Acceptance and Commitment Therapy (ACT) in Philadelphia

When getting rid of every difficult thought isn’t the answer

Sometimes the effort to feel better becomes part of what keeps you stuck.

You try to eliminate the anxiety before making the decision. You keep analyzing an intrusive thought until it finally feels resolved. You wait to feel certain before changing careers, ending a relationship, setting a boundary, or taking some other meaningful step.

Acceptance and Commitment Therapy — usually called ACT — offers another way forward. Rather than requiring difficult thoughts and feelings to disappear first, ACT helps you relate to them differently and make choices based more on what matters to you than on what your anxiety, fear, or self-doubt is telling you to avoid.

I’m Matt Sosnowsky, a Licensed Clinical Social Worker in Center City Philadelphia with more than 15 years of experience as a psychotherapist. I incorporate ACT into an integrative approach to therapy, particularly when working with anxiety, OCD, major life transitions, perfectionism, and people who feel stuck despite functioning well on the surface.

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When Trying to Control Your Thoughts Starts Controlling Your Life

Most people understandably want uncomfortable thoughts and feelings to go away.

The difficulty comes when avoiding them starts making your decisions for you.

You might recognize some version of this:

  • You keep revisiting a decision because you can’t achieve complete certainty.

  • You know you're overthinking, but another round of analysis still feels necessary.

  • You avoid situations that might make you anxious, embarrassed, rejected, or disappointed.

  • You spend enormous energy trying not to make mistakes.

  • An intrusive thought feels important simply because it showed up.

  • You understand your patterns intellectually but still repeat them.

  • You're successful by conventional measures but increasingly unsure whether the life you've built still reflects what matters to you.

  • You're going through a transition and the old rules for how you were “supposed” to live no longer seem to fit.

These strategies often provide short-term relief. That is precisely why they're easy to repeat.

ACT helps us ask a different question: Is this response helping you build the life you want, or is your life gradually becoming organized around avoiding discomfort?

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How Acceptance and Commitment Therapy Can Help

ACT is an evidence-based behavioral therapy focused on developing psychological flexibility — the ability to experience difficult internal events while retaining more freedom to choose what you do next.

The goal isn't to enjoy anxiety, approve of painful circumstances, or force yourself to “accept” things you can actually change.

It is to become less controlled by the internal experiences you can't completely control.

In ACT, that often means working on several related skills:

Making room for difficult feelings. Instead of treating anxiety, uncertainty, sadness, or self-doubt as emergencies that must immediately be eliminated, you develop a greater capacity to experience them without automatically reacting.

Stepping back from thoughts. ACT calls this cognitive defusion. A thought such as “I'm going to fail” can be noticed as something your mind is producing rather than accepted automatically as a fact or command.

Returning to the present. Worry pulls you toward what might happen. Rumination pulls you toward what already happened. Mindfulness helps bring your attention back to what is actually happening now.

Clarifying your values. Values help answer questions such as: What kind of partner, parent, professional, friend, or person do I want to be? What deserves more of my time and attention?

Taking committed action. Values become useful when they affect behavior. ACT helps translate what matters into concrete choices, including choices that may involve discomfort.

This is one important distinction between acceptance and resignation: ACT uses acceptance in the service of action.

How I Use ACT in Therapy

I don't approach every client with an ACT protocol.

I use ACT when its ideas fit the problem in front of us, alongside approaches such as Cognitive Behavioral Therapy, mindfulness, exposure and response prevention, psychodynamic work, emotion-focused approaches, and positive psychology.

Several applications come up frequently in my practice:

Anxiety, Overthinking and the Search for Certainty

With anxiety, there are times when examining an anxious thought using CBT is genuinely useful.There are other times when examining it for the fifteenth time is simply the fifteenth round of anxiety.ACT helps us distinguish between productive problem-solving and becoming entangled with your own thinking.Rather than needing to prove that a presentation will go well, that someone isn't upset with you, or that you've definitely made the right decision, the work may involve learning to tolerate what cannot be known with certainty and behaving according to your priorities anyway.That can be especially useful with perfectionism, chronic worry, reassurance-seeking, avoidance, and the kind of high-functioning anxiety that can look like diligence or ambition from the outside.

Life Transitions, Identity and Values

Values work is one of the ACT principles I use most often in therapy for life transitions.A job change, marriage, parenthood, divorce, relocation, loss, aging, or career success can create questions that aren't really symptoms to eliminate.Sometimes the question is:What matters to me now?The priorities that organized your life at 25 may not fit at 35 or 45. You may have achieved something you spent years pursuing and discover that it doesn't feel the way you expected. Or you may know that something needs to change without knowing what should replace it.My graduate training in Applied Positive Psychology at the University of Pennsylvania also informs this part of my work. ACT and positive psychology are distinct approaches, but both can help us move beyond simply reducing distress toward questions involving meaning, values, purpose, relationships, and how you want to live.

OCD and Intrusive Thoughts

ACT also complements the way I approach OCD treatment.Exposure and Response Prevention (ERP) remains central to OCD treatment. ACT can support that work by changing how you respond to the intrusive thoughts and uncertainty that trigger compulsions.Trying to establish that an obsession is definitely false can itself become another ritual. Instead, ACT helps make room for uncertainty without treating it as something that must be resolved before you can continue with your day.I also draw on psychologist Chad LeJeune's ACT-informed LLAMP framework for obsessive thinking:Labeling what is happeningLetting go of the struggle with the thoughtAcceptance of the internal experienceMindfulness of the present momentProceeding with purpose toward what mattersThe goal isn't to win an argument with the obsession. It's to become increasingly able to have the thought, resist the compulsive response, and keep living your life.

