Why I Love Practicing Acceptance and Commitment Therapy: Reflections From an ACT Therapist

Written By Jess Coleman, Ph.D.

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Every therapist has a therapeutic home: an approach that fits not just their training, but their understanding of what it means to be human and what can promote psychological well-being. Mine is Acceptance and Commitment Therapy. I'm a licensed psychologist providing ACT-based therapy to adults through telehealth in North Carolina, California, and 40+ PSYPACT states. In this post, I share why I love practicing ACT, what it looks like in my sessions, and why I believe it fits so well for the people I work with: adults navigating reproductive and perinatal mental health challenges, OCD, anxiety, and trauma.

ACT starts with a different question

Many people arrive at therapy with a reasonable goal: make this feeling stop. Make the anxiety go away, make the grief smaller, make the intrusive thoughts disappear. And many forms of therapy, at least implicitly, agree to that contract.

ACT begins somewhere different. Instead of asking "How do we get rid of what hurts?", ACT asks "What do you want your life to be about — and what is the struggle with what hurts costing you?" That shift changed how I practice, and honestly, it changed how I think about being a person.

Here is what I have observed in my work with clients: the harder someone fights their internal experience — suppressing thoughts, avoiding reminders, white-knuckling through feelings — the more territory that experience tends to claim. The anxiety about anxiety grows. The sadness and grief that is never allowed in the room starts running their life. ACT names this pattern without blaming the person for it, and offers something genuinely different: what if the goal is not a quieter mind, but a fuller life?

I love practicing ACT because that question respects people. It does not treat clients as broken machines to be repaired. It treats them as people whose pain makes sense, and whose lives are still available to them.

ACT is backed by a large body of research

Acceptance and Commitment Therapy is an evidence-based psychotherapy supported by more than one hundred randomized controlled trials across a wide range of conditions. A comprehensive review of 20 meta-analyses, covering 133 studies and more than 12,000 participants, found ACT to be effective for anxiety, depression, chronic pain, substance use, and transdiagnostic concerns. Research also supports ACT in medical populations, including cancer-related distress and infertility-related distress — areas at the heart of my practice.

I share this because loving an approach is not enough; my clients deserve therapy that works. What I find compelling about the ACT evidence base is not just that it demonstrates symptom reduction, but that ACT reliably improves psychological flexibility: the capacity to stay present, open, and engaged in what matters even when life is hard. That is an outcome that holds up in the real world, where difficult things may keep happening.

ACT makes room for pain that cannot be fixed

Much of my clinical work involves pain that has no easy fix. A pregnancy that ended. A diagnosis that changed everything. Years of infertility with no guarantee attached. Intrusive thoughts that are distressing. A birth that became a medical emergency. There is no cognitive technique that makes these things not have happened, and I think clients can feel it immediately when a therapist is subtly trying to talk them out of their pain.

This is where ACT feels most honest to me. ACT does not ask anyone to reframe a loss into a lesson, reassure someone that everything will be alright, or find the silver lining in a trauma. Acceptance, in the ACT sense, is not approval and it is not resignation. It is the willingness to stop spending precious energy at war with thoughts and feelings so that energy becomes available for living.

I have sat with clients who believed their grief was a problem to be solved, and who felt like failures because it would not resolve on schedule. ACT gave us different ground to stand on: grief is the shape love takes after loss. We are not here to eliminate it; we are here to help you carry it in a way that leaves room for the rest of your life. I love this work because that stance is deeply humane, and because I watch it bring people relief that symptom-elimination approaches often can't give them.

Values give therapy a direction

The "commitment" half of Acceptance and Commitment Therapy is just as important as the acceptance half, and it is the part I find most energizing as a therapist.

Many of my clients are standing at crossroads without a map: Do we do another round of IVF? Do I stay on medication during pregnancy? How do I parent while grieving? Do I go back for the follow-up scan I have been dreading? These are questions with no objectively right answer, and anxiety loves an unanswerable question.

ACT does not pretend to answer these questions. Instead, it offers a compass: values. Not values as slogans, but values as chosen directions — what kind of person, partner, or parent someone wants to be, especially when the outcome is uncertain. In session, values work sounds like: "If we cannot guarantee how this turns out, what do you want your role in it to look like?" I have watched clients make wrenching decisions with more peace, not because the uncertainty went away, but because they knew what they were standing for while they decided.

Values also transform the small moments. Committed action in ACT is rarely dramatic; it is calling the clinic, going to the baby shower or compassionately declining it, getting on the floor to play for ten minutes while anxiety hums in the background. I love that ACT honors these small, brave acts as the real substance of change.

What ACT looks like in my sessions

ACT has a reputation for metaphors and experiential exercises because this is a therapy you experience more than one you are lectured about. In my sessions, ACT often looks like:

  • Noticing thoughts as thoughts — practicing a little distance from the mind's commentary ("I'm having the thought that I can't handle this") rather than taking thoughts at face value
  • Willingness practice — making room for anxiety, grief, or dread on purpose, in small doses, in the service of something that matters
  • Values clarification — identifying what you want your life to stand for, separate from what fear says is possible
  • Committed action planning — small, concrete steps toward valued living, taken with difficult feelings along for the ride rather than waiting for them to leave
  • Present-moment grounding — returning attention to the life that is actually happening, rather than the feared future or the replayed past
  • Self-compassion woven throughout — because none of this work is possible from a posture of self-criticism

What I love about these practices is that they are portable. Clients do not need me in the room forever; they carry the skills into delivery rooms, fertility clinics, oncology waiting rooms, and their own kitchens. My goal is always to work myself out of a job.

