Criticism: "ACT is Outright Taken from Morita Therapy"

In June 2008 list serve post to the Academy of Cognitive Therapy, Bob Leahy, 2008 President-Elect of ACBT, made this claim:

"Moreover, the claim for a new, unique model of treatment made by ACT does not seem justified. As some of those on this Listserve know, many of the ideas and techniques that Hayes has advanced are directly taken from Morita therapy. And without attribution. See http://en.wikipedia.org/wiki/Morita_Therapy or
http://www.clcma.com/morita1.htm

Pay attention to the discussion about mindfulness, acceptance, character, values, etc. This was 1928. That's a long time ago. Does this remind you of anything?

Is this a coincidence?"

******************

This is a response written by Steve Hayes (on 6/29/08):

The claim is false.

Maybe folks in recent years have added things that I am unaware of ... ACT is a vast community .... but I am certain that no concepts or methods in the formative work on ACT came from Morita whatsoever.

I never heard of Morita therapy until well after the ACT model was developed and published. I am not sure when I first heard of it but I do recall that the person knew Japanese and told me that the English translations are not very accurate and they had been made too much like CBT by Westerners. That decreased my interest in reading the secondary sources. The methods I saw in the limited reading I did (e.g., keeping depressed folks in sensory deprivation, etc) it just seemed way too far away from our work to be useful, especially since I recall seeing no controlled data.

We have cited Morita several times as being relevant to the ACT work, however. For example in Hayes, S. C., & Ju, W. (1997). The applied implications of rule-governed behavior. Chapter in W. O'Donohue (Ed.), Learning and behavior therapy (pp. 374-391). New York: Allyn & Bacon, we said: "Conversely, the more traditionally non-empirical approaches, like Gestalt (Perls, 1969) and Morita (Morita, 1929), may be more consistent with the basic behavioral literature on rule-governance."

Rather than a dark vision of scientific theft the more plausible reason for the connection is that many traditions have gathered together things that seem to work, and some of these overlap to a degree with ACT. ACT is a more bottom up, Western science account but it has arrived at places other traditions inhabit to a degree. That is particularly true with just about any Eastern tradition since all you really need to overlap a bit with where ACT ended up is mindfulness (which always includes acceptance somewhere) and some kind of right action (values). Because of the history of development, ACT partitions these broad chunks into technical processes that are linked to a basic account. That quality is part of what distinguishes ACT from these traditions. ACT is a model linked to a basic theory, clear philosophy, and successful applied technology. In other words, what is most new about ACT is that it is part of contextual behavioral science, with all of the progressive features this brings.

ACT Book Summary: Pages 81-86

Contributed by: Francis De Groot

Part II: The clinical methods of ACT

Chapters 3 to 9 present the ACT concepts and strategies.
ACT = Acceptance and Commitment Therapy = Accept, Choose and Take action
Goal: to move in the direction of chosen values, and accept the automatic effects of life's difficulties.
Barriers: experiential avoidance & cognitive fusion
Source of these barriers: verbal
Act stages focus on shift from content of experience to context of experience
Why?: to enable clients to pursue valued goals in life.
During treatment metaphors, paradoxes, and experiential exercises are frequently used to undermine the traps of literal language and pliance.

Metaphors:

• are not specific & proscriptive (less pliance)
• are more like pictures (more experiential)
• are easily remembered

Therapeutic paradox:

• not the classic therapeutic paradox to eliminate certain sympoms: e.g. "don't obey me". They rely on pliance

• = inherent paradox: functional contradictions between literal and functional properties of a verbal event: e.g. "try to be spontaneous"

Experiential exercises:
To help contact potentially troublesome thoughts, feelings, memories, ...

• experience in a different context

• allows experience to be observed & studied experientially
• superior to discussing

Summary:

More:

• pursuing of valued goals

• direct experience
• acceptance of negative experiences (thoughts, feelings, memories, bodily sensations, ...)

Less:

• literal language

• pliance

Use of:
less "literalizing" verbal modalities: metaphors, paradoxes, experiential exercises
Focus on: WHAT DOES YOUR EXPERIENCE TELL YOU?
This also goes for therapists? Let's go for some tracking, not for pliance!

ACT Book Summary: Pages 87 - 91

Contributed by Kate Partridge

Creative Hopelessness: Challenging the Normal Change Agenda
[Comments in square brackets are from me. I know this summary is almost as long as the section itself, but doing it has really helped me understand it. Kate]

Theoretical Focus
Resistance to Change: Clients enter therapy because they have already struggled for a long time with "the problem", in many different ways (contemplation, planning, discussion, praying, reading, tapes, etc.)
In spite of so much effort having been exerted, no solution to the problem has arisen. In this sense, the client is resistant to change.

There are [at least] two reasons for this:
1) The client has not found the right way to fix the problem.
2) There is a fundamental flaw in the model for change, which is based on culturally sanctioned, language-based rules for solving problems.

Culturally Sanctioned [Unconscious] Problem-Solving Rules:

• Psychological problems = the presence of unpleasant inner experiences (feelings, thoughts, sensations, etc.). The presence of these unpleasant experiences signal that "something is wrong and must be changed".

• "Healthy living" = the absence of these negative experiences.
• These experiences need to be eliminated by the correction of inner deficits (e.g., lack of confidence), through the understanding or modification of their causes (e.g., overcritical parents).

The underlying metaconcept is: "The problem is one of bad content; change the content and the problem will go away."

ACT Assumption [Message of Hope and Liberation]: The Change Agenda Is Not Workable:
The culturally sanctioned problem solving rules are like water to fish - they are taken so much for granted that to challenge them seems nonsensical.
The ACT therapist works to undermine the sense of normality surrounding these rules, by showing that efforts based on these rules can actually be the source of problems, not their solution.

The therapist asks:
• "Which will you believe, your 'mind' or your actual experience of the unworkability of these rules?" [Not expressed in these words, naturally.]
The therapist takes apart for the client the underlying logical assumption:
1) Identify the problem: "bad" thoughts and feelings.
2) Eliminate the problem: " " " "
3) Life will then improve.
By drawing out multiple examples from the client's own history, the client can become experientially connected to what is often a long series of unsuccessful attempts to use this strategy. This can be quite painful.
The therapist aims to organize most of the client's solutions into a general class of events that can be described as: "Control of private experience = Successful living."
The client is (gently) encouraged to confront the reality of their multiple experiences of the unworkability of this assumption.
This leaves the client often not knowing what to do next, in a state of "creative hopelessness".
The state is "creative" because entirely new strategies can be developed with being overwhelmed by the old and previously unconscious rule system.

Clinical Focus
In this phase of ACT, the therapist focuses on the following issues:

• Client has tried everything, but the problem remains.

