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Acceptance and Commitment Therapy

for Students on Academic Probation:

A Treatment Manual

Michael L. Rosen, M.S.

Paul B. Ingram, M.A.

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NOTE FROM THE AUTHORS

We appreciate your time and interest in our treatment manual that incorporates

Acceptance and Commitment Therapy (ACT) with university students on academic

probation. While there is no gold standard treatment for these students, it is in the

opinion of the authors that ACT contains several qualities that can be tailor-made so that

university advising centers/career centers can utilize a brief, 4-5 session treatment

package. Although there is a dearth of empirical research applying ACT in a vocational

context, there is promising data that does exist, which will be discussed in the sections to

follow.

Given the complexity and density of ACT from a theoretical standpoint, the

authors highly recommend reading this manual in its entirety, and possibly more than

once to ensure absorption. It should also be noted that it is preferable that those

clinicians potentially using this manual have had previous experience in a therapeutic

setting (non-career related), although it is not required. Similarly, clinicians who have

previous training in ACT have even more of an advantage. However, we believe the

proposed model is promising for a reason: Given the more-often-than-not observed

mood/affective symptoms that accompany vocational conflict, it can be quite difficult for

the vocational psychologist to walk the line between traditional psychotherapy and

career counseling. Incorporating ACT into a vocational domain may help mitigate this

conundrum by acknowledging maladaptive or unwanted thoughts/feelings, and at the

same time constructively working towards career and academic goals. We believe this is

a unique modality in this regard, and are excited for its potential uses, perhaps

generalizing to other career-relevant populations as well.

This manual consists of a brief introduction to the theory behind ACT, as well as

a description of the population for which this manual is intended to serve. Each session

is clearly outlined so that clinicians can follow along and incorporate the content into

their own style or language, and sample transcripts are located toward the end of the

manual to give an idea of what an actual session might look like. Finally, sample

assessments that are part of the model are located in the appendix section.

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TABLE OF CONTENTS

Literature Review ................................................................................................................ 4 Background .............................................................................................................. 4 Population for Intended Use .................................................................................... 6 Theory of ACT ......................................................................................................... 7 Manual Outline ................................................................................................................. 13 Session 1 ........................................................................................................................... 14 Session 2 ......................................................................................................................... 18 Session 3 ........................................................................................................................... 23 Session 4 ........................................................................................................................... 28 Session 5 ........................................................................................................................... 32 References ......................................................................................................................... 33 Appendices ....................................................................................................................... 35 Appendix A: Sample Mindfulness Exercises ........................................................ 35 Appendix B: Sample Metaphors ............................................................................ 37 Appendix C: Acceptance and Action Questionnaire-II ......................................... 38 Appendix D: Coping Strategies Worksheet ........................................................... 39 Appendix E: Values Epitaph .................................................................................. 40 Appendix F: Goal Worksheet ................................................................................ 41 Appendix G: Sample Transcript ............................................................................ 42

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BACKGROUND

Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999)

is an evidence-based behavioral treatment intended to decrease experiential avoidance

and increase psychological flexibility. Experiential avoidance, or the unwillingness to

accept and experience private internal events, is considered a maladaptive behavioral

pattern associated with psychological distress. High experiential avoidance results in

psychological inflexibility, which is the inability to maintain contact with the present

moment, and to maintain or modify behavior when doing so does not serve ones values.

ACT presents acceptance as an alternative to avoidance. Acceptance incorporates the

active willingness to embrace private events without attempting to manipulate their

frequency or form. Acceptance is not used in the sense of resignation; rather it should be

viewed as a full-contact embrace of personal experiences. Instead of altering the form or

frequency of private events, defusion techniques reduces rigid identification with

thoughts. ACT promotes being present in the current moment by using unprejudiced

awareness of internal and external stimuli as they occur. With this contact, ones

awareness of the flow of experiences provides self-as-context, or the idea that we are

not the content of our experience. We are not our thoughts, our feelings, our experienced

sensations, the things we see, or our mental images. Instead, one is a transcendent self

that is not fused to thoughts and feelings.

Values are an essential theoretical component of ACT work, but this abstract

concept may differ from the common definition. Wilson, Sandoz, Kitchens, and Roberts

(2010) state that values are continually developed during a persons life, and are shaped

by our experience. Values are different from goals in that they cannot be completed in a

discrete or concrete manner. Gaining employment may be an achievable end goal, and

ACT uses goals similarly to many other behavioral treatments. However, in ACT, the

therapist would frame the goal of gaining employment as a behavior that represents

committed value-based action towards health, parenting, career, etc. Also, while a person

may not be highly concerned with one valued life area during one stage of life, certain

life events or changes in maturation may cause these values to evolve. For an individual

who values socializing, living a healthy social lifestyle and passing down healthy social

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behaviors and skills to ones children is intrinsically reinforced by feelings of doing what

is morally right.

Hexaflex Model

Phew, still with us? Good! The hexaflex is a visual representation of the six

key components of ACT discussed in the previous section. This can appear not only as

more pleasing to the eyes, but also as more parsimonious. A diagram of the hexaflex is

shown below.

As one can see from the hexaflex diagram, there is a clear interaction between all

six points of the model, with the center goal being psychological flexibility. This

interaction is true for treatment as well, and can be seen in the session outlines. It should

be noted that although the clinician may be touching on multiple facets simultaneously,

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there is a progression that should occur in order to best meet the client where he or she is

at; however, many of the same techniques can be used across sessions.

POPULATION FOR INTENDED USE

Academic probation is traditionally defined at the university level as when a

student is failing to meet adequate grades, often defined as below a 2.0. After one

semester of failing to meet this requirement, the student is placed on academic probation,

which means they have to obtain at least a 2.0 for each subsequent semester until the

cumulative GPA is raised to a 2.0 or higher (Hsieh, Sullivan, & Guerra, 2007). Although

the definition of academic probation may vary slightly from school to school, the

underlying problems are the same. Retention is currently one of the leading challenges

faced by colleges and universities across the nation (Hsieh et al., 2007). There are many

factors that contribute to retention difficulties, but underachievement seems to have the

highest predictability with academic achievement (Ames & Ames, 1984). There are

varying definitions of underachievement in the literature, but most researchers agree that

underachievement can be defined as a student performing lower academically than is

expected based on measures of potential (Balduf, 2009). Specifically, there are two traits

that influence underachievement: self-efficacy (a persons judgment of their own ability

to complete a task) and goal orientation (motives a person has for completing a task).

Hsieh et al. (2007) conducted a study to examine these two traits with students on

academic probation (GPA of under 2.0). Not surprisingly, it was found that high self-

efficacy and high goal orientation were positively correlated with academic achievement,

whereas performance-avoidance goals were negatively correlated with academic

achievement.

Smith & Winterbottom (1970) investigated personality traits that exist within the

student academic probation population. It was commonly found that lack of positive

motivation, lack of acceptance of responsibility for actions, self-defeating attitude, and

wishful thinking toward unrealistic goals were all common traits. Given the high amount

of avoidance behaviors found in students on academic probation, as well as their lack of

clarity in values and motivation, ACT makes sense as a treatment option.

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Despite an absence of empirical literature explicitly applying ACT in a vocational

setting, a number of studies exist employing mindfulness, a specific tenant of ACT, as an

efficacious coping mechanism for career counseling (Kurash & Schaul, 2006; Jacobs &

Blustein, 2008). Hoare, McIlveen, and Hamilton (2012) outlined the potential efficacy

for ACT as a treatment modality with career counseling populations, and proceeded to

effectively utilize ACT with career counseling in a case study. As Juntunen (2006)

points out, clinicians have a tendency to dichotomize career vs. non-career related

presenting problems, even though data show that this is simply not the case. Just as ACT

was originally developed for treating emotional/interpersonal issues, these are so

interwoven with career-related issues that the two are often synonymous.

