Learn ACT to become a better therapist
One of my favourite research papers is “Love yourself as a person, doubt yourself as a therapist.” Published in 2015, the authors share what they discovered when they investigated the impact of therapist in-session behaviours on client outcomes. Interestingly, therapists who embrace self-doubt, practice self-compassion, and actively deal with clinical problems tend to be more effective.
Acceptance and Commitment Therapy (ACT) is well-placed to help therapists adopt these wise practices. Focusing on six interrelated behavioural processes, ACT seeks to influence people’s behaviour toward better health and well-being. These processes are collectively known as psychological flexibility.
Psychological flexibility and mindfulness account for 45% of everything we know about why therapy works. When you add similar concepts like self-compassion, behavioural activation and anxiety sensitivity, it increases to 55%. Although there are many paths to change, a therapist who regularly employs these tools in their clinical work will likely outperform practitioners who merely rely on counselling skills, cognitive restructuring or increasing self-esteem.
Given the strength of the evidence supporting the efficacy of psychological flexibility and mindfulness, it makes sense for a practitioner to train in the ACT approach. In case you wanted a little more convincing, I’ve identified eight reasons I believe ACT will make you a better therapist.
As a lover of ACT who makes a living from teaching people how to use it, I hold a bias. I welcome alternative views if you share the data to support your argument.
Eight reasons ACT will make you a better therapist
#1 You only have to learn one model.
Acceptance and Commitment Therapy is one model. You needn’t learn many procedures because ACT focuses on 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.
ACT is a model for the human condition. In other words, you can use it to help people when they struggle or get stuck.
#2 You can use it with anyone and any presenting problem.
ACT focuses on context and function. In other words, your task is to look at what people do, how their history and environment influence them and how those actions get reinforced. Learn to do functional analysis effectively, and you’ll know how to formulate any person’s problems.
The ACT therapist does not need a personal or professional experience with every presenting condition. Of course, experience in one area will increase efficiency and help you empathise with your client.
As long as you use supervision to get support and guidance, then you’ll stay on track.
Curiosity establishes trust and builds a connection with your client. If you don’t understand something, then ask. Most people will not expect you to know every detail of their life or struggle, nor do you need to. Your client can teach you about their context, and you can help them explore the functions of their responses.
Sometimes we may feel thrown by what we see and hear. Set your confusion and self-doubt aside, and pick up your tools. Lean into the model, its principles and processes. They’ll show you the way.
#3 ACT integrates strategy with a relational approach.
Many moons ago, I worked in an NHS psychotherapy team that included CBT, Psychodynamic and Integrative Therapists. Like most services, we had a weekly meeting to discuss new referrals and assessments. Depending on their problems, goals and requests, we’d recommend adding the client to the CBT or the Relational waiting lists.
We framed CBT as strategy-based psychotherapy and psychoanalytic or humanistic models as relational, where the therapeutic relationship was the primary tool for change.
Given our different backgrounds and perspectives, we learned a lot from each other. It was a rich learning environment that served the local population well, but after IAPT came along in 2008, it was gradually disbanded.
I discovered ACT in 2009 and was immediately attracted to its methods. It gave my work heart and colour, which I felt it lacked. My ACT mentors and supervisors have shown me how to embody the approach allowing me to sit inside a conscious and deliberate therapeutic stance.
For me, ACT bridges the gap between strategy-based and relational psychotherapy. Sure, one can apply ACT in a technique-oriented fashion. However, you can go much deeper into the heart of ACT, where you learn to see the client’s processes, your personal contexts and functions, and the interplay between you and your client.
#4 ACT targets multiple dimensions, not just cognition and action
ACT recognises that many processes influence people’s suffering. It is not just cognition, action or interpersonal dynamics.
Attentional control is critical in the mediation of anxiety and depression. We must develop the capacity to bring our focus away from the future or past when it doesn’t serve us. It’s the reason mindfulness interventions are so powerful for mental health and well-being.
