What keeps clients out of the present moment?
From an ACT perspective, great suffering emerges from two major sources: fusion and avoidance. Fusion with a story about the world tells us the limitations inside which we must live. It tells us what’s possible and what’s not possible. It tells us where pain was, where it is now, and where it’s likely to be in the future. It tells us what we could do to prevent or attenuate pain and suffering. Experiential avoidance is a wholly sensible response to a world construed in this way. What happens? We shrink from the dangers of the world. We shrink from the unknown where danger might be—the bear that might be crouching behind the blueberry bush. We shrink our lives into something small and knowable. We shrink into what Thoreau called lives of quiet desperation, what Eliot called lives measured in coffee spoons. We shrink. We shrink, but there’s really no place to hide. Like cringing in the rain, we still get wet.
It is through the activation of mindfulness processes that we are best prepared to meet the world, to notice what we value in it, and to gently turn toward what’s important to us. As clinicians, when we notice that clients are fusing or avoiding in ways that promote their suffering, we can trace these behaviors back to a client’s understandable and natural impulse to turn away from the pain of the present moment. But patterns like rumination, worry, storytelling, and others keep clients stuck, interfering with our work of encouraging present-moment processes in sessions.
The following are just a few of the tell tale signs that a client has left the present moment. Being mindful of these signals as they occur is the first step toward bringing a client back to the present moment and encouraging greater psychological flexibility.
Worry and Rumination
In many respects, rumination and worry are two sides of the same coin. Rumination looks back over the past, while worry gazes forward into the future. Each involves verbally grinding over a time that is not the present. Both represent examples of fusion, as the storied version of events—whether past or future, real or imagined—sap the client’s focus from the present moment experience. The dominance of the storied version not only applies to the details of the events described in the stories themselves, but also to the qualities of experience that are present in the moments spent grinding over the story.
In rumination, clients grind over the past. They relive their stories about their history in their imaginations. This may take the form of repeatedly mulling over what they (or others) said or did, or didn’t say or do. They may imagine delivering punishments to themselves or others for misdeeds with lingering effects – and imagine that doing so somehow sets the world right, that the punished person is less likely to commit the misdeed again. Clients may also ruminate in search of reasons why some event occurred, in the hopes of finding a sense of resolution.
With worry, clients live feared futures over and over. Worrying about the future is simply the mirror image of ruminating about the past. The worrier imagines scenes and scenarios and all of the things that might go wrong. And much like clients may ruminate over the past to find reasons why bad things happened, they may worry about the why of future events, in the hopes of controlling them.
Most of us, including our clients, don’t live in the world directly. Instead, we live in storied versions of the world—a world that was modeled by the savanna-navigating minds of our distant ancestors and developed over thousands of years of fearing starvation and fleeing from predators. All of it is a story.
In psychotherapy sessions, certain kinds of storytelling indicate a failure of present-moment processes, and will interfere with your interventions. Spotting it when it’s occurring is an important step in helping facilitate mindfulness. What you want to learn to recognize and work with is the invariant and inflexible quality of the storytelling.
An example of stories to watch out for are those about negative events in a client’s history that are brought up again and again. They may involve blow-by-blow rehashing of every challenge encountered in the past week. As therapists, we may find something in these stories that we’re tempted to work on. But over time, this pattern will become exhausting. After all, there is a never-ending supply of difficulties and challenges in life.
Other types of stories to be aware of include the repeated describing of a better time, or the sharing of trivial information in efforts to keep the therapeutic conversation under control. Both leave little room for more profound or potentially uncomfortable conversations.
Persistent apologizing is another sign that clients may have left the present-moment. While it may seem odd that a person would come to therapy and then apologize for having a hard time, it’s something we see often as therapists.
Apologizing consistently during sessions — for interrupting, for being upset, for forgetting to do homework — implies that a client may be monitoring their relationship with you carefully and attempting to protect against anticipated rejection. To get a sense of the narrowness of this pattern, try mentioning it. Often you’ll find that clients will respond by apologizing further, highlighting the rigidity of the behavioral pattern.
There’s an inverse relationship between being in the present moment on the one hand and fusion and avoidance on the other. “Mind-y” conversations are packed with fusion and avoidance and are a tell-tale sign that a client has managed to escape from the present moment.
These conversations tend to include comparison and evaluation; complexity, busyness, and confusion; statements conjoined with “but”; adversarial posturing and side taking; strong future or past orientations; strong problem-solving orientations; strong focus on what something says about the client with respect to others; explanation instead of description; and categories instead of specifics.
The contents of these conversations tend to be extremely compelling. When clients initiate mind-y conversations, pay attention to how tempted you are to join in on them – or run away from them. More often than not, neither of these responses is helpful. Instead, try letting go of the content of the client’s spoken words for a moment, and focus your attention on the physical qualities the conversation presents, like the client’s tone, pace, posture, and so forth.
In clinical work, we must meet our clients where they are. If that means running a hundred miles an hour, it falls to us to get up to speed. And having met them at a dead run, we begin to gently engage in pace setting and bringing them gently into the present moment. When fusion and avoidance are driving psychological difficulties for our clients, interventions that are based in present-moment awareness, acceptance, and defusion have the power to make space for a greater level of psychological flexibility to emerge. With this increased flexibility, clients have an expanded capacity to make contact with what is most important to them and respond to challenges in ways that help them build deep, rich and meaningful lives.
Interested in learning more about bringing mindfulness into sessions? Don’t miss out on the opportunity to learn more about integrating mindfulness into your practice with Kelly Wilson at the upcoming ACT BootCamp, November 3 – 6 , 2016 in Tampa, FL. This four-day event is a distillation of everything that’s so exciting about acceptance and commitment therapy. Participants learn the basics of the model from some of the most experienced and respected trainers in the community, and gain deep experiential knowledge of ACT from the inside, out.
This article has been adapted from Mindfulness for Two: An Acceptance and Commitment Therapy Approach to Mindfulness in Psychotherapy, by Kelly G Wilson, PhD, and Troy DuFrene.