Earlier this week, we posted the first half of an in-depth interview with Matthew McKay, PhD, creator of the Advanced Training in ACT: Mastering Key In-Session Skills for Applying Acceptance and Commitment Therapy DVDs. In this second half of the interview, McKay talks about the need for a resource that would provide ACT therapists with in-session skills for navigating the hexaflex, and provides interesting commentary on the key differences between the mindfulness modality and ACT.
Why do you think ACT practitioners need this DVD?
McKay: Most introductory workshops to ACT focus on explaining the six processes and the hexaflex, and giving people a bunch of experiential exercises to learn about those processes to learn how they work and to learn the concepts. But you can’t learn act in this disjointed way. You learn about defusion, how to get in touch with values, basic ideas about mindfulness, self as context, and so forth. But in the end, you have a bunch of concepts and a bunch of exercises that are attached to those concepts of processes, but no real clear idea about how to navigate. When you’re sitting in a session and a client is saying something to you, how do you know what to do? Which of these things would you choose from? You’re thinking, should I do some defusion now? Maybe a little mindfulness would be the thing to do. So in the back of your mind you’ve got these six ACT processes and a bunch of exercises for each one, and it’s like, well what do I do? And how would I put any of this together? How would I know when it’s time to go over and work on the values, versus time to get mindful and hang out with feelings. So, the main reason why we did the DVD was to provide people tools to know how to navigate in the session, and a set of criteria as to when you use certain ACT processes versus others. To show people how you make the decision when you’ve done enough of this, and it’s time to do something else, and when to move from the left to the right side of the hexaflex. When is the time to work with values and intentions to act on them, and when is the time to get over here and get into the affect that shows up, work with painful thoughts? So the core of the DVD is really learning how not just to think of ACT as six separate processes and what shall I do with them, and shall I just teach them one after another, it’s about how to use them appropriately and sequentially in a session depending on what’s happening.
The right side of the hexaflex, mainly the values and committed action, is all about behavior. It’s moving forward, moving toward the things that matter to you. But when you run into barriers, when emotions, painful or negative thoughts come up and those barriers start getting in the way of the client being able to move in that direction, the other side becomes more important. Let’s use mindfulness. Notice what’s going on right now. What’s happening in your body? What are you experiencing? The client may actually be experiencing a rather painful feeling that they’ve run into as they began to look at this new direction that they want to take. Let’s expose to that feeling. That’s the acceptance part. Let’s be with that right now, observe it, let’s not run away from it. Your old way is to run away, let’s do something different, let’s see if we can just be with it. So now some thoughts have come up that are painful and also impacting the client, let’s work with that a little bit, let’s do some defusion. And after you’ve worked with the barriers for a while, then you ask this transitional question: would it be ok to have some of those feelings we’ve been looking at, and still move forward and do this committed action that we’ve been planning? Could you have all these experiences and still do this that we’re working toward and planning? And if it’s clear the client isn’t, or you start working toward committed action and the barriers start showing right up again, you have to go back and do the left side, and help the client notice that these experiences are coming up and let’s not run away from them, let’s be with them, and so forth. It’s a little dance really, a two-step dance on some level. We’re over there doing the behavioral work, moving toward things that matter to the client, and then we’re over doing acceptance, mindfulness, defusion, self-as-context, learning to observe the experience without getting too caught in it. And seeing it as not the core self, but just the context of life; stuff that’s going on around me, changing. And teaching the client to see that the self is really independent of all that. All these thoughts and feelings are constantly changing and I’m over here, the self that is observing that. I can learn to get into the observing self position, and not get so caught in this stuff.
Generally speaking, ACT always starts with mindfulness and “let’s notice what’s happening right now.” And most therapists will begin every session with some sort of present moment experience or exercise. But really, the process of beginning therapy is to help the client begin to acknowledge how stuck they are how they’ve been trying to get away from certain kinds of experiences and all the ways that they have failed to get away from them and that in fact worse things are happening now. So helping the client to understand how they got to the place they are. And learning to really notice their avoidance when it shows up, so early parts of therapy are helping the client be aware of when they are moving toward their values, and when they are avoiding. So really learning those two things: am I moving toward my values or am I over here trying to get away from stuff that feels hard.
Mindfulness is a component of ACT, but how would you explain the key difference between mindfulness-based therapies and ACT?
McKay: They are fundamentally different actually. Mindfulness is used as a coping strategy. It is used to get out of your crazy monkey mind and all of your thoughts about bad things that might happen in the future. Your thoughts about the future and past generally that make you crazy and distressed. Mindfulness is a coping strategy to get out of that and to be in this safer place of the present moment. So it’s really about deflecting from or rerouting from the typical kinds of things that the mind does. The perception is that we get in a lot more trouble when we leave the present moment, so let’s stay there as much as we can. Kabat-Zinn, With MBSR, was originally working with people who had chronic pain and people would get into trouble because their minds would say, well this bad thing will happen or that bad thing will happen, or I’ll never get away from this pain, my life is over, and so forth. So their minds would create so much worse pain, and so he was using mindfulness as a way to short-circuit that and get people out of that kind of thinking and into the present moment. And the same thing with mindfulness in DBT, it is used as a way of coping with stress.
ACT is totally different. ACT uses the same process, but the purpose is not to actually get away from pain. The purpose is to actually be present, it’s about exposing to whatever is happening right now, whatever is happening in your body, whatever your emotions are, whatever you’re feeling physically, let’s be with that. It’s about learning not to run away from your experience, learning not to run away from your pain and your emotions and the stuff that shows up, your private events, the stuff that’s going on inside of you. The ACT position is that your problem is here because you’ve been trying to run away from the pain, and that’s what’s creating your suffering. So we’re going to turn back to it using mindfulness as a portal to actually be present to some of this painful stuff, to actually be with these emotions. The focus is learning to observe and be with those experiences as opposed to just focusing on the breath or focusing on some innocuous place to put one’s attention. In ACT, mindfulness is a tool to turn toward rather than away from experience.
Matthew McKay, PhD, is a professor at the Wright Institute in Berkeley, CA. He has authored and coauthored numerous professional and self-help books, including Your Life in Purpose, ACT for Interpersonal Problems, and ACT on Life Not on Anger.
For more information, or to purchase a copy of Advanced Training in ACT, click here.