Acceptance and
Commitment Therapy:
Advanced Workshop
Julian McNally
Program Outline
Review Of ACT Model
Getting Stuck Into ‘Getting Stuck’
7 Frequent Problems And How To Respond
Sweet Spot And Client Descending
Matrix For Case Formulation
Developing Mastery In ACT
Contact with the Present
Moment
Values, Purpose &
Meaning
Acceptance & Willingness
Psychological
Flexibility
Defusion
Committed Actions
Transcendent Sense of
Self/ Self As Context
“Hexaflex”
ACT Model of Effective Living
Dominance of
Conceptualised Past or
Feared Future
Experiential Avoidance
Lack of Values Clarity or
Contact
Fusion
Inaction or Disorganised
Activity
Attachment to “Storied” or
Conceptualised Self
“InFlexaHex”
ACT Model of Psychopathology
Mindfulness & Acceptance
Behaviour Change
ProcessesContact with the PresentProcesses
Moment
Acceptance & Willingness
Values, Purpose &
Meaning
Defusion
Committed Actions
Transcendent Sense of
Self/ Self As Context
“Hexaflex”
ACT Model of Effective Living
Your turn!
Pair up - one is “A” the other is “B”
Decide who will be client first
Brief your partner on presenting problem, but not what’s
‘tricky’ about this client
Counsellor: Notice yourself getting stuck. Observe thoughts
and feelings
Client: observe and resist urge to be agreeable or make it
easy for counsellor
If counsellor is not getting stuck, brief “client” on what the
actual client does that’s ‘tricky’ and try again. Switch.
Getting Stuck Into “Getting
Stuck”
My experience is not authoritative because it is
infallible. It is the basis of authority because it can
always be checked in new primary ways. In this
way its frequent error or fallibility is always open to
correction.
Carl Rogers, On Becoming a Person
Bennet and Cari
•
Notice your reactions and make peace with them
•
Provide an ACT-consistent response
•
Where is the client on the Hexaflex?
•
Where are you on the Hexaflex?
7 Frequent Problems
1
2
3
4
5
6
7
What do I do if I get stuck?
Do I need to cover all 6 processes?
What if they say “it didn’t work”?
What if they don’t know/can’t say what their values
are or don’t have any?
What do I do with clients who are
sceptical/concrete/psychotic?
What if they (or I!) don’t “get” Self-As-Context?
What do I do with clients who are fused with their
beliefs or a ‘sick’ or ‘victim’ role?
What do I do if I get stuck?
General principles:

Slow down!

Be willing and accepting

Hold your formulation and treatment trajectory lightly

Stick closely to principles and loosely to techniques

Listen to client’s experience before yours

Listen to experience before models and ideas

Invite a change in action rather than in understanding or
feeling
Do I need to cover all 6
processes?

No!
What if they say “it didn’t
work”?

Is there a control agenda in place?

Try another part of the model

Try a different technique from the same part
What if they don’t know/can’t say
what their values are or don’t have
any?
 How do they know they don’t know?
 When was the earliest (last) time they remember
having values?
 Make the therapy about discovering/creating values?
 Check for semantic problems
 Detect values in the present
What do I do with clients who are
sceptical/concrete/psychotic?

“Trust your experience, not my words or your thoughts”

Workability of scepticism

Sideline “beliefs” and “being right” for a while

You don’t have to do “mindfulness” – just pay attention

Psychosis – ACT is not an EST – other treatments

Metaphor-imperviousness? Present-moment defusion
and willingness with Self-As-Context
What if they (or I!) don’t “get”
Self-As-Context?
Let’s practise!
Indicators Of Increased
Capacity For Self-As-Context
 Detecting and defusing from rules and stories
 Increased perspective taking and noticing
 Noticing own processes of fusion and unwillingness
 Naming or joking about own scripts and stories
 Able to dispassionately examine value-contradictory
behaviours and thoughts
 Recognising current choices and history as separate
phenomena
 Relating to multiple conceptualisations of self as
determined by context and values-in-the-moment
What if they are fused with their
beliefs or a ‘sick’ or ‘victim’ role?

Try Self-As-Context

Be curious and empathic

Appeal to workability
Template for Experiential
Exercises
1
Recognise your mind will interfere, so slow down and
accept
2
Contact with present moment – sounds and touch
3
Locate the moment of choice or ‘stuckness’
4
Immerse in the moment (file cabinet or movie screen)
5
Open eyes and express it
6
Hold the moment silently and appreciate
Sensory Experience
SwS
Valued Living
Mental Experience
The Grid - Kevin Polk
Even Simpler Model of ACT Processes
“I think that...”
“I’m having the thought that...”
“I notice I’m having the thought that...”
This is
unbearable
I notice those thoughts
are there again
Recontextualising the Problem
The Life I’m left with
Depressed
Unmotivated
Unemployed
Indecisive
Overweight
Unloveable
Need therapy!
What I want my
life to stand for
Depressed
Unmotivated
Unemployed
Indecisive
Overweight
Unloveable
Need therapy!