El modelo tres: NASDAQ, horizonte de inversión mes/ meses

Gathering a client history can take anything from a few minutes to an hour, depending upon the situation. For example, the excellent textbook ACT in Practice (Bach & Moran, 2008) recommends an entire session to take a detailed history and carefully conceptualize your client’s issues. On the other hand, ACT is increasingly used in primary care settings where the therapist may have only two or three sessions of fifteen to thirty minutes each, and this obviously necessitates a brief history (Robinson, 2008).

So once again, the message is this: adapt ACT to your own way of working, your own style, and your own clientele. And as part of taking the history, you can use whatever standardized assessment tools you like. A word of caution though: many popular assessment tools measure changes in the number or severity of symptoms (that is, changes in symptom form) but fail to measure changes in the psychological impact or influence of symptoms (that is, changes in symptom function). However, in ACT, our interest is in changing symptom function rather than form. So while there’s no absolute necessity for you to use ACT-specific assessment tools, such as the AAQ (Acceptance and Action Questionnaire), they can be very helpful. I won’t discuss such tools in this book, but you can down-load a wide variety at www.contextualpsychology.org/act-specific _ measures.

Before we move on to the nuts and bolts of history taking, take a look at figure 5.1 below. This figure summarizes the essence of most clinical issues from an ACT perspective.

Opening ACT

Figure 5.1 The Essence of Clinical Issues

This figure reminds us that the outcome we want from ACT is mindful, valued living. In other words, we want to reduce struggle and suffering (via defusion and acceptance) and create a rich, full, and meaningful life (via mindful, values-guided action). When we take a history, our clients generally find it far easier to describe their suffering and their struggles than to describe what a rich, full, and meaningful life would look like. However, we need to know both sets of information. Fortunately there are all sorts of tools and techniques to help people clarify their values, as we shall see later.

CASE CONCEPTUALIZATION: TWO KEY QUESTIONS

With regard to any client’s problem, we want to find the answers to two key questions:

The Essence or worsen life in the long run.

ACT Made Simple

54

2. What stands in the client’s way?

These two questions allow us to quickly conceptualize any issue from an ACT perspective. Let’s look at them in more detail.

What valued direction does the client want to move in? Here we seek to clarify values: How does the client want to grow and develop? What personal strengths or qualities does he want to cultivate?

How does she want to behave? How does he want to treat himself? What sorts of relationships does she want to build? How does he want to treat others in those relationships? What does she want to stand for in life? What does he want to stand for in the face of this crisis or challenging situation?

What domains of life are most important to her? What values-congruent goals does he currently have?

Once we can answer the question “What valued direction does the client want to move in?” we can use that knowledge to set valued goals and to guide, inspire, and sustain ongoing valued action.

And if we can’t answer this question, that tells us we’ll need to do some values-clarification work.

What stands in the client’s way? This question is about the three main barriers to mindful, valued living:

fusion, avoidance, and unworkable action. We can break it down into three smaller questions:

1. What unhelpful thoughts is the client fusing with?

2. What private experiences—thoughts, feelings, memories, urges, and so on—is the client trying to avoid or get rid of?

3. What is the client doing that restricts or worsens her life in the long run?

Put more simply:

 What is the client fused with?

 What private experiences is he avoiding?

 What unworkable action is she taking?

These three questions reveal the essence of any clinical problem: fusion, experiential avoidance, and unworkable action. (A quick reminder: “unworkable” means it doesn’t work to make life rich, full, and meaningful in the long run; it interferes with vital, valued living. When action is strongly influenced by fusion and avoidance, it’s likely to be unworkable.)

A BASIC GUIDE TO TAKING A HISTORY

For many of us, taking a history is not a neat, orderly, linear process (and it’s important to remem-ber, we don’t need to gather all our information in one session; we can always get more history later, as needed). Personally, to make this process quicker and easier, I ask my clients to fill out a couple of worksheets before the first session. (I either mail or e-mail the forms out, or ask the client to arrive

Opening ACT

twenty minutes early and complete them in the waiting room.) I give them Dissecting the Problem, and either the Bull’s Eye or the Life Compass. You’ll find these worksheets at the end of the chapter.

Please take a quick look at them now, then come back to this point. If we want to broadly assess values in different domains of life, the quickest and easiest form is the Bull’s Eye, which divides life into four domains: work/education, health/personal growth, relationships, and leisure. More complex but still very user-friendly is the Life Compass, which divides life into ten domains. You might like to experiment with both and see which works best in your practice. I personally use the Bull’s Eye initially with lower-functioning clients, and the Life Compass initially with higher-functioning clients.

The Dissecting the Problem worksheet breaks down the client’s “struggle and suffering” into its key components: fusion, avoidance, and unworkable action. I ask my clients to complete these worksheets to the best of their ability and bring them along to the first session. I explain that even if they only write a few words, that’s a good start. Alternatively, you can fill these worksheets in during the session or give them as “homework” to complete after the session.

Now let’s go on to the history itself. What follows is a very basic guide to taking a history.

Each of the numbered sections can be briefly covered in a few minutes or explored in depth over a much longer time frame, depending on your needs. There’s no need to ask all the questions in each section: they are merely guides. (Note: The term “thoughts and feelings” is short for “thoughts, memories, images, emotions, sensations, and urges.”) You can download a simplified version of this history guide from www.actmadesimple.com. Read through the guide now, and then we’ll explore it in more detail.

ACT Made Simple

56