Institute 1 - Focused ACT for Brief Interventions: The Basics and Beyond

For various reasons, behavioral health clinicians are increasingly confronted with the challenge of achieving positive clinical outcomes using fewer and fewer therapy sessions. The result is the need for trans-diagnostic, process-based intervention approaches that can produce positive clinical outcomes in a very limited number of sessions. Focused Acceptance and Commitment Therapy (FACT) is a brief, process-based therapy that uses the principles of acceptance, mindfulness and committed action to promote valued life outcomes for the client. FACT seeks to optimize the impact of every therapy session, including the first session, by creating a between-session behavior change goal with the client. Indeed, an underlying principle of FACT is to treat every session as if it might be the last one. In this institute, we will examine three psychological processes that lead to suffering and psychological dysfunction: rule following, emotional avoidance and behavioral avoidance. The antidote for these three toxic processes is to use brief interventions that promote openness to inner experience, awareness of the present moment, and value-based actions in real life. These three psychological processes (Open, Aware, Engaged) are often referred to as the "pillars" of psychological flexibility. Participants will learn how to first organize the "flow" of a brief intervention session using a system known as CARE. Each letter of the acronym represents a specific clinical activity the clinician will engage in to streamline the clinical conversation. Participants will then learn, and practice, several core FACT skills: Preparing the client for radical change; change-oriented, contextually based interviewing; use of in-session rating scales; undermining avoidance strategies via the use of the workability yardstick; problem reformulation strategies establishing motivation to do something different, and constructing powerful between session behavioral experiments. The workshop teaching methods will involve didactic presentation, role play demonstrations, experiential exercises and supervised dyadic skill building role play exercises. Participants will learn specific clinical skills that can immediately be incorporated into clinical practice.

Outline:

• Hour 1: How the approach-avoidance dynamic leads to both human suffering and human vitality; three toxic psychological processes that underlie all forms of suffering; CARE algorithm as the basic session organizational framework in FACT; the three basic processes of psychological resiliency; qualities of the FACT therapeutic relationship.

• Hour 2: Preparing the client for radical change; contextual interviewing strategies that both create and leverage intervention options; reframing unwanted distressing emotions as “signals” of unmet strivings, rather than “symptoms” of illness; undermining context insensitive rule following; clinical demonstration and dyadic skill practice.

• Hour 3: Hunting for and countering in-session emotional and behavioral avoidance strategies; reformulating the “problem” in approach-avoidance terms; using workability to create experiential contact with unworkable actions and associated unwanted life outcomes; injecting values into the conversation about workability.

• Hour 4: Learning to probe, read and react “on the fly” using FACT case conceptualization methods including the Four-Square Tool and Psy-flex Assessment Tool; Dyadic and small group practice

• Hour 5: Reframing as the “art” part of therapy; creating client buy-in for a new definition of the “problem”; reframing as a back and forth negotiation; qualities of effective reframes; matching reframe “risk-reward” level to client’s level of engagement and readiness to change; clinical demonstration/small group exercise.

• Hour 6-7: Therapy is all about promoting behavioral variability; creating powerful behavioral experiments that embody personal values in action; use of augmenting strategies to boost client motivation to follow through; use of in session rating scales to boost confidence, protect against therapist “over-reach”, model a “horizontal” relationship between client and clinician; putting it all together in dyadic skill practice.