ACT in Action Summary

Video 1 – Facing the Struggle

You can’t simply layout ACT and expect the person to understand what it is, because that
understanding will be based in the process that we seek to change, to that person will not really
know what to expect in the course of treatment. You have to find a more metaphotical/indirect
ways to fully inform the individual of what’s likely to occur so they can make an informed choice

Metaphors also serve as an organizing tool to unpack and re-pack the client’s experience and to
communicate the new approach you are doing with them

Obtaining consent
 So you’re back seeing a therapist again
o Client has an implicit demand for something new to happen when seeing a new
therapist but he gets more of the same and this doesn’t work
o I don’t think it’s right just to go into this blind. But it’s hard for me to really fully
explain what it is we’re going to do. Because if we’re going to do something really
new, it’s going to take a while to create that. You’ve worked pretty hard at this,
haven’t you?
 Quantify:
 Time spent
 Effort put in
 Is it fair to say that part of what has been there is a sense of struggle with
this problem, trying to figure out a way to outwit it or defeat it? What is the
core strategy here? (or to understand it)
 This core strategy is framed as a “war” going into “battle” against the
problem
o Instead of going to war – we will step out of the war. (Leave the war zone metaphor
to watch it only)
 Give client the choice to do the old way (CBT) or the new way (ACT)
o If you want to go the new way, there is a few things to expect – you have to be
willing for things to look confusing, to be stirred up. It’s kind of like if we had mud in
the bottom of a glass. If we’re going to try to clean it out and really go after it, the
immediate effect is going to be it’s going to look muddier (muddy glass metaphor)
o Get client to commit to a minimum number of sessions before we look back to see if
this new way is working (7 or 8 sessions)
 Up and down nature of therapy
 Can be confusing and upsetting
o If you’re willing to do that, I’m willing to walk through that with you, whatever it
takes
 Signpost that at the beginning therapist will do a lot more talking to orient client towards
new way of doing things and create target goal
o So if you’re thinking, man, he is talking a lot… you’re right. I’m talking a lot.
o To get a sense of what we are shooting for here, imagine magically this problem in
your life is solved. How are you going to know that things are really moving
forward? What are we going to see? What wold you be seeing? What would I be
 seeing? (the measure of the check in mentioned above is if the client feels he is
moving in that direction or not)
 Starting the therapy our goal is to shift the person from “mind-y” to contact with his
experiences
o Don’t challenge this right away but this a target in treatment
o In interviewing about the problem do push for feelings, though. Stick with it.
o Do a chain analysis of the behaviour and get it’s function down

