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Robyn Walser, Ph.D. - Guest
Robyn Walser, Ph.D. is Director of TL Consultation Services and co-director of the Bay Area Trauma Recovery Center and staff at the National Center for PTSD, Dissemination and Training Division. As a licensed psychologist, she maintains an international training, consulting and therapy practice. She is an expert in Acceptance and Commitment Therapy (ACT) and has co-authored 6 books on ACT including The Heart of ACT: Developing a Flexible, Process-Based, Client Centered Practice Using Acceptance and Commitment Therapy and The ACT Workbook for Anger. She also has expertise in traumatic stress and substance abuse and has authored a number of articles, chapters and books on these topics. |
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W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Keith Sutton, Psy.D (00:22):
Welcome to therapy on the cutting edge, a podcast for therapist who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco bay area and the director of the Institute for the advancement of psychotherapy today on the show, I'll be interviewing Robin waler PhD, who is co-director of the bay area trauma recovery center, and is on staff at the veteran's administration national center for PTSD dissemination and training division. She's a licensed psychologist and maintains an international training consulting and therapy practice. She's an expert in acceptance commitment therapy and has expertise in trauma, stress and substance abuse, and has authored a number of articles, chapters, and books on these topics, including the books she co-authored with Dar stra acceptance commitment therapy for the treatment of posttraumatic stress disorder and trauma related problems, a practitioner's guide to using mindfulness and acceptance strategies. Let's listen to the interview. Well, hi Robin. Welcome for joining me today.
Robyn Walser, Ph.D. (01:25):
Hi Keith. Thanks for inviting me. Happy to be here.
Keith Sutton, Psy.D (01:28):
Yeah, definitely. So Robin, I've known you for some years. I forget exactly how we originally got connected, but you came and did some trainings and acceptance commitment therapy for my Institute. And then we did a great one-way mirror series where you were the trainer. There was a therapist actually working with one of my clients that I had worked with over 10 sessions and just like, it was incredible to see the, the transformation that happened. And I know that we've, I think you've done a training for us on your work with PTSD, and you've been actually supervising a number of different associates that we've had over the years who are associate in nonprofit. So yeah, I would just love to, see if you could talk a little bit about your work and kind of and I was mentioning just before that, I haven't really heard the backstory on how you got so involved with actor and the PTSD work, and I know you work with the VA. Yeah. So tell me a little bit about it.
Robyn Walser, Ph.D. (02:22):
Sure, sure. Well, so where to begin is an interesting question. I would say that I first sort of got into where I was headed by being very bad at chemistry . And so I was planning to go to medical school. I could not get the chem. I was just getting CS in chem and that wasn't gonna get me where I needed to go. And so I started taking some psychology courses and got a job as a those on campus jobs where you work for like money as an assistant in an on-campus setting,
Keith Sutton, Psy.D (03:07):
Like a work study or something
Robyn Walser, Ph.D. (03:09):
Like where that was, it was work study. Yeah. And I was working in a behavioral research lab where I was running rats on mazes, basically training rats, run mazes and giving them little pieces of fruit for doing it correctly. And so I just started getting more and more interested and ultimately applied for a master's program at university of Nevada, Las Vegas and went down there and still started getting involved in some practicum where I was working with folks who'd been traumatized in particular youngsters like 10, 11, 12 year olds who had been suffering from childhood sexual abuse. And so we were getting them right as they were coming out of those situations and the pain and difficulty of it was really really challenging. And I discovered at that time that I didn't wanna work with trauma in particular with children. Sure. It's like, oh, so
Keith Sutton, Psy.D (04:16):
Heart work, it's heartbreaking.
Robyn Walser, Ph.D. (04:18):
Yeah. Heartbreaking work feeling a lot of distress about, who are the people that are doing this to these children, what's happening to them and do they know the impact and, questioning things a fair bit
Robyn Walser, Ph.D. (04:35):
And but I decided to pursue a master's degree looking at childhood sexual trauma, but with adults and you know, what were the long term impacts and did my masters in that area and then applied to a program in Reno where there was a lot of trauma work going on. And so I was gonna continue to grow my career there by working with professor Dr. Victoria Ette. And so went up there for my PhD. Yeah. And in the first year Steve Hayes invited all the students to an act, an acceptance and commitment, a therapy workshop. And I went, and I had such an amazing experience and felt like I had just come home
Robyn Walser, Ph.D. (05:35):
And really encountered some of my own trauma from my past and looked at how I was, is relating to myself and, sort of coming back to a place where I detected my own sense of wholeness, despite my personal trauma. And that was all she wrote, like I was hooked. I was in it and I straddled both labs, essentially. I worked in Vic lab and then I worked in Steve Hayes's lab, the developer of act and ended up doing a dissertation combining the two and plan to continue that trajectory. I actually got my dream job, right outta graduate school. I went to become a professor at a university setting on a tenure track discovered that I didn't wanna do that. And so left after a year and came to the bay area and worked in a substance use program for a bit of time and then applied to the national center for PTSD and have worked there now, and have worked there for 20 years and have really just made my career around acceptance and commitment therapy and trauma.
Keith Sutton, Psy.D (06:59):
Oh, wow. Okay. Interesting. And how long, I you know, I'm whatever got licensed back in, grad school and so on in the 2009 and in those times what was and what was ACT like, kind of, as you were going along, I guess you sounds like you got introduced to it, what was 25 years ago, or 20 years ago, or so?
Robyn Walser, Ph.D. (07:26):
30 years ago.
Robyn Walser, Ph.D. (07:29):
‘91 was when I first got introduced to.
Keith Sutton, Psy.D (07:32):
OK. Yeah.
Robyn Walser, Ph.D. (07:34):
And if you look at what was happening during that time with acceptance and commitment therapy, it was still very limited, like sort of the renal university of Nevada renal crowd, and a few other people were dipping into it. The research studies were just starting to come in. We were actually sitting in Steve's lab, developing the intervention and working on the intervention.
Keith Sutton, Psy.D (08:01):
Wow.
Robyn Walser, Ph.D. (08:02):
And so it was very new at that time. And I would say hardly anybody knew about it really. And then the, I used to actually be called comprehensive distancing. So if you do a literature search, you could find a couple of articles on comp comprehensive distancing, but it gave the wrong impression. Right. Like you're trying to comprehensively get away from
Keith Sutton, Psy.D (08:26):
Yourself. Yeah. Right. I not, what it's about this is, this is actually the approach is the opposite of avoidance. Not, not encouraging avoidance. Yeah.
Robyn Walser, Ph.D. (08:35):
Yeah. And so it was, they renamed it and came up with the six core processes, the psychological flexibility processes. And let's see the first book came out in 1999. So that was really when it launched more significantly. Yeah. Steve Hayes, Kelly Wilson and Kirk Strassel were the authors and that's when it started to really take off and research started growing, and it's now an evidence based psychotherapy for a number of disorders. And there's over like as close to 400 randomized controlled trials. Showing that it works.
Keith Sutton, Psy.D (09:19):
Yeah.
Robyn Walser, Ph.D. (09:20):
And so, and it's all over the world, like they're doing it in places like Jordan and Iraq, China and, New Zealand and, Malaysia. I mean, there's, it really has traveled South Africa. of course the United States, Canada, south America, like it's exploded. And well, I know that everywhere
Keith Sutton, Psy.D (09:47):
That it's part of the, I think they call it the third wave of CBT kind of that. And can you talk a little bit about that or kind of what that means to you or how that fits in?
Robyn Walser, Ph.D. (09:59):
Yeah, I mean, I probably wouldn't do the, do it the same justice as somebody like Steve Hayes would if he were talking about it. But you know, each sort of wave of psychotherapy, I think, is an advancement in things that we're doing. And there would probably be a another one and we'll see where that takes us, like right now. There's some kind of combination of evolution and the third wave behavior therapies like variability, adaptability selection, kind of linking those up to some of the things that we're doing inside of the acceptance commitment, the be broader association and group that are kind of interesting focusing more on process based interventions than simply on techniques or treatment programs per se. But the the waves are sort of a reaction to what came before. Not in a negative reaction, more like a building. Do we need to add or change or fix to move forward. And so if you think about things like Watsonian behaviorism and that kind of black box idea of what, give me a six year old and I'll make you a lawyer kinda thing.
Keith Sutton, Psy.D (11:21):
Sure.
Robyn Walser, Ph.D. (11:22):
And that it was too limited in terms of what, how human beings function and work that there, there is stuff going on inside the skin and people were thinking and emoting. And so what you, you saw a rise out of that was the second wave of the cognitive therapies that were really much more focused on: “What are you thinking?” And if you look at some of the like original writings, it's, thoughts are the main thing thoughts cause emotions cause behavior like sort of a linear process. And I think the third wave in a very sort of non-sophisticated sophisticated way that I'm speaking about it sort of rolled out out of that, that, that wasn't sufficient. I either because people are whole beings and sensations, emotions, thoughts, memories, these are interactional and context-based. And so and that maybe you could have a thought and not act on it, and maybe you, maybe, maybe it isn't a direct linear relationship. That's more complex than that, depending on your learning history. And so some of the more be radical behavioral kinds of theories moved out and we got things like DBT, which was developed almost simultaneously with that, like DBT and, and some of the mindfulness based therapies that mindfulness.
