This chapter will highlight how the principles and practices of acceptance and commitment therapy (ACT) can help therapists be mindful of, and manage their sexual attraction towards, clients. Instead of trying to control, avoid or eliminate sexual attraction, therapists can learn how to be mindful of it, accept it and coexist with it as they continue to serve their clients according to their professional codes of ethics.

Introduction

It is very common for sex therapists, coaches or educators to routinely encounter clients and students to whom they are sexually attracted. While it is clearly a breach of professional ethics for therapists, coaches and educators to have sex with their clients and students, being sexually attracted to them is not. Having sex with someone is a physical act, a behaviour that one can control. Being sexually attracted to someone is not. It is a type of mental activity that cannot be controlled, avoided or eliminated. In fact, ACT research regarding managing unwanted cognitive activity (troubling thoughts, painful emotions, etc.) shows that the worst way to deal with it is to try to control, avoid or eliminate it. This approach actually increases the troubling thoughts and painful emotions (Hayes, Barnes-Holmes, & Roche, 2001). Human sexual attraction is unique in that it is not regulated by fertility cycles or other factors inherent in other species. Human sexual attraction originates in the mind and can occur countless times a day, 365 days a year, until death. Therefore, sexual attraction towards clients and students cannot be regulated by professional boards and ethical codes of conduct. The responsibility for managing sexual attraction rests squarely on the shoulders of professionals entrusted with the care and nurturing of clients and students.

What Is ACT?

ACT is a form of psychotherapy based on cognitive behavioural therapy (CBT) and relational frame theory (RFT) (Hayes et al., 2001). An underlying premise of ACT is that clients’ mental distress and problematic behaviour is due to psychological inflexibility caused by unhelpful cognitions that are inconsistent with their values and goals. In addition, these unhelpful cognitions cause clients to get ‘stuck’ in a psychological rut. ACT helps clients become more psychologically flexible, get unstuck and behave in ways that support their goals and values. Getting unstuck and developing greater psychological flexibility starts with understanding the relationship between unhelpful self-talk, emotions and behaviour.

ACT helps clients examine the helpfulness of their thoughts, personal scripts, emotions and mental images in meeting their values-congruent goals. To help determine what is helpful and what isn’t, clients are taught to answer this basic question: ‘Are these thoughts, personal scripts, emotions, mental images helping me behave in ways that are consistent with my values and values-congruent goals?’ If the answer is yes, the thoughts, personal scripts, emotions and mental images are accepted as being helpful and the clients continue to behave in ways that move them closer to meeting their values-congruent goals. If the answer is no, the thoughts, personal scripts, emotions and mental images are rejected and attention on them is redirected to engaging in purposeful behaviour. Shifting attention off unhelpful thoughts, personal scripts, emotions and mental images and onto purposeful behaviour (particularly physical activity) results in the unhelpful cognitions dissipating on their own (Luoma, Hayes, & Walser, 2007).

ACT refers to the mind as a 24/7 thinking and feeling machine that works nonstop, churning out cognitions (Eifert & Heffner, 2003; Hayes, Strosahl, & Wilson, 1999). Many of those thoughts, feelings, personal scripts and mental images the mind churns out are related to sex. Like a computer that’s always on, the mind constantly processes information and is capable of running multiple programmes at the same time. Instead of running word processing, spreadsheets or other computer software, the mind’s programmes are thoughts, emotions, mental images and personal scripts.

Thoughts are the basic building blocks of your cognitive functioning. Some are rational and logical, while others couldn’t be more irrational or illogical. Some thoughts originate from a conscious effort to create them, while others come and go like the wind. Some thoughts are related to sexual attraction to clients and students.

Emotions are essentially impulses to act. They’re the result of an evolutionary process that forces people to stop, pay attention, analyze a threatening situation and act, all within a split second. Some of the stronger emotions like fear and anger are linked to the mobilization of energy that occurs during the fight-or-flight stress response. Sexual emotions including love, lust and passion are among the most powerful feelings there are.

Thoughts and emotions combine to form personal scripts about specific aspects of life. These scripts are the little internal story lines that accompany learning experiences. Clients and therapists have personal scripts related to childhood, work, school, relationships, politics and the world at large, just to name a few. In addition to these themes, many personal scripts relate to sexual scenes. Like thoughts, these scripts can be helpful or unhelpful, logical or illogical, factual or inaccurate, neutral or emotionally charged, and real or imagined. Often, sexual and other scripts become outdated when they are no longer helpful in meeting values-congruent goals.

Mental images are the internal pictures people see when they close their eyes and observe what their mind conjures up. Mental images can be neutral or linked to emotions. Some mental images are accompanied by pleasant emotions like hope, love and satisfaction. Others are linked to painful or negative emotions like jealousy, fear, worry and anxiety. Some sexual mental images are quite graphic and can be arousing or unsettling. For a variety of reasons, people often don’t want to view themselves as sexual beings. This is often the case when therapists’, coaches’ and educators’ minds conjure up images related to being sexually attracted to their clients and students.

Like the operating system and other programmes on a computer’s hard drive, many of the mind’s programmes run in the background without people even realizing they are on. For example, one can read this page while also listening to sounds in the environment, processing sensory inputs (changes in lighting, temperature and smell) and even daydreaming. The mind never stops working; you couldn’t even turn it off even if you wanted to.

