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acceptance and commitment therapy

For the past couple of weeks we’ve been discussing an integrative treatment approach for psychosis that incorporates acceptance and commitment therapy (ACT), compassion-focused therapy (CFT), and mindfulness approaches within the cognitive behavioral therapy tradition.

The reluctant client comes in many different shapes and sizes. She may be legally mandated to attend therapy by a court of law, a medical insurance agency, or a government welfare agency. He may be coerced by a partner who threatens to leave him or a boss who threatens to fire him unless he “sorts himself out.” She may be pushed into it by well-meaning friends or relatives or by health professionals, such as her general practitioner. But whatever triggered the visit, one thing’s for sure: reluctant clients aren’t enthusiastic, willing, or open.

Acceptance and Commitment Therapy (ACT) is a powerful treatment that is based in the belief that the road to lasting happiness and well-being begins with accepting our thoughts, rather than trying to change them. For ACT practitioners, it may be easy to adopt the basic principles of ACT, but it generally takes at least two or three years of hard work and ongoing study and practice to become truly fluent in the model. During that time, you will most likely find yourself “stuck” at some point, and so will your clients.

The Acceptance and commitment therapy (ACT) model rests on the concept of workability. An ACT therapist asks, “Is what you’re doing working to give you a rich, full, and meaningful life?” If the answer is yes, the behavior is workable. If the answer is no, it’s unworkable.

If you have clients who suffer with interpersonal problems, treatment begins with defining early maladaptive schemas and helping clients identify which schemas are relevant to them and contribute to their problematic relationships. Once you are able to identify which schemas are relevant to your client, you can move on to helping clients identify common schema triggers so they can bring more mindful awareness to these situations as they occur.

Clients struggling with interpersonal problems are frequent visitors to therapists’ offices. At the Berkeley Cognitive Behavioral Therapy Clinic, for example, more than 50 percent of our intakes identify significant recurring interpersonal difficulties. The majority of clients presenting with depression, trauma, anxiety, and Axis II disorders report interpersonal problems in more than one important relationship. Colleagues across the country report similar data.

This summer, New Harbinger released Advanced Training in ACT: Mastering Key In-Session Skills for Applying Acceptance and Commitment Therapy, an eight-hour workshop in the use of mindfulness and acceptance to treat emotional disorders.

Therapeutic interventions based on ACT are effective in both increasing worker resilience and enhancing innovation and performance. Circling back to our previous discussions of Relational Frame Theory, understanding how ACT interventions work is a crucial part of understanding the role of relational framing in this context. ACT interventions are designed to impact an individual’s psychological flexibility, that is, one’s ability to contact the present moment without avoidance, enabling persistence of change in behavior in pursuit of values or goals (Hayes, Luoma, Bond, Lillis, & Masuda, 2006).


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