Getting into the ACT with Psychoanalytic Therapy: The Case of" Daniel"

Daniel is a 44-year-old Caucasian male who has struggled with chronic depression and extreme

sensitivity to feeling judged and criticized. I have seen him for more than ten years in

psychoanalytic therapy. While he made significant progress in understanding the childhood

determinants of his difficulties and achieved some symptom improvement, Daniel continued to

struggle with observing and tolerating his feelings. This case study demonstrates how my

decision to integrate techniques from Acceptance and Commitment Therapy (ACT; Hayes,

2005), a contemporary form of cognitive behavioral therapy, broke an impasse in the treatment,

allowed the patient to resolve outstanding difficulties, and helped him move towards termination.

The case report discusses the challenges of integrating ACT into psychoanalytic work, as well as

ways that a psychoanalytic understanding of Daniel’s resistance to ACT techniques made that

treatment effective.