ACT With Compassion

One of the core processes in Acceptance and Commitment Therapy (ACT) is “self as context” work, or, as we prefer to call it, flexible perspective taking. In our work with those struggling with chronic shame and self-criticism, this flexible perspective taking is key to helping individuals to develop a more compassionate perspective towards themselves and others. In this work, the idea is to help individuals begin to see themselves as a conscious person with whom they have a relationship, just like they have relationships with others.  Once they see themselves someone with whom they have a relationship, they are then in a position to be able to get in contact with their values for relationships and begin to apply those to themselves. The idea of having a relationship with oneself is often a novel idea for clients. The question, “What type of relationship do you want to have with yourself” often results in either confusion or else an “aha” moment for clients, which can be signs that you are entering new territory where learning can occur.

Relational Frame Theory (RFT), which is the theory of language and cognition that underlies ACT, provides some very helpful guidance on ways to use what is called “deictic framing” to facilitate perspective taking work with clients. RFT tells us that there are different kinds of perspective taking frames that serve as contextual cues that underlie our ability to take and communicate perspective. These perspective taking frames include the following:

We have previously written about Person perspective taking (I/You) and we also wrote a poem illustrating Person perspective taking. In today’s post we wanted to talk about how to use temporal framing (i.e. Now/Then) as a way to facilitate flexible perspective taking.

Temporal frames can help transport a person to a different time, to contact a conceptualized past or future. When the individual can see themselves as a being that exists/existed in this different context, they have the opportunity to practice interacting with that “self” in more flexible and potentially more compassionate ways. For example, viewing themselves as a younger, more vulnerable child or a wiser, more experienced elder may allow the individual who typically responds to themselves in a rigidly critical or shaming manner, to treat those other “selves” in a different manner. They may be able to practice treating the vulnerable child with tenderness or take on the wisdom and gentleness of a more experienced self that may exist in their conceptualized future. Below is an example transcript where at therapist uses temporal frames used to help a client practice more flexible and compassionate perspective taking:

Client: On nights like that I feel so incredibly lonely and empty, like I’m crawling out of my skin. I just can’t stand it. The only way I can make it stop is to cut myself.

Therapist: At those time you feel like there is nothing that will help, nothing that can soothe you. But the cutting makes it better for a little while.

Client: But then I feel so terrible after I do it because I know it’s bad. I just hate being so weak and needy.

Therapist: So it seems like you’re really stuck. In those times you feel so empty and alone but then when you do the one thing you know how to do that helps, even for a little bit, you beat yourself up for being too weak. That’s a really tough spot. How long do you think this pattern has been going on? (therapist is beginning the exercise by building a sense of continuity between the self today and an earlier self)

Client: Well, I started cutting about 5 years ago.

Therapist: And is that when the feelings of loneliness and emptiness started? Or do you remember times of feeling alone and empty before that? (the self-injury is the solution, but the pain the client is trying to solve through self-injury goes back before that)

Client: Oh no, I’ve felt that way since I was a little kid. But I did other things then, like I’d overeat or when I was really young I can remember curling up under the covers in my bed and pretending that I was in a make believe world. I’d just sort of lose myself in that world.

Therapist: And how old were you then, when you’d be under the covers trying to escape to another world? (therapist is seeking to contact a specific, vivid image that will help the exercise be more experiential)

Client: I don’t know, maybe 6 or 7.

Therapist: Wow, so you’ve been suffering with this for a really long time? I’m wondering if you’d be willing to do a brief exercise with me so we can maybe see what’s happening from another perspective?

Client: Sure.

Therapist: OK. If you’re willing, can you close your eyes for me? [client closes her eyes]. Notice the feeling of your feet on the floor. Just follow the natural rhythm of your breath breathing itself, in and out. (pause) Now I want you to imagine that you’re there on your bed in your childhood bedroom and you are your 6-year-old self. Look down at your hands and notice what they look like. See what you’re wearing as your 6-year-old you. Feel your hair. Notice the bedding that is on your bed and what it feels like to sit on the bed. Is it hard or soft? What does it smell like in that room? What does the light look like? And see if you can hear any sounds that are going on there around you as you sit there on your bed. Are you there? Can you picture it? (therapist is using first person and present tense terms to coach the client to adopt the perspective of being the young child)

Client: Yes.

Therapist: OK, now see if you can feel what it feels like to be this 6-year-old and be so alone. You don’t know what to do, you’re only 6. And here you are, this little kindergartener on this bed, in her room, all alone and feeling very empty and scared. What does it feel like to be this little girl?

Client: I feel really overwhelmed and scared.

Therapist: Yes. And you just want to hide under the covers and escape to your make believe world. [client nods].

Therapist: OK, so now I want you to imagine that you are standing outside your childhood house but you are the age you’re at now. You’re wearing what you’re wearing now and you are just as you are now. You start walking into your house and you go to the bedroom you had as a child. You open the door, and you see this little 6-year-old girl who looks exactly like you. You can tell she’s scared and overwhelmed. She looks like she has been crying. Notice what it feels like to look at this little girl, this little kindergartener. How do you feel when you look at her?

Client: I feel sad for her. I want to go give her a hug.

Therapist: OK, go do that. See what it feels like to go to this little scared, overwhelmed girl who is so lonely and give her a hug.

Client: It feels right.

Therapist: Yes, it does feels right. OK, now you’re hugging the little girl and imagine that she just kind of disappears into your chest. She becomes part of you again. Because she is a part of you. You’re holding her in your heart. And now, you can notice your feet back on the floor again here. Notice your body in the chair. You can picture in your mind’s eye what you will see when you open your eyes and whenever you are ready, you can you’re your eyes.

You can see from this example that using temporal frames in these types of experiential exercises can be a powerful way to help elicit more flexible responding in clients that typically respond to their suffering with shame and criticism. These exercises often take the form of transporting oneself, using temporal framing as a key tool, to past events or past selves and interacting with the person in that situation. Once the person is virtually put in contact with another “self” that they can view in a different way, it is not uncommon that a more compassionate response naturally emerges. Then, in continuing the self-as-context work, when the individual can see the “self” that they treat harshly as being the same “self” that existed as a more innocent child or a wiser, kinder older future “self” that exists in the future, the ways of responding to those future or past selves may more easily translate to the present self.

It’s common that an exercise like the above might take more time and the client may need more coaching to adopt a more compassionate perspective. It’s also common for more self-hating clients may respond to a “child self” with contempt or disgust or a desire to avoid the child. If this is observed, it may be important to either modify the exercise such that it is the therapist who visits the child in the exercise. This provides the opportunity for the therapist to directly model a compassionate and caring response. Alternately, it may be that the client needs more time to work with activating their social safety system before returning to a similar exercise. Exercises like this may be repeated over a number of sessions, with different memories, and with different shame triggers in order for the new perspective taking repertoire to generalize. 

There are lots of other great ways to use these perspective taking frames to help facilitate more compassionate responding. Stay tuned for future posts for examples of how to use the “person” and “place” frames to facilitate more flexible responding. And if you are interested in this topic, there is a much more extensive chapter on this in the upcoming new edition of the Learning ACT book (Luoma, Hayes, & Walser, 2007) book set to come out in 2017.

Written by Jenna LeJeune, Ph.D., and Jason Luoma, Ph.D.