• The problem is not one of motivation, nor of specific tactics. The client is not to blame for being stuck.
• There is a paradox here: Working hard to solve the problem makes the problem seem worse. The solution is part of the problem. [I need some concrete examples here of how the solution makes things worse - KAP]
• The logic of the problem-solving system is flawed. A more valid and reliable source of problem-solving is the client's own direct experience and their feedback from life.

TABLE 4.1: ACT Goals, Strategies, and Interventions Regarding Creative Hopelessness.
[There is no point in summarizing this useful table. It is on Page 91].

Informed Consent
ACT interventions can be intense, and the client must be prepared for this by being provided with:

• general descriptions of operating principles [How general?]

• frank discussion of areas of ambiguity [What does this mean?]
• alternative forms of therapy that could be followed instead of ACT

Treatment involves the client in having to face previously avoided experiences.
When this occurs, the client can start to question his/her commitment to treatment.
Therefore, the client should be committed to meeting for a certain number of sessions, to expect ups and downs, and to hang in until a progress review occurs at a specified session.

In this way, the client is guided away from impulsively dropping out of treatment.

ACT Book Summary: Pages 92 - 98

Drawing out the system-developing the idea with the client that the process of trying to solve the problem-verbalized as actions taken by the mind or as "language", creates a logical trap that if directly described presents its own paradox of being linear, literal and analytical-the very process we are attempting to discredit. A less direct approach:

What do you want? Outcome goals: Love others, have children, be content...Process goals: A technique (I think) that leads to outcomes. Example-Outcome goal: living well, Process goal: changing bad feelings. Linking these two by a technique such as drinking is an unworkable system. I'm confused about this. "Process" seems dynamic while "Outcome" seems static. Aren't "drinking" and "changing bad feelings" both processes? In other words, isn't "changing bad feelings" a strategy while drinking is a tactic (subset)?

Anyway then-What has the client tried? This is where you identify with the client and follow along with his historic plan of solving his problems, clarifying with examples the process of attempts, and agreeing on their relative success of lack thereof(there should be lack thereof or the person wouldn't be here, right?).

How has it worked? Using the "mind" metaphor to reify the process of producing inflexible and unworkable verbal rules that persist as technique in spite of experiential feedback that they aren't working. Also pointing out the false solution of "trying harder" when confronted with this reality. This (1) focuses on verbal understanding and (2) helps client look at mental reactions rather than through them.

The essence of this section is creating the dichotomy of what your mind tells you versus what experience is telling you.

ACT Book Summary: Pages 98 - 105

Confronting the System: Creative Hopelessness
(this is a little long, but wanted to make sure I covered everthing adequately)

• Begins by noting that engendering creative hopelessness is the first ACT intervention (following thorough assessment of the client's 'presenting problem', change agenda, and strategies that have been tried to resolve it.

• Also notes (or warns) that doing this inevitably involves the use of human language, which is part of the trap the client is in anyway - the conundrum of attempting to side- step the trap of language, but needing to use language to deliver interventions. The therapist is thus just as susceptible as the client to the trap of literal language, and must be careful about too strongly believing or becoming fixed on the logic of words.
• This highlights the equality of therapist and client, with the therapist's only advantage that of having an outside perspective (the client would also have this advantage were the therapist's problems the topic of discussion).
• The therapist confronts the system by working outside it, using language only to meet certain ends, not to change beliefs or model more "rational" beliefs and thoughts. If those ends are not met, then the words are not true, no matter how logical. So this takes us from the typical reliance on logic to relying on workability - this become our metric. The question for both clients and therapists is "does that work for you?".

Workability and Creative Hopelessness

• In the beginning of this section, the authors provide a caveat that it is written with severely affected clients in mind (although the tools are still useful in less severe
  circumstances).

• The work starts with confrontation, although of a different sort than typically thought. The confrontation is between the client's change agenda and the client's experience of the workability of that system. The message of the therapist and client being in the same boat as far as confronting this system (i.e. the therapist is not some expert who has all the answers) can be powerfully conveyed by the therapist sitting next to the client, with the system imagined as out in front, being confronted by both people
  together.

• The therapist is armed at this point with information related to strategies the client has tried in the past that haven't worked.
• Unworkability is gently suggested - the therapist highlights how hard the client has been thinking and working at the change agenda, and that consulting a therapist is another attempt to find a solution. Another powerful intervention here is to highlight that usually when we work this hard, things get accomplished, but that this situation seems different. All this effort has not resolved the issue.(this is a subtle way to highlight the role of the client's experience)
• This moves into a discussion of the notion that perhaps looking for solutions is part of the problem. That the client is stuck, and it's not because they are not clever enough to figure it out or are not trying. Perhaps it is because it can't work. The authors suggest that a way to make this more tangible to the client is to suggest that the client doesn't actually believe there is a solution - that anything offered by the therapist would likely just be refuted by the client based on the client' s experience that it would not work. So here, the idea that experience and mind tell the client different things, and that experience is more accurate is brought to the discussion.
• The authors break from the therapeutic dialogue here to discuss the importance of framing creative hopelessness as a positive thing. Being careful not to suggest that the client is hopeless or to engender hopeless feelings. But rather to introduce this idea as a starting point for giving up unworkable strategies and opening up for new possibilities to emerge.
• Several metaphors are provided, including the Man in the Hole metaphor, p. 101, to side-step the trap of language. This metaphor is flexible and can be used to address many issues a client might raise, such as:
  • giving up

  • belief in the need to delve into the past
  • responsibility
  • blame
  • continuing to look for solutions - this one actually
    seems really important and I think best highlights the goals
    of this part of therapy. The therapist really seems to stay
    away from promising solutions, but takes on a role of
    saying "I don't know". The goal at this point is batter down
    the tendency toward sense-making and to stay with the
    importance of the client giving up unworkable strategies,
    even without any promise of what will come next. This is a
    leap of faith and should be noted as such, since clients
    (like the rest of us) are definitely not used to not trying
    to make sense of things when there are problems in our lives.

  • illustrating the opportunity suffering presents for
    us to learn to disentangle ourselves from our own minds.

  The goal of this dialogue and the highlighting of what experience tells us, then, is to break apart the control-private-events-to-control-life-quality believe system. It is also to make contact with the client's knowledge of how the world works (rather than systems of logical language and rules that govern behavior). The authors highlight the importance of being mindful of this goal through this discussion.

ACT Book Summary: Pages 105 - 110

Chinese Handcuffs Metaphor illustrates that sometimes the counterintuitive solution is the one that works. Brief; can be used to reinforce the message of the more extended Man in the Hole metaphor or to introduce the therapy as part of an informed consent procedure.

