Acceptance and Commitment Therapy

ACT skills and techniques:

1. Workability: “Is what you’re doing working to make your life rich, full, and
meaningful?”
2. Mindfulness : Mindfulness is a practice of paying attention to the present
moment with curiosity and openness. Mindfulness skills help in enhancing
an individual’s psychological flexibility, and enable them to stay connected
with their present self and experiences.
3. Defusion: Involves stepping away from our thoughts, memories, and
images, allowing them to pass by without getting tangled in them. These
cognitive processes are to be viewed as separate entities and not as truths
that can control us or our behaviour. The practice of defusion reduces the
impact of our unhelpful thoughts on our behaviour, and aims for a more
flexible behaviour that is in line with our values.
4. Acceptance: It’s common to try to avoid or suppress unpleasant
thoughts, emotions, or sensations. Name what you push away most (e.g.,
anger, physical pain, difficult thought, etc.) ; Your beliefs about your inner
experience affect your willingness to be present to it. Write down two
beliefs related to what you listed in the previous step, such as the belief that
certain emotions or sensations are dangerous, wrong, or proof of weakness ;
Opening to difficult experiences requires patience and an ongoing
commitment. Identify a situation that often brings up the undesired thought,
emotion, or sensation you previously identified.

It is the practice of making space for feelings, thoughts, sensations and urges
that are difficult without avoiding or suppressing them. ACT believes that
opening up to discomforting experiences and allowing them to linger around
will help us achieve a peaceful state of mind.
5. Self-as-context: Easily the most common meaning of SAC in ACT is the
“observing self”: that aspect of a human being that does all the
noticing/observing of one’s inner and outer world. You could call this “meta
awareness” or “pure awareness” if you prefer: it’s the awareness of one’s
awareness, or the noticing of one’s noticing, or the consciousness of one’s
 consciousness. (NB: To call it a ‘self’ or ‘part’ is to speak metaphorically;
technically, it’s a repertoire of behaviour.)
2) The less common meaning of SAC is “flexible perspective-taking”. When used
with this meaning, SAC refers to any and all type(s) of flexible perspective-taking
(which are all classed as “deictic framing” in relational frame theory). Flexible
perspective-taking underlies defusion, acceptance, contacting the present moment,
self-awareness, empathy, compassion, theory of mind, mental projection into the
future or past, etc.
This skill helps in separating the “thinking-self” from the “observing-self”.
The observing self is a stable state of awareness where we allow ourselves to
observe our thoughts and feelings without becoming entangled in them. This
is an act of seeing oneself as more than one’s mere thoughts and feelings.
6. Values: These are the qualities of our behaviour that we desire which guides
us to live the lives we want for ourselves. Understanding one’s values and
clarifying them is an important aspect of ACT. We are driven by our values
and if our actions are not aligned with them, it may create challenges in our
lives.
7. Committed action: These are interventions where we set goals to meet our
values or take steps towards them to achieve those values. This highlights
the significance of consistency and willingness to take action towards our
goals, despite them bringing discomforting experiences.

ACT’s beliefs about people:

1. The human mind can easily incline towards destructive patterns of

thinking, leading to psychological suffering.
2. Human language includes thoughts, feelings, memories, and judgment
and according to ACT, these languages are the roots of our suffering.
3. Pain is an unavoidable part of life’s experiences.
4. The human mind has its own ability to generate painful and unhelpful
thoughts or feelings even in positive moments by bringing memories
from the past or projecting fears about the future.
5. People are not broken, but stuck in patterns of cognitive fusion and
experiential avoidance.
ACT’s belief about change:

1. People change when they develop a greater sense of psychological flexibility

i.e. they are able to be present in their current experiences and their values
are in line with their actions.
2. Rather than moving away from our painful experiences, if we learn to stay
with it, change occurs.
3. Rather than justifying our thoughts as “right” or “wrong”, ACT encourages
people to evaluate if their thoughts are helpful and help them create a
meaningful life for themselves.
4. By changing our relationship with uncomfortable thoughts, through
mindfulness and defusion, we are able to heal from our problems.
5. ACT asserts that transformative belief changes are manifested when we
learn to live with our pain rather than struggling with it.
Compare and Contrast between Systems theory and ACT