Many of my supervisees learned Emotion Focused Therapy before discovering ACT. They find they can integrate the two approaches because of their common ground in targeting emotion.
ACT shows us how to receive and accept emotions without our minds making the experience worse. We learn to make room for physical sensations and hold ourselves with compassion. It’s often new territory for traditional CBT practitioners, and I do not doubt that it enriches their work.
#5 ACT has roots in an evolving scientific programme
The story of CBT’s great success is its research programme. Funding, dissemination and adoption unfold more easily when you can attest their worth scientifically.
At the time of writing this post, ACT has over 1000 RCTs and 400 meta-analyses to support its efficacy. The Association for Contextual Behavioral Science (ACBS) brings together researchers, social scientists and clinicians to exchange findings and ideas. The Journal of Contextual Behavioral Science (JCBS) offers a consistent and coherent platform for ACT and CBS professionals to showcase their contributions.
On attending one of my first ACT conferences, I heard Steve Hayes describe how ACT is far from perfect. We know it is no more effective than CBT and less so, according to the data in some areas. From the stage, with boldness and humility to his life’s work, he shared,
“we know that ACT is wrong. We don’t know where it is wrong.”Steve C Hayes
Never before had I witnessed such courage and authenticity. It’s far too familiar for our leaders in psychology to claim superiority in their favoured therapeutic model. Such certainty limits progress, and I feel at home in a community that wants to evolve its processes and methods in line with scientific advancements.
#6 ACT’s philosophy suits our modern age.
In ACT, everything is context. Nothing makes sense unless seen through the lens of evolution and culture. But when you understand a person’s history, background and setting, you begin to see how their experiences work.
To empathise, you need to acknowledge that you grew up in a particular culture that gave you a worldview that includes specific biases and blind spots. It’s not your fault; we can only see what we see. Your job is to explore different perspectives and expand your awareness to build a connection with your client.
ACT is wedded to contextual influences, and as we live in an age where people invite others to question their privilege, it can give us the tools to practice cultural humility. It allows us to be aware of our sex, gender, class, ethnicity, nationality, sexuality, religion and age. By taking a grounded, humble stance, we can make room for our experiences while holding a space for our clients.
# 7 You can be part of a friendly, supportive community.
ACT conferences are very welcoming places. The ACBS has been running world events since the noughties, and I am often taken back by the generosity of its members. ACBS is a global community with chapters in over 32 countries on six continents.
When you join ACBS, you get access to all its members. You can ask questions in forums, watch workshops and presentations, download worksheets, manuals and measures, listen to audio and get free access to the Journal of Contextual Behavioral Science. You can get free supervised practice and stay informed about local and online events throughout the year.
You can readily use people’s materials, and there will often be someone on hand to signpost you to a relevant resource if you cannot find it. If you’re interested in learning ACT, joining ACBS is a no-brainer!
# 8 ACT helps you personally and professionally.
ACT isn’t just a toolkit for helping your clients. You can use it on yourself too. You needn’t suffer from an enduring mental health difficulty because ACT is a model of the human condition. It will help you notice and open up to any challenging experience and guide you towards the values about which you care.
I am not the only ACT practitioner to describe how personal practice has helped me professionally and personally. I have become a better father, partner, friend, son, brother, colleague, teacher and therapist because of what I have learned from the ACT approach.
I do not wish to suggest that I have arrived at some utopian fantasy world whereby I am entirely self-actualised. Far from it, if it is at all possible. In truth, I find it more helpful to see psychological flexibility as an ongoing commitment to how I live.
If I were to stop practising openness and presence to experience, I would revert to older inflexible habits. Hell, I might even discover new ways to create suffering for myself.
To become a skilled ACT practitioner, you need to practice. You need to read, get feedback and seek consultation. You need to embody it in the therapy room and outside. You don’t have to, but I suspect it would inhibit your progress.
If you’d like to learn more about ACT, you can join my next training course for beginners. See below for further details.
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