Taking ACT out of the therapy room: an interview to D.J. Moran

DJmoran(la versión en español de esta entrevista está en este link)

If you are a member of the ACBS, you surely know D.J. Moran. He’s a tall, affable guy with a soft spot for heavy metal and a very humorous and unorthodox style for his lectures (the last time I went to one of his presentations, it was an IGNITE presentation called «Should I scratch my butt?«). Amongst many other remarkable things, he’s a very active board member of the ACBS and he has a highly recommendable ACT podcast.

In many ways, DJ has been taking ACT out of the therapy room for years: for example, the trainings in Africa, or the televised interventions for hoarders. But a few months ago I learned that he was working with ACT in a context I’ve never heard before: work safety. I got curious so I bought his book, Building Safety Commitment. It was an enlightening reading, since it describes the use of ACT principles in a area that is not generally associated with the model (actually, is a book for workers, not for psychologists). Since ACT tends to be usually associated with psychotherapy, I wanted to share that application with our readers, so I asked him for an interview, he kindly agree, and here is the result, I hope you enjoy the interview as much as I did.

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—Hi DJ, thanks for agreeing to the interview. It is an honor to have you for our blog, could you tell us a bit about your background as a psychologist?

Gladly… I earned my Ph.D. in Clinical & School Psychology at Hofstra University in New York.  Kurt Salzinger, a pioneer in the field of clinical behavior analysis was my supervisor. He taught me a great deal about radical behaviorism and B.F. Skinner.  I was such a fan of B.F. Skinner that I almost named my son, Burrhus Frederick Moran… but I’m glad that my wife talked me out of that!

—I’m glad for him too. As you know, people often think about ACT just as a psychotherapy approach, but you are working with ACT principles in a very different field, the field of work safety. You wrote a book for workers called Building Safety Commitment, and I have to say, I loved the intensely practical tone of the book. And you have some firsthand experience there, since you have an unusual background for a psychologist: a long time ago you worked as an electrician. Not many people are familiarized with the role psychology can play in that particular area, what can you tell us about work safety and how a behavioral approach is useful there?

Working is an intensely human endeavor. It’s what we do.  People work… as a boss, or a carpenter, or a factory worker, or a psychologist, or a teacher, or a parent… we engage in actions in order to achieve certain objectives that we care about.  All of the behavior analysis principles and ACT applications that we use to assist people meet certain objectives in the mental health clinic… well, many of those concepts can be applied to helping people with leadership, innovation, productivity, and safety at the worksite.  When I was an electrician, I realized that people had some close calls for getting injured just because they weren’t paying attention or they were distracted.  Once I started practicing mindfulness, I thought that having other people learn more about mindfulness would keep them safer. There is an area of research in Industrial/ Organizational Psychology called “situational awareness.”  That topic is about how aware you are of your surroundings.  I thought it would be a good idea to apply mindfulness practices to increasing situational awareness on the job.  The front-line employees who attend my trainings seem to have a very positive experience with learning more about mindful action.

I thought that the evidence-based approach for helping people act safely on the job, Behavior-Based Safety, was a good fit for the Committed Action component on the ACT hexagon model.  I blend ACT with BBS, and people seem to respond very positively.  I don’t really like calling it therapy, so I refer to what I do as ACTraining.

And by the way… thanks so much for the nice things you said about my book.

—It’s a very good book, indeed, and a different reading for me. So, how are you applying ACT principles in that area, and what can ACT do for them? What are the expected results of a work-safety intervention such as yours?

Well, one of my aims is to help turn mindfulness skills into something very understandable and practical for anyone.  I like talking about “mindful action” to the people I am working with, not just talking about meditation.  I like to teach them to pay attention to what they are doing while they are working, especially because they work in dangerous environments.  And in addition, I do very simple values clarification exercises with them.  We discuss the reason why they work at their job.  Of course, the people I work with first say that they work “For the money,” but then I go a bit deeper and ask why they need the money and what it gets spent on.  Most people start talking about their values if you follow this line of questioning.  It’s interesting to talk to front line workers about why they work so hard… An ACT directed conversation usually follows about the fact that they are working for their family, and their health, and shelter, and recreational values… and then we start linking those values to making a commitment to work safely so they can keep achieving goals in their valued directions.

I know that going to oil refineries, paper mills, and manufacturing plants in order to apply ACT concepts is fairly unusual, but I love it.

—Since we are talking about unusual areas: you are a TV star! I know you were one of the therapists at TLC’s “Hoarding: Buried Alive”, and AC’s “Confessions: Animal Hoarding”, both shows about people hoarding things or animals to the point it endangers their lives. How was to work with those folks? Could you tell us about the type of intervention you used there?

I really liked doing those shows.  I shot 25 episodes, but only 19 aired.  Some of the shows were really just too disturbing for television!

One of my favorite episodes was when I taught one individual about the ACT principles and then when she was upset with the fact that the cleaning crew was clearing out her house, I asked her: “Are you OK with these emotions?” and her answer was: “At the moment, no!”  I liked that she owned the fact that she was angry, was willing to accept it, but realized that it would ultimately pass.  And in fact she was willing to resume cleaning her house because that was an important value-directed goal… even though she was angry.

Prior to doing any treatment, a solid functional analysis is warranted.  During my individual therapy with my clients, I use ACT… and I see if it is reasonable to have the person commit to doing some cleaning of their living space.  I always get informed consent for that aspect of the treatment.  If you do that kind of exposure exercise at a pace that the client is willing to accept, you can really accomplish a great deal.

