Author: Matthew Boone, LCSW
Acceptance and commitment therapy (ACT), said as one word, is a form of cognitive behavioral therapy that focuses on acceptance and mindfulness.
I had heard about it, and read a little, in the early 2000’s, but I didn’t make it the center of my professional life until 2007 when I heard Steven C. Hayes, PhD, ACT’s co-founder, talking about it at a conference on mindfulness and psychotherapy in Boston.
Steve was, and is, a funny and dynamic speaker. But more important, he outlined a therapy that seemed to be exactly what I was going after in my practice, but not really succeeding at: helping people be mindful of their inner experience, become observers of their mind, and cultivate acceptance of what they could not control.
Acceptance and mindfulness had made a big difference in my own life dealing with chronic pain, but until then I didn’t really have the tools to bring mindfulness and acceptance to life in the work I was doing.
ACT offered me a flexible methodology, grounded in science, to do what I was trying to do. It also added a key component—values— that re-contextualized mindfulness and acceptance as strategies for helping you move towards what really matters in life, not just as ends in themselves.
I can confidently say that ACT made me better at psychotherapy. I don’t mean that my outcomes got better. I actually don’t have the data to support that. (It was only after digging into ACT, and other evidence-based therapies, that I started collecting outcomes.) What I mean to say is that I got better at being a practicing psychotherapist.
Helping Others and Encountering Your Own Pain
Practicing psychotherapy, or any kind of service profession in which you encounter the deep pain of other people, is hard. It’s easy to fall into feeling overwhelmed by all the suffering you encounter. You can walk out of a session feeling like you’re still carrying that suffering. You may even find yourself ruminating on it in the evening after work.
I’ve discovered that the very strategies ACT teaches for dealing with thoughts and feelings are perfect for handling the ups and downs of psychotherapy, as well as for listening more deeply to my clients.
In ACT, acceptance means taking an open and willing posture towards thoughts and feelings and the circumstances that gave rise to them. It also entails consciously choosing actions that may bring you in contact with discomfort if doing so brings you closer to what’s important to you (i.e., your values). Mindfulness plays a key role in this kind of acceptance: the practice of nonjudgmentally observing the present is one of the most effective ways to practice willingness to have what’s already there without trying to change it.
When someone talks about something painful, like the loss of a loved one, a long-term depression, or a traumatic experience, I always feel the urge to jump into problem-solving mode, to scramble to make the person feel better.
But there’s a problem with reflexive problem-solving: it can be the easiest way to miss out on the other person’s experience, to not really listen to what’s going on for them, and start pulling them in a direction that’s not effective for their care. Think back to some of your own worst appointments with people in helping professions, where the person didn’t really listen to you, made assumptions about what you needed, and started offering suggestions before you had completely organized your thoughts. It feels alienating. It feels bad.
I don’t want to speak for other practitioners, but for me, that kind of reflexive problem-solving is really about me, not the person I’m trying to help. I jump into problem-solving precisely because I feel so uncomfortable. I’m really trying to solve the problem of my own fear, sadness, sense of being out of control, or whatever else I’m experiencing. This is what can show up for me in the face of other people’s pain. And so to minimize my own pain, I make the mistake of minimizing theirs.
Getting Closer to Pain in Order to Better Help Others
So what can I do instead? I’m not practicing psychotherapy right now; my professional focus is more on training, supervision, and program development. But my work still brings me into contact with other people’s pain on a daily basis. When I was regularly practicing psychotherapy, and still to this day, I try to be willing with my own pain so that I can really hear the pain of others.
When sadness and anger show up in response to what someone else is saying, I do my best to make space for it. I notice these emotions as they arise, observe them curiously in my body, and imagine breathing in and out of them as I continue listening. This kind of dual attention actually helps me listen more deeply—it doesn’t distract me.
It also has a paradoxical effect. The more I can get closer to my own discomfort, the lighter it feels, and the more likely it is to move on in its own time. When I struggle with it by trying to push it away, or avoid it by ignoring it, it becomes more salient, occupying my attention even more. I end up focusing on myself more than the other person, and I’m therefore less able to walk with them through whatever they’re dealing with.
It also helps me be a better problem-solver when problem-solving is called for. If I’m more attuned to my internal experience, I’ve found that I am more attuned to the entire present, including what’s going on for the person I’m listening to. My responses are more thoughtful and more appropriate to their circumstances.
This is called being psychologically flexible, which is what ACT cultivates in clients, but which applies equally to practitioners. Psychological flexibility is the ongoing process of tuning into the present, opening up to experience, and making choices based on what’s most important. When I help people, what’s most important to me is being as effective as I can be. If I’m in my own head, wrestling with my thoughts and feelings, I’m not going to be there for others.
I’m not perfect at this. There is no perfection in psychological flexibility. But I have more options, and I think I’m probably more effective with people who are suffering. But who knows. At minimum, I’d like my work more, I take it home less, and I’m more apt to look forward to the next day.