Session structure

Typical architecture of an intervention session

Although this model is flexible, sessions usually follow a consistent structure to maximize effectiveness and maintain focus.

A standard session is not a rambling lecture, but rather psychological skills training.

Generally, the session begins with a grounding phase, often through a brief mindfulness or centering exercise (2-3 minutes).

This serves to allow both client and therapist to let go of the busyness of the day and connect with the present moment and the purpose of the therapy.

This is followed by a review of the previous week's homework or commitment.

This is vital: if you do not review what the client did outside of the consultation, the message is conveyed that change only happens by talking, when in fact it happens by acting.

The core of the session is devoted to the central therapeutic work, focusing on one or more points of the flexibility hexagon.

This is where metaphors are introduced, experiential exercises (such as the empty chair, visualization, or verbal defusion) are performed, and barriers that arise in situ are processed.

For example, if the client shows fusion with a concern, defusion is worked on at that very moment.

Finally, the session closes with the establishment of a new task or behavioral commitment for the following week. This task should be linked to what was worked on in the session and to the client's values.

The session ends with a brief mutual feedback on how the meeting went, adjusting the therapeutic alliance if necessary.

Duration and temporal approach of the treatment

As a therapy with cognitive-behavioral roots, ACT is usually approached as a medium-length and focused intervention, not as an indefinite analysis that lasts for years.

Although there is no fixed number of sessions (depending on the severity and chronicity of the problem), it usually works in formats of between 10 and 20 sessions for focused problems, and can be extended for personality disorders or complex traumas.

The approach is pragmatic: the aim is to provide the client with the tools to become his or her own therapist as soon as possible.

Therapy is conceived as a training course for life. The aim is not to "cure" the person forever, but to teach him or her how to navigate.

Therefore, the time between sessions can be spaced out as the treatment progresses (from weekly to biweekly or monthly) to encourage autonomy.

The message implicit in the time structure is that therapy is a temporary scaffold, not a permanent crutch.

The client is encouraged to view each session as an opportunity to practice skills to be applied outside.

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