Creative Hoeplessness
 Creative Hopelessness Intervention
o Sets up the client to do something new
o Goal: letting go of one’s attachment to things they have been doing that their direct
experience has been telling them does not work – going from pliance to tracking
 What have to done to solve this problem?
 How have the different methods worked for you?
 So here you are again seeing a shrink. In the grand scheme of things has this
problem been getting smaller and smaller – less and less important? (client
answers no) Or it’s becoming bigger, more central, more enmeshed?
o So here’s the thing – even though there might be some positive things in there you
might have learned… bottom line, solving the problem this way doesn’t deliver the
goods. Is this the kind of life that you want to live?
o What else? Get the person to list more solutions that failed based on their
experience
o So, if you were to go with what your direct experience is, not what you’ve been told
or what you believe or what your mind tells you, would it be over here with these
other two?
o Client’s mind might start trying to figure out what therapist is doing – use this
chance to have client observe his mind
 Notice what your mind is doing here now – what’s he up to? What is the
right answer? What does he want. This is really important to notice… and,
as I’m asking this all I want is to see what your lived experience has been.
Don’t let me put words in your mouth. I don’t want to cross off anything
 your mind and heart haven’t already, based on their experience, crossed off
o Put yourself on the list of solutions
 I think we need to look at this directly, it’s kind of like there’s four of us in
the room – you, me, your mind, and my mind. The problem here is our
minds are listening, talking, analysing. But, I want to get down to the two
people here and what your actual experience is. Because you’re are telling
me that these solutions haven’t delivered the goods for you. Like, no bluff,
just between you and the person in the mirror, this is not it. Suppose it
were the case not just that it hasn’t, but that it can’t. You know that sense
that you have? Don’t let me put words in your mouth. But there’s a sense
in here that you’re kind of stuck on this problem? (yeah) What if it were the
case that really what’s going oon here is that you’re stuck on this problem.
Watch what your mind’s about to do with what I’m saying. Just watch – go
ahead and say what you’re about to say… But also watch it.
 Do you hear me saying right now that I’m suggesting that maybe this is an
unsolvable problem and you need to give up? Notice, I didn’t say that.
  Even now your mind is trying to figure this out and if that hasn’t worked and
has lead to the same results that’s probably not where we need to go.
 What your mind trying to figure out, “What does this guy got?” It’s looking
for the new angle to fight this problem and that is the old way which hasn’t
worked. Are you with me, here? Another remake of the same old movie…
o We are trying to hit the idea that the client doesn’t like paradox and confusion and
will do anything to answer them – to avoid the feeling of being exposed to it
 Greek Temples metaphor – lots of stairs, bottom pillars that are scary – one
on the left was called paradox and the one on the right confusion.
 Maybe these are not bad things – trying to solve them is like being
in a rigged game? Maybe this isn’t a matter of smarts.
 Confused is not being stuck
 Quicksand metaphor
o Blindfold metaphor sums up Creative Hopelessness
 Blindfold metaphor – Maybe it’s like this. Suppose you’d been blindfolded,
given a little tool bag to carry. And you’re told, this is life. Run around. And
so you ran around. And some time, several years ago, you feel into a hole of
this social anxiety, withdrawal, fear that you’ve been living in. It’s a deep
enough hole that there’s no apparent way out. And so you wait a while to
be rescued. Nobody comes. So you see if you can tolerate it, put up with it.
It’s not a good place to be. Sooner or later it occurs to you – still blindfolded
– to get inside that bag and see what’s in there. Now suppose what was in
there was a nice, sturdy shovel. And so you did what we do with shovels.
You start digging. And you dig in one way, or another way, or another way,
and probably other we haven’t even mentioned. It’s like you dig with big
scoops and small scoops and fast scoops and slow scoops and fancy ones
and plain ones. And here we are. This hole is getting smaller or bigger?
That’s weird. You think about it because in every other area of your life, the
external part of your life at least this much effort solves problems. If we
were talking about painting your house, it would have two dozen coats of
paint by now. But it’s getting bigger. So just consider the possibility that
that’s the situation you’re in. And you’re in here basically thinking, or at
least the mind part of you is thinking, maybe this guy really understands
this, but probably not enough to show me how to really dig my way out.
Except maybe this is not a dig problem. Maybe this is not a dig-your-way-
out type of problem.
 If you saw a person in this situation what would you suggest? (Client
gives suggestions and therapist matches them to what was on the
list of failed attempts)
 People might suggest – just give up. That’s also on the list of “just
tolerate it.”
 If the client suggests getting a ladder, since person is blindfolded
he’ll use it as a shovel. We do want a ladder but our mindset gets us
to use it like a shovel.
 We’re going to do something very different – it will be scary. What
if I told you our only ally was the hole? It’s your pain? (pain is saying
this digging is not working) The big motivator here is if you’ve had
 enough – if you have suffered enough that you are willing to enlist
the hole’s help to get out of the suffering. There is no way out by
digging and our mind wants to know how to dig better. It wants a
solution.
 In your pain you find your values and in your values you find your pain – sometimes you can
leverage creative helplessness to bring out values to live for that are given up by only digging
in the hole

Video 2 – control and acceptance

Have client track of struggle, pain, and workability
 Notice the rule that the human mind deals with daily living more or less the same way - if
there is a problem, we fix it
o Everything in the room is a solution to a problem
o Yet, we suffer. We are the only species that suffers inside plenty
o Maybe this rule is a rigged game – like a casino. We keep trying to win by playing
the rules but we keep losing our money