—The first time I heard your name was in relation to the work the ACBS were doing at Sierra Leone, in Africa. I know you were working with the Commit and Act group, giving ACT training. What was the purpose of that initiative?

Going to Africa was a life-altering experience. Our primary purpose in Sierra Leone was to train trauma therapists in Acceptance and Commitment Therapy.  We gave workshops to social workers, nurses, and pastoral counselors so they could use the ACT principles with the people who were suffering the trauma of being civil war survivors.  In fact, some of the people who needed the most help were the child-combatants now that they had grown up and started having a more mature perspective on what they experienced during the war.  In fact, people who were in our workshops and were working as mental health practitioners were actually child-combatants.  We had very intense, rich, and emotional discussions about the horrors of war, and also about magnanimity of the community to embrace the child-soldiers after the civil war.  We discussed a great deal about forgiveness.  My training in ACT and in Functional Analytic Psychotherapy came in very handy when working in this situation.  To be able to talk about acceptance and values with the people in our workshop was very important.  Our aim was to train, but the outcome was also to heal.

—From time to time I have some interesting exchanges with folks coming from the more traditional –so  to speak– CBT   wings (we can call them ‘friendly battles’), and one issue that often arises in those discussions is the role of cognitive disputation procedures, if they are useful or harmful, if we should keep using them, and so on. Now, I read an interesting article about the subject you co-wrote with none other than Albert Ellis about RFT and REBT. What do you think RFT can offer to traditional CBT procedures and what would you say is their role in ACT? To say it more bluntly: would you say it is “wrong” –or at least, inconsistent with the model– to use cognitive disputation in ACT?

Wow… big question.  You know, Albert Ellis wrote the first CBT paper ever in 1958.  I am very blessed and honored to have coauthored his last paper, which is the paper you are referring to.  Working with Albert Ellis for the brief time that I did was a great experience.  I really admire what he did as a pioneer in cognitive-behavioral therapy.  He was open to the idea of having his theory analyzed through the lens of contextual behavioral science.  He wanted to know how Rational Emotive Behavior Therapy would be viewed from a Relational Frame Theory perspective.  In that paper we wrote together with J.T. Blackledge, we took a look at what happens – from a functional contextual behavioral science point of view – when CBT is useful.  It is a complex paper that would be difficult to unpack in a short period of time, and I would be happy to share it with readers who write me an email for it. Basically we put a natural science perspective on how certain CBT interventions try to change people’s language.  When clients in therapy can fluently learn to rationally say, “I’d prefer this certain event didn’t happen to me” instead of saying something more clinically relevant and irrational like “This awful event shouldn’t have happened to me,” then this can have an impact on suffering for some people.  In certain contexts, it seems reasonable to help people with irrational beliefs and cognitive distortions in a traditional CBT manner; however, and this is a strong however, I think that teaching people about defusion – being able to mindfully notice thoughts that might be problematic, and not let them lead you away from doing valued actions – can have a significant impact on faulty thinking and helping people reduce their own suffering and improve their quality of living.

As far as the idea of ACT-inconsistent therapy… this would take a great deal of discussion and perhaps case examples to make the point as clearly as possible.  But to say it very briefly, I don’t think the idea in therapy is to adhere strictly to a particular regimen, but to assess the client’s needs, behavioral repertoire, and environmental affordances, and from there consider what approach in that situation would be appropriate for that person there and then.  Sometimes psychoeducation and teaching clients new perspectives on their problems – which could be considered traditional CBT – does have a place.  You see, if you truly want to be ACT-consistent, then pragmatism in reducing suffering trumps rigidity in treatment approach.

—I think we never talked about the ACBS as an organization at the blog. Now, since you are a member of the ACBS board, what would you say is the mission of the ACBS and where would you want to be heading next?

ACBS is the home of my professional values.  It’s an honor to assist in leading this organizaiton as a Board member. .  I really enjoy being part of this scientific community that aims to reduce suffering and improve quality of living for people.

What I’m mostly interested in is getting our science more broadly disseminated.  As you can see from my previous answers, I like to spread the message of contextual behavioral science around to as many places as possible.  That’s why I went to Africa, agreed to go on television shows, started a company that brings ACT to safety and leadership situtations in companies, and even bridged the gap between CBT and ACT with the RFT paper I wrote with Al Ellis.

I’m about joining forces, finding commonalities, and disseminating solid behavioral science to potential partners around the world.  I’d like to see ACT and RFT spread far and wide.  I not only want to help ACBS grow and have greater impact, I’d like to see it become more diverse.   I think you should joing the ACBS Board, Fabian… you’d make great contributions to the leadership of our organization!

But in the end, I’m just aiming to help people. Really.  It sounds basic and perhaps overly simple, but I just know that is what I choose to do with my limited time on this planet: contribute to reducing suffering, improve quality of living for folks, and make time to enjoy fun expereinces with the people I love.  ACBS provides a channel for that kind of endeavor and I’m glad to be a part of it.

Thanks, Fabian!

—Thank you!

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You can purchase the Building Safety Commitment book using this link (it goes through ACBS site, so the ACBS gets a small revenue from Amazon if you buy it there). If you are a clinician, another great book by DJ and Patricia Bach is «ACT in Practice: Case Conceptualization in Acceptance and Commitment Therapy», that you can buy hereAlso, you can visit the Pickslyde Consulting website here, or read about DJ’s last book here