Session 9

This chapter describes a session focused on values work within the context of acceptance and commitment therapy (ACT). Values work or talking about values can help increase engagement in therapy, but the ultimate goal of clarifying values is to increase clients’ awareness of what truly matters to them so they have a meaningful direction in which to move. Specifically, values work entails defusing from external rules and expectations, defining values, providing examples of values, clarifying clients’ personal values, assessing consistency of current actions with values, setting goals consistent with values, and following through on chosen goals. Measures used to aid in doing values work include the Bull’s Eye Values Survey (BEVS) and the Values Living Questionnaire (VLQ).

Sessions 5 and 6

This chapter covers content that would be helpful after clients have been practicing willingness in the service of living a more meaningful life. More explicit work on values begins here, to give clients context for practicing difficult skills, such as acceptance and defusion. The chapter also describes how to further build on acceptance and defusion skills in these sessions, with more experiential exercises (e.g., self-compassion, ways to flexibly interact with a difficult current emotion, interacting with thoughts like an object). Mindfulness is introduced in this chapter to further expand acceptance and defusion work in the context of flexibly attending to one’s experiences in the present moment.

Session 11

This chapter provides an outline for a typical last session of acceptance and commitment therapy (ACT). The chapter describes how to assess readiness for therapy termination and debrief the course of therapy. In addition, the chapter highlights a few points that may be worth covering in a last session: predicting barriers to behavior change, troubleshooting potential issues, reminding clients to focus on moving toward their values, and formulating strategies to maintain therapeutic gains (e.g., setting reminders, reading relevant books). The chapter also discusses how to say goodbye to clients at the end of their time with the therapist.

Sessions 7 and 8

This chapter opens with teaching therapists how to lead a brief mindfulness exercise at the start of therapy sessions to increase clients’ present-moment awareness. The chapter describes the NOTE acronym as a means to help clients remember the skills they have learned up to this point: to notice what is happening, observe thoughts and feelings for what they are, turn toward their values, and engage in what matters. If clients have sufficiently built up acceptance and defusion skills, therapist may begin work on self-as-context. The chapter concludes with explaining how to introduce self-as-context to clients and provide metaphors to illustrate this tricky concept.

Session 1

This chapter outlines how a first session of acceptance and commitment therapy (ACT) might go. This first session typically includes two components: (1) orienting clients to what to expect from therapy generally and ACT specifically, and (2) beginning work on creative hopelessness. Key points emphasized in this chapter are learning about clients’ perception of therapy, clarifying clients’ treatment goals, collaboratively setting therapeutic expectations, exploring the effects and effectiveness of trying to control thoughts and feelings, and introducing an alternative to controlling thoughts and feelings (willingness). This content sets the stage for concepts to be covered in Chapter 5.

General Guide to the ACT Therapeutic Context

This chapter provides an introduction to the worldview underlying the therapeutic context in acceptance and commitment therapy (ACT) and how this worldview influences what ACT sessions typically look like. In ACT, the therapeutic relationship is seen as a context in which clients learn to become more psychologically flexible or to interact with their thoughts and feelings in new ways that may be more beneficial to their own well-being. The chapter provides tips for how to stay consistent with ACT principles in the areas of therapeutic stance, the therapeutic relationship, therapist behavior in session, and word choices, among other things.

Assessment

This chapter provides an overview of how to conduct a clinical assessment when doing acceptance and commitment therapy (ACT). It outlines the functional basis of ACT as a therapeutic model and its implication: ACT is focused on the effect or purpose of behaviors, rather than their form. The four main areas of assessment covered in this chapter are as follows: (1) how to determine the primary clinical concern; (2) how to determine the functional context maintaining the target behaviors (identified in area 1); (3) how to assess for contextual, historical, or cultural variables that play into the case presentation; and (4) how to set up an ongoing assessment program over the course of treatment.

What Is Acceptance and Commitment Therapy (ACT)?

This chapter provides a broad overview of acceptance and commitment therapy (ACT), including empirical evidence for its effectiveness, how it fits with other cognitive-behavioral therapies, and defining features of ACT. The chapter also explains the theory and scientific philosophy underlying ACT so that readers have a framework to which to refer as they learn how to implement ACT in practice. In addition, the chapter describes the model of psychological inflexibility that underpins assessment and intervention in ACT. This chapter also gives readers an introduction to terms associated with ACT and what they mean.

Sessions 3 and 4

This chapter provides session outlines for covering acceptance and defusion with clients. It also describes how to be experiential when doing acceptance and commitment therapy (ACT). At this point in therapy, we expect that clients may not be fully on board with the idea of acceptance. Thus, the chapter provides some guidance on how to practice acceptance with clients again, recognizing that doing so is novel for most people. In addition, work on acceptance provides a natural segue into work on defusion, as noticing thoughts and feelings for what they are can make being willing to experience them that much easier.

Session 2

This chapter builds on work described in Chapter 4, on creative hopelessness. Specifically, the therapist will continue to focus clients’ attention on the effects and effectiveness of trying to control thoughts and feelings. Once clients are able to track the limited effectiveness of attempts to control thoughts and feelings, the therapist can segue into exploring if attempts to control thoughts and feelings not only do not work as expected but may even be detrimental to well-being (control as the problem). Several examples of exercises to illustrate this point are provided. Finally, the chapter describes how to begin a discussion of practicing acceptance or willingness as an alternative to control. This session is the first in which structured homework tasks are assigned, and, accordingly, details on how to collaboratively set behavioral goals are included.