One of the cornerstones of Acceptance and Commitment Therapy (ACT) is the concept of workability. The aim of ACT is for our clients to create a rich, meaningful, and vibrant life. Workability is how we determine whether a client’s behaviors are serving that end. Usually, people know when their behaviors are not working for them, but because they are often fused with their thoughts, they may have a hard time acting any other way. Instead of bringing them closer to the life they want, their behaviors are more or less a means of struggling with or avoiding painful thoughts and feelings. To demonstrate how this might appear in a therapy session I’d like to present the case of Samantha (Of course names and details have been altered to protect confidentiality):
Samantha is in her late twenties, single, no children, has her own apartment in a suburban neighborhood, a cat, a steady job for the last year and a half, an unused gym membership, and hasn’t been on a date in four years. She complains about her female co-workers being “fake” and “slutty” yet she secretly wants to be like them and to be liked by them. Any time an opportunity arises where she is invited to attend a happy hour with work people, she has an excuse not to attend. She then goes home and cries before opening a pint of ice cream and watching pre-recorded episodes of “fill-in-the-blank-reality-television.”
Therapist: “So what were you thinking when your co-worker asked you to join them for drinks after work?”
Samantha: “I was trying to think of a polite way to get out of it.”
Therapist: “What prompted you to want to get out of it?”
Samantha: “I get so nervous around those girls. They’re always so happy and confident and I guess I’m afraid they’re secretly making fun of me behind my back.”
Therapist: “What makes you think they are making fun of you?”
Samantha: “Well, look at me! These girls are all thin and have perfect skin and hair, and wear cute outfits to work. I think they’re just trying to get laid personally. It’s gross.”
Therapist: “It sounds like you don’t much approve of them. (a pause to let that sink in) But you never answered my question. How do you know they are making fun of you?”
Samantha: “Because I’m fat! Can’t you see?”
Therapist: “So when your mind tells you that you’re fat and that people are probably making fun of you, you get nervous and you want to flee.”
Samantha: “Yeah. But it’s true. I am fat.”
And honestly, it was true. She was a portly woman, no doubt about it. Now here’s where the concept of workability comes in to play.
Therapist: “One thing I’m not going to debate with you is whether or not your thoughts are true or false, right or wrong. We think all kinds of thoughts all day long and some of them are true and some of them aren’t. What I am concerned about is whether or not a thought inspires you to do what works. Does it bring you closer to your ideal self? So tell me, when your mind tells you you’re fat, what happens?”
Samantha: (Tearing up) “I feel disgusting. I just want to hide. I want to disappear.”
Therapist: “And what do you do?”
Samantha: “I guess I just withdraw from people . . . and I eat.”
Her sobs revealed that when she said she eats, she wasn’t talking about a light afternoon snack. Unconsciously, because of her impulse to disappear, she eats to create more fat on her body to hide behind. It’s a vicious cycle. Prior to this session, Samantha had done some values clarification and what she really wants is to be a social, fun-loving person. She also wants to be healthy and energetic.
Therapist: “So when you get caught up I your thoughts about being fat, does this bring you closer or farther away from your ideal self?”
Samantha: “Farther. Much farther.”
Therapist: “And what about your thoughts that your co-workers are ‘slutty?’”
Samantha: “I guess it gives me more of a reason not to hang out with them. It’s probably not true though.”
Therapist: “Again, it really doesn’t matter whether it’s true or not. But the function of this thought is that it supports your choice to withdraw. This doesn’t seem at all like what you described you wanted your life to look like.”
Samantha: “No, I get it. I’m doing the opposite of what I know will make me happy, but how do I just get over my fears? How do I just stop thinking that I’m fat?”
Therapist: “You don’t have to. You couldn’t even if you tried because our minds are always creating problems for us and vying for our attention. This is normal. Our minds are problem-solving machines and usually, in life, when there is a problem, something unwanted, our minds are very good at coming up with solutions. And usually, in the physical world, the solution of choice is to either avoid the problem or get rid of it. But this doesn’t work with thoughts and feelings. When we apply the same kind of solutions to private experiences, we tend to make things worse. Instead, maybe you could have a different relationship with that thought. Instead of holding onto it tightly, can you allow it to be there without trying to struggle with it or make it go away?”
At this point, I introduced a mindfulness exercise to get her out of her thinking self (the part that problem-solves, worries, ruminates, etc.) and into her observant self (awareness of thoughts, feelings, physical sensations) so that she has first hand experience of what it’s like to just notice her thoughts without attachment to them. By learning mindfulness skills she will apply them to her thoughts about being fat. She will hold these thoughts loosely so that she isn’t pushed around or imprisoned by them, and she can be free to act in ways that are congruent with her chosen values and pursue the life she really wants for herself. When we focus on workability, we are not concerned with whether a thought is true or false, right or wrong, good or bad, but with whether it serves the client to live the life they want.
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