The hope for this manual is its incorporation and utilization in university

academic advising centers and/or career centers with students on academic probation.

While most students on academic probation are required to consult with an academic

advisor, many are not given any kind of manualized intervention. This manual will

provide use for those students who can then be referred from an academic advisor, or

even better, an in-house practitioner at the advising center. We leave the decision-

making up to the advisor as far as whether or not the student should be referred. It may

very well be the case the student does not need to be seen for any kind of intervention.

THEORY OF ACT

Each facet of the hexaflex is described in more detail in the following section in

relation to students on academic probation.

Acceptance

As described earlier, acceptance differs from resignation. Acceptance involves a

willingness to embrace ones private experiences, whether positive or negative (Hayes et

al., 1999). Given that ACT proposes avoidance as the source of many

psychological/social problems, willingness and acceptance are important for helping

clients live a more fulfilling life. Naturally, individuals experiencing unwanted private

events want to control the situation, but again ACT suggests this only exacerbates the

problems, illustrating the applicability for willingness/acceptance. How might this

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concept be relevant to students who are putting forth little effort in school,

underachieving, or simply struggling to make grades? We believe acceptance and

willingness is a great starting point for clinicians to use with students struggling in

school, as there are more than likely several other issues occurring other than simply Im

getting bad grades. This way, the clinician can get an understanding of some of the

psychological processes occurring, either leading up to, or concurrently with, the period

of academic probation. Perhaps most importantly is the potential usefulness for

acceptance strategies with students who are engaging in high levels of avoidance

behaviors with regard to school (e.g., continually going out drinking instead of studying

for an exam). As discussed earlier, helping students accept responsibility for their

actions can prove fruitful in terms of building motivation and treatment buy-in.

Contact with the Present Moment

Being in the present, also known as mindfulness, involves bringing awareness to

the present moment and being open and receptive to whatever private events occur

(Hayes et al., 1999). This can involve paying attention to internal bodily sensations,

thoughts, feelings, or external events such as sights, sounds, and smells. However, the

key is to avoid judgment or evaluation while experiencing these events. Although

mindfulness has been used in Buddhist meditation practices for the past approximately

2,500 years (Germer, 2005), it has more recently been used as an effective therapeutic

technique for a wide range of presenting problems, such as anxiety and depression

(Hayes et al., 2006; Jacobs & Bluestein, 2008). Given the growing concern of the rapidly

changing work climate, elevated levels of anxiety and employment uncertainty often

present in a career counseling setting. Jacobs and Bluestein (2008) suggest using

mindfulness as a coping mechanism for clients dealing with career uncertainty and

employment stress, freeing them to make calmer and potentially more informed

decisions. This theoretical argument can be applied to students on academic probation,

as they are likely experiencing stress and uncertainty as well.

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Defusion Cognitive defusion, or defusion, consist of techniques used when individuals fuse

with their negative or unwanted thoughts that is, they take said thoughts literally and

believe they are true (Hoare et al., 2012). For instance, a client experiencing trouble in

school may have the commonly occurring thought Im stupid. The clinician can help

the client observe these thoughts from an objective standpoint to understand that the

thoughts are simply a product of human language, thus taking some of the emotional

power away from the words themselves. Since these thoughts and feelings commonly act

as barriers to success, helping to distance ones self from unwanted thoughts can facilitate

progress towards ones goals. One quick exercise that can be used in virtually any setting

involves taking a word associated with an unwanted thought (e.g., loser), having the

client repeat the word quickly for 30 seconds, and then having the client notice the

resulting phenomenon (typically the word loses its meaning). There are a number of

experiential activities that tap into defusion, some of which are included in our session

summaries.

Self-as-Context Perhaps the most abstract concept in the hexaflex, the self-as-context sets itself

apart from other aspects of the self. Self-as-context, or the observing self, refers to a

viewpoint from which we are able to observe thoughts/feelings. This self cannot be

directly observed or described, but is a sort of awareness of our awareness (Harris,

2009). Often times, individuals fuse with their unwanted memories/thoughts/feelings,

and subsequently lose hope for future events and goals. Self-as-context attempts to help

clients notice the act of noticing these memories/thoughts/feelings, so that they can create

a safe space for themselves from which to observe these painful experiences. In other

words, you are not defined by the thoughts, feelings, or events you have experienced.

There is a constant you that remains at all times. This technique is often incorporate

into mindfulness, defusion, and acceptance exercises. With a university student on

academic probation, self-as-context can be beneficial in allowing the individual to gain

perspective on dealing with their current situation, and another aspect from which to

observe their thoughts and feelings. Given that academic probation is not a desirable

position to be in, it would be expected that students have a low sense of self-efficacy, and

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possibly feelings of worthlessness. This technique can allow the student to give

themselves some space from these unwanted thoughts, as well as understand that their

self is not defined or changed based on this particular point in their life.

Values The next two components of ACT are perhaps the most crucial with regard to our

chosen population. Values are important to ACT because the overall goal is to help

clients live a rich and meaningful life (Hayes et al., 1999). As described earlier, values

should be differentiated from goals in that they cannot be achieved in the same way a

goal can be attained. One useful metaphor to help conceptualize values is visualizing a

compass, and thinking of the direction north as ones value. You can never stop going

north, but you can stop along the way to take in the sights (goals). With a student on

academic probation, a goal may be to get off academic probation, but it is important to

identify more concrete, longer-lived values, such as wanting to be a good student or a

diligent worker. Values plays a key role in this treatment manual since so much hinges

on the identification of a persons values, as this is closely related to actively taking steps

to make changes in ones behavior.

Committed Action Committed action, or commitment to action, builds on exploration of ones values

and formulating goals to act upon. It is important to note that built into this component is

the anticipation of psychological barriers, which is why the entire hexaflex interacts in

the most pervasive way when an individual is planning their commitment to action. For

instance, a student works towards improving study skills even though he continually has

the self-defeating thoughts that he is going to fail. Committed action perhaps creates the

most complex sessions, as not only are you as clinicians introducing new behavioral goal-

setting material, but also incorporating previous techniques to simultaneously work

through barriers that arise. Clients are aided in developing gradually larger goals

congruent with their values, and taking steps to do so. For example, a student on

academic probation may commit to the short-term goal of being taken off academic

probation, so the clinician can facilitate this commitment with smaller behaviors, such as

improving studying skills or even regulated sleep hygiene. Clients can identify potential

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barriers to these behaviors, which are problem-solved collaboratively between clinician

and client. Behavioral activation techniques often look similar to commitment to action,

such as creating a hierarchy for activities, and are welcomed in this stage (Eifert &

Forsyth, 2005). The authors view some similarities between this component, and that of

Krieshok, Black, and McKays (2009) definition of occupational engagement: taking

part in behaviors that contribute to the career decision-makers fund of information and

experience of the larger world, not just the world as processed when a career decision is

imminent (pg. 284).

Psychological Flexibility As noted earlier, if one wants to think of an ultimate goal of ACT, it would be

psychological flexibility. Just like career adaptability (Super & Knasel, 1981; Savickas,

1997), psychological flexibility advocates adapting to a changing environment. This is

especially important with regard to this manual. One of the beautiful characteristics of

ACT is the lack of dogmatic practice, which opens up treatment to wiggle room. Just

as psychological flexibility is key for our clients, it is equally important for us as

clinicians. For example, if you as the clinician are finding that a particular student is

having trouble understanding or acting particularly resistant to defusion exercises, there is

no need to harp on these techniques in hopes of absorption, as this will likely only cause

boredom or checking out. It is up to you as the clinician to exercise judgment in

moving on, rephrasing, or touching back on a previously understood concept.

