Professional Documents
Culture Documents
“The matrix is transparent and user-friendly for both mental health and
medical providers working in brief treatment settings. As a matrix practitio-
ner, you will help many people, including those with addictions, chronic pain,
and relationship problems. Add The ACT Matrix to your bookshelf now and
benefit from Polk and Schoendorff’s numerous examples of how to use this
highly accessible tool.”
—Patricia J. Robinson, PhD, author of Real Behavior Change in
Primary Care and Brief Interventions for Radical Change
“In The ACT Matrix, editors Kevin Polk and Benjamin Schoendorff sim-
plify the entire ACT model into two basic distinctions. The first two chap-
ters of the book, written by the editors and collaborators, summarize the
matrix diagram by discriminating between sensory and mental experienc-
ing and between moving toward versus away from your values. These are
well-written and entertaining. I was unfamiliar with the matrix, and after
reading these introductory paragraphs, I had a good feel for what the work
would look and feel like with a client in the therapy room.
“The remaining chapters of the book apply to specific settings, pre-
senting problems and populations. I believe that you could skip to whatever
work you most commonly do, or read straight through—either would be
useful! These chapters are written by practitioners who are experts in each
of the areas, and the subtle details of how the matrix can be used differently
with each issue really shine through. I believe this will be a great addition
to many office bookshelves, and I would say to pick up a copy right away!”
—Amy R. Murrell, PhD, associate professor at the University
of North Texas
AC
The
T
m Atr i x
A New Approach to Building
Psychological Flexibility
Across Settings & Populations
Edited by
KEviN L.
PoLK, PhD
BENjAmiN
SchoENDorFF,
mA, mSc
Context Press
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.
“The Bull’s Eye” and “Join the DOTS” from ACT MADE SIMPLE by Russ Harris,
copyright © 2009 Russ Harris. Used by permission of New Harbinger Publications, Inc.
The love of my life, Mary Alyce Burkhart, PhD. Her love,
support, and collaboration lift me each and every day.
—Kevin Polk
To all the people who have made it their life’s mission to ferry
others through the dark straits of their suffering over into a
life worth living. Ours is a sacred calling, and my fervent hope
is that you’ll find within these pages a seaworthy vessel in
which to safely steer through the waters of this scary,
wondrous, and ultimately beautiful life.
—Benjamin Schoendorff
CONT ENTS
PART 1
Understanding the Matrix
1 The Psychological Flexibility Warm-Up �������������������� 7
Kevin Polk
PART 2
Populations and Settings
3 ACT for the Masses: Using the Matrix with the
General Public�����������������������������������������������������������41
Aisling Curtin
PART 3
The Matrix Outside the Box
12 The Matrix Goes to School: Promoting
Psychological Flexibility in Education�������������������� 207
Phil Tenaglia
Index���������������������������������������������������������������������������������257
vi
Foreword
seen. It was active, it was vital, and, to my delight, it was intently focused
on growing rich and meaningful lives. PTSD treatment can be pretty
grim, but there was nothing grim about this treatment. Hard thoughts,
emotions, and memories were all things to be sorted and noticed on the
way to a richer and more meaningful life. It was simple, and it was bril-
liant. The students loved it. One of them called it “ACT Gone Wild,”
and the name stuck.
Riding with Kevin back to his hotel, I knew that I wanted to see
these ideas loosed on the ACT community of scientists and practitio-
ners. I asked Kevin what he was doing in July. When he gave the slightest
indication that July might be open, I told him that he had to come to the
upcoming Association for Contextual Behavioral Science (ACBS) World
Conference in Houston. This work had to be moved beyond the VA
Medical Center to the broader treatment development community.
Clinicians needed simple, useful tools that could help them understand
and assist clients. With the right audience, I knew that this work would
spur wonderful innovations and applications.
Back in those days, the assembly of the conference program was far
less formal than it is now. I recall putting some early programs together
in a hotel room, a couple of months before the conference, with paper
submissions spread all across the floor. I think it had become a bit more
organized by 2007, but not a lot. I called the ACBS office, while sitting
in the car with Kevin, and told Emily Rodriguez, the executive director,
that we just had to get this guy on the program.
Kevin hesitated. From my living room to the world conference in a
couple hours’ time was quite a leap! However, I am not easily dissuaded.
I poked, prodded, begged, told him how important it could be, and
pointed out how many people could be helped. “We need you!” was my
message. Loud and clear! As I recall, I got a tentative yes that day and a
definite yes soon after.
As fate would have it, some other things were canceled during
Kevin’s first ACBS conference presentation, so he ended up with a big
room for his international unveiling of ACT Gone Wild. People loved it.
In the intervening years, Kevin and his partner in the development of
this work, Jerold Hambright, along with other colleagues, continued to
innovate and refine. ACT Gone Wild became the “iView” and then,
eventually, “the matrix.” What was created was quickly given away. The
result has been an explosion of work with the matrix all over the planet.
viii
Foreword
ix
I NT RODUC T ION
Kevin Polk
So after going to one conference and reading what we could about ACT,
my colleagues Jerold Hambright and Mark Websterand I began to use
the approach. By 2009 I had read pretty much every book and article
about ACT, participated in well over one thousand sessions of ACT, and
engaged in hundreds of in-depth conversations. I love to create simple
diagrams, and I worked the diagrams all the while.
Finally, in 2009, I was almost finished reading the latest ACT book
when, in my mind’s eye, I could see that ACT boiled down to two sorting
tasks: noticing the difference between sensory and mental experiencing;
and noticing the difference between how it feels to move toward impor-
tant stuff and how it feels to move away from unwanted mental experi-
encing. I stood up, walked over to one of my whiteboards, and drew the
two lines of the diagram, with “Five-Senses Experiencing” at the top,
“Mental Experiencing” at the bottom, “Toward” to the right, and “Away”
to the left. Noticing the differences is where the lines cross.
Five-Senses
Experiencing
Mental
Experiencing
2
What the Matrix Is All About
3
PA RT 1
Kevin Polk
This short chapter introduces the matrix diagram. It’s a warm-up for
psychological flexibility and presents the skills that can help you become
a great matrix practitioner.
The ACT Matrix
Five-Senses Experiencing
Figure 1.1. The basic matrix diagram. Try drawing it on a piece of paper
for clients.
8
The Psychological Flexibility Warm-Up
pen, smell the pen, and, now that you’re in your mind, taste the pen all
you want.
Now notice if there’s a difference between your five-senses experi-
encing of the pen and your mental experiencing of it. Just notice if there’s
a difference.
Noticing Differences
Throughout this book, in one way or another you’ll practice noticing
these two differences: the difference between your sensory and mental
experiencing, and the difference between how it feels to move toward
and move away.
All of us move within the matrix all of the time.
Sometimes we’re in our heads, toward the bottom of the diagram.
Sometimes we’re more connected with the five senses. Sometimes we’re
moving toward, and sometimes we’re moving away. Knowing where you
are on the diagram at any moment is sort of cool—something you’ll
experience for yourself as you read on.
9
The ACT Matrix
10
The Psychological Flexibility Warm-Up
Getting Unstuck
Getting unstuck from mental experiencing is the purpose of the matrix
diagram and noticing the two differences.
The primary reason for noticing the two differences is that noticing
requires no language, and language is the stuff of mental experiencing.
Of course we can’t completely free ourselves from language—nor should
we. It’s useful, and we’d lose our way in a hurry if we completely discon-
nected from it. Instead, we notice the difference between mental and
sensory experiencing and learn to have a choice.
Learning to have that choice is the essence of psychological
flexibility.
11
The ACT Matrix
people to do “sorting,” and this sorting will help them notice the
differences.
Essentially, we all tell stories. Those stories may be about what we
had for breakfast, where we went on vacation last year, or what we plan
to do this weekend. Each is a story that can be sorted into the matrix.
Part of each story includes the five senses: what was seen, heard, felt,
smelled, and tasted. If you go to a restaurant, there will be elements of
each of the five senses in the story of the trip to the restaurant. Each
story also has mental aspects: thoughts, emotions, and urges. The story
will also include actions taken both toward and away. As people tell a
story—any story—they can be invited to sort the elements of the story
into the matrix.
We have people do the sorting so they can practice noticing the dif-
ferences. In other words, to do the sorting, the person steps back and
notices the differences between elements of the story, sort of like dia-
gramming the story. Every act of sorting requires noticing the
differences.
Yes, And?
Sometimes people get hooked into telling their story and forget to do the
sorting. At these times, we use the gentle art of “Yes, and?” to draw them
back into sorting and noticing the differences. For example, someone
might be excitedly telling you about an emotionally charged event that
happened last week. You can see and hear that she’s stuck in her mental
processing of the story and could probably use a break toward flexibility.
You simply say something like, “Yes, and where would you sort that last
bit you were talking about?”
Obviously, you don’t interrupt every story this way, but if it seems
someone needs a little nudge toward psychological flexibility, a quick
“Yes, and?” can get the job done nicely.
Verbal Aikido
With “Yes, and?” we enter the world of what some call verbal aikido. If
you aren’t familiar with physical aikido, it’s a martial art that involves
12
The Psychological Flexibility Warm-Up
Noticing Hooks
To move the verbal aikido practice into life, the matrix practitioner often
uses a simple homework assignment that involves noticing hooks. Hooks
are those moments we all have when we quickly get emotionally charged.
Maybe a car cuts you off, maybe someone says something unkind, maybe
you see a beautiful person. There are all kinds of emotional hooks that
we each have every day, and each provides an opportunity to practice a
touch of verbal aikido.
The hook gets noticed, and then the next action is noticed. Inherent
in noticing the hook and noticing what is done next is noticing the effect
of the hook. Did the person expend much energy? Did the person fight
against the hook or carry it along? What came next, a toward move or an
away move? These questions are not necessarily asked directly; they’re
inherent in the noticing.
Conclusion
If the only thing you learn from this book is the following summary and
you practice what it teaches you, you’ll probably become a great matrix
practitioner:
1. Notice the difference between sensory and mental
experiencing.
13
The ACT Matrix
Now that you have the basic matrix moves down, I and the other
authors of this book hope you’ll join us on a journey through the many
facets and applications of this deceptively simple tool for psychological
flexibility we call the matrix.
References
Hayes, S. (with Smith, S.). (2005). Get out of your mind and into your life: The
new acceptance and commitment therapy. Oakland, CA: New Harbinger.
14
CH A P T ER 2
Benjamin Schoendorff,
Mark Webster, and Kevin Polk
The matrix is a simple way to help people to adopt a point of view that
enhances psychological flexibility. We’ll briefly show you that point of
view and then give you our understanding of some of what’s going on
behind the scenes of the matrix. It’s the stuff of basic human learning,
including the learning of language and thinking. Along the way, we’ll
ease into some technical language to sketch out what we believe goes on
under the hood of this deceptively simple vehicle for getting people on
track to psychological flexibility and a valued life. The matrix is a tool of
human liberation that rests on recent advances in the understanding of
learning and cognition, which underlie acceptance and commitment
training and therapy.
At its essence the matrix is a diagram that prompts the noticing of
two differences: the difference between five-senses experiencing and
mental experiencing (the vertical line of the matrix), and the difference
between how it feels to move toward stuff that’s important and how it
feels to move away from stuff inside, like anxiety or guilt (the horizontal
line of the matrix). People are simply invited to notice these two
The ACT Matrix
differences. Most people can readily notice these differences, but for
some folks it’s more difficult. Why someone would have trouble noticing
the differences goes to the heart of what’s going on behind the scenes of
the matrix. In this chapter we’ll lift the curtain and give you a quick run-
through of what science currently has to say about human learning and
cognition. We won’t be going deep into the science because that isn’t the
purpose of the chapter or this book. Rather, we’ll give you some under-
standable highlights that might help you use the matrix more effectively.
Along the way, we hope to give you a better sense of what makes the
matrix an effective tool in promoting psychological flexibility.
Basic Assumptions
All science stands upon basic assumptions. For example, we can look at
life and the universe as being like a machine, and a set of mathematical
equations can describe that machine and how its component parts inter-
act. Many of our Western notions of science are built on some variation
of the view that the universe is like a machine. However, there’s more
than one way to look at things, and the scientific foundation of the
matrix is built on a completely different set of basic assumptions. Put
simply, humans (and living organisms in general) are not machines.
Mathematic equations don’t fully do the trick when it comes to explain-
ing behaviors—the things that make up a life.
So instead of basing our science on a mechanistic view, we look at
how a person behaves in the situation the person is in at the time. We
look at the whole picture, rather than simply at how the constituent parts
interact. You can do this right now. Simply observe yourself reading these
words in whatever situation you find yourself. Maybe you’re on a bus,
maybe in a library, maybe in your house. You can look at the act (reading)
in context (the situation you’re in).
The matrix is an application of functional contextualism (Hayes,
1993), an approach that seeks to identify what works in particular con-
texts. In functional contextualism, the concern isn’t about how things
are in themselves or what’s true independent of what works to attain
particular goals. What’s true isn’t how things “really” are, but what works
in a given situation. This makes functional contextualism particularly
16
Under the Hood: Basic Processes Underlying the Matrix
17
The ACT Matrix
what’s true for each person; in other words, a model that puts psychologi-
cal flexibility center stage.
FIVE-SENSES EXPERIENCING
<- D1 ->
<- D2 ->
AWAY TOWARD
MENTAL EXPERIENCING
18
Under the Hood: Basic Processes Underlying the Matrix
Getting Stuck
When people enter therapy, they’re stuck, which is another way of
saying inflexible. People can get stuck in all sorts of ways: They get stuck
because they can’t imagine options other than moving away from
unwanted inner stuff. They get stuck because what’s important to them
is obscured by their struggle against unwanted inner stuff. They get stuck
because they focus exclusively on unwanted inner stuff. They get stuck
19
The ACT Matrix
Getting Unstuck
Consistent practice of the matrix point of view gets people noticing
the discriminations that will make a difference in their lives. Think of it
as stretching exercises that will gradually build flexibility—a yoga of the
mind—that requires deliberate, repeated practice. People get unstuck by
practicing noticing the two basic discriminations across their varied life
situations. As a result, they become increasingly able to choose actions
that move them toward what’s important to them in life, rather than
remaining stuck in trying to move away from unwanted inner stuff. They
become more psychologically flexible, and their actions move them
toward better relationships and more satisfying integration into their
community. This ensures that their toward moves continue over time. In
this way, the gains of treatment are consolidated over the long term.
20
Under the Hood: Basic Processes Underlying the Matrix
Jack, Amy, Mike, Bob, and John and Jill all get hooked by internal
stuff they don’t want. When their hooks show up, they bite and engage
in away moves. Technically speaking, they’re behaving under the control
of aversive antecedents. Aversives are things that people (and organisms
in general) move away from. For Jack and the others, these thoughts,
feelings, and sensations have (in certain contexts) acquired controlling
functions over their behavior through a process known as derived rela-
tional responding. According to relational frame theory (RFT; Hayes,
Barnes-Holmes, & Roche, 2001), derived relational responding is the
result of the way our minds transform five-senses experience into mental
experience. In this transformation, mental experience can acquire some
of the functions of five-senses experience. For example, a five-senses
experience of a charging bear naturally makes people run away. Through
derived relational responding, the mere thought of a charging bear can
make people run away or engage in other actions meant to move them
away from that thought and the fear it elicits. Because of derived rela-
tional responding, people react to the derived functions of things rather
than simply responding to the direct functions. That’s what we call
getting hooked by mental experience. When hooked, people have a hard
time noticing the difference between five- senses and mental
experience.
Derived relational responding is a very complex process, and one
that’s largely involuntary. It gets going as children learn language, and as
it does so, it not only relates five-senses experience to mental experience,
but also relates all types of inner experience among themselves: thoughts,
feelings, sensations, images, and memories. That’s why people try to
move away from the feeling of fear, even absent the thought of a charging
bear. Worse, an action or a comforting thought that serves to move away
from the initial thoughts and fears may come to evoke these thoughts
and fears. Derived relational responding can produce so many hooks that
people can easily get lost. Once people learn to speak, mental experience
largely dominates over five-senses experience. As a result, we live mostly
in our heads.
When people get hooked by the inside stuff they don’t want, they
naturally try to move away from it. What they do to move away often
works in the short term. For example, Amy feels relief when she moves
away from a person she wanted to meet. This makes it likely that she’ll
do it again—at the cost of her long-term life goals. In technical terms,
21
The ACT Matrix
22
Under the Hood: Basic Processes Underlying the Matrix
vulnerable to getting stuck again. This is most clearly seen in people with
addictive behaviors (see chapter 5), but it occurs much more broadly.
People who have been reinforced for moving away in this fashion are
liable to get stuck again—either in the same place or in some other
place—whenever aversives show up again.
The matrix orients toward a different kind of treatment. The goal
isn’t removing aversives; it’s training the ability to choose toward moves
in the presence of these aversives and to notice what happens. This is
quite close to the definition of psychological flexibility you’ll find in ACT
books. Psychological flexibility is key to long- term change and, we
believe, to improving the effectiveness of therapy and reducing the high
relapse rates that stand witness to the failure of the traditional model.
Actions under appetitive control are long-term patterns of behavior
that are, for the most part, reinforced by the social community. This has
two benefits for the therapist. First, people’s toward behavior stabilizes
over time, and they engage in fewer of the away moves that can lead to
impulsivity and a chaotic lifestyle. Second, the gains of treatment are
maintained in the community after clients stop attending sessions, dras-
tically reducing the probability of relapse.
23
The ACT Matrix
24
Under the Hood: Basic Processes Underlying the Matrix
25
The ACT Matrix
A Word of Warning
Some clients may give the answers they think the practitioner wants
to hear. This is known as pliance. Be on the lookout for it, as it will get
people even more hooked and keep them from responding from the per-
spective of their sorting. Reinforce the behavior of sorting rather than
particular responses or ways of sorting. The matrix practitioner seeks to
systematically reinforce noticing behavior while avoiding punishing any
kind of sorting. Gently nudging toward broader noticing is as simple as
saying, “Yes, and…,” with the sentence being completed by an invitation
to further discriminate. This is done by training the client’s attention to
a different aspect of the matrix than the one they’re currently notic-
ing—or hooked by. So in the example discussed in the previous section,
the practitioner was in effect saying, “Yes, you noticed drinking as a
toward move, and did you ever notice drinking as an away move?”
Hooks
The matrix practitioner invites the client to discriminate and track
verbal behavior and its consequences by asking if a particular verbal
experience works as a hook for the client and inviting her to notice what
she does next. This move involves two steps. First, a practice of D1 is
contained in the invitation to notice the hook because the client will
then notice mental experience as distinct from five-senses experience.
The second part of the question in turn is an invitation to track the
consequences of behavior (including verbal behavior). This move con-
tains two important moments of what is known in ACT as defusion:
distancing from content (antecedents), and noticing the functions
26
Under the Hood: Basic Processes Underlying the Matrix
What’s Important
The practitioner can also invite clients to discriminate what the
person they want to be would do. This allows clients to contact their
values and identify actions congruent with those values. When clients
practice noticing toward moves in the moment, they increase their ability
to interact with values as ongoing patterns of behavior, rather than as
purely verbal statements. Furthermore, the link between values and
actions helps derive reinforcing functions for their toward moves. This
promotes derived relational responses under appetitive control, making it
more probable that clients will derive further toward moves.
For example, if John invited Jill to go out for a weekly date night, that
would be a move toward being the husband he wants to be. Jill might
identify being empathic and listening to John as moves toward being the
wife she wants to be. The practitioner reinforces the derivation of these
reinforcing functions by asking clients to link toward moves with the
values they serve. The practitioner also encourages clients to notice,
through their five senses, the effect of their toward moves on their rela-
tionships and their lives.
27
The ACT Matrix
28
Under the Hood: Basic Processes Underlying the Matrix
29
The ACT Matrix
Figure 2.2. Some possible derived functions working the left side. Arrows
in boxes represent the direction of derived functions.
30
Under the Hood: Basic Processes Underlying the Matrix
After being invited to notice whether she made the lunches on the right
side (a toward move) or on the left (an away move) over the coming
week, Jill reported noticing that she prepared them on the right side
three nights out of five. In other words, verbal appetitive functions had
transferred to behavior previously under verbal aversive control.
