Therapy Concepts & Terms

ACCEPTANCE COMMITMENT THERAPY (ACT) uses mindfulness skills to develop psychological flexibility and helps clarify and direct values-guided behavior. Rather than trying to teach people to better control their distress, uncomfortable, or unpleasant thoughts and feelings, ACT (pronounced “act,” not by its initials A-C-T) teaches people to “just notice,” accept, and embrace those thoughts and feelings, especially the unwanted ones. ACT helps the individual get in contact with a sense of self known as “self-as-context” – the you that is always there observing and experiencing. An ACT counselor does not see people as damaged or flawed, and does not define unwanted experiences as “symptoms” or “problems,” but resolves to define the function and context of behavior in order to determine its “workability,” for the purposes of creating rich and meaningful lives and increasing their psychological flexibility. ACT aims to help people clarify their personal values and to take action on them, and increase psychological flexibility.

The core conception of ACT is that psychological suffering is usually caused by experiential avoidance, thought entanglement, and resulting in psychological rigidity that leads to a failure to take needed behavioral steps in accord with core values. As a simple way to summarize the model, ACT views the core of many problems to be due to the concepts represented by the acronym, FEAR:

F  usion with your thoughts
E  valuation of experience
A  voidance of experience
R  eason giving for behavior

And the healthy alternative is to ACT:

A  ccept your reactions and feelings and be present
C  hoose a valued direction
T  ake action

Core Principles: ACT commonly employs six core principles to help clients develop psychological flexibility:

Defusion: Learning methods to reduce the tendency to make thoughts and emotions real.

Acceptance: Allowing thoughts and feelings to come and go without struggling with them.

Connection with the present moment: Awareness of the here and now, experienced not with judging but with openness, interest and receptiveness.

The Observing Self: Awareness of what we’re thinking and feeling, not the thinking self (thoughts, beliefs, judgements, fantasies).

Values: Discovering what is most important to one’s true self.

Committed Action: Setting goals according to values and carrying them out responsibly.

These six processes are not separate, but overlapping and interconnected. All six of these processes are introduced and developed experientially over the course of therapy. Psychological flexibility can be defined simply as “the ability to be present, open up, and do what matters.” What is the Aim of ACT? The aim of ACT is to experience the fullness and vitality of life, which includes a wide spectrum of human experience, including the pain that inevitably goes with it. Acceptance (not the same as approval) of how things are, without evaluation or attempts to change it, is a skill that is developed through mindfulness exercises in and out of session. ACT does not attempt to directly change or stop unwanted thoughts or feelings (as in cognitive behavioral therapy), but to develop a new mindful relationship with these experiences that can free a person up to be open to take action that is consistent with their chosen values. The values clarification is a key component to ACT.

Being present means being in direct contact with the present moment, rather than drifting off into automatic pilot, and getting in touch with the observing self, the part that is aware of, but seperate from, the thinking self.

Mindfulness techniques are taught to experience the observing self firsthand, whether they bring awareness to each of the five senses, thoughts, or emotions.

Opening up is the ability to detach from thoughts (defusion) and accepting, or making space for and dropping the struggle with painful feelings, urges, sensations, etc. Acceptance is the ability to allow what is to be as it is instead of fighting or avoiding it. If someone is thinking, “I’m a terrible person,” they might be instructed to say, “I am having the thought that I’m a terrible person.” This effectively separates the person from the cognition, thereby stripping it of its negative charge. When someone is experiencing negative emotions, like anxiety for example, they might be instructed to open up, breathe into, or make space for the physical experience of anxiety and allow it to remain there, just as it is, without exacerbating or minimizing it. Often, these painful and uncomfortable experiences and feelings will lose their power.