Furthermore, as is the case in traditional therapy settings, we are not trying to fix our

clients, and the same is true here. The main goal of this treatment package is to help

equip these students with some tools, coping strategies, and new perspectives with which

they can begin to work towards a more adaptive academic experience, and potentially

market work position (if desired). Still, there should be a pervasive sense of

collaboration throughout.

Considerations

Given ACTs reliance on language and verbal ability (for both clinician and

client), this treatment manual has certain inherent limitations that may impact intended

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populations. Individuals experiencing severe intellectual/developmental disabilities or

other language-impairing disabilities should be referred to alternative services (i.e.,

psychological testing services). However, individuals with mild intellectual disabilities

(i.e., learning disorders, ADHD) on academic probation are still candidates. Similarly,

individuals on academic probation who are actively psychotic or suicidal should be

immediately referred to an outside resource.

A special note should be made regarding clients of nondominant cultural and

marginalized backgrounds. While there is not currently extensive literature applying

ACT to these populations, what does exist is promising, especially given the rapid growth

in popularity of ACT globally. A meta-analysis conducted by Fuchs et al. (2013)

examining ACT with minority populations found an overall effect size of .69, and

Woidneck et al. (2012) indicate what literature exists is promising. However, there is no

denying a need for further empirical research with larger sample sizes. Given these

considerations regarding what we currently know about ACT, the authors feel this

manual can be used with diverse populations in an effective manner. Exploring ones

values and taking active steps in congruence with said values is ubiquitous in many

cultures; However, for some cultures that are less prone to seeking therapy, discussing

unwanted thoughts (for example) might prove more tasking. The clinician ideally should

have an understanding of multicultural counseling, and how specific cultures respond to

treatment.

Similarly, international students should be given special consideration. Given this

manuals reliance on ACT theory (and it being in English), students whose first/native

language is not English may not necessarily benefit as much as those students for whom

English is a first language. That being said, it should be up to the clinician and academic

advisor to communicate regarding any potential concerns in this regard. If it is deemed

that the student is proficient in English, the authors feel this manual will be efficacious.

It may be harder to explain certain concepts (i.e., self-as-context), so the clinician may

have to play around with some different word combinations to find a definition that

registers.

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MANUAL OUTLINE

This treatment manual is designed to be used across five separate individual

sessions with a client who is having difficulties engaging in their academic work. This

lack of engagement often results in difficulties finding meaning in the day to day tasks

and in producing the level of work that may be required for the student to successfully

complete the courses they are enrolled in and, ultimately, their degree program. This

manualized treatment is intended to be implemented following an intake or diagnostic

assessment (presumably after the first meeting).

Choosing to incorporate five sessions was not arbitrary; Brown and Krane (2000)

illustrated via meta-analysis that the effect sizes for career counseling interventions

peaked at 4-5 sessions, and diminished by roughly half after five. The same study

found that including three key ingredients (rather than less than three) resulted in the

largest mean effect size. For this reason, we feel our manual incorporates several of these

ingredients, including written exercises, individualized interpretations/feedback, and

attention to building support. The fifth session is designed to be optional and intended to

allow the clinician to do a brief, comprehensive review or to refocus on a skill or area that

may have been particularly difficult for the client.

The following pages are broken down by those five sessions. A treatment

protocol is presented on the following pages for the clinician to use. Handouts and

exercises completed during session serve to take the clinician-guided concepts and help

put them into practice. Because ACT is based so much on individual exploration of

values and putting a new, and sometimes challenging skillset into practice, clinicians

should encourage their clients to practice their learned exercises to better incorporate into

their repertoire.

This treatment manual covers the following material:

Session 1 Introduction to ACT/Acceptance

Session 2 Defusion and Self-as-Context

Session 3 Values Exploration

Session 4 Committed Action

Session 5 Wrap-Up, Review, and Termination (Optional)

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Treatment Protocol: Session 1

Agenda

The purpose of this session is to introduce the core concept of acceptance and to

assist the client in exploring how a fixation on behaviors and thoughts held about their

academic achievement may be inhibiting their own success. The introduction to ACT

here should be brief without much focus placed on explaining the hexaflex model.

Instead, the session should focus on broadly explaining the process of mindfulness and

what it might look like to engage in that practice within an academic context.

Outline of Time in Session

0 5 minutes Greeting and rapport building.

5 10 minutes Agenda setting and outline 5 session treatment.

This portion of the session should be dedicated to outlining the flow of

treatment. This can be explained as a process of becoming more engaged

in school, fully noticing and experiencing the scholastic process, and on

identifying the things that drive you. The client has, after all, made the

choice to be in school and in this session to address his or her academic

difficulties.

10 20 minutes Mindfulness exercise (see page 16).

ACT is sometimes easier to demonstrate experientially than it is to explain

verbally. This is why the previous introduction is kept brief and broad; it

is intended to prime the client for the experiential exposure instead of

force a top-down learning process. With very minimal training, the client

is guided to experience an in the moment mindfulness exercise. While

the exercise itself is not centered around school, it is designed to provide a

sounding board and trial that they can look back to later and use to guide

their later work with ACT.

20 35 minutes Discuss acceptance and reflect on mindfulness exercise.

More often than not it is the struggle and resistance of a situation that

causes us distress (and at the very least exacerbates it). To some degree,

the client has to accept and go with the flow of the mindfulness exercise

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to be able to be engaged by it. As you directed their visualization, they

were not tasked with driving their thoughts or their emotions. Instead, they

likely experienced greater engagement if they were able to merely accept.

Relate this to behaviors that led them to where they are now.

35 40 minutes Inquire and identify goals in attending session

The purpose of this is not to directly build on the values aspect to ACT.

Instead, it works to prime them for it later on. It also serves to assist the

client in recognizing their ownership of both their academic difficulties

and the steps they are now taking to correct those problems.

40 45 minutes Session wrap-up and homework

Session 1: In Depth

A) It is very important to be welcoming to the client with whom you are meeting. Given

the overall praise of psychological flexibility, these session outlines should not be taken

as gospel, especially if other topics naturally arise. At the end of the day, we give the

client what they best need at that time. While giving a general outline is important to

keep the client informed, it should be made explicitly known that depending on your

work together, the meetings are relatively flexible.

B) Often ACT is viewed as a significant departure from traditional treatment. Clients

will sometimes find some of the exercises odd, silly, or stupid. This is a great

opportunity to preface this session with a disclaimer of sorts to inform the client that what

you two will be doing is more than likely unlike anything they have done before;

however, the main point is that what they have been doing likely has not been the most

adaptive, and that it cannot hurt to try something new. This is intended to further

promote buy-in.

C) This initial mindfulness exercise is a great introduction to some of the exercises you

will be doing in session. While the content of the exercise is not academic-related, the

purpose of the exercise should be relayed to the presenting issue. As discussed in the

literature, mindfulness is a great coping tool for uncertainty related to work, and

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academic probation is a very uncertain time in a students life. This point should be

made known.

Before we do our first exercise, it is important to discuss what we are doing. We call these exercises mindfulness, or being mindful, and they are meant to allow ourselves to stop, pay attention in the moment, and simply observe without judgment. These exercises are not intended as relaxation techniques, nor are they a means of escaping difficulties (see Appendix A for sample mindfulness exercises).