By putting suffering and values (the lower quadrants) in a frame of
coordination and creating a frame of hierarchy with values at the top,
the matrix can help the appetitive functions of values transform the
functions of aversive private experience, enhancing acceptance and
establishing aversive private experience as a possible antecedent of com-
mitted action. For example, after some matrix work, Amy’s uncomfort-
able feelings and self-doubting thoughts in social situations served to
alert her to the importance of relationships and became cues for striking
up conversations. Derivation had transferred new functions to her private
experience of shyness. The practitioner can actively promote such
framing by asking who or what is important behind the client’s suffering.
ACT manuals provide numerous examples of how to link suffering with
values in effective ways. (The two derivations described here are illus-
trated in figure 2.3.)
Figure 2.3. Some possible derived functions working the right side.
Arrows in boxes represent the direction of derived functions.
31
The ACT Matrix
32
Under the Hood: Basic Processes Underlying the Matrix
FIVE-SENSES EXPERIENCING
(PROCESS)
CONTENT:
what I can see, touch, hear, taste, or smell
AWAY
ME TOWARD
NOTICING
WHAT I DON’T WANT WHO OR WHAT IS
TO THINK OR FEEL IMPORTANT TO ME
CONTENT: CONTENT:
thoughts, memories, who and what
emotions, images, stories, I choose to hold
bodily sensations, as important
feelings, urges in my life
MENTAL EXPERIENCING
(PROCESS)
Figure 2.4. The matrix and the three senses of self. Self-as-content is
coded in gray, self-as-process in black, and self-as-context lies in the
center (“Me Noticing”).
When Amy meets new people, she gets hooked by the thought People
won’t talk to me. The fundamental move in the matrix, which is always
implicit in the D2 discrimination (toward versus away moves), is to take
the person out of the experience and establish a point of view that’s
external to the situation being described—that is, unhooked. The dis-
crimination between hooked and unhooked is D1, and it’s implicit in D2.
Making a discrimination is the act of an observer. In such moves,
perspective-taking framing is at work: people are taking perspective on
their experience and behavior from the point of view of “I-here-now”
noticing “me-there-then,” even when just noticing that their experience
of the moment, as verbal behavior, always lags a few milliseconds behind
their direct sensory experience.
33
The ACT Matrix
34
Under the Hood: Basic Processes Underlying the Matrix
FIVE-SENSES EXPERIENCING
PRESENT MOMENT
NON- COMMITTED
ACCEPTANCE ACTION
AWAY TOWARD
FUSION VALUES
SELF-AS-CONTEXT
MENTAL EXPERIENCING
Figure 2.5. The matrix (in black) and hexaflex (in gray).
35
The ACT Matrix
We may also become wedded to our terms and thus lose flexibility.
There are a number of social contexts in which the terms of the hexaflex
carry undesirable functions for the purpose of promoting derived rela-
tional responding under appetitive control. In some countries and cul-
tures, the term “values” has a socially conservative connotation; in
others, “acceptance” carries functions of resignation. We may not be at
our most effective if, right after mentioning values or acceptance, we
have to specify what these terms don’t mean.
The strength of the matrix diagram doesn’t reside in the terms used
to establish the point of view. These are largely interchangeable. This
book contains numerous examples of practitioners in various settings
changing the terms associated with the quadrants or the discrimina-
tions. Its strength is that from the get-go it frames the work of both prac-
titioners and clients in a functional contextual worldview, thereby
potentially preventing one of the dangers that come with the growing
popularity of ACT: the use of its exercises and procedures as borrowed
technological fixes in the absence of a functional contextual approach.
36
Under the Hood: Basic Processes Underlying the Matrix
Conclusion
As practitioners, we offer this chapter as our current understanding of
the basic processes underlying the use and effectiveness of the matrix
diagram as a tool to promote behavior under appetitive control, also
known as psychological flexibility or valued living. We believe that one
of the central modes of action of the matrix is rooted in the way it pro-
motes specific forms of derived relational responding through relational
framing, particularly perspective taking, or deictic framing. Through the
new derived relational responses the matrix affords, behavior that has
been largely under the control of aversive antecedents can gradually
move under the control of appetitive consequences.
Multiple exemplar training and shaping are at the heart of using the
matrix effectively. Adopting the matrix point of view provides practice in
perspective taking through the behavior of sorting. The matrix puts the
behaviors of noticing and taking perspective at the heart of clinical work,
thereby facilitating new and more workable derived relational responses.
It is our hope that this chapter will be of use to practitioners, and
that it might inspire basic researchers to start playing around with the
matrix diagram to illuminate it more fully at the basic process level.
References
Hayes, S. C. (1993). Analytic goals and the variety of scientific contextualism.
In S. C. Hayes, L. Hayes, H. W. Reese, & T. R. Sarbin (Eds.), Varieties of
scientific contextualism (pp. 11–27). Reno: Context Press.
Hayes, S. C., Barnes-Holmes, D., & Roche, B. (Eds.). (2001). Relational frame
theory: A post-Skinnerian account of human language and cognition. New
York: Kluwer Academic/Plenum.
Hayes, S. C., Strosahl, K. D., Bunting, K., Twohig, M., & Wilson, K. G. (2004).
What is acceptance and commitment therapy? In S. C. Hayes & K. D.
Strosahl (Eds.), A practical guide to acceptance and commitment therapy (pp.
3–29). New York: Springer.
37
The ACT Matrix
Hughes, S., Barnes-Holmes, D., & Vahey, N. (2012). Holding on to our func-
tional roots when exploring new intellectual islands: A voyage through
implicit cognition research. Journal of Contextual Behavioral Science, 1(1–2),
17–38.
McHugh, L., Barnes-Holmes, Y., & Barnes-Holmes, D. (2009). Under- standing
and training perspective taking as relational responding. In R. A. Rehfeldt
& Y. Barnes-Holmes (Eds.), Derived relational responding applications for
learners with autism and other developmental disabilities: A progressive guide to
change (pp. 281–300). Oakland, CA: New Harbinger.
Pepper, S. C. (1961). World hypotheses: A study in evidence. Berkeley: University
of California Press.
Skinner, B. F. (1972). Beyond freedom and dignity. New York: Springer.
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PA RT 2
Aisling Curtin
The matrix can be a very powerful and accessible tool for introducing
the general public to functional contextual frameworks. This chapter
aims to provide guidance to clinicians, coaches, educators, and facilita-
tors on how to use the matrix as a means of introducing the general
public to key elements of acceptance and commitment therapy—or
acceptance and commitment training, as it is referred to when working
with the general public.
A key element of using the matrix with the general public (hereafter
referred to as “people”) is to become aware of our own toward and away
moves in communicating these concepts. One of my away moves is to
overly complicate the conceptual framework, and one of my toward
moves is to speak about this approach in a way that’s readily accessible to
people with no preexisting knowledge of functional contextual concepts.
So my commitment to you in this chapter is to speak to you, as much as
possible, in the same way that I would speak to the general public. I hope
this will best inspire you to get out there and do this much-needed and
meaningful work.
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Since there are four areas of valued living, you should mark four Xs on the dartboard.
Work/ Recreation
Education
Health/
Personal growth Relationships
Then I ask participants to select one valued area in which they’d like
to move closer to the bull’s-eye right now. The Values as a Cube meta-
phor (McKay, Forsyth, & Eifert, 2010) can help establish focus while also
allowing for flexibility. It likens our choice of which value to pursue in
any given moment to seeing one side of a cube. Through life events or
change of context, another side of the cube might come to the
forefront.
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ACT for the Masses: Using the Matrix with the General Public
Opting out:
Valued
Domains:
Thinking:
Family
Intimate
Substances/self-harm/other: relationships
Parenting
Away Toward Friends
Unwanted Mental or Inner Experiences Work/ Recreation Education
Education
Troublesome thoughts: Work
Recreation
Spirituality
Citizenship
Uncomfortable bodily sensations:
Health/ Health
Personal growth Relationships
Mental
Experiencing
Inner World
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and My chapter will probably be the one that needs the most editing—if they
even accept it. The key is to model awareness of and willingness to share
whatever my experience is, even when it’s difficult.
Next, I ask participants to look for the top three emotions that they
get hooked by or entangled in trying to avoid in the valued domain
they’re working with. I use a simple definition of emotions: “Emotions
are generally words that can sum up how we’re feeling overall and aren’t
tied to a particular part of the body. Examples would be ‘sad’ or ‘anxious.’”
Finally, I ask participants to identify the top three bodily sensations they
most want to get rid of in that same valued domain, since these are often
regarded as inner experiencing in matrix work.
Initially, people often get thoughts, emotions, and bodily sensations
mixed up. Our job is to reinforce their willingness to share and then help
them more accurately label what they shared as a thought, emotion, or
bodily sensation. Labeling accurately is important because participants
will later learn different ACT strategies they can apply depending on
whether they’re struggling with a thought, a feeling, or a bodily sensa-
tion. I always allow enough time for participants to jot down their top
three unwanted experiences in each category. Parsing in this way keeps
people from getting thoughts, emotions, and bodily sensations mixed up.
Time permitting, we might look at unwanted urges and memories. It can
be helpful to use different colors of pens for each category of unwanted
mental experiencing to underscore the differences.
Distraction
Opting out
Thinking
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guys of being lazy. Maybe it’s just that you’re playing a rigged
game.”
2. In general, when you use these strategies rigidly or excessively, do
they make your unwanted mental experiences better or worse? The
answer is usually worse.
3. In general, when you use these strategies rigidly or excessively, do you
move closer to the bull’s-eye or farther away? The answer is typi-
cally farther away.
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ACT for the Masses: Using the Matrix with the General Public
Cultivating Mindfulness
At this point, I generally introduce mindfulness exercises, as I find
them a useful means of helping people connect to the principles of ACT
and the matrix. Participants become more aware of their habitual
thoughts, emotions, bodily sensations, and behavioral patterns in both
their internal and external worlds. This allows us to check in on these
processes from a vantage of workability. The underlying question is
“Does engaging in this pattern and acting in this way help me move
toward the bull’s-eye, or does it take me farther away?” Here are some
suggestions for guided mindfulness exercises that can fulfill this
function.
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The ACT Matrix
Now notice any moments, no matter how brief, when you brought a more
compassionate and allowing approach to your experience. Simply notice
whether, in these moments, you were moving closer to or further away from
who and where you want to be.
Cultivating self-compassion. I’d like to invite the you that is right here right
now to imagine looking into your eyes in a moment of vulnerability earlier in
your life. Simply notice what you can see. Do you see sadness, fear, regret,
disappointment, guilt, resentment, or some other emotion? From the vantage
point of the you that is right here right now, looking back to that you in that
moment of difficulty, do you see yourself doing things that brought you closer
to who and where you want to be, or do you see yourself doing things that took
you further away? Rest in the knowledge that the vast majority of us, myself
included, see ourselves doing things that take us further away, that this is part
of being human, and we are still worthy of love and connection.
Cultivating Defusion
The matrix and its primary functional discriminations can also aid in
gaining a functional understanding of how each of the six core ACT pro-
cesses work. Here again, the key is using examples and illustrations that
are personally relevant, humorous, and memorable. For example, with
regard to defusion, I ask participants to come up with a couple of examples
of thoughts they might get hooked by and what their toward and away
moves might look like on a video camera. Once we have two examples, I
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ACT for the Masses: Using the Matrix with the General Public
offer to demonstrate a defusion strategy for each example and invite par-
ticipants to choose which ones I’ll demonstrate. Generally, participants
choose to have me sing one of the thoughts to the tune of “Happy
Birthday” and to say the other in the voice of a cartoon character.
Common thoughts that people get hooked by include I’m too anxious,
I might panic, and I’m not confident enough to do that. For each unhelpful
thought, the toward move would be engaging in the feared action if
doing so is consistent with the person’s values, and the away move would
be distracting by doing an activity not guided by values or opting out of
a values-consistent activity.
I demonstrate this by role-playing Ann, whose anxiety is a barrier to
going out, and Mary, whose lack of confidence is a barrier to going out.
As Ann, I might pretend to be the Roadrunner and bleat, “I’m too
anxious; I might panic!” in a high-pitched voice while running across the
room and saying, “Beep beep!” This generally gets people laughing. I
then say that using this defusion strategy makes Ann laugh too, and she
feels so much better that she decides not to go out. Instead, she stays at
home and spends the evening surfing the Internet.
As Mary, I might sing the thought I’m not confident enough to do that
to the tune of “Happy Birthday.” I then say that after using this defusion
strategy Mary feels even worse and less confident than she did before.
However, this strategy gives her a chance to connect to her values, and
she decides to go out anyway because it’s a move toward her values.
I then ask who did defusion from an ACT perspective. Was it Ann,
who felt much better but didn’t engage in a toward move, or was it Mary,
who felt worse but engaged in a toward move anyway? People almost
always get this and realize that from an ACT perspective, it’s all about
living better—engaging in more toward moves—rather than feeling better
by numbing or moving away from unwanted thoughts and feelings.
Although I might give people handouts with a variety of strategies for
each of the six ACT processes, I find that demonstrating defusion in this
way often stays in people’s minds because these strategies are a bit on the
wacky side.
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ACT for the Masses: Using the Matrix with the General Public
also when the matrix is used in a large group. Verbal processes such as
judgment, reason giving, evaluations, and comparisons become evident.
Supplementary metaphorical and experiential exercises can be used
in conjunction with the matrix to illustrate relational frame theory (RFT;
Hayes, Barnes-Holmes, & Roche, 2001). I generally do this work by
looking at how words have the capacity to make both our past and our
future very much alive in the present. I find it important to look at both
the ways in which language works well (e.g., we are able to read direc-
tions and understand warnings whether in written or auditory form) and
the ways in which it leads to suffering (e.g., constant comparisons and
how a single aspect of our context can remind us of a time when we felt
incredibly sad or anxious). I give personal examples of comparisons that
I’m making in that moment. In any given room, I can notice people who
I believe to be more intelligent or attractive than I am, or who probably
have a better relationship history. In fact, I’m willing to bet that you,
reading this chapter now, fit into at least one of those categories.
Unfortunately, you’re probably so busy comparing yourself unfavorably to
others that you can’t fully connect with that. We know from RFT that
values and vulnerabilities are two sides of the same coin. So with lan-
guage we have the ability to make contact with both incredibly painful
and extremely pleasant elements simultaneously.
To show how randomly applicable language can be and how any-
thing can become bad, I often share a personal story. It’s about how I’m
not married, and if I ever were to get married, even to someone I deeply
care about and could see myself spending my life with, I know for certain
that on that day I would think of my brother Shane, who died tragically
almost fifteen years ago. I’d think about what age he would be, whether
he would have a partner, and how he would have felt on that day. And I
know that in that moment, I would feel his loss afresh and experience a
wave of sadness.
Even though I have the capacity to read directions, follow instruc-
tions, and book flights for conferences (and occasionally, but not always,
do this well), I have the capacity to suffer in a way that animals and
preverbal children don’t. Something seemingly minute in my environ-
ment or context, something that might not even be noticeable to someone
else, can trigger an internal experience within me that can make a reality
gap in my life very evident and very painful. I believe that the matrix
normalizes this experience and shows it clearly. And with this awareness
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comes an opportunity for choice. Do I get sucked into these verbal pro-
cesses and let them push me around? Or do I compassionately notice
how these processes impact me and mindfully choose an action that
brings me one step closer to the bull’s-eye? In this way, the matrix puts
the principles of RFT into action.
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ACT for the Masses: Using the Matrix with the General Public
Conclusion
This chapter will hopefully serve as a reference point on how to integrate
the matrix into work with the general public. At a time when people feel
that they’re doing more and more while enjoying less and less, an
approach that helps them learn strategies to manage thoughts and emo-
tions more effectively while moving toward a life that really matters is
infectious.
This chapter isn’t about knowing everything you need to know to
bring the matrix to the general public. The first thing and most impor-
tant thing isn’t something that can be taught. It’s a willingness to look at
the barriers to bringing this work to the public that you might face, and
finding a reason for doing so that’s big enough that you would choose to
take one step closer toward shining brightly—not because you have to,
should, or must, but because this work is worth having all of that stuff on
the bottom left side of the matrix if maybe, just maybe, you can help
people make meaningful changes in their lives.
References
Dahl, J., & Lundgren, T. (2006). Living beyond your pain: Using acceptance and
commitment therapy to ease chronic pain. Oakland, CA: New Harbinger.
55
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56
CH A P T ER 4
away from a deeper connection with our clients and their suffering,
hopes, and aspirations. Although ACT, as presented in the classic
manuals, is a powerful intervention to help clients develop a more accept-
ing relationship with their personal experience, we also noticed that it
didn’t always get at the roots of our clients’ interpersonal difficulties, at
least as we practiced it then. Though clients came to struggle less with
inner experience and engage in more valued actions, progress in inter-
personal effectiveness didn’t always follow.
FAP is a relationship-centered contextual therapy that focuses on
the therapeutic relationship as the vehicle of clinical change by means of
reinforcement of improved in-the-moment behavior. FAP alerted us to
the importance of noticing interpersonal functions in the room. It helped
us better track and make use of the effects of our behavior on clients, as
well as the effects client behavior had on us. FAP offers the therapeutic
relationship as a training ground for improved interpersonal behavior—
for both clients and therapists.
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Promoting Generalization
The relevance of the matrix to FAP work extends outside sessions to
problematic or improved daily-life behaviors. The matrix point of view
helps clients sort their behavior between sessions and, by increasing the
functional similarity between in-session toward moves and away moves,
promotes generalization of matrix sorting to clients’ everyday lives.
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You, Me, and the Matrix: A Guide to Relationship-Oriented ACT
Thus, neither client nor therapist needs to get stuck on a given model of
causality and argue about whether feelings and thoughts or outside
events “cause” behavior. Depending on the context, either form of analy-
sis can be helpful. The therapist helps clients gain flexibility in their
functional accounts by orienting them either to outside events or to
inner experience.
For FAP, CRB3s are also a way to promote generalization. The same
holds true when using the matrix. It promotes generalization of CRB by
inviting clients to notice away moves and toward moves in daily life and,
more generally, to spot the matrix in everyday experiences.
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You, Me, and the Matrix: A Guide to Relationship-Oriented ACT
Figure 4.1. Spiky and Flexi. The spikes represent suffering as well as moves
away from suffering. Whereas Spiky seeks to contract his experience of
what he doesn’t want to think or feel, thus creating further spikes by strug-
gling, Flexi makes room for what he doesn’t want to think or feel, allowing
him to contact what’s important in the situation and choose toward moves.
We’ve found that these characters offer an intuitive way for clients to
get a sense of the felt difference between away moves and toward moves.
They also nicely illustrate the interpersonal functions of struggling,
which makes others move away or enables only connection in superficial
ways, and the functions of acceptance and valued living, which make
others more inclined to move closer and seek deeper connection.
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In this dialogue, the client was first moving away from despair by
voicing disbelief and pushing the therapist away. The therapist let him
see the interpersonal functions of that statement and offered a possible
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Defusion
The matrix also helps promote defusion and can easily be blended
with traditional ACT exercises. We commonly use the Hook metaphor.
Clients are invited to notice if some aspect of their inner experience,
whether it’s a thought, an emotion, or a bodily sensation, is a hook for
them. If it is, they’re asked to notice what do they typically do next: a
toward move or an away move.
Therapist: So that’s what hooks are. What do you think your
hooks were earlier?
Client: A big hook for me is that nothing’s ever going to
change.
Therapist: You noticed that hook. Good! And when this hook
shows up, what do you do next?
Client: I become sad and angry, and I just want to shut the
whole world out.
Therapist: You notice what you do next. Good! For me, the hook is
that I’m not a good enough therapist. If I don’t notice
the hook, I may just shut down or propose an exercise
right away. Noticing the hook helps me notice what I
tend to do next, and notice if I can see what the person
I want to be would do next, which is generally a toward
move. How about you?
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You, Me, and the Matrix: A Guide to Relationship-Oriented ACT
Client: Hmm. I think the hook doesn’t come alone. There are
many others on the line. Like “People don’t care about
me,” and “I’m all alone anyway.”
Therapist: Ouch! Painful hooks. And what do you do next when
these show up?
Client: The same. I withdraw…get crabby.
Therapist: Okay, you noticed that. And what would the person you
want to be do when these hooks show up?
Client: Not push people away, so…
Therapist: Seems to me you’re biting less right now.
Client:
(Laughs.) Yeah, but that’s only because you’re helping
me. I don’t know if I could do it out there.
Therapist: How about seeing if you can notice hooks and what you
do next between now and next week?
Client: Sure.
