Acceptance and Commitment Therapy

for Students on Academic Probation:

A Treatment Manual
Michael L. Rosen, M.S.
Paul B. Ingram, M.A.

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NOTE FROM THE AUTHORS

We appreciate your time and interest in our treatment manual that incorporates
Acceptance and Commitment Therapy (ACT) with university students on academic
probation. While there is no gold standard treatment for these students, it is in the
opinion of the authors that ACT contains several qualities that can be tailor-made so that
university advising centers/career centers can utilize a brief, 4-5 session treatment
package. Although there is a dearth of empirical research applying ACT in a vocational
context, there is promising data that does exist, which will be discussed in the sections to
follow.
Given the complexity and density of ACT from a theoretical standpoint, the
authors highly recommend reading this manual in its entirety, and possibly more than
once to ensure absorption. It should also be noted that it is preferable that those
clinicians potentially using this manual have had previous experience in a therapeutic
setting (non-career related), although it is not required. Similarly, clinicians who have
previous training in ACT have even more of an advantage. However, we believe the
proposed model is promising for a reason: Given the more-often-than-not observed
mood/affective symptoms that accompany vocational conflict, it can be quite difficult for
the vocational psychologist to walk the line between traditional psychotherapy and
career counseling. Incorporating ACT into a vocational domain may help mitigate this
conundrum by acknowledging maladaptive or unwanted thoughts/feelings, and at the
same time constructively working towards career and academic goals. We believe this is
a unique modality in this regard, and are excited for its potential uses, perhaps
generalizing to other career-relevant populations as well.
This manual consists of a brief introduction to the theory behind ACT, as well as
a description of the population for which this manual is intended to serve. Each session
is clearly outlined so that clinicians can follow along and incorporate the content into
their own style or language, and sample transcripts are located toward the end of the
manual to give an idea of what an actual session might look like. Finally, sample
assessments that are part of the model are located in the appendix section.

TABLE OF CONTENTS
Literature Review................................................................................................................ 4
Background .............................................................................................................. 4
Population for Intended Use .................................................................................... 6
Theory of ACT ......................................................................................................... 7
Manual Outline ................................................................................................................. 13
Session 1 ........................................................................................................................... 14
Session 2 ......................................................................................................................... 18
Session 3 ........................................................................................................................... 23
Session 4 ........................................................................................................................... 28
Session 5 ........................................................................................................................... 32
References ......................................................................................................................... 33
Appendices ....................................................................................................................... 35
Appendix A: Sample Mindfulness Exercises ........................................................ 35
Appendix B: Sample Metaphors ............................................................................ 37
Appendix C: Acceptance and Action Questionnaire-II ......................................... 38
Appendix D: Coping Strategies Worksheet ........................................................... 39
Appendix E: Values Epitaph .................................................................................. 40
Appendix F: Goal Worksheet ................................................................................ 41
Appendix G: Sample Transcript ............................................................................ 42

BACKGROUND
Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999)
is an evidence-based behavioral treatment intended to decrease experiential avoidance
and increase psychological flexibility. Experiential avoidance, or the unwillingness to
accept and experience private internal events, is considered a maladaptive behavioral
pattern associated with psychological distress. High experiential avoidance results in
psychological inflexibility, which is the inability to maintain contact with the present
moment, and to maintain or modify behavior when doing so does not serve ones values.
ACT presents acceptance as an alternative to avoidance. Acceptance incorporates the
active willingness to embrace private events without attempting to manipulate their
frequency or form. Acceptance is not used in the sense of resignation; rather it should be
viewed as a full-contact embrace of personal experiences. Instead of altering the form or
frequency of private events, defusion techniques reduces rigid identification with
thoughts. ACT promotes being present in the current moment by using unprejudiced
awareness of internal and external stimuli as they occur. With this contact, ones
awareness of the flow of experiences provides self-as-context, or the idea that we are
not the content of our experience. We are not our thoughts, our feelings, our experienced
sensations, the things we see, or our mental images. Instead, one is a transcendent self
that is not fused to thoughts and feelings.
Values are an essential theoretical component of ACT work, but this abstract
concept may differ from the common definition. Wilson, Sandoz, Kitchens, and Roberts
(2010) state that values are continually developed during a persons life, and are shaped
by our experience. Values are different from goals in that they cannot be completed in a
discrete or concrete manner. Gaining employment may be an achievable end goal, and
ACT uses goals similarly to many other behavioral treatments. However, in ACT, the
therapist would frame the goal of gaining employment as a behavior that represents
committed value-based action towards health, parenting, career, etc. Also, while a person
may not be highly concerned with one valued life area during one stage of life, certain
life events or changes in maturation may cause these values to evolve. For an individual
who values socializing, living a healthy social lifestyle and passing down healthy social

behaviors and skills to ones children is intrinsically reinforced by feelings of doing what
is morally right.
Hexaflex Model
Phew, still with us? Good! The hexaflex is a visual representation of the six
key components of ACT discussed in the previous section. This can appear not only as
more pleasing to the eyes, but also as more parsimonious. A diagram of the hexaflex is
shown below.

As one can see from the hexaflex diagram, there is a clear interaction between all
six points of the model, with the center goal being psychological flexibility. This
interaction is true for treatment as well, and can be seen in the session outlines. It should
be noted that although the clinician may be touching on multiple facets simultaneously,

there is a progression that should occur in order to best meet the client where he or she is
at; however, many of the same techniques can be used across sessions.
POPULATION FOR INTENDED USE
Academic probation is traditionally defined at the university level as when a
student is failing to meet adequate grades, often defined as below a 2.0. After one
semester of failing to meet this requirement, the student is placed on academic probation,
which means they have to obtain at least a 2.0 for each subsequent semester until the
cumulative GPA is raised to a 2.0 or higher (Hsieh, Sullivan, & Guerra, 2007). Although
the definition of academic probation may vary slightly from school to school, the
underlying problems are the same. Retention is currently one of the leading challenges
faced by colleges and universities across the nation (Hsieh et al., 2007). There are many
factors that contribute to retention difficulties, but underachievement seems to have the
highest predictability with academic achievement (Ames & Ames, 1984). There are
varying definitions of underachievement in the literature, but most researchers agree that
underachievement can be defined as a student performing lower academically than is
expected based on measures of potential (Balduf, 2009). Specifically, there are two traits
that influence underachievement: self-efficacy (a persons judgment of their own ability
to complete a task) and goal orientation (motives a person has for completing a task).
Hsieh et al. (2007) conducted a study to examine these two traits with students on
academic probation (GPA of under 2.0). Not surprisingly, it was found that high selfefficacy and high goal orientation were positively correlated with academic achievement,
whereas performance-avoidance goals were negatively correlated with academic
achievement.
Smith & Winterbottom (1970) investigated personality traits that exist within the
student academic probation population. It was commonly found that lack of positive
motivation, lack of acceptance of responsibility for actions, self-defeating attitude, and
wishful thinking toward unrealistic goals were all common traits. Given the high amount
of avoidance behaviors found in students on academic probation, as well as their lack of
clarity in values and motivation, ACT makes sense as a treatment option.

Despite an absence of empirical literature explicitly applying ACT in a vocational

setting, a number of studies exist employing mindfulness, a specific tenant of ACT, as an
efficacious coping mechanism for career counseling (Kurash & Schaul, 2006; Jacobs &
Blustein, 2008). Hoare, McIlveen, and Hamilton (2012) outlined the potential efficacy
for ACT as a treatment modality with career counseling populations, and proceeded to
effectively utilize ACT with career counseling in a case study. As Juntunen (2006)
points out, clinicians have a tendency to dichotomize career vs. non-career related
presenting problems, even though data show that this is simply not the case. Just as ACT
was originally developed for treating emotional/interpersonal issues, these are so
interwoven with career-related issues that the two are often synonymous.
The hope for this manual is its incorporation and utilization in university
academic advising centers and/or career centers with students on academic probation.
While most students on academic probation are required to consult with an academic
advisor, many are not given any kind of manualized intervention. This manual will
provide use for those students who can then be referred from an academic advisor, or
even better, an in-house practitioner at the advising center. We leave the decisionmaking up to the advisor as far as whether or not the student should be referred. It may
very well be the case the student does not need to be seen for any kind of intervention.
THEORY OF ACT
Each facet of the hexaflex is described in more detail in the following section in
relation to students on academic probation.
Acceptance
As described earlier, acceptance differs from resignation. Acceptance involves a
willingness to embrace ones private experiences, whether positive or negative (Hayes et
al., 1999). Given that ACT proposes avoidance as the source of many
psychological/social problems, willingness and acceptance are important for helping
clients live a more fulfilling life. Naturally, individuals experiencing unwanted private
events want to control the situation, but again ACT suggests this only exacerbates the
problems, illustrating the applicability for willingness/acceptance. How might this

