The main thing I remember about learning ACT early on was the first powerful experience I had with acceptance and struggle-dropping. I’d been doing the ‘expansion’ exercise in workshops and with clients, but the first time I really used it for myself with a very sticky problem, was such a massive eye opener, it was the biggest pivotal moment in really ‘getting’ what acceptance is as a behaviour, and what it opens up.

The context: I was in a difficult time during a relationship. After a certain event in the relationship I experienced a rush of fear, nausea, a tightness and yet somehow I remembered ’expansion’. I sat alone, looked inside and found the tidal wave of emotion, in my stomach and chest, and watched it in amazement, its power was huge and impressive, but I didn’t feel afraid, just a sense of awe and compassion – a kind of ‘no wonder you did all those things, trying to resist a thing like this’. I sat maybe 15 minutes, watching the waves rise and fall again and again, until they seemed to subside, and I was back in the room.

I felt that this first big expansion experience took me from ‘reading about ACT’, ‘studying ACT’, ‘doing ACT exercises out of real context’ and ‘imparting ACT’, to ‘doing ACT’. It now feels like a way of life and is an ongoing process, transforming the way I relate to other people in particular.

ACT training with Mindfulness Training Ltd.

The day of the Fukushima disaster I met Tobias Lundgren in the foyer at the Intermediate Skills Workshop. The news from Japan was reeling across a screen as we made introductions; so there was a weird perspective moment with a mixture of feelings – ‘me, here, now’ – excited to meet the person whose book first brought me to ACT back in my chronic pain work days; and ‘they, there, now’ – shocked and sad about the people in Japan, facing the horrors and loss unfolding in front of them, and a grumbly anxiety about thoughts of widespread contamination. My main memories of Tobias’s workshops, are the warmth and compassion he brought to it and how experiential it was – great exercises – loved the Sweet Spot, the Life Line. It was in the months following, I took up Skype supervision with Tobias, was introduced to FAP, was attracted to the idea of a behavioural approach that allowed of the use of self in the service of helping clients develop better relationship skills.

Extended ACT training with FAP, RFT and supervision with Mindfulness Training Ltd.

When this was offered, I was excited by the chance to get some ACT-focused supervision again, sharpen up my (‘sloppy’) skills, broaden and deepen knowledge… Learning to deal with uncomfortable thoughts and feelings that throw me about in my sessions, so that sometimes I act in ways I really don’t like, so that I can be a more skilful therapist, be more helpful to my clients… Connecting with other ACT therapists. All important to me. Then on receiving the course guidelines and assessment information… more thoughts. ‘I’ll never get all this reading done… oh no, a reflective journal, I can’t write about reflection, that’s going to be rubbish…’ Getting a queasy feeling in my stomach… Avoidance of this experience showed up as ‘forgetting’ to do the journal as we went along, and so having to rely on sketchy supervision notes, memories and impressions.

It was so good to meet my supervision group face to face on the RFT workshop – that made such a difference to our relationship online – I’d been very phased by discovering they were all doctoral level trained (i.e. lots better than me, thanks Mind), and found them to be real, nice women with humour, and self doubt just like mine! RFT à la Louise McHugh – fun, fast and furious but I needed some bedding in, watched Joseph Rhinewine’s youtube videos, read Hayes again. Now starting to see RFT showing up in therapy, and linking with the processes.

I’d previously dipped into Tsai and Kohlenberg, but struggled to get the flavour of FAP until Jonathan Kanter’s workshop. Taking awareness, courage and love into therapy and life in general has really enriched my experience, and helped me form closer connections with people and my values. It’s helping me to work with clients where relationships are the main issue, with so much more confidence, and the supervision has been massively helpful there.

Start of supervision

Technical problems arise early on with sending recordings and stuff. Mine seems to work pretty well mostly, and I’ve made time available to get home, online and ready. This fortnightly haven soon becomes a bit of a highlight of my work life.

Hearing my therapy voice is at first excruciating. With a real nausea feeling, I plunge into sending it, and my heart sometimes hits the ground when I hear the excerpts. Hearing a sharpness in my tone, talking too much, being too didactic… happens often, and it hurts. There’s a sense that sometimes it isn’t as bad in the room as it sounds on tape, where there are no visual cues about my and my client’s interaction. But it’s sometimes clear that the client becomes disheartened, or submissive. Watching the faces of my colleagues, I’m imagining horrified judgement going on behind their neutral expressions. Fused, feeling exposed, vulnerable, experiencing this condemnation as if it were real and live. I get fused with an old story: ‘I’m a Nasty Person’, feel ashamed, find myself tearful in supervision… my mind gets to work on that too. Realising that though I’ve been working on helping my clients practise self-compassion, when this thought hooks me, I’m straight down the hole.

Finding kindness, validation and empathy there from the group was a big thing for me. A sense of ‘ok, yes it’s hard, and it can go differently’.

