these clients lives can also
bring great satisfaction. Ongoing connection with the purpose of your
work, with others also doing this work, and with the evidence supporting
what youre doing may truly help you in holding the inevitable unwanted
feelings with more kindness and self-compassion, nurturing and empowering your life both at work and at home.
Client Matrix with Chronic and Severe

Symptoms
The client in front of you is a person who cares. He or she cared enough
to come to your office and be in that chair. Even if youre seeing the
person in an institution, a hospital, or a jail, that client cares enough to
be willing to see a mental health practitioner, to have showered in the
last day or two, to have eaten and used the toilet. But if such clients have
experienced great pain over the years when getting close to people and
things that really matter to them, when you ask them, What matters to
you in life? Whats important? What do you value? they may well answer,
Nothing. I just dont care.
Yet clients with long histories of struggling have done a lot of advance
groundwork for matrix-oriented ACT therapists. Theyve taken their
time really getting to know their away moves and exactly what doesnt
work in the long term. They probably have low expectations that you can
help them get rid of emotions they dont like.
For clients with such histories, very softly and kindly exploring the
left side of the matrix can be helpful. This helps them notice the simple
normalcy of suffering and struggling. Its a gentle, compassionate, experiential way of contacting the immediate relief while also noticing the
long-term costs of a life lived primarily through away moves. It allows for
empathically noticing all of this from the minds problem-
solving,
protect from harm point of view, which is amplified by a society that
has come to value feeling good above all else. Small, collaborative
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explorations may gently move you toward a caring, compassionate therapeutic relationship with such clients.
Clients Values
Nothing man. I just dont care. What do you mean, what matters to
me? For clients feeling a weight of pain when they dare to care, not
caring can become a vital mental away move. It dulls the acute, searing
pain due to the gap between what they want and what theyve gotthat
sharp ache that comes from contemplating places their mind tells them
they can never hope to go. Not caring on the other hand, brings only
flatness and a dull ache, which they may prefer to the pain youre inviting
them to feel. Consider yourself the dentist they have come to see,
perhaps reluctantly. Its probably best to not go straight to probing the
most painful tooth!
Start with an Emphasis on Values

Conventional clinical assessment often begins with collecting background information. Our deepest values are often to be found within
demographic details. Simply begin to know your client as a human
being by asking about those details:
How old are you?
Are you single, or in a relationship?
Oh, for how long? Whats your partners name? All relationships
have their ups and downs. Hows it going just now? [Or] Would you
like to be in a relationship? Are you doing anything to make that
happen?
So do you work, or are you in training or on benefits of some kind?
Hows the job going? Are you happy enough with it? [Or] It must
be hard getting by on that.
Any kids? What are their names and ages? What are they up to in life?
Do you live in a house or flat? Is it a rental, or yours and the banks?
Do you have enough space, and is it comfy? How long have you been
in that neighborhood? Where were you living before that?
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As the time and setting permit, this line of questioning can gently
elicit a picture of the client as a human being within a context. All of this
information, along with details on activities of daily living, subtly connects with what matters, or could matter, without using scary words like
values or caring. Given time, we might expand this, catching even
tiny ways of passing the time, like watching TV and which shows,
reading, browsing the Internet, exercise, relationships with friends and
family members, pets, and so on, both currently and in the past, before
the client got so stuck. You might ask questions like, As a kid, what did
you do in school? Covering this ground is worth at least a third of assessment time. Make it clear that this is the important stuffa rough guide
to where the client might go on a life journey toward valued living. If the
client is living an impoverished life in which values have seemed unapproachable, keep it gentle and light.
Continue with an Emphasis on Values

Begin and end each clinical encounter by touching on purposeful
living. Notice small toward moves and instigate more. This engages and
immediately reinforces in-session and on the road toward moves. Begin
or end with exercises in just noticing (aka mindfulness) that emphasize
values, from coming to and being in session to daily activities. Another
possibility is a matrix warm-up of just noticing the feel of toward and
away moves. Notice increased presence, emotional openness, and flexible engagement in the client and reinforce these moves, checking out
how this reinforcement functions.
Remember always that in our pain we find our values, so tease out
and gently note, in a way that best fits the moment, the caring that
underlies each expression of suffering. You might ease into it by simply
asking what if something could happen in those realms. Openly and
authentically appreciate any courageous move toward values in session
and in daily life, no matter how tiny.
Touching on values can so easily be painful. Even as I write this, my
mind is giving me a hard time for often going too quickly into clients
caring, and therefore into their pain. Asking, Is it okay to ask you about
what might really matter to you? can be just as critical as asking, Is it
okay for us to do this exposure exercise?
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Clients Unwanted Mental Experiences

When we carefully explore where our clients want to go, stuff shows
up on the left side of their matrix and gets in the way: anxiety, panic,
depression, anger, pain, guilt, shame, loneliness, and more. As matrix
practitioners, we have very different assumptions and a very different
agenda from the mainstream agenda of eliminating difficult experiences.
Make it clear that you assume everyone suffers, including you, and that
this is normal. Emphasize that this in no way minimizes the clients suffering, struggle, and distress. Rather, it simply acknowledges that, in
some deep and important way, we humans really are all in this together.
Using the matrix allows us to step back and normalize this stuff.
Sensitively notice which unwanted mental experiences are most distressing to clients and which life situations are most painful. While their
previous change efforts have probably focused on the details of unwanted
experiencing and how to get rid of it, with the matrix youve collaboratively established a clear emphasis on whats important to clients and
their toward moves. So you can express deep concern for their pain and
suffering, and also de-
emphasize the finer details of that suffering.
Clients urges to carefully analyze their suffering may create frustration
in this area. Kindly ask how often theyve tried this approach in the past
and how well it has worked. Also ask what a focus on analyzing difficulties has cost them. Overanalyzing their unwanted experiencing may get
in the way of moving toward valued livingwhich leads us nicely to the
next topic.
Clients Away Moves

Clients challenging solutions to suffering arent inherently different
than those of any other human being. Theyre simply more pervasive,
persistent, resistant, and distress producing due to temperament, role
models, cultural influences, health issues, and individual, family, and
social contexts. Health care and other social or legal contexts can also be
highly reinforcing of common away moves. These take many forms.
Observable away moves include isolation, putting things off, deliberate self-harm, using mindfulness to relax, engaging in therapy, venting,
bottling up feelings, seeking reassurance, overworking, exercising to de-
stress, bingeing, purging, restricting, using alcohol, drugs, and
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The ACT Matrix
medications to get rid of bad feelings, and so on. Mental, or inner, less
easily observed away moves, which are often pervasive and heavily
invested include dissociating and ruminating, which may hook both
client and therapist due to their reasonableness and inevitability, and a
deeply felt need to understand or get insight. Remember, its always about
the function of the behaviorthe function in that moment, in that particular context in the clients life. Any of the moves listed above might be
fully toward or very much away. Cultivating and reinforcing an open,
aware, active matrix perspective allows for ongoing functional analysis of
behaviors, as we simply notice how theyre working for valued living.
Clients Toward Moves

The client in front of you is a person who cares, who has moved
toward health to be with you. In exploring the clients life during assessment, youve discovered something of who and what matters to this
person. Emphasizing movement toward what matters to the client commences your joint work on toward moves in a reinforcing fashion.
The first toward move clients will experience in the verbal context
oftoward move is likely to occur in the course of setting up the matrix
point of view. Simply learning to notice the feel of toward moves versus
that of away moves is in itself an absolutely vital toward move. By noticing from time to time whether what theyre doing in that moment feels
more like a toward move or an away move, clients may generalize this
critical behavior to their lives.
All of ACTs committed action strategies apply to challenging
clients toward moves: bulls-eyes, valued action plans, SMART goals,
and so on. Small steps may lead to big changes, gently connecting with
values, noticing and reinforcing these moves, and together checking out
how it works.
Clinical Matrix Dancing with Chronic

and Severe Struggles
Id like to finish this chapter with a couple of clinical vignettes that illustrate the dance outlined above, starting with Mike, who struggles with
142
anxiety, depression, and substance use. For convenience, lets assume the
therapist in these vignettes is male.
Therapist: So whats your living situation? For example, do you live
in a house or an apartment? Is it a rental, or is it yours?
Do you live alone or with others? Tell me about how you
spend your dayseven small things, like TV or perhaps
exercise.
Client: Well, Im stuck back at home. Pathetic isnt it, at my age,
living with my parents? Ever since I had to quit work
because of my depression, my illness, I dont do much,
mostly just getting stoned or popping Valium. Im mostly
feeling suicidal, but I cant kill myself because of my
damn parents. I havent been exercising since I gained
all this weight because of the meds. Its embarrassing!
Therapists mental experiencing: Notices that independence and
family are important for the client, despite mixed feelings. Notices that
the clients socially reinforced illness construct serves as mental explanation for moving away from frustration, sadness, and shame. Notices his
own frustration with such unworkable explanations, and his own away
moves in the form of thoughts about the client buying and using illness
as an excuse. Notices that in this realm the clients experience of the
unworkability of medication and its side effects might offer flexibility.
Notices his own anxiety and urge to distance himself on hearing the clients report of suicidality. Notices that family, health, and others are
important to the client. Connects with his own values of helping others
and engages the client in a discussion of values.
Therapist: It sounds really tough, Mike, feeling so stuck like that,
and with your mind giving you such a hard time. You
know, I can hear kindness in there for your parents,
even with the frustration. It sounds like being independent and a bit more active might matter to you. What if
our work could be about moving toward things like that,
even in tiny ways?
Now heres an exchange with Rachel, whos been diagnosed with
psychosis.
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The ACT Matrix
Therapist: How did you do with those valued actions we planned

last week, Rachel? Did you notice making some toward
and away moves? Did you practice any five-senses
experiencing while showering or brushing your teeth?
Did you get out for those walks? How about just noticing some of your mental experiencingdid you do that?
Client: Well, I noticed some toward moves with a bit of
walking, but the voices told me I was fat and uglythat
I shouldnt bother, that Id just yell and embarrass myself
again and look stupid. I dont really know if I want to do
that stuff anyway. Its easier to just stay home. I dont
know why we keep trying. I never get there. They dont
want me to, anyway. I hate them!
Therapists mental experiencing: Notices his own frustration with stuckness in therapy, yet also notices that coming to therapy with incomplete
valued actions is a significant, courageous move on the clients part toward
health, relationship, and closeness. Notices the clients fusion and struggle
with voices and the associated anger, frustration, and anxiety.
Therapist: So, Rachel, can we just notice whats showing up for you
here and now? That youre coming here, telling me this
stuff, even though its hard for youthat feels like a
toward move to me in this moment. How about you?
Client: Yeah, I dont know. It feels reallymaybe a bit each way.
They dont want me to get better.
Therapists mental experiencing: Again, notices the clients growing
repertoire of noticing how toward and away moves feel and increased
capacity to share about difficulties.
Therapist: It seems to me that, for you, growing your life matters,
at least a little bit. It must for you to come here and
share this with me. Is it okay for us to keep working on
moving toward this, toward you growing your life, even
with frustration and uncertainty? For this moment, can
we just let those voices, and those stories, come along
for the ride?
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Conclusion
In working with clients with chronic and severe symptoms, well have
plenty of unwanted painful experiences, both theirs and ours, coming
along for the ride. What if we could make a little room for these unwelcome passengers, welcoming them and allowing these painful thoughts
and feelings in the service of what we care about most deeply? They are
so closely connected. Gently carry them toward more valued lives for
your clients, and toward a valued path for you in your chosen work. With
kindness and compassion, we all might choose to explore whats possible
in this moment, and this next moment, and the next. I wish you well in
your journey.
References
Chiles, J. A., & Strosahl, K. D. (2005). Clinical manual for assessment and treatment of suicidal patients. Arlington: American Psychiatric Publishing.
Ferguson, D., Doucette, S., Glass, K. C., Shapiro, S., Healy, D., Herbert, P., &
Hutton, B. (2005). Association between suicide attempts and selective
serotonin reuptake inhibitors: Systematic review of randomised controlled
trials. British Medical Journal 330(7492), 396.
Hayes, S. C., Barnes-Holmes, D., and Wilson, K. G. (2012) Contextual behavioral science: Creating a science more adequate to the challenge of the
human condition. Journal of Contextual Behavioral Science 1(12), 116.
Kupfer, D. J., First, M. B., & Regier, D. E. (Eds.). (2002). A research agenda for
DSMV. Washington, DC: American Psychiatric Association.
Strosahl, K. D. (2004a). ACT with the multi-problem patient. In S. C. Hayes &
K. D. Strosahl (Eds.), A practical guide to acceptance and commitment therapy
(pp. 209245). New York: Springer.
Strosahl, K. D. (2004b). Forensic and ethical issues in the assessment and treatment of the suicidal patient. In W. ODonohue & E. R. Levensky (Eds.),
Handbook of forensic psychology: Resource for mental health and legal professionals (pp. 129154). San Diego: Elsevier Academic Press.
Strosahl, K. D., Robinson, P., & Gustavsson, T. (2012). Brief interventions for
radical change: Principles and practice of focused acceptance and commitment
therapy. Oakland, CA: New Harbinger.
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CH A P T ER 9
Something You Can

Never Forget: The
Matrix and PTSD
Kevin Polk and Mary Alyce Burkhart
The matrix began as a way of working with clients with PTSD. For well
over twenty years weve worked with people with severe trauma memories. First, we used a psychodynamic approach, then moved on to family
systems, stress inoculation training, cognitive behavioral therapy, prolonged exposure therapy, and finally acceptance and commitment
therapy. After about twenty thousand hours of reading about and doing
ACT, the matrix diagram emerged.
Almost everyone intuitively understands that some people who have
experienced trauma are severely troubled by memories of the trauma.
After the Civil War, soldiers who were struggling with their traumatic
memories of the war were referred to as having soldiers heart. Later
terms were shell shock and battle fatigue. Beyond those exposed to
combat, survivors of traumatic experiences such as rape and natural
disasters were also known to carry the wounds of their trauma for years.
PTSD
Only a small percentage of people who experience trauma develop
PTSD. Said another way, most people who experience trauma dont
The ACT Matrix
develop PTSD. Instead, the majority of people successfully incorporate

the trauma memories into their daily lives.
One of the basic symptoms of PTSD is avoidance of reminders of the
trauma memory. For example, the trauma might have occurred with a lot
of noise. Later, in noisy places the trauma memory is recalled. The feelings associated with the trauma memory are unpleasant, and the person
seeks to avoid the feelings. Soon the person avoids noisy places in order
to avoid having the trauma memory. In extreme cases, avoidance can
reach the level that the person almost never leaves home in order to
avoid noisy places that might trigger trauma memories. Anyone who
knows people who struggle with trauma memories is familiar with this
dynamic, called the avoidance cycle.
An early form of treatment was to send people who were struggling
with trauma memories away to quiet settings in the country. While this
avoidance-
centered approach probably prevented some recall of the
memories while people were at the retreat, the problems would immediately return once they returned to noisier life settings.
As mental health knowledge has increased, many approaches have
been used to help people struggling with trauma memories.
Psychodynamic, cognitive behavioral, and behavioral therapy approaches
have all been tried with varying success.
Evolution of the Matrix

The matrix diagram was developed as an offshoot of prolonged
exposure therapy (PE; Foa & Rothbaum, 1998). In brief, PE uses a couple
of approaches to the trauma memory. One is to record clients trauma
stories and have them listen to the recordings over and over again until
the distress elicited by the story drops to an acceptable level. The other
is to have clients do in vivo exposure, going to places theyve avoided
because they invoke too much distress. PE has proved to be an effective
approach for many of the clients who will engage in this therapy. However,
a large percentage of people who struggle with trauma memories wont
undertake PE. Many want nothing to do with a therapy that makes them
talk about the trauma. For this reason, many clinicians try to engage
clients in other psychoeducational treatments while hoping that one day
they will engage in PE.
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Something You Can Never Forget: The Matrix and PTSD
Acceptance and commitment therapy (ACT) can be seen as an

alternative to in vivo exposure. In the PE form of in vivo exposure, a
client identifies an avoided place, and then plans are made to go to that
place. Then the person goes into the environment and tolerates the discomfort until habituation occurs. This is measured with a subjective
units of distress scale (SUDS), usually a rating from 1 (no distress) to 10
(intolerable distress).
From an ACT point of view, this can be approached differently. The
avoided place is identified, but then its discussed in terms of the function
of going to such a place. For example, an avoided place might be a large,
crowded discount store. Some of the functions of going to such a place
might be to buy food, clothing, and gifts. Buying food, clothing, and gifts
can then be discussed in terms of valued actions. Continuing with this
example, a woman might have identified that her son is very important
to her. Now the sons birthday is coming up. She needs to buy a gift, and
the large, crowded store probably has just the right thing. From this point
of view, the action of going to the store can be noticed in the context of
buying a gift for a valued person. The discomfort can also be noticed in
this context, and the discomfort doesnt need to change. The only
change necessary is that the client successfully negotiates a trip to the
store and purchases a gift.
While ACT in vivo sounds better than PE in vivo, it still doesnt pass
the doable test for a lot of people who have long histories of struggling
with trauma memories. Theyve practiced avoidance to such an extent
that the mere thought of going to a crowded store or other dreaded place
invokes so much distress that they have the urge to abuse substances to
avoid this. ACT has a number of gentle ways to engage people in this in
vivo process. As you will soon see, the matrix diagram is one of the
gentlest.
Arriving in Therapy
Most people struggling with trauma memories show up to therapy fearing
that theyll have to talk about their trauma memories. And, of course,
with most therapies this is true; at some point, the trauma memories
must be talked about. Even ACT practitioners often believe that the
trauma must be talked about.
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The ACT Matrix
Lets briefly return to the 70 to 90 percent of people who dont suffer

from long-term, debilitating struggles with trauma memories. How did
that happen? Consider a unit of people, say firefighters, who suffered the
same trauma. Some subsequently developed PTSD but others didnt.
Why? It isnt that they forgot the trauma. When asked about the trauma,
they can tell you about it. They will even report that telling the story is
slightly distressing. However, they dont struggle with the memories in
such a way that it negatively impacts their life. Indeed, some have taken
the memories and done great things in life. When you ask them, these
people typically report that they didnt repeatedly tell their trauma
stories. For the most part, they kept the stories to themselves. They just
found a way to take the trauma story into their life. This is exactly what
ACT strives to do: help people accept internal experiencing while going
forward with life.
When using the matrix diagram, clients need not talk about their
trauma memories. This doesnt mean they cant talk about them; it just
means they have a choice whether or not to do so. The outcome of treatment is in no way dependent on telling the trauma story in treatmentor
anywhere else. The matrix clinician is encouraged to tell clients this
explicitly, for example, saying, You dont need to tell your trauma story
for this treatment.
The matrix diagram was designed to quickly get anyone into the
process of having memoriesall memories, including trauma memories
while engaging in life-affirming actions. Matrix clinicians need not
mention any type of memory. We can rely on clients to reveal what they
want to reveal. Lets briefly take a look at the matrix process, and then
well return to the topic of trauma memories.
Presenting the Matrix Process

The matrix is introduced in a matter-of-fact way, perhaps by saying something like I have this point of view that I work from. Would it be okay if
I show you that point of view? Although traditionally a therapist would
ask, What brought you here? or some other question, for the purposes
of informed consent, we prefer to show clients the point of view were
going to use first.
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To date, every person weve asked has said that its okay. With this
agreement, we then proceed to show them the diagram in one of two
ways. Heres an outline of the first approach:
1. We ask clients to use their five senses to notice a pen, pencil, or
some other object, usually omitting taste for sanitary reasons.
2. We ask clients to put the object away from their five senses and
then recall each of the sensory aspects of the object through
mental experiencing.
3. We ask them to notice the difference between their sensory and
mental experiencing of the object. (Note: It isnt necessary that
they notice a difference. Some clients will say there was no difference. To this we respond, Great! You noticed that to you
there was no difference.)
4. We ask clients to recall how it feels to move toward someone or
something important to them, such as walking toward a loved
one.
5. We ask clients to recall how it feels to move away from some
unwanted mental experiencing, such as moving away from fear.
6. We ask clients to notice the difference between how it feels to
move toward and how it feels to move away.
While weve been asking these six questions, weve been drawing the
matrix diagram on a whiteboard or other suitable surface. We end by
saying something like Psychological flexibility is in the center here
(drawing a circle in the center), with you noticing these two differences.
The other method we use is to ask the following questions while
drawing the matrix diagram, usually on a whiteboard:
1. Who and what are important to you? The answers are written in
the lower right of the diagram.
2. What shows up inside you, such as fear, that can get in the way of
moving toward who and what are important to you? These answers
are written in the lower left.
3. What kind of behaviors do you do to move away from unwanted
stuff that shows up inside you? For example, someone might run from
fear. These answers are written in the upper left.
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The ACT Matrix
4. What behaviors could you do to move toward who and what are
important to you? These answers are written in the upper right.
We end by saying something like Psychological flexibility is in the
center, here (drawing a circle in the center, with the label You Noticing).
You notice who or whats important to you, what shows up and gets in
the way, what you do to move away, and what you do to move toward, all
at the same time. Its cool; your mind can do that.
The Stuck Cycle

No matter how the matrix is presented, the next task is to present the
avoidance cycle, which plays out on the left side of the diagram. You can
say something like When one of these unwanted experiences you
noticed down here (pointing to the lower left) shows up, which one of these
behaviors (pointing to the upper left) do you most often do to move away
from it? For example, the client might have noticed that fear shows up,
and that drinking alcohol is used as an away move. Then you can draw
half of a circle, as in figure 9.1.
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Five-Senses
Experiencing
Drinking
Alcohol
Away
YOU
Noticing
Toward
Fear
Mental
Experiencing
Figure 9.1. Moving away.
Continuing with this example, youd next ask, Does drinking get
rid of the fear forever, or does the fear eventually come back? Clients
always answer that the fear comes back. At that time, you can complete
the circle back down to fear, as in figure 9.2.
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The ACT Matrix
Five-Senses
Experiencing
Drinking
Alcohol
Away
YOU
Noticing
Toward
Fear
Mental
Experiencing
Figure 9.2. The avoidance cycle.
Then ask, When the fear comes back, do you drink, or do some
other away move? Of course, the answer is yes, so you can draw another
half circle back up to drinking, or whatever away behavior the client
identified. Keep doing this, drawing smaller and smaller circles, and then
write Stuck underneath Away on the matrix, as in figure 9.3.
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Five-Senses
Experiencing
Drinking
Alcohol
Away
YOU
Noticing
Toward
Stuck!
Fear
Mental
Experiencing
Figure 9.3. Well and truly stuck.
Explain that everyone gets stuck in these kind of cycles. We all have
our stuck spots.
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The ACT Matrix
Sorting
After the matrix diagram is presented, the next stage of the process is
sorting. To do so, engage clients in telling some story, any story, and as
they do so, sort the story into the four categories of the matrix diagram:
Sensory experiencing
Mental or inner experiencing
Toward actions
Away actions
For example, a person might be telling a story and mention smelling
flowers. The matrix practitioner might ask, Where would smelling go
on the diagram? The client might continue and mention taking a walk.
The matrix practitioner might then ask, Where would you sort that
walking on the diagram?
Notice that the client is invited to do the sorting. Most matrix clinicians, us included, get excited and start doing the sorting for the client.
As best you can, resist this urge and have the client do the sorting.
Another important point about sorting is that the accuracy of the
sorting isnt important. The client who was smelling flowers might sort
that as a mental experience, whereas the clinicians mind might think,
Thats wrong. However, the act of sorting is whats important, not the
accuracy of the sorting.
At any time, the clinician can pause on any part of any story and ask
the client to sort it. The aim is to get clients accustomed to stepping back
from their story in order to do the sortingto get them to ask the questions Is this a mental or sensory experience? and Is this action a toward
or away move? The next phase of the process is to generalize this ongoing
asking of the two questions into life. Thats done by noticing hooks.
Noticing Hooks and What Is Done