concept be relevant to students who are putting forth little effort in school,
underachieving, or simply struggling to make grades? We believe acceptance and
willingness is a great starting point for clinicians to use with students struggling in
school, as there are more than likely several other issues occurring other than simply Im
getting bad grades. This way, the clinician can get an understanding of some of the
psychological processes occurring, either leading up to, or concurrently with, the period
of academic probation. Perhaps most importantly is the potential usefulness for
acceptance strategies with students who are engaging in high levels of avoidance
behaviors with regard to school (e.g., continually going out drinking instead of studying
for an exam). As discussed earlier, helping students accept responsibility for their
actions can prove fruitful in terms of building motivation and treatment buy-in.
Contact with the Present Moment
Being in the present, also known as mindfulness, involves bringing awareness to
the present moment and being open and receptive to whatever private events occur
(Hayes et al., 1999). This can involve paying attention to internal bodily sensations,
thoughts, feelings, or external events such as sights, sounds, and smells. However, the
key is to avoid judgment or evaluation while experiencing these events. Although
mindfulness has been used in Buddhist meditation practices for the past approximately
2,500 years (Germer, 2005), it has more recently been used as an effective therapeutic
technique for a wide range of presenting problems, such as anxiety and depression
(Hayes et al., 2006; Jacobs & Bluestein, 2008). Given the growing concern of the rapidly
changing work climate, elevated levels of anxiety and employment uncertainty often
present in a career counseling setting. Jacobs and Bluestein (2008) suggest using
mindfulness as a coping mechanism for clients dealing with career uncertainty and
employment stress, freeing them to make calmer and potentially more informed
decisions. This theoretical argument can be applied to students on academic probation,
as they are likely experiencing stress and uncertainty as well.

Defusion
Cognitive defusion, or defusion, consist of techniques used when individuals fuse
with their negative or unwanted thoughts that is, they take said thoughts literally and
believe they are true (Hoare et al., 2012). For instance, a client experiencing trouble in
school may have the commonly occurring thought Im stupid. The clinician can help
the client observe these thoughts from an objective standpoint to understand that the
thoughts are simply a product of human language, thus taking some of the emotional
power away from the words themselves. Since these thoughts and feelings commonly act
as barriers to success, helping to distance ones self from unwanted thoughts can facilitate
progress towards ones goals. One quick exercise that can be used in virtually any setting
involves taking a word associated with an unwanted thought (e.g., loser), having the
client repeat the word quickly for 30 seconds, and then having the client notice the
resulting phenomenon (typically the word loses its meaning). There are a number of
experiential activities that tap into defusion, some of which are included in our session
summaries.
Self-as-Context
Perhaps the most abstract concept in the hexaflex, the self-as-context sets itself
apart from other aspects of the self. Self-as-context, or the observing self, refers to a
viewpoint from which we are able to observe thoughts/feelings. This self cannot be
directly observed or described, but is a sort of awareness of our awareness (Harris,
2009). Often times, individuals fuse with their unwanted memories/thoughts/feelings,
and subsequently lose hope for future events and goals. Self-as-context attempts to help
clients notice the act of noticing these memories/thoughts/feelings, so that they can create
a safe space for themselves from which to observe these painful experiences. In other
words, you are not defined by the thoughts, feelings, or events you have experienced.
There is a constant you that remains at all times. This technique is often incorporate
into mindfulness, defusion, and acceptance exercises. With a university student on
academic probation, self-as-context can be beneficial in allowing the individual to gain
perspective on dealing with their current situation, and another aspect from which to
observe their thoughts and feelings. Given that academic probation is not a desirable
position to be in, it would be expected that students have a low sense of self-efficacy, and

possibly feelings of worthlessness. This technique can allow the student to give
themselves some space from these unwanted thoughts, as well as understand that their
self is not defined or changed based on this particular point in their life.
Values
The next two components of ACT are perhaps the most crucial with regard to our
chosen population. Values are important to ACT because the overall goal is to help
clients live a rich and meaningful life (Hayes et al., 1999). As described earlier, values
should be differentiated from goals in that they cannot be achieved in the same way a
goal can be attained. One useful metaphor to help conceptualize values is visualizing a
compass, and thinking of the direction north as ones value. You can never stop going
north, but you can stop along the way to take in the sights (goals). With a student on
academic probation, a goal may be to get off academic probation, but it is important to
identify more concrete, longer-lived values, such as wanting to be a good student or a
diligent worker. Values plays a key role in this treatment manual since so much hinges
on the identification of a persons values, as this is closely related to actively taking steps
to make changes in ones behavior.
Committed Action
Committed action, or commitment to action, builds on exploration of ones values
and formulating goals to act upon. It is important to note that built into this component is
the anticipation of psychological barriers, which is why the entire hexaflex interacts in
the most pervasive way when an individual is planning their commitment to action. For
instance, a student works towards improving study skills even though he continually has
the self-defeating thoughts that he is going to fail. Committed action perhaps creates the
most complex sessions, as not only are you as clinicians introducing new behavioral goalsetting material, but also incorporating previous techniques to simultaneously work
through barriers that arise. Clients are aided in developing gradually larger goals
congruent with their values, and taking steps to do so. For example, a student on
academic probation may commit to the short-term goal of being taken off academic
probation, so the clinician can facilitate this commitment with smaller behaviors, such as
improving studying skills or even regulated sleep hygiene. Clients can identify potential

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barriers to these behaviors, which are problem-solved collaboratively between clinician

and client. Behavioral activation techniques often look similar to commitment to action,
such as creating a hierarchy for activities, and are welcomed in this stage (Eifert &
Forsyth, 2005). The authors view some similarities between this component, and that of
Krieshok, Black, and McKays (2009) definition of occupational engagement: taking
part in behaviors that contribute to the career decision-makers fund of information and
experience of the larger world, not just the world as processed when a career decision is
imminent (pg. 284).
Psychological Flexibility
As noted earlier, if one wants to think of an ultimate goal of ACT, it would be
psychological flexibility. Just like career adaptability (Super & Knasel, 1981; Savickas,
1997), psychological flexibility advocates adapting to a changing environment. This is
especially important with regard to this manual. One of the beautiful characteristics of
ACT is the lack of dogmatic practice, which opens up treatment to wiggle room. Just
as psychological flexibility is key for our clients, it is equally important for us as
clinicians. For example, if you as the clinician are finding that a particular student is
having trouble understanding or acting particularly resistant to defusion exercises, there is
no need to harp on these techniques in hopes of absorption, as this will likely only cause
boredom or checking out. It is up to you as the clinician to exercise judgment in
moving on, rephrasing, or touching back on a previously understood concept.
Furthermore, as is the case in traditional therapy settings, we are not trying to fix our
clients, and the same is true here. The main goal of this treatment package is to help
equip these students with some tools, coping strategies, and new perspectives with which
they can begin to work towards a more adaptive academic experience, and potentially
market work position (if desired). Still, there should be a pervasive sense of
collaboration throughout.
Considerations
Given ACTs reliance on language and verbal ability (for both clinician and
client), this treatment manual has certain inherent limitations that may impact intended

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populations. Individuals experiencing severe intellectual/developmental disabilities or

other language-impairing disabilities should be referred to alternative services (i.e.,
psychological testing services). However, individuals with mild intellectual disabilities
(i.e., learning disorders, ADHD) on academic probation are still candidates. Similarly,
individuals on academic probation who are actively psychotic or suicidal should be
immediately referred to an outside resource.
A special note should be made regarding clients of nondominant cultural and
marginalized backgrounds. While there is not currently extensive literature applying
ACT to these populations, what does exist is promising, especially given the rapid growth
in popularity of ACT globally. A meta-analysis conducted by Fuchs et al. (2013)
examining ACT with minority populations found an overall effect size of .69, and
Woidneck et al. (2012) indicate what literature exists is promising. However, there is no
denying a need for further empirical research with larger sample sizes. Given these
considerations regarding what we currently know about ACT, the authors feel this
manual can be used with diverse populations in an effective manner. Exploring ones
values and taking active steps in congruence with said values is ubiquitous in many
cultures; However, for some cultures that are less prone to seeking therapy, discussing
unwanted thoughts (for example) might prove more tasking. The clinician ideally should
have an understanding of multicultural counseling, and how specific cultures respond to
treatment.
Similarly, international students should be given special consideration. Given this
manuals reliance on ACT theory (and it being in English), students whose first/native
language is not English may not necessarily benefit as much as those students for whom
English is a first language. That being said, it should be up to the clinician and academic
advisor to communicate regarding any potential concerns in this regard. If it is deemed
that the student is proficient in English, the authors feel this manual will be efficacious.
It may be harder to explain certain concepts (i.e., self-as-context), so the clinician may
have to play around with some different word combinations to find a definition that
registers.

