ACT Techniques Therapists Use in Session
By Kristen McClure, MSW, LCSW | TherapistWorksheet.com
Acceptance and Commitment Therapy is one of the most influential third-wave behavioral therapies — and one of the most misunderstood. It is not about accepting your situation. It is about accepting your internal experience so you can move toward what matters. This guide covers how ACT techniques translate into actual session work.
The ACT Hexaflex: Six Core Processes
ACT organizes its clinical model around six interconnected processes, sometimes visualized as the hexaflex:
- Acceptance — making room for difficult internal experiences rather than fighting them
- Defusion — creating distance from thoughts rather than being fused with them
- Present-moment awareness — engaging fully with the here and now
- Self-as-context — relating to oneself as the observer of experience, not as one’s thoughts and feelings
- Values clarification — identifying what genuinely matters to the client
- Committed action — taking steps toward valued living despite difficult internal experiences
ACT Techniques You Can Use in Session
Defusion techniques
The goal of defusion is to change the client’s relationship to their thoughts — from fused (“I am worthless”) to defused (“I notice I’m having the thought that I’m worthless”).
“Leaves on a stream” — ask the client to imagine each thought as a leaf floating past on a stream. Their job is not to stop the leaves or grab them — just to notice them passing.
“I’m having the thought that…” — simply adding this prefix to a thought creates cognitive distance. Try it with clients: “Instead of ‘I’m going to fail,’ try saying ‘I’m having the thought that I’m going to fail.’ What changes?”
“The story of…” — naming recurring thought patterns as stories: “There goes my ‘I’m unlovable’ story again.” Naming creates distance.
Acceptance and willingness
Acceptance in ACT is not resignation — it is willingness to have an experience without unnecessary struggle. “What would it look like to make room for this anxiety, just for now, rather than trying to make it go away?”
The Chinese Finger Trap metaphor: the harder you pull, the tighter it gets. The solution is to move toward, not away.
Values clarification
Values in ACT are not goals — they are directions, like headings on a compass. “If your anxiety were gone tomorrow and you could live exactly as you want, what would you spend your time on? What would matter? What kind of person do you want to be?”
The Life Compass exercise has clients rate different life domains by importance and current satisfaction, revealing values-behavior gaps.
Committed action
Once values are clear, committed action means moving toward them despite difficult internal experiences. This is where ACT overlaps with behavioral activation. Small, specific, values-consistent actions — not waiting until you feel better to start living.
The Observer Self
“Notice that you are aware of your thoughts. The part of you that is noticing — can you sense that? That part has been there your whole life, watching. It is not your depression or your anxiety. It is the one observing all of it.”
ACT in Session: What It Actually Looks Like
ACT sessions are often less structured than CBT. The therapist tracks which hexaflex processes are most relevant to this client’s current struggle and intervenes accordingly. Metaphors and experiential exercises are central — ACT tends to work through experience rather than explanation.
Key ACT stance: the therapist is not trying to get the client to feel better. They are helping the client relate differently to feeling bad, so they can move toward their values regardless.
Frequently Asked Questions
How is ACT different from CBT?
CBT works to change the content of thoughts (cognitive restructuring). ACT works to change the client’s relationship to thoughts (defusion and acceptance). CBT asks “is this thought accurate?” ACT asks “is holding this thought useful for living your values?” Both have strong evidence bases.
Is ACT appropriate for clients in acute distress?
ACT includes stabilization strategies and can be adapted for clients in acute distress. The acceptance and defusion processes can be helpful even in crisis — but timing and pacing matter. For highly activated clients, grounding and stabilization come first.
Do I need specialized training to use ACT?
Foundational ACT can be integrated by therapists with a solid understanding of the model. Deeper ACT work — particularly with trauma or complex presentations — benefits from specialized training. The Association for Contextual Behavioral Science (ACBS) offers training resources.
Can ACT be used with clients who are not psychologically minded?
Yes — ACT’s use of metaphors and experiential exercises often works well with clients who struggle with abstract discussion of thoughts and feelings. The approach can be adapted significantly based on the client’s style and preferences.
Kristen McClure, MSW, LCSW is a licensed therapist who creates practical clinical tools to help therapists navigate the hardest moments in their work.