I'm very new to ACT. Ive been a GP (family physician) who by default does a lot of counselling for over 20 years in Australia and a daily mindfulness meditator for about 7 years. I discovered ACT when a patient insisted I read The Happiness Trap a few months ago and soon after did the first workshop with Russ Harris. I am now a complete convert who has read and reread ACT made simple and started doing ACT very successfully on some of my patients (the ones Ive known for years and trust me but would never go to a "real counsellor"!) I love integrating the values and committed action (which is new to me) with the present moment awareness and unhooking/allowing thoughts and feelings (which is very familiar to me). I've read the last couple of threads on the ACBS with a mixture of excitement that there are people out there who discuss this sort of thing on a regular basis and embarrassment that I confess I dont really understand much of it! Part of the reason I joined was that I dont have a supervisor or know anyone else that does ACT so I was hoping to run some cases by folk to get some input. I'm not sure if this blog is the right place to do it but I'll put in a brief case and see if anyone gets back to me:
A 15 year old intelligent boy who has been having thoughts and feelings of suicide for months (thoughts: "hurry up and do it", "whats the point", you just die anyway"; feelings which he describes as a deep craving, hungry feeling in his belly to be dead). He feels that he has felt like this for years (though his parents say he has done fine at school, has laughed and smiled, interacted with friends and enjoyed surfing previously). He completely denies having any positive values despite showing him some cards with values for teenagers. His only value he will admit to his "life has no meaning" which I said I couldnt really work with. He does not appear to have shown many obvious signs of depression up until the last few weeks where he has been avoiding his friends, not going to school and sleeping for prolonged periods. There are no psychotic symptoms. He feels there is a 50% chance of him carrying through on the suicide in the next few weeks. His only answer to the question "what has stopped you so far'' was that he tells himself "it wont be long". (At the moment his parents are on 24 hour watch). An SSRI started by another dr was no help. He was refusing to see a psychologist or psychiatrist at this stage. On asking about his parents reaction if he committed suicide he agreed that they would be in severe emotional pain but "he would be dead so he wouldnt care". On asking was he willing to see me for a few sessions he said that he was, but he was close to 100% sure that it would make no difference. He agreed because he has known me since he was young and his parents are rightly insisting that he see someone. In fact he did not want to feel happier "because it would be fake" and "I'll always know the truth inside". He was reasonably cooperative but seemed to enjoy intellectual sparring and seemed very disconnected with any emotion. The only thing that caused a spark was the suggestion that we might need to admit him to the psych hospital: when I described the public psych hospital as a place where some seriously disturbed adults resided he told me that that sounded "vaguely interesting". Another interesting thing was that he told me (and I couldnt see any evidence against it) that he was not struggling with the thought and feelings at all: in fact he agreed that the feeling in his tummy was almost like an "old friend". Any suggestions along the ACT line would be greatly appreciated. (I dont need any advice about practical suicide prevention, psychiatric evaluation, psychologist involvement, medication or lack thereof: I feel quite comfortable with that side of things). Thanks. Adele