My Personal ACTr Matrix (Part I)

What is ACT and ACTr?

Acceptance and Commitment Therapy (ACT) is a psychotherapeutic approach which aims at increasing psychological flexibility and grit in order for the client to do more of what he or she cares about.  It is based on mindfulness, contextual behavior science, relational frame theory, and applied behavior analysis, with plenty of overlap among these influences.  

Acceptance and Commitment Training (ACTr) is considered a behavioral approach using the same core processes – behavior analysts can use this approach.  It is outside the scope of a behavior analyst to use it as a form of psychotherapy, unless they have additional, necessary training,  credentialing and licensing to use ACT as a form of psychotherapy.

What are the processes involved in both ACT and ACTr?

ACT and ACTr are based on six core processes for improving psychological (or behavioral) flexibility: acceptance, defusion (noticing and “unhooking” from powerful thoughts), present moment awareness, self-as-context (learning how to observe our own thoughts and feelings as an observing self which transcends what we experience), committed actions, and values clarification.

Each of these processes has an opposing polar end which presumably moves a person in the direction of psychological (or behavioral) inflexibility or “rigidity.”

Stick with me a bit longer.  I believe a lot of nuance is necessary before we anathematize the past and future, or even cognitive fusion.  I actually appreciate that Prevedini, et al, (2011) articulates in the “Hexaflex” diagram above that the problematic perspective of the future is when it is a “feared future.”  A Catholic perspective would encourage a hope for the future.

What is the ACT Matrix?

The ACT Matrix was designed by Dr. Kevin Polk in 2009.  Using the six core processes, an ACT Matrix is sometimes used during therapy or behavior intervention in order to help a client visualize what thoughts and feelings are: how they exert a lot of control in the person’s life and what values and committed actions will give direction to the client so that there is sufficient motivation to do mindfulness exercises (encompassing acceptance, defusion, present moment awareness, and self-as-context) and value-oriented committed actions.  Personally, I have found great use of this tool as is in both clinical application and personally.  I emphasize “as is” because this next part might come across as challenging this valuable tool.

The ACT Matrix by Dr. Kevin Polk. Credit: https://contextualscience.org/act_matrix 

A Catholic’s Personal Perspective

The following is not so much of a challenge as it is a (1) Catholic perspective on some of these concepts used in ACT/ACTr and the ACT Matrix, (2) a proposal for how to potentially integrate these Catholic concepts as a move towards cultural competence when working with Catholic clients, and (3) sharing some thoughts on how we can think more critically with nuances and further exploration of the ACT core processes.  

I am not recommending this “Catholic ACT” for clients because this is all speculative commentary on my part, but I am trying to keep an ongoing conversation about how we conceptualize these processes from a Christian standpoint.  If you are looking for something more formal, I would rather point you in the direction of Ingrid Ord, an ACT practitioner.  She has created a proposal for how to adapt the ACT model for Christian clients – information about her Compassionate Awareness Therapy (CAT) and training course can be found in this link.  I believe Catholics can find her model helpful for taking the best of ACT.  There have also been multiple publications discussing applications of ACT within a Christian framework (e.g., Sisemore, 2015).  ACT itself, has concerning philosophical underpinnings from which Catholics might diverge in some ways and converge in other ways, which is all the more reason for clinicians to be aware of how interventions may be received without cultural competence working with Catholics (BACB Ethics Code #1.07).

Below are my own theologically-based musings on how to translate ACT processes within the context of a Catholic understanding of the person.  Each of these concepts could have a whole article devoted to them, but I need to slow down on my writing.

Self-as-Beloved

Sometimes self-as-context is seen as a form of personal freedom in perspective taking (i.e., “I am the sky and everything else is the weather” – Pema Chödrön).  Hence, the popular phrasing in ACT, which I first heard from Dr. D.J. Moran, “I am here and now noticing my thoughts and accepting my feelings while doing what I care about” has been used to summarize this model in a nutshell.  Specifically “I am” refers to self-as-context.  The Catholic twist could be as follows: “The I AM, God Almighty, is here and now loving me.”  This is starting from a place of self-as-beloved-by-God.  Beyond self-as-context which is unconditional, God’s love for us goes before our observing self. 

