Accepatance and Commitment Therapy (ACT)

Philosophy:

• Considered an empirically based treatment centered around using acceptance and mindfulness strategies, along with commitment and behavior change strategies to increase psychological flexibility. 

• Human suffering is often the result of normal psychological processes; not a reflection of “abnormality.”

• Helps clients transform their relationship to difficult experiences and frees them from the need to avoid unpleasant events.

Therapeutic Goals:

• Increase Psychological flexibility

  • Help the clients to have more ability in staying present with their experience and taking action guided through their values even when facing difficult thoughts, emotions, or sensations.

Key Concepts:

• Six Core Processes:

  • 1. Contact with the present moment

    • Bringing full awareness to the here-and-now experiences.

  • 2. Cognitive defusion

    • Focus is on relationship with one’s thoughts; stepping back and separating/detaching from thoughts/images/memories.

  • 3. Acceptance

    • Active nonjudgmental embracing of the here-and-now experiences and mindfully letting go of obstacles.

  • 4. Self-as-context

    • Having an observer's perspective; developing a perspective of oneself as the conscious observer of thoughts, feelings, memories, and experiences.

  • 5. Values

    • Helping clients discover the “compass” that gives them direction; aiding them to become more fully themselves and live a life that is consistent with their values.

  • 6. Committed Action

    • Clients are asked to make mindful decisions about what they are willing to do to live a meaningful and valued life.

    • Moving forward with valued-based behavior in the midst of challenges.

Therapy Process (How it Works):

• Process-based, not technique-based; therapists show up as themselves and can adapt ACT techniques.

• Experiential and requires active participation from clients.

• Begins with psychoeducation on ACT followed with values clarification and identification to set the stage for therapy as guiding principles.

• Assisting clients to choose values they want to live by, designing specific goals, taking steps to achieve their goals.

Interventions/Techniques:

• Metaphors and experimental exercises

  • Helps clients understand concepts and offer new perspectives on their experiences

• Mindfulness and acceptance practices

  • Includes breathing exercises, body scans, and present-moment awareness techniques to get in touch with their experiences rather than caught in thoughts

• Values Clarification

  • Exercises to help clients identify what matters to them across life (work, school, relationships, etc)  and distinguish values from goals

• Cognitive defusion techniques

  • Methods to help clients see thoughts as mental events rather than literal truth.

• Behavioral activation

  • Committing to specific,values-based actions even in the presence of difficult internal experiences.

Nature of Therapeutic Relationship:

• The therapist plays the role of a fellow traveler.

  • Collaborative, egalitarian, model of acceptance and willingness. 

• Guide, facilitator of experiential learning

  • Helping clients connect their values to concrete actions while preparing them to handle barriers that arise.

One Strength and One Limitation:

• Strengths: Strong empirical support across a variety of conditions; addresses underlying processes rather than specific symptoms, practical, skills-based approach that can be applied immediately, flexible format can be applied in short-term or long-term therapy, less focus on pathology, more on human potential/growth. 

• Limitations: Philosophical underpinnings can be complex for therapists and clients to grasp, some clients may struggle with the experiential metaphorical style, less suitable for clients in crisis and those with severe mental illness, requires significant therapist training and flexibility.