ACT Book Summary: Pages 259 - 264

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THERAPEUTIC DO'S AND DON'TS

Even in Relapse, Values are Permanent
When client is experiencing a relapse, the first thing therapist and client must know is if there's a change in client's values. Most of the times, there's not a change in values but on client's confidence to achieve them. When client experiences a relapse, there's probably inner conflictive talk about different rules and memories. If the therapist confirms that the client's values are the same, he can use a metaphor to say that even though obstacles may show up in the way, the way to arrive to the committed goal is the same.

omments: What if the client's approach to his value allows him to foresee a "danger" (such as the non accomplishment of other values). On the other hand, the client might answer that if one is tired to drive to San Francisco it is not recommendable to do it, or that if he knows the road is blocked because of an accident, he should wait till another day or month. My comment might be silly but since my short therapeutic experience, clients are very good at refuting and turning over all kind of metaphors adjusting them to their immediate needs.

The Client Owns Committed Action
In this section, the authors emphasize the importance that the client follows his own values and not the ones that might be a non intentional influence of the therapist.

Noncompliance is not Failure
When client's behavior doesn't change, therapists use to think it's a failure, and when this happen, therapist pushes the client to act according to his own values (the ones of the client). That strategy doesn't lead to a good outcome, and client's behavior gets resistant or definitely avoidant. The best way to cope with that situation is to accept the client's struggle and non-action from the point of view of the client.

Comments: It's interesting to me that in this situation the main problem is not the client's resistance, but the therapist resistance to accept the client's behavior.

PERSONAL WORK FOR THE CLINICIAN: COMMITTED ACTION

In this exercise, the therapist takes one value and establishes goals, actions and obstacles according to it. Then, the therapist thinks about which private events would show up once committed action begins and if he is decided to make room for them.

Comments: it's very interesting to me the difference between ACT approach and CBT. In my clinical experience as a CBT I remember that after the assessment and before treatment, we had to write down together the client's goals, but most of the times, even though classifying them in different areas and making a hierarchy, there was a lack of certain "structure", not only in the result but also in the process of "outcoming" goals, so the goal sessions used to be quite unsatisfactory.

CLINICAL VIGNETTE

In this section, the authors expose an example of how a client can mislead committed action as a process, and as an outcome. The client relates "drinking again" to not to be a "loving and emotionally available husband", so he experiences negative private events. But he should consider "drinking again" as an obstacle which is part of the whole process, and not the outcome. The other point of the example to stand out is that the client misleads blame and responsibility. But considering "drinking again" as part of a process and not as an outcome, he would understand that he is able to choose again from now on. Three metaphors are provided.

APPENDIX: CLIENT HOMEWORK
Accepting Yourself on Faith Exercise

The therapist differentiates between conclusion and assumption, and defines assumption (something we use to do other work). Then, after checking that the client validates himself making a conclusion, impels the client to choose the assumption that he is acceptable and valid. That's called Faith Exercise. When the client chooses to be acceptable, some contents such as self-doubt depend on the previous assumption and so they loose their meaning.

Comments: I understand that assumptions are so frequent and necessary as breathing, and also, that approaching the problem of self acceptance might be easier and quicker that way. But I think that self validity can be approached from a filogenetical point of view. What we are is the outcome of millions of years of environmental and social selection. That has a great value per se, and is not an assumption. If we have being selected is that we are good. But on the other hand I understand that sometimes that's something difficult and maybe long to explain. What do you all think about it?