One day many years ago, I went to my friend Robyn Walser, oft- mentioned in this book, to consult her about a client I had been seeing. The client, a thirty- eight- year- old woman presenting with depression, had received the full course of ACT, grasped everything that was important to grasp, and— as far as I could tell— applied almost nothing. “Robyn,” I began, “I have tried everything. The client seems to get it. She is the first to say that as it stands, her life has little meaning, and she agrees that she actually has the ability to change that. But then she doesn’t make a move. It seems like every week we start over with everything that’s wrong in her life, then work through how she is still able to make valued choices and what might be standing in her way… .I don’t know what to do.” Robyn paused in her thoughtful way, then simply said, “Well, maybe she hasn’t cooked enough.”
Recalling this comment makes me smile. Those few words served as an impor- tant reminder of the distinction between my client’s life and my role as her therapist. In other words, what my client does with what I offer is not ultimately up to me. ACT is not some magical therapy that will always “work,” and ACT therapists are likewise not responsible for whether clients make changes in their lives. Perhaps there are times when we must content ourselves with having pulled the veil from our clients’ eyes— that is, having illuminated the ways in which they have been (and are) stuck and presented an alternative, a possible way to move forward, regardless of whether they choose to explore it. It may well be that some clients have not cooked enough, that they haven’t stewed enough in the soup of their lives to decide to start making behav- ioral changes.
I find myself wanting to say something along the lines of how this doesn’t mean we don’t try our damnedest to help clients move through such barriers, but hopefully all that should be clear by now. Rather, it is time to speak to the difficult part of any therapist’s professional life— when our clients simply do not improve. Here is where it is so important to compassionately hold our experience as therapists while also seeing with acuity what can be learned from the situation. If there were things you could have done better, allow that knowledge to be there along with the feelings that belong to that awareness. That means all of it— whether it be anger, resignation, defeat, discour- agement, frustration, or sadness. It is hard to watch someone turn away from living a more vital and meaningful life, to remain stuck while the precious minutes tick, tick away. The experience of defeat is a testament to your desire to improve the human condition. The frustration tells you how deeply you care about your work and about your clients. Regret— even shame— about something you did or didn’t do speaks to your caring and is a feeling to be honored. Check to see whether resignation doesn’t harbor a deeper sorrow that you can also hold with compassion. If you find yourself not caring as much as you “should,” notice that thought, and perhaps look to see if
174
Advanced ACTthe dispassion might be functioning as a way to keep something more uncomfortable at bay. You can hold these reactions gently and without defense, while also seeing with clear eyes what is there to be seen.
The final point I’d like to make here is a reminder that ACT is always part of a larger process. It sits in the context of the client’s life, a context that will continue to unfold long after the therapy has ended. Who knows what will or won’t stick— what little seed might be quietly germinating only to bloom in a different time and place? Many, many times, I have learned that something said or done in therapy, some concept or intervention that appeared nonproductive in the moment, actually burst into fruition at some later point. This is why, when in a situation where the client seems determined to remain stuck, I aim for clarity. Regardless of the choices the client will ultimately make (including choosing nonaction) she will be very clear it is a choice she is making. My clients will leave therapy with the veil lifted. My hope, of course, is that such clarity will help them eventually make at least a tiny move toward the life they say they wish to be living. Who knows what will happen next?
SUMMARY
This chapter has approached barriers to treatment— those inevitable and challenging behaviors that show us exactly how our clients stand in their own way. The chapter is far from an exhaustive accounting, and only touched upon some of the barriers that can appear over a course of ACT. My own ability to work with barriers continues to develop, and I am quite sure there’s no mastery to attain here. At the same time, it seems safe to say that what doesn’t work is to avoid, ignore, or try to override or other- wise control problematic behavior. Regardless of the form of the behavior in question, three clinical guidelines— getting present, leaning in, and illuminating function— have served me well and will hopefully prove as trustworthy to other ACT providers.