ACT As A Brief
Intervention Model
Kirk Strosahl Ph.D.
ACBS World Conference
Reno, NV
mountainconsult@msn.com
Why Use Brief Interventions?
• Average number of therapy sessions: 4
• Modal number of therapy sessions: 1
• Dose effect studies show most change in
therapy happens early (before session 8)
• Change beyond session 8 is very time
intensive
• Rapid response studies show it is common
• Some contexts require brief interventions
2
Evolution of Brief, Strategic
Change Approaches
• Concept of brief therapy pioneered at MRI by Haley,
Weakland, Fisch and Watzlavic in the 1960s, became
popular in the 1970s during managed care revolution
• John Grinder and Richard Bandler provided practical
guidelines for the application of some of the hypnotic
techniques of Milton Erickson (“The Structure of Magic”)
• Several different “schools” of brief strategic intervention
have emerged (Brief problem focused therapy, Solution
Focused Therapy, Narrative Therapy, Ericksonian
Therapy)
• Main problem is a suspicion of “outcomes” research
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Basic Issues in Brief Intervention
• Competing Theories of Human Suffering
– Bio-Medical model
• Emphasizes pathology, symptoms and syndromes,
disease concepts, and a focus on somatic
treatment
• Less weight attached to person and environment
interactions, context for behavior and the role of
language in shaping dysfunctional behavior
• Many syndromes share the same symptoms and
respond to the same treatments
• Emphasizes treatment over time
Basic Issues in Brief Intervention
• Competing Theories of Human Suffering
– Stress-coping-vulnerability models
• Emphasis on delicate relationship between stress
and coping responses
• “Symptoms” occur when coping responses are
insufficient to manage stress over time
• Emphasis on building positive coping responses
and/or decreasing stress
• Interventions tend to be more situation specific and
time limited
Basic Issues in Brief Intervention
• Competing Theories of Change
– Theory of big change (“cure”)
• People are “broken” and need to be fixed
• Success if defined by the elimination of symptoms
and eliminating underlying causes
• Treatments tend to be staged and longer
• Goal setting often emphasizes large changes in
behavioral, cognitive and emotional functioning
• Historically has been very ineffective with more
complicated patients
Basic Issues in Brief Intervention
• Competing Theories of Change
– Theory of strategic change (function)
• From a person-environment perspective, small
behavior change can have a domino like effect
• Evidence shows that small changes are easier to
make than big changes
• Focus on using coping skills that work and
stopping what doesn’t work
• Small change builds “self-efficacy” or the
conviction that one can make changes
• Basis of many evidence based treatments
Basic Issues In Brief Intervention
• Competing Theories of Agency
– Patient driven change (patient is in charge)
• Places patient in co-equal role with provider
• Responsibility for behavior change shifted to
patient
• Emphasis on patient education, basic goal setting
with consultation from provider
• Change occurs in real life settings, not in the
provider’s office
• Leads to greater motivation, adherence and better
delineation of “boundaries”
Basic Issues in Brief Intervention
• Competing Theories of Agency
– Provider driven change (therapist in charge)
• Places patient in subordinate role
• Provider assumes more responsibility for solving
the patient’s problems
• Generally requires longer and more frequent
contacts
• Runs the risk of engendering dependence,
passivity, low motivation for change and nonadherence
Brief Strategic Therapy Challenges
Some Cherished Beliefs
• That building “rapport” is a pre-requisite to
change and takes time
• That therapy “drives” behavior change, ergo, the
more therapy the better
• That one hour sessions are necessary to
facilitate change
• That long standing problems can only be
address with long term therapy
• That small changes don’t matter when people
have big problems
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Brief Therapy Challenges Some
Cherished Beliefs
• That getting the patient to “analyze” the source
of problem is a necessary step in change
• That the patient’s “story” is clinically accurate
and useful
• That the medical model (DSM-IV) approach is a
clinically useful way to guide treatment
• That having a behavioral health problem is
“abnormal”
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Key Brief Intervention Principles
• Establish a single point of clinical focus
• Pull the patient outside the “frame of
reference”
• The “problem” is not the problem; the
“solution” is the problem
• Don’t focus energy on issues that are not
going to change
• Try to identify what the patient is ready to
do
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Key Brief Intervention Principles
• Focus of behaviors that create a positive
motivational impact
• Have the patient take “ownership” of the change
process
• Try to re-activate healthy behaviors rather than
eliminating unhealthy ones
• Encourage limited, specific, concrete change
• Get the patient to state a behavioral intention
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ACT as a Brief Intervention?
• Core philosophies are very similar
• Both are skeptical of pathology and illness
explanations for maladaptive behavior
• Both heavily rooted in changing the
functions of language
• Both emphasize qualitative shifts of
awareness and self processing
• Both make no assumptions dose-effect
ACT Brief Intervention Principles
• Normalize and validate “toxic” private events that
are the natural results of being alive
• Reframe the issue from “whether to” to “how to”
experience what is there to be experienced
• Emphasize approach toward rather than retreat
from response ableness
• Use spontaneous contact with mindfulness to
help patient see an alternative
• Get the patient to “stand for something”
• Focus on small, value consistent actions
ACT Brief Intervention Strategies
• Is there anything in front of you here that you are not big
enough to have?
• What if the goal were not to feel good, but to feel it
good?
• Are you having this? Or is it having you?
• Looks like the more you try to control this thing, the more
uncontrollable it becomes. What about just letting it be
what it is?
• What would make what you are going through here
honorable, legitimate and purposeful?
• You don’t have to do this perfectly—just get from point A
to point B.
ACT Brief Intervention Strategies
• What do you think life is trying to teach you here?
• Is there anything about how you’re feeling, right here,
right now that you would not be willing to feel?
• What do you want to stand for here?
• What will make you feel like you’ve grown as a human
being when this situation is done?
• It sounds like your mind is telling you to do things that
your experience says doesn’t work.
• If you were free to choose how to respond here, what
would you like to do?
• Is there anything standing in the way of you and what
you want to be about here?