In this month’s blog article, I continue my discussion of Acceptance and Commitment Therapy (ACT) which began with last month’s discussion of ACT and the notion of psychological inflexibility. Countering the notion of inflexibility, ACT therapists conceptualize their work with clients as building psychological flexibility. ACT theorists have developed what they call the Hexaflex to conceptualize both psychological inflexibility and psychological flexibility. Last month’s article delineated the six core pathological processes that lead toward inflexibility. In this month’s article, I will delineate what ACT practitioners call the Six Core Therapeutic Processes that help clients strengthen psychological flexibility. The six core therapeutic processes are: 1) Contacting the Present Moment; 2) Defusion; 3) Acceptance; 4) Self-as-Context; 5) Values; 6) Committed Action. Each of these therapeutic processes counter the six core pathological processes discussed in Part I of my discussion of ACT.
A Couple of Reiterations
I want to recall some things from Part I of this discussion. First, one should keep in mind that the six core processes of ACT are not separate processes. All six processes work in a holistic manner to help clients develop psychological flexibility. Another clarification I want to reiterate is that as a counseling practitioner, I do not believe that one theoretical approach answers all concerns that clients bring to therapy. Even if such an approach could be developed, it would not eliminate the usefulness of other approaches that have been developed from which practitioners could draw. A final point I want to reemphasize is that I do believe ACT to be a theoretical model and way of practicing that easily integrates with a variety of other approaches to counseling. As one who practices from an existential framework, I find ACT a highly flexible (no pun intended) model for those practitioners who consider themselves integrationists or eclectic. The model itself pulls on several eclectic and philosophical ways of thinking. No doubt ACT purists consider themselves behaviorists. I think of ACT from a different perspective. I find this model intriguing, powerfully holistic, and one that clients can easily grasp, though much of the work, as any work in therapy, can be difficult.
The Six Core Processes of ACT
Contacting the Present Moment (Be Here Now)
Have you ever taken a morning stroll, whether it be through a wooded path, along a lake shore, or around the block, and when you return home you realize that you do not remember a thing you encountered because you were caught up in your ruminating thoughts, worries, and concerns the whole time you were walking? You don’t remember what you encountered, what you saw, the breeze or lack of breeze you felt, the sounds you heard, or the smells in the morning air. Quite frankly, such experiences are common among human beings. When we are caught up in our thoughts, we tend to lose contact with our experiential encounters with the world around us. Not that thinking is a bad thing, or that reflection on problems we want to solve is something we should never do. But when our thoughts capture us to the point that we lose all sense of what is going on around us, we have lost the ability to be present in the moment. Such present awareness is a grounding experience. Being present in the moment not only pertains to the physical environment around us, but also it pertains to our psychological world. Most importantly, it speaks to both simultaneously. Being here now is a personal awareness experience that helps us stay in the moment as opposed to drifting onto automatic pilot where we simply go through the motions during the day without being aware of anything around us. Why is contacting the present moment, being here now, an important component of psychological flexibility?
Defusion (Watch Your Thinking)
ACT practitioners talk about cognitive defusion, which is the opposite of getting caught up in the cognitive rumination whereby we are guided by our thoughts in a way that keeps us from being presently aware. The practice of defusion calls for people to step back from their thoughts, let them come and go, and disentangle themselves from ruminative thinking. From the conceptualization of ACT, thoughts are nothing more than words that we say to ourselves or pictures that fill our head. Rather than being grasp as realities, they can be held lightly so as to be understood as useful or not. The major work is to help clients in ways that they do not get tangled up in their thoughts. When it comes to experiences such as depression and anxiety, rumination and the inability to break out of certain patterns of thinking maintains those experiences. The practice of mindfulness can be used here to help clients defuse from their thinking. Mindfulness helps clients be here and now. When clients develop the practice of defusion, they are more psychologically flexible because their thoughts as patterns no longer have a hold on them.
Acceptance (Open Up)
When we experience painful feelings and unwanted emotions, naturally we want them to stop. We develop methods of avoiding them. Though such avoidance can be helpful at times, most of the time it prevents us from dealing with uncomfortable and painful experiences that face us. In a mindfulness way, acceptance means that we let go of the struggle we face with painful feelings, sensations, urges, and emotions. Mindfulness activities can be utilized with helping clients develop acceptance. In a sense, acceptance helps people give breathing space to those experiences they would rather avoid so as to cease the fight and resistance, and face them so as to deal with them. No doubt, acceptance is a loaded term. Acceptance does not mean that we learn to like such negative experiences, or that we welcome them. It simply means we accept the fact that they are with us, we give them breathing space, and we place them in some psychological light so that we can face them and understand what they mean for us.
Self-as-Context (Pure Awareness)
When we think of being human, different people conceptualize human beings in a variety of ways. The common language regarding being human revolves around words like mind, body, spirt, and soul. Some people believe we are pure mind, while others hold a more materialistic view of human beings. The behavioral formulation from ACT comes through in dealing with the concept of self. As I spoke in Part I of this ongoing discussion of ACT, I’m not a fully Eastern in my thought as some ACT therapists are. I do believe there are some things we can learn from Eastern thought, but I do believe in a core self and identity. ACT theorists conceptualize the mind in terms of what they call the thinking self and the observing self. When we are caught up in our thinking, which entail generating thoughts, beliefs, memories, and judgments, according to ACT we are experiencing the thinking self. The thinking self makes plans, daydreams, and fantasizes about things. The observing self, on the other hand, is an in-the-moment experience. We are experiencing the observing self when we are aware that we are thinking, feeling, sensing, or whatever it is we are doing in the moment. Some people call this pure awareness. ACT practitioners call it self-as-context. We all go through life changing, growing, developing, letting go of and picking up new values and beliefs. Yet the you that notices these changes across time does not change. This you is what ACT therapists consider the observing self or self-as-context. Again it is an understanding of human experience that contributes to our ability to become aware.
