Demystifying ACT: A Practical Guide for Therapists

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The ACT Therapist & Trauma

By Sonja Batten, Ph.D.

This video is part of our upcoming online course about ACT for PTSD.

Highlights

  • The stance of the ACT therapist is open, accepting, and nonjudgmental.
  • The therapist is in the same boat as the client.
  • ACT therapists focusing on trauma need to take good care of themselves.

 

Transcript

I’d like to talk to you a little bit about the role of the ACT therapist and talk about how we approach the therapeutic relationship within ACT.

So, within the ACT model, the development of a consistent and collaborative therapeutic relationship is really considered to be of central importance because it’s this relationship that provides the context for the work that gets done in therapy. And although a strong therapeutic relationship is considered to be fundamental from an ACT perspective, it’s not seen as being sufficient to effect the necessary clinical change for the majority of presenting problems. So, we still work on all of the skills and components of ACT within the therapeutic relationship. But the relationship is seen as the context within which those ACT interventions occur.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

In order to conduct ACT competently, sensitively, the therapist really has to strive to create an environment in which the therapist and the client are seen as being equals, that you and your client are on the same level rather than having the therapist be in an expert or one-up position.

And ACT therapists are encouraged to always stay present with the awareness that they are themselves in the same boat as their clients. We’re all humans. We all experience problems related to avoidance, cognitive fusion, a lack of follow through with committed actions. That’s part of the human experience. We’re all on the same boat.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

But that doesn’t mean that all experiences or all types of suffering are equivalent.

And the therapist has to really be careful not to imply that he or she always understands what it’s like to be the survivor of torture or to be a war veteran if you’re not or to understand the experience of a parent who’s lost a child tragically if you haven’t. Because even if the therapist has been through some sort of similar circumstances in terms of form or topography, the individual experience is still different, right?

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

You can see several people present on ACT and everybody is going to have a different interpersonal style. But the prototypical relationship in ACT is characterized by openness, acceptance, respect, care, and warmth. Hopefully, those things you see in common across most or all ACT therapists.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

So, for example, when the therapist doesn’t react with alarm or judgment when the client brings up a socially unacceptable thought or responds in a totally irreverent way when the client describes some piece of difficult content, the therapist is actually modeling that what the client is experiencing is not the enemy. It’s the struggle against it that’s harmful. So really, it’s kind of a fascinating parallel process because you’re trying to teach the client to not respond with alarm to a socially unacceptable thought. And so one way that you do that as the ACT therapist is by modeling that same sort of response so that then they can internalize that over time.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

So, when the therapeutic relationship is coherent and consistent with the ACT principles, it just allows for another way to reinforce the messages of acceptance, letting go of judgment, and moving forward in the service of values that underline the whole ACT model.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

And by demonstrating transparency and honesty throughout treatment, the therapist can help the client to build trust in the relationship. So, really being open about what your own experience is, in ways that are appropriate, is part of building that therapeutic relationship.

And this is especially important when you’re working with individuals who’ve been harmed or invalidated by others. Being transparent about where you’re coming from can be very important. Because if you have a hidden agenda or are somehow holding something back, a lot of times people who have experienced interpersonal trauma, especially in childhood, will be able to pick up on that.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

So really, it’s vital to have a genuine sense of respect for the client’s experiences, their strengths, and their wholeness as a person. And the ACT therapist begins from the assumption that the client already has what he or she needs to move forward. And you have to really try not to rescue the client from the difficulty and challenge of growth. Instead, the ACT therapist stands with their clients as they face those challenges that are in front of them.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

The ACT therapist also demonstrates radical respect for the client’s values and we’re very upfront about that. Basically, we tell our clients like, unless it’s something about causing harm to yourself or someone else, you get to decide what’s important to you. And it’s not about what I think or what anybody else in society thinks. You decide what you want your life to be about.

And the therapist has to really accept that only his clients can choose how they want to live their lives.
And it’s only when this sort of overarching relationship has been established based on acceptance, openness, and respect that the ACT therapist can truly engage in the more nuanced and challenging aspects of the therapy.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

You can find that the ways that the ACT concepts are talked about or the metaphors are written, they can come across as sort of an intellectual or heady way of talking about things. But it’s really important that the ACT therapist really stay away from intellectualizing in the session and that you can even sort of point out when things are getting too intellectual or too abstract or esoteric in session and bring them back to the person’s direct experience.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

And finally, just thinking a little bit about self-care. Trauma work is frequently difficult for the therapist, not just for the client, and can be really emotionally intense. And so, first of all, it’s important to acknowledge that that’s part of the experience for the trauma therapist. It’s also important for the therapist to maintain awareness of boundaries and his or her own emotional functioning.

So, the therapist really needs to be monitoring how the experience of doing this trauma work, especially if you work with a large caseload of trauma survivors, how it affects you so that you can be practicing self-care and you can be practicing those same skills that you’re working with your clients on demonstrating.

References

Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. W. W. Norton & Company.

And really by practicing that self-care, you’re not only taking steps to prevent vicarious traumatization and burnout but also you can look at it as gaining experiential practice with the same types of skills that you’re likely teaching to your clients.

References

Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. W. W. Norton & Company.

And so some key points about the therapeutic relationship. The stance of the ACT therapist is open, accepting, and nonjudgmental, recognizing that the therapist is in the same boat as the client. We all struggle to practice acceptance at times and to live our lives in accordance with our values. An ACT therapist focusing on trauma treatment truly needs to ensure that they’re taking good care of themselves, not just to avoid burnout, but to make themselves more likely to be able to help their clients and to model healthy behavior.

More ACT for PTSD presentations