Polygraph metaphor to challenge the idea that clients think the problems are
workable but they aren’t doing it right
 Suppose I hooked you up to a polygraph and I could know you are anxious
o I want you to try really really hard not to get anxious. I really want you to succeed
on this so I’m going to motivate you to not get anxious – I have a gun to your head.
What do you think is going to happen?
 This is the game we’re playing – your life is on the line, your self-esteem is
on the line… maybe some suicidal thoughts. This is the gun.
o You’re doing the logical reasonable stuff but it’s a rigged game
o Have you ever noticed you were in a social situation and you were feeling fine… until
you started to think about it?
 Then you try not to think about it… does that work? (no) This is the don’t
think about the pink elephant problem.
 This pushes the client to “just living with it” but this is also just a solution like digging
o We are going to be able to learn how to do this but “you the mind” and “me the
mind” will never learn how to do this. They not only don’t like it… they simply can’t.
We’ll be getting into tune with this other part of us separated from our mind… but
they are along for the ride. They eavesdrop
o Thinking we can control the internal world… even living with it is a type of control is
actually the problem
 We, as therapists, are hunting for control to expose it as being ineffective when it comes to
the internal world
o Arguing with judgemental voices – goads them on. Do you feel vitalized and
empowered when you fight them and demand they “stop doing that”

Bus metaphor
 Contains
o Acceptance and struggle – telling them to get off or forcing them off doesn’t work
o Fusion and diffusion
 o How life is a historical process – this is a bus where we only pick up passengers but
don’t let any off
o Importance of values – we are trying to erase entire segments of our lives rather
than feel the pain… time on this earth traded in to simply not have experienced it.
How much of our life is left?
o Where are you really trying to take this bus and where do you get bullied into taking
it instead
 Can you name me a painful memory that you’ve been totally able to kick off the bus… so
much so you can’t really tell me what it is?
o Things might not get air time but come back
 Trying to kick passangers off the bus – name one thing you would be doing right now if you
weren’t feel depressed (get the example concrete)
o So you’re husband comes home, you want to reach out to him and which voices get
in your way? Which passengers on the bus start making a fuss? (You are driving
towards the road of greater intimacy and the voices scream at you until you stop the
bus or take another road… then they are silent
o How long have you had the “I’m too tired” voice screaming at you?
o How did your life turn into their life – is it fair to say you are waiting for your life to
start? I’ll start living when these voices have been kicked off the bus?
 How long have you been waiting for the voices to be kind and finally start
your life?
 How long are you going to wait? How long is enough?
 Choice – would you rather be in control of your life and let go of control of the passengers or
would you rather try to be in control of passengers and, oh , I’m sorry, by the way, you will
lose control of your life?
o To zero in on one specific voice – which one of these has to change what they’re
saying, when they say, whether they’re there at all in order fr you to be driving in
whatever direction is up there?
o Zero in on who gave this voice to the person (mom, friend, etc)
o Get some history of it – how long has it been there, what solutions have been tried
and failed, etc?
o Sounds like it has really wrapped its tendrils around you. Are the tendrils worked
into your life because the thought was there? Or because you’ve done things with
the thought?
 We bury the thought but it’s like the heart under the floor boards – the
weeds sprout out of the ground and grab us no matter how much we stuff it
down

