Aside from the increase in mental health diagnoses observed worldwide, workplaces bring a unique set of risk factors that could detrimentally affect employees’ mental health (Harvey et al., 2017). According to Barkhuizen et al. (2014), counselling can include facilitation to guide people through a problem by increasing self-insight and empowerment and advancing optimal functioning. Counselling is a minimum skill required by industrial psychologists and relevant to other functions such as career guidance, psychometric feedback, performance management, retrenchment and occupational safety (HPCSA, 2019b). As mental health conditions are associated with a loss of productivity (Stepanek, Jahanshahi, & Millard, 2019), it is important that industrial psychologists are equipped to intervene. A literature review demonstrated the potential of work-based interventions for mental health conditions, to improve absence duration, economic outcomes, quality of life and work functioning (Pomaki, Franche, Murray, Khushrushahi, & Lampinen, 2012). Counselling is an effective intervention to address the mental health challenges of employees (Collins et al., 2012; McLeod, 2010).

Although there are many different counselling approaches, Minjoo, Mpofu, Brock, Millington and Athanasou (2014) found evidence for cognitive behavioural therapy (CBT) in the workplace, which holds promise as an intervention for industrial psychologists to address mental illness. ACT is recognised as a third-wave CBT therapy that is aimed at addressing mental health issues through enhancing psychological flexibility (Hayes, Strosahl, Luoma, Varra, & Wilson, 2004). Psychological flexibility is the ability to make contact with the present moment, without judging private experiences (e.g. cognitions and emotions) and a willingness to change action plans that do not serve meaningful life goals (Hayes, Strosahl, & Wilson, 2012). Meta-analytical evidence supports the efficacy of ACT in addressing mental health concerns such as anxiety and depression (Gloster, Walder, Levin, Twohig, & Karekla, 2020). There is also growing literature on the use of ACT as a brief intervention (Strosahl, Robinson, & Gustavsson, 2012), which is considered more appropriate for the industrial psychologist’s involvement in work-based counselling (Du Plessis & Thomas, 2021; Jorgensen-Graupner & Van Zyl, 2019).

In ACT, psychological flexibility is facilitated through six processes that will be discussed according to three response styles and the definitions provided by Hayes et al. (2012).

Open response style: Acceptance and defusion are critical elements that help facilitate a non-judgemental and more holistic understanding of direct experience. Acceptance is a process of enhancing willingness to attend to difficult inner experiences (including cognitions, emotions, memories and physical sensations). Defusion makes it possible to untangle from unhelpful inner experiences to the extent that it does not dictate behaviour.

Centred response style: A centred response style aids a mindful approach to everyday experience and includes two processes: Attention to the present moment involves a flexible shift in attention that is non-judging and allows greater awareness of private experiences. Self-as-context is about broadening perspectives regarding definitions of the self in an effort to combat limiting and self-defeating conceptualisations.

Engaged response style: Values and committed action are crucial for living a meaningful life. Values that are freely chosen and give purpose in life are explored whilst committed action involves a continuing set of behaviours, aimed at living according to values.

ACT is a structured approach to therapy and incorporates psychological skills that industrial psychologists might be more familiar with, such as goal-setting, reinforcing reasonable thinking and behavioural modification.

Two electronic databases were identified to conduct systematic literature searches, namely PsycInfo and Sabinet. PsycInfo provides access to social science and behavioural research globally, whereas Sabinet focusses on African electronic journals and allows access to African studies that are not always available to the global North (Laher & Hassem, 2020). The search included the following keywords with Boolean operator ‘AND’:

Whilst ‘industrial and organisational psychology’ is the most appropriate term to use in PsycInfo, ‘industrial psychology’ was used in the Sabinet search, in accordance with South African terminology. Work-based counselling rose to eminence in the 1940s (Highhouse, 1999) and the search for Stream 1 considered publications from 1940 to 2020. The ACT literature emerged in the 1980s, and the literature review included only literature published from 1980 to 2020.

