The Three Essential Strategies of ACT (Part 1)
The following three principles are the essential bare bones strategies for the therapist wishing to help her client improve their psychological flexibility:
Help the client discern the relationship between what they do and the problematic consequences they experience.
Help the client discern their own thoughts, emotions, and physical sensations by establishing an observational distance from them as they emerge.
Help the client use this skill to clarify what is important in their life and what would be concrete steps in that direction.
Here is a more in depth look at the first essential concept.
Discerning the relationship between what is done and the consequences
In clinical behavior analysis, this type of therapeutic strategy is usually referred to as a functional analysis or an ABC (antecedent-behavior-consequence) analysis (Ramnerö & Törneke, 2008). It can be found in any analytical approach, but is solidly found within all behavioral approaches including CBT, DBT, and ABA.
Given that one of the key aspect of psychological flexibility is how someone interacts with their own behavior, then recognizing this behavior and how it links to other events is crucial.
This is the metacognitive awareness aspect that all therapists are trained to employ.
By going through repeated examples of situations the your client finds distressing or troubling, you and your client can together identify antecedent factors (A) to the client’s behavior (B) and the resulting consequences (C) in order to help the client eventually develop alternative strategies. What do you do? Were the results useful or workable?
As the sessions and interactions progress, this approach will need to be supplemented with motivational and psychoeducational interventions. Getting clear on an experience and the consequences of the behavior will increase motivation to do the one thing over another, especially if they can see how that outcome might be better or at the very least, hurt less.
Reinforcing this further would be supplementing psychoeducational resources, since exposure to new ways of engaging, including skills or even simple concepts, will increase the client’s ability to learn and to integrate. This also allows clinicians to utilize any theoretical approach and a variety of ways to accomplish this. There is no need to learn anything else new here, just a slight adjustment to what we are focusing on, shifting from the actual content to the underlying processes and the context in which it all occurs.
By doing just this first step, the clinician will get a better sense of the client’s strategies and focus on the problematic ones which often are attempts to avoid automatically triggered emotional reactions. This step alone is enough to increase flexibility in that it serves as a way to expose and emotional process them.
What to watch for in session:
(A) What was the antecedent to the client's behavior here and now ?
(B) Was it something the therapist said or did?
(C) What followed? What exactly, did the client do?
Keeping this in mind allows us a moment to pause in the session and reflect upon a strong reaction without getting pulled into it ourselves, keeping both you and your client grounded in the present moment.
Again: By going through repeated examples of situations the client finds distressing or troubling, the therapist and client together identify antecedent factors (A) to the client’s behavior (B) and the resulting consequences (C) in order to help the client eventually develop alternative strategies.
Main Take Aways
This process is what is often referred to as “creative hopelessness" within the ACT approach with the goal of the clinician being in keeping the client from jumping away to a different topic when it is realized that the connections made do not give the conclusion that they would like to have.
In this situation the best two co-occurring supports would be to work with motivation and psychoeducation:
Motivation, since a clear experience of the consequences of our behavior affects our inclination to do the one thing or the other;
Psychoeducation, since a careful review of these links boosts the client’s faculty for learning with regard to the problems with which he is wrestling, and gives the therapist a variety of means by which she may illustrate for the client how central processes operate.