Going back to an earlier time – increases compassion

 Do you remember how old you were when you first had that thought?
o How tall were you?
o (Give a personal example – kid was naughty and got scolded. !5 minutes later found
him in his rom crying like he was hurt, “what happened?” He answers I’m a bad boy.
I didn’t even say that to him… when kids are little, they are perfect but as soon as
they can talk they are going to do that sort of stuff – they just think it with their little
mind and then it’s stuck.
o Go back and see if you can find it – how old would you be when I’m X showed up?
You’re probably not telling other people – it’s just in your head. Like a secret.
  (If they go back to three bring them to five so they are really verbal)
o What did you look like when you were that age?
o I want you to get in touch with what it was like to be that little girl, OK? And to be in
touch with what it felt like to have that show up in this kids head. Then, here is what
I want you to do – imagine that she’s waling in the room right now.
 She’s got that little dress on/those shoes on/little hands/that little hairdo
o If she were here, what would you want to say to her? (she doesn’t know you’re her
grown up self). She’s cool with you being here. You know what is going on inside
her – can you see her?
o You know what’s ahead of her, you know the path she will follow, and guess what?
You ended up here. And some of the things that are going on here were going on
there. What would you want to say to her?
 Client says X
o (Challenge client a little) But she has these thoughts. She has these scary thoughts
that deep down there’s something wrong with her. Can you see it? Can you see it in
her eyes?
o IS she doing a little act for you? Does she want to be thought of well? What does
she try to do with the adults around her? Is she drawing attention to herself? Is she
trying to hide? What did she do?
 Client describes coping mechanism
o So she’s doing that for us here but we can see through it and see what’s going on
with her. She doesn’t even know they are just thoughts. She thinks there’s
something bad about her
 Client will comfort her
o (Challenge the client) Just like when you’re arguing with your head, my guess is, do
you think that’s really doing it for her? Because just saying the words implies the
opposite. She’s probably feeling bad now – what do you suppose she really wants
from you and the adults around her? What does she really want? Does she want to
be told that she should think differently?
o Get client to just love and accept the little kid
o She still wants something from us. What would be something you might do in the
world of behavior that would express what it is that she wants
o Get client to smile and hold kid
o So let’s actually do that. We’re going to bring her up here. She’s going to get with
you. Because guess what, she’s here with you right now anyway. OK, so she’s up
there on your lap. IS there anything that has to change about this little girl before
she’s OK? IS what she’s asking for so outrageous. Like has she done something so
horrible?
o But when you challenge her and tell her not to think that it feels like, even now,
she’s done something wrong. You with me on this?
o So if she hasn’t done anything wrong that deserves this, why don’t we just get with
her? IS she a good little kid? It’s OK for her to be this little girl and to still be loved
and accepted even though sometime she worries. We’re going to tell her with our
behaviour, it’s OK.
o She’s here with you right now and completely inside of you.
o Now here’s the question – can you honor what you did behaviourally? What you did
was you basically said with your behaviour it’s OK for her to be her and you’d stand
with her.
  When you have a thought like, maybe I’m bad and you have to tell her not
to think that, you might as well just slap her in the face. Why don’t you just
slap her in the face? Why don’t you put her in the cornder?
 So when you have the thought and you stand with her, the form of that is
something more like – OK.

Moving from little kid to hugging all the passengers on the bus
 Can you handle even these bad voices like little dried flowers – holding them lightly so you
don’t crush them
 When you go after your thoughts you are saying there is something about me that’s
unacceptable – let’s just slap the little girl?
o Notice how little compassion you are having for yourself with the criticisms
o Let’s grow the kid up to the point she is now criticising herself – does she need
anything different or the same thing?
o Can we have what we do in here be about loving and accepting yourself? Even if it
means making room for some of those ugly passengers? Is it OK to be a whole
person with a history and lots of mind chatter?
 Let’s take this in the other direction – let’s imagine its 20 years from now. How old would
you be? Your old self is sittiing here and I’m asking her do you remember when you were
37? Remember how you felt? I then tell the 57 you to bring in the 37 you and she looks just
like you’re dressed now. What did she want? (she wants the same thing as the little girl)
o And is she so bad that she doesn’t deserve it? Watch what your mind does because
it’s going to run off into judgement.
o Your mind can’t do what I’m asking you to do – it’s an organ that predicts and
judges. We don’t have to accept what the mind throws at us. We can just accept
this little girl who just so happens to be having this thought.
o Is it OK for the 37 year old to have this thought? Are we going to slap her for it?
 You’ve been slapping her. Part of your feeling called depression is part of
that process. It is not OK to be me. This leads you nowhere.
 So here’s the 37 year old. Which of these thoughts, as a thought, can you
not have? Which of these thoughts, as a thought, show that deep down
there’s something wrong with you? (get client to “none of them. I can have
them all)
 So let’s take this 37 year old and put her on your lap
o Notice your mind making the judgements. What percentage are negative? There it
goes again. Thank your mind for the thought. Just watch it for a moment.
 Dull down Mr. Mind at this point making his judgements but go back to – is there anything in
that thought that needs to change before your life can be about what it is that you want,
what you value, and doing it in a way that’s loving and compassionate towards yourself? Is
there anything in there that you can’t have?
 Any thought/judgement that comes up can be responded to with: is there anything in that
thought, as a thought, that you can’t have and have this journey be about what’s important
for you? And be about standing with that little girl part of you and all the other parts of you
that want things in life, that want to be whole and accepted? Are you with me on this?
o Do you have to change it, make it go away, make it change its form?