Acceptance
Inviting clients to describe what shows up in the lower left quadrant
of their matrix is an effective way of promoting acceptance. The charac-
ter Flexi is also a versatile image for promoting and discriminating accep-
tance in the moment.
Therapist: When you talk about noticing your hooks and not
biting, would you say that’s more like Spiky or Flexi?
Client: Like Flexi. It’s when I bite that I become like Spiky.
Therapist: It’s great to see you make space for these hooks without
biting. See if you can notice how you do that, and
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FIVE-SENSES
EXPERIENCING
Figure 4.2. The matrix with an added layer of experiencing. The inner
experiencing layer allows clients to discriminate between bodily sensa-
tions and thoughts and images and can help them contact how it feels to
have a particular mental experience.
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You, Me, and the Matrix: A Guide to Relationship-Oriented ACT
Therapist: So when this thought that nothing will work shows up,
you become sad and angry. What’s that like?
Client: It’s both I guess. It’s how they make me feel. It grips me
here (pointing at his chest), and I feel this weight there
(pointing to his upper belly). I can’t stand it!
Therapist: So that’s your inner experience of feeling sad and angry?
Client: Yes. So it goes there? (Points to inner experiencing.)
Therapist: Yes. Often that’s the biggie. That’s what we really try to
move away from. Not so much the words or images, but
how they make us feel inside. That’s how we become
like Spiky, by contracting our inner experience so as to
not feel it.
In our clinical practice, we’ve also noticed that when clients have
difficulty or refuse to contact inner experience, training their attention
toward five-senses experiencing can help them gradually open up to their
bodily sensations. In this manner, clients can progressively learn to rec-
ognize their feelings and develop a more stable sense of self.
Values
Values work in ACT, particularly values clarification, can become a
verbal minefield. Traditionally, values work gets pushed back toward the
end of therapy, when progress with defusion and acceptance make it less
likely that client and therapist will get stuck. The matrix can help sim-
plify values work by recasting it in terms of discriminating between
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toward moves and away moves, allowing values to take center stage from
the get-go. Using the word “important” rather than “values” can protect
both client and clinician from falling into wordy confusion. A question
as deceptively simple as “What would the person you want to be do in
this situation?” can lead to the immediate derivation of valued action.
Here too, the therapeutic relationship provides a privileged context for
in-
the-moment derivation and engagement in moves toward what’s
important (CRB2). As the most important values often involve relation-
ships, this can be evoked by the therapeutic relationship itself.
Therapist: I noticed that when I told you I cared about you and
was wondering how you had been doing over the week,
you changed the subject.
Client: It makes me feel uncomfortable when you say that you
care about me.
Therapist: Okay, how about now? Can you open up to the fact that
I care about you and wonder how you’re doing during
the week?
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Perspective Taking
The matrix trains flexible perspective-taking skills. We do this work
by inviting clients to adopt the matrix perspective (discussed in chapter
2). In the therapeutic relationship, we invite clients to take our perspec-
tive and describe what they would experience if they were the therapist
and we were the client. Once the skill has been trained in the therapeu-
tic relationship, it can generalize to the client taking the perspective of
significant others by taking the perspective of their matrices.
Another effective way to train flexible perspective taking is inviting
clients as they are here and now, in contact with their matrix, to imagine
being teleported to a difficult situation and noticing their matrix in that
situation. Being aware of what shows up in the situation, is there some-
thing they, as they are here and now, could tell themselves, as they will
be there and then, that could help? This dialogue can lead to an explora-
tion of self-validation strategies, gently returning attention to what’s
important and choosing action. The therapist can conclude the exchange
by asking clients how probable they think it is that they, as they are here
and now, will be able to go and assist themselves there and then.
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Clinician Self-Disclosure
Through the matrix, clinicians may choose to self-disclose if this is
done in the interest of helping clients better identify the interpersonal
functions of their own behavior or as a way to model processes and let
clients contact their shared humanity with the therapist. A clinician
could thus choose to disclose that she’s feeling anxious because she’s
awaiting news of the outcome of an operation a sick relative is undergo-
ing. She could also choose to disclose that when the client rejects her
praise, she notices feeling pushed away.
Matrix Spotting
An effective way to promote generalization of behavior practiced in
session is inviting clients to see if they can spot the matrix in their life
outside of sessions, and especially in interpersonal relationships. We
sometimes tell clients that now that they’ve started looking through the
matrix, they won’t be able to unsee it no matter how hard they try, and
that it will start popping up in many life situations.
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Homework
When using the matrix, homework isn’t called homework; instead,
it’s home practice. It’s simply about noticing, not about having to do any-
thing in particular. In addition to ensuring client compliance with
“homework” (as long as they commit to noticing), it’s also an excellent
way of working through pliance and counterpliance issues.
Couples Work
Space precludes a thorough discussion of how to use the matrix for
couples work. However, many of the strategies outlined above can be
used with couples; therefore, we will briefly sketch how they can be
adapted to couples work.
Setting Up
As we introduce the matrix, we get each partner to fill out an indi-
vidual matrix, while we often fill in their matrix as a couple. Each partner
writes his or her own values, suffering, and away and toward moves as
they’re identified, and those they have in common are recorded on the
couple’s matrix. (See also the “Second Loop Around the Matrix,” in
chapter 14, for a discussion of shared matrix work.)
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You, Me, and the Matrix: A Guide to Relationship-Oriented ACT
Conclusion
In this chapter, we illustrated how the matrix could be used to integrate
relationship-centered strategies from FAP into ACT-based interventions,
and as a tool in couples work. We believe that the matrix is ideally suited
to integrating exercises and procedures from other approaches with
ACT-based interventions, as long as this is done in the service of moving
toward what’s important (i.e., under appetitive control, rather than aver-
sive control of moving away from discomfort). We hope this chapter has
given you a taste for using the matrix as a flexible cue for therapists
engaged in relationship-focused work, helping clients move toward the
life and relationships they want.
References
Boulanger, J. L., Hayes, S. C., & Pistorello, J. (2010). Experiential avoidance as
a functional contextual concept. In A. M. Kring & D. M. Sloan (Eds.),
Emotion regulation and psychopathology: A transdiagnostic approach to etiol-
ogy and treatment (pp. 107–134). New York: Guilford.
Kohlenberg, R. J., & Tsai, M. (1991). Functional analytic psychotherapy: Creating
intense and curative therapeutic relationships. New York: Springer.
Lara, M. E., Leader, J., & Klein, D. N. (1997). The association between social
support and course of depression: Is it confounded with personality? Journal
of Abnormal Psychology, 106(3), 478–482.
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Peirce, R. S., Frone, M. R., Russell, M., Cooper, M. L., & Mudar, P. (2000). A
longitudinal model of social contact, social support, depression, and alcohol
use. Health Psychology, 19(1), 28–38.
Teo, A. R., Choi, H., & Valenstein, M. (2013). Social relationships and depres-
sion: Ten-year follow-up from a nationally representative study. PLoS ONE,
8(4): e62396.
Tsai, M., Kohlenberg, R. J., Kanter, J. W., Holman, G., & Loudon, M. P. (2012).
Functional analytic psychotherapy: Distinctive features. Hove, Sussex, UK:
Routledge.
Tsai, M., Kohlenberg, R. J., Kanter, J. W., Kohlenberg, B., Follette, W. C., &
Callaghan, G. M. (Eds.). (2009). A guide to functional analytic psychother-
apy: Awareness, courage, love, and behaviorism. New York: Springer.
Tsai, M., Kohlenberg, R. J., Kanter, J. W., & Waltz, J. (2009). Therapeutic tech-
nique: The five rules. In M. Tsai, R. J. Kohlenberg, J. W. Kanter, B.
Kohlenberg, W. C. Follette, & G. M. Callaghan (Eds.), A guide to functional
analytic psychotherapy: Awareness, courage, love, and behaviorism (pp. 61–
102). New York: Springer.
Wilson, K. G., & Murrell, A. R. (2004). Values work in acceptance and com-
mitment therapy: Setting a course for behavioral treatment. In S. C. Hayes,
V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance:
Expanding the cognitive-
behavioral tradition (pp. 120– 151). New York:
Guilford.
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CH A P T ER 5
Mark Webster
What Is Addiction?
The term “addiction” is increasingly applied to widely different situa-
tions, ranging from substance misuse to gambling or sex to shopping and
even to ice cream consumption. What this tells us is that addiction is not
The ACT Matrix
a single condition that can be defined in the way that a disorder like
depression might be. Therefore, we need to look at addiction more as a
category of disorders that can have widely ranging differences in presen-
tation and underlying cause. There is extensive comorbidity with tradi-
tional mental health conditions and overlap with serious mental illness,
often referred to as dual diagnosis. It is a kaleidoscope, and a principle-
based model seems the only realistic approach.
Since this is not a chapter on addictions per se, I am going to limit
the use of the term “addiction” to describe typical behaviors that are
involved in maintaining a strong physical dependency on a chemical sub-
stance. Typically, this involves substances that are illegal in the UK at
this time, such as opiates, cocaine, and amphetamines. However, sub-
stance dependency in the UK more often involves legal substances,
including alcohol, nicotine, and prescription drugs, such as the benzodi-
azepine family, and such addictions are also addressed here. (I will leave
caffeine out of the discussion!)
As mentioned, the term “addiction” is often applied more widely to
describe behavior that does not involve ingesting a mood-altering sub-
stance, for instance gambling or sex. It can be taken even further to
describe engaging in a variety of behaviors compulsively, such as shop-
ping or spending, and even to describe our Western culture, as in the
label addictive society. The matrix will work equally well with these
“compulsive” addictions, as it does not require the focus on physical
dependence that is so heavily emphasized in the treatment of substance
misuse.
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Rolling Out the Matrix, Rolling Back Addiction
Client Group
People presenting to the system have usually reached a fairly desperate
situation in life, often referred to as rock bottom. This is a specific inci-
dent or moment that shocks people into action, such as a hospital admis-
sion, or having children removed by social services, or loss of a job.
Circumstances vary widely, and for many people these events just fuel
further substance use. For each individual, the rock bottom is personal
and comes after many, many years of sliding into an increasingly worse
condition. Clearly, such people need a model of treatment that is simple
and well organized.
What this means when considering a treatment model is that the
system is usually dealing with people whose physical and mental health
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are at an extremely low ebb. In most cases, their lives are chaotic and
filled with all sorts of difficult problems, and their support systems have
disappeared. People who present for help usually have a high level of life
difficulty and low access to resources. It is a very tough starting point,
and we can expect many relapses as people progress through the journey
of recovery.
This places an emphasis on engagement, and particularly the use of
the “Yes, and?” skill (discussed in chapter 1). People who enter treatment
are typically feeling unsafe and out of control in daily life, and they also
belong to a social group that is heavily stigmatized. For that reason, it is
particularly important to create an environment that is safe and interest-
ing for new clients. In fact, clients often report that having a safe place
really matters, and that being with a group of similar people is a relief
from the stigma experienced elsewhere in the course of their recovery.
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Group Treatment
My own background was ten years of experience with dialectical
behavior therapy (DBT), which is where my interest in behaviorism
started, as well as an interest in ACT fueled by my dissatisfaction with
the “symptom-first” approach of DBT. I had already run a few ACT-like
groups focused on the traditional six components of the hexaflex, but
with limited success. I was ready for something more effective and went
over to visit Kevin Polk, at the Togus VA Medical Center in Maine. I
brought the iView format, as it was then called, back over to the UK and
started using it in groups, but it proved to be confusing for clients.
Early on, we understood that the model needed to be simple and
visual because clients are in such a state of disarray when they enter the
treatment setting. The elements of noticing were there in iView, along
with acceptance and defusion, but the tool was not clear enough. We
could see that we were on to something—and that it was not yet the
finished article. Fortunately, enough clients started engaging with the
approach and making strides to recovery that we were able to maintain
funding for the project.
The Grid
When I was at Togus, we improvised a role-play in which the client
was visually presented with two choices. This was the first time I had
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Group Format
By this point, we were using the standard matrix diagram with the
two discrimination lines and four quadrants and getting clients to sort
their experiences onto the diagram. Next, we built a structure for the
group that allowed us to focus more clearly on some of the individual
components of ACT, such as values and acceptance. A structure for the
groups emerged in which we began with mindfulness, then sorted exam-
ples on the matrix, and then did an activity around one of the compo-
nents. We still use this standard structure today, though we leave out
formal mindfulness with drop-in groups. We use the standard homework
statement at the end, inviting people to either notice where they are on
the matrix or not to bother with the homework, as people often don’t like
homework and it’s all the same to us. These are all written up in the
manual 60 Ways to Use the Matrix, which is unpublished but available
from me by e-mail. (Please send requests to mark_swest@yahoo.ie.)
Group Guidelines
As the approach gained popularity, we started to diversify the loca-
tions where we ran groups, so we needed to have a clear set of guidelines
for groups that were independent of the setting. These guidelines were
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developed by the service users using a toward and away approach until
we arrived at a set that seemed to work (which is included in the manual
60 Ways to Use the Matrix).
Decentralized Groups
The number of groups we were running continued to grow, and we
were running more and more groups in the community. One of the
groups we started was in the local general hospital working in conjunc-
tion with the Alcohol Specialist Nurse Service, only the second such
service in the UK at the time. We set up an integrated psychosocial
interventions service offered in the ward—the first program of its kind in
the UK.
This was another pivotal moment. Although it had been a chance
decision to set up the groups in the hospital, we immediately started to
notice how popular this was with patients. When we asked them about
their experience, they tended to give similar responses. They liked
coming to the hospital because it was perceived as a normal environ-
ment, allowing them to avoid the stigma associated with specialized
addiction centers. Furthermore, many patients with alcohol problems
preferred not to be treated in the same groups as people with drug prob-
lems. We were also able to bypass the lengthy referral system so people
could self-refer after a relapse. We were surprised by how successful this
was, as we had all worked in addiction services for a long time, and this
didn’t conform to the usual pattern.
Excluded Clients
Because the first ward-based program was a pilot project, it under-
went an external audit. When we looked at the results, we had 100
percent satisfaction from those attending the matrix groups. This got us
thinking about the basic assumptions in the existing model of
provision.
Another group we were running, in a community center, had also
started attracting people who were in recovery but not attending special-
ized services. They were in differing stages of recovery and did not want
to be associating with people who were still involved in using. We real-
ized that there was a large group of people who wanted recovery-based
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Diversified Locations
The success of the hospital program allowed us to expand the alcohol
service, and we decided to base groups in community locations. We
wanted to see if we could expand the service and include clients who
wanted the recovery aspect of treatment rather than the drug or alcohol
aspect.
This meant working with other agencies and running groups on
their premises with a direct referral pathway. The first agencies we looked
at were Probation, Social Services, Mental Health, Primary Care, and
Housing. In each instance we met with the local managers and staff to
identify the needs of the client group and set up times for groups to be
run.
Generally, these groups flourished, and like the hospital groups they
were well attended and valued. The few groups that didn’t succeed were
closed down, and for those, we went back to the drawing board, did a
toward and away analysis, and tried again. Numbers of people attending
the groups continued to grow, and there was a demand for different levels
of groups so the work could be progressively more challenging.
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This helped explain the high rates of relapse and low rates of success
in the harm-reduction approach, a result of people switching from one
form of aversive control to another as treatment progressed.
Our analysis is that harm reduction helps people move away from
the consequences of their addictions. For example, these might be health
consequences in the hospital, family consequences in social services, or
criminal justice consequences in probation. In fact, hospitals, social ser-
vices, and the criminal justice system define good outcomes by the
absence of those very consequences, so the dominance of aversive control
is perpetuated by the institutional culture of these agencies and the gov-
ernment bodies that fund them. Government outcomes normally repre-
sent a successful use of aversive control, without any appetitive element.
And, of course, standard mental health outcomes are defined in a similar
fashion.
What we observed in stage one is that people would participate in
treatment and successfully escape the consequences of whatever got
them to engage with services in the first place. Then the services would
typically be withdrawn as if treatment were a success. However, once
people had engaged in treatment and reduced the frequency of their
initial presenting behaviors, they were left with the same unwanted
thoughts, feelings, and physical sensations that their addiction had
helped suppress. So as the aversive control of engaging in treatment
started to fade, a new set of aversive stimuli that would drive people back
into addiction emerged. No wonder people relapse— it’s a double
whammy. I call this the “relapse shuffle.”
Those who stayed with treatment, perhaps because some form of
appetitive control had been established, were then faced with the third
set of obstacles to recovery: the challenges of meeting new people, going
to new places, and trying new things in a community that stigmatizes
addiction. It became clear to us why people were not progressing into
stage-two and then stage-three work, which is about reintegrating into
the community. People would instinctively want to move away from that
and stay in the home group, which is more comfortable and safe. This
corresponded with another observation: that people typically stay in
their treatment settings and do not move on and reintegrate into the
community. Usually, clients were blamed for the failure, whereas in fact
we were not providing the necessary tools to help people overcome these
weighty obstacles.
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iGro
The Individualized Generic Recovery Outcomes (iGro) is a system
of measurement I developed based on the D1 (sensory vs. mental experi-
encing) and D2 (toward vs. away) structure of the matrix. Each dimen-
sion is based on a simple scale of 1 to 5 scored each time there is contact
with a client. The information is then entered into a database that allows
client progress through recovery to be charted at a push of a button. It
allows group leaders to make systematic assessments of clients’ progress,
rather than relying on feel or opinion. When we started to apply the
system, we discovered that our opinions were not very accurate, com-
pared to the scales!
Challenges
We developed challenges as one of the key components of the
program because this effectively tells us about the level of aversive control
being maintained. Including challenges allows us to monitor each client
to ensure that everyone is learning to overcome barriers and obstacles.
The term “challenges” is very intuitive for group members.
Challenges are set monthly in community programs and weekly or
biweekly in residential programs. The challenges are individualized
behavioral tasks that require each person to confront a higher level of
aversive control than previously, like raising the bar on a high jump a
notch at a time. Through the systematic application of challenges, each
person both develops new behavior under appetitive control and engages
in exposure work around the internal aversive stimuli that had previously
been generating away behaviors. Common challenges involve dealing
with difficult interpersonal situations, sorting out money issues, enrolling
in courses, applying for a job, or engaging in a new leisure activity.
Activities
We realized that we had to carry the focus on what is important
through to group activities. We now provide many more activities that
are focused on developing appetitive control, and have even created an
activities book called Take a Walk on the Wild Side that contains thirty
ways to work experientially in groups with the ACT components. We
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also noticed that people did not like talking about their away behaviors,
as doing so is also under aversive control due to the high levels of stigma
and shame that surround addiction. Consequently, we have increased
the level of aversive stimuli in group activities to provide another oppor-
tunity for exposure work and progress in facing aversives. For example,
not talking about away behaviors is an away move, so we include an
activity in which we put clients into small groups and get them to gener-
ate lists of away behaviors and think about which ones apply to them.
Then we ask them to think about and list the aversive stimuli that under-
pin these behaviors (known as “not wants”) and to think about and list
the long-term negative consequences of each. This is then processed in
the larger group using the whiteboard. In this way, all participants talk
about their own aversive stimuli, but they do so in a safe environment
that normalizes much of the experience.
Most of the activities follow a similar pattern. In another activity we
use laminated pictures that we spread on the floor. Clients are invited to
select one that represents an area of their life that is difficult. Each then
talks about why he or she chose that picture, thereby contacting some of
the aversive stimuli while talking and engaging in new behavior in the
presence of those stimuli.
From this work emerged a second overall direction for the project:
maintaining as high a level of exposure practice as is appropriate.
Community
In Portsmouth we are fortunate to have a strong 12-step community and
now a strong community of people in recovery who operate as a service
user group called PUSH (Portsmouth User Self Help) funded by the
commissioners. Over time, we have come to work more closely with
people who are in recovery, as they are in a better position to provide the
individual support and encouragement that clients need to overcome
their obstacles and barriers. PUSH members act as “recovery brokers”
and receive training and supervision. This community (PUSH) is rein-
forcing to belong to and provides opportunities for others in recovery to
safely learn new skills and try new activities. PUSH members follow the
same format of focusing on what is important, and they use their experi-
ence to help people along the road to a better life.
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Training
As the system has grown, we’ve needed to train more people to deliver
the groups. This is another area where we have innovated and made a
considerable change in the culture. I created a system of training people
that involves learning three main competencies: sorting to appetitive
control, using the “Yes, and?” skill, which is a relationship-building tool,
and understanding how to run activities and conduct exposure work.
