Getting Unstuck in ACT: A Clinician's Guide to Overcoming Common Obstacles in Acceptance and Commitment Therapy

by Russ Harris

Acceptance and commitment therapy (ACT) is a powerful, evidence-based treatment for clients struggling with depression, anxiety, addiction, eating disorders, and a host of other mental health conditions. It is based in the belief that the road to lasting happiness and well-being begins with accepting our thoughts, rather than trying to change them. However, ACT can present certain roadblocks during treatment. As a mental health professional, you may adopt basic principles of ACT easily, but it generally takes at least two or three years of hard work and ongoing study to become truly fluid in the model. During that time, you will probably find yourself "stuck" at some point, and so will your clients.

In Getting Unstuck in ACT, psychotherapist and bestselling author of ACT Made Simple, Russ Harris, provides solutions for overcoming the most common roadblocks in ACT. In the book, you will learn how to deal with reluctant or unmotivated clients, as well as how to get past certain theoretical aspects of ACT that some clients may find confusing. This book will help clients deal with sticky dilemmas and unsolvable problems, and will help simplify key ACT concepts to help you break down psychological barriers.

Other common problems with ACT that the book addresses are inconsistencies and sending mixed messages, talking and explaining ACT instead of doing it, being too eager to treat a client, being a "Mr. Nice Guy or Ms. Nice Girl," or putting too much focus on one process while neglecting others. The chapters of the book are based in real life scenarios that take place between therapist and client, and the author provides feedback by analyzing mistakes in what was said and where improvements could be made.

As more and more mental health professionals incorporate ACT into their practice, it is increasingly necessary to have a guide that offers them effective solutions to common ACT roadblocks. For that reason, this book is a must-have for any ACT therapist.

Genres: Psychology, Social Work, Nonfiction, Counselling, Mental Health

224 pages, Kindle Edition

First published January 1, 2012

About the author

Dr Russ Harris is a medically-qualified doctor, stress consultant, executive coach, trainer, author, and a leading authority in the powerful new paradigm of Psychological Flexibility. (This is a revolutionary new development in human psychology that enhances performance, reduces stress, and improves health and wellbeing.) Dr Russ regularly presents workshops on Psychological Flexibility at both national and international psychology conferences, and has a thriving business traveling around Australia running training seminars for psychologists, coaches and a variety of health professionals.

Dr Russ's first book, 'The Happiness Trap', was published in Australia in March 2007, and is already well on the way to becoming a bestseller. (The title reflects a key theme in the book - that popular ideas about happiness are misleading, inaccurate, and actually make us miserable in the long term.) He is currently completing his second book 'From Fear To Fulfilment' - which is also the title of his most popular talk.

Back in the early nineties, when Russ was a GP in Melbourne, he moonlighted as a stand-up comedian, and as well as appearing regularly on the Melbourne comedy circuit, he featured on TV shows such as Tonight Live with Steve Vizard, and The Mid-Day Show with Ray Martin. As a result of this experience, his talks are fast-paced, engaging and humorous - as well as being action-packed with information, tools, and techniques for reducing stress, enhancing performance, and increasing vitality.

Reviews

[Jeremy · Rating 5 out of 5]

Goodreads does not allow enough space in Private Notes or I would have put much of this information there. Sorry for such length, but these are my notes.


+ Common therapist problems:
Being inconsistent and sending mixed messages
Explaining ACT instead of doing it
Being too gung ho
Being Mr. Fix-It
Being Mr. Good Listener
Being Mr. Nice Guy
Being Mr. Dismissive
Being Mr. Grab-a-Tool
Trying to convince or be right
Taking a one-up position
Excessive focus on one process over others
Lack of understanding of theoretical underpinnings
Impersonating your ACT trainer

+ Two key questions:
What valued direction does the client want to move in?
What’s getting in the way?

