Sessions Three, Four, and Beyond
Creating a New Pattern
Moving forward with matrix work entails incorporating all of the previous concepts on a consistent basis. The matrix becomes a lens through which you and your clients conceptualize their life, as well as a tool used in session. As you begin each future session try to establish a structure that works for you while incorporating the matrix.
Many clinicians begin sessions with a short mindfulness exercise. Just about any mindfulness exercise will do, and after it is completed you and your client can work together to sort out what was noticed during the exercise into the matrix quadrants. Rather than begin with a specific mindfulness exercise, I tend to begin sessions just by asking the client to take a second to connect to the reasons they are choosing to be here in this room and engage in therapy. I ask them to think of all of the people and things that are important to them; to connect to the sense that they are human beings susceptible to the same stuck loops as anybody else; and also that they are capable of noticing their own experience and choosing to take action in a direction that matters to them.
From there we move on to processing any homework assignment from the previous week using the matrix language of toward and away, as well as analyzing function throughout the session. As content comes up within the session you can use all of the ACT consistent skills and processes that you already know, they will all be perfectly valid within the ACT matrix framework. In any case, the main aim of matrix work is to change the relationship between clients and their own experience. The very first time we set up the matrix with a client we are changing the relationship between their own experience and how they look at it, we’re also planting the seeds of changing the relationship of how much control they have over their actions and the impact their actions have in their life. But so far we’ve only been working along the horizontal line of toward and away. The vertical line of the matrix is the distinction between inner experience and outer experience, and it can be utilized to help clients change the relationship to all of the inner stuff that shows up.
As these relationships change the client begins to create new patterns of behavior that are self-sustaining. You can think of these as “workable loops”. Workable loops are those that involve meaningful connection to what matters in life, not just people, places, and things, but ways of being, and that produce real action and engagement. There’s no use in having deep connections to things in life if you don’t do anything to embody or actualize them. Over the course of the therapeutic process, we shape behavioral repertoires to become more expansive and values-driven.
Moving Up The Mountain
You will be surprised at the number of clients who start moving toward the life they want immediately after doing their first matrix in the initial session. Some people are just able to get the work going and remain flexible with little effort. They may come to see you for a handful of sessions and notice that they are ready to end treatment on their own. Other clients are stuck deep into their loops and see little movement toward a life that matters to them.
Nearly every person takes an immediate understanding to the concept of toward and away, but some have difficulty putting it into action. They can rattle off what actions are toward moves and what actions are away moves as well as how they function for them after the fact, yet in the moment they keep finding themselves caught up in that loop. It’s as if they are understanding the logic of the matrix but not connecting it to their own life. They may have thoughts like “I know what I need to do, but I just can’t do it.”
During these times you may find yourself feeling stuck as the clinician and you might even get caught up in a loop of your own, but never fear, the matrix is designed to help you and your client in just this sort of situation. When clients have a great working understanding of the horizontal line (i.e. they understand what moves would be workable and what moves would not be workable yet they can’t seem to engage in any real change) the only move you have is to shift the work to the other line of the matrix.
Nine times out of ten when I am facing a client who is deeply stuck it is not just that they are stuck, but rather that our work together has been too unbalanced in favor of the horizontal line and not enough work has been done along the vertical line. If the horizontal line represents the relationship between a person and their own actions, then the vertical line represents the relationship between a person and their thoughts, feelings, memories, images, and other inner stuff. The two lines must work in tandem to create a context of valued living.
I conceptualize this as similar to climbing a sheer rockface of a mountain. As a rock climber analyzes the hand and footholds available to them, they must find the route which works best in the aim of getting where they want to go, conserves the most energy, and allows them to move within their own ability. Climbing “up a mountain” does not involve steady progress in one direction. Rock climbers must exercise a vast repertoire of behavior to accomplish their goal. In order to move up vertically, a climber may have to move horizontally to better position themselves into the range of a workable path. Other times a climber may have to move down vertically to access a path on the horizontal plane. The horizontal and vertical axes become a coordinate plane which allow for movement in any direction.
So when a client is stuck or hits a plateau in progress, it is likely that they simply must now move along the other axis of the matrix in order to open up new avenues. Making these reads of when it is appropriate to switch from one axis of the matrix to the other comes with experience, though you may do yourself a favor by keeping a rough estimate of how much time you spend along each axis with your clients. Some sessions may be all horizontal line, others may be all vertical line, and still other sessions may flow back and forth between the two axes.
Working Along the Vertical Line
Traditionally the vertical line of the matrix represents the distinction between our inner experience and our outer experience, however, in practice our inner world and our outer world are in a constant interplay with each other. Consider the word EMOTION. If you use your finger to cover up the letter E in that word what does it leave you with? This is not a coincidence. In the original Latin this word meant to “move out” or “push away”. Our physical motions and our emotions are partnered intimately. We cannot have an emotion without it affecting us physically in some basic sense, and we cannot move through the world without it provoking emotion. All of life is learning to respond to this.
