ACT for Adolescents: Treating Teens and Adolescents in Individual and Group Therapy

279 Pages·2016·4.17 MB·English

by  Sheri L. Turrell

“ACT for Adolescents is a must- read for professionals working with adolescents and
their primary caregivers. Turrell and Bell emphasize the acceptance and commitment
therapy (ACT) view of person- in- environment, linking the interdependence and
mutual influence of adolescents in their social and physical environments. This
perspective in a helping relationship fosters empowerment, and this book guides a
flexible, holistic approach that clinicians working with adolescents will benefit
from. Readers will gain novel and practical ACT approaches to working with
adolescents.”
—T imothy Gordon MSW, RSW, social worker; ACT instructor at McMaster
University in Hamilton, ON, Canada; and peer- reviewed ACT trainer
“Sheri Turrell and Mary Bell have developed a step- by- step approach to using accep-
tance and commitment therapy (ACT) with teenagers, in individual and group treat-
ment, brimming with new exercises and metaphors, and creatively adapted traditional
ACT interventions. Amongst the strengths of this book are its integration of self-
compassion training and the powerful ACT matrix model.”
— Benjamin Schoendorff, international ACT trainer; director of the
Contextual Psychology Institute in Montreal, QC, Canada; and
coauthor of The Essential Guide to the ACT Matrix
“ACT for Adolescents is a well- written resource that steps therapists through the
hexaflex model, session by session. The authors have a deep understanding of young
people and how to approach therapeutic work with them. This book is a way to see
the acceptance and commitment therapy (ACT) model through the eyes of two
experienced adolescent therapists. A practical approach for setting up group and
individual therapy with young people.”
— Louise Hayes, PhD, senior fellow at Orygen, The National Centre of
Excellence in Youth Mental Health; and The University of Melbourne;
and coauthor of The Thriving Adolescent and Get Out of Your Mind and
Into Your Life for Teens
“Hats off to Turrell and Bell for giving us a high- quality manual to support clinicians’
use of acceptance and commitment therapy (ACT) with adolescents! They’ve tested
and refined their interventions over years, and now provide specific instructions on
how to use them in both individual and group treatments. The ACTion group proto-
col follows a ten- session model, and it’s filled with teen- friendly metaphors and sup-
ported by online mindfulness exercises. Bravo! Truly what we needed.”
— Patricia J. Robinson, PhD, director of training and program evaluation
at Mountainview Consulting Group; international ACT trainer; author
of numerous articles, chapters, and books; and coauthor of Inside This
Moment and Real Behavior Change in Primary Care
“Turrell and Bell have made a valuable and timely contribution to the field. The
authors provide a model that is comprehensive enough in theory and practice to
allow a confident foray into using acceptance and commitment therapy (ACT) with
adolescent clients. At the same time, the program is flexible and not overly prescrip-
tive, which allows the clinician to walk alongside the adolescent wherever they need
to go that day in the service of the therapy goals. Clients will feel that the work is
being tailored to them in the moment, which it is, and not some imposed system the
adolescent is expected to fit into.”
— Christopher McCurry, PhD, clinical child psychologist in private practice,
and author of Parenting Your Anxious Child with Mindfulness and Acceptance
and Working with Parents of Anxious Children
“Turrell and Bell are adolescent pros! In ACT for Adolescents, they provide a read-
able, organized, and practical protocol for treating adolescents using acceptance and
commitment therapy (ACT). They clearly describe sophisticated interventions, and
include dozens of powerful and engaging experiential exercises that will surely engage
and resonate with young people. This book can be used as a treatment manual,
allowing the reader to implement ACT immediately and effectively with teens, with
step- by- step instructions to guide the therapist through each session. The entire pro-
tocol can be implemented in a group setting, and specific modifications are suggested
for group work. The authors are clearly gifted therapists, and their experience,
wisdom, and respect for adolescents comes through on every page. Any therapist who
works with adolescents will find powerful tools that can be used immediately to
improve their outcomes with adolescents in this very accessible book.”