Saying words to notice what the mind does

 I’m going to say some words, and I just want you to notice what your mind does, OK?
 o I’m whole, valid, complete, perfect. OK, what did your mind do with it? (there are
protests, especially to perfect)
o One of the things that is worth noticing in that little exercise is I didn’t tell you to
think those thoughts about yourself. I said “I’m going to say some words. Notice
what your mind does with them, OK? So one that flew under the radar screen-
because this is how language works, like, what thought? I don’t have any thoughts-
was the word “I’m”. It’s just a sound but that is enough to make it about you. It’s
interesting that I’m immediately becomes self-referential
o The other thing I did was I started with whole and ended with perfect. Could it ever
be I said perfect and you were just fine with that (client says no and this is the
answer) Here’s the deal – there is a polarity here. If I said you were slime, where
does your mind go? It will argue that too with at least “I’m not that bad!”
o We will never get peace from a polarity – we can’t say but… say “and”
 Goal for week: notice the mind throwing up judgements and exercise just watching them
come at you. Don’t try to change them. Just notice them and how sticky they are and see I
you can get tour hands off them.

Video 3 – Cognitive Defusion

Diffusion technique
movies metaphor - sometimes we relate to the characters and sometimes it’s “eh” and what it
would be like to look at our thoughts in the second way

work to appreciate the gap between thoughts on the bus and the driver and that sometimes when
we don’t see this gap the thoughts are the ones driving

It’s like going to a nature reserve and watching the wild life from behind the blind – we are watching
the psychological wold life

 Can use when people throw situational things “they are hard to reach” as opposed to the
thoughts and feelings
 So you call up these folks and they don’t answer (got around the situation) that means
what? (looking for the thought). I want to know what it’s like from the inside. Let’s put it
right on the table.
 So it’s a feeling of being undesirable… but as soon as you say it the mind jumps up and starts
shouting, “Hey, that’s not quite right!”

For really avoidant clients who throw up barriers, point out the mind is doing this. It’s a habit of
mind we are observing

 Can you notice the sequence of events – thought, what thought? I don’t have a thought.
I’m not unloved… and you chuck the thought out the window (or pushing against it)

There’s a difference between letting go and a sticky note on your hand

One way of getting a problem solving mind-y client diffused with the process of using their mind to
get out of problems is to undermine their confidence in their mind that it can figure out everything (I
feel bad… but I don’t believe it. The “I don’t believe it” trick doesn’t actually work)
  Do you know how to touch your nose – explain it to me. (Be so literal that they really can’t
do it)
 What ever they say to do – bend your elbow – ask how to do that
 Stroke victims will actually do this – they will yell at their arm to move
 Your mind is telling you, “You know how to deal with this thought that you’re not loved…
and you’re in here seeing a shrink… I just want you to notice that your mind is telling you
how to do it. And yet it’s not working that way.

The odd conversation – When we’re talking about a thought, I’d like to say it this way, “I’m having a
thought that/feeling that…” We sort of call a spade a spade

The milk exercise – milk milk milk but then unleash the negative thought that has been hurting us so
bad and do the milk exercise to it to expose it as a “hologram”