Robyn Walser, Ph.D. (13:00):
Yeah. Now it's not to say that like big C little B cognitive therapy disappeared, just expanded upon and people can read about the distinctions between the two and, they're both evidence, space, psychotherapies as processes that can both be used. And so it's, it's not any sort of one or the other is better or, best or something like that. It's just the movement is looking more at the whole person rather than just thinking.
Keith Sutton, Psy.D (13:33):
Yeah, just completely the thoughts. And and I know that one way that I've kind of conceptualized it a little bit too, is that whereas maybe CBT or rational motor behavioral therapy, kind of the idea was to like identify the distorted thoughts or the rational thoughts and kind of like, almost get rid of them or replace them with, with something else where in act is, more about just kind of noticing and being with those thoughts and not necessarily trying to get rid of those thoughts and particularly, one of the, the main central themes that I've taken away from act is that idea that, that ultimately a lot, a lot of the difficulty is in our attempts to get rid of anxiety or get rid of negative thoughts and, being open to the full range of human experience.
Robyn Walser, Ph.D. (14:22):
Yeah, no, it's has that kind of more that human beings are built to feel and experience a lot, like they're designed to have anxiety and fear sadness, et cetera. And that thinking is a part of the context. It's not the full context. And so when I think about what I see in the CBT work today, it's all bidirectional it's changed and moved it, it has moved also and so, and shifted into other other places. And isn't sort of that rational emotive kind of, out with the bad and in with the good and, the, I think that kind of idea that you have stinking thinking, or, these, those kinda older ideas of you know, you're just, your thoughts are negative and you need to break 'em down mechanically and redo them and put 'em back together in a way that makes them rational and logical.
Robyn Walser, Ph.D. (15:31):
Although there's, there's still some of that kind of cognitive work today where you're wanting to move people from dysfunctional and illogical thinking to rational ways of thinking. And from the perspective of, acceptance and commitment therapy, we wouldn't necessarily say that a thought is irrational or dysfunctional. We would say that's a thought about a thought. You're labeling a thought and you still have to look at thinking as a whole that, that too functional thinking, the thought that's a dysfunctional thought also has to be analyzed. Like, where does that come from? What is that about? Yeah. But just, sort of looks at mind as a whole versus mind as certain kinds of thoughts
Keith Sutton, Psy.D (16:28):
And, I don't I don't know if I've ever heard the story so much. So actually one of the reasons I was actually attracted to cognitive behavioral therapy and act back in undergraduate, my minor was in Eastern philosophy and, kinda the, the Buddhist thinking. And just, even as you're saying, that reminds me of the, kind of noticing thoughts and the nonjudgmental and I really likes work and so on. And so that idea that our experience is colored by our perceptions and that we can learn to sit with and experience those. And, and notice those in a non-judgmental way. Is that, a significant piece of yeah. Steven, his kind of process as he was kind of developing after?
Robyn Walser, Ph.D. (17:17):
What he, he's not a Buddhist himself. Yeah. He like, like Marshall Lenahan, she practices Buddhism, and you can hear a lot of Eastern kind of mindfulness work is there. And yeah, Steve developed this more from relational frame theory and thinking about, what is mind and how do we learn to think? But they happen to line up, right? When you start looking at, you have a mind, you are not a mind that and you're conscious and aware being that can observe thinking, but I put that in quotes. You know, you might see symbolic, symbolic behavior at all, but you know, images or recognize that there's a process going on, that's called mind and that you can see it. is, has that same kind of quality as what you see in Buddhism when they're practicing meditation or mindfulness or something like that. Yeah. And a lot of the mindfulness work that in kinda east from an Eastern approach can be brought to act in a way that's very consistent and helpful.
Robyn Walser, Ph.D. (18:38):
Yeah. Yeah. I think the goal is like thinking about living consciously, which I think Buddhism would also espouse right. Living consciously and that, but it's been, I hear now aware I hear now experiencing.
Keith Sutton, Psy.D (18:58):
Yeah.
Robyn Walser, Ph.D. (18:59):
And I think that lines up with some Eastern ideology pretty, pretty nicely.
Keith Sutton, Psy.D (19:07):
Yeah, definitely. You kind of describe the aspects of ACT. What makes up its principles? What does that look like in a therapy?
Robyn Walser, Ph.D. (19:23):
Yeah. Well, so it's, it's based on principles of learning. So it's a behavioral approach and essentially we're doing a functional analysis of individual's behavior and looking at what's leading people to suffer. And so the six core processes are about addressing the suffering. And so those six core processes are openness or accept willingness to experience diffusion or of seeing that you have a mind, not that you are a mind. I can say more about that. Sure. Present moment, living in the here and now self as context or perspective, taking, being able to see yourself as a place where these emotion, thoughts, and sensations occur rather than you are those as they're defined like anxiety or not your anxiety. You're being with anxiety in this moment in time,
Robyn Walser, Ph.D. (20:29):
Values based living. And so we wanna hook up anything that we're doing in the room to creating meaningful living, according to what the client cares about rather than just feeling– it's not mindfulness for mindfulness sake, it's in the service of meaningful living and then committed action. Like what actions will you take to bring that meaning to life? And, if you look at the other side of that, what we're addressing is avoidance of internal experience. So that's the acceptance willingness part fusion with mind. I am my mind. I am my thoughts. They define me let you, so you're outta contact with, I have a mind, I'm not a mind living in the past, worrying about the future or very low self-knowledge. So I'm not aware of myself either and what my experiences are that matches up with present moment and then self as identity or self-story, which is the opposite of self as context where I am content of my life, rather than I am a context in which that content occurs.
Robyn Walser, Ph.D. (21:46):
So like a good example here with trauma might be something like I was victimized–maybe having a PTSD as a result and then sort of living inside of the victim identity– and I wanna be careful when I say this because is not a, it's a it's the victim's fault it's that our learning history sets us up in many ways to kind of buy what our mind is selling. Yeah. And so we can get inside of continuing to suffer because we were victimized and starting to buy that identity. So an example might be a Vietnam era veteran who has PTSD for 30 years. And when they come into your therapy room, it's not a human being that's walking in. It's Vietnam that’s walking in, right. Like their whole identity did has become about that experience or captured by it. And they've lost a father and a brother and a community member and a husband. Right? Like they're all of those other senses of themselves are given over to the one identity. I am my PTSD. Yeah. So that's sort of the place where we work with selfish context to help them expand their awareness of self
Robyn Walser, Ph.D. (23:15):
And then the opposite of values, if we think about inflexibility or rigidity is out of contact with it, or lack of clarity, not living my values and committed action is like holding still in action or impulsive with drinking or using drugs. So what we're doing is targeting all those things that create suffering yeah. By using their antidote, I guess you could call it.
Keith Sutton, Psy.D (23:43):
I've almost thought about like ACT as almost like a enhanced, almost motivational interviewing for exposure and kind of connecting to one's values and committing to going through the discomfort of say, addressing the trauma or, making making a deal with something that's hard rather than avoiding it. And then, and really kind of being able to be willing to, to experience those difficult emotions, to go towards something that's important and staying in that present moment, kind of having that perspective taking and being open to the full range and kind of moving forward, despite rather than, there's lots of great metaphors about making deals with anxiety and not leading to, kind of avoidance, but then anxiety kind of driving your life rather than values.
Robyn Walser, Ph.D. (24:41):
Yeah, precisely. So when like, in the case of a trauma survivor they might be very much sort of caught in problem solving sort of mind where they're experiencing fear or anxiety about what happened. And by the way, there's other responses to trauma like moral injury responses that are also part of, what we're looking at when we're looking at reactions to trauma. And so if like, if I put my mind to problem solving my emotions, then I could just do something like this. Well, I feel fear, or I get triggered when I'm at the grocery store, that's with a logical thing to do. If you're like problem solving is don't go to the grocery store.
Robyn Walser, Ph.D. (25:31):
Problem solved. And then the problem with it is emotions don't cooperate. And so then you, feel anxiety in the front yard. Cause it feels open or vulnerable or something like that. So problem solve again, don't go the front yard.
Keith Sutton, Psy.D (25:50):
Yeah. The list get longer.
Robyn Walser, Ph.D. (25:53):
And your life gets smaller, smaller, smaller, and you end up doing things like spending all of your time in your bedroom, in front of the game boy or something like that. Right. I think game boy is old by the way, too. Yeah.
Keith Sutton, Psy.D (26:09):
No, my, my kids have an Nintendo switch now.
Robyn Walser, Ph.D. (26:11):
No. I might be dating myself a bit with that, but the issue is, is like problem-solving is good and healthy and practical, depending on where it's applied. Like out there in the world, where you're interacting with your environment, problem solving can be a great thing. Like if you don't like the room you're sitting in, you can paint that room.
Robyn Walser, Ph.D. (26:39):
That problem solving applied to your internal experience. Like the stuff that's going on inside your skin fails. Like you can't problem solve away human emotion. And indeed, we now know that if you're, if you try to suppress any emotion, like pain or anxiety, you end up numbing out to all emotion. So we're not very good at taking one. And so if you're not willing to feel pain, you're gonna cut yourself off from joy as well. And so you sort of have to put it all down and you, I'll see from folks with PTSD and trauma who have no joy, there’s no joy at all. They're trying to solve something that is more like a sunset, right? It's something you experience, not something you treat like a math problem.