Understanding: Belief versus Experiential Wisdom
Expressions of belief or disbelief on the part of the client are irrelevant and probably signify that the old control agenda is trying to claim any new territory opened up by metaphorical talk. The dimension of belief and disbelief is toward the nonexperiencing, derived stimulus functions end of the experiencing-nonexperiencing continuum. This includes the therapist's beliefs as well as the client's.

Persuasion is not an ACT move; consulting one's experience is.

Confusing No Hope with Creative Hopelessness

2 possible errors: confusing creative hopelessness with hopelessness as a negative feeling state or with hopelessness as a belief.

Creative hopelessness is an action or a behavioral posture that results from experiencing the uselessness of deliberate control over unwanted thoughts and feelings, because this control cannot deliver the promised rewards. The over expansive track that maintains the control agenda is undermined. This prepares the way for a fundamentally new approach. However, talking about hopelessness is a sign of persuasion efforts on the part of the therapist.

Hopelessness the feeling is often used as a move to coerce someone (God, a spouse, the therapist, oneself) to rescue the client from despair.

Hopelessness the belief tends to be over expansive, in the sense that the person sees him or her self or life or situation as hopeless, rather than the more circumscribed control agenda.

Barriers to Giving Up the Unworkable System
It can be hard for clients to give up unworkable control strategies because previously avoided material quickly shows up in consciousness and there's no clear alternative. Metaphors that can be useful here include:

Feedback Screech Metaphor, which illustrates how control moves amplify the inherent discomfort in living and make "tiptoeing around the stage" seem like a good solution; and

Sports and Activities Metaphors, in which practice makes better, you have to "step up to the plate" or "get in the water," and overthinking interferes with the process.

Letting Go of the Struggle as an Alternative
Tug of War with a Monster Metaphor illustrates that letting go of the struggle with unwanted private experiences can be a more workable strategy than trying to win the struggle. Clients may want to know how to "let go of the rope" and describing the process would be a bit like describing how to swim or hit a baseball or drive a car: better learned by experience.

ACT Book Summary: Pages 110 - 114

The chapter on creative hopelessness ends with a few therapeutic do's and dont's. I took the freedom to add some do's and don'ts from the list and one of my own

1. Am I hurting or helping the client seems to be a question that's often asked in workshops. Kelly Wilson suggests on this list (April 15th) that this is about the therapists' own experiential avoidance when sitting with the patients' pain. Empirical findings show that you don't have to be afraid that your patients will quit therapy, get deeply depressed or even kill themselves when they discover the futility of their struggle. In other words the message is essentially a hopeful one, and patients may feel relieved. CR may be the first step towards an increase of degrees of freedom of the patients' respondent behavior.

2. I suggest that as a therapist you have to face your own creative hopelessness in order to be able to sit with the patient when he or she is testing his rule sytem against experience.

3. Don't expect anything to change (yet), because any change can be linked to the intentional change agenda, and so become just another avoidance strategy.

This is paradoxical. As I try to grasp it right now, experiential avoidance seems to be an escape reaction triggered (or conditioned) by a certain class of stimuli (Sd, like for instance the possibility of being criticized), and thus it's under antecedent control (see also Kelly Wilson's note on this). Each time I face this type of situation I feel stressed or aroused (CER), want to escape or avoid by procrastination, let's say (CAR). This is reinforced by nicely elaborated verbal rules (COV)(and each time I think I'm right is a reinforcement, a +S+). Moreover, i feel relieved in the short run because the criticism is avoided (-S-). If I try to change this chain of behavior without loosening the conditioned response, I may just get entangled in a more complex conditioned avoidance response. In terms of 'Mary had a little .... ' I will get even more 'lamb' connections on the dots. I guess the idea is that behavior change will result spontaneously when the link between the situation and your avoidance reactions will be weakened, for instance by an increase of awareness of the unworkability. And isn't hope just the same as finding more and new opportunities to achieve your goals?

Just like the two Swedish colleagues I 'd like to try to describe these processes in behavior analytic terms, but feel very insecure about it. It seems to me very helpful in the process of understanding ACT, and also in grasping the patient's struggle. So who wants to join or help in this enterprise?

4. Give homework to help people become aware of how they struggle, and what situations trigger it. Just do self monitoring, and not behavior change (see above)

5. The book (and the discussion on the list as well) seems to suggest that there should be a fixed order in therapy with CH as the starting point. I'd like to cite Kelly Wilson (April 15th) on this:
" No you absolutely don't need to do CH like it says in the book. If it needs to be done, you will end up doing it. why? Well as you pursue values, it will appear as an obstacle--then you will do defusion of hopelessness, and the emergence of what we like to call creative hopelessness."

6. A very important do was formulated yesterday by Joanne Steinwachs.
I'll just cite her contribution, can't do it better, as she's also including a beautiful metaphor.
"I find it useful to begin the questioning with 'beginner's mind'. Perhaps what they tried did work out, in some way for them. Of course, if they're stuck in a framework of unworkable rules, then in the larger picture, it doesn't work, but sometimes talking to people about what they do and how it works in their idiosyncratic rule system illuminates the rule system both for them and for me. If I start with the agenda of discovering unworkability, then I can miss a lot of the nuances of trappedness, both for them and for me, and I feel like I move into a place of expert rather than co-explorer. I also feel that using "discovering unworkability" as my guide, respect and curiosity are harder to maintain as my base feelings towards the client. I can't do this if I've got the agenda of discovering unworkability. I have to hold the idea that the system DOES work for the client as a possibility. Usually, in my experience, clients have worked hard and creatively, their shtick does work in some way and it's often an elegant and creative adaptation to some crazy rule. I talk to people about the pre-Copernican world, and how astronomers were trying to describe the path of the planets, starting from the wrong assumption that the earth was the center of the universe. They came up with elegant and complex theories that sometimes could predict the position of the planet. Men spent their entire lives on these theories. To let them go took enormous courage and great pain. That conversation comes after I and the client understand the complex rules that govern their "planetary movement" and we've paid tribute to the fact that the rules can in some ways predict and control their experiences."

Perhaps techniques as interviewing for solutions (De Shazer) can be useful here.
Progress to the next phase can be seen when clients express doubts about their system of coping and avoidance.
Personal work for the clinician is building on the work on page 80.
Somehow this questioning is a bit too abstract for me-as-a-client.
Me-as-a-client needs a bit more encouragement and support as to what is a problem, how can I analyze it in ACT terms, what level of detail is required to gain awareness or insight. I like to be as concrete and detailed as possible, and I try to find out what exactly is is what a client did (does), thought (thinks) and felt (feels) when using his or her strategies. Underneath abstract descriptions of an apparent intelligent strategy can hide a completely invalid schema (can I use such a term here?).