Training is delivered through workshops and observing a more expe-
rienced leader. All feedback is against the three competency areas and
the standard group structure. We have been able to train all manner of
nonspecialist workers in this way. This allowed us to make another para-
digm shift in the way we approach treatment; in addition to delivering
treatment away from specialized addiction centers, we can also deliver
treatment through nonspecialist workers.
Task Shifting
The matrix has allowed the development of a completely new paradigm
in addiction treatment. Although it is an extremely obvious statement,
addiction is a condition that affects all corners of society. People with
addictions turn up in all agencies and, up until now, the frontline workers
in these agencies have had to refer to specialized substance misuse ser-
vices. Most people referred never make it to those programs.
Using the matrix, we have not only been able to locate services
where clients are but have also created an integrated pathway that is
holistic and addresses the full range of client needs. In fact, the model is
so simple and straightforward that it can be taught to almost anyone.
This means we can teach people in many agencies, such as Housing,
Social Services, Probation, and Education, how to deal with the sub-
stance misuse element of the situation.
Through the matrix, we can transfer skills out to workers in all agen-
cies and equip them to deal with not only addiction problems but also
other behavior change problems. Behavior change is no longer just the
province of specialists; and, by shifting this task out into the community,
we can reach many more people and reach them much sooner, before
their lives get so bad that they need a specialized service. Through this
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work, we are now seeing changing attitudes toward substance misuse and
treatment across many agencies in the city.
Standards
Over the past two years, we have worked with the commissioners, service
providers, and service users to create a set of standards for practice based
on a recovery model. These standards are behavioral and based on the
idea of working on who or what is important for the client. The next
phase of the work is to reach the point where the whole system develops
appetitive control at every opportunity, and is monitored. The system is
becoming a functional contextual one, but it will take at least another
five years to change the wider culture.
Conclusion
While this has been the story of the journey toward a new model of
addiction treatment in Portsmouth, it is also a story of how the matrix
can be used to broaden the reach of the functional contextual approach
to the places where it is needed. The model is simple and universal, so it
is suitable for all people, whether they present in crisis or are simply
struggling with life. It can be taken outside the walls of traditional spe-
cialized centers and made available in a more timely fashion where and
when it is needed. It can also be delivered by anyone who has a sincere
wish to help others. These are all essential in addiction because it is a
condition that knows no limits, and affects the whole of society.
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CH A P T ER 6
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The Pain Matrix
treatment providers. The idea that the pain may have a biological cause
is only partially relevant to this conversation. The driving factor should
be that either there is a solution to the current pain problem—such as
surgery or any other treatment that can resolve it—or there isn’t. If there
is no medical solution, we may need to approach the pain from a differ-
ent perspective. The perspective I suggest can be represented using a
version of the matrix with some slight variations specific to this popula-
tion (see figure 6.1). The matrix places the person in the center, where
pain is a part—and only a part—of a full life.
External Experiencing
(Five Senses)
Values:
Family
Intimate Relationships
Parenting
Friends
Away Toward
Education
Work
Recreation
Spirituality
Citizenship
Health
Internal Experiencing
(Inside the Skin)
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Matrix Overview
Please refer to figure 6.1 for the perspective described in the rest of this
chapter. The self, or “me,” is the center of the model, because human
beings’ perspective has them at the center of their own universe. I will
usually write “Me” in a circle at the center and then ask, “How do you
experience or take in information about the world?” This begins the
exploration of the vertical axis, which represents the two ways that
humans experience things. At the top is the way that people take in
information about the world around them: through the five senses.
Through a mindfulness-based exercise, I invite people to experience an
object and describe their experience of it with each of their five senses.
People usually report that they haven’t paid attention to their direct
experience in that way in a long time. This slowing down is both useful
and unusual. Then I ask them to put the object aside and experience it
through the other way of experiencing: internal, represented at the
bottom of the vertical line. Here it may be useful to discuss everything
that can occur inside the skin, such as memories, thoughts, feelings, and
sensations, including pain. The horizontal line can be described as the
skin barrier, with things that happen inside the skin falling below the
line and things that happen outside the skin falling above the line
because they are experienced through the five senses.
The horizontal axis is the behavior line. It represents the two major
functions, or purposes, of behavior. I use a series of questions to create a
context that makes this distinction come alive. I begin with a trick ques-
tion: “Have you ever experienced pain?” This both highlights clients’
experience, and normalizes it, as all human beings experience pain. Pain
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gets placed in the lower left quadrant of the matrix, because it’s inside
the skin. The next question really begins the discussion of the behavior
line: “Have you ever done anything to move away from something
uncomfortable inside your skin, like pain?” If this question is unclear, I
clarify by asking about the present moment, for example, “Are you doing
that now?” We then contact the moving toward side through similar
questions. Sometimes it may be helpful to ask, “Who or what is impor-
tant to you?” and “Have you ever done anything to move toward some-
thing or someone important to you?” The key distinction is the difference
between moving toward something that’s important to the individual
and moving away from things inside the skin that are uncomfortable.
The bulk of the treatment can be mapped directly onto the two lines
and the circle at the center. Sometimes, just showing clients this model
is helpful enough to allow them to make a significant start in moving
toward a valued life; but often, more is needed. If a client is particularly
inflexible or focused on removal of pain as the goal of treatment, high-
lighting each piece of the model becomes necessary. The purpose of the
model and use of the diagram is to help create perspective on where the
client is placing attention and what is motivating behavior in the
moment. This is in keeping with the traditional ACT question “What
are you willing to do and experience in this moment to move toward the
things that are important to you?”
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Creative Hopelessness
In the first group session, the goal is to uncover the unworkable
change agenda by bringing attention to the pain story. Session 1 is
focused on the left side of the matrix diagram. During the initial assess-
ment, clients describe their pain problems, the location of the pain, its
intensity or severity, and the many things they try, possibly daily, to
manage or control the pain. In the first group session, we look at all of
this in a special way. First, we note how long the pain problem has
existed. In groups, it isn’t uncommon to find totals of well over one
hundred years of experience among all members in dealing and living
with pain. Who could argue with one hundred years of experience of
anything? I sure wouldn’t, and I tell them that. I let clients know that
their experience is what will be the guide. The point of this session is to
slow down and really look at what is. As clients work with individual
matrix worksheets, I invite them to list the problems they suffer in the
bottom left quadrant and the solutions they’ve tried in the upper left
quadrant.
They can then map out a real-life example on their individual matri-
ces. I ask for an example of pain showing up inside the skin, as illustrated
in this dialogue.
Therapist: Pain shows up. What do you do? What happens next?
Client: I go to the doctor.
Therapist: Okay, so you go to the doctor to find out what’s causing
the pain or to do something about it, right?
These solutions may work for a few minutes or hours, but usually
they fall into the category of short-term solutions to the pain problem.
Most medical answers (aside from surgery, when it works) are temporary
in that they don’t resolve the underlying problem. There are many things
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that alleviate pain in the short term, and some that work in the longer
term, but nothing that works to remove the pain for life. If it sometimes
goes away, it continues to show up. The goal of this session is for clients
to experience that the process of outlining the problems, solutions, and
how they’re linked frequently creates a circle that just keeps going around
and around, getting thicker and darker in some areas. This realization
can feel heavy and depressing. It’s supposed to—not for the sake of creat-
ing depression, but for the purpose of looking at what truly is. The process
of trying to control things inside the skin leads to feeling hopeless. It
looks like a downward spiral and feels like being stuck in a rut.
The matrix is helpful here to help initiate part of the ACT process
known as creative hopelessness (Hayes, Strosahl, & Wilson, 1999). If
there is a whole other side of the model, that must then mean there’s an
alternative. What might that alternative be? This is the creative part of
the hopelessness. The middle and right side of the model allow for expe-
riencing that the self, in the center, is not wrapped up in the downward
spiral of attempts to control inner experiencing. Frequently, I end the
creative hopelessness session with the Man in the Hole metaphor (Hayes
et al., 1999), which illustrates the process of the session and can lead to
a thoughtful summary of the experience.
Identifying Values
Session 2 is focused on the right side of the matrix: values and com-
mitted action. Values are defined as setting the course for treatment,
based on the important things in life. Establishing that values are indi-
vidual decisions already present inside each person and personal to each
person is of utmost importance in this session. Each individual is asked
what is important to him or her, and these values are recorded on the
right side of the matrix. Because some people have great difficulty stating
something important to them, the worksheet includes a list of life
domains that people often say are important, to help them explore what’s
important to them. This list is by no means exhaustive; it’s just one set of
possible domains.
In this session, I introduce committed action using the distinction
between choosing and deciding in the following riddle: “Three frogs sat
on a log. One decided to jump off. How many frogs are left on the log?”
The answer is three, because as long as the frog has only decided but not
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Therapist: Great, that’s all you need to do for this exercise. The
instructions are simple: making a circle represents
making a choice. I’m going to say something, and I just
want you to draw a circle to make a choice, okay?
Client: Okay.
Therapist: On your matrix, draw a circle around a value you’d like
to work toward this year. (Pause for one second.) Now
draw a circle around a value you’d like to work toward
this month. (Pause for one second.) Now draw a circle
around a value you’d like to work toward this week.
(Pause for one second.) Okay, great. Does everyone have
three circles on their matrix?
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that direction and serving as a goal along the path. The homework is
then simply to do the planned action and notice what happens.
The Mind
In session 3, mindfulness comes to the forefront. The purpose of the
session is to set up for defusion or mindfulness exercises. I begin by
describing the mind as a tool for humans to use and outline the mind’s
job. This session focuses on the lower half of the matrix: things inside the
skin and our reactions to them. In order to communicate mindfulness as
conceived in ACT and as relevant to the matrix, I’ll use your own expe-
rience to demonstrate, just as I would with clients.
The mind is a useful tool that lives inside the skin. It helps us learn
things, usually quite quickly. It does many things automatically. A short
mindfulness exercise can provide a vivid illustration of the automatic
nature of the mind’s functioning. Visualize a piece of fruit. See yourself
cutting up that ripe, delicious-looking fruit. Now imagine putting the
first piece up to your lips and taking a bite of that big juicy…lemon! What
happened? Did the words on this page perhaps make you salivate a bit?
Human minds evolved to turn words into responses so we could
learn by indirect means. If each of us had to learn from direct experience
that lions and bears are dangerous, we all would have been eaten before
the first book was ever written. However, at times this amazing function
of the mind can cause problems. For instance, sometimes when pain
shows up, the mind may say that something can’t be done. Has this ever
happened to you? Assuming it did, what happened next? Sometimes the
thought that we can’t do something hooks our attention, drawing the
mind further inward. When this occurs, we’re hooked. Have you ever
walked down a hallway and bumped into someone or something? How
did it happen? Usually folks say, “I wasn’t paying attention” or “I was lost
in my thoughts.” This is the essence of being hooked: attending to inter-
nal experiences to the exclusion of external experiences without noticing
that this is happening.
The story of Sid and Fido is a great representation of the power of the
mind. One Saturday, Sid gets tired of listening to his daughter’s radio and
decides to take his dog, Fido, out for a walk. By the time he gets to the
farthest point on his walk, thunder breaks out and rain begins to fall. He
returns home soaked and shivering to find that he accidentally locked
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himself out of the house. He can still hear his daughter’s music blaring
inside. He pounds on the door and checks every window to no avail.
Finally, the radio stops briefly and his daughter hears him banging at the
door. She lets them in. Fido shakes himself off quickly at the door, walks
over to his food dish, has a snack, curls up on the rug, and takes a nap.
What does Sid do? He grumbles to his daughter, stomps around, tells his
wife what happened when she arrives home, and may even tell this story
to his friends at work on Monday. This is the difference between animals
and humans who are focused on indirect experience. Humans get hooked
on mental content and experience stress in the absence of the stressor.
Who would you rather be, Sid or Fido?
Willingness
Willingness is balancing between the left and right sides of the
matrix. It has to do with how we treat the right side. Are we struggling
with internal experiences, or are we doing something differently? Session
4 focuses on willingness as a physical posture of acceptance toward inter-
nal experiences. It’s achieved through practice in noticing the struggle
and choosing to do something different. To illustrate this physical
posture, I use a rope to pull a client or a hand to push a client’s hand to
demonstrate what happens when something is touching us. An auto-
matic response is to tense muscles or push or pull back. Try this some-
time if you haven’t. It’s impressive what your body does, almost without
you thinking about it, when someone pushes against your hand or runs a
rope through your hand.
Reactions to pain are often similar: muscles tense automatically.
Pain hooks us, and then we struggle. This struggling usually lands us
back in hopelessness. However, at that point we can begin to physically
practice a new posture toward hooks and the struggle: acceptance.
Acceptance is like relaxed muscles creating a space inside us that allows
us to move forward, toward our values.
A further way of describing the posture of acceptance is to imagine
the difference between experiencing a sunset versus solving a math problem
(Wilson & DuFrene, 2009). Again, I’ll engage your own experience for the
purpose of illustrating how to bring these concepts to life for clients. Have
you ever seen a sunset? How did you respond to it? Think about how your
body was as you watched it. Actually pause here and experience that for a
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moment. Then contrast that experience with how you’ve felt while solving
a math problem. Which of these is more like how you treat pain or other
uncomfortable internal experiences? Do you treat those experiences like
sunsets or math problems? Could you watch your internal experiences
somewhat like a sunset, with that body posture? Could you do that if it
meant being able to have the life you want for yourself?
Self-as-Context
People can become lost in the patient role, as Dahl and colleagues
eloquently describe (2005). They become welded to their pain, and it’s as
if it defines them so completely that they can’t imagine a perspective or
life beyond it. They are stuck in self-as-content—in defining themselves
by the content of their experience. Their mind has reduced them to their
pain and the limitations it imposes. To pull people from this stuck place,
the intervention described above may begin the task but still fall short.
Clients need to adopt a new perspective from which they aren’t reduced
to their pain. Describing this perspective, known in ACT as self-as-
context, is one of those places where words fail us. Describing it to clients
isn’t helpful; what is needed is the ability to experience this perspective.
Mindfulness exercises can help clients contact a sense of self that remains
stable and consistent through the constant changes in all aspects of their
experience—physical, mental, sensory, and emotional—and through
their different roles and ages. When initiating this work, usually in
session 5, I warn clients, “Please notice your experience and don’t simply
trust everything I say.” Then we explore the self that experiences things
by finding the self that is consistent and has both changed over time and
remained the same.
Practicing sorting with the matrix is in itself an exercise in self-as-
context as clients gradually understand that the perspective from which
they observe their matrix remains constant over time and cannot be
reduced to their pain or their other experiences, or to their behavior or
roles. The Chessboard metaphor (Hayes et al., 1999) can be helpful at
this stage. Clients are encouraged to see the content of their experience
as a set of warring pieces on an infinite chessboard, and to contact the
sense of having always been there, like the board, throughout all the
changes in positions of the pieces and regardless of which side won a
particular round. To the chessboard, it matters little who wins. It remains
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unchanged; it’s always present and able to notice each piece without
needing to get involved. Contacting a perspective that fosters the experi-
ence of remaining the same through whatever changes may come can
greatly help people commit to bold moves toward values. When commit-
ments are made from this perspective, it often brings a genuineness to
values that feels intensely vital.
How are you treating your passengers? Do you struggle against them?
Are you hooked by them? Or can you accept them, treating them like
old friends that you invite along for the ride?
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Terminating Therapy
Sending clients off to enjoy a full, valued life is an excellent ending to
this type of work. Of course, there will be setbacks, relapses, and so on.
These are expected. Life is full of highs and lows, including pain and suf-
fering. I prepare clients for this eventuality with the question “Would you
be willing to receive your setbacks and relapses as you’ve learned to
receive other experiences in this group, so you can move toward enjoying
a full life with all of this and so much more?”
Conclusion
When working with patients with chronic pain, the matrix can offer a
useful perspective. The specific perspective presented by the matrix is
functional contextualism: the ability to base behavioral decisions on
what works—what moves people toward their values—using acceptance
of internal experiences to allow for flexible responding. This work is a
combination of difficult emotions, fun and energetic metaphors, and
exploration of internal and external experiences. This chapter simply
presents some examples of metaphors and exercises that I have found to
work well in groups. It isn’t a treatment manual; rather, it’s an outline of
some things I typically do in treatment that you may find helpful when
working with clients with chronic pain. The matrix has been useful for
me and my clients, and I hope that you’ll find this to be the case for your
practice as well. The matrix offers guidance in asking effective func-
tional questions, making it broadly useful in working with clients, in
supervising and consulting with other professionals, and in life more
generally.
References
Asmundson, G. J. G., Norton, P. J., & Norton, G. R. (1999). Beyond pain: The
role of fear and avoidance in chronicity. Clinical Psychology Review, 19(1),
97–119.
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt,
H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric proper-
ties of the Acceptance and Action Questionnaire-II: A revised measure of
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CH A P T ER 7
Florian Saffer
My Matrix
While doing ACT with eating-disordered clients, a strong therapeutic
relationship is invaluable. As a therapist, I can be assailed by aversive
thoughts and emotions just as often as my clients. I may be visited by the
fear of not being up to the task or the shame of not providing effective
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ME
noticing
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The matrix can help these clients better notice their hooks and
where they might get pulled when they bite—whether these hooks seem-
ingly appear on the left, as suffering; or on the right, as things their mind
claims are important, but which are really inflexible rules. The matrix
can also help them differentiate between mental experiencing and inner
or bodily experiencing, which in turn can help them reconnect with and
better recognize sensations of hunger and satiety.
Annie
I have chosen to illustrate how I work with the matrix through the case
of Annie. This case will help you see how I use the matrix from the first
session to help clients increase their psychological flexibility. Annie’s
case will also help you see how well suited the matrix is to treating clients
with eating disorders and how it can be used to train the different ACT
processes with this population.
First Session
Annie is a twenty-two-year-old law student. She comes with the goal
of getting her eating behavior under control. She binges about four or
five times a week, then purges by vomiting or using laxatives. When not
bingeing, she follows strict dietary restrictions. She describes herself as
impulsive and a perfectionist who dislikes the unexpected.
Early in our first interview, she confesses to being obsessed by food.
Her mind bombards her with rules about what, when, and how to eat—
often contradictory: Eat a hearty breakfast and a frugal dinner, No carbo-
hydrates if you’re not exercising, Eat your fill but not a bite more, Skip
breakfast… When these show up, she easily gets hooked. When hooked,
she becomes unable to fully engage with her experience of the moment.
She also has difficulties contacting her inner experience. She says she
has too much on her plate and is generally too stressed to know when
she’s hungry or tired. She’s constantly striving to silence her food-related
thoughts through sports, excessive studying, relaxation, and more, but
nothing really works.
When I asked Annie what she expected from our work, she answered
without hesitation: “I want to feel better.”
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Seeing how highly fused with her thoughts Annie was and how stuck
she was in struggling against them, I chose to start working on her fusion
with rigid dietary verbal rules right away, using the matrix. Rather than
performing a comprehensive functional analysis, I invited Annie to work
with me on a recent situation illustrative of her difficulties. I thought it
might be interesting to start with the right side of her matrix so that from
the get-go our work would focus on ACT’s central goal: commitment to
a meaningful life.
Therapist: Wow, it seems your mind never stops. Minds rarely do.
They love creating rules and telling us stuff. It’s quite
normal. Problems arise when these rules prevent us
from doing what’s meaningful to us. Could you
describe to me a situation where these rules prevented
you from having fun?
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FIVE-SENSES
EXPERIENCING
ME
AWAY TOWARD
noticing
My friendship
with Marie
MENTAL OR INNER
EXPERIENCING
Therapist: Let’s get back to the restaurant. If you didn’t have all
these rules and all this pain, how would you have
imagined that night? Tell me about the best possible
restaurant evening with Marie.
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FIVE-SENSES
EXPERIENCING
Discussing fashion
Appreciating a delicious
dessert
Sharing pleasantries
Being present for Marie
ME
AWAY TOWARD
noticing
My friendship
with Marie
MENTAL OR INNER
EXPERIENCING
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FIVE-SENSES
EXPERIENCING
Discussing fashion
Appreciating a delicious
dessert
Sharing pleasantries
Being present for Marie
ME
AWAY TOWARD
noticing
Anxiety My friendship
Thoughts: with Marie
“Don’t touch the fatty
stuff”
“Turn dessert down”
“You’ll have to make up
for all these excesses”
“You’ll put on at least
5 pounds!”
