ACT and Personal Coaching

Many of the individuals and couples we see in our practice are dealing with life problems that transcend medically-based diagnostic categories. These issues are not symptoms of larger problems like clinical depression, but the natural expression of our complicated human lives. Most of the time, our problems are just the result of our efforts to get through life as best we can - efforts which have had both positive and negative outcomes.

Despite the differences between psychotherapy and personal coaching, we have found that our training and experience as clinicians can be a tremendous benefit to our personal coaching clients. Not the least benefit is the fact that effective psychotherapists know that a great deal of our suffering comes from the fact that we are simply participating in the human condition (remember the first noble truth?).

I recently ran across a quote on Kelly Wilson's website that nicely articulates the humanism and far-reaching egalitarianism that underlies Acceptance and Commitment Therapy:

ACT does not allow a neat division between people doing treatment and people needing treatment. It is hard to get what is important about ACT without confronting the fact that in a very deep sense, we are all in the same boat. This means that the principles are scalable. ACT addresses obstacles to effective living that transcend diagnostic categories and even the notions of "sick" and "well." ACT attempts to address very fundamental issues that affect us all.

I've always been impressed by the totally non-pathologizing basis of the ACT approach. Its basic assessment categories are about skills and abilities, rather than diagnostic labels. We have found that ACT techniques are a powerful addition to our personal coaching services as well as a basis for psychotherapy. Here are some of the principles that we believe are central to positive change in both psychotherapy and personal coaching, starting of course with:

Acceptance and Commitment. Our coaching strategies rely on this fundamental principle, which we have learned through many years of helping people in psychotherapy: Meaningful change always requires both a thorough acceptance of ourselves as we are, and a commitment to act in accordance with our deep personal values. This is the basis of the ACT approach to psychotherapy.

Positive psychology figures prominently in both our psychotherapy and our personal coaching program. We have learned that happiness is not really the result of things that happen to us, but can be cultivated in the way we engage our lives. We draw on the growing body of psychological research on this topic to help people live more satisfying lives and realize their potentials.

Mindfulness is what enables us to be in the present, the place in which all change occurs. In taking action which actualizes our most far-reaching goals, the only thing we can ever do is take one step from right here. It can be startling to realize how much of our time we spend in daydreams and preoccupations, completely out of contact with our real life. Mindfulness helps us orient to who we really are, and what we are really experiencing. With this perspective, the path to our personal and professional goals is much clearer.

We've written a bit more about Integrative Health Partners' Personal Coaching Program on our website. Feel free to visit and browse.

This Friday's Study Topic

Image by practicalowl via FlickrIn our study group this Friday (the last for the summer) I'd like to focus on the topic of cognitive defusion and to discuss our experiences integrating this concept into clinical practice. You might find these lectures by Jason Luoma on Cognitive Defusion an interesting way to begin reflecting on the topic.

Cognitive defusion is one of the ways in which mindfulness of thoughts has found a home in psychotherapy theory and technique. I'm looking forward to deepening our understanding of this topic through our discussion on Friday.

Study Group Updates

At our next meeting of the Mindfulness and Psychotherapy Study Group, our guest will be Delany Dean, J.D., Ph.D. Delany is a psychologist in Kansas City who has been writing a great blog and website on mindfulness in psychology. She recently developed a Mindfulness Based Wellness program at Avila University, and she offers mindfulness based therapies in her private practice. We're really honored to have her visit with us while she is in Chicago presenting a poster at a conference.

Before the meeting on May 23, let's read this Baer (2003) review article about the uses of mindfulness training in therapeutic contexts. I'm also putting up a similar (but less technical) review paper (Mace, 2007) for you to peruse.

Finally, following up on our discussion last month, Laurie sent along this paper (Davisdon, et al, 2003) on the effect of mindfulness on brain function. Please enjoy your reading!

Every Day a Gift

This week in our study group on mindfulness and psychotherapy, we were discussing mindfulness of the body. In the Buddhist Sutra on the Four Establishments of Mindfulness, there is an instruction to contemplate the mortality of the body. The meditator is asked to envision the decomposition of a human corpse, holding the realization that his own body is of exactly the same nature, and there is no way for it to escape that fate. On one level, it seems to be the ultimate meditation on both impermanence and “impurity,” encouraging sobriety and a measure of detachment from the endless round of desire that we live in most of the time. It is easy to imagine this meditation as effective in controlling sensual cravings and helping monks uphold their vows of celibacy. And yet, this purpose seems much more appropriate to the homeless monks of India in 500 BCE than to ourselves as twenty first century psychotherapists and clients. During our discussion in the study group on Friday morning, the question arose: what possible value could this mindfulness practice have for us as therapists? Could it find its way into a therapeutic dialog, and if so, in what form?