D) While reflecting on the mindfulness exercise, this is a perfect time to incorporate

acceptance. The clinician should discuss control as the problem, and invite from the

client past attempts to control the unwanted situation. The clinician can inquire about the

costs of these attempts to control, as this often causes the individual to miss out on

other more desirable parts of life. Introduce acceptance as an alternative to control and

avoidance of the feelings surrounding academic probation, and ensure to differentiate

from resignation. Frame it as a willingness to experience private events, whether wanted

or unwanted. The important thing is to highlight that when we are actively NOT

accepting (e.g., controlling or avoiding) our difficulties, we suffer as a result. There are

many metaphors to illustrate this point (see Appendix B for links to more metaphors).

When were stuck in quicksand, the immediate impulse is to struggle and fight to get out. But thats exactly what you mustnt do in quicksand because as you put weight down on one part of your body (your foot), it goes deeper. So the more you struggle, the deeper you sink and the more you struggle. Very much a no-win situation. With quicksand, theres only one option for survival. Spread the weight of your body over a large surface area lay down. It goes against all our instincts to lay down and really be with the quicksand, but thats exactly what we have to do. So it is with distress. We struggle and fight against it, but weve perhaps never considered just letting it be, and being with the distressing thoughts and feelings, but if we did, wed find that we get through it and survive more effectively than if wed fought and struggled.

E) At the end of session, it is important to reflect and process the work that was

completed. Many clients may feel overwhelmed from the exercises, but it is important to

reassure them and encourage optimism moving forward. If necessary, draw back on the

what you have been doing in the past has not been working, so you might as well try

something different statement.

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F) For homework, the Acceptance and Action Questionnaire-II (Appendix C) and/or the

Coping Strategies Worksheet (Appendix D) can be given. Both address attempts to cope

with unwanted thoughts/feelings. This way, the clinician can gauge the extent to which

the client is struggling and/or avoiding these thoughts/feelings as true barriers to their

academic success, and move forward accordingly.

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Treatment Protocol: Session 2

Agenda

The purpose of this session is to assist clients in understanding ways that their

self-concept and self-labels impact our capacities. The overarching goal of this session is

to help the client come to understand that holding negative self-evaluative beliefs about

their academic achievement is not uncommon, unnatural, or indicative of vocational

outcomes. Since it is very common for struggling students to embrace their self-concept

negatively in the academic domain, the embracing of ACT principles in this session is

designed to assist the client in understanding that those beliefs are not indicative of them,

or even necessarily their ability, as individuals.

Outline of Time in Session

0 5 minutes Greeting and rapport building.

5 10 minutes Review homework.

In review of the homework, the clinician should inquire about the

experience of completing the assigned homework. However, it is not

vitally important to go in depth for how the client may have responded.

Instead, it is more important to simply touch base and make sure the client

has no outstanding questions or concerns before continuing to the content

areas being covered in session two.

10 15 minutes Introduce concept of defusion.

The purpose here is to help the client identify the self-perceptions

regarding academic ability that client holds. These self-perceptions (e.g., I

am stupid because cant do math) should be specific to their experience

because these same perceptions are going to be used as an example in the

following defusion exercises. As defusion is introduced, the clinician

should focus on normalizing the experience as a regular, expected, and

normal part of those in a troubled academic situation.

15 25 minutes Experiential defusion exercise.

During this part of the session, the clinician should use the academically

adapted leaves on a stream exercise (see Session 2, in-depth, page 20) In

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doing so, this part of the session targets the self-perceptions of the client to

help them begin to become more integrated with their views within

themselves as a whole context.

25 35 minutes Introduction of self-concept.

The clinician should explore the commonality of positive and negative

self-evaluative statements during the leaves on the stream exercise.

Reflecting upon the type of self-evaluation, the clinician aims to assist the

client in identifying both positive a negative aspects of themselves in the

academic setting. In doing so, the clinician is working to demonstrate a

more comprehensive, and thus less flat, description of the clients

academic self. Academic achievement is not simply grades. It is also

professionalism, timeliness, talkativeness, past performance, dedication,

and so on.

35 40 minutes Introduce the students in the classroom metaphor.

Having worked on increasing the clients self-perception, the purpose of

this next few minutes is to introduce a metaphor that the client can use to

help to conceptualize the way ACT is encouraging their understanding of

their academic self. It is not intended to introduce a new concept.

Instead, this is a review of the big concepts covered in session. A script of

the metaphor is located on page 22 of this treatment manual.

40 45 minutes Session wrap-up.

Given the more experiential nature of defusion and self-as-context, this

session does not include homework.

Session 2: In-Depth

A) Consistent with work across various psychotherapy contexts, the focus on rapport

during the first five minutes is vitally important to outcome. The clinician should make a

point to check-in on thoughts on mindfulness as it was introduced during the first session

and on any lingering questions that the client may have. While the session outline denotes

only five minutes to this greeting, helping to ensure the client feels comfortable engaging

with ACT and the mindfulness exercises is vitally important. In this way, some flexibility

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should be used with the implementation of the time in lieu of comfort with concept. One

overarching message the clinician may want to emphasize to the client is that ACT is a

different approach to try something since nothing else has worked and that much of the

experience is the part that drives the benefit it can have.

B) The following is an adapted script of the leaves on the stream exercise as described by

Harris (2009). This exercise should help the client notice the thoughts that they are

having about their educational experience. This is an important first step in ACT.

LEAVES ON A STREAM

Sit in a comfortable position and close your eyes or rest them gently on a fixed

stop in the room. Visualize yourself sitting beside a flowing stream with leaves

floating along the surface of the water. *PAUSE 10 SECONDS* For a moment I

would like you to think about yourself and your academic achievement. Think

about your experience as a student and about what that has been like. Now, for

the next few minutes, take each thought you have about your academic

performance and place it on a leaf let it float by. Do this with each thought you

have- pleasurable, painful, positive, or negative; place them on a leaf and let the

float by. If your thoughts stop, just watch the stream. Sooner or later your

thoughts will start up again. *PAUSE FOR 20 SECONDS* Allow the stream to

flow at its own pace. Dont try to speed or rush your thoughts. You are not trying

to rush the leaves along or to get rid of the thoughts you may be having. If your

mind says this is dumb or Im not doing this right then place those on a leaf

and let those pass as well. *PAUSE FOR 20 SECONDS* If a leaf gets stuck,

allow it to hang around until it floats by. If it comes up again, watch it float by

again.*PAUSE FOR 20 SECONDS* If you notice a difficult or painful feeling

arise, simply acknowledge it. Say to yourself, I notice myself having a feeling of

boredom or frustration. Place those thoughts on a leaf and let them pass. From

time to time you may notice your thoughts distract you. This is normal. When it

happens and when you notice you have been sidetracked, gently bring your

attention back to the stream.

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C) Having worked with the client to bring attention to the thoughts that they have

about the academic experience, the next section of the session aims to turn attention to

the self-as-context. In other words, the goal is to explore with the client that they are a

more comprehensive person within the academic context than how their thoughts may

have led them to believe. This may take some exploration, but the clinician should work

with the client to establish indicators of academic positives in addition to any negatives.

Potential strengths might be organizational and executive skills, timeliness and

attendance, achievement level in the past, or talkativeness in class.

D) The purpose of this is to bring the defusion and self-as-context aspects of ACT

together into practice in order to reinforce the holistic approach to understanding the

academic self. The purpose of this session is to help reinforce the two main ACT

constructs that are being addressed during this session (e.g., defusion and self-as-context)

using an adapted well-known ACT metaphor- the passengers on the bus metaphor .

Defusion is demonstrated in the metaphor in the context of not trying to fight with, argue,

or engage with the troublesome students. Self-as-context is emphasized by reflecting on

how there are a lot of students and that noticing only the loudest, darkest, or meanest

causes you to neglect the other students. Following the introduction to this metaphor, it

may be useful to review these concepts with the client in order to ensure that they were

able to pick apart how those concepts were represented in the metaphor.

