The Hexaflex Dimensional Approach to Diagnosis and the ACT ADVISOR Psychological Flexibility Measure are both relatively new iterations of the Hexaflex that have exciting applications for ACT clinicians. Let’s take a look at them…
Since I first saw it, I have found the Hexaflex to be a great visual tool for mentally conceptualizing where a client might be struggling in therapy. The original idea for using the hexaflex as a diagnostic and case formulation tool was presented by Kelly Wilson in a plenary talk he gave on the Hexaflex Dimensional Approach to Diagnosis he has developed as an alternative to our current creaky syndromal classification system embodied by the DSM-IV. That talk was last summer at the ACT Summer Institute III. Back in May at the Summer Institute IV, Kelly expanded on the diagnostic system in a two-day pre-conference workshop I was lucky enough to attend. It also looks like there will be more from Kelly Wilson on this diagnostic approach in his forthcoming book The Heart of Acceptance and Commitment Therapy.
The Hexaflex Dimensional Approach to Diagnosis has been and will be written about in other places, so let me spend some time looking at the ACT ADVISOR Psychological Flexibility Measure. It was developed by David Chantry, editor of the excellent resource Talking ACT. Without having used it with clients yet, what’s exciting to me about this measure is the fact that it makes the Hexaflex even that much more useful. Rather than a static chart, the ACT ADVISOR makes the hexaflex a dynamic, manipulable tool for charting progress. It’s a living document now–like the Constitution!
I also like the elegant symplicity of its format, and how easy all the anchor statements are for everyone to understand. The measure also comes with a chart for clinicians to use in tracking a client’s scores over time, adding up to a cumulative score for psychological flexibility. I like measures that keep ACT clincians’ eyes on the prize of enhanced psychological flexibility.
The two uncertainties I would have in using the measure were actually anticipated by David Chantry when he discussed it in an ACT listserve post. He noted that the design makes it pretty obvious that higher scores are ‘better’ to get, hence introducing possible response bias (pliance). He also said the design of the measure reveals the entirety of the ACT model, which might or might not be beneficial at some junctures in therapy. Clients could find it helpful to see where interventions are leading, but on the other hand it could also be at odds with ACT’s emphasis on experiential rather than intellectual learning. These cautions don’t apply for the Hexaflex dimensional diagnosis form since it is only seen and used by clincians.
Well, I hope ACT therapists out there will follow these links and give both the ACT ADVISOR Psychological Flexibility Measure and the impressive Hexaflex Dimensional Approach to Diagnosis a thorough trial run in your clinical work–and provide the developers with helpful feedback if you have any. (Note: You will have to be an ACBS member with a login to access these.)
You can really see the evolution of an idea–the hexaflex–looking at these two documents. And I don’t think this will by any means be the last time we will see the hexaflex used in interesting and dynamic ways in clincial work. Steven Hayes has also been active in re-imagining the hexaflex. In one workshop he displayed two hexaflexes facing each other with lines connecting them to represent the intricate parallel processes in therpay between client and therapist. And in his plenary at the Summer Institute IV, he overlayed a new image onto the hexaflex: a turtle. Stay tuned for more fascinating uses and re-envisionings of the good ol’ hexaflex.