The worksheet begins with the client’s description of the main problem or problems. This is important: we want to understand the cli-ent’s conceptualization of his issues, knowing it will differ from our own.
After that, the worksheet asks, “What does the client want from therapy or coaching?” For example, does she have an emotional goal, such as to stop feeling anxious or depressed, or to start feeling happy or confident? Does she have a behavioral goal, like stopping smoking, start-ing to exercise, or improvstart-ing a relationship? Does she have an insight goal, seeking the answer to a question such as “Why am I like this?” or
“Why do I keep doing this?” Does she have a material goal, such as making money, buying a house, finding a partner, or getting a job? This is important information. If we can’t answer this question, we need to ask the client in the next session.
Next, the worksheet asks about external barriers to vitality and flour-ishing; in other words, the obstacles that exist first and foremost in the outside world (as opposed to the internal barriers of fusion and avoid-ance). Are there legal issues, financial issues, social issues, medical issues, occupational issues, or even, in extreme cases, basic survival issues, such as food and shelter? In some cases, it may be necessary to tackle these external barriers first. All will require constructive problem solving and the formulation of an action plan informed by values. Many will also require skills training.
1. What Stands in the Way of Vitality and Flourishing?
The next section of the worksheet explores the internal psychologi-cal barriers to a rich and meaningful life. It has three subsections, cover-ing unworkable action, fusion, and experiential avoidance.
A. Unworkable Action
In the section on unworkable actions, we record everything the client is doing that makes her life worse in the long term. This includes things she is procrastinating on or persistently avoiding; self- defeating habits such as excessive or inappropriate gambling or use of drugs or
alcohol; social withdrawal or isolation; mindless, impulsive, or reactive behaviors; and so on. Here we document overt avoidance: important people, places, activities, or situations that the client is actively avoiding.
B. Fusion
In the section on fusion, we record anything the client says that throws us, alarms us, angers us, or makes us feel stuck or anxious. (After all, if we’re fused with it, we can be pretty sure that the same is true for the client!) We also document thought processes from any or all of the six main categories of fusion: fusion with reasons, rules, judgments, past, future, and self- description. We might also document specific thoughts, such as I’m a loser, or categories of thinking, such as worrying or rumination.
C. Experiential Avoidance
Recall that experiential avoidance means avoiding stuff inside our-selves: thoughts, feelings, and so on. If a client tells us he wants to stop feeling a certain way, stop having certain thoughts, or get rid of certain memories, we write those private experiences in this section. Avoiding external stuff— people, places, situations, and so on— is technically called overt avoidance, and it belongs in section 1A, on unworkable action.
In this section, on experiential avoidance, we identify the private experiences the client is trying to avoid, escape, or get rid of: emotions, thoughts, feelings, urges, memories, sensations, cravings, and so on. Note that the actions the client takes to avoid these experiences, such as ingesting drugs or alcohol, belong in section 1A, on unworkable action.
Keep in mind that people often try to avoid the very thoughts and memories they are fused with and that they also often fuse with internal events that they are avoiding. If we wonder, Is this avoidance or fusion? it’s probably both, so we record it under both 1B and 1C.
We may initially have to guess at what private experiences the client is avoiding. We can make a good start by documenting any emotion, feeling, sensation, urge, memory, or thought the client identifies as a barrier to the life he wants. For example, if the client says, “I want to do X, Y, and Z, but I can’t because I feel too anxious,” then clearly he wants
to avoid or get rid of anxiety. If the client says, “I can’t stop drinking because the cravings are too strong,” then clearly he wants to avoid or get rid of his cravings. If the client wants to get into an intimate relationship but won’t because he’s afraid of rejection, we would write “fear of rejec-tion” in this section. Therefore, when the client mentions a goal or course of action he’d like to pursue, a useful question is “What’s stopping you?”
The answer frequently reveals the client’s experiential avoidance.
We also need to be alert for emotional goals, such as “I want more confidence” or “I want to be happier.” We could record these in section 1B, since they represent fusion with rules, such as “I have to feel more confident before I can do the things that matter.” However, emotional goals often point to thoughts and feelings the client is trying to avoid. For example, the client who wants more confidence is generally trying to avoid anxiety, self- doubt, and fear of failure, in which case we would record those thoughts and feelings in section 1C.
2. What Valued Direction Does the Client Want to Move In?
In section 2, we identify domains of life important to the client: e.g., parenting, work, friendships, marriage, environment, leisure, or health. If this isn’t clear, we can consider what domains of life the client focuses on.
What does she get angry or anxious about, complain about, feel guilty about, or dwell on?
Next, we consider what values seem important to the client within that domain. If we can’t write down values for a client, that’s useful infor-mation too. It tells us that we need to do some values clarification. In the meantime, we can take a guess as to what her values may be and then check out our hunch in the next session. In addition, we consider whether the client already has some meaningful goals or ongoing meaningful activities within that domain. If so, what values might be linked to them?
Keep in mind that strong emotions are often linked to important values. So a useful question to ask clients is “What does this emotion tell you about what really matters to you, deep in your heart?”
Brainstorm
Once we’ve completed as much of the form as possible, it’s time to brainstorm: what tools, techniques, strategies, questions, metaphors, worksheets, or experiential exercises could we employ to address any of the subsections on the form? What intervention might facilitate even a tiny shift from fusion to defusion, from experiential avoidance to accep-tance, or from unworkable to workable action? What strengths and inner resources does the client already have that he can utilize in the service of valued living? Here, we also consider whether constructive problem solving or skills training is necessary.