Why ACT fits reproductive mental health, medical trauma, and OCD

ACT is a natural fit for reproductive and perinatal mental health because so much of this territory involves uncertainty that cannot be resolved and feelings that are mixed by nature. Pregnancy after loss means joy and fear in the same breath. Infertility treatment means hope and grief on alternating days. New parenthood can hold love and resentment and awe and depletion all before noon. ACT never asks clients to pick one true feeling; it makes room for all of them, which is often the first time anyone has given a client that permission. Research specifically supports ACT-based approaches for infertility-related distress, and my clients' experiences echo it.

The fit with medical trauma and procedural anxiety is just as strong. My own research on procedural anxiety among gynecologic cancer survivors taught me that people facing medical care they fear rarely need convincing that the procedure matters — they need help being willing to show up for it while afraid. That is ACT's home turf: willingness in the service of health and values.

And in my OCD and anxiety work, ACT is the lens through which I deliver Exposure and Response Prevention (ERP) and additional exposure therapy techniques. Connecting exposure to values transforms it from a series of anxiety endurance tests into acts of reclaiming a life.

When to seek support

ACT-based therapy may be a good fit if you notice that:

  • You are spending enormous energy fighting, avoiding, or trying to control your thoughts and feelings — and it is not working
  • Anxiety, grief, or dread is shrinking your life: fewer places, fewer people, fewer risks
  • You are facing a decision with no clear right answer and feel paralyzed
  • You are navigating infertility, pregnancy, postpartum, loss, or a medical diagnosis and feel like no one around you can hold the complexity of it
  • You have tried therapy focused on changing your thoughts, and it helped less than you hoped
  • You want a life that is bigger, even if you doubt your feelings will ever be less intense

You do not need to be in crisis to seek support. If the way you are relating to your own mind is costing you the life you want, that is reason enough.

If someone is experiencing thoughts of self-harm or suicide, immediate support is needed. In the U.S., calling or texting 988 connects to the Suicide and Crisis Lifeline. If there is imminent danger, call 911 or go to the nearest emergency room.

If any of this resonates, and you're wondering if therapy with a specialist might help, I'd be glad to connect. You can reach me through my contact form or at contact@drjesscoleman.com.

Telehealth ACT therapy in North Carolina, California, and PSYPACT states

I provide Acceptance and Commitment Therapy through secure telehealth to adults located in North Carolina, California, and more than 40 PSYPACT states. ACT translates beautifully to telehealth: the skills we practice are meant to be used in your real life, and meeting you there — in your home, between feedings, before an appointment — often helps the work translate quickly. If you are searching for an ACT therapist who works with adults online, you can reach out through my contact form or email me at contact@drjesscoleman.com to schedule a free consultation call.

Frequently Asked Questions

What is Acceptance and Commitment Therapy (ACT)?

Acceptance and Commitment Therapy (ACT) is an evidence-based form of behavioral therapy that helps people build psychological flexibility: the ability to stay open, present, and engaged in what matters even when difficult thoughts and feelings are present. Rather than focusing on eliminating symptoms, ACT teaches skills for relating differently to your inner experience while taking committed action toward a values-driven life.

Is ACT an evidence-based therapy?

Yes. ACT is supported by more than one hundred randomized controlled trials, and a review of 20 meta-analyses covering more than 12,000 participants found ACT effective for anxiety, depression, chronic pain, substance use, and transdiagnostic concerns. Research also supports ACT for medical populations, including cancer-related and infertility-related distress.

How is ACT different from traditional CBT?

Traditional cognitive behavioral therapy often focuses on identifying and changing the content of unhelpful thoughts. ACT focuses less on changing thoughts and more on changing your relationship to them — learning to notice thoughts without being ruled by them, while acting on your values. Both are evidence-based; many people who found thought-challenging unhelpful or exhausting find ACT to be a better fit.

Does "acceptance" mean giving up or approving of what happened?

No. In ACT, acceptance means willingness to acknowledge reality and make room for the feelings it brings, rather than exhausting yourself fighting them. It is not approval, resignation, or forced positivity. Accepting that a loss happened, and that it hurts, is what frees your energy for living — it never requires you to be glad about it.

What can ACT help with?

ACT has research support across anxiety, depression, OCD, chronic pain, trauma-related distress, and health-related concerns. In my practice, I use ACT with adults navigating perinatal and postpartum mental health, pregnancy and infant loss, infertility, medical trauma and procedural anxiety, sexual trauma, OCD, and grief. It is especially well suited to situations involving uncertainty, ambivalence, or pain that cannot simply be removed.

Can ACT be done through online therapy?

Yes. ACT is well suited to telehealth because its skills are designed to be practiced in your daily life. Sessions are held through a secure, HIPAA-compliant platform for adults in North Carolina, California, and 40+ PSYPACT states.

How do I know if ACT is a good fit for me?

ACT tends to fit people who are tired of fighting their own minds, who face situations that cannot be fixed or controlled, and who want therapy oriented toward building a meaningful life rather than only reducing symptoms. The best way to find out is a consultation call with an ACT therapist, where you can ask questions and get a feel for the approach before committing.

Further Reading

Jess Coleman, Ph.D.
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