The ACT Matrix: How to Maximize Your Intake Sessions

The ACT Matrix: How to Maximize Your Intake Sessions

by Jacob Martinez, MA, LPC

There’s nothing more satisfying to me than conducting an intake session with a new client. Especially an intake session where the client leaves feeling heard, and excited to take part in the treatment ahead. Over the years I’ve been tweaking and adjusting my methods for intakes.

As an ACT therapist who takes a very active approach, it’s important to me that the work begins as early as possible (yes, even on session one). My main goals when conducting an intake are to allow space for the client to tell their story, then begin to work with the client collaboratively in sorting their story out in an ACT consistent way. We focus on experiential learning and simplicity.

If we can build this solid foundation early—really get to the heart of Acceptance & Commitment Therapy. Then the client’s goals begin to align with treatment and clients leave the office with a healthy dose of hope. They are often, dare I say, eager to complete their homework and show it off at the next session. From there, the rest of the work flows – and it all begins in session one.

Intake sessions are, in my opinion, the most important moment in the therapeutic process. What is the secret to conducting these intakes? Why, the ACT Matrix! I’ve learned to apply the ACT Matrix in such a way as to structure the intake session so that it maximizes rapport building, defines treatment goals, and increases the likelihood of clients returning for their next session.

Starting with The Matrix in session one also helps me keep applying ACT in a consistent manner throughout the course of treatment. If all of this piques your interest, I invite you to check out our on-demand training, “Conducting Intake Sessions with The ACT Matrix.”

I’ll walk you through how to structure ACT consistent intake sessions, how to conduct an ACT Matrix with any client, and give you my scripts of how I set up and explain each step of the process in clear and simple way that you can use with clients instantly.

Jacob Martinez, MA, LPC is an Acceptance and Commitment Therapy (ACT) therapist and trainer living in Wisconsin. He is the former President of the Texas ACBS Chapter and host of ACT Naturally where he interviews great therapists, talks mental health & wellness, and demonstrates ACT skills. Learn more about his work at ACTNaturally.net Learn more about Jacob Martinez, MA, LPC and other trainers on our Trainers page.

 

Understanding ACT, DBT, and FAP: Similarities and Differences

Understanding ACT, DBT, and FAP: Similarities and Differences

by Michel Reyes, Ph.D.

Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and Functional Analytic Psychotherapy (FAP) are all considered ‘third-wave’ behavior therapies. Dialectical Behavior Therapy and Acceptance and Commitment Therapy are considered empirically supported treatments (ESTs), while Functional Analytic Psychotherapy, though also a principle-based behavior treatment, has yet to amass the same level of empirical validation. New learners of ACT, DBT, and FAP often struggle to distinguish these treatments from each other on the basis of more than their topography. Here, we provide a description of key features of these treatments and their similarities and differences.

Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy, or DBT, is a principle-based behavioral therapy in which clinicians have a wide range of treatment strategies and protocols that can be used with flexibility according to the client presentation in any particular point in time. DBT is an intersection between behavior therapy and Zen contemplative practice held together with a dialectical philosophy, these three are the foundations of DBT. The Behavioral foundation of DBT is linked to Arthur A. Staats psychological behaviorism and translate in DBT as the adoption of a scientific approach to the study and treatment of behavior, the application of learning theory to explain people’s behavior and the use of empirically supported Behavior Therapy assessment and treatment procedures. Zen foundations can be observed in the introduction of concepts such as Mindfulness and Radical Acceptance, the notion of pain as part of existence, the recognition that the denial of pain creates suffering, and several others. And the dialectical foundations can be noticed in DBT holistic view of behavior and the transactional perspective it takes to its understanding, the adoption of a dialectical perspective in which every perspective on reality is true but partial and so complimentary. And also, DBT embraces a dialectical approach in basically any aspect of DBT such as its biosocial theory, the balance between acceptance and change strategies and the balance between modifying client behavior and changing clients environment. Some distinctive features of comprehensive DBT are the presence of different treatment modalities aimed to develop client’s skills, generalized them, enhance motivation to use them, structure the environment and enhance therapists’ skills and motivation. DBT is an Empirically Supported treatment for adults and adolescents’ problems characterized by great emotion regulation difficulties and severe impulsivity.

Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy, or ACT, is a treatment rooted in the philosophy of science known as Functional Contextualism and the behaviorism wave known as Contextual Behavioral Science. ACT is, in many senses, the application of Relational Frame Theory, a contextual behavioral approach to the study of language and cognition, to the understanding and treatment of client self-regulatory behavior. ACT therapists seek to promote psychological flexibility, which is the skill to remain aware in the presence of discomfort while behavior is organized according to what is valuable in that particular moment. The way ACT therapists accomplish this is through developing acceptance of aversive private events, present moment awareness and committed action, which is behavior-oriented with the person individual values. ACT targets the tendency to follow ineffective rules, especially those that promote experiential avoidance at the expense of a valued life, through the use of metaphors, experiential exercises and defusion techniques. ACT is an empirically supported intervention for problems related to experiential avoidance and, more broadly, psychological inflexibility.

Functional Analytic Psychotherapy (FAP)
Functional Analytic Psychotherapy, or FAP, is closer to Skinner’s radical behaviorism. It is based on the observation that client’s behavior outside and inside therapy session is, in general, functionally equivalent. And so, the occurrence of behavior inside a session provides a great opportunity to make hypotheses about its controlling variables and a great opportunity to intervention. FAP technique is the application of five rules, this could be understood as observing the occurrence of Clinically Relevant Behaviors abbreviated as CRBs in session, the use therapists natural reactions to evoke CRB, reinforce desirable behavior, and if everything worked well enough analyzing the interaction between client and therapists and generalize desirable behavior shaped and reinforced in session to clients natural environment.

Similarities and Differences between DBT, ACT, and FAP
In this moment, the commonalities I find between DBT and ACT are the notion of suffering as a product of trying to avoid or suppress uncomfortable experience and attachment to rules about the way things and oneself are supposed to work, the goal of creating a life perceive as valuable or worth living, and the integration of acceptance and change, or commitment, interventions to enhance clients ability to stay mindful in the presence of uncomfortable situations while remaining aware of their values and goals, so that they can choose to behave in a conscious or effective way towards their life choosing directions. Both treatments make use of functional analysis, metaphors, experiential exercises and unconventional uses of language to help clients reframe their experience. The main differences would be that DBT adopts a more educative approach while ACT emphasizes an experiential one, DBT adopts a biosocial perspective on behavior while ACT perspective is contextual, DBT philosophy is dialectical while ACT is functional contextualistic, DBT is a treatment applied to a group of community of clients by a community of clinicians and ACT is much more used as an individual intervention although it can be adapted to group or commentary interventions. Both treatments have very specific strategies that make them unique. Also, ACT and FAP, targets functional classes of behavior, while DBT has very clear target priorities that aren’t defined by its function but by their severity.

Other similarities are that DBT, ACT, and FAP put a lot of attention to the transaction between therapist and client’s behavior and the observation of parallels between clients in session and out of session behavior. Also, these 3 therapy models target clients in session behavior as a way to strength client’s useful behaviors that can be generalized to their natural environment. Maybe the differences would be that FAP makes a greater emphasis in the disclosing of therapist’s reactions as a way to evoke and reinforce client’s desirable actions, while DBT and ACT therapists use self-disclosure in more moderated fashion and for additional purposes. Again, DBT has a specific target hierarchy of in session client’s behavior and specific strategies, ACT targets classes of behavior and they have specific strategies to target in session behavior, FAP targets are defined ideographically and since it depends on therapists natural reactions is difficult to define specific treatment processes and strategies.

