Committed Action in Practice: A Clinician’s Guide to Assessing, Planning, and Supporting Change in Your Client

226 Pages·2018·3.43 MB·English

by  Patricia A. Bach

“Committed action for specific behavior change is perhaps the most important piece of the
acceptance and commitment therapy (ACT) puzzle, and it is all too often overlooked.
Some of the true ACT pioneers and the brightest minds in behavior therapy have given
you the perfect roadmap to take your clients from possibility to action. Highly recom-
mended reading!”
—Dennis Tirch PhD, founder of The Center for Compassion Focused Therapy,
associate clinical professor at Mount Sinai, and coauthor of The ACT
Practitioner’s Guide to the Science of Compassion
“Years ago, as a young clinician trained in cognitive behavioral therapy (CBT), I was often
flummoxed in the face of this situation: I knew what clients needed to do to improve their
psychological well-being, but how could I get them to actually do it? Now, as a clinical
director and supervisor who works with complex and treatment refractory clients, that
same question continues to arise. Committed Action in Practice is a practical, pragmatic
book, useful for clinicians across a range of presenting issues, in the clinic, in schools, or
for life coaches. Its greatest strength is that it brings the evidence-based behavioral prin-
ciples and strategies inherent in ACT to bear on this simple yet quintessential question:
How do you help clients do what they need to do? This book distills ACT into elements of
valuing and committed action—the core motivational framework of ACT that will assist
clients to move forward in their lives whatever stage of change they are in. Clearly written,
and easily consumed, this is a book I highly recommend and will reach for again and again
when clients hit their stuck points in treatment.”
—Lisa W. Coyne, PhD, cofounder and director of the New England Center for
OCD and Anxiety (www.newenglandocd.org), founder and senior clinical
consultant of the McLean OCD Institute for Children and Adolescents, and
an assistant professor at Harvard Medical School
“Moran, Bach, and Batten did it again! This book is a must-read for all ACT practitioners
looking to optimize and augment their ACT skills by returning to core behavioral princi-
ples applied specifically to the process of committed action. This exciting new book shows
us how to assess, enhance treatment outcomes, and troubleshoot potential obstacles—as
they usually come in therapy—when facilitating values-based living. All chapters are
clearly written, full of examples, and have clear explanations. You won’t get lost when
reading this ACT book! Moran, Bach, and Batten also offer a fresh perspective about how
to blend committed action with other empirically supported interventions capitalizing on
the flexibility of the ACT model. This is a practical and powerful ACT book to read!”
—Patricia E. Zurita Ona, PsyD, founder of East Bay Behavior Therapy Center,
author of Parenting a Troubled Teen and Escaping the Emotional Rollercoaster,
and coauthor of Mind and Emotions
“This book is an essential tool for all professionals who apply evidence-based psychothera-
pies. It goes straight to the core of the ACT and all other evidence-based models: helping
the patient to move in the chosen valued direction. It describes how to build flexible pat-
terns of committed actions by creating and working inside a meaningful therapeutic rela-
tionship. As the therapist’s actions are the quintessential element of the therapeutic
relationship, it also carefully addresses the obstacles in his or her own committed patterns
to ease the process with the clients. A must-have, -read, and -practice for every ACT and
non-ACT therapist.”
—Giovambattista Presti, MD, PhD, psychotherapist, associate professor
in the department of general psychology at Kore University (Enna, Italy),
and president of the Association for Contextual Behavioral Science
“A must-read for ACT practitioners! The crucial importance of committed action is
evident, yet it is rarely illuminated how this core process is interwoven into the entire
model. Considering how committed action functions within the context of one’s life can
make the difference between intent and action, and Moran, Bach, and Batten give us the
tools to do just that.”
—M. Joann Wright, PhD, peer-reviewed ACT trainer, and coauthor of
Learning ACT for Group Treatment
“What a breath of fresh air! I highly recommend this original and much-needed book,
which truly fleshes out the ACT model in a myriad of ways. If you think committed action
is just goals, action plans, and problem-solving, think again. Committed action is an excit-
ing and ever-expanding part of ACT, and the authors do a fantastic job of explaining the
vast range of different interventions and strategies it covers, and teaching you how to
quickly and effectively implement them. No two ways about it: if you’ve got stuck clients
(and hey, who doesn’t?), you need this book!”
—Russ Harris, author of ACT Made Simple and The Happiness Trap
The Mastering ACT Series
Acceptance and commitment therapy (ACT) is a powerful,
evidence-based model that has been used successfully
in treating an array of disorders such as addiction,
depression, anxiety, self-harm, post-traumatic stress,
and eating disorders. Written by renowned leaders and
researchers in the field of ACT, the Mastering ACT series
explores each of the six processes of the ACT hexaflex:
acceptance, cognitive defusion, being present, self-as-
context, values, and committed action.
Based in the latest ACT research, this series is designed
to take complex theories and translate them into easy-to-
apply skills clinicians can utilize in treatment sessions.
Each book examines the theoretical aspects of a core
ACT process, details how each process can be seamlessly
and effectively introduced into therapy, and offers
multiple techniques to enhance treatment outcomes and
increase client psychological flexibility—the backbone
of ACT. These books are essential tools for clinicians,
researchers, students, and anyone interested in ACT.
Visit www.newharbinger.com for
more books in this series.

