ACT for Rehabilitation Counseling of Juvenile and Adult Offenders

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ACT and the Good Life Model for Rehabilitation Counseling of Juvenile and Adult Offenders

Table of Contents

Acceptance and Commitment Therapy

The Good Life Model

ACT for a Good Life

Assessment 

Intervention

Treatment

 

 

 

Acceptance and Commitment Therapy
The core conception of Acceptance and Commitment Therapy (ACT) is that psychological suffering is usually caused by the interface between human language and cognition, and the control of human behavior by direct experience. In a general sense, ACT is based on psychological flexibility which is the ability to contact the present moment (getting centered) as a conscious human being (open to experience), and to change or persist in behavior when doing so serves valued ends (doing what matters).
Getting Centered: contact with events as they occur in their psychological and environmental context.
Open to Experience: a willing to accept distressing private experiences in a diffused state.
Doing What Matters: committed actions related to freely chosen values

The Good Life Model
The Good Life Model (GLM) is a framework of offender rehabilitation rooted in a strengths-based approach. The core belief in GLM is that all human beings are motivated to secure some kind of valued outcome in their life. Those who are offenders lack in personal or environmental resources that cause them to seek out the good life in harmful and antisocial ways. Therefore, assessments and interventions in counseling are focused on finding out what drives the client’s life and what blocks are present that may cause maladaptive choices.
Following an extensive review of psychological, social, biological, and anthropological research, Ward and colleagues (e.g., Ward and Brown 2004; Ward and Marshall 2004) proposed 10 classes of primary goods.
1. Healthy living, functioning, and adaptability
2. Knowledge, information, and education
3. Excellence in work, play, and mastery of life skills
5. Independence, autonomy, power and self-directedness
6. Inner peace, relaxation, and rest
7. Belonging, intimacy, friendship, and familial relationships
8. Spirituality purpose and meaning in life
9. Pleasure, joy, and happiness
10. Creativity, expression, and originality.

 

ACT for The Good LIFE

Assessments are based on establishing the client’s primary goods in life considered to be valued. Once established, goods and values are clarified to actions in the recent past.
Interventions are individualized through use of Acceptance and Action Questionnaires and the client-therapist relationship.
Treatment is an application of individualized intervention to remove blocks and increase actions in relation to chosen values.

ASSESSMENT

Personal Values Questionnaire Instructions:

Each page includes one of the Good Life Values Domains below. To the best of your ability, rate the importance of each area (by circling a number) the scale of 1-10. 1 means that area is not important at all and 10 means that area is very important.

Values Domains:
Healthy living, functioning, and adaptability 1 2 3 4 5 6 7 8 9 10
Knowledge, information, and education 1 2 3 4 5 6 7 8 9 10
Excellence in work, play, and mastery of life skills 1 2 3 4 5 6 7 8 9 10
Independence, autonomy, and self-directedness 1 2 3 4 5 6 7 8 9 10
Inner peace, relaxation, and rest 1 2 3 4 5 6 7 8 9 10
Belonging, intimacy, friendship, and familial relationships 1 2 3 4 5 6 7 8 9 10
Spirituality purpose and meaning in life 1 2 3 4 5 6 7 8 9 10
Pleasure, joy, and happiness 1 2 3 4 5 6 7 8 9 10
Creativity, expression, and originality 1 2 3 4 5 6 7 8 9 10

Instructions:
In this section, we would like you to give a rating of how consistent your actions have been with each of your values in the past few weeks. We are not asking for actions based on what others think you should do or done to avoid feeling anxious, guilty, or ashamed. Rate each area (by circling a number) on a scale of 1-10. 1 means that your actions have been completely inconsistent with your value. 10 means that your actions have been completely consistent with your value.

Values Domains:
Healthy living, functioning, and adaptability 1 2 3 4 5 6 7 8 9 10
Knowledge, information, and education 1 2 3 4 5 6 7 8 9 10
Excellence in work, play, and mastery of life skills 1 2 3 4 5 6 7 8 9 10
Independence, autonomy, and self-directedness 1 2 3 4 5 6 7 8 9 10
Inner peace, relaxation, and rest 1 2 3 4 5 6 7 8 9 10
Belonging, intimacy, friendship, and familial relationships 1 2 3 4 5 6 7 8 9 10
Spirituality purpose and meaning in life 1 2 3 4 5 6 7 8 9 10
Pleasure, joy, and happiness 1 2 3 4 5 6 7 8 9 10
Creativity, expression, and originality 1 2 3 4 5 6 7 8 9 10

INTERVENTION

AAQ-II ACCEPTANCE AND ACTION QUESTIONARE 2

Below you will find a list of statements. Please rate how true each statement is for you by circling a number next to it. Use the scale below to make your choice.

