Acceptance and commitment therapy (ACT) is a form of counselling and a branch of clinical behaviour analysis exploring how behaviour, learning and language relates to patients’ experiences. It focusses on language as the root of suffering. ACT is based on modern behavioural psychology and relational frame theory (RFT) of language and cognition. It is a psychological intervention based on observation and experiences that uses acceptance and mindfulness together with commitment and behaviour-change strategies.
ACT is not about teaching people to remove or control difficult emotions, thoughts, sensation, or feelings. The core message within ACT is to observe, notice, accept and adapt to difficult thoughts, making room for feelings. ACT sees painful experiences as a part of life and learning and explores values and beliefs, committing to being fully present in the moment. It values working with struggle, fused thoughts and discomfort rather than avoiding, developing awareness in the present moment, accepting, and taking action to move towards valued direction. It embraces a willingness to fully experience to find inner peace and reconstruct new meaning, creating a meaningful life. ACT focusses on being open, present, and doing what matters to enhancing the quality-of-life experiences and increasing psychological flexibility from a place of inflexibility.
It uses mindfulness for emotion regulation as an awareness process, as a way of observing experiences, without judgement and paying attention to the present moment to diffuse from difficult thoughts. Mindfulness allows patients to choose how they want to respond to their emotions, thoughts, and feelings. It uses metaphors and language to see an alternative way of looking at something to support therapeutic change and explores a commitment to values-based living, using sound, repeating, speed, images, colour, shape, values, goals, meditation, body scans and noticing.
ACT patients work with 6 core principles:
- present moment
- committed action
- self as context
- cognitive defusion
Within Doncaster IAPT long term conditions (LTC), person centred counselling is interweaved with ACT to create an unconditional supportive relationship where patients connect to deep heartfelt emotions, openly exploring their loss of health, expectations, and life limitations where health has no cure and a feeling of existing in discomfort. Therapy aids self-awareness of what truly matters and choice for change to create new meaning. Therapy helps to separate story from experience, removing labels of good and bad and explores upset, illness and loss as a part of life. Common themes are loss of quality of life with an inability to let go or accept and in anxious anticipation for facing the future and mortality.
Patients express loss of identify, avoiding ill health. Patients lose contact with the present moment trying to retain their identity in roles and relationships. Therapy explores struggle with validation of ill health. Validation and self-awareness are key in any change process. Mindfulness explores self-compassion and the ability to pace within health limitations. ACT supports patients to find healthy ways to be with their LTC, pre planning how they function day to day within their health limitations to ensure they can live a full and meaningful life in the present moment.
Person centred counselling
Person centred counselling is a talking therapy and a helping relationship that enables patients to explore emotions, thoughts, and feelings at a deeper level, gaining self-awareness in the ‘here and now’. Therapy enables patients to explore the impacts of their values, beliefs, and conditions of worth that significant people instil in their lives. The Counsellor role is to accept, support and empower the patient, helping them to come to terms with and accept their own negative feelings to make their own choices for change.
Counsellors use core conditions of empathy, genuineness and unconditional positive regard which focusses on being non-judgemental, showing warmth, active listening, and acceptance to understand the patients from their own perspective. Counsellors also use skills such as reflection – on thought and feeling – mirroring emotional communication, paraphrasing – rewording feelings and contact, clarifying, summarising on content and themes, focusing to make content clear and challenging on immediacy, self-disclosure, themes, and patterns of the work. This enables patients to understand their own version of reality, choosing their responses.
Person centred counselling supports making the necessary changes to dissolve conditions of worth, values and beliefs, that may no longer be helpful, unlearning what they have been conditioned to believe in for their real self to emerge. Change occurs from the patients gaining a deeper personal awareness of how they view themselves, their identity as well as understanding their own behaviour, thoughts and feelings linked to emotional and psychological distress. From this they can chose to let go of outdated values and beliefs, creating new ones in their capacity to grow and develop, making necessary changes to move towards their full potential without denying or distorting experiences.
Focus is on support, recovery, problem solving, gaining insight, and feeling heard. Counselling is not about giving advice but more to understand the patient’s experiences, seeing them as the expert in their world, leading their own process. The therapist role is focussed on being in a helping and non-judgemental relationship, providing a safe environment for patients to explore their distress, enabling patients to take personal responsibility and empower themselves to achieve emotional independence.