Keith Sutton, Psy.D (27:33):
That reminds me of the [inaudible book named] from the prophet on love and that you can't experience the great greatest joy, unless you're willing to risk the greatest pain. And so if you try to protect yourself from ever feeling pain you, you aren't able to experience that the joy there and that, that love connection. And so that again, being open to that full range of human experience, definitely.
Robyn Walser, Ph.D. (28:03):
Well, and when I think about, if if you think about life as a menu in a way, right? Like, are you only gonna taste certain things on the menu? Like we're only here for a short period of time, right? We're born we're conscious. And then we die. And so this question, what are you gonna do with that time? And if all of your time is spent avoiding and running and, trying not to feel, then you can just feel the menu getting shorter and shorter and shorter. And part of what I wanna do is like invite people to do everything on the menu. Even the things you don't like you live and experience. And while you're here bring meaning to what you're doing and or create meaning is a better way to say it, like get out there, do things that matter to you. And so I wouldn't ask anybody to pain for pains sake, right. We always wanna link it up to living the way you wanna live. And so when people come into therapy, the question is kinda like this, do you wanna feel better or live well,
Robyn Walser, Ph.D. (29:22):
You sort of put that out there as you know, which you're gonna pick and you have this much time to be in your life. Like, which one do you pick? I mean, it's, I'm oversimplifying, but you can sort of see what, what the main issue is there.
Keith Sutton, Psy.D (29:36):
Cause if we choose a kind of the avoidance of this comfort. Sometimes we aren't able to live well because everything's focused and revolves around maintaining comfort.
Robyn Walser, Ph.D. (29:49):
Right. Life is not comfortable.
Keith Sutton, Psy.D (29:52):
Yeah. That's for sure.
Keith Sutton, Psy.D (29:58):
So what does this look like in therapy or particularly too? I know, I know you do a lot of work with trauma. Like what does this look like in, in, in work with trauma and work with clients?
Robyn Walser, Ph.D. (30:10):
Oh, so exposure is built into ACT emotional exposure, exposure to thinking exposure to your experiencing your body sensation. Like this is part of what willingness is about out is to allow what is present to be present and to process it, to move through it, to let it roll through you rather than to push against it and keep it at bay, which tends to sustain it.
Robyn Walser, Ph.D. (30:38):
And so what we're, what will run through a, a kind of a, a regular process of looking at the, how problematic control or attempts to control your internal experience have been, and try to undermine that control so that you are willing to kinda look at alternatives to control of internal experience. We want people to be in control of their lives, like in control of your behavior and what you're doing in the world, but letting go of what's going on inside your skin will free you up to do that. It's not that control is bad per se of internal experience. It's just contextually dependent, like where, and when do you control, but how much control? So it's excessiveness applied control that we wanna sort of get under me. Yeah. And get people to consider the alternative of letting go of that in the service of value based living. And so it's, the exposure is right inside of that. I will feel what's there to be felt.
Robyn Walser, Ph.D. (31:43):
And so some of the ways to work with ACT in the trauma in trauma therapy is to not just do exposure. I will integrate things like prolonged exposure, integrate EMDR, you can integrate accelerated reprocessing therapy. You can integrate the WET protocol, the written exposure therapy, so that you're not only exposing people to the emotions that they're having in general, but specific to the trauma.
Robyn Walser, Ph.D. (32:17):
Some of the fear-based stuff that's keeping them from living, or that's what they're avoiding. Yeah. So we're gonna integrate and expose but we're gonna tie all of that to creating meaning. So it's not just where we're gonna reduce your fear or the symptoms.
Robyn Walser, Ph.D. (32:38):
We might not even talk about reducing symptoms because in some ways the internal experiences are gonna be there. And so it's the suffering around those that we're interested in, reducing they're sort of natural pain that comes from trauma. And then all of the efforts to get rid of that pain, which we would define as suffering. So we're interested in reducing suffering by being present in the natural experience of pain and letting it rise and fall. All emotion rises and falls, and working with folks to live more in the here and now, instead of the past, helping them see that they were a victim, that they're not a victim, like opening up their sense of self and defining their values and getting them, doing things, behavioral. Making behavioral commitments that are in line with those, with those values that they're, that they're interested in.
Keith Sutton, Psy.D (33:44):
Yeah. And that, that kind of idea you're talking about that there's that primary pain and that secondary suffering, the pain of the loss or the pain of the, triggering or so on, but then that other secondary suffering, that's saying, oh, you shouldn't be feeling this and you're bad for feeling this or something wrong with you. You're not good enough. Or you're not trying hard enough or whatever it might be that kind of exacerbates it essentially. You know, I always like monsters on the bus, but I don't know if you have any favorites that kind of, I think that, I love the different metaphors with the ACT and cause it really brings to light that kind of idea of not making deals with anxiety and moving towards one's values rather. I don't know if maybe you can talk about that one or maybe your, any of your other favorite ones?
Robyn Walser, Ph.D. (34:41):
Well, I probably my favorite work is in self context or perspective taking because we, and there is a little bit of that in the passengers on the bus are monsters on the bus right. The passengers represent all of your feelings, sensations and thoughts, and you invite them on the bus to ride where you are going, not where they want you to go. So as sort a brief way of talking about it. What I find so relevant is when I think about my own experience back when I did my first ACT workshop was realizing that I'm a, I'm a being who has experiences. I am not those experiences themselves.
Robyn Walser, Ph.D. (35:39):
It has very Eastern quality too. Right? Like I am a place where all of these events are flowing through and maybe they flow through again and again, but they're rising and falling, rising and falling. And that sort of might be one of the metaphors that they use, and I know you're aware of is the chess board metaphor.
Keith Sutton, Psy.D (36:03):
Yeah. I was thinking chess board. Yeah.
Robyn Walser, Ph.D. (36:05):
Where your, where all the pieces on the board are your thoughts, feelings and emotions. Good and bad if we're gonna label them. Yeah. By the way, if I could do psychology over again, there would be no such thing as negative, even positive. Yeah.
Keith Sutton, Psy.D (36:18):
Right.
Robyn Walser, Ph.D. (36:19):
Just emotions.
Keith Sutton, Psy.D (36:22):
They're just emotions. Yeah.
Robyn Walser, Ph.D. (36:24):
Yeah. They're just emotion. Just thoughts. Right? Like we've sort of categorized them in ways that tell people, and this is a language based thing. Like tell people that you should get rid of those that are negative. Yeah. And you know, we know pretty well from the literature on things like suppression that it's very hard to undo a thought you can't unlearn, you only add to learning, so if I say things like Mary had a little
Keith Sutton, Psy.D (36:53):
Lamb,
Robyn Walser, Ph.D. (36:54):
Something pops up and if I told you, you need to now never think that again, you need to not think lamb. When I said Mary had a little like, can you there's an impossibility in it. that same thing happens with trauma, thoughts and trauma memories. And so we can add to 'em and grow your, a change, your relationship with them and, get things happening that expand Mary, I had a little lamb and a dog, a little lamb and a dog and a rabbit so that you can start to expand the way you're interacting with your experiences. And part of what I think is happening in cognitive therapy, by the way, expansion.
Keith Sutton, Psy.D (37:35):
Yeah.
Robyn Walser, Ph.D. (37:37):
And that, but that selfish context metaphor is so freeing that like I am the board, not the piece of this, I hold these I'm in contact with them. I'm not away from 'em. Right. I'm not comprehensively distanced from them. They're they rest on me. They touch me, they’re embodied. They're part of my experience. And they're not all of my experience. Indeed. They're minuscule. When you think about all of the experiences that you have as a human being and the place where they occur,
Robyn Walser, Ph.D. (38:13):
Which is that selfish context place. So I'd say that's probably, my favorite place and you can get people to like, notice I'm not my trauma.
Robyn Walser, Ph.D. (38:24):
I'm so much more than that experience. you start looking at all of the days of your lives and all of the things that you learned like that trauma is just one aspect of you and it doesn't have to be all of you and it can be freeing to kind of connect to that, that place. And I'm so much more than that event or event, even if it was multiple traumas.
Keith Sutton, Psy.D (38:51):
Yeah. That reminds me of a, a client I worked with in a EMDR session at the end, when we went back to the image, he was an artist and he said, he said, now I see it. But I actually see it as one part of a mosaic that makes up a self portrait of me. And that one is one small moment in my life that makes up who I am that doesn't define me. And it was this kinda shift that, that he had, that was very significant that, and that visual kind of, I thought was really stood out to me. So tell me about, what have you been thinking about or interested in lately or either in your work or what's going on with awkward or anything in the field that's, that's picking your interest.
