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Counseling Theory

Pain is Inevitable; Suffering is Optional

The goal of Acceptance and Commitment Therapy (ACT) is to create a rich, full, and meaningful life while accepting the pain that inevitably goes with it. This is done by changing one’s relationship to their symptoms in order to live a more value-driven life. Further, the goal is to accept what is outsideof one’s control, and commit to taking action to enrich one’s life. It can be summed up in one basic premise: pain is inevitable, but suffering is optional.

Oftentimes, trying to get rid of symptoms actually results in being more bothered by the symptoms. For example, try to not picture a pink elephant in your mind’s eye. What happened? You saw a pink elephant. This is just what happens when we try NOT to focus on any particular thing!

Being too focused on symptoms impacts our ability to life a value-driven life. We’re too busy and using all our energy on “symptom-reduction” rather than choosing to focus on what is meaningful in our lives, such as family, friends, relationships, advancing career, rest, self-care, and so forth. When we instead focus on our values, our symptoms can drift to the background, rather than take center stage.

ACT asserts that problems are essentially caused by two things: cognitive fusion and experiential avoidance. Cognitive fusion is when we become inseparable from our thoughts, and then our thoughts dominate our behavior. Experiential avoidance happens when we attempt to avoid, get rid of, suppress, or escape unwanted experiences (thoughts, feelings, memories, sensations, etc.).

Trying too hard to control how we feel simply gets in the way of a rich, full life. We can’t do important, value-driven things if we are always trying to get rid of symptoms. Control is the problem, not the solution.

What can we do about this? Practice defusion to get stuck from our thoughts and gain distance from them. Defusion is taking a step back and seeing our thoughts for what they are: nothing more or less than words and pictures. As I like to say, look AT your thoughts, rather than FROM your thoughts.
Thought Defusion PICTURE for blog post - Copy

Here are some ways you can attempt to defuse from your thoughts:

  • Say “I’m having the thought that…”
  • Use a silly voice to say the thought
  • Sing the thought like a song
  • Repeat the thought nonstop for 30 seconds until it sounds like gibberish

Another way to defuse from unhelpful thoughts is to practice mindfulness. What is mindfulnessMindfulness means paying attention with flexibility, openness, and curiosity. It allows you to be aware of your experience in the moment as opposed to being “caught up” in your thoughts. Mindfulness involves an attitude of openness; being curious about your experience rather than fighting with it. This is helpful because often times the more we try to fight the way we feel, the more we end up feeling it.
hexagon-4
 
The goal of ACT is referred to as psychological flexibility, which entails being present, opening up, and doing what matters. An important facet of psychological flexibility is acceptanceallowing thoughts and feelings to be present, regardless of whether they are pleasant or painful.

The fun part of ACT (in my humble opinion) is valued living: doing what we want to be doing with our lives. What’s important to us? What do we want to stand for? How do we want to behave and act on a daily basis? Our values are our compass; they guide our decisions and behavior. A good way to figure out what your values are is to imagine your retirement party or funeral — Who would you want to speak about your life and what would you want to hear them say?

Once you have figured out what your values are, then final step is to take committed action (effective action motivated by your values). One helpful way to do this are to make a public commitment; tell someone about it. This will create some level of accountability for you. Another thing you can do is create an action plan worksheet. Last, but not least, simply take the first, tiniest step. The first step is often the hardest, but if you can manage to get started, the rest will follow.

For more on Acceptance and Commitment Therapy, click here and here!

How to Dispute Irrational Beliefs

Albert Ellis is known as the grandfather of Cognitive Behavior Therapy. He combined humanistic, philosophical, and behavioral therapy to form Rational Emotive Behavior Therapy (REBT) in 1955. A main assumption of REBT is that people contribute to their psychological problems by the way they interpret events. Further, our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations. REBT assumes that cognitions (thoughts), emotions, and behaviors interact significantly and have a reciprocal cause-and-effect relationship. Additionally, REBT postulates that people are born with a potential for both rational and irrational thinking.

