Acceptance and Commitment

Therapy: Advanced
Workshop

Julian McNally

Program Outline
Review Of ACT Model
Getting Stuck Into Getting Stuck
7 Frequent Problems And How To Respond
Sweet Spot And Client Descending
Matrix For Case Formulation
Developing Mastery In ACT

Contact with the Present

Moment

Values, Purpose &

Meaning

Acceptance & Willingness

Psychological
Flexibility

Defusion

Committed Actions
Transcendent Sense of
Self/ Self As Context

Hexaflex
ACT Model of Effective Living

Dominance of
Conceptualised Past or
Feared Future
Lack of Values Clarity or
Contact

Experiential Avoidance

Inaction or Disorganised
Activity

Fusion

Attachment to Storied
or Conceptualised Self

InFlexaHex
ACT Model of Psychopathology

Mindfulness & Acceptance

Behaviour Change
Processes Contact with the Present Processes
Moment

Acceptance & Willingness

Values, Purpose &

Meaning

Defusion

Committed Actions

Transcendent Sense of
Self/ Self As Context

Hexaflex
ACT Model of Effective Living

Your turn!
Pair up - one is A the other is B
Decide who will be client first
Brief your partner on presenting problem, but not whats
tricky about this client
Counsellor: Notice yourself getting stuck. Observe thoughts
and feelings
Client: observe and resist urge to be agreeable or make it
easy for counsellor
If counsellor is not getting stuck, brief client on what the
actual client does thats tricky and try again. Switch.

Getting Stuck Into Getting

Stuck
My experience is not authoritative because it is
infallible. It is the basis of authority because it can
always be checked in new primary ways. In this
way its frequent error or fallibility is always open
to correction.
Carl Rogers, On Becoming a Person

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?

7 Frequent Problems
1
2
3
4

6
7

What do I do if I get stuck?

Do I need to cover all 6 processes?
What if they say it didnt work?
What if they dont know/cant say what their values
are or dont have any?
What do I do with clients who are
sceptical/concrete/psychotic?
What if they (or I!) dont get Self-As-Context?
What do I do with clients who are fused with their
beliefs or a sick or victim role?

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 clients experience before yours

Listen to experience before models and ideas

Invite a change in action rather than in understanding or

feeling

Do I need to cover all 6

processes?

No!

What if they say it didnt

work?

Is there a control agenda in place?

Try another part of the model

Try a different technique from the same part

What if they dont know/cant say

what their values are or dont have
any?
How do they know they dont 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

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 dont 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

What if they (or I!) dont get

Self-As-Context?
Lets practise!

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

What if they are fused with their

beliefs or a sick or victim role?

Try Self-As-Context

Be curious and empathic

Appeal to workability

Template for Experiential

Exercises
1

Recognise your mind will interfere, so slow down

and accept

Contact with present moment sounds and touch

Locate the moment of choice or stuckness

Immerse in the moment (file cabinet or movie screen)

Open eyes and express it

Hold the moment silently and appreciate

Sensory Experience
Valued Living

SwS

Mental Experience

The Grid - Kevin Polk

Even Simpler Model of ACT Processes

I think that...
Im having the thought that...
I notice Im having the thought that...

This is
unbearable

I notice those thoughts

are there again

Recontextualising the Problem

The Life Im left with

Depressed
Unmotivated
Unemployed
Indecisive
Overweight
Unloveable
Need therapy!

What I want my
life to stand for
Depressed
Unmotivated
Unemployed
Indecisive
Overweight
Unloveable
Need therapy!