Key targets for willingnessHelp clients let go of the agenda of control as

applied to internal experience

Help clients to see experiential willingness as an alternative to experiential control

Help clients come into contact with willingness as choice, not a desire

Help clients to understand willingness as a process, not an outcome

ControlA great deal of suffering and struggle is found in the

denial of the inevitability of human pain.

When we feel a whole range of negative emotions, we generally try our best to undo these experiences

These attempts at controlling our private experience (via suppression, avoidance, distraction, re-structuring etc.) can often back fire

Despite being a perfectly natural coping strategy, and despite sometimes working very hard to avoid painful events, the positive effects of avoidance are short-livedFor example, imagine a social phobic who values

relationships with people. Initially avoiding people may provide relief, but the long term implication for this action is isolation

Attempts at controlling unwanted, unpleasant experiences can cost us in two major ways

Firstly, often when we try to reduce or remove pain it returns stronger to haunt and distress us. It also leads to the development of a vicious circle where pain is something to be feared. Therefore we feel pain about having pain, or anxiety about feeling anxious or depression about being depressed! ACT calls this dirty pain! In contrast ‘clean pain’ refers to the discomfort that is natural and the automatic consequence of living life!

Second, attempts at avoiding painful experiences comes from our huge need to ‘feel good’. However, often a life lived in pursuit of feeling good is not lived in the service of our most deeply held values. Often, doing what is important or matters is painful and creates that sense of vulnerability. Ironically, often trying to feel good via avoidance will only lead to feeling bad!

What is willingness?ACT specifically targets letting go of the control

agenda, which aims to get rid of experiences that cannot be gotten rid of

ACT offers willingness as this alternative

If a client is unwilling then he or she makes choices based on the avoidance of internal experiences, rather than his or her core values

Willingness can be defined as ‘being open to one’s whole experience while also actively and intentionally choosing to move in a valued life direction’

Willingness is an action and has an all or nothing quality to it, it is a choice

Clients sometimes confuse willingness for a feeling. But one does not have to feel willing to be willing

Clients can often mistake willingness for tolerance. Tolerance implies that negative experience is to be withstood until something better comes along. Willingness on the other hand involves openness and

allowing, not as waiting or needing for something to change to a better thing if we are tolerant enough

Finally willingness is not loss or resignation, as the word acceptance can sometimes imply. It is life affirming, empowering and vitalizing

Willingness is a skill to be learned, not just a concept that provides miraculous results

It therefore takes time and practise

The job of the therapist is to manufacture situations where clients can choose to experience difficult thoughts or feelings

But there are steps the therapist employs in order to manufacture willingness in the client

The MethodThe process of fostering willingness usually

involves two steps;

Firstly, the therapist must undermine control as the dominant way of relating to one self and ones world. With the aim of creating an initial openness, this is a good precursor for introducing willingness

Secondly, willingness is introduced and the therapist will try to create situations that allow the client to practice these skills

Undermining controlAttempts to control are so second nature that

managing and controlling unwanted events is not a choice, but ‘the way it is’.

Indeed the idea that clients might be able to willingly accept anxiety is a bit like suggesting they could live without breathing!

Therefore substantial work is done at the beginning of therapy, introducing the client to this new way of thinking.

The therapist will focus on a few issues when trying to undermine control attempts;Help the client to become aware of his or her

attempts at control based on their own experience. This is called ‘drawing out the system’

Examining the workability of these strategies relative to larger life goals

Guiding the client to a place where he or she can let go of these strategies

The outcome of the process of undermining control is often a loosened attachment to and confidence in the control agenda

Draw out the systemStart with asking the client the nature of the issue i.e.

why are you here?Almost always clients will report a struggle with some

emotion, memory or self evaluation (pain, anxiety, self doubt, worthlessness)

Next we move on to the strategies that the client has used to ‘solve’ the problemBe careful some of these problem solving strategies may

seem helpful (talking to friends) as well as unhelpful (getting really drunk!)

Importantly, the client probably isn't aware of the ways that they struggle to control their private experience. It is the therapists job to slowly ‘draw these out of the system’For example a depressed client may not immediately see

how oversleeping and over eating are intended to modulate a mood state

Examine workabilityAt the same time as drawing out the possible

ways that the client has attempted to solve their problems, the therapist must also examine the workability of these strategies The basic question here is ‘have these strategies worked out

as your mind said they would?’

There are spheres to explore hereFirstly - has what the client did to reduce or

eliminate anxiety actually eliminated anxiety Your are in a win-win here, because the fact they have come

to see you in therapy means that every other attempt at solving their problem hasn’t worked

Secondly, in what ways has the client constricted or limited their lives to deal with the problem?

