harris3day advanced

Acceptance & Commitment Therapy ADVANCED Workshop with Russ Harris

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Psychological Flexibility

Contact With The Present Moment

Defusion

Acceptance Values

Committed Action

Self-as-context

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Workshop Rules

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Workshop Aims n  Case Conceptualisation: DSM & non-clinical n  ABA: function analysis n  Getting Unstuck n  Overcoming ‘resistance’ n  Mandated/coerced clients n  Trauma & Suicidality n  Addiction & Urge surfing n  Barriers to acceptance n  Values & ‘I don’t know’ n  Self-as-context & the observing self n  Compassion & Forgiveness

The Aim of ACT:

§  To maximise human potential for a rich, full and meaningful life

§  To reduce suffering and increase vitality §  To increase psychological flexibility

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THE WHOLE ACT MODEL RESTS ON .....?

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Contact with the Present Moment

Defusion

Acceptance Values

Committed Action

Self-as-context

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Be Present

Open Up Do What Ma2ers

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Be Present



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The Resilience Formula

4 approaches to any problem situation: 1. Leave 2. Stay & change what can be changed 3. Stay & accept what can’t be changed & live

by your values 4. Stay & give up & do stuff that makes it worse

Exercise: 2 memories

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a)  Client responds well b)  Client responds poorly - What was that like? - What happens to your values as a coach/

therapist etc. when you get fused/avoidant?

‘Physicalising’ an emotion

Shape & size? Weight (or weightless)? Location? (E.g. at the surface, deep inside) Liquid, solid, gaseous? Colour(s)? Transparent or opaque? Temperature? Hot or cold spots? Texture of the surface? Movement, vibration or sound? Are you willing to make room for this object, in order to … NB: In ACT, acceptance is always in the service of

values/goals – otherwise, why bother?

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3 Elements of Self-compassion

(Kristin Neff) 1.  Mindfulness (i.e. defusion, acceptance,

contacting the present moment) 2.  Kindness 3.  Common Humanity

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Qualities of an ACT Coach/Therapist

n  Compassionate, radically respectful -- and (often but not always) playful

n  Accepting, defused, present, and guided by values

n  Willing to experience discomfort in the service of helping others

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Qualities of an ACT Coach/Therapist

n  Sees people as ‘stuck’, not ‘broken’; as ‘sunsets’, not ‘maths problems’

n  Stance of equality and commonality: my mountain, your mountain

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Common Coach/Therapist problems (adapted from Steve Hayes.) n  Inconsistencies & mixed messages n  Talking & explaining ACT, instead of doing it n  Being Mr Fix-it n  Being Mrs Good-listener n  Being Mr Nice Guy

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Common Coach/Therapist problems n  Trying to convince or 'be right’ n  Taking a “one-up” position n  Excessive focus on one process, while

neglecting others n  A lack of understanding of the theoretical

underpinnings

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Hands As Thoughts In front of you is everything that matters: the people, places,

activities you love etc. Now get caught up in your thoughts Notice 3 things: How much are you missing out on? How disconnected and disengaged are you? How difficult is it to take action, to do the things that make your life

work? (give examples) Now slowly separate from your thoughts What’s your view of the room like now? How much easier is it to

engage and connect? How much easier is it to take action? Notice these things (i.e. hands) haven’t disappeared. If you can use

them, do so. If not, just let them sit there.

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Informed Consent

•  ACT is a very active form of therapy or coaching – not just talking about problems.

•  Learning skills to handle difficult thoughts and feelings more effectively, so they have less impact and influence over you

•  Clarifying your ‘values’: what matters to you, what you want to stand for in life, how you want to treat yourself and others, what gives you a sense of meaning or purpose

•  Taking action: to solve problems, and do things that make life better

•  Like playing a guitar – needs practice both in session and between sessions.

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Informed Consent - additional

Also consider discussion of: a) Number of sessions b) Pre-empt urge to drop out c) Evidence base d) How ACT gets its name: accept what is out of

your personal control and commit to action that improves your life

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Informed Consent - additional

Also consider asking this: Can I have permission to interrupt you: so if I

see you doing something that looks like it might be making your problems worse, I can point it out, and we can address it?

