Room for the hard things.

ACT is a behavioral and mindfulness-based approach developed by psychologist Steven C. Hayes in 1986. It's part of the third wave of cognitive behavioral therapy, sharing CBT's empirical foundation while departing from its core assumption that the goal of treatment is to change unhelpful thoughts and feelings. ACT's central contribution is psychological flexibility: the capacity to remain in contact with present experience, including painful thoughts and emotions, without suppressing them or being dominated by them, while taking action consistent with what you genuinely value.

The Association for Contextual Behavioral Science has documented over 1,000 randomized controlled trials examining ACT, making it one of the most researched psychotherapy approaches available. ACT works through six core processes: acceptance, cognitive defusion, present-moment contact, self as context, values clarification, and committed action — woven together as the clinical moment requires.

ACT sessions are experiential rather than primarily didactic. A session might explore a pattern of avoidance: where it shows up, what it's protecting you from, and what it's costing you in terms of valued action. Defusion exercises help create distance from rigid thought patterns that have been experienced as facts rather than as mental events that can be observed without being obeyed.

Values clarification work explores what you genuinely want your life to be about, distinct from what you've been avoiding or chasing in response to pain. ACT concepts are drawn on when they serve the clinical moment, combined with IFS and somatic work when those frameworks address dimensions of the pattern that ACT alone doesn't fully reach.

ACT has been validated across anxiety disorders, depression, chronic pain, substance use, eating disorders, and PTSD. A consistent finding is its effectiveness where cognitive fusion — the tendency to treat thoughts as literal truths that must be obeyed or fought — is maintaining the difficulty.

Within my practice, ACT is most useful in three situations: avoidance patterns maintaining anxiety, burnout, or relational difficulty, where the client understands what they're avoiding but the avoidance feels stronger than the intention to change; values clarification for adults in significant transitions, identity confusion, or cultural conflict; and the meaning dimension of recovery from trauma, burnout, or substance use.

I use ACT because it addresses a dimension that depth-oriented and somatic approaches don't always reach directly: the client's relationship to their own mind and the behavioral patterns that relationship produces. For many adults, insight isn't the problem — they know they're avoiding intimacy, catastrophizing, or staying in depleting situations. What they can't do is choose differently consistently enough for the pattern to shift. ACT provides concrete tools for that.

I find ACT particularly useful in combination with IFS. IFS identifies the parts in conflict; psychodynamic work traces the history of those conflicts; ACT holds the question underneath both: what do I actually want my life to be, and what am I willing to do toward it?

Alchemy Psychotherapy is a private-pay, out-of-network practice. A reduced fee is available in limited circumstances based on financial need and current caseload. I do not bill insurance directly, but I provide a Superbill on the first of each month for clients with out-of-network mental health benefits, and HSA and FSA cards are accepted. Under the No Surprises Act, you have the right to a Good Faith Estimate of expected charges before treatment begins.