Harris, R. (2019). Fifty shades of acceptance. In ACT made simple: An easy-to-read primer on acceptance and commitment therapy (2nd ed.) (pp. 256-264). New Harbinger Publications.
As usual, I encourage you to read this script out loud as if talking to a client. The ellipses indicate brief pauses of two to four seconds.
Link to Values and Goals
| Therapist: | So we’re about to do an exercise that involves learning a new way of responding to difficult feelings … and this will be challenging … so take a moment to get clear on your motivation here … what values are you living in doing this work? … And what’s this in the service of? … What’s it going to help you with? … What will this enable you to do differently? |
Observe Like a Curious Child
| Therapist: | I invite you to sit upright in your chair with your back straight and your feet flat on the floor. Most people find they feel more alert and awake sitting this way, so check it out and see if this is the case for you. And either close your eyes or fix them on a spot, whichever you prefer. And take a moment to tap into a sense of curiosity— as if you are a curious child discovering something completely new— and with that sense of genuine curiosity, notice how you are sitting … notice your feet on the floor … the position of your back … where your hands are, and what they are touching … and whether your eyes are open or closed … Notice what you can see … and notice what you can hear … and smell … and taste … and notice what you are thinking … and feeling … and doing. |
The Part That Notices
| Therapist: | So there’s a part of you that notices everything … always there, always noticing. And in this exercise, you’re going to use that part of you to step back and observe your difficult feelings, without getting pulled into them or swept away by them. Radio Mind Therapist: Let your mind chatter away like a radio playing in the background … and keep your attention on the feeling … And at any point, if your thoughts hook you and pull you out of the exercise, the moment you realize it, acknowledge it, unhook, and refocus … |
Notice
| Therapist: | Notice where it starts and where it stops … Learn as much about it as you can … If you drew an outline around it, what shape would it have? … Is it 2D or 3D? Is it on the surface of the body or inside you, or both? … How far inside you does it go? … Where is it most intense? … Where is it weakest? (Pause 5 seconds.) And if at any moment you realize you’ve been hooked, simply unhook and refocus on the sensation … Observe it with curiosity … How is it different in the center than around the edges? Is there any pulsation or vibration within it? … Is it light or heavy? … Moving or still? … What is its temperature? … Are there any hot spots or cold spots? … Notice the different elements within it … Notice that it’s not just one sensation— there are sensations within sensations … Notice the different layers. (Pause 5 seconds.) |
Name
| Therapist: | Take a moment to name this feeling … What would you call it? … Okay, silently say to yourself, I’m noticing a feeling of X … [X = the name that the client gave the feeling, e.g., anxiety.] |
Breathe
| Therapist: | And as you’re noticing this feeling, breathe into it … Imagine your breath flowing into and around this feeling … Breathing into and around it … |
Expand
| Therapist: | And it’s as if, in some magical way, all this space opens up inside you … You open up around this feeling … Make space for it … Expand around it … However you make sense of that idea is just fine … Breathing into it … opening up … expanding around it … |
Allow
| Therapist: | And see if you can just allow this feeling to be there. You don’t have to like it or want it … Just allow it … Just let it be … Observe it, breathe into it, open up around it, and allow it to be as it is. (Pause 10 seconds.) You may feel a strong urge to fight with it or push it away. If so, just acknowledge the urge is there without acting on it. And continue observing the sensation. (Pause 5 seconds.) Don’t try to get rid of it or alter it. If it changes by itself, that’s okay. If it doesn’t change, that’s okay too. Changing or getting rid of it is not the goal. Your aim is simply to allow it … to let it be. (Pause 5 seconds.) |
Physicalize
| Therapist: | Imagine this feeling is a physical object … As an object, what shape does it have? … Is it liquid, solid, or gaseous? … Is it moving or still? … What color is it? … Transparent or opaque? … If you could touch the surface, what would it feel like? … Wet or dry? … Rough or smooth? … Hot or cold? … Soft or hard? (Pause 10 seconds.) Observe this object curiously, breathe into it, and open up around it … You don’t have to like it or want it. Just allow it … and notice that you are bigger than this object … no matter how big it gets, it can never get bigger than you. (Pause 10 seconds.) |
Normalize
| Therapist: | This feeling tells you some valuable information … It tells you that you’re a normal human being with a heart … it tells you that you care … that there are things in life that matter to you … And this is what humans feel when there’s a gap between what we want and what we’ve got … The bigger that gap, the bigger the feeling. (Pause 5 seconds.) |
Be Self-Compassionate