ACT Book Summary: Pages 115 - 118

Control Is the Problem
In ACT, attempts at controlling private events are thought of as part of the system that have brought the client into therapy. Four factors are identified that most clients bring into therapy (and, that have been wrestled with at various times in this forum):

1. "Deliberate control works well for me in the external world."

2. "I was taught it should work with personal experiences (e.g., 'Don't be afraid...')."
3. "It seems to work for other people around me (e.g., 'Daddy never seemed scared...')."
4. "It even appears to work with certain experiences I've struggled with (e.g., relaxation works for a while to reduce my anxiety symptoms)." It is emphasized that the examination of control strategies is based entirely on the clients experience, with workability as the unit of analysis, and that the therapist needs to be extremely careful not to dictate or demand that the client evaluate their control strategies as unworkable. Therapist techniques that are mentioned include using metaphors and experiential exercises to help the client develop increasing sensitivity to directly experienced contingencies. Also, the authors mention that asking questions rather than stating conclusions can be helpful in reducing pliance on the part of the client.

ACT Book Summary: Pages 119 - 125

Giving the struggle a name - control is the problem
Continuing to explore unworkable strategies (i.e., "digging" in the man in the hole metaphor) without interpretation.
The goal here is to explore the form and function (immediate goals) of client's behaviors and hold these up against the change agenda.
At this point in time there is no need to do any more than just touch and clarify these behaviors and their functions.
Eventually the goal is to lump these responses into a single class "emotional control"

The rule of private events
The key lesson here is that purposeful control works in the successful manipulation of external events but that the same strategies do not work in controlling private events as these are governed by historical and automatic factors.
The rule "if bad events are removed, then bad outcomes can be avoided" is not effective with regards to private events.
On pages 120-122 is a good transcript showing a therapist bringing out the paradox of control:

• If I'm not willing to have it (e.g., anxiety), I have it

• If I don't get so uptight about being anxious, I will be less anxious
• If I am willing to have it in order to get rid of it, I am not willing to have it and I will have it again

Polygraph metaphor (page 123) is a core intervention in this stage of therapy - particularly useful for anxiety or mood disordered clients.

In short the metaphor describes being hooked up to the most sensitive and accurate lie detector ever built. The task is simple, STAY RELAXED. An extra incentive is given, "stay relaxed or I’ll shoot you". Not surprisingly, any hint of anxiety would escalate ("Oh my god, I’m getting anxious.") and BAM!, it’s all over.

There are three elements that can be drawn from this metaphor:

1. contrast between controllable behaviors (i.e., paint the wall or I will shoot you) versus behavior that is not regulated successfully by verbal rules (relax or I'll shoot you)

2. People carry their own polygraph with them all the time (their nervous system) and their own gun (self-esteem, self-worth). They are constantly monitoring for symptoms (e.g., anxiety) and firing the gun at themselves
3. How seemingly successful attempts to make situation work, don't work in the long term. For example, taking valium may help you relax initially but what about when it wears off?

Chocolate cake exercise (124) - particularly effective with clients struggling with obsessive thoughts or ruminations
In short, don't think about delicious warm chocolate cake with icing and cream! (yum)
Two things here:

1. either it is particularly difficult not to think about it (me included in this group)

2. or attempts to not think about it (e.g., "I thought about something else") actually require you to think about chocolate cake (you have to know what you are not thinking about)

Similar idea can be applied to physical reactions (e.g., salivation)
"The key lesson here is for the client to make direct contact with the ineffectiveness of conscious purposeful control in these domains"

(my own personal comments: I really like these ideas, and regularly use similar concepts no matter what therapeutic style I am incorporating. I think a lot of these ideas have filtered into the CBT framework, whereby automatic thoughts are treated more as uncontrollable private events and B (behavior change) is emphasized.

The only trouble I have with some of this stuff is picking those clients that respond well to discussing these kinds of issues. This is totally my personal opinion, but I think many therapies suffer from some kind of intellectual bias, that is, techniques developed by well-educated, trained minds. I have trouble breaking down psych concepts to layman concepts. This is not a big issue at this stage, because the use of metaphors breaks down that barrier, but when it comes later to exploring the traps of language, I think this is so.

ACT Book Summary: Pages 125 - 132

How Emotional Control Is Learned

At this point in therapy, the client is coming to the realization that "control doesn't work". In the recovery business this is the same as "taking" the first step (12 step approach) where the client comes to the realization that they are "powerless." This can be a frightening step. As the book points out, the "thought that repeatedly applying a seemingly unworkable strategy proves there is something wrong with the client 'deep down inside.'" and this can be quite troubling. Again, in recovery we would say, that this is like "doing the same thing and expecting a different result."

It is like the guy that thought he had figured out how to fly with a wing like contraption attached to his arms. He got up on his roof and ran straight off the end and flapped his arms like crazy. But, as you would expect, he landed with a thud and broke several bones in his body. After healing he thought, well I don't think I jumped high enough, or flapped my arms fast enough. That's what I have to do, jump higher and flap faster. I don't think I need to tell you what happened.

Getting back to my assignment, at this point it would be easy for the client to blame them self for the predicament that they have gotten themselves into, however, as the book points out, all of the conditioning that got them here is actually very random. The trick now is how do we "come to believe"(step 2) this. The book suggests, "Experiential exercises are particularly useful for demonstrating how easy it is to condition a irrelevant and nonfunctional private response." The "'What Are The Numbers?" exercise is a good intervention at this point. In this exercise the book demonstrates the arbitrariness of reactions, thus hopefully helping the client see that ""I'm bad" is no more meaningful than "one, two, three."" The therapist would than help the client move into examining the apparent success of a control agenda.

Which brings us to, Examine The Apparent Success Of Control

At this point it is suggested that we help the client explore the "cost of using this change agenda in the wrong places." The therapist is helping the client "establish discrimination." Which always makes me think of the serenity prayer,

God grant me the serenity to accept the thing I can not change (or control), the courage (or willingness) to change (or control) the things I can, and the wisdom to know the difference ("establish discrimination").

I see this step as helping the client become more aware of when this control (change) agenda works and when it doesn't. The book gives a good dialogue of walking a client through this process. But as the client begins to get a sense of the unworkability of this control agenda, they can feel naked and vulnerable to the world, and desperately looking for someway to cover up. At this point all we want to do is help the client recognize what thoughts and feelings are showing up. This is not an easy task. The therapist needs to continually undermine the clients need to avoid the distressing thoughts and feelings and to help the client become more "willing" to experience these things in the here and now.

All of this leads the client to "the alternative to control: willingness" which is next weeks homework. However, it brings me back to the serenity prayer, and how I see willingness (or courage), "to change the things that I can."

