A flexible mind: How we used Acceptance and Commitment Therapy (ACT) to find freedom behind locked doors

Secure settings pose a unique challenge for psychological therapists in trying to engender hope and change within an environment of restrictions. In particular trying to support recovery whilst maintaining physical, procedural and relational security requires an adaptive mindset to standard clinical practice. These restrictions also provide challenges for service users in being able to feel empowered and have choice, where therapy may be viewed as coercive and relating to professionals may seem uncomfortable or intolerable. This article describes lived experience of Acceptance and Commitment Therapy (ACT) being delivered within a secure mental health unit and how this impacted the service user and therapist. Reflections and recommendations are provided for how ACT can be used to increase psychological flexibility and navigate the challenges of forensic spaces.