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MANUAL OUTLINE
This treatment manual is designed to be used across five separate individual
sessions with a client who is having difficulties engaging in their academic work. This
lack of engagement often results in difficulties finding meaning in the day to day tasks
and in producing the level of work that may be required for the student to successfully
complete the courses they are enrolled in and, ultimately, their degree program. This
manualized treatment is intended to be implemented following an intake or diagnostic
assessment (presumably after the first meeting).
Choosing to incorporate five sessions was not arbitrary; Brown and Krane (2000)
illustrated via meta-analysis that the effect sizes for career counseling interventions
peaked at 4-5 sessions, and diminished by roughly half after five. The same study
found that including three key ingredients (rather than less than three) resulted in the
largest mean effect size. For this reason, we feel our manual incorporates several of these
ingredients, including written exercises, individualized interpretations/feedback, and
attention to building support. The fifth session is designed to be optional and intended to
allow the clinician to do a brief, comprehensive review or to refocus on a skill or area that
may have been particularly difficult for the client.
The following pages are broken down by those five sessions. A treatment
protocol is presented on the following pages for the clinician to use. Handouts and
exercises completed during session serve to take the clinician-guided concepts and help
put them into practice. Because ACT is based so much on individual exploration of
values and putting a new, and sometimes challenging skillset into practice, clinicians
should encourage their clients to practice their learned exercises to better incorporate into
their repertoire.
This treatment manual covers the following material:

Session 1

Introduction to ACT/Acceptance

Session 2

Defusion and Self-as-Context

Session 3

Values Exploration

Session 4

Committed Action

Session 5

Wrap-Up, Review, and Termination (Optional)

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Treatment Protocol: Session 1

Agenda
The purpose of this session is to introduce the core concept of acceptance and to
assist the client in exploring how a fixation on behaviors and thoughts held about their
academic achievement may be inhibiting their own success. The introduction to ACT
here should be brief without much focus placed on explaining the hexaflex model.
Instead, the session should focus on broadly explaining the process of mindfulness and
what it might look like to engage in that practice within an academic context.
Outline of Time in Session
0 5 minutes

Greeting and rapport building.

5 10 minutes Agenda setting and outline 5 session treatment.

This portion of the session should be dedicated to outlining the flow of
treatment. This can be explained as a process of becoming more engaged
in school, fully noticing and experiencing the scholastic process, and on
identifying the things that drive you. The client has, after all, made the
choice to be in school and in this session to address his or her academic
difficulties.
10 20 minutes

Mindfulness exercise (see page 16).

ACT is sometimes easier to demonstrate experientially than it is to explain

verbally. This is why the previous introduction is kept brief and broad; it
is intended to prime the client for the experiential exposure instead of
force a top-down learning process. With very minimal training, the client
is guided to experience an in the moment mindfulness exercise. While
the exercise itself is not centered around school, it is designed to provide a
sounding board and trial that they can look back to later and use to guide
their later work with ACT.
20 35 minutes

Discuss acceptance and reflect on mindfulness exercise.

More often than not it is the struggle and resistance of a situation that
causes us distress (and at the very least exacerbates it). To some degree,
the client has to accept and go with the flow of the mindfulness exercise

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to be able to be engaged by it. As you directed their visualization, they

were not tasked with driving their thoughts or their emotions. Instead, they
likely experienced greater engagement if they were able to merely accept.
Relate this to behaviors that led them to where they are now.
35 40 minutes

Inquire and identify goals in attending session

The purpose of this is not to directly build on the values aspect to ACT.
Instead, it works to prime them for it later on. It also serves to assist the
client in recognizing their ownership of both their academic difficulties
and the steps they are now taking to correct those problems.
40 45 minutes

Session wrap-up and homework

Session 1: In Depth

A) It is very important to be welcoming to the client with whom you are meeting. Given
the overall praise of psychological flexibility, these session outlines should not be taken
as gospel, especially if other topics naturally arise. At the end of the day, we give the
client what they best need at that time. While giving a general outline is important to
keep the client informed, it should be made explicitly known that depending on your
work together, the meetings are relatively flexible.
B) Often ACT is viewed as a significant departure from traditional treatment. Clients
will sometimes find some of the exercises odd, silly, or stupid. This is a great
opportunity to preface this session with a disclaimer of sorts to inform the client that what
you two will be doing is more than likely unlike anything they have done before;
however, the main point is that what they have been doing likely has not been the most
adaptive, and that it cannot hurt to try something new. This is intended to further
promote buy-in.
C) This initial mindfulness exercise is a great introduction to some of the exercises you
will be doing in session. While the content of the exercise is not academic-related, the
purpose of the exercise should be relayed to the presenting issue. As discussed in the
literature, mindfulness is a great coping tool for uncertainty related to work, and

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academic probation is a very uncertain time in a students life. This point should be
made known.
Before we do our first exercise, it is important to discuss what we are doing.
We call these exercises mindfulness, or being mindful, and they are meant to
allow ourselves to stop, pay attention in the moment, and simply observe
without judgment. These exercises are not intended as relaxation techniques,
nor are they a means of escaping difficulties (see Appendix A for sample
mindfulness exercises).
D) While reflecting on the mindfulness exercise, this is a perfect time to incorporate
acceptance. The clinician should discuss control as the problem, and invite from the
client past attempts to control the unwanted situation. The clinician can inquire about the
costs of these attempts to control, as this often causes the individual to miss out on
other more desirable parts of life. Introduce acceptance as an alternative to control and
avoidance of the feelings surrounding academic probation, and ensure to differentiate
from resignation. Frame it as a willingness to experience private events, whether wanted
or unwanted. The important thing is to highlight that when we are actively NOT
accepting (e.g., controlling or avoiding) our difficulties, we suffer as a result. There are
many metaphors to illustrate this point (see Appendix B for links to more metaphors).
When were stuck in quicksand, the immediate impulse is to struggle and fight
to get out. But thats exactly what you mustnt do in quicksand because as
you put weight down on one part of your body (your foot), it goes deeper. So
the more you struggle, the deeper you sink and the more you struggle. Very
much a no-win situation. With quicksand, theres only one option for
survival. Spread the weight of your body over a large surface area lay
down. It goes against all our instincts to lay down and really be with the
quicksand, but thats exactly what we have to do. So it is with distress. We
struggle and fight against it, but weve perhaps never considered just letting it
be, and being with the distressing thoughts and feelings, but if we did, wed
find that we get through it and survive more effectively than if wed fought
and struggled.
E) At the end of session, it is important to reflect and process the work that was
completed. Many clients may feel overwhelmed from the exercises, but it is important to
reassure them and encourage optimism moving forward. If necessary, draw back on the
what you have been doing in the past has not been working, so you might as well try
something different statement.

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F) For homework, the Acceptance and Action Questionnaire-II (Appendix C) and/or the
Coping Strategies Worksheet (Appendix D) can be given. Both address attempts to cope
with unwanted thoughts/feelings. This way, the clinician can gauge the extent to which
the client is struggling and/or avoiding these thoughts/feelings as true barriers to their
academic success, and move forward accordingly.

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Treatment Protocol: Session 2

Agenda
The purpose of this session is to assist clients in understanding ways that their
self-concept and self-labels impact our capacities. The overarching goal of this session is
to help the client come to understand that holding negative self-evaluative beliefs about
their academic achievement is not uncommon, unnatural, or indicative of vocational
outcomes. Since it is very common for struggling students to embrace their self-concept
negatively in the academic domain, the embracing of ACT principles in this session is
designed to assist the client in understanding that those beliefs are not indicative of them,
or even necessarily their ability, as individuals.
Outline of Time in Session
0 5 minutes

Greeting and rapport building.

