.comment-link {margin-left:.6em;}

Monday, February 20, 2006

 

Acceptance and commitment therapy

I think I have a name now for what I do...

The goal of ACT is to help clients consistently choose to act effectively (concrete behaviors in alignment with their values) in the presence of difficult or interfering private events.

I confess I was not aware of the raging debate within cognitive therapy between ACT therapists (acceptance and commitment therapy) and cognitive therapists until I read a recent Time magazine article about Steven Hayes. The few things I had seen about Dr. Hayes sounded like solution-focused therapy to me. When people ask me what I do I usually say cognitive-behavioral therapy with a nod to solution focused techniques. But in looking at the www.contextualpsychology.org website, I think I may have been doing ACT for quite awhile and not knowing it.

On the SSA front, I only worked on change for a very brief period first starting out. Instead, I have been about pursuing the goal of ACT with my clients who want to be post-gay. That is, I provide a context for clients to choose to act consistent with their values in the presence of SSA. In the process, some of those people experience a significant change in their experience of attraction. Many do not; however, a focus on changing those feelings is considered counterproductive. Rather, the emphasis is on expanding the awareness of agency in achieving an alignment of behavior and values.

Comments:
Act therapy seems to be an application of the sanctification theology of Christianity. Simply stated, it is the goal of every believer to bring their behavior in alignment with their religious beliefs regardless of their feelings.

I realize this may be way too simplistic.

I also worry that this form of therapy seems wedded to early Greek and Christian thought of a triune view of man (body, mind and spirit). The pressure to have the mind rule the body has been effective for some. For others, it has led to endless promises to control impulses with numerous lapses in self-control.

Psychoanalytic psychotherapy has sought to address this by asserting that troubling feelings (like SSA) are due to developmental errors which can be corrected. The promised outcome is a decrease in feelings that put the mind and the body at war with one another.

Gay Affirmative therapy seeks to quell the battle between the mind and the body by having the body inform the mind. My attractions are part of my essential nature, my mind poorly informs me to be disgusted by my attractions. I must retrain my mind to accept and love who I am.

Nuerobiologists are currently exploring the notion of the unitary mind: it is the notion that there is no tripartate human, unless they are poorly integrated. Rather the mind and the body are one and the more we study human behavior and anatomy, the more we find that this is true.
For those struggling with SSA I think this model is very useful to add to Act or Psychodynamic psychotherapy.

I would worry that Act therapy would work best with the most integrated of clients and most poorly with the least integrated clients. For this latter population it would encourage repression and splitting defenses which would lead to lots of unrealistic expectations and unstable progress in treatment.

These are my initial impressions as a psychodynamically trained psychologist.

I would welcome other responses.

David Blakeslee
 
ACT does not have any ideological ties but rather focuses on the values of the client.

I think the difference here is that the therapist does not say will power is the key. It is not mind versus body but rather mind versus mind. Our brains do play tricks on us and we are quite biased in our judgments. My brain really wants me to quit working right now and go have some fun. If I followed the thoughts and associated feelings my quite convincing brain is creating (in reaction to an afternoon of office hours, grading and test making), I would be leaving this office soon.

Feelings are not just colors experienced without commentary. Thoughts are quite influenced by feelings and vice versa. What ACT does is work toward a more solid observing and choosing ego. I would think a psychoanalytically oriented therapist might cheer at that prospect :)
 
Our brains do play tricks on us and we are quite biased in our judgments. My brain really wants me to quit working right now and go have some fun ... (in reaction to an afternoon of office hours, grading and test making), I would be leaving this office soon.

Actually, as someone who watches performance levels, your brain may not be playing tricks with you :)

Task fatigue will typically make for worse performance than the intrusion of a brief thought or two. At the same time, task commitment (and therefore performance) suffers if they crowd out your ability to wade through those individual papers in that ugly stack on your left...

Balance guided by judgement. Yeah, yeah, yeah -- I know these papers all need to be marked. But perhaps stopping and going to have a good laugh and a romp with the kids will put you in the best frame of mind. There's always the quiet of the evening for those papers...

