COMPETENCY 1:
The therapist communicates to the client that he or she is not broken but is using unworkable strategies.EXERCISE 2.1
A fifty-six-year-old male client has come to therapy seeking relief from his anxiety associated with PTSD. He has been in a number of treatment programs and worked with at least three other therapists and psychiatrists. He complains he cannot do regular, everyday kinds of things because his anxiety is too high. He isolates him- self and wishes things would be different, as well as using other avoidance strategies.
Client: [after listing about ten strategies for getting rid of anxiety] What I would really like to do is find
a way to get this anxiety under control.
Therapist: It seems you have tried a lot of different things. You’ve certainly made an effort.
Client: Yeah, I just need to try harder … to find one thing that will make this different.
Write here what your response would be (remember you are using competency 1):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 2:
The therapist helps the client make direct contact with the paradoxical effects of emotional control strategies.EXERCISE 2.2
This transcript continues with the same client as in competency 1.
Therapist: [gives the response found in Sample 2.1b in the Core Competency Model Responses section
below]
Client: I see what you mean, but I just want things to be different. I’m feeling anxious all the time. I
can’t stand being like this.
Therapist: If things were different, what would you be doing?
Client: Everything would be different. I would be able to be around people, I could work. Everything
would be a lot better.
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 3:
The therapist actively uses the concept of workability in clinical interactions.EXERCISE 2.3
This transcript continues with the same client as in competency 2, but later in the session. Therapist: How successful have you been at making it different when you try harder?
Client: Well, it works for a little while, and then the problems start all over again. The anxiety comes
back.
Write here what your response would be (using competency 3):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 4:
The therapist actively encourages the client to experiment with stopping the struggle for emotional control and suggests willingness as an alternative.EXERCISE 2.4
A forty-one-year-old female client is seeking therapy to alleviate anger and sadness around the breakup of a relationship. The breakup occurred three years prior to entering therapy. The client explained in the initial session that she feels betrayed and unable to move past the pain of the breakup. She notes that her anger is interfering with her ability to move on. She also notes she is angry with herself for “being duped” in the rela- tionship. This dialogue occurs in the fourth session.
Client: I feel overwhelmed by my anger … and I feel stupid. It has been three years. Why can’t I get
over this? It’s embarrassing.
Therapist: Somehow getting over this seems like the thing to do, and then embarrassment and “stupid”
will go away … in addition to the anger?
Client: Silly, isn’t it?
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 5:
The therapist highlights the contrast between the workability of control and willingness strategies.EXERCISE 2.5
Let’s assume you have the same client as in competency 4, but the session goes like this:
Client: I feel overwhelmed by my anger … and I feel stupid. It has been three years. Why can’t I get
over this? It is embarrassing.
Therapist: Somehow getting over this seems like the thing to do, and then embarrassment and “stupid”
will go away … in addition to the anger?
Client: Silly, isn’t it?
Therapist: I can see you have a lot of judgment about your anger. You think it’s silly and stupid.
Client: It is. I just can’t believe I’m still angry about this. It doesn’t make any sense to me.
Write here what your response would be (using competency 5):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 6:
The therapist helps the client investigate the relationship between willing- ness and suffering.EXERCISE 2.6
This transcript continues with the same client as in competency 5, but later in the session. Therapist: What kind of effort have you put into making the anger go away?
Client: A lot. I can’t even begin to describe how hard it has been.
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 7:
The therapist helps the client make contact with the cost of unwillingness relative to valued life ends.EXERCISE 2.7
This transcript continues with the same client as in competency 6.
Therapist: What are some of the things that have happened because of this difficulty? How has your life
changed as a result of how hard this has been?
Client: Well, I am suspicious of men. I think they’re all trying to pull the wool over my eyes. I have
stopped dating completely. I tried it a couple of times, but found myself being cranky on the dates. I’m incredibly lonely and feel angry at men … I blame men for that. I’m just out of control about men… How can I ever trust them?
Write here what your response would be (using competency 7):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 8:
The therapist helps the client to experience the qualities of willingness.EXERCISE 2.8
This transcript continues with the same client as in competency 7, but in a later session. Therapist: How important is it to you to have another relationship?
Client: I would really like one, but I just don’t think it is possible. Something really significant would
have to change.
Write here what your response would be (using competency 8):
COMPETENCY 9:
The therapist uses exercises and metaphors to demonstrate willingness as an action in the presence of difficult internal experience.EXERCISE 2.9
A fifty-year-old male is in therapy because his wife has insisted he get help for his withdrawn and irritable style of interacting with her. He reports feeling distant and wanting his wife to leave him alone following a misun- derstanding during which some of his money was lost. He notes that he is extremely disappointed.
Therapist: What would you choose to have happen with this relationship? Are you wanting it to end?
Client: No, I don’t want a divorce or anything like that. I just can’t bring myself to talk to her, I almost
can’t even look at her. I know the lost money was not her fault, but I still blame her. I want the money back.
Write here what your response would be (using competency 9):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 10:
The therapist models willingness in the therapeutic relationship and helps the client to generalize these skills outside therapy.EXERCISE 2.10
This transcript continues with the same client as in competency 9, but later in the session.
Client: I am ashamed that I’m so focused on the money. It is hard to admit. I am worried you might
think I’m an asshole.
Therapist: It is hard to admit these things. It can be anxiety provoking.
Client: Yeah, I’m having a hard time talking about it with you … I’m not sure you can help.
Write here what your response would be (using competency 10):