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Advanced act-workshop-counselling-college-100410


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Advanced act-workshop-counselling-college-100410

  1. 1. Acceptance and Commitment Therapy: Advanced Workshop Julian McNally
  2. 2. Program OutlineReview Of ACT ModelGetting Stuck Into ‘Getting Stuck’7 Frequent Problems And How To RespondSweet Spot And Client DescendingMatrix For Case FormulationDeveloping Mastery In ACT
  3. 3. Contact with the Present Moment Values, Purpose &Acceptance & Willingness Meaning Psychological Flexibility Defusion Committed Actions Transcendent Sense of Self/ Self As Context “Hexaflex” ACT Model of Effective Living
  4. 4. Dominance of Conceptualised Past or Feared Future Lack of Values Clarity orExperiential Avoidance Contact Fusion Inaction or Disorganised Activity Attachment to “Storied” or Conceptualised Self “InFlexaHex” ACT Model of Psychopathology
  5. 5. Mindfulness & Acceptance Behaviour Change Processes Contact with the Present Processes MomentAcceptance & Willingness Values, Purpose & Meaning Defusion Committed Actions Transcendent Sense of Self/ Self As Context “Hexaflex” ACT Model of Effective Living
  6. 6. Your turn! Pair up - one is “A” the other is “B”Decide who will be client firstBrief your partner on presenting problem, but not what’s‘tricky’ about this clientCounsellor: Notice yourself getting stuck. Observethoughts and feelingsClient: observe and resist urge to be agreeable or make iteasy for counsellorIf counsellor is not getting stuck, brief “client” on what theactual client does that’s ‘tricky’ and try again. Switch.
  7. 7. Getting Stuck Into “Getting Stuck”My experience is not authoritative because it isinfallible. It is the basis of authority because it canalways be checked in new primary ways. In thisway its frequent error or fallibility is always opento correction.    Carl Rogers, On Becoming a Person
  8. 8. Bennet and Cari• Notice your reactions and make peace with them• Provide an ACT-consistent response• Where is the client on the Hexaflex?• Where are you on the Hexaflex?
  9. 9. 7 Frequent Problems1 What do I do if I get stuck?2 Do I need to cover all 6 processes?3 What if they say “it didn’t work”?4 What if they don’t know/can’t say what their values are or don’t have any?5 What do I do with clients who are sceptical/concrete/psychotic?6 What if they (or I!) don’t “get” Self-As-Context?7 What do I do with clients who are fused with their beliefs or a ‘sick’ or ‘victim’ role?
  10. 10. What do I do if I get stuck?General principles: Slow down! Be willing and accepting Hold your formulation and treatment trajectory lightly Stick closely to principles and loosely to techniques Listen to client’s experience before yours Listen to experience before models and ideas Invite a change in action rather than in understanding or feeling
  11. 11. Do I need to cover all 6 processes? No!
  12. 12. What if they say “it didn’t work”? Is there a control agenda in place? Try another part of the model Try a different technique from the same part
  13. 13. What if they don’t know/can’t say what their values are or don’t have any? How do they know they don’t know? When was the earliest (last) time they remember having values? Make the therapy about discovering/creating values? Check for semantic problems Detect values in the present
  14. 14. What do I do with clients who are sceptical/concrete/psychotic? “Trust your experience, not my words or your thoughts” Workability of scepticism Sideline “beliefs” and “being right” for a while You don’t have to do “mindfulness” – just pay attention Psychosis – ACT is not an EST – other treatments Metaphor-imperviousness? Present-moment defusion and willingness with Self-As-Context
  15. 15. What if they (or I!) don’t “get” Self-As-Context?Let’s practise!
  16. 16. Indicators Of Increased Capacity For Self-As-Context Detecting and defusing from rules and stories Increased perspective taking and noticing Noticing own processes of fusion and unwillingness Naming or joking about own scripts and stories Able to dispassionately examine value-contradictory behaviours and thoughts Recognising current choices and history as separate phenomena Relating to multiple conceptualisations of self as determined by context and values-in-the-moment
  17. 17. What if they are fused with theirbeliefs or a ‘sick’ or ‘victim’ role? Try Self-As-Context Be curious and empathic Appeal to workability
  18. 18. Template for Experiential Exercises1 Recognise your mind will interfere, so slow down and accept2 Contact with present moment – sounds and touch3 Locate the moment of choice or ‘stuckness’4 Immerse in the moment (file cabinet or movie screen)5 Open eyes and express it6 Hold the moment silently and appreciate
  19. 19. Sensory Experience SwS Valued Living Mental Experience The Grid - Kevin PolkEven Simpler Model of ACT Processes
  20. 20. “I think that...” “I’m having the thought that...” “I notice I’m having the thought that...” This is I notice those thoughtsunbearable are there again
  21. 21. Recontextualising the ProblemThe Life I’m left with Depressed Unmotivated Unemployed What I want my Indecisive Overweight life to stand for Unloveable Need therapy! Depressed Unmotivated Unemployed Indecisive Overweight Unloveable Need therapy!