Contact with the present moment is intimately connected with the development of self as context (see chapter 5). This is because being aware of the content of experience in an ongoing, fluid way under- mines attachment to a static, conceptualized self and requires a more fluid sense of consciousness. For this reason, coming into the present can be fostered by noting a conscious sense of self-observation. During mindfulness exercises, the therapist can say things such as, “And as you notice that, also notice there is a part of you noticing all these things,” or “Just for a moment, I’d like you to connect with the sense that you are here now, noticing what you feel in your body and what emotions you are having.”
Some clients have a difficult time doing mindfulness exercises because they have a difficult time locating a sense of self as observer. In this circumstance, the therapist may wish to work in smaller and more immediate ways on a sense of perspective as part of work on the present moment. For instance, the therapist can ask at appropriate times, “Who is saying this right now?” or “And as I ask you again, can you tell that someone is there listening, having the experience of listening, and in a moment is going to have the experience of speaking as you answer the question?” (Walser & Westrup, 2007). This kind of questioning can begin to help the client connect with the observer self that is encountering an experience in each new moment.
The therapist can model both of these processes (i.e., contact with the present and a transcendent sense of self), as well. For example, the therapist can say, “And even as you say that, I notice my heart rate pick up a bit, and my thoughts begin to get more evaluative. That gives me a sense that if I were in your shoes looking out at this set of difficulties, I’d be feeling more anxious and be pulled to be judgmental.” The latter part of that statement is deictic and thus fosters an observing sense, as we discuss in chapter 5.
CORE COMPETENCY PRACTICE
This section is intended to provide practice in using techniques designed to amplify contact with the present. As in previous chapters, we present a description of a clinical situation and a section of a tran- script. At some point, the transcript ends after a client statement, and you are asked to provide a sample response that reflects the core competency at issue. Remember, the model responses are not the only right responses. If you disagree with the responses or want to double-check your response or talk more about it, you can post a question to the bulletin board at www.learningact.com/forum/. Try to generate your own responses before you look at the samples at the end of the chapter.
CORE COMPETENCY EXERCISES
COMPETENCY 1:
The therapist can defuse from client content and direct attention to the moment.EXERCISE 4.1
The client is a fifty-seven-year-old veteran of the Vietnam War who is presenting to therapy to work on issues of PTSD. He has been in and out of therapy for about twenty years. He has complaints about the government and its response following the war. He feels his life has been permanently changed by his experience.
Client: I have a lot of resentment about the government. I mean, they should have done something. It
has been how many years? I still have all this anger.
Therapist: It seems like the past has taken over your life?
Client: It has, every day. I mean, every damn day this is with me.
Write here what your response would be (remember you are using competency 1):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 2:
The therapist brings his or her own thoughts or feelings in the moment into the therapeutic relationship.EXERCISE 4.2
This transcript continues with the same client as in competency 1.
Therapist: [gives the response found in Sample 4.1b in the model response section]
Client: It’s just that I’ve been working on this for so long, I have forgotten what it is like to be normal,
to be without a problem. I know I said this, but all I think about is the government and how they screwed me. They really did a number on me.
Therapist: It is hard for me to imagine the level of frustration you must have felt across the years.
Client: You can’t even begin to know. There is a strong part of me that wants to get back at them. This
grudge is really strong.
Therapist: It really does linger, and even in here it has lingered. We have spent quite a bit of time talking
about it … It even has a grip in here.
Write here what your response would be (using competency 2):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 3:
The therapist uses exercises to expand the client’s sense of experience as an ongoing process.EXERCISE 4.3
This transcript continues with the same client as in competency 2, but a little later in the session. Therapist: It seems part of the struggle is related to how much this issue has consumed your life.
Client: Yeah, I hate it. This is all I think about.
Write here what your response would be (using competency 3):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 4:
The therapist detects the client drifting into past or future orientation and teaches him or her how to come back to now.EXERCISE 4.4
This transcript continues with the same client as in competency 3, but in a later session.
Therapist: What could you do today to take one specific action with respect to your value about your
wife? Is there something you could do to let her know you love her?
Client: She’s been asking me to fix the door handle to the closet for months now. I guess I could do that.
Therapist: Great. I can see how that might bring appreciation into the relationship.