‘What would you be doing with your time if you were not busy managing your anxiety’

The reason the therapist explores these two avenues is because the two are linked in the experiential control agenda

Namely, control strategies often promise us not only that we will feel good, but that we will be living well also. The therapist in ACT attempts to undermine these two promises

Its ironic that most clients/people believe that if they feel good first, then living well is easy. And some spend their whole lives trying to achieve the first, at the expense of actually living

Therapeutic stance and pitfallsThe therapist should view whatever attempts at

control the client has tried as perfectly reasonable and understandable

It is also important to focus on workability. This is not about being right, or proving that the therapist has a better way. Its about helping the client to apply the criterion of workability to their lives

Don’t get caught up in the content of what the client is saying i.e. don’t get side-tracked into discussing the clients problems in too much detail, we just want to know if the strategies worked

Remember that the client would have verbally rehearsed his or her stories many times, and may feel threatened and begin to defend themselves and their strategies, at this point come back to the issue of workability

The next stepDiscussion is likely to show that past strategies have not

worked too well.

In order to move the clients forward to a place where they can let go of these attempts, the therapist tries to foster a state of creative hopelessness, where the therapist suggests that perhaps those attempts ‘cant work’.

The idea of creative hopelessness is to ask the client to recognise that their attempts have not been working, and to suggest that a place of not having a solution is where we want to be. Because it’s a place where new possibilities are bornImportantly, at this point the therapist shouldn’t come up

with a solution. Just let the client sit with their not knowing.

The importance of metaphorThroughout the entirety of ACT metaphors are

used to demonstrate the principles the therapist talks about.

With creative hopelessness the therapist will want to convey that usually, the more effort we make with something the more reward we receive. Yet in this case the client has made a lot of effort to no avail. The following metaphors may helpStruggling with quicksandA person who has fallen into a hole with only a

shovel to get outFeeding a hungry tiger so that he will leaveRunning on a hamster exercise wheel that goes

nowhere

Lets look at some transcripts to see if we can spot what the therapist is

doing

Important point 1Be respectful and humble even when being

confrontational, otherwise it can seem like your playing a game

The idea is to let the client know that the strategies reinforced by the social community are not working, not that he or she is incorrect the agenda is hopeless, not the client

The idea of leaving the client ‘hopeless’ comes from the fact that when were not busy engaging in avoidance we can see our lives more clearly

Remember that each client will need different amounts of time on this. Some are steeped in their avoidance, others not so much

Important point 2Here the therapist moves on from workability to

suggesting that ‘control might be the problem’ rather that the solution to the clients problems

The problem is that our history tells us that if we have a problem, then we get rid of it and all will be well, but this may not be the case with psychology.

In all of these examples, clients think that getting their internal experiences under control will enable them to live (just like with physical problems). But what if it was all a lie!When I get my anxiety under control, I’ll get a jobWhen the pain stops I’ll find another relationshipWhen I don’t feel guilty anymore, I’ll reconnect with

my children

At this point a number of metaphors are available to the therapist to help outChinese handcuffTug of war with a monsterThe polygraph metaphorAnd many more

These all convey the same message – if you're not willing to have it, you’ve got it!

Fostering acceptance/willingnessOnce the client recognises unworkable strategies

and realizes that control might be the problem, therapy turns to willingness.

In this phase, attention is turned towards building new behaviours that are about embracing, holding and compassionately accepting one’s experience

Clients often enter therapy to feel better (be happier), acceptance aims to let clients feel better (get better at feeling) in the service of living better

The therapist guides the client to practise willingness so that they can apply it broadly to their lives

Remember that the client is taking a big step into the unknown here.

Not many people allow themselves to come into contact with their emotions/issues.

The therapist is there to gently guide the client to take these steps. They will do this in two ways;

Teaching the client what willingness is

Actively practising willingness in the present moment

Willingness involves embracing the moment, in the here and now, as it unfolds, fully and without defenceWhat we mean by fully is broad and inclusive, all

emotions and mind content are there to be experienced, not just the parts we like.

Willingness is a choice – making a selection because we can

Many clients might provide many reasons why they do not have a choice, it is your job to allow the client to defuse from their reasons and take action

There is a quick way you can do thisTea or coffee?List the reasons why you would not choose one

over the otherAnd now ask if the client could still drink that

option despite all the reasons not toIt is not the reason that chooses, but the

person

Would you be willing to choose willingness if it meant you got to live your life?

Lets look at a classic willingness metaphor

Willingness is an actionJust like teaching someone to ride a bike, it is

difficult to instruct and must instead be experienced and practised

Willingness tends to be practised throughout the therapeutic process. The therapist will do this by continually giving clients the choice to do a difficult exercise or discuss a difficult topic

Popular exercises;Eyes on exerciseTin can monster exerciseLooking for Mr discomfort exercise

Important pointsWillingness is often decided by the context i.e. a social

phobic could be willing in a bookstore, but not a shopping centre, he or she could be willing or five seconds or one hourTherapists would usually start by asking the client to be

willing in a small way, then increase the steps with time.

Willingness is on-going – we can never achieve it, simply continue to choose willingly in each situation

Willingness is heavily integrated into the other parts of the ACT modelWe will therefore come across many willingness exercises

in the next few weeks

Now lets do some examples!!!!