Acceptance & Commitment Therapy With Couples

1. Acceptance & Commitment TherapyWith Couples Dr Russ Harris, M.B.B.S., M.A.C.Psych.Med. Medical Practitioner, Psychotherapist russharris@actmindfully.com.au www.actmindfully.com.au

2. Aims of the Workshop • ACT conceptualisation of relationship issues • ACT interventions for relationship issues • Interspersed with experiential exercises

3. 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?

4. 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?

5. 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?)

6. 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?

7. 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

8. 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

9. Typical Core Values • Connection • Caring • Contribution

10. Values to Goals • What’s a small step you can take? • What’s a little thing you could do?

11. Values to Goals • If your partner actually does that, what difference would it make to you? • How will you let them know that?

12. 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?

13. 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?

14. The Barriers to change: F.E.A.R. • Official ACT version: • Fusion • Evaluation • Avoidance • Reason-giving

15. The Barriers to change: F.E.A.R. • Alternative version: • Fusion • Excessive expectations • Avoidance • Remoteness from values

16. The Antidote to FEAR is DARE • Defusion • Acceptance • Realistic expectations • Embrace values

17. 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

18. Key Issues • Behaviour change 101: • What’s in your control, and what’s not? • Carrot versus stick

19. 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

20. 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)

21. 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

22. 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!

23. 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.

24. 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 ..

25. Key Issues CONFLICT • Being right versus being loving • I’m right; you’re wrong

26. 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?

27. Key Issues CONFLICT : Defusion of Rigid rules • Expect them • Notice them • Name them

28. 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

29. 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

30. 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?

31. 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?

32. 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’

33. Key Issues • CHANGING BEHAVIOUR • Identify barriers: FEAR • N.B. reason-giving • Discuss ‘relapse’ • When your partner stuffs up, how will you respond?

34. Key Issues • LOVE • Distinguish the action of love from the feeling of love • Magic wand

35. Key Issues • INTIMACY • Be present • Share valued activities • Practise connection • ‘Eyes on’

36. Key Issues • COMPASSION • Kindness • Commonality • Mindfulness

37. Key Issues • FORGIVENESS • Give yourself what was there before • Doit for yourself • Anger & resentment – costs • Handle it with mindfulness; let it come & go

38. Key Issues • FORGIVENESS RITUAL • Each 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 it • Choose a special place, read it out, do something symbolic (eg burn it & scatter the ashes) then do something to connect lovingly

39. 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