1. How Change Occurs: According to ACT, change occurs through psychological

flexibility which is gained through a person’s observation of their own internal
language, accepting the difficult thoughts and feelings and committing to actions
aligned with their values. However, according to systems theory, change is a result
of our external interactions and feedback mechanisms. It highlights the influence of
the system over an individual and changing one changes the other. Change is
bringing balance to the system which naturally affects the individual.

2. About people: ACT views people as capable of living a meaningful life and
individuals are seen as a whole and not fundamentally broken. ACT believes
people have the strength to act in line with their values if they accept the
discomforting feelings and commit to their actions. Systems theory sees
individuals as part of the larger system and people are heavily influenced by the
roles, relationships, responsibilities and behaviors within their community. They
tend to see people in their context and that they are constantly changing and
adapting to their surrounding environments.

3. Goal: The goal of ACT is to help people reach their psychological flexibility
through skills and techniques like mindfulness, meditation, journaling etc. so that
they are able to live a meaningful life despite the ongoing challenges. The goal of
ACT is not symptom reduction but to be able to live meaningfully in the presence
of those symptoms. While systems theory focuses on improving the system as a
whole, where the individual is a part of that system. This is done by altering
feedback loops, addressing difficult interactions and improving communication
patterns within the system.

4. How problems are formed: In ACT, problems are formed through cognitive
fusion and experiential avoidance and when individuals are not living their values.
In systems, problems are often systemic then individual. One person’s problem
may be a product of a dysfunction of their larger system.
Both the models however have a depathologizing approach : systems theory
sees the imbalance in the system as the problem and ACT believes the
problem is unhelpful thinking rather than seeing the individual as flawed or
incapable.

Multiple Perspectives:
• ACT encourages clients to accept multiple perspectives on their
internal experiences (e.g., thoughts, feelings) and to view themselves from a
self-as-context position, which helps in detaching from rigid identifications
with thoughts.
• Systems Theory encourages therapists and clients to consider
multiple perspectives within relational systems, focusing on how different
individuals in a system perceive and influence one another.
3. Focus on Patterns:
● ACT addresses patterns of avoidance or fusion with thoughts that keep
clients stuck.
● Systems Theory looks at repetitive interaction patterns within families
or relational systems that maintain dysfunction.
4. Non-Judgmental Stance:
• Both approaches adopt a non-judgmental attitude toward
experiences or behaviors, whether they are internal (as in ACT) or relational
(as in Systems Theory). Clients are seen as reacting to situations with the best
tools available to them, without being labeled as “good” or “bad.”

Integration:

Assessing Systemic Dynamics and Individual Psychological Flexibility:

