Acceptance & Commitment TherapyWith Couples

Dr Russ Harris, M.B.B.S., M.A.C.Psych.Med.

Medical Practitioner, Psychotherapistrussharris@actmindfully.com.au

www.actmindfully.com.au

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Aims of the Workshop

1. ACT conceptualisation of relationship issues

2. ACT interventions for relationship issues

3. Interspersed with experiential exercises

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ACT Case Conceptualisation

2 simple questions:

1. What sort of relationship do(es) the client(s) want to build?

2. What stands in their way?

- 2a) What are they fused with?

- 2b) What are they avoiding?

- 2c) What ineffective actions are they taking?

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Taking A History

What’s the problem?

-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? What has it cost?

-What have you done that has contributed to this issue, or made it worse?

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Taking A History

Relationship history: how did you meet, what attracted you, wedding day etc.

What do you value in your relationship & your partner, currently?

(What did you value in your relationship & your partner back then?)

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Taking A History

On a scale of 1-10, how sure are you about staying in this relationship?

On a scale of 1-10, how much work are you willing to do to improve the relationship?

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Stay or leave?

Assess pros & cons of each Have you given it your best shot? Whichever option you choose, you’ll need to

make room for anxiety, doubt, worry etc Sitting on the fence metaphor Live by your values, whether you stay or

leave

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Taking A History

What sort of partner do you want to be?What sort of relationship do you want to build?

- Magic wand- Visualise: self as ideal partner vs self as

reactive partner – reflect & share- 80th birthday – partner gives a speech- Valued living questionnaire- Share values

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Typical Core Values

Connection Caring Contribution

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Values to Goals

What’s a small step you can take?

What’s a little thing you could do?

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Values to Goals

If your partner actually does that, what difference would it make to you?

How will you let them know that?

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Values to Goals

If client makes positive changes: What was that like for you? What happened to your relationship as a

result? What’s another little step you can take?

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Values to Goals

If client doesn’t make positive changes: What was that like for you? What happened to your relationship as a

result? What got in the way?

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The Barriers to change: F.E.A.R.

Official ACT version:

Fusion

Evaluation

Avoidance

Reason-giving

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The Barriers to change: F.E.A.R.

Alternative version:

Fusion

Excessive expectations

Avoidance

Remoteness from values

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The Antidote to FEAR is DARE

Defusion

Acceptance

Realistic expectations

Embrace values

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Key Issues

4 approaches to any problem situation

1. Leave

2. Stay & Change what can be changed & live by your values

3. Stay & Accept what can’t be changed & live by your values

4. Stay & Give up & increase your suffering through self-defeating behaviours

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Key Issues

Behaviour change 101:

What’s in your control, and what’s not?

Carrot versus stick

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Key Issues

Communication 101:

Ask clearly for what you want, (and explain why)

Express clearly what you don’t want, (and why)

As you do this, be the partner you want to be!

Boundaries & consequences

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Key Issues

When you’re upset: Breathe out I notice I’m feeling x I’m having the thought that .. Get present; ground yourself If necessary leave the situation If you do leave, practise mindfulness &

acceptance (practise letting go of unhelpful stories)

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Key Issues

Once grounded, ask yourself What sort of partner do I want to be? What

are my values here? If I could be that ideal partner, I would

respond by doing … Then take action, guided by those values Visualise/write/rehearse those responses

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Key Issues

In other words: ACT Accept your thoughts and feelings Connect with your values Take effective action

Or more simply:

Be present & do what matters!

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Key Issues

CONFLICT Stop arguments in session Do mindfulness then and there What’s your body doing? Breathe into it. What’s your mind saying? Name it.

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Key Issues

CONFLICT What judgments does your mind make

about him/her? What happens if you buy those judgments? I’m making the judgment that ..

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Key Issues

CONFLICT Being right versus being loving I’m right; you’re wrong

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Key Issues

CONFLICT Rigid rules What are your rules? What are your partner’s rules? Where did these rules come from? What happens when you fuse with them?

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Key Issues

CONFLICT :

Defusion of Rigid rules Expect them Notice them Name them

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Key Issues

CONFLICT Discuss inevitability Increase awareness of triggers Increase acceptance ‘Pet arguments’ Name your stories Being right versus being loving ‘But’ vs ‘And’ Anger management if necessary

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Key Issues

CONFLICT Repair attempts What’s the tiniest step you could take that

might repair some of the damage? Acknowledge & accept repair attempts John Gottman: 7 Principles of Making

Marriage Work

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Key Issues

REFRAMING PROBLEMS How can I grow from this? What can I learn from this? What ACT skills will this enable me to

improve? Imagine your partner is a teacher: what is the

lesson?

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Key Issues

THE PERFECT PARTNER Do they exist? Do you always act the way you expect

yourself to act? Acceptance exercise: if I could give you a

choice - a) no painful feelings, but no capacity to love or care; b) you get to love and care, and that means that at times you have these painful feelings – which would you choose?

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Key Issues

CHANGING BEHAVIOUR Willingness to change, versus wanting to

change Facilitate willingness through values Distinguish values-driven change from:

resentful change/ guilt-induced change/ trying to ‘keep her happy’/ trying to ‘put up with him’

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Key Issues

CHANGING BEHAVIOUR

Identify barriers: FEAR N.B. reason-giving Discuss ‘relapse’ When your partner stuffs up, how will you

respond?

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Key Issues

LOVE Distinguish the action of love from the feeling

of love Magic wand

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Key Issues

INTIMACY Be present Share valued activities Practise connection ‘Eyes on’

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Key Issues

COMPASSION

Kindness Commonality Mindfulness

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Key Issues

FORGIVENESS

Give yourself what was there before Do it for yourself Anger & resentment – costs Handle it with mindfulness; let it come & go

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Key Issues

FORGIVENESS RITUALEach partner writes:-The thoughts, feelings memories I’ve been

holding on to are …How holding on has hurt me & our relationship:Commitment to letting all this old stuff come and

go without holding on to itChoose a special place, read it out, do

something symbolic (eg burn it & scatter the ashes) then do something to connect lovingly

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Key Issues

TRUST

Distinguish the action of trust from the ‘feeling’ of trust (not really a feeling; more a ‘sense’ – strong cognitive component)

No control over ‘feelings’ of trust – only over the actions.

Balance values around trust with values around self-protection