5 10 minutes

Review homework.

In review of the homework, the clinician should inquire about the

experience of completing the assigned homework. However, it is not
vitally important to go in depth for how the client may have responded.
Instead, it is more important to simply touch base and make sure the client
has no outstanding questions or concerns before continuing to the content
areas being covered in session two.
10 15 minutes

Introduce concept of defusion.

The purpose here is to help the client identify the self-perceptions

regarding academic ability that client holds. These self-perceptions (e.g., I
am stupid because cant do math) should be specific to their experience
because these same perceptions are going to be used as an example in the
following defusion exercises. As defusion is introduced, the clinician
should focus on normalizing the experience as a regular, expected, and
normal part of those in a troubled academic situation.
15 25 minutes

Experiential defusion exercise.

During this part of the session, the clinician should use the academically
adapted leaves on a stream exercise (see Session 2, in-depth, page 20) In

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doing so, this part of the session targets the self-perceptions of the client to
help them begin to become more integrated with their views within
themselves as a whole context.
25 35 minutes

Introduction of self-concept.

The clinician should explore the commonality of positive and negative

self-evaluative statements during the leaves on the stream exercise.
Reflecting upon the type of self-evaluation, the clinician aims to assist the
client in identifying both positive a negative aspects of themselves in the
academic setting. In doing so, the clinician is working to demonstrate a
more comprehensive, and thus less flat, description of the clients
academic self. Academic achievement is not simply grades. It is also
professionalism, timeliness, talkativeness, past performance, dedication,
and so on.
35 40 minutes

Introduce the students in the classroom metaphor.

Having worked on increasing the clients self-perception, the purpose of

this next few minutes is to introduce a metaphor that the client can use to
help to conceptualize the way ACT is encouraging their understanding of
their academic self. It is not intended to introduce a new concept.
Instead, this is a review of the big concepts covered in session. A script of
the metaphor is located on page 22 of this treatment manual.
40 45 minutes

Session wrap-up.

Given the more experiential nature of defusion and self-as-context, this

session does not include homework.
Session 2: In-Depth
A) Consistent with work across various psychotherapy contexts, the focus on rapport
during the first five minutes is vitally important to outcome. The clinician should make a
point to check-in on thoughts on mindfulness as it was introduced during the first session
and on any lingering questions that the client may have. While the session outline denotes
only five minutes to this greeting, helping to ensure the client feels comfortable engaging
with ACT and the mindfulness exercises is vitally important. In this way, some flexibility

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should be used with the implementation of the time in lieu of comfort with concept. One
overarching message the clinician may want to emphasize to the client is that ACT is a
different approach to try something since nothing else has worked and that much of the
experience is the part that drives the benefit it can have.
B) The following is an adapted script of the leaves on the stream exercise as described by
Harris (2009). This exercise should help the client notice the thoughts that they are
having about their educational experience. This is an important first step in ACT.
LEAVES ON A STREAM
Sit in a comfortable position and close your eyes or rest them gently on a fixed
stop in the room. Visualize yourself sitting beside a flowing stream with leaves
floating along the surface of the water. *PAUSE 10 SECONDS* For a moment I
would like you to think about yourself and your academic achievement. Think
about your experience as a student and about what that has been like. Now, for
the next few minutes, take each thought you have about your academic
performance and place it on a leaf let it float by. Do this with each thought you
have- pleasurable, painful, positive, or negative; place them on a leaf and let the
float by. If your thoughts stop, just watch the stream. Sooner or later your
thoughts will start up again. *PAUSE FOR 20 SECONDS* Allow the stream to
flow at its own pace. Dont try to speed or rush your thoughts. You are not trying
to rush the leaves along or to get rid of the thoughts you may be having. If your
mind says this is dumb or Im not doing this right then place those on a leaf
and let those pass as well. *PAUSE FOR 20 SECONDS* If a leaf gets stuck,
allow it to hang around until it floats by. If it comes up again, watch it float by
again.*PAUSE FOR 20 SECONDS* If you notice a difficult or painful feeling
arise, simply acknowledge it. Say to yourself, I notice myself having a feeling of
boredom or frustration. Place those thoughts on a leaf and let them pass. From
time to time you may notice your thoughts distract you. This is normal. When it
happens and when you notice you have been sidetracked, gently bring your
attention back to the stream.

20

C)

Having worked with the client to bring attention to the thoughts that they have

about the academic experience, the next section of the session aims to turn attention to
the self-as-context. In other words, the goal is to explore with the client that they are a
more comprehensive person within the academic context than how their thoughts may
have led them to believe. This may take some exploration, but the clinician should work
with the client to establish indicators of academic positives in addition to any negatives.
Potential strengths might be organizational and executive skills, timeliness and
attendance, achievement level in the past, or talkativeness in class.
D)

The purpose of this is to bring the defusion and self-as-context aspects of ACT

together into practice in order to reinforce the holistic approach to understanding the
academic self. The purpose of this session is to help reinforce the two main ACT
constructs that are being addressed during this session (e.g., defusion and self-as-context)
using an adapted well-known ACT metaphor- the passengers on the bus metaphor .
Defusion is demonstrated in the metaphor in the context of not trying to fight with, argue,
or engage with the troublesome students. Self-as-context is emphasized by reflecting on
how there are a lot of students and that noticing only the loudest, darkest, or meanest
causes you to neglect the other students. Following the introduction to this metaphor, it
may be useful to review these concepts with the client in order to ensure that they were
able to pick apart how those concepts were represented in the metaphor.

21

STUDENTS IN THE CLASS

Imagine for a moment that the different thoughts you have about your academic
self are all students in a class that you are teaching. Maybe the course is required
and so a lot of different students may be in the class. Some of the students are very
pleasant. Its great to have them along and they have a lot of useful and helpful
things to say. Many even most are pretty neutral. But some students are
horrible. They are ugly, loud, aggressive, threatening. They tell you youre a
terrible teacher. They warn you that you are not teaching the right way. They
threaten that if you do not change your teaching style that your career will end.
Now take a moment and consider the students in the class. Who are the loudest?
Who are the darkest? Who are the most prominent? With bothersome students the
natural reaction may be to want to argue with them and engage them when they
do something bothersome. But instead, take a moment and ask yourself do these
students often drop out of the class on their own after a while? Does engaging
with them make them more important, more central, in our lives at that moment?
Does arguing make them leave the class?
What about the other students- the ones that are nice, calm, and that you enjoy
talking to? Does arguing with the dark ones make it easier or harder for you to
notice the nice students- the ones that make you smile? How long will you allow
yourself not to enjoy the good parts of the class you are teaching?

22

Treatment Protocol: Session 3

Agenda
This session aims to assist the client in exploring their values relative to their
academic achievement and sense of self. Consistent with concepts of ACT, academic
value exploration examines the aspirations and drives that have led the client to get to
where they are now. Although it may seem that values exploration for those on academic
probation may emphasize poor achievement, clarification of values will instead likely
show that there is a divide in which the client does have some values congruent with
academic success.
Outline of Time in Session
0 5 minutes

Greeting and rapport building.

5 10 minutes

Introduce concept of ACT values exploration.

The purpose here is to show that there can be complex sets of behaviors
and beliefs that can lead the client to be where they are. The clinician
should emphasize that although there may be some reasons that academic
success seems unlikely or not important, there are other reasons which
contradict this. This can be seen as consistent with the self-as-context
concept described in session 2 of this treatment manual. If they do not
recall this concept, a brief review of self-as-context may be warranted to
assist in value exploration engagement later in this session.
10 20 minutes

Guided value exploration exercise.

Once the client has a firm grasp of the self-as-context idea and how this
may relate to their own values and academic performances, it is time to
take the next step and help them identify in an explicit way what those
values may be. Although the guided exercise (see page 27) is brief, the
discussion afterwards may not be. The clinician should attempt to prompt
and query the client about the identified values. If externalized reasons are
presented (i.e., my mom wanted me to go to school), then the client should
be redirected to how that implies their value (e.g., I value my familys
opinions).

23

20 30 minutes

Priority in value.

The purpose of this part of the session is to help clients understand that
values, both those in an academic setting and in a broad life sense, are
always with us. It is done through a discussion of their identified values. It
should be explained to the client that sometimes we act incongruent with
our values, but that does not make the value go away. The client is
responsible to tap into their own values for academic success and they
should also accept that sometimes the value will be more apparent. Up
until now, perhaps they have not been embracing the set of values that
lead them to school as much as they have been embracing other values
(such as socializing with peers via fraternities or sororities).
30 40 minutes

Values reflect goals.

