Learning ACT: An Acceptance and Commitment Therapy Skills-Training Manual for Therapists

by Jason B. Luoma, Steven C. Hayes, Robyn D. Walser

The groundswell of interest in acceptance and commitment therapy (ACT) is among the most remarkable developments in contemporary psychotherapy. Whether you are new to the profession or an experienced clinician with an established career, seeking to incorporate ACT work into your practice, this book is an essential resource. ACT is both a unique approach and somewhat counterintuitive in its methods. Learning to “do ACT” well requires practice, patience, and good information. This book is a major contribution to ACT professional literature: a comprehensive, activity-based workbook that will help you understand and take advantage of ACT’s unique six process model, both as a tool for diagnosis and case conceptualization and as a basis for structuring treatments for clients.

Learning ACT begins with an overview of the ACT model, outlining its theoretical and philosophical underpinnings. Next you will learn how to understand and make use of the six core ACT processes. In later chapters, you'll be introduced to the ACT approach to establishing an effective and powerful therapeutic relationship and learn to conceptualize cases from an ACT perspective. Throughout these chapters are numerous exercises to help you apply what you are learning in order to process the material at a deeper level.

Unique to this volume is a DVD that includes role-played examples of the core ACT processes in action. Use this helpful addition to bring to life the concepts developed in the text. An invaluable aid to serious ACT study, the DVD can be reviewed often as you gain facility with the model.

Genres: Psychology, Counselling, Social Work, Psychiatry, Nonfiction, Self Help, Social

320 pages, Paperback

First published November 1, 2007

Reviews

[Robin Savile · Rating 5 out of 5]

While this book is aimed at its core market of clinical psychologists, it is actually of immense value to anyone looking to understand the human condition better, and to learn some tools for living better.
Highly recommended to everyone.

[Alex Giurgea · Rating 5 out of 5]

O carte recomandata pentru a dobandi abilitatile necesare in practica terapiei ACT. Plina de exercitii si exemple edificatoare.

[Xin · Rating 5 out of 5]

Read this on a long day of flights. I would say like Computer Science for someone who has never been exposed to the concept, ACT is not intuitive at first.. but once you understand its language and its structure, everything comes together. Definitely what got me into ACT.

[Jake · Rating 5 out of 5]

A fantastic and thorough training manual.

[Jeremy · Rating 4 out of 5]

Quotes:

The focus in ACT is explicitly on living better. Although this may involve feeling better, it also may not.

Compared with traditional cognitive behavioral therapy (CBT), doing ACT tended to produce more anxiety in therapists, slower reduction of anxiety with experience in applying these methods, and significantly better clinical outcomes in patients.

The same things that work well in the external world can easily create harm when turned toward the internal world.

Literal language leads to increases in pain and the tendency to over extend a problem-solving mode of thinking as a way to solve that pain. As a result, we try to escape and avoid our feelings, we become entangled in our thinking, we lose contact with the present, And we begin to believe and defend our own stories about ourselves. An overextension of human language leads to a rigid, psychologically inflexible way of living.

Trying to control anxiety involves thinking of anxiety, which tends to evoke anxiety.

It is not what we think that is most troublesome; it is how we relate to what we think.

We are constantly interacting with the world as cognitively organized, without noticing that we are constantly organizing it.

Verbally constructed why answers are considered “real” simply because the verbal community treats them that way.

On the language of reason-giving: “This formulation is rarely challenged. It is almost rude to ask, ‘Why did you forget?’ or ‘Why didn't you just feel the fear and still do it?’”

A whole life can be consumed by process goals, such as defending oneself from anxiety, handling depression, or defending one's self-esteem, rather than many other possible outcome goals that could have greater meaning, depth, and vitality. The person is metaphorically consumed with always sharpening the axe, never getting the chance to actually put it to use chopping trees and building the home in which they want to live.

Values are choices. Values are the answer to the question, “In a world where you could choose to have your life be about something, what would you choose?”

Contact with the present moment and self as context occur in both groupings because all psychological activity of conscious human beings involves the now as known.

Willingness can be defined as being open to one's whole experience while also actively and intentionally choosing to move in a valued life direction.

Willingness is experienced as an ongoing process, not as a waiting for something to change to a better thing if we are tolerant enough.

The pain caused by the effort to not have pain is referred to in the ACT community as “dirty pain.” In contrast, “clean pain” refers to pain that is the natural and automatic result of living life.

This therapy is not about confronting the client, but rather about confronting the social-verbal-cultural system of experiential control in which the client is stuck.

Ask the client in a nonjudgmental and nondefensive way (which cannot be faked) to step back for a moment and consider “defending the rightness of my views” as a strategy, and to see if it has worked in his or her life.

