The River and The Rock: Acceptance and Commitment Therapy

Ever feel like you’re fighting your patient just to get through a session? Explore Acceptance and Commitment Therapy (ACT) as a framework for speech therapy—not psychotherapy, but a way to rethink how we approach resistance, engagement, and progress. Using the metaphor of “the river and the rock,” Eva and Emily unpack how ACT shifts us away from power struggles and toward flexibility, values-based care, and meeting patients where they are. They break down the research on ACT in post-stroke depression and emerging work in aphasia, showing how emotional adjustment and communication recovery are deeply connected. Plus, we translate ACT concepts into real clinical scenarios—from dysphagia refusals to cognitive pushback to aphasia shutdowns—and walk through how to respond without arguing, forcing, or “fixing.” Because sometimes the most effective therapy isn’t pushing harder—it’s learning how to flow. Citations Niu, Y., Sheng, S., Chen, Y., Ding, J., Li, H., Shi, S., Wu, J., & Ye, D. (2022). The efficacy of group acceptance and commitment therapy for preventing post-stroke depression: A randomized controlled trial. Journal of Stroke and Cerebrovascular Diseases, 31(2), 106225. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106225 Evans, W. S. (Principal Investigator). (2021–2025). Adapting acceptance and commitment therapy for stroke survivors with aphasia (ClinicalTrials.gov Identifier: NCT04984239). University of Pittsburgh. https://clinicaltrials.gov/study/NCT04984239 Evans, W. S. (n.d.).Acceptance and commitment therapy (ACT) framework [Continuing education course]. https://www.speechpathology.com/slp-ceus/course/acceptance-and-commitment-therapy-introduction-10771 Get in Touch: hello@speechtalkpod.com Or Visit Us At: ⁠www.SpeechTalkPod.com⁠ Instagram: @speechtalkpod Support: buymeacoffee.com/speechtalkpod Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices