ACT With LOVE Russ Harris, ACT World Con 2011

1. ACT With LOVERuss Harris, ACT World Con 2011

2. Are relationships easy?

3. 1. The perfect partner 2. It should be easy 3. Everlasting luurrve 4. You complete me Fight-or-Flight PopularMyths? • Ever had thoughts about leaving the person you love? • Ever had thoughts about hurting the person you love?

4. Exercise • Reactive partner versus ideal partner • What does this tell you about your values, as a partner?

5. Mindfulness of the Hand • How did your relationship with your hand change? • How does this apply to your intimate relationships?

6. DRAIN • How to DRAIN the vitality from a relationship: • Disconnection • Reactivity • Avoidance of discomfort • Inside-your-mind • Neglecting values

7. LOVE • How to increase the vitality in a relationship: • Letting go • Opening up • Valuing • Engaging

8. Setting Up: Informed Consent • ACT: involves learning new skills to handle difficult thoughts and feelings more effectively • And clarifying your values, and using them to guide your behaviour, so you can: • 1) Contribute to the relationship • 2) Influence your partner constructively

9. Setting Up – Informed Consent • ‘Guitar lessons’ metaphor: talking is not enough; you need to pick up the guitar and practice

10. Setting Up - Workability • Explain ‘workability’ • Workability is the ultimate authority • Clients, not therapist, are the experts on what works for them

11. Setting Up - Workability • Express your intention to highlight both workable and unworkable behaviour • Get permission to: • a) interrupt unworkable behaviour, • b) rehearse a workable behaviour instead Practice in session is Essential!

12. If consequences lead to an increase in behaviour over time = ‘reinforcement’ Something an organism does Public or private Situation Thoughts Feelings Biological State Short term Long term If consequences lead to a decrease in behaviour over time = ‘punishment’ Mindfulness Values & action Situation: heated argument with wife about drinking habits Thoughts & Feelings: ‘I can’t stand this marriage’ Anger & anxiety Righteousness: ‘Who is she to tell me what to do?’ Urge to drink Bio state: tired and sleep-deprived Short term: Feeling of relief; painful thoughts, feelings, urges disappear Drinks alcohol B & C = Workability Long term: Drinking problem worsens; tension in marriage worsens

13. Behaviour Change 101 • How do we influence behaviour?

14. Behaviour Change 101 • Most effective way to influence behaviour, while maintaining a good relationship? • Positive reinforcement of desired behaviour • NB: Shaping

15. Behaviour Change 101 • Least effective way to influence behaviour, if you want to maintain a good relationship? • Punishment of unwanted behaviour

16. Behaviour Change 101 • Ideal ratio of positive reinforcement to punishment? • 5: 1 • What is the ratio in your relationship?

17. Behaviour Change 101 • Therapist aims to: • Reinforce workable behaviour when it happens in the room. How? • Undermine unworkable behaviour when it happens in the room. How? • Teach clients to do the same. How?

18. Taking A History • We’ll get to the problems shortly, but first: • What do you appreciate about your partner? • What are their greatest strengths/qualities? • What do you like to do together? • What attracted you when you first met?

19. Taking A History • Relationship history: how did you meet, what attracted you, wedding day etc. • What did you appreciate in your relationship & your partner back then? • What do you not want to change in your relationship?

20. Taking A History • Can you tell me about a recent event that represents the main issue(s)? • What have you tried so far to fix this? How did it work?

21. Taking A History • What sort of workable and unworkable behaviour might we observe as we ask these questions? • How could we reinforce the workable stuff?

22. Taking A History • Model, instigate & reinforce factual description versus judgment & criticism • ‘Differences versus defects’ (Jacobson, ICBT) • Assess the behaviour, not the person

23. Taking A History • Model, instigate & reinforce mindful attention

24. Taking A History • Validate each partner’s pain • Model, instigate, reinforce compassion. How? • What does it feel like for you when he/she behaves like that? • What does it feel like for you to hear that’s how your behaviour affects him/her?

25. Taking A History • Draw out values wherever possible. How? • Continually ask clients to notice both values-congruent and values-incongruent actions.