1 2 3 4 5 6 7
Never
true very seldom true seldom
true sometimes
true frequently
true almost always true always
true

1. My painful experiences and memories make it difficult for me to live a life that I would value. 1 2 3 4 5 6 7
2. I’m afraid of my feelings. 1 2 3 4 5 6 7
3. I worry about not being able to control my worries and feelings. 1 2 3 4 5 6 7
4. My painful memories prevent me from having a fulfilling life. 1 2 3 4 5 6 7
5. Emotions cause problems in my life. 1 2 3 4 5 6 7
6. It seems like most people are handling their lives better than I am. 1 2 3 4 5 6 7
7. Worries get in the way of my success. 1 2 3 4 5 6 7

This is a one-factor measure of psychological inflexibility, or experiential avoidance. Score the scale by summing the seven items. Higher scores equal greater levels of psychological inflexibility.

Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (in press). Preliminary psychometric properties of the Acceptance and Action Questionnaire – II: A revised measure of psychological inflexibility and experiential avoidance Behavior Therapy.

 

 

 

 

AFQ-Y ACCEPTANCE FUSION QUESTIONARE-YOUTH (GRECO, MURRELL, & COYNE, 2005)
We want to know more about what you think, how you feel, and what you do. Read each sentence. Then, circle a number between 0-4 that tells how true each sentence is for you.
Not at all
True
A little True
Pretty True
Very True
1. My life won’t be good until I feel happy. 0 1 2 3 4
2. My thoughts and feelings mess up my life. 0 1 2 3 4
3. If I feel sad or afraid, then something must be wrong with me. 0 1 2 3 4
4. The bad things I think about myself must be true. 0 1 2 3 4
5. I don’t try out new things if I’m afraid of messing up. 0 1 2 3 4
6. I must get rid of my worries and fears so I can have a good life. 0 1 2 3 4
7. I do all I can to make sure I don’t look dumb in front of other people. 0 1 2 3 4
8. I try hard to erase hurtful memories from my mind. 0 1 2 3 4
9. I can’t stand to feel pain or hurt in my body. 0 1 2 3 4
10. If my heart beats fast, there must be something wrong with me. 0 1 2 3 4
11. I push away thoughts and feelings that I don’t like. 0 1 2 3 4
12. I stop doing things that are important to me whenever I feel bad. 0 1 2 3 4
13. I do worse in school when I have thoughts that make me feel sad. 0 1 2 3 4
14. I say things to make me sound cool. 0 1 2 3 4
15. I wish I could wave a magic wand to make all my sadness go away. 0 1 2 3 4
16. I am afraid of my feelings. 0 1 2 3 4
17. I can’t be a good friend when I feel upset. 0 1 2 3 4

 

A QUICK GUIDE TO ACT CASE CONCEPTUALIZATION
1. What valued direction does the client want to move in? (What domain of life and what values seem most important to this client? Does she have any values-congruent goals or ongoing valued activities?)

2. What stands in the client’s way? (Identify the barriers to valued living: fusion, avoidance, and unworkable action.)
a) What is he fusing with? (Identify problematic fusion, including reasons, rules, judgments, past, future, and self-description.)
b) What is she avoiding? (Identify thoughts, feelings, memories, urges, sensations, and emotions that this client is trying to avoid or get rid of.)
c) What unworkable actions is he taking? (What is the client doing that makes his life worse or keeps him stuck?)