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STUDENTS IN THE CLASS

Imagine for a moment that the different thoughts you have about your academic

self are all students in a class that you are teaching. Maybe the course is required

and so a lot of different students may be in the class. Some of the students are very

pleasant. Its great to have them along and they have a lot of useful and helpful

things to say. Many even most are pretty neutral. But some students are

horrible. They are ugly, loud, aggressive, threatening. They tell you youre a

terrible teacher. They warn you that you are not teaching the right way. They

threaten that if you do not change your teaching style that your career will end.

Now take a moment and consider the students in the class. Who are the loudest?

Who are the darkest? Who are the most prominent? With bothersome students the

natural reaction may be to want to argue with them and engage them when they

do something bothersome. But instead, take a moment and ask yourself do these

students often drop out of the class on their own after a while? Does engaging

with them make them more important, more central, in our lives at that moment?

Does arguing make them leave the class?

What about the other students- the ones that are nice, calm, and that you enjoy

talking to? Does arguing with the dark ones make it easier or harder for you to

notice the nice students- the ones that make you smile? How long will you allow

yourself not to enjoy the good parts of the class you are teaching?

23

Treatment Protocol: Session 3

Agenda

This session aims to assist the client in exploring their values relative to their

academic achievement and sense of self. Consistent with concepts of ACT, academic

value exploration examines the aspirations and drives that have led the client to get to

where they are now. Although it may seem that values exploration for those on academic

probation may emphasize poor achievement, clarification of values will instead likely

show that there is a divide in which the client does have some values congruent with

academic success.

Outline of Time in Session

0 5 minutes Greeting and rapport building.

5 10 minutes Introduce concept of ACT values exploration.

The purpose here is to show that there can be complex sets of behaviors

and beliefs that can lead the client to be where they are. The clinician

should emphasize that although there may be some reasons that academic

success seems unlikely or not important, there are other reasons which

contradict this. This can be seen as consistent with the self-as-context

concept described in session 2 of this treatment manual. If they do not

recall this concept, a brief review of self-as-context may be warranted to

assist in value exploration engagement later in this session.

10 20 minutes Guided value exploration exercise.

Once the client has a firm grasp of the self-as-context idea and how this

may relate to their own values and academic performances, it is time to

take the next step and help them identify in an explicit way what those

values may be. Although the guided exercise (see page 27) is brief, the

discussion afterwards may not be. The clinician should attempt to prompt

and query the client about the identified values. If externalized reasons are

presented (i.e., my mom wanted me to go to school), then the client should

be redirected to how that implies their value (e.g., I value my familys

opinions).

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20 30 minutes Priority in value.

The purpose of this part of the session is to help clients understand that

values, both those in an academic setting and in a broad life sense, are

always with us. It is done through a discussion of their identified values. It

should be explained to the client that sometimes we act incongruent with

our values, but that does not make the value go away. The client is

responsible to tap into their own values for academic success and they

should also accept that sometimes the value will be more apparent. Up

until now, perhaps they have not been embracing the set of values that

lead them to school as much as they have been embracing other values

(such as socializing with peers via fraternities or sororities).

30 40 minutes Values reflect goals.

The purpose of this part of the session is to set-up the client for the active

process of developing steps to align themselves with their values in

session 4. Because values reflect action and because action indicates a

desired outcome, clients are helped to reflect what it is that their values

reflect in terms of goals. It is important here to explore with the client

about what they would look like if they achieved that goal. If they adhered

to the identified value, what would that look like in their life?

40 45 minutes Session Wrap-up and homework assignment.

Sometimes value exploration can be a bit difficult and clients may have a

harder time identifying the full range of their values in the moment. For

this reason, they should be assigned the values epitaph (see Appendix E)

to do on their own. This exercise is simply a picture of a headstone, and

the client is asked to write down their ideal epitaph, or what they would

want it to read on their stone that others will see and remember them by.

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Session 3: In-depth

A) Consistent with concepts of ACT, the purpose of this session is to help clients

examine their values. Values can be tough to identify - especially when they may

contradict behaviors we engage in. It can sometimes be difficult to grasp that we are

acting in a way that is incongruent with what we value. That is, unless we are able to see

ourselves as complex, multi-faceted individuals. By guiding the client through self-as-

context exercises in the previous session, this session starts with the assumption that the

client is able to understand, appreciate, and conceptualize themselves according to that

idea. If they are not, it becomes very important for those clients who are academically

struggling to have the ideas reviewed. Without doing so, it is possible that the client will

fixate on their struggles and the negative aspects of their school experience instead of the

more holistic and realistic interpretation.

B) Individuals on academic probation may find it difficult to identify values that are

congruent with school success. It may be difficult for them to see themselves as having

values that align to attending class, studying for what may be difficult, or completing

work at a level that the instructor requires. The clinicians job at this juncture is to help

highly the multi-faceted nature of the clients values come to light. As expressed in the

session overview, perhaps values of material gain, family acceptance, social

normalization play an integral role with why the client has taken the past steps that they

have taken. Again and again it may be emphasized to the client that although they may

not identify a high value placed on academics, their actions have shown that the value is

there.

C) The waxing and waning of values is a natural part of who we are. There are times

where we will make choices that reflect other (and sometimes contradictory) values

because of the complex needs we have as people. This active process of value

development is integral to who we are as people because it allows us to be adaptive.

Values are important to remember and we can use them like a compass - as a flexible

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guide that is there to help us but not as something we clutch tightly every step of the way.

The compass is a tool we can pull out and use to help us find our way when we are lost.

D) Value exploration, because of its multi-faceted nature, can involve examining not

only academic values but other values as well. Social, family, and work values can also

play a role. If the client has a difficult time identifying values consistent with why they

are making the choices that they are to achieve academically (remembering that even a

small step is a step that demonstrates a value), it may be useful to explore those values as

well. Because values are freely chosen, the client can then be asked to place them in order

of their own priority to help see how some values may be helping them work towards

academic achievement and how others may not.

E) Values are the first part of developing goals. A client who has a value also has an

aspiration. They have something that they aspire to because they have a value.

Sometimes clients may not have thought a great deal about what their actions imply in

terms of values. Likewise, they may not have spent much time thinking about what their

values mean in terms of goals. Questions can be a useful way to explore this

contradiction with clients.

What would you like to be different?

How would you act if things were different?

What personal qualities or strengths do you have?

What would achieving that goal do that matters in the big picture?

It may be useful to do a guided imagery with the client for some of their more salient

(and thus more highly prioritized) goals in order to help them come to the answers to

these questions.

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GUIDED VALUE INQUIRY

We have a lot of values. There can be a lot of external pressures placed on us, such as

family, friends, or coaches. No matter what those external pressures say, we have to

choose to change. We have to want ourselves, or something about our situation, to be

different from what it is right now.

Take a moment to reflect on why you are doing this. Something motivated you; something

matters to you that is making you take time out of your life to come to this session. There

is something that is motivating you to re-examine what you are doing in your academic

life at this point. Is that choice you are making about improving your life? Personal

growth? Learning new skills? Search inside of your heart and clarify to yourself what

values led you here today. What are the things inside of yourself that make you want to

change your academic life?

What strengths do you fell you already have? What are the things that you do well

already? What does your ability to do these things say about you as a person and about

the values you hold? Is it determination, loyalty to family, or social ability? Is it a desire

to learn and improve yourself and your life?

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Treatment Protocol: Session 4

Agenda

Once a client has identified a set of values that they have, no matter to the degree

to which they adhere or identify with their value (i.e., it may be a value that is not

particularly acted upon), they are ready for the next step of ACT treatment in their

academic troubles. This session focused on helping the client to develop committed

action.

