The following three principles are the essential bare bones strategies for the therapist wishing to help clients improve their psychological flexibility:
Help the client discern the relationship between what they do and the problematic consequences they experience.
Help the client discern their own thoughts, emotions, and physical sensations by establishing an observational distance from them as they emerge.
Help the client use this skill to clarify what is important in their life and what would be concrete steps in that direction.
Here is a more in depth look at the second essential concept.
Help the client discern his own thoughts, emotions, and physical sensations by establishing an observational distance from them as they emerge.
In keeping with and supporting the first essential point, in order for someone to discern problematic responses, there needs to be an ability to be aware of the situation as it arises in order to be able to anything about it. This is one of the main goals of any mindfulness based approach and it is no different in Acceptance and Commitment Therapy (ACT).
Put another way, just think about one of the main underlying goals in many therapeutic approaches, we are working to help a client become more aware of the many aspects of them self through a dialectic process, with specific questions about past behaviors, in order to help the person to better "see" (gain distance from) and predict their behavior.
If this can be accomplished they will now have an opportunity to try something new other than what they might typically do, offering them a possibility that was until then, unavailable versus the problematic consequences they would experience.
But what is it that compelled them to react the way that they did in the first place?
What to watch for in session:
The client-therapist relationship is an ideal setting, especially when looking at the ABC of the situation for a clinician to note escape, avoid, or control strategies. If the client changes the subject abruptly, falls silent, becomes belligerent, highly emotional or dismissive, back the conversation up and then slow it down to double check for the object of functional analysis as it appears in the therapeutic interaction.
Again, this is still the A-B-C, antecedent, behavior, and consequence, happening right then in the session. You are getting a front row look at the underlying mechanism and its function. When you back everything up and slow it down, you are helping them to track what just occurred, something they are most likely, completely unaware that they are doing. If they are doing this with you right then in that moment, then there is a pretty high probability this response is involved in whatever challenge or challenges brought them in to sit in front of you.
What to Implement in session:
Rewinding a bit and then slowing down the conversation allows for an opportunity to be present with whatever personal event tried to come to the surface. Since problematic strategies commonly comprise attempts to avoid these personal events and the accompanying automatically triggered reactions, the focus should then shift to that state. From a behavioral point of view, this serves as an exposure to such phenomena and an emotional processing of them.
Consider using questions like the following when an occurrence like described shows up in response to either and functional analysis or difficulty in clarifying personal values and actions that might move them in a fulfilling direction:
Did you notice that shift there a moment ago?
Can you take a moment with me and notice what showed up for you physically in your body right before the mood/topic shifted?
Could you point to where in your body that you felt that?
If it had a shape, color, texture, what would those be?
Can you hold onto that sensation and look back across your life and tell me when you first recall experiencing this physical reaction? Where were you? How old were you?
A useful acronym for this type of personal event and all of the relational frames would be TEAMS: Thoughts, Emotions, Associations, Memories, and Sensations. They are always connected to each other and act as triggers making it more and more difficult over time to avoid such a personal experience. It is like a cob web, that if we touch anywhere on that web, we set off the whole web. Another consideration is that when this response was initially done (and most likely a good many of other times since then) the behavior (the response) was positively reinforced.
In essence, we are helping them develop an ability to "track" a personal event when it happens and trace along with them where their mind goes and in doing so. In doing so, we can tie this personal event back to the first essential point, allowing them to see the necessity of the rule that formed, when it formed and help free them from a rigid adherence to the rule and the compulsion to automatically respond in a way that does not work for them in the present moment (context) nor in the long run.
Main Take Away
Psychological inflexibility, as understood by RFT, is our tendency to interact with our own reactions without distinguishing them from ourselves as acting beings. If you think about this, it makes perfect sense, since our reactions are an aspect of ourselves.
Where we get into trouble, and what we need to watch for is where an individual generalizes their responses and uses them automatically across all contexts. That is what this step is all about. Making space to be able to “see’ this process.
By taking time to identify the A-B-C's and watching them as they show up in session, we can pause the conversation there and help them to get present in the moment and notice all that is coming up for them. Think mindfulness or situational awareness, with one of the most effective inquiries being on what is happening physically right in that moment they jumped away.
Developing the ability to establish an observational distance from our own reactions in situations when these reactions (what we feel, think, sense, and remember) risk misguiding and giving us unworkable responses is absolutely essential to all work with psychological change and is the core of psychological flexibility training and of this second essential strategy.
What the client thinks, how you the clinician is experiencing, and the meaning we attach to all of this is what we are trying to both do and model in that moment. In doing this we help to distinguish this as part of us, and yet not completely us as a being in action.
It allows us all, and specifically in this case the client, a way to see that they can experience life in a certain way and then choose what to do next based upon what will matter to them in the long run (which is the essence of the third essential strategy). This is often referred to as emotional processing. Again, we can observe what we feel and sense and then choose how we will respond rather than reacting more or less automatically to whatever is occurring.
This is not the easiest skill to develop since some of these spontaneous emotional reactions are intense and have been the object of avoidance for, in many cases, decades. Yet, this process is truly psychotherapeutic in that it allows for a controlled exposure strategy that works seamlessly with the functional analysis approach described in part one of this series and is essential in establishing an observational distance from reactions needed in order to redirect our actions toward that which is important to us.
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