Acceptance and Commitment Therapy (ACT) and Case Work

Hi all,

I have been thinking a lot about how ACT can be applied in various aspects of social work. It is very clear to me that ACT can be a powerful tool to affect behavioral change in multiple contexts. The most obvious is in individual and group psychotherapy. There has been a tremendous amount of research and application toward this end.

I am curious what people think about ACT as it relates to case management – another primary focus of social work. Anyone anyone out there that is using ACT as a case management tool?

As the director of a program working with men and women leaving incarceration, I supervise a group of post release case workers who provide outreach services to our clients. While inside the facility, clients participate in DBT and ACT groups and receive individual therapy. Upon release, care is transferred to the reentry case workers (RCW’s) who help clients navigate the adversity of reentering society.

I would like to offer some tools that we have developed to help our RCW’s be effective. Special shout out to my colleagues Ruben Mercado-Lugo and Jenn Avery who co-created much of the material below.

First, I would like to frame the case management conversation in a tool that comes from Charlie Swenson’s comprehensive DBT training – you know an acronym is coming at you 🙂

F – Focus
A – Assess
V – Validate
O – Offer
R – Reinforce

This acronym provides an easily accessible and memorable tool that orients the case worker to the processes involved in coaching a client through a difficult situation.

The first three processes are rather straight forward, however knowing what to “offer” comes from an accurate functional contextual assessment.

In the second process (assessing), there is a determination that needs to be made regarding the clients current state – what is the client able to functionally access? In the work that we do with individuals returning to the community from jail, we have found that there are many times when the volume of adversity a client is facing is extremely high, and a client can become highly dysregulated, at which point values/committed action work to be tricky/invalidating. At this point making a decision as to how to work with the client is vital.

Working with a client experiencing a high volume of adversity, we start with noticing, naming, defusing and accepting.

However, if the client continues to be highly dysregulated, motivating the client to commit to the use of concrete skills to regulate can be helpful:

If after that the client has become more regulated, value orientated actions can often be accessed as a higher degree of defusion has occurred, creating more space for choice. At which point perspective taking, values clarification, committed action and interpersonal effectiveness skills can be employed:

Here is a picture of the whole model:

Basically – there are times when a client has very little acceptance/defusion/present moment awareness/SAC of their emotional or cognitive state. At this point the case worker can assist the client to commit to putting “roadblocks” in their way so as to protect themselves from harmful, unproductive behavior. Roadblock strategies can include, but not limited to, many of the distress tolerance and emotional regulation skills offered through DBT skills modules.

We have found that this strategy can be very effective in helping client move toward value driven behavior. It also frames the use of behavioral skills learned in DBT (and other modalities) as committed actions that can move clients toward vital workable lives.

As always, I am interested in feedback and in particular, how do you conceptualize the processes found in ACT as applied to case work?

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