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

This article focuses on the use of Acceptance and Commitment Therapy (ACT) within a secure forensic mental health setting, exploring its impact on both a service user diagnosed with Borderline Personality Disorder and Post-traumatic Stress Disorder and the delivering psychologist. ACT, a "third-wave" therapy emphasizing psychological flexibility, personal values, and acceptance of reality, was chosen to address challenges such as self-harm, trauma processing, and relationship difficulties in a restrictive environment where therapy can feel coercive. The service user reported that ACT’s use of metaphors, consistent language, and value-based focus helped foster hope, stability, and internal change despite ongoing external restrictions. Reflections highlight the importance of adapting therapy to secure settings, embedding ACT principles across clinical teams, and recognizing that psychological flexibility can promote recovery even within constrained circumstances.