| Therapist: | Take one of your hands and place it on this part of your body … imagine that this is a healing hand … the hand of a loving friend or parent or nurse … and feel the warmth flowing from your hand into your body … not to get rid of the feeling but to make room for it … to soften up and loosen up around it. (Pause 10 seconds.) Hold it gently, as if it’s a crying baby or a frightened puppy. (Pause 10 seconds.) And feel free to leave your hand there, or to rest it in your lap, whichever you prefer. |
Expand Awareness
| Therapist: | Life is like a stage show … and on that stage are all your thoughts, and all your feelings, and everything that you can see, hear, touch, taste, and smell … And what we’ve been doing here is dimming the lights on the stage, and shining a spotlight on this feeling … and now it’s time to bring up the rest of the lights … So keep this feeling in the spotlight, and at the same time, bring up the lights on your body … notice your arms and legs and head and neck … and notice that you’re in control of your arms and legs, regardless of what you’re feeling … Just move them around a little to check that out for yourself … and now take a stretch, and notice yourself stretching … And also bring up the lights on the room around you … Open your eyes, look around, and notice what you can see … and notice what you can hear … and notice that there’s not just a feeling here; there’s a feeling inside a body, inside a room, where you and I are working together on something very important … and welcome back! |
In the above script, we focused on just one sensation— the most intense one. Often this is enough so that acceptance “spreads” through the whole body. But sometimes there may be other strong sensations in different parts of the body, in which case we can repeat the procedure with each one. And if the client becomes fused or overwhelmed at any point, we can segue into dropping anchor and defusion, and then return to acceptance.
Practical Tip
We can work with numbness in the same way as we work with other feelings. Find the area of greatest numbness, notice it, name it, describe it, open up, make room for it, and so on. Often when we do this, numbness dissipates and other “buried” or “hidden” feelings “rise to the surface.”
As we take the client through these kinds of exercises, one of two things will happen: either her feelings will change, or they won’t. It doesn’t matter either way. The aim is not to change or reduce feelings but to accept them— to acknowledge, allow, and accommodate them. Why? Because when we aren’t investing so much time, energy, and effort in trying to control how we feel, we can invest it instead in acting on our values.
Our clients often find that when they accept a painful emotion or sensation, it reduces significantly, and sometimes disappears. When this happens, we need to clarify that (1) this is a bonus, not the goal, and (2) it won’t always happen, so don’t expect it. We could say, “Well, isn’t that interesting? Quite often when we open up and make room for our feelings, they reduce in intensity. Sometimes they even disappear. But there’s really no way to predict it. At times they will; at times they won’t. So when it happens, enjoy it. But please keep in mind, it’s a bonus, not the main point. If you start using these techniques to try to make these feelings go away, you’ll soon be back here telling me ‘it’s not working.’”
If the client seems confused or disappointed by this, then it’s wise to repeat the Pushing Away Paper exercise or the Struggle Switch metaphor (which you’ll encounter later in this chapter) to make it really clear. I can’t overemphasize the importance of this. If we don’t explicitly address this issue, then, as with defusion, our clients will start doing “pseudo-acceptance”—that is, using “acceptance” techniques to try to avoid or get rid of unwanted inner experiences. And, of course, that will soon backfire, and the disappointed client will come back and complain, “It isn’t working.” We respond to this as we covered in chapter 16.
Now I’ll give you some pointers about these techniques. I’ll also give you a ten-second version of each.
Link to Values and Goals
Remember, in ACT, we’d never encourage anyone to accept pain or discomfort unless it’s in the service of living values and pursuing values-congruent goals. So we need to come back to this, over and over again. Without such motivation, many clients will resist acceptance.
The Ten-Second Version
Therapist: Remind me why we’re doing this. What’s this going to help you do differently?
Observe Like a Curious Child; Notice; Name
The first stage in accepting a difficult inner experience is to notice it; to acknowledge it is here, right now. (This is where flexible attention overlaps with acceptance.) The metaphor of “observing like a curious child” helps to encourage openness and curiosity toward the feeling: in other words, approach instead of avoidance.
We want to also name the feeling (which clients often need help with, as we’ll see in the next chapter). In everyday language, when we name our emotions, we often say things like “I am sad,” which makes it sound like “I am the emotion.” So in mindfulness-speak, we say things like “I’m noticing anxiety,” “Here is a feeling of sadness,” “I’m having a feeling of anger.” When you name an emotion in this manner, it helps you to see that it’s not who you are but an experience passing through you.