ACT Book Summary: Pages 132 - 135

The Alternative to Control and the Two Scales Metaphor

The objective here is to point to an alternative to the control agenda.
Use willingness instead of acceptance-because it is often confused with resignation or tolerance/defeat.

Two Scales Metaphor

• designed to look at concept of control and its relationship to distress

• Should be linked to clients' experience of their own futile effort to control distress, can link it to more mundane or less meaningful examples for the client (for example, trying to sleep during a bout of insomnia. The harder you try to fall asleep the less sleep you get. In supervision, we often use the Chinese finger trap example-the harder you try to get out of it, the less out of it you are- you get stuck.)
• Want to undermine the client's confidence in the control strategy and depathologize the struggle over control
• Not crazy, just using the wrong strategy

Metaphor
Two scales--anxiety (or whatever fits for the client here) and willingness. Willingness has been low, anxiety has been high. Client came in with the goal of getting anxiety to be low. But what if there's this other scale that we haven't been using, haven't even seen, called willingness. Make a promise about what will happen if willingness is set high-anxiety will be low except when it is high and then it will be high. If you move willingness up, then anxiety is free to move around.

Seems like the goal here is not describing acceptance or distinguishing acceptance/resignation, but merely providing an alternative to their endless, futile struggle

Can distinguish between mind/experience here. Mind tells you that if you demand anxiety to go down, then it will. However, experience says that this doesn't work

"Suppose life is giving you this choice: You can choose to try to control what you feel and lose control over your life, or let go of control over discomfort and get control over your life" (p.135)

Willingness is one thing that only you have control over. I can influence you feeling anxiety for example, but I cannot control how willing you are to have that anxiety.

Comment: This was a perfect reading for me this week! I recently used ACT in my abnormal psychology class in the service of changing the stigma of the mentally ill and making a difference in my students' lives. I provided an alternative to their control agenda, but I spent a lot of time distinguishing between acceptance and resignation. I had one student in particular who would not "accept" the thing he hated most about himself (which was what I used in exposure and defusion exercises) because he refused to "just get over it and move on". I like using willingness instead of acceptance because it frames the whole concept in a different way. There's no question about what willingness is, acceptance can have different connotations.

Another thing: When first reading this section, I thought "how can you describe willingness", "willingness to what...?" I think that my class would have benefited from my using the willingness to experience as opposed to acceptance. This seems much clearer to me.

ACT Book Summary: Pages 136 - 141

The Cost of Unwillingness
CLEAN DISCOMFORT: discomfort that comes and goes as a result of just living your life (= primary discomfort?) ------------- cannot be controlled

DIRTY DISCOMFORT: emotional discomfort & disturbing thoughts created by efforts to control feelings = discomfort over discomfort (= secondary discomfort?) ------------- disappears when willingness is high and control is low
---------------> clean discomfort stays when dirty discomfort disappears

Box full of stuff metaphor: p. 136. Shows the additive nature of history; nothing is subtracted! You can only add to life. You can fill it up with things you want to avoid until you can't move anymore.
Various reactions are put into the box = deliteralizing: treated as objects, dispassionate observation of reactions.

WATCH OUT!
Client's worldview can be put upside down!
Clients can insist on using old strategies. This has to be supported.

DON'T START LECTURING
DON'T START INTELLECTUALIZING (& do all the talking; it's no question of trying to convince)
DON'T START EXPLAINING & DISCUSSING CONTROL STRATEGIES (this keeps you within the existing language paradigm)
DON'T FEEL PRESSURED TO MOVE INTO SUBSEQUENT STAGES with multiproblem clients (they need more time)

DO ENCOURAGE CLIENTS TO NOTICE THE COMING AND GOING OF DISTRESS (when they cling to control strategies)
DO STAY ON THE EXPERIENTIAL TRACK
DO STAY WITH THE CLIENT's EXPERIENCE OF THE WORKABILITY OF CONTROL STRATEGIES

Clients may be ready for the next stage when:

• willingness is appearing spontaneously in situations that used to elicit control

• clients report spontaneous examples of feeling feelings differently

ACT Book Summary: Pages 141 - 147

Chapter 5 finishes with:

1. personal work for the clinician

2. a clinical vignette
3. appendices containing daily experiences diary, identifying programming exercise, feeling good exercise, rules of the game exercise and clean versus dirty discomfort diary. I'll deal with each of these in turn:

Personal work for the clinician
Having identified a problem in your own life, explore the strategies that you have used or are currently using to solve this problem
a) consider each strategy and designate it as either an acceptance or control strategy
b) examine the distribution of control and acceptance strategies. Is there a trend?
c) For each control strategy, identify what it was that you hoped (hope) to control, avoid, manipulate, change or eliminate

Clinical Vignette
The clinical vignette describes a 45yo male with severe anxiety attacks at work and more recently at home. There is stress at work (high stress job), a recent move and relationship difficulties. The client uses deep breathing, distraction, hypervigilance to physical symptoms, avoidance of work and tranquilizers to cope with the anxiety.

The question(s) for clinicians are:
a) how would you conceptualize the client's major coping strategies and assumed goals?
b) How would you discuss these solutions with the client?
c) What would your goal(s) be in doing so

The answers are as follows:
a) strategies are primarily to reduce or control anxiety and appear not to work (long term)
b) is anxiety serving another function? Are there areas in your life that you legitimately have reason to be anxious about
c) Goal is to separate clean versus dirty anxiety (legitimate stressors versus the struggle, fusion)

Appendices

Daily experiences diary
Client records uncomfortable moments, including feelings, thoughts and bodily sensations as well as efforts to handle these things
Client and therapist can explore the use of acceptance versus control strategies. Therapist can reinforce strategies that reflect acceptance.

Willingness diary
Client provides a global rating for each day (e.g., emotion rating from 1-10).
Client records the amount of effort put in to getting this to go away (rating 1-10)
Client records how workable the day was (rating 1-10)
Client and therapist explore the relationships between the struggle to controland the workability of the day.

Identifying programming exercise
Clients are encouraged to explore how a significant childhood event (or events) shaped or programmed who they are now to demonstrate how dysfunctional coping strategies are passed on. This is to demonstrate the arbitrary nature of learning events.

