Get Off the Therapy Treadmill With Counseling that Focuses on Possibilities, Not Problems
John (not his real name) fidgeted on the couch as he looked around the office, feeling a bit out of his element. He had been to therapy before and didn’t think much of it. His wife had encouraged him to give it another try after he confessed to her that he was feeling stuck and frustrated after losing his job. This was our first session and we were both trying to get a sense of the other person. I wanted to know more about what brought him into therapy while he wanted to see if I was actually going to be something different or just like the others he had tried.
“I don’t know what I’m expecting here. I’ve tried therapy before, but talking about my problems hasn’t done any good,” he said as he sullenly crossed his arms. “I tell you about how I feel like a failure or a loser and then you just nod and say something back that’s the same thing just with different words.”
“Sounds like you know your problems pretty well. Talking in circles is kind of like running on a treadmill. A lot of work but you don’t really get anywhere,” I replied, knowing that I was giving him one of those cliched therapist-type answers.
“Exactly,” he said as he waggled a finger at me. “I don’t need more problem talk. I need solutions.”
“Let’s say we found those solutions and you knew exactly how to manage your problems. You knew what to do when words like ‘failure’ or ‘loser’ come into your thoughts so that they didn’t have power over you,” I responded as I leaned in.
This was the moment I always looked for in a first session when I could pivot away from what the client was expecting and change things up. I’ll confess I tend to bring a hint of Trickster Spirit energy into these moments since it often catches new clients off-guard.
“What do you imagine you’d be doing differently?” I asked.
John paused with a hint of confusion furrowing his brow. I had just disrupted the script he expected to follow for this session and now he was in uncharted territory.
“I… gosh, I don’t know. I never stopped to think about that,” he replied as he uncrossed his arms and cocked his head in thought.
What is ACT and How is it Different from Traditional Therapy?
To understand what Outcome-Oriented Acceptance and Commitment Therapy (ACT) is, let’s first briefly define what we’re talking about with ACT (pronounced “act” like “to act” rather than “ay-see-tee”). ACT is often referred to as a “third wave” theory that grew out of cognitive behavioral therapies - which is a fancy term for saying that they focus on your thoughts and actions. These earlier therapies focused on changing things like thoughts, beliefs, attitudes, self-talk, and other stuff happening in your head.
You might be familiar with therapies like Cognitive-Behavioral Therapy (CBT), itself, which is still held as the gold standard of therapy even today. With CBT, a thought like, “I’m a loser,” might be challenged as irrational, tested, and eventually replaced with a thought that is considered less problematic and painful like, “I am strong and capable, even if I’m struggling right now.”
While that’s a bit of an oversimplification, the point is that therapies like CBT attempt to target and change your thinking patterns. For some, this has proven quite successful. For others, not so much.
Acceptance and Commitment Therapy, on the other hand, puts the focus on changing how you relate to those thoughts, even when they pop up. Because the truth is you generally can’t change the thoughts your mind throws at you or the feelings you experience.
For example, what if I told you not to think about a yellow car?
Chances are, you’re thinking about a yellow car right now. And it doesn’t help that there’s a picture of a yellow car right here on the page.
Even if you try to think about something else, like a blue crayon, a green truck, or a rainbow unicorn – you’re still making an effort push out the thoughts of that yellow car. You might be trying so hard it’s difficult to focus on reading this article right now.
Now, imagine trying to fight your own mind like that when it throws you thoughts like, “I’m a loser” or, “I’ll never amount to anything.” Chances are, your natural reaction is to try and fight those thoughts just like how you tried not to think of a yellow car. You might argue with your mind, reason with it, or just shut it down with drugs, alcohol, social media, or video games. All the while, those thoughts are there, keeping you from really engaging in the life you want to be living.
With ACT, you can learn to let thoughts come and go without getting tangled up in them or trying to fight them. That thought of the yellow car might still be there in your head, but you can learn to shift your attention to doing something like reading this article. The thought of the yellow car doesn’t have to go away for you to engage in something meaningful.
The spirit of this is embodied in one of my favorite quotes from Zen master Shunryu Suzuki:
Leave your front door and your back door open.
Allow your thoughts to come and go.
Just don’t serve them tea.