And can I also do that if I see you doing something that looks like it might be really helpful or useful?

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DSM?

“The goal of validating these syndromes and discovering common etiologies has remained elusive.

Despite many proposed candidates, not one laboratory marker has been found to be specific in identifying any of the DSM defined syndromes

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DSM?

“Epidemiological and clinical studies have shown extremely high rates of co-morbidities among disorders, undermining the hypothesis that the syndromes represent distinct etiologies.

Furthermore, epidemiological studies have shown a high degree of short term diagnostic instability for many disorders.

With regard to treatment, lack of specificity is the rule rather than the exception.”

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DSM?

“Many, if not most, conditions and symptoms represent a somewhat arbitrarily defined pathological excess of normal behaviors and cognitive processes.

This problem has led to the criticism that the system pathologizes ordinary experiences of the human condition.”

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DSM?

“Researchers’ slavish adoption of DSM-IV definitions may have hindered research in the etiology of mental disorders”.

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DSM?

“Reification of DSM-IV entities, to the point that they are considered to be equivalent to diseases, is more likely to obscure than to elucidate research findings”.

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Where do these quotes come from?

The American Psychiatric Association planning committee, for the fifth version of the Diagnostic and Statistical Manual

Pages xviii & xix Kupfer, D. J., First, M. B. & Regier, D. A. (Eds.).

(2002). A research agenda for DSM-V.

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One More Quote

From same source: Pages xviii & xix ofKupfer, D. J., First, M. B. & Regier, D. A. (Eds.). (2002). A research agenda for DSM-V.

“All these limitations in the current diagnostic paradigm suggest that research exclusively focused on refining the DSM-defined syndromes may never be successful in uncovering their underlying etiologies.

For that to happen, an as yet unknown paradigm shift may need to occur.”

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Defusion

Acceptance Values

Committed Action

Self-as-context

Fusion with past or future

Fusion with the conceptualised self

Fusion with reasons, rules, and judgments

Experiential Avoidance

Unworkable action

Remoteness from values

Psychological Rigidity

Painful Private Experience

FUSION

THREAT

EXPERIENTIAL AVOIDANCE

Paradoxical Effects

Life Costs


THREAT


Paradoxical Effects

Life Costs



Paradoxical Effects

Life Costs


Plus FUSION

Plus AVOIDANCE

Plus UNWORKABLE ACTION

TRAUMA

Plus DEFUSION

Plus ACCEPTANCE

Plus WORKABLE ACTION

RESILIENCE

‘BURNOUT’

DEPRESSION

ANXIETY DISORDER

ADDICTION

ANOREXIA

SUICIDALITY

TRAUMA

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Defusion

Acceptance Values

Committed Action

Self-as-context

Fusion with past or future

Fusion with the conceptualised self

Fusion with reasons, rules, and judgments

Experiential Avoidance

Unworkable action

Remoteness from values

Psychological Rigidity

Flashbacks

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FEELINGS

THOUGHTS SMELL

TASTE

TOUCH HEAR

SEE

PAIN MEMORY FEELING THOUGHT SENSATION URGE

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PAIN

SMELL

TASTE

TOUCH HEAR

SEE

FEELINGS

THOUGHTS

SELF-COMPASSION

VALUES & ACTION

Drop Anchor

•  Something very painful has just shown up, and I want to help you handle it

•  Push your feet hard into the floor •  Sit forward in your chair •  Push your hands hard together, •  As well as this painful thought/feeling/memory, notice your

body in the chair – hands, feet, back •  Also look around – notice 5 things you can see •  And notice 3 or 4 things you can hear •  And also notice you and I, working together •  So there is a painful thought/feeling/memory here •  And your body in the chair •  And a room around you •  And you and I working together 39

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Be Present



NIGHTMARES

Sleep Hygiene Nightmare Rehearsal

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SUICIDALITY

Kirk Strosahl’s “three I’s” Pain is perceived as: Intolerable Interminable Inescapable