Next
We all have events in life that are emotionally provoking. Maybe someone
cuts you off in traffic. Maybe someone grabs the last cookie just before
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you were going to walk over and get it. Maybe someone calls you an
insulting name. The list of potential hooks goes on and on.
To explore this, simply engage clients in a conversation about hooks.
If youre running a group, a discussion of peoples favorite hooks is likely
to be humorous, lively, and enjoyable. Even in an individual session, this
is usually a lighthearted discussion. Toward the end of the discussion,
ask, What hook do you think will show up next in your life?
Once clients predict the hook, you can ask, Do you think you could
notice the hook and then notice what you do next? Essentially everyone
is willing to try to remember to notice their hooks and what they do
next. Some people get excited and say things like So Im supposed to
notice the hook and then do a toward move? To this, you would respond
that, after noticing the hook, both toward and away moves should be
noticed.
At the end of the session, clients are given the homework assignment
to notice hooks and what they do next, with the clinician noting that the
homework either will or wont be done, and that either way will work for
learning.
In the next session, a discussion about hooks that were noticed or
not noticed ensues. Clients are likely to tell other toward and away stories
and engage in some sorting into the matrix diagram.
Clients with trauma memories might notice that theyre especially
likely to get hooked by their trauma memories and that they have trouble
having those memories and getting on with productive living. For these
clients, the following routine can be very helpful.
Because these clients are already very familiar with the matrix
diagram and sorting, you can simply say something like, Yes, sometimes
trauma memories can be very troubling. Some clients have told me that
the following mixing or blending exercise was very helpful to them.
Would you like to hear about it? To date, all of our clients have said yes.
When you notice having a trauma memory, pause and notice your
current five-senses experiencing. Where would you sort that trauma
memory? They are almost always sorted into the lower left of the matrix.
And where would you sort the five-senses experiencing? It is almost
always sorted right at the top of the vertical line. Continue by saying,
Great! Now, if you get the chance, you can pause and literally mix or
blend the two experiences together. While saying this, draw your fingers
together in a visual representation of a mixing action. Explain that all
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The ACT Matrix
they need to do is notice what that mixing does. During subsequent sessions, you can ask clients whether they tried the mixing. They usually
have, and they often tell some interesting stories about the experience.
If you are like most clinicians, us included, your mind is saying, This
is too simple. Theres no way something so simple will work. However, since
its so simple and takes so little time, its worth a try. You might just find
that it leads to a lot more valued living for clients.
The Matrix Process Explained

You may have guessed that while the matrix process seems very simple,
a lot is going on under the surface. Some of the details of the processes
going on under the hood are discussed in chapter 2. Here, well briefly go
through some of whats happening with a few observations specific to
working with traumatic memories.
Cognitive Distancing
Many people dont know that the original name for ACT was comprehensive distancing, but we can all quickly understand why Steve
Hayes and company switched to the much sexier ACT. However, comprehensive distancing remains part of the model, even if its not discussed
much. Imagine a client sitting in your office with a story to tella story
thats mucking up the clients life. The client doesnt have much distance
from the story, if any. As you describe the matrix, you also draw it on a
whiteboard or some other surface a few feet away from the client. The
two crossed lines are very primitive and easy to stare at. Then you place
the essential elements of the story on the diagram: five-senses experiencing, mental experiencing, toward behaviors, and away behaviors. As the
clients story is plotted on the diagram several feet away, it is physically
distanced from the client.
In addition, the story is being taken apart through the process of
pausing and sorting the story. Sorting allows new experiences of the story
to be related to the story, including that the story is being told in a safe
place with no ill results. This is defusion, as it is now called in ACT.
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Clarifying Values
In matrix work, who or what is important to you corresponds to
the ACT term values. This is simply because the term values tends to
carry some baggage. For example, a client might think of the religiously
and politically loaded family values when you refer to values. Then youre
stuck explaining how ACT values are different from family values. This
isnt productive, so the simpler who or what is important to you can be
used to good effect in values clarification.
Committed Action
Committed actions are inherent in the matrix and need not be
taught. These actions are usually sorted in the upper right quadrant.
They are toward moves.
Recognizing Appetitive and Aversive

Control
Moving toward who or what is important usually results in positive
reinforcement. Moving away from unwanted mental experiencing is negatively reinforcing. Both are powerful reinforcers, but moving toward
who or what is important gets people somewhere in life, whereas moving
away keeps them stuck in an endless loop. Obviously, moving away from
real danger (like an oncoming bus) is very functional, but moving away
from fear of imagined events or inner experiencing often isnt functional.
Most people who struggle with trauma memories simply dont notice the
difference between these two reinforcers. The matrix makes this distinction obvious, and thats part of how it helps.
Working on Trauma Memories

At no time are clients asked to discuss any trauma memory out loud.
Even in the case of the mixing exercise outlined above, clients can
keep these memories to themselves. They notice these memories (and
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The ACT Matrix
other mental experiences) showing up in real life, and then notice the
choices they make after experiencing the memory.
The matrix also inherently takes into account who and what are
important to the client in working with trauma memories. After they
notice a trauma memory (possibly as a hook), clients are drawn into
choosing between moving away from or toward who or what is important. They learn that reactions to trauma memories need not be
automaticthey have a choice. Notice that this choice is not forced
upon clients; rather, its there for them to discover.
Present-Moment Awareness
An often mentioned part of ACT is present-moment awareness,
including the practice of mindfulness. Because mindfulness is another
term that many people dislike for a variety of reasons, it isnt mentioned
in the basic matrix routines. Instead, present-moment awareness is referenced with the word noticing, as noticing can only occur in the present
moment. In this way the matrix diagram automatically returns people to
the present moment with no explicit intervention needed.
Self-as-Context
One of the more complex terms in ACT is self-as-context. Its
easiest to think about it by first thinking of self-as-content. That simply
means totally buying the words youre saying about yourself. In much of
life this is fine. You might say, Im an accountant. If indeed you practice
that profession, to an extent it is you. If youre a mental health professional, you might say, Im a mental health professional. Again, no
problem.
Lets take that further. If youre a mental health professional, wed
like you to do the following exercise: The next time you see a loved one,
stand up straight, put your hands on your hips, and sternly proclaim, I
am a mental health professional. Notice the reaction you get. Then try
this with a stranger or someone you dont know well. For example, next
time youre eating at a restaurant, stand up straight, with your hands on
your hips, and proclaim to the waitperson, I am a mental health professional. Again, notice the reaction you get.
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Were only kidding! You dont need to do that exercisebut just

imagine if you did. No matter where you go in life, to no matter who you
meet, mental health professional is your one and only identity. Would
you feel sort of stuck? Thats the point. If you buy the content of your
words to such an extent, it can get you stuck. Now think about people
with the labels PTSD, ADHD, depressed, OCD, and so on.
Self-as-process is the ACT term that refers to noticing how we are
all information processors. Information comes in, it gets processed, and
then theres some reaction. Its the same with food. We take it in, it gets
processedyou get the picture. Self-as-process is simply seeing oneself as
a processor.
Now we can tackle self-as-context. This is basically seeing oneself
being. Its all that child of the universe stuff we talk about. You can see
yourself as being born, being one way as an infant, being another way as
a toddler, and so on. You can note the changes in yourself over time. In
addition, you can note that you have choices about what you might
become in terms of your behaviors in the world. At the same time, you
also have a sense of the permanent self: the you that took the first breath
you ever took, and every breath youve ever taken.
The reason self-as-context is emphasized in ACT and is absolutely
inherent to the matrix process is choice. From the self-as-content perspective there is no choice. You are what you are. You are your content
and always will be. You are stuck. The self-as-process perspective leaves
you pretty stuck, as well. You might try to process differently, but theres
not much flexibility; how we process things, at every level, is fairly fixed.
However, from the perspective of self-as-context, you have maximum
flexibility.
The really good news is that when you work with the matrix, you can
forget about self-as-context. Its part of the process and occurs naturally.
Conclusion
Another way of saying self-as-context is psychological flexibility. In
matrix terms, people have the choice to do one of several away moves or
one of several toward moves at any moment. Further, the choice thats
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The ACT Matrix
made is informed by the current context. The matrix facilitates ongoing

practice in choosing in this way.
By far and away the most significant part of matrix work with people
struggling with trauma memories is their discovery of appetitive (toward)
moves. After a session or two, they will come to you and tell you about
noticing hooks and choosing toward moves, even if you didnt suggest at
any time that choosing toward moves is necessary. When clients report
these toward moves, its extremely rewarding for both client and clinician. Try it and youll see what we mean.
References
Foa, E. B., & Rothbaum, B. O. (1998). Treating the Trauma of Rape: CognitiveBehavioral Therapy for PTSD. New York: Guilford Press.
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CH A P T ER 10
Spot the Matrix:

Psychological Flexibility in
Private Psychiatric Practice
Jean-Michel Vincent
I am a psychiatrist in private practice in Besanon, France. Coming from

a psychodynamic approach, I have trained in cognitive behavioral
therapy since 2003, in acceptance and commitment therapy since 2008,
and with the matrix since its inception in 2009. I use the matrix with all
my clients. By the time this book is published, I might have reached my
ten thousandth matrix session. I work under a convention with the
French public health system, meaning that my fees are capped and clients
are reimbursed for their sessions. This gives my clients access to free
psychotherapy services. My sessions are thirty minutes long and I see no
more than eleven clients a day.
When I first started working from the ACT model, I would formally
work through the six processes of the hexaflex. Then, with the inception
of the matrix model, I started to introduce contextual functional analysis
to my clients right away, without having to explain the model first. The
matrix allows for a contextual conversation from the very first exchanges.
This chapter presents my way of working with the matrix in this setting.
The ACT Matrix
The Matrix in Context

The matrix allows therapists to adopt a functional contextual perspective and helps clients see their experience in context. From this perspective, clients can pragmatically choose workability with respect to who or
what is important rather than the away moves that suffering induces.
From the perspective of the central me of the matrix, I invite
clients to notice their experience and this perspective itself. Its a mindfulness for two skill that doesnt require formal mindfulness exercises.
Flexibility shows up when clients start perceiving different aspects of
their experience. One of the first discriminations they can make is
between left-side and right-side experiences. This allows them to choose
a functional criterion as their truth criterion, acting in accordance with
their values rather than trying to avoid or escape suffering. Pragmatism
is then governed by the right side, rather than the left, leading to a broadening of behavioral repertoires.
A matrix diagram sits permanently on my desk and guides the conversation from the very first exchanges. I dont explain the matrix to
clients; rather, I guide them through the functional correspondence
between their experience and the axes of the matrixat first by pointing
to the different aspects of their experience on the diagram, and then, as
the exchange progresses, by inviting them to point to where the different
aspects of their experience go on the diagram.
Introducing the Perspective: An

Introductory Dialogue
Heres an example of how I introduce the matrix perspective.
Therapist: A life that works is a flexible and broad lifea life
where there is freedom and vitality (pointing toward the
right side of the matrix). In a life that works, were guided
by whats important to us. Its a life that looks to stories
of possibilities in which our actions are in line with
whats important to us.
Client:
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Thats not how it works for me at the moment!
Spot the Matrix: Psychological Flexibility in Private Psychiatric Practice
Therapist: So how does it work for you at the moment?

At this point, clients often get caught up in limiting stories, such as
I cant do this or that or I always do this or that. They then turn to
the left side of their matrix and notice their experience of a narrowing
life due to avoidant behaviors and the attendant rigidity and harshness.
They observe their experience of inflexibility, and we share around that.
Together, we validate the suffering (lower left) and the struggle (upper
left) and observe their behaviors (both public and private) related to
their struggles.
Therapist: Okay, so when your experience is here on the left, you
notice your life narrowing. Its a life of struggle, devoted
to solving the problems you experience in the lower left
quadrant by doing the actions in the upper left. But can
life be reduced to solving these problems, or should it be
guided by whats important to you? Our greatest
freedom is to be able to notice the whole of our experience, to notice both the left and the right. What could
your experience on the right side be like?
Here I invite clients to notice their experiential avoidance in context
so they can also notice another side to their experiencethe side where
whats important guides their life and where their actions are congruent
with their values. My job as a therapist boils down to inviting clients to
notice these two aspects of their experience: the left and the right, away
and toward. If they notice something on the left, contextually there has
to be something corresponding on the right. The therapists job is asking
questions that help clients observe their experience in this wider context.
Training the Toward-Away

Discrimination
At first I help clients discriminate between away moves (away from aversive functions) and toward moves (toward appetitive functions). I invite
them to notice this discrimination through their inner experience. In my
experience, establishing the away versus toward discrimination is often
sufficient to get therapy moving. Having practiced this discrimination in
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The ACT Matrix
session with the matrix diagram, clients start applying it to their everyday lives and come back for their next session with functional contextual
stories evidencing an increase in flexibility.
When clients cant discriminate between toward and away moves, I
spend time training this discrimination in our exchanges and help them
observe their experience in context. What works well for me is to invite
clients to observe whether they see anything on the right side. I do this
through questions such as In a workable life, what would you do instead
of your actions in the upper left quadrant? What would the stories that
fill a life that works be for you? What did you use to do before suffering
showed up? What did you do to move toward whats important? And if
you didnt have all this stuff showing in the lower left quadrant, what
would you do?
When Nothing Shows Up on the

Right Side
Of course, sometimes clients are so fused with their suffering in the
lower left quadrant and so locked into the struggle against these experiences that they cant see anything on the right side. I might then use the
therapeutic relationship to help them experience more flexibility even in
the presence of the content in the lower left quadrant. Below are two of
the strategies I may use.
Validating Suffering
I unconditionally validate my clients experience of their suffering.
For example, I might say, I see that this is really painful for you and that
you feel totally stuck. Is this how it is for you? I find that validating suffering often opens the door to more flexibility on clients part. They
might then say, Well, yes, Im stuck. But I still manage to do a few things
on the right side. Unconditionally validating clients suffering allows
them to look at it for what it is: an experience of suffering, something in
the lower left quadrant. I invite them to slow down for a moment and
look at what this experience is made of, like a scientist observing a phenomenon for the very first time and taking inventory of the different
aspects of their experience of it. I also ask them to write the mental and
sensory aspects of their suffering on different-colored sticky notes.
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Observing their experience represents a broadening, a stretching of

their matrix. It is already a toward move, a valued action, which can then
generalize out of session. While slowing down and observing content at
the lower left, I ask questions like And what would a life on the right
look like? What actions would you do? What do you see if you look to the
right? In a broader life, what would you do? As their attentional repertoire broadens toward the right, clients become better able to identify
committed actions (upper right) that would move them toward a value
(lower right).
Revealing the Suffering-Values Connection

Validating clients experience of suffering also allows them to see
that their suffering corresponds to something very important to them
and is thus the flip side of their values. In my experience, the frame of
coordination between suffering and values is a highly useful functional
axis in the matrix. Whereas suffering previously tended to push toward
negatively reinforced avoidant actions (upper left), as soon as clients can
see their suffering as the flip side of their values, it will start to function
differently, taking on approach functions.
I often summarize functional analysis to clients thus: Suffering is
really hard! It narrows our lives. It gets us stuck. Id really like to help you
see your suffering as a useful experience, if not a pleasant one. We can
see the values that hide behind our suffering and that guide our lives.
Seeing whats important can give a direction to our actions that isnt just
moving away from suffering.
Being Stuck
Sometimes clients can be so stuck in suffering and avoidance that
they feel hostility toward the therapist. In turn, the therapist may feel
stuck in the left part of his or her own matrix. Being stuck need not be a
problem in itself as long as the therapist doesnt make a problem of it.
Ideally, the therapist can adopt a matrix perspective on his or her experience in the moment and initiate a toward move, for example, by sharing
with the client that he or she feels stuck and is having trouble connecting with the client. In this situation, I may then ask, And how is it for
you? This invites clients to notice their suffering (lower left) and away
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The ACT Matrix
moves (upper left) in the therapeutic relationship itself. I reveal my own

matrix and invite clients to do likewise.
After a few minutes of sharing what we notice ourselves feeling and
thinking, I ask clients whether they felt we were moving closer to or
further away from one another while sharing around feeling stuck.
Clients often note that they felt we were moving toward one another, and
I seek to reinforce that by validating and sharing my own experience of
moving closer. I then note that the client just engaged in a toward move
in the presence of feeling stuck in suffering and ask whether the client
noticed a difference in the experience of feeling stuck and moving away
and the experience of feeling stuck and moving toward. Then I ask, In
the presence of feeling stuck, which would you want to choose?
Reinforcing Toward Moves

In my experience, clients often choose moving toward. I seek to reinforce this by praising the courage it takes to do that, especially in the
presence of intense suffering. I then ask clients whether applying such
skills in life could make a difference, and in which domains, thus promoting generalization of the behaviors practiced in session. Sometimes
clients feel so stuck that they say theyd choose to move away. I might
then model flexibility by validating that sometimes the stuff in the lower
left can be so painful that the only option appears to be trying to move
away from it by closing downfor example, in relationships. In such
cases, I may ask clients if choosing to stay on the left makes that suffering
go away. In other words, does closing down in relationships work? If the
client says no, we get back to functional analysis with the matrix.
Making Space for Resistance

If clients say yes, away moves work, I model flexibility by validating
their experience that sometimes suffering is so intense that closing down
seems to be the only option. There will be further opportunities to come
back to a contextual functional analysis through the matrix. Looking at
any experience through the prism of the matrix, including an experience
of stuckness, allows clients to notice their experience in context and
gradually shapes flexibility and a broadening of their behavioral and
attentional repertoire.
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What is important is for therapists to be themselvesto be able to

choose to act on the right side of their own matrix. This will prompt
clients to engage in their own toward moves and promote functional
generalization of new behaviors.
Celia
Having described the skills that the matrix can cultivate, I will now illustrate them with examples from my clinical practice, starting with Celia,
a ten-year-old who wont touch doorknobs. Her compulsions are a major
impediment to her.
Therapist: Look at this little diagram I call the matrix. What you
dont like is on the left, and what you really want to do
is on the right. So what do you put on there?
Celia: To the left, doorknobs!
Therapist: And what do you do when you see a doorknob?
Client:
I dont want to touch it.
Therapist: And what happens when you dont want to touch it?
Client: I get stuck and I cant do what I want.
Therapist: Good. You noticed that. And what do you really want
to do?
Client: Id like to do all the things I want to do.
Therapist: Good. And whats stopping you?
Client: The doorknobs. Everybodys touched them!
Therapist: Oh yes, your head tells you this. And when your head
says this, what do you do?
Client: I get stuck!
Therapist: Good, you noticed that. And does that move you
toward or away from what you really want to do?
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The ACT Matrix
Client: Away.
Therapist: Good, you noticed that too. So on the left is what gets
you stuck, and on the right what you really want to do.
What do you choose? Do you do what your head tells
you and get stuck, or do you do what you really want to
do?
Client: Id choose what I really want to do, but my head tells me
fifty people have touched this doorknob!
Therapist: I see this is hard for you. Heres a little exercise that
could help us. Try to have the thought I cant raise my
hand, and when you have it, raise your hand to show
me. Okay?
Client: Okay. (Raises her hand.)
Therapist: Good. And what did you notice?
Client: Well, I was thinking that I couldnt raise my hand, and
still I did it.
Therapist: Yes. Do you see a connection with what youre thinking
about doorknobs?
Client: That I could not always do what my head says?
Therapist: Good. You noticed that! So, Celia, when your head tells
you to do something on the left and what you really
want to do is on the right, could you practice noticing if
you can see both sides of your matrix, and then see if
you can choose what you dowhether on the right or
on the left? What counts is that you can choose,
because when your head tells you not to touch the
doorknob, does it give you a choice?
With Celia, I conducted a contextual functional analysis from the
very first session, using the matrix as the perspective from which to
conduct the clinical conversation. Celia went home with a small paper
matrix and instructions to practice noticing when the matrix showed up
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in her life. In other words, I invited her to conduct her own contextual
functional analysis every time anxiety showed up in her life.
Celia came to the second session with functional contextual stories,
such as My head was saying fifty people had touched the doorknob, but
it was important to me to get through that door to do what I really
wanted. First I avoided touching the doorknob because of fear, but it was
still important to do what I really wanted. I saw the two sides, left and
right, and I saw that opening the door was possible. So, even with the
fear, I touched the doorknob.
Michael
Michael is stuck at home. He has anxiety attacks that bring tremors and
uncontrollable head shaking. Hes lost his job and lives on welfare. After
presenting the matrix and its perspective on a life that works, I initiated
this dialogue.
Therapist: Given the stuff that shows up, how is your life working?
Client:
I live on the left. I live on the left
Therapist: Living on the left, thats when all of our actions are
linked to our suffering and fears, when everything we do
is in the service of moving away from anxiety. Is this
how it works for you?
Client: Yes, I spend all my time worrying about when the next
anxiety attack might happen.
Therapist: And does that stop you from doing things that would be
important to you?
Client: I dont do anything anymore. I dont even see my friends
anymore.
Therapist: Ouch. Whats important to you that gets left behind?
Client: I dont do anything anymore. I didnt even go to my
dentist appointment for fear of an anxiety attack.
Therapist: Could you describe to me how these attacks feel?
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The ACT Matrix
Client: My neck stiffens, my head twists Its so stupid to be

