Category: Therapy

Therapy

Values Clarification: Discovering What Truly Matters

S. Reimers, JD/LICSW

Part Four in a Six Part Series on the Core Principles of ACT Therapy

This post is the fourth in our series exploring the core principles of Acceptance and Commitment Therapy (ACT), an evidence-based approach designed to foster psychological flexibility and help individuals live meaningful, values-driven lives. In previous posts, we discussed Acceptance, Cognitive Defusion, and Present Moment Awareness. Now, we delve into another essential principle of the ACT hexaflex: Values Clarification.

What Is Values Clarification in ACT?

Values clarification is the process of identifying, articulating, and committing to what truly matters in your life. In ACT, values are described as chosen life directions—qualities of being and doing that give our lives meaning and purpose. Unlike goals, which can be achieved or completed, values are enduring and guide our actions across all areas of life.

Values clarification helps us connect with the deeper reasons behind our actions and decisions. It involves exploring what we stand for, what we care about, and how we want to show up in the world. This process is deeply personal and unique to each individual, as it reflects our inner sense of purpose and fulfillment.

Why Is Values Clarification Important?

Values serve as a compass that guides our actions, especially during challenging times. Without clarity about our values, we may feel directionless, make choices that don’t align with our true selves, or avoid discomfort in ways that undermine our long-term well-being. Clarifying values helps us:

  • Prioritize What Matters: By understanding what is most important to us, we can focus our energy and attention on activities and relationships that align with our values.
  • Navigate Challenges: Values provide a sense of direction and motivation, even in the face of pain, uncertainty, or adversity.
  • Enhance Psychological Flexibility: Acting in accordance with our values fosters resilience and a sense of purpose, enabling us to adapt more effectively to life’s difficulties.

Values Clarification in Action: A Metaphor

A helpful metaphor for values clarification is the “Lighthouse.” Imagine you are sailing in rough waters. The lighthouse represents your values—a steady beacon that guides you toward your destination, even when the seas are stormy or the journey is difficult. While the lighthouse doesn’t eliminate the waves, it provides direction and purpose, helping you navigate through the challenges.

Practical Strategies to Clarify Your Values

Values clarification is an ongoing process that evolves as we grow and change. Here are some strategies to help you identify and connect with your values:

  1. Reflect on Meaningful Moments: Think about times in your life when you felt truly fulfilled, proud, or alive. What qualities or actions were present in those moments? These reflections can provide clues about your core values.
  2. Explore Different Life Domains: Consider various areas of your life, such as relationships, work, health, personal growth, and community involvement. What kind of person do you want to be in each domain? What qualities do you want to embody?
  3. Write Your Eulogy: Imagine what you would want others to say about you at the end of your life. What would you want them to remember about your character, actions, and contributions? This exercise can reveal your most cherished values.
  4. Use Values Lists or Card Sorts: Tools like values lists or card sorting exercises can help you identify and prioritize values. These activities involve reviewing a list of potential values, selecting the ones that resonate most with you, and ranking them by importance.
  5. Ask Values-Based Questions: Questions such as, “What kind of person do I want to be?” or “What do I want my life to stand for?” can help you clarify your values.

Common Misconceptions About Values Clarification

To fully embrace values clarification, it’s important to address common misconceptions:

  • Values Are Not the Same as Goals: While goals are specific, measurable outcomes, values are ongoing qualities that guide our actions. For example, “being a caring parent” is a value, while “spending one hour of quality time with my child each day” is a goal that aligns with that value.
  • Values Are Not Fixed: Values can evolve over time as we gain new experiences and insights. The process of values clarification is dynamic and adaptable.
  • Values Are Not Universal: Each person’s values are unique and deeply personal. What matters to one person may not resonate with another, and that’s okay.

The Role of Values Clarification in the ACT Hexaflex

Values clarification is central to the ACT hexaflex, connecting directly to committed action, another core principle of ACT. Once we identify our values, we can take purposeful actions that align with them, even in the face of discomfort or obstacles. By grounding ourselves in our values, we cultivate a sense of meaning and direction, enhancing our overall well-being.

Final Thoughts

Values clarification is a transformative process that helps us discover what truly matters and align our actions with our deepest aspirations. By connecting with our values, we can navigate life’s challenges with greater clarity, resilience, and purpose.

In the next post in this series, we will explore the principle of Committed Action, which builds on the foundation of values clarification to help us take meaningful steps toward a fulfilling life. For now, take some time to reflect on your own values. What matters most to you? How can you begin to align your actions with your values today? The journey to a values-driven life begins with these small but significant steps.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy, Uncategorized

Present Moment Awareness: Fully Engaging with Life

S. Reimers, JD/LICSW

Part Three in our Six Part Series on the Core Principles of ACT Therapy

This post is the third in our series exploring the core principles of Acceptance and Commitment Therapy (ACT), an evidence-based approach that helps individuals develop psychological flexibility and lead values-driven lives. Having covered Acceptance and Cognitive Defusion in the previous posts, we now turn to another foundational principle of the ACT hexaflex: Present Moment Awareness.

What Is Present Moment Awareness in ACT?

Present moment awareness, often synonymous with mindfulness, is the practice of fully engaging with the here and now. It involves consciously attending to your current experiences—thoughts, emotions, sensations, and surroundings—without judgment or distraction. In ACT, this principle emphasizes being present, open, and flexible, regardless of whether the moment is pleasant or uncomfortable.

Modern life often pulls us out of the present moment, with distractions, worries about the future, and ruminations on the past dominating our attention. Present moment awareness helps us reconnect with what is happening right now, grounding us in our immediate experience. This practice fosters clarity and focus, enabling us to respond to life with intention rather than reacting automatically.

Why Is Present Moment Awareness Important?

Present moment awareness is crucial for psychological flexibility. When we are caught up in worries, regrets, or automatic thoughts, we can lose touch with what truly matters. By bringing our attention back to the present, we create space to observe our experiences with curiosity and compassion, rather than judgment or avoidance.

This principle also helps reduce the impact of unhelpful thought patterns and emotions. For example, instead of becoming overwhelmed by anxiety about an upcoming event, present moment awareness allows us to notice the feeling of anxiety, acknowledge it, and refocus on the current task or situation. Over time, this practice can improve emotional regulation, reduce stress, and enhance overall well-being.

