Table Of ContentUS $39.95 PSYCHOLOGY A
ACT
C
A Session-by-Session Guide to Maximizing Results in
T
Acceptance and Commitment Therapy
V
This collection of transcripts, organized and annotated by Michael P. Twohig and
E
acceptance and commitment therapy (ACT) founder Steven C. Hayes, guides you
through ACT-based therapy processes session-by-session. The transcripts featured in this R
volume present common situations that arise in clinical practice, while the commentary
B
explains how to identify the six target ACT processes and help clients work through them
A
to achieve psychological flexibility.
T
For the most detailed view of ACT therapy, the clinical transcripts included here follow
V E R B A T I M
I
the development of one client struggling with anger, anxiety, and depression. Since ACT
M
is process- rather than technique-oriented, this kind of “in the moment” analysis is a
singularly effective way to learn to apply this therapeutic model.
f
o
These transcripts will help you: r for Depression & Anxiety
D
• Identify client indicators that suggest you should target
e
a specific process in therapy
p
• Create useful exercises to foster client development r
e
in the core processes of ACT s
s
• Evaluate client advancement and structure sessions i
o
for maximum progress n Annotated Transcripts
• Learn the different styles other therapists use to &
implement ACT in their own ways
A for Learning Acceptance
n
x
MICHAEL P. TWOHIG, PH.D., is assistant professor of psychology at Utah State University
i & Commitment Therapy
in Logan, UT. e
t
y
STEVEN C. HAYES, PH.D., is Foundation Professor of Psychology at the University of
Nevada, Reno, and author of the successful ACT workbook Get Out of Your Mind and into Your Life. T
HW
ISBN-10: 1-57224-523-9 A
O
ISBN-13: 978-1-57224-523-5
Y
H
E MICHAEL P. TWOHIG, PH.D.
53995
SI
G
newharbingerpublications, inc. STEVEN C. HAYES, PH.D.
www.newharbinger.com
9 781572 245235
ACT
V E R B A T I M
for Depression & Anxiety
Annotated Transcripts
for Learning Acceptance &
Commitment Therapy
MICHAEL P. TWOHIG, PH.D.
STEVEN C. HAYES, PH.D.
Context Press
New Harbinger Publications, Inc.
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject
matter covered. It is sold with the understanding that the publisher is not engaged in rendering psycho-
logical, financial, legal, or other professional services. If expert assistance or counseling is needed, the
services of a competent professional should be sought.
Copyright © 2008 by Steven Hayes and Michael Twohig
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
All rights reserved. Printed in the United States of America.
Distributed in Canada by Raincoast Books.
Acquired by Catharine Sutker; Cover design by Amy Shoup;
Edited by Elisabeth Beller; Text design by Tracy Carlson
Library of Congress Cataloging-in-Publication Data
Twohig, Michael P.
ACT verbatim for depression and anxiety : annotated transcripts for learning acceptance and
commitment therapy / Michael P. Twohig and Steven C. Hayes.
p. ; cm.
Includes bibliographical references.
ISBN-13: 978-1-57224-523-5 (pbk. : alk. paper)
ISBN-10: 1-57224-523-9 (pbk. : alk. paper) 1. Acceptance and commitment therapy--Case
studies. I. Hayes, Steven C. II. Title.
[DNLM: 1. Cognitive Therapy--methods--Case Reports. 2. Emotions--Case Reports. 3. Self
Concept--Case Reports. WM 425.5.C6 T974a 2008]
RC489.A32T96 2008
616.89’1425--dc22
2008003620
10 09 08
10 9 8 7 6 5 4 3 2 1
First printing
To my wife, Katie, for supporting me from the beginning.
—MPT
To my wife, Jacque, for loving me.
—SCH
CHAPTER 1
Contents
A Letter from the Series Editors . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .vii
Preface . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..ix
Acknowledgments . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . xi
CHAPTER 1
What Is ACT? . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1
•
THE SIx CORE ACT PROCESSES CLUSTERS OF ACT PROCESSES
•
SUMMARy AND STRUCTURE OF THE BOOK
CHAPTER 2
Committing to Therapy and Beginning to Let Go of the Struggle .. .. .. .21
•
TRANSCRIPT STRUCTURE DESCRIPTION OF THE
•
CLIENT BEGINNING THE
•
WORK: SESSION ONE FINAL COMMENTARy
CHAPTER 3
Problems with Control and the Beginning of Self as Context . .. .. .. .. .. .51
•
SESSION TWO FINAL COMMENTARy
CHAPTER 4
Self as Context .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .75
•
SESSION THREE FINAL COMMENTARy
CHAPTER 5
Learning to Be Present and to See Self as Context.. .. .. .. .. .. .. .. .. .. .. 93
•
SESSION FOUR FINAL COMMENTARy
CHAPTER 6
Applying Acceptance, Defusion, and Self as Context
in Imaginal Exposure .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . 109
•
SESSION FIvE FINAL COMMENTARy
CHAPTER 7
Choice and values . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 135
•
SESSION SIx FINAL COMMENTARy
CHAPTER 8
Self-Compassion . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..155
•
SESSION SEvEN FINAL COMMENTARy
CHAPTER 9
Choosing values . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 179
•
SESSION EIGHT FINAL COMMENTARy
CHAPTER 10
values, Defusion, and Back.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 197
•
SESSION NINE FINAL COMMENTARy
CHAPTER 11
values, Commitment, and Wrap-Up .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..213
•
SESSION TEN FINAL COMMENTARy
Postscript .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..227
References.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..231
vi act verbatim for Depression and anxiety
Dear Reader:
Welcome to New Harbinger Publications. New Harbinger is dedicated to publishing
books based on acceptance and commitment therapy (ACT) and its application to
specific areas. New Harbinger has a long-standing reputation as a publisher of quality,
well-researched books for general and professional audiences.