The purpose of this part of the session is to set-up the client for the active
process of developing steps to align themselves with their values in
session 4. Because values reflect action and because action indicates a
desired outcome, clients are helped to reflect what it is that their values
reflect in terms of goals. It is important here to explore with the client
about what they would look like if they achieved that goal. If they adhered
to the identified value, what would that look like in their life?
40 45 minutes

Session Wrap-up and homework assignment.

Sometimes value exploration can be a bit difficult and clients may have a
harder time identifying the full range of their values in the moment. For
this reason, they should be assigned the values epitaph (see Appendix E)
to do on their own. This exercise is simply a picture of a headstone, and
the client is asked to write down their ideal epitaph, or what they would
want it to read on their stone that others will see and remember them by.

24

Session 3: In-depth
A)

Consistent with concepts of ACT, the purpose of this session is to help clients

examine their values. Values can be tough to identify - especially when they may
contradict behaviors we engage in. It can sometimes be difficult to grasp that we are
acting in a way that is incongruent with what we value. That is, unless we are able to see
ourselves as complex, multi-faceted individuals. By guiding the client through self-ascontext exercises in the previous session, this session starts with the assumption that the
client is able to understand, appreciate, and conceptualize themselves according to that
idea. If they are not, it becomes very important for those clients who are academically
struggling to have the ideas reviewed. Without doing so, it is possible that the client will
fixate on their struggles and the negative aspects of their school experience instead of the
more holistic and realistic interpretation.
B)

Individuals on academic probation may find it difficult to identify values that are

congruent with school success. It may be difficult for them to see themselves as having
values that align to attending class, studying for what may be difficult, or completing
work at a level that the instructor requires. The clinicians job at this juncture is to help
highly the multi-faceted nature of the clients values come to light. As expressed in the
session overview, perhaps values of material gain, family acceptance, social
normalization play an integral role with why the client has taken the past steps that they
have taken. Again and again it may be emphasized to the client that although they may
not identify a high value placed on academics, their actions have shown that the value is
there.
C)

The waxing and waning of values is a natural part of who we are. There are times

where we will make choices that reflect other (and sometimes contradictory) values
because of the complex needs we have as people. This active process of value
development is integral to who we are as people because it allows us to be adaptive.
Values are important to remember and we can use them like a compass - as a flexible

25

guide that is there to help us but not as something we clutch tightly every step of the way.
The compass is a tool we can pull out and use to help us find our way when we are lost.
D)

Value exploration, because of its multi-faceted nature, can involve examining not

only academic values but other values as well. Social, family, and work values can also
play a role. If the client has a difficult time identifying values consistent with why they
are making the choices that they are to achieve academically (remembering that even a
small step is a step that demonstrates a value), it may be useful to explore those values as
well. Because values are freely chosen, the client can then be asked to place them in order
of their own priority to help see how some values may be helping them work towards
academic achievement and how others may not.
E)

Values are the first part of developing goals. A client who has a value also has an

aspiration. They have something that they aspire to because they have a value.
Sometimes clients may not have thought a great deal about what their actions imply in
terms of values. Likewise, they may not have spent much time thinking about what their
values mean in terms of goals. Questions can be a useful way to explore this
contradiction with clients.
What would you like to be different?
How would you act if things were different?
What personal qualities or strengths do you have?
What would achieving that goal do that matters in the big picture?
It may be useful to do a guided imagery with the client for some of their more salient
(and thus more highly prioritized) goals in order to help them come to the answers to
these questions.

26

GUIDED VALUE INQUIRY

We have a lot of values. There can be a lot of external pressures placed on us, such as
family, friends, or coaches. No matter what those external pressures say, we have to
choose to change. We have to want ourselves, or something about our situation, to be
different from what it is right now.
Take a moment to reflect on why you are doing this. Something motivated you; something
matters to you that is making you take time out of your life to come to this session. There
is something that is motivating you to re-examine what you are doing in your academic
life at this point. Is that choice you are making about improving your life? Personal
growth? Learning new skills? Search inside of your heart and clarify to yourself what
values led you here today. What are the things inside of yourself that make you want to
change your academic life?
What strengths do you fell you already have? What are the things that you do well
already? What does your ability to do these things say about you as a person and about
the values you hold? Is it determination, loyalty to family, or social ability? Is it a desire
to learn and improve yourself and your life?

27

Treatment Protocol: Session 4

Agenda
Once a client has identified a set of values that they have, no matter to the degree
to which they adhere or identify with their value (i.e., it may be a value that is not
particularly acted upon), they are ready for the next step of ACT treatment in their
academic troubles. This session focused on helping the client to develop committed
action.
Outline of Time in Session
0 5 minutes

Greeting and rapport building.

5 10 minutes

Introduce concept of committed action.

Committed action is, in plain language, the process of taking larger

patterns of effective action by setting goals and breaking those goals down
into small, specific actions. Commitment to the small action produces a
pathway to the larger goal. It is the process of translating values into
action.
10 25 minutes

Develop a four step plan to committed action.

Following the four-step guideline (i.e., choosing an area of academic life

to change, choosing the value underlying this domain change, developing
goals guided by that value(s), and taking action mindfully) according to
the S.M.A.R.T. acronym (see page 29).
25 35 minutes

Barriers to Goals.

The purpose here is to explore how to respond mindfully to barriers, snags

in the plan, and other slow-downs that may happen in life summarized
by the F.E.A.R. anonym (Fusion, Excessive goals, Avoidance of
discomfort, and Remoteness from values; see page 30). Clients previously
identified S.M.A.R.T. goals, and now can discuss foreseen obstacles . The
defused self and self-as-context concepts are central to the F.E.A.R.
barriers (review concepts if necessary).
35 40 minutes

Mindfulness practice.

28

One difficult aspect of mindfulness is incorporating it into our lives and

finding a way of defusing, being mindful, and feeling at ease with
ourselves, especially when experiencing barriers. Because of this,
brainstorming how to respond without feeling so overwhelmed as to
prevent our desired actions is the first step. Incorporating and practicing
mindfulness is a second part. The mindfulness exercise below (see page
31) provides a guided meditation to assist the client in seeing themselves
AFTER they have completed school and accomplished the very goals they
are setting in this session.
40 45 minutes

Session Wrap-up.

The purpose of this session, above all else, is to have identifiable concrete
goals that the client can work towards. These goals should have clear steps
that they can actually begin to take within the next 24 hours. As you wrap
up the session, it is important to remind them of their 24-hour goals.
Session 4: In-depth
A)

Goals within ACT are driven by the acronym S.M.A.R.T. Goals need to be (a)
specific, (b) meaningful, (c) adaptive, (d) realistic, and (e) time-framed. These
goals should not be emotional (the purpose is to change behavior) or dead person
goals (those that a dead person can accomplish, such as I will stop feeling angry
after a test).
Specific

Describe explicitly the action you will take so that

is it easy to know if you have achieved it.

Meaningful

The goal should be guided by values not rigid rules,

trying to please others, or trying to avoid pain.

Adaptive

The purpose of the action is to improve, enhance, or

enrich your life as far as you are able to predict. It is
important that it changes life to a better place based
on how the client perceives it so remaining clientcentered in this aspect is particularly important.

Realistic

It should be obtainable based upon your current

29

health, finances, time, and skills. This is a

particularly difficult area for those struggling
academically because it may not be realistic to stop
failing.
Time-framed :

Set a day or time for your goal to be completed. If

this isnt possible then, as best as possible, create a
time frame.

B)

Along with the S.M.A.R.T. goal-setting acronym, make sure clients follow the
four-step plan to committed action. The worksheet (see Appendix F) can provide
the clients a guide to formulate a goal-based action. Although the purpose of this
session is to guide the client through the creation of one goal-driven behavior,
encourage them to follow the template within the worksheet on their own and to
explore additional aspects of their values as they go forward from him.

C)

The most common of barriers to committed action in goal making can be

summarized by the acronym F.E.A.R. During the third part of the session, the
purpose is to introduce clients to barriers they may encounter so that they can
mindfully respond to them.
F

Fusion. This barrier is when we become engrossed and

encapsulated by our negative thoughts (i.e., I cant do
math) instead of being more defused (see session 2).