Present Moment Awareness in Action: A Metaphor

A common ACT metaphor for present moment awareness is the “Observer on the Mountain.” Imagine you are sitting on top of a mountain, watching the valley below. You see weather patterns come and go: sunshine, rain, storms, and clouds. From your vantage point, you can observe these changes without being swept away by them. Similarly, present moment awareness helps you observe your internal experiences from a place of stability, rather than getting lost in them.

Practical Strategies to Cultivate Present Moment Awareness

In ACT, present moment awareness is developed through mindfulness practices and intentional exercises. Here are some practical strategies to integrate into your daily life:

  1. Mindful Breathing: Focus on the sensation of your breath as it enters and leaves your body. When your mind wanders, gently bring your attention back to your breath. This simple practice anchors you in the present moment.
  2. Body Scan: Take a few minutes to scan your body from head to toe, noticing sensations, tension, or areas of relaxation. This practice fosters awareness of your physical state and helps ground you in the present.
  3. Five Senses Exercise: Pause and take note of your surroundings using your five senses. What do you see, hear, smell, taste, and feel? This exercise helps you reconnect with your environment and shifts your focus away from unhelpful thoughts.
  4. Labeling Experiences: As you notice thoughts or emotions, label them objectively. For example, say to yourself, “I am noticing a feeling of sadness” or “I am having a thought about failure.” This practice encourages nonjudgmental awareness.
  5. Engaging Fully in Activities: Choose an everyday activity, such as washing dishes or drinking coffee, and give it your full attention. Notice the textures, smells, and sensations involved. This practice helps you appreciate the richness of ordinary moments.

Common Misconceptions About Present Moment Awareness

To fully embrace present moment awareness, it is important to address common misconceptions:

  • Mindfulness Is Not About Eliminating Thoughts: The goal is not to empty your mind but to observe your thoughts and experiences without judgment or attachment.
  • Mindfulness Is Not Always Relaxing: While mindfulness can reduce stress over time, the practice itself may involve confronting uncomfortable emotions or sensations.
  • Mindfulness Is Not a Fixed State: Present moment awareness is a skill that requires ongoing practice. It is normal for your mind to wander, and bringing it back to the present is part of the process.

The Role of Present Moment Awareness in the ACT Hexaflex

Present moment awareness is a foundational component of the ACT hexaflex, deeply intertwined with acceptance, defusion, and values-based living. By cultivating this principle, we enhance our ability to stay connected to our values and respond flexibly to life’s challenges. It allows us to fully engage with each moment, fostering a sense of presence and purpose.

Final Thoughts

Present moment awareness is a powerful tool for living a more intentional and fulfilling life. By grounding ourselves in the here and now, we can reduce the influence of unhelpful thoughts and emotions and create space for meaningful action. As you practice mindfulness, remember to approach yourself with patience and kindness. Each moment is an opportunity to begin again.

In the next post in this series, we will explore the principle of Values Clarification, which helps us identify and prioritize what truly matters in our lives. For now, take a moment to pause and notice your current experience. What do you see, hear, or feel? The present moment is always available to you, waiting to be explored.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy

Cognitive Defusion: A Key to Psychological Flexibility

S. Reimers, JD/LICSW

Part Two of a Six Part Series on the Core Principles of ACT Therapy

Changing Your Relationship with Thoughts

This post is the second in our series exploring the core principles of Acceptance and Commitment Therapy (ACT), an evidence-based approach designed to enhance psychological flexibility and promote a values-driven life. Following our discussion of Acceptance, we now turn to another foundational principle of the ACT hexaflex: Cognitive Defusion.

What Is Cognitive Defusion in ACT?

Cognitive defusion is the process of changing how we relate to our thoughts. In ACT, thoughts are not viewed as inherently good or bad, true or false. Instead, the focus is on how much power we give to these thoughts and whether they help us live according to our values. Cognitive defusion involves stepping back from thoughts, seeing them for what they are—simply words or images in our minds—rather than as literal truths that must dictate our actions or emotions.

When we become fused with our thoughts, we treat them as absolute facts and allow them to dominate our decisions and behaviors. Defusion helps us break free from this grip, enabling us to observe our thoughts with curiosity and perspective. By doing so, we can reduce their impact and influence, allowing us to act in alignment with our values rather than being controlled by unhelpful mental content.

Why Is Cognitive Defusion Important?

Cognitive defusion is crucial because it helps us disentangle from thought patterns that contribute to emotional distress and behavioral avoidance. Many psychological struggles, such as anxiety, depression, and low self-esteem, are fueled by unhelpful thinking. When we take our thoughts too seriously or treat them as ultimate truths, we can become stuck in patterns of rumination, worry, or self-criticism.

Defusion allows us to create distance from these thoughts, diminishing their power and influence. It helps us see that thoughts are not commands we must obey or obstacles we must eliminate. Instead, they are transient experiences that we can observe and let pass without getting caught up in their content. This shift empowers us to make choices based on our values rather than being driven by automatic thought patterns.

Cognitive Defusion in Action: A Metaphor

One of the most well-known metaphors for cognitive defusion is the “Passengers on the Bus” metaphor. Imagine you are driving a bus, and the passengers represent your thoughts. Some passengers are loud, critical, or demanding, while others are quiet or supportive. If you stop the bus every time a passenger yells at you, you won’t make much progress toward your destination. Cognitive defusion teaches you to keep driving the bus, acknowledging the passengers’ presence but not letting them dictate your journey.

Practical Strategies to Cultivate Cognitive Defusion

In ACT, cognitive defusion is a skill that can be practiced and developed. Here are some techniques to help you foster this skill:

  1. Labeling Thoughts: Practice noticing your thoughts and labeling them as they arise. For example, instead of thinking, “I’m a failure,” you might say, “I’m having the thought that I’m a failure.” This simple shift creates distance and reminds you that thoughts are not facts.
  2. Silly Voices Exercise: Repeat a troubling thought in a silly voice or imagine it being said by a cartoon character. This exercise highlights the arbitrary nature of thoughts and reduces their emotional impact.
  3. Thought Clouds: Visualize your thoughts as clouds drifting across the sky. Notice them come and go without trying to hold onto or push them away. This imagery reinforces the idea that thoughts are temporary and not inherently powerful.
  4. Leaves on a Stream: Imagine placing each thought on a leaf and letting it float down a stream. Watch as the leaf drifts away, carrying the thought with it. This technique helps you practice letting go of unhelpful thoughts.
  5. Thank Your Mind: When your mind produces a particularly challenging thought, try saying, “Thank you, mind,” with a touch of humor or kindness. This response acknowledges the thought’s presence without becoming entangled in it.