Robyn Walser, Ph.D. (39:42):
Well, I've, I've been super busy with a couple of things and hopefully this doesn't sound like too much of a plug, but I've written several books in the last couple of years. So I wrote a book, the heart of that to get at the interpersonal and interpersonal processes that are happening in that kind of inner behavioral field between you and your client. And then a colleague. And I just wrote, because of the times we were thinking about how much anger has been in the world and, anger at racism anger at inequality anger at the government, all the anger at COVID and what it's done. And so myself and Manuel, O'Connell just finished a book called ACT for anger to so self-help books.
Robyn Walser, Ph.D. (40:40):
We have people work on anger and we just finished another self-help on moral injury where it's a trauma-related thing too, where we're looking at people who maybe perpetrated an act of trauma, or by accident did something that caused somebody else's death or some like that, and that their morals were violated in some way. And now they're struggling with guilt and shame.
Keith Sutton, Psy.D (41:06):
And other sense of who they are that they did that, or, or yeah. Intentionally or unintentionally.
Robyn Walser, Ph.D. (41:13):
You see this in veterans who have perhaps getting swept up in some of what's going on in war who commit a war crime, or maybe they had to, were under fire and they had to return fire in a innocent person got killed or maybe somebody's texting while driving and they cause an accident that kills somebody. You know, so there's lots of ways that these, these morally challenging things can show for people. And so we're using sort of values based work truly to get people back in line with their values. Working on forgiveness of themselves, maybe others, if it's a betrayal or something like that. And so that's, I'm sort of swimming around in that territory right now.
Keith Sutton, Psy.D (42:02):
I actually with a lot of my clients I do a lot of work with shame, and I do a lot of work with adults with ADHD where that's a very big too that makes me me think of, yeah. That shame of kind of what one has done. And oftentimes people then go into a shame spiral and avoid it. And, sometimes the way I think about the antidote to shame and through integrity, taking responsibility, making amends, and then kind of taking the next steps in the direction of one's values, the display and the willingness to kind of walk through that fire and discomfort of acknowledging and dealing with. And so on. Is that out now that book, or is that something you're working on?
Robyn Walser, Ph.D. (42:44):
So that book is out now acceptance and commitment therapy for a moral injury. And we're doing a feasibility and acceptability trial with act compared to present-centered therapy in veterans with moral injury., I'm working with a great team here locally, Kent Drescher and some folks in Denver, Colorado Sean Barnes and Jacob Barnes. And I feel like, I thought I say their names, Lauren Boes, to get the cred they deserve. They're really fantastic group of colleagues who have been working on ACT for moral injury and we've written some papers about it and just, what are moral emotions and what's getting violated. How do you, how do you define moral injury? And we conceptualize it as there's moral pain from when you first commit the act or the act happens.
Robyn Walser, Ph.D. (43:46):
The pain that would come behind that would be very natural, right? I did something that I wish I wouldn't have done something happened. That was not good. But then the injury is from now, I need to hide myself. And that not let people see my shame and I need to be away from people cuz I'm evil or however they might be interpreting their experience. And then what happens though, is more people get harmed, they get harmed and the yeah. The problem of it, of it just grows and, and shame is such an interesting like it's a fascinating emotional experience to me because it, the hiding of it is so powerful. if I were to ask everybody, who's listening to the podcast right now to say, I want you to come on and tell Keith and your most shameful moment, like they probably all like click off. Cause it's very hard to report about those events. And so that shame sits there and eats at people and what we need to do is see it. And what is it trying to tell us? And what's important about it and use it as information rather than avoidance and see what it's, imagine if we didn't have shame.
Keith Sutton, Psy.D (45:10):
I mean, it's kind of something to keep us on track of whatever yeah. That, that moral compass is that we have. Yeah, it reminds me about, it makes me think of like 12 step programs and so on. And oftentimes with alcoholism, the getting up in front of the room and telling one story, telling about the, the things that happen, the shameful that might have happened and such, and kind of being with that and not avoiding it and kind of growing from that rather than just kind of like it's over moving on, kind of piece. Its very desregulating.
Robyn Walser, Ph.D. (45:53):
And making repairs behind it, like the AA philosophy. I think it's step nine where you make a repair. There's something that's valuable, right? Like AA has a healing kind of quality to it where you can, do something that's value based that realigns you with what your own integrity or authenticity important to you can. Yeah. I think make some changes for people in terms of recovering and healing from these kinds of struggles that they have. And what I mean by recovering and healing is the suffering goes down. Right. Doesn't mean that the emotions disappear.
Keith Sutton, Psy.D (46:36):
Yeah. I'm not gonna get rid of
Robyn Walser, Ph.D. (46:38):
Yeah, yeah,
Keith Sutton, Psy.D (46:39):
There’s a–I dunno, you've ever seen–it's a sitcom type show of my name is Earl about a guy who is kind of, he says steal stuff and Rob things and so on. And then he like kind of finds karma and he creates a list and every episode he's going around and he amends for all the bad things that he did and kinda how that, that unfolds.
Robyn Walser, Ph.D. (47:00):
Fantastic show. It's a really good one. Yeah, yeah,
Keith Sutton, Psy.D (47:04):
Yeah.
Keith Sutton, Psy.D (47:07):
Well, great. Well, it sounds like you're doing some wonderful stuff. And oh, and you know what, actually, one more thing that I forgot, you've all also done some work with couples in ACT haven't you cause something that made me think about that is, especially with the veterans and I know in, in emotionally focused couples therapy, they've been doing some work with veterans and kind of helping them, some, having them sometimes share those moral injuries with their partner and the fear of seeing the repulsion from a partner or discuss or so on. And instead, seeing love and compassion, oftentimes how, how through those attachment relationships can really, help someone heal from, from the shame and be more present, be more connected in relationships.
Robyn Walser, Ph.D. (47:57):
Well, so Dara west and I wrote a book called The Mindful Couple, a few years back and I've done a little work with supervising folks who are seeing couples and seeing couples in my own very, very small practice. And I really like working with couples it's, it's interesting to see them getting working on their willingness to feel when they feel when they're, when they when their partners feeling something.
Keith Sutton, Psy.D (48:29):
Yeah.
Robyn Walser, Ph.D. (48:30):
Like, can I be present in my own emotional experience or do I have to shut my partner down? So I don't feel what I feel yeah. To get them thinking about their shared values and how to move forward in creating those kinds of things. And so I quite like the couple's work. I'm not doing it as much as I was, but I certainly do some couples in my, in my private practice and get them working on those things.
Keith Sutton, Psy.D (48:56):
Well, I like that idea of sitting with the emotions. I oftentimes will even show that clip from Bene Brown's Ted talk with the it's a little animation, how like a little bear that goes down to the hole that, and it talks about the difference between shame and pity and talks about to have true between empathy and pity or so on. To really have empathy, we have to sit with those emotions and connect with having felt that feeling that the other person is feeling, and sometimes that gets dysregulating. And so people shut it down and say so, and so's doing good in school or whatever it might be. But I think, like you're saying, it's that aspect of, can you sit with your own emotions and connect with them? Cause that's what ultimately kind of is that bridge to the empathy to really understand the others experience. So I like, I like that what you're talking about with the ACT and helping the person kind of tune in and kinda experience their experience as they're connecting with their partner or talking to their partner.
Robyn Walser, Ph.D. (49:56):
If you look at what partners are doing, when they're struggling, they're often wanting to control the other person in some way. I want you to stop doing what you're doing. I want you to start doing something else. And they're trying all different kinds of ways to make that happen. And what I'm interested in is what part of trying to control your partner is about trying to like, not feel on something or maybe has a very rigid rule inside of it or something like that. Not that you can't negotiate with your partner. Of course, we want people to negotiate with each other, but some of these really tough places are about, I want you to do what I want you to do. And I don't wanna feel this when you don't do it. Right. And so couples will get into a kind of a who's in control battle. And you know, one of the great things to do is to think about your own relationships and how much control of your partner do you actually try to do either? that, you're doing or might be a little bit you know, like you're not to putting it out there that, you're doing it. It's a lot.
Keith Sutton, Psy.D (51:15):
Yeah. Interesting. I notice that. Yeah.
Robyn Walser, Ph.D. (51:20):
Did look at your own, like when you start looking at like how much, and I've, I've asked couples to do things like a, I want you to just take this week and your whole week is to resist controlling your partner. Yeah. And you should just see, they go like, no things are gonna fall apart. It's gonna be terrible. You don't know my partner if I do that. But yeah. It's when they come back, it's a, I get all kinds of responses. Like it was really interesting, like things didn't fall apart and
Keith Sutton, Psy.D (51:51):
Yeah.
Robyn Walser, Ph.D. (51:52):
Free and, so it's, it's fascinating to kind of watch some of those things.
Keith Sutton, Psy.D (51:57):
Interesting. Well, Robin, thank you so much. It's always great talking with you. I love hearing about the, the work that you're doing and love the, the ACT approach. Definitely will look out for this book and those other books that you've written and I'll, put some of that information on the website and such too. Thanks again. I appreciate for joining us.
Robyn Walser, Ph.D. (52:17):
And thank you for having me. It's nice to talk with you and see you again, Keith.
