How can we help you be a better therapist?
For many clients, the last thing they want to hear you say is, “have you thought about accepting your difficulties?” The thought of spending the rest of their life anxious or depressed is too overwhelming. It feels hopeless and despairing. “Why should I accept it? I came to see you because I want to get rid of it.”, they say. “Are you telling me you can’t help me?”
Practitioners often dread these moments; we can’t bear the experience of being unable to help. It disturbs us and shakes us to the bone. We try to avoid it at all costs by working hard and nudging the client forward to do more exposure or experiment. Only to hear the following week that the homework did not go to plan.
We may get sucked into the story of why it wasn’t possible. We offer validation and look for more assumptions or core beliefs. If only we could get to the root of the problem, we’d be able to help them stop avoiding life.
ACT can help you when you don’t know what to do
People are mind-y. Clients spend a lot of time lost in thought, worrying and ruminating. They quickly justify their reactions, blame others for what they experience or give themselves a hard time for failing to improve. They get stuck in loops that send them on a downward spiral, or they feel easily overwhelmed when they try to get on with life. It’s a tortuous back-and-forth between fear and shame.
It can feel unclear for the CBT practitioner who is used to following protocols. What problem do we tackle first? Which diagnostic intervention should I follow?
Traditional CBT invites you to learn many diagnostic templates. It’s not easy remembering them all, and you can quickly get lost when your client wants to address all their problems at once.
There is a simple alternative solution.
Acceptance and Commitment Therapy is one model. You can use whatever the client’s presenting difficulties. You needn’t learn many different procedures because ACT focuses on a common set of behavioural processes that occur across psychiatric diagnoses.
Since the 1950s, the DSM has significantly increased the number of possible diagnoses. More disorders are available to us now than there have ever been. Do we need all these new possibilities?
In my experience, we do not.
Acceptance and Commitment Therapy gives you and your client a simple way to understand their distress and develop specific skills to help in life.
Many CBT protocols offer solutions to eliminate anxiety or depression. However, they don’t provide anything once those so-called symptoms have decreased.
ACT is a model for the human condition. In other words, you can use it to help people when they struggle or get stuck.
How does ACT work?
Acceptance and Commitment Therapy (ACT) combines six interrelated behavioural processes that shape people’s well-being. When people get stuck, they struggle and suffer because they have learned to rely on specific actions.
It’s not to say that people are to blame for their suffering. Of course, they are not. We are human, and we all set out to do our best. It doesn’t help to assume it’s our fault because we don’t choose to feel scared, sad or guilty. It simply happens.
Our job is to help people see how they get stuck and teach them skills that set them free.
ACT recognises that we encounter difficulties relating to these dimensions in specific ways.
Fusion with thoughts
Traditional CBT advises us to rewrite negative automatic thoughts to reflect a more accurate or helpful truth. ACT offers an alternative approach to dealing with beliefs.
ACT suggests that the problem is less with the form of thought but linked more to the ‘relating pattern’. For example, when a person gets too close to their mind, takes thinking literally or follows it without awareness, they allow their mind to control their activity.
ACT teaches people to step back from their mind’s chatter and let go of unhelpful thoughts. It is called cognitive defusion; we don’t achieve it by restructuring thoughts.
We apply experiential exercises to thinking so that a person can improve their awareness. People learn to put unhelpful thoughts aside and focus their energy on doing stuff that makes life more vibrant and meaningful. In other words, we use mindfulness and acceptance to help people sustain better habits.
What else does ACT do?
ACT uses many techniques to help clients increase psychological flexibility. Psychological flexibility is the term used to describe the complete set of six behavioural processes. We help clients let go of excessive emotional control, build openness to experience and take small steps outside their comfort zones.
They learn to guide their attention where they want it to go to minimise getting lost in thought about the past or the future. We help clients identify unhelpful views of themself so they can use alternative perspectives to move their feet.
Clients often get stuck when they have a fixed view of themselves, e.g. I am weak, defective or unlovable. In traditional CBT, we would seek to loosen the attachment to these core beliefs.
In ACT, we do something similar, but it is more of an awareness intervention than a cognitive one. We help clients to be curious about alternative views and add them to their consciousness. Instead of wrestling with core beliefs, we help clients to notice they are more than one thing.
The more familiar you are with the ACT approach, the more you learn to harness the power of flexible perspective-taking by drawing on relational frame theory and self-compassion. In ACT, we call it Self-As-Context, which is highly influential in helping people change their behaviour.
One of my mentors and a well-known and popular ACT trainer, says,
“we help people to live from the feet up, not the head down.”Robyn Walser
We encourage, nudge and support people to start acting differently quickly.
The ACT therapist assumes a stance that sees people as complete and capable. We take the risk that they can accomplish extraordinary things. Even though people may believe they are broken or powerless, we take a compassionate view that anything and everything about their difficulties makes sense once you know their history.
The ACT therapist shows a client that change is possible. We help them build a kinder, braver approach to their experiences and life by believing in them before they do. The ACT model invites practitioners to embody psychological flexibility. We model it to clients, ask them to do something new and gift them bags of reinforcement when they experiment.
I love the ACT approach because it combines the power of CBT’s behaviour-change techniques and the heart of the humanistic therapeutic alliance. Rooted in behavioural analysis, ACT draws on long-standing behavioural principles. It is a truly modern approach that looks at experiences and activity in context. It is a humble, curious and bold psychotherapy that suits our progressive age.