Part 1: How does ACT work?

Let’s start by looking at what generally happens when you go to see a counsellor.

Someone goes to see a counsellor when they have a problem that won’t go away, or a problem or an issue that is affecting the quality of their life.

During your fist visit with the counsellor, he or she will attempt to get some sort of history from you to better understand who you are and where this problem fits in, or even attempt to create an understanding of what created the problem.

For example, if you have depression, telling your history may help reveal that you had a very unhappy or even abusive childhood. Links can often be made with life events and family history with regard to the prevalence of depression.

Linking history to your problem often helps identify the origins of the problem. The next step with traditional counselling such as cognitive behavioural therapy, is to then look at how you are dealing with the problem.

If I keep on doing what I've always done, I'll keep on getting what I've always got.

The thing with behaviours such depression, anxiety, arguing a lot in relationships, always being angry, feeling guilty regularly, etc, is that they become familiar and so are more easily repeated rather than finding alternatives to these often dysfunctional behaviours.

In traditional counselling the counsellor or therapist will then look at alternatives to acting in the usual way. Counselling can also focus on trying to get you think differently to the way you usually do. For example the angry person may be encouraged to think of the glass half full rather than half empty, or that not everyone is out to get them.

With ACT the counselling process is very different. The one major difference is not focusing on the problem. Below is how I practise ACT.

When someone comes to me for counselling I often listen as they tell me their problem. The reason I do this is that people just naturally tend to do this when they first go to counselling. It could be something like the following conversation:

“I’m feeling so sad lately. The sadness just won’t go away. I find I’m not going out much anymore – I don’t even want to see my friends. I’ve stopped exercising and I just don’t enjoy work anymore …..”

As with traditional counselling getting this history is good in helping me as the counsellor identify with the client what they see their problem as.

But that’s about as close to following traditional counselling as I go.

The next step for me practising ACT is to then get the client to do a Suffering versus Vitality worksheet. With this, together we identify the thoughts and feelings that are associated with the problem for the client. This then introduces the concept of theobserver. This can initially be achieved by getting the client to engage in a mindfulnessexercise where our attention is brought back to the here and now.

This is achieved by focusing on our senses. Why? The reason is that we get all of our information about what is happening in our lives through our senses, particularly in the here and now. So that is what we see, hear, feel, smell, sense through touch and taste. In the exercise I do, we focus firstly on breathing and what is happening during that verybasic process of breathing. Then we concentrate on what we can see, hear and feel. This process takes about 5 minutes and many clients report on how much more relaxed they feel after doing that exercise, though the aim is not to get them relaxed but rather to slow the clatter on noisy thinking in their heads.

With my hands over my face I can't see the world but then I can't participate either.

Then we look at the thoughts and feelings that happen when the problem is around. We explore them fully. What do those feelings look like? What shape do they have? Where do you feel them? What colour are they? Are they solid or fluid? Does it spread? We thoroughly explore the feelings and thoughts.

Often people will avoid the full extent of their feelings and this then can perpetuate the problem. For instance the sad person doesn’t go out to see friends because their negative feelings associated with seeing friends can be increased when you are sad, so by avoiding seeing friends you perpetuate the sadness. The logic here is that the person has said when they are sad they stop seeing friends, but the very act of not seeing friends perpetuates the sadness, the very thing they are trying to avoid. Remember this is when sadness has become a problem that is adversely affecting a persons life.

So, next I’ll explain a bit more about the Suffering versus Vitality exercise.