People high in experiential avoidance get strong payoffs for any behavior that provides relief from pain, no matter how short- lived that relief may be. They are therefore very reluctant to let go of the avoidance agenda. For such clients, we bring in creative hopelessness.
Creative hopelessness interventions create a sense of hopelessness about the client’s agenda of avoidance. The aim is to make her more open to the alternative agenda of acceptance. There are many different ways to do creative hopelessness interventions, and they vary enormously in duration, from as brief as a few minutes to as long as an entire session.
We may use them very sparingly— perhaps even as a one- time interven-tion— or we may use them extensively, in session after session. Despite their diversity, they all revolve around three questions:
“What have you tried to make the pain go away?”
“How has that worked in the long term?”
“When you’ve used these strategies excessively, what has it cost you?”
I’m not going to describe any specific creative hopelessness interven-tions here because you can find good examples in any introductory ACT text, such as ACT Made Simple (p. 83). However, I will provide some tips that can help you be more effective with any creative hopelessness tech-nique you use.
Tip 1: Prompt the Client
Most clients can’t readily recall all the avoidance strategies they use, so we often need to prompt them—e.g., “Have you ever tried…?” A useful acronym that will help you recall the most common strategies is DOTS:
D = Distraction: What are all the ways you use to distract yourself?
O = Opting out: What people, places, situations, and activities do you opt out of, stay away from, quit, or withdraw from?
T = Thinking: How do you try to think yourself out of pain—
for example, worrying, fantasizing, blaming, “analysis paralysis,”
positive affirmations, challenging thoughts, blaming others, self- criticism, or fantasizing?
S = Substances, Self- harm, and all other Strategies
(You might like to check out the Join the DOTS Worksheet in ACT Made Simple, p. 84.)
Tip 2: Clearly Acknowledge the Payoffs
We need to make sure we clearly acknowledge the payoffs of avoid-ance. We might say to the client, “So, clearly, many of these strategies help you reduce or get rid of the pain, for a little while.” We should also add, “And if any of these things improve your life in the long term, it makes sense to keep doing them!” This is a very important message. We aren’t mindfulness fascists in ACT; we don’t expect people to give up all their avoidance strategies. Many avoidance strategies aren’t problematic if used moderately, flexibly, and appropriately. They generally become unworkable only when we use them excessively, rigidly, and inappropriately.
Tip 3: Remind the Client That the Pain Always Returns
At the same time that we acknowledge the payoffs of avoidance—
that it can cause the painful thoughts and feelings to go away in the short term— we also get the client to contact the fact that, in the long term, the pain returns. For example, we might say, “You’ve got many ways to
make these feelings go away for a short while. But do they go away per-manently and never come back?”
Obviously we expect the client to answer no. If the client says yes, we reply along these lines: “Well, now I’m a bit confused. If you’ve found a way to permanently eliminate painful thoughts and feelings, I don’t understand what you’re doing here. I mean, why not just go away and do more of it?”
Tip 4: Ask but Don’t Lecture about the Costs
We want the client to take a good, honest look at the costs of these behaviors, but we don’t want to lecture him; we want him to see for himself that although his behavior has payoffs, it also comes with signifi-cant costs. For example, we might ask, “How many of these strategies give you some relief in the short term but keep you stuck or make your life worse in the long term? Would you say none, a few, most, or all of them?”
Here, we expect the answer “most of them.” If the client says, “none,”
“a few,” or “not many,” we again reply along the lines of “Well, I’m a bit confused. If you’ve got all these ways way to get relief from painful thoughts and feelings, and they’re not keeping you stuck or making your life worse in the long term, then I don’t understand what you’re doing here. Why not just go away and do more of them?”
Assuming the client answers, “most of them,” we can follow up with a question such as “When you’ve relied excessively on these methods, what have they cost you in terms of health, money, wasted time, relation-ships, missed opportunities, or increased emotional pain?”
We can also explicitly link the costs to valued living by asking, “Do these behaviors generally help you create the life you want to live [be the person you want to be, do the things you want to do, etc.]?” or “In general, when you’ve used these strategies, have they taken you closer to the bull’s- eye or farther away?” We could also point to each quadrant of the bull’s- eye in turn and, for each one, ask, “What have these strategies cost you in this domain?”
Finally, a gentle reminder: Do this in a compassionate, nonjudgmen-tal manner, with a genuine attitude of openness and curiosity. If we come from a place of judgment, being “right,” or “knowing best,” this interven-tion will backfire.
Tip 5: Arouse Curiosity
At the end of any creative hopelessness intervention, we want to arouse the client’s curiosity about the alternative we’re offering. Here’s an example of how we might do this.
Therapist: So you have these very painful feelings, and, quite naturally, you’ve tried very hard to make them go away.
Many of the things you’ve tried gave you some relief in the short term. But in the long term, those painful feelings keep coming back. And unfortunately, most of the strategies you’ve used to get rid of those feelings have had significant costs. In the long term, they’ve made your life worse, not better. So I’m wondering: Would you be open to trying something different— something radically new?
Would you like to try a new way of responding to difficult feelings so they have much less impact and influence over you— something that’s radically different from everything else you’ve tried?
Ideally, by this stage we’ve created a willingness in the client to let go of the avoidance agenda, and a curiosity about what the alternative is. If so, we can now introduce acceptance using very gentle, extremely brief interventions. (For examples of extremely brief interventions, see the wide range of ten- second acceptance techniques in ACT Made Simple, pp. 140– 143.) Then, as the client’s mindfulness skills improve over time, we can move on to longer and more challenging exercises.