Values (Know What Matters)
Much of my work with clients revolves around their becoming aware of what they value and then seeking to live in alignment with their values. Sometimes such work leads to clients’ exploring what they claim to value, only to find out that they, in fact, do not value what they claim. Such values exploration is important work because if I become aware that I really don’t value things as I say, or perhaps I’ve merely inculcated them from my surrounding family, society, or culture, then I must pursue and discover for myself what I truly value. Exploring and questioning values is important awareness work as well. Clients enter therapy at times saying they value things, but find they are acting in ways not in alignment with what they claim to value. Why is this the case? A value is that which deep in our heart says, this is what I want my life to be about. So questions such as, what do I stand for, or what do I want to do with this one life I have in this brief moment that I have it, get at what we value. We can watch the ships sail by and never choose to set sail with any of them. We can listen to the second hand of the clock tick by while never getting off our ass to do anything. This is a possible sad scenario for many people, whether we want to admit it or not. Values apart from action are meaningless. In fact, what we value imbues our actions with desired qualities that align with the value. Values define how we want to behave on a day-to-day basis. I remember standing outside of an academic building one winter in a cold, sprinkling rain, questioning whether or not I wanted to continue with my Ph.D. work in counseling. The work was going to be long, I was looking at being tight with money, and I was at an age that either I was going to do it or not. My values pushed me on at that moment. But the experience speaks to how difficult at times it is to live in alignment with core values. I truly believe it is easy to give up on living according to our values. I think people enter counseling at times because they are trying to clarify their values, are experiencing the difficulty in aligning with their values, and are trying to find the courage to live according to their values. Exploring and recognizing values can be some of the most difficult work people can do. Then doing what it takes to live those values out is another difficulty that life offers us.
Commitment (Do What It Takes)
Commitment is action. Effective actions are those that are guided by our values. Obviously, not living out what we value gives rise to a plethora of uncomfortable and unwanted thoughts and emotions. This is no less true when we seek to live in alignment with our values. Doing so gives rise to an array of both pleasant and unpleasant thoughts and emotions. It takes courage to live out what one values. Effective and committed action is the opposite of experiential avoidance, which can come about due to a lack of courage to do what it takes to live out our values, even when it’s difficult. The last year of my doctoral work was some of the most stretching times I experienced up to that point in my life. I was strapped for money, living in a dump of a house and apartment, and wondering whether or not when all was said and done, would it take me anywhere. Effective action then is value-congruent action. Many behavioral techniques can come into play here, including goal setting, planning, skills training, and other behavioral activation techniques. But these techniques are mere formalities if the work around a client’s actions are not value-congruent actions.
The six core processes of psychological flexibility counter those six points of the ACT Model of Psychopathology discussed in Part I in last month’s blog. Contacting the present moment counters problems that ensue through the dominance of the conceptualized past and future. Defusion counters what happens when people become cognitive fused with their thoughts and rumination. Acceptance helps us open up so as not to deny painful thoughts and emotions, thereby experientially avoiding ways of recognizing and dealing with them. The notion of the self as context helps us detach from the wooden and rigid conceptualized self. Knowing what matters, that is becoming aware of our values, provides clarity and contact that are lacking with we are unclear and unaware of our present values. Effective action, which is action in alignment with our values, enables us to escape unworkable action. These core processes are merely a conceptual framework for ACT. There is much more to this approach as therapists and clients delve into any one of these processes. The work is also holistic. By exploring any point of the six-point Hexaflex or diamond, all six points will be effected in some manner.
It is important to recognize that ACT is simply not a set of techniques tied to the Hexaflex. The aim of ACT entails a philosophical take on life. ACT therapists state that their aim is to help clients create a rich, full, and meaningful life while accepting the pain that inevitably goes with it. This philosophical perspective is why I believe that ACT meshes well with my spiritual and existential framework for my work. Likewise, the emphasis on mindfulness is an important piece that integrates well with how I work. As an ancient concept, mindfulness is found in a wide and historical range of spiritual traditions, including Buddhism, Taoism, Hinduism, Judaism, Islam, and Christianity. Western psychology via research and practice had begun to recognize its usefulness in the practice of counseling. Mindfulness can be used to increase awareness, openness, and psychological flexibility. Above all, however, ACT is about valued-living. In that sense, it overlaps and can be easily integrated with many counseling approaches.
I’m not a one-theory man. I’ll use whatever I can get my hands on in order to help my clients reach their desired goals. In saying that, I’m not a pure pragmatist either. We all have values on which we base our living, whether we are aware of it or not. I too have mine. And like many people, I’m striving day-to-day to become, not only more aware of what they are on deeper levels, but also I’m looking to become more aware of how to act on them in a consistent manner. A rich, full, meaningful life is most definitely worth living. Is it not?
References: Harris, R. (2009). ACT made simple. Oakland, CA: New Harbinger Publications.
John V. Jones, Jr, Ph.D., LPC-S/May 14, 2017