like this!
Therapist: So you get all these sensations and thoughts.
Client: Its happening again, right now. I cant keep my head
straight. My neck is stiffening and Im shaking!
Therapist: Yes, its exactly how you were describing your anxiety
attacks. Would you be willing for us to continue, using
this session as an opportunity to notice whats happening right here, right now?
Client: Youre a doctor after all. I know you can understand me.
So okay.
Therapist: Thank you for your trust. Now, can you bring your
attention to your bodily sensationsand the thoughts
that show upand at the same time notice the sensations around your breathing? See if you can just notice
what shows up, without trying to change those sensations or thoughts or push them away. See if perhaps you
can receive them with curiosity and kindness. See if you
can slow down and notice all this from the central point
on your matrix, the perspective from which you can
notice all of this while keeping some distance from it.
Client: I can notice my bodily sensations and my thoughts.
Therapist: Congratulations for courageously staying with all of this
without trying to run away, and for staying connected in
our exchange. Could it make a difference if you could
do this in your life?
Client: Yes. It would allow me to reconnect with people and
look for work.
Therapist: Would you be willing to see if you can spot the matrix
in your experience between now and next week? When
you do, could you simply sort what shows up as five-
senses versus mental experience, and then see if you
have a chance to choose to do a toward move?
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In this example, Michael had opportunity in session to notice the

different aspects of his anxiety attacks while I encouraged him to notice
the right side of his matrix: whats important to him and what actions he
could do in valued directions. I then invited him to bring this perspective
to his life.
Corrina
Corrina is a forty-seven-year-old woman whos been suffering from loneliness since the breakup of her twenty-five-year marriage. She says her life
is over. She cries a lot and feels utterly stuck in despair.
Client: Its been a year since my husband left me, and Ive lost
all zest for life.
Therapist: Where does this go on your matrix?
Client: Ive lost all zest for life, thats suffering, so to the
left. Its like last Sunday: I went on this outing with
a group of people who like impressionist art and I
felt so bad. I cant feel good with other people
anymore. I should have stayed home and watched
TV. It would be better if I simply disappeared. (Sobs.)
Therapist: I see that theres a lot of suffering around connecting
with others. When suffering is very intense, it can make
us feel stuck and become rigid. I too feel stuck when you
tell me this. Is that also how it is for you?
Client: Yes. I cant feel good with other people anymore. I dont
feel like going out anymore.
Therapist: And where does that go on your matrix?
Client: On the left. Its linked to my suffering.
Therapist: And what did spending the afternoon with this group
allow you to do? What was on the right? What was
important?
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The ACT Matrix
Client: We visited the museum and learned about this painter,
Courbet. I could share with others in the group. I could
never share about art with my husband.
Therapist: Im touched that you would share with me that art is
important to you. And where does sharing about art go
on your matrix?
Client: On the right side.
Therapist: And as we talk about this together, does it make us
move closer to or further away from one another?
Client: Closer.
Therapist: Im also noticing that it brings us closer, so thank you
for sharing about art.
Client: Yes, I really like art. But my husband never had an
interest.
Therapist: Could you notice, as you were on that museum outing,
that two types of experiences were present, on the left
and on the right?
Client: Yes. But I feel horrible, and it would be better if I
disappeared.
Therapist: When suffering is very intense, our minds can suggest
that we should escape our suffering by whatever means,
including suicide. Is that how it is for you? And where
do you see that on the matrix?
Client: I dont want to feel this pain inside. Thats in the lower
left corner.
Therapist: And yet does sharing about art with others count less
when the pain is there? Does it bring you closer to or
further away from other people?
Client: Its important and brings me closer.
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Therapist: Would you be willing to notice how it feels inside when

you share with others about art and your mind tells you
that you should end it all? What do you choose to do?
Client: I choose to share with others.
Therapist: Thats a courageous choice to make, because when you
choose the right side, the left side also comes along for
the ride. And this choice that youre making right now,
herecould it make a difference to your life if you
could make that choice for everything that shows up?
Isnt it a great freedom to be able to choose whats
important, rather than letting suffering rule your life?
Client: Hmm. I guess Ill get back in touch with the impressionists appreciation group and see what other outings they
have planned.
Therapist: It makes me feel closer to you to hear you say that. Ive
appreciated sharing with you around your passion for
painting. How about you?
Client: Ive liked it too.
In this example, I consistently invited Corrina to broaden her attention toward the right side as a means to help her stuck story become
more flexible. When she opened up, I reinforced this by expressing the
impact her sharing had on me.
Gina
Gina is thirty-three years old and has lived with her partner for three
years. She dearly wants children, but her partner has already fathered
two daughters and doesnt want more kids. She resents it but is afraid to
discuss it with him. Heres an excerpt from our first session.
Therapist: Theres a lot of suffering around your wish to have
children.
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The ACT Matrix
Client: Yes. I wonder what Im gonna do. He even tells me, If

you dont like it, you can leave.
Therapist: How does it feel when he says that?
Client: I freeze. I cant discuss it anymore, and I feel bad.
Therapist: As if your life has narrowed?
Client: Yes, exactly.
Therapist: And a broader life, what would that contain?
Client: It would be a life in which I could speak sincerely with
my partner and be listened to.
Therapist: I see this is precious to you. And what actions could
move you toward that?
Client: I could tell him how important it would be for me to
have children.
Therapist: What obstacles stand in your way?
Client: Hes told me that he has enough kids as it is, especially
considering how badly things are going with his ex.
Therapist: And how does that feel?
Client: I feel stuck and I clam up.
Therapist: You feel stuck. And does clamming up make you move
closer to or further away from him?
Client: I think it will never be possible, and I feel Im moving
away from him.
Therapist: Would you be willing to look at how this works with
two matrices? When he says, If you dont like it, you
can leave, where is he in his matrix?
Client: Upper left.
Therapist: And what does that make you do?
Client: I get stuck on the left too.
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Therapist: Well noticed. Does that bring you closer or further

away?
Client: Further.
Therapist: And what would moving toward your relationship
values look like?
Client: Telling him that its important to me that he listens and
takes my wishes into account. But he tells me he doesnt
want more kids.
Therapist: So you feel stuck. But is whats important to you still
important to you?
Client: Yes.
Therapist: And do you choose to let fear control your life, or to be
guided by whats important to you?
Client: Whats important. But he wont talk about it!
Therapist: And where is that on your matrix?
Client: Lower left.
Client: Clam up.
Therapist: And does that bring you closer or further away?
Client: Further.
Therapist: What would moving closer look like?
Client: Telling him what I feel.
Therapist: Great! And how would you do that?
Client: Id tell him, You never want to talk about whats
important to me.
Therapist: And would that be on the right or on the left?
Client: Well. On the left?
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The ACT Matrix
Therapist: Its a judgment, something our minds tell us when were

struggling, so yes, it seems to be on the left. What could
you say on the right to move closer? We often move
closer to one another by sharing our feelings.
Client: I could say, Its hard for me when you wont talk about
whats important to me.
Therapist: Great! Would you be willing to ask him what he feels
around the idea of having children? It would be like
asking him to show you the lower part of his matrix. In
this way, you could maybe move closer to whats important to you in your relationship, regardless of the result.
Client: Okay.
In our second session, I continued to invite Gina to take the perspective of the two matrices (hers and her partners) to help her navigate
their interactions. I also used the two-matrix perspective of client and
therapist to work on inflexible repertoires in the context of the therapy
relationship in the service of helping Gina generalize enhanced flexibility to interactions with her partner.
Client: I think Im not going to come back. In any case, the
problem is him, and I cant change him.
Therapist: When you say this, I feel stuck. Im on the left of my
matrix. How about you?
Client: Im on the left too.
Client: It makes me move away and want to stop therapy.
Therapist: So you noticed that. And is whats important to you less
important to you?
Client: No. It will always be important to me to have children.
(Looks away and starts crying.)
Therapist: I can see youre moved.
Client: Yes, its very painful.
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Therapist: Its moving to see how painful it is for you. I was moved
when you told me how important it is for you to have
children. Im wondering whether you could also do this
with your partnerif he too might be moved if you told
him.
Client: Yes, but its not possible. He doesnt want to hear about
it.
Therapist: And where are you in your matrix right now?
Client: On the left.
Therapist: And what would moving toward whats important look
like?
Client: But Ive already told him Im an honest person, and if
we ever separated, Id let him see his children.
Therapist: And is that on the left or on the right?
Client: Well, its linked to my fear, so its moving away.
Therapist: Well noticed. Arguing is often in the service of controlling fear. What impact does it have on your partner
when you argue?
Client: He starts arguing back.
Therapist: And where are both of you on your matrices?
Client: Were both on the left.
Therapist: What would moving to the right look like?
Client: Well, I could tell him that I understand its hard for him
to think of having children againthat I can see its
not easy for him. I could ask him if its important for
him to have children and what he could do if he had
more children.
Therapist: Yes. You could ask him to show you his matrix. You
could validate what he feels and help him notice the
different aspects of his experience. You could also show
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The ACT Matrix
him your matrix and let him know how important it is

for you to have children. You could ask what you could
do together and see if maybe hed be touched like I was
when you shared how important it is for you.
Client: I think I want to continue therapy so we can work on
this.
Its also possible to do couples therapy with both partners using a
two-matrix perspective and noticing their interactions in session. The
therapist would encourage toward behaviors, and train both partners not
to get stuck in trying to get rid of suffering by engaging in away behaviors
incompatible with their relational values, which are to move toward one
another if its important for them to live together.
Conclusion
I hope that by sharing around my use of the matrix diagram in my practice as a psychiatrist in private practice, Ive given you a sense of the
flexibility of this model. In my experience, its the model thats allowed
for the fastest progress toward a valued life for many of my clients.
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CH A P T ER 11
Casing the Matrix: A Tool

for Case Conceptualization
Clinical case conceptualization is an exercise that often vexes students

and evokes away moves in even the most experienced clinicians. Its
often thought of as a linear process that requires a thorough knowledge
of both diagnostic systems and ones chosen approach. In practice, many
clinicians make do without written case conceptualization. Indeed, what
is the function of conceptualizing clinical cases? If its a purely intellectual exercise, no wonder busy clinicians dont bother. However, when
case conceptualization is evolved collaboratively with the client, it can
serve as a powerful tool for clinical change.
The matrix diagram can be turned into an effective tool for collaborative case conceptualization. Its intuitive simplicity makes it easy for
the clinician to use and just as easy for clients to grasp and take an active
part in conceptualizing their own case. In this way, case conceptualization can become an integral part of the therapeutic process and help
therapy move forward, rather than gathering dust in the clinicians files.
This chapter presents a matrix-based conceptualization worksheet
and explains how to use it to evolve a joint conceptualization with
clients, leading to flexible and collaborative treatment planning. The
worksheet can also double up as an instrument for tracking client progress in the most relevant dynamic clinical dimensions (symptoms and
processes).
The ACT Matrix
My Own Case Conceptualization Matrix

Case conceptualization is not a natural appetitive for me. In acceptance
and commitment therapy (ACT) and functional analytic psychotherapy
(FAP) books, I used to stand in awe of the case conceptualization chaptersthey seemed so clever and obvious. Yet when I was faced with
writing up case conceptualizations for my clients, a strange fear gripped
me and a kind of fog descended on my mental abilities. Then my mind
started chattering, producing in equal parts self-deprecating judgments
regarding my intellectual and clinical abilities, and rationalizations as to
how and why case conceptualization is a pointless exercise. So in the
context of conceptualizing my clients cases, a lot of unwanted content
showed up for me in the lower left quadrant of my matrix (see figure
11.1). Faced with this content, the temptation was (and at times still is)
strong to engage in various away moves, first among them using my computer for Internet browsing rather than case conceptualization. In the
context of training clinicians in ACT, one of my away moves was to tell
trainees that case conceptualization wasnt that important.
CONTEXT: CONCEPTUALIZING MY CLIENTS CASES
FIVE-SENSES
EXPERIENCING
Procrastinating
Reading stuff on the internet
Making do without case
conceptualizations
Telling trainees they dont need
to conceptualize their cases
AWAY
Reading about case conceptualization

Involving colleagues in developing a case
conceptualization worksheet
Testing the worksheet with clients
Involving clients in conceptualizing their
case
Testing the worksheet with trainees
Writing about case conceptualization
TOWARD
Fear
Brain fog
Shame
Some constriction in the back of
my throat
How can these people do it?
Is there really any use to this?
Ill never be a proper clinician if
I cant do this
Do I really have to do this?
Honestly, whats the use?
Better planning treatment

Progressing as a clinician
Being useful
Better helping my clients
Mastering a new skill
Becoming more flexible
Better training clinicians in ACT
MENTAL
EXPERIENCING
Figure 11.1. My matrix around conceptualizing clinical cases.

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Casing the Matrix: A Tool for Case Conceptualization
Yet if I turn my attention to the right side of my matrix and consider

whats important to me in this context, I notice a number of things:
developing my planning skills, progressing as a clinician, being useful,
better serving my clients and trainees, mastering a new skill, and becoming a more flexible clinician and trainer. When I contact whats important, I can more easily identify possible toward moves: reading about case
conceptualization, involving colleagues in developing a case conceptualization tool, testing the tool with clients and involving them in conceptualizing their own cases, testing the worksheet with trainees, and
writing about case conceptualization, as I am doing now.
Through the matrix perspective, I became better able to notice not
just the aversive functions that conceptualizing cases had for me, but
also a number of significant appetitive functions, which led me to delve
deeper into the matter and, in collaboration with colleagues, create a
conceptualization worksheet based on the matrix diagram.
Introducing the Case Conceptualization

Worksheet
The matrix diagram can offer a perspective on client functioning that
includes what is difficult (suffering), what is important (values), what the
client does to escape whats difficult (experiential avoidance), and what
the client does to move toward who or what is important (committed
action). In terms of the ACT model, it contains the most important
aspects of the clients functioning.
An Alternative to Linear Conceptualizing

Using the matrix diagram frees clinicians from having a conceptualize in a linear fashion. They, together with their clients, can choose to fill
in the matrix diagram in whatever way they feel most effective, starting
from any quadrant they like. Thus, for a client who comes to therapy
seeking help in moving toward important goals, one might start filling in
the lower right quadrant, then perhaps move to the inner obstacles that
can stand in the clients way (lower left), then to the away moves that
such obstacles evoke (upper left), and finish with the toward moves the
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The ACT Matrix
client would want to engage in (upper right). Alternatively, after filling in

the values quadrant, client and clinician may consider the toward moves,
then what the client tends to do instead of moving toward (away moves),
and finally what the client is moving away from (suffering).
On the other hand, when a client presents with intense suffering and
is highly stuck in moves away from that suffering, clinician and client
may start by filling in the suffering quadrant, then go up to the away
moves, then over to what the client may wish to do (toward) moves, and,
finally, down to what or who would be important in making these toward
moves (values). When clients have been stuck in suffering and the struggle to escape that suffering for a long time, they may initially be unable
to consider the possibility that anything could be important in their life
beyond ending their suffering. This path through the matrix may ease
them toward seeing that, no matter what, there are people or things they
value and hold important. The worksheet I developed (together with
Egide Altenloh and Marie-France Bolduc) is shown in figure 11.2, and its
verso in figure 11.3. (The worksheet can be downloaded as a PDF file at
http://www.newharbinger.com/29231, along with an Excel worksheet
that tracks and graphs evolution of the quantified processes.)
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Matrix Case Conceptualization Worksheet
Name :
Initial goals:
Q1 Q2
Therapist toward moves
Therapist away moves
Away
AWAY MOVES
TOWARD MOVES
WHAT I DONT WANT TO THINK/FEEL
WHAT/WHO IS IMPORTANT
Toward
D2
Maintaining factors :
Treatment plan :
Q4
D1
Q3
Inner Experiencing
Q1 Q2 Q3 Q4 IE
Figure 11.2. Matrix Case Conceptualization Worksheet (front).
Conceptualizing Therapist Behaviors

In a feature borrowed from functional analytic therapy, the worksheet contains boxes where therapists can note their own toward and
away moves in the context of working with a particular client. Discussing
these collaboratively with the client helps foster an atmosphere of openness and reinforces the ACT stance of radical equality with clients.
Other features of the worksheet include a space to note the clients
initial goals, maintaining factors, and treatment plan. The back of the
worksheet (figure 11.3) includes spaces for significant client history,
client strengths, and therapist notes. It also includes a table that allows
therapists to quantify and track clinically relevant client processes from
session to session, using ratings assigned in each session. The scale used
for all of these ratings is from 0 to 10, with 0 indicating minimal flexibility in the process and 10 indicating maximal flexibility.
185
186
Notes:
Date
Consultation
Five-senses/Mental discrimination (D1)
Toward/Away discrimination ( D2)
Perspective-taking/Observer self (P)
Away moves/Experiential avoidance (Q1)
Toward moves/Committed action (Q2)
Contact with what is important/Values (Q3)
Suffering/Avoided content (Q4)
Contact with inner experience (IE)
Process tracking
Client strengths
Significant history
10 11 12 13 14 15 16 17 18 19 20 21 22 23
The ACT Matrix
As client and clinician go through the matrix, a collaborative case

conceptualization gradually emerges from filling in the form. In the rest
of this chapter, Ill illustrate use of the worksheet with a clinical example.
Figure 11.3. Matrix Case Conceptualization Worksheet (back).
Conceptualizing a Case: Linda

Linda is thirty-five years old and lives with Jim, her forty-year-old partner,
and Ella, their nine-
month-
old daughter. After several unsuccessful
attempts at solving her difficulties through therapy and medication,
Linda is once again in therapy. She has little hope that things might
change but feels she needs help or she might do something stupid. In our
first session she explains that she has all her life been tormented by her
emotions. She traces her difficulties to childhood physical abuse by her
father. She says she could never fully confide in her mother, who would
immediately make excuses for her husband, tell Linda how hard things
were for both her parents, and end up blaming her for all the problems
she caused them.
In high school Linda started hanging out with peers who drank, took
drugs, and engaged in self-
harm. She also started self-
harming but
stopped after graduation. She mentions having started binge-
eating
occasionally around that time. She started college but dropped out after
two years. After a first relationship with a boy who forced her to have
sexual intercourse even though shed said she wasnt ready, her intimate
relationships grew increasingly chaotic. At the end of three of these relationships, she felt so crazy she attempted suicide. The third time she
nearly died from an overdose of prescription drugs. After this she swore
off intimate relationships and for a while avoided most contact with men.
Her professional life has been affected by recurrent conflicts that often
got her fired. When no open conflict showed up, shed start feeling that
she wasnt in the right place and would quit.
In her last job, temping as a filing clerk, she met Jim, a kind man who
felt strongly attracted to her. In spite of her fears, she let him approach
her and a relationship developed. Jim is supportive and always treats her
kindly. Because he was so different from her previous partners, she
decided to give it a go. Theyd only been dating for three months when
she accidentally became pregnant. They decided to move in together.
Linda stopped working toward the end of her pregnancy, and in the nine
months since the birth of their daughter, Ella, Linda has been staying at
home and looking after the baby. She says shes never dared to tell Jim
everything about her past, though he does know a little bit.
Lately, shes often felt empty and had a sense that shes not in the
right place in this relationship and cant be trusted with a baby. Jim would
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The ACT Matrix
like to get married, but Linda is plagued by thoughts that hes too good
for her, that he doesnt know who she really is, and that if he did, hed
leave her. When shes alone with Ella, she sometimes fears she might hurt
her, especially if the baby demands attention when Linda is feeling down
and confused. She regularly phones her mother for support, but their
conversations always leave her feeling confused and angry, and with a
strong sense that her mom doesnt really care about her. She also regularly calls Jim for reassurance. He readily assures her that shes a good
mother, but lately shes started doubting that he could really mean it.
Shes convinced he has no idea how damaged she really is. She says her
objective is to regain her self-esteem so she can feel better and not be
such a burden on Jim and a danger to Ella.
During our first session, I heard her story and presented the matrix
model in broad strokes, suggesting there might be an alternative to trying
to hold back her thoughts and feelings lest she become submerged by
them and do things she didnt want to do. Using Jon Kabat-Zinns Surfing
metaphor (Kabat-Zinn, 2005), I likened her feelings to waves and suggested that Linda might be able to learn to surf so that she wouldnt be
submerged by the waves and might also be able to choose in what direction to surf. At the end of the first session, Linda asked me if she was
worse than other clients and if I thought she could be helped. I reassured
her she was no worse than others. In the second session, I presented the
matrix in more detail and invited her to start sorting her experience
around a difficult situation with Ella. She had some trouble sorting
actions as away or toward moves, as well as difficulties sorting inner
experience from five-senses experience. I gave her sorting exercises to
explore at home. At the end of the session, Linda expressed strong doubts
that she could be helped. I reassured her that she was making good
progress.
Evaluating Lindas Discrimination

Repertoire
The matrix serves as a visual cue to help clients operate discriminations that are likely to make a difference in their lives by helping them
struggle less against what they dont want to think or feel and improving
their ability to choose to move toward whats important to them. As
matrix clinicians, we pay particular attention to our clients ability to
188
perform the two main discriminations: between five-senses experience

and mental experience (discrimination 1, or D1); and between actions to
move away from what they dont want to feel or think and actions to
move toward whats important to them (discrimination 2, or D2). The
matrix conceptualization worksheet contains boxes in which to evaluate
clients ability to operate these two central discriminations.
For session 2, I gave Linda a 4 on both D1 and D2, reflecting her
difficulties in discriminating. As clinicians, we are also interested in
evaluating how well clients are able to take perspective on their experience. This can be seen as the clients ability to take the matrix perspective and sort from it, which maps onto their ability to contact the observer
self and perspective-taking skills, as sorting ones experience on the
matrix requires enough distance from that experience to be able to place
it in one of the quadrants. In this dimension, Lindas ability to sort with
the matrix and identify items in all four quadrants inspired me to rate
her at 5.
Conceptualizing Lindas Case Through

the Matrix
At the third session, Linda reported noticing a few new toward
moves, such as cooking a nice dinner for Jim and telling him about her
therapy work. She also noted how painful it was to notice so many away
moves and asked if she would ever be free from her consuming doubts.
This time I didnt reassure; instead, I validated how hard things were for
her. I offered that we could look at how things functioned through the
matrix point of view and fill the worksheet together. Linda agreed.
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190
Feeling empty Feeling hopeless
Thoughts that Im not in my
place Fear of betrayal
Thoughts that I cant trust anyone
Thoughts that if Jim knew me
hed leave me Anger Shame
Guilt Sugar cravings
Lack of self esteem
Memories of abuse
WHAT I DONT WANT TO THINK/FEEL
Therapist toward moves
D2
Ella - being a good mother

Jim - having someone to share life
Being a good partner
Feeling good about myself
A fulfilling job
Health
Being genuine
Trusting
WHAT/WHO IS IMPORTANT
TOWARD MOVES
Treatment plan :
Toward
Figure 11.4. Lindas case conceptualization worksheet (front).
72 5 8 2
Q4
Practicing D2 toward/away
Q3
Feels
Practicing opening up and
D1 Feeling hopeful,
nothing in
trusting in the therapeutic
her body
scared and sad
relationship
Practicing recognising hooks and what I
Inner Experiencing
Jims willingness to provide reassurance
do next
Mothers unwillingness to validate
Practicing D1 5 senses/mental, then feelings &
and provide support, her blaming
Q1 Q2 Q3 Q4 IE bodily sensations, and eating mindfully
No job to go back to
Practicing flexibly noticing and choosing
Maintaining factors :
Away
Therapist away moves
Validating how tough

