Introduction
Transitioning is a deeply personal and individualized decision. It is not the therapist’s role to dictate how, when, or where someone should transition. Instead, the goal is to guide the client in making those decisions for themselves. In the initial stages of therapy, the therapist focuses on understanding the client’s perception of their gender identity, what is important to them about transitioning, and what that process looks like for them moving forward. Clients often struggle with stigma, shame, and fear of rejection related to their transgender identity. The aim is to create a safe and supportive environment where they can explore and accept their identity while reducing self-criticism and societal pressures.
The ACT Choice Point
One effective tool the therapist uses to set the stage for therapy is the ACT Choice Point, which provides a roadmap for clients to navigate their therapy journey. It helps ensure that therapy doesn’t get sidetracked by short-term discussions—like casual check-ins—but instead remains focused on long-term goals. This visual tool serves to clarify what we are trying to achieve in therapy using the Acceptance and Commitment Therapy (ACT) model.
Defining Behavior and Values
The therapist explains to clients that everything we do, external actions or internal processes like thinking and worrying, is a behavior. Some behaviors bring us closer to the person we want to be and the values we care about; the therapist refers to these as towards moves. These actions and choices align with our values and help us live authentically.
On the other hand, some behaviors bring us further away from the person we want to be; these are away moves. For example, drinking wine with friends might be a towards move that promotes connection, while drinking a bottle of wine alone in the dark may be an away move, inconsistent with one’s health values. Context matters greatly, as the same action can have different impacts depending on the situation.
The Impact of Difficulties on Choices
Life’s challenges—such as financial stress, health issues, relationship problems, or lack of sleep—make it more difficult for us to choose toward moves. When life is hard, it becomes easier to fall into away moves like ruminating, isolating, or not being our best selves. These difficulties are part of life, but recognizing when we are pulled toward away moves can help us course-correct.
Applying the Choice Point
In therapy, the therapist encourages clients to identify influential people in their lives and consider what behaviors would reflect that importance if their lives were a silent film. For Ava, she identified Dan, Micah, and Grayson as essential people. The therapist then asked her to imagine what behaviors would show others that these relationships matter to her. Ava’s responses included spending time with these individuals and sharing meaningful aspects of her life.
Next, we explored her broader values—the things she wants to pursue in life. Ava identified values like kindness, understanding, curiosity, openness, and authenticity. These values form the foundation of her towards moves. On the other side of the map, the therapist asked her to reflect on what she does when complex thoughts and feelings arise. She mentioned that she tends to ruminate, isolate, or become terse and irritable.
Understanding the Payoff
The therapist and Ava then discussed the payoff of these away moves. People often engage in behaviors, even harmful ones, because they offer something in return—whether it’s temporary relief or avoidance of difficult emotions. Ava noted that her away moves, like isolating and being terse, took less energy and allowed her to avoid the emotional effort of regulating her feelings. However, the cost of these behaviors includes pushing people away and acting in ways that are incongruent with her values.
Conclusion
The ACT Choice Point helps clients like Ava identify behaviors that either move them towards or away from their values. Therapy can remain focused on long-term goals by raising awareness of these patterns and providing a visual roadmap. This tool enables clients to reflect on their actions and make choices aligned with their authentic selves, even in difficult emotions.