As you read the transcript, what were your reactions? How did you feel? Was it uncomfortable for you in any way? If so, how? What emotions did you notice? Did you have any evaluations? Make a note of these.
It is important to be respectful and humble when working in a lengthy, confrontational fashion; oth- erwise it can appear as if you are playing a game with the client or as if you are invalidating him or her. The idea is to validate the client’s actual experience of control not working, and to suggest that the social message he or she was given might be incorrect, rather than that the client is incorrect. It is also important to point out before the end of this kind of session that you are suggesting that the agenda is hopeless, not that the client is hopeless.
The creative piece in creative hopelessness refers to an openness that comes when needless experien- tial control is finally abandoned and attention is focused instead on living a life that comports with chosen values. The goal is not a feeling of hopelessness or belief in hopelessness; in fact, usually this process feels hopeful. The goal is to speed the process of abandoning what is not working (Hayes et al., 1999). Often when old control agendas are stripped away, the client experiences a sense of being lost or confused. This is not a negative sign; it is a sign the old control behaviors are beginning to fall away. Other common reac- tions include the client slowing down or being more thoughtful; periods of silence; a sense of lightness in the room; laughter; and starting and stopping the dialogue, as if the client were catching habitual patterns of thinking.
Other guidelines are important to keep in mind. A very common mistake by the therapist is trying to convince the client that avoidance is not working or that he or she must give up the experiential avoidance agenda. The therapist can also try to push the client beyond where he or she is ready to go. It is impor- tant that the client’s experience be the absolute arbiter. Creative hopelessness will only function as it should if the confrontation is between the client’s mind/system of experiential control and his or her experience, not between the therapist and the client. The therapist is simply there to guide this process of helping the client examine his or her own experience and determine whether the solutions that have been put forward by his or her mind have actually worked out as they were supposed to, or whether experience has shown otherwise.
It is important for the therapist not to get caught up in the content of what clients say. It is a mistake, for example, to encourage a client who offers a seemingly logical or healthy solution without first thor- oughly exploring its actual function. This mistake is especially tempting if what is put forward is similar or formally identical to ACT methods. However, the purpose is not to list formally correct methods; it is to explore the functional impact of any and all solutions and to let go of what is not working. Typically, what is not working is the client’s cognitive entanglement and the resulting unseen control agenda, which may not be seen easily or logically. Client experience is the biggest ally.
It is also important to note that creative hopelessness is not a one-time, all-or-nothing shift in behav- ior, but rather is about establishing the possibility of something other than control—in this moment, and the next moment, and then the next moment. It is about eventually helping clients see that each moment of existence offers an opportunity to say no to their experience and feed the agenda of experiential avoid- ance, or to say yes and feed the vitality of a life embraced.
The relative emphasis on undermining control largely depends upon the pervasiveness of experiential avoidance and control in the client’s life. For some clients, experiential control has been their dominant way of living for many years and they are very entrenched in the pattern; for other clients, experiential control is less pervasive, less practiced, or less dominant, and they are more ready to give it up as a solution. The higher the chronicity and pervasiveness, the more likely it is that this part of ACT needs to be empha- sized. The therapist can probably move through this step more rapidly with clients who have relatively less pervasive patterns of experiential avoidance and can move into helping them develop mindfulness and acceptance skills in the context of pursuing their values.
The following transcript comes from an early session with a bright, young, relatively functional client with social anxiety.
TRANSCRIPT 2.2
Therapist: [after reviewing how the client has tried to deal with anxiety] Let me suggest something. If
this were any easy, obvious thing to do, you would have figured it out.
Client: I think, yeah.
Therapist: You’re a smart, capable person. You’ve been struggling with this a good portion of your life.