 

 

 

 

 

 

 

 

ACT Session to Session Measure
Adapted from Steve Hayes ACT daily diary measure. The ACT daily diary and weekly report can be clinically useful in monitoring progress.
Date:

Describe any particularly stressful events you encountered since the last session and how you handled them:

Suffering
Rate how distressed [NOTE: IN ACTUAL CLINCIAL USE YOU CAN REPLACE THE GENERAL LANGUAGE WITH THE SPECIFIC FORM OF DISTRESS THAT IS THE MAIN COMPLAINT, SUCH AS “depressed” OR “anxious”] you were today overall:
None 0 1 2 3 4 5 6 7 8 9 10 Extreme

Struggle
Rate how much effort was put into making these upsetting feelings or thoughts go away (for example, through suppression; distraction; reassurance)
None 0 1 2 3 4 5 6 7 8 9 10 Extreme

Workability
If life in general were like this time before our session, to what degree would this time be part of a vital, workable way of living?
None 0 1 2 3 4 5 6 7 8 9 10 Extreme

Valued Action
Rate how effected you were in taking actions in relation to your values since the last session?
None 0 1 2 3 4 5 6 7 8 9 10 Extreme

 

 

TREATMENT

Simple Ways to Get Centered
© Russ Harris 2009 www.actmadesimple.com reprinted by permission of New Harbinger: www.newharbinger.com

Take Ten Breaths
This is a simple exercise to center yourself and connect with your environment. Practice it throughout the day, especially any time you find yourself getting caught up in your thoughts and feelings.
1. Take ten slow, deep breaths. Focus on breathing out as slowly as possible until the lungs are completely empty—and then allow them to refill by themselves.
2. Notice the sensations of your lungs emptying. Notice them refilling. Notice your rib cage rising and falling. Notice the gentle rise and fall of your shoulders.
3. See if you can let your thoughts come and go as if they’re just passing cars, driving past outside your house.
4. Expand your awareness: simultaneously notice your breathing and your body. Then look around the room and notice what you can see, hear, smell, touch, and feel.

Drop Anchor
This is another simple exercise to center yourself and connect with the world around you. Practice it throughout the day, especially any time you find yourself getting caught up in your thoughts and feelings.
1. Plant your feet into the floor.
2. Push them down—notice the floor beneath you, supporting you.
3. Notice the muscle tension in your legs as you push your feet down.
4. Notice your entire body—and the feeling of gravity flowing down through your head, spine, and legs into your feet.
5. Now look around and notice what you can see and hear around you. Notice where you are and what you’re doing.
Notice Five Things
This is yet another simple exercise to center yourself and engage with your environment. Practice it throughout the day, especially any time you find yourself getting caught up in your thoughts and feelings.
1. Pause for a moment
2. Look around and notice five things that you can see.
3. Listen carefully and notice five things that you can hear.
4. Notice five things that you can feel in contact with your body (for example, your watch against your wrist, your trousers against your legs, the air on your face, your feet upon the floor, your back against the chair).
5. Finally, do all of the above simultaneously
Informal Practices to Be Open to Experience
1. Mindfulness in Your Morning Routine
Pick an activity that constitutes part of your daily morning routine, such as brushing your teeth, shaving, making the bed, or taking a shower. When you do it, totally focus attention on what you’re doing: the body movements, the taste, the touch, the smell, the sight, the sound, and so on. Notice what’s happening with an attitude of openness and curiosity.
For example, when you’re in the shower, notice the sounds of the water as it sprays out of the nozzle, as it hits your body, and as it gurgles down the drain. Notice the temperature of the water, and the feel of it in your hair, and on your shoulders, and running down your legs. Notice the smell of the soap and shampoo, and the feel of them against your skin. Notice the sight of the water droplets on the walls or shower curtain, the water dripping down your body and the steam rising upward. Notice the movements of your arms as you wash or scrub or shampoo. When thoughts arise, acknowledge them, and let them come and go like passing cars. Again and again, you’ll get caught up in your thoughts. As soon as you realize this has happened, gently acknowledge it, note what the thought was that distracted you, and bring your attention back to the shower.
2. Mindfulness of Domestic Chores
Pick an activity such as ironing clothes, washing dishes, vacuuming floors—something mundane that you have to do to make your life work—and do it mindfully. For example, when ironing clothes, notice the color and shape of the clothing, and the pattern made by the creases, and the new pattern as the creases disappear. Notice the hiss of the steam, the creak of the ironing board, the faint sound of the iron moving over the material. Notice the grip of your hand on the iron, and the movement of your arm and your shoulder.
If boredom or frustration arises, simply acknowledge it, and bring your attention back to the task at hand. When thoughts arise, acknowledge them, let them be, and bring your attention back to what you’re doing. Again and again, your attention will wander. As soon as you realize this has happened, gently acknowledge it, note what distracted you, and bring your attention back to your current activity.
3. Mindfulness of Pleasant Activities
Pick an activity you enjoy such as cuddling with a loved one, eating lunch, stroking the cat, playing with the dog, walking in the park, listening to music, having a soothing hot bath, and so on. Do this activity mindfully: engage in it fully, using all five of your senses, and savor every moment. If and when your attention wanders, as soon as you realize it, note what distracted you, and re-engage in whatever you’re doing.

