Facing the Current Situation: Creative Hopelessness
What are you seeking ?
What have you tried ?
How has it worked ?
What has it cost you ?
1. What are you seeking ?
Most clients have the same goal when entering therapy: to find strategies that will make their pain go away. The problem-solving mode of mind specifies a simple solution: in order for the individual to feel better, the pain must be eliminated, removed or controlled (the change agenda). “What are you seeking” elicit what the client believes the outcome of successful intervention will be. This is often to “feel better” (remove the cause of dysfunction) because then, and only then, can normal behaviors occur.
2. What have you tried ?
The next step is to explore the strategies the client has used to solve the presenting problem. “If the outcome you’re seeking is to ..[reduce your depression, have your anxiety go away, get your mum to stop criticizing you, and so on], what have you tried to accomplish this outcome ?”. It is essential to be non- judgmental and accepting of every strategy the client mentions and avoid fine-tune a particular strategy or suggest other strategy the client might use. You need to gather enough detail to give you a good sense of what the client’s basic approach has been. They might seem different on the surface but have the same function. There are two main functional dimensions to consider that will be important in selecting an eventual intervention: First you want to know the prevalence of the client’s avoidance strategies (for example, not going to work, isolating, and playing video games). Second you want to know what rules are driving these strategies (for example, The way to cope with being sad and depressed is to just not think about it). In general the more prevalent the avoidance strategies and the more they are driven by rules (rather than direct experience) the more invested the client is likely to be in needing to control or avoid distressing private experiences.
3. How has it worked ?
Think of workability as the acid test of the client’s strategies. The question is – Is the desired outcome indeed being realized, or is a different, paradoxical result occurring? It is only by bringing the clients into contact with the direct results of behavior that you can begin to drive a wedge between them and their mind. Slow down the pace of the interview, paraphrase clients’ answers more often, and allow periods of silence to occur as the clients ponder the issue of workability. The clinician aims to create some doubt in the client about whether the problem-solving mind’s change agenda is achievable or workable. Repeat back what the client has been telling you and raise one simple question: “Could it be that following your mind’s advice is the problem ?”. Understand that this isn’t about helping the client to develop insight; it’s designed to help them make contact with the direct results of their behavior. Behaviors are neither ”good” or ”bad” but are either helpful or unhelpful in achieving valued ends (Functional Contexualism).
4. What has it cost you ?
Generally following rules that promote avoidance has costs, resulting in increasing restriction of life over time. To gain control people will sacrifices valued life activities as they will trigger unpleasant emotions, thoughts, intrusive memories, or unpleasant physical symptoms. The more they avoid things, the more they get in the habit of avoiding things. Getting the clients in contact with the costs of this expanding pattern is necessary to create the motivation for change. The quest to gain control is causing them to lose control of life. This phase of the interview isn’t about rubbing the client’s nose in the consequences of avoidance; it’s about helping the client to develop a healthy motivation to try something new.
Creative Hopelessness - Challenges for the therapist:
Discomfort can show up with sitting with client’s sense of distress and hopelessness
Beginning ACT therapists often fear that CH would make clients drop out
Our experience is that clients often feel a sense of being validated: ”You have worked hard. It’s not
your fault. This is a rigged game. You now have knowledge and a chance to do something truly
Paraphrasing and summarizing important
Ole Taggaard Nielsen (2012) based on: Brief Interventions for Radical Change. Principles and Practice of Focused Acceptance and Commitment Therapy. By authors: Kirk D. Strosahl PhD, Patricia J. Robinson PhD, Thomas Gustavsson MSc. New Habinger (2012).