Last week I completed a treatment and in the last session we evaluated. The man I worked with tended to talk at length, and I found our conversations tiring at such times. I had to work really hard to find the line of his story and to keep my focus. I interrupted him regularly, to return to the focus of that moment. I found that difficult. It took quite a few sessions before I noticed his talk getting shorter and more concise. At the end he told me that he had learned a lot from being interrupted. It had made him aware of what he really wanted to say and that he didn’t have to say so much to be understood.
In the introductory ACT courses I teach, I let students practice coming into the present moment. In pairs or threes, participants practice therapist-client roles. The therapist tries to bring the client to the experience of that moment and keep the focus there for a while. You can see how this works in the first fragment of this video: https://www.youtube.com/watch?v=oT2iPNcPejA&t=301s.
After the practice, students often ask: what now? Now I’ve brought someone to the here-and-now and what’s next? This is often a concrete question about how you wrap up the exercise, but also what meaning this exercise has in the larger whole of the therapy or guidance. I suddenly realized this when I read a chapter by Kelly Wilson as part of his online training “Working with Self and Identity in ACT” from Praxis*.
Kelly’s is one of the founders of ACT and comes from a behavioral analytics or behaviorist tradition. His great strength is to explain complicated concepts clearly and understandably. He makes extensive use of behavioral analytical insights in his ACT work. These insights are of great importance to me in my ACT treatments. They help me to work in a process-oriented way and to connect well with the person in front of me.
In the chapter “The Self and mindfulness” from McHugh & Stewart, 2012: The Self and Perspective Taking (Context Press), Kelly describes that he understands “self” as a verb and not as a noun. From the perspective of behavioral analysis, ‘self’ is seen as an integrated set of behavioral repertoires. It is the sum of someone’s learning history introduced at the moment when certain behavior is requested by the environment or the person himself. Behavioral repertoires often help us do what is necessary or desirable, but can also be rigid and restrictive. Therapy consists of expanding the behavioral repertoire and in ACT this is about the six processes of psychological flexibility.
And how do you do that, expanding or building a behavioral repertoire? Practice makes perfect. If you want to learn to play the piano, you start simple, you practice, you learn something, you practice and so you gradually master a form of piano playing, based on your own learning history with playing the piano. You get the exercises from a book and/or you get them from a teacher, who helps shape your learning process.
The same goes for the behavioral repertoires of acceptance, defusion, selving, being in the present moment, values, and committed action. We help people expand their repertoire by offering them targeted exercise. This practice can literally consist of exercises such as “leaves on a stream” for defusion, or a mindfulness practice in which one learns to bring the focus to the breath. But the exercise also consists of doing during the therapy. When we invite someone, time and again, to reflect on their own experience, someone learns to reflect on their own experience. But not only that. Someone also learns to consciously focus attention, to make choices about what one wants to focus on, to recognize certain patterns in the experience, the advantages of being able to reflect on one’s own experience. When we can see psychological flexibility as expanding the behavioral repertoire, we are less tied to certain goals and we can better connect with the learning process of the person we work with.
How is this important for perspective taking? The questions we ask clients are personal questions. Questions that make someone stop and think about themselves. The question can only be answered from one’s own perspective. There is one constant factor in this question and answer process and that is that perspective. The way we learn is that if there is a constant factor in a learning process, we abstract that constant factor. You may recognize that you have heard a word from a foreign language used a number of times and suddenly ‘know’, without anyone telling you, what that word means. You figured that out from the different contexts in which you’ve heard that word used. As children, we learn to use words like “I” or “you” correctly, because we are given questions that we answer from our own perspective. We are rewarded when we do it right and corrected when we don’t. For example, when you ask a child what food daddy likes and he mentions a dish that he or she likes, we correct: no, you like that, daddy likes …. That’s how the questions we ask as therapists lead. to a strengthening of contact with one’s own perspective.
Learning processes do not always lead to more flexibility. When we think about ourselves in an evaluative and comparative way, it can lead to rigidity. We see ourselves as ‘not good enough’ or a variant thereof. We can’t move freely in our own lives, because that doesn’t fit with the view we have of ourselves, or how we think we are seen. In order not to amplify this process, it is therefore important that we touch a wide range of ‘content’ in our conversations. “What is important to you in life, how is that important now, how was it important in the past, how do you notice that it is important, where do you see it reflected in your life, where do you miss it?” These questions are about values. These questions are also about the person to whom we ask these questions and we train this person to reflect on the deictic frameworks of ‘I’ in combination with ‘past-now-future’ and ‘here-there’. Although it is always about values, it is always about a different aspect of values. This creates flexibility. We increase the chance that someone can see themselves as an ‘I’ that is separate from the content, if that content is successively different. And this we can repeat with questions about avoidance or acceptance, fusion or defusion, committed action, etc.
The exercises we do with people in an ACT treatment, whether they are concrete exercises or practice through the question-and-answer process, expand their behavioral repertoire. If we persist, this will unfold. This is not always immediately visible, and that creates uncertainty on part of the therapist. Nevertheless, this is an important learning process. The man I worked with gained insight and his behavior changed from the way we worked, without this being explicitly discussed.
You can find the online training at: https://www.praxiscet.com/courses/working-with-self-and-identity-in-act/