 

 

The Willingness and Action Plan
My goal is to (be specific):

The values underlying my goal are:

The actions I will take to achieve that goal are (be specific):
The thoughts/memories, feelings, sensations, urges I’m willing to make room for (in order to achieve this goal):-
• Thoughts/memories:
• Feelings:
• Sensations:
• Urges:

• It would be useful to remind myself that:

• If necessary, I can break this goal down into smaller steps, such as:

• The smallest, easiest step I can begin with is:

• The time, day and date that I will take that first step, is:

 

 

 

 

Clarifying Values and Making Life Changes
From The Confidence Gap by Russ Harris – Chapter One
Please take as long as you need to read through and carefully consider the important questions that follow. Then complete the written section that follows. (Note: this exercise is from a book on ‘confidence’, but feel free to change the key word. For example, if you are searching for ‘happiness’ or ‘self-esteem’, then substitute the term ‘unlimited happiness’ or ‘unlimited self-esteem’ for ‘unlimited confidence’)
In a world where you had unlimited confidence:
• How would you behave differently?
• How would you walk and talk differently?
• How would you play, work and perform differently?
• How would you treat others differently: your friends, relatives, partner, parents, children and work colleagues?
• How would you treat yourself differently?
• How would you treat your body?
• How would you talk to yourself?
• How would your character change?
• What sort of things would you start doing?
• What would you stop doing?
• What goals would you set and work towards?
• What difference would your new-found confidence make in your closest relationships, and how would you behave differently around those people?
• What difference would your new-found confidence help you to make in the world?
Now please write your answers below, in the spaces provided. And if there’s lots of overlap between your answer – good! That’s to be expected; it points you to core values.

The Life Change List
As I develop genuine confidence . . .
• Here are some ways I will act differently:

• Here are some ways I will treat others differently:

• Here are some ways I will treat myself differently:

The Costs of Avoidance Worksheet
Complete the following sentences:
The thoughts I’d most like to get rid of are:
The feelings I’d most like to get rid of are:
The sensations I’d most like to get rid of are:
The memories I’d most like to get rid of are:

Next, take a few minutes to write a list of every single thing you’ve tried in order to avoid or get rid of these unpleasant thoughts or feelings. Try to remember every strategy you have ever used (whether deliberately or by default). Below is a guide to help you:
Distraction: list everything you have ever done to distract yourself from, or ‘zone out’, or take your mind off these painful thoughts, feelings, sensations or memories.
Opting out: list all the activities, interests, events, people, or places that you have avoided or withdrawn from, and all the opportunities you have missed out on, because you did not feel good or wanted to avoid feeling bad:
Thinking strategies: list all the different ways of thinking you have tried (deliberately or unintentionally) when painful thoughts and feelings started showing up. Tick any of the following that you have done, and write in any others:
• Worrying • Dwelling on the past • Fantasizing about the future • Imagining escape scenarios (eg leaving your job or your partner) • Imagining revenge scenarios • Imagining suicide scenarios • Thinking ‘It’s not fair …’ • Thinking ‘If only ….’ • Thinking of killing yourself • Blaming yourself • Blaming others • Blaming the world • Talking logically to yourself • Talking positively to yourself • Talking negatively to yourself • Analyzing yourself (trying to figure out why you are like this) • Analyzing the situation (trying to figure out why this happened) • Analyzing others (trying to figure out why they are like this)

Substances: list all the substances you have ever used to try and feel better, including foods, drinks, cigarettes, recreational drugs, and prescription drugs.

Anything else: write down anything else you can think of you have ever tried to make yourself feel a bit better, or not so bad, when these painful thoughts and feelings showed up.
Once you’ve done that, go through your list and for each item, ask yourself:
1. Did this get rid of my painful thoughts and feelings in the long term?
2. Did it bring me closer to a rich, full, and meaningful life?
3. If the answer to question 2 is “no”, then what did this cost me in terms of time, energy, money, health, relationships, and vitality?