Originally submitted by Josh Hillie:
Attached is an exercise that I transcribed from Dr. Sonja Batten's interview from “ACT in Context podcast #4” time mark 48:20 – 1:04. Overall I have found the podcast to be a great resource and very informative. Thank you to all who are doing this good work!
Important pieces for clinician to be mindful of:
1) It is important to have some kind of therapeutic bond/trust first where the client is willing to have therapist do something a bit odd/unconventional.
2) It is not about creating this grand AHA! moment, but more about the process of getting the client to understand the different ways of responding to their struggles.
3) This exercise does not have to make complete sense to the person at that very moment it was conducted. The clinician can revisit the exercise, and/or parts of it, and tie it in to later in that session, our revisit it in later sessions.
4) Therapist and client can create their own shorthand and sometimes when people can relate to things physically it can make it a little more understandable.
5) Appropriately choose your target for this type of exercise. For someone who has a significant very real trauma history you do not want to work with them to defuse or minimize their experience in anyway. Rather you might choose a medium level target, so maybe not focusing on your client’s thoughts and feelings about the traumatic event itself, but instead come up with examples about how in other ways these struggles are coming up in their lives.
Ex. An Interpersonal violence survivor where intimacy is really difficult: rather than doing this exercise with the actual thoughts, feelings, memories of the specific event itself… but instead some of the thoughts and feelings that show up when they are with their significant other or with other people who get physically close to them and it makes them physically uncomfortable. Focusing on targeting something in the here and now vs. targeting something that is related to the past trauma itself.
Acceptance Physical metaphor via Dr. Sonja Batten: ACT in Context podcast
Materials: small index cards & marker
First: Identify what person is struggling with.
Second: Once issue is identified then ask:
When dealing with ___ what’s the first thing that shows up? Client responds.
Third: When your [insert person’s response] what thought goes through your head?
Fourth: And what shows up next?
Fifth: Continue asking questions until you have 6 – 10 separate index cards with client responses pertinent to the specific struggle that they have identified.
(i.e. Thoughts?, Feelings?, Bodily Sensations?, Images that come to mind?, Memories that show up?, Urges?)
Example Script:
Client identifies struggle with Panic.
When dealing with Panic what’s’ the first thing that shows up?...My chest gets tight.
Clinician: write on index card “chest gets tight”
So when your chest starts getting tight what thought goes through your head?...I can’t take this.
Clinician: Write on a separate index card “I can’t take this”
And what Happens next? I have trouble breathing
Clinician: Writes on a separate card “Trouble breathing”
Sixth: Ask permission.
Clinician: “Would you be willing to do something a little bit odd/different/wacky with me?”
If client agrees “Yes”
Seventh: Set up 2 chairs across from each other (a couple feet apart)
Suggest if they would be open to practicing different ways to responding to these thoughts, sensations, images etc. when they show up.
Eighth: Sit in respective opposite chairs:
Clinician: “I am going to gently toss these cards one at a time over to you and what I want you to do is bat them away or move your body or do whatever you have to do to not be in touch with these cards in anyway. Clinician goes through each card one by one reads it and gently toss it over to the person…take a pause...then read next card…pause…repeat until all cards are read.
Process activity: Take time to process with the person what that experience was like.
Clinician: “How was the experience for you?”
Client: “I was a little nervous at first but I was able to batt them away and it was ok I was able to do something about it”
Clinician: “So as we were doing that do you think you would have been able to do something that was important to you at the same time?” (Adapt that to something that is important to the person that these problems have been getting in the way of)
Ex. Clinician: “Do you think while you were batting those things away could you have____ ? “ ex. done that work presentation?... read that book to your kids?,… had that important conversation with a loved one?
Client: “No, I was too focused on making sure that those cards didn’t touch me.”
Ninth: Gather the cards up with the person and tell them we are going to do this in a different way.
Clinician: “This time I want you to cover your eyes with your hands and try to distract yourself however you can. You are not going actively fight with these things but I want you to not to look at them, not to try to notice what’s going on, and just try to distract yourself as much as you can.”
Clinician goes through each card one by one reads it and gently toss it over to the person…take a pause...then read next card…pause…repeat until all cards are read.
Process activity: Take time to process with person what that experience was like.
Clinician: “What was that experience like for you?
Client: “It was sort of upsetting, I wasn’t doing anything, but after a while I was able to check out and distract myself thinking about what happened yesterday” (or whatever they were distracting themselves with during the activity)
Clinician: “And when you were in that stance would you have been able to ____?” Ex. do that work presentation?... read that book to your kids?,… have that important conversation with a loved one?
Client: “well no because I was focused on just checking out at that moment”
Note: Distraction or numbing emotions, or finding different ways to check out in the present moment, if that is your characteristic, most common, and routine way of dealing with stress or difficult situations, then that is likely to be a problem.
Experiential avoidance: It’s not that avoidance is bad per say, it’s just that when doing so creates more problems, or it can be harmful (i.e. doing drugs). Pervasive way vs. way that someone mindfully chooses to use distraction.
Tenth: Third step in this exercise gather up cards again with the client.
Clinician: “Ask you to remain in the chair with feet flat on the floor and put your arms on your lap with palms facing up in an open welcoming gesture. Would you be willing to try this a third time?"
If yes…
Clinician: "Now I am going to call out each card one at a time and gently toss these cards over to you and I want you to notice what I am saying, be present here in the moment, and keeping you open welcoming gesture can you let the cards come over and do what they are going to do?”
Clinician: goes through each card one by one reads it and gently tosses it over to the person…take a pause...then read next card…pause…repeat until all cards are read. This time the cards might fall on the persons lap, bounce off them, miss them and land at their side. Client’s job is just to be there and be present and in contact with each one of those experiences for however long it’s there.
Process activity: Take time to process with person what that experience was like.
Clinician: “So if you were in this open stance could you at the same time that these cards were coming over to you have been able to____?” Ex. do that work presentation?... read that book to your kids?,… have that important conversation with a loved one?
Client: “Yeah, at least in this stance I could get closer to it. I feel I did a little better than the other times at least.”
Purpose of activity: It is not trying to get the person to have any one particular experience but rather it’s a physical metaphor to help distinguish between the different ways that we can respond when these certain thoughts, memories, feelings, sensations come up.
a) We can try to fight them and take these active measures to control these thoughts, feelings, sensations etc. when they show up.
b) We can try to ignore, dissociate, distract, or numb and not be in touch with what’s going on.
c) Or can you be open and willing to experience whatever is there for however long it wants to stick around for. Without Holding onto it or pushing it away.