1 ACT With LOVE Russ Harris, ACT World Con 2011

2 Are relationships easy?

3 Fight-or-Flight 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?

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

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

12 A – AntecedentsB – BehaviourC- Consequences Situation Thoughts Feelings Biological State Short term Long term 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 Long term: Drinking problem worsens; tension in marriage worsens Drinks alcohol MindfulnessValues & action B & C = Workability Something an organism does Public or private If consequences lead to an increase in behaviour over time = ‘reinforcement’ If consequences lead to a decrease in behaviour over time = ‘punishment’

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 - 10 th 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

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

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

53 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?

54 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?

55 The Barriers to change: F.E.A.R. Fusion Excessive goals Avoidance of discomfort Remoteness from values

56 The Antidote to FEAR is DARE Defusion Acceptance of discomfort Realistic goals Embrace values

57 Key Issues: Willingness 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’

58 Key Issues: Influencing What’s in your control, and what’s not? Carrot versus stick Shaping

59 Key Issues: Conflict Name your tactics! Name your ‘pet arguments’! Agree to call them out

60 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.

61 Key Issues: Conflict Always come back to workability: What sort of things do you say & do? How does that work in the short term? Does it help your relationship in the long term?

62 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.. Naming the story; putting it on a card

63 Key Issues: Conflict Being right versus being loving I’m right; you’re wrong Superior/inferior stories

64 Key Issues: Conflict Distinguish values from rules What are your rules? What are your partner’s rules? Where did these rules come from? What happens when you fuse with them?

65 Key Issues: Conflict Defusion of Rigid rules: Expect them Notice them Name them

66 Key Issues: Conflict Discuss inevitability Increase awareness of antecedents Increase acceptance

67 Key Issues: Conflict Shark vs puppy dog Doormat or battering ram

68 Key Issues: Conflict ‘Needs’ versus values Values: how do I want to behave while I try to get my ‘needs’ met? Values: how do I want to behave when I don’t get my ‘needs’ met? Values: how do I want to behave when I DO get my ‘needs’ met?

69 Key Issues: Conflict Be wary of simple solutions ! For many issues there is no simple solution. Examples? Can that be accepted? Learn to discuss difficult issues with mindfulness and compassion

70 Key Issues: Conflict Staying on track Two cards 1: values I want to live by while we discuss 2: the issue, and the desired outcome

71 Key Issues: Conflict Therapist repeatedly comes back to: Workability Grounding/dropping anchor Acceptance/defusion Compassion to self and partner Values

72 Key Issues: Solutions Win-win options: Ideal: outcome meets both partners needs Exchange Take turns Willing sacrifice Relative importance Draw: Compromise

73 Key Issues: Solutions Lose-lose options: DRAIN In relationships, there is no ‘win-lose’ option A ‘win-lose’ for one person is a ‘lose-lose’ for the relationship

74 Key Issues: Solutions Win-win solutions are ideal, but not always possible Eg one partner wants a child, the other doesn’t Shift from a specific goal/outcome to brainstorming multiple ways of meeting both partner’s needs on an ongoing basis Recommended reading: Getting To Yes

75 Key Issues: Solutions You can’t always get what you want Validate reality gap & facilitate compassion Recall: 4 approaches to the situation How can I get my needs met, even though I can’t get the outcome I want? Acceptance & grieving

76 Key Issues: Aggression ‘Anger Management’? Run through the ABCs

77 A - AntecedentsB - BehaviourC - Consequences Situation, thoughts, feelings, biological state What you doshort term & long term

78 Key Issues: 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)

79 Key Issues: Repair attempts Conflict into compassion Vulnerability and openness Drop the story, reveal the emotion

80 Reframing Problems How can I grow from this? What can I learn from this? Imagine your partner is a personal trainer or life coach that you have hired to help you grow: what skills can you learn, what strengths can you develop?

81 Key Issues: High Expectations The Perfect Partner Story Do they exist? Do you always act the way you expect yourself to act?

82 Key Issues: Communication 101 Ask clearly for what you want (& explain why) – video description, non-judgmental Express clearly what you don’t want (& why) – video description, non-judgmental Be clear about boundaries & consequences -– video description, non-judgmental Speak in a way that works to build the relationship – body language/voice/ vocab

83 Key Issues: Calming down Drop anchor! If necessary leave the situation If you do leave the situation, practice mindfulness (defuse from unhelpful stories, accept feelings, self-compassion)

84 Key Issues: Calming down 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 … Visualize/write/rehearse those responses

85 Key Issues: Relapse Discuss inevitability of ‘relapse’ When your partner screws up, how will you respond? When you screw up, how will you respond?

86 Key Issues: Refresher Be present, open up & do what matters: Letting go Opening up Valued action Engaging fully

87 Key Issues: Intimacy Be present Share valued activities Practice connection Acceptance of vulnerability/anxiety

88 Key Issues: Intimacy Emotional, psychological and physical Sharing thoughts Showing feelings ‘Eyes on’ exercise Mindful touching (‘sensate focus’)

89 Key Issues: Intimacy Be present Share valued activities: create rituals Practice connection Acceptance of vulnerability/anxiety

90 Key Issues: Affairs Metaphor: it’s like taking drugs Motivation: avoid pain & seek pleasure Relationship problems don’t cause affairs Affair = a personal choice (like taking drugs)

91 Affairs: Both Partners Validate pain Full disclosure or not? Discuss pros and cons If yes, ensure it is ‘once off’, not lingering on

92 Affairs: The Unfaithful Partner Take responsibility Acknowledge personal choice Genuine apology Make amends

93 Affairs: The Betrayed Partner 4 options What can your partner do to make amends? Normalise the desire to know ‘why’? No explanation is likely to be satisfying Can you accept an apology? How can you both rebuild?

94 Key Issues: Forgiveness Give yourself what was there before Anger & resentment – costs of fusion Respond with mindfulness Not just about ‘letting go’; the aim is to let it come, let it stay and let it go - as it chooses!

95 Key Issues: Forgiveness FORGIVENESS RITUAL Each partner writes:- The thoughts, feelings/ memories I’ve been holding on to are … How holding on has hurt me & our relationship:

96 Key Issues: Forgiveness FORGIVENESS RITUAL 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

97 Key Issues: Trust Distinguish the action of trust from the ‘feeling’ of trust No control over ‘feelings’ of trust – only over the actions. Balance values around trust with values around self-protection Mindful trust versus blind trust

98 Key Issues: Trust Mindful trust: look for Sincerity Reliability Responsibility Competence

99 Key Issues: Trust What are small actions of trust you can take? Mindfully assess what happens! What will you need to do to honour your values around self-protection? What will your partner need to do to demonstrate he/she is trustworthy?

100 Key Issues: Trust Acceptance of time involved Acceptance of both partners emotional reactions This will never be forgotten Commitment to working on the relationship

101 Key Issues: What Is Unacceptable? Follow all legal obligations & be transparent about it. After that, it is up to the client to decide. The extreme case: domestic violence.

102 Key Issues: What Is Unacceptable? You can share your feelings, in a defused, open, accepting, non-judgmental manner - but do not try to enforce your beliefs on the client. Deal with your own stuff!

103 Key Issues: What Is Unacceptable? Focus on building the therapeutic relationship and making a safe space for the client. Help clients increase their psychological flexibility. Then let them choose for themselves.

104 Other Common Issues Chaser/distancer cycles Deep-seated fears Jealousy Anger/blaming cycles Parallel lives

105 Parting Words “For one human being to love another: that is perhaps the most difficult of our tasks; the ultimate, the last test and proof, the work for which all other work is but preparation.” - Rainer Maria Rilke