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Defusion

Acceptance Values

Committed Action

Self-as-context

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Be Present


ACT is based on ABA – Applied Behavioural Analysis

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ABA is a BIG model Brief look at 3 bits: 1.  Appetitive control vs aversive control 2.  Reinforcement versus punishment 3.  The ‘3-Term Contingency’

Aversive Control Vs Appetitive Control

•  Behaviour under aversive control •  moving away from what you don’t want •  escape/avoid an ‘aversive stimulus’

•  Behaviour under appetitive control •  gaining access to what you do want •  approach/explore an ‘appetitive stimulus’

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Exercises in pairs

Eating chocolate, running through a forest, making love, playing with your kids, doing housework

create scenarios where these things are under: a) aversive control (avoid/escape something unwanted) b) appetitive control (access something wanted) What is the difference, experientially?

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In each session we:

Undermine narrow, inflexible behaviour under aversive control

Model, instigate and reinforce broad, flexible behaviour under appetitive control

Note: narrow inflexible behaviour can be under appetitive control

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A – Antecedents

B – Behaviour C- Consequences

C

Situation Thoughts Feelings

Immediate outcomes that either increase or decrease the behaviour

If consequences => lNCREASE in behaviour, they are ‘REINFORCING’

Something an organism does

- Public - Private

If consequences => DECREASE in behaviour, they are ‘PUNISHING’

PUNISHMENT vs REINFORCEMENT

DIFFERENTIAL REINFORCEMENT

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A – Antecedents

B – Behaviour C- Consequences (reinforcing)


immediate outcomes that maintain the behaviour

Situation: alone in house at night, tired Thoughts & Feelings: ‘I have no friends’ ‘I wish I had a social life’ Sadness, loneliness, Anxiety, boredom Urge to smoke dope

Feeling of relief; painful thoughts, feelings, urges disappear

Costs: Addiction worsens; stays home more & social isolation increases; more feelings of loneliness and sadness

Smokes marijuana

Present Moment, Defusion, Acceptance

Values & Committed action

Workability


- Public - Private

‘TRIGGERS’ ‘PAYOFFS’

DIFFERENTIAL REINFORCEMENT OF A MORE WORKABLE BEHAVIOUR

payoffs VS costs

Reinforcing Consequences (Payoffs)

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1. Escape/avoid an aversive stimulus

2. Access an appetitive stimulus

‘negative reinforcement’

‘positive reinforcement’

Functional Analysis: 3 Questions For Any Unworkable Behaviour:

B- BEHAVIOUR: What is the person doing? A- ANTECEDENTS (‘TRIGGERS’): What situations, thoughts, feelings immediately

precede the behaviour? C – CONSEQUENCES reinforcing it (‘PAYOFFS’): What immediate outcomes of the behaviour maintain

it over time?

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7 Common Reinforcing Consequences (payoffs) for Unworkable Behaviour

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1. I avoid/escape an unpleasant situation/event

2. I avoid/escape unpleasant thoughts/feelings 3. I feel good 4. I gain attention 5. I get my needs met 6. I feel like I am ‘problem solving’ 7. I feel like I am ‘making sense’ of things

WORKABILITY: payoffs VS costs

Exercise in pairs: ‘Functional Analysis’

Identify Antecedents (triggers): situation, thoughts, feelings

Identify Reinforcing consequences (payoffs) NB: This will be unique for each individual! Client 1: B – Behaviour = drug/alcohol use Client 2: B – Behaviour = social withdrawal Client 3: B – Behaviour = procrastination on a task Client 4: B – Behaviour = aggression

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Exercise in threes Client: Pick a quadrant of the bull’s eye to work on.

Identify a problematic behaviour in that quadrant. Therapist/coach 1: Identify the ‘Triggers’ (situation, thoughts, feelings) Identify the ‘Payoffs’ Therapist/coach 2: Summarise: “So in the short term, this helps you to X,Y,Z.

But in the long term, what costs does this have?” Identify the ‘Costs’ Validate: So this really takes you away from the bull’s eye Summarise briefly how ACT can help (ultra-brief version

of informed consent)

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A Common Reply To Questions About Values:

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I DON’T KNOW!

Consider the function of this behaviour

Is it a request for help, due to lack of knowledge?

