ACT case formulation (hexaflex)
Locate psychological inflexibility across six processes and identify the workable direction.
Early and throughout; ACT formulation is functional and continuous rather than a one-time document.12 fieldsAcceptance and Commitment Therapy
How this document is used well
ACT formulation asks one question in six ways: where is this person’s behaviour being controlled by internal experience rather than by what matters to them? Note that every process has a "toward" and an "away" pole; the target is never a feeling but always a pattern of behaviour in a context.
| Inflexibility process | Flexibility counterpart | Listen for |
|---|---|---|
| Experiential avoidance | Acceptance | "I can’t stand feeling…" and what gets skipped |
| Cognitive fusion | Defusion | Thoughts spoken as facts; rules governing behaviour |
| Dominance of past/future | Present-moment contact | Rumination, worry, absence from one’s own life |
| Attachment to conceptualised self | Self-as-context | "I am an anxious person" as identity |
| Lack of values clarity | Values | Goals borrowed from others; "should" without "want" |
| Inaction / impulsivity / avoidant persistence | Committed action | Stuckness, or frantic activity that goes nowhere |
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Shows why each item is asked
7 required fields outstanding: What the patient wants to be rid of; Creative hopelessness: what have they tried, and how has it worked in the long run?; Experiential avoidance — what is avoided, and how …