ACT for Trauma: PTSD and Beyond

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Last Updated Dec 8, 2022|

ACT for PTSD: Session Overview

By Sonja V. Batten, Ph.D.

This presentation is an excerpt from the online course “ACT for Trauma: PTSD and Beyond”.

Highlights

  • There is no one official protocol or sequence for presenting ACT concepts and treatment.
  • Move through adherence into competence.
  • Work through a specific sequence or protocol to ensure you understand the concepts.
  • Over time, you can apply them in a more flexible way.

 

Transcript

Welcome to Module 2. In this module, I will begin walking you through the actual process of conducting ACT with posttraumatic stress disorder.

But before I get into that, I think it’s important to note that there is no one protocol or session structure that should be used with all clients. Every client is different. And although you’ll see protocols presented in a certain way, in reality, you might modify that for a given client.

So, I’m going to walk you through one potential topic-by-topic structure in the remainder of this course, but that’s not to say that it’s the sequence that should always be used with all trauma clients.

ACT really requires flexibility based on presenting concerns and the case conceptualization that you arrive at.

References

Dinger, U., Zilcha-Mano, S., Dillon, J., & Barber, J. P. (2015). Therapist adherence and competence in psychotherapy research. In R.L. Cautin and S.O. Lilienfeld (Eds.), The encyclopedia of clinical psychology. John Wiley & Sons, Inc.

But the beauty is that you can truly start anywhere within that hexaflex model I described earlier, that hexagon that has acceptance, defusion, present moment contact, self-as-context, values, committed action. There’s no real right or wrong answer about where to start.

But when you’re conducting a training on ACT, I have to start somewhere.

References

Dinger, U., Zilcha-Mano, S., Dillon, J., & Barber, J. P. (2015). Therapist adherence and competence in psychotherapy research. In R.L. Cautin and S.O. Lilienfeld (Eds.), The encyclopedia of clinical psychology. John Wiley & Sons, Inc.

And in fact, when you’re first learning ACT, I really think it’s important to walk through a protocol from beginning to end—honestly, probably a couple of times before you really start modifying anything—because here’s how it can go.

References

Dinger, U., Zilcha-Mano, S., Dillon, J., & Barber, J. P. (2015). Therapist adherence and competence in psychotherapy research. In R.L. Cautin and S.O. Lilienfeld (Eds.), The encyclopedia of clinical psychology. John Wiley & Sons, Inc.

You hear me say, well, ACT is really flexible and you can start anywhere you want. And so by the end of this course, you’re really comfortable with the acceptance and the values pieces. And so you end up focusing mostly on acceptance and values.

References

Dinger, U., Zilcha-Mano, S., Dillon, J., & Barber, J. P. (2015). Therapist adherence and competence in psychotherapy research. In R.L. Cautin and S.O. Lilienfeld (Eds.), The encyclopedia of clinical psychology. John Wiley & Sons, Inc.

Well, what can happen is you end up only doing the things that you’re comfortable with and not really challenging yourself to learn the other parts of the treatment that are actually part of the full model.

And it is the full model that the evidence rests on, not just applying small pieces of the model. So, I think it’s really important especially when you’re learning ACT to not just skip around because you have the risk at that point of just becoming sort of eclectically applying random pieces of ACT.

References

Dinger, U., Zilcha-Mano, S., Dillon, J., & Barber, J. P. (2015). Therapist adherence and competence in psychotherapy research. In R.L. Cautin and S.O. Lilienfeld (Eds.), The encyclopedia of clinical psychology. John Wiley & Sons, Inc.

You know, I think it’s important here to remember sort of the distinction between adherence and competence. And when you’re learning psychotherapy, my philosophy is that you move from adherence to a given treatment into competence.

So, therapist adherence refers to the extent to which a therapist uses the specific techniques of a particular therapy approach.

And then competence is the degree of skillfulness in their delivery.

So, adherence is: Can you go through a protocol and deliver the exercises and the homework assignments and say the right things, in general, so that you’re adhering to the treatment protocol and philosophy?

Competence is being able to flexibly apply those things on the fly.

References

Dinger, U., Zilcha-Mano, S., Dillon, J., & Barber, J. P. (2015). Therapist adherence and competence in psychotherapy research. In R.L. Cautin and S.O. Lilienfeld (Eds.), The encyclopedia of clinical psychology. John Wiley & Sons, Inc.

And I think it’s really important to work in a focused way to move through adherence into competence. Because if you have a relatively straightforward client, you might be able to, you know, sort of take things a little bit more on the fly. But without truly understanding the theoretical underpinnings of ACT and having practiced all of the different components, you will not be as well prepared to address those unexpected things that happen that aren’t written about in the protocol.

References

Dinger, U., Zilcha-Mano, S., Dillon, J., & Barber, J. P. (2015). Therapist adherence and competence in psychotherapy research. In R.L. Cautin and S.O. Lilienfeld (Eds.), The encyclopedia of clinical psychology. John Wiley & Sons, Inc.

So, both adherence and competence are essential to treatment integrity. And that’s especially important when conducting studies on the efficacy of a specific form of psychotherapy.

Adherence and competence are also important so that you can address the real-world client who is there in front of you with the real-world challenges that shift from session to session.

So, once you’ve become competent, then you can experiment with applying the principles more flexibly on a case-by-case basis. But if you jump too quickly into the flexible application, you’re likely to be using just a hodgepodge style that doesn’t truly reflect ACT and, therefore, is likely to be less effective.

References

Dinger, U., Zilcha-Mano, S., Dillon, J., & Barber, J. P. (2015). Therapist adherence and competence in psychotherapy research. In R.L. Cautin and S.O. Lilienfeld (Eds.), The encyclopedia of clinical psychology. John Wiley & Sons, Inc.

So, to review the key points: There is no one official protocol or sequence for presenting ACT concepts and treatment. However, in order to learn ACT and move through adherence into competence,

it’s useful to challenge yourself to work through a specific sequence or protocol to ensure that you truly understand the concepts. Then over time, you can apply them in a more flexible way that is still theoretically consistent with the ACT model.

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