If so, do brief psychoeducation, give some examples of values, then do an experiential exercise

A far more common function of ‘I don’t know’:

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A – Antecedents




Situation: therapy/coaching session – being asked about values Thoughts & Feelings Oh shit!’ ‘I don’t know!’ Anxiety, confusion. Urge to change the topic

Says ‘I don’t know’



Workability


- Public - Private



payoffs VS costs Costs: Fail to clarify values, Fail to set meaningful Goals Remain stuck – nothing changes

Conversation ends Feeling of relief; anxiety/confusion disappears

Validate: yes, right now, you don’t know. So would you be willing to: Sit with the question a bit longer? Do an exercise with me? Fill in a worksheet?

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Clues: Important Domains of Life

What does the client: n  Complain about? n  Get angry about? n  Worry about? n  Feel guilty about? n  Fear? n  Desire?

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Clues: Important Domains of Life

§  Explore pain in all its forms: what does this

pain tell you really matters? §  For suicidal clients: What has stopped you

from killing yourself? §  If these painful thoughts/feelings/memories

were no longer a problem, what would you do differently?

Useful Questions For Crisis/Loss

What do you want to stand for in the face of this?

10 years from now, if you were to look back at the way you dealt with this issue, what would you like to say about the way you behaved, the way you handled it, what you stood for?

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More Useful Questions

You are 80 years old, looking back on your life today; complete these sentences:

I spent too much time worrying about …. I did not spend enough time doing things such

as … If I could go back in time, what I’d do differently

is …

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Values Checklist

n  Take 10 minutes

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Life Compass

n  Take 10 minutes

Get People Moving: 3 Factors

1.  Small change 2.  Positive direction 3.  Owned by the client

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On a scale of zero to ten, how likely are you to do this?

The Brief Bull’s Eye

§  A) Pick a quadrant §  B) What matters to you in this part of your life? §  C) Where are you now, on the dartboard? §  D) What’s one tiny thing you could do in the next week to

move you towards the bull’s eye? §  E) How will your mind try to talk you out of that? §  F) What difficult feelings might show up? §  G) Are you willing to make room for those thoughts and

feelings, in order to do this? §  H) On a scale of zero to ten, how likely are you to do this?

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Mandated/Coerced Clients: 5 Steps 1.  Normalise: e.g. “Most people feel upset or annoyed” 2.  Validate & empathise: e.g. “Of course you feel that way! I’d feel the same!’ 3.  Declare your values: e.g. “My aim is to help people have better lives” 4.  Q: “What possible outcome from this would make it feel like a good use of

your time?” 5.  The ‘Free Will Switch’ (adapted from Kelly Wilson) ‘Off’ = you are here for others/ waste of your time/ nothing in it for you ‘On’ = you are here for yourself/ can make free use of my resources/ something of value in it for you ‘On’ or ‘Off’, you are still in the session: it just determines if it’s a waste of your time or not. If client chooses off: either a) ‘In that case, we may as well end the session, because without your cooperation I’m powerless’ or b) ‘Okay, well let’s keep going then, but notice how keeping the switch off really makes the session drag/ sucks the life out of you/ makes this seem like a total waste of time

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Resistance To Change: 7 Factors

•  Treatment mismatch •  Discordant Therapeutic Relationship •  Secondary Gains FEAR: •  Fusion •  Excessive goals •  Avoidance of discomfort •  Remoteness from values

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Informed consent

Pros & Cons of change

Defusion

Realistic goals

DARE

Acceptance of discomfort

Embracing Values

Embody ACT in session

Why don’t we stop it?

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Problematic In-Session Behaviour

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A – Antecedents




Situation: the client is doing some form of problematic behaviour Thoughts & Feelings Anxiety ‘If I confront this, that’s rude/ will destroy rapport/ she’ll get angry or upset/ he’ll leave/ she’ll complain about me’

Therapist/coach makes no active attempt to point out, confront, address or interrupt the client’s behaviour. Instead, opts for ‘active listening’



Workability


- Public - Private


WHAT’S A MORE WORKABLE BEHAVIOUR?

payoffs VS costs Costs: Client’s problematic behaviour persists Unable to do effective therapy/coaching Increasing frustration, anxiety/ boredom/ disengagement for the therapist/coach

Feeling of relief; anxiety disappears

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Defusion

Acceptance Values

Committed Action

Self-as-context

I’m noticing something problematic here and I’d like to share it with you

I’m feeling pretty anxious about it. My heart’s racing.