The purpose is not to list formally correct methods; it is to explore the functional impact of any and all solutions and to let go of what is not working.

The more you try to control your internal experience, the more you lose control.

“If you aren’t willing to have it, you’ve got it. If you are not willing to lose it, you’ve lost it.”

Ask if it is not true that the client could still choose tea and drink it, despite all the good reasons. The answer is, of course, yes. It is not the reason that chooses, but the person who chooses.

"Are you willing to feel what you feel; have the thoughts that you have; let the sensations be there, fully and without defense; and do what works for you according to what you value?"

"Maybe this isn’t about winning this tug-of-war, but learning how to drop the rope."

"What if all this struggle you have been experiencing is about avoiding pain, but the only way to move forward is to turn toward the pain, rather than away from it? "

Suggesting “no effort” is both a willingness move and can potentially lead to a decrease in suffering.

Willingness is not about the future, but about the present.

"I know it doesn’t seem as easy as what I just did, but I want to point out that this might be both easy and hard at the same time. It is hard because your mind says it is, and it is easy because it is as simple as a chosen action."

Thoughts do not control behavior. They are associated but not causal.

The therapist continues working while also feeling the anxiety that comes from pressing the client in a direction he has avoided.

If the client can see the thought as a thought, then its power to control actions is lost, even if that thought continues to occur.

You probably learned how to walk before you even had words. We learned to walk by experience. There are many things that you know by experience; for instance, you know feelings won’t harm you, even if your mind tell you they will.

On riding a bike: “Having a parent tell us to ‘stay balanced’ doesn’t teach us to balance.”

Coming to ACT sessions and not engaging in exercises outside of sessions is a bit like going to the hardware store, buying a new table saw, and then leaving it at the checkout counter.

[There was an] ancient king who, in his arrogance, sat in the sea and commanded the tide not to come in, and then drowned.

“Who is talking to me now, you or your mind?”

Playfully give the client’s mind a name.

Minds are not in charge.

Bring the focus back to the immediate implications of the client’s talk and away from attempting to figure it out, be correct, or analyze the situation.

“Well, that sounds right. But which would you rather be: right or living a vital life?”

Replace the word “but” with the word “and.”

"Your salesman mind shows up and sells you the thought, 'I can’t connect with people.' It looks as if you’ve been buying that so far. Maybe the important question here for us is whether that’s a thought you want to continue to buy."

Being right can actually stand in the way of living a vital life.

“Is this helpful, or is this what your mind does to you?”

Contrast what their minds say will work with what their experience says about what has worked.

“Do you need to change the story for you to move forward with your life or can you just let it be there, as a story, as a thought, and move forward?”

“So which are you going to believe: your mind or your experience?”

“How about this? Just let them be there as thoughts, as feelings. Don’t do anything with them, except notice them.”

“Have you had enough pain to try something else? Or do you want to wait for more?”

“Do you want defended reasons or effective actions? Suppose you can only pick one. Which do you choose?”

Much of what is present is, in and of itself, not threatening: feelings, thoughts, sensations, and so on. When we lose the present, we can lose awareness and end up entangled with evaluations, judgments, and assessments about the feelings and thoughts and sensations, creating needless suffering.

It is when we fight against a feeling, wishing it were not so, that harm can occur.

On meditation: “You may have to slow down, show up, and look thousands of times before doing this becomes more natural.”

Metaphorically, the goal is to live with real people, rather than with cartoons.

ACT is a very active therapy and is not a therapy in which the therapist provides supportive listening most of the time.

The mind is great at dragging people around.

The shift back to the past may have been an attempt to avoid the emotional pain associated with years of not living the value.

Even though her mind handed her what seemed like a literal truth (“I can’t take it anymore”), the experience of the moment shows she can and does take it.

If a literal verbal sense of knowing dominates, it seems that immediate action must be taken or some awful event will follow. Behavior is quickly organized around fixing or controlling the mind’s content, but that very work can be problematic.

Feared experiences often threaten a person’s very sense of self. Making contact with the transcendent “I” can help clients see there is a place – in fact, they are a place – that is unchanging and stable and does not need to be threatened by the experiences of their mind or felt emotions.

Chess metaphor: “Although the pieces are threatening to each other, they are not threatening to the board.”

“Check your experience and see. Have you ever been able to kick the pieces that you didn’t want off the board?”

If any action is to be taken, at some point you need to just take a stand and say, “I hold this to be important.”

What I want to do is start swimming toward something, not away from it.

If the therapist can help clients describe their most basic values for their life, clients can contact a source of stability in an often-chaotic landscape of changing thoughts and feelings.