Knowing When ACT Fits — and When Something Else Does

One advantage of working integratively is that we don't have to force one therapy model to answer every question.Sometimes your thinking really is distorted and CBT helps us examine it.Sometimes avoidance is maintaining anxiety and behavioral change matters most.Sometimes an intrusive thought needs less analysis, not more.Sometimes the real work involves understanding why the same relationship pattern keeps recurring.And sometimes you're not particularly symptomatic at all — you're deciding what you want the next part of your life to look like.The approach should follow the problem rather than the other way around.

Why Work With Me for ACT-Informed Therapy?

I've practiced psychotherapy for more than 15 years and hold dual graduate degrees from the University of Pennsylvania: a Master of Social Work (MSW) and a Master of Applied Positive Psychology (MAPP).

That combination has shaped the way I practice.

I'm interested in reducing distress, but I'm also interested in what comes after that: how you make decisions, build relationships, use your strengths, establish priorities, and construct a life that feels meaningful rather than simply manageable.

My practice is also intentionally integrative. ACT is an important part of my clinical toolkit, but I can move between ACT, CBT, ERP, mindfulness, psychodynamic concepts, emotion-focused work, positive psychology, and straightforward problem-solving depending on what seems most useful.

And because Philadelphia Talk Therapy is a small solo practice, you work directly with me throughout therapy rather than being assigned to a clinician from a larger roster.

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Who I Typically Work With

Most of my clients are adults in their 20s, 30s, and 40s who are functioning reasonably well — and often exceptionally well — in many parts of their lives.

They may have demanding careers, relationships, children, financial responsibilities, or other outward markers of stability while privately feeling anxious, uncertain, burned out, disconnected, or stuck.

ACT principles can be especially useful when you're dealing with:

You do not need to know that ACT is the treatment you need before contacting me. Most people don't.Part of my job is helping determine what kind of therapy is likely to be useful.

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What to Expect From Therapy

We start with a free 30-minute video consultation. You'll tell me what's been going on and what you're hoping to change. I'll give you my sense of whether I can help and answer questions about how I work.

The first sessions are broader than ACT. I want to understand the problem, your history, what you've already tried, and what may be maintaining the difficulty before deciding which therapeutic tools make sense.

We connect ideas to specific situations. Rather than discussing “acceptance” or “values” only in the abstract, we look at the Tuesday morning when you couldn't stop checking, the job offer you're afraid to accept, the conversation you keep postponing, or the evening you stayed at your desk three hours longer than you intended.

There may be things to practice between sessions. That could involve noticing a recurring thought differently, tolerating uncertainty without seeking reassurance, experimenting with a new behavior, clarifying a value, or taking a small action you've been avoiding.

We adjust as the work develops. ACT may be central for a period of therapy and less important later. If CBT, ERP, more exploratory therapy, or another approach becomes more useful, we'll shift.

Sessions are generally 50 minutes and initially weekly. I offer in-person therapy from my Center City Philadelphia office near Rittenhouse Square and virtual therapy for clients located in states where I'm licensed.

FREQUENTLY ASKED QUESTIONS

  • Acceptance and Commitment Therapy (ACT) is a behavioral therapy that helps people develop greater psychological flexibility.

    Rather than making the elimination of difficult thoughts and emotions the primary goal, ACT helps you respond to those experiences differently while taking actions that reflect your values.

  • No, although the approaches are related and can work well together.

    CBT often helps you examine whether a thought is accurate and develop a more balanced interpretation. ACT is frequently less concerned with proving a thought right or wrong and more interested in whether becoming entangled with that thought is helping you.

    For example, CBT might examine the evidence behind “Everyone will think I'm incompetent.” ACT might help you notice that your mind is producing that prediction and still give the presentation because doing your work well matters to you.

    I use both approaches depending on the situation.

  • ACT can be particularly helpful when anxiety is leading to avoidance, reassurance-seeking, overthinking, perfectionism, or attempts to control internal experiences that cannot be controlled completely.

    Rather than waiting to feel no anxiety before acting, you learn to become more capable of doing meaningful things with some anxiety present.

  • I use ACT principles alongside ERP, not as a replacement for it.

    Acceptance, defusion, mindfulness, and values-directed action can help you experience intrusive thoughts and uncertainty without automatically engaging in the compulsions OCD uses to provide temporary relief.

    The aim isn't perfect certainty. It's greater freedom when certainty isn't available.

  • No.

    Values clarification is part of the work, and it's often more nuanced than simply listing what's important to you.

    For example, “family” may be something you value, but therapy might explore what being the kind of spouse, parent, sibling, or adult child you want to be actually looks like in behavior.

    Values aren't a test you need to complete before therapy.

  • No. My approach is deliberately integrative.

    ACT is one framework I use alongside CBT, ERP, mindfulness, psychodynamic and emotion-focused approaches, positive psychology, and other tools depending on the person and the problem.

    Many people who contact me have heard of ACT, CBT, or another therapy approach but aren't sure which one is actually the best fit. You don't need to figure that out before starting. We'll talk about what you're dealing with and use the approaches that seem most useful.

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You don't need to eliminate every uncomfortable thought, solve every uncertainty, or finally feel completely ready before you can begin moving forward.

Sometimes meaningful change comes from learning which thoughts deserve your attention, which struggles you can loosen your grip on, and what you want your behavior to stand for either way.

I offer ACT-informed individual therapy from my office in Center City Philadelphia near Rittenhouse Square, as well as virtual therapy for clients in Pennsylvania, New Jersey, Washington, D.C., Maryland, Virginia, and Washington State.

If you're curious whether ACT — or another part of my approach — might be useful for what you're dealing with, the next step is a free 30-minute video consultation.

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