Dr. Reyes has worked in the development of three public sector outpatient clinics for persons with severe emotion dysregulation problems and coordinated the implementation of a DBT based program in 52 schools in Guadalajara Jalisco. He is co-founder of Mexico’s CBS & Therapy Institute where he coordinates an outpatient DBT program. Michel has published four books in Spanish, two manuals on emotion regulation, another on Functional Analytic Psychotherapy, and co-authored a manual on ACT for grief-related problems. These titles include Functional Analytic PsychotherapyEmotion Regulation in the Clinical Practice, and Acceptance and Commitment treatment of Grief.

The Parthenon on Quicksand

The Parthenon on Quicksand

by Angela Cathey

This may be a time of transition for psychology. Our path as a field has led to some great advances but as it has grown it also has begun to unravel at its seams.

The credibility of psychology
Though every field has its strong personalities and theoretical battles, psychology is one of the few fields so advanced, and yet, resistant to settling on common language and methodology. Having a level of fundamental disagreement that runs so deeply as to prevent basic agreement around measurement is obstructing the growth of our field. We advance a view of measurement at the base level of observable behavior, whenever possible, and fitting of this under different traditions. Relying on this level of metric allows various schools to find a common language around fundamental and observable relationships between behavior.

The impact of not having a common language
Disagreements about metrics expand into disagreements around the constructs they measure, application of methods to move these constructs, and finally the construction of methodologies to measure the effects of application. We see this in raising up of the Randomized Controlled Trial (RCT) as a standard research methodology for deeming treatments efficacious. RCTs are a research methodology established around finding differences between groups, assumptions that behaviors and symptoms vary on a normal curve, and attempts to reduce measurement ‘error’ around a hypothetically constant construct. Backing down to the level of measuring actual behavior, when possible, allows us to scale to construct with less statistical and methodological ‘noise’ added to the top of everything. Use of these methods and reliance on assumptions to make the normal curve ‘work’ have likely contributed to the replication crises currently observed in behavioral science research. Some of this is inherent in the process of developing a science itself; however, as a science, we need to agree at the methodological level so we can soundly disagree at other levels. Allowing our science to further build on highly variable methodology is building the Parthenon on quicksand.

How to liberate behavioral scientists through entrepreneurship.

How to liberate behavioral scientists through entrepreneurship.

by Todd A. Ward, PhD, BCBA-D
bSci21Media, LLC

In modern society, our behavior ultimately functions to do two things – to pay your mortgage and feed your kids.  For those of us in the behavioral community, we would prefer to achieve said ends by doing what we know best – behavioral science.  For many, that means getting a job in your industry and working as an employee to fulfill someone else’s dream.  Even in the halls of academia, drawn by the allure of the tenure track, faculty commonly succumb to a byzantine bureaucracy that saps brilliant people of their motivation.  Trapped by the golden handcuffs of academia, many simply “settle” for security at the expense of passion.  But it doesn’t have to be that way.

I know because I’ve been there.

It’s 2018, and the world has finally figured out how to use the Internet.  Today, we can reach millions of people easier than ever before, and without any “middlemen.”  The Internet is the great equalizer, giving everyone a voice.  Those with just a dash of entrepreneurial know-how are able to leverage the freedom and opportunity brought about by our interconnectedness in ways that were never before possible.

So, if you find yourself “spacing out” at your desk, staring blankly at your computer like Peter Gibbons in Office Space, now is the time to do something about it.  You can liberate yourself from the confines of a steady paycheck to start down a path that will allow you to follow your valued directions more so than ever before.

Members of the behavioral science community have a major entrepreneurial advantage that others don’t have.  Our emphasis on behavior change means most businesses emphasize services rather than products.  And if we do have products, they are commonly logistically light, such as ebooks, apps, online courses, and the like.

This means we can be light and agile.  We don’t need to negotiate complex logistical chains for our products.  We don’t need to purchase large amounts of inventory or buildings.  We don’t need to chase investors and submit to their strings.  We don’t even need to be location bound.  A single person can create an independent business and make it on their own in 2018.  If things take off, you can always scale up with contractors and employees down the road.