My mind’s telling me you’ll be upset or angry or think I’m rude

So even though I’m feeling really nervous, I’m going to tell you what I’ve noticed

But my aim in here is to help people live better lives – so if I ignore this, I’m not being true to myself and I’m doing you a disservice

Staying On Track 1

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1.  Permission to start session ‘differently’ & rationale for doing so (e.g. not making progress, sessions inefficient)

2.  Confirm that you are a team, working together

3.  Agree to a specific domain/area to work on 4.  Your mind will try hard to ‘get us off track’.

Lets see if we can notice all the tactics it uses.

Staying On Track 2

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1.  Notice, name and normalise each ‘tactic’ Write them down on a piece of paper

2.  Ask the client to tick a ‘tactic’ whenever it recurs

3.  If client say ‘This won’t work because X,Y,Z’ then ask, ‘Shall we stop the session, because your mind says XYZ – or shall we let your mind say that and carry on?’

Staying On Track 3

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1.  Return to the agenda repeatedly 2.  Repeatedly draw attention to mind’s tactics;

unhook and return 3.  Reinforce any workable behaviour you see –

eg point out and comment favourably on functionally positive non-verbal behaviour (e.g. eye contact, body posture), acceptance, defusion, engagement, willingness, vulnerability, commitment, connection with values etc.

1.  Ask client to assess their own behaviour in session in terms of workability: ‘towards’ or ‘away’ from values (e.g. the bull’s eye)

2.  Ask client to assess how their behaviour affects the therapeutic/coaching relationship

3.  Permission to interrupt, and rationale for doing so

4.  Rationale for learning to focus, unhook, and refocus

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Other Useful Tips

1.  Keep noticing and naming habitual cognitive patterns

2.  Psycho-education about automaticity versus choice: ‘I want you to have more choice about what you do – at the moment you seem to be totally controlled by your thoughts and feelings’

3.  Have client take ownership of agenda

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Other Useful Tips

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A – Antecedents




TAKING DRUGS

Workability = payoffs VS costs


- Public - Private





GAMBLING CHECKING EMAILS COMPULSIVE CLEANING MICRO-MANAGING WORKING LATE HAIR PULLING SHOUTING AT EMPLOYEES

TAKING DRUGS

REASON GIVING: Reasons why I can’t change/ won’t change/ shouldn’t have to change

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A – Antecedents




Situation: therapy/coaching session – talking about changing behaviour Thoughts & Feelings Anxiety Feeling ‘Under pressure’ Thoughts about why I can’t change/won’t change/shouldn’t have to change

Reason-giving ‘ I can’t change/ won’t change/ shouldn’t have to change because of X,Y,Z’



Workability


- Public - Private



payoffs VS costs Costs: Problematic behaviour maintains

Conversation ends Feeling of relief; anxiety disappears pressure lifts

REASON-GIVING

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What if client identifies a tangible benefit?

What if client identifies tangible

benefits? VALIDATE IT!

Workability: Payoffs vs costs

Are there more workable ways of

getting those payoffs?

Is skills-training required?

REASON-GIVING

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What if client identifies a tangible benefit?

What if client identifies genuine

barriers? VALIDATE IT!

If resources are missing:

Change the goal! Either: get the

resources Or modify to

adapt to the lack

If the resource missing

is a skill?

TRAIN IT!

REASON-GIVING

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I can’t help it I’ve got no

control! I can’t resist it!

It happens before I know it!

REASON-GIVING

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VALIDATE! Yes, right now that’s how it is!

Like to change it? Requires learning some new skills

Avoidance of discomfort

Why accept pain?

