Acceptance and Commitment Therapy Archives

Cover image of "Thriving in a Relationship When You Have Chronic Illness" by Lisa Gray, LFMT

Thriving in a Relationship When You Have a Chronic Illness

Thriving in a Relationship When You Have a Chronic Illness, Lisa Gray, LFMT. New Harbinger Publications (ISBN: 9781648486081) 2025.

Summary: Using ACT therapy, skills to keep relationships strong during chronic illness.

It is probably stating the obvious to say that chronic illness changes one’s life. But what may be less obvious is that chronic illness impacts relationships. Activities once shared in may not be possible, and with that shared dreams. Intimacy may change leading to guilt and frustration. Both the one with the illness and the well partner are affected. In other words, the dynamic of the relationship is altered.

Lisa Gray, LFMT writes this book to address the relational challenges of chronic illness. She believes partners going through chronic illness both pass through, or indeed, cycle through the classic five stages of grief. These are: shock and denial, anger, bargaining, depression, and testing and acceptance. She then uses skills drawn from Acceptance and Commitment Therapy (ACT) to provide tools for working through these stages:

Present Moment Awareness during shock and denial: staying in the moment rather than “future-tripping.”
Cognitive Defusion during the anger stage: Stepping aside and observing one’s emotion, helping one decide how one will respond.
Finding Values during bargaining: Rather than chasing “if onlys,” aligning personal and team values to pursue what’s important.
Self-as-Context during depression: there is a “you” that isn’t your thoughts and that you do not need to become your thoughts.
Committed Action and Acceptance during testing and acceptance. You experiment with actions aligning with your values in moving forward and you accept that life has changed while having found new ways to live in relationship.

The book devotes two chapters to each stage. The first explains the stage as it relates to chronic illness. Then it explores how this impacts communication and emotions, shared activity, intimacy and sex, and friends, family and gatekeeping. Finally, the first chapter introduces the ACT skill for that stage. The second chapter goes back through the relational impacts, discussing them for both well and sick partners, interspersed with exercises. Gray uses summaries of key points and reflection questions to bring home key concepts.

Throughout, the tone is non-judgmental. The writer anticipates and discusses all the feelings and thoughts people go through in chronic illness. I thought the skills and exercises very clear and practical. While the book is best worked through together, a partner can work through it alone to work on their response to chronic illness, not their partner’s.

Chronic illness changes life for partners. One of the most critical things for a relationship is constructive communication as couples go through this. While the book is not a substitute for seeing a mental health professional, it can facilitate both understanding and skills that help couples work together through this difficult time in their life together.

_____________

Disclosure of Material Connection: I received a complimentary copy of this book from the publisher for review through LibraryThing’s Early Reviewers Program.

A Liberated Mind: How to Pivot Toward What Matters, Steven C. Hayes, Ph.D. New York: Avery Books, 2019.

Summary: An introduction to Acceptance and Commitment Therapy (ACT), a psychological counseling approach that develops psychological flexibility through learning acceptance rather than resistance or flight from painful thoughts and reality, and how we may pivot toward commitments rooted in what we value most deeply.

Steven C. Hayes proposes we all have a Dictator Within. We all have thoughts that cause us problems. We try not to think about pink elephants, painful experiences, messages that tell us all sorts of negative things about ourselves, or that raise our anxieties. We try to argue with those thoughts or avoid them or get rid of them, often in inflexible ruts where we go round and round with little success. At very least, we struggle with lack of peace of mind. At worst, these ways of thinking hamstring the way we live and the relationships we form.

Hayes, one of the pioneers of Acceptance and Commitment Therapy (ACT) proposes a very different approach. He describes an approach that begins with acceptance of our thoughts. He proposes that one of the things that defuses the power of our thoughts is simply to stop trying to get rid of them and notice them. There is a sense that we step outside these mental processes and take perspective. And it means acceptance of the painful and approaching that pain with curiosity and openness where our goal no longer is feeling GOOD but FEELING good.

Moving from Acceptance to Commitment we learn the practice of presence, of living in the now, the present rather than a painful past or a yearned for future. We identify what we value and then identify actions to which we may commit that support our values.

After tracing the development of this approach in Part 1 and the idea of developing psychological flexibility rather than rigidity through crucial pivots in our lives, in Part 2, he describes the six pivots in greater depth:

Defusion–Putting the Mind on a Leash
Self–The Art of Perspective Taking
Acceptance–Learning from Pain
Presence–Living in the Now
Values–Caring by Choice
Action–Committing to Change

He devotes a chapter to each, sharing, and even walking us through exercises for each pivot.

In Part 3, Hayes applies ACT principles to a variety of aspects of life including healthy behaviors, mental health, nurturing relationships, various types of performance, including sports performance, spiritual well-being, and coping with illness. Here and elsewhere Hayes cites studies showing the superior effectiveness of ACT to other counseling approaches.

I cannot assess his claims. I do have two criticisms. One is how often he repeats the claim of the superiority of this approach, to a point that I found tiresome. The second is that there seemed to be an inadequate “cutting room floor” and I felt that at times, his central ideas and arguments were obscured by excessive verbiage.

Nevertheless, the ideas of acceptance, of defusing, of perspective-taking, of becoming attentive and curious, even about pain, are at the heart of contemplative spirituality that has been helpful to many. To couple this with learning to be present and to live in the now, and to allow our values to shape our commitments seem to reflect the wisdom of many approaches toward transformation. I appreciated Hayes receptiveness to religious faith and an approach that recognized the complementary character of his therapeutic approach and the formational practices in religious traditions.

Perhaps the founder of this approach may be forgiven what I criticized as excesses. He’s talking about his baby! What is evident throughout the pages of this book is the author’s personal embrace and passion for ACT principles, his extensive clinical practice, and the deep care he has for clients and for seeing people flourish in their lives through applying the psychological flexibility skills he teaches in this work.

________________________________

Disclosure of Material Connection: I received a complimentary review copy of this book from the publisher through LibraryThing’s Early Reviewers program. The opinions I have expressed are my own.