According to Ellis, we have an inborn tendency toward growth and actualization, yet we often sabotage our movement toward growth due to self-defeating patterns we have learned. We originally learn irrational beliefs from significant others during childhood, and we actively reinforce these self-defeating beliefs by repetition, and by behaving as if they are useful. But it is not useful to blame ourselves and others; instead, it is important that we learn how to accept ourselves despite our imperfections. Therefore, a major goal of REBT is to achieve unconditional self-acceptance and unconditional other acceptance; the more one is able to accept him or herself, the more likely he is to accept others.

The therapeutic process involves identifying irrational beliefs, and replacing such beliefs with more rational and effective ways of thinking. Changing one’s thinking results in changing one’s emotional reactions to situations. Ellis succinctly puts it this way, “You mainly feel the way you think.” Some examples of irrational beliefs that lead to self-defeat include: I must have the approval of all the people in my life, or else I am worthless. I must perform all tasks perfectly, or else I am a failure. It is better to avoid life’s difficulties than to try and end up looking foolish.

The A-B-C framework and method of disputing irrational beliefs is central to REBT theory and practice.

A = an event, behavior, or attitude
B = belief about the event
C = emotional & behavioral consequence or reaction (can be healthy or unhealthy)
D = disputing irrational or self-defeating beliefs
E = effective philosophy of replacing unhealthy thoughts with healthy ones
F = a new set of healthy feelings

A (the activating event) does not cause C (the emotional consequence); rather, B (the person’s belief about the event) largely causes C. D is the application of methods to challenge irrational beliefs by detecting, debating, and discriminating irrational (self-defeating) beliefs from rational (self-helping) beliefs. E is the new and effective belief system that consists of replacing unhealthy thoughts with healthy ones. In doing this, F (a new set of healthy feelings) is created.ABC Framework 11

In summary, Rational Emotive Behavior Therapy entails the following steps: (1) acknowledge that we are largely responsible for our own emotional problems, (2) accept that we have the ability to change these disturbances significantly, (3) recognize that our emotional problems often stem from irrational beliefs, (4) accurately perceive these beliefs, (5) see the value of disputing such self-defeating beliefs, (6) accept that we need to counteract our dysfunctional beliefs/feelings/behaviors, and (7) practice these methods to improve current and future circumstances.

References:
Corey, Gerald. Theory and Practice of Counseling and Psychotherapy. Belmont. Thomas Learning, Inc. 2005.

3 Core Conditions for Therapeutic Change

The person-centered counseling approach was established in the 1940’s by humanistic psychologist, Carl Rogers. The goal of a person-centered therapy is to create the necessary conditions for clients to engage in meaningful self-exploration of their feelings, beliefs, behavior, and worldview, and to assist clients in their growth process, enabling them to cope with current and future problems.

A major concept of this approach is that people are generally trustworthy, resourceful, capable of self-understanding and self-direction, able to make constructive changes, and able to live effective and productive lives. Another key concept is that the attitudes and characteristics of the therapist, and the quality of the client-therapist relationship are prime determinants of the outcome of the therapeutic process.

Rogers maintains that therapists must have three attributes to create a growth-promoting climate in which individuals can move forward and become capable of becoming their true self: (1) congruence (genuineness or realness), (2) unconditional positive regard (acceptance and caring), and (3) accurate empathic understanding (an ability to deeply grasp the subjective world of another person).

1. CONGRUENCE (GENUINENESS)
Congruence refers to the therapist being real, authentic, and genuine with their clients. It’s called congruence because their inner experience and outward expression match. In being authentic, the therapist shows they are trustworthy, which helps in building a good therapeutic relationship with the client. It also serves as a model for clients, encouraging them to be their true selves, expressing their thoughts and feelings, without any sort of false front.

2. UNCONDITIONAL POSITIVE REGARD and ACCEPTANCE
Unconditional positive regard means the therapist genuinely cares for their clients and does not evaluate or judge their thoughts, feelings, or behaviors as good or bad. Each client is accepted and valued for who they are, as they are, without stipulation. Clients need not fear judgment or rejection from the therapist.

3. ACCURATE EMPATHIC UNDERSTANDING
Accurate empathic understanding means that the therapist understands their client’s experience and feelings in an accurate and compassionate way. The therapist recognizes that each client’s experience is subjective and therefore strives to see things from the client’s unique perspective. An important part of accurate empathic understanding is for the therapist to convey that they “get it” by reflecting the client’s experience back to them. This encourages clients to become more reflective with themselves, which allows for greater understanding of themselves.

