ACT is a collaborative therapy model - therefore the therapist and client are both actively engaged in helping the client build the framework of acceptance. It is a paradox seen often in ACT that once an individual truly accepts their feelings even those that are contradictory , they are then able to take values-guided action. A client may come into treatment expressing difficulty with anxious ruminations. No matter what they do to try to change their thoughts, they keep coming back to their anxiety and dread.
An ACT-informed therapist could provide psycho-education around the concept of thought diffusion.
RACGP - Acceptance and commitment therapy – pathways for general practitioners
A client may come into therapy saying that their life would be so much better if the other people in their life e. In doing so, the client could discontinue repeating failed attempts of getting their needs met, and instead focus on what they can actively do to improve their own lives. This may involve the individual mindfully grieving the things that they expected from other people but did not get. ACT is helpful for obstacles like mood disorders such as anxiety or depression , substance abuse issues, and trauma.
While most people can learn the concepts and techniques associated with ACT in a matter of months, change does take time! Despite the length it may take to achieve lasting change, one will be motivated by the small successes along the way. ACT is a flexible enough framework that it can be adapted to both short-term and long-term applications.
Like many other therapies, if you are open to self exploration, and open to new ways of thinking about the world around you, then ACT would be a good fit. I want to control everything even if I rationally know that is impossible. Letting go of control can feel like failure; however, ACT has helped me reframe those emotional reactions from failure to empowerment. ACT is, however, contraindicated for those individuals who are in situations where acceptance would be dangerous.
For example, for those in abusive relationships, or behavioral problems where the individual is placing their physical health and safety at risk, ACT may not be the most appropriate approach. ACT usually works very well, if delivered well and with adherence to the theoretical model! If you experience this, you should speak with your therapist about your concerns and your therapist should be open to considering alternate approaches. Though this can also happen in session, you can begin to explore your values - what is important to you and how has this come to be?
Similarly, you may want to explore mindfulness exercises such as meditation, deep breathing, and visualization to get a feel for what is to come. Most importantly, you should put time into finding a therapist that is the right fit for you. Therapy is intimate work that requires a sense of safety for vulnerability to exist. Spend the time needed to find a therapist that creates that safe space and that you feel comfortable with. Making room for emotional discomfort also makes room for growth. Building this compassionate and accepting relationship with myself has been life changing for me and for my clients.
If you have been in therapy before and it has been unhelpful or not as successful as you hoped, ACT will likely be a refreshing and effective change. It integrates acceptance and mindfulness, aspects that might have been missing from your previous therapeutic experiences. Thank you, Vanessa, for sharing your perspective with us and helping us learn more intimately and humanly about Acceptance and Commitment Therapy ACT. If you would like to reach Vanessa directly to continue the conversation or schedule an appointment, please email her at vanessa vkpsychotherapy.
Any thoughts, questions, or feedback? While there are therapeutic challenges in any system of therapy, the apparent or real relationship between ACT and Buddhism can lead to unique challenges and resistance when teaching or applying ACT clinically. For some non-Buddhists, mindfulness meditation may be perceived as a religious practice violating their own religious beliefs.
Other times, this critique stems from a particular religious perspective based on different branches of Buddhism, common cultural conceptions of Buddhism by non-Buddhists, or personalized belief systems. In group therapy, it is clear that some patients are able to make rapid gains with the ACT model while others have difficulty making use of it. For instance, some may get stuck on using mindfulness as a tool to directly eliminate suffering, even though this is counter to the therapeutic aim.
From the standpoint of ACT, much like Buddhism, a verbal intellectualized understanding is insufficient and can be counterproductive. Metaphors and experiential exercises are used as therapeutic techniques to advance the six core processes. However, given that individuals have different preferred ways of learning, there is great variation in the ways that patients are able to benefit from commonly employed techniques. This section describes experiences adapting ACT with a pilot group of 7 women at a local community mental health agency in Toronto in cooperation with the Head Abbott and Holy Monk from our Cambodian community.
The group consisted of 12 sessions of 1. A brief period of mindfulness meditation took place at the start of each session see Table 1. This was followed by a review of homework. For some sessions, cooking was part of the agenda as a holistic therapy group. Table 1. The patients had chronic major mood and anxiety disorders, with limited or modest responses to medication treatment and most had considerable difficulty with individual therapy sessions.
