ckm_a’s Reviews > ACT in Steps: A Transdiagnostic Manual for Learning Acceptance and Commitment Therapy > Status Update

"People often say, “I’m depressed,” or “I’m anxious,” or “I’m mad.” It is less common to say one feels that way. But it makes a difference. If one is something then it is really difficult to change that...Therefore, we prefer to say experiencing anxiety, feeling sad, or noticing depressive thoughts...as events that the person observes instead of is defined by."

"Don’t explain the six processes or draw the hexaflex...In ACT, we prefer to help clients pay closer attention to how things are working for them. Our goal is to decrease rule following. If clients can pay closer attention to how things work in their lives, then they can figure out ways of responding that will work better in the long run."

“Thus, watch for the pull to argue when the client says something that is factually wrong. Focus on what effect the thought has on the client...Just listen. There is something accurate in the client’s experience. It is your job to help the client find that and use it to guide their future choices...give them time to contact more experiences and they will see how things work for them."

“This is because by stating the rule, you are undermining their opportunity to contact direct contingencies in their life, to explore and reflect on their own experiences with anxiety, and to learn the consequences of how they react to it.”

"For example, saying “Struggling with anxiety is like struggling with quicksand” is more effective than saying “Struggling with anxiety is like struggling with quicksand—you know, the more you fight against it the larger it will be.”"

"We do everything we can to work with experiences in vivo rather than discuss them. We certainly avoid telling a client how something works. We would rather give them the space to work with it and then help them accurately appreciate what just occurred (i.e., see contingencies as they are, rather than the verbal representation of them). The client’s life will show the client how things work."

"Although I was sure to assess the severity and risk of suicidality later that session, I didn’t start there or treat the thoughts themselves as a sign she was at imminent risk. If I had treated the thought itself as dangerous and scary, then she would have as well, and we would have lost a perfect opportunity to practice defusion together."

"...I treated her suicidal thoughts like other thoughts we had discussed at previous sessions, focusing on the function of the thought (how she reacts to it) rather than its content. I did not make a big deal out of them. Toward the end of the conversation I said something like, “As long as you don’t act on those thoughts, we will have time to figure all this out.”"

"I (M.P.T.) once had a client tell me she thought about killing herself over the weekend. I believe my response was something like, “How powerful were those thoughts?” and “What did you do with them?” Making a mental note to assess risk later in the session, we continued that discussion, focusing on how she interacted with those thoughts...

"We understand their situation because we deal with many of the same things. We also have thoughts we do not like, that show up at the wrong time, and that interfere with the things we want to do. While our inner experiences may get in the way less, we can still relate to clients’ issue as fellow humans."