De-bunking ACCCEPTANCE and COMMITMENT THERAPY (ACT)

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Therapists are all talking about ACT (Acceptance and Commitment Therapy).

ACT is a ‘third wave’ behaviour therapy approach with a supposedly ‘expanded perspective on how to guide clients to skilfully self-regulate emotional distress and conflicting states of mind’, or at least, that is what all the literature suggests this new so-called approach to same age-old problematic experiences therapists encounter when treating their patients.

These are patients, according to the literature on ACT, who experience affective dysregulation from a new or existing anxiety, PTSD, depression diagnosis and/or deep interpersonal conflict.

The theory behind ACT is a framework which posits through the application of traditional mindfulness exercises and intensive psychotherapy targeting specific cognitive processes, the patient will experience relief through acceptance of private experiences; active cognitive defusion; being present; and self as context.

When all of these targeted modalities are mobilised in the course of psychotherapy, patients supposedly become more flexible in their interpersonal kinship networks and other interactions in their professional work and personal lives.

Building upon the assumption that firstly, a positive increase in prosocial interactions will result in the cultivation of value-based behaviours.

ACT theoretical underpinnings go a layer deeper. The literature suggests this algorithm for conducting therapy will yield further patient insight into their own personal set of values, developing a stronger commitment to positive action and behaviour. This chain reaction yields, what ACT terms, the behavioural and cognitive activation which contributes to the success of patients experiencing therapeutic gains in the course of their treatment.

The framework of ACT builds upon basic mindfulness. While I doubt many therapists would minimise the importance of patients understanding basic mindfulness or even a nuanced deep and complex awareness of self-awareness tools, the use and validity of research confirming this existing modality is already widely accepted and utilised across the board by therapists in mental health.

So, what’s really new then? Self-acceptance? I haven’t met a social worker, psychologist or psychiatrist that hasn’t, in the course of treating anxiety, depression, and PTSD, forgotten to teach self-acceptance strategies when the opportunity presented itself in the course of their patients’ treatment.

The next wheel I like to suggest isn’t so inventive is active cognitive defusion. Even more problematic, cognitive defusion, which has patients confront or raise problematic areas of their dysfunction or conflict without affective state escalation or agitation isn’t even accepted as completely effective in treating the symptoms of these disorders.

I have seen first-hand, both experienced and inexperienced therapists clumsily use this technique, and sessions collapse shortly after as their patients unravel, become irritated, and begin to flood with emotion and negative sense memory.

So, if this technique is so delicate and difficult to apply in practice, why incorporate it into this already complex and overly technical so-called ACT paradigm. I am assuming, much of this has to do with the assumption that ACT-trained therapists will go through rigorous training, and attend every webinar possible throughout their careers and tenure or practising ACT.

The final two underpinnings are in my opinion, the basic skills taught in social work 101. Maybe I am missing something here? Or, just maybe, contextualising the self in more meaningful and meaning-laden terms is what we are already doing as therapists. So many of these so-called new and exciting modalities we chit-chat about at the water cooler and gloat about to our colleagues should already be in our tool kit for practising psychotherapy.

Maybe I am a brilliant clinician, or just maybe, I’ve taken the time to truly be person-centred, read a diagnosis for what it is, and apply my existing and ever broadening skill set to my patients and experience good outcomes without calling upon the buzz of a new acronym or miracle modality.

I get it, we all do it and want to talk about our skills in broad colourful strokes of positive regard, but we therapists should also be a little more humble, and learn our craft from the moment we commit to the helping process. Instead, we blame our shortcomings and inability to successfully treat our patients on our incomplete education of new terminology and the next, ‘in’ therapy.

About the Author

J. Peters

J. Peters is the Editor-in-Chief of Mental Health Affairs.

Award-winning book author and Bold 10 Under ten award recipient J. Peters, LCSW. Through his work as a Licensed Clinical Social Worker. Mental health therapist and disability rights advocate Mr. Peters fights for those without a voice in various care systems, such as the New York City Department of Social Services, the New York State Office of Mental Health, or the city's Department of Corrections.

Mr. Peter's battle with Schizophrenia began at New London University in his last semester of college. Discharged from Greater Liberty State Hospital Center in July 2008, Jacque's recovery was swift but not painless and indeed brutal after spending six months there.

He has published several journal articles on recovery and mental health and three books: University on Watch, Small Fingernails, and Wales High School. He is also a board member of the newspaper City Voices. Mr. Peters currently sits on the CAB committee (Consumer Advisory Board) for the Department of Mental Health and Hygiene in NYC and the Office of Mental Health (OMH) as a peer advocate.

Owner of Recovery Now in New York, a private psychotherapy practice, Mr. Peter's approach is rooted in a foundation of evidence-based practices (EBP). Jacques earned a master's degree in Social Work from Binghamton University and worked as a field instructor for master's and bachelor's level students in NYC.

He is blogging daily on his site mentalhealthaffairs.blog, Mr. Peters regularly writes articles relating to his lived experience with a mental health diagnosis.

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