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

Abstract

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.