We move now from treatment and goals formulation to actual interventions. While ACT concepts are evidence-based and positive, it can be hard for clients struggling with depression to shift their perspective enough to make changes.
Use of Language
One of the most important interventions available to us in ACT and in some other traditions is our use of language. Therapy sessions are opportunities to develop desirable behavior, and to have meaningful interpersonal conversations as a form of experiential work.
ACT Processes and Language
Present Moment Awareness
We can encourage the client to be in the present moment in session. Hannah was stuck in the past and scared of the future. Much work in conversations focused on her present experience. The therapist might say, “As you are remembering that horrible thing which happened to you, how are you feeling right now in this moment? Is it better or worse now than it was?” Or, “Can we take a moment to drop anchor and be here now for this work, instead of six months ago? What is important in this moment?” The choice of language alone is saying, “Try to be here now.”
We can consciously use language to shift attention and change perspectives. “Wow! Your mind tells you some really harsh stories about yourself. That whole “I’m broken” story, that’s painful. How long has your mind been telling you that story, or that thought?” We’re using conversation to invite clients to notice that what’s happening in their minds is part of a broader experience, not always or necessarily hard and fast truths about themselves or the world.
Using language, we invite clients in session to catch emotions, notice them, and stay and slow down with them. People think of acceptance as an end state, but it’s a process: one of showing up for what’s happening even if it’s painful, and being with it, to get better at having difficult thoughts and feelings yet still be living your life. Mindfulness practices lend themselves beautifully to slowing down, paying attention, and being present.
We can use language to reflect values back when clients don’t have clarity on or need support with their values. Almost any conversation provides an opportunity to say, “Wow, you really care about being a/an (adjective) person.” Or in Hannah’s case, ”You really care about being a good friend, being reliable, and learning how to be the best writer you can be.” You’re guiding clients to shape more helpful self-stories that are tied to their values.
We can also use language to reinforce small moves in the desired direction. For example, if the therapist asks Hannah, “Did you do that one-minute-a-day meditation we agreed on?”, and she says, “No, not really. I did it a couple of times,” that’s an opportunity. We can say, “Great, you did it a couple of times. How did it go?”, as opposed to, “Oh, you said you’d do it five times but you only did it twice.”
Exploratory questions are helpful: “How was it? What did you like about it? What did you not like? What can we do differently next time so you could do more of it?” Remember that we want to reinforce even tiny moves toward what we want, because clients deep in depression have trouble making any kind of behavior change.