The ACT Matrix Matrix Case Conceptualization Worksheet

Matrix Case Conceptualization Worksheet

Name : Initial goals:

Five-Senses Experiencing
Q1 Q2
Therapist away moves Therapist toward moves

AWAY MOVES P TOWARD MOVES

Away D2 Toward
WHAT I DON’T WANT TO THINK/FEEL WHAT/WHO IS IMPORTANT

Maintaining factors : Treatment plan :

Q4 Q3
D1

Inner Experiencing

Q1 Q2 Q3 Q4 IE

© 2014 Kevin Polk and Benjamin Schoendorff / New Harbinger Publications. Permission is granted to the reader to reproduce this form for personal use.
The ACT Matrix Matrix Case Conceptualization Worksheet

Matrix Case Conceptualization Worksheet

Significant history

Client strengths

Process tracking Date

Consultation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Five-senses/Mental discrimination (D1)
Toward/Away discrimination ( D2)
Perspective-taking/Observer self (P)
Away moves/Experiential avoidance (Q1)
Toward moves/Committed action (Q2)
Contact with what is important/Values (Q3)
Suffering/Avoided content (Q4)
Contact with inner experience (IE)

Notes:

© 2014 Kevin Polk and Benjamin Schoendorff / New Harbinger Publications. Permission is granted to the reader to reproduce this form for personal use.
The ACT Matrix Matrix Activity Record Sheet
The ACT Matrix Matrix Activity Record Sheet

ACTIVITY RECORD SHEET Name: _____ Week:__________________ Date:

Day

6 – 7 am

7 – 8 am

8 – 9 am

9 – 10 am

10 – 11 am

11 – 12 am

12 – 1 pm

1 – 2 pm

2 – 3 pm

3 – 4 pm

4 – 5 pm

5 – 6 pm

6 – 7 pm

7 – 8 pm

8 – 9 pm

9 – 10 pm

10 – 11 pm

For each action you note on the sheet, add an A if it was an away move and a T if it was a toward move. For the toward moves, add a *
if it was easy to engage, ** if it was moderately difficult and *** if it was very difficult to engage.
© 2014 Kevin L. Polk and Benjamin Schoendorff / New Harbinger Publications.
Permission is granted to the reader to reproduce this form for personal use.
The ACT Matrix The Matrix Exercise

The Matrix Exercise (Transcript)

Stage 1: Grounding and settling
Start by making yourself comfortable in a mindfulness posture. It’s best to sit with your legs uncrossed
and feet touching the ground. Now, either close your eyes, or gently direct your gaze to a fixed point
on the ground or at your knees. The main thing is that you are not looking around the room, as this
makes it hard for most people to concentrate and can be a little disconcerting for others around you.
(Pause 5 seconds.)
Now, notice both of your arms. See if you can become aware of carrying more tension in either
your right arm or your left arm. (Pause 5 seconds.) Next, noticing your face and gently becoming aware
if you are carrying any tension or strain in your face, particularly in your forehead or at your mouth or
jaws. (Pause 5 seconds.) You will most likely notice that your mind wanders. This is exactly what the
mind does. So whenever you notice this, gently acknowledge your wandering mind and come back to
the current focus. (Pause 5 seconds.)
Now, bringing the primary spotlight of your attention to your breath and your breathing. You can
pay attention to the breath at the nostrils where the air enters and leaves the body. (Pause 5 seconds.)
Or you can pay attention at the chest, lungs, or belly as these parts of your body rise and fall with each
in-­breath as a new beginning and each out-­breath as a complete letting go. (Pause 5 seconds.) Resting
in a knowing that, from a mindfulness perspective, the very fact that you’re alive shows that you’re
able to breathe just fine, so you don’t need to change or manipulate your breathing in any way. Gently
come back to the breath as a source of groundedness and connectedness even with everything else
that is going on in your life. (Pause 5 seconds.) Recognizing the breath that forms a thread of sustain-
ability throughout your entire life.