26. Taking A History • Q: How would you like your relationship to improve? What would you like there to be more of - both from yourself and from your partner? • Watch out for ‘dead man’s’ goals

27. Taking A History • Q: If I could wave a magic wand, so that your partner was suddenly perfect – then how would you behave differently?

28. Taking A History • On a scale of 1-10, how much work are you willing to do to improve the relationship? • Therapist models accepting, non-judgmental stance (even if score is low) then moves on to the resilience formula

29. The Resilience Formula • 4 approaches to any problematic 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

30. Addressing Willingness • Q: So in terms of changing the situation, what do you have most control over? • Q: So let’s come back to workability: how will it affect your relationship if you are not willing to work on it? • If one partner is unwilling, we can still work with the willing one and get positive change

31. Stay or leave? • If possible, see the client alone. • BUT reserve the right that anything shared in private can be raised in a duel session, if relevant • Assess pros & cons of each choice • Q: Have you given it your best shot?

32. Stay or leave? • Sitting on the fence metaphor • Live by your values, whether you stay or leave

33. Stay or leave? • Until the day you actually leave, you’re staying – so what do you want to stand for? • Both options = anxiety, doubt, uncertainty • Set a brief period each day to reflect on the decision. Rest of the time, defuse. How?

34. Taking A History • Family of origin/ psychodynamic? • Brief therapy approaches • My preference: gather this information as you go & link it to what is happening in the room

35. Taking A History • E.g. How old is this story? When was the earliest you can remember it showing up? • E.g. How old is this behaviour? Did anyone model this for you, growing up? How did your family deal with issues like this? • E.g. Where does that rule come from? Who told you, or how did you learn it?

36. Taking A History • E.g. Do you react that way in other relationships – parents, siblings etc? • Eg. Have you reacted that way in the past, in other relationships, parents, siblings etc? • E.g. Has anyone in the past elicited these reactions from you, parents, siblings etc?

37. End of first session • What is one issue that you’d like to address first? • Do you both agree? • If not, each choose one issue to work on. • NB: sexual issues – almost always need to improve the non-sexual aspects first

38. End of first session • Notice what both you and your partner do that’s workable • Notice what you personally do that’s unworkable • Notice what thoughts and feelings show up before you start doing the unworkable stuff

39. 6 Things Each Partner Can Do • 1.Stop acting in ways that make it worse • 2.Clarify and act on your values: be more like the partner you ideally want to be • 3.Accept what is out of your control • 4.Notice & reward behavior you like • 5.Facilitate change via effective negotiation & communication skills • 6.Create rituals to cultivate affection, warmth, fun, sensuality, sexuality, intimacy etc.

40. 6 Things Each Partner Can Do • The best outcome is likely if both partners do these things. • Pre-empt: No two partners will do these things to the same extent.

41. 6 Things Each Partner Can Do • Many approaches focus heavily on 5 & 6 • In ACT, we focus on all six - but first and foremost on 1,2, 3 & 4 • Why?

42. 6 Things Each Partner Can Do • 1,2, 3 & 4 are more empowering; you don’t have to ask your partner to do anything! • The Paradox: If you live by your values, stop trying to control your partner, instead practice acceptance, and actively show appreciation… often your partner will make positive changes spontaneously!

43. Acceptance & Change • Each partner typically starts from this: • You need to change … • …but accept me as I am!

44. Acceptance & Change • Think of everything that’s wrong with your partner. • Write it down • Do you like being judgmental and critical?

45. Compassion for your partner • What is it like for you to be looked at as a problem? • Imagine your partner as a young child – and yourself as an adult, shouting all those negative judgments & criticisms

46. Key Issues: Self-Compassion • Kristin Neff, 2002: • Mindfulness • Kindness • Common humanity

47. Values • Magic wand • Ideal vs reactive partner • 10th anniversary – partner gives a speech • Values worksheets • Sweet spot • Share values • Read out values in session

48. 3 Important Values • Connection • Caring • Contribution

49. Key Issues: Acceptance • Love & Pain are intimate dance partners

50. Key Issues: Acceptance • NAME the emotion • Notice it • Acknowledge it by name • Make room • Expand awareness