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Pushing Away Paper In front of you is everything that matters: the people, places,

activities you love etc. Now push these feelings away from you, hard as you can Notice 3 things: How tiring is it? How distracting is it; how difficult is it to fully engage or connect? How difficult is it to take action, to do the things that make your life

work? (give examples) Now rest it on your lap How much less effort is that? How much easier is it to engage and

connect? How much easier is it now to take action? Notice your feelings (i.e. the paper) haven’t disappeared. But you

have a new way of responding to them, so they don’t hold you back or tie you down or stop you engaging in your life

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I Just Want To Get Rid of It #1

Validate: Of course you do. Who wouldn’t? Values: If I had a magic wand and I made it disappear, then

what would you do differently? What have you given up, or missed out on, while

trying so hard to avoid or get rid of your pain? If making room for this pain, and letting it flow

through you without a struggle, could help you to … (mention key values and goals) … would you be interested in learning how to do that?

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Research shows: lots of good research showing that when we use this approach symptoms reduce. But it doesn’t happen through directly attacking them – they reduce as a side-effect of doing this (push the paper demo)

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Declare your own helplessness: I don’t know how to get rid of your pain. But I do know a new way of responding to it, so it has

less impact and influence over you…etc N.B. Double-check: did you get informed consent

from the client? Does the client know or remember you are working from the ACT model? If not, go through it!

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Only Two Ways: As long as you only have these two ways of responding (fusion & avoidance demo with paper) it will always seem horrible/ feel overwhelming/ control your life.

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Creative Hopelessness: What have you tried doing to get rid of it? How has it worked, long term? What has it cost you? What have you missed out on? The more effort you put into avoiding or getting rid of

this pain, the worse your life gets. Do you want to do more of what’s not working?

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Medical metaphor: it’s like diabetes or asthma – can’t get rid of those, but learn new ways of responding to them so you can still live a rich, full and meaningful life

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Hard facts: no coach or therapist or doctor, working from any model of therapy, can guarantee to get rid of unwanted thoughts and feelings. They all work the same way: new ways to handle thoughts and feelings so they have less impact and influence over you. I can’t do the impossible. But I can help you find new ways to handle etc …

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Confront the illusion of control: Of course you want to get rid of it – that’s natural. But let’s have a look at how much control we actually have:

•  - delete a memory •  - don’t think about ice cream •  - make your leg go numb •  - polygraph metaphor

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Defusion: so your mind says ‘I have to get rid of it’ -that’s the only solution’ So do we end the session, because your mind says ‘I have to get rid of it; there is no other solution’ - or do we let your mind say that, and carry on and try to find another way?

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Self-compassion: This must be really hard for you. What are you

feeling right now? Where is that in your body? Can I get you to try something: place a hand over it, and hold it gently … etc. What’s that like?

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Is the pain there now? Can I get you to try something? Push your feet into the floor … sit up straight … look around you … notice what you can see and hear … engage with me … notice that your pain is here, AND there’s a lot of other stuff here too: your body, and the room, and you and me, doing something important right now …

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The things you’re doing to avoid/get rid of this pain – are they taking you closer to the bull’s eye, or further away?

If I could show you a new way of handling this pain, that would help you get closer to the bull’s eye, would that be time well spent?

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Would you be willing to try an experiment? To try doing something completely different than what you normally do when this pain shows up? Just for a few seconds, to see what it’s like?

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Urge Surfing

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Urge Surfing

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Use your breath as an anchor Notice where the urges arise, and how your body responds Watch like a curious child Breathe into and make room for whatever discomfort arises Let your mind chatter away like a radio in the background If it seems like you have to swallow, count to ten. Then make a choice: either swallow mindfully, or keep watching the urge and see what it does next Notice your relief when the urge drops, and your anxiety when it rises again

Even if your mouth is full of saliva, you can breathe through your nose

If you get lost or overwhelmed, come back to your breath, anchor yourself, then re-engage in the exercise

Notice even with the urge present, you can a) direct your attention and b) control your arms and your legs

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Defusion

Acceptance Values

Committed Action

Self-as-context

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Be Present


Self-as-context

“Flexible Perspective Taking” Ability to observe and describe from a

perspective or point of view enables or facilitates many different

experiences, including theory of mind, empathy, compassion, self-compassion, acceptance, defusion, and a transcendent sense of self (often called ‘the observing self’).

