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Creative Hopelessness: Emotional Control and Workability in Acceptance and Commitment Therapy (ACT).

It's fair to say that a majority of clients come to therapy in hope that we will be able to control their emotions more effectively. This is an understandable goal, given the distress they are often experiencing, but, in ACT, we take the perspective that habitual attempts to control emotions very frequently result in increased suffering. Therefore, we try to move away from attempts to directly control our emotions and towards alternative ways of responding when difficult emotions show up.

What is also true is that it is likely that most of our clients are already engaging in various strategies to try and control unwanted or painful emotions. The fact that they are coming to therapy at all is strongly suggestive that these strategies aren't working well enough for them and very likely are standing in the way of them being able to live their lives fully, in the way they want to live them. However, making the decision to come to therapy doesn't mean that the client has necessarily recognised that the strategies they are using to control their emotions, and indeed the aim of emotional avoidance/control itself, is what is keeping them stuck. Instead they, and all of us at various points, persist like the Greek King Sisyphus, punished for all eternity to roll a boulder up a hill, only for it roll down hill again whenever it neared the top, with strategies that are sadly never going to work, if the aim is to banish unwanted emotions AND live a meaningful life. Indeed, many clients will be coming to therapy in the hope that therapy will be the solution that WILL work for them by helping them to control their unwanted emotions. Unaddressed, the potential is for clients to use any strategy we discuss as simply another way to try and control their emotions, leading us to get stuck in our work together.

Which brings us to creative hopelessness. It is a process devised by Prof. Steve C. Hayes (one of the co-creators of ACT) of loosening the emotional control agenda that underlies the strategies that most clients will come to therapy with. It involves helping the client to look closely at the various strategies, they are using to control unwanted emotions, and to connect with the consequences of them on their lives. The aim is cultivate hopelessness (not a term I would use directly with clients) in strategies which lead to their life becoming stuck, or even get worse, in the long-term.

Russ Harris, the author of ACT Made Simple, has created a simple acronym to help clients consider these strategies - D.O.T.S - which can be used to think of the different types of strategies clients commonly use to control how they feel.

Distractions: Simply put, engaging in other activity in order to refocus their minds away from their difficult or painful feelings. These activities could be almost anything, from watching TV to going to the gym, but the defining feature is that they are done primarily to get away from what the client is feeling rather than to move them towards more meaningful and satisfying lives.

Opting out: Otherwise known as avoidance, this is about the client physically taking themself away from situations that they would otherwise engage in (if they didn't evoke uncomfortable or painful feelings) because they are part of meaningful, purposeful, satisfying, life for them (As Russ Harris explains, if they aren't meaningful, purposeful, or life enhancing, then avoiding them isn't a problem)

Thinking strategies: These are ways the client thinks that are intended to change how they feel, such as worry, rumination; self-criticism; fantasising; blaming of themselves, others, or the world; self-analysis; positive affirmations; challenging and disputing thoughts; planning; problem-solving; etc.

Substances (and other strategies): Alcohol and drugs (legal or not), not to mention food, are probably the first substances that come to mind as substances put into their body with the aim of changing how the client feels. As with all these strategies, they aren't a problem in themselves but, when they become a habitual response to difficult feelings, they can start to become unworkable. Other strategies include anything, not already covered, done to escape or get rid of pain such as self-harming, suicide attempts, arguments or fights, mindfulness (when done to escape or control pain), or even attending therapy.

Working through the D.O.T.S we will uncover multiple strategies for escaping and getting rid of painful emotions. It is likely that many of them are at least partially effective in the short-term, which makes sense as, if they didn't work at all, then clients wouldn't keep doing them. We know, that when used flexibly and in moderation, some of these strategies may be helpful, but, in the long-term, they fail to get rid of painful or unwanted emotions permanently, and, when used habitually, and rigidly, they cause difficulties, leading to clients' lives becoming worse in the long-term.

Helping clients to connect with the unworkability of their continuing with strategies which are either failing to get rid of painful emotions, or leading to their lives becoming less meaningful and satisfying (and very often both) encourages the client to be open to the possibility of alternative approaches, such as acceptance. For e.g., the client with social anxiety who can recognise that a strategy of avoiding social contact not only doesn't make their anxiety go away permanently but also leads to them feeling less satisfied with their life, because they lack deeper and meaningful relationships with others, may be more open to challenging that avoidance and taking steps towards connecting with others. On its own, creative hopelessness probably isn't going to be enough to cause clients to change the strategies they're using, but by connecting with the hopelessness of those strategies, the client tends to loosen their grip on their emotional control agenda. For clients who have been very strongly attached to this agenda, it is necessary first step to opening them up to the possibility that something else is needed, and to exploring those alternative approaches in our work together.

Christian K Hughes is a Psychotherapist, Clinical Supervisor, and Clinical Trainer, specialising in Acceptance and Commitment Therapy, with expertise in Trauma, PTSD, and a special interest in Moral Injury.

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