Resultados, Análisis y Discusión

Most of the strategies just discussed are aimed at undermining literal attachment to smaller sets of mind chatter. Different strategies are required to work on more complex forms of mind behavior. The mind holds extended and interconnected forms of verbal behavior, such as clients’ stories about who they are, how they came to be the way they are, and reasons for doing what they do. These stories and reasons provide the verbal glue that creates the incredible stability of many unworkable patterns of behavior.

As humans, we are taught that we must have explanations for our behaviors, and furthermore that these explanations must be coherent. In the realm of behavior that doesn’t work, we all the more so are expected to have good explanations. The social community demands a person with depression have a really good reason for not getting out of bed or to account for not having worked in three months, and so on. For example, for some people, having a “chemical imbalance” is a good reason for depressed behav- ior. Data exist that show people who think they have good reasons for their depression tend to be more depressed and less responsive to therapy (Addis & Jacobson, 1996).

Unfortunately, through attachment to these stories, these verbal networks come to control our behav- ior. Our past becomes our future, with the potential for very negative outcomes. If a client has a story that he or she can’t have good relationships because of being abused as a child, then that client is really stuck because no other childhood can be had. If the client is unable to see this story as one of many possible stories, but rather fuses with it and sees it literally as “the truth,” then we can easily see how he or she might not engage in finding a relationship. It becomes particularly difficult if clients also buy that they are right about their stories. They can get stuck in very difficult and unworkable patterns of behavior. Fortunately, defusion seems to modify attachment to the validity of reasons to an even greater degree than does cognitive disputation of them (Zettle & Hayes, 1986).

Consider Jessica. A few years ago, she was diagnosed with bipolar disorder following an episode of manic behavior. She since has engaged in extensive reading about what people diagnosed with bipolar

disorder are like and how it is a genetic problem resulting in a chemical imbalance in the brain. She feels that because this is biological, she is doomed to repeat endless cycles of excruciating lows and out-of-control highs for the rest of her life, and that there’s not much she can do about it. Although her acknowledgment of the diagnosis of bipolar disorder might be potentially helpful in some ways, her story suggests she cannot recover and thus has no reason to try.

As with most clients in such a situation, Jessica has good evidence for her story in the form of research and personal anecdotes of medications helping her. She has been following this story for several years, with the outcome that she takes her medications, but doesn’t take many other active steps to improve her life. From an ACT perspective, the question is not whether this story is literally true, but whether it is helpful. Does it lead Jessica toward the kind of life she wants?

The basic strategy ACT uses to undermine attachment to unhelpful stories is to help clients make experiential contact with their constructed nature so their focus can turn from the literal truth of the story to its workability. These strategies are aimed at helping clients develop a healthy skepticism about the mind’s ability to evaluate and explain aspects of personal history in a useful way. The following transcript provides an example of how a therapist can introduce this idea.

Therapist: We’re constantly telling ourselves a story about our lives. In the background, there’s a voice

that is always narrating about things—telling us about who we are, what we like, how things are going, and so on. It’s constantly going, and it’s narrating a story to you. The question is, is that story necessarily true? From where did it come? For instance, if I ask you what happened three days after your eleventh birthday, and I want to know in detail about that day, would you be able to tell me?

Client: Hmm. No.

Therapist: [playfully] How about four days after or five days after? [pause] We could try even one

hundred days, and you might catch one or two details. We know very little about what went on in our lives. We remember just a few snippets, and we string these little pieces together into a story. Do you see this? We have these little snippets of things we remember, and massive portions of what happened are missing. We then try to string it all together and create stories to make sense of the pieces we still remember. We tell these stories to ourselves frequently. We conclude things about ourselves—what we are capable of, who we are—and then we live out of that.

Client: I see.

Therapist: Interestingly, these stories build. Our minds just keep taking in new stuff. And this isn’t

something that just happened way in our past; it’s happening right now. Let’s do an exercise about new content being added all the time … and about how we usually don’t even recognize it. I’m going to tell you about an imaginary creature called a Gub-Gub (Hayes & Smith, 2005). If you remember what the Gub-Gub says, then we have a million dollars set aside to give to you. Are you ready? Here it is. Gub-Gubs go “Wooo.” Can you say it?

Client: Wooo.

Therapist: Now, don’t forget it. Because if I ask you tomorrow and you get those million bucks, it’s worth

it. What do Gub-Gubs say?

Therapist: Okay, so now I have to let you know that there’s no million dollars. So you can just forget it.

What do Gub-Gubs say?

Client: [laughs] Wooo.

Therapist: Suppose I came back in a month. Would you know what Gub-Gubs say? Client: Sure.

Therapist: How about two months? A year? What do Gub-Gubs say? Client: [chuckles]

Therapist: If we spent a bit more time talking about Gub-Gubs, it might be that I could visit you at your

deathbed and say, “What do Gub-Gubs say?” Might you remember? Now think about what this means. We spend a few minutes on something, and you carry it around in your head for the rest of your life. You have things like this that reach way back across your history. You may not be sure where it came from, but this is the stuff that’s your story. These are the thoughts you have about yourself. For example, “The worst thing about me is …” [pauses and directs the client to answer]

Client: I’m weak.

Therapist: The best thing about me is … [pause] Client: I’m kind.

Therapist: The reason I am so weak is …

Client: I never learned to be able to stand up for myself.

Therapist: Good. That’s a beautiful one. Magical. See how fun this is? [sarcastically] Your mind

generates explanations, stories, reasons for everything. We could go on, right? There’s a story for everything.

Other ACT techniques can point to this same issue and also serve to disrupt problematic in-session storytelling. Most clinicians have had the experience of a client who talks for hours about what has happened to him or her, eating up the session with complaints, explanations, and descriptions. One way to disrupt this process is to focus on the functional utility of the client’s talk. Therapist statements such as, “And what is this story in the service of?” or “Let’s say God came down and said you were 100 percent correct. How would this help you?” (Hayes et al., 1999, p. 164) bring the focus back to the immediate implications of the client’s talk and away from attempting to figure out, be correct, or analyze the situation.

Another example, called the autobiographical rewrite, has clients explore the largely arbitrary connec- tions between events in their life stories (Hayes & Smith, 2005, pp. 91–93). In this exercise, participants are given the homework to write their life story on a couple of pages. Following this, clients are asked to rewrite the story, keeping all the events exactly unchanged, but shifting the meaning and outcome of the story. The story is not challenged directly, but hopefully seen as one of many possible life stories that are available.

The ACT therapist is sometimes challenged on the grounds of the literal truth of reasons. Arguing back is almost always unhelpful. Instead, reasons are acknowledged as possibly helpful verbal formulations, and the question turns to, “What does your experience say … how helpful is this?” A client may also be asked, “Well, that sounds right. But which would you rather be: right or living a vital life?”

WORKING WITH ONGOING DEFUSION