Attending to Ella with warmth
things are
when she asks for attention
Showing willingness
Sharing more with Jim
Calling Jim to ask about his day
to stay present
Committing to the relationship
when it gets tough
Researching further education options
Gently encouraExercising
ging toward
Sharing openly with my therapist,
moves and
including my doubts
opening up
Q1 Q2
Initial goals: Strengthen self-esteem
Yelling
Blaming
Drinking
Reassuring
Taking drugs
Avoiding difficult
Going shopping
subjects
Bingeing - Eating sugar
Missing opportuCalling Jim for reassurance
nities to validate
Avoiding others/relationships
Trying to convince Callinging mum for support
Pushing too hard Clamming up
Quitting jobs
Attempting suicide
Not expressing my
doubts in therapy AWAY MOVES
Name :
The ACT Matrix
Conceptualizing the Left Side

I asked Linda if she wanted to start with what was important to her
or what she didnt want to think or feel. She chose the latter, so we began
filling in the lower left quadrant.
Therapist: So what goes in this areawhat you dont want to
think or feel, or memories you dont want to have?
Client: Theres so much to write there! I hate feeling empty and
hopeless. I always feel like Im not in my place. Im afraid
to trust anyone and I fear betrayal. I think if Jim knew
me, hed leave. I feel angry and ashamed.
Therapist: Okay, so all of that goes down there. What else goes
there?
Client: I feel so guilty! And when I do, I have these horrible
sugar cravings. I just lack self-esteem.
Therapist: Okay. Anything else that goes there?
Client: Well, there are also the memories of my father beating
me up. Images of blood on the kitchen floor. I cant
remember who had been hit, if it was me or my mum
only the blood on the tiles. And the fearfear wed all
die. Thats pretty much it.
Therapist: So there are all these things. (Reads them back.) Okay,
so when these show up, what have you done to move
away or escape from them?
Client: Going crazy. Yelling. Blaming others. Drinking. For a
while I took drugs and self-harmed, but not anymore.
These days Ill eat sugar or go shopping and spend
money I dont have.
Therapist: So those things go in the top left. Anything else youve
done or still do when the things in the lower left show
up?
Client: For a while after my suicide attempts, I avoided getting
involved with men at all.
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The ACT Matrix
Therapist: Was attempting suicide also a way to move away from

this (pointing to the bottom left)?
Client: (Pauses.) Yeah, I guess. It was just too much, and it
scared me. But I wouldnt do that now, even though
I still get scared at times.
Therapist: What else do you do when these things show up?
Client: These days I call Jim just to make sure hes there and
ask him to reassure me that hes gonna come back.
Therapist: Is that a bit like when you asked me if therapy would
work?
Client: (Laughs.) Yes. Actually it is. The thing is, the minute
I put the phone down, I start worrying again. (Pauses.)
Sometimes I also try calling my mum, but that never
works. I just get angry because she doesnt care about
me.
Therapist: And quitting your jobs, where does that go?
Client: Oh, there! No question. (Pauses.) Well another thing
I might do is just shut up. But after a while, I start
boiling inside and Ill explode or quit
Therapist: And might this happen with me too?
Client: (Laughs.) Well, I guess if I have my doubts, I may not
necessarily share them.
Therapist: That would be a shame. Its important to me that you
feel you can share anything you feel and think when
youre here.
Client: Thanks. Ill try.
Therapist: So weve looked at your away moves. How about we take
a look at mine?
Client: At yours?
192
Therapist: Sure. I also have stuff I dont want to think or feel, and
sometimes I do things to move away from it. For
example, when you asked me to reassure you last time,
I noticed I was afraid youd think I was incompetent,
so I reassured you. So that goes in the other top left
box. Did my reassurance work?
Client: It did. But the minute I left your office, I started worrying again.
Therapist: Sounds like when you call Jim. And what happened
earlier today when I didnt reassure you but told you
I could see how hard this was for you?
Client: I liked that. I wish my mum could simply tell me this
sometimes. But she never does. Shes always trying to
tell me what I should think.
Therapist: Okay, so recognizing and validating your difficulties,
thats a toward move for me. Ill put it in that other box
at the upper right. Before I ask you about your toward
moves, can I add a couple more things in my away
moves box? (Linda nods yes.) Okay, sometimes I avoid
difficult subjects. I can also miss opportunities to
recognize your difficulties. And when I feel confused or
insecure, I have a tendency to try to convince. These
are my away moves.
Conceptualizing the Right Side

After having jointly conceptualized Lindas left side processes as well
as mine, we turned to the right side.
Therapist: So what would the person you want to be do instead of
these away moves?
Client: The number one thing for me would be taking care of
Ella when she asks for my attention, rather than getting
short-tempered with her.
Therapist: What would that look like?
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The ACT Matrix
Client: Id be warmer, more encouraging. More motherly,

I guess.
Therapist: Okay, so can I write Attending to Ella with warmth
when she asks for attention?
Client: Yes. Sure.
Therapist: What else would you want to do?
Client: Be more open with Jim, share my feelings more, let him
truly see me. I guess Id call him to ask about how his
day is going rather than to check that hes coming back.
I guess Id like to be able to really commit to our
relationship. Exercising. Oh, and I have this dream to
start studying againif only I didnt have such low
self-esteem.
Therapist: So, sharing with Jim, calling him to ask about his day,
committing to the relationship, and exercising. And for
education, what would we see you do?
Client: I could start looking up whats available. Perhaps going
back to psychology
Therapist: So researching further education options. And in here
with me, what could I see you do to move toward whats
important?
Client: I could share more openly with you.
Therapist: Including when you have doubts or feel youre not in
your place or being a good client?
Client: (Laughs.) Yes. That too.
Therapist: Do you do many of these toward moves at the moment?
Client: (sadly) No. Thats bad isnt it?
Therapist: Its tough for you at the moment.
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Therapist Toward Moves

Having helped Linda identify some toward moves, I volunteered
some of my own.
Therapist: Can I also write a couple of toward moves Id want to
do to support you?
Client: Sure.
Therapist: In addition to validating how hard things can get for
you, Id like to show my willingness to stay present
with you when things get tough. Id also like to gently
encourage your toward moves and your opening up.
Do you think that would help?
Client: Sure, though sometimes I dont need gentlyI need
a kick in the butt!
Therapist: Ouch! How do you think youd respond if I tried to
push you in the way you suggest?
Client: Id probably push back. (Laughs.)
Therapist: Okay, so pushing goes to the left for me, right there with
trying to convince. Lets explore gently first, okay?
Client: Okay.
Lindas Values
At this point, we could complete Lindas matrix by having her notice
whats important behind her toward moves.
Therapist: So what would be important to you in doing these
toward moves? What important life domains would they
allow you to move toward?
Client: Well, for Ella, being a good mother to her. For Jim,
being a good partner, maybe wife. Having someone to
share my life with. Feeling good about myself.
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The ACT Matrix
Therapist: Feeling good about yourself? How would these toward

moves help with that?
Client: I could feel I was doing the right thing.
Therapist: Okay. So feeling good about yourself. What else?
Client: Health. A fulfilling job.
Therapist: How about sharing openly? What would be important
there?
Client: I could really be myselfbe genuine and trust again.
Therapist: Is that important?
Client: Very important. But I dont know if Ill ever be able to
trust again.
Therapist: So being genuine. Does trusting go there too?
Client: Yes.
Therapist: When you consider these important things and
domains, how do you feel?
Client: Hopeful. But mostly scaredand sad.
Therapist: Okay, so feeling hopeful, scared, and sad goes there.
(Writes them in the inner experiencing area.) And where
in your body do you feel this?
Client: Uhin my head?
Quantifying Matrix Processes

In addition to quantifying client discrimination repertoires and perspective taking, the worksheet also offers the possibility of quantifying
other matrix processes. Clinicians can ascribe ratings to each of the
matrix quadrants. Giving numerical ratings to quadrants 1 (away moves)
and 2 (toward moves) allows the clinician to track the evolution of experiential avoidance and valued action. Doing so for quadrant 3 (values)
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gives an estimate of flexible contact with values, and rating quadrant 4

(suffering) gives a broad-brush estimate of symptom intensity.
Linda and I came to some agreed values for this session. A Q1 score
of 7 indicated a good number of away moves, and a Q2 score of 2 indicated that Linda currently was doing few of the toward moves shed like
to. For Q3, Linda appeared to have fairly good and flexible contact with
her values and whats important to her. However, some feel-good items
in this quadrant may indicate avoidant valuesvalues that are actually
a solution to suffering. Linda noted that it was painful for her to think
about whats important, and in light of this, we agreed on a score of 5.
Finally, Lindas suffering was intense, so we agreed on a Q4 score of 8.
The final dimension clinicians might be interested in is clients
ability to contact their inner experience. Therefore, we added a distinction between mental and inner experiencing (discussed more fully in
chapter 4). The function of this discrimination is to help orient work
with clients who have difficulty coming into contact with their feelings
and bodily sensations. For such clients, quantifying their inner experiencing allows for tracking of their gradual progress in reconnecting with
their bodily sensations and feelings. Linda is such a client, as she appears
stuck in her head and unable to locate where feelings show up in her
body. Her initial score on this dimension (IE) is 2, reflecting the fact that
she can name emotions but cant locate or describe them.
Other Relevant Contextual Aspects

We next turned to broader contextual aspects that have played a
role in Lindas difficulties. First I explored external maintaining factors.
Therapist: Lets look at the things that serve to maintain your away
moves. Are there things people do or circumstances
that make it more likely youll do these away moves? For
example, do you think the fact that Jim reassures you
makes it more or less likely that youll continue asking
him for reassurance?
Client: More likely.
Therapist: Okay, so this goes in the maintaining factors box. And
how about your mum?
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The ACT Matrix
Client: Well, I dont seem to be able to give up hope that shell

respond differently.
Therapist: So the way she refuses to give you support actually
makes you engage in more away moves?
Client: Definitely.
Therapist: Anything else?
Client: I guess the fact that I dont have a job to go back to.
The Back of the Worksheet

The back of the worksheet provides space for recording relevant contextual information, such as significant history and client strengths. It
also provides a table to record client progress in critical processes and a
space for clinician notes.
Significant History
For the purposes of conceptualization, significant history comprises
those elements of the clients history that have a bearing on the functioning conceptualized on the front of the worksheet. Heres what I recorded
for Linda:
35 years old. Partner Jim, 40 years old. Daughter Ella, 9 months old.
Physically abusive father. Invalidating and blaming mother.
Some self-mutilation, drinking, and drug use in teenage years and early
adulthood. Binge eating.
Dropped out of college after two years.
Forced to have intercourse in her first intimate relationship. String of
chaotic relationships leading to three suicide attempts.
Professional difficulties. Conflicts or quitting.
Relationship with Jim different. Hes kind and supportive. Became
pregnant by accident.
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Client Strengths
This box allows for an interesting conversation with clients and
invites us to look at their valuable qualities. Some clients may have particular difficulties with this. The therapist can help them explore their
strengths.
Therapist: So, the last box for us to fill in is your strengths. What
would you say those are?
Client: I dont know. At times I think I only have weaknesses
and defects.
Therapist: Well, you had the courage to start a new relationship
even though youd been hurt so much.
Client: I guess so.
Therapist: And now the courage to start therapy again even
though it didnt work in the past. Can I write
courageous?
Client: Yes. Okay. You know, its hard for me to hear
compliments.
Therapist: Would it be a toward move to open up to the positive
qualities people see in you?
Client: I guess so.
Therapist: Excellent. So what other qualities and strengths might
people see?
Client: I love my daughter. In fact I came here because of her.
Therapist:
(Writes that down.) Great. What else?
Client: I love learning new things and discovering new places.
I used to love meeting people and going to ball games.
I just loved the atmosphere of togetherness.
Therapist: So love of learning and discoveries. People oriented,
likes being with others.
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The ACT Matrix
Client: I can be persistentwhen my doubts leave me alone.

Therapist: Okay. Persistent. What else?
Client: Im a good cook! And thats pretty much it as far as
I can see.
Therapist: Great. Can I contribute a few Ive noticed since we
started meeting?
Client: Uhsure.
Therapist: Smart, warmhearted, earnest, courageous. Or did I say
that already? I like to make a note of client strengths
because they give us an idea of what to nurturewhat
seeds we can water to see you grow in the way you want
to.
Client: Its nice of you to say all these good things about me.
Therapist: I mean them.
Tracking Processes Over Time

The table on the back of the worksheet allows for tracking progress
over time in the clients capacity to operate the discriminations, initiate
toward moves, take an observer perspective, contact values, and notice
inner experience. It can also help to track symptomatic dimensions
through ratings of away moves and suffering. An example of Lindas first
ten sessions is shown in figure 11.5. (The downloadable Excel worksheet,
available at http://www.newharbinger.com/29231, automatically produces progress-tracking graphs.) The first graph tracks the evolution of
Lindas matrix quadrants. The second tracks discriminating, perspective
taking, and contact with inner experience.
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Matrix Quadrants
9
8
7
6
Q1
Rating
Q2
Q3
Q4
2
1
0
10
Session
Discriminations, Perspective, and Inner Experience

9
8
Rating
7
6
D1
D2
IE
2
1
0
10
Session
Figure 11.5. Tracking matrix quadrants, discriminations, perspective

taking, and inner experience over time.
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The ACT Matrix
Using Case Conceptualization as a

Guide to Treatment
Once the conceptualization is recorded on the worksheet, treatment
priorities can be organized and noted in the area below and left of the
matrix. I invite you to notice where clients are flexible and to use this as
a springboard to work on areas where you notice significant
inflexibilities.
I had noticed that Linda was able to identify toward moves with relative ease, so I resolved to practice D2 first. Building on the fledgling
strength of our therapeutic relationship, I could offer to practice opening
up and trusting in session. I also thought of helping Linda recognize
hooks and what she does in response, to help her distance from unhelpful thoughts and better assess the consequences of taking the bait. I also
planned to gradually help Linda better notice her feelings and bodily
sensations, first by practicing the D1 discrimination, then by helping her
note the difference between thoughts and images and the feelings and
sensations that come with theman aspect of treatment that would
include work on eating mindfully. Finally, I planned to encourage Linda
to flexibly notice all aspects of her experience, and mindfully choose
what to do.
Filling in the conceptualization worksheet collaboratively is a way to
train clients to sort with the matrix and take perspective. Sorting historical factors and client strengths can also provide grist for the mill. With
this approach, there is no hidden conceptualization, which makes for a
strong working alliance with the client. Furthermore, clients can see that
all the dimensions of their problem and situation are taken into account.
Strengths and Potential Difficulties

Producing such a written conceptualization might feel too rigid for some
clinicians. In my own practice, I dont systematically use the worksheet.
Filling the worksheet in its entirety might prove too complex for some
clients. In such cases, the clinician may want to choose just the elements
of the worksheet that seem most relevant. If you do this, see if you can
use the matrix part of it, including it as a tool for conceptualizing your
own toward and away moves in the context of working with the client.
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With the matrix, treatment planning is rarely a linear exercise.

Typically, all processes are used in nearly every session as clinician and
client notice different aspects of the matrix, an approach that trains flexibility. So the treatment plan in the worksheet serves more as a reminder
of which processes appear to be particularly relevant for the client than
as a sequential plan.
Lastly, though it may at first feel a bit confusing, Id like to encourage
you to practice giving client scores, session by session, on the matrix
dimensions by filling out the table on the back of the worksheet or using
the Excel worksheet. These ratings and their progression will orient
treatment more effectively than a linear treatment plan could. When my
colleagues and I present these ratings in our training workshops, including to novice ACT therapists, we are always struck by the high level of
inter-rater reliability. This suggests that these ratings are not only clinically significant, but also reliable ways to look at clinical processes over
time.
Ive found that using the conceptualization worksheet is an effective
way to train therapists in using ACT and adopting the matrix point of
view. This in turn helps them rapidly find their way through the model
and become more adept at flexibly choosing which intervention might
best help a given client notice and choose. Keeping in mind that, from
the matrix point of view, the main task of the therapist is to train the
client in adopting the matrix point of view, this worksheet is perhaps
most helpful to use until the clinician can sort client information almost
automatically, as a background task that provides moment-to-moment
pointers to effective interventions.
Conclusion
The matrix diagram is well suited to helping clinicians conceptualize
clinical cases, share the conceptualization with clients, and make conceptualizing a collaborative enterprise. It can help orient clients to the
model and further train them to adopt a functional contextual point of
view on their difficulties. It can also bring down some of the common
barriers to case conceptualization that clinicians commonly encounter,
in particular by providing an alternative to more linear and sequential
modes of conceptualization. Practicing quantification of matrix
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The ACT Matrix
processes, discriminations, and quadrants can also give a good feel for
client progress. In the end, the matrix is a tool for increasing flexibility,
and the worksheet presented in this chapter is just one possible approach
to conceptualizing with it. My hope is that it may prove useful to you,
your clients, and your trainees.
Reference
Kabat-Zinn, J. (2005). Wherever you go, there you are: Mindfulness meditation in
everyday life. New York: Hyperion.
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PA RT 3
The Matrix Outside

the Box
CH A P T ER 12
The Matrix Goes to

School: Promoting
Psychological Flexibility in
Education
Phil Tenaglia
I have a point of view that I use when I work with people. Would you be
willing to let me show it to you? The sullen fifteen-year-old sitting next
to me in my office looks up and nods as I rise to approach the whiteboard
in front of us. He and his mother have come to see me today because hes
failing in school. Hes coming to our alternative educational program to
get a fresh start and possibly salvage his school year with the help of our
teachers and support staff. Together, he and I begin to sort his experiences onto the matrix. On the wall behind him hangs a movie poster
from The Lord of the Rings: The Two Towers, showing Samwise Gangee
and Frodo amidst the ruins of a besieged city. They look lost, beaten, and
utterly confused, but also determined to press on.
Taking in the image of the student, the poster, and the matrix, I
notice that this is the context of my work with students, educators, and
parents. My valued direction is helping whomever is in front of me get in
touch with what is important to him or herhelping people learn for
themselves what works to get them where they want to go. They frequently present like the bewildered hobbits in the movie, not knowing
The ACT Matrix
what to do. They have tried many thingsmostly things that havent
worked. What I have to offer are some simple words and actions, along
with as much flexibility as I can muster. The fact that someone is sitting
in front of me means that this person hasnt given up. We notice that and
see what shows up.
Learning to Ride the Matrix Bike

My journey to acceptance and commitment therapy, the matrix, and the
seat next to the young man mentioned above began several years ago. As
a longtime school psychologist and family therapist, Ive always been a
perpetual student. I spend most of my professional time in schools, so the
phrase invested in education shows up frequently in my mind. I believe
that one of the best ways to influence learning in others is to be in the
continual process of learning. Thats what brought me, one cold January
day, to a conference room, anticipating my first ACT workshop. The
presenter was Kevin Polk. He was there to talk about his work using
ACT for trauma.
I had learned about ACT, Steven Hayes, and his colleagues through
my interest in meditation and mindfulness-based approaches to treatment. I had begun reading about the ACT experiential approach, and I
wanted firsthand experience. Kevin began the workshop by asking for
permission to show us his point of view and invited us to participate in
the process he used with his clients. Part clinician and part improv artist,
Kevin wove us into the matrix with all of the curiosity, confusion, defusion, acceptance, and glimpses of clarity that manifest along the way. By
days end I was hooked (standard matrix lingo), and my journey into the
matrix had begun. Three years and hours of consultations and matrix
sessions later, Ive experienced firsthand what two crossed lines can do to
enhance learning and development for my students and myself.
Most of my day is spent in a small alternative educational program
for secondary level students. Each student has unique and challenging
learning and behavioral issues. Prior to their arrival these students
received academic support, specialized programming, agency resources,
medications, and so on. Diagnostically, they have been given a wide
range of labels (ADHD, Aspergers, learning disabled, oppositional
defiant, depressed, substance dependent, etc.). Their shared experience
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The Matrix Goes to School: Promoting Psychological Flexibility in Education
is they are failing in school, which is pretty much the most important job
anyone under eighteen can have in our society. Individually and collectively, they havent received much positive reinforcement for school-
based learning. Traditional learning environments have taken on aversive
functions, and avoidance is their default position. I have never been a big
fan of labels (nor are my students), and I immediately adopted the matrix
language view of them as stuck. Its as if theyre trying to get somewhere
using a faulty compass. The valued direction I move toward is our collective task as educators to help them get unstuck so they can more readily
come into contact with what is important and rewarding to them.
Learning is a natural process. Schools focus on verbal learning, but
we humans primarily learn from our experience through the process of
trial and error. We get on the bike, we wobble, we fall, and so on, until
we get it or perhaps move onto something else. Following my initial
exposure to the matrix, I was excited and eager to try it out. In our school
program my role is to provide counseling, consult with staff, and intervene with students who present with various crises. While I knew the
matrix approach had potential, it was nothing short of a paradigm shift,
since I came from a primarily psychodynamic or family systems model.
As far as I knew, the matrix hadnt been tried in schools before. Along
with my enthusiasm, I noticed my apprehension, my sense of inadequacy,
and thoughts like This wont work, They wont get it, and I dont know what
Im doing. I also noticed the thought If I want them to develop some new
skills, I need to keep developing mine.
My first new move when students presented for counseling or in
crisis was to turn to a previously unused small whiteboard and say, Hey,
let me show you this cool way of looking at things I just learned.
Presenting it in this way, from an open, accepting, nonjudgmental stance,
I wasnt telling them what to do, so willingness to listen showed up. We
talked; we sorted their toward moves, away moves, and five-senses and
mental experiencing onto the whiteboard; and they walked out more
psychologically flexible than when they came in. In the process, I experienced one of the many benefits of matrix use: it promotes flexibility in
the clinician or educator, as well as in the client or student. It has a bidirectional effect on psychological flexibility. I was engaging in different
behaviors with my students (working from the whiteboard, moving
around the room, getting curious about the functions of our shared languaging, and so on). The kids were in the room with me noticing both
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The ACT Matrix
their behaviors and their unwanted issues, and they were free to choose
what they would do with all of that. The urge to fix it was there for all
of us, and we were learning not to scratch it, instead creating space for
the students to come up with new behaviors and keep going.
As I developed a functional contextual point of view, I came into
contact with my own language-based traps. The students I work with
have exquisitely developed avoidance behaviors from years of not feeling
good about education or being rewarded for it. Working with them frequently results in my feeling defeated and beat up, as well. When students were sorting moving toward whats important (coming to school,
going to class, taking notes) and away from what they dont want (yelling
to get away from anger, sleeping to get away from sadness), I also noticed
my own toward and away moves. I could see and feel a difference in
working with the matrix process (including continuously noticing the
thought Its too simple!) as well as the pull to get into the stuck stories
the kids presented to me in words and deeds. I experienced that buying
the stories led to less flexibility in me and limited my problem solving. I
also experienced the matrix running inside of me. I was consistently
returning to the process of influencing my students and staff toward discovering what works for them.
The Benefits of Riding the