Keith Sutton, Psy.D (52:21):
Okay. Take care. Thank you for joining us today. If you'd like to receive continuing education credits for the podcast you just listened to, please go to therapyonthecuttingedge.com and click on the link for CE. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, where we provide trainings for therapists in evidence-based models through live and online workshops, on-demand workshops, consultation groups, and online one-way mirror trainings. To learn more about our trainings and treatment for children, adolescents, families, couples, and individual adults, with our licensed experienced therapists in-person in the Bay Area, or throughout California online, and our employment opportunities, go to sfiap.com. To learn more about our associateships and psych assistantships and low fee treatment through our nonprofit Bay Area Community Counseling and Family Institute of Berkeley, go to sf-bacc.org and familyinstituteofberkeley.com. If you'd like to support therapy for those in financial need and training and evidence-based treatments, you can donate by going to BACC’s website at sfbacc.org. BACC is a 501(c)(3) nonprofit so all donations are tax deductible. Also, we really appreciate your feedback. If you have something you're interested in, something that's on the cutting edge of the field of psychotherapy, and you think therapists out there should know about it, send us an email. We're always looking for advancements in the field of psychotherapy to create lasting change for our clients.
Welcome to therapy on the cutting edge, a podcast for therapist who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco bay area and the director of the Institute for the advancement of psychotherapy today on the show, I'll be interviewing Robin waler PhD, who is co-director of the bay area trauma recovery center, and is on staff at the veteran's administration national center for PTSD dissemination and training division. She's a licensed psychologist and maintains an international training consulting and therapy practice. She's an expert in acceptance commitment therapy and has expertise in trauma, stress and substance abuse, and has authored a number of articles, chapters, and books on these topics, including the books she co-authored with Dar stra acceptance commitment therapy for the treatment of posttraumatic stress disorder and trauma related problems, a practitioner's guide to using mindfulness and acceptance strategies. Let's listen to the interview. Well, hi Robin. Welcome for joining me today.
Robyn Walser, Ph.D. (01:25):
Hi Keith. Thanks for inviting me. Happy to be here.
Keith Sutton, Psy.D (01:28):
Yeah, definitely. So Robin, I've known you for some years. I forget exactly how we originally got connected, but you came and did some trainings and acceptance commitment therapy for my Institute. And then we did a great one-way mirror series where you were the trainer. There was a therapist actually working with one of my clients that I had worked with over 10 sessions and just like, it was incredible to see the, the transformation that happened. And I know that we've, I think you've done a training for us on your work with PTSD, and you've been actually supervising a number of different associates that we've had over the years who are associate in nonprofit. So yeah, I would just love to, see if you could talk a little bit about your work and kind of and I was mentioning just before that, I haven't really heard the backstory on how you got so involved with actor and the PTSD work, and I know you work with the VA. Yeah. So tell me a little bit about it.
Robyn Walser, Ph.D. (02:22):
Sure, sure. Well, so where to begin is an interesting question. I would say that I first sort of got into where I was headed by being very bad at chemistry . And so I was planning to go to medical school. I could not get the chem. I was just getting CS in chem and that wasn't gonna get me where I needed to go. And so I started taking some psychology courses and got a job as a those on campus jobs where you work for like money as an assistant in an on-campus setting,
Keith Sutton, Psy.D (03:07):
Like a work study or something
Robyn Walser, Ph.D. (03:09):
Like where that was, it was work study. Yeah. And I was working in a behavioral research lab where I was running rats on mazes, basically training rats, run mazes and giving them little pieces of fruit for doing it correctly. And so I just started getting more and more interested and ultimately applied for a master's program at university of Nevada, Las Vegas and went down there and still started getting involved in some practicum where I was working with folks who'd been traumatized in particular youngsters like 10, 11, 12 year olds who had been suffering from childhood sexual abuse. And so we were getting them right as they were coming out of those situations and the pain and difficulty of it was really really challenging. And I discovered at that time that I didn't wanna work with trauma in particular with children. Sure. It's like, oh, so
Keith Sutton, Psy.D (04:16):
Heart work, it's heartbreaking.
Robyn Walser, Ph.D. (04:18):
Yeah. Heartbreaking work feeling a lot of distress about, who are the people that are doing this to these children, what's happening to them and do they know the impact and, questioning things a fair bit
Robyn Walser, Ph.D. (04:35):
And but I decided to pursue a master's degree looking at childhood sexual trauma, but with adults and you know, what were the long term impacts and did my masters in that area and then applied to a program in Reno where there was a lot of trauma work going on. And so I was gonna continue to grow my career there by working with professor Dr. Victoria Ette. And so went up there for my PhD. Yeah. And in the first year Steve Hayes invited all the students to an act, an acceptance and commitment, a therapy workshop. And I went, and I had such an amazing experience and felt like I had just come home
Robyn Walser, Ph.D. (05:35):
And really encountered some of my own trauma from my past and looked at how I was, is relating to myself and, sort of coming back to a place where I detected my own sense of wholeness, despite my personal trauma. And that was all she wrote, like I was hooked. I was in it and I straddled both labs, essentially. I worked in Vic lab and then I worked in Steve Hayes's lab, the developer of act and ended up doing a dissertation combining the two and plan to continue that trajectory. I actually got my dream job, right outta graduate school. I went to become a professor at a university setting on a tenure track discovered that I didn't wanna do that. And so left after a year and came to the bay area and worked in a substance use program for a bit of time and then applied to the national center for PTSD and have worked there now, and have worked there for 20 years and have really just made my career around acceptance and commitment therapy and trauma.
Keith Sutton, Psy.D (06:59):
Oh, wow. Okay. Interesting. And how long, I you know, I'm whatever got licensed back in, grad school and so on in the 2009 and in those times what was and what was ACT like, kind of, as you were going along, I guess you sounds like you got introduced to it, what was 25 years ago, or 20 years ago, or so?
Robyn Walser, Ph.D. (07:26):
30 years ago.
Robyn Walser, Ph.D. (07:29):
‘91 was when I first got introduced to.
Keith Sutton, Psy.D (07:32):
OK. Yeah.
Robyn Walser, Ph.D. (07:34):
And if you look at what was happening during that time with acceptance and commitment therapy, it was still very limited, like sort of the renal university of Nevada renal crowd, and a few other people were dipping into it. The research studies were just starting to come in. We were actually sitting in Steve's lab, developing the intervention and working on the intervention.
Keith Sutton, Psy.D (08:01):
Wow.
Robyn Walser, Ph.D. (08:02):
And so it was very new at that time. And I would say hardly anybody knew about it really. And then the, I used to actually be called comprehensive distancing. So if you do a literature search, you could find a couple of articles on comp comprehensive distancing, but it gave the wrong impression. Right. Like you're trying to comprehensively get away from
Keith Sutton, Psy.D (08:26):
Yourself. Yeah. Right. I not, what it's about this is, this is actually the approach is the opposite of avoidance. Not, not encouraging avoidance. Yeah.
Robyn Walser, Ph.D. (08:35):
Yeah. And so it was, they renamed it and came up with the six core processes, the psychological flexibility processes. And let's see the first book came out in 1999. So that was really when it launched more significantly. Yeah. Steve Hayes, Kelly Wilson and Kirk Strassel were the authors and that's when it started to really take off and research started growing, and it's now an evidence based psychotherapy for a number of disorders. And there's over like as close to 400 randomized controlled trials. Showing that it works.
Keith Sutton, Psy.D (09:19):
Yeah.
Robyn Walser, Ph.D. (09:20):
And so, and it's all over the world, like they're doing it in places like Jordan and Iraq, China and, New Zealand and, Malaysia. I mean, there's, it really has traveled South Africa. of course the United States, Canada, south America, like it's exploded. And well, I know that everywhere
Keith Sutton, Psy.D (09:47):
That it's part of the, I think they call it the third wave of CBT kind of that. And can you talk a little bit about that or kind of what that means to you or how that fits in?
Robyn Walser, Ph.D. (09:59):
Yeah, I mean, I probably wouldn't do the, do it the same justice as somebody like Steve Hayes would if he were talking about it. But you know, each sort of wave of psychotherapy, I think, is an advancement in things that we're doing. And there would probably be a another one and we'll see where that takes us, like right now. There's some kind of combination of evolution and the third wave behavior therapies like variability, adaptability selection, kind of linking those up to some of the things that we're doing inside of the acceptance commitment, the be broader association and group that are kind of interesting focusing more on process based interventions than simply on techniques or treatment programs per se. But the the waves are sort of a reaction to what came before. Not in a negative reaction, more like a building. Do we need to add or change or fix to move forward. And so if you think about things like Watsonian behaviorism and that kind of black box idea of what, give me a six year old and I'll make you a lawyer kinda thing.
Keith Sutton, Psy.D (11:21):
Sure.
Robyn Walser, Ph.D. (11:22):
And that it was too limited in terms of what, how human beings function and work that there, there is stuff going on inside the skin and people were thinking and emoting. And so what you, you saw a rise out of that was the second wave of the cognitive therapies that were really much more focused on: “What are you thinking?” And if you look at some of the like original writings, it's, thoughts are the main thing thoughts cause emotions cause behavior like sort of a linear process. And I think the third wave in a very sort of non-sophisticated sophisticated way that I'm speaking about it sort of rolled out out of that, that, that wasn't sufficient. I either because people are whole beings and sensations, emotions, thoughts, memories, these are interactional and context-based. And so and that maybe you could have a thought and not act on it, and maybe you, maybe, maybe it isn't a direct linear relationship. That's more complex than that, depending on your learning history. And so some of the more be radical behavioral kinds of theories moved out and we got things like DBT, which was developed almost simultaneously with that, like DBT and, and some of the mindfulness based therapies that mindfulness.
