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'I Understand But It Doesn't Make Me Feel Better'. Bridging The Head/Heart Gap With ACT

The head/heart gap is an experience that many clients in therapy will recognise. They understand the concept being discussed, but it is not translating into making them feel any different, or into any meaningful change in their lives. As practitioners, we can probably relate to this too, as we know, from our own experience, that there is a big difference between understanding something is helpful, and actually making use of it.

The reason for this is that, even when we are armed with quality information, we still have to deal with the difficult thoughts, feelings, sensations, and urges, (our uncomfortable and unwanted experiences), that tend to come up whenever we try to make significant changes in our lives, and move towards the things that really matter to us. That is why knowing what we should do, and actually doing it, are often frustratingly distant from one another. For e.g., accessing information on healthy eating is relatively easy in the age of the internet and the smartphone, but that does not mean it's easy to put into practice when we are hungry, tired, or feeling stressed, because comfort food helps us get rid of those experiences, at least in the short term. But, as we know, they do tend to come back, because we have yet to learn to respond to them in ways that are more aligned with our values and goals.

In a similar way, keeping therapy at an analytical level can function as a way to escape uncomfortable feelings in session. It can often be an emotional control/avoidance strategy, which functions to prevents the client from having to experience uncomfortable thoughts, feelings, sensations, and urges, and it can be pretty effective. The problem is, if that occurs regularly, the client will lose the opportunity to change their relationship to these experiences and to learn new workable responses. As a strategy for effective therapy then, it is likely unworkable because it will mean the client will not learn, through experience, how to respond differently, leaving their responses inflexible and meaning change is less likely to occur.

In ACT, we address this by working experientially with clients. A lot of emphasis is placed on bringing clients' attention to what is happening for them, by noticing the thoughts, feelings, urges, and physical sensations, they are experiencing at any given moment. We do this to help them connect with, rather than avoid, their experiences, and to change the relationship to them in such a way that they can develop workable responses that align with their values. By actively bringing attention to their experience in the moment, rather than remaining analytical and discussing concepts in the abstract, the client has the opportunity to develop a new response to that experience, live in the session, and their behavioural repertoire is widened - a necessary part of developing psychological flexibility that is core to our work. Outside of sessions, clients are encouraged to continue to notice their experience, and to take committed action towards what matters to them. The practice of repeated exposure to these experiences, whilst changing how they respond, disrupts the emotional control strategy, and turns academic knowledge into experiential learning. This is the what bridges the head/heart gap for clients, moving them from knowing what may be helpful to make changes into doing, and experiencing, that change.

Despite knowing this, it is not uncommon for practitioners, especially (but by no means only) those who are relatively new to ACT, to fall into the trap of over-explaining aspects of the therapeutic model to clients. This is particularly true for ACT, because it contains concepts that many clients, and practitioners, may be very new to. Concepts like self-as-context, cognitive-fusion, and even the A word itself, acceptance, may seem alien to some, and understandably practitioners can feel some anxiety when they begin introducing them to clients. Of course, discussing the concepts is not wrong and, in the right context, some psychoeducation may be helpful, but a guiding principle in ACT is that doing is usually more helpful than telling.

Nonetheless, it's very normal for therapists to worry about their ability to use these exercises effectively, and for helpful psychoeducation to become a tool for unhelpful experiential avoidance for the therapist. They may cognitively fuse with thoughts that doubt their own ability, that say they do not know enough, that the client will reject them, or that the exercises and techniques simply won't work. Therapists, of course, are not immune to finding ways to manage these uncomfortable experiences in ways that limit their ability to act flexibly, when they experience them, and falling into strategies to minimise, or avoid, that discomfort. Spending too much time talking about ACT, instead of doing of ACT, is a very common strategy for this.

As practitioners, while our focus is on the client, we might therefore miss that we are engaging in the same experiential avoidance strategy of keeping the conversation at the level of explanation. When we do, our own behaviour can become rigid & unworkable; losing the flexibility we need to help our clients develop new ways to respond to what is showing up for them, precisely because we are struggling to respond flexibly to what is showing up for us.

Acceptance and Commitment Therapy places emphasis on working collaboratively with clients and on the idea that we, as therapists, are not fundamentally different to our clients. We are human too, and have the same struggles that come with being human. If we are working from an ACT approach, it is useful then to consider if the ideas and concepts that may be helpful for our clients to apply, may be also be useful for us to apply to ourselves. When our own difficult stuff is showing up in the room for us (and it will), it is useful to notice the function of our responses to it, and to notice if they are moving us towards, or away, from our values and goals in the session? The better we get at that, the better we will be to do ACT *with* our clients, instead of talking to them about it, and the better will be able to bridge the gap between the head and the heart in session, for both us and our clients.

Christian 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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