Matrix Bike
Collaboration is engendered through the matrix process and is a natural,
evolutionary step with repeated use. I knew enough to be in the ballpark
most of the time, so the next natural derivation was to begin consulting
with Kevin to develop my skills and knowledge. I did this initially via
podcasts and later through regularly scheduled Skype sessions.
Simultaneously, I began to share my developing point of view with my
colleagues and started using the matrix to consult with teachers about
students (more on this later). I also got a bigger whiteboard. I decided to
present the matrix at our back-to-school in-service meeting by announcing, Heres something Ive been doing with the kids that seems to be
useful.
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Educational in-service meetings are great places to catch up on sleep,

so I stood before my crew with fear and trepidation. Happily, I noticed
that the effect on the staff was similar to that on the students. Several of
them began to come up with ideas about how they could use the matrix
in their classrooms. I was invited to present the matrix to students in
some of their classes. In this way, I began to introduce a shared point of
view that promotes greater flexibility and less stuckness for everyone.
The challenge for me was to continue to promote this while noticing my
hooks.
Frequently, hooks are unwanted internal and external barriers that
show up and pull us toward internal experiencing and away from sensory
experiencing. When fused with unwanted mental experiencing, I am less
present, more in my head, and prone to doing something to get away
from the hook. Im also less likely to engage in values-driven behavior.
Rather than get stuck in thoughts like This kid cant control himself or
feelings of futility, resentment, and so on, my goal was to notice the
stuck stuff and what I did next (either getting more hooked or taking
it with me). One of the really neat things in matrix work is noticing
hooks. It never gets old, and its a wonderful way to foster my own psychological flexibility. Thoughts like I have to do something or urges to
teach or impart knowledge continue to show up. Over time, I learned to
sort these into my matrix and stay with the process of influencing students and staff toward discovering what works for them.
Hooks show up everywhere and can influence both toward moves
(approaching what is important) and away moves (trying to avoid what is
experienced as unwanted). The more I used the matrix, the more rewarding it became (a toward hook), and the more I looked for opportunities
to apply it. Moving toward collaboration entails holding the self-as-
content thinking of self-as-expert lightly and embracing the approach
of Lets look at this together and see what happens. The hooks, of
course, just keep coming. With the matrix we get to notice them and
what we do after they show up. This leads to the humbling realization
that we are all swimming in the same word soup of mental experiencing.
Noticing, or present-moment awareness of, hooks is the pause that connects. Choice shows up, and new behaviors, otherwise known as derivations, are usually not far behind.
My next derivation was to run a regular matrix group. (My initial
matrix work was done in a group setting.) I chose our six middle school
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The ACT Matrix
students to work with and decided to include the teacher and educational assistant for maximum exposure. Running groups with folks struggling with self-control and attentional issues is daunting and can easily
become chaotic. Plunging in, I presented the matrix point of view on the
whiteboard. Each week we gathered and sorted our experiences onto the
matrix, and everyone hung in there. Having plenty of art supplies and
paper helped. Our shared experiences did the rest. Together, we practiced noticing our toward and away moves. We noticed our hooks and,
using the Passengers on a Bus metaphor (Hayes, Strosahl, & Wilson,
1999), we practiced driving our buses with our wanted and unwanted
passengers. Rambunctiousness, frustration, and confusion routinely
showed up, and we kept moving. It wasnt long before the kids asked to
run the group. A great way to learn the matrix is to teach it, so we gave
it a whirl. We decided to take turns so each had an opportunity to lead
our weekly sorting parties. If a new student entered the program, one of
the students ran the introductory session.
It was fun, and they were taking on the task of sorting their experiences and learning to cooperate, take turns, share, acknowledge different perspectives, and give feedback. The cool part was that none of this
was being explicitly taught or targeted. Prosocial behaviors kept showing
up week after week. My valued direction was simply promoting psychological flexibility, or as I called it noticing if what youre doing is getting
you where you want to go. To do that, I held the thought of getting
somewhere lightly and let the students be their own guides. Including
the staff in the group exposed them to the matrix in the service of
helping the students, and everyone got to see everyone else from a different perspective. Staff members were free to choose to use the matrix
elsewhere or not. Those that did use it began to use the language both
for themselves and their students, and it became a form of shorthand
communication, further enhancing collaboration.
Matrix Evolution
Curiosity and engagement go hand in hand with the matrix. My colleague
and talented case management partner Lynda Marasco was also beginning to use the matrix with her students and experienced the flexibility
it gave her. We had the beginnings of systemic interventions for
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influencing students based on a functional contextual approach. Both of

us also started using the matrix with parents who consulted with us, and
this helped defuse escalating issues with their children. The principal,
Dawn White, also began to use the matrix in student conferences, and
several teachers started to use it in their everyday lessons and inter
actions with students. It helped promote positive interactions and gave
them a way to approach instructional and behavior management issues
that got reluctant learners on board. Each person took the basic approach
and adapted it to his or her particular circumstances (more
derivations!).
Andrew Bezila, in secondary special education, uses the keywords
noticing, flexibility, and choices and has them prominently displayed on his classroom wall. Students entering his room are encouraged
to notice internal experiences of boredom, frustration, and anger when
they show up, and theyre given credit for doing so. The question Andrew
asks after saying, Its great that youre noticing that! is What do you
want to do with it? Using the matrix empowers his students and gives
them choices. Collectively, they look at what they can do when stuckness
shows up to move toward whatever is important that day. He believes its
made a difference for all of them.
Seeing and experiencing how matrix training promoted prosocial
behaviors led me to look for ways to increase matrix trainings. I decided
to introduce the matrix at the beginning of every new student orientation. My goal was to invite students in and give them an experience that
differed from their previous lack of success. What better way than to ask
them for permission to show them my point of view and start with the
question Who or what is important to you? Parents and guardians who
accompanied new students were also invited to sort their experiences. In
the midst of failure and obdurate noncompliance, cooperation has
showed up every time. This simple step has served to lay the groundwork
for future consultations with all of them and to give them a focus and a
sense of forward direction. Parents exposure to the matrix has promoted
their flexibility at home and around difficult school issues.
We have referrals throughout the school year, and I opted for group
intakes. Incoming students experience from the start that they are not
alone and that others are making valued choices toward attending to
and, possibly, salvaging their education. Lynda and I developed follow-up
matrix groups over the course of the academic year, where students have
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the opportunity to monitor their progress, celebrate successes, and

address issues that get in the way of moving toward whats important.
The groups are voluntary and have been well attended. The students
have moved toward engagement.
Psychologists, social workers, and learning consultants from our
school district who refer students to us have also been exposed to the
matrix. Ive offered small workshops for them and many have attended.
Ive also introduced the matrix to workshop attendees in my capacity as
the districts nonviolent crisis intervention trainer. Staff rmembers eport
that its incredibly useful for managing crisis situations and for noticing
what works and what doesnt, giving them a practical set of tools to use.
Many have adapted the matrix for regular classroom use as well.
Most recently I was asked by a good friend and colleague to lead a
workshop for our state school psychology conference. A consultation
with Kevin yielded the title Setting the Context for Creative Problem
Solving. I once again had the opportunity to notice thoughts such as
This wont work, Theyll think this is stupid, and What do I have to offer? and
the accompanying feelings as I stood before my fellow professionals.
Once I had the matrix up on the whiteboard, the process did the rest,
leading to the usual group collaboration and cooperation. There is
nothing quite like standing before a group of people with two crossed
lines behind you. The matrix is simple, elegant, and empowering.
I dont know where the matrix will take me next, but I do know that
it works wonderfully to help me and others using it derive new
behaviors.
The Matrix for Education

I begin all of my individual, group, and consulting training work the
same way. The following example is for groups and is easily adapted.
Whats standard is getting the matrix up in front of people and asking for
permission to show them my point of view. This way we get willingness
off and running.
Our groups are voluntary. Most kids want to come, and if they dont,
I dont push thatyou know what happens when you push kids. Lynda
and I co-lead. I focus on the process and Lynda focuses on content to
keep the flow going. I help the group back off the sticky language traps
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that show up. We keep the groups small (four to six students), and the
time frame is around forty minutes. Lynda and I also collaborate and
process a bit after each group.
We begin by drawing the matrix up on the chalkboard or whiteboard
(see figure 12.1). I put up the crossed lines with the arrows on the horizontal line, write Toward and Away on either side, and label the vertical line with World of Behaviors and World of the Mind. I use my
words and actions to continually bring the focus to the matrix diagram.
We all take turns sorting. I usually go first. The key is to say yes to whatever the students are verbalizing, and then sort that into the matrix with
a question such as Where does what you just said fit on the matrix? In
this way, I groom awareness and give them credit for participation.
World of
Behaviors
3. What have I been doing
to the stuff thats
getting in the way ?
Is it working?
Am I moving closer to
whats impoertant to me?
4. What behaviors can I do

to move toward whats
important and take the
stuff inside that I dont
along for the ride?
2. What inside stuff has

been getting in the way of
moving toward what is
important to me?
1. Who is important to me?

What is important to me?
What do I want to do?
Toward
Away
World of
the Mind
Figure 12.1. The matrix for secondary school students.

I ask, Who is important to you? either to one person or the group.
I then write the responses in the lower right quadrant. We may or may
not chat about this a bit. I may also add What is important to you? to
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get at valued life directions. Kids say things like friends, family, fun,
education, and so on. Once we have a list, I say something like And all
of this is the important stuff that you move toward, adding, All people
have important stuff they notice themselves moving toward all of the
time. Most of the time it feels good. Students share what toward moves
feel like, and all of that goes onto the board (toward moves in the upper
right and their feelings about them in the lower right). I continue, saying
Sometimes when were moving toward important stuff, things show up
inside of us that get in the way of doing whats important to us.
I then slide over to the lower left and ask, What inside stuff, such as
unwanted thoughts, feelings, or memories, have you noticed showing up
inside you that gets in the way of moving toward whats important to
you? With new groups I may have to get things going by writing something like fear or anger as an example of something that shows up
inside. I might give an example like I sit in a traffic jam. Anger or frustration shows up inside me. I complain. The point here is that something shows up, we dont like how it feels, and we do something to get
way from it. Students usually list internal content like fear, anger, worry,
doubt, sadness, depression, or urges to do harmful things. All of that is
sorted into the lower left quadrant of the matrix.
I move to the upper left and ask, What kinds of things have you
tried to deal with your unwanted stuff, like to make it go away or get rid
of it? They typically say things like ignore it, think of something else,
yell, sleep, not go to school, or, for teens, smoke or do drugs.
Groups really get into this, and you can get a good list going. In matrix
language we call theseaway moves because they are things people do to
get away from what they dont want to have (think fusion here). After we
record the away moves, I say, So you feel X or have thought Y down here
(pointing to the unwanted stuff below) and come up here and do Z (an away
move) to get away from this stuff. Right? Does this unwanted stuff down
here go away and not come back, or does it show up again? Kids usually
say something like It goes away for a while or No, its still there, or
report that something else unpleasant shows up.
I start to draw arrows going from the lower left to the upper left and
back down again, illustrating an unworkable change agenda. As the
circle of arrows gets tighter and tighter, I say, So you dont want this stuff
down here, so you go up here and do this stuff (away moves), and then
you notice more stuff you dont want, and it kind of goes round and
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round until you feel stuck. I chat a bit about how everyone gets stuck
sometimes and say its okay to get stuck once in a while, but getting stuck
a lot doesnt feel good or work to get us where we want to go. Everyone
agrees that it doesnt feel good. Along the way I may also ask the question
Who is noticing this? Participants say I am or me, which highlights
that there is an I or me that notices what they are doing. I sprinkle
this question in often to encourage perspective taking and present-
moment awareness.
Next I slide over to the upper right and say, So what kinds of things,
moves, or behaviors do you want to do to move toward who or what is
important to you? Kids will say things like Talk to my mom, Hang
out with friends, Go to school, or Pay attention to the teacher. We
keep it simple. I then say, And you can notice the moves youre making
and how they work to help you get where you want to go. Noticing what
youre doing gives you choice about what you do next. You can notice
yourself moving toward whats important to you and take your unwanted
stuff with you. For example, you could have the thought I dont want to be
here yet still be in class. You could have the feeling of being bored and do
your work. You could be angry or sad and talk to a friend. You could also
keep doing things to get away from what you dont want and see if that
works to get you where you want to go. Future discussions are in the
service of everyone noticing and sorting what were saying onto the
matrix. We also notice our hooks (lower right and left), since hooks can
take us either toward or away.
When I mention homework, the typical response is ugh! I say, You
can either do it or not do it. Its fine either way. The homework is to
notice what you do and whether its a toward move or an away move. If
they do the homework, they get credit. If they dont, they get credit for
noticing that they didnt do it, and then we notice what they did instead,
taking us back into the matrix process. We also notice if any hooks
showed up.
All of this is all done collaboratively from an open, accepting stance.
We dont tell the kids what to do. We want them noticing what they do
and sorting their experiences onto the matrix. Once they get the basic
language down, such as toward moves and away moves, they learn to
notice their behaviors. The key is to stay in process through responses to
their statements: So when you put your head down in class, was that a
toward move or an away move? So you went out to the movies with
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The ACT Matrix
your friends and took your sadness with you. Where would you put that
story on the matrix? Is that a story where you have lots of choices or few
choices? The kids learn to sort their experiencesbehaviors up top,
and thoughts, feelings, images, and memories belowand become aware
of the toward and away functions of their actions. Flexibility increases,
and they come up with more behaviors (derived relational responding) to
keep moving in valued directions.
Once kids get the process down, the groups more or less run themselves. Prosocial behaviors show up. For example, they help each other
notice their moves, come up with solutions, and try new behaviors.
School attendance and compliance among group attendees improves significantly. We even overhear conversations in the hallways about toward
moves versus away moves and being hooked. Its fun and rewarding, and
you can plug in your favorite ACT exercises for added enjoyment.
Matrix Derivations
Here are some other examples of how learners and educators have used
the matrix:
A struggling ten-year-old student notices that when he goes to
class, looks at his teacher, does his work, and so on, he feels good
and wants to do it more. He also notices that, in response, his
teacher smiles at him and helps him.
After several months of sorting, a learning-
disabled middle
school student notices that shes disturbing others in her efforts
to move away from her anger. She has the thought Maybe I
shouldnt do this and chooses on her own to reengage in the
lesson.
A high school teacher has an image of the matrix in her head as
a student fires provocative questions at her. She notices the urge
to move away from both her anger and the student and pauses.
She begins to slowly and calmly respond in more detail than the
student wanted, obliterating the insults and the challenge. She
also notices that the class is more attentive and tuned in to her.
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An eight-year-old boy with binaural sensorineural hearing loss

discovers how to move toward success in education and school.
Anger is his identified internal obstacle. His valued move when
anger showed up is to put his anger in his backpack and take it
with him. He experiences satisfaction, pride, and amazement.
His mother also learns how to reward his toward moves and
model flexibility. Hes able to transition from a specialized school
to a public school with specialized support.
Conclusion
Three characteristics define a learner in trouble: they act before thinking; theyre disorganized; and they lack attention to detail. My experience as a clinician and practitioner is that the matrix addresses all of
these issues. Promoting psychological flexibility with the matrix enhances
mindful awareness and choosing valued actions, organizes the learners
experiencing, and improves attention in real time with no agenda other
than what the learner brings to the table. Each act of matrix sorting
noticing toward versus away moves, and noticing sensory experience
versus internal experience versus who is noticingis a brief flexibility
training. How much training someone needs to get unstuck and engage
in more valued behaviors is highly dependent on the individual and the
context. It may take a few sorts, or it may take hundreds. When I asked
the student I met with at the beginning of the chapter what he did with
his unwanted stuff, his response was I live it in me. Then, with a big
smile on his face, he added, I dont know where that came from!
The matrix helps learners of all ages notice and analyze the function
of their own behaviors while targeting the core ACT processes of cognitive defusion, acceptance, present-
moment awareness, observer self,
values, and committed action. I tell people, Using the matrix teaches
you how to fish. I see again and again how learners and educators are
loosened up from aversive control and move toward increased appetitive
functioning. This is knowledge gained through experience, not through
textbooks or curriculums, and its pointed toward growing and thriving.
Rather than having the goal of imparting knowledge, we can use this
point of view to influence individuals and groups to go out and discover
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The ACT Matrix
the knowledge and experience that works for them. This is influence
with precision, scope, and depth. From just two crossed lines and a few
simple words and actions comes limitless variation at the individual,
group, and organizational level. Pretty cool stuff.
Reference
Guilford.
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CH A P T ER 13
In Business: The Matrix for

Team Building and
Professional Stress
Annick Seys
Im a social worker. I have a private clinical practice where I work with

people suffering from burnout, professional stress, and performance
anxiety but also clients who suffer from more severe psychological disorders, such as eating disorders. More recently I moved to organizational
work as a cofounder of a consulting and training partnership. Our clients
are mostly organizations in the private social sector, typically groups of
psychologists, social workers, therapists, or dietitians, and we are seeing
increased interest from coaches working in business environments. We
teach them about acceptance and commitment therapy in six-day courses
and workshops with different ACT themes. We also offer more tailored
interventions on demand, intervene in teams, and have a stress management or crisis and conflict management mandate. I have been using
ACT since 2010 and the matrix since 2011.
ACT has been shown to be an effective intervention to help manage
workplace stress and improve employee performance (Flaxman & Bond,
2006; Hayes, Bond, & Barnes-Holmes, 2006). In my work with organizations, I have found the matrix to be a practical, efficient tool that is
especially effective in helping improve the atmosphere in the workplace.
The ACT Matrix
I have been particularly impressed by how versatile and swift the matrix
can be in getting the ACT point of view across.
Working with Teams

I do workplace interventions among members of teams. This can be a
challenging environment, as consultants are often called in only after
difficulties have become long-standing. Communication problems, conflict (latent or open), distrust, personal stress, and dissatisfaction with
work-life balance are common. In such an environment, consultants
must tread lightly and are rarely welcomed with open arms by the team
as a whole. Using the matrix, I have seen people quickly open up and,
though this isnt common in organizational settings, dare to speak openly
and kindly about whats bothering them, why they behave the way they
do, and, most of all, what is truly important to them. Remarkably, this
always happens in an atmosphere of serenity. In short order, people let go
of stories about what others should change so they can at last feel better.
Early in the process, people visibly recognize that they have a choice to
act in accordance with their values. Workplace communication improves,
along with respect for others opinions. Being more open to themselves
and to their colleagues helps bring participants closer together, and soon
theyre able to talk about issues that had seemed hopelessly stuck.
I believe these positive outcomes have to do with the fact that the
matrix normalizes participants inner experiences from the get-go and
makes them see that their colleagues (and people in general) have similar
feelings and thoughts and can get stuck in similar ways. Through the
matrix, people become better able to flexibly take perspective and experientially contact self-as-context. From there, they can pivot from nonacceptance and fusion to values and committed action. Orienting to the
right side of the matrix helps build a strong foundation for moving to
defusion and acceptance. Participants become better able to step back
from thoughts and feelings that can get in the way of doing what they
truly want to do.
Working with the axis of mental experiencing versus the five senses
lets people experience how they can get hooked by judgments, predictions, memories, and all of the other links the mind makes that arent
always useful and invariably take them away from the present moment.
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In Business: The Matrix for Team Building and Professional Stress
Soon enough, team members start making jokes about their own thoughts,
a sign that theyre taking a different perspective on the minds workings.
The matrix ignites the power of the ACT processes and allows team
members to quickly learn hexaflex skills without the trainer having to
mention theose skills by name. In short, people learn how they can focus
on whats important to them and act upon it while taking all these pesky
emotions and thoughts with them. ACT books invariably advise clinicians to instigate experience rather than talk theory. Because of the way
the matrix is designed, you dont have to talk about it at all; you can just
let people experience what it can do for them. In fact, if youre only just
starting to work with ACT, using the matrix might help you develop your
ACT skills much more easily.
One of the rewarding consequences of working with this model is
seeing that, by the end of a workshop, participants are often looking at
moving toward their values in areas beyond their professional life. They
start looking at how to do more toward moves in their personal life, which
in turn has a positive impact on their functioning in the workplace.
In Practice
In this section, Ill discuss a couple of case examples that illustrate the
versatility of the matrix in organizational settings.
A Team Negotiating Changes