Common Misconceptions About Cognitive Defusion

It is important to clarify what cognitive defusion is and what it is not:

  • Defusion Is Not Suppression: Defusion does not involve pushing thoughts away or trying to eliminate them. Instead, it involves changing your relationship with them.
  • Defusion Is Not Distraction: While defusion techniques may reduce the immediate impact of a thought, their primary goal is to foster awareness and perspective, not to avoid or distract from the thought.
  • Defusion Is Not About Truth: The goal is not to determine whether a thought is true or false but to assess whether it is helpful and aligned with your values.

The Role of Cognitive Defusion in the ACT Hexaflex

Cognitive defusion is closely connected to other principles of the ACT hexaflex, such as mindfulness and acceptance. Together, these principles create a flexible approach to managing difficult thoughts and emotions while pursuing a meaningful life. By practicing defusion, you can increase your ability to stay present, act intentionally, and focus on what matters most.

Final Thoughts

Cognitive defusion is a transformative skill that allows us to step back from our thoughts and see them for what they are: fleeting mental events rather than absolute truths. By cultivating this skill, we can reduce the power of unhelpful thinking and make choices that align with our values and goals.

In the next post in this series, we will explore the principle of Present Moment Awareness, which builds on the concepts of acceptance and defusion to help us engage more fully with life. For now, consider how cognitive defusion might apply to your own experiences. How might your life change if you could view your thoughts with greater curiosity and detachment? The journey to greater psychological flexibility starts with small steps like these.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy

Acceptance: Greeting Life Without Judgment

S. Reimers, JD/LICSW

Part One in a Six Part Series on the Core Principles of ACT Therapy

Embracing Life as It Is

This post is the first in a series exploring the core principles of Acceptance and Commitment Therapy (ACT), an evidence-based approach designed to help individuals build a meaningful and values-driven life. ACT is structured around six interrelated principles, often visualized as a hexaflex. These principles work together to cultivate psychological flexibility, a key component of well-being. In this series, we begin with one of the foundational principles: Acceptance.

What Is Acceptance in ACT?

Acceptance in ACT is not about passive resignation or giving up. Rather, it is an active process of opening up to our inner experiences—thoughts, emotions, memories, and sensations—without judgment or attempts to avoid, suppress, or control them. It is the practice of making room for these experiences, even when they are uncomfortable, while continuing to engage with life in meaningful ways.

At its core, acceptance challenges the natural human tendency to fight against discomfort or unpleasant emotions. In modern society, we are often taught to “fix” problems, avoid pain, and pursue happiness at all costs. While this approach can be helpful in many contexts, it becomes problematic when applied to our internal world. Struggling against pain often amplifies suffering, creating a cycle of avoidance and distress that prevents us from living fully.

Why Is Acceptance Important?

Acceptance is vital because it frees us from the exhausting battle of trying to control what we cannot. Many psychological struggles stem from attempts to avoid difficult emotions or thoughts, a process known as experiential avoidance. While avoidance may bring short-term relief, it often leads to long-term problems, such as anxiety, depression, addiction, or a diminished sense of meaning in life.

When we practice acceptance, we learn to approach our internal experiences with curiosity and compassion rather than fear or aversion. This shift allows us to respond more effectively to life’s challenges, enabling us to focus our energy on what truly matters. Importantly, acceptance does not mean liking or approving of painful experiences. It simply means acknowledging their presence without allowing them to dominate our lives.

Acceptance in Action: A Metaphor

A powerful metaphor used in ACT to explain acceptance is the “struggle with quicksand.” Imagine you are trapped in quicksand. Your first instinct might be to struggle and thrash in an effort to escape. However, this reaction only causes you to sink deeper. The way out is counterintuitive: stop struggling, spread your weight evenly, and allow yourself to float. Similarly, acceptance involves letting go of the struggle with difficult emotions and thoughts, creating the space to move forward.

Practical Strategies to Cultivate Acceptance

In ACT, acceptance is not just a concept but a skill that can be developed through practice. Here are some strategies to help cultivate acceptance in daily life:

  1. Mindful Observation: Practice noticing your thoughts and emotions as they arise, without labeling them as “good” or “bad.” For example, if you feel anxious, simply acknowledge, “I am noticing anxiety right now.” This nonjudgmental awareness helps create distance from the experience, reducing its intensity.
  2. Allowing and Breathing: When faced with a challenging emotion, pause and take a few deep breaths. Visualize yourself creating space for the emotion, allowing it to be there without resistance. Remember that emotions, like waves, will naturally rise and fall if you let them.
  3. Anchoring in the Present: Engage your senses to ground yourself in the present moment. Focus on the feel of the ground beneath your feet, the sound of birds chirping, or the sensation of your breath entering and leaving your body. This practice can help you stay present rather than getting caught up in avoidance.
  4. Self-Compassion: Speak to yourself with kindness and understanding, especially during difficult times. Remind yourself that it’s okay to feel pain and that you are not alone in your struggles. Self-compassion can soften resistance and create a safe space for acceptance.
  5. Acceptance Imagery: Imagine your thoughts and emotions as leaves floating down a stream or clouds passing across the sky. This imagery can help you see them as temporary and separate from your core self, reducing the urge to control or suppress them.

Common Misconceptions About Acceptance

It is important to address some common misunderstandings about acceptance:

  • Acceptance Is Not Endorsement: Accepting an experience does not mean you agree with it or want it to continue. It simply means you are choosing to stop fighting against its presence.
  • Acceptance Is Not Passive: Acceptance is an active stance. It requires courage and effort to turn toward discomfort and make space for it.
  • Acceptance Does Not Replace Action: Acceptance works hand-in-hand with committed action. While you make room for difficult experiences, you also take steps aligned with your values and goals.

