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Answers such as this have rich meaning in an ACT model. They indicate that negative private content (e.g., symptoms of anxiety) is functioning as a barrier. They suggest that experiential avoidance (e.g., the attempts to get rid of the anxiety) and cognitive fusion (e.g., fusion with verbal formulations about how to live more positively, such as, "first feel better,
Sources of Psychological Flexibility Acceptance Defusion Contact with the Present Moment Self as Context Contact with Values Patterns of Committed Action Table 3.1. A Simple ACT Case Formulation Matrix Presenting Problem Analysis (Core Questions) What private experiences (thoughts, feelings, memories, sensations) is the client unwilling to have? What patterns of avoidance are in place? Can the client "make room" for experience in an undefended, non-judgmental way? Is the client overly attached to beliefs, expectations, right-wrong, good-bad evaluations of experience? Does the client confuse evaluations and experience? Does the client exhibit ongoing, fluid tracking of immediate experience? Does the client find ways to "check out" or get off into their head? Does client seem pre-occupied with past or future or engage in lifeless story telling? Can client see a distinction between provocative and evocative content and self? Is client's identity defined in simplistic, judgmental terms (even if positive), by problematic content or a particular life story? Can client describe personal values across a range of domains? Does client see a discrepancy between current behaviors and values? Does client describe tightly held but unexamined goals (e.g., making money) as if they are values? Is client engaged in actions that promote successful working? Does patient exhibit specific, step by step pattern of action? Can client change course when actions are not working? Are there chronic self control problems such as impulsivity, and self defeating actions? Analysis of Motivational Factors Factors Contributing to Psychological Inflexibility Factors Contributing to Psychological Flexibility Treatment Implications
ACT Case Formulation 63 then live better") may have a role in the rigid focus on unworkable solutions that chronic difficulties usually entail. They also suggest certain possible values (wanting to participate in the world, to have relationships, to make a contribution). These might both be a source of healthy pain (the pain of not living a life is often much greater than the pain of unwanted private events) and an ally in clinical change. Superficially, ACT treatment targets are different than the client's pre-senting problem. Instead of "eliminating anxiety so that I can start to live" (the client's view of the presenting problem) you may eventually refor-mulate "the problem" in other ways (e.g., "warring with anxiety" or more specifically "not getting on about the business of living while needlessly warring with anxiety"). At a deeper level such reformulations must be con-sistent with the client's true goals. The therapeutic contract and consent to a treatment plan is no mere formality that for reason.