The point of mindfulness exercises is not so much to develop mindfulness during the periods of the exercises themselves, but to raise present moment awareness more generally, so it is available when needed or helpful. As such, ACT therapists also work to weave mindfulness into the fabric of the sessions in an ongoing manner. One common way to bring more present moment focus into sessions is to begin sessions with a brief mindfulness exercise (for an excellent example see Eifert & Forsyth, 2005, pp. 125–126). This can be particularly appropriate for clients—and for therapists, if you do it with the client—who are more in their heads because it helps them to get present and to psychologically show up to the session, ready to work. We recommend doing mindfulness exercises along with the client, if possible, because this often
results in more fluid and better-timed exercises, helps the therapist be mindful and present, and can help equalize the therapeutic relationship.
Contact with the present moment is an essential skill for fostering acceptance, defusion, and values in session. Experiential work with all of these processes requires clients to bring experiences into the room in order to work with them. One way to do this is to have clients slow down, stop, and check in with their own present experience during moments that suggest something is showing up that the client is avoiding or with which the client is fused (either consciously or unconsciously).
Cues that indicate it may be helpful to have a client stop and attend to what is showing up include shifts in client vocal tone; sudden changes in the direction of the conversation; the appearance of bodily tension or hoarseness in the client’s voice; repetitiveness in thinking or speaking (e.g., worry, obsessiveness, or rumination); or anything that suggests restriction, tension, or inflexibility. When these behaviors are noted, you can gently ask the client to slow down, get present, and notice what he or she is feeling, sensing, or thinking. It can be useful during these moments to intentionally direct the client’s attention to various domains of experience (e.g., emotions, thoughts, bodily sensations, urges to act, associated memories) and directly ask him or her to notice what is being felt in each domain. Sometimes it can be helpful to have a client slowly and carefully repeat a particularly poignant phrase in order to further heighten what is present and make it easier to identify. Here is an example from a session.
Therapist: You have been talking a lot about your difficulties at work, yet you don’t seem too bothered.
It must be frustrating.
Client: It is frustrating. It makes me really mad.
Therapist: It seems as if it might be painful, too. This is the third job you’ve had this year, and it is
unfolding just like the last two.
Client: [turns red] Well, they are just so stupid. I mean, I’m doing what they tell me to do. If they would just leave me alone and let me do my job, things would be better.
Therapist: It seems you wish for that quite a bit, and yet it never seems to happen.
Client: [pause] Oh, yeah, I just remembered. I wanted to let you know I went to see the psychiatrist. She thinks I should get some more testing done.
Therapist: Did you see what just happened? We started to talk about pain, and you changed the topic. Client: Yeah, I see … But I don’t want to cry. I look silly when I cry. I feel stupid.
Therapist: [pauses to slow down the process] I wonder if you could notice those thoughts … silly, stupid
… and let yourself show up to what is happening right now, to your feelings?
Client: [gets tearful]
Therapist: All I want you to do is just notice this experience as it is unfolding right now. [pause] What
do you feel in your body? Take a slow moment to look. Look and see exactly where you feel it.
Client: [answers]
Therapist: And what kind of judgments and evaluations show up? Just pause, and even before you
answer, take a careful, calm look.
Client: [answers]
Client: [answers]
Therapist: And when you have all of that, what do you notice yourself wanting to do? Client: [answers]
Therapists can use a number of other ways to work with clients to help them discover the moment in therapy (Strosahl et al., 2004, p. 44). These include asking clients to simply be aware of thoughts, feelings, and memories as they arise; to identify when being present is needed; to pay attention to the shift between being present and getting pulled into the future or the past; and to do an experiential seeking exercise in which they notice the sights, sounds, and sensations that are present in the room. If clients are not very effective in noticing what is present, it is a good idea to start with simple, structured bodily sensations. A client can be asked, for example, to say out loud what sitting in a chair feels like or what it feels like to hold a breath, extend an arm, or rub his or her face with a cloth.