I was called to give a one-day workshop for a troubled team that
worked with underprivileged children. The situation was acute. Jan, the
new team coordinator, wasnt sure that two members, Chrissie and Bart,
had the capacity to implement the sweeping changes the team needed.
He told me hed fired Chrissie on the eve of the workshop and was set on
firing Bart the next day, and Bart knew this was likely. Nonetheless, both
Chrissie and Bart participated in the workshop.
Over the past year, the team had undergone extensive coaching.
This had helped some, but the team was still in crisis. Gossip was sapping
morale, conflicts were left unresolved, frustrations remained unspoken,
and tensions ran high. Three major issues remained unresolved. This is
how the teams objectives had been phrased:
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We have judgments toward each other that stand in the way of good
collaboration, but we dont dare express them because we dont want
any conflicts.
We want more openness and closeness toward each other, with
respect for everyones abilities and personality.
We want to find a way to implement the new policy together.
This team was undergoing profound changes. It had previously been
tasked with structuring leisure activities for underprivileged children,
and team members had been recruited on that basis. Now, with the
arrival of a new regional coordinator, the policy had changed. The teams
new goals now included teaching the children specific skills to help them
deal with particular challenges they faced. The team was now responsible for identifying each childs specific needs and providing the appropriate skills training.
Jans expectations were for team members to be open with one
another and for the team to become tighter. He wanted them to stop
thinking as individuals and start thinking as a teamsomething theyd
never done before.
The Workshop
I started off by telling the group that what they wanted to do with me
is against human nature: we dont like to be vulnerable and feel the associated anxiety. I explained that this was one of the important points of
view that wed be discussing that day. Then I started exploring the five-
senses versus mental experience axis. I gave everyone a candy bar that,
though it looked different, tasted the same as a very well-known one. I
invited them to hold it and imagine what the candy bar might taste like.
Then I told them that it actually tasted like the well-known candy bar
and invited them to notice what their mind did with that. After inviting
them to taste the candy bar, I talked about how we can have a very clear
image of a five-senses experience in our minds, but that regardless of
what that image is, it can differ from the actual five-senses experience.
I then shifted to the theme of the day, saying, Imagine you walk into
the office on a rainy morning and your colleague says Good morning in
a curter way than usual. What is your mental experience in that
moment? Next we looked at how the chatter of the mind makes it
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virtually impossible to perceive anything as a pure five-senses experience, particularly other peoples behavior. The mind will always color the
experience and add a running commentary. Thats how the mind works.
Laying this out seemed to allow Chrissie to explain, in a very vulnerable, nonaccusing way and for the first time, how she felt about the team.
She said she was okay with being laid off after more than twenty years in
the organization. She said she knew she didnt have what was required in
the new context. Despite the fact that she didnt feel others respected her
personality or abilities, she wanted to say that she didnt blame the team
or feel frustration toward them. Clearly, the individual coaching she had
received helped Chrissie express herself. Though Chrissie had been fired,
it was good for her and the team that she participated in the workshop.
It made working together during her notice period easier for both her and
the team.
I then gave the group some insight on how the mind works, using
Kelly Wilsons story of the blueberry bush (Wilson & DuFrene, 2009).
Two prehistoric men venture out on the savanna looking for blueberries.
One thinks every blueberry bush he sees is a bear and keeps retreating to
the cave they share. The other knows no fear and boldly makes his way
toward every seeming bush. For a couple of days he gorges on blueberries
while his friend hunkers, hungry and scared, in their cave. On the third
day, it turns out one of those bushes actually is a bear. We humans are
probably the descendants of the worried and cautious caveman, who
went hungry but survived.
Then, to help the group see how thoughts are not as easily controlled
as we might think, I asked them not to think of apple pie with ice cream.
Next we took some time to notice how the mind constantly judges things
and people around us.
At this point, we came back to the matrix and worked the right side
of the toward-away axis. We started listing the values that were important to participants as a team and as individuals. I put the following two
questions to the team: Imagine that your community work suddenly
came to an end. What would you want the teenagers and parents to say
about you? and Imagine youre leaving to go home, but on your way you
overhear your colleagues talking about how you participated today. What
would you hope theyd say about you? Next we looked at the top quadrant of their matrix and the actions they already did to move toward
these values in the team.
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The ACT Matrix
Moving to the left side of the matrix, I asked the group what they
could see themselves doing as a team and as individuals that moved
them away from their values. We also summed up the feelings and
thoughts they noticed when they engaged in away moves. I asked them
to take a minute to think about this question: If what you want is an
open atmosphere, how can you be more open toward your colleagues
with all of these thoughts and feelings toward each other? At that point,
the group went quiet, so I asked them to look at the matrix on the whiteboard and share, if they were willing, how they felt upon seeing the list
theyd created. The conclusion was that they werent alone in how they
felt
that everybody has these kinds of thoughts and feelings, gets
hooked by them, and reacts to them. However, and importantly for a
team that wanted to create openness, they were already sharing fundamental things about themselves in the early stages of the workshop. They
hadnt realized that they were already doing what they wanted to achieve.
Finally, I asked everyone to fill in their own matrix and choose one
action they would commit to doing to move closer to the team. I suggested that the chosen action be about something important to them
that they werent acting upon. Afterward, everyone shared their matrix
and committed action with the group. I invited them to notice the judgments about one another that showed up and to see how they could
respond with a values-driven toward move. The openness experienced in
that moment was very powerful and brought everyone closer together.
And whereas in the morning the team had barely responded to Chrissie
announcing her termination, by the end of the day they could tell her
how theyd appreciated her participation and empathically reflect how
hard the day must have been for her. They even told Jan that the organization needed to take good care of Chrissie during her notice period.
The Aftereffects
That evening after the workshop, I received a message from Jan:
After that team session, I want to end this magical day with the following philosophical words: When my senses fall asleep, the sheet of feeling
covers me and I realize with tears of joy that Im happy to be alive. On
behalf of our team, thank you Annick. Im sharing his message to illustrate how meaningful just one day of working with the matrix can be.
Bart didnt get fired. He and Jan had a long talk the day after the
workshop. They used the matrix to give one another feedback in a
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values-driven way. The matrix also helped them stay in the present
moment and in contact with each other instead of getting hooked by
everything that went on in their minds. For the first time, Bart could
speak openly about what hed felt during this difficult time of change and
how he really wanted to stay on the team. He could also admit to himself
and to Jan that he needed to acquire new skills if he wanted to stay. His
commitment to doing so allowed Jan to keep him on. Jan also made some
changes in the team and assigned Bart to a new position within the team
where he could best use his abilities.
A few weeks after the workshop, Jan told me that during a meeting
someone in the team had reverted to the old habit of communicating
without taking the feelings of other team members into consideration.
The rest of the team responded in a way that helped the person see that
he was appreciated, but that they didnt like this behavior. Before the
workshop, none of the team members would have even considered doing
that, and if they had tried, a heated argument probably would have
broken out immediately. Instead, the person apologized and worked to
change his behavior.
Teachers Stuck in Severe Stress

In the second scenario, the principal of a school contacted me to ask
if I could set up a training course for teachers to increase their motivation and decrease their stress. The school serves a population of disadvantaged teenagers. Truancy is rife, and the kids often hang around in
the street and get involved in illegal activities. The students come from
poor homes and different cultures and often dont speak Dutch well.
They express themselves differently and have different opinions about
education and life than those of most native Dutch students.
After some discussion, we settled on nine hours of teacher training,
occurring in three-hour sessions spread over three weeks. Six teachers
took part in the training, all presenting with high levels of stress. They
struggled with questions like What am I doing in this job? Should I go
to the trouble of preparing anything when its not appreciated anyway?
and How can I manage this? along with thoughts like I prepare so much,
but I dont seem to find time for my personal life anymore. Some of the teachers were embroiled in conflict with a colleague and wanted to be able to
handle it better, and one of them had all the symptoms of severe burnout.
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The ACT Matrix
Because this intervention wouldnt be lengthy, I immediately thought of

using the matrix.
Session 1
To begin, I set up the matrix on a whiteboard, and as in the workshop described above, we started working on discriminating five-senses
experience versus living in your head. I took some time to do exercises
that would help participants notice how the mind works. We looked for
examples of judging, making predictions, and so on, and throughout the
session we regularly paused to notice what showed up for participants
around our work in the momentwhat thoughts and feelings they were
experiencing.
Next we looked at the toward and away axis, starting with whats
important. I took quite a bit of time to work on the process of creative
hopelessness. We talked about how we humans can easily lose sight of
what matters to us when were hooked by our thoughts and emotions and
struggle to avoid them. In the moment, its natural to want to move away
from whats bothering us, but this also usually means were moving
further away from ourselves and what matters to us.
I ended the session by explaining that the purpose of the matrix is to
allow us to notice what were doing so we can choose if we want to shift
our focus or not. Then I invited participants to notice their toward and
away moves and to practice sorting five-senses and mental experience
over the next week.
Session 2
I started the second session by going over the matrix again and
having participants fill it in as a group. In this session I also invited participants to become aware of their level of engagement toward this training: Did they do their noticing homework? Had they started applying the
suggestions in daily life? As it turned out, they had started using the
matrix, and not only in school, but also in other difficult areas of their
lives.
Next we worked on defusion using the concept of hooks. I explained
that hooks are thoughts, emotions, or memories that show up and have
a quality that, when we bite, we tend to get violently pulled away from
the present moment and into actions that are rarely those the person we
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want to be would choose. I shared that one of my hooks is that I am only

a social worker, and as such grossly underqualified to deliver this intervention, much less claim expertise in ACT. Demonstrating my own away
moves, I said that when this hook shows up, I may start to give wordy and
theoretical-sounding explanations to move away from the shame and
thoughts of being inadequate. I then invited participants to identify their
hooks in their professional context and what they did next.
The teacher who was suffering from burnout dearly wanted to continue teaching. One of her hooks was that she couldnt let her students
down. When it showed up, she tried to force herself to carry on, but she
also became irritable and often reacted in ways she regretted, which only
added to her stress. She realized she couldnt go on like this, but every
time her hook showed up, she bit. Looking at her matrix, she clearly
identified her hook. Then she made a choice not to bite and to choose
self-care, which she identified as important. She resolved to make a doctors appointment and seek help.
Session 3
In our final session we used the matrix to look at participants experiences over the past week. We also practiced some expansion strategies
as a way to help make room for feelings of stress and to enhance the
ability to notice whats important in stressful situations.
The Aftereffects
I received spontaneous e-mails from four of the six participants
saying that, as a result of the workshop, they avoided less, were more
focused on what worked for them, were moving closer to their values,
and were applying these tools in many different situations.
Reflections on Your Matrix as an

ACT Trainer
The purpose of ACT is to increase psychological flexibility, whether in
clients or systems. As a trainer, you want to respond as effectively as possible to signs of psychological inflexibility. One way this is done is by
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modeling psychological flexibility. As an ACT trainer, when youre able

to notice whats going on inside you and respond in a flexible way, it
stimulates the flexibility of the group youre working with. Here again,
the matrix can be a precious tool. Make time, aside from your formal
preparation for trainings, to look at where you stand in your matrix.
What Kind of Trainer Do You

Want to Be?
Start at the bottom right of your matrix, with the question Who do
I want to be as an ACT trainer? The more openheartedly you approach
this question and the more you stay in contact with it, the more able
youll be to keep your focus on that during a workshop. It will also help
you get through the rough moments of participant resistance, negative
feedback, and so on. Imagine you can hear participants chatting together
in the training room at the end of the day. What would you love to hear
them say about you and about how the day went? What could you do to
move toward being a trainer who would make them say that?
What Do You Want to Move Away From?

Next, look at what you may not want to think or feel. Working with
participants who feel stressed or tense can be stressful for the trainer too.
Based on conversations with other ACT trainers, common thoughts
include I dont know who these people will be. How will they respond? Will I
be able to manage their reactions? Will I have enough time to do what I
planned to? Most revolve around Will I succeed? and Am I good enough?
You might even have had the thought that teaching people ACT means
you shouldnt be nervousthat you of all people should know how to
handle your feelings effectively. Other common ideas are that the matrix
is just too simple and that people wont like it.
How Can You Cultivate Toward Moves?

Some of those difficult thoughts and concerns can be useful, helping
you better prepare for the task ahead. Some of them might only get you
hooked and restrict your options. Notice what you do next. Here are a
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couple of suggestions for using painful inner experiencing to cultivate

toward moves.
Unhooking
If you get hooked and are pulled to away moves, use your defusion
skills to unhook. Heres an exercise I came up with that works for me. I
imagine a theater in my mind, with red velvet curtains and chairs. I am
the audience. On the stage stands a row of empty chairs with golden
armrests and red velvet cushions. Every time Im aware of a thought
popping into my mind, such as What if? or Will I be able to? I invite
it to take a seat and wait for the others to arrive. Ive noticed that every
time a new pesky thought pops up, by the time it takes its seat the other
thoughts have already disappeared.
Embracing Your Nerves

Gently make room for the discomfort youll inevitably feel, and let go
of automatic away moves; they will only increase your nervousness and
cause more discomfort. See if you can notice and stay in touch with
whats going on in your mind and body, such as butterflies in your
stomach, trembling or sweaty hands, faster breathing, or a dry mouth.
Nurture compassion for the stress and distress that will inevitably show
up. Aisling Curtin suggests going into the bathroom before the workshop
starts and taking some time for yourself. Rest your hands on your chest
and tummy and breathe gently into these spots, welcoming any nervous
feelings in that moment. This helps me every time.
What Are Your Away Moves?

Away moves may show up as youre preparing or while youre conducting workshops.
Before the Workshop

Can you stay in the moment while preparing? Can you focus on the
task at hand, or is your mind predicting all kinds of stuff or reminding
you how the previous workshop went? In conversation, psychologist Rob
Archer has pointed out how when we find a task too stressful or boring,
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The ACT Matrix
we might get up to get some coffee, talk to colleagues, go on Facebook or

Twitter, read a newspaper, and so on. Notice your own away moves. They
might signal how youre feeling about what youre working on. Recognizing
these feelings and practicing acceptance and contact with the present
moment as youre preparing can make it easier to receive them when they
show up during a workshop.
During the Workshop

When a workshop starts, the idea of letting go of your preparation
may be scary. Yet being too occupied with your notes or a preconceived
plan could prevent you from noticing whats going on in the group and
the way participants respond. As a result, you may ask for a level of openness that they arent ready for. This might make it harder to train how to
handle awkward feelings and thoughts in a more flexible way. The ACT
perspective differs from what most people are used to, and it takes some
time to grasp it. If you go too quickly, you could lose your participants for
the rest of the workshop.
Another risk is excessive preoccupation with the schedule. This may
tempt you to explain things rather than propose an exercise, and this can
backfire, especially when it comes to creative hopelessness. If people
cant experience that what theyre doing causes more pain and is unworkable for moving toward whats important, how will they be motivated to
change?
As a trainer, you might want to notice people going quiet on you,
getting annoyed, telling you youre going too fast, asking you where this
is going, asking why they should do an exercise, and so on. If you notice
people resisting or moving away from you or the workshop content, you
could share your thoughts and feelings in the moment and check in with
participants. The more you can stay in touch with all of your feelings and
thoughts, the more you can respond flexibly and not let your inner experiencing determine how you conduct your training.
Working in Organizational Settings

In organizational settings, people typically arent interested in theories or
concepts. Their objectives are often clearly defined, and they want to see
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results. Models are only of interest to the extent that they work.
Pragmatism is built-in. ACT is based around six processes of inflexibility
versus flexibility. Laying these processes out in detail may try the tolerance of people looking for quick and concrete help. In such contexts, the
matrix is a compact, powerful tool that allows for adaptable work with
the ACT processes. It quickly promotes psychological flexibility and
itself is flexible enough that it can be modified to fit the contexts and
situations in the training room and in peoples lives. With the matrix,
not only do people learn how to deal with stress and conflicts, but by the
end of a workshop collaboration is typically strengthened and a stronger
group identity emerges. Participants have gained psychological flexibility
as individuals and as a group, which makes teams stronger and tighter.
The matrix can help trainers stay flexible and identify where in their
matrix they are at any given moment, helping them model, instigate, and
reinforce flexibility. Based as it is on normal functioning, it allows for a
quick setting up of a perspective in which all people can recognize that
their inner experience and what they dont want to feel or think is part
of their common humanity. Although the matrix is pragmatic, it allows
for a firm focus on whats important and thus injects deep meaning into
interventions. This focus on values also means that matrix interventions
are ultimately in the service of each and every participant moving toward
whats important individually, rather than submitting to company or
management values and imperatives. In this way, it can quickly overcome the distrust that interventions focused on making employees fit the
mold can rightly elicit.
Conclusion
Ive found the matrix to be an ideal tool for interventions in organizations for many reasons:
It can help set ground rules for conducting an effective meeting.
It can help manage major changes in an organization.
Its an effective tool for conflict resolution.
It can help build team purpose and effectiveness.
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It can aid in identifying possible sources of stress and working

out what to do about them.
It can help individuals and teams be more effective and values
driven.
It can assist in giving effective feedback within teams.
This list is far from exhaustive, and I have no doubt broader uses for
the matrix will be derived, perhaps by readers of this chapter.
In my relatively short time using the matrix in organizational settings, Ive seen people grow after very short interventions. Still, I recommend conducting a couple of coaching or refresher sessions to keep the
process of change alive, to ensure the new skills are practiced, and to
troubleshoot any potential setbacks.
References
Flaxman, P. E., & Bond, F. W. (2006). Acceptance and commitment therapy
(ACT) in the workplace. In R. A. Baer (Ed.), Mindfulness-based treatment
approaches: Clinicians guide to evidence base and applications (pp. 377402).
Burlington MA: Elsevier Academic Press.
Hayes, S. C., Bond, F. W., & Barnes-Holmes, D. (2006). Acceptance and mindfulness at work: Applying acceptance and commitment therapy and relational
frame theory to organizational behavior management. London: Routledge.
Wilson, K. G., and DuFrene, T. (2009). Mindfulness for two: An acceptance and
commitment therapy approach to mindfulness in psychotherapy. Oakland, CA:
New Harbinger.
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CH A P T ER 14
The Matrix, Evolution, and

Improving Work-Group
Functioning with Ostroms
Eight Design Principles
Kevin Polk
In this chapter, Ill quickly review the origins of acceptance and commitment training and therapy and then discuss how acceptance and commitment therapy and especially the matrix are directly connected to the
evolutionary process. To do so, Ill quickly run through functional contextualism and relational frame theory; touch on the evolution of language and ACTs approach to the problems language can cause; take a
brief look at the social ramifications of these processes and Elinor
Ostroms eight core design principles for optimal group functioning; and
land right back on ACT and the matrix.
Functional Contextualism
ACT is based on functional contextualism, a scientific point of view that
seeks to increase the frequency and variety of behaviors that work to
improve the human condition. It looks at a human behavior (action) in
context, and in that regard the whole human is the action. This is like
The ACT Matrix
seeing someone walking (action) down the street (context). You dont see
a body and a mind walking down the street; you see one whole human
being walking down the street. Also, from a functional contextual
perspective, when a human uses language, it is the whole human
behaving, head to toe. So the person walking down the street might
pause and talk to us; its the whole human talking to us, not a mind plus
a body. To help lessen human suffering, improve the human condition,
and enhance evolution, we strive to predict and influence behavior with
precision (with the fewest symbols), scope (across contexts like home,
school, and work), and depth (psychologically, sociologically, and
anthropologically).
Functional contextualism is most often contrasted with mechanism,
which has its roots in Newtonian physics. Newtons ideas have been very
fruitful for humans. His equations led to the industrial revolution and
helped shape our understanding of the universe. Using Newtons equations, we can predict with great accuracy the movement of objects like
bicycles, cars, and planets. It was only natural that the predictability
within Newtonian physics found its way into explanations of human
behavior, to the extent that language like the following has become
common: That other driver really made me angry; I had no choice but
to honk my horn and give him the finger! Said another way, the other
driver caused the anger, which then caused the behaviors of horn
honking and gesturing. When pressed, almost everyone would agree that
there was a choice of whether to honk the horn or not and whether to
give the finger or not. But many would still maintain that the anger was
caused by the other driver, which means the other driver has taken away
the persons choice of emotion. In the greater scheme of things, this artificial, mechanistic removal of choice can limit the human condition.
Functional contextualism is more in line with the approach of
another great thinker: Charles Darwin. While Newton was concerned
with planets and rocks, Darwin was writing about how living things
arrived at both their physical form and their behaviors in a given environment. The combination of physical form and behaviors in the environment could have life-and-death consequences for a single organism or
a species. Organisms live in a Newtonian physical world, yet how their
behaviors and physical forms transform through the ages cant be predicted through Newtonian physics. Darwin saw that three processes
came together to shape the evolution of any living thing: variability
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The Matrix, Evolution, and Improving Work-Group Functioning
(both physical form and behavior); consequences (perhaps life-

and-
death, or perhaps just better success at breeding); and heritability (in
which successful changes in physical form and behavior are passed to
future generations).
While causational and mechanistic Newtonian thinking has long
informed descriptions of the function of human language and cognition
(e.g., the mind being represented by cogs and wheels spinning inside the
skull), Darwinian thinking currently doesnt have much of a foothold in
the discussion. Relational frame theory and ACT seek to describe and
influence human behavior in Darwinian, or noncausal, terms. The
notion is that while mechanistic thinking tends to limit psychological
flexibility, functional contextual thinking increases.
Relational Frame Theory

Relational frame theory (RFT) is a theory of how humans learn language and cognition. It uses the functional contextual worldview of
finding workable behaviors in context that are then passed on through
generations. The whole human participates in languaging, not some
mind-body split. RFT is different than other accounts of language in that
it looks at the function of words, not the accuracy of what words represent. For example, most people might agree on what a tree looks like and
what a bush looks like. You could show them pictures of trees and bushes,
and they could sort the pictures into two piles: trees and bushes. The
sorting works almost all the timeuntil you find a picture of a tree that
looks like a bush, or a bush that looks like a tree. Then the plant scientists get involved and provide technical language to sort out trees and
bushes. However, there are still a few pictures that dont quite fit in either
category. Scientists have argued for ages about perfect trees and perfect
bushes. Dont think this really happens? Take a look at a duckbill
platypus.
RFT isnt concerned with the accuracy of categorizing things like
trees, bushes, animals, vegetables, and so on. It looks at the function of
words and language. The question becomes Is this languaging (maybe
about trees and bushes) working to move us in the direction we want to
go in life? Said on an individual level, the question is Is my languaging
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The ACT Matrix
moving me toward who or what is important to me? On a societal level

it might be Is this languaging moving us toward peace or destruction?
Why is categorization versus functioning so important? Because
people get into huge Im right and youre wrong arguments about categories like trees versus bushes, or my religion versus your religion. From
a functioning view of language, we instead ask, Is this languaging
working to move us toward our values? We replace Im right and youre
wrong with the question Is this working?
It is far beyond the scope of this chapter to explain RFT in detail. In
brief, RFT gives a behavioral account of language rather than using
made-up mechanistic terms for different parts of the mind, such as the
language module or short-term memory module. Instead, RFT might
sound like this: As an infant you saw your mother a lot. She was warm
and fuzzy and gave you nurturing stuff. People kept uttering the sound
mom when she was around. Then one day you saw her and uttered
mom, and she gave you a broad smile and a big hug. Pretty soon you
said mom a lot in her presenceand got more smiles and hugs. Then
one day mom showed up in your mental experiencing. At that moment
you had put it together: saying mom made sense, and making sense was
rewarding. With the rewards your mom was giving you for uttering the
sound mom, you began to get hooked on language. Sensory information from the world (for example, sights, sounds, and smells of mom) is
combined with your internal experiencing and related to a sound, and
you get rewarded for that relating. In RFT terms this is called relational
framing.
Lets look at another example. If I tell you that A = B and B = C,
you know something more. You know that A = C. In RFT, that little
trick is called derived relational responding, and its huge. We humans
are forever learning one thing, and then another thing, and then putting
those things together into further understanding. Weve sent astronauts
to the moon by deriving new relations.
While language is obviously very useful, people have become so
good at taking worldly experiencing and transforming it to internal
sounds and symbols (language) that its easy to live in an imaginary world
inside the mental experiencing. Great scientists, such as Einstein, have
engaged in thought experiments to derive great things using this ability.
Sadly, mass murderers have concocted imaginary worlds to such an
extent theyve killed many people. Business and political leaders often
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seem to be living inside the mind and not paying attention to real-world
facts. And people often suffer horrible pain as they struggle to avoid
imaginary demons in the mind. The trick is to lift people out of excessive
mental experiencing when such thinking is becoming too restricting and
harmful.
Language Is Social
Language probably evolved in humans for social functions. One was
to help protect us and others, for example, by yelling, Watch out!
Another was to make babies, by saying stuff like Hey good-looking,
want to hang out tonight?
While languaging is social, its done from the me point of view, as
in me over here and you over there. Once the me showed up as language, people could talk to others (me to you) and to themselves (me to
me). Since language is great (to a point) for symbolically dividing things
up into categories, such as trees, shrubs, predators, rocks, and so on,
eventually the self was divided up into the categories of me and mind.
From an outsiders perspective, thats just silly; in the outer world, it looks
like one person behaving. From inside the skin, the separate selves make
sense thanks to social language. Said another way, to use language I need
someone else to talk to, so one part of me talks to another part of me.
From the perspective of your own language, theres always more than one
of you in the room, even when youre by yourself.
This artificial language-based separation of the self into at least two
parts is important because of Newtonian and Darwinian thinking. If we
apply Newtonian thinking, one part of the mind causes another part of
the mind. For example, the sentence How you think determines how
you feel applies Newtonian determinism to the artificial, language-
based separation of self, as if thinking were a cue ball striking the emotion
ball and sending it in a predictable emotional direction. But in reality,
there is just one of each of us, and the whole human being behaves.
Thinking and feeling are of course related, but relation is not causation.
For example, most people would say that thinking Im a failure causes
sadness or some similar emotion. However, there are people out there
who might get pleasure from that thought.
The more a person believes that thinking one thing automatically
leads to a certain set of behaviors, the less psychologically flexible the
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The ACT Matrix
person becomes. ACT and the matrix seek to reverse the inflexibility of
such languaging and increase peoples adaptive behaviors.
Evolution and Language

