One of the ways therapists often inadvertently work against the principles we are hoping to further in ACT occurs when discussing the mind’s tendency to engage in evaluations. I have observed that many therapists draw a distinction between describ- ing and evaluating, but then neglect to bring home the point of this distinction. That is, they educate the client on how an evaluation differs from a physical description, but leave out how we humans tend to literalize evaluations, how we relate to evaluations as though they are descriptions. When these important pieces are left out, the client is left with a sort of “so what?” experience, or is apt to conclude that evaluating is wrong. I have also observed that many therapists readily go with the idea that evaluation is problematic but then proceed to work with this idea in a fashion that is more remi- niscent of traditional CBT than it is ACT- consistent. In other words, rather than help
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shift the function of evaluative thoughts, they work with them in such a way that the main message to the client is that he needs to stop incorrectly evaluating. For example:Therapist (conducting an individual ACT session with a male Vietnam veteran who is also a participant in a weekly support group run by the therapist): “I noticed you were pretty quiet in group this week.” Client: “Yeah, didn’t feel like talking.”
Therapist: “Was that a feeling you were having then? Not wanting to talk? Or were there thoughts going on as well?”
Client: “There’s always thoughts going on.”
Therapist: “Yeah, right. I ask because you told me before that you often have thoughts about not having anything useful to say, like you don’t have anything to contribute.”
Client: “Yeah, there was some of that.”
Therapist: “Can you tell me more about that? It would help me understand what you experience in those situations. So you have the thought ‘I don’t have anything to say… .’”
Client: “Yeah, like ‘Why say anything if it’s just gonna bring everybody down? If I don’t have anything good to say, why say it?’”
Therapist: “Oh, so your mind told you that you would bring people down.” Client: “I do! That’s why it’s better to just keep to myself. Why ruin
things for everybody else? I’ll just be a downer.”
Therapist: “It’s like what you were saying last week about being toxic.” Client: “That’s right! Toxic. Better to just keep to myself.”
Therapist: “And yet, you told me last week that your grandson told you he loved you. And your wife seems to want you around more, not less.”
Client: “Hmm. They don’t know what’s really inside me.”
Therapist: “So even though some people do like to be around you, you still have the thought, the evaluation, that you are toxic, a downer— that if others knew what was inside they would not want to be around you. Like that?”
Client: “And that they would never think of me the same. If they knew what I really am, how I really feel…some of the things I’ve seen… they wouldn’t want to know, believe me!”
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Advanced ACTTherapist: “So because of all the stuff you’ve just mentioned— the
experiences you’ve had, things you’ve seen and done, thoughts you have— you have the thought, the evaluation, that you’re toxic.” Client: “That’s right.”
Therapist: “And when you have that evaluation, what happens next?” Client: “I just keep to myself. That way I won’t bother anybody.” Therapist: “And how does that make you feel?”
Client: “Lonely. Depressed.”
Therapist: “Hmmm. So evaluating isn’t working. You just end up feeling worse. But if you were to check your actual experience, you might see that your grandson, for example, doesn’t experience you as being toxic.”
Client: “He doesn’t know what’s really going on with me, though.”
This exchange is actually a pretty typical example of the potential (depending on how it actually functions) misstep I’ve just described. Taking a closer look at this exchange, we can see that the therapist may have stepped off course a bit at the point he first responds to the veteran’s evaluation about being toxic:
Client: “That’s right! Toxic. Better to just keep to myself.”
Therapist: “And yet, you told me last week that your grandson told you he loved you. And your wife seems to want you around more, not less.” (The potential risk here is that the client may interpret this to mean that he needs to have different thoughts. While we might want to bring the client’s attention to aspects of his experience, it is important not to convey the message that he should not be having evaluative thoughts. We hope to alter the function of such thoughts by helping the client recognize the distinction between what his mind tells him and his actual experience. One way to approach this would be to help the client track his own experience, observing not only his thoughts around this but also what happens in his interactions with others.)
Client: “Hmm. They don’t really know what’s inside me.”
Therapist: “So you have the thought, the evaluation, that you are toxic, a downer— that if others knew what was inside they would not want to be around you?”
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Client: “And that they would never think of me the same. If they knewwhat I really am, how I really feel…some the things I’ve seen… . they would not want to know, believe me.”
Therapist: “So because of all the stuff you’ve just mentioned— the
experiences you’ve had, things you’ve seen and done, thoughts you have— you have the evaluation that you’re toxic.”
Client: “That’s right.”
Therapist: “And when you have that evaluation, what happens next?” Client: “I just keep to myself. That way I won’t bother anybody.” Therapist: “And how does that make you feel?” (I prefer to say something
along the lines of “And what sorts of feelings show up at times like this?” to better work against the idea that feelings— having pleasant ones and getting rid of uncomfortable ones— are the objective.) Client: “Lonely. Depressed.”
Therapist: “Hmm. So evaluating isn’t working.” (This may be true in this case, but knowing it doesn’t stop the mind from evaluating. Rather than the mind doing something wrong, it is doing what it is geared to do.) “You just end up feeling worse.” (This statement supports the problematic idea that avoiding feeling bad is the goal, and that if we are feeling bad it’s because we are having the wrong sorts of thoughts, or evaluations. This idea is what gets clients—and us—stuck in the first place.) “If you check your actual experience, for example, you might see that your grandson doesn’t experience you as being toxic.” (There is a fine line between pointing out that our evaluations might not necessarily be true and implying that evaluation itself is bad. That is the overarching message implied in this exchange— that evaluation is bad, and therefore the client needs to stop it.)
