ACT Book Summary: Pages 119 - 125

Giving the struggle a name - control is the problem Continuing to explore unworkable strategies (i.e., "digging" in the man in the hole metaphor) without interpretation. The goal here is to explore the form and function (immediate goals) of client's behaviors and hold these up against the change agenda. At this point in time there is no need to do any more than just touch and clarify these behaviors and their functions. Eventually the goal is to lump these responses into a single class "emotional control" The rule of private events The key lesson here is that purposeful control works in the successful manipulation of external events but that the same strategies do not work in controlling private events as these are governed by historical and automatic factors. The rule "if bad events are removed, then bad outcomes can be avoided" is not effective with regards to private events. On pages 120-122 is a good transcript showing a therapist bringing out the paradox of control:

• If I'm not willing to have it (e.g., anxiety), I have it
• If I don't get so uptight about being anxious, I will be less anxious
• If I am willing to have it in order to get rid of it, I am not willing to have it and I will have it again

Polygraph metaphor (page 123) is a core intervention in this stage of therapy - particularly useful for anxiety or mood disordered clients. In short the metaphor describes being hooked up to the most sensitive and accurate lie detector ever built. The task is simple, STAY RELAXED. An extra incentive is given, "stay relaxed or I’ll shoot you". Not surprisingly, any hint of anxiety would escalate ("Oh my god, I’m getting anxious.") and BAM!, it’s all over. There are three elements that can be drawn from this metaphor:

1. contrast between controllable behaviors (i.e., paint the wall or I will shoot you) versus behavior that is not regulated successfully by verbal rules (relax or I'll shoot you)
2. People carry their own polygraph with them all the time (their nervous system) and their own gun (self-esteem, self-worth). They are constantly monitoring for symptoms (e.g., anxiety) and firing the gun at themselves
3. How seemingly successful attempts to make situation work, don't work in the long term. For example, taking valium may help you relax initially but what about when it wears off?

Chocolate cake exercise (124) - particularly effective with clients struggling with obsessive thoughts or ruminations In short, don't think about delicious warm chocolate cake with icing and cream! (yum) Two things here:

1. either it is particularly difficult not to think about it (me included in this group)
2. or attempts to not think about it (e.g., "I thought about something else") actually require you to think about chocolate cake (you have to know what you are not thinking about)

Similar idea can be applied to physical reactions (e.g., salivation) "The key lesson here is for the client to make direct contact with the ineffectiveness of conscious purposeful control in these domains" (my own personal comments: I really like these ideas, and regularly use similar concepts no matter what therapeutic style I am incorporating. I think a lot of these ideas have filtered into the CBT framework, whereby automatic thoughts are treated more as uncontrollable private events and B (behavior change) is emphasized. The only trouble I have with some of this stuff is picking those clients that respond well to discussing these kinds of issues. This is totally my personal opinion, but I think many therapies suffer from some kind of intellectual bias, that is, techniques developed by well-educated, trained minds. I have trouble breaking down psych concepts to layman concepts. This is not a big issue at this stage, because the use of metaphors breaks down that barrier, but when it comes later to exploring the traps of language, I think this is so.