The Ten-Second Version
Therapist: Notice that feeling. Notice where it is. Notice where it’s most intense.
The Part That Notices
As in any mindfulness exercise, we can plant seeds for self-as-context. We may later water these seeds, as in chapter 25. The “noticing self” facilitates acceptance because it offers a “safe place” inside or a “safe viewpoint” from which to observe.
The Ten-Second Version
Therapist: Use that noticing part of you to really observe this.
Radio Mind
We expect all sorts of unhelpful thoughts to pop up when doing acceptance. If we’ve done some work with defusion already (which I highly recommend), we can bring it in here. I’m a big fan of the simple metaphor, “Let your mind chatter away like a radio in the background.”
The Ten-Second Version
Therapist: Whenever your mind hooks you, acknowledge it, unhook, and refocus.
Breathe
Many clients— but not all— find breathing into a feeling enables them to make room for it. Slow, gentle diaphragmatic breathing seems particularly useful for a lot of people (however, it does make a small minority of people feel dizzy, light-headed, or anxious, in which case, skip it).
The Ten-Second Version
Therapist: Notice that feeling and gently breathe into it.
Expand
Metaphorical talk around making room, creating space, opening up, or expanding is often helpful. This takes us from the realms of “acknowledge” and “allow” into the realm of “accommodate.”
The Ten-Second Version
Therapist: See if you can just open up around it — give it some space.
Allow
Again and again and again, we remind our clients that acceptance does not mean liking, wanting, or approving of a thought or feeling; it means allowing it, or letting it be.
The Ten-Second Version
Therapist: I know you don’t want this feeling, but see if you can just let it sit there for a moment. You don’t have to like it — just allow it.
Physicalize (Or Objectify)
Quite often our clients, especially those who are very visual, will spontaneously do this when we ask them to observe their feelings. When we imagine a feeling as a physical object, it helps us experience that this feeling is not bigger than we are; we have plenty of room for it.
In some models of therapy, you might try dissolving the object with white light or shrinking it in various ways. In ACT we would not do this, as that would reinforce the agenda of emotional control. However, as it happens, the object almost always spontaneously changes. Typically it gets smaller or softer, but sometimes it gets bigger. If the latter occurs, we might say, “No matter how big this feeling gets, it can’t get bigger than you. So observe it, breathe into it, and make more room for it.”
The point is, we don’t need to shrink or remove the object; we just need to make room for it. With acute grief work, I often have clients leaving my office with a heavy black rock inside their stomach or a thick plank of wood on their chest. That’s only to be expected. Major losses give rise to painful feelings. Let’s help our clients to carry those feelings willingly, instead of getting bogged down in a struggle with them, so they can engage fully in life and do what matters.
The Ten-Second Version
Therapist: If this feeling were an object, what would it look like?
Normalize
If we can recognize that it’s normal and natural to have painful feelings — that this is an inevitable part of being human — we’re more likely to accept them.
The Ten-Second Version
Therapist: It’s completely natural and normal that you would feel this way.
Be Self-Compassionate
Self-compassion— being kind and caring toward yourself — adds an extra element to acceptance. Presumably the warm sensations of the hand and the rich metaphor of “healing hands” contribute to the effectiveness.
The Ten-Second Version
Therapist: Just place a hand where you feel this most intensely — and see if you can hold it gently.
Expand Awareness
At times, we may want to focus intently on our emotions — such as when we’re learning a mindfulness skill or grieving for a loved one. However, much of the time, focusing too intently on our feelings will get in the way of living life. At times, clients will leave your session with strong unpleasant feelings or sensations in their body. This is very likely when working with clients with chronic pain syndrome, acute grief due to a sudden loss, or anxiety about some impending major crisis or challenge. We want clients to be able to make room for their feelings and expand awareness to engage with the world around them so they can do whatever they need to do to make their life work.
This expansion of awareness is of course a big component of all dropping anchor exercises, so we may choose to explicitly mention that metaphor. If not, the Stage Show metaphor is a good alternative, and it makes it clear that this is not distraction. The feeling remains on the stage, but as the stage lights up, we get to see the whole show — and the feeling as just one part of it. This in itself facilitates acceptance: when it’s just “one part of the whole show,” the feeling no longer seems so big and threatening.
The Ten-Second Version
Therapist: Notice the feeling, and your body, and the room around you, and you and me working here together; there’s a lot going on.