The opposing concept of self-as-context is self-as-content (believing that one is actually their thoughts, feelings, experiences, etc.).  Internal family systems therapy, in which those thoughts and feelings are listened to as “parts” of the self, seems to go in the opposite direction.  Here is where I think some nuance can be helpful.  You can still have that observing self and you can have those different “parts.”  We need to have the actual self who can objectively observe thoughts and feelings as they arise which transcends all the different personalities (i.e., I would say contextualized emotive-behavioral repertoires from a behavior-analytic standpoint) that compose who we are.  If all the “parts” were equal in status, then we might find ourselves progressing towards disintegration.  However, if none of the “parts” of ourselves matter except for some neutral, blank-faced, transcendent observer, then we fail to hear ourselves in our wholeness.  Any behaviorist with integrity would admit that those thoughts and feelings don’t “come out of nowhere.”  So why are we tempted to disregard all thoughts and feelings as inconsequential and separate from who we are in the name of “protecting” ourselves from psychological distress?  There certainly is a place for distancing ourselves from aversive thoughts and feelings, but can we claim that “accepting them” non-judgmentally as a transcendent being is just as helpful as (or even better than) dialoguing with these “parts” as an actual self?  If someone claims this, can that person claim that it is always the case?  I tend to be wary of using the word always when it comes to behavior analysis and psychology.  Yet here I am saying it is good to always have an “a priori” cognitive fusion to the thought: “I am beloved by God.”

Present Moment Awareness in Kairos

Present moment awareness has a rich tradition in not only Buddhism, but also Catholicism.  The present moment is a window into eternity and the timeless-ness of Heaven where everything is now.  This is sometimes referred to as the Greek word “Kairos” (God’s “time” found in Scripture; different from “chronos” which is sequential time).  This kairos is the present moment to which Catholics are oriented when practicing Catholic mindfulness.  Recent spiritual books, like Interior Freedom by Fr. Jacques Philippe, help one to focus on the present moment as a means of growing in holiness.  Perseverating on the past or the future is problematic in ACT and in Catholicism.  Yet, I believe we find another opportunity for an integration of the past and future.

I conceptualize present moment awareness (in charity) and self-as-context being in the center.  This contextualizes the past and future as grounded in the present moment (the “higher” time).  With this framework, we can “live in memorial” to borrow a phrase from my brother, Fr. Peter Clem, YA.

By living in memorial, we look forward to the future with hope and to the past in faith (toward committed actions).  Regarding the past, we remember God’s promises.  Remembering how God has worked in the past for my good.

When we are moving away from our committed actions and values, we are looking forward to the future in despair and to the past in disbelief (toward problematic behaviors and anti-values).

If faith and hope are proper to the past and future, respectively, then the present moment corresponds to charity.  In the present moment, we can receive the gift of God’s love by receiving His merciful love and opening ourselves up to affections of gratitude, contrition, joy, and compassion.  Perhaps this is one of the reasons that among faith, hope, and love, St. Paul says “the greatest of these is love” (1 Cor 13:13).

I believe we can hold a contextualized self-as-content as “parts” to be loved by the self-as-context — we could conceptualize these “parts” as individual constellations of behavioral repertoires, including emotional, verbal, and motoric behaviors evoked by particular contexts.  In this regard, behavior analysis might diverge from psychology’s Internal Family Systems with how to conceptualize “parts.”  Regardless, the self-as-context approach protects the individual from equating the self to any one of these parts, but the self-as-content approach can open the individual to being more willing to hear (with reverence) to those different “parts” within the self.  For a Catholic perspective on “parts work” and Internal Family Systems, check out CatholicPsych Institute.

May God bless you for reading (or even skimming) this far.

Sincerely,

The Catholic Behavior Analyst

If you liked this article, please consider sending $1 or more to my wife, Rachel.  Any donations go directly to her because she is the one who makes sacrifices for me to write.  You can Venmo her at @Rachel-Clem-2

Bio & Disclaimer: 

Joseph (Joey) Clem is a Catholic licensed behavior analyst in Virginia. He is a husband, father, and lifetime full member in Youth Apostles.  He works primarily with children diagnosed with Autism and volunteers in youth ministry.  This article does not constitute professional advice or services.  All opinions and commentary of the author are his own and are not endorsed by any governing bodies, licensing or certifying boards, companies, or any third-party. 

REFERENCES

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/ 

Polk, K. (2009).  The ACT Matrix [diagram]. https://contextualscience.org/act_matrix 

Prevedini, A., Presti, G., Rabitti, E., Miselli, G., & Moderato, P. (2011). Acceptance and Commitment Therapy (ACT): The foundation of the therapeutic model and an overview of its contribution to the treatment of patients with chronic physical diseases. Giornale italiano di medicina del lavoro ed ergonomia. 33. A53-63. 

Prevedini, A., Hirvikoski, T., Holmberg Bergman, T., & Berg, B., Miselli, G., Pergolizzi, F. & Moderato, P. (2020). ACT-based interventions for reducing psychological distress in parents and caregivers of children with autism spectrum disorders: Recommendations for higher education programs. European Journal of Behavior Analysis. 21. 1-25. 10.1080/15021149.2020.1729023. 

Sisemore, T. A. (2015). Acceptance and Commitment Therapy: A Christian translation. Christian Psychology, 8(1), 5-15.