Feeling good exercise
Clients fill out a questionnaire tapping into a number of specific language rules that act as self-instructions (e.g., "the way to be healthy is to learn better and better ways to control and eliminate negative emotions")

Rules of the game exercise
Clients are asked to generate their favorite life sayings (e.g., no pain, no gain).
Client and therapist can then explore sayings with reference to acceptance versus control strategies or on the basis of a number of other dimensions (e.g., black/white thinking, severity of consequence, good versus bad)

Clean versus Dirty discomfort diary
Client is encouraged to explore particular "high risk" situations in terms of clean discomfort (what immediately showed up in the way of thoughts, feelings etc) versus dirty discomfort (what emerged as a result of the struggle with these initial feelings)

ACT Book Summary: Pages 148 - 154

Building Acceptance by Defusing Language

Here are some nuts and bolts followed by questions and critiques:

1. The distinction between process and content: language is a learned set of derived stimulus relations, while languaging is the action of deriving those relations.
2. Humans (therapists, clients, etc.) often don't make this distinction and often relate on (and become connected to) the content level. Taking these contents at "face value" (i.e., literally, tangibly) in turn, leads to powerful and predictable behavior patterns (that are often destructive) on the part of the client.
3. One of the main paradoxes in ACT is that language cannot be weakened by more language; however the essence of deliteralization is to take advantage of loopholes in the way language functions (by teaching the client to see that thoughts and feelings are just that-thoughts and feelings).
4. Page 152 contains a table (6.1) of ACT goals, strategies, and interventions to use regarding deliteralization.
5. One of the ways to begin addressing the paradox and function of language is to demonstrate to the client the limits of language in deciphering human experience (and to elicit their own examples). For example, there are two metaphors (found on page 153) that communicate how describing something is different from experiencing it. One metaphor is "finding a place to sit," which essentially describes how talking about a chair (its features, uses) does not help when one wants to actually sit down. In other words, one cannot "sit" in a description of a chair. One can only sit IN an actual chair. A corollary of this metaphor is that one can describe the experience of swimming (how the water feels moving through it, its temperature, etc.). However, one cannot learn to swim in or by a description.
6. There is an assumption in ACT that "your mind is not your friend." Extrapolating from pre-human experience, one can see that the (human) mind was not developed to make humans or "prehumans" feel good. It was developed to keep humans from danger and was mostly comprised of negative content. Explain to clients the paradox "your mind is not your friend AND you cannot live without it."
7. Another assumption is that language is arbitrary and that once it is learned, it becomes relatively independent of immediate environmental support. This reminds me of my nanny's (successful) efforts to train my 20 month-old son to say "bling-bling" when he sees jewelry-now without her having to label it.
8. There is a provocative quote related to the usefulness of nonverbal (experiential?) knowledge at the end of this section on page 154: "If we suddenly had all nonverbal knowledge removed from our repertoires-we would fall to the floor quite helpless."

Comments/questions:
9. It has been my experience that, while clients appear "fused" to a lot of different ideas/contents, a great share of them come to my office without having specific terms/language to describe their experience. In fact they come ONLY with experience, which they have a difficult time describing in words. For example, an extremely anxious patient I had (with Posttraumatic Stress Disorder) wouldn't ever label himself as "anxious," rather he just knows he feels bad.
10. I don't know if behavior patterns follow from the premise that one does not make a distinction between the process of thinking and actual thought, and becomes fused with actual thought content, thereby leading directly to ingrained behavior patterns. I suppose one could explain this as troublesome behavior patterns becoming automatic due to conditioning (i.e., not being aware of the interaction pattern itself); however, I'm not sure if this is because one is fused to a verbal event.
11. Have any of these hypotheses been evaluated using individuals with various types of brain injuries (resulting in apraxia, aphasia, acquired deficits in language versus acquired deficits in motor ability, etc.)?

ACT Book Summary: Pages 154 - 158

Deliteralizing Language

Several exercises are described to help people improve their skill of looking at the process of language instead of looking from language.

• Thoughts are used to structure our perception of the world. We don't even notice that we look at the world from our thoughts, because we believe them in literal way. To look at the process of language involves focusing attention on language as language, cryptic as this may sound. A bit of defusion from literal 'understanding' can be achieved by watching the direct stimulus functions of language like sound, the feeling of your muscles, the sight, etc.

• An elegant way to watch your attention switch from the symbolic function of a word to some of its direct stimulus functions is by repeating a word over and over again for one or two minutes. This is the classic milk, milk, milk exercise (Titchener, 1916). Present it as an experiment or experiential exercise and help the client notice how the literal meaning of the word disappears and one can see the word as an instant of the language process.
• I like the notion of skill learning here. Deliteralization is a skill you can practice, it's not another rule to follow. One can play with direct stimulus properties and thereby loosen the 'grand illusion of language' by realizing that the symbolized thing is not there at all. The only thing that's there is sound, movement, breathing and so on. And this is not a fact, but a skill, something you do.

Another skill that helps to defuse from nasty or frightening thoughts is practiced in the passengers on the bus exercise. In this exercise the relation between a person and his or her thoughts (or avoided inner experiences) is reframed.
These are the elements of the metaphor:

1. You, the driver of the bus. You want to go places and do your job.

2. The passengers are your thoughts and all kinds of inner states. Some are nice, some ugly, scary, nasty.
3. The scary ones threat you and want to come up front where you'll see them.
4. You take this very serious and stop the bus (you don't go anywhere anymore) and try to make a deal with them: they'll keep quiet in the back of the bus, only when you do exactly what they tell you.
5. This means your route plan is greatly impaired and you're always on the watch inside the bus.
6. What happens is that you let these passengers control the whereabouts of the bus. You, the driver, are not in control at all.
7. Even though these passengers look scary, nasty, threatening etc. they can't take control (unless you let them). They can't make you do something against your will.

ACT Book Summary: Pages 158 - 168

Summary: We are in Chapter 6, Building Acceptance by Defusing Language. Page 158 begins the section titled "Don't Buy Thoughts". The subject is the deliterization of language. The explanations, exercises and metaphors are designed to enable the client to become aware of and "assume" self as perspective and to focus that perspective on thoughts and feelings themselves as they are experienced. Comment: The ease or difficulty of this and degree of success may vary greatly from person to person, but those who find it most difficult may also reap the greatest benefits.

The shift to looking at literal meaning from looking through literal meaning is subtle. "Having a thought" may be distinguished from "buying a thought" or "buying in". A common example is the shift from "I am a bad person" to "I am having the thought that I am a bad person". The idea is to expose the process of thinking often hidden behind the content of thinking. Mindfulness exercises include Zen-like meditation, Soldiers in the Parade Exercise, Leaves in the Stream Exercise, Contents on the Card Exercise, and Taking Your Mind for a Walk Exercise. The client/therapist dialogue (pgs. 159-161) illustrates a therapy situation using the Soldiers in the Parade. Note how you have to get the client to try this and then give you feedback as to what they are experiencing. The client is specifically reminded that thoughts like "This isn't working" or "I can't do this" should be placed on the soldiers' placards (along with "This therapist must be one of those nutty Gestalt guys I've heard about."). The therapist sort of anthropomorphizes the mind and speaks of it trying to "hook" the client on literal meaning. He also points out how the parade stops when the client "buys" or is "hooked" by a thought. I additionally had the thought in this section that while "Contents on Cards" and "Taking Your Mind for A Walk" may seem gamey or contrived, these might be necessary and effective with certain clients who experience very emotional fusions such as cluster B type folks(or the more politically correct "multi problem client").