Values Clarification and ACT

Doing what matters is all about values clarification, knowing what matters to you personally, and taking effective action guided by those values. Various exercises are employed to help identify chosen values, which act like a compass from which to direct intentional and effective behavior. People who are fused with their thoughts tend to struggle with or avoid painful emotions, and often struggle with choosing a purposeful and values-guided action. Through mindful liberation from such struggle, they find acting congruently with their values quite natural and fufilling. (Back to Top)

Adapted from the following sources:

• Jiovann Carrasco (www.goodtherapy.org/Cognitive_Behavioral_Therapy.html)
• Wikipedia (http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy)

COGNITIVE BEHAVIORAL THERAPY uses a practical approach in which the counselor helps the client examine the relationship between beliefs, feelings, and thoughts and the effect these have on behavior patterns and actions. The client learns that his or her perception may directly affect the reaction to certain conditions and circumstance and that this thought process can affect his or her behavior. CBT is “problem focused” (undertaken for specific problems) and “action oriented” (therapist tries to assist the client in selecting specific strategies to help address those problems). CBT is thought to be effective for the treatment of a variety of conditions, including mood, anxiety, depression, and substance abuse. CBT techniques can help individuals challenge their patterns and beliefs and replace “errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing” with “more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior” or to take a more open, mindful, and aware posture toward them so as to diminish their impact. CBT may refer to different interventions, including “self-instructions (e.g. distraction, imagery, motivational self-talk), relaxation and/or biofeedback, development of adaptive coping strategies (e.g. minimizing negative or self-defeating thoughts), changing maladaptive beliefs about pain, and goal setting”.

Adapted from the following sources:

• Good Therapy  (http://www.goodtherapy.org/Cognitive_Behavioral_Therapy.html)
• Wikipedia (http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy)

EMOTIONALLY FOCUSED THERAPY (EFT) EFT’s main goals are to expand and reorganize important emotional responses, implement and foster the creation of a secure bond between partners, and help shift each partner’s position of interaction while initiating new cycles of interaction that are more beneficial for the relationship. EFT helps create secure and lasting bonds between partners and family members and strives to reinforce the positive bonds that already exist. EFT is a practical technique that has enormous success with couple, and can facilitate change in marriages and relationships that exhibit a wide range of challenges. EFT works to intervene where needed and create change to help relationships work more effectively through a spirit of harmony and respect.

Adapted from the following source:

• Good Therapy (http://www.goodtherapy.org/emotionally-focused-therapy.html)

FAMILY OF ORIGIN the family we grew up in, as opposed to the people we live with now–is the place we learned to be who we are, for better and worse. From our family we learn how to communicate, deal with our emotions, and get our needs met. We also learn many of our values and beliefs from our families. We often develop our sense of self in the context of our family of origin–a strong sense of self if we are loved and kept safe most of the time; often, a damaged sense of self if love and safety are frequently unavailable.

FAMILY SYSTEMS THEORY works with individual, families, or couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between relationships. It emphasizes relationships (current and family of origin) as an important factor in psychological health. Systems therapy gains insight into each member’s role as it relates to the healthy functionality of the whole. Systems Theory can be applied to organizations, couples, communities, or families. The technique relies on identifying specific behavior patterns and how each member responds to anxiety within the dynamic. By doing this, the individual participants can begin to understand and transform their patterns to more adaptive, productive behaviors. Systems Theory has evolved from a rather single dimensional form of treatment to a multi-faceted method that is applied to many different situations. It strives to help the members of the group attain positive, secure relationships in order to improve their well-being and inter-relational experiences. Many different conflicting situations and issues can be effectively treated, and it is a common belief that, regardless of the origin of the problem, and regardless of whether the clients consider it an “individual” or “family” issue, thinking in terms of family relationship in solutions often benefits the process. This involvement of families does not have to be accomplished by their direct participation in the session; much of the involvement is often done through insight into family patterns and how they relate to adult relationships. The skills of the family counselor thus include the ability to influence insight and conversations in a way that catalyses the strengths, wisdom, and support of the wider system.

Adapted from the following sources:

• Good Therapy (http://www.goodtherapy.org/systems-theory-therapy.html)
• Wikipedia (http://en.wikipedia.org/wiki/Family_systems_theory)

GENOGRAM is a multi-generational pictorial display, created by the counselor, of a person’s family relationships and family history. It goes beyond a traditional family tree by allowing the user to visualize hereditary patterns and psychological factors that punctuate relationships. It can be used to identify repetitive patterns of behavior and to recognize hereditary tendencies. In therapy, genograms are used to study and record relationship patterns between family members and the individual characteristics that make up these patterns that occur. A genogram helps to make an appropriate assessment of the relationship patterns and where intervention may be needed to help reduce the problematic situation that was brought into therapy.

