Acceptance and Commitment Therapy (ACT): What It Looks Like in Counselling

If I tell you that I use Acceptance and Commitment Therapy, that probably doesn’t tell you very much about what we would actually do in a counselling session.

ACT is one of the main approaches I use in my work. In grad school, I learned that the formal definition is that it's an evidence-based behavioural therapy concerned with psychological flexibility: being able to respond more flexibly to thoughts, feelings, circumstances, and what matters to us, rather than getting pulled around by them automatically. That definition is accurate. It’s also not usually how I explain ACT to someone sitting across from me.

In counselling, ACT might look like noticing that anxiety keeps pulling you away from something important. It might mean figuring out what keeps happening when you get stuck in the same argument with someone. We might look at a decision you’ve been going back and forth on, or at what happens when your mind gives you a very convincing list of reasons not to do something you care about. Sometimes we might make a mind map or write something down. Sometimes I might draw a Choice Point. Sometimes we just sit together and talk.

The ACT part is less about using a particular exercise and more about the questions underneath what we’re doing.

What is pulling you around?

One of the things I pay attention to is what I sometimes call getting hooked. A thought, feeling, memory, rule, worry, or expectation shows up, and suddenly it has a lot of influence over what happens next. Anxiety can be especially sneaky this way. It can pull attention into what might happen in the future, back toward something that already happened, or away from something that matters because avoiding it offers some relief right now.

That doesn’t mean the anxiety is bad or that we need to make it disappear. We might instead get curious about what happens when it shows up. What does it tend to pull you toward? What does it pull you away from? What helps you notice that happening before you’re several steps down the road?

ACT calls some of this work defusion: learning to have a little more room around thoughts rather than automatically treating everything the mind says as an instruction or a fact. In a session, I’m much more likely to say, “Your mind is giving you a pretty convincing story here,” than to announce that we’re now doing cognitive defusion.

What matters here?

ACT also pays a lot of attention to values. That can sound bigger and more philosophical than it needs to. Sometimes I might ask what kind of parent, partner, friend, worker, or person you want to be in a particular situation. Sometimes the question is simply, What matters to you here?

The answer doesn’t automatically tell us what to do. Two things can matter at the same time. You might care deeply about someone and also need to say no to them. Work may matter to you and so may having enough capacity left for the rest of your life. Staying connected to family may matter, while so does protecting yourself from the way someone treats you. That’s often where the useful work begins. ACT doesn’t assume that values make difficult decisions easy. Values give us a direction to work with when there may not be a perfect answer.

Then we look at what you can actually do

This is an important part of ACT for me because I don’t want values work to become another way to tell someone what they should be doing.

Once we have some idea of what matters, we can look at what’s actually possible in the circumstances you’re in. Sometimes that means a fairly small next step. Sometimes it means experimenting with doing something differently and seeing what happens. Sometimes we discover that the barrier isn’t motivation at all. There may be pain, fatigue, disability, money, caregiving, an inaccessible environment, another person’s behaviour, or simply too many demands competing for the same capacity.

ACT includes committed action: taking steps in directions that matter. But that doesn’t require pretending context is irrelevant. So if you tell me, “I know what I’m supposed to do. I just can’t seem to make myself do it,” I’m not particularly interested in assuming you need more discipline.

I want us to figure out what is happening.

ACT can also mean making room for what cannot be fixed

There are times when the problem in front of us can be changed, and there are times when it can’t. If the mountain can’t be moved, we may need to stop using all our energy trying to move the mountain.

That doesn’t mean liking it, approving of it, or pretending it doesn’t hurt. It means looking at the reality that’s here and asking what choices are still available. Can we go around the mountain? Change the route? Move to a different position? See it differently from where we’re standing?

This is one place where the word acceptance in Acceptance and Commitment Therapy can be misleading. Acceptance isn’t resignation. In ACT, it’s about making room for experiences that are already here when fighting with them isn’t helping, while still being able to act in ways that matter. Sometimes that creates room for change. Sometimes it helps someone carry something that can’t simply be made to go away.

We don’t have to call everything ACT

I use ACT quite explicitly with some clients. We might talk about hooks, toward and away moves, values, acceptance, or Choice Point work. With someone else, very little ACT terminology may show up at all. The approach isn’t supposed to be a fixed set of techniques applied in the same order to everyone. That fits well with how I work.

If a mind map is useful, then we can use one. If you absolutely hate mind maps, that’s also useful information and we can do something else. The same is true of metaphors, worksheets, writing things down, exercises, or simply talking something through. I’m interested in whether what we’re doing helps us understand what is happening and gives you more room to respond in a way that works for you.

So what does ACT look like in counselling?

Usually, it looks much less like learning a therapy model and much more like working with whatever brought you into the room. We may notice that your mind has hooked you into a very convincing story. We may ask what matters here, what the situation is actually asking of you, and what choices are available within the circumstances you’re in.

Sometimes that means doing something differently. Sometimes it means making room for something you can’t change.

Most of the time, you don’t need to know which ACT process we’re using. You need counselling that helps you understand what is happening and gives you a little more room to choose what you do next.