Presentation on theme: "Acceptance & Commitment Therapy With Couples"— Presentation transcript:
1 Acceptance & Commitment Therapy With Couples Dr Russ Harris, M.B.B.S., M.A.C.Psych.Med.Medical Practitioner, Psychotherapist
2 Aims of the Workshop ACT conceptualisation of relationship issues ACT interventions for relationship issuesInterspersed with experiential exercises
3 ACT Case Conceptualisation 2 simple questions:1. What sort of relationship do(es) the client(s) want to build?2. What stands in their way?- 2a) What are they fused with?- 2b) What are they avoiding?- 2c) What ineffective actions are they taking?
4 Taking A History What’s the problem? -Can you tell me about a recent event that represents the main issue(s)?-What have you tried so far to fix this? How did it work? What has it cost?-What have you done that has contributed to this issue, or made it worse?
5 Taking A HistoryRelationship history: how did you meet, what attracted you, wedding day etc.What do you value in your relationship & your partner, currently?(What did you value in your relationship & your partner back then?)
6 Taking A HistoryOn a scale of 1-10, how sure are you about staying in this relationship?On a scale of 1-10, how much work are you willing to do to improve the relationship?
7 Stay or leave? Assess pros & cons of each Have you given it your best shot?Whichever option you choose, you’ll need to make room for anxiety, doubt, worry etcSitting on the fence metaphorLive by your values, whether you stay or leave
8 Taking A History What sort of partner do you want to be? What sort of relationship do you want to build?Magic wandVisualise: self as ideal partner vs self as reactive partner – reflect & share80th birthday – partner gives a speechValued living questionnaireShare values
10 Values to Goals What’s a small step you can take? What’s a little thing you could do?
11 Values to GoalsIf your partner actually does that, what difference would it make to you?How will you let them know that?
12 Values to Goals If client makes positive changes: What was that like for you?What happened to your relationship as a result?What’s another little step you can take?
13 Values to Goals If client doesn’t make positive changes: What was that like for you?What happened to your relationship as a result?What got in the way?
14 The Barriers to change: F.E.A.R. Official ACT version:FusionEvaluationAvoidanceReason-giving
15 The Barriers to change: F.E.A.R. Alternative version:FusionExcessive expectationsAvoidanceRemoteness from values
16 The Antidote to FEAR is DARE DefusionAcceptanceRealistic expectationsEmbrace values
17 Key Issues 4 approaches to any problem situation 1. Leave 2. Stay & Change what can be changed & live by your values3. Stay & Accept what can’t be changed & live by your values4. Stay & Give up & increase your suffering through self-defeating behaviours
18 Key Issues Behaviour change 101: What’s in your control, and what’s not?Carrot versus stick
19 Key Issues Communication 101: Ask clearly for what you want, (and explain why)Express clearly what you don’t want, (and why)As you do this, be the partner you want to be!Boundaries & consequences
20 Key Issues When you’re upset: Breathe out I notice I’m feeling x I’m having the thought that ..Get present; ground yourselfIf necessary leave the situationIf you do leave, practise mindfulness & acceptance (practise letting go of unhelpful stories)
21 Key Issues Once grounded, ask yourself What sort of partner do I want to be? What are my values here?If I could be that ideal partner, I would respond by doing …Then take action, guided by those valuesVisualise/write/rehearse those responses
22 Key Issues In other words: ACT Accept your thoughts and feelings Connect with your valuesTake effective actionOr more simply:Be present & do what matters!
23 Key Issues CONFLICT Stop arguments in session Do mindfulness then and thereWhat’s your body doing? Breathe into it.What’s your mind saying? Name it.
24 Key Issues CONFLICT What judgments does your mind make about him/her? What happens if you buy those judgments?I’m making the judgment that ..
25 Key Issues CONFLICT Being right versus being loving I’m right; you’re wrong
26 Key Issues CONFLICT Rigid rules What are your rules? What are your partner’s rules?Where did these rules come from?What happens when you fuse with them?
27 Key Issues CONFLICT : Defusion of Rigid rules Expect them Notice them Name them
28 Key Issues CONFLICT Discuss inevitability Increase awareness of triggersIncrease acceptance‘Pet arguments’Name your storiesBeing right versus being loving‘But’ vs ‘And’Anger management if necessary
29 Key Issues CONFLICT Repair attempts What’s the tiniest step you could take that might repair some of the damage?Acknowledge & accept repair attemptsJohn Gottman: 7 Principles of Making Marriage Work
30 Key Issues REFRAMING PROBLEMS How can I grow from this? What can I learn from this?What ACT skills will this enable me to improve?Imagine your partner is a teacher: what is the lesson?
31 Key Issues THE PERFECT PARTNER Do they exist? Do you always act the way you expect yourself to act?Acceptance exercise: if I could give you a choice - a) no painful feelings, but no capacity to love or care; b) you get to love and care, and that means that at times you have these painful feelings – which would you choose?
32 Key Issues CHANGING BEHAVIOUR Willingness to change, versus wanting to changeFacilitate willingness through valuesDistinguish values-driven change from: resentful change/ guilt-induced change/ trying to ‘keep her happy’/ trying to ‘put up with him’
33 Key Issues CHANGING BEHAVIOUR Identify barriers: FEAR N.B. reason-givingDiscuss ‘relapse’When your partner stuffs up, how will you respond?
34 Key IssuesLOVEDistinguish the action of love from the feeling of loveMagic wand
37 Key Issues FORGIVENESS Give yourself what was there before Do it for yourselfAnger & resentment – costsHandle it with mindfulness; let it come & go
38 Key Issues FORGIVENESS RITUAL Each partner writes:- The thoughts, feelings memories I’ve been holding on to are …How holding on has hurt me & our relationship:Commitment to letting all this old stuff come and go without holding on to itChoose a special place, read it out, do something symbolic (eg burn it & scatter the ashes) then do something to connect lovingly
39 Key IssuesTRUSTDistinguish the action of trust from the ‘feeling’ of trust (not really a feeling; more a ‘sense’ – strong cognitive component)No control over ‘feelings’ of trust – only over the actions.Balance values around trust with values around self-protection