Excessive goals. It is important to ensure that our goals do

not exceed our desires or our resources to accomplish them.
We need resources that address health, finances, skills, and
time (as well as others).

Avoidance. Change can be uncomfortable and if we are

unable or unwilling to accept some discomfort along the
way, we may not move forward.

Remoteness. If we lose touch with our values, if they

30

become remote and not central to our committed actions,

then we will not have the meaning behind our goals
necessary to help us accomplish them.
D)

The client has identified goals and is aware of the barriers that they may

encounter along the way to achieving said goals. However, accomplishment may be
something that is new and difficult for the client. They may have never given themselves
permission to think that they could actually succeed. Prior to closing the session, the
clinician directs the client to engage in a mindfulness practice in order to help them begin
to acknowledge and accept that their goals are not simply lofty steps, but that they can
produce the desired change. Below is a sample mindfulness script to assist. Some
adaptation on the part of the script may be needed in order to ensure that it addresses, as
directly as possible, the clients academic difficulties and desired goals.
FUTURE PERFECT DAY
For the next few moments I would like you to allow your mind and your body to relax. If
you are comfortable enough to do so, close your eyes. Take a moment and notice your
body. Be mindful of your physical self. Notice your breath how it enters and leaves your
body. *PAUSE 10 SECONDS* When you start to feel more relaxed, allow yourself to
begin to imagine a day in the future. While you may have faced academic difficulties in
the past, on this future day I would like you to imagine that you have overcome them.
Picture yourself seated amongst your peers at your graduation. Imagine the mortarboard
on your head and the graduation robes you are wearing. There may be a commencement
speaker talking about the trials, tribulations, and then subsequent successes that they,
like you, have faced to get to where you are at. Now imagine a few moments later that
you are crossing the stage, accepting in hand your college diploma. Notice how it feels to
have accomplished your goal and the sense of yourself that you have in this moment. As
you imagine this moment, recall the goals you had, the steps you took, and the values that
guided you to this accomplishment.

31

Treatment Protocol: Session 5

Agenda
The final session is intended as an optional wrap-up session. If the client is struggling
with concepts or was not able to move as quickly through the treatment manual, this
session is intended to cover those bases and to review the constructs. Because session 4
covers committed action, this session may not be necessary for all clients.
Outline of Time in Session
0 5 minutes

Greeting and rapport building.

5 15 minutes

Review the self-as-context and defusion.

15 30 minutes

Review value exploration.

30 40 minutes

Review committed action.

40 45 minutes

Session wrap-up and termination.

Session 5: In-depth

A)

The purpose of this session is to help the client review their understandings

gathered over the last few sessions. As each of the concepts are gone through in order of
this treatment manual, the clinician may find it useful to refer to guided meditations or
worksheets completed within each session. This can help to reinforce the skills learned
through ACT.
B)

Because some clients may be facing greater obstacles than others in terms of their

academic successes, they may request additional focus regarding a particular area. This is
especially likely for committed action formulation. In these cases, it is acceptable to use
session 5 to repeat the content material within session 4, but only if the client has a grasp
on values, defusion, and self-as-context.

32

REFERENCES
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Elementary School Journal, 85, 3952.
Balduf, M. (2009). Underachievement Among College Students. Journal Of Advanced
Academics, 20(2), 274-294.
Brown, S. & Krane, N. (2000). Four (or five) sessions and a cloud of dust: Old
assumptions and new observations about career counseling. In S. Brown & B.
Lent (Eds.) Handbook of Counseling Psychology, pp. 740-766 (Chapter 23). New
York: Wiley.
Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety
disorders: A practitioners guide to using mindfulness, acceptance, and valuebased behavior change strategies. Oakland, CA: New Harbinger.
Fuchs, C., Lee, J.K., Roemer, L., & Orsillo, S.M. (2013). Using Mindfulness and
Acceptance-Based Treatments with Clients from Nondominant Cultural and/or
Marginalized Backgrounds: Clinical Considerations, Meta-Analysis Findings, and
Introduction to the Special Series. Cognitive and Behavioral Practice, 20, 1-12.
Germer, C.K. (2005). Mindfulness: What is it? What does it matter? In Germer,
Siegel, & Fulton (Eds.), Mindfulness and Psychotherapy (pp. 3-27). New York,
NY: Guilford Press.
Harris, R. (2009). ACT made simple: An easy-to-read primer on acceptance and
commitment therapy. Oakland, CA: New Harbinger.
Hayes, S. C , Strosabl, K. D., & Wilson, K. C. (1999). Acceptance and commitment
therapy: An experiential approach to behavior change. New York, NY: Guilford
Press.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and
commitment therapy: model, processes, and outcomes. Behavioral Research
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Hoare, N., McIlveen, P., & Hamilton, N. (2012). Acceptance and commitment therapy
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Hsieh, P., Sullivan, J. R., & Guerra, N. S. (2007). A closer look at college students:
Self-efficacy and goal orientation. Journal Of Advanced Academics, 18(3), 454476.
Jacobs, S.J., & Blustein, D.L. (2008). Mindfulness as a Coping Mechanism for

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Employment Uncertainty. The Career Development Quarterly, 57(2), 174-180.

Juntunen, C.L. (2006). The Psychology of Working: The Clinical Context.
Professional Psychology: Research and Practice, 37(4), 342-350.
Krieshok, T.S., Black, M.D., & McKay, R.A. (2009). Career decision making: The limits
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Vocational Behavior, 75, 275-290.
Kurash, C., & Schaul, J. (2006). Integrating Mindfulness Meditation Within a
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Savickas, M. L. (1997). Career adaptability: An integrative construct for life-span, lifespace theory. The Career Development Quarterly, 45(3), 247-259.
Smith, C. P., & Winterbottom, M. T. (1970). Personality characteristics of college
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Appendices
Appendix A: Sample Mindfulness Exercises
[Sampled from www.the-guided-meditation-site.com]
Exercise 1: Conscious Observation
Pick up an object that you have lying around. Any mundane everyday object will do...a
coffee cup or a pen for example. Hold it in your hands and allow your attention to be
fully absorbed by the object. Observe it. Dont assess it or think about it, or study it
intellectually. Just observe it for what it is. Youll feel a sense of heightened "nowness"
during this exercise. Conscious observation can really give you a feeling of "being
awake". Notice how your mind quickly releases thoughts of past or future, and how
different it feels to be in the moment. Conscious observation is a form of meditation. Its
subtle, but powerful. Try it...by practicing mindfulness in this way youll really start to
sense what mindfulness is all about.
Exercise 2: The Ten Second Count
This is more of an exercise in practicing concentration than it is in mindfulness, and it is a
simple variation on exercise 1. In this exercise, rather than focussing on your breath, you
just close your eyes and focus your attention on slowly counting to ten. If your
concentration wanders of, start back at number one! For most people, it goes something
like this...
One...two...three...do I have to buy milk today or did John say hed do it? Oh, whoops,
Im thinking.
One...two...three...four...this isnt so hard after all... Oh no....thats a thought! Start
again.
One...two...three... now Ive got it. Im really concentrating now...
Exercise 3: Mindfulness Cues
In this exercise you focus your attention on your breathing whenever a specific
environmental cue occurs. For example, whenever you hear the phone ring, you promptly
bring your attention into the present moment and stay focussed on your breath.
Simply choose a cue that works for you. Perhaps you will choose to become mindful
every time you look in the mirror. Perhaps it will be every time your hands touch each
other. Perhaps it will be every time you hear a bird.

35

Mindfulness cues are an excellent mindfulness technique that are designed to snap you
out of the unconscious autopilot state of mind and bring you back into the present
moment.
Exercise 4: One Minute of Mindfulness
This is an easy mindfulness exercise, and one that you can do anytime throughout the
day. Take a moment right now to try this. Check your watch and note the time. For the
next 60 seconds your task is to focus all your attention on your breathing. Its just for one
minute, but it can seem like an eternity. Leave your eyes open and breathe normally. Be
ready to catch your mind from wandering off (because it will) and return your attention to
your breath whenever it does so.
This mindfulness exercise is far more powerful than most people give it credit for. It
takes some people many years of practice before they are able to complete a single
minute of alert, clear attention.
Keep in mind that this mindfulness exercise is not a contest or a personal challenge. You
cant fail at this exercise, you can only experience it.
Use this exercise many times throughout the day to restore your mind to the present
moment and to restore your mind to clarity and peace.
Over time, you can gradually extend the duration of this exercise into longer and longer
periods. This exercise is actually the foundation of a correct mindfulness meditation
technique.

