Tools to help you understand the process of moving toward greater psychological flexibility.
“At the center of your being
you have the answer;
you know who you are
and you know what you want.”
Self-awareness is a prerequisite for self-acceptance and meaningful change. If you are planning a trip, you need to know your current location and your desired destination. It also helps to have a way to track your progress. The assessment tools in this section will provide you with some key insights into your current quality of life, awareness of your deepest sources of meaning and purpose, and strengths and areas for growth in terms of psychological flexibility. Each of the tools in this section can be used repeatedly, so they are great for tracking changes over time.
Acceptance and Action Questionnaire-2 (AAQ-2)
The Acceptance and Action Questionnaire-2 (AAQ-2) is a brief self-assessment tool that measures psychological flexibility. This tool will give you a sense of your current capacity for psychological flexibility.
Five Factor Mindfulness Questionnaire (FFMQ)
The Five Factor Mindfulness Questionnaire was developed by Ruth Baer and her collegues. It measures the five facets of mindfulness: observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experiences. Each of these facets is a foundational skill that can be improved with practice. This is a useful tool for assessing and tracking your strengths and areas for growth in the five mindfulness skills.
The WHO Quality of Life Questionnaire (WHOQOL)
WHO defines Quality of Life as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.”
This tool will give you a really nice overview of your perception of your current quality of life.
- What is deeply important to me?
- What sort of person do I want to be?
- What sort of relationships do I want to build?
- If I weren’t struggling with feelings and avoiding fears, what would I channel my time and energy into doing?
The Values Bullseye has two parts. The first part will ask you to think about and name what is most important to you in four, broad domains of your life. The second parts (the bullseye) will ask you to consider how consistent your actual behavior (what you do) is with what really matters to you.
Valued Living Questionnaire (VLQ)
The Valued Living Questionnaire (VLQ) was developed by Kelly Wilson and his collegues. It is another great resource for noticing the parts of life that are most important to you and being honest with yourself about the consistency of your behavior (what you do) with what matters most to you.
Phases of Treatment
“We don’t receive wisdom; we must discover it for ourselves after a journey that no one can take for us or spare us.”
― Marcel Proust
Each of my clients has a unique trajectory and path through our work together. That said, it can be useful to think of the process of therapy as unfolding over the course of three different phases. Each phase builds on and includes the work done in the previous phase. Let’s take a look at each phase.
Learning and Discovery
Knowing where you are and where you want to go are crucial to taking any journey. Therapy is no different. The first taks of treatment is to have at least some sense of your desired goals and outcomes.
Assessment is a fancy word for learning more about your current state and situation. This part of the initial phase of treatment involves learning practical ways to notice different aspects of your experiences. Typically, this will involve answering a lot of questions, learning to notice connections between your behavior and its consequences, and discovering what is working and what is not working.
As assessment progresses, your ability to notice your own behavior and its consequences will improve. This will allow you to discover the key to developing psychological flexibility: workability.
You might be familiar with the Serenity Prayer:
“Grant me the serenity to change the things I can, to accept the things I can’t, and the wisdom to know the difference.”
You and I will explore the limits of control in your life, especially when it comes to attempts to control your inner experiences such as thoughts, emotions, urges, memories, and physical sensations. Most of my clients are surprised to discover that attempts to control their inner lives often don’t work well and have some significant costs.
Once you can track the extent to which your behavior is maintaining your struggles and interfering with living the life that you want, you can begin to discover choice points. When this happens, the real focus of therapy begins to emerge and presenting problems start to be reframed as opportunities for growth.
Nearly all of my clients come to therapy with at least one goal that is related to controling their inner experiences. Controling inner experiences seems like a prerequisite to making even more important and meaningful changes. Once my clients begin to discover the unworkability and cost of making this type of control a priority, a shift begins to occur.
