Brief Interventions for Radical Change: Principles and Practice of Focused Acceptance and Commitment Therapy

297 Pages·2012·1.89 MB·English

by  Kirk D. Strosahl

“This book is a must-read not only for ACT therapists with an interest in
brief therapy, but for any ACT therapist who wants to improve their
efficiency and effectiveness with the model. Low on theory and high on
practicality, this book is choc-a-bloc full of new tools and techniques for
brief but powerful ACT interventions. You’ll be amazed at how simple
and easy it makes the trickier aspects of ACT, such as self-as-context and
creative hopelessness. If you want to get better results in less time with
more clients, then you need to read this book right now!”
—Russ Harris, author of The Happiness Trap
“If you are looking for a rapid way to help people reduce their suffering
and make positive changes, this book can show you the way. The four
questions Strosahl, Robinson, and Gustavsson provide can give you a
quick handle both on what’s going on with clients and on how to help
them change. A nice variation on the ACT method with some new
insights and additions to make it compatible with clients’ and third-party
payers’ demands for efficient and effective treatment.”
—Bill O’Hanlon, author of Change 101, A Brief Guide to Brief
Therapy, and The Change Your Life Book
“Brief therapy alert: This book is valuable reading for anyone interested
in time-sensitive ‘brief’ therapy. It provides theory, methodology, research
evidence, and numerous clinical examples for how to help clients rapidly
make significant changes. It is also an excellent introduction to the larger
field of acceptance and commitment therapy, offering concepts and
techniques that clinicians can adapt to their own practices. Strongly
recommended!”
—Michael F. Hoyt, PhD, author of Brief Psychotherapies and
Interviews with Brief Therapy
“This book has the wrong title. It should be: Everything You Need to Know
Stated Clearly, Free of Jargon and Hype that Will Enable You to Help a Broad
and Diverse Range of Clients Effectively and Efficiently. On second thought,
Brief Interventions for Radical Change, like the book, is more to the point.”
—Scott D. Miller, PhD, director at the International Center for
Clinical Excellence, Cummings professor of behavioral health
at Arizona State University, and author of The Heart and Soul
of Change
“Strosahl, Gustavsson, and Robinson have written an inspiring book for
all clinicians to read and to use in their daily practice. The genius of
focused acceptance and commitment therapy is that it not only includes
new insights, but it also dispels the myths about brief interventions. This
book shows that a focused approach is exactly what many people need to
help them recapture a sense of being fully alive.”
—Mark Williams, professor of clinical psychology at the
University of Oxford, and coauthor of The Mindful Way
Through Depression
“Brief Interventions for Radical Change is an excellent resource for primary
care clinicians wanting to make efficient use of their time with patients.
It’s a practical guide for a patient-centered, functional approach, and pro-
vides case examples with individuals, couples, and groups.”
—Debra A. Gould, MD, MPH, family physician and coauthor of
Real Behavior Change in Primary Care, Improving Patient
Outcomes and Increasing Job Satisfaction
Brief
for
Interventions
Radical
Change
of
Principles and Practice
Focused Acceptance
& Commitment Therapy
KIRK STROSAHL, Ph D
PATRICIA ROBINSON, Ph D
THOMAS GUSTAVSSON, MSc
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 © 2012 by Kirk Strosahl, Patricia Robinson, and Thomas Gustavsson
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup
Acquired by Catharine Meyers
Edited by Jasmine Star
All Rights Reserved
Library of Congress Cataloging in Publication Data on file
To all the courageous clients I’ve seen over the years, who have
taught me so much about what is humanly possible. Your words of
wisdom permeate this book. To my wife and soul mate, Patti, and my
three lovely daughters, Regan, Frances, and Joanna. You help keep
me in the present moment and call me on it when I’m not there!
— Kirk Strosahl
To Ryland Day, my grandson, and Regan, Ezra, Frances, and
Joanna May, my children, with the hope that your walk on the
Good Red Road will be one of respect and trust and that your own
true north pulls you, again and again.
—P atricia Robinson
This is my first book, and I hope it helps people who are in caregiving
roles in all kinds of settings. I would like to thank my coauthors, Kirk
and Patti, for being such great teammates, and my teachers, supervisors,
colleagues, and clients over the years, who have taught me so much. I
also extend gratitude to Cecilia, for many years of companionship and
for being a friend; to my dog, Ella, who keeps me in shape with one
thousand walks a year; and most of all, to my lovely children, Edith and
Alice. You are the ones who make this all worth doing.
— Thomas Gustavsson
To Jasmine Star, your positive energy, inquisitive nature, wonderful
interpersonal skills, and superlative editing and writing skills made this
book not only possible to write, but fun to write. You are the greatest!
— All of the authors

Contents

 Introduction 1
Part 1
Principles of Brief Intervention
1
2 A Brief Review of Brief Therapy 11
3 How People Get Stuck 27
The Process of Radical Change 49
Part 2
Practice Tools and Methods for Brief, Focused
Interventions
4
5 Focused Interviewing 69
Strategies and Tools for Increasing
6 Motivation 85
Promoting Radical Change 105
Brief Interventions for Radical Change
Part 3
Case Examples
7
Big Like Swallow: FACT with a Sexually
8 Abused Child 129
Lost in Space: FACT with a
9 Poly-Substance-Abusing Adult 155
Playing It Safe: FACT with an Adult
10 Survivor of Sexual Abuse 179
Disconnected and Demoralized:
FACT with a Depressed Elderly Woman 203
Part 4
FACT with Couples and Groups
11
Until Death Do Us Part: Conducting FACT
12 with Couples 229
The More the Merrier: Conducting FACT
in Groups and Classes 247
  Appendix: Interview, Case Formulation, and
Assessment Tools 265
 References 273
 Index 279
vi
Introduction
When we are no longer able to change a situation…
we are chall—en Vgeikdt otor Fchraannkgle ourselves.
T
his book is designed to help you, the clinician, help people who
are struggling, sometimes desperately so, to experience rapid,
life- altering change. When people lack the skills to be flexible in
their approach and are unwilling to change strategies that aren’t working,
many of life’s most difficult moments can seem emotionally overwhelm-
ing, and it is easy to get stuck, or frozen in place. Interestingly, some
individuals, when confronted with these types of difficulties, “get large”
and seem able to transcend the situation. We know that this can happen
even under the most horrifying life circumstances— just read Viktor
Frankl’s Man’s Search for Meaning (1992) as one example— so there is no
reason to believe it can’t happen in the normal course of everyday living.
The quest to develop a model for promoting rapid, lasting change starts
with this question: How does one person recruit the inner resources to
accept what has happened and move on in life, while another is all but
annihilated by the same type of life challenge?
In Frankl’s case, he witnessed horrible atrocities on a daily basis and
struggled to make sense of the barbarism he observed. His transforma-
tion involved accepting that he might never see his wife again (and in