Some of us realized that, as challenging as it was, we have derived great benefit from the encounters we have had with of our mortality. Those of us who have been cured of serious illnesses, or narrowly escaped terrible injury in an auto accident, have found in these experiences a certain clarification of what is important, what is heartfelt in our lives. We all know (or are!) people who, after a serious diagnosis, have made real changes in our lives. Our awareness of mortality gives us another perspective from which to ask the question, "What is the most important thing?"

So how does a meditation on death enter into the therapeutic dialog? Mostly, I think, more subtly than in the Mahasatipatthana Sutra. One member of the study group (NR) pointed out that in Native American shamanist traditions, using death as an advisor is a recommended practice. Essentially the same point is made in a Zen monastery, where the instrument that is used to call the monks to meditation is often inscribed with a verse like: "Life and death are serious. Gone is gone. Wake up! Don't waste time."

We do not necessarily notice it, but actually, mortality is a natural part of the discussion whenever we take up the question of how we live our lives, whether in psychotherapy or elsewhere. Questions like “What should I do next…” take on a much deeper meaning when we finish them “…given that my time in this life is limited.” Conventionally, we agree to suppress our mindfulness of this part of the discussion, but it’s worthwhile to consider whether in doing so we are depriving our clients of an important source of meaning and motivation.

Consider this typical statement from the viewpoint of Acceptance and Commitment Therapy:

We explain to clients that the perspective we work from seeks to understand people’s difficulties in the context of a whole life. Sometimes problems become so overwhelming that it is easy to lose contact with the “big picture.” We do want to know how the client has struggled, but seek an understanding of that struggle in the context of a whole person with hopes, desires and aspirations. (Wilson and Murrell, 2004, p. 136)

In this formulation, our mortality lurks just outside the frame of the intervention. The “context of a whole life” inevitably includes the limited nature of that life, whether we choose to recognize it or not. It’s quite possible that Wilson and Murell’s statement could naturally open the door to a discussion of how our impermanence contributes to the quality of our actual presence in life. In fact, it is arguable that such an investigation can be avoided only by the active suppression of awareness.

That discussion would naturally take on different dimensions with different people. But it is frequently found that one outcome of increased awareness of the impermanence of this life is the commitment to pay attention while we are still living. As Mary Oliver says in her poem “When Death Comes,” “I don’t want to end up simply having visited this world.” In some paradoxical way, the reality of the end of life brings us into our lives with awareness, vigor, and appreciation. It is somewhat hard to imagine a context for therapeutic change that does not mobilize this type of engagement.

In my mindfulness and stress reduction classes, one question I have used to good result is: "If life could be about something, what would you want your life to be about?" (see also Wilson and Murrell, 2004, p. 135). This discussion is a critical support to the development of mindfulness practice. No one ever says, “I’d like to find a way to sleep my life away.” Instead, people talk, for example, about wanting to develop their mindfulness so they can pass a deep appreciation of life on to their children. For people to undertake such an unconventional practice as mindfulness, there must be a good reason, and that reason must be consciously affirmed. To remind ourselves of Jon Kabat-Zinn’s basic insight, mindfulness is a deliberate attention.

Occasionally, when my wife and are walking with our mobility-challenged twelve year old golden retriever, she will remark: “Each day with Bailey is a gift.” Inevitably, we are put in touch with our appreciation of and gratitude for the opportunity to have this walk together. It is really worthwhile to pay attention to this moment when we recognize it as irreplaceable.

One insight from the Mahasatipatthana Sutta is that mindful awareness is nurtured by the awareness of life’s actual and limited nature. In the psychotherapeutic field, this tenet has so far been the rather exclusive province of the Existential therapies. Possibly, with the support of those ancients who devoted their lives to mindful awareness, the mindfulness-oriented therapies will take a second look at this basic observation, and consider whether it can be cultivated to therapeutic effect.

Note: to see a draft of the Wilson and Murrell paper mentioned in this post, click here. The reference for the final version is:

Wilson, K. G. & Murrell, A. R. (2004). Values work in Acceptance and Commitment Therapy: Setting a Course for Behavioral Treatment. In Hayes, S. C., Follette, V. M., & Linehan, M. (Eds.) Mindfulness & Acceptance: Expanding the cognitive-behavioral tradition (pp. 120-151). New York: Guilford Press.