Outline of Time in Session

0 5 minutes Greeting and rapport building.

5 10 minutes Introduce concept of committed action.

Committed action is, in plain language, the process of taking larger

patterns of effective action by setting goals and breaking those goals down

into small, specific actions. Commitment to the small action produces a

pathway to the larger goal. It is the process of translating values into

action.

10 25 minutes Develop a four step plan to committed action.

Following the four-step guideline (i.e., choosing an area of academic life

to change, choosing the value underlying this domain change, developing

goals guided by that value(s), and taking action mindfully) according to

the S.M.A.R.T. acronym (see page 29).

25 35 minutes Barriers to Goals.

The purpose here is to explore how to respond mindfully to barriers, snags

in the plan, and other slow-downs that may happen in life summarized

by the F.E.A.R. anonym (Fusion, Excessive goals, Avoidance of

discomfort, and Remoteness from values; see page 30). Clients previously

identified S.M.A.R.T. goals, and now can discuss foreseen obstacles . The

defused self and self-as-context concepts are central to the F.E.A.R.

barriers (review concepts if necessary).

35 40 minutes Mindfulness practice.

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One difficult aspect of mindfulness is incorporating it into our lives and

finding a way of defusing, being mindful, and feeling at ease with

ourselves, especially when experiencing barriers. Because of this,

brainstorming how to respond without feeling so overwhelmed as to

prevent our desired actions is the first step. Incorporating and practicing

mindfulness is a second part. The mindfulness exercise below (see page

31) provides a guided meditation to assist the client in seeing themselves

AFTER they have completed school and accomplished the very goals they

are setting in this session.

40 45 minutes Session Wrap-up.

The purpose of this session, above all else, is to have identifiable concrete

goals that the client can work towards. These goals should have clear steps

that they can actually begin to take within the next 24 hours. As you wrap

up the session, it is important to remind them of their 24-hour goals.

Session 4: In-depth

A) Goals within ACT are driven by the acronym S.M.A.R.T. Goals need to be (a)

specific, (b) meaningful, (c) adaptive, (d) realistic, and (e) time-framed. These

goals should not be emotional (the purpose is to change behavior) or dead person

goals (those that a dead person can accomplish, such as I will stop feeling angry

after a test).

Specific : Describe explicitly the action you will take so that

is it easy to know if you have achieved it.

Meaningful : The goal should be guided by values not rigid rules,

trying to please others, or trying to avoid pain.

Adaptive : The purpose of the action is to improve, enhance, or

enrich your life as far as you are able to predict. It is

important that it changes life to a better place based

on how the client perceives it so remaining client-

centered in this aspect is particularly important.

Realistic : It should be obtainable based upon your current

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health, finances, time, and skills. This is a

particularly difficult area for those struggling

academically because it may not be realistic to stop

failing.

Time-framed : Set a day or time for your goal to be completed. If

this isnt possible then, as best as possible, create a

time frame.

B) Along with the S.M.A.R.T. goal-setting acronym, make sure clients follow the

four-step plan to committed action. The worksheet (see Appendix F) can provide

the clients a guide to formulate a goal-based action. Although the purpose of this

session is to guide the client through the creation of one goal-driven behavior,

encourage them to follow the template within the worksheet on their own and to

explore additional aspects of their values as they go forward from him.

C) The most common of barriers to committed action in goal making can be

summarized by the acronym F.E.A.R. During the third part of the session, the

purpose is to introduce clients to barriers they may encounter so that they can

mindfully respond to them.

F : Fusion. This barrier is when we become engrossed and

encapsulated by our negative thoughts (i.e., I cant do

math) instead of being more defused (see session 2).

E : Excessive goals. It is important to ensure that our goals do

not exceed our desires or our resources to accomplish them.

We need resources that address health, finances, skills, and

time (as well as others).

A : Avoidance. Change can be uncomfortable and if we are

unable or unwilling to accept some discomfort along the

way, we may not move forward.

R : Remoteness. If we lose touch with our values, if they

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become remote and not central to our committed actions,

then we will not have the meaning behind our goals

necessary to help us accomplish them.

D) The client has identified goals and is aware of the barriers that they may

encounter along the way to achieving said goals. However, accomplishment may be

something that is new and difficult for the client. They may have never given themselves

permission to think that they could actually succeed. Prior to closing the session, the

clinician directs the client to engage in a mindfulness practice in order to help them begin

to acknowledge and accept that their goals are not simply lofty steps, but that they can

produce the desired change. Below is a sample mindfulness script to assist. Some

adaptation on the part of the script may be needed in order to ensure that it addresses, as

directly as possible, the clients academic difficulties and desired goals.

FUTURE PERFECT DAY

For the next few moments I would like you to allow your mind and your body to relax. If

you are comfortable enough to do so, close your eyes. Take a moment and notice your

body. Be mindful of your physical self. Notice your breath how it enters and leaves your

body. *PAUSE 10 SECONDS* When you start to feel more relaxed, allow yourself to

begin to imagine a day in the future. While you may have faced academic difficulties in

the past, on this future day I would like you to imagine that you have overcome them.

Picture yourself seated amongst your peers at your graduation. Imagine the mortarboard

on your head and the graduation robes you are wearing. There may be a commencement

speaker talking about the trials, tribulations, and then subsequent successes that they,

like you, have faced to get to where you are at. Now imagine a few moments later that

you are crossing the stage, accepting in hand your college diploma. Notice how it feels to

have accomplished your goal and the sense of yourself that you have in this moment. As

you imagine this moment, recall the goals you had, the steps you took, and the values that

guided you to this accomplishment.

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Treatment Protocol: Session 5

Agenda

The final session is intended as an optional wrap-up session. If the client is struggling

with concepts or was not able to move as quickly through the treatment manual, this

session is intended to cover those bases and to review the constructs. Because session 4

covers committed action, this session may not be necessary for all clients.

Outline of Time in Session

0 5 minutes Greeting and rapport building.

5 15 minutes Review the self-as-context and defusion.

15 30 minutes Review value exploration.

30 40 minutes Review committed action.

40 45 minutes Session wrap-up and termination.

Session 5: In-depth

A) The purpose of this session is to help the client review their understandings

gathered over the last few sessions. As each of the concepts are gone through in order of

this treatment manual, the clinician may find it useful to refer to guided meditations or

worksheets completed within each session. This can help to reinforce the skills learned

through ACT.

B) Because some clients may be facing greater obstacles than others in terms of their

academic successes, they may request additional focus regarding a particular area. This is

especially likely for committed action formulation. In these cases, it is acceptable to use

session 5 to repeat the content material within session 4, but only if the client has a grasp

on values, defusion, and self-as-context.

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Brown, S. & Krane, N. (2000). Four (or five) sessions and a cloud of dust: Old

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Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety

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Fuchs, C., Lee, J.K., Roemer, L., & Orsillo, S.M. (2013). Using Mindfulness and

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Germer, C.K. (2005). Mindfulness: What is it? What does it matter? In Germer,

Siegel, & Fulton (Eds.), Mindfulness and Psychotherapy (pp. 3-27). New York, NY: Guilford Press.

Harris, R. (2009). ACT made simple: An easy-to-read primer on acceptance and

commitment therapy. Oakland, CA: New Harbinger. Hayes, S. C , Strosabl, K. D., & Wilson, K. C. (1999). Acceptance and commitment

therapy: An experiential approach to behavior change. New York, NY: Guilford Press.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: model, processes, and outcomes. Behavioral Research and Therapy, 44, 1-25.

Hoare, N., McIlveen, P., & Hamilton, N. (2012). Acceptance and commitment therapy

(ACT) as a career counselling strategy. International Journal of Educational and Vocational Guidance.

