The simplest way to get in the therapy room as a person rather than simply as a thera- pist is to use words that convey what you are currently experiencing. That is, you make a statement about what’s going on with you in that moment (a thought, feeling, or sensation), rather than restricting yourself to asking a question or making an observa- tion about the client.
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Advanced ACTScenario 1: The therapist notices that the client has a confused expression, and
wonders whether the client understood what she was saying.
EXAMPLE 1.
Therapist: “You seem confused. Is what I’m saying making sense to you?”
EXAMPLE 2.
Therapist: “I just noticed that I’m worrying about whether I’m making any sense. What’s going on for you?”
In the second example the therapist has simply included her experience. Even though the difference is quite slight, there’s much more going on here. “I just noticed (modeling present-moment, defusion) that I’m worrying about whether I’m making any sense (defusion; self- as- context; being authentic, vulnerable, and equally human). What’s going on for you (furthering being present and willingness)?”
Scenario 2: The therapist and client have been working on values, and the client has
balked when asked to come up with concrete goals around establishing friendships.
EXAMPLE 1.
Therapist: “You just said you don’t care about making friends, but
I remember that was one of the first things you mentioned when we started out.”
Client: “Well, I don’t know. Sometimes I want friends, but sometimes I don’t want the hassle. I’m more of a loner anyway.”
Therapist: “So you are having the thought that you’re a loner, because making friends seems like too much hassle?”
And therapy goes on from here. For comparison, let’s look at the same scenario with the therapist getting in there on a more personal level:
EXAMPLE 2.
Therapist (after client balks when asked to come up with concrete goals around establishing friendships): “Hmmm. I’m not quite sure what to do with this.” (Pauses.)
Client (waits, then): “What do you mean?”
Therapist: “Let me stop and think a moment because I want to get clear (long pause). Well, there’s a lot going on. I’m noticing that I want to
Style Matters
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point out that earlier on you were pretty clear about wanting to have more friends, so one thought I’m having, a question really, is whether you are avoiding something right now by saying that you don’t care about friendship. But I’m also realizing that I might be putting my own value on you. That is, I happen to believe that your life would be enhanced if you had more meaningful relationships, but I’m realizing that might be my value, not yours.”In this exchange we can almost imagine the client coming back with “Well, I do want more meaningful relationships, but…” There is an opening there. The therapist essentially modeled being authentically present to what was happening, creating an opening for the client to do the same.
In the second exchange, the therapist’s authentic use of her experience in the moment helped her avoid a potential barrier with her client (such as a power struggle or debate over whether or not the client wants to develop friendships) and also fur- thered the therapy. The therapist used present- moment awareness and willingness to work with something potentially difficult. This approach can also enhance positive developments in session. Said another way, I have noticed at times that therapists’ tendency to leave themselves out—sticking with offering observations, interpretations, or questions about the client—can actually diminish the good stuff that also happens in session.
Scenario 3: The client suddenly announces near the end of a session that she has
decided to make an extremely bold move and contact her daughter, whom she’d given up for adoption nearly thirty years ago.
EXAMPLE 1:
Client: “…and then I just got on that online service and there she was! There was my daughter… .She’d been looking for me.” (Begins to cry.)
Therapist: “That must have been so amazing to see her there! What was that like for you?”
Client: “I couldn’t believe it! I was scared, but I e- mailed her and she wrote me right back. We’ve been exchanging e- mails and even talked on the phone— we’re making plans to meet each other in person.”
Therapist: “That was a bold move.” Client: “Yeah, I still can’t believe it.”
Therapist: “You chose to make that move even though you’ve had fear around it for thirty years.”
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Advanced ACT Client: “Yeah.”Nothing untoward here. However, let’s explore an alternative:
EXAMPLE 2:
Client: “…and then I just got on that online service and there she was! There was my daughter… . She’d been looking for me.” (Begins to cry.)
(Therapist is silent but listens attentively. Specifically, she uses nonverbal behaviors such as facial expression and body position to convey absolute absorption and recognition of the importance of what the client is saying. The client begins to cry harder, then releases and really begins to sob. The therapist remains silent, making it clear by her demeanor that there is plenty of room in the session for the client’s emotion.)
Therapist (as the client begins to quiet): “I am really moved by what you are telling me.”
Client (through fresh tears): “I know. This has been my whole life.” Therapist: “I am so moved, and so impressed by you, and so very excited for
you and your daughter.”
Client (absolutely lit up): “Thank you! Thanks for helping me get here. I can’t believe it!”
Hopefully you can see the difference I am talking about here. One response is fine; in the other, where the therapist meets the client and connects at an authentic, emotional level, the exchange is far more vital. In ACT we are continually on the lookout for experiential avoidance, out of recognition of how costly the control agenda can be. We look for opportunities to demonstrate that it is possible to notice and hold whatever is there, pleasant or unpleasant. For many, strong emotion of any kind is uncomfortable. We fear and avoid “being a mess” and then wonder why life has become flat. In this session the therapist did not settle for simply acknowledging the positive step the client had made. Rather, she leaned fully in to the experience, revel- ing in its richness and helping her client do the same.