According to Russ Harris, psychotherapist, renowned ACT trainer, and author of Getting Unstuck in ACT: A Clinician’s Guide to Overcoming Common Obstacles in Acceptance and Commitment Therapy, everybody who practices ACT gets stuck. While most people can pick up the basic principles of ACT pretty quickly, it generally takes at least two or three years of hard work and ongoing study to become fluid and flexible in the model, during which time all ACT therapists, and their clients, will get stuck. Repeatedly.
In Getting Unstuck in ACT, Harris presents some of the most common ways both clients and practitioners get stuck when new to ACT. These issues (some of which are also outlined in a PowerPoint presentation by ACT co-founder Steven C. Hayes, PhD), are drawn from Harris’ years of training and supervising practitioners in the ACT model. Here are just a few of the most common ways in which therapists find themselves stuck when implementing ACT.
1. Being inconsistent and giving mixed messages
Sending mixed messages is easy to do in the ACT model. For example, suppose you do an exercise around acceptance of anxiety and the client says “Oh, I feel so much better now. All my anxiety has disappeared.” If you reply, “That’s great!” you’re sending the message that the aim of the exercise is to reduce anxiety, which is actually encouraging experiential avoidance. Or if you encourage the client to defuse from negative self-judgments, but encourage fusion with positive ones in order to build self-esteem, you keep the client stuck in fusion with the conceptualized self, which is the same trap that created much of the suffering in the first place.
2. Talking and explaining ACT instead of doing it
Delivering ACT is much like driving a car, making a cake, or riding a bike. You can learn them only by practicing them. Though it is challenging, ACT skills need to be practiced in session. Many therapists feel anxious about asking clients to participate in active psychological exercises, particularly those that involve discomfort for the client. Therapists need to actively model, instigate, and reinforce the core ACT processes in session. Notice if you’ve been talking about ACT instead of doing it.
3. Being Mr. Grab-a-Tool
When you’re not sure what you’re trying to achieve in a session, it’s a common mistake to start frantically reaching into the ACT tool kit, grabbing tools and techniques at random without any clear strategy and hoping something will work. For example, something humorously called “metaphor abuse,” in which a therapist opens up a can of metaphors and throws them at the client one after the other, hoping something will stick.
4. Taking a one-up position
If you look at a client through the lens of a clinical diagnosis instead of appreciating him as a whole, complete human being, you take a one-up position. When this happens, it’s important to remember the ACT stance that clients aren’t broken, just stuck. If you’re not mindful, it’s easy to forget this. The one-up position can also manifest as arrogance, righteousness, or being the expert. Or it can take the form of reassurance, as in when you find yourself saying, “You’ll be all right,” or “It’ll be fine.” When you speak to clients like this, you’re placing yourself above them, like a parent talking to a child, talking from a space of “I know best.” This is a world apart from the gentle, nonverbal reassurance that you give clients simply by being present, open, and respectful as you compassionately sit with them in their pain.
5. Placing excessive focus on one process while neglecting others
Your prior training will influence the way you do ACT. If you trained in models heavily focused on processing emotions, you’ll probably find yourself overemphasizing related aspects of the ACT model and under-emphasizing the values, goals, and committed action components. Conversely, if you’ve trained in models heavily focused on cognition, you could easily overemphasize cognitive defusion while neglecting emotional acceptance. Beware of your biases and actively work on building experience in the processes you’re least comfortable or familiar with.
6. Therapist fusion and avoidance
When clients don’t respond the way you want them to, you may fuse with highly judgmental and extremely unhelpful thoughts about yourself, your clients, or even the ACT model itself. You also may tend to struggle with the painful feelings that arise. Many of the problems that will get you stuck in ACT stem, at least in part, from your fusion and avoidance. For example, having the thought “I shouldn’t make my clients feel uncomfortable” may lead to experiential avoidance of the anxiety that comes with confronting problematic behavior in clients. This is why every professional book on ACT emphasizes the need to apply the model to yourself, because you build the strongest therapeutic rapport when you defuse from your own unhelpful thoughts, make room for our discomfort, act in line with your values, and engage fully with the client.
Some clients will take to ACT like a duck to water, but even their successes are not final, and working with those who don’t like ACT or don’t respond to it can be like chipping away at concrete. Fortunately, failure is not final either. So if a client doesn’t respond, you can refer him to another therapist who works from a different model. If you cultivate the courage to continue learning from your failures and mistakes, to reflect nonjudgmentally on what went wrong and what went right, to be self-compassionate when you make errors, and to continually invest in developing your knowledge and skills, then over time your successes will increase and your failures will decrease.
If you are learning or already practicing ACT, it is safe to assume that this model speaks to you on a deep level, and helps you get in touch with your heart and do what matters. If you apply it to your own issues and allow it to transform the way you respond to life’s challenges, and if you bring that sense of trust and confidence in the model into your sessions with clients, then you are already well on the way to becoming a better ACT therapist.
In the coming weeks, we’ll delve deeper into a selection of these common roadblocks and offer must-have insight from Getting Unstuck in ACT on what exactly these challenges look like in-session, and how you and your clients can move forward.
Part 2: What to Do When a Client Is Participating in Self-Judgment?