How I work
Acceptance and commitment therapy (ACT)
Loosening the grip of difficult thoughts and feelings so you can get on with what matters to you. An approach I am trained in and integrate into my work, online across the UK in English or Spanish.
What ACT helps with
ACT belongs to the same family as CBT — it is usually described as one of its third-wave developments — and it has a substantial and growing evidence base across anxiety, depression, stress, and living with a long-term health condition. NICE names it among the psychological therapies to consider for chronic primary pain.
I reach for it when the problem is less what someone is thinking and more the war they are having with it. Worry that has been analysed to death and has not budged. Self-criticism that responds to being challenged by getting more sophisticated. Perfectionism, procrastination, burnout, the flat feeling of a life organised entirely around not feeling bad.
It also suits people whose difficulty is not going anywhere: chronic pain, an ongoing illness, grief, a permanent change in circumstances. Where a problem cannot be solved, ACT asks a different and more useful question — what kind of life is still available here, and what would it take to move towards it?
This is an approach I am trained in and integrate into my work rather than one I hold a separate accreditation in; my accreditations are in CBT with the BABCP and in EMDR with EMDR Europe.
How ACT works
ACT starts from an awkward observation: most of what we do to get rid of unwanted thoughts and feelings works in the short term and costs us in the long term. Avoiding the thing that makes you anxious reliably reduces anxiety now, and reliably shrinks your life over years. The struggle is often the problem, not the feeling.
So instead of trying to control what shows up internally, ACT builds two things: the ability to have a difficult thought or feeling without it running the show, and a clear enough sense of what you actually care about that it can steer you instead.
The first is often called defusion. A thought like I am going to make a fool of myself arrives as a fact about the future. Held slightly differently — noticed, named, seen as a piece of mental activity rather than a report — it stops being a set of instructions. Nothing about the thought has to change; your relationship to it does.
Alongside it goes acceptance in the practical sense: making room for a feeling because the alternative — fighting it — has been tried extensively and did not work. This is not resignation, and it is not pretending to like it.
The second half is values and committed action, and this is where ACT stops being abstract. What kind of parent, colleague, partner, friend do you want to be? What have you stopped doing that used to matter? Then: what is one step in that direction this week, taken while the anxiety is still present rather than after it has gone? Because waiting for it to go first is exactly the deal that has kept you stuck.
What to expect
Sessions are 50 minutes, weekly at first, and a course commonly runs 8 to 16 sessions. ACT often works well as part of a broader piece of therapy rather than on its own — for instance alongside CBT, where the CBT changes the loop and the ACT changes the relationship with what is left.
Expect it to feel more experiential than analytical. There will be short exercises in session: noticing where your attention is, watching thoughts arrive and pass, trying on a bit of distance from something that usually grips. Some of them feel odd the first time. I will always explain why we are doing one before we do it.
Expect metaphors, too — ACT leans on them heavily, because the ideas are simple to state and slippery to feel. If one does not land for you, we drop it and find another.
The values work tends to be the part people remember. It is not a goal-setting exercise: goals can be finished, values are directions you can keep moving in. Getting clear on yours is often uncomfortable and usually clarifying.
Sessions are online by secure video, wherever you are in the UK, in English or Spanish.
Common questions
Does acceptance mean putting up with it? No. Acceptance in ACT is about stopping a fight you cannot win — the fight to not have a feeling — so your energy goes into the things you can change. Where a situation can be changed, we change it.
Is ACT the same as mindfulness? Mindfulness skills are part of it, but they are a means rather than the point. The point is being able to move towards what matters while difficult thoughts and feelings are present.
Is it evidence-based? Yes, with a large and growing research base across anxiety, depression, stress and long-term conditions, and a mention in the NICE guideline on chronic primary pain. For some specific diagnoses — OCD, for instance — the best-established treatment is still CBT with ERP, and I will say so.
Can I have ACT alongside CBT? Yes, and often that is exactly what happens. They come from the same family and combine naturally.
Do I have to be spiritual about it? Not at all. ACT has no religious content; it is a behavioural therapy with a good deal of research behind it.
Can sessions be in Spanish? Yes — I offer therapy in English and Spanish.
Ready to take the first step?
Send an enquiry and Gisela will be in touch within one working day.