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The Importance of Acceptance and Commitment Therapy in Drug Treatment

Jessica Hamilton


Jessica Hamilton, LCSW
Primary Therapist
Center for Change

  All approaches to therapy share one common objective: to support the client in effecting positive change.  Although the ultimate goal remains uniform, there is a wide range of modalities by which a therapist can help to facilitate such change.  In this article, I will focus on an approach that I have found to be very effective in the context of our client population and clinical setting – Acceptance and Commitment Therapy. The core of the ACT model rests on the premise that effective change begins with acceptance of a need for change.  As a clinician, I find that much of my work at this acceptance stage involves supporting clients in coming to terms with their personal past, successes and shortcoming alike.  My role in facilitating this process involves offering permission to the client to make mistakes as well as to achieve successes.  It also requires consistency in supporting the belief that clients can endure this sometimes very uncomfortable process of early recovery.  I find that this belief can be effectively supported by using examples from the client’s own life that are unique to his/her journey. Mindfulness is a therapeutic technique that has particular relevance to ACT.  Teaching mindfulness supports the recovery process by providing clients with a new way to manage cravings and/or intrusive thoughts by simply observing thoughts as they come along without modifying their actions. The idea is to allow the person to identify the intrusive thought, memory, or craving, and then choose not to respond to it in a negative or harmful way. An example might make the therapy a bit easier to understand: Prior to treatment, a client might say, “I’m anxious about a big test and I can’t go to school. I need to stay home and drink instead.”  In time, following treatment, the same person might say, “I’m anxious about a big test AND I am going to school.” The feeling and the action both exist in the same sentence and enhance flexibility and change in thoughts as well as behaviors.   Client: “I want to change but I am too anxious.” Therapist: “You want to change AND you are anxious about it.”   This subtle verbal and cognitive shift is the essence of acceptance and commitment theory.  Instead of opting for change alone, the most effective approach may be to accept and then change.  In other words, this is a shift from the content of experience to the context of experience. Turnbridge’s integrated behavioral and clinical supports offer every resident a unique opportunity for change though promotion of client commitment to recovery and development of a fulfilling and meaningful life.  The methods by which I, as a clinician, support a client’s commitment to recovery are continuously evolving as progress is made through the Stages of Change.  To be effective in my work at Turnbridge, I find that I need to be mindful of demonstrating acceptance of my clients, listening attentively without judgment, reflecting and highlighting strengths, and meeting clients where they are at (not where I want them to be) – all without judgment or foisting my personal agenda. ……………………………………………………………………………. Jessica Hamilton, LCSW