The Role of Acceptance in the ACT Hexaflex

Acceptance is intricately linked with the other principles of the ACT hexaflex, such as mindfulness, cognitive defusion, and values-based action. Together, these principles create a framework for navigating life’s challenges with greater flexibility and resilience. By practicing acceptance, you lay the foundation for engaging more fully with the present moment and pursuing a meaningful life.

Final Thoughts

Learning to embrace acceptance is a transformative journey. It allows us to let go of the struggle with pain and focus on what truly matters: living in alignment with our values. In the next post in this series, we will delve into the principle of cognitive defusion, another essential component of the ACT model.

For now, consider how acceptance might play a role in your life. What would it feel like to stop fighting against difficult emotions or thoughts and instead make space for them? The path to greater well-being often begins with this simple yet profound shift.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

LGBT, Political, Therapy, Transgender

The Truth About Gender-Affirming Care

S. Reimers, JD/LICSW

Countering the Mischaracterization of Trans Healthcare

A recent study published in JAMA Pediatrics reveals an important yet often overlooked fact about transgender healthcare in the United States: a “very, very small number” of teens receive gender-affirming medical care. This finding underscores the reality that much of the rhetoric surrounding transgender youth is rooted not in evidence but in sensationalism. Despite claims to the contrary, doctors and mental health professionals who follow the World Professional Association for Transgender Health (WPATH) standards are not “grooming” children. Instead, they are providing thoughtful, evidence-based care that often involves slowing down the decision-making process and exploring various options.

What the Study Tells Us

The study, which analyzed private insurance claims for over 5 million adolescents from 2018 to 2022, found that fewer than 18,000 teens were diagnosed with gender dysphoria during this period. Even more strikingly, fewer than 1,000 accessed puberty blockers, and fewer than 2,000 received hormone therapy. In total, this represents less than 0.1% of teenagers with private insurance.

These numbers stand in stark contrast to the political narrative that frames gender-affirming care as a widespread and reckless phenomenon. Instead, the data reveals that such care is exceedingly rare and highly specialized. Moreover, many transgender youth do not pursue medical interventions at all, opting instead for non-medical changes like adopting a new name or altering their clothing and hairstyle.

A Thoughtful and Cautious Process

The standards of care set forth by WPATH emphasize a thorough, patient-centered approach to gender-affirming care. This process often begins with mental health evaluations and discussions aimed at helping young people explore their gender identity in a safe and supportive environment. Puberty blockers, for instance, are reversible treatments that give adolescents more time to consider their options before making permanent decisions.

Contrary to the inflammatory claims of critics, these interventions are not rushed or taken lightly. Decisions about puberty blockers and hormones are typically made after careful consideration, involving not just the patient but also their family and healthcare team. This aligns with WPATH guidelines, which prioritize the well-being of the individual and recommend age-appropriate care based on robust scientific evidence.

Mischaracterizing Trans Healthcare

Despite the thoughtful nature of gender-affirming care, it has been severely mischaracterized in public discourse. Opponents often portray it as experimental or dangerous, ignoring endorsements from major medical organizations like the American Academy of Pediatrics and the American Medical Association. These groups recognize that access to gender-affirming care can significantly improve mental health outcomes for transgender youth, including reducing rates of depression, anxiety, and suicidal ideation.

The political weaponization of trans healthcare has also led to widespread misinformation. For example, opponents frequently conflate gender-affirming care with irreversible surgeries on minors—a practice that is exceedingly rare and not recommended under WPATH standards for adolescents. Instead, the focus is on non-invasive or reversible treatments designed to provide support during a critical developmental period.

The Disproportionate Focus on Trans Youth

The study’s findings also highlight the disproportionate attention given to transgender youth in political and media discourse. While fewer than 0.1% of teens with private insurance receive gender-related medical care, this small group has become the target of legislative efforts in half of U.S. states. These efforts often ignore the lived experiences of transgender individuals and the consensus of medical professionals in favor of divisive political messaging.

This focus is not only unwarranted but also harmful. Transgender youth already face significant challenges, including higher rates of bullying, discrimination, and mental health struggles. The stigmatization of gender-affirming care exacerbates these issues, creating barriers to accessing supportive and life-affirming treatment.

Slowing Down to Support

Far from “pushing” children into irreversible decisions, providers who adhere to WPATH standards often help young people slow down and consider their options. This approach reflects the core principles of medical ethics: autonomy, beneficence, non-maleficence, and justice. By creating a space for open dialogue and careful deliberation, healthcare professionals empower patients and their families to make informed decisions based on their unique needs and circumstances.

Moreover, delaying or banning access to gender-affirming care does not eliminate the need for support—it merely shifts the burden onto already vulnerable populations. Denying care increases the risk of negative mental health outcomes, as individuals are forced to navigate their identities without the tools and resources they need to thrive.

The Path Forward

As debates about transgender healthcare continue, it is essential to center evidence and compassion over fear and misinformation. The findings from the JAMA Pediatrics study remind us that gender-affirming care is not a widespread or reckless practice—it is a rare, carefully considered intervention that helps young people navigate their identities with dignity and support.

Rather than demonizing healthcare providers and transgender youth, policymakers and the public should strive to understand the realities of gender-affirming care. This means listening to medical experts, uplifting the voices of transgender individuals, and rejecting the harmful narratives that misrepresent their experiences.

By doing so, we can move toward a more inclusive and compassionate society—one that recognizes the humanity of all its members and ensures that everyone has access to the care they need to live authentically.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy

Understanding Acceptance and Commitment Therapy

S. Reimers, JD/LICSW

Embracing Life’s Challenges with Mindful, Values-Based Commitments

Acceptance and Commitment Therapy (ACT), pronounced as “act” rather than spelled out, represents a groundbreaking approach in the field of psychotherapy. Rooted in the principles of mindfulness, behavioral science, and acceptance, ACT encourages individuals to embrace life’s challenges rather than resist them. This philosophy aims to foster psychological flexibility, empowering people to live meaningful lives even in the face of adversity.