Client: I don’t know. She asks me to do stuff, and I wait so long to do it that I’m not even sure she
knows I’ve done it. She doesn’t comment on it, anyway. She just kind of leaves me alone … except to ask me to do stuff. I think I’ve been a “leave me alone” kind of guy for so long that she just keeps her distance. Ever since I got out of the service, things have been different. If the government only would have recognized what a lousy deal it was to be in Vietnam …
Write here what your response would be (using competency 4):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 5:
The therapist tracks content at multiple levels and emphasizes the present when it is useful.EXERCISE 4.5
The client is a thirty-three-year-old female who is complaining about wanting to hurt herself. She feels depressed and anxious and has come to this session angry at her boyfriend. She is extremely emotionally avoidant, not showing any pain since the beginning of therapy five weeks earlier.
Client: [matter-of-factly] On top of all of my other problems, I’m now having problems with my
boyfriend. I hate to say this, but he is just getting under my skin. Don’t get me wrong, I love him. But, man, I don’t think I can take this anymore.
Write here what your response would be (using competency 5):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 6:
The therapist practices and models getting out of his or her own mind and coming back to the present moment in session.EXERCISE 4.6
This transcript continues with the same client as in competency 5.
Therapist: [gives the response found in Sample 4.5b in the model response section]
Client: Yeah, I can see that, but you don’t know how upset he’s making me. I really think I’m going
to go over the edge if he doesn’t stop. This week alone, he asked me for more than a hundred dollars. I don’t have that kind of money. He’s draining me dry. I have to pay bills, I have to get my car paid off. He just doesn’t get it. I think I’m going to snap.
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
Core Competency Model Responses
COMPETENCY 1
Sample 4.1a
Therapist: The pull is to try to figure this out. But you’ve been doing that for years, and you told me it
did little to move things forward. Let’s shift from the past for a moment, and tell me: What are you aware of right now? What do you notice this moment?
Explanation: As the therapist, it can be easy to get caught up in client content. Many clients have compel-
ling stories that can lead the therapist down a path that may be helping the client to avoid. This is not to say we shouldn’t listen to what our clients have to say. However, ACT is a very active therapy and is not a therapy in which the therapist provides supportive listening most of the time. Supportive listening is valu- able, but plays a smaller role in ACT than it does in many other types of therapy.
This kind of response, if engaged by the client, immediately pulls the client out of the past and into the now. If the client is able to stay with being aware of what he is currently feeling, the therapist can point to how the client is not in the past but is here, feeling this feeling, being aware of what is present. Even if the feeling is anger, the therapist can work with that to explore how anger is affecting the client’s life and can see if there is something underneath the anger, such as sadness. These strategies are much more focused on the now than staying with the story of what happened because of the government in the past.
Sample 4.1b
Therapist: So, one of the things we could do in here is focus on how the government messed up so
many years ago. Do you think that would be helpful?
Client: Not really.
Therapist: Is it possible that focus is problematic, and what we need to do is focus on what you can do
now … work on finding out what is available to you in this moment, today?
Explanation: Here, the therapist suggests the strategy of focusing on the past is not going to be helpful.
Many clients are aware this is true. Helping the client to show up to today and to what can be done from this moment forward is a useful step for a client who has been stuck in the past for a long period of time.
COMPETENCY 2
Sample 4.2a
Therapist: So, I’m feeling this sense of frustration. [pause] I really want you to be able to move forward,
but we keep landing back here. I don’t want you to rescue me here. I just want to share what feeling is showing up for me. It feels hopeless. What shows up for you as I say that?
Explanation: This is a more risky move, wherein the therapist directly models showing up to personal
experience and is willing to state this experience. This is an honest, in-the-moment response to the client being stuck. The goal would be to model willingness to experience in the moment, while also pointing to the feelings of hopelessness that arise when trying to undo history. It also points directly to how the therapist needs to be willing, exactly as he or she is asking the client to do.
Sample 4.2b
Therapist: Right now, I’m having the experience of finding myself wanting to tell you to move on and
let go. My mind is really working on me. I wonder if this is what happens to other people in your life … they tell you to move on or let go?
Explanation: The therapist reports on the honest content of his or her mind. This in-the-moment reaction
and report not only model being present to content, but can serve to elucidate a larger problem: what it is like for other people in the client’s life. If the client is always focused on how the government has ruined his life and is holding a grudge, then probably it is affecting most of his relationships. The therapist can link this back to values and see if this is what the client intended to happen with his relationships.
