Clinical essay 4 of 13

The Observer and the Witness

Acceptance and commitment therapy, and two ways of standing back

A client says, with some pride, that she is having the thought that she is a fraud. She has learned the sentence, and it does what the training says it does: the thought is now an object on the table between you instead of a verdict on the table she is sitting at. Steven Hayes's cognitive defusion is a small grammatical move with a large effect, and she has been practicing it on the drive to work.

Two of the six processes in acceptance and commitment therapy share ground with the path. Self as context is the position from which experience is noticed, a perspective that does not change as the content does. The path's witness is the plain statement, made alone, of what is true about oneself, without an attempt to fix it. One is a stance and the other is a sentence, and a client often finds that the sentence makes the stance easier to take. She writes that she was told early that being useful was the price of being kept, and then she notices that she is the one who wrote it down.

Values are where the frameworks part, and the difference deserves to be said out loud to a client who will meet both. In ACT values are freely chosen qualities of ongoing action, and the work is to clarify them and move toward them. In the path a value is excavated rather than selected. It arrives as one word, late, and is recognized and not decided, and it is never offered from a list or named before the stage called Alignment. The axis is assumed versus discovered. Both frameworks can be honest about the gap. A therapist who asks for values in the second session should not be contradicted by anything her client has read, and the client can hold both accounts of where a value comes from until one of them earns her trust.

Committed action turns a value into behavior under discomfort. The path has a smaller cousin in the later stages, the smallest action that can be taken from what was found and not from the old rule, placed on a calendar so that it stops being an intention. It is small on purpose, because direction compounds and magnitude does not. A client who has drafted a value in your office can test it against a week of actually living, and a client who has found a word on her own can take it to you to see whether it survives the clinical frame.

You decide how the chosen and discovered accounts are framed. Naming the difference early keeps a client from receiving two stories about where her values come from and assuming she has to pick.

The one page brief sets the six processes beside the path and notes the points of fit.

For clinicians

A one page brief sets Acceptance and Commitment Therapy beside the Path to Freedom, with the points of fit, the division of labor, and the coordination notes. Read the brief (PDF).

The clinician kit has the full briefing, a client authorization template, and a client handout. To talk through a particular client population or a particular case, use the clinician inquiry form on the therapy page.

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