It is key when learning and later applying ACT to ensure that there is good fidelity to the model. For those newer to ACT, by fidelity we mean the degree to which the intervention is ACT consistent. This can encompass both the techniques, as well as any underlying philosophy of science. The ability to deliver effective, high-fidelity therapy is crucial for client success. The ACT-FM is a measure of therapist fidelity which is a handy assessment tool to this purpose. The ACT-FM is available in the resource hub. This blog will explore how implementing this measure can enhance your practice and improve client outcomes.
The ACT fidelity measure is a systematic tool designed to evaluate how well therapists implement ACT principles and practices in their sessions. It assesses various components, including:
- Therapeutic relationship: the quality of the therapist-client relationship and the establishment of trust.
- Use of ACT processes: how well the therapist incorporates ACT processes such as cognitive defusion, acceptance, mindfulness, and values clarification.
- Flexibility in approach: the ability to tailor interventions to meet the unique needs of each client.
- Client engagement: the level of client participation in therapy and their commitment to the therapeutic process.
It is important to note that this is grounded within the philosophy of science for ACT. By this we mean considering the functional contextualist nature of the work, and therefore retaining fidelity to the model is more than merely collecting and delivering techniques. This is what separates this from a more positivist approach to assessing ACT coherence, and ensures that this is in keeping with the underlying principles and mechanisms of change. To explain further, we must balance integrity / fidelity to the model, alongside ensuring psychological flexibility and individualising of the intervention to the specific client. Therefore, the fidelity measure should be used as one way to evaluate and explore your practice.
Benefits of using the ACT fidelity measure
Enhancing therapeutic skills: by evaluating adherence to ACT principles, you can identify specific areas for skill enhancement. This self-awareness facilitates targeted training and professional development, leading to improved therapeutic techniques.
- Improving client engagement: understanding how well you engage clients in the therapeutic process is critical. The fidelity measure can help identify strategies to enhance client involvement, making therapy more effective and meaningful for them.
- Fostering accountability: regular fidelity assessments promote accountability among therapists. Knowing that your practice will be evaluated encourages therapists to maintain high standards and continuously seek improvement.
- Strengthening the therapeutic alliance: by focusing on the therapeutic relationship, the fidelity measure can help you as therapists to assess and strengthen your connection with your clients. A strong alliance is fundamental to successful therapy and can lead to better outcomes; linked to client engagement as above.
- Guiding treatment planning: the fidelity measure can inform treatment planning by highlighting areas that need more focus or adjustment; this is especially helpful if you record and review sections of interventions as it can help to bring awareness outside of the therapy room. This can lead to more personalised and effective interventions for clients.
How to implement the ACT-FM in your practice
Step 1: Conduct a baseline assessment
Start by conducting an initial assessment using the ACT-FM to evaluate your current implementation of ACT. Use observation (if possible), self-reflection (using the ACT-FM), and recordings for a more objective assessment to gather comprehensive data.
Step 2: Analyse the findings
Review the assessment results to identify strengths and areas for improvement. Look for patterns or trends that can inform your understanding of your practice. These can be done independently, but we recommend seeking supervision to explore the findings / get a second rater.
Step 3: Develop an action plan
Create an action plan based on your findings. This should include specific goals for improvement, strategies to address identified gaps, and timelines for implementation. Again, we recommend seeking ACT specific supervision in order to manage this most effectively.
Step 4: Implement changes
Put your action plan into action. Ensure you use supervision effectively to enhance your practice further. Regularly check in on your progress and make adjustments as needed.
Step 5: Conduct regular follow-up assessments
Schedule regular follow-up assessments to monitor your progress over time. This ongoing evaluation will help ensure that you stay aligned with ACT principles and continue to improve your practice.
Expert tips:
- Consider recording sessions every so often (with consent!) and bring snippets of these to supervision for particularly tricky interactions, or areas where you are not sure you responded in an ACT-consistent manner.
- When completing the more formal fidelity assessment consider ahead of time how to pick the sessions / snippets to be assessed so you are not cherry picking. This could be a percentage of a session or picking a specific timed part of a number of sessions which are randomly allocated. Time permitting, assessing entire sessions can be helpful but this requires a significant time investment.
- Ask a colleague to do a swap – each record sessions and assess each other
- Note: here, it is important to set this up in line with confidentiality and consent. Setting up a formal peer supervision arrangement is helpful when gaining informed consent from clients
- Recording sessions can feel exposing. It is important to consider that nurturing the ACT approach in us can help to explore these feelings and prevent avoidance. Explore this with your supervisor!
Summary
Using the ACT-FM is a powerful way to enhance your therapeutic practice. By systematically assessing and improving your adherence to ACT principles, you can foster greater client engagement, strengthen therapeutic relationships, and ultimately improve client outcomes. Embrace this tool as a means of professional growth and a commitment to providing the highest quality of care, alongside other useful developmental tools such as supervision. In doing so, you will not only enhance your practice but also make a meaningful impact on the lives of those you serve as you become a more efficient practitioner.
Th ACT-FM is just one of many resources available for you to download from our resource hub. Packed with free measures, book chapters, videos and more to support you as you implement acceptance and commitment therapy into your practice.