This shift begins with reframing goals related to control. Rather than working to eliminate unwanted inner experiences, we start to work toward making room for those experiences. This frees up time and energy to focus on developing responses and habits that support a lifestyle that is more likely to bring about a sense of meaning, purpose, and fulfillment.
Practice and Consolidation
Awareness is about developing flexible attention to the present moment. It involves learning several important shifts in perspective taking: inside/outside, now/before/after, and here/there. In addition, awareness will help you to notice and name your experiences rather than being absorbed in them. This process of developing awareness organically results in the ability to shift into a more objective and compassionate stance toward yourself.
Openness is the ability to have your experiences without fighting with them. It’s a set of skills that allows you to relate to your thoughts, emotions, physical sensations, urges, and memories as sources of information rather than dictators you MUST obey. Often, this process involves boldly facing the experiences and situations your mind says that you can’t or shouldn’t in the service of building a sense of resilience and freedom.
Developing Valued Engagement
Once you are able to step out of unproductive struggles with your own experiences, you can put that time and energy into taking actions in the service of what matters to you. Valued engagement skills allow you to clarify and reorient to what truely matters to you and taking steps in that direction. The goal is to initiate and recommit to building larger and larger patterns of workable behavior.
Mastery and Transition
As you continue to practice awereness, openness, and valued engagement, you will develop new, more workable habits. These habits might be very simple:
- Taking a breath before acting
- Noticing unhelpful thoughts and letting them go
- Asking yourself, “what really matter here?
- Resuming a healthy habit after letting it go for a day or two
These new, more workable habits become the framework of a lifestyle that is “about” flourishing. Mastery is a life-long practice. There is no arrival.
The goal of therapy is to not be in therapy. Ultimately, our work will come to an end, and this period of transition will carry you to the next phase of your life. This transition will look different for each client. I like to think of life as a series of episodes in a longer narrative. Therapy is an “episode of care and transition.” Sometimes, that episode is brief and has a clear end. At other times, the work continues over a longer period of time and has a gradual period of phasing out. We will work together to decide on the best transition for you.
What happens during a therapy session?
The things we talk about in each therapy session will likely change from session to session, but the general structure of therapy will remain relatively similar. Each session has four phases that often seamlessly blend together. Some sessions will include all of these phases and some sessions will only include some of them. Likewise, the time we spend in each phase is going to vary depending on the work we have to do. However, the goal of every single session is for us to develop an action plan for the next week. Here is a description of the four phases:
Anatomy of a Therapy Session
At the beginning of our session, we will greet each other and collaboratively decide on our topic for the day. Ideally, we will choose a topic that directly links up with your overall treatment goals. We will also chat about the things you noticed when doing your action plan from the following session.
Once we have our topic of the day, I will likely ask you several questions about it. The purpose of these questions is to put the topic in context and to identify our treatment targets and goals for the session.
During this phase, we will address our treatment targets and work toward our session goals, especially the goal of developing your weekly action plan. This will include a mixture of learning new skills, perspective taking, in-session exercises, and collaborative investigation.
One goal of each session will be to develop an action plan for the next week. The key to a useful action plan is designing a behavioral experiment. Behavioral experiments involve trying something new to see if a new behavior has the potential to decrease your suffering and/or increase your opportunities to flourish.
Want to learn more?
Webinars and Such
CDP Presents Engaging Acceptance and Commitment Therapy Processes to Enhance Resilience in Military Personnel
Andrew Santanello, Psy.D. and Wyatt Evans, Ph.D.
Cognitive Processing Therapy Session Notes (with cartoon Andy!)
Practical for Your Practice Podcast
This bi-weekly podcast features stories, ideas, support and actionable intel to empower providers to keep working toward implementing EBPs with fidelity and effectiveness. Check out Drs. Jenna Ermold, Kevin Holloway, Andy Santenello and national expert guests as they discuss practical issues between colleagues which can enhance the work you do
Association for Contextual Behavioral Science
Learn more about ACT and the rapidly evolving field of Contextual Behavioral Science.