• In therapy, both the individual’s internal struggles (addressed
through ACT) and their role within larger systems (addressed through
Systems Theory) can be examined simultaneously. For example, a client who
struggles with emotional regulation might be encouraged to practice ACT
techniques such as mindfulness and acceptance while also considering how
family patterns (such as communication styles or family roles) reinforce these
difficulties.
2. Using ACT to Address Systemic Patterns:
• Cognitive Defusion techniques from ACT can be applied to help
clients detach from rigid family beliefs or roles. For example, if a family
system tends to assign roles like “the responsible one” or “the emotional one,”
ACT’s defusion can help family members step back from those roles and
choose more flexible ways of interacting.
3. Values-Based Action in Systemic Context:
• ACT’s focus on values can help family or couple systems define
collective goals and individual contributions. For instance, during family
therapy, each member’s values can be explored to understand how the family
can work toward shared goals (e.g., better communication, more support).
This creates a more values-driven system while allowing each member to
pursue their own goals in a healthy way.
4. Mindfulness and Present Moment in Relationships:
• Integrating ACT’s mindfulness practice into systemic work allows
individuals in families or couples to stay grounded in the present moment
during interactions. It helps family members become more aware of their
reactions and break negative communication patterns. In sessions, therapists
can help family members become mindful of their reactions and behaviors
within the system.
5. Acceptance of Relational Discomfort:
• ACT’s acceptance strategies can be used in systems work to help
family members accept uncomfortable emotions or relationship dynamics that
cannot be immediately changed. This might involve helping a parent accept
their child’s growing independence or helping a partner accept the need for
space in a relationship, while still maintaining a commitment to positive
family functioning.
6. Flexibility in Therapist Roles:
• The therapist can integrate both approaches by being flexible in
their role depending on the needs of the system. For example, early in therapy,
the therapist might focus on more directive interventions (from Systems
Theory) to address dysfunctional relational patterns, while later focusing on
more supportive and non-directive ACT interventions to encourage individual
psychological flexibility and growth.

By integrating ACT’s focus on individual psychological flexibility with

Systems Theory’s relational understanding, therapy becomes a holistic
process, addressing both internal psychological experiences and relational
patterns that influence and sustain problems .
Greg and Suzanne’s story involves a long-term relationship marked by significant
emotional struggles tied to their family histories. Greg, who is legally separated
from his wife but has not moved forward with divorce, is burdened by feelings of
guilt and a sense of responsibility rooted in his family of origin, particularly his
unresolved issues with his father. He has been emotionally distant from his wife
and children for years and is hesitant to commit fully to Suzanne, despite their
four-year relationship.

Suzanne, who is divorced and raising two adopted children, desires a public
commitment from Greg. Her self-esteem issues, shaped by a difficult childhood,
contribute to her feelings of rejection and insecurity when Greg does not move
forward with divorce. She fears that Greg’s hesitation means he does not truly love
her, leading her to distance herself emotionally from him.

In therapy, Greg and Suzanne reveal that many of their current relationship
difficulties stem from unresolved family-of-origin issues. Greg’s guilt about his
children and his father prevents him from committing to Suzanne, while Suzanne’s
low self-esteem makes her feel unlovable and fearful of abandonment.

The couple works through these issues in therapy using both systems theory and
ACT techniques. They begin to recognize and accept the emotional patterns that
come from their past, and through mindfulness, defusion, and values-based actions,
they start to change how they interact with each other. Greg takes steps toward a
legal divorce and opens up emotionally, while Suzanne works on overcoming her
insecurities. Together, they strive to create a more secure and committed
relationship, breaking away from their past patterns.

Their therapy involves individual sessions, joint sessions, and family work, helping
both partners address personal growth while also working on the dynamics of their
relationship.
Integration

In Greg and Suzanne’s case from Myers’ chapter on the integration of

Acceptance and Commitment Therapy (ACT) with Systems Theory, the
therapist uses both approaches to address individual and relational dynamics.
Here’s how the integration works:

1. Contextual Understanding of Behavior:

• Systems Theory views Greg and Suzanne’s issues as part of

broader relational patterns influenced by their family of origin. Greg’s sense
of responsibility (rooted in his relationship with his father) and Suzanne’s
self-esteem issues (linked to her family upbringing) are examples of how their
individual experiences are shaped by systemic factors.
• ACT helps Greg and Suzanne address these internal experiences
by encouraging them to accept their thoughts and feelings without avoidance
or judgment. For example, Greg’s guilt about his parenting and divorce was
linked to his family history, but ACT helps him confront this guilt, defuse
from it, and stop letting it control his behavior.

