Harris, R. (2009). ACT in a nutshell. In ACT made simple: An easy-to-read primer on acceptance and commitment therapy (pp. 13-18). New Harbinger Publications.
Section 1
| Therapist: | It’s hard to explain what ACT is about simply by describing it, and it probably wouldn’t make much sense even if I tried. So would it be okay if I showed you what it’s about by using a metaphor? |
| Client: | Sure. |
| Therapist: | Great. (The therapist picks up a clipboard or a large hardback book and shows it to the client.) I want you to imagine that this clipboard represents all the difficult thoughts and feelings and memories that you have been struggling with for so long. And I’d like you to take hold of it and grip it as tightly as you can so that I can’t pull it away from you. (Client grips it tightly.) Now I’d like you to hold it up in front of your face so you can’t see me anymore – and bring it up so close to your face that it’s almost touching your nose. (The client holds the clipboard directly in front of her face, blocking her view of both the therapist and the surrounding room.) |
| Client: | Now what’s it like trying to have a conversation with me while you’re all caught up in your thoughts and feelings? |
| Therapist: | Very difficult. |
| Client: | Do you feel connected with me, engaged with me? Are you able to read the expressions on my face? If I were doing a song-and-dance routine now, would you be able to see it? |
| Therapist: | (chuckling) No. |
| Client: | And what’s your view of the room like, while you’re all caught up in this stuff? |
| Therapist: | I can’t see anything except the clipboard. |
| Client: | So while you’re completely absorbed in all this stuff, you’re missing out on a lot. You’re disconnected from the world around you, and you’re disconnected from me. Notice too, that while you’re holding on tightly to this stuff, you can’t do the things that make your life work. Check it out – grip the clipboard as tightly as you possibly can. (the client tightens her grip). Now if I asked you to cuddle a baby, or hug the person you love, or drive a car, or cook dinner, or type on a computer while you’re holding on tightly to this, could you do it? |
| Therapist: | No. |
| Client: | So while you’re all caught up in this stuff, not only do you lose contact with the world around you and disconnect from your relationships, but also become incapable of doing the things that make your life work. |
| Therapist: | (nodding) Okay. |
Section 2
| Therapist: | Is it alright if I just drag my chair across so I’m sitting beside you? There’s something else I want to demonstrate here. |
| Client: | Sure. |
| Therapist: | (pulls his chair alongside that of the client) Could I have the clipboard back for a moment? (Therapist takes the clipboard back) Can I just check – you don’t have any neck or shoulder problems do you? |
| Client: | No. |
| Therapist: | Okay. I’m just checking because this involves a bit of physical exertion. What I’d like you to do is place both your hands flat on one side of the clipboard here, and I’m going to place my hands on the other side, and I’d like you to push the clipboard away from you. Push firmly, but don’t push so hard you knock me over. As the client tries to push the clipboard away, the therapist pushes back. The harder the client pushes, the more the therapist leans into it) And just keep pushing. You hate this stuff right? You hate these thoughts and feelings. So push as hard as you can – try to make them go away. (The therapist maintains the struggle so that the client keeps pushing while the therapist pushes back.) So here you are, trying very hard to push away all these painful thoughts and feelings. You’ve been doing this for years, and are they going anywhere? Sure, you’re keeping them at arm’s length, but what’s the cost to you? How does it feel in your shoulders? |
| Client: | (chucking) Not too bad actually. It’s a good workout. |
| Therapist: | Okay, this is fine for now, we’ve only been going for a few seconds, but how will you be feeling after a whole day of this? |
| Client: | I’d be pretty tired. |
| Therapist: | (still pushing the clipboard back and forth with the client) And if I asked you now to type on a computer, or drive a car, or cuddle a baby, or hug somebody you love while you’re doing this, could you do it? |
| Client: | No. |
| Therapist: | And what’s it like trying to have a conversation with me while you’re doing this? |
| Client: | Very distracting. |
| Therapist: | Do you feel a bit closed in or cut off? |
| Client: | Yes. |
Section 3
The therapist now stops resisting. He eases off the pressure, and takes the clipboard back.
| Therapist: | Okay, now let’s try something else. Is it okay if I just place the clipboard on your lap and we just let it sit there? (Client nods. The therapist places the clipboard on the client’s lap.) Now isn’t that a lot less effort? How are your shoulders now? |
| Client: | A lot better. |
Therapist drags his chair back across the room.
