An Overview of Inside This Moment: Promoting Radical Change in Acceptance and Commitment Therapy

Mindfulness has come a long way from the fringes of psychotherapy to a widely used, empirically-supported tool with a host of proven benefits. But when it comes to communicating about present moment experiences and intervening with those experiences, clinicians often fall short.

As humans, it’s not surprising that clinicians struggle to stay present enough to be effective when painful or difficult emotions arise. Our brains have evolved to respond to threat by either fighting or fleeing. It isn’t our fault.

A Road Map

But because there was an evident need for better tools to utilize the present moment in therapy, psychologists Kirk Strosahl, Ph.D., and Patricia Robinson, Ph.D., developed a road map to help.

“As clinicians we have a really hard job. It’s hard to stay present with our clients. Working on this is an ongoing challenge for most of us,” says Robinson, who has pioneered the use of the mindfulness-based Acceptance and Commitment Therapy in primary care and other brief intervention settings.

“When you’re sharing a moment of intense personal pain with somebody, something that maybe they haven’t made contact with in years, it takes a willingness to stand in the moment and to not run away yourself, because that’s what your client is going to try to do.

Our model helps clinicians strengthen their ability to stay centered in the moment, aware of the client’s pain and the pain that it may elicit in themselves, and to use that pain, rather than run from it,” says Strosahl, a clinical psychologist and co-founder of Acceptance and Commitment Therapy.

Getting a client into the present moment is just one phase of Strosahl and Robinson’s intervention model which aims to help clients make contact, experience, and ultimately use their emotions to move forward in the direction of their values.

The five phases are:

  1. Notice
  2. Name
  3. Let Go
  4. Soften
  5. Expand

Each phase is described in-depth in their book, “Inside the Moment: A Clinician’s Guide to Promoting Radical Change Using Acceptance and Commitment Therapy” along with chapters covering how to apply the model to a range of populations including those struggling with post-traumatic stress, addiction, and lifestyle changes.

Part of the confusion around doing mindfulness exercises may boil down to a lack of clarity about the function they serve as part of the therapeutic process. The goal is to drop into the raw experience of an emotion, in order to access the natural healing power of emotions in their pure form.

“The point of coming into the moment and working in the moment, is to accept what is going on and to use it to transform how the person is living his or her life. A lot of times this involves re-framing what’s going on in the moment, calling out the importance of the experience and helping the person come back, stay there and find a new way of holding that very difficult experience that they’ve avoided sometimes for years, multiple times everyday.

In the process, clients come to realize that the experience of their emotions is not actually that toxic. But it’s usually connected to something very important to them,” says Robinson.

“People sometimes think that emotions are dangerous but the mind is the thing that makes emotions dangerous, not the emotions themselves,” says Strosahl.

But when a client is caught in the throes of harshly judging and evaluating their pain, as we humans tend to do, it may be difficult to tell him or her that the pain is, in fact, benign.

“This model actually works better when the emotion is terribly painful, like when a client has been traumatized as a child or carries some unresolved loss or grief. We try to teach people that emotions are not the enemy. It’s your mind’s evaluations of what emotions mean that is toxic, because that fuels the fires of emotional avoidance,” says Strosahl.

An Active Approach

Strosahl believes that while mindfulness is an important tool, being in the present moment may not be inherently useful. This belief can be a source of stagnation or confusion for clinicians who are new to or wish to begin incorporating mindfulness-based practices in sessions.

“There’s this assumption that something magical will happen on its own and all you have to do is get there, but I don’t think that’s how it works. I think there has to be an active approach to processing what is unfolding in front of the clients as they go through their pain,” says Strosahl.

Strosahl is a primary care psychologist in a community mental health center. Sometimes the typical mindfulness vernacular doesn’t resonate with clients, and just as often, they’re not interested in or able to practice building their skills outside the session. His extensive experience working with these challenges is evident in his and Robinson’s approach; they specialize in making a little go a long way with a model suited for brief interventions in a range of settings.

“I don’t care how weak a client’s mindfulness skills are. With guidance, they can learn how to be present and learn how to directly experience what is there and heal from it. If people are interested in practicing those skills as a result of the interaction, more power to them. We’ll help them do that,” says Strosahl.

Those interested in learning more about how to apply the five phase present moment awareness intervention model are encouraged to read additional blogs available here.