Perspectives on ACT from aSystems View of Change

J. Scott Fraser, Ph.D.

ACT Propositions Will Often AlternateWith Those of the Process of Change View

Life Difficulties …tend to be unpleasant situations that draw action to either change, assimilate or accommodate them...common solutions can & do work, and often difficulties simply need to be accepted

Life Problems …tend to arise from vicious cycles of more of the same solutions applied at a first-order level… The solution has become the problem…2nd order solutions are needed for resolution

“It is psychologically healthy to have unpleasant thoughts and feelings as well as pleasant ones, and doing so gives us full access to the richness of our unique personal histories.” (p.23) (Life Difficulties Life Difficulties are “Normal”are “Normal”) (“Life is one damned thing after another, but it’s the only game in town.” [John Weakland of MR])

The clinical establishment “…views distressing states of mind as signs of disorder and disease.” (p.8) Attempting to solve these “problems” then becomes the problem. (Life Problems as Life Problems as Vicious CyclesVicious Cycles)

Social ConstructivismSocial Constructivism::Reality is relative and dependent upon contextReality is co-created within social context

The Process of ChangeThe Process of Change::First-order changeFirst-order change, , withinwithin perceived reality

and rulesSecond-order changeSecond-order change, or a change ofof reality

and rules

Co-created premises guide our viewing and doing…channeling our interactions

This applies to ideas on the nature of problems and how to resolve them

Applies equally to therapists’ theories and practices in therapy

First-Order ChangeFirst-Order Change::A change in intensity, frequency, location,

duration, etc. of interactions (solutions)

Variations of similar interactions within the accepted premises and patterns of a system

Often does resolve problems

Only yield problems when failed solutions are re-applied over and again

Vicious Cycle PatternsOf first-order change

“The ACT perspective, however, is that the conceptualized outcome, that is, the supposed solution, is often itself the problem.” (p.165 emphasis added.)

Second-Order Change:Second-Order Change:A change of a system’s primary premises,

rules and patterns

Usually yields strikingly different or opposite interactions

May appear counter-intuitive or paradoxical from first-order premises

It is the key element of most effective treatments

The Nine Dot Problem. . .. . .. . .

The Child’s Finger Trap

The Bird in The Vestibule

Socially Mediated Language Frames Our Socially Mediated Language Frames Our Realities (Cognitive Fusion fuels problems)Realities (Cognitive Fusion fuels problems)“…we formulate a situation symbolically and then

organize our behavior to fit the demands of the rules that we are programmed to follow.” (p.245)

“These rules are socially inculcated into us and thus appear to be the “normal, rational thing to do.” (p.245)

“…the clients’ problem-solving efforts are channeled by culturally sanctioned rules that describe how problems are to be identified, analyzed, and solved.” (p. 245)

[Or…Socially Constructed Reality]

Experiential Avoidance Fuels Most Experiential Avoidance Fuels Most ProblemsProblems“…the person is more likely to follow blindly the

instructions that are socially transmitted through language.”

“In some circumstances, this result can be adaptive;” (p.20) (First-Order ChangeFirst-Order Change)

“But in other cases, people may engage repeatedly in ineffective sets of strategies because to them they appear to be “right” or “fair” despite negative real-world consequences.” (p.20) (Vicious CyclesVicious Cycles; Second-Order Second-Order Change is neededChange is needed)

Represent the classic description of problem patterns across most, if not all models of effective psychotherapy

They involve a trigger, within a frame describing the situation, repeated failed solutions, and escalation

Interdicting vicious cycles is the heart of all effective treatments

Escalating Patterns

ATTEMPTEDSOLUTIONS

Positive Feedback

“There is an inherent paradox in attempting to avoid, suppress, or eliminate unwanted private experiences in that often such attempts lead to an upsurge in the frequency and intensity of the experiences to be avoided..” (p.20) (The Classic Vicious CycleThe Classic Vicious Cycle)

Pattern Re-Direction Pattern Re-Direction and second-order and second-order

changechange

Changing the ViewingViewing and/or the DoingDoing around the defined problem.ReframeReframe and/or DeframeDeframe descriptions and rulesInitiate interactional/behavioral pattern pattern

shifts/reversalsshifts/reversalsOr Accept Premises and Build New InteractionsOr Accept Premises and Build New Interactions

Initiate a small shift small shift and then build upon itClarify ValuesValues, GoalsGoals and ContractContractEngage Positive Feedback CyclesPositive Feedback CyclesInitiate Virtuous CyclesVirtuous Cycles

Enhance Psychological FlexibilityInitiate Defusion from current language and

framesInitiate Acceptance and Present Moment

FunctionClarify Values and enhance Willingness for

Action

Support Flexible Response StylesOpen…Acceptance—Defusion Centered…Present Moment—Self-As-ContextEngaged…Values—Committed Action

The elements common to all effective treatments

Common Elements of Effective Common Elements of Effective Treatments:Treatments:An emotionally charged relationship or allianceA rationale, structure, or “myth” explaining

problems and implying solutionsRelated procedures implying direction to solutions

and instilling hope

Recent meta-analyses of psychotherapy research suggest that these elements are common across all effective therapy (Wampold, 2012)

The key element that this model adds to the Contextual Model is that the focus of change in all

effective treatments is upon

second-order changesecond-order change

The creative essence of therapeutic change across all therapies is second-order change

The Labyrinth of Crete:A Path of Dilemmas

The Labyrinth of Chartres: A Path of Meditation

In Greek mythology, the warrior Theseus was given a golden thread to guide him to the center of the labyrinth of Crete. Once he defeated the fierce Minotaur, he used the thread to find his way back out. “The Golden ThreadThe Golden Thread” has thus come to refer to a guide that helps find the unifying path through disorienting and seemingly disconnected alternatives.

Once we can trace the path of this golden thread across the broad tapestry of effective interventions to a wide array of problems, we can see the essential “tie that binds” them all together.

Following the process of change helps us integrate approaches while empowering our own creative, flexible, and effective clinical practice.

This ancient Celtic design has been used to symbolize the spiral connections among all things.

We have used this design to represent the spiral connections among all effective psychotherapies.

All effective treatments describe problems as vicious cycles and interdict them through

second-order change interventions.

Fraser, J.S. & Solovey, A. (2007)Second-order change in psychotherapy: The golden thread that unifies effective treatments. Washington, DC, APA Books