Recall that, according to Darwin, evolution needs three ingredients:
variability, consequences, and heritability. Language is infinitely variable; it has consequences (sometimes life-and-death consequences); and
its easily passed down through generations. However, the evolution of
language is much, much faster than the evolution of most organisms. In
just a few hundred years, humans, using language, have created really
helpful stuff for humanity and really hurtful stuff for humanity. For
example, we now have enough nuclear weapons to destroy several earths.
We are polluting our environment (the stuff our bodies live within) at an
extinctive rate because language allows us to create polluting machines
of great size (factories) or in great numbers (cars). Yet because language
is so powerful and fast, it is also possible to change language for the better
quite quickly, given symbols that can exert a positive influence on variability, consequences, and heritability. We would want symbols that
allow us to derive more behaviors (variability) for continued human existence, allowing us to get out of our heads and experience the worldly
consequences of our actions. Finally, we need symbols that are easily
passed to future generations.
Human Conflict
A big part of language is classifying things in the right category.
Humans just love sorting things into the right categories, probably
because we get positively reinforced for things making sense. Therefore,
being right about how things are organized and categorized becomes
very important. People get into heated verbal spats (and sometimes physical fights) about whos right and whos wrong regarding how things are
categorized and organized. As this categorization and organization
process expands to determine how neighborhoods, towns, cities, states,
and nations are organized, we humans are at risk for lots of fights over
whos right and whos wrong about how things should be categorized and
organized.
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To put this succinctly, language can get us stuck in arguing over

categories while the world is burning. People become so fused with their
language that they forget language represents the world but isnt the
actual world. When were fused with language, it seems that the stuff
going on inside our heads is the world. Then we arent open to experiencing the real-world consequences of the behavior called language. We
instead look inward for reassurance that our thinking, categorizing, or
organizing behavior is right, regardless of real-world evidence. We also
look outward, to those who are literally referred to as like-
minded
individualsthose who share our views and biases and provide reassurance that were right.
Whats the answer? To use the title of a popular ACT book (Hayes,
2005), get out of your mind and into your life! Said another way, stop
relying on the behavioral consequences you think are happening and
instead pay closer attention to the real-world consequences you can
experience through your five senses. From the matrix point of view, its
like being lifted from the lower half of the diagram, down in mental
experiencing, up toward the center, where theres a healthier mix of
sensory and mental experiencing. How we go about getting out of the
mind in this way is the process stuff of ACT.
Acceptance and Commitment Training

and Therapy
ACT is based on the notion that people can get trapped in the mind to
such an extent that they lose psychological flexibility. That is, they lose
the ability to choose when to discontinue behaviors and derive new
behaviors that might work better. To counteract this loss of psychological
flexibility, ACT proposes several processes that can be worked on one at
a time or together to increase psychological flexibility: acceptance, defusion, present-moment awareness, self-as-context, values, and committed
action. The matrix is a simplification of these processes, reducing them
to two discrimination tasks: noticing the difference between sensory and
mental experiencing, and noticing the difference between how it feels to
move toward whats important and how it feels to move away from
unpleasant internal experiencing.
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The ACT Matrix
ACT is a way of interacting with others to lessen the bonds of language and get people more in touch with real-world consequences.
Mental consequences are still important; they just dont take precedence
over consequences perceived through our senses.
Recall the basic idea of RFT: that reactions to the physical world,
such as fear, pain, happiness, and love, get transformed into sounds
languagewithin a person. Since language is social, this gives us the
ability to have conversations with others about fear, pain, happiness, and
love, and about the wider world and ourselves. And because all of that
stuff is represented by sounds and such inside our minds, we can simply
recall events from the past and then have the emotions associated with
those events. Likewise, we can think about events in the future and have
emotions. Thoughts (internal sounds) and images show up and we have
emotions. One emotion that can show up independent of an environmental reason is fear, as when one thinks of a tiger and fear shows up.
In general, humans want to move away from fear. That makes evolutionary sense; moving away from real-world fear keeps a person alive for
the self, the group, and procreation. In addition, humans want to move
toward emotions like joy, love, and happiness. We can find some of those
feelings on our own, but we can find more with other people. We are a
social species, and were drawn to the good feelings we get with others.
Within me to me conversations, we can escape from danger and
pain or move toward joy and love. Life inside these conversations requires
little contact with the physical world. We can practically live our lives
inside them. However, getting stuck in your head is a problem because it
removes you from contact with consequences. Yet its one thing to talk
about people being stuck in their heads and losing contact with consequences, and entirely another to influence people out of their heads and
toward being engaged with consequences. Experience shows that simply
teaching people about the problem isnt enough. But how do we go about
engaging people in a process that lifts them out of the mind and into
noticing consequences?
Acceptance and commitment therapy was designed to be one way of
influencing people away from the stuckness of language and back into
noticing whats happening in the moment. In more evolutionary terms,
ACT is designed to get us out of our heads and back to noticing the
consequences of behaviors, both old and newhence the title of Steven
Hayess book Get Out of Your Mind and Into Your Life (2005). ACT is an
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intervention that combines functional contextualism, relational frame

theory, and evolution science into one package designed to influence
people by engaging them in a process rather than just sending information their way. Driven by functional contextualism, ACT strives to find
succinct language that engages and influences people, getting them out
of their mind and paying closer attention to the consequences of languaging. This book is about one succinct way of going about engaging
and influencing: the matrix diagram and the words used with it.
How the Matrix Works

The matrix was originally conceived as a game in which people would
sort trauma memories into categories so that defusion would occur,
increasing the probability that people would derive new responses to
their trauma memories. Therefore, the matrix was designed to increase
psychological flexibility by engaging people in two discrimination
(sorting) tasks: noticing the difference between sensory and mental
experiencing, and noticing the difference between how it feels to move
toward values and how it feels to move away from unwanted mental
experiencing. Some psychological distancing (defusion) is required to do
both of these discrimination tasks, and this psychological distancing is
synonymous with psychological flexibility. Psychological flexibility
increases the probability that the person doing the discrimination tasks
will derive new behaviors.
Notice that the toward and away discrimination task implicitly
includes values. Therefore, psychological flexibility is being increased in
the context of a behaviorally organizing reference called values. Like a
tree on the horizon, values provide a reference point for adjusting behaviors to reach a point in the distance. Values provide psychological points
of reference for testing the workability of behaviors.
Away moves are not organizing because they are short-term fixes and
thus cannot provide direction. Metaphorically, these are behind us and
cant provide a reference point for organizing our behaviors. A popular
ACT metaphor is to imagine youre running away from a swarm of angry
bees. People tend to look over their shoulder to see how close the bees
are, and as a result, they zigzag in no particular direction. They may
indeed avoid being stung, but they might also end up somewhere they
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The ACT Matrix
dont want to be. Avoiding fear often doesnt get you where you want to
go in life.
Both toward and away behaviors can be very functional depending
on the context. For example, in the presence of danger (like the bees or,
even worse, a tiger), an away behavior can save ones life. However, language allows humans to recall a story of bees or a tiger to such an extent
that a human can avoid imaginary bees and tigers while sitting in the
living room. This probably isnt very functional from an evolutionary
viewpoint, given that we end up staying home to avoid these dangers.
The workability of toward behaviors is also subject to context. For
example, engaging in chitchat with a potential lover might be very workable on a sunny day in the park, but that same chitchat might not work
at all while sitting at a funeral.
The key, in terms of evolution, is for humans to notice the consequences of their behavior while in context, and that requires being open
to both sensory and mental inputs while engaging in both toward and
away behaviors. And being able to analyze the consequences of a behavior requires knowing ones values.
Community
Ive been focusing on an individuals behaviors in the context of the individuals values. However, humans are very social animals. One need not
look too closely to notice that humans cluster together in groups, communities, and citiesand for good reason. Much of human existence is
dependent on working together with other humans to solve the problems
of food and safety. Humans long ago learned how to cooperate and divide
labor into small parts, with the small parts coming together as a whole.
For example, one person might clear a field of trees and stumps, another
might plow, another might plant seeds, and so on. No single person is
responsible for the entire crop, and working together, the group can
produce much more food. Humans have turned this ability to the task of
creating machines that could do much of the work of producing food,
further multiplying the effect of individuals. Those machines led to more
machines, and so on.
A small group cooperating to produce food is an example of a group
sharing common resourcesland and waterfor the survival of the
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group. For the group to continue to prosper, it needs to be flexible in

developing new behaviors as the context the group is living within
changes. In Darwins terms, the group needs to adapt to the changing
environment. However, since much of life is dependent on keeping things
the same (homeostasis), much of the group will always be invested in
keeping the sharing behaviors the same, rather than adapting. This
balance between keeping the common sharing behaviors the same and
changing behaviors to adapt is one of the most fundamental conflicts of
all human groups. Managing that balance is of vital importance to
human adaptation and has been the topic of countless books and articles. Indeed, our systems of government are in large part based on balancing between keeping things the same and making changes to adapt.
For many years, the dominant thinking was that a large, central government was necessary to manage common resources like land and
water. Small groups were thought to be incapable of such balancing.
Then along came Nobel Prizewinning economist Elinor Ostrom, who
found that, contrary to popular late twentieth-century economic thinking, small groups could manage the commons, as she termed them. No
large central governing body was needed. She found that groups who
were successful at managing the commons had some behaviors in
common (Ostrom, 1990).
Ostroms Eight Core Design Principles

After studying successful and not-so-successful groups around the world,
Ostrom described eight core design features for successful group management of the commons. While her observations were of social groups
sharing scarce resources such as land and water, her eight design principles have proved to be a functional way of looking at group behavior for
a wide variety of social groups (Wilson, 2011). The following are paraphrases of Ostroms principles:
1. Shared identity or purpose
2. Proportional costs and benefits
3. Collaborative decision making in the group
245
The ACT Matrix
4. Monitoring and gentle reminders for people not to cheat the

system
5. A trusted system of conflict resolution for cases where gentle
reminders dont work
6. A system of graduated sanctions such that the punishment fits
the crime
7. When nested in a larger group (such as a state in a country), the
smaller group has minimal rights to organize
8. When nested in a larger group, the larger group operates by the
same principles
While the matrix diagram can function to increase the psychological flexibility of an individual, these principles are concerned with
increasing the psychological flexibility of the group. So how does a group
come together and use the behaviors described in these principles to
keep things the same when needed but change when required by the
context? Anyone who has observed group behavior would recognize that
many groups dont possess these eight design features. Bureaucratic and
individual inflexibility often enter into group dynamics, leaving the
group incapable of successfully managing the commons in the present
and adapting for success in the future. What is needed is a way of influencing individuals in the group toward flexible group behavior for successful management of the commons in the present while also setting up
the group for successful adaptation across the changing contexts of time.
Groups depend on the psychological flexibility of each group
memberthe ability to notice the consequences of both away and
toward behaviors and to adjust behavior to improve group functioning.
However, groups can be a context where psychological flexibility is
limited by fears that are inherent to being a member of a group, such as
being laughed at or gossiped about. Its interesting how we humans are
drawn to groups but at the same time fear being part of a group. The
study of the fears inherent to group membership is summed up under the
term group flexibility. High group flexibility means group members are
at ease to speak their mind; low flexibility means they shut up. What is
needed is a way to increase psychological flexibility within individual
members of the group and then set the stage for group dynamics where
the products of that flexibility can be shared.
246
Two Loops Around the Matrix

To do this work with any type of group, we first do the basic psychological flexibility warm-up (see also chapter 1):
1. An exercise in five-senses experiencing
2. An exercise in mental experiencing
3. Noticing the difference between five-
senses and mental
experiencing
4. Recalling how it feels to move toward whats important
5. Recalling how it feels to move away from unwanted mental
experiencing
6. Noticing the difference between how toward moves and away
moves feel
First Loop Around the Matrix

Following the warm-up routine, we can take a quick loop around the
matrix to help increase psychological flexibility, using the following
questions:
1. Who or what is important to you? (Answers are written in the
lower right.)
2. What shows up inside you that can get in the way of moving toward
who or what is important to you? (Answers are written in the
lower left.)
3. What behaviors do you do to move away from or lessen unwanted
internal experiencing? (Answers are written in the upper left.)
4. What behaviors could you do to move toward who or what is important to you? (Answers are written in the upper right.)
Notice that by the end of this first loop around the matrix, anyone
will be taking a more distanced self-view. If we were doing the usual
psychological flexibility training, we would simply do more to increase
this distanced view and the chances that the person will learn behaviors
that work for valued living. Here, because were interested in peoples
247
The ACT Matrix
behavior within a group, we need to create a level of group flexibility that

allows members to speak up and help the group evolve behaviors that
help the group, so we make a second loop around the matrix.
Second Loop Around the Matrix

The second loop around the matrix serves the purpose of getting
negative emotions that can show up during group life out in the open.
Almost everyone has these unwanted mental experiences, and almost
everyone engages in behaviors to move away from thembehaviors that
ultimately dont work for the groups shared purpose. In this second loop
around the matrix, thoughts, feelings, and urges that are usually under
the surface can be brought out in the open quickly and painlessly. Heres
how we might conduct the second loop:
1. Look around the room and take in your fellow group members
through the appropriate senses, such as seeing and hearing.
2. Now close your eyes and experience your group members in your
mental experiencing.
3. Notice the difference between your sensory and mental experiencing
of your fellow group members.
4. Recall moving toward shared group purposes with this group or some
other group youve been a member of.
5. Recall moving away from unwanted feelings that have shown up in
this or some other group, for example, the fear of speaking up.
6. Now notice the difference between how it feels to move toward a
shared group purpose and how it feels to move away from unwanted
internal feelings when part of the group.
7. What is the purpose of this group? (All members talk, and the
results are written in the lower right quadrant.)
8. What might show up inside each of you that could get in the way of
moving toward the shared purpose of the group? (All members participate, and their answers, such as envy, jealousy, and anger, are
written in the lower left.)
248
9. What kind of behaviors might you do in the group that would move
you away from the mental experiencing in the lower left? (Answers,
such as gossiping, not working, and naysaying, are written in the
upper left.)
10. What kind of behaviors can group members do to move toward the
shared purpose of the group? (Answers are written in the upper
right.)
Obviously, the tenth item can take a lot of time as group members
come up with individual duties and roles that can contribute to the
shared purpose. The group can do both loops as often as needed to maintain group functions.
The Spoke Diagram

Monitoring
Collaborative Decision
Making
10
10
Polycentric
Governance
10
Proportional Benefits
and Costs
10
10
10
Minimal Recognition
of Rights to Organize
Graduated
Sanction
10
Conflict Resolution
10
Group Identity or Purpose
Figure 14.1. Ostroms eight principles.
249
The ACT Matrix
Now lets take a look at a way in which the group can monitor its functioning according Ostroms eight principles. Figure 14.1 has a spoke for each of
the principles. The bottom spoke, Group Identity or Purpose, is the most
important and was addressed during the two loops around the matrix. So
now the group can turn its attention to the other seven spokes, learning
about each and assessing group functioning on each dimension.
Notice that theres a 0 at the center of the spokes and a 10 at the end
of each spoke, forming a rating scale that allows the group to rate functioning on each of the eight spokes. If all are at 10, the group is rolling
along. When one or more of the spokes is at less than 10, the group is
bumping along, and those spokes could use some work.
Conclusion
From a behavioral and political view, the approach briefly outlined here
increases psychological flexibility and group flexibility by helping the
members of a group step back and view their individual functioning
within the group from a more distanced perspective. From this perspective, they can learn to be flexible, and theyll feel safe in the knowledge
that sticky group processes can quickly be addressed with the matrix and
spoke diagrams.
From an evolutionary view, this approach increases the variability of
behaviors by enhancing psychological flexibility and group flexibility. It
also increases the groups awareness of the consequences of individual
and collective behaviors and provides a ready means of passing along
successful group behavior by allowing the group to show other groups
how they use the matrix and spoke diagrams.
References
Hayes, S. (with Smith, S.). (2005). Get out of your mind and into your life: The
new acceptance and commitment therapy. Oakland, CA: New Harbinger.
Ostrom, E. (1990). Governing the commons: The evolution of institutions for collective action. Cambridge, UK: Cambridge University Press.
Wilson, D. S. (2011). The neighborhood project: Using evolution to improve my city,
one block at a time. New York: Little, Brown and Company.
250
CONCLUSION
Going Viral
Kevin Polk and Benjamin Schoendorff
Thus far the matrix has made its way into mental health settings, prisons,
schools, businesses, communities, Olympic athletics, and summer youth
camps. By the time this book is published it will have made its way into
more settings. Within weeks after what was then called the grid emerged,
the two lines were being referred to as a virus because many people who
learned it were compelled to pass it on to others. It began with people in
mental health groups sharing with their family and friends. Then students who learned the matrix in school shared it with their friends and
family. When we presented it to community groups, we soon heard of
more people showing the matrix to others. You too may have the irresistible urge to share the diagram with others, and we certainly encourage
you to do so.
From the beginning it was clear that after working with the matrix
diagram, people started coming up with cool new things to do to move
toward their values. Its wildly reinforcing to stand or sit in front of other
humans, show them a couple of lines, ask them just a few easy questions,
have them sort the answers into the categories, and see them quickly
derive new, more workable behaviors. We arent kiddingyou see the
deriving happening in front of you, and you get a huge rush of reinforcement when it does. At that point theres no putting the diagram down;
youre looking for your next fix. That reinforcement process drives the
viral aspect of the matrix.
The matrix is also evolutionary. Once people learn it, they find new
places and new ways to present it. In that sense, theres just no telling
The ACT Matrix
where the matrix will go. Its already in the hands of a few thousand
people. With the publication of this book, it will be in the hands of thousands morereaders like you who will find new places to present the
matrix.
In our opinion, the most crucial place for the matrix to take off is in
the education system. Weve heard that many teachers feel stuck in the
role of classroom enforcers. Theyve been taught that a style of teaching
that conforms to the Newtonian perspective is the only way. They teach;
the students listen and learn. Above all, the students are to follow the
rules of behavior as if they were Newtons laws. Many students and teachers feel stuck, and maybe the matrix can help them find a way out.
Using the matrix in conjunction with Elinor Ostroms eight core
principles (1990; see chapter 14) can help classrooms come alive as students become responsible for their own behaviors, knowing when their
behaviors are moving them toward who or what is important to them
and when theyre moving away from unwanted feelings and disrupting
the learning process. In this way, classrooms could become places where
students and teachers alike engage in cooperative movement toward
individual and group aspirations. With the matrix diagram, such a
change is possible. It doesnt require special skills to present the matrix.
Teachers dont need to be incredibly adept student whisperers. They
simply need to learn a few basic skills for increasing psychological flexibility in the context of who or what is important.
We also see the matrix moving into the professional sphere and
helping workplaces become environments where people can start to
choose to move toward who or what is important to them. Introducing
the matrix can shift the perspective in the workplace, moving away from
trying to force employees to submit to the needs of the business or simply
reduce stress, and instead moving toward creating a space in which
everyone can flexibly adapt their behaviors to be more in line with who
or what they want to move toward. Team meetings around building and
implementing a team matrix could unleash workplace creativity as team
members evolve an approach to moving toward whats important for
them and for the team as a whole.
Finallyand you may say we are dreamerswe envision the matrix
making its way into society at large, helping all types of organizations
move toward psychological flexibility. The matrix is fundamentally nonjudgmental, so its use is unlikely to leave people stuck in conflict. Its
252
Going Viral
literally like learning to play a very simple tune on the piano. Almost
anyone can practice the notes and pauses until it sounds like beautiful
music and others cant resist joining in. With the matrix, that skill level
is just a few practice sessions away.
In closing, the future of the matrix diagram depends on a very ACT-
like question: Are you willing to have some discomfort and make some
mistakes while presenting the matrix to others? The more people who
can answer yes to that question, the more psychological flexibility will
spread. Lets give increased psychological flexibility a try and see how it
works.
Reference
Ostrom, E. (1990). Governing the commons: The evolution of institutions for collective action. Cambridge, UK: Cambridge University Press.
253
Editor Kevin L. Polk, PhD, is a clinical psychologist who has been a practicing for twenty-three years, primarily helping veterans and others with
troubling trauma memories. For the past eight years he has dedicated
himself to the study of acceptance and commitment therapy (ACT),
spending close to 20,000 hours studying the philosophy and theory
behind ACT, and learning and designing ACT interventions. He is a
peer-reviewed ACT trainer who is passionate about teaching others how
to use the matrix to increase psychological flexibility and valued living.
Find out more at http://www.drkevinpolk.com.
Editor Benjamin Schoendorff, MSc, MSc, is a clinical psychologist with a
passion for disseminating contextual psychotherapies. He is the author of
two French language books, an ACT self-help book, and a clinicians
manual based on the matrix diagram. A peer-reviewed ACT trainer, he
leads international workshops on integrating ACT and relationshipfocused functional analytic psychotherapy through the use of the matrix.
You can find out more at http://www.ipc-cpi.com.
Foreword writer Kelly G. Wilson, PhD, is associate professor of psychology at the University of Mississippi. He is a central figure in ACT, and
was one of the authors of the landmark Acceptance and Commitment
Therapy. Wilson is among the most sought-after ACT trainers. His
popular experiential workshops touch thousands of clinicians and students each year. Find out more at http://www.onelifellc.com.
Index
A
acceptance: chronic pain and,
103104; matrix for working with,
6769
Acceptance and Action
Questionnaire-2 (AAQ-2), 96
acceptance and commitment therapy
(ACT), 241243; chronic pain
and, 94106; comprehensive
distancing and, 158; functional
analytic psychotherapy and, 54,
5861; hexaflex diagram used in,
3436; in vivo exposure used in,
149; integrating with the matrix,
4852; modeling by trainers of,
229232; origins of the matrix in,
12; present-moment awareness
in, 160; self-as-context in,
160161; stress management
using, 221; values clarification in,
159
ACT Gone Wild, viii
actions: linked to values, 27, 100
102, 105, 137; motivations behind,
43. See also committed action
adaptation, human, 245
addiction: definition of, 7778;
substance abuse and, 78
addiction treatment: activities for,
8889; appetitive control and, 85,
86, 8789; aversive control and,
8586; challenges developed for,
88; client group for, 7980;

community for, 89; diversified
locations for, 84; groups used for,
81, 8283; iGro measurement
system for, 88; matrix model and,
8091; stages and barriers in,
8485; standards of practice, 91;
task shifting in, 9091; training
people to deliver, 90; UK context
for, 7879. See also substance
abuse
aikido, verbal, 1213
alcohol abuse. See substance abuse
Altenloh, Egide, 184
anger, working with, 218219
anxiety attacks, 171173
appetitive control: addiction
treatment and, 85, 86, 8789;
moving toward as, 2223, 3031;
recognition of, 159
assessment: addiction recovery, 88;
chronic pain, 9496; workability,
4748
Association for Contextual
Behavioral Science (ACBS), viii
aversive control: addiction treatment
and, 8586; moving away as,
2122, 2829; recognition of, 159
avoidance cycle, 152155
away moves, 9, 2122, 2829; client
matrix, 141142; clinician matrix,
The ACT Matrix