Hsieh, P., Sullivan, J. R., & Guerra, N. S. (2007). A closer look at college students: Self-efficacy and goal orientation. Journal Of Advanced Academics, 18(3), 454-476.

Jacobs, S.J., & Blustein, D.L. (2008). Mindfulness as a Coping Mechanism for

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Employment Uncertainty. The Career Development Quarterly, 57(2), 174-180. Juntunen, C.L. (2006). The Psychology of Working: The Clinical Context.

Professional Psychology: Research and Practice, 37(4), 342-350. Krieshok, T.S., Black, M.D., & McKay, R.A. (2009). Career decision making: The limits

of rationality and the abundance of non-conscious processes. Journal of Vocational Behavior, 75, 275-290.

Kurash, C., & Schaul, J. (2006). Integrating Mindfulness Meditation Within a

University Counseling Center Setting. Journal of College Student Psychotherapy, 20(3), 53-67.

Savickas, M. L. (1997). Career adaptability: An integrative construct for life-span, life- space theory. The Career Development Quarterly, 45(3), 247-259.

Smith, C. P., & Winterbottom, M. T. (1970). Personality characteristics of college

students on academic probation. Journal Of Personality, 38(3), 379-391.

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Appendices

Appendix A: Sample Mindfulness Exercises [Sampled from www.the-guided-meditation-site.com] Exercise 1: Conscious Observation

Pick up an object that you have lying around. Any mundane everyday object will do...a coffee cup or a pen for example. Hold it in your hands and allow your attention to be fully absorbed by the object. Observe it. Dont assess it or think about it, or study it intellectually. Just observe it for what it is. Youll feel a sense of heightened "nowness" during this exercise. Conscious observation can really give you a feeling of "being awake". Notice how your mind quickly releases thoughts of past or future, and how different it feels to be in the moment. Conscious observation is a form of meditation. Its subtle, but powerful. Try it...by practicing mindfulness in this way youll really start to sense what mindfulness is all about. Exercise 2: The Ten Second Count

This is more of an exercise in practicing concentration than it is in mindfulness, and it is a simple variation on exercise 1. In this exercise, rather than focussing on your breath, you just close your eyes and focus your attention on slowly counting to ten. If your concentration wanders of, start back at number one! For most people, it goes something like this...

One...two...three...do I have to buy milk today or did John say hed do it? Oh, whoops, Im thinking.

One...two...three...four...this isnt so hard after all... Oh no....thats a thought! Start again.

One...two...three... now Ive got it. Im really concentrating now... Exercise 3: Mindfulness Cues

In this exercise you focus your attention on your breathing whenever a specific environmental cue occurs. For example, whenever you hear the phone ring, you promptly bring your attention into the present moment and stay focussed on your breath.

Simply choose a cue that works for you. Perhaps you will choose to become mindful every time you look in the mirror. Perhaps it will be every time your hands touch each other. Perhaps it will be every time you hear a bird.

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Mindfulness cues are an excellent mindfulness technique that are designed to snap you out of the unconscious autopilot state of mind and bring you back into the present moment. Exercise 4: One Minute of Mindfulness

This is an easy mindfulness exercise, and one that you can do anytime throughout the day. Take a moment right now to try this. Check your watch and note the time. For the next 60 seconds your task is to focus all your attention on your breathing. Its just for one minute, but it can seem like an eternity. Leave your eyes open and breathe normally. Be ready to catch your mind from wandering off (because it will) and return your attention to your breath whenever it does so.

This mindfulness exercise is far more powerful than most people give it credit for. It takes some people many years of practice before they are able to complete a single minute of alert, clear attention.

Keep in mind that this mindfulness exercise is not a contest or a personal challenge. You cant fail at this exercise, you can only experience it.

Use this exercise many times throughout the day to restore your mind to the present moment and to restore your mind to clarity and peace.

Over time, you can gradually extend the duration of this exercise into longer and longer periods. This exercise is actually the foundation of a correct mindfulness meditation technique.

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Appendix B: Sample Metaphors Person-in-the-Hole Metaphor The situation you are in seems a bit like this. Imagine that youre placed in a field, wearing a blindfold, and youre given a little tool bag to carry. Youre told that your job is to run around this field, blindfolded. That is how you are supposed to live life. And so you do what youre told. Now, unbeknownst to you, in this field there are a number of widely spaced, fairly deep holes. You dont know that at first. So you start running about and sooner or later you fall into a large hole. You feel around and sure enough, you cant climb out and there are no escape routes you can find. Probably what you would do in such a predicament is take the tool bag you were given and see what is in there; maybe there is something you can use to get out of the hole. Now suppose the only tool in the bag is a shovel. So you dutifully start digging, but pretty soon you notice that youre not out of the hole. So you try digging faster and faster. But youre still in the hole. So you try big shovelfuls, or little ones, or throwing the dirt far away or not. But still youre in the hole. All this effort and all this work and oddly enough the hole has just gotten bigger and bigger and bigger. Isnt that your experience? So you come to me thinking, Maybe he has a really huge shovel a gold plated steam shovel. Well, I dont. And even if I did I wouldnt use it, because digging is not a way out of the hole digging is what makes holes. So maybe the whole agenda here is hopeless you cant dig your way out, that just digs you in. Demons on the Boat Metaphor http://www.youtube.com/watch?feature=player_embedded&v=z-wyaP6xXwE The Unwanted Party Guest Metaphor http://www.youtube.com/watch?feature=player_embedded&v=VYht-guymF4

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Appendix C: ACCEPTANCE AND ACTION QUESTIONNAIRE-II

Below you will find a list of statements. Please rate how true each statement is for you by circling a number next to it. Use the scale below to make your choice.

1 2 3 4 5 6 7 never true

very seldom true

seldom true

sometimes true

frequently true

almost always true

always true

1. My painful experiences and memories make it difficult for me to live a life that I would value. 1 2 3 4 5 6 7

2. Im afraid of my feelings. 1 2 3 4 5 6 7

3. I worry about not being able to control my worries and feelings. 1 2 3 4 5 6 7

4. My painful memories prevent me from having a fulfilling life. 1 2 3 4 5 6 7

5. Emotions cause problems in my life. 1 2 3 4 5 6 7

6. It seems like most people are handling their lives better than I am. 1 2 3 4 5 6 7

7. Worries get in the way of my success. 1 2 3 4 5 6 7

This is a one-factor measure of psychological inflexibility, or experiential avoidance.

Score the scale by summing the seven items. Higher scores equal greater levels of psychological

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Appendix D: Coping Strategies Worksheet

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Appendix E: Values Epitaph

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Appendix F: Goal-setting worksheet

Specific : Describe explicitly the action you will take so that is it easy to

know if you have achieved it.

Meaningful : The goal should be guided by values not rigid rules, trying to

please others, or trying to avoid pain.

Adaptive : The purpose of the action is to improve, enhance, or enrich your

life as far as you are able to predict. It is important that it changes

life to a better place based on how the client perceives it so

remaining client-centered in this aspect is particularly important.

Realistic : It should be obtainable based upon your current health, finances,

time, and skills. This is a particularly difficult area for those

struggling academically because it may not be realistic to stop

failing.

Time-framed : Set a day or time for your goal to be completed. If this isnt

possible then, as best as possible, create a time frame.

My value based S.M.A.R.T. goals are. ______________________________________________________________________ Immediate goal(s) (something I can do in the next 24 hours): ______________________________________________________________________ Short-term goal(s) (something I can do in the next few days): ______________________________________________________________________ Medium-term goal(s) (something I can do in the next few months): ______________________________________________________________________ Long-term goals(s) (Something I can do in the next year):

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Appendix G: Sample Transcript from Session 3 (Values Exploration)

Therapist: Hows your last few days

been?

