The Acceptance and commitment therapy (ACT) model rests on the concept of workability. An ACT therapist asks, “Is what you’re doing working to give you a rich, full, and meaningful life?” If the answer is yes, the behavior is workable. If the answer is no, it’s unworkable.
To an ACT therapist, thinking, feeling, and remembering are all considered behaviors, because they are all things an organism does. During sessions, we look for workable and unworkable behaviors. We reinforce workable behaviors—that is, we respond in ways that lead to the persistence or increase of the behavior. Unworkable behavior, on the other hand, should be interrupted, and in its place a workable behavior should be reinforced. In any ACT session, the aim is to continually model, instigate, and reinforce the six core ACT processes. But how do we do this?
According to Russ Harris, author of Getting Unstuck in ACT, we model the six core ACT processes by embodying ACT in the room: we work from a mindful, compassionate, values-congruent mind-set; we pay attention with openness and curiosity; we defuse from our own unhelpful mind chatter; we willingly make room for our own discomfort in the service of helping the client; and we stay in touch with our values as coaches or therapists—compassion, respect, integrity, authenticity, caring, connection, contribution, and so on.
We also want to actively instigate psychological flexibility in each session. We want to induce the client to practice mindfulness, connect with values, set goals, and take action, all during the session itself. There are two main ways to do this, which often overlap: structured exercises, and noticing and commenting.
Structured exercises include physical metaphors (those that are acted out); verbal metaphors (those that are described); worksheets; specific techniques such as singing thoughts or thanking one’s mind; and experiential exercises such as mindful breathing, visualizing thoughts as leaves floating down a stream, or imagining one’s own funeral. Newer ACT practitioners may tend to stick with structured exercises when trying to instigate psychological flexibility within sessions.
As we get more familiar with ACT, we realize that we can instigate core processes simply by commenting on what’s happening. For example, we can instigate defusion by asking the client questions such as “Can you notice what your mind is telling you right now?” or “Do you notice how your mind keeps pulling you back to this topic?” We can instigate acceptance through comments such as “How are you responding to this feeling right now? Actively fighting it? Putting up with it? Dropping the struggle with it?” And we can connect with values through comments like “It seems as though this is really important to you. What is it that matters about this?”
When we notice signs of psychological flexibility in session—connecting with values, defusing from unhelpful thoughts, accepting discomfort, engaging in the here and now, practicing self-compassion, and so on—these are all instances of workable behavior. Our aim is to hone in on these behaviors and actively reinforce them as they occur. There are many ways to do this. We might share with a client what we’re noticing and comment on it in a way that’s likely to be perceived as encouraging or appreciative. We can show curiosity about how the client is doing the behavior. We might ask the client to notice what she’s doing and the effect it’s having. Or we can share with the client how her behavior makes us feel or what impact it has on the therapeutic relationship.
We won’t know for sure whether such interventions will be reinforcing or not for the behavior, but we’ll have to make a guess. Ask yourself, “What can I say and do that I think will be reinforcing?” Then try it, and mindfully assess the consequences.
In addition to modeling, instigating, and reinforcing workable behavior in session, we want to encourage it as much as we can between sessions. In our next post on Getting Unstuck in ACT, we’ll go over some ways to encourage clients to commit to some form of action between sessions.
Part 2: What to Do When a Client Is Participating in Self-Judgment?