Robyn Walser, Ph.D. (13:00):
Yeah. Now it's not to say that like big C little B cognitive therapy disappeared, just expanded upon and people can read about the distinctions between the two and, they're both evidence, space, psychotherapies as processes that can both be used. And so it's, it's not any sort of one or the other is better or, best or something like that. It's just the movement is looking more at the whole person rather than just thinking.
Keith Sutton, Psy.D (13:33):
Yeah, just completely the thoughts. And and I know that one way that I've kind of conceptualized it a little bit too, is that whereas maybe CBT or rational motor behavioral therapy, kind of the idea was to like identify the distorted thoughts or the rational thoughts and kind of like, almost get rid of them or replace them with, with something else where in act is, more about just kind of noticing and being with those thoughts and not necessarily trying to get rid of those thoughts and particularly, one of the, the main central themes that I've taken away from act is that idea that, that ultimately a lot, a lot of the difficulty is in our attempts to get rid of anxiety or get rid of negative thoughts and, being open to the full range of human experience.
Robyn Walser, Ph.D. (14:22):
Yeah, no, it's has that kind of more that human beings are built to feel and experience a lot, like they're designed to have anxiety and fear sadness, et cetera. And that thinking is a part of the context. It's not the full context. And so when I think about what I see in the CBT work today, it's all bidirectional it's changed and moved it, it has moved also and so, and shifted into other other places. And isn't sort of that rational emotive kind of, out with the bad and in with the good and, the, I think that kind of idea that you have stinking thinking, or, these, those kinda older ideas of you know, you're just, your thoughts are negative and you need to break 'em down mechanically and redo them and put 'em back together in a way that makes them rational and logical.
Robyn Walser, Ph.D. (15:31):
Although there's, there's still some of that kind of cognitive work today where you're wanting to move people from dysfunctional and illogical thinking to rational ways of thinking. And from the perspective of, acceptance and commitment therapy, we wouldn't necessarily say that a thought is irrational or dysfunctional. We would say that's a thought about a thought. You're labeling a thought and you still have to look at thinking as a whole that, that too functional thinking, the thought that's a dysfunctional thought also has to be analyzed. Like, where does that come from? What is that about? Yeah. But just, sort of looks at mind as a whole versus mind as certain kinds of thoughts
Keith Sutton, Psy.D (16:28):
And, I don't I don't know if I've ever heard the story so much. So actually one of the reasons I was actually attracted to cognitive behavioral therapy and act back in undergraduate, my minor was in Eastern philosophy and, kinda the, the Buddhist thinking. And just, even as you're saying, that reminds me of the, kind of noticing thoughts and the nonjudgmental and I really likes work and so on. And so that idea that our experience is colored by our perceptions and that we can learn to sit with and experience those. And, and notice those in a non-judgmental way. Is that, a significant piece of yeah. Steven, his kind of process as he was kind of developing after?
Robyn Walser, Ph.D. (17:17):
What he, he's not a Buddhist himself. Yeah. He like, like Marshall Lenahan, she practices Buddhism, and you can hear a lot of Eastern kind of mindfulness work is there. And yeah, Steve developed this more from relational frame theory and thinking about, what is mind and how do we learn to think? But they happen to line up, right? When you start looking at, you have a mind, you are not a mind that and you're conscious and aware being that can observe thinking, but I put that in quotes. You know, you might see symbolic, symbolic behavior at all, but you know, images or recognize that there's a process going on, that's called mind and that you can see it. is, has that same kind of quality as what you see in Buddhism when they're practicing meditation or mindfulness or something like that. Yeah. And a lot of the mindfulness work that in kinda east from an Eastern approach can be brought to act in a way that's very consistent and helpful.
Robyn Walser, Ph.D. (18:38):
Yeah. Yeah. I think the goal is like thinking about living consciously, which I think Buddhism would also espouse right. Living consciously and that, but it's been, I hear now aware I hear now experiencing.
Keith Sutton, Psy.D (18:58):
Yeah.
Robyn Walser, Ph.D. (18:59):
And I think that lines up with some Eastern ideology pretty, pretty nicely.
Keith Sutton, Psy.D (19:07):
Yeah, definitely. You kind of describe the aspects of ACT. What makes up its principles? What does that look like in a therapy?
Robyn Walser, Ph.D. (19:23):
Yeah. Well, so it's, it's based on principles of learning. So it's a behavioral approach and essentially we're doing a functional analysis of individual's behavior and looking at what's leading people to suffer. And so the six core processes are about addressing the suffering. And so those six core processes are openness or accept willingness to experience diffusion or of seeing that you have a mind, not that you are a mind. I can say more about that. Sure. Present moment, living in the here and now self as context or perspective, taking, being able to see yourself as a place where these emotion, thoughts, and sensations occur rather than you are those as they're defined like anxiety or not your anxiety. You're being with anxiety in this moment in time,
Robyn Walser, Ph.D. (20:29):
Values based living. And so we wanna hook up anything that we're doing in the room to creating meaningful living, according to what the client cares about rather than just feeling– it's not mindfulness for mindfulness sake, it's in the service of meaningful living and then committed action. Like what actions will you take to bring that meaning to life? And, if you look at the other side of that, what we're addressing is avoidance of internal experience. So that's the acceptance willingness part fusion with mind. I am my mind. I am my thoughts. They define me let you, so you're outta contact with, I have a mind, I'm not a mind living in the past, worrying about the future or very low self-knowledge. So I'm not aware of myself either and what my experiences are that matches up with present moment and then self as identity or self-story, which is the opposite of self as context where I am content of my life, rather than I am a context in which that content occurs.
Robyn Walser, Ph.D. (21:46):
So like a good example here with trauma might be something like I was victimized–maybe having a PTSD as a result and then sort of living inside of the victim identity– and I wanna be careful when I say this because is not a, it's a it's the victim's fault it's that our learning history sets us up in many ways to kind of buy what our mind is selling. Yeah. And so we can get inside of continuing to suffer because we were victimized and starting to buy that identity. So an example might be a Vietnam era veteran who has PTSD for 30 years. And when they come into your therapy room, it's not a human being that's walking in. It's Vietnam that’s walking in, right. Like their whole identity did has become about that experience or captured by it. And they've lost a father and a brother and a community member and a husband. Right? Like they're all of those other senses of themselves are given over to the one identity. I am my PTSD. Yeah. So that's sort of the place where we work with selfish context to help them expand their awareness of self
Robyn Walser, Ph.D. (23:15):
And then the opposite of values, if we think about inflexibility or rigidity is out of contact with it, or lack of clarity, not living my values and committed action is like holding still in action or impulsive with drinking or using drugs. So what we're doing is targeting all those things that create suffering yeah. By using their antidote, I guess you could call it.
Keith Sutton, Psy.D (23:43):
I've almost thought about like ACT as almost like a enhanced, almost motivational interviewing for exposure and kind of connecting to one's values and committing to going through the discomfort of say, addressing the trauma or, making making a deal with something that's hard rather than avoiding it. And then, and really kind of being able to be willing to, to experience those difficult emotions, to go towards something that's important and staying in that present moment, kind of having that perspective taking and being open to the full range and kind of moving forward, despite rather than, there's lots of great metaphors about making deals with anxiety and not leading to, kind of avoidance, but then anxiety kind of driving your life rather than values.
Robyn Walser, Ph.D. (24:41):
Yeah, precisely. So when like, in the case of a trauma survivor they might be very much sort of caught in problem solving sort of mind where they're experiencing fear or anxiety about what happened. And by the way, there's other responses to trauma like moral injury responses that are also part of, what we're looking at when we're looking at reactions to trauma. And so if like, if I put my mind to problem solving my emotions, then I could just do something like this. Well, I feel fear, or I get triggered when I'm at the grocery store, that's with a logical thing to do. If you're like problem solving is don't go to the grocery store.
Robyn Walser, Ph.D. (25:31):
Problem solved. And then the problem with it is emotions don't cooperate. And so then you, feel anxiety in the front yard. Cause it feels open or vulnerable or something like that. So problem solve again, don't go the front yard.
Keith Sutton, Psy.D (25:50):
Yeah. The list get longer.
Robyn Walser, Ph.D. (25:53):
And your life gets smaller, smaller, smaller, and you end up doing things like spending all of your time in your bedroom, in front of the game boy or something like that. Right. I think game boy is old by the way, too. Yeah.
Keith Sutton, Psy.D (26:09):
No, my, my kids have an Nintendo switch now.
Robyn Walser, Ph.D. (26:11):
No. I might be dating myself a bit with that, but the issue is, is like problem-solving is good and healthy and practical, depending on where it's applied. Like out there in the world, where you're interacting with your environment, problem solving can be a great thing. Like if you don't like the room you're sitting in, you can paint that room.
