Section 3: ACT intervention to reduce stigma of mental illness
Activity 2.3 Chair sculpture of stigma
ACT Processes:
- Acceptance
Objectives:
- Identify the use of avoidance and control strategies to avoid internalized stigma and other unwanted thoughts and feelings and their costs
- Observe that despite best efforts, avoided thoughts and feelings persist
- Foster acceptance of avoided thoughts and feelings, including internalized stigma
Participation Format:
- At the start, the group is sitting in a horseshoe shape. After orientation, Facilitator #1 will put his/her chair in the centre. As outlined in the instructions below, participants will one by one pile their chairs in the middle around the facilitator’s chair. After debriefing, the participants will retrieve their chairs and reseat themselves for final debriefing of the exercise.
Number of Facilitators:
- 2
Time Required:
- 40 mins
Materials Required:
- Chairs that participants are sitting on;
- Post-it notes (optional)
Activities & Instructions
Instructions for participants
- Introduction
Facilitator #1 describes the overall purpose of the exercise.- Have you ever been stigmatized or shamed in some way by others? In this exercise, we will explore how we deal with these thoughts and feelings that come up.
Notes for facilitators:
Connect where possible to previous discussions about shame and stigma.
- Set up the space
Facilitator #2 stands up and pushes his/her own chair to the centre of the room. - Physicalize our internalized stigma and shame.
Facilitator #1 asks participants to share some common thoughts and feelings that are associated with stigma and shame.- If you are willing, think back to an instance when you were shamed and stigmatized by others. What kinds of feelings and thoughts came up for you?
- See if you can project these unwanted thoughts and feelings on to the chair…these are the thoughts and feelings you wish to disappear or avoid…this chair is now the Chair of Shame.
Notes for facilitators:
Participants may spontaneously share their back-stories about being shamed. Empathize with the story, while clarifying, focusing on, and highlighting the unwanted thoughts (e.g. “I’m no good”) or feelings (e.g. “I feel abandoned”) that come up as a reaction to the event. Do not let the group to get too caught up in the details at this stage.
- Identify coping and control strategies and form the Chair Sculpture of Shame
Facilitator #1 asks participants to share their way of coping with stigma and shame. As each of the participants takes a turn to respond, ask them to get up, use their chair to represent their coping strategy, place their chair in a representative relationship to the center chair, and return to stand at their original spot. As participants contribute their coping strategies, a pile of chairs will be haphazardly stacked or placed in the middle of the room, and many participants will be left standing around it.- Can anyone share with us how you have dealt with these thoughts and feelings that come up for you when you feel stigmatized or shamed? How do you cope? How do you help yourself feel better?
- Thanks for sharing… can you please stand-up? Let your chair represent this coping strategy – this is now the ‘Chair of [type of coping strategy]’…
- Can you please show us how your coping strategy relates to your feelings of stigma and shame – by placing your ‘Chair of [type of coping strategy]’ in a representative way in relationship to the centre ‘Chair of Shame’? You can position your own chair in any way – e.g. upside down or on the side – anywhere you like – e.g. stacked on top of the centre chair or far away from it… you cannot move the centre chair though…
- Thanks … can you please return to where you were and keep standing? Who else would like to share next?
Notes for facilitators:
The facilitator ideally should remain standing in the entire exercise. When participant volunteers an answer, the facilitator may choose to walk closer to the participant to engage in a dialogue. Allow brief stories to emerge, as long as they do not dominate the exercise. If needed, offer the participant help when moving or stacking the chair.
As a concrete example, a participant may share that s/he tries to “forget about the problem”; s/he may choose to stack his/her “Chair of Forgetting” upside down on top of the centre “Chair of Shame”.
Note that the “Chair of Shame” represents the internal thoughts and feelings. It does not represent the actual person doing the shaming or the problem itself.
The facilitators may clarify and thank the participants for sharing, but do not comment, judge, evaluate, or discuss the coping strategies.
Depending on the size of the group, time allotted, and the engagement of the group, the facilitator may elect to involve most or all group members.
Optional – depending on the concreteness of the group, one may elect to stick Post-it notes to label the centre chair as Stigma and Shame and each of the other chairs as they are being named e.g. “calling a friend”.