I know because I’ve done it.

Below are a few simple steps that you can take today to find a new life as a values-driven entrepreneur.

Take an inventory of your own strengths within behavioral science.
We all came to behavioral science because we have a passion for behavior change – to improve people’s lives and make the world a better place.  But within the science, we each excel at something.  For you, this could mean a passion for data analytics, writing, research, or even building relationships.

Take an inventory of your own strengths in your larger life.
We all have professional strengths, but we also have strengths and passions in our larger lives.  Perhaps you enjoy art, cooking, fishing, or sports.  Anything goes here, because whatever you list is behavior, which is within the realm of behavioral science.  The important thing is that you are passionate and motivated to do these things.

Adjust your view of your own field if necessary.
Behavioral science isn’t really about procedures so much as the underlying principles.  After all, if we were really that hung up on procedures, we would still be running rats and pigeons with Skinner.  If you are able to see through particular techniques and procedures to the underlying principles, then you have a formless science with unlimited applications.  This is what Skinner repeatedly talked about with his “technology of behavior” – a science applicable to any human problem.  “Let those extrapolate who will” he said at the end of Behavior of Organisms.  This is your moment to answer Skinner’s call.

Clarify your life values.
Values are chosen life directions that can never be fulfilled.  It might be more appropriate to talk about the behavior of “valuing” rather than “values” as a thing.  Clarifying your own life values can function to establish new reinforcers in your life, and can help you track the extent to which you are living in accordance with your valued direction and adjust as needed.  When thinking about your own values, try to come up with words ending in “-ing”.  For example, if you value “learning”, you can learn in any situation in life, and you can never stop learning – no one can ever “learn everything.”  But you can gauge the degree to which you turn each moment into a learning opportunity and adjust accordingly.

Put the pieces together.
So now you have clarity on your professional and personal strengths and your life values.  Now it’s time to put the pieces together.  Create a relational network amongst the elements that you outlined above.  In doing so, consider how you can leverage your own strengths towards the development of a values-based business that is personally fulfilling to you and creates value for larger society.  A great tool that will help map your ideas onto a business model is the free business plan template developed by SCORE.  The template covers all aspects of a business, from mission and vision to pricing, competition, and more.  As Skinner once said, you often have to “discover what you have to say” – and the first step is putting pen to paper.  You are guaranteed to come up with ideas you never would have otherwise.

Todd A. Ward, PhD, BCBA-D is President of bSci21Media, LLC, which owns bSci21.org, a world leader in the dissemination of behavior analysis to the public through articles, video production, web design, and entrepreneurial consultation.  He is a passionate believer in the role of entrepreneurship in fulfilling Skinner’s vision of a technology of behavior change to improve the world. Dr. Ward received his PhD in behavior analysis from the University of Nevada, Reno in 2013 and specializes in Organizational Behavior Management and Behavioral Systems Analysis.  He has served as a Guest Associate Editor for the Journal of Organizational Behavior Management and currently serves on the Editorial Board of Behavior & Social Issues.

Todd Ward, PhD, BCBA-D

Todd Ward, PhD, BCBA-D

Contributing Writer

Todd A. Ward, PhD, BCBA-D is President of bSci21Media, LLC, which owns bSci21.org, a world leader in the dissemination of behavior analysis to the public through articles, video production, web design, and entrepreneurial consultation.  He is a passionate believer in the role of entrepreneurship in fulfilling Skinner’s vision of a technology of behavior change to improve the world. Dr. Ward received his PhD in behavior analysis from the University of Nevada, Reno in 2013 and specializes in Organizational Behavior Management and Behavioral Systems Analysis.  He has served as a Guest Associate Editor for the Journal of Organizational Behavior Management and currently serves on the Editorial Board of Behavior & Social Issues.