2. Acceptance of Individual and Relational Patterns:

• ACT emphasizes the importance of accepting difficult emotions

rather than avoiding or suppressing them. Greg, for instance, struggles with
guilt and responsibility, which he has avoided confronting directly. The
therapist uses ACT principles to help him accept these feelings while still
taking committed action toward what matters—improving his relationship
with Suzanne.
• In Systems Theory, the therapist views Greg and Suzanne’s
relationship as part of a larger interactional pattern where both are stuck in a
repetitive “dance.” Suzanne feels rejected by Greg’s inability to divorce, while
Greg feels immobilized by guilt. The therapist integrates ACT to help them
become aware of these patterns and accept the discomfort, rather than
reacting to it in ways that perpetuate the cycle.
3. Values and Relational Goals:

• ACT’s focus on values helps each individual clarify what is truly

important in their lives. Greg begins to recognize his desire to be a better
father and partner, while Suzanne acknowledges her need for love and
security. These values serve as guiding principles for both Greg and Suzanne
to move forward in their relationship, despite their struggles.
• From a Systems Theory perspective, these individual values
influence the broader system (their relationship). The therapist helps them
understand how their personal values can contribute to creating a healthier
and more fulfilling relationship.

4. Defusion and Breaking Rigid Systemic Patterns:

• Cognitive defusion in ACT allows both Greg and Suzanne to step

back from their thoughts and see them as just thoughts, rather than truths
that dictate behavior. Greg defuses from the thought, “I am a bad father,” and
Suzanne works on defusing from the belief, “I am unlovable.”
• In Systems Theory, this defusion process breaks rigid
interactional patterns. For example, Suzanne’s fear of abandonment leads her
to withdraw when she perceives Greg pulling away. Through ACT’s defusion,
she can recognize her fears without letting them dictate her behavior, which
helps change the relational pattern.

5. Mindfulness and Present-Moment Awareness in Relationships:

• Mindfulness is key in ACT, helping Greg and Suzanne become

more aware of their emotional reactions and patterns in the present moment.
For instance, Greg becomes mindful of his guilt and how it affects his ability
to move forward with divorce, while Suzanne becomes aware of her
insecurities and how they impact her interactions with Greg.
• Systems Theory also benefits from this increased awareness, as
mindfulness helps each partner recognize their roles in maintaining or shifting
relational patterns. When Suzanne threatens to leave Greg due to insecurity,
mindfulness allows her to pause and reflect before reacting, creating space for
new responses in the relationship.

6. Committed Action and Systemic Change:

• Committed action in ACT involves taking steps in alignment with

values, even when it is uncomfortable. Greg starts working toward a divorce
and improving his relationship with Suzanne and his children, despite the
discomfort it brings.
• In Systems Theory, this committed action begins to shift the
dynamics within the system. As Greg and Suzanne start acting on their values
(rather than reacting based on old patterns), the relationship begins to change.
The therapist supports both partners in taking these steps, ensuring that their
individual growth also leads to healthier interactions within the system.

7. Therapist’s Flexibility in Roles (ACT Styles and Systems View):

• The therapist switches between directive and supportive roles

depending on the clients’ needs, a concept borrowed from both ACT’s
adaptive styles and Systems Theory’s attention to relational dynamics. Early
on, the therapist provides more structure to help them address their
individual and relational issues, later allowing them to take more ownership of
the therapy process as they grow more capable of managing their patterns
independently.
• In Systems Theory, this adaptability mirrors the therapist’s role
in understanding their place in the client system, knowing when to intervene
more forcefully or when to step back and allow the couple to work through
their issues on their own.

Summary of Integration:

• ACT helps individuals like Greg and Suzanne manage their

internal experiences (thoughts, emotions) and stay committed to their values.
 • Systems Theory addresses how their individual issues are part of a
larger relational dynamic, ensuring that change happens not just within
themselves but within their relationship.
• Together, the two models offer a comprehensive approach that
targets both internal psychological flexibility and systemic relational patterns,
providing a pathway to deeper, sustained change.

This integration allows the therapist to work holistically, addressing both the
personal struggles and the relational dynamics that sustain those struggles 
.