Letting Go: Opening to Change
As we have seen, letting go of technique as therapy doesn’t mean that you shouldn’t use ACT exercises and metaphors. Bringing them into the therapy is part of the work. However, one of the core competencies within the ACT therapeutic relationship is avoiding the use of “canned” ACT interventions, instead fitting interventions to the particular needs of particular clients. The most important part of this ACT core competency is changing course to fit the needs of the client at any moment, and the most important word in this competency is “changing.” Below are strategies to assist with this process.
Balancing Client, Therapist, and Intervention
It may be helpful to rebalance the therapy work in any efforts you make to step away from overreliance on technique. It is important to consider the ongoing process of the therapeutic relationship in the arc of therapy. The therapist, client, and intervention are all part of the process, as shown in the diagram that follows.
Striking a balance among these three elements across time can assist the therapist in deeming whether too much time or energy is being spent in one of these three “areas” over the distance of the full therapy. That is, if the therapist is frequently talking, and is “overemphasized” regarding what is happening across time, then a rebalance is needed. The same is true for the client, by the way. If the client is doing the majority of the talking over time, then a rebalance is worthwhile. An overfocus on intervention (i.e., the therapy) can also occur. This can take place when therapist and client spend large amounts of time looking at pieces of ACT paperwork that have been placed between them, or when both are engaging in analysis, explanation, and understanding of ACT. This can also happen when the therapy is packed full of exercises, and the client doesn’t get the chance to talk or engage with the therapist on other levels. Again, a rebalance is needed. Maintaining a reasonable balance between therapist, client, and intervention over time can assist you in many ways. For instance, it may help you to consider your own presence in therapy (e.g., I am talking, explaining too much). Or it may help with recognizing if the client is caught in storytelling (e.g., Is the client always talking, explaining their behavior?). It may help you to step back from a protocol or favorite tool when you’re focusing on it too much, and the relationship is getting lost to the tools and techniques of ACT. Keeping the triangle of therapy in reasonable balance over time is a lightly held self-check on the process.
Setting a Therapeutic Intention
Setting a therapeutic intention involves choosing a stance toward the client and then consistently responding from that stance. This stance is a personally selected position consistent with behavioral commitment and most broadly linked to self-as-context. It is one of holding the client as fully capable and whole. I will define and explore the therapeutic stance more fully in chapter 10 but will briefly note some of its qualities here.
Inside of the ACT therapeutic stance, it is essential to be mindful of the kind of languaging that therapists can get caught up in concerning their clients. At times, therapists will find themselves talking about clients with others, talking to clients themselves, or thinking to themselves specific thoughts about the ability or capacity of a client. I have noticed a tentativeness that can be projected in these dialogues. It manifests in holding the client as fragile or incapable. The problem with this perspective is at least twofold. First, and most importantly theoretically speaking, it undoes what should be a very defused, noticing language as language process that ACT holds. If I buy that the client is fragile and incapable, then I am fused with a concept about the client. I have moved away from the perspective that the client is a larger whole—a being that “holds” experience—and I have bought the idea that the client is inherently broken in some way. It makes sense then, to remain theoretically consistent, to hold these ideas of client as fragile and incapable lightly. Standing firmly in the position, session after session, that the client is whole and capable is about recognizing the experiencer and their ability to respond, respectively labels.
Integrating and Embedding ACT Technique
In support of ACT techniques and exercises, I have and will continue to argue that these are part of the therapeutic relationship process. However, they are fully embedded inside the therapeutic context, which includes you as well as the client. Indeed, ACT exercises can be said to lose their impact if they are separated from the therapist employing them and from the client with whom they are being used. As I have emphasized, the techniques and exercises are not the central focus; they are firmly enveloped in, or incorporated as a part of, a more substantial ongoing interaction. Therapist use of techniques and exercises, when embraced as part of a larger whole, is guided by a kind of listening “beneath” the surface of behavior (a concept we will explore further in chapter 2). For instance, when listening to a client, the therapist’s responses, followed by use of ACT techniques, are based on more than a simple reflection of what the client is saying and what appears to be the story at hand. Rather, what happens next is based on a deeper kind of listening, a listening that “hears” the function of behavior(s), in this moment, occurring with this client, with their history, in this context. This is a listening that is broad in nature. It includes awareness of the experiential state of the client, the experiential state of the relationship, and the experiential state of the self. It takes in emotion, sensation, story, body language, history of interaction, current interaction, and intention linked to a direction moving forward. It is conscious awareness of self and other in relationship. It is mindfulness connected to workable action.
Adapted from an excerpt from The Heart of ACT
Robyn D. Walser, PhD, is codirector of the Bay Area Trauma Recovery Clinic, staff psychologist at the National Center for PTSD Dissemination and Training Division, and assistant clinical professor in the department of psychology at the University of California, Berkeley. As a licensed clinical psychologist, she maintains an international training, consulting, and therapy practice. Walser is developing innovative ways to translate science into practice, with a focus on the dissemination of state-of-the-art knowledge and treatment interventions.