ACT Book Summary: Pages 110 - 114

The chapter on creative hopelessness ends with a few therapeutic do's and dont's. I took the freedom to add some do's and don'ts from the list and one of my own 1. Am I hurting or helping the client seems to be a question that's often asked in workshops. Kelly Wilson suggests on this list (April 15th) that this is about the therapists' own experiential avoidance when sitting with the patients' pain. Empirical findings show that you don't have to be afraid that your patients will quit therapy, get deeply depressed or even kill themselves when they discover the futility of their struggle. In other words the message is essentially a hopeful one, and patients may feel relieved. CR may be the first step towards an increase of degrees of freedom of the patients' respondent behavior. 2. I suggest that as a therapist you have to face your own creative hopelessness in order to be able to sit with the patient when he or she is testing his rule sytem against experience. 3. Don't expect anything to change (yet), because any change can be linked to the intentional change agenda, and so become just another avoidance strategy. This is paradoxical. As I try to grasp it right now, experiential avoidance seems to be an escape reaction triggered (or conditioned) by a certain class of stimuli (Sd, like for instance the possibility of being criticized), and thus it's under antecedent control (see also Kelly Wilson's note on this). Each time I face this type of situation I feel stressed or aroused (CER), want to escape or avoid by procrastination, let's say (CAR). This is reinforced by nicely elaborated verbal rules (COV)(and each time I think I'm right is a reinforcement, a +S+). Moreover, i feel relieved in the short run because the criticism is avoided (-S-). If I try to change this chain of behavior without loosening the conditioned response, I may just get entangled in a more complex conditioned avoidance response. In terms of 'Mary had a little .... ' I will get even more 'lamb' connections on the dots. I guess the idea is that behavior change will result spontaneously when the link between the situation and your avoidance reactions will be weakened, for instance by an increase of awareness of the unworkability. And isn't hope just the same as finding more and new opportunities to achieve your goals? Just like the two Swedish colleagues I 'd like to try to describe these processes in behavior analytic terms, but feel very insecure about it. It seems to me very helpful in the process of understanding ACT, and also in grasping the patient's struggle. So who wants to join or help in this enterprise? 4. Give homework to help people become aware of how they struggle, and what situations trigger it. Just do self monitoring, and not behavior change (see above) 5. The book (and the discussion on the list as well) seems to suggest that there should be a fixed order in therapy with CH as the starting point. I'd like to cite Kelly Wilson (April 15th) on this: " No you absolutely don't need to do CH like it says in the book. If it needs to be done, you will end up doing it. why? Well as you pursue values, it will appear as an obstacle--then you will do defusion of hopelessness, and the emergence of what we like to call creative hopelessness." 6. A very important do was formulated yesterday by Joanne Steinwachs. I'll just cite her contribution, can't do it better, as she's also including a beautiful metaphor. "I find it useful to begin the questioning with 'beginner's mind'. Perhaps what they tried did work out, in some way for them. Of course, if they're stuck in a framework of unworkable rules, then in the larger picture, it doesn't work, but sometimes talking to people about what they do and how it works in their idiosyncratic rule system illuminates the rule system both for them and for me. If I start with the agenda of discovering unworkability, then I can miss a lot of the nuances of trappedness, both for them and for me, and I feel like I move into a place of expert rather than co-explorer. I also feel that using "discovering unworkability" as my guide, respect and curiosity are harder to maintain as my base feelings towards the client. I can't do this if I've got the agenda of discovering unworkability. I have to hold the idea that the system DOES work for the client as a possibility. Usually, in my experience, clients have worked hard and creatively, their shtick does work in some way and it's often an elegant and creative adaptation to some crazy rule. I talk to people about the pre-Copernican world, and how astronomers were trying to describe the path of the planets, starting from the wrong assumption that the earth was the center of the universe. They came up with elegant and complex theories that sometimes could predict the position of the planet. Men spent their entire lives on these theories. To let them go took enormous courage and great pain. That conversation comes after I and the client understand the complex rules that govern their "planetary movement" and we've paid tribute to the fact that the rules can in some ways predict and control their experiences." Perhaps techniques as interviewing for solutions (De Shazer) can be useful here. Progress to the next phase can be seen when clients express doubts about their system of coping and avoidance. Personal work for the clinician is building on the work on page 80. Somehow this questioning is a bit too abstract for me-as-a-client. Me-as-a-client needs a bit more encouragement and support as to what is a problem, how can I analyze it in ACT terms, what level of detail is required to gain awareness or insight. I like to be as concrete and detailed as possible, and I try to find out what exactly is is what a client did (does), thought (thinks) and felt (feels) when using his or her strategies. Underneath abstract descriptions of an apparent intelligent strategy can hide a completely invalid schema (can I use such a term here?).