act as a brief intervention model
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ACT As A Brief Intervention Model. Kirk Strosahl Ph.D. ACBS World Conference Reno, NV [email protected]. Why Use Brief Interventions?. Average number of therapy sessions: 4 Modal number of therapy sessions: 1 - PowerPoint PPT PresentationTRANSCRIPT
ACT As A Brief ACT As A Brief Intervention ModelIntervention Model
Kirk Strosahl Ph.D.Kirk Strosahl Ph.D.ACBS World ConferenceACBS World Conference
Reno, NVReno, [email protected]@msn.com
Why Use Brief Interventions?Why Use Brief Interventions?
• Average number of therapy sessions: 4
• Modal number of therapy sessions: 1
• Dose effect studies show most change in therapy happens early (before session 8)
• Change beyond session 8 is very time intensive
• Rapid response studies show it is common
• Some contexts require brief interventions
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Evolution of Brief, Strategic Evolution of Brief, Strategic Change Approaches Change Approaches
• Concept of brief therapy pioneered at MRI by Haley, Weakland, Fisch and Watzlavic in the 1960s, became popular in the 1970s during managed care revolution
• John Grinder and Richard Bandler provided practical guidelines for the application of some of the hypnotic techniques of Milton Erickson (“The Structure of Magic”)
• Several different “schools” of brief strategic intervention have emerged (Brief problem focused therapy, Solution Focused Therapy, Narrative Therapy, Ericksonian Therapy)
• Main problem is a suspicion of “outcomes” research
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Basic Issues in Brief InterventionBasic Issues in Brief Intervention
• Competing Theories of Human Suffering– Bio-Medical model
• Emphasizes pathology, symptoms and syndromes, disease concepts, and a focus on somatic treatment
• Less weight attached to person and environment interactions, context for behavior and the role of language in shaping dysfunctional behavior
• Many syndromes share the same symptoms and respond to the same treatments
• Emphasizes treatment over time
Basic Issues in Brief InterventionBasic Issues in Brief Intervention
• Competing Theories of Human Suffering– Stress-coping-vulnerability models
• Emphasis on delicate relationship between stress and coping responses
• “Symptoms” occur when coping responses are insufficient to manage stress over time
• Emphasis on building positive coping responses and/or decreasing stress
• Interventions tend to be more situation specific and time limited
Basic Issues in Brief InterventionBasic Issues in Brief Intervention
• Competing Theories of Change– Theory of big change (“cure”)
• People are “broken” and need to be fixed• Success if defined by the elimination of symptoms
and eliminating underlying causes• Treatments tend to be staged and longer• Goal setting often emphasizes large changes in
behavioral, cognitive and emotional functioning• Historically has been very ineffective with more
complicated patients
Basic Issues in Brief InterventionBasic Issues in Brief Intervention
• Competing Theories of Change– Theory of strategic change (function)
• From a person-environment perspective, small behavior change can have a domino like effect
• Evidence shows that small changes are easier to make than big changes
• Focus on using coping skills that work and stopping what doesn’t work
• Small change builds “self-efficacy” or the conviction that one can make changes
• Basis of many evidence based treatments
Basic Issues In Brief InterventionBasic Issues In Brief Intervention
• Competing Theories of Agency– Patient driven change (patient is in charge)
• Places patient in co-equal role with provider• Responsibility for behavior change shifted to
patient • Emphasis on patient education, basic goal setting
with consultation from provider• Change occurs in real life settings, not in the
provider’s office• Leads to greater motivation, adherence and better
delineation of “boundaries”
Basic Issues in Brief Intervention Basic Issues in Brief Intervention
• Competing Theories of Agency– Provider driven change (therapist in charge)
• Places patient in subordinate role• Provider assumes more responsibility for solving
the patient’s problems• Generally requires longer and more frequent
contacts• Runs the risk of engendering dependence,
passivity, low motivation for change and non-adherence
Brief Strategic Therapy Challenges Brief Strategic Therapy Challenges Some Cherished BeliefsSome Cherished Beliefs
• That building “rapport” is a pre-requisite to change and takes time
• That therapy “drives” behavior change, ergo, the more therapy the better
• That one hour sessions are necessary to facilitate change
• That long standing problems can only be address with long term therapy
• That small changes don’t matter when people have big problems
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Brief Therapy Challenges Some Brief Therapy Challenges Some Cherished BeliefsCherished Beliefs
• That getting the patient to “analyze” the source of problem is a necessary step in change
• That the patient’s “story” is clinically accurate and useful
• That the medical model (DSM-IV) approach is a clinically useful way to guide treatment
• That having a behavioral health problem is “abnormal”
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Key Brief Intervention PrinciplesKey Brief Intervention Principles
• Establish a single point of clinical focus• Pull the patient outside the “frame of
reference”• The “problem” is not the problem; the
“solution” is the problem• Don’t focus energy on issues that are not
going to change• Try to identify what the patient is ready to do
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Key Brief Intervention PrinciplesKey Brief Intervention Principles
• Focus of behaviors that create a positive motivational impact
• Have the patient take “ownership” of the change process
• Try to re-activate healthy behaviors rather than eliminating unhealthy ones
• Encourage limited, specific, concrete change• Get the patient to state a behavioral intention
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ACT as a Brief Intervention?ACT as a Brief Intervention?
• Core philosophies are very similar
• Both are skeptical of pathology and illness explanations for maladaptive behavior
• Both heavily rooted in changing the functions of language
• Both emphasize qualitative shifts of awareness and self processing
• Both make no assumptions dose-effect
ACT Brief Intervention PrinciplesACT Brief Intervention Principles
• Normalize and validate “toxic” private events that are the natural results of being alive
• Reframe the issue from “whether to” to “how to” experience what is there to be experienced
• Emphasize approach toward rather than retreat from response ableness
• Use spontaneous contact with mindfulness to help patient see an alternative
• Get the patient to “stand for something”• Focus on small, value consistent actions
ACT Brief Intervention StrategiesACT Brief Intervention Strategies
• Is there anything in front of you here that you are not big enough to have?
• What if the goal were not to feel good, but to feel it good?
• Are you having this? Or is it having you?• Looks like the more you try to control this thing, the more
uncontrollable it becomes. What about just letting it be what it is?
• What would make what you are going through here honorable, legitimate and purposeful?
• You don’t have to do this perfectly—just get from point A to point B.
ACT Brief Intervention StrategiesACT Brief Intervention Strategies
• What do you think life is trying to teach you here?• Is there anything about how you’re feeling, right here,
right now that you would not be willing to feel?• What do you want to stand for here?• What will make you feel like you’ve grown as a human
being when this situation is done?• It sounds like your mind is telling you to do things that
your experience says doesn’t work.• If you were free to choose how to respond here, what
would you like to do?• Is there anything standing in the way of you and what
you want to be about here?