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Acceptance and Commitment Therapy: Advanced Workshop Julian McNally.

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Presentation on theme: "Acceptance and Commitment Therapy: Advanced Workshop Julian McNally."— Presentation transcript:

1 Acceptance and Commitment Therapy: Advanced Workshop Julian McNally

2 Program Outline Review Of ACT Model Getting Stuck Into Getting Stuck 7 Frequent Problems And How To Respond Sweet Spot And Client Descending Matrix For Case Formulation Developing Mastery In ACT

3 Hexaflex ACT Model of Effective Living Values, Purpose & Meaning Defusion Committed Actions Contact with the Present Moment Acceptance & Willingness Transcendent Sense of Self/ Self As Context Psychological Flexibility

4 InFlexaHex ACT Model of Psychopathology Lack of Values Clarity or Contact Fusion Inaction or Disorganised Activity Dominance of Conceptualised Past or Feared Future Experiential Avoidance Attachment to Storied or Conceptualised Self

5 Hexaflex ACT Model of Effective Living Values, Purpose & Meaning Defusion Committed Actions Contact with the Present Moment Acceptance & Willingness Transcendent Sense of Self/ Self As Context Mindfulness & Acceptance Processes Behaviour Change Processes

6 Your turn! Decide who will be client first Brief your partner on presenting problem, but not whats tricky about this client Counsellor: Notice yourself getting stuck. Observe thoughts and feelings Client: observe and resist urge to be agreeable or make it easy for counsellor If counsellor is not getting stuck, brief client on what the actual client does thats tricky and try again. Switch. Pair up - one is A the other is B

7 Getting Stuck Into Getting Stuck My experience is not authoritative because it is infallible. It is the basis of authority because it can always be checked in new primary ways. In this way its frequent error or fallibility is always open to correction. Carl Rogers, On Becoming a Person

8 Bennet and Cari Notice your reactions and make peace with them Provide an ACT-consistent response Where is the client on the Hexaflex? Where are you on the Hexaflex?

9 7 Frequent Problems What do I do if I get stuck? Do I need to cover all 6 processes? What if they say it didnt work? What if they dont know/cant say what their values are or dont have any? What do I do with clients who are sceptical/concrete/psychotic? What if they (or I!) dont get Self-As-Context? What do I do with clients who are fused with their beliefs or a sick or victim role?

10 What do I do if I get stuck? General principles: Slow down! Be willing and accepting Hold your formulation and treatment trajectory lightly Stick closely to principles and loosely to techniques Listen to clients experience before yours Listen to experience before models and ideas Invite a change in action rather than in understanding or feeling

11 Do I need to cover all 6 processes? No!

12 What if they say it didnt work? Is there a control agenda in place? Try another part of the model Try a different technique from the same part

13 What if they dont know/cant say what their values are or dont have any? How do they know they dont know? When was the earliest (last) time they remember having values? Make the therapy about discovering/creating values? Check for semantic problems Detect values in the present

14 What do I do with clients who are sceptical/concrete/psychotic? Trust your experience, not my words or your thoughts Workability of scepticism Sideline beliefs and being right for a while You dont have to do mindfulness – just pay attention Psychosis – ACT is not an EST – other treatments Metaphor-imperviousness? Present-moment defusion and willingness with Self-As-Context

15 What if they (or I!) dont get Self-As-Context? Lets practise!

16 Indicators Of Increased Capacity For Self-As-Context Detecting and defusing from rules and stories Increased perspective taking and noticing Noticing own processes of fusion and unwillingness Naming or joking about own scripts and stories Able to dispassionately examine value-contradictory behaviours and thoughts Recognising current choices and history as separate phenomena Relating to multiple conceptualisations of self as determined by context and values-in-the-moment

17 What if they are fused with their beliefs or a sick or victim role? Try Self-As-Context Be curious and empathic Appeal to workability

18 Template for Experiential Exercises Recognise your mind will interfere, so slow down and accept Contact with present moment – sounds and touch Locate the moment of choice or stuckness Immerse in the moment (file cabinet or movie screen) Open eyes and express it Hold the moment silently and appreciate

19 The Grid - Kevin Polk Even Simpler Model of ACT Processes SwS Valued Living Sensory Experience Mental Experience

20 I think that... Im having the thought that... I notice Im having the thought that... This is unbearable I notice those thoughts are there again

21 Recontextualising the Problem DepressedUnmotivatedUnemployedIndecisiveOverweightUnloveable Need therapy! What I want my life to stand for DepressedUnmotivatedUnemployedIndecisiveOverweightUnloveable Need therapy! The Life Im left with


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