Demystifying ACT: A Practical Guide for Therapists

Learn how to apply ACT principles in your everyday practice.  Earn 5 CE/CME credits.

Creative Hopelessness and PTSD: The Quicksand Metaphor

By Sonja Batten, Ph.D.

This video is part of our upcoming online course about ACT for PTSD.

Highlights

  • Creative hopelessness is focused on helping the person to identify the strategies that don’t work.
  • The problem is that the strategies that they’ve been using aren’t workable.
  • We default to control strategies, which may work in the short term.

 

Transcript

For clients who indicate an openness to learning more about what the therapist means by the idea that the effort to move away from pain might itself be part of the problem, it can be useful to start therapy with a stage that’s called creative hopelessness.

Now, please note that the term creative hopelessness is just a term I might use when I’m referring to this phase of treatment with another therapist. I honestly would never use this term in the room with the client.

But, in case you’re curious where the term comes from and what it refers to, the idea is that as you work with the client to potentially understand the hopelessness of the agenda of focusing on controlling thoughts and feelings. It allows the client to open up to new options, even creative options, about other ways to engage with their private events, even ones related to a traumatic experience. That’s just how I might describe this component of ACT to you, as you’re learning it, and not a phrase I would use with the client.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

So now, I’ll launch into examples of what we might do in this initial phase of therapy in a moment.
I would usually recommend that you start with a brief mindfulness exercise at the beginning of the session to help ground and focus the client for work ahead.
Early in treatment, it can be helpful to pick relatively innocuous mindfulness exercises that are less likely to serve as trauma triggers. So, you might pick something like focusing for 60 seconds on what the person can hear, or you can even play a piece of music and have the person focus on the various sounds that comprise that piece of music.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

As I work on introducing this piece of work that we’re going to do, I might start suggesting things like, what if it’s the case that it’s not that the client hasn’t tried hard enough or hasn’t worked hard enough or been smart enough or demonstrated enough willpower to change? I’d suggest to the client that, if they think about how hard they’ve worked to deal with or try to change their memories and reactions to what happened to them, if they had put that much effort into anything else in their lives, think of how far they would’ve gotten. So, what I’m suggesting is that maybe there’s another explanation. Perhaps the client has simply been applying a strategy to solve a problem that cannot work for that purpose.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

So, here’s something that I might say to the client: It seems to me that you’ve been working very hard at trying to solve this situation and change the way things are for quite some time now. And what if it’s not the case that these strategies just haven’t worked yet? What if it’s more like these strategies actually can’t work to solve the particular problem of dealing with your trauma history?

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Sometimes, I think it’s helpful to have an image to capture what I’m trying to say. So, I’d like you to imagine that there’s a patch of quicksand in the woods.

And some sort of animal, I don’t know, maybe a deer or something lopes along and falls into the quicksand. What is that deer’s first instinct going to be?

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

To struggle like mad to try to climb its way out. And I would actually be miming, in sort of a grand way, struggling with arms and legs flailing around. And we all know from watching movies or cartoons what happens when you try to struggle your way out of quicksand, right? Usually, the client will say something like, “Well, you go deeper and deeper down in the sand.” Right.
 
References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

So instead, what do we know from watching those same movies that we’re supposed to do? We’re supposed to do something counterintuitive, right, if we have the unlucky circumstance of falling into quicksand. And if the client has seen something like that, they might answer, “Lie flat and stay still.” Exactly.

You’re supposed to stop struggling, spread yourself out, and try to get in as much surface area contact with the quicksand as possible, at least as an initial step until you figure out what else to do.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

But the first thing is to stop struggling and just get in contact with the stuff that you’re struggling with. It’s not that you haven’t been trying hard enough to deal with your current situation, to deal with those traumatic memories and the feelings that you have.

It’s just that sometimes we have to realize that we’re in the quicksand so that we can stop struggling long enough to try something else.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

So, the clinical goal at this stage of treatment is to work with the client to get into experiential contact with the awareness that the current tools or strategies have not worked and likely will not work.

If the client can recognize, for example, that struggling to try to get out of quicksand only gets the person more and more stuck, then this opens up all sorts of other creative strategies that you can try instead once the client stops trying to climb out of the bog. The ACT perspective maintains that it’s not that the client hasn’t worked hard enough, tried hard enough, or had enough willpower.

It’s that purposeful control of thoughts and feelings is a pretty problematic strategy for effective living.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

So, for clients to move toward psychological flexibility and workable life choices, they may instead need to work on increasing willingness to experience the full range of private events in the service of their own valued life directions.

We’re focusing on giving up the agenda of controlling thoughts, feelings, and other reactions to their stories, not giving up on controlling their lives.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

So if control is such a problem, then why do we all engage in it?

Well, there are 4 main reasons why a person would engage in experiential control or avoidance strategies.

First of all, modeling. We learn to control our private experiences, or at least how they’re expressed, first by watching parents and other influential people in our lives model emotional control as we’re growing up. From the outside, it often looks like it works.

Adults don’t go around crying as much as little children do. It’s only later that maybe we realize how much mom or dad had to drink every night to be able to deal with their anxiety or their depression or whatever. So it’s modeled for us, that experience of emotional control.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

It’s also directly instructed to us, things like “Stop crying or I’ll give you something to cry about” or “Be a big boy,” “Be a big girl,” you know, like “Just move on.” It’s instructed to us.

The third thing is that control strategies generally work really well in the external world, so it seems natural to apply those same strategies to your private events. For example, if you have a rotten piece of food in the refrigerator and it stinks, you can throw it away and solve the problem. But the same strategy doesn’t apply to unwanted or rotten memories.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

And fourth, control even seems to work sometimes in the internal world with thoughts and feelings, at least in the short term, like using things to distract you or having a drink every night to relieve stress after work. And because we respond really strongly to short-term contingencies, it makes perfect sense that experiential control strategies would be so common.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

So, to review the key points.
The stage of ACT treatment called creative hopelessness is focused on helping the person to identify the strategies that he or she has been using that don’t work so that the person’s energy can be freed up to find alternative ways of dealing with difficult thoughts, feelings, and other private events.

It’s important to help make clear during this phase of treatment that the problem isn’t that the person hasn’t tried hard enough or worked hard enough but that the strategies that they’ve been using to try to deal with their pain are not workable and may even be making things worse.

And it makes perfect sense why we default to control strategies. They may even work in the short term. But if they truly work to help the person have a life worth living, then the person wouldn’t be presenting for treatment right now.

More ACT for PTSD presentations