Committed
Action
IN PRACTICE
A CLINICIAN’S GUIDE TO
ASSESSING, PLANNING &
SUPPORTING CHANGE
IN YOUR CLIENT
DANIEL J. MORAN, P D
h
PATRICIA A. BACH, P D
h
SONJA V. BATTEN, P D
h
C P
ontext ress
An Imprint of New Harbinger Publications, Inc.
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to
the subject matter covered. It is sold with the understanding that the publisher is not engaged
in rendering psychological, financial, legal, or other professional services. If expert assistance
or counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2018 by Daniel J. Moran, Patricia A. Bach, and Sonja V. Batten
Context Press
An imprint of New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup
Acquired by Catharine Meyers
Edited by Susan LaCroix
Indexed by James Minkin
All Rights Reserved
Library of Congress Cataloging-in-Publication Data on file
Contents
1 What Is Committed Action?                   1
2 Perspectives on Commitment                  17
3 The Fundamentals of Contextual Behavioral Science for
Supporting Committed Action                  33
4 Assessing and Planning Committed Actions with Contextual
Behavioral Science                       53
5 Identifying Obstacles to Committed Action            69
6 Addressing Obstacles to Committed Action on the Part
of the Client                          81
7 Addressing Obstacles to Committed Action on the Part
of the Therapist                        97
8 Reviewing Evidence- Based Psychotherapies           115
9 Blending Evidence- Based Approaches with ACT        141
10 Application of Committed Action: Case Examples        163
11 Bringing It All Together                   183
References                          195
Index                            205

CHAPTER 1
What Is Committed Action?
S
ofia complains to her clinician that therapy isn’t helping her become the person
she wants to be. After three months, she still doesn’t have a job, she still lives
with her parents, she hasn’t lost any weight, and her English skills haven’t
improved. In addition, she is still depressed and anxious most of the time, and isn’t sure
she can change anything else in her life while feeling so depressed and anxious. At a
casual glance, Sofia appears to be a dedicated therapy client, always arriving early to
her sessions, completing detailed and neatly written behavioral logs between sessions,
and able to articulate goals. However, when it comes to action, she frequently makes
plans to do things, and rarely carries them out.
Sofia wants to move out of her parents’ house and live independently, and she’s
acknowledged that she needs to earn an income in order to do so, yet she’s been unem-
ployed since she completed training as a dental hygienist two years ago. At times, she
says that she really wants to earn money, and at other times she says that her parents
owe it to her to take care of her. Further, she recently stated that because she’s an immi-
grant from Mexico and speaks English with a heavy accent, she can’t apply for jobs
until she improves her English. However, when her therapist invites her to brainstorm
about opportunities to practice her English, Sofia balks at most of the suggestions
because she doesn’t want to look stupid to others. She also reports that she believes
she’ll have more success finding a job if she loses weight. Every few weeks she announces
that she has a new diet plan and describes in detail why she thinks this one will work.
She successfully follows each diet for five to ten days, then abandons it, giving reasons
such as “It’s unbearable feeling hungry all the time,” “This week was really stressful, and
I just can’t diet when I’m stressed out,” or “It was my mother’s birthday, and I had to eat
the birthday cake my tía made for my mom. Since I broke my diet, I just gave up.”
Sofia is like many clients in therapy. She wants her life to be different, yet she isn’t
entirely clear about how she wants it to be different. Perhaps more importantly, she’s
convinced that she must feel better before she can take action and that she can’t behave
effectively when she feels distressing emotions. She gives up easily when obstacles arise,
and she isn’t very open to exploring the multiple courses of action available to her. Sofia