During my practicum and Internship in Graduate School, I learned to use CBT in sessions with clients. I understood and saw the value in the approach, but if I’m being honest, I never “vibed” with it or felt it was for me as a therapist. I want to say, I think CBT is great, and for the right therapist, I’m sure it works amazingly, but it didn’t feel that way for me.
The biggest struggle for me with CBT was that while I understood it academically, it did not feel like a genuine approach to use with clients. I was worried that trying to reframe some of these thoughts would feel invalidating to the client. In school, they were teaching us to sit with the client in what they were experiencing, but this modality was telling me to reframe it. It just did not match for me.
When thinking about my future as a counselor, I knew I wanted an approach that felt validating to the client. One that would meet them where they were without making them feel like their immediate experience needed to be changed
I primarily worked with grief during my internship, and it felt WEIRD for me to sit with individuals experiencing blame, guilt, and so much more and think that my role in that moment was to change an “unhelpful thought.” I kept wondering: “What if this thought is serving some purpose right now?” “What if this person needs space to experience what is coming up before we try to do anything with it?”
When I interviewed at the practice I’m at now, one of the other employees expressed her dislike for CBT, and I immediately thought, “I’m not alone in this line of thinking???” We continued to talk about the humanistic approaches they use in the practice and what that looked like. When my now supervisor introduced me to ACT, something clicked for me. You mean I can work with clients on accepting their thoughts instead of changing them?! This was what really drew me towards ACT. Think about how many thoughts run through your head each day that could be labeled as good/bad, true/false, positive/negative.
“I’m not good enough.”
“What is wrong with me?”
“I’ll mess this up; I always do.”
“I should be in a better place than I am now”
As therapists, we aren’t immune to these thoughts either. While I was learning ACT, I started practicing some of these tools myself and realized how different it felt to work on being okay with a thought being there instead of immediately trying to make it go away. I feel like we often label anxiety as “bad” or something we shouldn’t experience, when anxiety itself is a normal emotion that can serve a purpose. Of course, anxiety can also become significant enough that it interferes with our ability to live our lives, which is a different story.
A common immediate response to these thoughts is to push them away or distract ourselves, but ACT offers a different approach. Instead of trying to change this thought, we can notice simply what that thought is: a thought. It is not saying we have to act like thinking, “what is wrong with me?” doesn’t bring up emotions. We can learn that having this thought doesn’t mean it determines what we do next.
Cognitive defusion can be helpful in these moments. Rather than getting completely caught up in what our mind is telling us, we practice noticing the thought as something our mind is doing. For example, when we think “I should be in a better place than I am now”, we can instead say “I’m noticing that I’m having the thought that…”
The thought might still be there. The feeling might still be there. We aren’t trying to prove the thought right or wrong. Instead, we’re working to take a step back from it, notice what is happening, and continue engaging with the present moment around us.
With ACT, acceptance doesn’t mean that we are asking clients to accept that whatever happened to them was okay. Instead, we work on making room for the thoughts and feelings that are coming up, rather than trying to change or avoid them.
One of the main goals is to be psychologically flexible and to live in ways that move towards our values. If connection is something we value, but anxious thoughts lead us to cancel plans every time we’re invited somewhere, avoiding those plans might make us feel better in the moment. But over time, we may actually be moving further away from something that matters to us.
For myself, I have anxiety about driving to places I have never been before. With ACT, I help myself recognize these thoughts as they come up: “What if there is no parking?” “What if I accidentally go to the wrong place?” “What happens if there is too much traffic and I’m late?” These thoughts help me realize that I want to be safe when I arrive, be timely, and make sure I find my location safely. The difference for me now is that I don’t have to wait for those thoughts to go away before I leave. I can notice that my mind is trying to prepare me for everything that could go wrong, let those thoughts be there, and still get in the car and go.
This approach sits right with me because I am also integrating it into my own life and seeing its benefits. We all have anxious thoughts, and sometimes we let them define us, but ACT gives us another option. The option to realize that we can have these thoughts, acknowledge them and the feeling they are creating, and then work to continue living mindfully towards our values.
References:
Association for Contextual Behavioral Science. (n.d.). Acceptance & commitment therapy (ACT).https://contextualscience.org/act
Assaz, D. A., Tyndall, I., Oshiro, C. K. & Roche, B. (2023). A Process-Based Analysis of Cognitive Defusion in Acceptance and Commitment Therapy. Behavior Therapy 54(6), pp. 1020-1035. https://doi.org/10.1016/j.beth.2022.06.003