What is it?

The attached Word files are intended for ACT Clinicians to monitor their fidelity to the treatment principles of ACT. This is done by rating the therapist's practice immediately after each session.

Essentially the "ACT Core Competency Session Rating Form" is a less wordy form of the Core Competencies self rating form. The difference is that this form I've uploaded has very brief, generally three-word, descriptions of the items from the Core Competencies Self Rating Form. If you want to see how each item in the "Session Rating Form" corresponds to the ones in the "Competencies self rating form", read the "ACT Core Therapeutic Session Checklist Cross reference" file below. The Session rating form also has a checkbox for each session so that the sheet can be used for ten sessions with the one client.

How does it work?

You can score it in a number of ways. Here are some examples:

1. Check mark or cross in the box for presence of the dimension/behavior;
2. Check mark or cross for absence of the dimension/behavior;
3. Combination of both of the above - check for presence, cross for absence, dash for neutral or not applicable;
4. Score from say, 0 to 10 for degree/quality/frequency of the dimension/behavior.

Obviously if you're using this for research or for practitioner training, evaluation or supervision, you need a consistent approach across sessions and clients. N.B. US version is for Letter sized paper, UK version for A4.

Why did you do it?

I haven't had the opportunities that many ACT practitioners have had of being immersed in an ACT-focused research program or of attending a Summer Institute or World Conference. Consequently I've been trying to improve my ACT practice without the benefit of observational 'live' supervision. I've used this kind of self-monitoring sheet when learning other therapeutic approaches and found it very helpful. Using this kind of self-monitoring session rating sheet is one way I believe, of achieving expertise through effortful practice.

What's next?

If you download the session rating form and use it, please post your opinions, comments, suggestions for change/revision and findings here. If you have an extended comment or heaven forbid, actually use it in research or formal practitioner training, I'd suggest making a child page here.

As well, I'd ultimately like to see the 60-odd items here reduced to a manageable 12 or less. Workability of the tool will ensure its use. Parsimony, validity and reliability are essential.

The attached spreadsheet gives some idea of the direction in which I think this endeavour could develop. I've proposed six 'global dimensions' of in-session therapist behavior. They are Structure, Flexibility, Workability, Presence, Precision and Compassion.

These dimensions are not the same as the dimensions of the Hexaflex because the Hexaflex describes processes and I am attempting to describe either therapist traits or if you like, 'therapist qualities demonstrated in session'. Clearly though there is some degree of overlap - Being Present with Presence, and Acceptance with Flexibility (but also with Compassion).

I've developed these 'global dimensions' to give the therapist some 'touchstones' or compass points for their own practice. I welcome practitioners', trainers' and researchers' comments on any of these documents.

I've been using a process with both group, couple, and individual clients that seems to work pretty well. I stumbled upon this, but I'm sure it's been thought of before. If someone has refinements, I'd love to hear it.

 I've been using the back of old business cards to conduct a chain analysis of behaviors with clients. Business cards seem to be just the right size for this, as you can't really put much on them. I have the clients write down all of the pieces of the situation, behavioral chain, what have you, and then they lay them out.

The cool thing is, sometimes they'll lay out two cards that seem to have a lot more to them, and I can challenge them to make sure there's no more steps. For example, my mother calls me on one card, I want to die, on the next. We can tease apart all of the behavioral steps in the chain, group different parts together, shift them around, add new or different steps, change the order. It seems to work pretty well for defusion and self as context.

At the end of the session, clients take their business card chains home with them, and bring them back to session the next time. We talk about walking even with the cards in their pockets.

It's fun.

Core Processes/Metaphors Tracking

Have you ever had this situation: You are meeting with your sixth patient of the day and, in the therapeutic moment, you see a perfect opportunity to present a particular ACT metaphor....but you can't quite remember if you had done that other metaphor which sets the stage for this one.....and you ask "have we talked about the person in the hole yet?" Now, many of the perfect therapists on this list surely would never do this. However, for the rest of us, how do you keep track of what you have covered?

I designed the attached form (see bottom) for jotting down what I have covered. I sometimes review it prior to sessions along with progress notes from those earlier sessions. Now, granted, I still occasionally check-in about whether we covered an exercise/metaphor (no big deal), though less often and less awkwardly. You will note that the exercises and metaphors often target multiple core processes, so this form is just a coarse tracking guide. But I find it helpful.

Content of the Attachment

Page 1 is the form. Page 2 is an example of what it might look like after multiple sessions (metaphors/exercises would be hand-written, of course). Upon review, the sample on Page 2 contains far more actual content than the completed forms I have used with patients.

Using the Form

Time proceeds from middle (1st session) to out (in my use of it). Going from out to in results in much crowding of the content in the middle. It also makes it more difficult to get a sense for the progress of therapy (at a glance).

Using the Form for Self-Assessment

The form can also be used as a tool for ongoing self-assessment, revealing your therapy habits. For example, even a casual glance at some of my completed forms quickly revealed that I favor Values work and Cognitive Defusion, using a handful of mindfulness techniques, mostly for getting clients and myself into the Present Moment, less so in the service of promoting Self-As-Context. While this evident pattern may merely reflect my personal style in using ACT, it also challenges me to do some self-examination about processes that I may avoid (one's style is always a work in progress, right?). I also find it useful to compare completed forms to my responses on the ACT Core Competency Self-Assessment, an excellent learning tool available on this site.

Improvements and Revisions

Feel free to edit, change, and improve the Core Processes/Metaphors Tracking Form to fit your needs. If others have similar tools/guides or improve upon this form, please share the work!