If you’ve ever had an experience where you felt like someone just really got you…they completely understood where you were coming from, or could truly relate to the way you felt – that’s accurate empathic understanding.

Rogers asserts that empathy helps clients (1) pay attention and value their experiencing; (2) see earlier experiences in new ways; (3) modify their perceptions of themselves, others, and the world; and (4) increase their confidence in making choices and pursuing a course of action. Jeanne Watson (2002) states that 60 years of research has consistently demonstrated that empathy is the most powerful determinant of client progress in therapy. She puts it this way:

“Therapists need to be able to be responsively attuned to their clients and to understand them emotionally as well as cognitively. When empathy is operating on all three levels – interpersonal, cognitive, and affective – it is one of the most powerful tools therapists have at their disposal.”

 

References:
1. Watson, J. C. (2002). Re-visioning empathy. In D. J. Cain (Ed.), Humanistic psychotherapies: Handbook of research and practice (pp. 445-471). American Psychological Association, Washington, DC.
2. Corey, Gerald. Theory and Practice of Counseling and Psychotherapy. Belmont. Thomas Learning, Inc. 2005.

6 Principles for Meaningful Living

The Happiness Trap: How to Stop Struggling and Start Living [A guide to ACT: the mindfulness-based program for reducing stress, overcoming fear, and creating a rich and meaningful life] by Russ Harris

Acceptance and Commitment Therapy is based upon six core principles that work together to help a person develop a mind-set known as “psychological flexibility.” Psychological flexibility is the ability to adapt to a situation with awareness, openness, and focus, and to take effective action, guided by your values. For short, psychological flexibility can be thought of as Mindfulness + Values + Action.

  1. DEFUSION is creating distance and separating from unhelpful thoughts. It entails recognizing that most of our thoughts are neither true nor false; rather, most of our thoughts are actually opinions, judgments, beliefs, and morals and related plans, goals, wishes, and values. The idea is not to determine whether a thought is true or false, but whether it is helpful. One way to create distance from an unhelpful thought is to simply insert the following phrase in front of the thought: “I’m having the thought that…” or “I notice I’m having the thought that…” DEFUSION recognizes that thoughts may or may not be true; therefore, we mustn’t automatically believe them. It also recognizes that thoughts may or may not be important; therefore, we only pay attention if they’re helpful.

Thought Defusion PICTURE for blog post

  1. ACCEPTANCE (EXPANSION) literally means “taking what is offered.” It is fully opening yourself to your present reality – acknowledging what is, right here and now, and letting go of the struggle with life as it is in this moment. This philosophy is encapsulated in Russ Harris’s “Serenity Challenge” (his version of the Serenity Prayer): Develop the courage to solve those problems that can be solved, the serenity to accept those problems that can’t be solved, and the wisdom to know the difference.

In practicing EXPANSION, the aim is to observe your emotions, not think about them. The four steps of EXPANSION are (1) Observe, (2) Breathe, (3) Create Space, and (4) Allow.

  • Observe the sensations in your body (i.e. a lump in your throat or a knot in your stomach) and focus your attention on that sensation with curiosity.
  • Breathe into and around the sensation with a few deep, slow breaths co provide a center of calm within you, like an anchor in the midst of a storm to hold you steady.
  • Create Space with your breath flowing in and around the feeling, giving it plenty of room to move around.
  • Allow the sensation to be there (even if you don’t like it or want it); simply let it be. Acknowledge any urges to fight with the feeling or push it away, and bring your attention back to the sensation.

Expansion PICTURE for blog post

  1. CONTACT WITH THE PRESENT MOMENT (CONNECTION) means being fully aware of you’re here-and-now experience, fully in touch with what is happening at this moment. The goal is to pull yourself out of the past or the future and bring yourself back to the present – right here, right now.

Why practice Connection?

  • so you can appreciate the richness and fullness of life
  • because the only moment we have is NOW
  • so that you can take effective, mindful, value-driven action (which requires being aware of what’s happening, how you’re reacting, and how you wish to respond).

