Where do I start when doing ACT?
Many clinicians have mixed feelings about Acceptance and Commitment Therapy.
On the one hand, they love its philosophy and experiential approach. But, on the other hand, practitioners can struggle with the doubts and uncertainties of not knowing how to apply ACT effectively.
In this article, I am going to help you with that challenge.
It’s not surprising that practitioners find this tricky; ‘Acceptance and Commitment Therapy’ is not a linear model. So, although you can follow a protocol, ACT invites you to be flexible.
In my time as an ACT Trainer, I’ve often tried to bridge the gap for novice ACT therapists. In my left hand, I hold the desire to help people embody the model, and in my right, I recognise I need to help people learn the form of Acceptance and Commitment Therapy.
You can’t have flexibility without stability.
The human body bends. We use our muscles, ligaments and tendons to stretch, twist and turn. If it weren’t for our skeleton, we’d fall to the ground.
Your bones give you stability, and you rely on being able to stay standing before you bend or lean sideways. Therefore, in ACT, you need to know some basic principles first to be fluid later.
Which processes in the hexaflex should you target focus?
As with all questions about ACT interventions, the answer is nearly always, “well, it depends…”. However, context never goes away, and we need to remain rooted in that principle.
Context and function make up your skeleton; they hold you upright and give you a place from which to experiment and return to base.
Here are a few examples worth thinking about:
- A client says they feel lost, that they don’t know what to do with their life. They’re worried they’ll miss out on vital relationships.
- Someone comes to see you, and they’re drinking a lot of alcohol. They indicate that bad things have happened to them, and they don’t feel they can trust people.
- A person attends their first therapy session with a family member because they were too anxious to come alone. They’re scared of saying something offensive or inappropriate, so they bring the other person to reassure them they didn’t.
Where would you start with each person?
Why would you begin there?
When you identify a possible course of action, it’s often helpful to follow up with a curious question about the functions of your choice.
For example, in the first scenario, you could start with values clarification. The person seems to be upset they’re not living fully. However, you could also explore patterns of avoidance in relationships. Both choices would likely reveal something valuable that you can address in your work together.
What about Functional Analysis?
A functional analysis needn’t be a long, drawn-out process. It can be fast, and you can develop it as you go.
People often enter therapy with an unconscious control agenda. As a result, they tend to be unaware that excessive control and avoidance have worsened their problems.
A helpful first step is to lean into creative hopelessness. It’s the process of getting curious about a person’s experience and the impact of their coping strategies.
When clients discover the futility of excessive control, they’re more likely to open the door a little to their unwanted experiences.
Doing this work early on can help you and your client to be on the same page. Instead of teaching them how to control their thoughts and feelings with mindfulness or defusion, you make the work about moving towards a bigger and more powerful existence.
Ground yourself with a focus on function and context; that’s your skeleton.
Practice responding in different ways. If your first thought is to do some defusion, pause for a moment and ask yourself what else you could do. Even if your mind says ‘that can’t work’, would it be worth trying it out to see what happens?
Would you like to learn more about Acceptance and Commitment Therapy?
We have a range of articles and videos to help you build your knowledge and skills in ACT.