IntroductiontoAcceptanceandCommitmentTherapy：接受与承诺疗法介绍.ppt

Acceptance and Commitment Therapy: Advanced Workshop Julian McNally Program Outline Review Of ACT Model Getting Stuck Into Getting Stuck 7 Frequent Problems And How To Respond Sweet Spot And Client Descending Matrix For Case Formulation Developing Mastery In ACT “Hexaflex” ACT Model of Effective Living Values, Purpose & Meaning Defusion Committed Actions Contact with the Present Moment Acceptance & Willingness Transcendent Sense of Self/ Self As Context Psychological Flexibility “InFlexaHex” ACT Model of Psychopathology Lack of Values Clarity or Contact Fusion Inaction or Disorganised Activity Dominance of Conceptualised Past or Feared Future Experiential Avoidance Attachment to “Storied” or Conceptualised Self “Hexaflex” ACT Model of Effective Living Values, Purpose & Meaning Defusion Committed Actions Contact with the Present Moment Acceptance & Willingness Transcendent Sense of Self/ Self As Context Mindfulness & Acceptance Processes Behaviour Change Processes Your turn! Decide who will be client first Brief your partner on presenting problem, but not whats tricky about this client Counsellor: Notice yourself getting stuck. Observe thoughts and feelings Client: observe and resist urge to be agreeable or make it easy for counsellor If counsellor is not getting stuck, brief “client” on what the actual client does thats tricky and try again. Switch. Pair up - one is “A” the other is “B” Getting Stuck Into “Getting Stuck” My experience is not authoritative because it is infallible. It is the basis of authority because it can always be checked in new primary ways. In this way its frequent error or fallibility is always open to correction. Carl Rogers, On Becoming a Person Bennet and Cari Notice your reactions and make peace with them Provide an ACT-consistent response Where is the client on the Hexaflex? Where are you on the Hexaflex? 7 Frequent Problems 1What do I do if I get stuck? 2Do I need to cover all 6 processes? 3What if they say “it didnt work”? 4What if they dont know/cant say what their values are or dont have any? 5What do I do with clients who are sceptical/concrete/psychotic? 6What if they (or I!) dont “get” Self-As-Context? 7What do I do with clients who are fused with their beliefs or a sick or victim role? What do I do if I get stuck? General principles: uSlow down! uBe willing and accepting uHold your formulation and treatment trajectory lightly uStick closely to principles and loosely to techniques uListen to clients experience before yours uListen to experience before models and ideas uInvite a change in action rather than in understanding or feeling Do I need to cover all 6 processes? uNo! What if they say “it didnt work”? uIs there a control agenda in place? uTry another part of the model uTry a different technique from the same part What if they dont know/cant say what their values are or dont have any? How do they know they dont know? When was the earliest (last) time they remember having values? Make the therapy about discovering/creating values? Check for semantic problems Detect values in the present What do I do with clients who are sceptical/concrete/psychotic? “Trust your experience, not my words or your thoughts” Workability of scepticism Sideline “beliefs” and “being right” for a while You dont have to do “mindfulness” just pay attention Psychosis ACT is not an EST other treatments Metaphor-imperviousness? Present-moment defusion and willingness with Self-As-Context What if they (or I!) dont “get” Self-As-Context? Lets practise! Indicators Of Increased Capacity For Self-As-Context q Detecting and defusing from rules and stories q Increased perspective taking and noticing q Noticing own processes of fusion and unwillingness q Naming or joking about own scripts and stories q Able to dispassionately examine value-contradictory behaviours and thoughts q Recognising current choices and history as separate phenomena q Relating to multiple conceptualisations of self as determined by context and values-in-the-moment What if they are fused with their beliefs or a sick or victim role? uTry Self-As-Context uBe curious and empathic uAppeal to workability Template for Experiential Exercises 1Recognise your mind will interfere, so slow down and accept 2Contact with present moment sounds and touch 3Locate the moment of choice or stuckness 4Immerse in the moment (file cabinet or movie screen) 5Open eyes and express it 6Hold the moment silently and appreciate The Grid - Kevin Polk Even Simpler Model of ACT Processes SwSValued Living Sensory Experience Mental Experience “I think that.” “Im having the thought that.” “I notice Im having the thought that.” This is This is unbearableunbearable I notice those thoughts I notice those thoughts are there againare there again Recontextualising the Problem DepressedDepressed UnmotivatedUnmotivated UnemployedUnemployed IndecisiveIndecisive OverweightOverweight UnloveableUnloveable Need therapy!Need therapy! W