+ Six main categories of fusion:
Reasons
Rules
Judgments
Past
Future
Self-description

+ Four main categories of payoff for problematic behavior:
We get to feel good
We get to avoid or get rid of uncomfortable thoughts and feelings
We get to escape from an unpleasant situation
We get attention

+ Four steps to selling ACT to reluctant clients:
Empathize
Normalize and validate
Declare your values
Use the Free Will Switch metaphor (“With the switch on, you’re here for you and can use this time to make your life better, as defined by you”)

+ Five step Off-Track, On-Track technique:
Agree you’re a team
Predict interference from the mind
Notice and name the mind’s tactics
Establish the unworkability of stopping the session
Repeat as required

+ Three main stuck areas for values:
When to bring them in
How to bring them in
How to handle negative reactions

+ Two standard questions for the first session:
Do you ever experience a sense of meaning, purpose, or fulfillment?
If our work could make an important difference in one relationship, which one would that be, and how would you behave differently in that relationship?

+ Steps for introducing values:
Why do values matter?
What are values?
Directly connect with values through experiential exercise(s)
Help clients put their values into words

+ Key questions about destructive behaviors:
What beliefs or rules is this person fusing with? (Especially shoulds)
What emotions is this person struggling with?
What values might we find beneath the fusion and avoidance?

+ Steps to interrupting unworkable behavior:
Acknowledge that it’s rude to interrupt
Genuinely apologize for interrupting
Give a rationale for why it’s necessary

+ Six steps to undermining unworkable behavior:
See the client’s behavior as an opportunity
Respectfully interrupt the behavior
Nonjudgmentally describe the behavior
Clarify the intention of the behavior
Consider the workability of the behavior
Reinforce an alternative workable behavior

+ Elements of interruption requests:
Asking permission
Being willing to be wrong
Giving a rationale
Agreeing to an interrupt signal

+ Three approaches for preventing resistance to acceptance:
Choosing our words carefully
Explaining acceptance effectively
Preceding acceptance with grounding and defusion

+ Common sticking points in acceptance:
Lack of validation from therapist
Remoteness from values
Strong payoffs for avoidance
Fusion with the thought “But I hate it!”
“Overwhelming” feelings
Pseudoacceptance

+ Three questions for creative hopelessness:
What have you tried to make the pain go away?
How has that worked in the long term?
When you used these strategies excessively, what has it cost you?

+ Four ways of unintentionally keeping clients stuck in fusion:
Intellectualizing
Invalidating
Being inflexible with technique
Encouraging pseudo diffusion

+ Two basic steps for workability of fusion:
Notice the thought
Consider the workability of acting on it

+ Three main problems with the self:
Labeled self (Can be used to avoid action: I can’t because I’m depressed; Target with defusion)
Underdeveloped self (Target with contacting the present then values clarification)
Disconnected self (Target thought flexible perspective taking)

+ Three main ways of getting stuck with observer self work:
Unclear about when and why it’s indicated
Overcomplicate the way we present it
Get thrown by client’s objections

+ Four indications for using observer self:
Aids in defusion, especially from conceptualized self
Aids in acceptance
It’s an important aspect of spirituality
Powerful experience for survivors of trauma: A part of you came through unharmed

+ 10 strategies for motivating the unmotivated
Link the goal to values
Set goals effectively
Take small steps
Use the carrot, not the stick
Anticipate obstacles
Confront the costs
Cultivate willingness
Defuse from reason giving
Enlist support
Use reminders

+ 10 steps to dealing with a difficult dilemma:
Establish there is no quick fix
Analyze the costs and benefits
Help client recognize there is no perfect solution
Explain there is no way not to choose
Ask client to acknowledge today’s choice
Encourage client to take a stand
Recommend client to make time to reflect
Help client name the story
Encourage client to practice expansion
Help client develop self-compassion