Client: Ok, I guess.

T: Just ok?

C: Well theres just been so much going

on, and while I feel the stuff weve been

talking about has definitely made some

sense and helped me cope a bit better, I

dont feel like anything is actually

changing.

T: I see. What do you mean by

actually changing?

C: I just mean my situation is still the

same.

T: Mhm. Yeah. I can understand your

frustration, especially given all the hard

work youve been putting in with me. I

really see you take this seriously and that

you want to help yourself.

C: Well yeah

T: Well I think you bring up a good

point, and as it happens most of what

were going to talk about today seems to

fit more with some of these more

concrete ideas you have.

C: Thats good.

T: Good, Im glad, it sounds like youre

feeling optimistic about today, and I

think thats really important. You

definitely seem to be able to take a

crummy situation and look on the

brighter side, especially looking toward

the future.

C: I like to think so. I like to think that

Im a fairly resilient person. Im not

sure if I told you this or not, but my

parents used to really appreciate it when

I would talk to them about my day,

including all the bad things that

happened. I really believed them when

they said that they wanted to hear about

my day. Like they clearly cared.

T: Yeah. I can really hear how much

you value your relationship with your

parents [emphasizing value].

C: Definitely. And not just them. I

mean, Jessica (sister) too. I feel

comfortable opening up to her about

almost anything.

43

T: Definitely. Its not often enough in

my opinion that I see a college-aged

student who cares so deeply for his

family, even in the midst of a hectic

situation. Sort of like a port in the

storm, have you ever heard that

expression [emphasizing family as a

value]?

C: Yeah, I think so. Just that I turn to

them when I need to.

T: Exactly. I also can tell that you care

about your grades and school, otherwise

I dont think you would be here with me.

Especially since this is the third time

weve met! [Emphasizing school as a

value]

C: Well I dont want to lose my

scholarship and be kicked out of school.

T: Right, I know weve talked about how

difficult it would be to have to suddenly

find yourself in a different situation, but

remember the exercise we did last week

where I had you just notice those

thoughts as leaves, and how having

those scary thoughts really dont change

anything about you as a person, or what

you are able to accomplish?

C: Yeah I remember. My observing

self or whatever.

T: Right. But, I also think theres more

to your story than just you not wanting

to be kicked out of school and lose your

scholarship. I think theres probably

more than one reason you came to this

university in the first place.

C: Yeah, I mean Ive always been a

pretty hard worker in school, and even

though I didnt necessarily have my

priorities straight in high school, I still

got most of my work done, and did it

well.

T: What sorts of other things do you

think led you to pursue a degree in

education?

C: Im not sure. I feel like I havent

thought about it in a long time, I just

kind of assumed college was the next

step. It was that way for all of my

friends, and both my older siblings for

that matter. I guess I didnt put that

much more thought into picking my

major either. That sounds kind of bad

when I say it out loud [laughs].

T: No, I dont think it sounds bad, I

think its important that youre owning it

rather than avoiding the issue. If youll

humor me for a minute, I have another

exercise Id like to try with you that

44

might help clarify some of these issues

that you havent been thinking about

recently, or perhaps ever. Sound ok?

C: Yeah definitely.

T: Awesome. So, we have a lot of

values. There can be a lot of external

pressures placed on us, such as family,

friends, or coaches. No matter what

those external pressures say, we have to

choose to change. We have to want

ourselves, or something about our

situation, to be different from what it is

right now. Take a moment and reflect

on why you are doing this. Something

motivated you; something matters to you

that is making you take time out of your

life to come to session. There is

something that is motivating you to re-

examine what you are doing in your

academic life at this point. Is that choice

you are making about improving your

life? Personal growth? Learning new

skills? Search inside of your heart and

clarify to yourself what values led you

here today. What are the things inside of

yourself that make you want to change

your academic life?

C: Well other than not wanting to get

kicked out of school, I really care about

being a good student. Like I said before,

even though I didnt necessarily

prioritize the best in high school, I

always sort of prided myself in being

smart. I guess Im lucky that way.

T: Thats great. So Id say thats

definitely something thats super

important to you, being a good student.

Let me ask you another couple of

questions: What strengths do you feel

you already have? In other words, what

are the things that you do well already?

C: I guess Im good doing a high quality

of work whenever I actually was able to

get myself to sit down and finish my

papers and assignments on time. It

always just sort of clicked with me.

Especially being an education major, I

seem to really understand the concept of

teaching, and I think I would be pretty

good I guess at teaching others.

T: Ok, so what does your ability to do

these things say about you as a person

and about the values you hold? Is it

determination, loyalty to family, or

social ability? Is it a desire to improve

yourself and your life?

C: Yeah, I guess I want to improve

myself as a person. I mean, if guess if I

didnt care quite as much I wouldnt

45

have come to see you after seeing my

advisor. I just guess I never thought of it

that way.

T: Which way?

C: Bettering myself as a person. I dont

know. Maybe this is a good thing, a

good wake-up call for me to change.

T: Yeah, maybe.

C: I also definitely dont want to let my

family down. I mean, I really care what

they think about me.

T: Yeah, I[interrupted]

C: Well, and I also really value the

friendships Ive made so far at school! I

dont know! I think that might be part of

the problem. Since I was so easily

distracted with going around and doing

other stuff besides work, maybe thats

not such a good value.

T: I wouldnt necessarily say that. I

agree with you that it wasnt helpful to

your schoolwork to be distracted, but I

also can see a connection between the

major youve chosen, being that

education is a social enterprise, and you

having enjoyed so much socializing the

past couple of semesters with friends

youve met.

C: I just need to figure out better time

management skills I guess.

T: Maybe. That definitely wouldnt

hurt, I agree. But simply saying Im

going to learn time management skills

may not be motivating enough.

C: What do you mean?

T: Well, let me put it to you this way.

All in all, the best sources of motivation

come from inside of us. Often times, we

need to tap in to some of those sources

that already exist in us. For instance,

some of the things youve just

mentioned that you value, those are great

sources of motivation. In fact, those are

things that will probably always be with

you in life.

C: Yeah, probably.

T: In fact, one way of looking at it is that

even though you werent necessarily

acting in line, or congruent, with your

value of high quality work and

intelligence, that does not mean that that

value does not exist. That doesnt

negate that value. And similarly, the

46

fact that you clearly enjoy socializing

will probably make you a very good

educator. The fact that it gets in the way

of your academics does not negate your

socialization as a value either. You just

have been acting in a way that is

incongruent with your value of

intelligence.

C: Ok, so how do I act congruent with

that value?

T: Well, thats definitely something

were going to work on, especially next

time. But just as a quick preface, we

will work on goal setting, and breaking

some larger goals up into smaller goals.

C: That makes sense I guess.

T: Are you sure? Because I really want

you to feel comfortable telling me if

something doesnt make sense.

C: I mean, maybe Im just confusing

myself, but is that not what were doing

right now?

T: You mean setting goals?

C: Yeah.

T: I think thats a very understandable

concept to be a bit confused on. I think

this way of explaining it will make a bit

more sense. Why dont you just imagine

that you have a compass with you, one

that you use to navigate around the

woods.

C: [Laughing] ok, but I never hang out

in the woods.

T: Ok, just humor me. How about

helping navigate the ocean if you were

lost. I remember you saying something

about sailing with your dad in one of our

first sessions.

C: Yeah.

T: So some of the values that weve been

talking about, such as caring about your

family, turning in high quality work, and

intelligence, those would be similar to

the directions on the compass, such as

north. Can you ever get to north?

C: No. Not really.

T: Right, never. You cant obtain the

direction north. BUT, there are things

you can do along your path in the

northern direction. For instance,