5 Ways Acceptance and Commitment Therapy Improves Outcomes in Group Therapy
Acceptance and commitment therapy (ACT) maximizes the change mechanisms of groups. When done well, ACT magnifies therapeutic change mechanisms inherent in group therapy. Developed as the clinical response to an increased understanding of the origins of human suffering, the model articulates the processes that can keep humans stuck, and how those same processes can be used to alleviate suffering. This directly translates to the therapy room. Here are five ways that ACT succeeds in group therapy.
1. ACT Enhances Individual Learning
When several individuals come together to learn something, more learning opportunities are created for everyone. Members learn from one another both in terms of mutual feedback and from being privy to their peers’ learning process. In ACT this is particularly the case because the core processes targeted in sessions are common to all. Each member will be somewhere along the continuum of psychological flexibility at any point in time. So it is not necessary that members relate to the content of a peer’s words or struggles.
The processes in play will apply to each member’s personal struggle regardless, and indeed to what each is experiencing at any point in the group session. In short, what is being worked on is directly applicable to everyone at all times. And because these core processes are ubiquitous, there will be many, many examples of how they show up in our lives. That’s a pretty big learning opportunity!
2. ACT Harnesses Social Support
ACT group therapy members learn to be better present to their peers, creating an opening for empathy. In therapy, we are working on what it means to be human, as opposed to trying to solve problems or rectify certain diagnoses, symptoms, and the like. The core processes of ACT are common to all, and participants easily connect over the shared struggle of being human. Along with learning to be present in groups, members also learn to be willing to experience what is there to be had. When combined with the commonality of the struggle, being willing enables participants to experience discomfort and, thus, each other’s pain.
The abilities targeted in ACT also foster group participation. Members learn to defuse from what their minds are telling them about speaking up (This will sound stupid; I need to know exactly what to say). Finally, there is evidence that our ability to reach personal goals is increased when we have people in our lives who support our efforts (Dailey, Crook, Glowacki, Prenger, & Winslow, 2016). The success of Alcoholics Anonymous and similar groups is a good example of how this can work in a group setting. In ACT, clients are guided to identify their values in various life domains as well as specific goals that take them in these valued directions.
3. ACT Facilitates Compassion
ACT can engender empathy. Difficulties are phrased as human difficulties, and learning to be present to that struggle helps group members contact a sense of compassion for their shared experience. In ACT, we view emotions as part of an unfolding stream of experiences. We do not hold the idea that certain ones are good and others are bad, or that we can arrive at the desirable ones as we can a destination (e.g., achieving happiness). Rather, feelings come and go, adding richness, depth, vitality, and yes, pain, to our lives. We aim not so much for the feeling of self-compassion, but rather for self-compassion as a stance, or an action. We might ask our client, “If you were being compassionate toward yourself, what might that look like?” Treating oneself kindly, even if the internal experience is one of judgment or unworthiness, is within the client’s grasp. As it applies to group work, being compassionate might include refraining from issuing harsh judgments (verbally, that is, as judgmental thoughts and feelings could well show up) and actively listening to one’s peers. As it pertains to self, it might involve noticing and defusing from self-judgments and making room for what one is experiencing.
4. ACT Assists with Problematic Responses
Just as groups can be powerful vehicles for positive change, they can be powerful vehicles for staying stuck. Members can behave in ways that stifle growth for the entire group and can facilitate behaviors that run counter to what they are hoping to accomplish. Even the best intentions can result in dynamics that are problematic, and looking through that ACT lens helps therapists recognize when “helping” is actually standing in the way. In fact, the model not only illuminates problematic group dynamics, but also offers a way to work with these in ways that increase group members’ psychological flexibility.
5. ACT Fosters Constructive Feedback
One of the greatest offerings of a group setting is interpersonal feedback. If we were actively tracking how our behavior was functioning, for example, we might notice that we weren’t really listening to someone and that authentic connection was therefore lacking. Or perhaps we might notice that although feeling vulnerable seems intolerable, we are, in fact, able to hold that experience. The therapy group provides a context wherein it is permissible, even desirable, for members to articulate how they experience each other. This provides invaluable information to participants; essentially, members track for one another how their behavior functions in the group. The group setting also provides ample opportunities for natural consequences of behavior to occur in that workable behavior is socially reinforced and unworkable behavior is socially ineffective. The core processes in ACT serve to enhance this potential learning mechanism.
For example, in learning to defuse from thoughts, members gain important space between what their minds are telling them and how they then respond. The therapist facilitates and models being present, willingness, defusion, self-as-context, values, and committed action—all of which serve to make interpersonal feedback fruitful. For example, rather than making a comment such as “You don’t respect what others have to say,” a member might learn to offer, “When you said that just then I had the thought that you don’t respect me. I felt really frustrated.” Notice that not only does the member being referred to receive important feedback, but all the core processes are nicely modeled for the group.
While ACT isn’t the only therapeutic approach out there, it’s particularly good at harnessing the mechanisms of therapeutic change. In illuminating and targeting the processes that uniquely define the human experience—both our suffering and our incredible capabilities—we set ourselves up to maximize the opportunity that exists when people come together with the intention to grow.
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This article has been excerpted and adapted from Learning ACT for Group Treatment.