Undermining Reasons as Causes
A troublesome class of thoughts, reasons tend to disguise themselves as deterministic statements with a cause-effect function which they really may not have. Reasons often actually function as language community justifications. Personal history is often cited as a reason things can't change. This has always been a real pain for psychodynamic therapists (I speak from personal experience). Statements focusing on functional utility rather than literal truth are suggested as helpers, such as, "And what is this story in the service of"(Ouch! They may get angry!), "If God told you that your explanation is 100% correct, how would this help you?", etc. Another dialogue (pgs. 164-166) illustrates how reasons may be deliteralized to the clients' advantage without loosing their true function.

An additional "tips" section is Disrupting Troublesome Language Practices (pgs. 166-168). A discussion of the etymology of the word "but", for example, reveals how it can be a psychologically limiting verbal behavior that may be changed to "and". "I want to go, but I am angry" could be "I want to go and I am angry" leading to behavior which may not be controlled by the language conceptualization of it. The "And/Be Out Convention" inset describes how this might be communicated to a client. I had the thought that this requires some careful listening to insert this timely intervention when it can be most useful to the client.

I will only comment that this is an extremely important section, drawn from RFT research and Zen and Gestalt traditions which are nuclear to ACT. It strikes me as needing a great deal of experience and/or training to be handy with it. I suspect that psychodynamically trained therapists, such as myself, have a harder time with it because we have to unlearn and learn at the same time.

ACT Book Summary: Pages 168 - 174

Evaluation versus Description
Evaluations masquerade as descriptions of things and events because language makes little distinction between them. Descriptions may be thought of as primary properties of things and events while evaluations are secondary properties, reactions to things and events.

The authors point out that most clients bring negative self-referential evaluative self-talk directed toward themselves ("I'm a despicable human being") to therapy that would be difficult to accept if it described the essence of a person.

The Bad Cup Metaphor illustrates this principle by pointing out the difference between essential properties of a cup (such as that it is made of metal or ceramic or whatever) and our evaluations of the cup (good cup/bad cup). As an aside, my husband, who is not a therapist, really related to the question of "If all the humans on earth died tomorrow, would this still be a good (or just, or moral, etc.) ____?" as a way of identifying evaluations.

A second strategy for highlighting the kind of thought or speech someone is engaged in is to have them label each thought or sentence as a description, an evaluation, a feeling, a thought, a physical sensation, a memory, etc (Cubby Holing). Although this is awkward, it can be very effective at promoting defusion with private events.

Willingness: The Goal of Deliteralization
The goal of deliteralization is to decrease the role of evaluation and strengthen the client's ability to take a non-judgmental, observer perspective so that they can begin to observe their own disturbing private events with less struggle and more willingness.

Two exercises that give the client live experience with willingness are the Physicalizing Exercise and the Tin Can Monster Exercise.

The Physicalizing Exercise has the client treat their unwanted content (depression, anxiety, addiction, etc) as an object, by describing its physical attributes (size, weight, color, density, etc). Then the client sets it aside and describes reactions to the "object" they described; they repeat the exercise with the reaction. They then go back and look at the first "object"; often it is less intense in some attributes (smaller, lighter, etc).

The Tin Can Monster Exercise helps the client get in touch with their "observer you," then uses that perspective to explore several domains (physical sensations, thoughts, feelings, memories) associated with the problem area. The focus is on staying with the uncomfortable, unwanted content while letting go of the struggle to make it go away.

ACT Book Summary: Pages 174 - 179

Therapeutic do's and don'ts
The goal of deliteralization is a hefty one. Chapter Six offers a dazzling array of ACT metaphors and exercises: confronting nasty passengers on the bus, endlessly saying milk, milk, milk, soldiers wandering around in a parade amongst the recesses of the mind, taking your mind for a walk, reasons as causes, avoid use of those 'buts," and practicing awareness of your experience, to name just a few. Deliteralization is an essential step in the ACT process, and yet its filled with perilous pitfalls for our heroic ACT therapist.

First, there is the challenging task of entering the client's language system The therapist seeks to realize that it is a language system, while at the same time avoid the many opportunities presented to "fuse" with the system. This challenge occurs because we are using language to point out the dangers of language in an effort to convince a person to avoid being taken in by the power of their own words. Encouraging willingness and deliteralization by using words alone may result in an overuse of logic. Hence, words are always connected to metaphor (and hopefully experience) as a way of avoiding this pitfall.

On the other hand, the use of metaphors presents another challenge in that the therapist may get totally caught up in the process of painting pictures. Telling stories and doing exercises keeps everyone awake, but the goal of willingness and deliteralization may get lost in the mix. Focusing on one metaphor per session at most (and any given metaphor may be useful for more than one session) is the best remedy. Most important, metaphors are adapted to fit a client's particular form of fusion. Context always is combined with content in the client's experience for the proper and judicious use of metaphor.

Next -- How to determine when its time to get out of Dodge City and move on to the next stage of ACT?

First, we know there's progress when a person does not automatically respond to every troublesome thought (or emotion) with the same overwhelming and automatic connection. They cease to automatically fuse with their language system and instead are able to "wake up" and be aware of non-workable reactions, sometimes in the very midst of the process. Second, from this evolving stance of observer to their reactions, a person demonstrates an increased capacity for a willingness to experience content that would have previously brought automatic fusion. In other words, they do not always and automatically respond with well worn methods of control and avoidance. ACT would argue that this occurs when a person ceases to fuse and there is a "weakening of social/verbal context of control." The client is able to have more difficult experiences and demonstrates a willingness to set aside moves of experiential avoidance.

From this point, the clinician is then advised to observe thyself in an exercise which eventually encourages one to "release" attachment to cherished notions of self, whether they be the best of things or the worst of things that you think about who you are. How difficult is it to release our attachment to these statements about self as "literal" realities of who we are? Perhaps this will develop an empathy for the challenges faced by our clients.

Then we are presented with a clinical vignette about a 31 year old man with panic attacks whose life has become constricted because he avoids situations that produce feelings of anxiety and panic. How to conceptualize this situation? What strategies are we to use here?

An ACT perspective would suggest that the client is confusing content with context by treating any appearance of a dreaded symptom of anxiety and panic as a harbinger of absolute danger ahead. An effective strategy would seek to use deliteralization exercises (e.g. Milk, Milk or Tin Can Monster) that encourage the person to step back and avoid the automatic literal response (disaster is here), and instead see these experiences as experiences -- nothing more and nothing less. Can the client allow these symptoms to occur without fusing? Then these symptoms can take their "natural course" without the rollercoaster wrought by cognitive fusion.