The Core Philosophy of ACT

ACT is grounded in the belief that psychological suffering arises from the human tendency to avoid or suppress difficult emotions, thoughts, and experiences. At its heart, ACT challenges the conventional goal of eliminating distress, arguing instead that it is our relationship with discomfort—not the discomfort itself—that determines our mental well-being.

The therapy is deeply influenced by Relational Frame Theory (RFT), a modern behavioral science framework that explores how language and cognition influence our behavior. RFT posits that humans are uniquely capable of forming complex associations through language, which, while advantageous, can also lead to cognitive traps such as self-criticism, worry, and avoidance.

ACT emphasizes six interconnected processes that form its therapeutic foundation, often visualized as the points of a hexagon, collectively referred to as the ACT Hexaflex. These processes work in harmony to cultivate psychological flexibility, the ability to stay present, open, and committed to value-driven action even when faced with challenging emotions or thoughts.

The Six Core Processes of ACT

1. Acceptance

Acceptance involves an active and open stance toward difficult thoughts, emotions, and sensations rather than attempting to suppress, control, or avoid them. ACT posits that fighting against unpleasant experiences often amplifies suffering. Instead, acceptance fosters a willingness to coexist with discomfort, recognizing it as a natural part of life.

For instance, rather than avoiding anxiety-provoking situations, an individual learns to acknowledge and make room for the anxiety, allowing them to engage more fully with life.

2. Cognitive Defusion

Cognitive defusion refers to the process of disentangling from unhelpful thoughts and seeing them for what they are—words and images—rather than absolute truths. This practice helps reduce the power and influence of negative thinking.

A common exercise involves imagining a distressing thought as a cloud floating across the sky or writing it on a leaf carried down a stream. These metaphors encourage clients to observe their thoughts from a distance rather than becoming entangled in them.

3. Present Moment Awareness

Mindfulness lies at the heart of ACT, emphasizing non-judgmental awareness of the present moment. This practice encourages individuals to fully experience their surroundings, sensations, and emotions without judgment or distraction.

Present moment awareness helps individuals break free from the grip of past regrets or future anxieties, grounding them in the here and now. Techniques such as mindful breathing, body scans, and sensory awareness exercises are commonly employed to cultivate this skill.

4. Self-as-Context

ACT introduces the concept of “self-as-context,” which differentiates between the “self” as a constant, observing entity and the transient thoughts, feelings, and roles we often associate with our identity. By recognizing that they are more than their thoughts or emotions, individuals can gain perspective and reduce the impact of self-limiting beliefs.

For example, instead of saying, “I am a failure,” an individual might reframe it as, “I notice that I am having the thought that I am a failure.” This subtle shift creates space for self-compassion and empowerment.

5. Values Clarification

ACT emphasizes the importance of identifying and living in alignment with one’s core values. Values are the guiding principles that give life meaning and purpose, such as kindness, creativity, or community involvement. Therapy often involves exercises to help individuals clarify what truly matters to them, serving as a compass for decision-making and goal-setting.

Rather than focusing on symptom reduction, ACT asks, “What do you want your life to stand for?” This shift encourages individuals to focus on what they can control: taking steps toward a fulfilling and values-driven life.

6. Committed Action

Once values are clarified, ACT encourages committed action—taking meaningful steps toward living those values, even in the face of obstacles. This process involves setting realistic goals, developing action plans, and building resilience to persist despite setbacks.

For instance, a person who values connection might commit to reaching out to a friend despite feelings of social anxiety. Over time, these actions build momentum, fostering a sense of agency and purpose.

The Unique Approach of ACT

What sets ACT apart from other therapeutic modalities is its emphasis on acceptance over avoidance and its integration of mindfulness into practical, action-oriented strategies. Unlike Cognitive Behavioral Therapy (CBT), which often focuses on challenging and changing unhelpful thoughts, ACT encourages clients to change their relationship with their thoughts. This distinction shifts the focus from controlling internal experiences to engaging meaningfully with external ones.

Another hallmark of ACT is its use of metaphors, experiential exercises, and storytelling to convey complex ideas. For example:

  • The Tug-of-War Metaphor: Imagine you’re in a tug-of-war with a monster (representing your struggles), and there’s a pit in the middle. The harder you pull, the more the monster pulls back. ACT suggests letting go of the rope—not to surrender but to stop exhausting yourself in a battle that keeps you stuck.
  • Passengers on the Bus: In this metaphor, you are the driver of a bus, and your thoughts, emotions, and fears are the passengers. While some passengers may be loud and unpleasant, they don’t control the direction of the bus—you do.

Evidence Base and Applications

ACT has been extensively researched and shown to be effective for a wide range of psychological and physical conditions, including:

  • Anxiety disorders
  • Depression
  • Chronic pain
  • Substance use disorders
  • PTSD
  • Obsessive-compulsive disorder (OCD)

Additionally, ACT is increasingly applied in workplace settings, coaching, and education, demonstrating its versatility and relevance.

Challenges and Critiques

While ACT has gained widespread acceptance, it is not without its critics. Some argue that its concepts can be abstract or difficult to grasp for clients who prefer structured, problem-solving approaches. Additionally, practitioners must strike a balance between acceptance and action, ensuring clients do not become passive in the face of challenges.

Conclusion

Acceptance and Commitment Therapy offers a transformative approach to psychological well-being by teaching individuals to embrace life’s inevitable challenges while staying true to their values. By fostering acceptance, mindfulness, and committed action, ACT helps people navigate their internal experiences with greater flexibility and resilience.

Ultimately, ACT is not about eliminating pain but about creating space for a rich, meaningful life—a life in which discomfort is not a barrier but a companion on the journey toward growth and fulfillment.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Legal, LGBT, Political, Therapy, Transgender

Debunking Rapid Onset Gender Dysphoria: Key Findings

S. Reimers, JD/LICSW

Addressing the One Controversial Theory Fueling Anti-Trans Legislation

In the ever-evolving conversation surrounding gender diversity, research provides critical insights to guide compassionate and evidence-based understanding. A 2022 study published in Pediatrics by Jack L. Turban and colleagues challenges the controversial “Rapid Onset Gender Dysphoria” (ROGD) hypothesis, which posits that social contagion and peer influence drive sudden transgender identification among adolescents. This study’s findings highlight the resilience of transgender and gender-diverse (TGD) youth and underscore the importance of supporting their well-being through gender-affirming care.