Robyn Walser, Ph.D. (26:39):
That problem solving applied to your internal experience. Like the stuff that's going on inside your skin fails. Like you can't problem solve away human emotion. And indeed, we now know that if you're, if you try to suppress any emotion, like pain or anxiety, you end up numbing out to all emotion. So we're not very good at taking one. And so if you're not willing to feel pain, you're gonna cut yourself off from joy as well. And so you sort of have to put it all down and you, I'll see from folks with PTSD and trauma who have no joy, there’s no joy at all. They're trying to solve something that is more like a sunset, right? It's something you experience, not something you treat like a math problem.
Keith Sutton, Psy.D (27:33):
That reminds me of the [inaudible book named] from the prophet on love and that you can't experience the great greatest joy, unless you're willing to risk the greatest pain. And so if you try to protect yourself from ever feeling pain you, you aren't able to experience that the joy there and that, that love connection. And so that again, being open to that full range of human experience, definitely.
Robyn Walser, Ph.D. (28:03):
Well, and when I think about, if if you think about life as a menu in a way, right? Like, are you only gonna taste certain things on the menu? Like we're only here for a short period of time, right? We're born we're conscious. And then we die. And so this question, what are you gonna do with that time? And if all of your time is spent avoiding and running and, trying not to feel, then you can just feel the menu getting shorter and shorter and shorter. And part of what I wanna do is like invite people to do everything on the menu. Even the things you don't like you live and experience. And while you're here bring meaning to what you're doing and or create meaning is a better way to say it, like get out there, do things that matter to you. And so I wouldn't ask anybody to pain for pains sake, right. We always wanna link it up to living the way you wanna live. And so when people come into therapy, the question is kinda like this, do you wanna feel better or live well,
Robyn Walser, Ph.D. (29:22):
You sort of put that out there as you know, which you're gonna pick and you have this much time to be in your life. Like, which one do you pick? I mean, it's, I'm oversimplifying, but you can sort of see what, what the main issue is there.
Keith Sutton, Psy.D (29:36):
Cause if we choose a kind of the avoidance of this comfort. Sometimes we aren't able to live well because everything's focused and revolves around maintaining comfort.
Robyn Walser, Ph.D. (29:49):
Right. Life is not comfortable.
Keith Sutton, Psy.D (29:52):
Yeah. That's for sure.
Keith Sutton, Psy.D (29:58):
So what does this look like in therapy or particularly too? I know, I know you do a lot of work with trauma. Like what does this look like in, in, in work with trauma and work with clients?
Robyn Walser, Ph.D. (30:10):
Oh, so exposure is built into ACT emotional exposure, exposure to thinking exposure to your experiencing your body sensation. Like this is part of what willingness is about out is to allow what is present to be present and to process it, to move through it, to let it roll through you rather than to push against it and keep it at bay, which tends to sustain it.
Robyn Walser, Ph.D. (30:38):
And so what we're, what will run through a, a kind of a, a regular process of looking at the, how problematic control or attempts to control your internal experience have been, and try to undermine that control so that you are willing to kinda look at alternatives to control of internal experience. We want people to be in control of their lives, like in control of your behavior and what you're doing in the world, but letting go of what's going on inside your skin will free you up to do that. It's not that control is bad per se of internal experience. It's just contextually dependent, like where, and when do you control, but how much control? So it's excessiveness applied control that we wanna sort of get under me. Yeah. And get people to consider the alternative of letting go of that in the service of value based living. And so it's, the exposure is right inside of that. I will feel what's there to be felt.
Robyn Walser, Ph.D. (31:43):
And so some of the ways to work with ACT in the trauma in trauma therapy is to not just do exposure. I will integrate things like prolonged exposure, integrate EMDR, you can integrate accelerated reprocessing therapy. You can integrate the WET protocol, the written exposure therapy, so that you're not only exposing people to the emotions that they're having in general, but specific to the trauma.
Robyn Walser, Ph.D. (32:17):
Some of the fear-based stuff that's keeping them from living, or that's what they're avoiding. Yeah. So we're gonna integrate and expose but we're gonna tie all of that to creating meaning. So it's not just where we're gonna reduce your fear or the symptoms.
Robyn Walser, Ph.D. (32:38):
We might not even talk about reducing symptoms because in some ways the internal experiences are gonna be there. And so it's the suffering around those that we're interested in, reducing they're sort of natural pain that comes from trauma. And then all of the efforts to get rid of that pain, which we would define as suffering. So we're interested in reducing suffering by being present in the natural experience of pain and letting it rise and fall. All emotion rises and falls, and working with folks to live more in the here and now, instead of the past, helping them see that they were a victim, that they're not a victim, like opening up their sense of self and defining their values and getting them, doing things, behavioral. Making behavioral commitments that are in line with those, with those values that they're, that they're interested in.
Keith Sutton, Psy.D (33:44):
Yeah. And that, that kind of idea you're talking about that there's that primary pain and that secondary suffering, the pain of the loss or the pain of the, triggering or so on, but then that other secondary suffering, that's saying, oh, you shouldn't be feeling this and you're bad for feeling this or something wrong with you. You're not good enough. Or you're not trying hard enough or whatever it might be that kind of exacerbates it essentially. You know, I always like monsters on the bus, but I don't know if you have any favorites that kind of, I think that, I love the different metaphors with the ACT and cause it really brings to light that kind of idea of not making deals with anxiety and moving towards one's values rather. I don't know if maybe you can talk about that one or maybe your, any of your other favorite ones?
Robyn Walser, Ph.D. (34:41):
Well, I probably my favorite work is in self context or perspective taking because we, and there is a little bit of that in the passengers on the bus are monsters on the bus right. The passengers represent all of your feelings, sensations and thoughts, and you invite them on the bus to ride where you are going, not where they want you to go. So as sort a brief way of talking about it. What I find so relevant is when I think about my own experience back when I did my first ACT workshop was realizing that I'm a, I'm a being who has experiences. I am not those experiences themselves.
Robyn Walser, Ph.D. (35:39):
It has very Eastern quality too. Right? Like I am a place where all of these events are flowing through and maybe they flow through again and again, but they're rising and falling, rising and falling. And that sort of might be one of the metaphors that they use, and I know you're aware of is the chess board metaphor.
Keith Sutton, Psy.D (36:03):
Yeah. I was thinking chess board. Yeah.
Robyn Walser, Ph.D. (36:05):
Where your, where all the pieces on the board are your thoughts, feelings and emotions. Good and bad if we're gonna label them. Yeah. By the way, if I could do psychology over again, there would be no such thing as negative, even positive. Yeah.
Keith Sutton, Psy.D (36:18):
Right.
Robyn Walser, Ph.D. (36:19):
Just emotions.
Keith Sutton, Psy.D (36:22):
They're just emotions. Yeah.
Robyn Walser, Ph.D. (36:24):
Yeah. They're just emotion. Just thoughts. Right? Like we've sort of categorized them in ways that tell people, and this is a language based thing. Like tell people that you should get rid of those that are negative. Yeah. And you know, we know pretty well from the literature on things like suppression that it's very hard to undo a thought you can't unlearn, you only add to learning, so if I say things like Mary had a little
Keith Sutton, Psy.D (36:53):
Lamb,
Robyn Walser, Ph.D. (36:54):
Something pops up and if I told you, you need to now never think that again, you need to not think lamb. When I said Mary had a little like, can you there's an impossibility in it. that same thing happens with trauma, thoughts and trauma memories. And so we can add to 'em and grow your, a change, your relationship with them and, get things happening that expand Mary, I had a little lamb and a dog, a little lamb and a dog and a rabbit so that you can start to expand the way you're interacting with your experiences. And part of what I think is happening in cognitive therapy, by the way, expansion.
Keith Sutton, Psy.D (37:35):
Yeah.
Robyn Walser, Ph.D. (37:37):
And that, but that selfish context metaphor is so freeing that like I am the board, not the piece of this, I hold these I'm in contact with them. I'm not away from 'em. Right. I'm not comprehensively distanced from them. They're they rest on me. They touch me, they’re embodied. They're part of my experience. And they're not all of my experience. Indeed. They're minuscule. When you think about all of the experiences that you have as a human being and the place where they occur,
Robyn Walser, Ph.D. (38:13):
Which is that selfish context place. So I'd say that's probably, my favorite place and you can get people to like, notice I'm not my trauma.
Robyn Walser, Ph.D. (38:24):
I'm so much more than that experience. you start looking at all of the days of your lives and all of the things that you learned like that trauma is just one aspect of you and it doesn't have to be all of you and it can be freeing to kind of connect to that, that place. And I'm so much more than that event or event, even if it was multiple traumas.
Keith Sutton, Psy.D (38:51):
Yeah. That reminds me of a, a client I worked with in a EMDR session at the end, when we went back to the image, he was an artist and he said, he said, now I see it. But I actually see it as one part of a mosaic that makes up a self portrait of me. And that one is one small moment in my life that makes up who I am that doesn't define me. And it was this kinda shift that, that he had, that was very significant that, and that visual kind of, I thought was really stood out to me. So tell me about, what have you been thinking about or interested in lately or either in your work or what's going on with awkward or anything in the field that's, that's picking your interest.
