The distinction between attempts to control problems outside versus inside the skin is an important one in ACT. Using examples such as removing a clock from the room because you don’t like it or taking your car to the shop when you begin to hear a loud
noise under the hood helps illustrate the usefulness of problem solving for practical, outside- the- skin problems. In fact, this type of problem solving is so ingrained that people can launch into this mode instantaneously without even thinking of the actual steps involved in solving a problem. Reviewing the specific steps in the problem- solving process can help highlight how the steps that are meant to fix a situation might actu-ally contribute to the pitfalls of the unworkable control agenda.
For example, take the situation of coming home and smelling gas in the kitchen.
This problem can probably be fixed within a matter of seconds, but doing so could involve several steps:
1. Recognizing that something is wrong (detecting a strange odor)
2. Identifying the cause (figuring out that the odor is gas from the stove and that a knob isn’t completely shut off)
3. Anticipating what could happen if things continue and no action is taken (knowing that there could be an explosion if there’s a spark)
4. Determining what should be done and executing it (turning the knob off and opening windows)
5. Evaluating whether the plan worked by comparing the actual outcome to the expected outcome (waiting to see if the odor dissipates)
6. Determining what was learned and figuring out how to prevent or handle similar problems in the future (calling one’s partner and sharing the experience)
In this example, each step seems to have a role in moving toward resolution of the problem. However, if these steps are applied to problems under the skin, is it possible that they could be involved in generating suffering or psychological inflexibility? For instance, step 2, identifying a cause, could be harmful if it shows up in the form of attributing blame or responsibility (e.g., “It was all my fault” or “You should have known better”). Likewise, looking into the future for potential consequences of situations and choices, as in step 3, might look like excessive worrying (e.g., “I know I need to do this, but what if happens?”) if it becomes a predominant mode. Step 4, determining what should be done and doing it, requires accessing verbal knowledge or a rule (e.g., a spark will cause an explosion if there’s a dense concentration of flam-mable gas). However, when dealing with problems outside our control, trying to adhere
to such rules about how things should be and behaving strictly based on those rules (e.g., “I’ll make changes only on my terms” or “Tit for tat— that’s how I see it”) can maintain the position of being stuck as a person who waits for his circumstances or other people to change, and struggles against what is.
Furthermore, when the processes of evaluation, comparison, and judgment required in step 5 are applied to the self, they might contribute to a persistent view of chronically falling short of a standard and the use of negative labels about oneself (e.g., “Why can’t I just stop being this way?” or “I’m a loser, and most people probably think that way about me too.”). Finally, while incorporating cognitive units from experience (e.g., lessons about what worked, evaluations) into verbal knowledge, as in step 6, might help a person deal effectively with similar situations in the future, when this process is applied to the self or problems under the skin, it may come at a tremendous cost.
Evaluations and labels can be incorporated into a conceptualized view of the self or the world that’s harmful and limiting (e.g., “I should just stop trying,” “Maybe if I stop caring, I won’t get hurt again,” or “That’s how people are, so why should I bother getting close to anyone?”).
You can conduct a similar exercise with a client by outlining the steps involved in solving an external problem from his life and then applying those steps to the problem the client is bringing into therapy. For instance, the two of you can work with an exter-nal problem where the client can readily envision a specific, desired outcome (e.g., having more financial flexibility during retirement in fifteen years). Together, you can identify factors in his current circumstances that may hinder reaching this outcome (maintaining a lifestyle that’s creating more debt); brainstorm all behavioral options that will make this goal possible (making financial compromises now and saving a certain amount per month); and develop a plan to monitor progress. You can then highlight processes involved in executing these steps, such as focusing on problem areas (what isn’t working well), forecasting and planning ahead, and evaluating progress along the way to see if the changes are actually beneficial.
You can then compare how the client has engaged in these same steps in “resolv-ing” a problem under the skin (e.g., trying to improve his self- esteem through continu-ous efforts to prove himself to others, losing weight, or focusing on his imperfections) and explore how well these efforts have worked (e.g., by asking, “Are you finally a more confident version of your old self? If not, did you try hard enough? What if things never change for you?”). This can underscore the distinction between what works in the outside world and what works inside the skin. It can also generate an understanding of the costs of these control processes when applied to problems outside his control, and especially when applied to himself.
Experiential avoidance or efforts to control can not only create and maintain “dirty”
pain and suffering but also undermine a person’s ability to take helpful action. After reviewing all of the mind’s suggested ways of fixing the problem that a client struggles with internally, you might ask if any of the strategies from “this fixing the problem”
approach have helped the client get through his difficult experience. The answer is often a clear no, and in most cases, these strategies have only made things worse. This creates an opening to shift the focus from problem solving to acknowledging his experi-ence openly and exploring other behavioral options for responding to difficult circumstances.