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anguage plays a starring role in ACT. In fact, much of the therapy is about unveiling language. We help clients see language for what it is and isn’t. We work to lessen the influence of certain forms of language processes (such as fusion with unworkable rules and rigid self- concepts) while increasing the influence of language processes in other areas (such as making value- driven choices). In short, the way words are used is important in ACT. Every verbal exchange has the potential to either further or work against the therapy.It might be fruitful to focus on two main ways in which therapists miss the mark with the words they use in session. One is by using language that works against the principles in ACT; the other is more about missed opportunities. Starting with the first, missing the mark might include making statements that directly oppose the model, such as suggesting to a client that acceptance will decrease discomfort, or that the point of defusing from thoughts is to make those thoughts less painful. It also could include less obvious examples that nonetheless contradict the therapy. For example, I have often advised consultees to stay away from using the term “depres- sion” with their clients, because they tend to use that term in the same way as their clients do (for example, “How long have you been struggling with your depression?” or “What happens on the days when you’re depressed?”). This word usage runs the risk of supporting the idea that depression is a thing that is in the client, or that something called depression somehow lands at certain times and as such has a lot of power. Even if this choice of words occurs as part of an explicit conversation about self- as- context, the therapist could potentially reinforce cognitive fusion and a conceptualized self by making such statements. Similarly, something as simple as reflecting back a client’s statement that she was “overwhelmed” by something (as in “So you were overwhelmed;
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Advanced ACTwhat else was going on?”) can support the notion that such a thing is possible. There are many, many such examples that I hear as therapists conduct the therapy.
Such statements not only can work against the model but are missed opportu- nities to actually move things forward. Even if you are just beginning with a client, with thoughtful wording you can begin to undermine cognitive fusion and develop an awareness of self- as- context. For example, you can rephrase these sorts of statements to reflect that the client is the Experiencer who had, or is having, an experience. If the client tells you that depression has been the main problem for him, you might respond with “Tell me what you mean by the experience of depression. What happens for you when you are having that experience, those thoughts and feelings about being depressed?” or “So it was one of those times when you were feeling down, having painful thoughts… .” Reframing in this way also helps the client begin to see that, rather than some concrete thing, depression (or overwhelm, or whatnot) is a series of thoughts, feelings, and sensations that are actually fluid and ever- changing. If you can continu- ally turn toward the idea that you and your clients are Experiencers who are constantly experiencing the internal phenomena of the moment, you will be guided to choose words that are more consistent with where you are headed with the therapy.
An oft- mentioned example of the importance of words in ACT is the distinction between “but” and “and.” Using the word “but” supports the verbal rule of the moment (as in “I wanted to ask her out but I was too nervous”), whereas “and” (as in “I wanted to ask her out and I was nervous”) helps clients get more in touch with their actual experience. When therapists are careful about the use of such words, clients can better see that they can make such choices regardless of what their minds are telling them. I include this particular distinction as an example of how even seemingly insignificant words have important clinical implications when it comes to ACT.
Another potential mistake, and one I’m certainly guilty of, is saying “right” at the end of a statement— such as “We’ve already talked about how thoughts and feelings aren’t in control, right?” If you are listening for this one, you may be amazed by how often it shows up in your sessions. The problem is that it can function as persuasion. It could pull clients toward therapist pleasing that may not be in their best interests.
Here’s another example of a tricky word choice I’ve heard more than once. Pointing it out may seem to be splitting hairs, but actually the choice can involve important clinical considerations: this is telling a client that a particular thought, or self- concept, is “only one part of him,” rather than pointing to such experiences as dis- tinct from the self that is experiencing them. It’s not about one part more than another, or even about balance among the parts. It’s about contacting what’s beyond the parts. We will take a closer look at this idea in chapter 9.
It can seem like a lot, though, can’t it? Not only are you trying to coherently introduce particular topics, relate metaphors, and conduct strange experiential exercises in the service of furthering core ACT processes, you are prioritizing being present and adding your reactions to the mix as well. And now you must also think about the par- ticular words you are using? Yup. Here’s some really good news: doing this perfectly is not remotely necessary. Doing it smoothly is not necessary. We really, truly, don’t have
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to do this all just right. In fact, it is a red flag for me when I am listening to a session that is very smooth, when there’s a slick exchange going on, when the session seems very intellectual and “heady.” At such times I picture two brains at a party, kicking back with a cocktail or two and holding forth. The important thing here is to be alert to the role of language and to how it is functioning in the room, so that we can point to it in a way that is useful. As ACT therapists we get to say things like “Did you hear that? I just suggested you should have different thoughts! I can thank my mind for that one!” or “I just realized I was trying to control how you were reacting to all this so that I would feel less anxious. I’m going to just hold my anxieties gently here.” One of my consultees was so prone to say “…Right?” after everything she said that she asked her client to join her in catching it during their sessions together. You can see how clinically effective such modeling can be— far more so than doing or saying things perfectly.Lately I have been likening language to a carving knife. While we use a carving knife because of its utility, we don’t forget its edge. We use such tools with intention and care. Handling language in this way can help us maximize its utility while remem- bering its edge. Here is a short list of things to think about when using this particular implement:
1. Be aware of the words you and your client are using. To repeat, every exchange is an opportunity to further the therapy. Every exchange can also work against psychological flexibility.
2. Be thoughtful as to how words are functioning in the moment. What purpose is being served or intended here? How is this conversation functioning in the session?
3. When given the opportunity to create space between the Thinker and the thought, or the Feeler and the feeling, take it. Even slight changes, such as “You are having the thought about being depressed” can alter how that expe- rience functions for the client.
4. SLOW DOWN. Take time to think things through, even if it means there’s a long pause (in which case you can say, “I’m pausing for a moment because I want to make sure I say this in the way I mean… .”) or you need to take another run at something altogether (“Wait, that didn’t come out the way I wanted; let me try that again.”). Defuse from what your mind is telling you about needing to have an immediate, perfect response.