133134; discriminating from
toward moves, 165166; noticing
toward moves in, 7172; shared by
therapists, 72; workshop trainer,
231232. See also toward moves
B
basic assumptions, 1617
Bezila, Andrew, 213
biomythologies, 136
blueberry bush story, 225
body-mind conflict, 124
body scan exercise, 125
Bolduc, Marie-France, 57, 68, 184
Bulls-Eye Worksheet, 4344
Burkhart, Mary Alyce, 147
business settings. See organizational
settings
C
cartoon character voice, 51
case conceptualization, 181204;
alternative to linear, 183184;
client strengths explored in,
199200; clinician challenges
with, 182183; discrimination
repertoire evaluation, 188189;
example of using the matrix for,
187202; left side
conceptualization, 191193;
quantifying matrix processes,
196197; relevant contextual
factors in, 197198; right side
conceptualization, 193194;
significant history recorded for,
198; strengths and potential
difficulties, 202203; therapist
behaviors in, 185186, 195;
tracking progress based on,
200201; treatment guidance
258
based on, 202; values considered

in, 195196; worksheet for,
184185, 186, 190, 198201
Cereal Box metaphor, 7374
challenging patients, 130131
chemical imbalances, 136
Chessboard metaphor, 104105
choices vs. decisions, 100101
chronic and severe symptoms,
129145; client matrix for,
138142; clinician matrix for
working with, 131138; examples
of matrix dancing with, 142144;
overview of behaviors indicating,
129131
chronic pain, 93106; acceptance
and, 103104; ACT assessment of,
9496; creative hopelessness and,
99100; human mind and,
102103; matrix for working with,
95, 96106; Passengers on the Bus
metaphor for, 105; self-as-context
and, 104105; terminating therapy
for, 106; values identification and,
100102; willingness and,
103104
Chronic Pain Acceptance
Questionnaire (CPAQ), 9596
clinically relevant behaviors (CRBs),
54, 6061
clinician matrix, 131138; away
moves, 133134; eating-disordered
clients and, 109110; toward
moves, 134137; unwanted mental
experiencing and, 132133; values
related to, 132
clinicians. See therapists
cognitive distancing, 158
collaboration, 210, 211
committed action, 10; choices vs.
decisions and, 100101;
Index
cultivation of, 50; eatingdisordered clients and, 123124;
matrix process and, 159
communities, 244245
comprehensive distancing, 158
compulsions, 169171
conflict: body-mind, 124; language
and, 240241
consequences, 237
contextual behavioral science,
134135
cooperation, 244245
couples work, 7375; combining
values in, 7375; home practice in,
75; noticing workable/unworkable
behaviors in, 74; perspective
taking in, 74; setting up, 73;
two-matrix perspective in, 180
creative hopelessness: chronic pain
and, 99100; workability
assessment and, 48
Curtin, Aisling, 41, 231
D
Darwin, Charles, 236
decentralized groups, 83
decisions vs. choices, 100101
defusion, 35; cultivating, 5051;
exercise used for, 231; hexaflex
processes and, 35; hooks and
moments of, 2627, 6667; matrix
for working with, 6667; sorting
related to, 158
deictic framing, 34
demographic details, 139
depression, 5859
derived relational responding: cued
by the matrix, 2834; explanation
of RFT and, 238; getting hooked
by, 2022; learning principles for

training, 25; moving toward
flexibility using, 2327; promoting
involuntary, 32
despair, client stuck in, 173175
diagnostic away moves, 133
dialectical behavior therapy (DBT),
81
differences, noticing, 9, 1112
discriminations, 1819
distraction strategies, 47
distress-producing behaviors, 131
DOTS approach, 4647
drug abuse. See substance abuse
dysfunctional behaviors, 130131
E
eating-disordered clients, 109128;
case example of working with,
112123; committed actions
engaged by, 123124; experiential
learning for, 126127; hooks
experienced by, 111112, 125, 126,
127; inner vs. mental experiences
in, 124126; the matrix used with,
111112, 113123; sensations of
hunger in, 124126; therapeutic
relationship with, 109110; values
clarification for, 123124
educational settings: matrix use in,
208220, 252; traditional learning
in, 209
emotions: definition of, 46; hooks
based on, 13, 46; identifying
unwanted, 46; thoughts related to,
242; watching reactions to, 4950
evolution: Darwins theory of,
236237; language and, 240
exercises: body scan, 125;
experiential noticing, 121122,
259
The ACT Matrix

140; Matrix Mindfulness, 49. See
also metaphors; worksheets
experience: content vs. functions of,
24; exercise on noticing, 121122;
five-senses vs. mental, 89, 1819
explicit sorting, 3637
exposure therapy, 148149
F
FAP. See functional analytic
psychotherapy
five-senses experiencing, 89, 1819,
4243
Flexi and Spiky characters, 6263,
6768
frames of opposition, 29
functional analytic psychotherapy
(FAP): FAP rap given in, 61;
integrating with ACT, 5861;
in-the-moment functional
analysis, 6061; the matrix and,
5455, 6061, 62
functional contextualism, 1617, 52,
235237, 243
G
generalization, 60
Get Out of Your Mind and Into Your
Life (Hayes), 11, 242
the grid, 8182
groups: addiction treatment in, 81,
8283; format and guidelines for,
8283; matrix work in, 8283,
247249; Ostroms principles for,
245246, 250; psychological
flexibility in, 246, 247248; school
setting for, 211212; training
leaders of, 90
260
Guide to Functional Analytic

Psychotherapy, A (Tsai,
Kohlenberg, and Kanter), 54
H
Hambright, Jerold, viii, 2, 57
Happy Birthday tune, 51
harm reduction, 86
Harris, Russ, 43, 46
Hayes, Steve, 11, 158, 208, 242
heritability, 237
hexaflex diagram, 3436
home practice, 73; couples work and,
75; noticing hooks in, 157;
secondary school students and,
217; valued action and, 101102
Hook metaphor, 6667
hooks: chronic pain and, 103;
defusion exercise for, 231; derived
relational responding and, 2022;
eating-disordered clients and,
111112, 125, 126, 127;
educational settings and, 211;
emotions as, 13, 46; noticing, 13,
2627, 6667, 156158, 211;
trauma memories as, 157158;
unhooking from, 33, 231
human conflict, 240241
human mind, 102103
hunger, 124126
hypercontrol, 128
I
iGro system, 88
implicit sorting, 3637
in vivo exposure, 149
Individualized Generic Recovery
Outcomes (iGro), 88
Index
inner experience: explanation of, 68;
mental experience vs., 68,
124126; unwanted, 10
interpersonal processes: couples work
and, 7375; importance of, 5859;
matrix spotting in, 72; modeling
intrapersonal and, 59; two-matrix
perspective in, 178180
intrapersonal processes, 59
involuntary derivations, 32
IJK
Join the DOTS approach, 4647
just noticing exercises, 140
Kabat-Zinn, Jon, 188
L
language: double-edged sword of,
5253; evolution and, 240; human
conflict and, 240241; inflexibility
of, 239240; relational frame
theory of, 237241; social function
of, 239; traps based on, 210
learning: experiential, 126127;
natural process of, 209
left side work, 2830
loneliness and despair, 173175
loops around the matrix, 247249
M
Man in the Hole metaphor, 100
Marasco, Lynda, 212
the matrix, 8; addiction treatment
using, 8091; business use of,
221234; case conceptualization
based on, 181204; case examples
of using, 112123, 169180;
chronic and severe symptoms and,
138144; chronic pain and, 95,
96106; clinician, 109110,

131138; derived relational
responding cued by, 2834;
111112, 113123; educational use
of, 208220, 252; evolution of,
148149; explanation of processes
in, 158161; functional analytic
psychotherapy and, 5455, 6061,
62; group work based on, 247249;
hexaflex diagram and, 3436;
home practice related to, 73; how
it works, 243244; inner vs.
mental experience and, 68,
124126; integrating ACT with,
4852; introducing to the general
public, 4148; left side work using,
2830; organizational use of,
221234; origins and development
of, 12, 243, 251252; private
psychiatric practice and, 163180;
psychological flexibility warm-up,
714, 247; PTSD and, 147162;
quantifying quadrants in, 196
197; relational frame theory and,
5254; relationship-centered
clinical practice and, 6171; right
side work using, 3031; risk
viewed through, 136137;
self-disclosing to clients, 6465,
72; sorting stories into, 12;
spotting outside of sessions, 72;
summary points about using,
1314; three senses of self and, 33;
two discriminations and, 18
Matrix Case Conceptualization
Worksheet, 184185, 186, 190,
198201
Matrix Mindfulness Exercise, 49
me noticing, 26, 33
mechanistic view, 16, 236
medical model, 129, 130
medication, 137
261
The ACT Matrix

memories, trauma: hooks related to,
157158; working on, 159160.
See also PTSD
mental experiences: clinician matrix
and, 132133; five-senses
experiences vs., 89, 1819,
4243; getting hooked by, 21;
inner experiences vs., 68, 124
126; noticed by therapists,
143144; unwanted, 4546,
132133, 141, 211. See also
thoughts
metaphors: Cereal Box, 7374;
Chessboard, 104105; Hook,
6667; Man in the Hole, 100;
Passengers on the Bus, 105, 212;
Path Up the Mountain, 43;
Surfing, 188; Values as a Cube, 44.
See also exercises
mind, human, 102103
mindfulness: chronic pain and, 102;
cultivating, 4950; presentmoment awareness as, 160;
self-as-context and, 104; values
emphasis and, 140
multiple exemplar training, 25
N
nerves, embracing, 231
Newtonian physics, 17, 236, 237, 239
noticing: differences, 9, 1112; hooks,
13, 2627, 6667, 156158, 211;
practice of, 27, 160
O
observer perspective: self-as-context
and, 26, 3234; shifting to, 24
opting out, 47
organizational settings: ACT for
managing stress in, 221; benefits of
262
using the matrix in, 232233, 252;

case examples of matrix work in,
223229; working with teams in,
222227
Ostrom, Elinor, 235, 245
Ostroms eight core principles,
245246, 249, 250, 252
P
pain: ACT assessment of, 9496;
matrix for working with, 95,
96106; strategies used to avoid,
4647. See also chronic pain
pain matrix, 95, 96106; acceptance
and, 103104; creative
hopelessness and, 99100; human
mind and, 102103; illustration of,
95; overview of, 9798; Passengers
on the Bus metaphor, 105;
self-as-context and, 104105;
terminating therapy with, 106;
values identification and, 100
102; willingness and, 103104
Passengers on the Bus metaphor, 105,
212
Path Up the Mountain metaphor, 43
persistent behaviors, 130
personal away moves, 134
perspective taking: couple
communication and, 74;
experiential training of, 3234;
matrix for working with, 71
pervasive behaviors, 130
pliance, 26
point of view, 1819
Polk, Kevin, viiviii, 1, 7, 15, 43, 57,
81, 82, 147, 208, 235, 251
post-traumatic stress disorder. See
PTSD
present-moment awareness, 160
Index
private psychiatric practice, 163180;
examples of matrix use in,
169180; introducing the matrix
in, 164165; making space for
resistance in, 168169; reinforcing
toward moves in, 168; stuckness of
clients in, 167168; sufferingvalues connection in, 167;
toward-away discrimination in,
165169; two-matrix perspective
used in, 178180; validating client
suffering in, 166167
professional self, 134135
prolonged exposure (PE) therapy,
148149
Prompted Bulls-Eye Matrix
Worksheet, 4546
prosocial behaviors, 212, 213, 218
psychological flexibility: ACT and,
241; group behavior and, 246,
247248; hexaflex diagram and,
3436; long-term change and, 23;
matrix for increasing, 243;
modeling as ACT trainer,
229232; noticing hooks for, 211;
pain matrix and, 98105; point of
view and, 1819; school setting
and, 207220; self-as-context and,
161162; stretching toward, 10, 20;
warm-up for, 714, 247
Psychological Inflexibility in Pain
Scale (PIPS), 96
PTSD, 147162; avoidance cycle in,
148, 152155; experience of
trauma and, 147148, 150;
explanation of matrix processes
for, 158161; in vivo exposure
used for, 149; noticing hooks
related to, 156158; presenting
the matrix for, 150152; prolonged
exposure therapy for, 148149;
sorting process for, 156
purposeful living, 140

Purssey, Rob, 129
PUSH community, 89
Q
quantifying matrix processes,
196197
R
relapse patterns, 8586
relational frame theory (RFT),
237241; derived relational
responding in, 21, 28, 238; though
the lens of the matrix, 5254. See
also language
relational framing, 28
relationship-centered clinical
practice: couples work in, 7375;
the matrix used in, 6171; special
clinical skills in, 7173
resistance: behaviors indicative of,
131; making space for, 168169
RFT. See relational frame theory
right side work, 3031
risk, dealing with, 136137
Rodriguez, Emily, viii
root metaphors, 17
S
Saffer, Florian, 109
Schoendorff, Benjamin, 15, 43, 57,
181, 251
school settings: matrix use in,
208220, 252; traditional learning
in, 209
science, basic assumptions of, 1617
self, three senses of, 3233
263
The ACT Matrix

self-as-content, 32, 33, 104, 160161,
211
self-as-context: chronic pain and,
104105; experiential training of,
3234; explanation of, 160161;
matrix diagram illustrating, 33;
me noticing as, 26, 33;
psychological flexibility and,
161162
self-as-expert thinking, 211
self-as-process, 32, 33, 161
self-compassion, 50
self-disclosure, 6465, 72
self-harm, 47, 136137
self-nurturing, 134135
Serenity Prayer, 52
severe symptoms. See chronic and
severe symptoms
Seys, Annick, 221
shared matrix work, 7375
Sid and Fido story, 102103
significant history, 198
60 Ways to Use the Matrix (Webster),
82, 83
Skinner, B. F., 24
small groups, 244245
social language, 239
social support, 5859
sorting: behavior by successive
approximations, 2526; clinical
relationship and in-the-moment,
6566; explicit to implicit, 3637;
observer perspective trained by,
24, 25, 104; stories into the
matrix, 12, 156
Spiky and Flexi characters, 6263,
6768
spoke diagram, 249250
storytelling, 12, 156
264
strengths, client, 199

stress: effectiveness of ACT for
managing, 221; teachers stuck in
severe, 227229
stretching exercises, 10, 20
Strosahl, Kirk, 130
stuckness, 1920, 154155, 167168
subjective units of distress scale
(SUDS), 149
substance abuse: addiction and, 78;
avoiding pain with, 47; groups for
working with, 81, 8283; matrix
model and, 8091; treating in the
UK, 7879. See also addiction
treatment
successive approximations, 2526
suffering: connecting to values, 167;
validating in clients, 166167
suicidality, 136137
Surfing metaphor, 188
symptoms: chronic and severe,
129131, 138145; unworkable
behaviors defined as, 129
T
teachers: matrix use by, 208220,
252; stuck in severe stress,
227229. See also educational
settings
teams, organizational: case example
of matrix work with, 223227;
overview of matrix use with,
222223
temporal frames, 29
Tenaglia, Phil, 207
terminating therapy, 106
therapeutic away moves, 133134
therapeutic relationship, 109110
Index
therapists: away moves of, 133134;
conceptualization behaviors of,
185186; modeling of
psychological flexibility by,
229232; personal matrix for,
109110, 131138; private practice
of, 163180; self-disclosure by,
6465, 72, 110; toward moves for,
134137, 230231; unwanted
mental experiencing by, 132133;
values identified by, 132
thinking: Newtonian perspective on,
239; thoughts distinguished from,
47
thoughts: definition of, 45; emotions
related to, 242; identifying
unwanted, 4546; thinking
distinguished from, 47; watching
reactions to, 49. See also mental
experiences
topographic diagnosis, 135
toward moves, 9, 2223, 3031; client
matrix, 142; clinician matrix,
134137; discriminating from
away moves, 165166; noticing in
away moves, 7172; personal
cultivation of, 230231;
reinforcing in clients, 168; shared
by therapists, 72, 195. See also
away moves
tracking client progress, 200201
training: addiction treatment, 90;
multiple exemplar, 25; perspective
taking, 3234; self-as-context,
3234
trauma: different responses to,
147148, 150; working on
memories of, 159160. See also
PTSD
tug-of-war example, 124
12-step programs, 79
two-matrix perspective, 178180
U
unhooking: defusion skills for, 231;
perspective taking as, 33. See also
hooks
unwanted experiences: inner
experiences, 10; mental
experiences, 4546, 132133, 141,
211
V
validating suffering, 166167
Valued Living Questionnaire (VLQ),
95
values, 10; actions linked to, 27,
100102, 105, 137; addiction
treatment based on, 81; Bulls-Eye
Worksheet, 4344; chronic pain
and identifying, 100102;
clarifying in matrix work, 159;
clients not caring about, 139;
clinician matrix and, 132;
123124; emphasizing with
clients, 139140; matrix for
working with, 6970, 243;
mindfulness related to, 140;
suffering connected to, 167
Values as a Cube metaphor, 44
Vander Lugt, Amanda Adcock, 93
variability, 236237
verbal aikido, 1213
verbal learning, 209
Vincent, Jean-Michel, 163
W
Webster, Mark, 2, 15, 57, 77
White, Dawn, 213
WILD acronym, 87
willingness, 103104
265
The ACT Matrix

Wilson, Kelly G., ix, 121, 225
workability, assessing, 4748
workplace: ACT for managing stress
in, 221; benefits of using the
matrix in, 232233, 252; case
examples of matrix work in,
223229; working with teams in,
222227
worksheets: Bulls-Eye Worksheet,
4344; Matrix Case
Conceptualization Worksheet,
184185, 186, 190, 198201;
Prompted Bulls-Eye Matrix
Worksheet, 4546
WTF (whats the function)
acronym, 43
XYZ
Yes, and? inquiry, 1213
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I love the matrix.

Sometimes you need a way of thinking about ACT that

A New Approach to Building

An Imprint of New Harbinger Publications, Inc.

Library of Congress Cataloging-in-Publication Data

The love of my life, Mary Alyce Burkhart, PhD. Her love,

2 Under the Hood: Basic Processes Underlying

4 You, Me, and the Matrix: A Guide to

5 Rolling Out the Matrix, Rolling Back Addiction 77

6 The Pain Matrix 93

7 ACT in Digestible Bites: The Matrix and

Eating Disorders 109

The ACT Matrix

8 Out of the Hole: The Matrix with Chronic

and Severe Symptoms129

9 Something You Can Never Forget: The Matrix

10 Spot the Matrix: Psychological Flexibility in

Private Psychiatric Practice163

11 Casing the Matrix: A Tool for Case

Psychological Flexibility in Education 207

13 In Business: The Matrix for Team Building

and Professional Stress221

14 The Matrix, Evolution, and Improving Work-

roup Functioning with Ostroms Eight Design

Conclusion: Going Viral 251

Since I arrived at the University of Mississippi in 2000, I have run an

The ACT Matrix

I currently use the matrix in treatment, in supervision, and in case

What the Matrix Is

How the Matrix Came to Be

The ACT Matrix

What the Matrix Is All About

How the Matrix Travels

Understanding the Matrix

The Psychological Flexibility

The ACT Matrix

Five-Senses Experiencing vs. Mental

The Psychological Flexibility Warm-Up

Toward and Away

The ACT Matrix

Stretching Toward Psychological

Who or What Is Important

Unwanted Inner Experience

The Psychological Flexibility Warm-Up

How We Get Stuck

Noticing the Differences

Training the Noticing

The ACT Matrix

The Psychological Flexibility Warm-Up

redirecting physical energy. When someone strikes out, the energy is

The ACT Matrix

2. Notice the difference between how it feels to move toward and

Under the Hood: Basic

The ACT Matrix

Under the Hood: Basic Processes Underlying the Matrix

well adapted to interventions in which whats important isnt what people

The ACT Matrix

Setting Up the Point of View

Figure 2.1. The two basic discriminations.

Under the Hood: Basic Processes Underlying the Matrix

Heres an exercise to introduce D1. If you didnt try it in chapter 1,

Toward Psychological Flexibility

2 Under the Hood: Basic Processes Underlying

4 You, Me, and the Matrix: A Guide to

5 Rolling Out the Matrix, Rolling Back Addiction 77

6 The Pain Matrix 93

7 ACT in Digestible Bites: The Matrix and

Eating Disorders 109

8 Out of the Hole: The Matrix with Chronic

and Severe Symptoms129

9 Something You Can Never Forget: The Matrix

10 Spot the Matrix: Psychological Flexibility in

Private Psychiatric Practice163

11 Casing the Matrix: A Tool for Case

Psychological Flexibility in Education 207

13 In Business: The Matrix for Team Building

and Professional Stress221

14 The Matrix, Evolution, and Improving Work-

Conclusion: Going Viral 251

Observing self and perspective taking, or seeing the bigger