(and perhaps the real dialog in your mind has nothing to do with those papers... maybe your ideological viewpoints cause you to resist the instrusion of "pleasure". We know how the devil uses those moments to lead people astray, right? Oh, now there's an old Greek argument for you -- dear ol' Epicurus!)

And PS: I don't have any problem with people trying to live within their value framework (obvious examples excepted). I do have a problem with being demanding, intrusive and cruel to other people who don't live within that framework :)
 
I am a therapist, trainer, and researher of ACT. I've been surprised by how many people are willing to jump to conclusions based on an article written by a writer for Salon or TIME where there have been recent articles on Steve Hayes and Acceptance and Commitment Therapy (ACT). Unfortunately, the comments above betray a simple lack of knowledge of the therapy. This is a complex therapy/theory based on a huge body or research that has emerged over the decades in psychology, starting with early experiments in behaviorism back in the early 20th century by Wople and Skinner and most recently with the scores of studies on the theory most directly underlying ACT called Relational Frame Theory. In order to not turn it into a strawman, one needs to read about it to at least begin to get a sense of its scope and precision. If you are interested, I'd encourage you begin with "Get Out of Your Mind" to begin to get a sense for what this is all about. This is the nontechnical, non-professional book, while other technical books are available.

While many religious people may find this theory and therapy compatible to their beliefs, some may not, as it is not explicitly religious. Anyways, ACT has little to do with Christianity, little to do with any religion directly, even buddhism, with which it may share the most similarities at first glance. It also has little to do with psychoanalysis.

I've never heard of anything about a "triune view of man", and this division doesn't sound anything like I've heard in behavior analysis or ACT (a version of clinical behavior analysis).

In terms of the issue of working worst with "less integrated clients," I'm not sure what that means, but there have been two randomized clinical trials published on ACT used with psychotic persons (with two separate research teams) both with darn good promising, prelminary outcomes. So preliminary data seem promising. Is that what you mean by poorly integrated? Its also been tested with people with math anxiety (is that what you mean by more integrated?). Not sure. Anyways, hope that's helpful.

Jason Luoma (www.drluoma.com)
 
I am a therapist, trainer, and researher of ACT. I've been surprised by how many people are willing to jump to conclusions based on an article written by a writer for Salon or TIME where there have been recent articles on Steve Hayes and Acceptance and Commitment Therapy (ACT). Unfortunately, the comments above betray a simple lack of knowledge of the therapy. This is a complex therapy/theory based on a huge body or research that has emerged over the decades in psychology, starting with early experiments in behaviorism back in the early 20th century by Wople and Skinner and most recently with the scores of studies on the theory most directly underlying ACT called Relational Frame Theory. In order to not turn it into a strawman, one needs to read about it to at least begin to get a sense of its scope and precision. If you are interested, I'd encourage you begin with "Get Out of Your Mind" to begin to get a sense for what this is all about. This is the nontechnical, non-professional book, while other technical books are available.

While many religious people may find this theory and therapy compatible to their beliefs, some may not, as it is not explicitly religious. Anyways, ACT has little to do with Christianity, little to do with any religion directly, even buddhism, with which it may share the most similarities at first glance. It also has little to do with psychoanalysis.

I've never heard of anything about a "triune view of man", and this division doesn't sound anything like I've heard in behavior analysis or ACT (a version of clinical behavior analysis).

In terms of the issue of working worst with "less integrated clients," I'm not sure what that means, but there have been two randomized clinical trials published on ACT used with psychotic persons (with two separate research teams) both with darn good promising, prelminary outcomes. So preliminary data seem promising. Is that what you mean by poorly integrated? Its also been tested with people with math anxiety (is that what you mean by more integrated?). Not sure. Anyways, hope that's helpful.

Jason Luoma (www.drluoma.com)
 
Post a Comment

Links to this post:

Create a Link



<< Home

This page is powered by Blogger. Isn't yours?