+ Three elements to self-compassion:
Mindfulness
Kindness
Common humanity

+ General tips and advice:
- Exercises: Pushing Paper, Hands as Thoughts, Be Aware You’re Noticing
- Ensure sessions end with some sort of commitment
- Start each session with a review of the commitment
- Strong emotions are often linked to important values
- Set an agenda and follow it
- Consider: Am I willing to feel discomfort in the service of helping my clients?
- Don’t spend so much time talking about the problem that you never get around to doing anything constructive about it
- Not interrupting problematic behavior is reinforcing it (“You’ll feel better for a while because someone has listened to you and treated you nicely, but nothing much will change”)
- There are many ways to teach mindfulness skills that don’t require that clients meditate
- Always start with the assumption that destructive behavior isn’t a reflection of core values (Destructive or antisocial behavior is usually caused by fusion with unhelpful rules and beliefs rather than antisocial values)
- Values conflicts are usually conflicts of time allocation or conflicts between rigid rules
- “I don’t know how to make pain go away permanently, but I do know a different way of responding to it so it has much less impact and influence.”
- Observer self is only one of many possible outcomes with Self-as-Context. SAC includes many relations from the perspective of “I, Here, Now.”
- “On a scale from 0 to 10, how likely are you to actually do this?” If less than 7, consider changing the goal to something smaller and easier



Potent Quotables:

The more stuck the client, the more stuck the therapist - and vice versa.

* “Success is not final. Failure is not fatal. It is the courage to continue that counts.” Sir Winston Churchill

* An anchor doesn’t make the storm go away; it just holds you steady until the storm passes.

In the long term, does this work to give you the life you want?

Just because your mind says something doesn’t mean you have to obey it.

The mind is a problem-solving machine: whenever it encounters something unwanted, it tries to either avoid it or get rid of it.

At the moment, your thoughts and feelings are mostly in control of your actions, and that’s obviously not working too well for you.

What creates anxiety disorders is not anxiety itself, but ineffective ways of responding to it.

The point of doing this isn’t to get rid of these feelings, but to free you from struggling with them. When you drop the struggle, you can put your energy into doing the things that really matter to you.

If we wait until the mind stops giving reasons, we’ll never get started.

Suffering isn’t something weird, abnormal, or pathological: it’s part of the human condition.

[Nicholas Hatcher · Rating 5 out of 5]

I completed this book after reading ACT Made Simple. This book was an excellent extension of the work done by Russ Harris. He provides a well-structured approach to common problems and "stuck points" in ACT. I have been able to successfully implement some of these techniques and find them largely beneficial. This book is recommended recommended the ACT therapist who wants to build on ways to work with problems encountered while performing ACT. I highly recommend his work and look forward to reading his other publications.

[Joseph Santiago · Rating 5 out of 5]

This book introduced me to the ACT for therapy and after reading it I feel like I just went through training. It is a great resource that presents complicated information in easy to understand chunks. I’m happy to have discovered it and recommend it as a good read!

Joe

[Amy · Rating 3 out of 5]

Good reminder of skills to use as a clinician however I’m not sure how ACT it is. This seemed more like a “what to do when a client is —-“ I am eager to read Harris’ book of ACT made Simple; perhaps that will provide more ACT specific techniques.

[Kelly Michelle · Rating 5 out of 5]

Great practical ideas for managing challenges in ACT. Will definitely be practicing some of these! This book is for clinicians who already have a knowledge of and are actively using Acceptance and Commitment Therapy in their practice rather than a beginners guide to the approach.

[Kayley · Rating 5 out of 5]

Really helpful and straightforward primer on the things that might trip us up in ACT and how to overcome them. I implemented some of these tools with my clients while reading and saw immediate benefit.

[Jennifer Vahsholtz · Rating 5 out of 5]

Great next level for using ACT. This is not an introductory book. As the intro says, if you haven’t read other ACT books then don’t start here! You’ll be lost. But if you are already loving and using ACT this is a great next read.

[Yorgo · Rating 5 out of 5]

Great book on how to overcome struggles with a patient when practicing ACT.
I will definitely have to re-read this one a few times and practice the lessons to really make it stick.

[Clint · Rating 5 out of 5]

Possibly one of the best ACT texts I've read so far.

[Adele · Rating 5 out of 5]

Great as all Russ Harris books are

[Mark · Rating 5 out of 5]

how to get unstuck

This is a great book on ways to get unstuck when you are working with clients and you hit that preverbal wall.