And you know directly that there is something inherently tricky about this problem. So, for example, even noticing that something is not there is enough to create it. It’s like, “Oh, I’m feeling better,… oh no,… oh no I’m not.” Like that. Let’s look at what was on this list of things you’ve done to manage anxiety. There was distracting, reassurance, talking yourself out of it, avoiding it, and perhaps some other things we haven’t talked about yet. See if they all have this characteristic in common: They can, at certain times, be a little helpful, and … ultimately they’re not that helpful.
Client: Yeah.
Therapist: They don’t solve it. Client: No. I know that. [laughs]
Therapist: And see if even this isn’t true. They can work for a short period of time, and they might even
make it worse in a moderate or longer period of time. Like this. If you do something to distract yourself, sooner or later you have to check to see if it worked. And then when you check to see if it worked, it’ll remind you of what you were trying to forget … and it’s back.
Client: Yeah, sometimes I’ll be thinking, “Okay, I’m going to distract myself. Let’s think about something
fun. So I think … skiing, riding down the hill, getting to the lodge, hanging with friends at the lodge— crap! Okay, start over.”
Therapist: Yeah.
Client: Or sometimes it happens like, gosh, I’ll notice I’m feeling better, and then it’ll be back. Therapist: Yeah. And here’s the problem. You talked about the tricks your mind plays on you, right?
The problem is, your mind is in the room, not just you. So you’re doing a lot of stuff your mind is telling you to do. And it works however it works, and in the long term, it doesn’t seem to work, and here you are. And yet it’s in the room, listening to what we’re saying.
Client: It knows. [giggles]
Therapist: Yeah, it knows what’s going on, right? Client: Yeah.
Therapist: But it doesn’t seem to be able to give you ultimate, final answers. If anything, it seems to
torment you. It reminds you of some random memory you don’t want to think about.
Client: And I can’t logically make it go away. I think I understand what you’re saying. I know what I’m
thinking isn’t logical, but it just doesn’t get through.
Therapist: Right, because this isn’t just a logical deal, it’s a psychological deal. And that’s not the same
thing. So let’s put these things together. We need to carve out some space here in which to work. I want you to consider the possibility that the things that seem logical, reasonable, sensible you’ve pretty much exhausted. They pay off like this. [spreads hands] They don’t pay off in some other way.
Client: [laughs] No, they don’t.
Therapist: They pay off like this. And if that’s the case, then we’re going to have to open up the
possibility that a whole other attack on it is what’s needed. And yet we’ve got a mind in the room that’ll say, “Oh yeah, I get that. That’s like that,” and will try to pull it back into the same system. [pause] So, you know what quicksand is?
Client: Yeah.
Therapist: When people step in it, they do the normal, logical, reasonable, sensible thing: they try to
get out of it.
Client: Which makes it worse.
Therapist: Yeah. So the normal way to get out of things is you push to get out of it. The problem is,
when you do that with quicksand, it just sinks you in deeper. The one foot didn’t work, so you push on the other. Now you’ve got two of them in there. Maybe it’s like that. Maybe the things you’ve been doing are like the normal, logical, reasonable, sensible things people do when they are stuck in suction mud. And, in fact, it’s not liberating you; if anything, it’s making you more stuck. So, if that’s true, then we have to find something that might work that’s outside the set of all the things that might work. You know what I mean?
Client: [laughs] Yeah. [pause] So, what are we going to do, then?
Therapist: [pauses, smiles] Well, your experience is telling you, “I do something, and it doesn’t pay off.
It pays off short term and it doesn’t pay off long term.” And, really, the problem just keeps hanging around. Sometimes it’s better, sometimes it’s worse, but here it is. And you’re trying not to let it grow. But it’s still here, and you’re stuck.
Client: [murmurs agreement]
Therapist: Well, I want to open the door and say, “You know that sense that you have that you’re stuck?
Well, maybe you have that because you really are stuck.” This game is a stuck game. It’s not going to work some other way. It works like this. You know in your experience how things have worked. If you back up and look at it, it looks almost as though this were a rigged game. In other areas of your life, you put in the effort and get the outcome. Not here. So, we will need to do something really different.