A genogram is created with simple symbols representing gender, and various lines to illustrate family relationships.

It explores family details and trends such as: socioeconomic status, culture and heritage, finances and relationships to money, class and status expectations, health, secrets, communication styles, cut-offs, abuse, trauma, unspoken family rules, family themes, family expectations, and family values.

A genogram can contain a wealth of information on the families represented, in both adult relationships as well as a client’s family of origin. Genograms include multi-generational relationships and are an in-depth analysis of how individuals relate to one another. It will not only show you the names of people who belong to your family lineage, but how these people relate to each other. For example, a genogram will not only tell you that your uncle Paul and his wife Lily have three children, but that their eldest child was sent to boarding school, that their middle child is always in conflict with her mother, that their youngest has juvenile diabetes, that Uncle Paul suffered from depression and alcoholism, and was a philosopher, while Aunt Lily has not spoken to her brother for years, has breast cancer and has a history of quitting her jobs.

Adapted from the following sources:

• Wikipedia (http://en.wikipedia.org/wiki/Genogram)

THE GOTTMAN MODEL the principle goals of the Gottman Model with counseling couples are to disarm conflicting verbal communication, to increase intimacy, respect, and affection, to remove barriers that create a feeling of stagnancy in conflicting situations, and to create a heightened sense of empathy and understanding within the context of the relationship. Gottman found that there are four negative behaviors that most predict divorce or break up: criticism of partners’ personality, contempt (from a position of superiority), defensiveness, and stonewalling, or emotional withdrawal from interaction. On the other hand, stable couples handle conflicts in gentle, positive ways, and are supportive of each other.

Adapted from the following sources:

• Good Therapy (www.goodtherapy.org/gottman-method.html)
• Wikipedia (http://en.wikipedia.org/wiki/John_Gottman)

POSITIVE PSYCHOLOGY is the scientific study of the strengths that enable individuals and communities to thrive, of what makes life most worth living, or the scientific study of positive human functioning and flourishing on multiple levels that include the biological, personal, relational, institutional, cultural, and global dimensions of life. The field is founded on the belief that people want to lead meaningful and fulfilling lives, to cultivate what is best within themselves, and to enhance their experiences of love, work, and play.

Positive psychology began as a new domain of psychology in 1998 and is a reaction to the focus of “mental illness” which emphasizes maladaptive behavior and negative thinking. Instead, positive psychology encourages an emphasis on happiness, well being, and positivity.

Positive psychologists have suggested a number of ways in which individual happiness may be fostered. Social ties with a spouse, family, friends and wider networks through work, clubs or social organizations are of particular importance, while physical exercise, laughter and the practice of meditation may also contribute to happiness.

Adapted from the following sources:

• Positive Psychology Center (www.ppc.sas.upenn.edu)
• Wikipedia (https://en.wikipedia.org/wiki/Positive_psychology)

PREPARE/ENRICH is a customized couple assessment completed online that identifies a couple’s strength and growth areas. It is one of the most widely used programs for premarital counseling and premarital education. It is also used for marriage counseling, marriage enrichment, and couple in long term relationships or that are co-habitating. Based on a couples’s assessment results, a trained facilitator (counselor) provides 4-8 feedback sessions in which the facilitator helps the couple discuss and understand their results as they are taught proven relationship skills.

Adapted from the following source:

• www.prepare-enrich.com

THERAPEUTIC RELATIONSHIP also called the helping alliance, the therapeutic alliance, and the working alliance, refers to the relationship between a healthcare professional (counselor) and a client (or patient). It is the means by which they hope to engage with each other, and effect beneficial change. While much early work on this subject was generated from a psychodynamic perspective, researchers from other orientations have since investigated this area. It has been found to predict treatment adherence (compliance) and outcome across a range of client/patient diagnoses and treatment settings. Research on the statistical power of the therapeutic relationship now reflects more than 1,000 findings.