Study Overview

The research examined the assigned-at-birth sex ratios and experiences of TGD adolescents using data from school-based surveys conducted across 16 U.S. states in 2017 and 2019. The study’s objectives included evaluating trends in TGD identification, exploring whether social contagion disproportionately affects certain groups, and addressing myths about the motivations behind identifying as TGD. By analyzing responses from a large, diverse sample, the researchers aimed to separate fact from speculation about the lived experiences of TGD youth.

Key Findings

  1. Sex Assigned at Birth Ratios
    The study found that in both 2017 and 2019, there were more assigned-male-at-birth (AMAB) TGD adolescents than assigned-female-at-birth (AFAB) TGD adolescents. This challenges the ROGD hypothesis, which claims that AFAB youth are uniquely susceptible to social contagion driving TGD identification.The slight shift in ratios over time, attributed to fewer AMAB TGD participants rather than an increase in AFAB TGD participants, further debunks claims of an AFAB-specific phenomenon. These findings contradict the idea that peer or social influences are creating clusters of transgender identification among AFAB youth.
  2. Bullying and Mental Health Challenges
    TGD youth were significantly more likely than cisgender peers to experience bullying and mental health struggles, including suicide attempts. The rates of bullying were higher for TGD youth than even for cisgender sexual minority youth. These patterns highlight the vulnerability of TGD adolescents to external stigma and the critical need for supportive environments.The data also counters the assertion that identifying as TGD offers a social advantage or serves as a way to escape sexual minority stigma. Instead, many TGD youth also identified as gay, lesbian, or bisexual, underscoring that their experiences with stigma are compounded rather than reduced.
  3. A Decrease in TGD Identification Over Time
    The percentage of adolescents identifying as TGD decreased from 2.4% in 2017 to 1.6% in 2019. This decline contradicts the notion of a social contagion effect driving exponential increases in TGD identification. If social contagion were at play, one would expect a steady or growing trend rather than a decrease.
  4. Debunking the ROGD Hypothesis
    The study directly refutes claims central to the ROGD hypothesis: that social influences uniquely drive AFAB youth toward TGD identification and that these identifications result from peer pressure or efforts to gain social status. By leveraging robust, population-based data, the researchers demonstrated that these narratives lack empirical support.

The Importance of Gender-Affirming Care

One of the most critical implications of this study is its support for gender-affirming medical care. Myths such as ROGD have been weaponized in legislative debates to deny TGD adolescents access to care, despite overwhelming evidence from major medical organizations that such care improves mental health outcomes. The researchers emphasize that restricting access to gender-affirming care based on unfounded hypotheses is not only scientifically unsound but also harmful to the well-being of TGD youth.

A n Affirming Perspective

This study reinforces that TGD youth deserve acceptance, support, and access to life-affirming care. The persistence of stigma and misinformation, such as the ROGD hypothesis, underscores the importance of amplifying evidence-based narratives that respect the lived experiences of transgender individuals. Rather than questioning the validity of TGD identities, society should focus on addressing the systemic factors—like bullying and discrimination—that harm these adolescents.

Ultimately, this research affirms that TGD youth are not merely responding to fleeting social trends or peer influences. They are navigating complex identities in a world that often misunderstands them. By creating a society grounded in empathy, evidence, and inclusion, we can empower these young people to thrive authentically.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy

Overcoming Seasonal Affective Disorder (SAD) This Winter

S. Reimers, JD/LICSW

Tips for Coping with a Case of the Winter Blues

As the vibrant colors of autumn fade into muted shades of gray and white, winter begins to assert itself, typically starting in late December and extending through late March. For those in the northern parts of the country, this season brings its unique challenges. The days grow alarmingly short, with the sun rising late and setting as early as mid-afternoon. Cold temperatures and icy conditions make outdoor activities less inviting, while snow-covered landscapes, though beautiful, can feel isolating. These seasonal changes often lead to a phenomenon many refer to as the “winter blues.”

The winter blues, also known as seasonal affective disorder (SAD) in its more severe forms, can leave you feeling lethargic, unmotivated, and even depressed. This is a widespread issue, with millions experiencing a dip in their mental health during these colder months. But understanding why this happens and exploring ways to counteract it can make winter a more manageable, even enjoyable, time of year.

Why Does Winter Impact Our Mood?

The primary culprit behind the winter blues is the lack of sunlight. Sunlight plays a crucial role in regulating our circadian rhythms, the internal clock that governs our sleep-wake cycle. Reduced exposure to daylight can disrupt this rhythm, leading to fatigue and difficulty concentrating. Additionally, limited sunlight can decrease serotonin levels—a neurotransmitter that contributes to feelings of well-being—and increase melatonin production, which can make us feel sleepy and sluggish.

Another contributing factor is the limited opportunity for outdoor activities and social connection. In warmer months, it’s easier to meet friends for a walk, enjoy a picnic, or take part in community events. But when temperatures plummet and sidewalks are slick with ice, many people opt to stay indoors, leading to feelings of isolation. The festive holiday season, while joyful for some, can exacerbate feelings of loneliness for others, especially once the celebrations are over and January’s stark reality sets in.

Fighting Back: Strategies to Beat the Winter Blues

Although winter’s challenges are real, there are numerous strategies you can employ to lift your spirits and maintain your mental health during the colder months. Here are some effective ways to combat the winter blues:

1. Maximize Sunlight Exposure

Whenever possible, try to get outside during daylight hours. Even a short walk during your lunch break can make a difference. If natural light is scarce, consider investing in a light therapy box. These devices mimic natural sunlight and can help regulate your circadian rhythms, boost serotonin levels, and improve your mood. Place the light box on your desk or dining table and use it for about 20-30 minutes each morning for optimal results.

2. Stay Active

Exercise is a powerful mood booster. While outdoor activities may be less accessible, there are plenty of ways to stay active indoors. Join a gym, try yoga or Pilates at home, or explore online workout classes. If you’re an outdoor enthusiast, consider winter-friendly activities like snowshoeing, cross-country skiing, or even brisk walks on clearer days. Physical activity releases endorphins, which are natural stress relievers and mood enhancers.