Acceptance and Commitment Therapy
They all experienced trauma through the Khmer Rouge regime and had personal difficulties, such as marital and medical problems. In practice, because of logistic challenges, the attendance by the group members was irregular. It also became clear that homework assignments were mostly not completed. It was noted, however, that the participants enjoyed the group when they attended, often behaving in ways that were not seen in the one-to-one psychiatric follow-up sessions. For example, one of the members when seen individually had a difficult time opening up.
When silence was used or when she was asked to close her eyes to do meditation, she seemed to comply in the session but appeared unable to focus or access her emotions. She later related to our mental health worker that she experienced these therapeutic techniques as similar to torture. However, she was able to participate more actively in the group including eyes closed meditation even though she encountered the usual challenges in meditation itself.
Empirical Support for ACT
Another elderly woman in the group, who had experienced both the trauma of Khmer Rouge as well as domestic violence from her husband, also opened up much more in the group than in individual sessions. As the oldest member of the group and the most religious, she showed deep reverence toward the Holy Monk and actively participated in the dharma discussion.
When the group was cooking as a team, a hierarchy was quickly established based on age, and she was transformed from the role of a helpless traumatized frail old woman to a respected leader of the group, delegating responsibilities to complete cooking tasks.
awaxoqoqovys.tk Although similar messages were delivered through ACT and from the teachings of the Holy Monk, there were some significant differences. The ACT metaphors in some ways carried a similar message and played the same role as the teachings and stories told by the Monk. For instance, a story about how the Buddha helped a bereaved widow to finally let go of her attachment when she realized the multiple past lives and relationships she had had drew on the concept of karma and rebirth.
The belief in karma was a strong rationale for accepting current suffering and motivating change in behavior. In addition, due to his position, the Monk was expected to be explicit in giving direct advice and teaching about the correct and incorrect ways of behaving and coping, drawing from Buddhist teachings and his past experiences of helping others in the community. For example, a group member who was angry and had a fight with her husband after feeling neglected significantly changed her interaction with her husband after hearing the Holy Monk discuss the common difficulties in marriage, the correct way of enhancing relationships, and his past interventions with other couples.
This direct instruction extended to the teaching of mindfulness meditation.
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In terms of therapeutic relationship, the patients demonstrated tremendous respect to both the monk and the clinician. With the presence of the Holy Monk, this was elevated and even more apparently demonstrated through verbal and non-verbal means, including gestures in greeting and deep bowing. When cooking was involved, the session time was adjusted earlier as the Holy Monk was only to eat a single meal before noon.
The patients would wait for us to start eating first before proceeding with their meals. They expressed gratitude and honor that we ate the food they prepared, and some even expressed astonishment that I as their psychiatrist would eat with them. In principle, ACT encourages a more egalitarian relationship between the patient and therapist to reinforce that we are involved with the same struggles, while acknowledging there are inevitable power differences.
This was seemingly more difficult given the religious and cultural context in the presence of the Holy Monk.
While it was not possible to gather a quantitative evaluation of the group, qualitative feedback was obtained by our Cambodian mental health worker. The results were extremely positive about the group. This analogy added to their sense of psychological resilience. The participants also gave some ideas about their hopes for future therapeutic groups. They requested that more groups be run in this hybrid format.
They thought that the group could continue to expand on interactive activities and have more cooking activities. Since the group ended, I have continued to follow most of the members in individual treatment. It is apparent that there was a positive change in the therapeutic relationship with the members, and we often make references to ACT or Buddhist ideas first discussed in the group. Most reported an increase in their own meditation or participation in Buddhism, such as through listening to dharma talks on the radio or the internet.
The more religious as well as the more intellectual members of the group appeared to gain the most, while almost all had some degree of improvement. For example, one participant had voluntarily given up her children to child protection services due to her severe depression and hopelessness and later regretted this action. Her symptoms completely remitted with medication treatment, the ACT-Buddhism group, and our engagement with her husband and the family was able to get their children back.
The potential enhancement of adding an explicit spiritual component in Buddhism to psychotherapy group treatment also warrants further study.