 Unknown language metaphor – speak Chinese. Words are just sounds. We get attached to
the meaning of the words but they are all just sounds.
 We are set up with the word punch line:
o Mary had a little ____(lamb)
o 2, 4, 6 _____ 8
o I’m not hard working, I’m ____ (lazy)
 It’s like a tug of war with a monster – the hardest thing to do is not take it seriously and just
drop the rope
 Is it the thought that’s putting you in the hole or is it all those secret deals, and the struggle
–where is its power coming from? Where is the wiggle room
 Here’s a word, it has a certain sound, and it makes you feel a certain way when you say it…
this is your enemy? This sound is your boss?
 Dear mind lazy means ___?
o Is it OK you think those thoughts? You want to get rid of them but the more you try
the more they stay around. What if it was like a two dial radio. You want to turn the
volume down but the more you do it the louder it gets. What if there was a secret
dial on the other side – the dial of willingness. When you turn that up then the
sound actually gets more quite.
o I’m going to get this thing to go away so I can feel good about myself but the very
effort means there’s something wrong with you and only makes it come back
harder.
 Our mind’s solution then is - The way I’m going to be OK is going to be being
not OK
o Here’s the guarantee – when we make it our goal to allow those thoughts to be,
show up when they want, and leave when they want two things are going to
happen: either they are going to go now or they won’t… but isn’t that just another
passanger?

Pg. 48

Video 4

Video 5
Video 6
Segment with client who is over involved with her children and is afraid for them
Interventions

Diffusion:

 Can you put an image to that emotion

o If we can put it out in front of us, what would be your first reaction to that image
o Would you be willing to bring this in and hold it, but in a loving way? As if this is a
child too? Create a safety net for it (the sharp pointed red embodiment of her fear
of losing her children/cutting the umbilical cord)

Acceptance

 What piece of this are you not wanting to feel? This pain that you’ve been feeling for a
while in this process or the pain of your children not needing you as much anymore.
o Is there some space here where letting go means you being alone?
o So now there’s another fear, like the unknown
o I can see several places here where we can bring in some willingness to feel with the
sharp, fiery thing, the sense of cutting both ways (of the umbilical cord)

Values

 Makes a discrimination between the fear based place and her values for adventure, love,
and compassion

Commitment

 Do you have to believe it (it’s time for me not as a mother but as my own person living the
values of courage and providing for myself – the fridge is full for me) to do it
o Holding this fear. Holding the sharpie thing, the main thing, willingness to have that.
And then do those things that are about being the parent that you want to be. Not
the safety parent that’s created the thing that you didn’t want. But the parent that
helps create the thing that you do want for your children, like adventurous
compassionate people

Diffusion

 Will this fear dictate your future and theirs? Or will this adventure be the ting that you
gravitate to and get in line with?
 …where the feeling of loneliness is another piece on your board that you can hold

Acceptance

 …a lot of what will be happening is working with being willing to have what shows up as you
make those cuts

Segment with therapist in brief ACT intervention with brother she fights with over his
drinking and smoking
Interventions

Values
  Other than your caring about him a lot obviously, and this is really important, that you value
his being your brother. You want to be a good sister, it sounds like. Try to help him avoid
making mistakes. How does this get destructive? What does it look like when you push into
that?
o Investigate experience
o When you’re in the middle of doing that, what are the feelings that go along with
that? When you’re getting “harrumphing” and disdainful. What shows up with the
evaluation?
o Look for what’s important in the judgment – not in a judgy way
o What feelings go along for the ride when you’re in this space of right and wrong?
 Second order struggle – the client judges self for being judgemental
o So underneath the judgements is a sense that you’re actually somehow failing,
you’re wrong by making the judgements
o If I were really accepting he’d give me something back (and he’s not… and this
thought gets in the way of actually being accepting. It’s simply not accepting)
 Commentary: ACT is a behaviour therapy. All behavioral techniques fit into ACT and ACT as
its bottom line is always going to be whatever commitment and behaviour change processes
best fit the actual problem the client has.
o So let’s just talk about what you might be willing to do because this is all going to
show up in your behaviour. And in some senses, you pretty much know what’s
going to show up in your head because you’ve been practicing it a lot, right? So let’s
talk about what would show up in your behaviour that might be different. What can
you do differently that will pull you in a different direction?
o What small action, something he might not even notice, would tell you that you are
going in a different direction and taking a small important step?
o Check to make sure the small behaviour is within the person’s grasp

Segment of exposure therapy with client afraid of dirt pg. 39