| Therapist: | Notice that you are now free to invest your energy in doing something constructive. If I asked you now to cook a meal, or play the piano, or cuddle a baby, or hug somebody you love – now you could do it right? |
| Client: | (chuckling) Yes. |
| Therapist: | And what’s it like to have a conversation with me now as opposed to doing this (mimes pushing the clipboard away) or this (mimes holding the clipboard up in front of his face)? |
| Client: | Easier. |
| Therapist: | Do you feel more engaged with me? Can you read my face now? |
| Client: | Yes. |
| Therapist: | Notice, too, you now have a clear view of the room around you. You can take it all in. If I started doing a song-and-dance routine, you’ll be able to see it. |
| Client: | (smiles) Yes. (She gestures down at the clipboard) But it’s still here. I don’t want it. |
Section 4
| Therapist: | Absolutely. It’s still there. And of course you don’t want it; who would want all these painful thoughts and feelings? But notice, now this stuff is having much less impact on you. Now I’m sure in the ideal world you’d like to do this. (Therapist mimes throwing the clipboard on the floor). But here’s the thing: you’ve been trying to do that for years. Let’s do a brief recap. You’ve tried drugs, alcohol, self-help books, therapy, withdrawing from the world, lying in bed, avoiding challenging situations, beating yourself up, blaming your parents, distracting yourself, rehashing the past, trying to figure out why you’re like this, being busy, doing self-development courses and lots of other things too, I’m willing to bet. So no one can call you lazy! You’ve clearly put a lot of time, effort, and money into trying to get rid of these thoughts and feelings. And yet, despite all that effort, they’re still showing up. They’re still here today. (The therapist points to the clipboard in the client’s lap.) Some of these things you do make this stuff go away for a short while, but it soon comes back again, doesn’t it? And isn’t it the case that this is now bigger and heavier than it was all years ago when you first started struggling with this stuff? There are more painful feelings, thoughts, and memories here than there were five years ago right? |
| Client: | Yes. |
| Therapist: | So even though this is what every instinct in your body tells you to do (mimes throwing the clipboard on the floor), that strategy clearly isn’t having the effects you want. It’s really just making things worse. So we don’t want to do more of what doesn’t work, right? |
| Client: | I guess not. |
Section 5
| Therapist: | So here’s what ACT is all about. We’re going to learn some skills called mindfulness skills that will enable you to handle painful thoughts and feelings far more effectively – in such a way that they have much less impact and influence over you. So instead of doing this (picks up clipboard and holds it in front of his face) or this (mimes pushing clipboard away), you can do this (drops the clipboard into his lap and lets go of it.) And notice, this not only allows you to be connected with the world around you and to engage in what you’re doing, but it also frees you up to take effective action. When you’re no longer struggling with this stuff, or absorbed in it, or holding on to it, you are free. (The therapist holds his arms up in a gesture of freedom.) So now you can put your energy into doing the things that improve your quality of life – like hugging people you love or riding your bike or playing the guitar. (The therapist mimes these activities.) How does that sound to you? |
| Client: | (Smiling) Okay. |
Obviously it doesn’t always go that smoothly—when does therapy ever go as smoothly as in the textbooks?—but hopefully this metaphor gives you a sense of what ACT is all about: creating a rich and meaningful life while accepting the pain that goes with it. It also demonstrates that we teach mindfulness skills not as some spiritual pathway to enlightenment but in order to facilitate effective action. (Unfortunately, we don’t have the space here to describe some of the ways clients may occasionally object to this metaphor, and how we can respond effectively to those objections. However you can download a description of these objections and responses at: www.actmadesimple.com/nutshell _ metaphor _ objections _ and _ responses)
Dissecting the Metaphor
ACT speculates that there are two core psychological processes—“cognitive fusion” and “experiential avoidance”—that are responsible for most psychological suffering. Section 1 of the transcript is a metaphor for cognitive fusion: getting caught up or entangled in our thoughts, or holding on to them tightly. Section 2 is a metaphor for experiential avoidance: the ongoing struggle to avoid, suppress, or get rid of unwanted thoughts, feelings, memories, and other “private experiences.” (A private experience means any experience you have that no one else can know about unless you tell them: emotions, sensations, memories, thoughts, and so on.) N.B. You don’t want to turn this exercise into a strength test or a pushing competition. If you suspect your client may push aggressively against the clipboard, then preempt him. Say, “When I ask you to push, please don’t push too hard. Don’t try to push me over, just push gently!” Also, modify your own counterpressure; after a few seconds you could ease off and just leave the clipboard resting gently in midair, gently sandwiched in between your hands and the client’s hands.
Section 3 is a metaphor for acceptance, defusion, and contacting the present moment. Instead of the term “acceptance,” we often talk about “dropping the struggle,” “sitting with the feeling,” “letting it be,” “making room for it,” or “willingness to have it.” You can see how these terms nicely fit the physical metaphor of letting the clipboard sit on the client’s lap. Instead of the term “defusion,” we often talk about “letting go” or “stepping back” or “distancing,” “separating,” “disentangling,” or “dropping the story”—and again, as the client separates from the clipboard and lets go of it, the metaphor ties in well with such ways of talking.
Section 4 highlights the ineffectiveness and the costs of experiential avoidance; in ACT, this process is referred to as creative hopelessness or confronting the agenda. Why such odd names? Because we’re trying to create a sense of hopelessness in the client’s agenda of controlling her thoughts and feelings. This paves the way for the alternate agenda of mindfulness and acceptance, which is the very opposite of control.
Finally, section 5 highlights the link between mindfulness, values, and committed action. Presenting the entire ACT in a Nutshell Metaphor as an exercise generally takes no more than about five minutes.