MENTAL OR INNER
EXPERIENCING
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FIVE-SENSES
EXPERIENCING
Anxiety My friendship
Thoughts: with Marie
“Don’t touch the fatty
stuff”
“Turn dessert down”
“You’ll have to make up
for all these excesses”
“You’ll put on at least
5 pounds!”
MENTAL OR INNER
EXPERIENCING
Figure 7.5. Annie’s completed matrix with her away moves in the
situation.
Therapist: What feelings came along with these things you did?
Client: I felt on edge…overwhelmed…frustrated…
Therapist: So complying with these rules didn’t help you feel
better? It sounds as though it might even have made it
worse.
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Therapist: So it kind of went around like this? (Draws the arrows on
the left side in figure 7.6.)
Anxiety My friendship
Thoughts: with Marie
“Don’t touch the fatty
stuff”
“Turn dessert down”
“You’ll have to make up
for all these excesses”
“You’ll put on at least
5 pounds!”
MENTAL OR INNER
I’m frustrated
EXPERIENCING
and sad
Figure 7.6. Annie’s away moves create more frustration and sadness and
further distance her from what’s important.
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Client: Tense!
Client: Hmm, yes. I’d rather feel the stuff on the right.
Therapist: Cool. See if you can notice this difference in your daily
life. Now let’s get back to your thoughts. These thoughts
usually come and go in your head. Does it make a
difference to see them written in black-and-white on the
matrix?
At this point in our work with the matrix, Annie noticed two con-
sequences of getting entangled with rigid eating rules:
It didn’t allow her, in this specific context, to effectively control
her pain.
It kept her away from her friend.
Client: Well, I’m afraid of failure, and hopeful that I can get
my life back to normal.
Client: Eating when hungry goes in the upper right, and the
fear that this won’t work goes in the bottom left.
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Therapist: It’s normal for stuff to show up on the right and on the
left. Moving toward what’s meaningful can often give
rise to feelings that aren’t always pleasant, such as fear
or shame. For example, during our consultation I
wanted to help you, and at the same time I could notice
a fear of not being up to it. To be totally honest, this
fear sometimes prevents me from being effective for my
clients. If you want, in our next consultation we could
look at these feelings that can prevent us from moving
toward what’s important.
Second Session
By our second session, Annie had noticed some changes in her
eating behavior. Twice, she’d added carbs to her lunch, which she identi-
fied as a toward move, yet she’d also felt guilty for doing so. Because she
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Therapist: Would you like to share what you felt during this
exercise? Okay if we use the matrix?
Therapist: Would you say you were more like Flexi or Spiky?
Client: The spiky one.
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- -
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the blues away, and so on—all can be hooks that would seem to be on
the right side and thus are commonly reported as being important. By
helping people identify the function of these verbal rules, the matrix
gradually helps them sort between the hooks that appear as a function of
suffering and those that contact what is truly important and vital.
By the end of the exercise, Annie’s face looked more serene. I invited
her to notice, over the next week, experiences of suffering and whether
she could receive them in a similarly kind fashion.
Therapist: As you struggle less, you may find that you have
more energy for the important stuff. You mentioned
how the shame you feel around your body image can
push you to isolate or spend hours in front of the
computer. But what would the Annie you want to be
do in these situations?
Therapist: Well, we all know this pull to move away from suffering.
Unfortunately, it can stop us from living the life we
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ACT in Digestible Bites: The Matrix and Eating Disorders
Conclusion
The matrix has become essential to my practice and central to my work.
As illustrated in this chapter, it’s a great tool for helping clients struggle
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128
CH A P T ER 8
Rob Purssey
“I’m just tired of always having to struggle. I’d be better off dead.” Clients
with chronic and severe symptoms often cause therapists to feel frustra-
tion, anxiety, sadness, and other unwanted experiences. We may struggle
in our work with these clients, at a personal and professional cost. And
yet, when these very clients make small moves toward values, they can
utterly transform their lives, over time. If I asked you to recall some
clients who have really moved you, as a clinician and as a fellow human
being, with their resilience and humanity, I bet those with chronic and
severe struggles would top the bill.
(Note: At times I use the term “symptoms” instead of “problem
behaviors” or “struggles” for the sake of workability and brevity, but this
doesn’t imply symptoms in the sense used in the medical model, indica-
tive of an underlying disease or disorder. Here, “symptoms” simply means
behaviors that are unworkable over the longer term in a particular
context—clients’ problem behaviors or struggles.)
These clients may face various obstacles: traumatic histories; chronic
struggles with anxiety, depression, or pain; isolated or conflictual lives;
recurrent self-destructive behaviors; marginal living in harsh, unforgiv-
ing situations; ongoing psychotic experiences; dependence on substances
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Clinician Matrix
Notice that you are reading these words—with both your five-senses and
mental experiencing. Who is doing the noticing? Why are you reading
this? What discomfort might show up that could get in the way of moving
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toward the values that brought you to this book? Simply notice what
happens next: an away move or a toward move. Clarifying and remain-
ing aware of our own behavior in clinical work is essential, especially
with challenging clients. The matrix provides a simple and effective ori-
enting tool. As we introduce and use the matrix framework in each
session with clients, simply noticing what’s happening for us in each
quadrant of the matrix focuses and amplifies our awareness.
Clinician’s Values
The lower right quadrant of the matrix addresses what’s important
to us in working with challenging clients. Think for a moment about
what brought you to your training and your daily work as a health care
professional: perhaps helping others, kindness, caring, empowering, con-
necting, curiosity about the human condition, easing suffering, or social
justice—changing the world one life, one family at a time. Values like
these are probably guiding your toward moves in this very moment. Yet
when working with challenging clients in challenging situations, con-
necting with these values from moment to moment can often be…
challenging!
It’s easy to lose contact with what matters during difficult clinical
work or in inadequate, undersupported work environments. An ongoing,
intentional connection with our values—gently returning to them when
we inevitably drift—is essential for nurturing and sustaining ourselves.
From time to time during each session, notice why you’re choosing to be
with that client in that moment, and what tiny toward move is possible
in that moment. If what shows up is I’m not choosing; I have to, can you
perhaps find a “choose-to” even in that moment?
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Out of the Hole: The Matrix with Chronic and Severe Symptoms
In this way, we notice and emphasize the normal and natural away
move functions of suicidality in the client—and their consequences,
which are often very effective in the short term yet very life-narrowing in
the longer term. This view reframes such behaviors as attempts at
problem solving, functioning as perfectly understandable moves away
from unwanted mental experiences. Holding these functional analyses
foremost for ourselves and our clients allows us to notice our natural
anxious reactions with less entanglement.
Similarly, while it’s important to minimize external reinforcers for
clients’ suicidal behaviors, it’s equally important to manage our own exter-
nal reinforcers for therapeutic behaviors that are reactive and “risk-averse”
(and life narrowing for clients), such as inappropriate hospitalization,
increasing medication, involuntary treatment, “contracts,” and so on.
Simple measures include clearly documenting chronic rather than acute
suicidality; clarifying our functional, empirically based harm-minimization
approach; giving advice about crisis services; maintaining appropriate pro-
fessional indemnity insurance; and being aware of the extensive literature
supporting outpatient care of chronic suicidality and self-harming behav-
iors. There is no unbiased evidence supporting the use of medication to
decrease the incidence or severity of self-harm or of suicidality—quite the
opposite. There is evidence that, for instance, selective serotonin reuptake
inhibitors often increase suicidality (Ferguson et al., 2005). Maintaining
professional support, education, and supervision from within the profes-
sional communities you inhabit is critical.
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Client’s Values
“Nothing man. I just don’t care. What do you mean, what matters to
me?” For clients feeling a weight of pain when they dare to care, not
caring can become a vital mental away move. It dulls the acute, searing
pain due to the gap between what they want and what they’ve got—that
sharp ache that comes from contemplating places their mind tells them
they can never hope to go. “Not caring” on the other hand, brings only
flatness and a dull ache, which they may prefer to the pain you’re inviting
them to feel. Consider yourself the “dentist” they have come to see,
perhaps reluctantly. It’s probably best to not go straight to probing the
most painful tooth!
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As the time and setting permit, this line of questioning can gently
elicit a picture of the client as a human being within a context. All of this
information, along with details on activities of daily living, subtly con-
nects with what matters, or could matter, without using scary words like
“values” or “caring.” Given time, we might expand this, catching even
tiny ways of passing the time, like watching TV and which shows,
reading, browsing the Internet, exercise, relationships with friends and
family members, pets, and so on, both currently and in the past, before
the client got so stuck. You might ask questions like, “As a kid, what did
you do in school?” Covering this ground is worth at least a third of assess-
ment time. Make it clear that this is the important stuff—a rough guide
to where the client might go on a life journey toward valued living. If the
client is living an impoverished life in which values have seemed unap-
proachable, keep it gentle and light.
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medications to get rid of “bad” feelings, and so on. Mental, or inner, less
easily observed away moves, which are often pervasive and heavily
invested include dissociating and ruminating, which may hook both
client and therapist due to their reasonableness and inevitability, and a
deeply felt need to understand or get insight. Remember, it’s always about
the function of the behavior—the function in that moment, in that par-
ticular context in the client’s life. Any of the moves listed above might be
fully toward or very much away. Cultivating and reinforcing an open,
aware, active matrix perspective allows for ongoing functional analysis of
behaviors, as we simply notice how they’re working for valued living.
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anxiety, depression, and substance use. For convenience, let’s assume the
therapist in these vignettes is male.
Therapist: So what’s your living situation? For example, do you live
in a house or an apartment? Is it a rental, or is it yours?
Do you live alone or with others? Tell me about how you
spend your days—even small things, like TV or perhaps
exercise.
Client: Well, I’m stuck back at home. Pathetic isn’t it, at my age,
living with my parents? Ever since I had to quit work
because of my depression, my illness, I don’t do much,
mostly just getting stoned or popping Valium. I’m mostly
feeling suicidal, but I can’t kill myself because of my
damn parents. I haven’t been exercising since I gained
all this weight because of the meds. It’s embarrassing!
Therapist: It sounds really tough, Mike, feeling so stuck like that,
and with your mind giving you such a hard time. You
know, I can hear kindness in there for your parents,
even with the frustration. It sounds like being indepen-
dent and a bit more active might matter to you. What if
our work could be about moving toward things like that,
even in tiny ways?
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Therapist: So, Rachel, can we just notice what’s showing up for you
here and now? That you’re coming here, telling me this
stuff, even though it’s hard for you—that feels like a
toward move to me in this moment. How about you?
Therapist: It seems to me that, for you, growing your life matters,
at least a little bit. It must for you to come here and
share this with me. Is it okay for us to keep working on
moving toward this, toward you growing your life, even
with frustration and uncertainty? For this moment, can
we just let those voices, and those stories, come along
for the ride?
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Conclusion
In working with clients with chronic and severe symptoms, we’ll have
plenty of unwanted painful experiences, both theirs and ours, coming
along for the ride. What if we could make a little room for these unwel-
come passengers, welcoming them and allowing these painful thoughts
and feelings in the service of what we care about most deeply? They are
so closely connected. Gently carry them toward more valued lives for
your clients, and toward a valued path for you in your chosen work. With
kindness and compassion, we all might choose to explore what’s possible
in this moment, and this next moment, and the next. I wish you well in
your journey.
References
Chiles, J. A., & Strosahl, K. D. (2005). Clinical manual for assessment and treat-
ment of suicidal patients. Arlington: American Psychiatric Publishing.
Ferguson, D., Doucette, S., Glass, K. C., Shapiro, S., Healy, D., Herbert, P., &
Hutton, B. (2005). Association between suicide attempts and selective
serotonin reuptake inhibitors: Systematic review of randomised controlled
trials. British Medical Journal 330(7492), 396.
Hayes, S. C., Barnes-Holmes, D., and Wilson, K. G. (2012) Contextual behav-
ioral science: Creating a science more adequate to the challenge of the
human condition. Journal of Contextual Behavioral Science 1(1–2), 1–16.
Kupfer, D. J., First, M. B., & Regier, D. E. (Eds.). (2002). A research agenda for
DSM–V. Washington, DC: American Psychiatric Association.
Strosahl, K. D. (2004a). ACT with the multi-problem patient. In S. C. Hayes &
K. D. Strosahl (Eds.), A practical guide to acceptance and commitment therapy
(pp. 209–245). New York: Springer.
Strosahl, K. D. (2004b). Forensic and ethical issues in the assessment and treat-
ment of the suicidal patient. In W. O’Donohue & E. R. Levensky (Eds.),
Handbook of forensic psychology: Resource for mental health and legal profes-
sionals (pp. 129–154). San Diego: Elsevier Academic Press.
Strosahl, K. D., Robinson, P., & Gustavsson, T. (2012). Brief interventions for
radical change: Principles and practice of focused acceptance and commitment
therapy. Oakland, CA: New Harbinger.
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CH A P T ER 9
The matrix began as a way of working with clients with PTSD. For well
over twenty years we’ve worked with people with severe trauma memo-
ries. First, we used a psychodynamic approach, then moved on to family
systems, stress inoculation training, cognitive behavioral therapy, pro-
longed exposure therapy, and finally acceptance and commitment
therapy. After about twenty thousand hours of reading about and doing
ACT, the matrix diagram emerged.
Almost everyone intuitively understands that some people who have
experienced trauma are severely troubled by memories of the trauma.
After the Civil War, soldiers who were struggling with their traumatic
memories of the war were referred to as having “soldier’s heart.” Later
terms were “shell shock” and “battle fatigue.” Beyond those exposed to
combat, survivors of traumatic experiences such as rape and natural
disasters were also known to carry the wounds of their trauma for years.
PTSD
Only a small percentage of people who experience trauma develop
PTSD. Said another way, most people who experience trauma don’t
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Something You Can Never Forget: The Matrix and PTSD
Arriving in Therapy
Most people struggling with trauma memories show up to therapy fearing
that they’ll have to talk about their trauma memories. And, of course,
with most therapies this is true; at some point, the trauma memories
must be talked about. Even ACT practitioners often believe that the
trauma must be talked about.
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Something You Can Never Forget: The Matrix and PTSD
To date, every person we’ve asked has said that it’s okay. With this
agreement, we then proceed to show them the diagram in one of two
ways. Here’s an outline of the first approach:
1. We ask clients to use their five senses to notice a pen, pencil, or
some other object, usually omitting taste for sanitary reasons.
2. We ask clients to put the object away from their five senses and
then recall each of the sensory aspects of the object through
mental experiencing.
3. We ask them to notice the difference between their sensory and
mental experiencing of the object. (Note: It isn’t necessary that
they notice a difference. Some clients will say there was no dif-
ference. To this we respond, “Great! You noticed that to you
there was no difference.”)
4. We ask clients to recall how it feels to move toward someone or
something important to them, such as walking toward a loved
one.
5. We ask clients to recall how it feels to move away from some
unwanted mental experiencing, such as moving away from fear.
6. We ask clients to notice the difference between how it feels to
move toward and how it feels to move away.
While we’ve been asking these six questions, we’ve been drawing the
matrix diagram on a whiteboard or other suitable surface. We end by
saying something like “Psychological flexibility is in the center here
(drawing a circle in the center), with you noticing these two differences.”
The other method we use is to ask the following questions while
drawing the matrix diagram, usually on a whiteboard:
1. Who and what are important to you? The answers are written in
the lower right of the diagram.
2. What shows up inside you, such as fear, that can get in the way of
moving toward who and what are important to you? These answers
are written in the lower left.
3. What kind of behaviors do you do to move away from unwanted
stuff that shows up inside you? For example, someone might run from
fear. These answers are written in the upper left.
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4. What behaviors could you do to move toward who and what are
important to you? These answers are written in the upper right.
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Something You Can Never Forget: The Matrix and PTSD
Five-Senses
Experiencing
Drinking
Alcohol
Fear
Mental
Experiencing
Continuing with this example, you’d next ask, “Does drinking get
rid of the fear forever, or does the fear eventually come back?” Clients
always answer that the fear comes back. At that time, you can complete
the circle back down to fear, as in figure 9.2.
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Five-Senses
Experiencing
Drinking
Alcohol
Fear
Mental
Experiencing
Then ask, “When the fear comes back, do you drink, or do some
other away move?” Of course, the answer is yes, so you can draw another
half circle back up to drinking, or whatever away behavior the client
identified. Keep doing this, drawing smaller and smaller circles, and then
write “Stuck” underneath “Away” on the matrix, as in figure 9.3.
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Something You Can Never Forget: The Matrix and PTSD
Five-Senses
Experiencing
Drinking
Alcohol
Fear
Mental
Experiencing
Explain that everyone gets stuck in these kind of cycles. We all have
our stuck spots.
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Sorting
After the matrix diagram is presented, the next stage of the process is
sorting. To do so, engage clients in telling some story, any story, and as
they do so, sort the story into the four categories of the matrix diagram:
Sensory experiencing
Toward actions
Away actions
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you were going to walk over and get it. Maybe someone calls you an
insulting name. The list of potential hooks goes on and on.
To explore this, simply engage clients in a conversation about hooks.
If you’re running a group, a discussion of people’s favorite hooks is likely
to be humorous, lively, and enjoyable. Even in an individual session, this
is usually a lighthearted discussion. Toward the end of the discussion,
ask, “What hook do you think will show up next in your life?”
Once clients predict the hook, you can ask, “Do you think you could
notice the hook and then notice what you do next?” Essentially everyone
is willing to try to remember to notice their hooks and what they do
next. Some people get excited and say things like “So I’m supposed to
notice the hook and then do a toward move?” To this, you would respond
that, after noticing the hook, both toward and away moves should be
noticed.
At the end of the session, clients are given the homework assignment
to notice hooks and what they do next, with the clinician noting that the
homework either will or won’t be done, and that either way will work for
learning.
In the next session, a discussion about hooks that were noticed or
not noticed ensues. Clients are likely to tell other toward and away stories
and engage in some sorting into the matrix diagram.
Clients with trauma memories might notice that they’re especially
likely to get hooked by their trauma memories and that they have trouble
having those memories and getting on with productive living. For these
clients, the following routine can be very helpful.
Because these clients are already very familiar with the matrix
diagram and sorting, you can simply say something like, “Yes, sometimes
trauma memories can be very troubling. Some clients have told me that
the following mixing or blending exercise was very helpful to them.
Would you like to hear about it?” To date, all of our clients have said yes.
“When you notice having a trauma memory, pause and notice your
current five-senses experiencing. Where would you sort that trauma
memory?” They are almost always sorted into the lower left of the matrix.
“And where would you sort the five-senses experiencing?” It is almost
always sorted right at the top of the vertical line. Continue by saying,
“Great! Now, if you get the chance, you can pause and literally mix or
blend the two experiences together.” While saying this, draw your fingers
together in a visual representation of a mixing action. Explain that all
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they need to do is notice what that mixing does. During subsequent ses-
sions, you can ask clients whether they tried the mixing. They usually
have, and they often tell some interesting stories about the experience.
If you are like most clinicians, us included, your mind is saying, This
is too simple. There’s no way something so simple will work. However, since
it’s so simple and takes so little time, it’s worth a try. You might just find
that it leads to a lot more valued living for clients.
Cognitive Distancing
Many people don’t know that the original name for ACT was “com-
prehensive distancing,” but we can all quickly understand why Steve
Hayes and company switched to the much sexier “ACT.” However, com-
prehensive distancing remains part of the model, even if it’s not discussed
much. Imagine a client sitting in your office with a story to tell—a story
that’s mucking up the client’s life. The client doesn’t have much distance
from the story, if any. As you describe the matrix, you also draw it on a
whiteboard or some other surface a few feet away from the client. The
two crossed lines are very primitive and easy to stare at. Then you place
the essential elements of the story on the diagram: five-senses experienc-
ing, mental experiencing, toward behaviors, and away behaviors. As the
client’s story is plotted on the diagram several feet away, it is physically
distanced from the client.
In addition, the story is being taken apart through the process of
pausing and sorting the story. Sorting allows new experiences of the story
to be related to the story, including that the story is being told in a safe
place with no ill results. This is defusion, as it is now called in ACT.
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Clarifying Values
In matrix work, “who or what is important to you” corresponds to
the ACT term “values.” This is simply because the term “values” tends to
carry some baggage. For example, a client might think of the religiously
and politically loaded family values when you refer to values. Then you’re
stuck explaining how ACT values are different from family values. This
isn’t productive, so the simpler “who or what is important to you” can be
used to good effect in values clarification.
