ACT Book Summary: Pages 87 - 91

Contributed by Kate Partridge Creative Hopelessness: Challenging the Normal Change Agenda [Comments in square brackets are from me. I know this summary is almost as long as the section itself, but doing it has really helped me understand it. Kate] Theoretical Focus Resistance to Change: Clients enter therapy because they have already struggled for a long time with "the problem", in many different ways (contemplation, planning, discussion, praying, reading, tapes, etc.) In spite of so much effort having been exerted, no solution to the problem has arisen. In this sense, the client is resistant to change. There are [at least] two reasons for this: 1) The client has not found the right way to fix the problem. 2) There is a fundamental flaw in the model for change, which is based on culturally sanctioned, language-based rules for solving problems. Culturally Sanctioned [Unconscious] Problem-Solving Rules:

• Psychological problems = the presence of unpleasant inner experiences (feelings, thoughts, sensations, etc.). The presence of these unpleasant experiences signal that "something is wrong and must be changed".
• "Healthy living" = the absence of these negative experiences.
• These experiences need to be eliminated by the correction of inner deficits (e.g., lack of confidence), through the understanding or modification of their causes (e.g., overcritical parents).

The underlying metaconcept is: "The problem is one of bad content; change the content and the problem will go away." ACT Assumption [Message of Hope and Liberation]: The Change Agenda Is Not Workable: The culturally sanctioned problem solving rules are like water to fish - they are taken so much for granted that to challenge them seems nonsensical. The ACT therapist works to undermine the sense of normality surrounding these rules, by showing that efforts based on these rules can actually be the source of problems, not their solution. The therapist asks: • "Which will you believe, your 'mind' or your actual experience of the unworkability of these rules?" [Not expressed in these words, naturally.] The therapist takes apart for the client the underlying logical assumption: 1) Identify the problem: "bad" thoughts and feelings. 2) Eliminate the problem: " " " " 3) Life will then improve. By drawing out multiple examples from the client's own history, the client can become experientially connected to what is often a long series of unsuccessful attempts to use this strategy. This can be quite painful. The therapist aims to organize most of the client's solutions into a general class of events that can be described as: "Control of private experience = Successful living." The client is (gently) encouraged to confront the reality of their multiple experiences of the unworkability of this assumption. This leaves the client often not knowing what to do next, in a state of "creative hopelessness". The state is "creative" because entirely new strategies can be developed with being overwhelmed by the old and previously unconscious rule system. Clinical Focus In this phase of ACT, the therapist focuses on the following issues:

• Client has tried everything, but the problem remains.
• The problem is not one of motivation, nor of specific tactics. The client is not to blame for being stuck.
• There is a paradox here: Working hard to solve the problem makes the problem seem worse. The solution is part of the problem. [I need some concrete examples here of how the solution makes things worse - KAP]
• The logic of the problem-solving system is flawed. A more valid and reliable source of problem-solving is the client's own direct experience and their feedback from life.

TABLE 4.1: ACT Goals, Strategies, and Interventions Regarding Creative Hopelessness. [There is no point in summarizing this useful table. It is on Page 91]. Informed Consent ACT interventions can be intense, and the client must be prepared for this by being provided with:

• general descriptions of operating principles [How general?]
• frank discussion of areas of ambiguity [What does this mean?]
• alternative forms of therapy that could be followed instead of ACT

Treatment involves the client in having to face previously avoided experiences. When this occurs, the client can start to question his/her commitment to treatment. Therefore, the client should be committed to meeting for a certain number of sessions, to expect ups and downs, and to hang in until a progress review occurs at a specified session. In this way, the client is guided away from impulsively dropping out of treatment.