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And now ….

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“I” “You”

“Here” “There” “Now”

“Then”

“What are you doing here?” “What am I doing here?” “ What were you doing there?” “What was I doing there?” “What are you doing now?” “What am I doing now?” “What were you doing then?” “What was I doing then?” The only constants?

I Here Now

THEN

NOW

YOU

I

HERE

THERE

Perspective Taking Skills

Slide Courtesy of Steve Hayes

Self-as-Context

The ‘locus’ of consciousness: everything is noticed from a perspective of ‘I, here, now’

Slide Courtesy of Steve Hayes

‘Flexible Perspective Taking’

CONTACTING THE PRESENT MOMENT I, here, now noIce WHAT I see, hear, touch, taste, smell, think, feel, do

DEFUSION I, here, now noIce my thoughts and see them as words and pictures

ACCEPTANCE I, here, now noIce my thoughts and feelings and allow them to be as they are TRANSCENDENT SELF

or OBSERVING SELF I, here, now noIce THAT I am conInuous, unchanging, disInct from, & more than WHAT I see, hear, touch, taste, smell, think, feel, do

VALUES I, here, now noIce what is important and meaningful to me and put it into words

COMMITTED ACTION I, here, now noIce my acIons and take control of them

EMPATHY I, here, now noIce what someone else is feeling and feel it too

COMPASSION I, here, now noIce suffering and respond with kindness

SELF-‐AS-‐PROCESS I, here, now noIce THAT I see, hear, touch, taste, smell, think, feel, do

Notice X

•  Contact with the Present Moment = notice WHAT you see, hear, touch, taste, smell, think, feel, do

•  Self-as-process = notice THAT you are seeing, hearing, touching, tasting, smelling, thinking, feeling, doing … and noticing

•  Observing self (transcendent self) = notice THAT ‘part’ of you which is continuous, unchanging, distinct from, and more than WHAT you see, hear, touch, taste, smell, think, feel and do

•  Self-as-context = flexibly noticing from a perspective of I, here, now

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The ‘Observing Self’: why bother?

1.  Aids defusion – especially from the conceptualised self

2.  Aids acceptance, willingness, and formal exposure: a ‘safe place’ inside you

3.  Important aspect of spirituality 4.  For survivors: a part of you was unharmed

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NB: 1 & 2 are easily achieved through defusion & acceptance skills without need for explicit ‘observing self’ exercises.

Observing Self

Two Simple interventions: •  Notice X - and be aware you’re noticing •  Stage show metaphor

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•  Notice your breath (10 seconds pause) •  Be aware you’re noticing (10 seconds pause) •  Notice what you’re thinking ... •  Be aware you’re noticing ... •  Notice what you can hear .... •  Be aware you’re noticing .... •  Notice what your mind is telling you ... •  Be aware you’re noticing .... •  Notice what you can feel in your feet .... •  Be aware you’re noticing .... •  Notice what thoughts you’re having .... •  Be aware you’re noticing ... •  So there’s a part of you that notices everything •  Optional: Life is like a stage show … and on that stage are all your

thoughts and feelings and everything you can see, hear, touch, taste and smell … and there’s a part of you that

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Dilemmas # 1: The Hard Facts

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1.  There is no simple answer. If one choice was clearly much better then you wouldn’t have a dilemma!

2.  So we probably won’t solve it in today’s session! 3.  No matter what choice you make, anxiety and

doubt is certain. 4.  There is actually no way not to choose.

Dilemmas #2: The Practicalities

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1.  Each morning: acknowledge today’s choice. 2.  Each morning: What do I want to stand for in

the face of this? Live those values 3.  Through the day: ‘name the story’, get present 4.  Spend 5-10 mins each day MINDFULLY

focusing on pros and cons of each choice – using a pen & paper, or computer

5.  Self-compassion; this situation may go on for a long time

Anger

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Anger Management? Aggression Management!

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A – Antecedents




Workability = payoffs VS costs


- Public - Private





AGRESSION

Forgiveness

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