ACT & The Process of Change Model

1. ACT & The Process of Change Model Perspectives on ACT from a Systems View of Change J. Scott Fraser, Ph.D.

2. Holding Up a Mirror With ACT ACT Propositions Will Often Alternate With Those of the Process of Change View

3. Life Difficulties & Life Problems • Life Difficulties …tend to be unpleasant situations that draw action to either change, assimilate or accommodate them...common solutions can & do work, and often difficulties simply need to be accepted • Life Problems …tend to arise from vicious cycles of more of the same solutions applied at a first-order level… The solution has become the problem…2nd order solutions are needed for resolution

4. From ACT: • “It is psychologically healthy to have unpleasant thoughts and feelings as well as pleasant ones, and doing so gives us full access to the richness of our unique personal histories.” (p.23) (Life Difficulties are “Normal”) (“Life is one damned thing after another, but it’s the only game in town.” [John Weakland of MR]) • The clinical establishment “…views distressing states of mind as signs of disorder and disease.” (p.8) Attempting to solve these “problems” then becomes the problem. (Life Problems as Vicious Cycles)

5. Two Foundation Concepts of the Process of Change Model • Social Constructivism: • Reality is relative and dependent upon context • Reality is co-created within social context • The Process of Change: • First-order change, within perceived reality and rules • Second-order change, or a change ofreality and rules

6. Socially Constructed Reality • Co-created premises guide our viewing and doing…channeling our interactions • This applies to ideas on the nature of problems and how to resolve them • Applies equally to therapists’ theories and practices in therapy

7. The Process of Change*MRI* • First-Order Change: • A change in intensity, frequency, location, duration, etc. of interactions (solutions) • Variations of similar interactions within the accepted premises and patterns of a system • Often does resolve problems • Only yield problems when failed solutions are re-applied over and again

8. Solution-Generated Problems Vicious Cycle Patterns Of first-order change

9. From ACT: “The ACT perspective, however, is that the conceptualized outcome, that is, the supposed solution, is often itself the problem.” (p.165 emphasis added.)

10. The Process of Change*MRI* • Second-Order Change: • A change ofa system’s primary premises, rules and patterns • Usually yields strikingly different or oppositeinteractions • May appear counter-intuitive or paradoxicalfrom first-order premises • It is the key element of most effective treatments

11. Traps, Paradox & 2nd Order Change • The Nine Dot Problem . . . . . . . . . • The Child’s Finger Trap • The Bird in The Vestibule

12. Two Foundation Concepts of the ACT Model (Hayes et al., 2012) • Socially Mediated Language Frames Our Realities (Cognitive Fusion fuels problems) • “…we formulate a situation symbolically and then organize our behavior to fit the demands of the rules that we are programmed to follow.” (p.245) • “These rules are socially inculcated into us and thus appear to be the “normal, rational thing to do.” (p.245) • “…the clients’ problem-solving efforts are channeled by culturally sanctioned rules that describe how problems are to be identified, analyzed, and solved.” (p. 245) [Or…Socially Constructed Reality]

13. Two Foundation Concepts of the ACT Model (Hayes et al., 2012) • Experiential Avoidance Fuels Most Problems • “…the person is more likely to follow blindly the instructions that are socially transmitted through language.” • “In some circumstances, this result can be adaptive;” (p.20) (First-Order Change) • “But in other cases, people may engage repeatedly in ineffective sets of strategies because to them they appear to be “right” or “fair” despite negative real-world consequences.” (p.20) (Vicious Cycles; Second-Order Change is needed)

14. Vicious Cycles • Represent the classic description of problem patterns across most, if not all models of effective psychotherapy • They involve a trigger, within a frame describing the situation, repeated failed solutions, and escalation • Interdicting vicious cycles is the heart of all effective treatments

15. Vicious Cycles Positive Feedback Escalating Patterns ATTEMPTED SOLUTIONS KICK POINT

16. From ACT: “There is an inherent paradox in attempting to avoid, suppress, or eliminate unwanted private experiences in that often such attempts lead to an upsurge in the frequency and intensity of the experiences to be avoided..” (p.20) (The Classic Vicious Cycle)

17. Effective Intervention Pattern Re-Direction and second-order change

18. Process Model Goals • Changing the Viewing and/or the Doing around the defined problem. • Reframeand/or Deframedescriptions and rules • Initiate interactional/behavioral pattern shifts/reversals • Or Accept Premises and Build New Interactions • Initiatea small shift and then build upon it • Clarify Values, Goalsand Contract • Engage Positive Feedback Cycles • Initiate Virtuous Cycles

19. ACT Goals • Enhance Psychological Flexibility • Initiate Defusion from current language and frames • Initiate Acceptance and Present Moment Function • Clarify Values and enhance Willingness for Action • Support Flexible Response Styles • Open…Acceptance—Defusion • Centered…Present Moment—Self-As-Context • Engaged…Values—Committed Action

20. The Contextual Model ofJerome Frank The elements common to all effective treatments

21. The Contextual Model *Jerome Frank* Common Elements of Effective Treatments: • An emotionally charged relationshipor alliance • A rationale, structure, or “myth” explaining problems and implying solutions • Related proceduresimplying direction to solutions and instilling hope • Recent meta-analyses of psychotherapy research suggest that these elements are common across all effective therapy (Wampold, 2012)

22. The Process of Change Model The key element that this model addsto the Contextual Model is that the focus of change in all effective treatments is upon second-order change

23. The Golden Thread The creative essence of therapeutic change across all therapies is second-order change

24. Second-Order Change asThe Golden Thread In Greek mythology, the warrior Theseus was given a golden thread to guide him to the center of the labyrinth of Crete. Once he defeated the fierce Minotaur, he used the thread to find his way back out. “The Golden Thread” has thus come to refer to a guide that helps find the unifying path through disorienting and seemingly disconnected alternatives. • The Labyrinth of Crete: • A Path of Dilemmas The Labyrinth of Chartres: A Path of Meditation

25. The Golden Thread Once we can trace the path of this golden thread across the broad tapestry of effective interventions to a wide array of problems, we can see the essential “tie that binds” them all together. Following the process of change helps us integrate approaches while empowering our own creative, flexible, and effective clinical practice.

26. The Labyrinth of Effective Psychotherapies This ancient Celtic design has been used to symbolize the spiral connections among all things. We have used this design to represent the spiral connections among all effective psychotherapies.

27. Following the Golden Thread Through Effective Therapies All effective treatments describe problems as vicious cycles and interdict them through second-order change interventions.

28. Following The Golden Thread of The Process of Change Fraser, J.S. & Solovey, A. (2007) Second-order change in psychotherapy: The golden thread that unifies effective treatments. Washington, DC, APA Books