Therapy comes in many shapes and sizes. I have been asked to do a summary of various therapy styles (therapists call them modalities) so I am going to start with my preferred one this week, Acceptance and Commitment Therapy.

ACT resonates strongly with me. ACT therapists are strongly encouraged to “do ACT on themselves”, so i did that. In fact, I do that. I have found it to be engaging and effective in times of anxiety. As a therapist, I don’t use this style of therapy all the time and in fact, I mix some of the activities together with other modalities but the principles tend to underpin all my other counselling work. There is always an emphasis on working with my client as a team. ACT ha been shown to have a positive impact on a wide variety of mental health issues including anxiety, depressesion, grief, chronic pain and substance abuse.

ACT (its referred to as “ACT”, not A.C.T, to emphasize the active nature of the ACT strategies and participation between the therapist and client as a team) is great like that. ACT is also fun and experiential, using lots of engaging metaphors and, of course, has solid research behind it. ACT will involve a client participating in mindfulness activities, and then practicing them at home. The fun nature makes the principle and the strategies memorable and relatable for clients and aids with buy-in, which is essential. I’m going to add a few videos below, to help illustrate ACT’s engaging metaphors and mindfulness activities, but there are thousands more and clever ACT practitioners are coming up with more and more all the time.

If you want to go a bit deeper, jump right now to the bottom of this page and click on the links or watch this great video. Today’s blog is longer than my previous ones, (because this is my most familiar modality, and I absolutely love it), but the most relevant information is at the start (of course).

Acceptance and Commitment Therapy is based on modern behavioural psychology, including Relational Frame Theory, and evolutionary science. ACT applies mindfulness and acceptance of suffering with commitment to behaviour change processes to bring about psychological flexibility (the opposite of stuckness - see below). People really want to thrive, but they often get stuck in certain negative or unhelpful patterns of thought, feelings and behaviour, which do not bring about the life that they desire or value. This ‘stuckness’ can lead to attempts to avoid those feelings (such as rumination, isolation, procrastination, substance abuse, and much much more) , which actually reinforces the stuckness, rather than freeing one up to live their best life. ACT often labels this avoidance as ‘unworkable’.

THE UNWELCOME PARTY GUEST

In ACT, rather than challenging those thoughts and feelings, trying to get free of their internal struggles, trying to think about something else (that’s more the CBT approach) ACT strategies, such as mindfulness, practice accepting the feelings and thoughts, while giving oneself some distance from them, so that they no longer have the power to determine one’s choices. Choices can now be values- based and suffering is reduced, even though symptom- reduction was never main the goal. This is ‘workability’. I love this witty youtube video, to demonstrate (metaphorically) the value of acceptance. https://youtu.be/VYht-guymF4?si=VverbX6lQKFIK7TF

The six core principles of developing psychological flexibility; defusion, (getting unstuck by stepping back from our psychological suffering) acceptance (making space to experience unpleasant thoughts and feelings), contact with the present moment (mindfully focussing on the here and now), the observing self (stepping back and noticing your thoughts), values (what really matters), and committed action (taking effective action, in line with your values). ACT therapy does not tend to focus on past events as much as future value-based goals.

Another ACT metaphor by Russ Harris

THE POWER OF METAPHOR

An ACT therapy session can take many forms. Ideally, the therapist will describe their style of therapy in a way that the client understands and ask for their agreement to participate, to work with the metaphors, to use mindfulness strategies, and to seek to move forward in their lives. The therapist will also ask the client why they have come to therapy and what they are hoping to talk about or what problem are they hoping to solve. In conversation between therapist and client, there will be a focus on how the client would like to live, what their core values are in a variety of life domains (eg family, work, leisure, education…) and what goals are being blocked by their psychological suffering or choices being made. Then, a mindfulness strategy will be practiced in the therapy room, in a way that brings to mind and emotion, the suffering involved, and helps the client to experience being less controlled by the suffering. A couple of examples of such mindfulness strategies are below but there are many many more. A therapist is likely to use at least one per session, with the aim being to discover which ones really resonate with the client, and build up a ‘mindfulnes toolkit’ for them. The client will be asked how that strategy felt for them, and they will be asked to practice it at home. I often provide my clients with a youtube or mp3 link to help them practice the strategy. Of course, there are many other variables (such as resistance) in a counselling session. This is just a very simple description. However, metaphors can really help with resistance or hopelessness.

LEAVES ON A STREAM Just one example of a powerful mindfulness strategy is called Leaves on the Stream. If you practice this one, it will become an easily accessible strategy that you can use in your day to day life when a thought or feelings hooks you in. https://youtu.be/vjKltKKSur8?si=We-t40wOuvO5jgEf

Here is another one that I use all the time in my personal life, even though the video is designed for teenagers. https://youtu.be/GIJn5XhqPN8?si=k9NuoZEQYSSEZOPw

And another one, called Dropping Anchor (2 minute version), based on the idea that a boat a storm cannot calm the storm but can drop anchor to create safety. https://www.actmindfully.com.au/wp-content/uploads/2018/06/Drop-Anchor-Audio-Exercise-2-minutes-1.mp3

ACT is great to adolescents too. The engaging metaphors resonate with teens and can really help them to thrive as they move towards their authentic value-driven life. Louise Harris has developed a version of ACT for teenagers called DNA-V. https://vimeo.com/169644777

Acknowledgements:

World leaders in the field of Acceptance and Commitment Therapy include Steven Hayes, Louise Hayes (no relation) and Russ Harris.

My short article (above) owes much of its content to this article:

A plain english explanation: https://www.actmindfully.com.au/wp-content/uploads/2018/01/Dr_Russ_Harris_-_A_Non-technical_Overview_of_ACT.pdf

A very sciencey explanation https://contextualscience.org/about_act

https://positivepsychology.com/act-acceptance-and-commitment-therapy/

https://childmind.org/article/acceptance-and-commitment-therapy-for-teens/

Some Excellent Books (based on ACT)

The Happiness Trap

The Happiness Trap : stop struggling, start living (by Russ Harris) https://youtu.be/93LFNtcR1Ok

Your Life, Your Way: Acceptance and Commitment Therapy Skills to Help Teens Manage Emotions and Build Resilience. by Joseph V. Ciarrochi (Author), Louise L. Hayes (Author), Katharine Hall (Illustrator)

Stuff that Sucks by Ben Sedley - Acceptance and Commitment therapy based advice for teens in a fun format.

Acceptance and Commitment Therapy (ACT) - Mental Health Therapies in Brief

Less Family Anxiety & Tension-Family Systems Theory

Affirmations