— Britt H. Rathbone, MSSW, LCSW- C, expert adolescent therapist, trainer,
author, and coauthor of What Works with Teens, Dialectical Behavior Therapy
for At-R isk Adolescents, and Parenting a Teen Who Has Intense Emotions
AC T
for
Adolescents
Treating Teens and
Adolescents in Individual
and Group Therapy
SHERI L. TURRELL, P D
h
MARY BELL, MSW, RSW
C P
ontext ress
An Imprint of New Harbinger Publications, Inc.
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered.
It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other
professional services. If expert assistance or counseling is needed, the services of a competent professional should be
sought.
Distributed in Canada by Raincoast Books
Copyright © 2016 by Sheri L. Turrell and Mary Bell
Context Press
An imprint of New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
DOTS, “The Acetate,” “Demons on the Boat,” “Observe, Breathe, Expand,” “Struggle Switch,” and the exer-
cises in “Defusion Exercises: How to Unstick” are modified from ACT MADE SIMPLE by Russ Harris,
copyright © 2009 Russ Harris. “Quicksand Metaphor” adapted from GET OUT OF YOUR MIND AND
INTO YOUR LIFE by Steven C. Hayes and Spencer Smith, copyright © 2005 Steven C. Hayes and Spencer
Smith. “LLAMA” and “The Wrinkled Sock” are modified from THE WORRY TRAP by Chad LeJeune,
copyright © 2007 Chad LeJeune. “The Rocks” adapted from ACT FOR DEPRESSION by Robert Zettle,
copyright © 2007 by Robert Zettle. All used by permission of New Harbinger Publications.
“The Tiger” adapted from METACOGNITIVE THERAPY FOR ANXIETY AND DEPRESSION by Adrian
Wells, copyright © 2009 by The Guilford Press. Adapted by permission of The Guilford Press.
Cover design by Amy Shoup; Acquired by Tesilya Hanauer; Edited by Ken Knabb; Indexed by James Minkin
All Rights Reserved
Library of Congress Cataloging-in-Publication Data on file
Printed in the United States of America
18 17 16
10 9 8 7 6 5 4 3 2 1 First printing
Contents
Foreword v
Introduction 1
PART 1 ACT Basics 11
PART 2 The Sessions 39
Session 1 The Assessment 41
Session 2 Creative Hopelessness 55
Session 3 Identifying Values 89
Session 4 Setting Goals: Putting Values into Action 115
Session 5 Willingness and Allowing of Feelings 133
Session 6 Defusing from Thoughts 155
Session 7 Defusing from “Story” 187
Session 8 Self-a s-C ontext 207
Session 9 Self- Compassion 219
Session 10 Pulling It All Together 233
Acknowledgments 251
References 253
Index 259

Foreword
I have done hundreds of acceptance and commitment therapy workshops, and always
get this question: “What about ACT for kids?” My pattern of responding is sadly
predictable. It comes in the form of an apologia— name any topic in psychology and
search that topic in our scientific database; now, add the words “and adolescents” to
the search and watch the number of results plummet, sometimes to zero. My answer
is true, but not useful. It’s really about the question behind the question: “How can I
apply what I find in ACT to the adolescents I see in my clinic?”
I have spent a career working to develop broadly applicable psychological prin-
ciples and have advocated adherence to established treatment principles. But there is
a problem with this strategy. Outside of replications of highly controlled randomized
clinical trials, which are exceedingly rare, we are always extrapolating. And some
extrapolations are easier than others. Many exercises, metaphors, and other interven-
tions can be moved with little or no modification from one population to another.
The extrapolation to adolescents is more challenging.
Adolescents present with problems that must be understood in the context of a
host of variables that differ in kind or at least in magnitude from those we find in
adults. At minimum, psychological struggles are encountered perhaps for the first
time as the child passes through varying developmental trajectories. Adolescents are
often subject to circumstances over which both the clinician and client have little
control. Although I do not imagine different principles, I recognize the enormous
differences that must shape interventions. Among adolescents in particular, the navi-
gation of autonomy and emerging interpersonal relationships are persistently high-
stakes issues. “Who will I be in all this mix?” “How will I be understood, if at all?”