Finally, the chapter concludes with two exercises for client homework
The first seeks to analyze the extent to which reason giving pervades experiences outside the session. This will hopefully make the client more aware of how they use reason giving and to see reasons as merely content to be considered as useful only when they meet the criteria of workability.

The second exercise is an awareness exercise which encourages a mindfulness and acceptance of present moment experience that helps one practice being in the role of observer. A useful and life long task indeed.

ACT Book Summary: Pages 180 - 187

This is all open to feedback, of course, as I am never sure I have this stuff quite right. But then again, it's only a bunch of thoughts, so don't believe me anyway.

Somehow this self stuff reminded me of a recent interview with Clint Eastwood (paraphrased from memory) --

• Int: So, we've talked a lot about what your critics think of you and your work, what your wife and ex-wives and children think. I have to ask, what do you think about Clint Eastwood?

• CE: I tend not to think about him very much.

ACT (181): In order to face one's monsters head-on, it is necessary to find a place where this is possible.

I believe there is a Zen story (don't recall where I heard or read this) of a man who is alone in his house trying to eliminate all of his demon's. One after one, he faces them down, and they all disappear as he sees them for what they are -- except one. This is the largest demon of all, and as hard as the master-to-be tries, he cannot eliminate this demon. He cannot avoid the monster, he cannot talk the demon into going away, he cannot make a deal with the chimera.

Finally, after he thinks he has attempted everything he could possibly do, he jumps right into the mouth of the demon, and it disappears.

ACT- Three Senses of Self
Conceptualized Self -- The me who I think I am
Clients come into therapy, counseling, etc with varying goals regarding this self -- to defend the self, to fix the self, to find the self, to avoid the self

ACT View for Success Regarding the CS -- to have the client voluntarily experience conceptual self suicide expurgate the boundaries of the self and (my thought) broaden the psychological world of the client to make room for all history and experience - to bring the clients to where they began and to see it again for the first time (I can't remember where I stole that one, either).

Self as concept might make a statement like "I am a person who ....." and this statement is taken literally with many predicates, even predicates which do not work. Examples "I am a person who breathes" compared to "I am a person who is sad, happy, " This universality can cause mucho problems. (Here's a reach) If I am a person who is sad, I may not notice the times when I am happy- they don't fit my self concept. On the other hand, if I am a person who is happy, what does it mean on an afternoon - when it is cold and wet and rainy in Minnesota, and it is June, and dammit, isn't supposed to warm and sunny now - when I am sad?

With this concept we, and the community around us becomes very invested in my maintaining my "image" of being a certain kind of person; or

1. When I am x and I and my community do much better when I am x, I am pretty invested in remaining x, because if I act as Y there are consequences

2. Our history has taught us to see and maintain patterns.
3. We have equivalency statements that may not be equivalent "I am 5'10" (maybe 9") becomes the same as "I am alcoholic."
4. If I try to act outside of "who I think I am," it seems almost life (or self?) threatening. Note: I wonder about this with the "guys" I work with. Many are domestic violence offenders, and even though their physicality is usually not threatened, many lash out when their sense of "self" is threatened, the "manly man syndrome." OR "Eliminate conceptualization = eliminate me."

The self can be "maintained more easily simply by distorting or reinterpreting events if they are inconsistent with our conceptualized self."

I am concurrently (as my bathroom bibliotherapy) reading a book - The Tao of Zen - there is a quote there that I somehow want to fit into this chapter. You decide -

" For all Chinese philosophy is essentially the study of how [people] can best be helped to live together in harmony and good order ... [There is] nothing more dangerous than that theories and doctrines which belong to the world of language should be mistaken for truths concerning the world of fact."

Our conditioned responses to and with language create the prison which many people go into therapy to theoretically escape, and get there and work hard to build stronger walls. Page 183 - "To escape a prison it is first necessary to see the prison itself."

Most therapy to date has been designed to paint the walls of the prison with different thoughts and/or emotions, whereas ACT's design is for the client to see the prison from both the inside and the outside.

Ongoing Self Awareness
While the conceptualized self is a verbal trap, it is still necessary to have an idea of who you are and how you are when you are there. Without getting attached to the content, there still has to be a verbal self knowledge of life to engage with it. In this sense, it seems it is more like a surfer riding the waves, than a swimmer battling the water, or maybe, better yet, than a non-swimmer flailing in the waves. The surfer knows the water (language, words, content) is there, but does not get caught up in the depth, the swirls and eddies that come along moment to moment.

A thought is just a thought, a feeling is just a feeling. The client is encouraged to engage some of these things descriptively, rather than evaluatively - to look at a thought, rather than through it.

The Observer Self
The "I" is a place, a locus, a perspective. It came about and is used to differentiate my experience from the experience of others? "I" am looking at my computer screen. "You" are not. The "I" sets up the context for description. ( I think I have this right, or at least am making sense of it.)

Spirit/Matter distinction which has emerged in all cultures.
Spirit - a private event that cannot be experiences as a thing or object. Sense of self-as-perspective has same properties as spirit.

This is important because we/I/You as context is the one place any of us can stand that is enduring. Even though we are constantly changing, we always have that sense of "being there," of seeing all that is in our life from behind these eyes.

This important in the change process because there is something grounding about there being one part of us that will go through all of "this" unscathed, at least for the time we are aware of. With all of the threatening things that happen in therapy, life, etc, there is that sense of I that will remain. ( I think)

In ACT, it is important that the I/you-as- context will always be there, at night, in the clouds, through sleet and hail and thunder, wherever I am, whatever happens, there I go.

Page 187 - "The trick lies in teaching the client how to be aware of content, to be aware of the awareness of content, and yet not be so preoccupied with content or attached to it as a matter of personal identity ... without objectifying these events or mistaking them for" the real me. Be careful not to pay too much "attention to that little man behind the curtain."

ACT Book Summary: Pages 187 - 192

We're looking at the first part of the 'Clinical Focus' section of
chapter 7 'Discovering Self, Defusing self'.

As will have been outlined earlier, this is an important part of ACT.

The section begins with a brief outline of the core perspectives that
are introduced here. Table 7.1 (p.188) provides the ACT goals,
strategies and interventions regarding self.

Initially, it is helpful to 'Undermine Attachment to a Conceptualized
Self'. Clients may vary in readiness to work on this area. The
timeless struggle between content and context is presenting itself
here. ACT promotes the idea that the problem may lie in attachment
to beliefs, rather than in the beliefs themselves. This may be seen
as a reversal of some views in which self-conceptualization and
performance are linked. The 'Mental Polarity Exercise' can be used