This third-wave therapy approach is an effective way to help clients design a new internal narrative, and it can be particularly useful with children.
Article summary:
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Jodie Wassner MAPS, educational and developmental psychologist, explains how acceptance and commitment therapy (ACT) can be useful in therapy for children.
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ACT emphasises accepting rather than fighting thoughts and feelings, helping clients design a new internal narrative.
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ACT focuses on psychological flexibility, rather than merely reducing symptoms.
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ACT uses metaphors and a playful approach to address kids’ struggles, encouraging them to understand and accept their feelings rather than suppress them.
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APS is running a webinar on ACT for children on 17 July.
Western health practices are often focused on trying to 'fix' a problem. Take this tablet to make your pain go away; try this technique to stop feeling so low. While there is certainly a time and place for this approach, symptom reduction strategies don't always work for everyone. In fact, they can sometimes make it worse.
On top of this, our social media-obsessed world – where we post highly curated (and often slightly inflated) versions of our lives – often encourages people to cloak their hardships and the challenging aspects of their lives.
Essentially, we're often not willing to embrace our struggles. But doing just that is often what helps us to overcome them. This is the basic principle of acceptance and commitment therapy (ACT), which centres around encouraging participants to accept their thoughts and feelings rather than fighting against them.
"The goal is acceptance and moving forward rather than getting rid of difficult inner experiences, such as thoughts, feelings, memories and urges," says Jodie Wassner MAPS, educational and developmental psychologist at Curious Kids Psychology and author, who has been studying and practising ACT for over 20 years.
Completely ridding ourselves of anxiety is a futile exercise, she says, because "life can be hard and we've all got tough stuff to deal with".
"It's not just about fixing something. It's more of a way of life. It's cognitive, it's behavioural, it's all this evidence-backed stuff that we know well, but our approach is a little bit different… [it's about] untangling people's tightly held beliefs," she says.
ACT is a third-wave therapy that encompasses cognitive and behavioural techniques, but it has some distinct differences from traditional Cognitive Behavioural Therapy (CBT) , says Wassner.
"The goal of CBT is typically symptom reduction. So at the beginning of CBT therapy, the client might have a certain level of anxiety and, by the end of therapy, you'd hope they're less anxious. But in ACT, it's a little more complex.
"We talk about carrying our anxiety and still moving forward with doing things that are valued for us. A nice by-product is that our anxiety can reduce. But if our end goal is anxiety reduction, we find that can be counterproductive."
It's kind of like that feeling you get when you're trying to fall asleep at night but can't. You know you'll feel better in the morning if you've had a good night of rest, so you worry about still being awake and that perpetuates your feelings of alertness.
"Whereas if you take an acceptance framework, you might say, 'If I can't fall asleep right now, I'll still be able to function tomorrow,' that drops a bit of that struggle and we may or may not end up getting to sleep more quickly."
Two streams to focus on
The premise of ACT is built upon two main streams, psychological flexibility – being able to accept that feelings, emotions and experiences won't always work in our favour – and valued living.
"Valued living is often confused with goal setting. When we have a goal, we set something specific like, 'I want to get into uni, so I'm going to study hard for this exam.' Whereas values are about a way of living life.
"One of the things we talk about in ACT is, 'If I was the best version of myself, what would that look like?' Often we have a list of things like: creativy, honesty and being adventurous. Sometimes we'll then rank those and say, 'This one's really important to me,' then we can think about how much they client is actually living that value in the moment.
"Often we spend our days getting caught in the daily grind, and we don't pause to think about what a valued life would look like."
It's important to define valued living from the outset, she says, as this can help clients engage their psychological flexibility to move through the painful moments in pursuit of those things they're passionate about – the things that "feed their souls".
When kids experience difficult thoughts or feelings, often the adults in their lives are telling them that their feelings are wrong. An example might be saying, 'Don't cry over that,' or, 'That's nothing to be scared of. - Jodie Wassner MAPS, educational and developmental psychologist
Practising ACT with children
As an educational and developmental psychologist, Wassner is particularly interested in applying ACT when working with young people. She is running a webinar for APS on this very topic on 17 July, and APS members can sign up at a discounted rate.