ACT Verbatim is the first book of its kind to provide readers with an intimate
window on the inner workings of ACT as it is applied, in real time, with a client present-
ing with anxiety, depression, and anger-related concerns. This is not a how-to manual
on ACT, nor is it a book about ACT techniques. Rather, it is a book for those on the
path toward developing greater competence in the flexible application of acceptance
and commitment therapy. In short, ACT verbatim is ACT demystified. Here’s why we
think this is so.
The authors, both seasoned ACT therapists and trainers, reveal the fluid applica-
tion of ACT with a complex case over ten therapeutic sessions. The book is framed
early on within the ACT process model of psychological health, suffering, and change.
The model is then woven into the fabric of therapy, where the reader is given a unique
opportunity to get into the head and heart of therapist and client alike as they move
together on a journey out of suffering and into something more vital and new. This
insider perspective is unique and helps to make ACT much less mysterious.
Clinically rich therapist and client transcripts provide a structure for much of the
book. The authors guide the reader into the pulse of each session and gently point
to the presence and absence of important ACT processes as they emerge. This, along
with periodic discussion and commentary, also serve an important learning function by
teaching the reader how to develop greater sensitivity to the ACT therapeutic stance
and ACT-relevant targets of change. Each chapter ends with the authors reflecting on
the previous session, with attention to ACT competencies, skills, processes, and thera-
peutic progress. The book demands that you work with it as you read, and if you do that,
ACT Verbatim will help enrich your competency, clinical sensitivity, and flexibility as an
ACT therapist. you may even benefit personally too.
There are many ways to learn about ACT and how to apply it in clinical practice.
you can attend a workshop or two. you might read several excellent ACT books, join
a reading or online discussion group, or perhaps follow the growing research literature.
you may even take a class on the topic, observe training tapes/DvDs, or practice apply-
ing ACT under the guidance of an experienced ACT supervisor.
yet, even with all of that, you may still feel unsure about what to look for at the
process level and how to link those processes with therapeutic actions that are ACT
consistent, flexible, genuine, and helpful. The authors of ACT Verbatim will help you
fill in those gaps and round out your professional development as a more effective and
skillful ACT therapist. This exceptionally well crafted book is not the way to do ACT,
but will show you one of many ways to do ACT.
As part of New Harbinger’s commitment to publishing sound, scientific, clini-
cally based research, Steve, Georg, and I oversee all prospective ACT books for the
Acceptance and Commitment Therapy Series. As ACT Series editors, we review all
ACT books published by New Harbinger, comment on proposals and offer guid-
ance as needed, and use a gentle hand in making suggestions regarding content,
depth, and scope of each book. We strive to ensure that any unsubstantiated
claim or claims that are clearly ACT inconsistent are flagged for the authors so
they can revise these sections to ensure that the work meets our criteria (see
below) and that all of the material presented is true to ACT’s roots (not passing
off other models and methods as ACT).
Books in the Acceptance and Commitment Therapy Series:
> Have an adequate database, appropriate to the strength of the
claims being made.
> Are theoretically coherent—they will fit with the ACT model
and underlying behavioral principles as they have evolved at the
time of writing.
> Orient the reader toward unresolved empirical issues
> Do not overlap needlessly with existing volumes
> Avoid jargon and unnecessary entanglement with proprietary
methods, leaving ACT work open and available
> Keep the focus always on what is good for the reader
> Support the further development of the field
> Provide information in a way that is of practical use to readers
These guidelines reflect the values of the broader ACT community. you’ll
see all of them packed into this book. They are meant to ensure that profession-
als and the general public get information that can truly be helpful, and that can
further our ability to alleviate human suffering by inviting creative practitioners
into the process of developing, applying, and refining this approach to meet the
needs of the human condition. Consider this book such an invitation.
Sincerely,
John Forsyth, Ph.D., Steven C. Hayes, Ph.D., and Georg H. Eifert, Ph.D.
viii act verbatim for Depression and anxiety
Preface
The empirical evidence for the underlying processes of acceptance and commitment
therapy (ACT) and supportive clinical outcomes is rapidly growing. As a result, so is
professional interest in ACT. First-year graduate students as well as experienced clini-
cians are taking notice and desire to know more about it.
Ten years ago, it was very difficult to find any training in ACT, and most pub-
lished pieces were theoretical and did not deal with procedures. People had to take
fairly drastic measures, such as flying to Reno to be trained by the developer, to learn
about ACT. This is now far less of a problem. There are experienced clinicians, profes-
sors, and trainers who are teaching people in ACT (see www.contextualpsychology.org).
There are excellent books available that are extremely practical, not just theoretical.
And several DvDs are being issued, either alone (e.g., Hayes, 2007) or in conjunction
with books (Luoma, Hayes, & Walser, 2007), that show ACT sessions. There is still
much more interest than existing trainers can address, however, and additional training
resources are needed. People need multiple examples and multiple opportunities to learn
to become proficient in the application of ACT.
This book is intended to help therapists and students learn the target processes
in ACT. It will not be sufficient as the only means through which to learn them; you
will need to read the basic texts on the treatment and use this book as a supplement.
It is our feeling that reading these transcripts and comments will help solidify some of
the knowledge acquired from other sources. It is sort of like watching a sporting event,
where knowledge of the sport increases your appreciation of it. It allows you to see the
small moves that are very important to making the final score, such as, “Why did the
therapist target that process instead of the more obvious one?” or “Why didn’t the thera-
pist respond to that?”