36

Appendix B: Sample Metaphors

Person-in-the-Hole Metaphor
The situation you are in seems a bit like this. Imagine that youre placed in a field,
wearing a blindfold, and youre given a little tool bag to carry. Youre told that your
job is to run around this field, blindfolded. That is how you are supposed to live
life. And so you do what youre told. Now, unbeknownst to you, in this field there
are a number of widely spaced, fairly deep holes. You dont know that at first. So
you start running about and sooner or later you fall into a large hole. You feel
around and sure enough, you cant climb out and there are no escape routes you
can find. Probably what you would do in such a predicament is take the tool bag
you were given and see what is in there; maybe there is something you can use
to get out of the hole. Now suppose the only tool in the bag is a shovel. So you
dutifully start digging, but pretty soon you notice that youre not out of the
hole. So you try digging faster and faster. But youre still in the hole. So you try
big shovelfuls, or little ones, or throwing the dirt far away or not. But still youre
in the hole. All this effort and all this work and oddly enough the hole has just
gotten bigger and bigger and bigger. Isnt that your experience? So you come to
me thinking, Maybe he has a really huge shovel a gold plated steam shovel.
Well, I dont. And even if I did I wouldnt use it, because digging is not a way out
of the hole digging is what makes holes. So maybe the whole agenda here is
hopeless you cant dig your way out, that just digs you in.
Demons on the Boat Metaphor
http://www.youtube.com/watch?feature=player_embedded&v=z-wyaP6xXwE
The Unwanted Party Guest Metaphor
http://www.youtube.com/watch?feature=player_embedded&v=VYht-guymF4

37

Appendix C: ACCEPTANCE AND ACTION QUESTIONNAIRE-II

Below you will find a list of statements. Please rate how true each statement is for you by
circling a number next to it. Use the scale below to make your choice.

never
true

very seldom
true

seldom
true

sometimes
true

frequently
true

almost always
true

always
true

1. My painful experiences and memories make it difficult for me to live a

life that I would value.

2. Im afraid of my feelings.

3. I worry about not being able to control my worries and feelings.

4. My painful memories prevent me from having a fulfilling life.

5. Emotions cause problems in my life.

6. It seems like most people are handling their lives better than I am.

7. Worries get in the way of my success.

This is a one-factor measure of psychological inflexibility, or experiential avoidance.

Score the scale by summing the seven items. Higher scores equal greater levels of
psychological

38

Appendix D: Coping Strategies Worksheet

39

Appendix E: Values Epitaph

40

Appendix F: Goal-setting worksheet

Specific

Describe explicitly the action you will take so that is it easy to

know if you have achieved it.

Meaningful

The goal should be guided by values not rigid rules, trying to

please others, or trying to avoid pain.

Adaptive

The purpose of the action is to improve, enhance, or enrich your

life as far as you are able to predict. It is important that it changes
life to a better place based on how the client perceives it so
remaining client-centered in this aspect is particularly important.

Realistic

It should be obtainable based upon your current health, finances,

time, and skills. This is a particularly difficult area for those
struggling academically because it may not be realistic to stop
failing.

Time-framed :

Set a day or time for your goal to be completed. If this isnt

possible then, as best as possible, create a time frame.

My value based S.M.A.R.T. goals are.

______________________________________________________________________
Immediate goal(s) (something I can do in the next 24 hours):
______________________________________________________________________
Short-term goal(s) (something I can do in the next few days):
______________________________________________________________________
Medium-term goal(s) (something I can do in the next few months):
______________________________________________________________________
Long-term goals(s) (Something I can do in the next year):

41

Appendix G: Sample Transcript from Session 3 (Values Exploration)

Therapist: Hows your last few days

fit more with some of these more

been?

concrete ideas you have.

Client: Ok, I guess.

C: Thats good.

T: Just ok?

T: Good, Im glad, it sounds like youre

feeling optimistic about today, and I

C: Well theres just been so much going

think thats really important. You

on, and while I feel the stuff weve been

definitely seem to be able to take a

talking about has definitely made some

crummy situation and look on the

sense and helped me cope a bit better, I

brighter side, especially looking toward

dont feel like anything is actually

the future.

changing.

C: I like to think so. I like to think that

T: I see. What do you mean by

Im a fairly resilient person. Im not

actually changing?

sure if I told you this or not, but my

C: I just mean my situation is still the

parents used to really appreciate it when

same.

I would talk to them about my day,

including all the bad things that

T: Mhm. Yeah. I can understand your

happened. I really believed them when

frustration, especially given all the hard

they said that they wanted to hear about

work youve been putting in with me. I

my day. Like they clearly cared.

really see you take this seriously and that

you want to help yourself.

T: Yeah. I can really hear how much

you value your relationship with your

C: Well yeah

parents [emphasizing value].

T: Well I think you bring up a good

C: Definitely. And not just them. I

point, and as it happens most of what

mean, Jessica (sister) too. I feel

were going to talk about today seems to

comfortable opening up to her about

almost anything.

42

T: Definitely. Its not often enough in

T: Right. But, I also think theres more

my opinion that I see a college-aged

to your story than just you not wanting

student who cares so deeply for his

to be kicked out of school and lose your

family, even in the midst of a hectic

scholarship. I think theres probably

situation. Sort of like a port in the

more than one reason you came to this

storm, have you ever heard that

university in the first place.

expression [emphasizing family as a

C: Yeah, I mean Ive always been a

value]?

pretty hard worker in school, and even

C: Yeah, I think so. Just that I turn to

though I didnt necessarily have my

them when I need to.

priorities straight in high school, I still

got most of my work done, and did it

T: Exactly. I also can tell that you care

well.

about your grades and school, otherwise

I dont think you would be here with me.

T: What sorts of other things do you

Especially since this is the third time

think led you to pursue a degree in

weve met! [Emphasizing school as a

education?

value]

C: Im not sure. I feel like I havent

C: Well I dont want to lose my

thought about it in a long time, I just

scholarship and be kicked out of school.

kind of assumed college was the next

step. It was that way for all of my

T: Right, I know weve talked about how

friends, and both my older siblings for

difficult it would be to have to suddenly

that matter. I guess I didnt put that

find yourself in a different situation, but

much more thought into picking my

remember the exercise we did last week

major either. That sounds kind of bad

where I had you just notice those

when I say it out loud [laughs].

thoughts as leaves, and how having

those scary thoughts really dont change

T: No, I dont think it sounds bad, I

anything about you as a person, or what

think its important that youre owning it

you are able to accomplish?

rather than avoiding the issue. If youll

humor me for a minute, I have another

C: Yeah I remember. My observing

exercise Id like to try with you that

self or whatever.

43

might help clarify some of these issues

even though I didnt necessarily

that you havent been thinking about

prioritize the best in high school, I

recently, or perhaps ever. Sound ok?

always sort of prided myself in being

smart. I guess Im lucky that way.

C: Yeah definitely.

T: Thats great. So Id say thats

T: Awesome. So, we have a lot of

definitely something thats super

values. There can be a lot of external

important to you, being a good student.

pressures placed on us, such as family,

Let me ask you another couple of

friends, or coaches. No matter what

questions: What strengths do you feel

those external pressures say, we have to

you already have? In other words, what

choose to change. We have to want

are the things that you do well already?

ourselves, or something about our

situation, to be different from what it is

C: I guess Im good doing a high quality

right now. Take a moment and reflect

of work whenever I actually was able to

on why you are doing this. Something

get myself to sit down and finish my

motivated you; something matters to you

papers and assignments on time. It

that is making you take time out of your

always just sort of clicked with me.

life to come to session. There is

Especially being an education major, I

something that is motivating you to re-

seem to really understand the concept of

examine what you are doing in your

teaching, and I think I would be pretty

academic life at this point. Is that choice

good I guess at teaching others.

you are making about improving your

T: Ok, so what does your ability to do

life? Personal growth? Learning new

these things say about you as a person

skills? Search inside of your heart and

and about the values you hold? Is it

clarify to yourself what values led you

determination, loyalty to family, or

here today. What are the things inside of

social ability? Is it a desire to improve

yourself that make you want to change

yourself and your life?

your academic life?