Committed Action
Committed actions are inherent in the matrix and need not be
taught. These actions are usually sorted in the upper right quadrant.
They are toward moves.
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other mental experiences) showing up in real life, and then notice the
choices they make after experiencing the memory.
The matrix also inherently takes into account who and what are
important to the client in working with trauma memories. After they
notice a trauma memory (possibly as a hook), clients are drawn into
choosing between moving away from or toward who or what is impor-
tant. They learn that reactions to trauma memories need not be
automatic—they have a choice. Notice that this choice is not forced
upon clients; rather, it’s there for them to discover.
Present-Moment Awareness
An often mentioned part of ACT is present-moment awareness,
including the practice of mindfulness. Because “mindfulness” is another
term that many people dislike for a variety of reasons, it isn’t mentioned
in the basic matrix routines. Instead, present-moment awareness is refer-
enced with the word “noticing,” as noticing can only occur in the present
moment. In this way the matrix diagram automatically returns people to
the present moment with no explicit intervention needed.
Self-as-Context
One of the more complex terms in ACT is “self-as-context.” It’s
easiest to think about it by first thinking of self-as-content. That simply
means totally buying the words you’re saying about yourself. In much of
life this is fine. You might say, “I’m an accountant.” If indeed you practice
that profession, to an extent it is you. If you’re a mental health profes-
sional, you might say, “I’m a mental health professional.” Again, no
problem.
Let’s take that further. If you’re a mental health professional, we’d
like you to do the following exercise: The next time you see a loved one,
stand up straight, put your hands on your hips, and sternly proclaim, “I
am a mental health professional.” Notice the reaction you get. Then try
this with a stranger or someone you don’t know well. For example, next
time you’re eating at a restaurant, stand up straight, with your hands on
your hips, and proclaim to the waitperson, “I am a mental health profes-
sional.” Again, notice the reaction you get.
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Something You Can Never Forget: The Matrix and PTSD
Conclusion
Another way of saying “self-as-context” is “psychological flexibility.” In
matrix terms, people have the choice to do one of several away moves or
one of several toward moves at any moment. Further, the choice that’s
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References
Foa, E. B., & Rothbaum, B. O. (1998). Treating the Trauma of Rape: Cognitive-
Behavioral Therapy for PTSD. New York: Guilford Press.
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CH A P T ER 10
Jean-Michel Vincent
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session with the matrix diagram, clients start applying it to their every-
day lives and come back for their next session with functional contextual
stories evidencing an increase in flexibility.
When clients can’t discriminate between toward and away moves, I
spend time training this discrimination in our exchanges and help them
observe their experience in context. What works well for me is to invite
clients to observe whether they see anything on the right side. I do this
through questions such as “In a workable life, what would you do instead
of your actions in the upper left quadrant? What would the stories that
fill a life that works be for you? What did you use to do before suffering
showed up? What did you do to move toward what’s important? And if
you didn’t have all this stuff showing in the lower left quadrant, what
would you do?”
Validating Suffering
I unconditionally validate my clients’ experience of their suffering.
For example, I might say, “I see that this is really painful for you and that
you feel totally stuck. Is this how it is for you?” I find that validating suf-
fering often opens the door to more flexibility on clients’ part. They
might then say, “Well, yes, I’m stuck. But I still manage to do a few things
on the right side.” Unconditionally validating clients’ suffering allows
them to look at it for what it is: an experience of suffering, something in
the lower left quadrant. I invite them to slow down for a moment and
look at what this experience is made of, like a scientist observing a phe-
nomenon for the very first time and taking inventory of the different
aspects of their experience of it. I also ask them to write the mental and
sensory aspects of their suffering on different-colored sticky notes.
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Being Stuck
Sometimes clients can be so stuck in suffering and avoidance that
they feel hostility toward the therapist. In turn, the therapist may feel
stuck in the left part of his or her own matrix. Being stuck need not be a
problem in itself as long as the therapist doesn’t make a problem of it.
Ideally, the therapist can adopt a matrix perspective on his or her experi-
ence in the moment and initiate a toward move, for example, by sharing
with the client that he or she feels stuck and is having trouble connect-
ing with the client. In this situation, I may then ask, “And how is it for
you?” This invites clients to notice their suffering (lower left) and away
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Spot the Matrix: Psychological Flexibility in Private Psychiatric Practice
Celia
Having described the skills that the matrix can cultivate, I will now illus-
trate them with examples from my clinical practice, starting with Celia,
a ten-year-old who won’t touch doorknobs. Her compulsions are a major
impediment to her.
Therapist: Look at this little diagram I call the matrix. What you
don’t like is on the left, and what you really want to do
is on the right. So what do you put on there?
Therapist: And what happens when you don’t want to touch it?
Therapist: Good. You noticed that. And what do you really want
to do?
Therapist: Oh yes, your head tells you this. And when your head
says this, what do you do?
Therapist: Good, you noticed that. And does that move you
toward or away from what you really want to do?
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Client: Away.
Therapist: Good, you noticed that too. So on the left is what gets
you stuck, and on the right what you really want to do.
What do you choose? Do you do what your head tells
you and get stuck, or do you do what you really want to
do?
Client: I’d choose what I really want to do, but my head tells me
fifty people have touched this doorknob!
Therapist: I see this is hard for you. Here’s a little exercise that
could help us. Try to have the thought I can’t raise my
hand, and when you have it, raise your hand to show
me. Okay?
Therapist: Good. You noticed that! So, Celia, when your head tells
you to do something on the left and what you really
want to do is on the right, could you practice noticing if
you can see both sides of your matrix, and then see if
you can choose what you do—whether on the right or
on the left? What counts is that you can choose,
because when your head tells you not to touch the
doorknob, does it give you a choice?
With Celia, I conducted a contextual functional analysis from the
very first session, using the matrix as the perspective from which to
conduct the clinical conversation. Celia went home with a small paper
matrix and instructions to practice noticing when the matrix showed up
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Spot the Matrix: Psychological Flexibility in Private Psychiatric Practice
in her life. In other words, I invited her to conduct her own contextual
functional analysis every time anxiety showed up in her life.
Celia came to the second session with functional contextual stories,
such as “My head was saying fifty people had touched the doorknob, but
it was important to me to get through that door to do what I really
wanted. First I avoided touching the doorknob because of fear, but it was
still important to do what I really wanted. I saw the two sides, left and
right, and I saw that opening the door was possible. So, even with the
fear, I touched the doorknob.”
Michael
Michael is stuck at home. He has anxiety attacks that bring tremors and
uncontrollable head shaking. He’s lost his job and lives on welfare. After
presenting the matrix and its perspective on a life that works, I initiated
this dialogue.
Therapist: Given the stuff that shows up, how is your life working?
Client: I live on the left. I live on the left…
Therapist: Living on the left, that’s when all of our actions are
linked to our suffering and fears, when everything we do
is in the service of moving away from anxiety. Is this
how it works for you?
Client: Yes, I spend all my time worrying about when the next
anxiety attack might happen.
Therapist: And does that stop you from doing things that would be
important to you?
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Therapist: Yes, it’s exactly how you were describing your anxiety
attacks. Would you be willing for us to continue, using
this session as an opportunity to notice what’s happen-
ing right here, right now?
Client: You’re a doctor after all. I know you can understand me.
So okay.
Therapist: Thank you for your trust. Now, can you bring your
attention to your bodily sensations…and the thoughts
that show up…and at the same time notice the sensa-
tions around your breathing? See if you can just notice
what shows up, without trying to change those sensa-
tions or thoughts or push them away. See if perhaps you
can receive them with curiosity and kindness. See if you
can slow down and notice all this from the central point
on your matrix, the perspective from which you can
notice all of this while keeping some distance from it.
Therapist: Would you be willing to see if you can spot the matrix
in your experience between now and next week? When
you do, could you simply sort what shows up as five-
senses versus mental experience, and then see if you
have a chance to choose to do a toward move?
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Corrina
Corrina is a forty-seven-year-old woman who’s been suffering from loneli-
ness since the breakup of her twenty-five-year marriage. She says her life
is over. She cries a lot and feels utterly stuck in despair.
Client: It’s been a year since my husband left me, and I’ve lost
all zest for life.
Client: “I’ve lost all zest for life,” that’s suffering, so to the
left. It’s like last Sunday: I went on this outing with
a group of people who like impressionist art and I
felt so bad. I can’t feel good with other people
anymore. I should have stayed home and watched
TV. It would be better if I simply disappeared. (Sobs.)
Client: Yes. I can’t feel good with other people anymore. I don’t
feel like going out anymore.
Therapist: And what did spending the afternoon with this group
allow you to do? What was on the right? What was
important?
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Client: We visited the museum and learned about this painter,
Courbet. I could share with others in the group. I could
never share about art with my husband.
Therapist: I’m touched that you would share with me that art is
important to you. And where does sharing about art go
on your matrix?
Client: Closer.
Client: I don’t want to feel this pain inside. That’s in the lower
left corner.
Therapist: And yet does sharing about art with others count less
when the pain is there? Does it bring you closer to or
further away from other people?
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Client: Hmm. I guess I’ll get back in touch with the impression-
ists appreciation group and see what other outings they
have planned.
Therapist: It makes me feel closer to you to hear you say that. I’ve
appreciated sharing with you around your passion for
painting. How about you?
Gina
Gina is thirty-three years old and has lived with her partner for three
years. She dearly wants children, but her partner has already fathered
two daughters and doesn’t want more kids. She resents it but is afraid to
discuss it with him. Here’s an excerpt from our first session.
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Client: Yes. I wonder what I’m gonna do. He even tells me, “If
you don’t like it, you can leave.”
Therapist: You feel stuck. And does clamming up make you move
closer to or further away from him?
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Client: Further.
Therapist: So you feel stuck. But is what’s important to you still
important to you?
Client: Yes.
Client: Further.
Client: I’d tell him, “You never want to talk about what’s
important to me.”
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Client: I could say, “It’s hard for me when you won’t talk about
what’s important to me.”
Client: Okay.
In our second session, I continued to invite Gina to take the perspec-
tive of the two matrices (hers and her partner’s) to help her navigate
their interactions. I also used the two-matrix perspective of client and
therapist to work on inflexible repertoires in the context of the therapy
relationship in the service of helping Gina generalize enhanced flexibil-
ity to interactions with her partner.
Client: I think I’m not going to come back. In any case, the
problem is him, and I can’t change him.
Therapist: When you say this, I feel stuck. I’m on the left of my
matrix. How about you?
Therapist: So you noticed that. And is what’s important to you less
important to you?
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Spot the Matrix: Psychological Flexibility in Private Psychiatric Practice
Therapist: It’s moving to see how painful it is for you. I was moved
when you told me how important it is for you to have
children. I’m wondering whether you could also do this
with your partner—if he too might be moved if you told
him.
Client: Yes, but it’s not possible. He doesn’t want to hear about
it.
Client: But I’ve already told him I’m an honest person, and if
we ever separated, I’d let him see his children.
Client: Well, I could tell him that I understand it’s hard for him
to think of having children again—that I can see it’s
not easy for him. I could ask him if it’s important for
him to have children and what he could do if he had
more children.
Therapist: Yes. You could ask him to show you his matrix. You
could validate what he feels and help him notice the
different aspects of his experience. You could also show
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Conclusion
I hope that by sharing around my use of the matrix diagram in my prac-
tice as a psychiatrist in private practice, I’ve given you a sense of the
flexibility of this model. In my experience, it’s the model that’s allowed
for the fastest progress toward a valued life for many of my clients.
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CH A P T ER 11
Benjamin Schoendorff
FIVE-SENSES
EXPERIENCING
AWAY TOWARD
Fear Better planning treatment
Brain fog Progressing as a clinician
Shame Being useful
Some constriction in the back of Better helping my clients
my throat Mastering a new skill
«How can these people do it?» Becoming more flexible
«Is there really any use to this?» Better training clinicians in ACT
«I’ll never be a proper clinician if
I can’t do this»
«Do I really have to do this?»
«Honestly, what’s the use?»
MENTAL
EXPERIENCING
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Casing the Matrix: A Tool for Case Conceptualization
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The ACT Matrix
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Casing the Matrix: A Tool for Case Conceptualization
Five-Senses Experiencing
Q1 Q2
Therapist away moves Therapist toward moves
Q4 Q3
D1
Inner Experiencing
Q1 Q2 Q3 Q4 IE
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Matrix Case Conceptualization Worksheet
186
Significant history
The ACT Matrix
Client strengths
Notes:
of this chapter, I’ll illustrate use of the worksheet with a clinical example.
conceptualization gradually emerges from filling in the form. In the rest
Casing the Matrix: A Tool for Case Conceptualization
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like to get married, but Linda is plagued by thoughts that he’s too good
for her, that he doesn’t know who she really is, and that if he did, he’d
leave her. When she’s alone with Ella, she sometimes fears she might hurt
her, especially if the baby demands attention when Linda is feeling down
and confused. She regularly phones her mother for support, but their
conversations always leave her feeling confused and angry, and with a
strong sense that her mom doesn’t really care about her. She also regu-
larly calls Jim for reassurance. He readily assures her that she’s a good
mother, but lately she’s started doubting that he could really mean it.
She’s convinced he has no idea how damaged she really is. She says her
objective is to regain her self-esteem so she can feel better and not be
such a burden on Jim and a danger to Ella.
During our first session, I heard her story and presented the matrix
model in broad strokes, suggesting there might be an alternative to trying
to hold back her thoughts and feelings lest she become submerged by
them and do things she didn’t want to do. Using Jon Kabat-Zinn’s Surfing
metaphor (Kabat-Zinn, 2005), I likened her feelings to waves and sug-
gested that Linda might be able to learn to surf so that she wouldn’t be
submerged by the waves and might also be able to choose in what direc-
tion to surf. At the end of the first session, Linda asked me if she was
worse than other clients and if I thought she could be helped. I reassured
her she was no worse than others. In the second session, I presented the
matrix in more detail and invited her to start sorting her experience
around a difficult situation with Ella. She had some trouble sorting
actions as away or toward moves, as well as difficulties sorting inner
experience from five-senses experience. I gave her sorting exercises to
explore at home. At the end of the session, Linda expressed strong doubts
that she could be helped. I reassured her that she was making good
progress.
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189
Matrix Case Conceptualization Worksheet
190
Name : Initial goals: Strengthen self-esteem
Five-Senses Experiencing
Yelling
Q1 Q2
Therapist away moves Blaming Therapist toward moves
Drinking
The ACT Matrix
Feels
Q4 Q3 Practicing D2 toward/away
Practicing opening up and
nothing in
D1 Feeling hopeful,
trusting in the therapeutic
her body 4 scared and sad relationship
Therapist: Okay, so all of that goes down there. What else goes
there?
Therapist: So there are all these things. (Reads them back.) Okay,
so when these show up, what have you done to move
away or escape from them?
Therapist: So those things go in the top left. Anything else you’ve
done or still do when the things in the lower left show
up?
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Therapist: Is that a bit like when you asked me if therapy would
work?
Client: (Laughs.) Yes. Actually it is. The thing is, the minute
I put the phone down, I start worrying again. (Pauses.)
Sometimes I also try calling my mum, but that never
works. I just get angry because she doesn’t care about
me.
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Casing the Matrix: A Tool for Case Conceptualization
Therapist: Sure. I also have stuff I don’t want to think or feel, and
sometimes I do things to move away from it. For
example, when you asked me to reassure you last time,
I noticed I was afraid you’d think I was incompetent,
so I reassured you. So that goes in the other top left
box. Did my reassurance work?
Client: It did. But the minute I left your office, I started worry-
ing again.
Therapist: Sounds like when you call Jim. And what happened
earlier today when I didn’t reassure you but told you
I could see how hard this was for you?
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The ACT Matrix
Client: Be more open with Jim, share my feelings more, let him
truly see me. I guess I’d call him to ask about how his
day is going rather than to check that he’s coming back.
I guess I’d like to be able to really commit to our
relationship. Exercising. Oh, and I have this dream to
start studying again—if only I didn’t have such low
self-esteem.
Therapist: So, sharing with Jim, calling him to ask about his day,
committing to the relationship, and exercising. And for
education, what would we see you do?
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Casing the Matrix: A Tool for Case Conceptualization
Client: Sure.
Therapist: In addition to validating how hard things can get for
you, I’d like to show my willingness to stay present
with you when things get tough. I’d also like to gently
encourage your toward moves and your opening up.
Do you think that would help?
Therapist: Okay, so pushing goes to the left for me, right there with
trying to convince. Let’s explore gently first, okay?
Client: Okay.
Linda’s Values
At this point, we could complete Linda’s matrix by having her notice
what’s important behind her toward moves.
Client: Well, for Ella, being a good mother to her. For Jim,
being a good partner, maybe wife. Having someone to
share my life with. Feeling good about myself.
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The ACT Matrix
Client: Yes.
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Casing the Matrix: A Tool for Case Conceptualization
Therapist: Let’s look at the things that serve to maintain your away
moves. Are there things people do or circumstances
that make it more likely you’ll do these away moves? For
example, do you think the fact that Jim reassures you
makes it more or less likely that you’ll continue asking
him for reassurance?
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The ACT Matrix
Therapist: So the way she refuses to give you support actually
makes you engage in more away moves?
Client: Definitely.
Client: I guess the fact that I don’t have a job to go back to.
Significant History
For the purposes of conceptualization, significant history comprises
those elements of the client’s history that have a bearing on the function-
ing conceptualized on the front of the worksheet. Here’s what I recorded
for Linda:
35 years old. Partner Jim, 40 years old. Daughter Ella, 9 months old.
Some self-mutilation, drinking, and drug use in teenage years and early
adulthood. Binge eating.
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Casing the Matrix: A Tool for Case Conceptualization
Client Strengths
This box allows for an interesting conversation with clients and
invites us to look at their valuable qualities. Some clients may have par-
ticular difficulties with this. The therapist can help them explore their
strengths.
Therapist: So, the last box for us to fill in is your strengths. What
would you say those are?
Therapist:
(Writes that down.) Great. What else?
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The ACT Matrix
Client: Uh…sure.
Client: It’s nice of you to say all these good things about me.
Therapist: I mean them.
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Casing the Matrix: A Tool for Case Conceptualization
Matrix Quadrants
9
8
7
6
Q1
5 Q2
Rating
4
Q3
3
Q4
2
1
0
1 2 3 4 5 6 7 8 9 10
Session
4
P
3
IE
2
1
0
1 2 3 4 5 6 7 8 9 10
Session
201
The ACT Matrix
202
Casing the Matrix: A Tool for Case Conceptualization
Conclusion
The matrix diagram is well suited to helping clinicians conceptualize
clinical cases, share the conceptualization with clients, and make con-
ceptualizing a collaborative enterprise. It can help orient clients to the
model and further train them to adopt a functional contextual point of
view on their difficulties. It can also bring down some of the common
barriers to case conceptualization that clinicians commonly encounter,
in particular by providing an alternative to more linear and sequential
modes of conceptualization. Practicing quantification of matrix
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The ACT Matrix
processes, discriminations, and quadrants can also give a good feel for
client progress. In the end, the matrix is a tool for increasing flexibility,
and the worksheet presented in this chapter is just one possible approach
to conceptualizing with it. My hope is that it may prove useful to you,
your clients, and your trainees.
Reference
Kabat-Zinn, J. (2005). Wherever you go, there you are: Mindfulness meditation in
everyday life. New York: Hyperion.
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PA RT 3
Phil Tenaglia
“I have a point of view that I use when I work with people. Would you be
willing to let me show it to you?” The sullen fifteen-year-old sitting next
to me in my office looks up and nods as I rise to approach the whiteboard
in front of us. He and his mother have come to see me today because he’s
failing in school. He’s coming to our alternative educational program to
get a fresh start and possibly salvage his school year with the help of our
teachers and support staff. Together, he and I begin to sort his experi-
ences onto the matrix. On the wall behind him hangs a movie poster
from The Lord of the Rings: The Two Towers, showing Samwise Gangee
and Frodo amidst the ruins of a besieged city. They look lost, beaten, and
utterly confused, but also determined to press on.