CONNECTION happens through the OBSERVING SELF; it involves bringing full attention to what is happening here and now without getting distracted or influenced by the thinking self.

  1. THE OBSERVING SELF (as opposed to the THINKING SELF) is a viewpoint from which you can observe thoughts and feelings. It’s essentially pure awareness; without the observing self, you would have no capacity for self-awareness. Your thoughts, feelings, and sensations change continuously; sometimes they’re pleasant, sometimes painful, helpful, happy, calm, angry, etc. The observing self can’t be judged as good or bad, right or wrong, because all it does is observe, nor does it judge or criticize you (because judgments are thoughts, which come from the THINKING SELF); it simply sees things as they are. You can think of the observing self as being like the sky, while thoughts and feelings are like the weather – constantly changing.
  1. VALUES are (1) Our heart’s deepest desires: how we want to be, what we want to stand for, and how we want to relate to the world around us, and (2) Leading principles that can guide us and motivate us as we move through life.

To identify what your values are, here are some questions to ask yourself:

  • Deep down inside, what is important to you?
  • What do you want your life to be about?
  • What sort of person do you want to be?
  • What sort of relationships do you want to build?
  • If you weren’t struggling with your feelings, or avoiding your fears, what would you channel your time and energy into doing?

Values are not the same thing as goals; a value is a direction we desire to keep moving in, and ongoing process that never reaches an end, while a goal is a desired outcome that can be achieved or completed. For example, getting married is a goal, whereas being a loving and caring partner is a value. One can think about their values in relation to different domains of life, such as Family, Marriage/Intimate Relationships, Friendships, Employment, Education/Personal Development, Recreation/Fun/Leisure, Spirituality, Community Life, Environment/Nature, and Health.

Values PICTURE for blog post

  1. COMMITTED ACTION entails setting meaningful goals for your identified values. Use the following steps to create a Committed Action Plan for yourself:
    • Summarize Your Values for each domain. For example, “In the domain of Family, I value being honest, respectful, authentic, and supportive.”
    • Set an Immediate Goal – something that can be accomplished right away. For example: “During my lunch break, I’ll call my husband and encourage him because I know he’s having a stressful day.”
    • Set Short-Term Goals: ask yourself what small things you can do over the next few days and weeks that are consistent with your identified values.
    • Set Medium-Range Goals: think of larger challenges you can set for the next few weeks and months that are consistent with valued living.
    • Set Long-Term Goals: decide upon major challenges you can set for the next few years that will continue to take you in your valued direction. A good question to ask yourself is, “Where do I want to be five years from now?”

Ten Rules for Confidence

[from The Confidence Gap: A Guide to Overcoming Fear and Self-Doubt, by Russ Harris]

Rule 1: The actions of confidence come first; the feelings of confidence come later.
The concept of confidence is defined as “an act of trust or reliance” (trusting and relying on one’s abilities and competencies), rather than viewing confidence as “having a feeling of absolute certainty or assurance.” This is a better approach, because if you wait for the feelings of confidence to come before taking any sort of action, then there’s a chance you might end up waiting forever. That’s not very effective. Harris offers four steps to follow in order to become more confident in any action: (1) Practice the skills, (2) Apply them effectively, (3) Assess the results, and (4) Modify as needed.

Rule 2: Genuine confidence is not the absence of fear; it is a transformed relationship with fear.
People believe many myths about fear, such as: fear is a sign of weakness; fear is the enemy; fear holds you back; confidence is the absence of fear. But the truth is that when anyone steps out of their comfort zone, takes a risk, or faces a challenge, they will experience fear. That’s not a sign of weakness; it’s the natural human response. Fear doesn’t have to be viewed as an enemy, or something to hold you back, rather, it can be used as a motivating source of energy to be used for your benefit. It is not true that confident people don’t feel anxious or afraid, but perhaps they have figured out how to handle it and channel it effectively.