The impact of an Acceptance and Commitment Therapy (ACT) intervention on parent behavior towards children with Autism

The impact of an Acceptance and Commitment Therapy (ACT) intervention on parent behavior towards children with Autism

by Lisa Truong

Parents of children with autism or other developmental delays often face difficult challenges and negative private thoughts, which in turn inhibits parents’ abilities to implement effective interventions for their children. The parents’ behaviors are influenced by rule-governed behavior as opposed to contingency shaped behavior. Contingency-shaped behavior is controlled by being exposed to environmental contingencies, while rule-governed behavior (RGB) is an effect of our ability to derive rules from other experiences. Our ability to learn from other experiences and the verbal behavior of others and then apply it to other situations is thought to be an essential human ability that explains many of our higher thinking capabilities. However, RGB can result in over-extension of rules to situations in which they do not apply. One particular category of RBGs, called plys (or “pliance”) is the over-extension of socially derived rules for behavior. For example, a child told by a parent that they should always wear a jacket when they go outside may derive a rule driven by social contingencies rather than the appropriate response to the environment. If the child then tends to put on their jacket based on the rule, without regard for whether it is hot or cold outside, then this child is acting in pliance. This is likely to occur, in part, because one of the known properties of RGB is a reduction in sensitivity to environmental contingencies and contingency-shaped behavior. In a sense, the stronger RGB, the more in tune an individual is with rules rather than the environment. This tends to result in behavior that becomes increasingly narrow and inflexible.

Parents may also act in rule-governed ways when it comes to responding to their child’s behavior. An example would be how a parent would respond to their child crying in public. Rather than ignoring the child’s inappropriate behavior, parents tend to act according to societal expectations. Further, parents may experience accompanying aversive emotional states (e.g., anxiety and embarrassment) and seek to avoid these emotions by parenting in such a way that ends their child’s problematic behavior more quickly in the short-run but extends the life of the behavior through reinforcement. This can lead parents struggling to deal with their own private events to effectively follow behavior plans.

Acceptance and Commitment Therapy (ACT) is a contemporary behavior analytic approach to addressing these private events. The goal of ACT is to increase response flexibility so that clients can better track and engage in behaviors that lead them toward valued living. The ability to act in such ways is often referred to as “psychological flexibility.” Recent research has shown that parenting-specific psychological flexibility leads to more adaptive parenting behaviors and lower levels of child problem behaviors.

The main goal of ACT for parents of children on the autism spectrum is to increase adaptive parenting behaviors in the service of the parents’ values. Parents are asked to identify specific overt behaviors (e.g., playing with their child for at least 15 minutes each day) which would move them towards their own parenting values. A 2017 study (Gould, Tarbox, & Coyne) indicated that a six-week ACT protocol produced an increase in value-directed, overt behaviors in parents with children with autism. These increases in value-directed behavior were maintained at follow-up.

Sources

Gould, E. R., Tarbox, J., & Coyne, L. (2018). Evaluating the effects of Acceptance and Commitment Therapy on overt behavior of parents of children with autism. Journal of Contextual Behavioral Science, 7, 81-88.

Lisa Truong

Lisa Truong

Contributing Writer

Lisa Truong graduated from the University of Texas of Austin with degrees in Psychology and Human Development and Family Sciences, with a concentration in personal relationships. She has over a year of experience in the applied behavioral analysis field and currently works as a behavior therapist at The Behavior Exchange. She has experience working with children from 2 to 16 years of age in both clinical and in-home settings. She also has an interest in tech, visual design, and art since she was young. Since graduating, she has been trying to find opportunities to bridge behavioral sciences, technology, and visual aesthetics to create beautiful and easy-to-follow experiences.

A behavioral intervention to reduce the impact of stigma (ACT).

A behavioral intervention to reduce the impact of stigma (ACT).

by Lisa Truong

Psychological inflexibility is a psychological process that can be used to explain how stigma affects us. Recent research (Krafft, Ferrell, Levin, & Twohig, 2017) indicates that distress experienced in reaction to stigmatization is less when those experiencing stigmatization are more “psychologically flexible.” Psychological flexibility is a mid-level construct frequently used in Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) that refers to adaptive flexibility in behavioral repertoire, particularly in the face of distress or barriers.

