The challenge of implementing ACT as a brief therapy: Navigating complexity when time is limited.

Finding an approach to therapy that suits both therapists and clients can be a daunting task. When using acceptance and commitment therapy (ACT) this can present its own set of challenges as the intricate concepts and relatively unstructured nature means applying ACT principles in real-time situations can prove to be demanding.

This blog post explores the difficulties faced by therapists today, where time is limited and clients’ engagement is crucial plus looks at how focused ACT (or FACT) could address some of these challenges.

The issue

The importance of effective application strategies

ACT requires more than just a theoretical understanding; it demands practical application. However, without effective strategies for its implementation, therapists may find themselves struggling to use ACT in the moment. This challenge becomes even more pronounced when time constraints are a constant pressure.

Assessment and the issue of premature termination

To ensure the successful application of ACT, some practitioners devote multiple sessions solely to assessment. By thoroughly understanding clients’ unique circumstances, therapists can tailor interventions to their specific needs individually. However, while this approach aims to enhance the effectiveness of therapy, it comes with its own limitations and a significant hurdle remains: many individuals do not stay engaged in therapy for an extended period. Factors such as personal circumstances, lack of motivation, or other barriers often lead clients to discontinue therapy after the initial visit. Even for those who continue, a significant portion terminates therapy by the fifth session, sometimes without even consulting the therapist.

The value of the first appointment

While it may seem disheartening that many clients do not complete a full course of therapy, there is evidence to suggest that some individuals still benefit from the act of booking the initial appointment. Hoyt, Rosenbaum and Talmon conducted their first pilot study in single session therapy (1992), 58% of the patients considered a single session to be enough to feel better. Simply taking that step towards seeking help can create a sense of hope and initiate positive change. However, the question remains: is it enough?

From a functional perspective, the true measure of therapy’s success lies in equipping clients with the necessary tools to navigate life’s challenges more effectively. If clients leave therapy without acquiring these adaptive skills, they are no better off than when they first sought help. It highlights the importance of finding ways to integrate ACT’s principles and techniques in a time-limited therapy setting, ensuring that clients receive tangible and practical support during their brief engagement. Ultimately, our goal is to empower individuals to lead more fulfilling lives, armed with the skills to navigate life’s challenges with resilience and acceptance.

Can less be more?

Paradoxically, limited time can be an unexpected advantage. When we have less time, we are compelled to be more intentional and strategic in our therapeutic interventions. It forces us to distil the essential elements of therapy and discard unnecessary distractions. By embracing the boundaries of time, we can create a sense of urgency and purpose that drives meaningful progress for clients. It’s not about cramming more into a smaller time window or hastily rushing towards any intervention. Instead, it’s about ensuring that every element we bring to the table is purposeful and targeted. By doing so, we can avoid wasting precious time and instead invest it in our clients’ success.

It’s not about rushing through sessions or providing superficial care. Instead, it’s about recognising the value of each moment and making deliberate choices. By focusing on the most relevant and impactful strategies, we can make a significant difference in a shorter span.

The opportunity in limited time

Brief interventions in therapy simply require a shift in mindset. Rather than viewing limited time as a hindrance, therapists can leverage it as an opportunity for focused and effective interventions. By embracing the constraints, we can create a sense of urgency and momentum. This encourages clients to engage actively in the therapeutic process and make the most of the time they have available. The key lies in making deliberate choices, using evidence-based techniques, and maintaining a clear focus on the client’s success.

FACT as a solution?

Focused acceptance and commitment therapy (FACT) presents a brief intervention approach that prioritises individuals’ functional abilities. With a focus on value-based behavioural changes, it optimises each session’s impact and promotes long-term well-being.

Context is key

FACT clinicians conduct contextual interviews to gain insight into the individual’s life context. By understanding the broader picture, they can develop a comprehensive understanding of the challenges faced by the client. Rather than fixating on symptoms, the therapy seeks to facilitate productive behavioural changes that align with the individual’s values. By helping individuals develop functional skills, therapists empower them to make meaningful progress in their lives. This holistic approach allows for tailored interventions that address the person’s unique circumstances and needs.

Psychological flexibility is a central construct in FACT. Therapists focus on teaching individuals the skills they need right now to adapt to challenging circumstances, manage difficult emotions, and make value-based choices. Through nurturing this flexibility, therapy becomes a catalyst for personal growth and resilience.

Reframing therapy for quicker transformations

In therapy, embracing the possibility of rapid change can be a transformative perspective. By reframing clients’ understanding of their situation and offering a limited scope of therapy, we can introduce the concept of swift improvement, even within just a session or two. This is often in contrast with daunting introductions like ‘rehabilitation won’t be overnight” and “this might take years’ etc. Letting them know we can help, and doing it fairly quickly, is important to getting clients to open up.

An emphasis on accessibility and lifelong support

Focused ACT places importance on accessibility and long-term support. Clinicians strive to be available when individuals seek help, recognising the significance of timely intervention. Moreover, the therapy aims to remain accessible to individuals and their families throughout their lifetime, providing ongoing support and guidance as needed.

A value-based and functionally oriented approach

The goal of focused ACT is to help individuals lead fulfilled lives. Rather than solely targeting symptoms, the therapy concentrates on facilitating functional improvements aligned with personal values. By concentrating on value-based behavioural changes, the therapy promotes meaningful and sustainable progress.

Navigating complexity when time is limited of course can be tricky but using the principles of FACT In our interventions, we can strive to optimise each session’s impact and promote lasting fulfilment in individuals’ lives.

To learn more about this topic we are pleased to be hosting Dr Kirk Strosahl and Dr Patricia Robinson, the founders of FACT, for a workshop – Focused ACT for brief interventions. Gain valuable expertise in the clinical techniques that make FACT efficient and effective. Through practical demonstrations and hands-on exercises, you’ll learn to help clients be open to their distressing thoughts and feelings, live in the present moment and recognise the mind’s tendencies. These sessions will enhance your therapeutic skills and help you become a more effective therapist by preparing clients for change in a much quicker and targeted way.

Reference

Hoyt, M. F., Rosenbaum, R. L. & Talmon, M. (1992). Planned single-session psychotherapy. In S.H. Budman, M.F. Hoyt & S. Friedman (eds.), The First Session in Brief Therapy (pp. 59-86). New York: Guilford Press.

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