Although I am not an expert on the treatment of adolescents, I have helped in the
development of ACT for adolescents by consulting with those who specialize in that
treatment.
The idea for this book began over dinner at a restaurant in Toronto. Sheri Turrell
and Mary Bell had enlisted me on such consultation. Over a period of years, they had
tried different ACT approaches with adolescents with varying success. Some
ACT for Adolescents
components fell flat. Others were picked up enthusiastically by adolescents in both
group and individual treatments. Little by little, these women crafted a flexible
manual, one that retained the parts of ACT they found to be workable and left
behind or modified what was not.
I suggested over that dinner that they turn their treatment manual into a book.
They were stunned by the idea. Committing to a book is a frightening prospect. But
from our many conversations I was certain they could write the book they’d wished
they had when they started the journey.
We are a long way from definitive answers to the treatment of psychological dif-
ficulties. Many of our best- supported treatments leave half of those treated still suf-
fering at long- term follow- up. And as I suggested earlier, our knowledge about the
treatment of children almost always lags behind that of adults. This is a book written
by and for clinicians who are interested in exploring the application of ACT to ado-
lescents in individual and group treatment. It was developed through collaboration
between Mary and Sheri and the adolescents they have served. These adolescents
were not hand- selected, single- problem children. They were quite often children with
multiple problems, coming from the most difficult of circumstances.
It is in the nature of community mental health that specialization is not an
option. Readers will find in these pages a highly adaptable guide to the application of
ACT to adolescents. Along with many, many treatment examples, Sheri and Mary
provide a very nontechnical and user- friendly look at the basic processes that under-
lie ACT. I am sure they will join me in hoping that the readers of this book will help
in the ongoing development of this important work.
With warmest regards from Oxford, Mississippi,
Kelly G. Wilson, PhD
Professor, University of Mississippi
vi
Introduction
We are two clinical therapists who are passionate about the work we do with adoles-
cents suffering from mental health issues. The clients we see are young people expe-
riencing symptoms associated with anxiety, depression, suicidality, self- harm,
substance abuse, eating disorders, and a high level of emotional dysregulation. We
have dedicated our lives to helping adolescents with these difficulties, Sheri as a psy-
chologist and Mary as a social worker. Doing this work matters to us a great deal. We
expect that it matters to you, too. We don’t need to tell you that not only is each of
these adolescents a unique, special, precious human being, each is somebody’s child—
the most important person in a parent’s world. We want to find the best possible ways
to help them. We would like to share what we have tried and learned with you.
Before we met, neither of us was completely satisfied with the treatment modali-
ties we were using. We had both come to a place in our lives where we wanted to
provide something more helpful to our adolescent clients. We had each developed a
mindfulness practice and had begun reading about acceptance and commitment
therapy (ACT). The more we stepped into mindfulness and the more we understood
about ACT, the more it became obvious to us that ACT could be a promising treat-
ment modality for our clients. When Mary was hired at the clinic where Sheri was
working, mindfulness and ACT came up quickly in our first conversation. They have
been the focus of hundreds of hours of discussion since then.
This book is what resulted from voracious reading, attending workshops, ques-
tioning, debating, clinical work, and our ongoing, endless discussions about ACT. As
our conversations unfolded, we realized we were not clear about how to actually
practice ACT with our clients. The resources at our disposal were too technical and
we couldn’t figure out how to make the transition from theory to practice, or how to
connect the concepts within a session or between sessions. Yet, at the same time, we
knew this was going to be important, so we persevered.
Because ACT involves lots of experiential learning, mostly accomplished by
“experiments” that are playful, we hoped our adolescent clients would be open to
engaging with us. We asked them if they would be willing to experiment with us in