Taking in the image of the student, the poster, and the matrix, I
notice that this is the context of my work with students, educators, and
parents. My valued direction is helping whomever is in front of me get in
touch with what is important to him or her—helping people learn for
themselves what works to get them where they want to go. They fre-
quently present like the bewildered hobbits in the movie, not knowing
The ACT Matrix
what to do. They have tried many things—mostly things that haven’t
worked. What I have to offer are some simple words and actions, along
with as much flexibility as I can muster. The fact that someone is sitting
in front of me means that this person hasn’t given up. We notice that and
see what shows up.
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The Matrix Goes to School: Promoting Psychological Flexibility in Education
is they are failing in school, which is pretty much the most important job
anyone under eighteen can have in our society. Individually and collec-
tively, they haven’t received much positive reinforcement for school-
based learning. Traditional learning environments have taken on aversive
functions, and avoidance is their default position. I have never been a big
fan of labels (nor are my students), and I immediately adopted the matrix
language view of them as stuck. It’s as if they’re trying to get somewhere
using a faulty compass. The valued direction I move toward is our collec-
tive task as educators to help them get unstuck so they can more readily
come into contact with what is important and rewarding to them.
Learning is a natural process. Schools focus on verbal learning, but
we humans primarily learn from our experience through the process of
trial and error. We get on the bike, we wobble, we fall, and so on, until
we get it or perhaps move onto something else. Following my initial
exposure to the matrix, I was excited and eager to try it out. In our school
program my role is to provide counseling, consult with staff, and inter-
vene with students who present with various crises. While I knew the
matrix approach had potential, it was nothing short of a paradigm shift,
since I came from a primarily psychodynamic or family systems model.
As far as I knew, the matrix hadn’t been tried in schools before. Along
with my enthusiasm, I noticed my apprehension, my sense of inadequacy,
and thoughts like This won’t work, They won’t get it, and I don’t know what
I’m doing. I also noticed the thought If I want them to develop some new
skills, I need to keep developing mine.
My first new move when students presented for counseling or in
crisis was to turn to a previously unused small whiteboard and say, “Hey,
let me show you this cool way of looking at things I just learned.”
Presenting it in this way, from an open, accepting, nonjudgmental stance,
I wasn’t telling them what to do, so willingness to listen showed up. We
talked; we sorted their toward moves, away moves, and five-senses and
mental experiencing onto the whiteboard; and they walked out more
psychologically flexible than when they came in. In the process, I expe-
rienced one of the many benefits of matrix use: it promotes flexibility in
the clinician or educator, as well as in the client or student. It has a bidi-
rectional effect on psychological flexibility. I was engaging in different
behaviors with my students (working from the whiteboard, moving
around the room, getting curious about the functions of our shared lan-
guaging, and so on). The kids were in the room with me noticing both
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The ACT Matrix
their behaviors and their unwanted issues, and they were free to choose
what they would do with all of that. The urge to “fix it” was there for all
of us, and we were learning not to scratch it, instead creating space for
the students to come up with new behaviors and keep going.
As I developed a functional contextual point of view, I came into
contact with my own language-based traps. The students I work with
have exquisitely developed avoidance behaviors from years of not feeling
good about education or being rewarded for it. Working with them fre-
quently results in my feeling defeated and beat up, as well. When stu-
dents were sorting moving toward what’s important (coming to school,
going to class, taking notes) and away from what they don’t want (yelling
to get away from anger, sleeping to get away from sadness), I also noticed
my own toward and away moves. I could see and feel a difference in
working with the matrix process (including continuously noticing the
thought It’s too simple!) as well as the pull to get into the “stuck” stories
the kids presented to me in words and deeds. I experienced that buying
the stories led to less flexibility in me and limited my problem solving. I
also experienced the matrix running inside of me. I was consistently
returning to the process of influencing my students and staff toward dis-
covering what works for them.
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students to work with and decided to include the teacher and educa-
tional assistant for maximum exposure. Running groups with folks strug-
gling with self-control and attentional issues is daunting and can easily
become chaotic. Plunging in, I presented the matrix point of view on the
whiteboard. Each week we gathered and sorted our experiences onto the
matrix, and everyone hung in there. Having plenty of art supplies and
paper helped. Our shared experiences did the rest. Together, we prac-
ticed noticing our toward and away moves. We noticed our hooks and,
using the Passengers on a Bus metaphor (Hayes, Strosahl, & Wilson,
1999), we practiced driving our buses with our wanted and unwanted
passengers. Rambunctiousness, frustration, and confusion routinely
showed up, and we kept moving. It wasn’t long before the kids asked to
run the group. A great way to learn the matrix is to teach it, so we gave
it a whirl. We decided to take turns so each had an opportunity to lead
our weekly “sorting parties.” If a new student entered the program, one of
the students ran the introductory session.
It was fun, and they were taking on the task of sorting their experi-
ences and learning to cooperate, take turns, share, acknowledge differ-
ent perspectives, and give feedback. The cool part was that none of this
was being explicitly taught or targeted. Prosocial behaviors kept showing
up week after week. My valued direction was simply promoting psycho-
logical flexibility, or as I called it “noticing if what you’re doing is getting
you where you want to go.” To do that, I held the thought of “getting
somewhere” lightly and let the students be their own guides. Including
the staff in the group exposed them to the matrix in the service of
helping the students, and everyone got to see everyone else from a differ-
ent perspective. Staff members were free to choose to use the matrix
elsewhere or not. Those that did use it began to use the language both
for themselves and their students, and it became a form of shorthand
communication, further enhancing collaboration.
Matrix Evolution
Curiosity and engagement go hand in hand with the matrix. My colleague
and talented case management partner Lynda Marasco was also begin-
ning to use the matrix with her students and experienced the flexibility
it gave her. We had the beginnings of systemic interventions for
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that show up. We keep the groups small (four to six students), and the
time frame is around forty minutes. Lynda and I also collaborate and
process a bit after each group.
We begin by drawing the matrix up on the chalkboard or whiteboard
(see figure 12.1). I put up the crossed lines with the arrows on the hori-
zontal line, write “Toward” and “Away” on either side, and label the ver-
tical line with “World of Behaviors” and “World of the Mind.” I use my
words and actions to continually bring the focus to the matrix diagram.
We all take turns sorting. I usually go first. The key is to say yes to what-
ever the students are verbalizing, and then sort that into the matrix with
a question such as “Where does what you just said fit on the matrix?” In
this way, I groom awareness and give them credit for participation.
World of
Behaviors
3. What have I been doing 4. What behaviors can I do
to the stuff that’s to move toward what’s
getting in the way ? important and take the
Is it working? stuff inside that I don’t
Am I moving closer to along for the ride?
what’s impoertant to me?
Away Toward
World of
the Mind
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get at valued life directions. Kids say things like “friends,” “family,” “fun,”
“education,” and so on. Once we have a list, I say something like “And all
of this is the important stuff that you move toward,” adding, “All people
have important stuff they notice themselves moving toward all of the
time. Most of the time it feels good.” Students share what toward moves
feel like, and all of that goes onto the board (toward moves in the upper
right and their feelings about them in the lower right). I continue, saying
“Sometimes when we’re moving toward important stuff, things show up
inside of us that get in the way of doing what’s important to us.”
I then slide over to the lower left and ask, “What inside stuff, such as
unwanted thoughts, feelings, or memories, have you noticed showing up
inside you that gets in the way of moving toward what’s important to
you?” With new groups I may have to get things going by writing some-
thing like “fear” or “anger” as an example of something that shows up
inside. I might give an example like “I sit in a traffic jam. Anger or frus-
tration shows up inside me. I complain.” The point here is that some-
thing shows up, we don’t like how it feels, and we do something to get
way from it. Students usually list internal content like fear, anger, worry,
doubt, sadness, depression, or urges to do harmful things. All of that is
sorted into the lower left quadrant of the matrix.
I move to the upper left and ask, “What kinds of things have you
tried to deal with your unwanted stuff, like to make it go away or get rid
of it?” They typically say things like “ignore it,” “think of something else,”
“yell,” “sleep,” “not go to school,” or, for teens, “smoke or do drugs.”
Groups really get into this, and you can get a good list going. In matrix
language we call these away moves because they are things people do to
get away from what they don’t want to have (think fusion here). After we
record the away moves, I say, “So you feel X or have thought Y down here
(pointing to the unwanted stuff below) and come up here and do Z (an away
move) to get away from this stuff. Right? Does this unwanted stuff down
here go away and not come back, or does it show up again?” Kids usually
say something like “It goes away for a while” or “No, it’s still there,” or
report that something else unpleasant shows up.
I start to draw arrows going from the lower left to the upper left and
back down again, illustrating an unworkable change agenda. As the
circle of arrows gets tighter and tighter, I say, “So you don’t want this stuff
down here, so you go up here and do this stuff (away moves), and then
you notice more stuff you don’t want, and it kind of goes round and
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round until you feel stuck.” I chat a bit about how everyone gets stuck
sometimes and say it’s okay to get stuck once in a while, but getting stuck
a lot doesn’t feel good or work to get us where we want to go. Everyone
agrees that it doesn’t feel good. Along the way I may also ask the question
“Who is noticing this?” Participants say “I am” or “me,” which highlights
that there is an “I” or “me” that notices what they are doing. I sprinkle
this question in often to encourage perspective taking and present-
moment awareness.
Next I slide over to the upper right and say, “So what kinds of things,
moves, or behaviors do you want to do to move toward who or what is
important to you?” Kids will say things like “Talk to my mom,” “Hang
out with friends,” “Go to school,” or “Pay attention to the teacher.” We
keep it simple. I then say, “And you can notice the moves you’re making
and how they work to help you get where you want to go. Noticing what
you’re doing gives you choice about what you do next. You can notice
yourself moving toward what’s important to you and take your unwanted
stuff with you. For example, you could have the thought I don’t want to be
here yet still be in class. You could have the feeling of being bored and do
your work. You could be angry or sad and talk to a friend. You could also
keep doing things to get away from what you don’t want and see if that
works to get you where you want to go.” Future discussions are in the
service of everyone noticing and sorting what we’re saying onto the
matrix. We also notice our hooks (lower right and left), since hooks can
take us either toward or away.
When I mention homework, the typical response is “ugh!” I say, “You
can either do it or not do it. It’s fine either way. The homework is to
notice what you do and whether it’s a toward move or an away move.” If
they do the homework, they get credit. If they don’t, they get credit for
noticing that they didn’t do it, and then we notice what they did instead,
taking us back into the matrix process. We also notice if any hooks
showed up.
All of this is all done collaboratively from an open, accepting stance.
We don’t tell the kids what to do. We want them noticing what they do
and sorting their experiences onto the matrix. Once they get the basic
language down, such as “toward moves” and “away moves,” they learn to
notice their behaviors. The key is to stay in process through responses to
their statements: “So when you put your head down in class, was that a
toward move or an away move?” “So you went out to the movies with
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your friends and took your sadness with you.” “Where would you put that
story on the matrix? Is that a story where you have lots of choices or few
choices?” The kids learn to sort their experiences—behaviors up top,
and thoughts, feelings, images, and memories below—and become aware
of the toward and away functions of their actions. Flexibility increases,
and they come up with more behaviors (derived relational responding) to
keep moving in valued directions.
Once kids get the process down, the groups more or less run them-
selves. Prosocial behaviors show up. For example, they help each other
notice their moves, come up with solutions, and try new behaviors.
School attendance and compliance among group attendees improves sig-
nificantly. We even overhear conversations in the hallways about toward
moves versus away moves and being hooked. It’s fun and rewarding, and
you can plug in your favorite ACT exercises for added enjoyment.
Matrix Derivations
Here are some other examples of how learners and educators have used
the matrix:
A struggling ten-year-old student notices that when he goes to
class, looks at his teacher, does his work, and so on, he feels good
and wants to do it more. He also notices that, in response, his
teacher smiles at him and helps him.
After several months of sorting, a learning- disabled middle
school student notices that she’s disturbing others in her efforts
to move away from her anger. She has the thought Maybe I
shouldn’t do this and chooses on her own to reengage in the
lesson.
A high school teacher has an image of the matrix in her head as
a student fires provocative questions at her. She notices the urge
to move away from both her anger and the student and pauses.
She begins to slowly and calmly respond in more detail than the
student wanted, obliterating the insults and the challenge. She
also notices that the class is more attentive and tuned in to her.
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Conclusion
Three characteristics define a learner in trouble: they act before think-
ing; they’re disorganized; and they lack attention to detail. My experi-
ence as a clinician and practitioner is that the matrix addresses all of
these issues. Promoting psychological flexibility with the matrix enhances
mindful awareness and choosing valued actions, organizes the learner’s
experiencing, and improves attention in real time with no agenda other
than what the learner brings to the table. Each act of matrix sorting—
noticing toward versus away moves, and noticing sensory experience
versus internal experience versus who is noticing—is a brief flexibility
training. How much training someone needs to get unstuck and engage
in more valued behaviors is highly dependent on the individual and the
context. It may take a few sorts, or it may take hundreds. When I asked
the student I met with at the beginning of the chapter what he did with
his unwanted stuff, his response was “I live it in me.” Then, with a big
smile on his face, he added, “I don’t know where that came from!”
The matrix helps learners of all ages notice and analyze the function
of their own behaviors while targeting the core ACT processes of cogni-
tive defusion, acceptance, present- moment awareness, observer self,
values, and committed action. I tell people, “Using the matrix teaches
you how to fish.” I see again and again how learners and educators are
loosened up from aversive control and move toward increased appetitive
functioning. This is knowledge gained through experience, not through
textbooks or curriculums, and it’s pointed toward growing and thriving.
Rather than having the goal of imparting knowledge, we can use this
point of view to influence individuals and groups to go out and discover
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the knowledge and experience that works for them. This is influence
with precision, scope, and depth. From just two crossed lines and a few
simple words and actions comes limitless variation at the individual,
group, and organizational level. Pretty cool stuff.
Reference
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commit-
ment therapy: An experiential approach to behavior change. New York:
Guilford.
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CH A P T ER 13
Annick Seys
I’m a social worker. I have a private clinical practice where I work with
people suffering from burnout, professional stress, and performance
anxiety but also clients who suffer from more severe psychological disor-
ders, such as eating disorders. More recently I moved to organizational
work as a cofounder of a consulting and training partnership. Our clients
are mostly organizations in the private social sector, typically groups of
psychologists, social workers, therapists, or dietitians, and we are seeing
increased interest from coaches working in business environments. We
teach them about acceptance and commitment therapy in six-day courses
and workshops with different ACT themes. We also offer more tailored
interventions on demand, intervene in teams, and have a stress manage-
ment or crisis and conflict management mandate. I have been using
ACT since 2010 and the matrix since 2011.
ACT has been shown to be an effective intervention to help manage
workplace stress and improve employee performance (Flaxman & Bond,
2006; Hayes, Bond, & Barnes-Holmes, 2006). In my work with organiza-
tions, I have found the matrix to be a practical, efficient tool that is
especially effective in helping improve the atmosphere in the workplace.
The ACT Matrix
I have been particularly impressed by how versatile and swift the matrix
can be in getting the ACT point of view across.
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Soon enough, team members start making jokes about their own thoughts,
a sign that they’re taking a different perspective on the mind’s workings.
The matrix ignites the power of the ACT processes and allows team
members to quickly learn hexaflex skills without the trainer having to
mention theose skills by name. In short, people learn how they can focus
on what’s important to them and act upon it while taking all these pesky
emotions and thoughts with them. ACT books invariably advise clini-
cians to instigate experience rather than talk theory. Because of the way
the matrix is designed, you don’t have to talk about it at all; you can just
let people experience what it can do for them. In fact, if you’re only just
starting to work with ACT, using the matrix might help you develop your
ACT skills much more easily.
One of the rewarding consequences of working with this model is
seeing that, by the end of a workshop, participants are often looking at
moving toward their values in areas beyond their professional life. They
start looking at how to do more toward moves in their personal life, which
in turn has a positive impact on their functioning in the workplace.
In Practice
In this section, I’ll discuss a couple of case examples that illustrate the
versatility of the matrix in organizational settings.
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We have judgments toward each other that stand in the way of good
collaboration, but we don’t dare express them because we don’t want
any conflicts.
We want more openness and closeness toward each other, with
respect for everyone’s abilities and personality.
We want to find a way to implement the new policy together.
The Workshop
I started off by telling the group that what they wanted to do with me
is against human nature: we don’t like to be vulnerable and feel the asso-
ciated anxiety. I explained that this was one of the important points of
view that we’d be discussing that day. Then I started exploring the five-
senses versus mental experience axis. I gave everyone a candy bar that,
though it looked different, tasted the same as a very well-known one. I
invited them to hold it and imagine what the candy bar might taste like.
Then I told them that it actually tasted like the well-known candy bar
and invited them to notice what their mind did with that. After inviting
them to taste the candy bar, I talked about how we can have a very clear
image of a five-senses experience in our minds, but that regardless of
what that image is, it can differ from the actual five-senses experience.
I then shifted to the theme of the day, saying, “Imagine you walk into
the office on a rainy morning and your colleague says ‘Good morning’ in
a curter way than usual. What is your mental experience in that
moment?” Next we looked at how the chatter of the mind makes it
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Moving to the left side of the matrix, I asked the group what they
could see themselves doing as a team and as individuals that moved
them away from their values. We also summed up the feelings and
thoughts they noticed when they engaged in away moves. I asked them
to take a minute to think about this question: “If what you want is an
open atmosphere, how can you be more open toward your colleagues
with all of these thoughts and feelings toward each other?” At that point,
the group went quiet, so I asked them to look at the matrix on the white-
board and share, if they were willing, how they felt upon seeing the list
they’d created. The conclusion was that they weren’t alone in how they
felt—that everybody has these kinds of thoughts and feelings, gets
hooked by them, and reacts to them. However, and importantly for a
team that wanted to create openness, they were already sharing funda-
mental things about themselves in the early stages of the workshop. They
hadn’t realized that they were already doing what they wanted to achieve.
Finally, I asked everyone to fill in their own matrix and choose one
action they would commit to doing to move closer to the team. I sug-
gested that the chosen action be about something important to them
that they weren’t acting upon. Afterward, everyone shared their matrix
and committed action with the group. I invited them to notice the judg-
ments about one another that showed up and to see how they could
respond with a values-driven toward move. The openness experienced in
that moment was very powerful and brought everyone closer together.
And whereas in the morning the team had barely responded to Chrissie
announcing her termination, by the end of the day they could tell her
how they’d appreciated her participation and empathically reflect how
hard the day must have been for her. They even told Jan that the organi-
zation needed to take good care of Chrissie during her notice period.
The Aftereffects
That evening after the workshop, I received a message from Jan:
“After that team session, I want to end this magical day with the follow-
ing philosophical words: ‘When my senses fall asleep, the sheet of feeling
covers me and I realize with tears of joy that I’m happy to be alive.’ On
behalf of our team, thank you Annick.” I’m sharing his message to illus-
trate how meaningful just one day of working with the matrix can be.
Bart didn’t get fired. He and Jan had a long talk the day after the
workshop. They used the matrix to give one another feedback in a
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values-driven way. The matrix also helped them stay in the present
moment and in contact with each other instead of getting hooked by
everything that went on in their minds. For the first time, Bart could
speak openly about what he’d felt during this difficult time of change and
how he really wanted to stay on the team. He could also admit to himself
and to Jan that he needed to acquire new skills if he wanted to stay. His
commitment to doing so allowed Jan to keep him on. Jan also made some
changes in the team and assigned Bart to a new position within the team
where he could best use his abilities.
A few weeks after the workshop, Jan told me that during a meeting
someone in the team had reverted to the old habit of communicating
without taking the feelings of other team members into consideration.
The rest of the team responded in a way that helped the person see that
he was appreciated, but that they didn’t like this behavior. Before the
workshop, none of the team members would have even considered doing
that, and if they had tried, a heated argument probably would have
broken out immediately. Instead, the person apologized and worked to
change his behavior.
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Session 1
To begin, I set up the matrix on a whiteboard, and as in the work-
shop described above, we started working on discriminating five-senses
experience versus “living in your head.” I took some time to do exercises
that would help participants notice how the mind works. We looked for
examples of judging, making predictions, and so on, and throughout the
session we regularly paused to notice what showed up for participants
around our work in the moment—what thoughts and feelings they were
experiencing.
Next we looked at the toward and away axis, starting with what’s
important. I took quite a bit of time to work on the process of creative
hopelessness. We talked about how we humans can easily lose sight of
what matters to us when we’re hooked by our thoughts and emotions and
struggle to avoid them. In the moment, it’s natural to want to move away
from what’s bothering us, but this also usually means we’re moving
further away from ourselves and what matters to us.
