This document fleshes out content from chapter 19 of 2nd edition of ACT Made Simple.

THE RUMINATING, WORRYING, LOW MOOD CLIENT

Therapists often ask me about how to deal with clients who are already living their values and taking action
and doing what matters, but not enjoying their lives because they go through their days worrying and
ruminating; forcing themselves to do what they need to do, but getting little or no satisfaction from
anything. Typically, their mood tends to be low for much of the day, and often they dwell on this and
ruminate about why they feel this way. Commonly they will fuse with an ongoing inner commentary about
how miserable or dissatisfying life is and how bad or low or unhappy they feel.

Do you have a client like this?

If so:
a) It’s a good idea to establish covert behavioral goals, as described in chapter 6 (e.g. who/what do you want
to engage in/focus on/be more attentive to/be more present with); and
b) You will need to do creative hopelessness (chapter 8).

Be warned: if you skip creative hopelessness with these types of clients, you will almost certainly get stuck
very quickly. Why? Because almost always they believe that the problem is their painful emotions and low
mood - and naturally they want you to help them get rid of these feelings and moods, so they can feel
happy.

After you’ve gone through creative hopelessness, the most practical next steps are usually going to be
dropping anchor or simple defusion. Once you’ve covered those, you could go further into opening up
(meditative defusion, acceptance, self-compassion), or delve deeper into being present. If you opt for the
latter, a good strategy is to tease out how it’s hard to enjoy or appreciate or find fulfilment in anything if a)
you aren’t fully focused on/engaged in what you are doing and b) you’re fused with a negative inner
commentary; and then follow that up by doing in-session exercises involving mindful appreciation and
savoring – e.g. mindful eating, drinking, listening to music, or (my favorite) mindfulness of the hand. And of
course, as we do those exercises, we want to help the client to repeatedly unhook from rumination and
judgment and refocus attention on the task.

Many such clients are fused with rigid rules and unrealistic ideals about how they should be living their
values. Such fusion pulls clients away from the satisfaction, meaning and fulfilment that can usually be found
when we live our values flexibly and mindfully. Again, this is usually a fruitful area to explore and work with
experientially.

© Russ Harris 2019 www.ImLearningACT.com