C: Yeah, I guess I want to improve

C: Well other than not wanting to get

myself as a person. I mean, if guess if I

kicked out of school, I really care about

didnt care quite as much I wouldnt

being a good student. Like I said before,

44

have come to see you after seeing my

past couple of semesters with friends

advisor. I just guess I never thought of it

youve met.

that way.

C: I just need to figure out better time

T: Which way?

management skills I guess.

T: Maybe. That definitely wouldnt

C: Bettering myself as a person. I dont

hurt, I agree. But simply saying Im

know. Maybe this is a good thing, a

going to learn time management skills

good wake-up call for me to change.

may not be motivating enough.

T: Yeah, maybe.

C: What do you mean?

C: I also definitely dont want to let my

family down. I mean, I really care what

T: Well, let me put it to you this way.

they think about me.

All in all, the best sources of motivation

come from inside of us. Often times, we

T: Yeah, I[interrupted]

need to tap in to some of those sources

C: Well, and I also really value the

that already exist in us. For instance,

friendships Ive made so far at school! I

some of the things youve just

dont know! I think that might be part of

mentioned that you value, those are great

the problem. Since I was so easily

sources of motivation. In fact, those are

distracted with going around and doing

things that will probably always be with

other stuff besides work, maybe thats

you in life.

not such a good value.

C: Yeah, probably.

T: I wouldnt necessarily say that. I

T: In fact, one way of looking at it is that

agree with you that it wasnt helpful to

even though you werent necessarily

your schoolwork to be distracted, but I

acting in line, or congruent, with your

also can see a connection between the

value of high quality work and

major youve chosen, being that

intelligence, that does not mean that that

education is a social enterprise, and you

value does not exist. That doesnt

having enjoyed so much socializing the

negate that value. And similarly, the

45

fact that you clearly enjoy socializing

this way of explaining it will make a bit

will probably make you a very good

more sense. Why dont you just imagine

educator. The fact that it gets in the way

that you have a compass with you, one

of your academics does not negate your

that you use to navigate around the

socialization as a value either. You just

woods.

have been acting in a way that is

C: [Laughing] ok, but I never hang out

incongruent with your value of

in the woods.

intelligence.

T: Ok, just humor me. How about

C: Ok, so how do I act congruent with

helping navigate the ocean if you were

that value?

lost. I remember you saying something

about sailing with your dad in one of our
first sessions.

T: Well, thats definitely something

were going to work on, especially next

C: Yeah.

time. But just as a quick preface, we

will work on goal setting, and breaking

T: So some of the values that weve been

some larger goals up into smaller goals.

talking about, such as caring about your

family, turning in high quality work, and

C: That makes sense I guess.

intelligence, those would be similar to

T: Are you sure? Because I really want

the directions on the compass, such as

you to feel comfortable telling me if

north. Can you ever get to north?

something doesnt make sense.

C: No. Not really.

C: I mean, maybe Im just confusing

T: Right, never. You cant obtain the

myself, but is that not what were doing

direction north. BUT, there are things

right now?

you can do along your path in the

northern direction. For instance, you

T: You mean setting goals?

might want to stop on a beautiful island

C: Yeah.

while youre sailing north and have a

look around. Those stops could be

T: I think thats a very understandable

more like goals, in that they can be

concept to be a bit confused on. I think

attained. But you will never finish

46

caring about your parents, or wanting to

C: Yeah, I get that. You already said

learn. Or wanting to teach others. Does

that part. I dont know how to set goals

that make sense?

that are related to my family.

C: Yeah it does.

T: Ok, how about we try this then. I

know that some of your values may not

T: And, sticking with the compass

seem related to where you are right now,

metaphor, your values are always

but they are. Lets do another quick

something that will stay with you, like a

exercise.

compass, in that when you feel lost

you can turn to them for direction.

C: Ok.

C: Makes sense. I kind of like that

T: I just want to ask you a couple of

actually.

quick questions. I know it can be hard to

imagine, but what do you want to be

T: Good! Im glad. I really actually like

different in your life right now? And

that metaphor as well, I use it in my own

dont just say not be on academic

life all the time.

probation.

C: Hmm

C: Well why not? Its true that I dont

T: Whats going on in your mind?

want to be.

C: I just am thinking about how I can

T: I know that its true. But thats what I

use that NOW. Like I get that these

would call a dead person goal. You

things are important to me, but Im not

know why I call it that? Because a dead

sure what to do with that information.

person is capable of not being on

academic probation. I want to hear from

T: Yeah, definitely. I know it can seem

you some more active descriptions.

kind of weird to just sit here and talk

about things that are important to you,

C: Ok.[long pause].I guess I

especially things that may not seem

would want to be making more time to

directly related to school. But

study, and only hanging out with my

remember, we are going to work on

friends on the weekends.

some goal-setting..[interrupted]

47

T: Ok, great! Thats definitely

like maybe doing something in the

something we can work with. So given

community with teachers, or a career fair

what you just said, that tells me that

or something like that.

right now you value your school more

T: Excellent! Excellent, excellent,

highly than socializing, but you havent

excellent. I cant tell you how important

been necessarily acting that way.

it is for you to have said that you

C: Yeah.

actually want to engage more in

something that is related to your

T: How would you act if things were

potential career.

different?
C: You mean if I werent on probation?

C: Thanks.

T: Sure.

T: I think were about out of time, but I

think youve really said a lot of good

C: Well I definitely would be able to

stuff today. Its not always easy to

take better care of myself. I love

identify the things that are most

spending time outside, but lately I

important to you, but I think as we can

havent been able to just because Ive

see, that doesnt mean they arent there,

been playing a constant game of catch-

right?

up with my late work.

C: Right.

T: Thats great, that definitely tells me

some more about the things you value

T: So, I was asking you some basic

and care about.

questions about what you would do if

things were different, and you gave me

C: I also wouldnt be so stressed out.

some great descriptive stuff. One thing I

T: Ok, but remember, a dead person

want to tell you, and that ACT really hits

doesnt feel stressed out either. What

on, is that despite feeling these unwanted

would that LOOK like?

things, like being super stressed about

school, you are STILL able to do these

C: So, the being outside

things. I know it seems kind of weird,

thing..definitely allowing myself to

but it most definitely is possible to have

concentrate more on my future career,

those stressed thoughts and feelings,

48

C: Ok, what do I need to do?

AND still allow yourself permission to

go outside, to engage in a career fair, to

T: Well, this is called an epitaph. Have

talk with your family - so long as you

you ever heard of an epitaph?

are prioritizing the way that you see your

C: No.

own values. In this case, that would

mean making sure youre on top of your

T: Ok, well as you can see, this is simply

schoolwork before going out with

a picture of a tombstone, like someone

friends.

would have in a cemetery where theyre

buried.

C: That all makes sense, I can kind of

see how a lot of that other stuff plays

C: What do you want me to do with it?

into it. So like, the stuff we were talking

T: All I want you to do, is to fill out

about in some of the past sessions, is that

those few lines on the tombstone.

stuff to help me cope to THEN allow

C: With what?

myself to do some of these things?

T: Imagine that you are long dead and

T: Exactly. Thats exactly right.

gone. I dont mean this as any kind of

morbid exercise, so bear with me. What

C: Ok, got it.

would you want to have written on your

T: So, theres another quick worksheet I

tombstone? What would you want

want to give you for next time.

people to remember you by?

C: [Groans]

C: I think that would be pretty hard to

cram into this small space.

T: Dont worry, this is a super quick

exercise, and I think after today you

T: Ok, do you feel like theres a good

might actually find it interesting. It

amount of things you would want said

shouldnt take you more than 5 or so

about you?

minutes to complete, especially since I

C: Yeah, for sure.

know that you have enough on your

plate right now as far as homework, I

T: Ok, thats totally fine. Why dont we

dont want to give you anything else that

do this, then. Sticking with the happy

would interfere in any way.

thoughts of death [laughs], picture your

49

closest friends and relatives are

T: No, thats ok. Why dont you either

attending your funeral. Lets take age

just write some thoughts down on a

out of the equation, since it is very

blank piece of paper, or just make some

possible some of your older relatives

mental notes if you feel youre able to

would not be alive to speak at your

just remember them. Sound good?

funeral. What are some things you

C: Yep, sounds good.

would want them to say about you?

T: So Ill see you in a few days, then?

What would you want them to remember

C: Definitely. Thanks for today.

you by?

T: You are most welcome. Ill see you

C: I still cant write that on this paper.

soon.

50