Many groups (e.g., racial minorities, sexual minorities, and various social classes) experience stigmatization and distress as a result of this stigmatization. It is believed that observed elevations in psychological and physical health issues in these groups may be, in part, a result of the effects of stigmatization. Further, people who belong to stigmatized groups may generalize the stigmatization to their own self-concept, further exacerbating their distress. Self-stigmatization may lead to isolating behaviors and a lower overall quality of life.

ACT is believed to reduce the negative effects of stigma by targeting the relationship with stigmatizing thoughts and attitudes. ACT techniques were developed based on Relational Frame Theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001) a post-Skinnerian behavior analytic formulation of how thought and human language develops. ACT techniques are thus meant increase one’s ability to accurately track the natural environment and react adaptively, rather than getting hung up in the distressing and awareness reducing properties that occur as a result of “languaging.” In practice, this means that ACT practitioners build psychological flexibility by experientially teaching them how to engage in adaptive behaviors in accordance with their values, even when difficult emotions come along for the ride. This often involves the use of metaphor, experiential exercises, and other techniques that briefly alter the functions of verbal behavior such that other contingencies may be better contacted.

Numerous studies now indicate that ACT interventions for reducing the detrimental effects of stigmatization above other alternatives (e.g., education, multi-cultural training). These studies support the efficacy of ACT as an intervention for reducing the distress associated with stigmatization and reducing internalized negative self-concept. Further, similar research has indicated that ACT may reduce the negative impact of stigma in a variety of groups, including but not limited to: those with Schizophrenia, HIV, obesity, substance abuse issues, and those who belong to racial and sexual minority groups.

Sources

Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2001). Relational Frame Theory: A post-
Skinnerian account of human language and cognition. Kluwer Academic: New York.

Hayes, S. C., Strosahl, K. D., & Wilson, K. (1999). Acceptance and Commitment Therapy: An 
experiential approach to behavior change. Gilford Press: New York.

Krafft, J., Ferrell, J.; Levin, M. E.; & Twohig, M. P., (In Press). Psychological inflexibility and 
stigma: A meta-analytic review. Journal of Contextual Behavioral Science

Lisa Truong

Lisa Truong

Contributing Writer

Lisa Truong graduated from the University of Texas of Austin with degrees in Psychology and Human Development and Family Sciences, with a concentration in personal relationships. She has over a year of experience in the applied behavioral analysis field and currently works as a behavior therapist at The Behavior Exchange. She has experience working with children from 2 to 16 years of age in both clinical and in-home settings. She also has an interest in tech, visual design, and art since she was young. Since graduating, she has been trying to find opportunities to bridge behavioral sciences, technology, and visual aesthetics to create beautiful and easy-to-follow experiences.

Strengthening the Roots of Our Science and Practice.

Strengthening the Roots of Our Science and Practice.

by Angela Cathey, MA, LPC (Owner, Behavior-Behavior.org & Evolve, by ENSO Group)

Behavior-Behavior was founded as a part of a movement to strengthen the roots of our science and practice as behavioral scientists and practitioners.

As a field, we have moved too far under the conditions that influence our training and funding as researchers and practitioners. Training programs more and more spend significant time training their students on particular treatment protocols and their components, without spending adequate time teaching students what drives these protocols – the principles, methodology, and contingencies that move our field.

As practitioners and researchers, it becomes our responsibility to obtain a deeper level of skill and to do so in environments that don’t typically support the time and cost needed to keep abreast of important developments in our field.

Behavior-Behavior is an effort to make strengthening and deepening your practice based on principles and the latest research more workable for practicing clinicians and researchers. We offer news, practice tools, online training, and consultation for the discriminating clinician and researcher.

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