Rule 3: Negative thoughts are normal. Don’t fight them; defuse them.
Dealing with negative thoughts can be annoying, but the fact that we have them is actually a good thing! It’s a sign that our brains are working: trying to anticipate what could hurt us or harm us, trying to predict what might go wrong, etc. If your mind has negative or anxious thoughts, congratulations – you have a normal brain. Negative thoughts are not inherently problematic, they only become so if we get all caught up in them, give them all our attention, treat them as the gospel truth, allow them to control us, or get into a fight with them. The goal is defusion: separate from your thoughts and realize that they are simply words.

Rule 4: Self-acceptance trumps self-esteem.
Having high self-esteem means evaluating oneself positively. The trouble is that it gets hard to do this when one is not successful, or when one makes mistakes. On the other hand, self-acceptance means accepting oneself in spite of deficiencies. It involves letting go of all self-judgments. It doesn’t mean that we stop paying attention to the way we behave, and the impact of our actions; it simply means that we let go of blanket self-judgments. When we make a mistake, we reflect on it and assess our actions. Harris puts it well when he poses: “If beating ourselves for every mistake we make was productive, wouldn’t we all be perfect by now?”

Rule 5: Hold your values lightly, but pursue them vigorously.
Values are one’s guiding principles of behavior, according to what is important to them in life. Harris likens values to a compass: they give us direction, guide our journey, and help us stay on track. (Goals are what we want to achieve along the way). Examples of values include: adventure, authenticity, connection, contribution, courage, creativity, flexibility, honesty, humor, intimacy, open-mindedness, respect, self-awareness, spirituality, and trust. One reason to hold your values lightly is the tendency for them to turn into inflexible requirements, such as, “I must be adventurous at all times.” Remember, the goal is to live by guiding values, not rigid rules.

Rule 6: True success is living by your values.
This means using one’s values to set goals, and to sustain movement toward set goals. You don’t have to wait until you achieve a goal in order be successful; you can be successful right now through living by your values. Maybe a goal of yours is to become a doctor because you hold the value of helping others. It will take you several years to actually become a doctor, but you can do many things to help people along the way.

Rule 7: Don’t obsess about the outcome; get passionate about the process.
Process is the way you go about doing something, whereas outcome is the result of what you’ve done. The idea here is not to give up on your goal(s), but to shift the emphasis to engaging fully in the process, and embracing it as an opportunity for learning, rather than obsessing about the outcome.

Rule 8: Don’t fight your fear: allow it, befriend it, and channel it.
Russ Harris Speaks of using “The ABC of Fear-Whispering” for dealing with fear (A=allow, B=befriend, C=channel). Trying to fight against or avoid an emotion oftentimes just makes the unpleasant emotion stronger. So, instead of fighting your experience of fear, try simply allowing it to be. Harris encourages befriending one’s fear: building a positive relationship with it. You don’t necessarily have to like it, but haven’t you ever been friendly to a person whom you don’t necessarily like? It’s kind of like that. Also, fear is worth befriending if it helps you live by your values, achieve your goals, perform at your peak, and live a richer, more meaningful life. Fear is kind of like nervous energy, but it can be less scary if you frame it as feeling “excited” or “pumped” instead. Think to yourself, “How can I make good use of this energy? What can I channel it into?” Use your fear to your benefit. And remember, you can have fear and confidence at the same time. If you recall Rule 2: Genuine confidence is not the absence of fear, it is a transformed relationship with fear.

Rule 9: Failure hurts – but if you’re willing to learn, it’s a wonderful teacher.
In the words of John Dewey (American philosopher): “Failure is instructive. The person who really thinks learns quite as much from his failures as from his successes.” Just like fear, failure is a fact of life. It’s also a natural part of learning; we reflect on what didn’t work, and think about what might work better next time. It is productive to acknowledge what went “wrong,” while also appreciating what went well. It provides good feedback from which to learn!

Rule 10: The key to peak performance is total engagement in the task.
Peak performance requires practice, defusing from reasons not to do it, making room for discomfort or fear, and fully engaging in the process. The key to peak performance is having focused attention on the task at hand. This requires mindfulness: defusing from unhelpful thoughts, such as, what you look like, what others are thinking, judging your performance, thinking about past or future events, etc. While you can’t eliminate unhelpful thoughts or feelings, you can make space for them while remaining focused and engaged in what you are doing in the present moment. It is in this state of mindful, focused action that we perform at our best.