What Are We Targeting in ACT?

When doing Acceptance & Commitment Therapy the "target" or "focus" of the therapy (for lack of better words), is often not the presenting issue itself but the relationship between the individual and the presenting issue and its aspects.

For example we may be working with someone who is struggling with certain parts of their experience, whether that be external events, thoughts, feelings, sensations, or so on.

The therapy is not designed to change or alter the experience per se but to bring awareness to and possibly change the relationship between the individual and the experience.

In the drawing here, I've labeled the individual, the experience, and the relationship as #1, #2, and #3 respectively.

What I mean by relationship is the thing that comes between the individual and their experience. This can include things like how they are "holding onto" an experience, evaluations about an experience, their awareness of the experience, among many other things.

For example, a person could have anxiety, and also have a relationship with their own anxiety that is one of opposition or resistance. "Anxiety is my enemy" "Anxiety is wrong." "I have to be rid of my anxiety before I can live a better life." "I can't do this anymore."

The process of ACT for the most part focuses on #3 and #1, especially in the present moment.

Clients will often unintentionally attempt to shift focus away from #3 and #1 back to #2. It's our job as therapists to notice when this is happening and use that in the work. This can take a variety of forms including but not limited to gentle redirection, and direct confrontation.

As we shift to #3 and #1 we want to do it in vivo as much as possible. Evoking and commenting on what is occurring in the here & now, rather than the there & then. Questions like "As you are recalling that experience, what do you notice showing up for you in this moment?" "When you talk about that stuff, can you notice what's happening in your body as you sit here?" "It sounds like that feeling is very present for you, what else do you notice here with you right now?" "Have you noticed that today every time we start to broach a certain topic we end up going down a rabbit hole and end up somewhere completely different? I'm wondering if we could choose to bring our attention to that part that is painful and stay there intentionally for a few moments here together? Would you be willing?"

As you look back on your work recently where do you notice your focus has been in terms of #1, #2, and #3?

In what ways can you think of to shift focus to #3 and #1 with your clients?