The therapist’s job is to draw out the client’s hopes and dreams, and to help the client detect the life directions he or she would choose freely, not select in order to avoid guilt, anxiety, shame, or the negative opinions of others.

Just because behavior is constrained by a situation does not mean the value cannot still be held.

Committed action allows clients to experience that thoughts, feelings, and sensations cannot literally harm them, but are only harmful if allowed control over how the clients act in their lives.

Avoid dead man goals. Dead man goals are goals that a dead person could do better.

When people make public commitments, they are more likely to accomplish them.

Without connection to a value, clients have little motivation to engage in the hard work of therapy and the process of contacting feared states.

What matters most is maintaining forward movement and growth, not the amount or the rate of movement.

“Where do you find yourself in your own life: Are you sitting in the stands, watching, evaluating? Or are you on the court, working, having conversations that will advance the game?”

Accept
Choose
Take Action

Fusion
Evaluation
Avoidance
Reason Giving

The therapist points out this pattern to the client and suggests he choose to make a new pattern that includes recommitting after a broken commitment. Building a pattern of recommitment after a slip is a necessary pattern to have as part of our lives because we all get off track.

ACT assumes that much of the client’s problem lies in the linkage between the process goals and outcome goals. ACT therapists often challenge the linkage during therapy.

Repeatedly help clients examine what their experience has to say about the workability of their current behavior versus what their mind has to say.

As humans, we generally try to live up to our own and others’ view of ourselves, even to our own detriment.

Looking through a functional lens means repeatedly asking yourself during session, “What is the client’s current behavior in the service of?”

If you find yourself attempting to change a client’s mind rather than trying to liberate the client’s life, stop: you are not doing ACT.

Inside our values we find our pain and inside our pain we find our values.

“What we’re working on here is your ability to stay present with yourself even as you do some things that are difficult; to learn to make room for whatever part of your history shows up in the moment and to keep your feet moving in your valued direction. Remember this is not about making this stuff go away; it is about learning to carry your own history forward into a more powerful and effective life.”

Sometimes, rather than more information, clients need to simply make room for whatever mind chatter and emotions are present and to take action toward their values.

Be assured the client is doing exactly what he or she should be doing, given his or her learning history and current context. Consider again your plan or action and change course if needed.

Contact with the present needs to occur during or immediately before values work, otherwise such work is dry and intellectual.

Clients usually come to therapy implicitly espousing the dominant cultural story, which is that they need to feel better in order to live better. Living inside this story, they mind themselves endlessly pursuing feeling better, while living is put on the back burner.

The ACT model assumes that because suffering is ubiquitous, the cause of suffering must be something ubiquitous. ACT/RFT suggests that the culprit is language itself.

The creative hopelessness phase of therapy is about validating the client’s direct experience, letting go of what does not work, and preparing for real change. The result is typically hopeful and empowering, not depressing and hopeless.

[Megan Hricovec]

I don’t feel like I can really rate this one since I read it for work but I really loved it as a training tool and would def recommend it to anyone learning Acceptance and Committment Therapy! Reading it after the original Hayes manual was helpful because it placed a lot of emphasis on experiential learning for the clinician (tons of good hands-on worksheets and vignettes).

Idk why I chose a bunch of massive books at the very end of my reading challenge though because this was a bit brutal to finish under a time crunch.

[LHN · Rating 4 out of 5]

Good for those begin learning to be a therapist. It benefits me personally in daily life.

[Pablo · Rating 5 out of 5]

Probablemente uno de los libros claves para entender ACT y complementar el aprendizaje con los libros más teóricos.

[Altuğ Bilgin Altıntaş · Rating 5 out of 5]

One the best book I have ever read

[charlotte]

still confused by act lol

[Cameron · Rating 5 out of 5]

This educational book for those who provide therapy is excellent. A unique way of integrating cognitive strategies and acceptance. There are a number of exercises designed to help the reader feel more proficient in the concepts being discussed. Keeping in mind that this is an educational manual you can plan on reviewing it a number of times. I believe you'll enjoy it each time.

[Sara W. · Rating 5 out of 5]

This is one of the most amazing book I read. It was really hard to accept and make a commitment with others. With this we will learn and will train ourselves of therapy skills that people mostly need. Patience is a virtue and this will actually lead us to a peaceful living and happy life. With the help of this book, I can find myself helping others. Thanks for this!

[Olwen · Rating 3 out of 5]

Extremely in-depth training manual, including DVD with excerpts of counselling sessions. Useful if you have oodles of time to spend on learning this therapy in depth.

[Andy Schramm · Rating 5 out of 5]

This is my favorite ACT book. Very useful. Approachable and laid out well. Templates for treatment plans, etc. are helpful. The DVD alone is worth the cost of the book, in my opinion.