Respectfully Interrupt the Behavior

Once we’re in the right head space, seeing the behavior as an oppor-tunity for therapy, not an obstacle to it, our next step is to interrupt the behavior. There are many ways to do this. Here are just a few examples:

 “May I please interrupt you for a moment?”

 “Is it okay if I call time- out for a moment?”

 “You know, there’s something I’m noticing happening in this room, and I’d like to share it with you.”

 “Can I stop you right there? There’s something really important happening here, and I think we need to address it.”

Interrupting the client is the step we’re most likely to balk at, typi-cally due to our own fusion and avoidance. So we could take the oppor-tunity to use the situation to model ACT for the client, as in the follow-ing example.

Therapist: There’s something I notice happening here in the room—

something that’s a bit problematic. And I’d really like to share it with you. My mind’s telling me you’re going to be upset or offended or angry about what I say. And I’m feeling really anxious about it: my stomach is churning, and my heart is pounding away. And I have to admit, I have a strong urge just to bite my tongue and keep quiet about it. But my aim in this room is to help people live better lives. So if I just sit here and say nothing about what I’ve noticed, then I would not be true to my values as a therapist. And I wouldn’t be doing you a service, either. So even though I’m feeling really anxious and my mind is yelling at me to keep my mouth shut, I’m going to tell you what it is I’ve been noticing.

Notice how the therapist has explicitly modeled five of the six core ACT processes: defusion, acceptance, values, committed action, and contacting the present moment. Plus, by now, the therapist undoubtedly has the client’s full attention!

To be most effective and respectful, include the following elements in a request to interrupt the client:

 Asking for permission

 Being willing to be wrong

 Giving a rationale

 Agreeing to an interrupt signal

Asking for permission. When we ask the client for permission to inter-rupt, it communicates respect. (At other times in ACT, we may ask for permission to introduce a new exercise or keep going a bit longer with one that is challenging. For example, we may say, “Is it okay if we do a little exercise right now? You don’t have to; I’m only suggesting it because I think it will be helpful” or “Is it okay if we stay with this exercise a while longer? You certainly don’t have to; we can stop anytime. It’s just, if we can go a bit longer, I think you’ll get more out of it. But it’s totally up to you.”) Willingness to be wrong. A genuine, humble willingness to be wrong is very important. Our theories, observations, and predictions may be spot- on, but they may also be way off. It’s often helpful to use the phrase “I’m willing to be wrong about this” as a preface to comments or observations, particularly if theorizing about the function of a client’s behavior or sug-gesting that an exercise will be helpful.

Giving a rationale. Giving a good rationale for an intervention often facilitates willingness in the client. It also communicates respect.

Sometimes the rationale might be pretty vague: “I think this will help you” or “I think you’ll learn something useful.” Other times it may be specific and detailed, as in the next transcript.

Agreeing to an interrupt signal. With some clients, especially those who won’t stop talking, it’s useful to get permission to interrupt on an ongoing basis and to agree to a signal for doing so.

Here’s an example of how those four elements might be combined.

Therapist: I’m willing to be wrong about this, but it seems to me that when your mind tells you to say something, you just have to say it. It’s like you’ve got no choice in the matter; you just have to do whatever your mind tells you to. One of the things I think would be really helpful here is if we could work together to help you get back some control over what you do. At the moment, your thoughts and feelings are mostly in control of your actions, and that’s obviously not working too well for you. I’d like to help you take more control of your actions so you can do the things you really want to do, deep in your heart. How does that sound to you? (Client agrees.)

Great. So at those times when I think your mind has taken over and is calling all the shots, is it okay if I interrupt you? I’ll just put up my hand like this (holding hand up, palm open), and when I do that, it means stop talking for five seconds, notice what your mind is doing, and notice what you’re feeling in your body. Would that be okay? I know it sounds a bit odd, yet it’s a simple but powerful first step in taking back control of your actions.

When I do it, you’ll still feel a strong urge to keep speaking, but you’ll learn that you don’t have to act on that urge.

Step 3: Nonjudgmentally Describe