3. Prioritize Social Connections

Combat isolation by staying connected with friends and family. Schedule regular phone calls, video chats, or socially distanced meetups. If it’s safe and feasible, host small gatherings or join virtual communities and groups that share your interests. Social interaction is a cornerstone of mental well-being, and making an effort to connect can help you feel less alone.

4. Maintain a Healthy Routine

Establishing a consistent daily routine can provide structure and a sense of normalcy during the darker months. Aim to wake up and go to bed at the same time every day to support your circadian rhythm. Eat a balanced diet rich in whole foods, including fruits, vegetables, lean proteins, and whole grains. Foods rich in omega-3 fatty acids, like salmon and walnuts, as well as those high in vitamin D, can be particularly beneficial.

5. Practice Mindfulness and Gratitude

Mindfulness techniques, such as meditation and deep breathing, can help reduce stress and improve your overall mental state. Take a few minutes each day to sit quietly and focus on your breath or practice guided meditations. Gratitude journaling is another effective tool; write down three things you’re thankful for each day to shift your perspective and cultivate positivity.

6. Seek Professional Help if Needed

If your feelings of sadness or lethargy persist and interfere with your daily life, don’t hesitate to seek help from a mental health professional. Therapy, medication, or a combination of both can be highly effective for managing seasonal affective disorder. Remember, asking for help is a sign of strength, not weakness.

Embracing the Season

While winter may not be everyone’s favorite season, finding ways to embrace its unique offerings can make a significant difference. Cozy up with a good book by the fire, explore new indoor hobbies like painting or baking, or take time to reflect and plan for the year ahead. Viewing winter as an opportunity for rest and rejuvenation, rather than a burden, can shift your mindset and help you make the most of this quieter season.

Winter’s challenges are undeniable, but with intentional effort and a proactive approach, it’s possible to not just survive but thrive during these colder, darker months. By staying active, connected, and mindful, you can keep the winter blues at bay and emerge into spring feeling strong and refreshed.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Therapy

It’s the New Year! Let’s Make New Commitments (Not Resolutions)!

S. Reimers, JD/LICSW

Resetting Our Mental Health with Acceptance and Commitment Therapy

As the New Year dawns, many of us find ourselves reflecting on the past and looking ahead with hope. It’s a natural time for self-assessment, but instead of setting traditional resolutions—which often focus on fixing perceived flaws—the New Year offers a unique opportunity to recommit to values-driven actions that nurture our mental well-being. From an Acceptance and Commitment Therapy (ACT) perspective, this is not about striving for perfection or erasing difficulties. Instead, it’s about cultivating a meaningful life through acceptance, mindfulness, and purposeful commitments.

The Pitfall of Traditional Resolutions

Traditional New Year’s resolutions often aim for significant changes: losing weight, quitting a habit, or achieving a milestone. While these goals are well-intentioned, they often stem from a place of self-criticism or societal pressure. This approach can inadvertently set us up for feelings of failure if we don’t meet rigid expectations. Moreover, resolutions tend to focus on outcomes, which we can’t always control, rather than on processes that align with our core values.

ACT encourages us to step away from this cycle. Rather than framing the New Year as a time to fix ourselves, we can see it as an invitation to reconnect with what truly matters and to act in ways that honor our values, even when challenges arise. This shift in perspective can help reduce the burden of self-judgment and open the door to greater psychological flexibility.

Reflecting on Your Values

Values are the heart of ACT. They represent what is deeply important to us, guiding how we want to behave and what kind of person we want to be. Unlike goals, values are not something to achieve but rather qualities we bring to our actions. For example, if you value kindness, your commitment might involve being compassionate toward yourself and others, regardless of external outcomes.

To start, take a moment to reflect on the past year. Ask yourself:

  • What brought me a sense of fulfillment or connection?
  • When did I feel aligned with my values?
  • Are there areas where I’ve drifted from what matters most to me?

This exercise isn’t about judgment; it’s about noticing. From here, you can identify the values you’d like to prioritize in the coming year and consider how they might shape your mental health commitments.

Committing to New Actions

Once you’ve clarified your values, the next step is to create actionable commitments. In ACT, these are not rigid rules but flexible guides that help you move toward your values. Start small and specific. For example:

  • If you value connection, you might commit to calling a loved one weekly or joining a community group.
  • If you value growth, you might explore therapy, start journaling, or learn a new skill.
  • If you value self-care, you might schedule regular breaks or practice mindfulness for five minutes a day.

Remember, commitments are not about perfection. They’re about showing up, even when it’s hard. You might stumble—and that’s okay. Each moment offers a chance to recommit.

Practicing Acceptance and Mindfulness

A cornerstone of ACT is acceptance—the willingness to experience difficult emotions, thoughts, and sensations without struggling against them. The New Year can bring excitement but also anxiety or doubt. Practicing acceptance doesn’t mean resigning yourself to suffering; it means making space for these experiences while still moving toward your values.

Mindfulness can support this process. By staying present, you can notice when your mind wanders to self-criticism or unhelpful comparisons. Gently bring your focus back to the present and remind yourself of your values. Over time, this practice can help you build greater psychological flexibility and resilience.

Embracing the Journey

The beauty of a values-driven approach is that it transforms the New Year from a deadline for achievement into a journey of ongoing growth. It’s not about becoming someone new but about becoming more authentically you. Each step, no matter how small, is a victory when it aligns with your values.

As you step into the New Year, consider letting go of rigid resolutions and instead embrace commitments that reflect your true self. Be kind to yourself as you navigate this process. Life will continue to have its ups and downs, but by staying anchored in your values, you can create a sense of purpose and fulfillment that carries you through—not just this year, but for many years to come.

If you live in Washington State, and you would like to make an appointment, please feel free to contact me here. I’m looking forward to hearing from you.

:), Susan Reimers, JD/LICSW

Climate, Therapy

Coping with Climate Anxiety: DBT Techniques for a Better Future

S. Reimers, JD/LICSW

What Dialectical Behavioral Therapy Can Teach Us About Coping With an Uncertain Future

What is DBT?