Just to be clear, I’m not suggesting ACT is the greatest counseling approach there is or that all others are garbage. I, myself, use other theories like Internal Family Systems Theory (IFS) at times when it seems like the client is better served by that theory. There are many different counseling theories and each one has something to offer. Each one will work great for some people and not work so great for others. But I often find the outcome-oriented approach works well for many of my clients, especially in my work with men.
The Outcome-Oriented Difference
Now that we understand how ACT is different in that it focuses on how we respond to our thoughts, feelings, and sensations, let’s look at the next difference – the focus on outcomes rather than problems.
This approach isn’t without precedent. Another counseling theory known as Solution-Focused Brief Therapy (SFBT), places the focus on the change you want to bring into your life rather than the things you want to remove in your life. The very name itself tells you what it’s all about!
Outcome-Oriented ACT takes this same idea – that focusing on your desired outcomes supports change more than endless talk about your problems – but applies the tools that ACT offers to help you become more psychologically flexible. It’s not that we avoid talk about your problems. After all, we have to get an idea of what those problems are before we get an idea of what to do about them.
From there, however, we start to turn things around to look at the outcomes you’d hope to get. We might explore questions like:
What are the things that are important to you?
Where do your problems currently pull you away from those things that are important?
What would you be doing differently if your problems were manageable?
What is the first thing you would notice that tells you change is happening?
What is the first thing other people in your life would notice that told them things are changing for you?
With questions like this, the conversation in a therapy session shifts toward the things you want more of in life rather than less of. It starts to move the focus toward the things you want to pursue rather than the things you are trying to escape.
What a Focus on Outcomes Means for Therapy
You might be wondering at this point how this focus on outcomes over problems makes a difference when it comes to therapy. After all, you probably know what you want out of therapy, right? But how are you wording those desires?
When I ask clients what they hope to get out of therapy, they often respond with something like:
“I’d feel less anxious.”
“I’d be less depressed.”
“I wouldn’t be overthinking everything.”
“I wouldn’t feel lonely.”
“I wouldn’t let my anger get the best of me.”
“I’d feel more confident.”
But look at those statements again. Notice how most of them are worded with a focus on what the person doesn’t want. While each one states a desired outcome, it’s expressed as a lack of the problem instead of the presence of the alternatives.
It’s kind of like saying, “I don’t want to be thinking about yellow cars all the time.”
The last one starts to get a little closer to where Outcome-Oriented ACT takes a different approach, but it’s still very vague. That one we might refine more with questions like:
What would you be doing if you felt more confident?
Would you be willing to try doing those things even if you didn’t exactly feel confident?
What is the first thing you’d be willing to try that’s a step in that direction?
You might notice that these questions start to point the conversation toward things that are more concrete and actionable than what you might typically find in therapy. While most therapists’ treatment plans eventually have solid action steps, they may still focus on lessening the symptoms of the problem rather than increasing things like engagement in daily living, living a life of purpose, and being more of the person you want to be. This can keep the focus more on the problem than the client’s desired outcomes, depending on the therapist.
It can also make it seem like YOU are the problem rather than the problem itself being the problem. But, what does that mean if you’re not the problem? It means that how you react to those anxious thoughts, those feelings of sadness, or the symptoms of post-traumatic stress disorder (PTSD) in unhelpful ways are causing the problems.
You are not broken, weak, or a problem to be fixed.
Your problem is the problem. You can change how you respond to your problems.
With Outcome-Oriented ACT, the focus on what you want more of in your life described in very concrete ways provides a few added advantages:
It gives you something to move toward rather than away from. This is more how our minds work and how we work in general. Think about your days in school. Your teacher generally had a lesson plan that was based on something like learning to add, subtract, multiply, and divide rather than “be less uneducated about math.”
It gives you a starting point. While every therapist has to start somewhere, the outcome-oriented approach can start where you are today without having to dig into your past if that’s not helpful for you.
It gives you a progression plan. I pull this idea from working out in gyms and will have a whole post about that later. For now, though, the idea is to start by challenging yourself in small ways that help you grow without taking on more than you can handle. This sets you up for a feeling of success rather than failure and makes the challenge of changing your ways of living and reacting seem manageable rather than overwhelming. This can also help you create a sense of safety if you’re addressing challenges related to trauma.
