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Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists Jason B. Luoma, Steven C. Hayes and Robyn D. Walser Oakland, CA: New Harbinger Publications, 2007. pp. 352. £22.68 (pb). ISBN: 978-157224-498-4.

Published online by Cambridge University Press:  16 September 2008

Eric Morris*
Affiliation:
South London and Maudsley NHS Foundation Trust
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Abstract

Type
Book Review
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2008

In the last 10 years Acceptance and Commitment Therapy (ACT) has emerged as one of the major approaches in a modern wave of contextual behaviour therapy. Readers of the original ACT manual (Hayes, Strosahl and Wilson, Reference Hayes, Strosahl and Wilson1999) will be aware that, aside from the presentation of a novel model of working with human suffering, it also contained some challenging and counter-intuitive ideas regarding theory and innovation in behavioural and cognitive therapies.

Despite the length of time that ACT has been on the scene, there has been a relative lack of training opportunities, particularly outside of the USA. Many practitioners may have read the 1999 ACT manual, and/or attended an introductory workshop, been excited by the ideas but, given limited availability for further training/supervision, may have not felt sufficiently confident to start using ACT with their clients. It could also be argued that in the CBT community the challenging ideas of ACT have overshadowed its accessibility as a talking therapy.

This new guide, Learning ACT, will go a long way in meeting the needs of therapists for a general, how-to approach to ACT (extending the benefits of training and supervision). This workbook sets out to de-mystify ACT for therapists who are curious about an experiential form of behaviour therapy, and also provides a structured learning opportunity for developing ACT skills.

Luoma, Hayes and Walser have written a competency-based workbook that intends to increase therapists' familiarity with the functional analytic model of ACT, and also provide guidance for timely and effective use of therapy techniques. Consistent with ACT's behavioural approach, the workbook tackles skills development as a form of discrimination training, with many opportunities through written exercises for the reader to receive feedback regarding their understanding.

Learning ACT is not intended to be a stand-alone guide, but rather complements previously published work; thus, for a number of the metaphors and exercises mentioned, the reader is referred to the existing literature for a detailed description. The workbook teaches general skills in case formulation and techniques, relevant to a range of disorders and will supplement the various published ACT manuals for working with particular problems. There is no extensive discussion of the evidence for ACT in this guide, although the reference list does point to the key studies.

The first chapter probably presents, to date, the most succinct and straightforward description of the philosophy, basic science, and model of psychopathology underpinning ACT. Even Relational Frame Theory, the behaviour analytic account of language that ACT is based upon, is briefly and clearly described. The reader is directed to further reading for more detailed accounts. The rest of the book is structured into chapters outlining components of the ACT model, containing descriptions of key therapy targets, methods and transcripts of sessions (with commentary on the use of language and theory links). At the end of the chapters are exercises to test readers' identification of ACT-consistent and -inconsistent therapeutic responses. The chapters outline skills in developing willingness/acceptance, undermining cognitive fusion (teaching mindfulness and decentring), getting in contact with the present moment, learning to distinguish self-as-content from an observing self, values clarification, and building patterns of committed action. Competencies for each skill are described; for example from the Self as Context chapter (p. 121), “Competency 3 – The therapist utilizes behavioural tasks to help the client notice the workings of the mind and the experience of emotion while also contacting a self who chooses and behaves with these experiences, rather than for the experiences”.

There is also a chapter on case formulation, describing an idiographic, functional analytic method to understanding client problems in terms of core ACT and behavioural processes. This chapter's philosophy will be familiar to CBT therapists who work using an individualized, case formulation approach, and of interest in understanding a contemporary behavioural approach to thinking and emotion.

The accompanying DVD (included with the workbook and 2 hours in length) complements and extends the discrimination training. The DVD comprises short role-played vignettes of the core ACT processes (modelled by the three authors, working with a variety of client problems), with examples of consistent and inconsistent therapist responses. For each vignette, the watcher is encouraged to rate how ACT-consistent the responses are, and then receives a brief rationale for the answer. The DVD is very helpful in seeing ACT in action, as the mindful and compassionate stance described in the book becomes apparent, and the vignettes clarify some of the potentially confusing concepts.

Learning ACT is a very approachable and well-structured guide to a therapy that is tricky to learn just from reading. The experiential stance of ACT encourages learning through action rather than providing a formula or cookbook, and this guide suitably reflects this, encouraging the reader to engage in constructive exercises and reflection. This is a very useful workbook to anyone who is serious about learning to use ACT competently. It will be of value as a reference in a number of contexts: for the individual therapist wanting to develop skills and knowledge, as a key text on training courses, and for discussion material within study groups or peer supervision.

References

Hayes, S. C., Strosahl, K. and Wilson, K. G. (1999). Acceptance and Commitment Therapy: an experiential approach to behavior change. New York: Guilford Press.Google Scholar
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