- Observe and reflect the Sculpture
Facilitator #1 asks the group to observe and reflect on their experience and the mass of chairs in front of them.- Would anyone like to share what you observe here?
- We can call this our Chair Sculpture of Shame.
Important points of discussion to draw out include:
-
- Empathize with our human efforts against suffering
It seems like that we all try quite hard to cope with our unwanted emotions and thoughts when we feel hurt; we do try our very best, and it’s not our lack of trying- We are quite creative too, and we use many different strategies
- Do you notice that you may use some of the strategies that others have mentioned too? Observe our common struggle against the issue of shame and stigma
- Persistence of hurtful thoughts and feelings
- What has happened to the Chair of Shame? Has it disappeared?”
- Though it may be surrounded or even buried, it’s still there.
- Cost of our efforts – Explore the costs of our avoidance and control efforts, including the time, energy, activities, and opportunities expanded.
- What are the costs of our efforts?”
- Notice – how much space does our sculpture take up? Does it just take over the space in the room and our collective energy and attention? …just as it is that we may find our lives revolve around trying to cope with our hurt and our pain, with our coping strategies adding to our suffering and taking up so much space in our lives…”
- Notice – are you able to sit? Instead of sitting comfortably as a group, we are left standing, as we expand and sacrifice our energy – our very own chairs.We are even pushed to the periphery and up against the wall if we put more chairs in the middle.
- Looking at the function of our actions rather than judging them categorically
- Notice that you may be drawn to judge the strategies that are mentioned and even label some of them as good strategies and some of them as bad.Yet when we use any of them to avoid and control, they only add to the Sculpture of Shame
- Tthe good strategies – it’s not that we should not do them, but when we use them to avoid and control our thoughts and feelings, you can see what happens.So, if you meditate or exercise – do this in the service of your values, rather than using them to control and avoid your thoughts and feelings.
- Empathize with our human efforts against suffering
Notes for facilitators:
The facilitator may want to highlight that everyone encounters challenges and we often struggle in a very similar way with them. This often builds group cohesion and empathy for one another.
Some participants may have self-blame or encounter messages from others that they should not be feeling the way they feel (e.g. they should” be thinking “positivelythey should” be able to let go and accept things. Or they should be trying harder) The facilitator can use this exercise to empathize and emphasize that they indeed have tried hard and there is no further need to blame themselves. It is just that in some contexts, like dealing with our thoughts and feelings, efforts to avoid, control, and problem-solve may not be workable.
Participants may dislike the sculpture and be struck by its chaos and disorganization… just as our lives may be quite disrupted and chaotic when we are busy controlling and avoiding.
On the other hand, some participants may actually admire it… just as we can admire our patterns of behaviours – it is a work of art – our intellect, efforts, and sophisticated defenses – though not without costs…
Some participants may have mentioned poor coping strategies in a self-deprecating way (e.g. I drink – I know I shouldn’t do that) while others may have mentioned “good” coping strategies (e.g. thinking positive, being accepting and mindful, meditating, etc.) Gently point out that in this context, they serve the same function and result in the same consequence – adding to the sculpture.
Some may feel so struck by the exercise that they want a memento of it – facilitators can invite them to take a photo of the sculpture with a cellphone.
- Acceptance: dismantle the sculpture and release the chairs.
Have the participants take back their own chairs and return to their seats, leaving only the facilitator’s Chair of Shame in the centre. Ask them to reflect on the difference between the Sculpture and the lone Chair.- Please take a last look at our Chair Sculpture of Shame.If you could please retrieve your chair and return to your seats Observe again the Chair of Shame,what is this like now?”
- What is it like if we simply accept the sculpturebe willing to have it here with us?
Notes for facilitators:
Facilitators can use this opportunity to discuss acceptance – as our willingness to experience (our internal thoughts and feelings), just as they presently are. It does not mean giving up. It does not mean we need to love our negative emotions or thoughts in a masochistic way. It does not mean we cannot work to change our situation and environment through our actions. In fact, even if we choose not to accept, they (the internal thoughts and feelings) are here anyways (the centre Chair).
References & Sources
- Based on Fung, K. P., & Zurowski, M. (2016). Chair Sculpture of Suffering.
- Inspired by Box Full of Stuff Metaphor (Hayes et al, 1999, p 136-138)