Guilt and Self-loathing (not in Las Vegas, not Hunter Thompson)
Guilt = "I'm bad" is a stance that weakens the client's valuing ability. It is connected to past, dead behavior, and, when functionally connected to such a chimera, prevents the client from living in the present, in real time, and moving ahead with life..
In the example shown, the client implies that guilt/shame regarding past behavior is making a visit with a brother an extraordinarily stressful event. The client holds on to contradictory concepts, "I want to be close to my brother, so I cannot tell him the truth." The client is feeling numerous emotions, and seems to get that he is trying to bargain with them, and get them to the back of the bus. When he sees the cognitive dissonance (?), he appears to be able to also see the disconnect, which scares him. Therapist asks what is between him and honesty with his brother -- answer: fear, He can bring that to the front of the bus as well and is still able to drive.
Forgiveness
Clients often think fear is a change in stance where once they 'knew' someone was wrong, bad, untrustworthy, and to forgive is to say they are no longer these things, they are right, good, etc. The client has, in essence, changed their mind. It can also appear to be emotional avoidance -- excusing, denying, forgetting old angers.
It is actually a gift to oneself, to give the self that which came before. It gives the for-giver the ability to regain the grace under which they can neutralize the injustices -within themselves. To paraphrase "the injustices of others can only be made permanent by the victim, not the perpetrator," or pain is unavoidable, but suffering is optional.
Example used is the Gestalt "empty chair" exercise. It may be best to allow the client work on the pivotal, profoundly personal issue of forgiveness outside of the session, where the necessary privacy and time for self-reflection is available.
Behavior
When the client is nearing the end of the willingness and commitment phase, ACT begins to resemble other Behavior Therapy, while maintaining an ACT flavor. Skill building, couples work, role-playing et al, are used from an ACT perspective.
Termination
Termination comes when the client has reached a point where valued behavior change has been actualized for him or her. Therapy is not designed to be permanent -- Woody Allen "I have been in Analysis for twenty years. I think I will give it another ten and if that doesn't work, I will call it quits."
It is to help the client get unstuck. When a client shows openness to change, a rating scale may be used to gauge further commitment to same. Termination may be tapered off, shorter for the functional client, and longer for the multiple problem client. This phase is used to bolster key ACT principles (Oh how quickly we forget) and for relapse prevention. This, thinking of diClemente's stages of change, is the maintenance and transition stage. During this period, if the need to reenter therapy arises, the therapist will be aware of it during these phasing out visits.