The FAP workshop really helped to bring my awareness more into the impatience and frustration I sometimes feel, that push my CRB1s (work harder, talk more, listen less). Spotting the antecedents (e.g. client rambling, not getting it), and responding to that by slowing down, shifting focus from thoughts to feelings – noticing ‘stuckness’ together. Saying ‘yes’ to the stuckness feeling. It’s noticeable how much kinder and accepting I feel now towards all my clients, and the more this happens, the more I find I appreciate them, enjoy being with them. The work feels richer and more intense and I have hugely more energy for it. Also, how important and worthwhile it felt in the FAP workshop to contact shame and realising how shame-avoidance moves (especially playing ‘I’m right, you’re wrong’) had led me more deeply into the ‘I’m a Nasty Person’ quicksand so often in my life. Committing now to slowing down, practising presence and openness both in clinical work and with friends, family, colleagues, and feeling closer connection from this, and in the clinic, seeing clients trusting the therapy more.

Supervision experiences and learning – including some wisdom and golden questions, things I’m practicing:

• formulating with the Hexaflexi – asking ‘where are this client’s skills deficits?’
• selling the idea of short term pain for long term gain
• always considering – what’s the function/motivator of a given behaviour
• Self as Context – favourite metaphors – bus/hijackers (you’re bigger than your thoughts and feelings – you’re the busii); party guest; quicksand; tug of war; thoughts as balloons to take along; chessboard (or box of stuff)
• keep experiential whenever possible – up out of the chair, meditation, imagery, metaphor, in vivo contact with the problem
• spot when fusioniii serves a ‘protective’ function – e.g. ‘it will never improve’ implies – I don’t have to try, won’t dash my hopes.
• creating alliance with angry/rejecting clients – ‘I’ll stay no matter what you throw at me’
• tackling unhelpful relational framesiv through transformation of stimulus function – metaphors, analogy, paradox, defusion
• self compassion and resilience in adversity: ’I’m just doing the best I can’
• learning about how to supervise by Joe’s example, empathy, compassion and validation when we make mistakes or disappoint ourselves
• getting in touch with anger that erupts ‘out of control’ – encourage to role play how they are when angry – learn defusion ‘on the fly’
• 2 pieces of paper metaphor – one with thoughts, one values – move values to the fore a bit – more prominent as a guide to behaviour
• using humour says ‘I think you can take this… our relationship is good enough’
• loving the phrase (for defusion) ‘Watching your mind at work’ – nice, ongoing process, for problems like worry, rumination
• self-compassion – ‘this isn’t easy’
• approaching voice-hearing with functional analysis/down-playing a bit/listening to them a bit/ catching triggers/Self as Context and values
• rumination metaphor – ‘steering with your eye on the rear-view mirror’
• use metaphors from client’s own experience – e.g. training a dog to fight – how were you trained?
• ‘If you could inject a bit more choice into what you’re doing – what could you then do?’
• focus on function: ‘When you do that, what do you hope will happen?’
• (In the face of adversity) ‘How would you want to be seen? If this was a chance to show this? If you were doing this e.g. for your kids?’ (to see you managing in difficult times)
• using values cards – pick the top 3 (why are these there?), and then the bottom 3… ‘tell me a little story about those – why don’t they get in?’
• If I annoy you… how will we manage that?
• What’s the worst thing about being ‘out of control’?
• Getting around intellectualising – how do we learn to play the guitar? how do we fall in love? appreciate a sunset?
• defusion/SAC: how long have you had that thought?

The process of self-reflection has been one of the most helpful things, especially listening to recordings of my own therapy. I’ve kept this going and try to listen to snippets regularly, wanting to be aware of where and how my ACT consistency might fall off, and to keep an eye on relationship issues. Doing this, finding less I feel ashamed about as time goes on, and even noticing some real spells of fluency in the ACT processes!

Mindfulness in movement

After plenty of exposure and practice, I’m decided that sitting mindfully for long periods is not my style and I don’t seem to need it to practice ACT; my nature is to be on the go, and I really value being fit and being musical, and developing ability in these, and being open to big physical challenges. My ACT learning has coincided with running regularly, learning to scull, and with working on improving my flute playing; I find these activities the most demanding of mindfulness of any I do outside the clinic, where all the processes of fusion with self as content (‘useless’), unwillingness to be with the discomfort involved, the pain, the embarrassment. Using the ACT interventions has gradually flowed into all these areas, and I feel able to continue with all of them with steady persistence, where in the past I often cycled through overdoing/dropping my hobbies.
Before I came to ACT, I was rather sneering about concepts like ‘spirituality’, framing that with ‘New Age nonsense’. And now I’d have to say that the sense of connectedness with something bigger is both really strong in me and massively enriching for my life. I feel passionate about this stuff and energised to keep learning.

Fleur Joyce
Cognitive Behavioural Therapist, NHS

i Hexaflex – Six processes for psychological flexibility: Present Moment, Acceptance/Willingness, Cognitive Defusion – thoughts just thoughts, Self as Context/Observer self, Committed Action guided by Valued directions.
ii See for an animated illustration of the bus metaphor.
iii Fusion – Taking thoughts literally or without having any distance from them.
iv Relational Frames – Cognitive relations between concepts e.g. She is the same as my mother. I am worse than my father.