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How to learn ACT (or any psychotherapy)?

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How to learn ACT is a really good question. Paradoxically, despite the title, I do not intend to answer the question in this article, because before being able to tell “how to learn?”, we must ask a more fundamental question “what to learn?”. So, let’s do first things first!

CURRICULUM

Almost every therapeutic approach has its own curriculum, which specifies what kind of theoretical and practical knowledge you need in order to safely and effectively deliver the treatment. A good curriculum suggests not only what to learn, but also in which order.  Ethical considerations should be an integral part of a curriculum.

As said, “almost every approach has its own curriculum”. Unfortunately, this is not the case with Acceptance and Commitment Therapy. Such curriculum has never been officially adopted by any professional organization. Thus, ACT learners lack a broadly accepted training plan that could help them structure their learning process step by step and monitor their progress. The question “what stuff to learn and in what order to become an ACT therapist?” remains unanswered, at least officially.

There are of course some training programs run by various people, but their structure and content has never been broadly consulted with other peer-reviewed ACT trainers, so they may differ significantly.

The lack of training standards is linked to the lack of formal certification or verification of ACT therapists. ACT may be the only serious therapeutic approach in the world without any certification/attestation of its therapists. It means that you can literarily attend two or three ACT workshops (or even the same kind of workshop multiple times) and pronounce yourself an “ACT psychotherapist”. Even more, you can present yourself as an ACT trainer or “supervise” others.

Is that good or bad? Well, it depends who for and where. Association for Contextual Behavioral Science chose to abstain from a formal recognition of ACT therapists for good reasons. The dark side of certification programs is a pyramid-like training business with all its pathologies and exploitive practices, well known in our field.

However, I guess that from a client’s perspective the fact that literarily anyone can self-declare themselves as “ACT therapists” may not be especially encouraging. In countries where the title “psychotherapist” is not protected by law, certification offered by various therapeutic schools is the only guarantee of client safety. A systematic personal supervision is often the best way to prevent people with serious mental health issues, e.g. personality disorders, from treating clients, who are in a very vulnerable position.  But the issue is outside the scope of this article, so I won’t discuss it any further.

Although there is no official ACT curriculum, the majority of ACT trainers agree on some core training topics. There is for example a broad consensus about the importance of Relational Frame Theory (RFT). And if you want to become an ACBS peer-reviewed ACT trainer, good knowledge of RFT is not only a recommendation but a formal requirement. Why and in what way is RFT important for an effective delivery of ACT, then? Well, it’s a good question. Different trainers would probably give different answers, but in fact anything that might be said in this matter is just assumptions, not conclusions.

As far as I’m aware, there is no data showing that learning RFT by a therapist is relevant for better client outcomes. We simply don’t know whether ACT therapists with solid RFT knowledge are more effective than those without that knowledge. And should it be the case, we don’t know how much of this knowledge is necessary to make a difference. Acceptance and Commitment Therapy is not unique here. If you look at other therapeutic approaches, you’ll find curricula full of things of unknown practical value. In the best case they will widen your intellectual horizons, in the worst case they can make you conceptually confused, incoherent in your actions and less efficient. Don’t get me wrong: I’m not saying that learning RFT is not helpful. I’m just pointing out that we don’t know whether this knowledge makes any difference for the results of your interventions.

THERAPEUTIC SKILLS

Traditionally, the process of learning (and teaching) psychotherapy is perceived as a two-fold path. On the one hand, adepts learn theoretical stuff that allows them to conceptualize clients’ problems and choose treatment strategy. For that part we need curriculum. On the other hand, training consists of acquiring and strengthening some practical skills. Parallel learning of theory and skills bridges the science with the art of psychotherapy.

Psychotherapeutic skills are usually divided into two categories: specific and general. By specific skills we mean behavioral repertoire necessary for delivering intervention that is consistent with a particular approach, like ACT, DBT, EMDR or psychodynamic psychotherapy. The term “general skills” refers to practical competencies required from therapists across various schools and approaches.

It is not always easy to tell the general from the specific, as it often depends on the clinical context. For example, therapist’s ability to build a supportive and purposeful relationship with the client, called “therapeutic alliance”, is commonly viewed as a general therapeutic skill.  This ability is widely considered as a prerequisite of any effective intervention, independent of theoretical approach, population or clinical problem.  However, the role of therapeutic relationship may vary between clinical situations.

In some cases, for instance while treating isolated phobias, therapeutic relationship may merely facilitate the use of specific techniques, like exposure.  It strengthens client’s willingness to collaborate with the therapist on doing unpleasant and emotionally difficult tasks. It reduces also the risk that the client drops out of therapy.

However, therapeutic relationship may play a different role in other cases, for example in work with personality disorders and clients who struggle with relational problems.  When you work with a client who experienced emotional neglect in childhood and multiple rejections or social exclusion in adulthood – building safe, stable and trustful relationship between you and the client may serve as an active agent of change in itself.

LEARNING RESOURCES

There is a practice-oriented Facebook group created specifically for the purpose of facilitating practical training in Acceptance and Commitment Therapy and implementation of ACT in various settings. You are welcome to consider joining hundreds of other ACT practitioners in our closed and moderated group: Practice Acceptance and Commitment Therapy.

If you want to learn more about what can make you a more effective therapist, independent of theoretical approach, I would recommend you a research-based book How and Why Are Some Therapists Better Than Others?: Understanding Therapist Effects by Louis Castonguay and Clara Hill.

If you want to make your interventions more ACT-consistent, I would recommend you study the list of the Core ACT Competencies. The list was put together by a group of ACT trainers and is not a product of the entire ACT training community. However, it is widely accepted by ACT trainers and if you use the thirty competencies to structure your own training in Acceptance and Commitment Therapy, it will make your interventions more consistent with this approach. You may also consider using the book Learning ACT by Luoma, Hayes and Walser, both as a good overview of basic ACT-skills and as a mini-curriculum.

PROCESS-ORIENTED APPROACH TO LEARNING

Curriculum-based and skills-based are the two traditional approaches to learning psychotherapy. However, my own trainings and courses are structured around something that I call a process-oriented approach. I will present the idea in the next article before moving finally to the question “how”. Stay attuned!

CC BY-NC-ND 4.0 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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licensed clinical psychologist, psychotherapist, researcher, peer-reviewed ACT trainer
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