As an early adopter of ACT, and having spent time working as a school psychologist, Wassner saw a gap in the market in terms of different therapies that worked well with children.
"I did a workshop on ACT and was so blown away by it that I immediately started adapting the strategies for the young people I was working with at the school. It was amazing to see how well kids relate to the metaphors [I was using]. I was so amazed by how quickly I was getting results."
She attributes part of the success of this therapy approach to the type of language that ACT practitioners use with young people.
"What we find is that when kids experience difficult thoughts or feelings, often the adults in their lives are telling them that their feelings are wrong. An example might be saying, 'Don't cry over that,' or, 'That's nothing to be scared of.'
"That teaches the kids, first of all, not to trust their own feelings, but it also gives them a message that they're getting it wrong, or if they just tried harder they'd be able to do it. Whereas we know that difficult feelings are normal, so we're actually encouraging kids to struggle."
Instead of accidentally using dismissive language, she encourages parents and teachers to accept and acknowledge those feelings, such as saying, "I can see you've had a really bad day today. Is there anything I can do to help you?"
ACT also relies heavily on the use of metaphors to help explain concepts – both with children and adult clients.
"One of the most common ACT metaphors that most people who've done a bit of ACT will know is what's called the 'quicksand metaphor'. The idea is that if you fall into quicksand and struggle [to get out], then you sink more quickly. Whereas if you can relax… you've got more chances of getting out. It just speaks to the idea that when a difficult feeling shows up, if you struggle with it, it could drag you down further."
When working with children, Wassner says you can get quite imaginative with the metaphors you pose. For example, she recounts working with a nine-year-old boy who had a severe phobia of the wind.
"Every time there was a little bit of wind outside, his mind told him there was going to be a terrible tornado or hurricane. It became very debilitating."
In the early stages of this experience, the adults in his life were enabling these thoughts by allowing him to stay out of the wind.
"The more we enable these maladaptive safety behaviours, the worse the phobia gets. So his phobia got worse and worse, and it got to the point where he was sitting in reception at lunchtime because he had this belief that it was the safest place at school. So he stopped playing with his friends at lunch.
"Then when he got home, he'd sit in the study with the blinds down because, again, his mind had told him that would be the safest place to be."
To help him, Wassner created the 'Wizard of Oz metaphor', where she had him imagine the scene when the tornado blows through Kansas and Aunty Em and Uncle Henry go into an underground bunker where it's safe from the tornado.
"So I then said to the kid, 'What do you think is down in the bunker?' And he said, 'Probably nothing. It's probably dirty and dusty down there.' So the tornado goes past, they come back up and they are safe from harm.
"Then I say, 'What would happen if they went down there every time there was a small bit of wind?' So we can start having conversations about whether that would be a valued life – spending all our time in a dingy, underground space. He saw that in order for him to have a valued life, he had to have a little bit of uncertainty about what the wind might do."
You can also apply a play lens to ACT with children, adds Wassner.
"One of the things I love about ACT is that it's quite quirky and playful. I definitely have a play therapy approach. We sit on the floor; we have fidgets and we're all over the place. For a child to learn anything, they need to feel safe and relaxed.
"I also use subtle language when we're playing even just a simple game of Connect 4. The language I use will be really affirming some of these ideas around struggle versus acceptance.
"This might look like shifting people from thinking 'I'm dumb', for example, to 'My mind is telling me that I'm dumb.' It's about pausing and noticing what your mind is doing. Treat it with curiosity rather than thinking it's true and disastrous."
Often when people are starting out in ACT training, they can feel like they're making slow progress, says Wassner.
"They say things like, 'I feel like I'm just playing', but there's so much implicit learning going on. That's why I describe it as a way of life because I think getting out a bunch of worksheets can be a bit of a rapport killer.
"I feel really privileged to be able to do this work, and to have been an early adopter of ACT."
Want to learn more about how ACT works with children? Sign up to APS's webinar on 17 July at 4pm to learn more from Josie Wassner MAPS.