About this note
An ACT-oriented note for therapists using Acceptance and Commitment Therapy. This template focuses on psychological flexibility processes, experiential avoidance, values, internal experiences, workability, committed action, and between-session practice. It is useful when a therapist wants to track how the client relates to difficult thoughts and feelings, connects with values, and takes values-based action.
Example note
Session Summary
The client reported cancelling one social plan since the previous session after anxiety rose beforehand, but also sent a message to rearrange rather than withdrawing completely. The session focused on the workability of avoidance, the value of friendship, and practising defusion from the awkwardness thought. The client agreed to a small committed action of attending a short walk with a friend while making room for anxiety.
Current Presentation and Context
The client reported wanting more connection but feeling anxious before informal social plans. They described cancelling a dinner because of nausea, chest tightness and thoughts that they would have nothing to say. They also reported that rearranging the plan felt different from disappearing because it kept the friendship active.
ACT Process Formulation
The therapist framed the pattern as a possible cycle of social cue, anxious thoughts and sensations, cancellation, short-term relief, then loneliness and self-criticism. The client agreed that cancelling works in the moment but moves them away from the relationships they want. The client was unsure whether every cancellation is avoidance, noting that tiredness is sometimes genuine.
Values and Chosen Direction
The client identified friendship, reliability and warmth as valued qualities. They distinguished the goal of feeling confident from the value of being present with people they care about. The client said they wanted to be someone who can show up imperfectly rather than wait until anxiety is absent.
Progress, Obstacles and Workability
Progress included sending a repair message after cancelling rather than avoiding the friend completely. Obstacles included nausea before plans, the thought that awkwardness would be intolerable, and concern that repeated cancellations could damage friendships. The client described avoidance as workable for immediate relief but not workable for connection.
ACT Interventions and Psychoeducation
The therapist used workability questions to examine whether cancellation served the client’s longer-term aims. The therapist introduced defusion as changing the client’s relationship to thoughts rather than disputing them. The client practised labelling the awkwardness prediction as a thought and reported that this created a little more distance from it.
Experiential Exercises and Metaphors
The therapist used the passengers-on-the-bus metaphor to illustrate bringing anxiety along while moving toward connection. The client identified anxiety, shame and the awkwardness thought as passengers that become loud before social plans. The client’s takeaway was that the aim is not to remove the passengers before leaving home.
Committed Action and Next Steps
• Client-chosen committed action: Attend a 20-minute walk with one friend this weekend in service of friendship and reliability.
• Between-session practice or reflection: Use the practised defusion wording when the awkwardness thought appears, and record whether this changes the client’s next action.
• Next-session focus: Review what happened before, during and after the walk, including barriers and any values-consistent action.
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