This article has been adapted from Inside This Moment: A Clinician’s Guide to Promoting Radical Change Using Acceptance and Commitment Therapy, a book by Kirk Strosahl, PhD, Patricia Robinson, PhD, and Thomas Gustavsson, MSc.
Most of us have a limited capacity to remain in the rawness of the present-moment. It’s common for a client interaction to trigger a particular thought, feeling, or memory that causes the mind to drift away from the present. But if we can stay in contact with what’s in our awareness, we can learn from those experiences.
Consider whether any of the following triggers and behaviors have tempted you to escape the present-moment in session. We also offer some tips for how to move back to awareness.
Trigger: Feeling Like a Failure
Most of us have chosen to be clinicians out of a deep desire to help people. Though we may know that we won’t succeed with every client, many of us still fuse with the belief that the inability to help represents a personal failure.
In therapy, the moment when you come to believe that you haven’t and won’t be able to help the client in front of you is an intense present-moment experience. The thought that someone is disappointed with you, thoughts of inadequacy, can inspire powerful urges to escape.
One of the most common ways that clinicians will avoid thoughts of not being good enough is by blaming the client. You might find yourself thinking, “She wasn’t motivated to change.” Or, “This treatment approach has worked for everyone else. He just didn’t get it.”
Trigger: Having Your Flaws Exposed
If you’re sensitive to perceived failure, take a moment to imagine what it might be like to have a client, supervisor, or colleague tell you outright, “You don’t know what you’re doing.” Not easy, right?
As difficult as it may be to hear this kind of feedback—particularly from a client you’re trying to help—you can recognize that the person saying it may have something useful to share with you if you can make space for it.
The reality that you are bound to make mistakes in clinical work is both obvious and terrifying. Making mistakes exposes our flaws, which can bring up a host of other thoughts and sensations from our personal learning histories.
When faced with this kind of intense content, typical escape behaviors might be to reason that it’s impossible for you to be good at everything or to disqualify the source of critical feedback. You might be escaping if you’re fusing with thoughts like, “She’s probably always dissatisfied with her therapists.”
Most clinicians are familiar with the concept of countertransference, or over-identifying with what a client is sharing due to the clinician’s own unresolved issues with a similar situation.
Every therapist is prone to identifying with clients who are struggling with the same things they have personally struggled with. The danger of this as an escape routine is that you may overuse self-disclosure to bring the discussion back to how you have dealt with that particular issue or you may actually look to the client for validation. The focus of your time together becomes you.
In a therapeutic setting, codependency is the act of knowingly or unknowingly conspiring with clients to help them avoid making contact with painful present-moment experience. Codependent behavior is typically intended to please clients and get their approval. In doing this, the therapist gets to avoid the discomfort of challenging conversations.
A therapist who models avoidance of painful experiences, and retreats from the opportunity for immersion in distressing content, blocks the client from the learning that happens in exposure to distressing internal experiences. A client’s inclination to avoid painful experiences is then enforced.
How to Work with Escape Triggers and Behaviors
Does any of this sound familiar? Perhaps other escape patterns come to mind.
When you need to regroup and move on with awareness, attend to the present. The present is the space in which you make contact with what shows up: noticing what’s there, naming what’s there, holding what’s there softly or letting it go, and reframing its meaning.
The first step to working more effectively with triggers and escape behaviors in sessions is to notice when similar situations come up for you. Perhaps you weren’t able to help a client in the way you had hoped, or you realize that you have been complicit in a client’s unconscious agenda to avoid painful present-moment material. Aim to simply notice when these urges to escape arise.
Name the Thoughts
Once you begin noticing, you’re ready to identify and name the thoughts you’re having. For instance, “I’m having the thought that I’m an incompetent therapist,” or “I felt the exact same way when my partner said something similar to me.”
Naming the thoughts associated with triggers and the urge to escape is the next step in allowing them to be there.
Once you’ve labeled distressing thoughts, you can choose to let them go instead of becoming absorbed in critical judgments. When you step back from self-criticisms, you make space for self-compassion. Remind yourself that you are only human and that you’re doing the best you can.
Finally, reframing a difficult or triggering experience can help you grow. Ask yourself what your shortcomings have to teach you. If you look closely, you will find that these experiences contain information that can help you become a better clinician and person.
For more about being in the present-moment and other ACT fundamentals, check out our upcoming ACT BootCamp in San Diego. This essential workshop has been the foundation of ACT training for thousands of practitioners, and whether you’re hearing about ACT for the first time or already have formal training, BootCamp can take your skills to the next level.