The ACT for OCD Toolbox: A Guide for Therapists

Earn 8.75 CE/CME Credits and ACT Right Away in OCD

Learn more
Last Updated Nov 2, 2022|

The ACT Beginners’ Guide

By Kate Morrison, Ph.D.

This presentation is an excerpt from the online course “The ACT for OCD Toolbox: A Guide for Therapists“.

Highlights

  • There are common struggles that occur when new to using ACT.
  • Avoid being too didactic, rapid use of metaphors, and explaining exercises.
  • Notice if you’re struggling to engage in ACT processes yourself.
  • Pause, attend to the present moment, and redirect behavior to return to ACT-consistent therapy.
  • Model the use of ACT by expressing the process with the client.

 

Transcript

Now, let’s go through some guidance that I have for people who are ACT beginners. So as therapists with any, and as humans with any new skill we learn, we’re not going to be great at it the first time we do it.

There are some common struggles that occur with providers that are new to ACT, and especially if you’re used to providing other treatments for OCD, you may find yourself slipping into that approach when you’re feeling stuck within ACT or if you’re uncertain how to proceed within the ACT framework. So, let’s go through some of the common things that people run into, and I can give you some tips on how to respond in those moments if this happens for you.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

The first one I often see is people being too didactic, so trying to teach ACT rather than helping guide the person through ACT. ACT is not a didactic treatment. If you catch yourself doing this teaching or talking too much, pause and reorient yourself to the client and what they’re experiencing.
 
References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

This isn’t just something that beginner ACT people do. I’ve been doing ACT for a long time, and I still find myself doing this from time to time. I pause, and I do a present moment exercise or any other exercise that gets me to just shut my mouth and be in the moment and notice my urges to explain and breathe into those. Then I ask the client what’s showing up for them in that moment, and then redirect to the process that we’re working on at hand.
 
References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

I find this for myself that it often shows up in times where I’m feeling pulled to want the client to understand a certain concept. They’re not quite getting it, I see them so close to it and I want to just help them get there. And that’s where urges really show up for me and I really have to practice keeping my mouth shut, breathing, hanging out with my urges, and letting them work through it.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Whenever you’re feeling stuck, it never hurts to be present and focus on values-consistent action. Those two skills alone will get you out of being stuck and working toward meaningful change much of the time. Again, that is being present and focusing on values-consistent action.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

The next one we notice is providers explaining metaphors, the exercises or the processes. Don’t explain. I think we’ve covered this one enough in previous videos. If you need to explain the exercise or the metaphor, it didn’t work and explaining it doesn’t make it better or more effective. If it is not working, drop it, let it go, move on to something else.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Sit with that painful experience for you as a provider that can come with that and any judgments you have about yourself of like, “Ah, I didn’t do that well”, or “I didn’t pick the right one.” Practice ACT with yourself being aware and noticing of what’s pulling you to explain and let it go. Move on to something else that will be effective for your client because that one just happens to not be working and that is okay. That totally happens.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

The next thing I will say, especially if you’re coming from treatments that have a cognitive therapy focus where you may just slip into addressing the content of a thought that someone is having. That is ACT inconsistent, and so it’s something that you got to be mindful of. Sometimes, we can get caught up in the client’s thoughts or our own just like they do.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

For example, they might say something like, “This is too hard”, and your response if you’re responding to the content of that thought, you might say something like, “Oh, you can do this. You’ve done hard things before.” But in that moment, you are responding to what that thought is saying, not the fact that they’re just having that thought.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

And so instead, what, how you’d want to respond to that is something like, “Oh, good noticing that thought”, or “Oh, that’s a tempting one.” Or you can say something like, “Oh, your mind is telling you it’s too hard.” Those are more ACT-consistent responses.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

So that’s great if you can get yourself doing or the urge to respond to that content ahead of time but more often than not, I would say for those of us that get caught in that you notice it after you’ve said it. And there might be this moment of like, “Oh, shoot, I shouldn’t have said that.” When you notice that, don’t keep it to yourself obviously within moderation here, own it because you want to help your client see that you’re human also, you also do this and it’s a process.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Model how to go through this. So own it. Say you got caught up in it. Like don’t just let it slide. And this can be something really quick. I’d be just like, “Ah, I got caught up in that one too. Okay, let’s just notice that and let’s move on.”

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

The next is what I call metaphor frenzy which I hope that I have shown it throughout this training that ACT is not just a bunch of metaphors thrown at clients. It’s a common misconception of this therapy. We do use a lot of metaphors in this therapy, but they are well thought out and purposefully used. And ACT beginners may just try throwing a bunch of metaphors hoping that something sticks for the client, and this often is mixed with more that didactic and explaining approach which is just ACT inconsistent all around.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

What I recommend doing is plan 1, maybe 2 metaphors for your entire session with that person and that will encourage you to guide the person through it rather than teaching it because if you teach a metaphor, it could take you 5 minutes. If you guide someone through it, it may take you 30 minutes. It’s a very different experience for the client. And so, this is a spot where you can really challenge yourself to say, “I am only going to stay on this metaphor or this exercise for the entirety of the session today and cover it thoroughly instead of this surface coverage of 5 of them.”

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

The next thing we know, and this can happen in any therapy session especially if you’re new to treatment, we can react to our own discomfort. Sitting with discomfort can be hard obviously. I think that’s what we help clients do much of the time. If it were easy, we wouldn’t have jobs. So that’s the case for our clients as well as it is for us. So same thing here. Own up to it if you do something that is clearly an avoidance move in session.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

You want to model that we all do it, and that you can have an awareness of it, and you can do something differently. We’re not striving for you to look as if you are a perfect being and that you are perfectly consistent with ACT because that is unrealistic. We don’t want to send that message to the clients that that’s the only goal we’re going for. We’re looking at this more of a process. So show them that you can do that too.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

If you find that you are struggling to stay with your own discomfort with your clients, there are lots of options here. If it’s something that feels like a pretty regular concern for you, it might be something that’s worth speaking with a supervisor or engaging in your own work through therapy, engaging in mindfulness practices on a regular basis. Regularly sitting with someone else’s pain is hard work and so make sure that you’re feeling equipped to be with your clients while also caring for yourself here.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Now, in the midst of the session with a client, there are certain obsessions and compulsions that can be harder for some to hear than others. I will say that the obsession I hear people struggling to be with the most are thoughts of harm, especially harm to children or fears of sexually molesting children. Obviously, it depends on you and what is the difficult thing for you to hear and to sit with but be aware of those.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Because you need to be able to sit with the client in that discomfort and show them that there’s nothing to be afraid of with those thoughts. And so, if you are also afraid of those thoughts, again that is a spot that you want to make sure that you are doing your own work around that. So you can show up fully for your clients and so those therapy sessions don’t feel so draining for you either.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change (1st ed.). Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

The key points here are that whether you are new to ACT or new to ACT for OCD you probably wouldn’t be great at it the first time or the fourth or the fifth. Like there are some really common struggles that can occur when new to using ACT. So avoid being too didactic, rapid use of metaphors, and explaining exercises.

Notice if you’re struggling to engage in ACT processes yourself like getting caught up in the thoughts and the content of them and avoidance of distress. And pausing and attending to the present moment as well as redirecting behavior based on values is a reliable way to return to ACT-consistent therapy. And you as a therapist can model the use of ACT when you notice this by expressing the process with the client obviously as appropriate.

More The ACT for OCD Toolbox: A Guide for Therapists