Outcome-Oriented ACT: A Hypothetical Case Study
Let’s revisit John from the beginning and look at a conversation that illustrates where this outcome-oriented approach can differ from the kinds of therapy you might be used to seeing or have experienced.
Me: “What do you imagine you’d be doing differently?”
John: “I… gosh, I don’t know. I never stopped to think about that. I guess I’d be less anxious. Less worried what people think of me… that I’m not measuring up.”
Me: “So you’re feeling less anxious. You’re not worrying about what others think of you. What would you be doing now that those concerns don’t have power over you?”
John: “I’d feel more confident in myself.”
This is often how the flow of the conversation goes at first, because that’s how we’re used to talking about our problems. We naturally focus on the problem we want less of and the feelings we want more of. But this is still very vague, so this is where we push a little deeper.
Me: “Okay. You’re less anxious and feeling confident enough that people’s opinions of you don’t matter. Say we’re watching a video of you going through your day. Some highlight reels. We can’t know what you’re thinking or feeling in that moment but your actions let us know you’re not being controlled by anxiety and feeling more confident. What do we see?”
John: “Well… I’d probably be applying for jobs. Going to interviews. That kind of thing, because I get so nervous about being rejected that I just don’t bother. I end up playing video games instead of job hunting, or I cancel an interview. Fake a cold then never reschedule. Stuff like that.”
Me: “That is pretty rough, putting yourself out there like that only to get a lot of people turning you down or ghosting you. So, it sounds like anxiety shows up and undermines your confidence, pulling you into gaming when you know job hunting and interviewing would be more in line with the life you want to create for yourself.”
John: “Pretty much.”
Me: “Would you say, then, that the work ahead of us is to help you learn ways to untangle yourself from those thoughts and fears so that you can at least start job hunting? Maybe go to some interviews in time?”
John: “Sounds like a direction to go, yeah.”
Based on this conversation, we established with John that fears of rejection from potential employers led him to avoid the source of that fear all together - applying and interviewing. As a result, he spent more time gaming than job hunting, which created stress at home with his partner. Not only that, but avoiding job hunting just fed that part of him that was calling him a “loser.” He was on the treadmill of suffering and avoidance.
By identifying the outcome John wanted – to be able to manage his anxiety and thoughts enough to start applying for jobs and going to interviews – we were able to work out some solid action steps like first searching for job listings and noticing what his mind was trying to tell him that pulled him away from the search and into gaming. That revealed the obstacles we had to clear to help him move toward the things he wanted in life and gave us a place to start the work and ideas for the progression plan that would help him build on his growing ability to untangle himself from his thoughts and feelings.
In a few sessions, we were able to practice the skills that helped him unhook from those thoughts and fears enough to start applying them in real life and get back to job hunting. We didn’t have to wait for him to feel infinitely confident or wait until his mind stopped saying, “You’re a loser.” With a clear vision of what to do, John was able to move toward the things he did want rather than put all of his time and energy fighting things he didn’t want.
Outcome-Oriented Therapy Means There’s an End in Sight
One last difference this approach offers compared to what you might imagine with therapy is that there is a definite endpoint based on your desired outcomes and the work you want to do on yourself and your life. Some folks might choose to end therapy once they’ve achieved their desired outcomes in just a few sessions. Other folks might want to shift their focus to something else to build on the work they’ve done so far.
For example, John might choose to wrap up therapy once he feels comfortable with the challenges of searching and interviewing for jobs. Or, he might decide he wants to work on how to handle stress and be less reactive once he has a job. Either way, he knows that therapy will only last as long as he feels it’s helpful rather than going on and on for years.
Is Outcome-Oriented ACT For You?
Hopefully, this has given you enough of an idea about this outcome-oriented approach to know if it’s right for you. If you’re the kind of person who prefers to focus on solutions to your problems rather than the problems themselves, or you feel like you’ve got a good handle on what your problems are but struggle to figure out what to do about them, it might be a good approach to try.
If you have any questions about this approach, feel free to drop them in the comments below or send me an email.
If you’re looking for a therapist in Arkansas and want to find out more about working together, you can click the button below to contact me or go straight to my calendar to book your free, 20-minute consultation call to find out more! I offer online counseling no matter where you are in Arkansas as well as in-person sessions in Fayetteville.