The vertical line then is the continuum between our motion and our emotion. The matrix as we draw it in session is balanced evenly along each axis, but take a look at the following matrix and consider what a person with this kind of imbalance along the vertical line might look like.
This matrix indicates a very limited awareness of what’s going on inside both in terms of cognitive and emotional experience, as well as what’s truly important. As a result, this person may be all action or inaction or an alternation between the two. We have all met people like this. This is a person constantly driven by physical desires, someone who has few or no deep personal connections with others let alone a connection to their own self. An underdeveloped sense of who and what are important can lead to endless exhaustive searching or experimentation.
Think of the clients who find a job, leave a job, find a job, leave a job, sell their car, buy a car, dye their hair, shave their head, gamble their money away, drown their sorrow in liquor and do it all over again the following day.
On the other hand a disconnection from what’s going on inside if severe enough becomes dissociation, anhedonia, empty efforts to feel something, anything, at all.
Now let’s take a look at an imbalance on the other end of the spectrum.
Think of the clients you’ve seen with this kind of imbalance. They’re all emotion, overwhelming, intense, unbearable emotion. The highly sensitive person. They’re one constant rumination playing in an endless loop. They love deeply and crash hard. A never-ending fire hose of internal experience that won’t slow down, but on the outside they’re frozen, engaging in only very, very, very small acts of movement.
Looking at both of these diagrams and you can easily begin to sort out these behaviors into diagnoses in terms of the DSM. It’s in this way that the matrix helps to conceptualize cases, but there will be more on that in a later chapter. For now, let’s stay with the vertical line. We can see how finding a healthy balance between inner and outer experiencing is vitally important to living. Seeing the interplay between our inner experiencing and our outer experiencing in this way hopefully also illuminates how much suffering comes from being stuck in these loops.
Coming back to the idea of motion and emotion, we want to work with clients to practice new ways of responding to their inner and outer experience that are workable and serve to reinforce psychological flexibility. We set up contexts in which clients can succeed in having their emotions without being consumed by their emotions. We design experiments where clients can hold onto their experience without getting bucked off and trampled like a bull rider. The therapy room and your relationship to the client play vital roles in this process. As each client is different and has different needs you will have to work together with them to establish contexts that work in the service of their values. In general, this is the space where you can utilize experiential acceptance, self-compassion, and mindfulness exercises designed to help clients come into contact with their inner experience in new and different ways. There’s no need to re-invent the wheel here, many of the techniques you already know will be workable just so long as they fit within the framework of the toward and away system and pass through the filters of function in context.
Becoming aware of the patterns of responding when caught up in a loop is a first step in the process of working along the vertical line. Yet simple awareness is often not enough to get things going. The work in this realm requires experiential learning. Luckily for us as therapists clients are constantly showing us their loops. It is our job to not only point out patterns of behavior, but to intervene at times, and to allow the space for clients to intervene on their own behalf to practice disrupting their stuck loops. If we ask a client to point onto the matrix where their current experience is showing up this is by definition a new and different way of responding to their inner stuff as it is highly unlikely that they have ever done that “out in the wild”. Taking the time to slow down, think, sort, and point involves a ton of processes. There’s a lot going on there! Over time as they practice sorting out their experience in this way it becomes second nature and just like that their behavioral repertoire of how they respond to their inner experience has widened.
An important thing to note is that attending to and responding to our inner experience does not only include the stuff that shows up on the lower left quadrant it also includes everything that shows up in the lower right-hand quadrant. Our clients have people, places, qualities, and ways of being that are deeply meaningful to them, and at the same time, they may have limited or narrow ways of responding to that rich content. An equal amount of the work with clients is paid to clarifying, contacting, and opening up to what makes life wonderful as it is to learning how to identify, read, and respond to uncomfortable emotional and cognitive content.
The rest of this book will show you how to use the matrix in a variety of ways, including how to use it to foster self-compassion, engage in flexible perspective-shifting, contact the present moment, and a whole lot of other things. As you continue work with a client, you can incorporate essentially any element into the sessions as you see fit. There’s really no set protocol that you will rigidly adhere to. As you go about your work those reads of what a client needs in terms of horizontal or vertical axis processing will start popping out to you more and more. When in doubt fall back on the matrix itself and it will help guide you in a direction that matters. Walk yourself through the matrix at the end of this chapter to help get unstuck with difficult clients.
Sessions Three, Four, and Beyond Outline
For the majority of sessions we stick to a rough outline or structure. Doing this consistently allows for clients to anticipate the context of the therapy session, get in the rhythm of the work, and helps both of you pace the session appropriately.
Step 1: Summarize previous session
Step 2: Review homework of noticing toward and away moves and any other activity assigned
Step 3: Process content through lens of function in context
Step 4: Move along the horizontal and vertical line freely as the needs arise, teaching skills along the way
Step 5: End session by creating a new matrix specific to the current day
Step 6: Brainstorm SMART toward moves and assign homework
Homework: Attempt SMART toward moves; continue to track toward and away moves generally; apply filters of workability; practice any skills learned in session