Stage 2: Looking at the form of experience in terms of workability

While remaining anchored in the breath, shifting your attention to check in to see how much time
over the past few days you have spent really actively connected to the present moment—­to right here
and right now. (Pause 5 seconds.) See if you can recall any moments, no matter how brief, where you
felt really connected. (Pause 5 seconds.) And just noticing whether in these moments you were moving
closer towards who and where you want to be, or whether you were moving further away. (Pause 5
seconds.) Next, shifting your attention to those moments where you felt more disconnected—­those
moments when you were really caught up in your head and with what was going on inside your skin.
(Pause 5 seconds.) Noticing what it was like in those moments and gently checking in to see whether
you were moving closer towards who and where you want to be or whether you were moving further
away. (Pause 5 seconds.) Resting in a knowing that the vast majority of us move further away when we
are in this mode. With the next out-­breath, gently let go of this part of the exercise.

Stage 3: Transitioning and checking in

With the next in-­breath, really connecting to your breath and your breathing. Gently noticing any
thoughts that you are having about this exercise. (Pause 5 seconds.) The mind is almost constantly
generating a series of judgments, evaluations, and comparisons. So it’s likely you will have some

© 2014 Kevin Polk and Benjamin Schoendorff / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The ACT Matrix The Matrix Exercise

judgments, evaluations, and comparisons about this exercise, how I am leading it and how you are
participating in it. Whether this exercise is a good use of your time or not. (Pause 5 seconds.) Recognize
any of these thoughts, and also any unwanted emotions, such as frustration or boredom, and bodily
sensations, such as tension or strain, with kindness. (Pause 5 seconds.)

Stage 4: Looking at the function of experience in terms of workability

And now gently shifting the spotlight of your attention to whatever the primary motivation of your
actions over the past couple of days was. (Pause 5 seconds.) Seeing if you can connect to any moments,
no matter how brief, in which you were consciously moving towards things that matter you. (Pause 5
seconds.) Looking with curiosity to the various valued areas of your life, such as health and well-­being,
relationships, work or education and learning, and leisure. (Pause 5 seconds.) Simply notice the impact
on you when you step towards who and where you want to be in these areas of your life. (Pause 5
seconds.) Simply noticing and breathing into your experience, whatever it may be. And whenever your
mind wanders, gently notice this and come back to the current focus. (Pause 5 seconds.) Observing
and acknowledging what it might be like for you to engage in further towards moves in the future.
(Pause 30 seconds to one minute for people to connect to this.)
Next, gently shifting the spotlight of your attention to any moments, no matter how brief, in which
you engaged in actions that were primarily motivated by trying to get away from something you did
not want to experience. (Pause 5 seconds.) Connecting to exactly how that felt for you both in that
moment and afterwards. Once again, look with curiosity to the various valued areas of your life, such
as health and well-­being, relationships, work or education and learning, and leisure. Simply notice the
impact on you when you move away from unwanted experiences on these areas of your life. (Pause 5
seconds.) Simply noticing and breathing into your experience whatever it may be. Observing and
acknowledging what it might be like for you to engage in further away moves in the future. (Pause 30
seconds to one minute for people to connect to this.)

Stage 5: Connecting with the form and function of experience right now
Acknowledging that each in-­breath brings fresh energy into the body, and each out-­breath releases
stale energy. (Pause 5 seconds.) Connecting to what you want to be about right here and right now. Is
there something important enough to you that you would be willing to connect to if this could help
you consistently move closer towards who and where you want to be in this area? (Pause 5 seconds.) Of
course we will all, myself included, become disconnected and move away from what’s important to us
from time to time. The important thing here is about coming back on track and connecting and
moving in valued directions once more. (Pause 30 seconds to one minute for people to connect to this.)
Gradually becoming more aware of your body as a whole as you sit here. Imagining that your
breath could permeate through your entire body—­all the way up to the top of your head, and all the
way down to the base of your toes. (Pause 15 seconds.) Gently becoming aware of your feet against the
ground that unconditionally supports you. (Pause 5 seconds.) And when you’re ready, in your own time
and in your own way, opening over your eyes, taking a gentle stretch or doing whatever feels right to
you, and bringing this more connected mode of mind that is focused on moving closer towards your
values to the everyday moments in your life.

© 2014 Kevin Polk and Benjamin Schoendorff / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.