I ended the session by explaining that the purpose of the matrix is to
allow us to notice what we’re doing so we can choose if we want to shift
our focus or not. Then I invited participants to notice their toward and
away moves and to practice sorting five-senses and mental experience
over the next week.
Session 2
I started the second session by going over the matrix again and
having participants fill it in as a group. In this session I also invited par-
ticipants to become aware of their level of engagement toward this train-
ing: Did they do their noticing homework? Had they started applying the
suggestions in daily life? As it turned out, they had started using the
matrix, and not only in school, but also in other difficult areas of their
lives.
Next we worked on defusion using the concept of hooks. I explained
that hooks are thoughts, emotions, or memories that show up and have
a quality that, when we bite, we tend to get violently pulled away from
the present moment and into actions that are rarely those the person we
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Session 3
In our final session we used the matrix to look at participants’ expe-
riences over the past week. We also practiced some expansion strategies
as a way to help make room for feelings of stress and to enhance the
ability to notice what’s important in stressful situations.
The Aftereffects
I received spontaneous e-mails from four of the six participants
saying that, as a result of the workshop, they avoided less, were more
focused on what worked for them, were moving closer to their values,
and were applying these tools in many different situations.
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Unhooking
If you get hooked and are pulled to away moves, use your defusion
skills to unhook. Here’s an exercise I came up with that works for me. I
imagine a theater in my mind, with red velvet curtains and chairs. I am
the audience. On the stage stands a row of empty chairs with golden
armrests and red velvet cushions. Every time I’m aware of a thought
popping into my mind, such as What if…? or Will I be able to…? I invite
it to take a seat and wait for the others to arrive. I’ve noticed that every
time a new pesky thought pops up, by the time it takes its seat the other
thoughts have already disappeared.
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results. Models are only of interest to the extent that they work.
Pragmatism is built-in. ACT is based around six processes of inflexibility
versus flexibility. Laying these processes out in detail may try the toler-
ance of people looking for quick and concrete help. In such contexts, the
matrix is a compact, powerful tool that allows for adaptable work with
the ACT processes. It quickly promotes psychological flexibility and
itself is flexible enough that it can be modified to fit the contexts and
situations in the training room and in people’s lives. With the matrix,
not only do people learn how to deal with stress and conflicts, but by the
end of a workshop collaboration is typically strengthened and a stronger
group identity emerges. Participants have gained psychological flexibility
as individuals and as a group, which makes teams stronger and tighter.
The matrix can help trainers stay flexible and identify where in their
matrix they are at any given moment, helping them model, instigate, and
reinforce flexibility. Based as it is on normal functioning, it allows for a
quick setting up of a perspective in which all people can recognize that
their inner experience and what they don’t want to feel or think is part
of their common humanity. Although the matrix is pragmatic, it allows
for a firm focus on what’s important and thus injects deep meaning into
interventions. This focus on values also means that matrix interventions
are ultimately in the service of each and every participant moving toward
what’s important individually, rather than submitting to company or
management values and imperatives. In this way, it can quickly over-
come the distrust that interventions focused on making employees fit the
mold can rightly elicit.
Conclusion
I’ve found the matrix to be an ideal tool for interventions in organiza-
tions for many reasons:
It can help set ground rules for conducting an effective meeting.
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This list is far from exhaustive, and I have no doubt broader uses for
the matrix will be derived, perhaps by readers of this chapter.
In my relatively short time using the matrix in organizational set-
tings, I’ve seen people grow after very short interventions. Still, I recom-
mend conducting a couple of coaching or refresher sessions to keep the
process of change alive, to ensure the new skills are practiced, and to
troubleshoot any potential setbacks.
References
Flaxman, P. E., & Bond, F. W. (2006). Acceptance and commitment therapy
(ACT) in the workplace. In R. A. Baer (Ed.), Mindfulness-based treatment
approaches: Clinician’s guide to evidence base and applications (pp. 377–402).
Burlington MA: Elsevier Academic Press.
Hayes, S. C., Bond, F. W., & Barnes-Holmes, D. (2006). Acceptance and mind-
fulness at work: Applying acceptance and commitment therapy and relational
frame theory to organizational behavior management. London: Routledge.
Wilson, K. G., and DuFrene, T. (2009). Mindfulness for two: An acceptance and
commitment therapy approach to mindfulness in psychotherapy. Oakland, CA:
New Harbinger.
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CH A P T ER 14
Kevin Polk
In this chapter, I’ll quickly review the origins of acceptance and commit-
ment training and therapy and then discuss how acceptance and com-
mitment therapy and especially the matrix are directly connected to the
evolutionary process. To do so, I’ll quickly run through functional con-
textualism and relational frame theory; touch on the evolution of lan-
guage and ACT’s approach to the problems language can cause; take a
brief look at the social ramifications of these processes and Elinor
Ostrom’s eight core design principles for optimal group functioning; and
land right back on ACT and the matrix.
Functional Contextualism
ACT is based on functional contextualism, a scientific point of view that
seeks to increase the frequency and variety of behaviors that work to
improve the human condition. It looks at a human behavior (action) in
context, and in that regard the whole human is the action. This is like
The ACT Matrix
seeing someone walking (action) down the street (context). You don’t see
a body and a mind walking down the street; you see one whole human
being walking down the street. Also, from a functional contextual
perspective, when a human uses language, it is the whole human
behaving, head to toe. So the person walking down the street might
pause and talk to us; it’s the whole human talking to us, not a mind plus
a body. To help lessen human suffering, improve the human condition,
and enhance evolution, we strive to predict and influence behavior with
precision (with the fewest symbols), scope (across contexts like home,
school, and work), and depth (psychologically, sociologically, and
anthropologically).
Functional contextualism is most often contrasted with mechanism,
which has its roots in Newtonian physics. Newton’s ideas have been very
fruitful for humans. His equations led to the industrial revolution and
helped shape our understanding of the universe. Using Newton’s equa-
tions, we can predict with great accuracy the movement of objects like
bicycles, cars, and planets. It was only natural that the predictability
within Newtonian physics found its way into explanations of human
behavior, to the extent that language like the following has become
common: “That other driver really made me angry; I had no choice but
to honk my horn and give him the finger!” Said another way, the other
driver caused the anger, which then caused the behaviors of horn
honking and gesturing. When pressed, almost everyone would agree that
there was a choice of whether to honk the horn or not and whether to
give the finger or not. But many would still maintain that the anger was
caused by the other driver, which means the other driver has taken away
the person’s choice of emotion. In the greater scheme of things, this arti-
ficial, mechanistic removal of choice can limit the human condition.
Functional contextualism is more in line with the approach of
another great thinker: Charles Darwin. While Newton was concerned
with planets and rocks, Darwin was writing about how living things
arrived at both their physical form and their behaviors in a given envi-
ronment. The combination of physical form and behaviors in the envi-
ronment could have life-and-death consequences for a single organism or
a species. Organisms live in a Newtonian physical world, yet how their
behaviors and physical forms transform through the ages can’t be pre-
dicted through Newtonian physics. Darwin saw that three processes
came together to shape the evolution of any living thing: variability
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seem to be living inside the mind and not paying attention to real-world
facts. And people often suffer horrible pain as they struggle to avoid
imaginary demons in the mind. The trick is to lift people out of excessive
mental experiencing when such thinking is becoming too restricting and
harmful.
Language Is Social
Language probably evolved in humans for social functions. One was
to help protect us and others, for example, by yelling, “Watch out!”
Another was to make babies, by saying stuff like “Hey good-looking,
want to hang out tonight?”
While languaging is social, it’s done from the “me” point of view, as
in “me over here and you over there.” Once the “me” showed up as lan-
guage, people could talk to others (me to you) and to themselves (me to
me). Since language is great (to a point) for symbolically dividing things
up into categories, such as trees, shrubs, predators, rocks, and so on,
eventually the self was divided up into the categories of “me” and “mind.”
From an outsider’s perspective, that’s just silly; in the outer world, it looks
like one person behaving. From inside the skin, the separate selves make
sense thanks to social language. Said another way, to use language I need
someone else to talk to, so one part of me talks to another part of me.
From the perspective of your own language, there’s always more than one
of you in the room, even when you’re by yourself.
This artificial language-based separation of the self into at least two
parts is important because of Newtonian and Darwinian thinking. If we
apply Newtonian thinking, one part of the mind causes another part of
the mind. For example, the sentence “How you think determines how
you feel” applies Newtonian determinism to the artificial, language-
based separation of self, as if thinking were a cue ball striking the emotion
ball and sending it in a predictable emotional direction. But in reality,
there is just one of each of us, and the whole human being behaves.
Thinking and feeling are of course related, but relation is not causation.
For example, most people would say that thinking I’m a failure causes
sadness or some similar emotion. However, there are people out there
who might get pleasure from that thought.
The more a person believes that thinking one thing automatically
leads to a certain set of behaviors, the less psychologically flexible the
239
The ACT Matrix
person becomes. ACT and the matrix seek to reverse the inflexibility of
such languaging and increase people’s adaptive behaviors.
Human Conflict
A big part of language is classifying things in the “right” category.
Humans just love sorting things into the right categories, probably
because we get positively reinforced for things making sense. Therefore,
being “right” about how things are organized and categorized becomes
very important. People get into heated verbal spats (and sometimes phys-
ical fights) about who’s right and who’s wrong regarding how things are
categorized and organized. As this categorization and organization
process expands to determine how neighborhoods, towns, cities, states,
and nations are organized, we humans are at risk for lots of fights over
who’s right and who’s wrong about how things should be categorized and
organized.
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The Matrix, Evolution, and Improving Work-Group Functioning
241
The ACT Matrix
242
The Matrix, Evolution, and Improving Work-Group Functioning
243
The ACT Matrix
don’t want to be. Avoiding fear often doesn’t get you where you want to
go in life.
Both toward and away behaviors can be very functional depending
on the context. For example, in the presence of danger (like the bees or,
even worse, a tiger), an away behavior can save one’s life. However, lan-
guage allows humans to recall a story of bees or a tiger to such an extent
that a human can avoid imaginary bees and tigers while sitting in the
living room. This probably isn’t very functional from an evolutionary
viewpoint, given that we end up staying home to avoid these dangers.
The workability of toward behaviors is also subject to context. For
example, engaging in chitchat with a potential lover might be very work-
able on a sunny day in the park, but that same chitchat might not work
at all while sitting at a funeral.
The key, in terms of evolution, is for humans to notice the conse-
quences of their behavior while in context, and that requires being open
to both sensory and mental inputs while engaging in both toward and
away behaviors. And being able to analyze the consequences of a behav-
ior requires knowing one’s values.
Community
I’ve been focusing on an individual’s behaviors in the context of the indi-
vidual’s values. However, humans are very social animals. One need not
look too closely to notice that humans cluster together in groups, com-
munities, and cities—and for good reason. Much of human existence is
dependent on working together with other humans to solve the problems
of food and safety. Humans long ago learned how to cooperate and divide
labor into small parts, with the small parts coming together as a whole.
For example, one person might clear a field of trees and stumps, another
might plow, another might plant seeds, and so on. No single person is
responsible for the entire crop, and working together, the group can
produce much more food. Humans have turned this ability to the task of
creating machines that could do much of the work of producing food,
further multiplying the effect of individuals. Those machines led to more
machines, and so on.
A small group cooperating to produce food is an example of a group
sharing common resources—land and water—for the survival of the
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The Matrix, Evolution, and Improving Work-Group Functioning
245
The ACT Matrix
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The Matrix, Evolution, and Improving Work-Group Functioning
Notice that by the end of this first loop around the matrix, anyone
will be taking a more “distanced” self-view. If we were doing the usual
psychological flexibility training, we would simply do more to increase
this distanced view and the chances that the person will learn behaviors
that work for valued living. Here, because we’re interested in people’s
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The ACT Matrix
248
The Matrix, Evolution, and Improving Work-Group Functioning
9. What kind of behaviors might you do in the group that would move
you away from the mental experiencing in the lower left? (Answers,
such as gossiping, not working, and naysaying, are written in the
upper left.)
10. What kind of behaviors can group members do to move toward the
shared purpose of the group? (Answers are written in the upper
right.)
Obviously, the tenth item can take a lot of time as group members
come up with individual duties and roles that can contribute to the
shared purpose. The group can do both loops as often as needed to main-
tain group functions.
Monitoring
Collaborative Decision 10 Proportional Benefits
Making and Costs
10 10
Polycentric Graduated
Governance 10 0 10 Sanction
10 10
Minimal Recognition Conflict Resolution
of Rights to Organize
10
Group Identity or Purpose
249
The ACT Matrix
Now let’s take a look at a way in which the group can monitor its function-
ing according Ostrom’s eight principles. Figure 14.1 has a spoke for each of
the principles. The bottom spoke, “Group Identity or Purpose,” is the most
important and was addressed during the two loops around the matrix. So
now the group can turn its attention to the other seven spokes, learning
about each and assessing group functioning on each dimension.
Notice that there’s a 0 at the center of the spokes and a 10 at the end
of each spoke, forming a rating scale that allows the group to rate func-
tioning on each of the eight spokes. If all are at 10, the group is rolling
along. When one or more of the spokes is at less than 10, the group is
“bumping along,” and those spokes could use some work.
Conclusion
From a behavioral and political view, the approach briefly outlined here
increases psychological flexibility and group flexibility by helping the
members of a group step back and view their individual functioning
within the group from a more distanced perspective. From this perspec-
tive, they can learn to be flexible, and they’ll feel safe in the knowledge
that sticky group processes can quickly be addressed with the matrix and
spoke diagrams.
From an evolutionary view, this approach increases the variability of
behaviors by enhancing psychological flexibility and group flexibility. It
also increases the group’s awareness of the consequences of individual
and collective behaviors and provides a ready means of passing along
successful group behavior by allowing the group to show other groups
how they use the matrix and spoke diagrams.
References
Hayes, S. (with Smith, S.). (2005). Get out of your mind and into your life: The
new acceptance and commitment therapy. Oakland, CA: New Harbinger.
Ostrom, E. (1990). Governing the commons: The evolution of institutions for col-
lective action. Cambridge, UK: Cambridge University Press.
Wilson, D. S. (2011). The neighborhood project: Using evolution to improve my city,
one block at a time. New York: Little, Brown and Company.
250
CONCLUSION
Going Viral
Kevin Polk and Benjamin Schoendorff
Thus far the matrix has made its way into mental health settings, prisons,
schools, businesses, communities, Olympic athletics, and summer youth
camps. By the time this book is published it will have made its way into
more settings. Within weeks after what was then called the grid emerged,
the two lines were being referred to as a virus because many people who
learned it were compelled to pass it on to others. It began with people in
mental health groups sharing with their family and friends. Then stu-
dents who learned the matrix in school shared it with their friends and
family. When we presented it to community groups, we soon heard of
more people showing the matrix to others. You too may have the irresist-
ible urge to share the diagram with others, and we certainly encourage
you to do so.
From the beginning it was clear that after working with the matrix
diagram, people started coming up with cool new things to do to move
toward their values. It’s wildly reinforcing to stand or sit in front of other
humans, show them a couple of lines, ask them just a few easy questions,
have them sort the answers into the categories, and see them quickly
derive new, more workable behaviors. We aren’t kidding—you see the
deriving happening in front of you, and you get a huge rush of reinforce-
ment when it does. At that point there’s no putting the diagram down;
you’re looking for your next fix. That reinforcement process drives the
viral aspect of the matrix.
The matrix is also evolutionary. Once people learn it, they find new
places and new ways to present it. In that sense, there’s just no telling
The ACT Matrix
where the matrix will go. It’s already in the hands of a few thousand
people. With the publication of this book, it will be in the hands of thou-
sands more—readers like you who will find new places to present the
matrix.
In our opinion, the most crucial place for the matrix to take off is in
the education system. We’ve heard that many teachers feel stuck in the
role of classroom enforcers. They’ve been taught that a style of teaching
that conforms to the Newtonian perspective is the only way. They teach;
the students listen and learn. Above all, the students are to follow the
rules of behavior as if they were Newton’s laws. Many students and teach-
ers feel stuck, and maybe the matrix can help them find a way out.
Using the matrix in conjunction with Elinor Ostrom’s eight core
principles (1990; see chapter 14) can help classrooms come alive as stu-
dents become responsible for their own behaviors, knowing when their
behaviors are moving them toward who or what is important to them
and when they’re moving away from unwanted feelings and disrupting
the learning process. In this way, classrooms could become places where
students and teachers alike engage in cooperative movement toward
individual and group aspirations. With the matrix diagram, such a
change is possible. It doesn’t require special skills to present the matrix.
Teachers don’t need to be incredibly adept “student whisperers.” They
simply need to learn a few basic skills for increasing psychological flexi-
bility in the context of who or what is important.
We also see the matrix moving into the professional sphere and
helping workplaces become environments where people can start to
choose to move toward who or what is important to them. Introducing
the matrix can shift the perspective in the workplace, moving away from
trying to force employees to submit to the needs of the business or simply
reduce stress, and instead moving toward creating a space in which
everyone can flexibly adapt their behaviors to be more in line with who
or what they want to move toward. Team meetings around building and
implementing a team matrix could unleash workplace creativity as team
members evolve an approach to moving toward what’s important for
them and for the team as a whole.
Finally—and you may say we are dreamers—we envision the matrix
making its way into society at large, helping all types of organizations
move toward psychological flexibility. The matrix is fundamentally non-
judgmental, so its use is unlikely to leave people stuck in conflict. It’s
252
Going Viral
literally like learning to play a very simple tune on the piano. Almost
anyone can practice the notes and pauses until it sounds like beautiful
music and others can’t resist joining in. With the matrix, that skill level
is just a few practice sessions away.
In closing, the future of the matrix diagram depends on a very ACT-
like question: Are you willing to have some discomfort and make some
mistakes while presenting the matrix to others? The more people who
can answer yes to that question, the more psychological flexibility will
spread. Let’s give increased psychological flexibility a try and see how it
works.
Reference
Ostrom, E. (1990). Governing the commons: The evolution of institutions for col-
lective action. Cambridge, UK: Cambridge University Press.
253
Editor Kevin L. Polk, PhD, is a clinical psychologist who has been a prac-
ticing for twenty-three years, primarily helping veterans and others with
troubling trauma memories. For the past eight years he has dedicated
himself to the study of acceptance and commitment therapy (ACT),
spending close to 20,000 hours studying the philosophy and theory
behind ACT, and learning and designing ACT interventions. He is a
peer-reviewed ACT trainer who is passionate about teaching others how
to use the matrix to increase psychological flexibility and valued living.
Find out more at http://www.drkevinpolk.com.
258
Index
259
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260
Index
261
The ACT Matrix
memories, trauma: hooks related to, using the matrix in, 232–233, 252;
157–158; working on, 159–160. case examples of matrix work in,
See also PTSD 223–229; working with teams in,
mental experiences: clinician matrix 222–227
and, 132–133; five-senses Ostrom, Elinor, 235, 245
experiences vs., 8–9, 18–19, Ostrom’s eight core principles,
42–43; getting hooked by, 21; 245–246, 249, 250, 252
inner experiences vs., 68, 124–
126; noticed by therapists,
143–144; unwanted, 45–46, P
132–133, 141, 211. See also pain: ACT assessment of, 94–96;
thoughts matrix for working with, 95,
metaphors: Cereal Box, 73–74; 96–106; strategies used to avoid,
Chessboard, 104–105; Hook, 46–47. See also chronic pain
66–67; Man in the Hole, 100; pain matrix, 95, 96–106; acceptance
Passengers on the Bus, 105, 212; and, 103–104; creative
Path Up the Mountain, 43; hopelessness and, 99–100; human
Surfing, 188; Values as a Cube, 44. mind and, 102–103; illustration of,
See also exercises 95; overview of, 97–98; Passengers
mind, human, 102–103 on the Bus metaphor, 105;
self-as-context and, 104–105;
mindfulness: chronic pain and, 102;
terminating therapy with, 106;
cultivating, 49–50; present-
values identification and, 100–
moment awareness as, 160;
102; willingness and, 103–104
self-as-context and, 104; values
emphasis and, 140 Passengers on the Bus metaphor, 105,
212
multiple exemplar training, 25
Path Up the Mountain metaphor, 43
262
Index
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264
Index
265
The ACT Matrix
XYZ
“Yes, and?” inquiry, 12–13
Uploaded by [StormRG]
266
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