"Arms at Rest" by Siri Hustvedt is an article that appeared in a recent New York Times issue.  It's a poignant and inspiring account of a person's journey of acceptance of her chronic lifelong migraines. 

The author's comments about the way in which our culture has confused accepting adversity in one's life with being 'passive' or a 'pessimist' strongly brought to mind the nature of acceptance as it is understood and practiced in ACT.

It also sent me on a hunt to discover what resources are out there on ACT for chronic pain...   

One aspect of supervision with Acceptance and Commitment Therapy (ACT) that is different from many of the other empirically-supported approaches is the emphasis on the trainee utilizing the same therapeutic processes with themselves that they are asking their clients to use. Thus, supervision typically includes an experiential element in which the supervisor serves as a guide or faciltator of the trainees experiential learning. The job of the supervisor during these times is to help the trainee utilize the processes of mindfulness, acceptance, and committed action in regards to their own "stuff" that shows up in their professional life, for example in the room while doing therapy. The ACT model holds that it's important, perhaps essential, that ACT therapists are able to adopt the same embracing, loving, stance toward their own struggles that they ask their clients to adopt. In part, the therapist serves as a model of the very processes he/she is asking the client to test out in his or her life.

When I am working in this way as a supervisor, I am always looking for what the supervisee is struggling with, not accepting, or fused with in their work with their clients. A fair amount of supervision can focus on helping the therapist/trainee to accept, embrace, defuse from, or find a more compassionate stance in regards to difficult thoughts, feelings, memories, images, or sensations that emerge as they live their professional life. 

When introducing the experiential focus on mindfulness/acceptance in supervision, I might relate three ideas:

1. We want to create a space in supervision for the trainees own personal acceptance.
2. We want to create a space where the trainee can openly discuss and feel his/her own thoughts/emotions.
3. It is hard to be accepting with clients when you are not accepting with yourself.

In this post, I thought I'd share three suggestions for working experientially in supervision. The variety of ways in which you can do experiential work in supervision is endless. Here are three:

      Start supervision sessions with a brief mindfulness exercise. Usually I try to vary the focus of the meditation to focus on whatever ACT process I think might relate to today's session. For example, if I am planning to work on values in the session, I might introduce a values focus during part of the meditation.

      Move the focus to the trainee's experience in the room with the client. If the session is overly didactic, dry, or unproductive, sometimes you can increase the experiential focus of supervision by directing the trainee to focus on, contact, and relate their experience in the room with a client. Particularly useful can be to focus on times where the therapist was feeling stuck, self-critical, or judgmental of the client. Sometimes it can be useful to have the trainee remember a specific incident and bring back the details of what happened in their mind's eye (e.g., the sights, the sounds, their thoughts, the meaning of the situation, their feelings). This can then create the opportunity to work with whatever the trainee may have been struggling with in that moment.

    Ask the trainee directly about using an experiential focus. Sometimes you can ask the trainee directly whether they think that a more experiential or more didactic supervision experience would be more helpful in the given situation. For example, the supervisor might ask, "Given what you know of yourself, is an experiential barrier that calls for willingness, or is this something else?" Sometimes this can provide an opening and permission to do experiential work with the trainee..

     If you have any suggestions for methods that you have used in supervision, feel free to relate them in the comments or discuss them in the Learning ACT Forum. 

A few years ago a group of ACT trainers got together and used to consensus process to create a set of ACT core competencies. My coauthors and I recently revised these competencies in our book Learning ACT. Over the last couple years, I have found myself using the ACT Core Competency Rating Form at an increasing rate in helping people learn ACT and I thought I'd share some of my experiences with other ACT supervisors.  Most of my experience is based on my work in advanced consultation for people who are already licensed, but I do engage in some formal supervision with students.

The form can be used as either a self or other rating form. One way I use the form is to have the trainee self-rate on their utilization of the various competencies. This is often most useful when the trainee is new to you and you would be unable to evaluate their own use of the competencies. This can serve as a nice baseline of their self assessment of competency and areas for improvement. Repeated self assessment over time can continue to help focus supervision and also help to track change. Another way to use the form is to rate the trainees use of the ACT core competencies, usually only appropriate once you have a fair amount of experience observing their work. Reviewing this with the trainee can serve an important feedback function.

Usually I will review the ratings with the trainee and talk about any patterns that we see. In these reviews, I emphasize that the purpose of the ratings is primarily to assist learning and to help focus the supervision.

In reviewing the ratings I try to look for patterns in the data. One pattern I look for is whether any individual competency items are rated much lower than the other items within a particular process. If this is present, then we discuss the reason for this discrepancy. Commonly a practice exercise that might emerge out of this conversation would be some sort of between-session practice in which thee trainee identifies a client or clients with whom they can use that competency. It can also be helpful to identify the manner or context in which they might use that competency. They might be specifically asked to prepare and study various metaphors or exercises that they might use when implementing the competency. Finally, the trainee implements that competency in as many situations as it is relevant and ethical. The goal is to help them to practice the competency and to produce material to respond to in the next supervision session.

Other patterns to look for are broader, for example when certain processes are more often focused on than others. Perhaps the trainee tends to focus heavily on values and commitment but rarely works on contact with the present moment. Looking at these broader patterns can suggest longer term areas of focus for the supervision and perhaps help trainee and supervisor prioritize areas of skill-building in their learning of ACT. This might take the form of additional readings, practice role plays (with both supervisor or trainee as therapist), or experiential work, depending upon the barriers to utilization of the competency. 

Keep in mind when using the form, that it can be filled out using various time frames, depending upon what you are wanting to assess. The form could be used to rate a single session, the past month, or even how they are in general. Each of these can serve specific training functions.

I'd be interested in anyone's comments or ideas on this post. You can either reply right here, or in the Learning ACT Forum . Either would be welcome! 

BTW, there are additional ideas on supervision/consultation in the appendix of the Learning ACT book, if you are wanting more to read on that subject.

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