Robyn Walser, Ph.D. (39:42):
Well, I've, I've been super busy with a couple of things and hopefully this doesn't sound like too much of a plug, but I've written several books in the last couple of years. So I wrote a book, the heart of that to get at the interpersonal and interpersonal processes that are happening in that kind of inner behavioral field between you and your client. And then a colleague. And I just wrote, because of the times we were thinking about how much anger has been in the world and, anger at racism anger at inequality anger at the government, all the anger at COVID and what it's done. And so myself and Manuel, O'Connell just finished a book called ACT for anger to so self-help books.
Robyn Walser, Ph.D. (40:40):
We have people work on anger and we just finished another self-help on moral injury where it's a trauma-related thing too, where we're looking at people who maybe perpetrated an act of trauma, or by accident did something that caused somebody else's death or some like that, and that their morals were violated in some way. And now they're struggling with guilt and shame.
Keith Sutton, Psy.D (41:06):
And other sense of who they are that they did that, or, or yeah. Intentionally or unintentionally.
Robyn Walser, Ph.D. (41:13):
You see this in veterans who have perhaps getting swept up in some of what's going on in war who commit a war crime, or maybe they had to, were under fire and they had to return fire in a innocent person got killed or maybe somebody's texting while driving and they cause an accident that kills somebody. You know, so there's lots of ways that these, these morally challenging things can show for people. And so we're using sort of values based work truly to get people back in line with their values. Working on forgiveness of themselves, maybe others, if it's a betrayal or something like that. And so that's, I'm sort of swimming around in that territory right now.
Keith Sutton, Psy.D (42:02):
I actually with a lot of my clients I do a lot of work with shame, and I do a lot of work with adults with ADHD where that's a very big too that makes me me think of, yeah. That shame of kind of what one has done. And oftentimes people then go into a shame spiral and avoid it. And, sometimes the way I think about the antidote to shame and through integrity, taking responsibility, making amends, and then kind of taking the next steps in the direction of one's values, the display and the willingness to kind of walk through that fire and discomfort of acknowledging and dealing with. And so on. Is that out now that book, or is that something you're working on?
Robyn Walser, Ph.D. (42:44):
So that book is out now acceptance and commitment therapy for a moral injury. And we're doing a feasibility and acceptability trial with act compared to present-centered therapy in veterans with moral injury., I'm working with a great team here locally, Kent Drescher and some folks in Denver, Colorado Sean Barnes and Jacob Barnes. And I feel like, I thought I say their names, Lauren Boes, to get the cred they deserve. They're really fantastic group of colleagues who have been working on ACT for moral injury and we've written some papers about it and just, what are moral emotions and what's getting violated. How do you, how do you define moral injury? And we conceptualize it as there's moral pain from when you first commit the act or the act happens.
Robyn Walser, Ph.D. (43:46):
The pain that would come behind that would be very natural, right? I did something that I wish I wouldn't have done something happened. That was not good. But then the injury is from now, I need to hide myself. And that not let people see my shame and I need to be away from people cuz I'm evil or however they might be interpreting their experience. And then what happens though, is more people get harmed, they get harmed and the yeah. The problem of it, of it just grows and, and shame is such an interesting like it's a fascinating emotional experience to me because it, the hiding of it is so powerful. if I were to ask everybody, who's listening to the podcast right now to say, I want you to come on and tell Keith and your most shameful moment, like they probably all like click off. Cause it's very hard to report about those events. And so that shame sits there and eats at people and what we need to do is see it. And what is it trying to tell us? And what's important about it and use it as information rather than avoidance and see what it's, imagine if we didn't have shame.
Keith Sutton, Psy.D (45:10):
I mean, it's kind of something to keep us on track of whatever yeah. That, that moral compass is that we have. Yeah, it reminds me about, it makes me think of like 12 step programs and so on. And oftentimes with alcoholism, the getting up in front of the room and telling one story, telling about the, the things that happen, the shameful that might have happened and such, and kind of being with that and not avoiding it and kind of growing from that rather than just kind of like it's over moving on, kind of piece. Its very desregulating.
Robyn Walser, Ph.D. (45:53):
And making repairs behind it, like the AA philosophy. I think it's step nine where you make a repair. There's something that's valuable, right? Like AA has a healing kind of quality to it where you can, do something that's value based that realigns you with what your own integrity or authenticity important to you can. Yeah. I think make some changes for people in terms of recovering and healing from these kinds of struggles that they have. And what I mean by recovering and healing is the suffering goes down. Right. Doesn't mean that the emotions disappear.
Keith Sutton, Psy.D (46:36):
Yeah. I'm not gonna get rid of
Robyn Walser, Ph.D. (46:38):
Yeah, yeah,
Keith Sutton, Psy.D (46:39):
There’s a–I dunno, you've ever seen–it's a sitcom type show of my name is Earl about a guy who is kind of, he says steal stuff and Rob things and so on. And then he like kind of finds karma and he creates a list and every episode he's going around and he amends for all the bad things that he did and kinda how that, that unfolds.
Robyn Walser, Ph.D. (47:00):
Fantastic show. It's a really good one. Yeah, yeah,
Keith Sutton, Psy.D (47:04):
Yeah.
Keith Sutton, Psy.D (47:07):
Well, great. Well, it sounds like you're doing some wonderful stuff. And oh, and you know what, actually, one more thing that I forgot, you've all also done some work with couples in ACT haven't you cause something that made me think about that is, especially with the veterans and I know in, in emotionally focused couples therapy, they've been doing some work with veterans and kind of helping them, some, having them sometimes share those moral injuries with their partner and the fear of seeing the repulsion from a partner or discuss or so on. And instead, seeing love and compassion, oftentimes how, how through those attachment relationships can really, help someone heal from, from the shame and be more present, be more connected in relationships.
Robyn Walser, Ph.D. (47:57):
Well, so Dara west and I wrote a book called The Mindful Couple, a few years back and I've done a little work with supervising folks who are seeing couples and seeing couples in my own very, very small practice. And I really like working with couples it's, it's interesting to see them getting working on their willingness to feel when they feel when they're, when they when their partners feeling something.
Keith Sutton, Psy.D (48:29):
Yeah.
Robyn Walser, Ph.D. (48:30):
Like, can I be present in my own emotional experience or do I have to shut my partner down? So I don't feel what I feel yeah. To get them thinking about their shared values and how to move forward in creating those kinds of things. And so I quite like the couple's work. I'm not doing it as much as I was, but I certainly do some couples in my, in my private practice and get them working on those things.
Keith Sutton, Psy.D (48:56):
Well, I like that idea of sitting with the emotions. I oftentimes will even show that clip from Bene Brown's Ted talk with the it's a little animation, how like a little bear that goes down to the hole that, and it talks about the difference between shame and pity and talks about to have true between empathy and pity or so on. To really have empathy, we have to sit with those emotions and connect with having felt that feeling that the other person is feeling, and sometimes that gets dysregulating. And so people shut it down and say so, and so's doing good in school or whatever it might be. But I think, like you're saying, it's that aspect of, can you sit with your own emotions and connect with them? Cause that's what ultimately kind of is that bridge to the empathy to really understand the others experience. So I like, I like that what you're talking about with the ACT and helping the person kind of tune in and kinda experience their experience as they're connecting with their partner or talking to their partner.
Robyn Walser, Ph.D. (49:56):
If you look at what partners are doing, when they're struggling, they're often wanting to control the other person in some way. I want you to stop doing what you're doing. I want you to start doing something else. And they're trying all different kinds of ways to make that happen. And what I'm interested in is what part of trying to control your partner is about trying to like, not feel on something or maybe has a very rigid rule inside of it or something like that. Not that you can't negotiate with your partner. Of course, we want people to negotiate with each other, but some of these really tough places are about, I want you to do what I want you to do. And I don't wanna feel this when you don't do it. Right. And so couples will get into a kind of a who's in control battle. And you know, one of the great things to do is to think about your own relationships and how much control of your partner do you actually try to do either? that, you're doing or might be a little bit you know, like you're not to putting it out there that, you're doing it. It's a lot.
Keith Sutton, Psy.D (51:15):
Yeah. Interesting. I notice that. Yeah.
Robyn Walser, Ph.D. (51:20):
Did look at your own, like when you start looking at like how much, and I've, I've asked couples to do things like a, I want you to just take this week and your whole week is to resist controlling your partner. Yeah. And you should just see, they go like, no things are gonna fall apart. It's gonna be terrible. You don't know my partner if I do that. But yeah. It's when they come back, it's a, I get all kinds of responses. Like it was really interesting, like things didn't fall apart and
Keith Sutton, Psy.D (51:51):
Yeah.
Robyn Walser, Ph.D. (51:52):
Free and, so it's, it's fascinating to kind of watch some of those things.
Keith Sutton, Psy.D (51:57):
Interesting. Well, Robin, thank you so much. It's always great talking with you. I love hearing about the, the work that you're doing and love the, the ACT approach. Definitely will look out for this book and those other books that you've written and I'll, put some of that information on the website and such too. Thanks again. I appreciate for joining us.
Robyn Walser, Ph.D. (52:17):
And thank you for having me. It's nice to talk with you and see you again, Keith.
Keith Sutton, Psy.D (52:21):
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