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Rethinking Clinical Science and Practice

The Rhode Island ACT group formed with a shared dedication to improving lives through effective mental health practices. Recognizing the inherent challenges in fostering lasting change, even among clients with similar diagnoses, we sought to enhance our approach to therapy. Traditional methods often fail to explain why some clients struggle to progress, while others thrive despite similar circumstances. This discrepancy prompted us to explore new avenues, leading us to Acceptance and Commitment Therapy (ACT).

Human suffering is multifaceted, and clients present unique challenges that require flexible, adaptable solutions. As practitioners, we experience both triumphs and setbacks, which can be disheartening and lead to self-doubt. Despite our commitment to making a difference, the unpredictability of therapeutic outcomes can be frustrating. Therefore, we convened as a group to support each other in navigating these complexities and to refine our skills in delivering impactful therapy.

We recognize that pain, encompassing difficult emotions, thoughts, and sensations, is a universal aspect of the human experience. Many clients believe that eliminating these painful feelings is necessary for happiness, a notion deeply rooted in both societal norms and traditional therapeutic practices. However, efforts to control or avoid pain often exacerbate suffering rather than alleviate it. Through ACT, we aim to shift the focus from controlling pain to embracing it as a natural part of life.

ACT promotes a paradigm shift from the futile struggle against pain to a life of meaning and fulfillment. By teaching clients to accept their internal experiences and commit to actions aligned with their values, we help them live more resilient and satisfying lives. This approach not only benefits clients but also enhances clinician well-being and professional satisfaction.

Our goals as the Rhode Island ACT group are multifaceted:
 

  1. Support and Collaboration: We provide a network of support and resources for practitioners facing the inevitable challenges of mental health work, fostering an environment of mutual learning and growth.

  2. Enhancing Therapeutic Practice: By integrating ACT principles, we aim to improve client outcomes, enabling them to lead richer, more meaningful lives despite their pain.

  3. Professional Development: We are committed to ongoing education and skill enhancement, ensuring that we remain at the forefront of effective therapeutic practices.

  4. Promoting Flexibility and Adaptability: We advocate for a flexible approach to therapy that transcends diagnostic labels, focusing on individual client needs and the biopsychosocial processes that drive change.


We are dedicated to transforming the therapeutic landscape by embracing the complexities of human behavior and leveraging the power of acceptance and commitment and hope that through our collective efforts, we will make a lasting impact on our profession, our clients, and the broader mental health community.

Our Goals
Windsurfers at the Horizon
ACT A Model of Process Based Psychotherapy.jpg

The Flexibility
Processes

In Acceptance and Commitment Therapy (ACT), the six core processes, often referred to as the "hexaflex" but increasingly are also described as "human yearning," reflect essential psychological skills or attitudes that individuals strive to develop.

 

These processes are aimed at increasing psychological flexibility.

ACT in a Nutshell

ACT In a Nutshell

The Six Pivots
 

Psychological flexibility encompasses six essential skills, each necessitating a pivot away from inflexible cognitive patterns.

Central to the efficacy of these pivots is the understanding that each rigid cognitive pattern conceals an underlying, healthy yearning. Individuals often engage in maladaptive behaviors for adaptive reasons—seeking to imbue their lives with significance. These flexibility pivots enable the redirection of this concealed yearning toward a more adaptive and flexible mode of functioning, thereby fulfilling the underlying need.

Below is an introduction to each skill and the corresponding yearning each pivot addresses:

Defusion: This pivot involves transitioning from cognitive fusion (over-identification with thoughts, allowing them to dictate behavior) to cognitive defusion (detaching from thoughts). The cognitive fusion serves to attain coherence and understanding. The defusion pivot, involving the observation of thoughts without engagement, redirects the need for coherence and understanding.

Self: This pivot requires moving from adherence to maladaptive self-narratives to adopting a perspective-taking stance. Individuals often cling to rigid self-stories to fulfill the need for connection and belonging, even when these stories are counterproductive. The pivot towards perspective-taking involves recognizing oneself as more than these narratives, thus addressing the underlying need for connection and belonging.

Acceptance: This pivot involves shifting from experiential avoidance (attempts to evade or control thoughts, feelings, and sensations) to acceptance of these experiences. This transition redirects the inherent need to experience and feel without avoidance.

Presence: This pivot necessitates shifting from rigid attentional focus on the past (rumination) and future (worry) to present-moment awareness. This redirection addresses the need for orientation, moving away from the mental fog created by past and future preoccupations towards a clear focus on the current moment.

Values: This pivot involves transitioning from adherence to socially compliant goals (perceived obligations) to engagement with personally chosen values (intrinsically meaningful activities). This shift redirects the need for self-direction and purpose, leveraging values as a sustainable source of motivation.

Action: This pivot entails moving from inaction or procrastination to committed action. Recognizing that change necessitates action, even small steps, is crucial. This is often challenging due to high expectations or the desire for perfect outcomes. The action pivot focuses on the continuous, incremental development of habits aligned with values.

For simplicity's sake, you can think of these six as follows:

  1. Observe thoughts with sufficient distance to enable choice in behavior, irrespective of cognitive content.

  2. Recognize and gain perspective on self-narratives, appreciating the broader self-concept.

  3. Embrace emotional experiences, even when they are uncomfortable or evoke vulnerability.

  4. Cultivate intentional present-moment awareness, counteracting habitual attentional patterns.

  5. Deliberately select and pursue values-based qualities and actions.

  6. Develop and maintain habits that support these values through consistent, small steps.

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Again, this is what we are dedicated to supporting in order to enhance our, our client's, and our community's psychological flexibility.​

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