Dialectical Behavioral Therapy (DBT) is an effective, evidence-based therapeutic tool that teaches practical skills in the areas of Mindfulness, Interpersonal Effectiveness, Emotional Regulation and Distress Tolerance. It is considered an important tool in the treatment of Borderline Personality Disorder and a host of other mental health conditions. As it happens, it’s also a good tool for combating the very real and very understandable issue of Climate Anxiety.

How Can DBT Help with Coping?

At the most basic level, DBT posits that any problem can be solved in four distinct ways. Reading through the list below, you’ll notice there are three active solutions, and one that requires no action at all:

  1. You can actually SOLVE the problem.
  2. You can FEEL BETTER about the problem.
  3. You can ACCEPT/TOLERATE the problem.
  4. You can DO NOTHING and stay miserable.

But what do these options mean exactly? Let’s take a moment to explore them one by one.

SOLVING Climate Change

Solving a problem is always the best solution, yet, it’s not always a realistic option. When it comes to climate change, no one person on the planet has the ability to completely resolve the issue of greenhouse gas emissions. That said, each of us has the ability to do what we can. This might mean living small, cutting back on beef consumption, living in a walkable/bikeable neighborhood, buying an electric vehicle next time you’re in the market for a car, cutting back on plane trips, or any number of other things. In addition, you have the option of voting for leaders who care about climate change, supporting the work of climate activists and communicators, or creating innovative ideas, products and services. You may not be able to end the global crisis, but you can solve the smaller issue of your personal contribution

It’s true, you’re only one person. The change you make is a tiny drop in a very large bucket. It’s also true that climate change cannot be solved without your contribution. That bucket needs every drip. A jigsaw puzzle remains unfinished without every single piece. When many people acknowledge their carbon footprint and make necessary adjustments, the aggregate effect is very significant. In fact, it’s the only path to a complete solution.

Don’t get caught in the bystander effect! Don’t assume someone else will solve the problem! Be the change you want to see!

FEELING BETTER about Climate Change

While it’s very understandable to harbor deep-seated concerns about the planet we live on, it is also easy to catastrophize and engage in mental-filtering or all-or-nothing thinking. When we concentrate on our failures, it’s easy to lose sight of hopeful developments and the significant progress we’ve already made. Clean energy production has become 99% cheaper to build and implement than old-fashioned coal-burning power plants. A global solar power boom is underway, changing the way human kind generates energy, heats water, and fuels their vehicles. Speaking of electrified transportation, EV sales are growing year after year. And while there has been negative press regarding the ethical and environmental costs of mining vital battery components, or the strain EVs will put on our current power grid, these problems can (and will) be solved. Oil, coal and gas production is rife with its own ethical and environmental costs, and our current fossil fuel infrastructure didn’t leap into existence overnight. We’re moving in the right direction, but change takes time.

When you find yourself falling into a pit of despair, start asking questions. “Are my thoughts balanced? Are they evidence-based?” Put your thoughts on trial. Fact check. It won’t hurt, and it just might help relieve some anxiety!

In addition, you might try “reframing”. For example, when you think about problems that exist on a global scale, they can seem utterly hopeless and overwhelming. This is because your frame might be too big. Global problems require global solutions, and last time I checked, no one person has that much power. Try a smaller frame. Focus on your personal realm of influence. At the national level, you can help select leadership, you can make consumer choices, and support non-profits and activism. You’ll have even more influence at the regional and local levels, where your unique voice is more likely to stand out. You have still more power in your home, family, and close-knit communities. You have a choice. Use a frame that feels hopeful and empowering!

ACCEPTING or TOLERATING Climate Change

Learning to tolerate the distress of a bad situation is not as ideal as solving the problem, or even feeling batter about it. That said, it can be a way to find relief from intense emotions. DBT offers an entire suite of Distress Tolerance Skills ranging from those designed for crisis experiences to practical, everyday strategies for tolerating mild distress. Here are a few examples:

The TIPP Skill (Temperature, Intense exercise, Paired muscle relaxation, Paced breathing) offers quick and effective ways to calm your body when anxiety runs high.

The ACCEPTS Skill (Activities, Contributions, Comparisons, Emotions, Pushing away, Thoughts and Sensations), on the other hand, offers practical methods to lower our distress on a day to day basis.

One important distress tolerance skill is Radical Acceptance. Often, we add an additional layer of distress/anxiety when we struggle to accept certain unpleasant realities. While the stressor (climate change) is painful enough all on its own, we can amplify that distress by believing that things “should” be different. Just as a person who has lost their life savings might struggle to accept their new circumstances- holding on to outdated notions of what resources they used to have- doing so may prevent that person from embracing life as it currently is. Accepting the fact that climate change is happening, that you cannot solve it alone, and that human beings are a complicated and frustrating lot can help you end your fight against reality. That doesn’t mean you suddenly feel like everything’s fine. Nor does it mean sacrificing your values.

That person who lost their life savings might begin to improve their financial health through budgeting, saving and investment, If they practice radical acceptance along the way, they can do so without the added distress of feeling or believing that life should be anything other than what it is. Settling that fight against reality leaves room for the present, for joy, and for undistracted time with our loved ones. How would radical acceptance improve your life? What kind of difference could it make?

DOING NOTHING and STAYING MISERABLE

This last “solution” is really just the status quo, isn’t it? Doing nothing really is an option. You’re reading this post because you are anxious about the present and future of our climate. Your anxiety is so significant that you’re looking for tools and perspectives to help. If you do nothing at all, you can remain in that distress. That’s a choice you have. Problem is, it’s not a solution. Not really. It won’t help you solve the problem (or contribute to mitigation. Doing nothing won’t help you feel better. It won’t even help you deal with your distress. It only helps maintain the status quo (your very understandable climate anxiety).

So, rather than doing nothing, what’s the harm in dabbling in the above three strategies?

MORE RESOURCES

If you’d like to learn more about Dialectical Behavioral Therapy, there are a number of searchable sites online (Google, Psychology Today and YouTube are good sources). Focus on the four major skill areas: Mindfulness, Emotional Regulation, Distress Tolerance, and Interpersonal Effectiveness.

If you’d like to make a therapy appointment, and you live in Washington State, you can do so by visiting my Psychology Today page and contacting me directly. I offer TeleHealth services statewide.

:), Susan Reimers, JD/LICSW