Staying Faithful to the Heart of ACT

Over the years, acceptance and commitment therapy (ACT) has grown and evolved, in part, due to the unique contributions of the clinicians who use it. The freedom within the framework is one feature that makes ACT so effective.

It is said that ACT is happening as long as the six core processes of ACT are being advanced: Acceptance, Present Moment, Defusion, Self-as-Context, Values, and Committed Action. The hexaflex model shows that you can generally go from any one process into another, and a familiar ACT mantra is, “You can go just about anywhere, with anyone, at any time.” Each process flows into the others.

With this kind of creative license, you may wonder if you are wandering away from the core principles, especially if you are new to ACT. You can stay faithful to the heart of ACT by asking yourself some guiding questions. The three following questions have been adapted from Darrah Westrup’s book, Advanced Acceptance and Commitment Therapy: The Experienced Practitioner’s Guide to Optimizing Delivery.

What is the function?

A style is not wrong because of a verbal rule that you heard in a presentation or read in a book. From a contextualist perspective, the issue of style is a functional one.

One simple way to tell if something you’re doing in therapy is consistent with the ACT model is by asking yourself the broad question: Am I furthering the client’s psychological flexibility or impeding it? A flexible space is the ultimate measure of success. Although there are a lot of useful ACT metaphors to draw upon with your clients (see The Big Book of Act Metaphors), if your personal style is a means to the same end of promoting psychological flexibility, you are on the right track.

Does the exchange feel equal?

One of the first things ACT therapists learn is that we share many of the same struggles as our clients. The behavioral processes informing ACT apply to human beings in general. And yet, there is a tendency in session to remain in the expert role.

It is helpful to understand that the expert role is often a therapist’s response to feeling uncertain and incompetent. The key is to allow uncertainty to exist for what it is (uncertainty) and not what it might say (incompetence). Step back from the idea that your expertise is what matters most to clients. In fact, it is your humanity. The desire to appear competent is natural, but don’t miss the opportunity to explore uncertainty in the room with your client. The full power of ACT is accessible when we are able to meet the client at an equal and authentic level.

Are you respectfully directive?

Many therapists struggle with the idea that they must prioritize what the client wishes to do in a session. This stems from the belief that guiding the session in a particular direction is disrespectful or will upset the client in some way.

But in reality—at the very least—you have a good idea of what kind of inflexible thinking brought the client to your office and what areas of their life need attention. These may be areas that a client prefers to avoid. Discuss their goals for therapy. Discuss your common goals and the overarching plan for treatment. And receive consent to go in directions that are outside of their routine.

As ACT therapists, we strive to be mindful of the subtle ways we may disempower our clients. Remember that being directive will involve refocusing, at times, on where they are and where they’re going. Refocusing on the present moment (“What is happening in this moment with my client?”)  and values (“How does this moment support the client’s values?”) will help you find ways to respect the client and advance the therapeutic work in directions that may be challenging. Believe you can strike that balance.

Much of the beauty of the ACT model is in its adaptability to a range of clinical settings and human problems. With a better understanding of the underlying intentions at the heart of the model, you can ACT with more confidence.