Like viruses that invade a computer and cause it to freeze, unhelpful thoughts and feelings, along with the negative self-talk that often accompanies them, can invade the mind’s programmes, slow its processing and cause it to freeze. When this happens, the mind, like the hard drive on a computer, gets stuck and can’t function properly. When this happens to people, they feel stuck and can’t move forward. To get unstuck, the mind, like a computer needs to be rebooted and cleared. ACT uses helpful exercises, activities and metaphors to help clients do this.

Research related to relational frame theory, the learning theory that underlies ACT, has found that past learning (sexual and otherwise) plays a major role in processing troubling thoughts and painful emotions in the present moment. According to this research, when people learn something new, they learn it in relation to other things that are specific to that time and place. This is called the relational frame for that learning experience. It is the context for the learning. RFT research has found that the context of learning is as important as the content of what is actually learned (Hayes et al., 2001).

For example, therapists’, coaches’ and educators’ sexual learning all took place at specific times, with specific people, in a variety of different places, and was linked to specific thoughts, feelings, personal scripts and mental images. The actual content of what occurred during the sexual learning experiences was forever linked to the context in which the learning occurred. These initial relational frames may be helpful or unhelpful in managing present moment sexual attraction and encounters. When people recall these learning frames of reference or describe them to someone else, they are actually referring to their mind’s version of the experience. This is a version of the event – not the actual event. ACT and RFT teach clients that they can get into trouble when they believe that their thoughts about past or imagined sexual encounters are the same thing as actual experience in the present moment. Every time people recount past sexual experiences, they are always subject to embellishment or distortion, because they are based on memories of the events. This is important for people to understand because it can help them shift their focus off their outdated, unhelpful sexual cognitions when necessary. Unhelpful sexual thoughts, emotions, personal scripts and mental images about past events do not have to dictate present moment or future behaviour. Acceptance training teaches people that they do not have to control, avoid or eliminate troubling sexual thoughts, emotions, mental images and personal scripts in order to behave purposefully in the present moment and to move forward in the future in a values-congruent way.

Accepting What Can’t Be Controlled

The acceptance part of ACT has four dimensions: (1) becoming more mindful of sexual thoughts, emotions and actions; (2) understanding how sexual thoughts, emotions and actions support or oppose personal values and goals; (3) accepting what can’t be controlled (sexual thoughts, emotions, personal scripts and mental images); and (4) accepting what can be controlled (sexual behaviour and physical environment) (Blonna, 2010).

Committing to Values-Congruent Action

The commitment part of ACT revolves around committing to actions that are consistent with personal and professional values and goals. A big part of commitment training is learning how to set values-congruent goals and objectives and to stick to them. Acceptance and commitment work together by using personal and professional values and goals as the starting point in setting the direction of one’s life. Acceptance and commitment work together with all types of goals, sexual and otherwise. Commitment training shows people how to coexist with troubling thoughts and painful emotions while taking values-congruent action in meeting their goals. Commitment training shows people that they don’t have to control, avoid or eliminate painful sexual thoughts and feelings in order to act in ways that are more consistent with their personal and professional sexual values and goals. For example, therapists do not need to control, avoid or eliminate their troubling thoughts and painful emotions related to being attracted to their clients. They can accept that these cognitions exist, admit that they are troubling and painful and then commit to coexisting with them as they continue to work with the very clients they are attracted to. In addition, they shift their focus off of the attraction and onto what needs to be done to help the clients. This shift in focus helps the attraction dissipate on its own.

The Importance of Words and Thoughts in ACT

Sexual memories are often filled with words and self-talk that undermine present thinking and contribute to getting stuck. ACT operates from the premise that all words and thoughts don’t have equal weight. From an ACT perspective, three kinds of words and thoughts exist: (1) helpful; (2) minimally important or silly; and (3) illogical, negative and self-destructive.

Helpful words and thoughts support people’s values and help them meet their goals. For example, imagine you are a therapist working with a client you are attracted to or who is very seductive. You might find yourself thinking, ‘Boy, this is very distracting. Staying focused on her story is much harder because of this attraction. I need to take a deep breath and get centred again’. This kind of thinking and the words used to express it help the therapist stay focused and accept the hard work involved in working with this client.

Thoughts that are of minimal importance or silly usually don’t play a role in getting stuck. For example, imagine you’re a therapist working with the same client and you find yourself thinking about what he might look like with his clothes off. You say to yourself, ‘I bet he has a great body under those clothes’. You realize your thoughts have drifted away from listening to his story and onto your fantasies about what he might look like with his clothes off. To manage this type of thinking, you simply acknowledge what happened and tell yourself, ‘That was interesting. I’d better get my mind back on my work or I’ll never be able to help him’.

The third category of thoughts (illogical, negative and self-destructive) makes it difficult for therapists to meet their values-congruent professional goals. For example, imagine you’re a therapist working with the same client and you find yourself thinking, ‘Wow, this woman is really coming on to me. She is practically asking for it. I can cancel my next appointment and ask her if she wants a drink. I could probably have sex with her right in the office. She looks like she really wants me. I’m a jerk if I do not take advantage of this situation’. This kind of unhelpful thinking is inconsistent with your values as a therapist and is contrary to your goals of helping clients and fostering your career and discipline. ACT therapists help people become more mindful of their thinking and of the words they use and to assess their helpfulness or unhelpfulness.