COMPETENCY 3
Sample 4.3a
Therapist: I wonder if we could work to find the cracks in this idea that this is all you think about. A
while ago, you told me something about your wife and your children. So your thinking, and I suspect your feeling, changed across time. It is just when you’re stuck in this piece about the government that it feels like nothing changes. Would you be willing to do an exercise with me?
Client: Yes.
Therapist: [The therapist guides the client through an exercise in which the client has a pen and paper,
draws a line down the center of the page, and writes “thoughts” on the top left and “feelings” on the top right; suggests the client observe his thoughts moment by moment and write them in the left-hand column and also observe his feelings and write them alongside in the right- hand column. Alternately, any other present moment awareness exercise can be used here, such as the Continuous You exercise.]
Explanation: The therapist is working with the client to help him see he is more than his single experi-
ence with the government. In fact, he has had experiences without number. He has been stuck on this single experience, and his efforts to fix it have made it grow rather than diminish. The experiential exer- cise directly helps the client contact a sense of ongoing experiencing self that has numerous experiences, not only one.
Sample 4.3b
Therapist: Would you be willing to explore with me the possibility that you are larger than this
experience … that it is not everything?
Client: Sure.
Client: [closes eyes]
Therapist: Tell me what you become aware of when you do that; notice what is happening in the
moment.
Client: I hear the sound of your voice.
Therapist: Good. Now focus your attention, and I’m going to sit quietly for a minute. Stay in the
moment and tell me what you notice with each moment that passes.
Client: I hear a car outside … I feel uncomfortable with my eyes closed … I notice my leg feels stiff and I want to stretch it. [continues to report]
Therapist: [lets this continue for a minute or so; alternately, the therapist may need to be more directive
and repeatedly ask, “What do you notice now?”]
Explanation: The therapist is working with the client in the moment to help him discover he is an ongoing
experiencing being. This helps loosen the grip of “I’m a mad person, I hate the government,” so the client can see he has much more experience than that. Pointing to moment-by-moment experiencing and the sense of ongoing process can help the client discover this larger sense of being.
COMPETENCY 4
Sample 4.4a
Therapist: [interrupts the client] Notice what just happened. We were talking about ways you could
bring your value about your wife alive today, and you drifted right back into the past. Did you see it happening? What feelings might show up for you if we shifted back to working on the value?
Explanation: Here, the therapist has detected the shift into the past and makes the client aware of that
shift. It is helpful to work with clients on discovering these shifts. Sometimes they happen so quickly and naturally that the client is barely aware of what is going on. The mind is great at dragging people around. After the therapist helps the client notice the shift, the client can be helped to shift back to the present by noticing the current experience of making another shift and then refocusing on working on the value. It can also be important for the therapist to explore what emotion shows up about focusing on the value. The shift back to the past may have been an attempt to avoid the emotional pain associated with years of not living the value. This, too, can be felt, observed, and experienced, while making the choice to fix the door to the closet.
Sample 4.4b
Therapist: Do you recognize where you are going now? Client: Yeah.
Therapist: Is that a place you want to go? Client: No.
Therapist: Where would you like to be now? Client: Anywhere but there.
Therapist: Just prior to this, we were talking about how you might show your love for your wife. Would
you prefer to talk about this?
Explanation: Again, the therapist is drawing the client back to the here and now. The therapist helps the
client notice what the latter is doing because shifting into past-focused thinking is something the client could benefit from catching in flight. The therapist then reorients the client to the room.
COMPETENCY 5
Sample 4.5a
Therapist: Yeah, you feel right on the edge, like there’s nowhere else to go … Can I ask you a question? Client: Sure.
Therapist: What are you noticing in your body right now? Client: Nothing.
Therapist: Take a second, let yourself slow down and look inside. What’s showing up? If you need to,
you can close your eyes. And as you do this, see if you can let go of any resistance you feel to letting this stuff show up. See if there’s not some sense of something important in sticking with whatever you feel right now. What does your mind say would happen if you were to simply sit, holding these reactions, without doing anything to make them go away?
Client: I can’t.
Therapist: Good. And can you notice that thought, as a thought, and stay here, stay present?
Explanation: The therapist could engage this at a content level by talking to the client about the prob-
lems in the relationship. However, the therapist suspects the client is contacting some feelings not being expressed in the session. The therapist uses this opportunity to help this emotionally distant client contact a reaction at some other level than the purely cognitive, and to do so by noting something very concrete— her bodily reactions. Then, when the emotion is present, the therapist suggests taking an acceptance stance, while also being mindful of the mind because the mind might pull the client back into a struggle.