Client: “He doesn’t know what’s really going on with me, though.”
As I mentioned earlier, there are many rich metaphors and powerful exercises that help therapists work with language in a way that clients can understand. Here is an example applied to the scenario described above:
Client: “That’s right! Toxic. Better to just keep to myself.”
Therapist: “So one of the thoughts your mind hands you is that you better stay away from people, keep to yourself.”
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Advanced ACTTherapist: “What else is there? What I mean is, what else does your mind hand you around the notion of being toxic in situations like this?” (Here the therapist is working on cognitive defusion via word usage— “what does your mind hand you”— and building
self- as- process by helping the client observe the flow of his thoughts. He is also flushing out at least part of the relational network the client has developed around the word “toxic,” and showing that there is a collection of thoughts that tend to show up when the client has this particular experience.)
Client: “I don’t know what you mean.”
Therapist: “It sounds like there’s a problem with being toxic. You need to keep to yourself and hide that you’re toxic because…”
Client: “…because other people will be brought down.”
Therapist: “And that’s bad because…” (The therapist continues to point to the flow of thoughts around the relational network associated with being toxic and is attempting to unearth the experiential avoidance at the heart of the issue— in other words, that the client doesn’t want to feel the way he feels when he perceives others to be evaluating him as a downer.)
Client (after pausing to think): “…they wouldn’t want to be around me anymore.”
Therapist: “And that would…”
Client: “ That would really…that would make me feel even worse about myself.”
Therapist: “Huh, that’s really tricky, isn’t it? Your mind tells you that you need to not be around people so that they won’t want to not be around you… .” (The therapist continues to chip away at cognitive defusion, getting at the idea that some of what the client’s mind is handing him is suspect. This change may seem slight, but it’s quite a difference from how the client has been holding his thoughts. Notice, though, that the point is more that the mind needs to be taken with a grain of salt than that something wrong is happening here—that something is wrong with the client because he is evaluating.) Client: (laughs ruefully): “Yeah, that doesn’t make any sense.”
Therapist: “It sure puts you in a bind— especially since this is what minds do. Our minds’ job is to assess, problem- solve, evaluate…and
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it gets really tricky because the way we relate to our minds, to our thoughts and evaluations, can really get us stuck. That is, once language comes along and we learn to label things and start attaching meanings to things, it can get really sticky.” (The therapist makes a point of normalizing what the client’s mind is doing and introduces the topic of language itself.)Client: (Listening.)
Therapist: “Language is useful, obviously, but it also does a number on us in a way, particularly when it comes to evaluations.” (The therapist rises and moves an empty office chair closer to where they are sitting.) “Take this chair, for example. We English- speaking people have agreed to call this object a chair. In France it would be ‘chaise.’ We could just as easily agree to call it a ‘barg.’ In fact, if I said, ‘Can you please move that barg?’ you would know what I mean, right?”
Client: (Laughs, nods.)
Therapist: “And we’ve also agreed to call this ‘metal’ (touching the legs), and this particular material ‘plastic’ (touching the seat back), and this part the ‘seat,’ and this (touching the fabric seat) ‘fabric.’ We could just as easily have named them something else, but the point is that we’ve assigned words to refer to these physical properties of the chair.”
Client: “Okay…”
Therapist: “Now, if I were to say, ‘That chair is the best chair,’ or ‘That is a snazzy chair,’ that’s a bit different. When we talk about the metal legs, or the cloth seat, we are describing the various physical aspects of this object we are calling a chair. But we aren’t going to find ‘best’ in this chair, like we can find metal or plastic. We’re not going to actually find ‘snazzy’ in there, either.”
Client: “Okay, I see that.”
Therapist: “‘Best’ and ‘snazzy’ aren’t in the chair— they are evaluations. Evaluations require an Evaluator. That is, ‘best’ and ‘snazzy’ are created by the interaction between the observer and the chair, rather than being a property of the chair itself. Is that making sense?”
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Advanced ACTTherapist: “What gets so tricky about that is that we tend to relate to our evaluations of things as though they are literally true, as though we could take the chair apart and find snazzy in there. For example, you have the evaluation of being toxic, and you relate to that as though we could open you up and actually find toxic inside of you somewhere.”
Client: “I think I see what you’re getting at… .”
Therapist: “And can you see that part of the trickiness here is that knowing this doesn’t make it go away? Knowing that our evaluations are subjective doesn’t mean we stop evaluating. But we can recognize what our mind is handing us, and that even though the thought ‘I’m toxic’ is sure to show up here and there, that doesn’t represent literal truth. You are having the thought that you are toxic, rather than you are toxic.”
The use of a physical object such as a chair or cup to illustrate how descriptive and evaluative processes function for humans was introduced in the first ACT book (Hayes et al., 1999). I have seen it done effectively with any manner of objects as a useful way to help clients understand the distinction between describing and evaluat- ing and how fusion with evaluations can result in being stuck.