As displayed in Figure 1, the initial search yielded 1297 publications (703 from PsycInfo and 594 from Sabinet). Screening followed to distinguish articles relevant to answering the research question and that were of an acceptable quality. Included articles had to be written in English or Afrikaans, and samples of studies were restricted to adults of the age of majority in South Africa (18 years or older). Peer-reviewed publications are considered more rigorous; therefore, grey literature (publications not subject to the blind peer-review process) was excluded (Hassem & Laher, 2019). Each stream of literature had further criteria for inclusion and exclusion, namely:

The authors (an industrial psychologist and a clinical psychologist with doctoral degrees in their respective fields) conducted independent screening processes to determine the eligibility of the publications for inclusion. The screening process proposed by Hassem and Laher (2019) was utilised, namely researchers should first screen titles, then abstracts and then full texts to ascertain the relevance of each article, before establishing consensus between the two reviewers on publications to include in the review. Inspection of the quality of the publications was the final step in the screening process. Articles related to the role of the industrial psychologist as counsellor was limited in scope and, therefore, all articles were included. The rating system proposed by the Critical Appraisal Skills Programme (2020, p. 1) provides 11 key considerations to determine the validity and applicability of randomised control trails in Streams 2 and 3, of which 10 were considered relevant and used as guidelines. The guidelines are listed as follows:

As suggested by Question 1, only randomised controlled trials were included to determine whether a protocol could be constructed from a causally valid evidence base (Lilienfeld, McKay, & Hollon, 2018). Although none of the studies from Streams 2 and 3 were conducted in South Africa, per Question 9, ACT is regarded as a unified and transdiagnostic framework, which is applicable to many contexts (Hayes et al., 2012). One ACT randomised control trial, conducted in South Africa, showed significant effect sizes for improvement in quality of life and seizure frequency in people who suffer from epilepsy (Lundgren, Dahl, Melin, & Kies, 2006). Question 9 also concerns the relevance of the studies to the practices of South African industrial psychologists. The literature from Stream 3 was not specific to industrial psychologists (i.e. applicable to the work context), but there was sufficient convergence with the protocols found in Stream 2 to suggest applicability for industrial psychologists.

The elimination process yielded a total of 25 publications for inclusion as illustrated in Figure 1.

In a systematic review, content analyses are usually implemented in a quantitative manner to code specific categories, which are then reported using descriptive statistics (Laher & Hassem, 2020). In this study, the content analysis focused on the following categories: author, design and participants, procedures, measures of outcomes and results. Calculations of frequencies and percentages provide an indication of the elements on which the studies in literature Streams 2 and 3 converged in terms of methods and results reported.

ACT 1 (Orientation): An orientation to the principles of ACT, and the associated aim to enhance psychological flexibility via the hexaflex model, serves to prepare the employee for therapy and promotes adherence to the conditions of the intervention. Issues surrounding informed consent and confidentiality should also be clarified at the outset of therapy to establish a psychologically safe environment where intimate details can be shared (Bond, 2004).

ACT 2 (Case formulation): Once the rules and structure of therapy is explained, a case formulation is composed. In ACT, the focus is less on the manifestation of psychopathology and more on its functional impact on the client. The prevalence of depression, for example, has implications for how clients structure their lives and how the sense of self is defined by the presence of depression (Hayes et al., 2004). Two questions, central to the case formulation are: (1) ‘What kind of life does the client most deeply want to create and love?’ and (2) ‘What are the psychological and environmental processes that have inhibited or interfered with the pursuit of that kind of life?’ (Hayes et al., 2012, p. 106). The timeline of the problem should be established by considering its trajectory, antecedents and consequences (Hayes et al., 2012). The Flexibility Rating Sheet proposed by Hayes et al. (2012) can be used to help therapists structure their thoughts around a case formulation within the hexaflex framework of ACT.

ACT 3 (Values clarification): Inquiring about the extent to which employees are living according to their major life goals could enhance insight into the discrepancy between current behaviour and major life goals, and if facilitated correctly, can be used as a positive strength-based approach (Hayes et al., 2012). There is considerable overlap between the ACT definition of values and how Roberts and Robins (2000) typify major life goals. Given the brevity of the process, clarifying the employee’s major life goals (broad agendas for major life domains) (Roberts & Robins, 2000) can serve as a compass to establish more effective life patterns. Major life goals consist of economic goals, aesthetic goals, social goals, relationship goals, political goals, hedonistic goals, religious goals, personal growth goals, physical well-being goals and theoretical goals (Roberts & Robins, 2000). Utilising major life goals is a pragmatic method of linking broad values to specific goals that can be advanced through the counselling process. Major life goals come with the added benefit of existing literature, situated in a nomological net that is associated with interest and personality research (Stoll, Einarsdóttir, Song, Ondish, Sun, & Rounds, 2020).

A scene from ACT 3: A powerful ACT strategy to elicit major life goals is the eulogy exercise, which requires of clients to think about what they would like others to say about them at their funeral (Strosahl et al., 2004). Clients could also rank their major life goals to determine their most valued direction for the future.

Intermission: Homework is assigned after Session 1, to ensure further reflection and refinement of major life goal descriptions, in preparation for the subsequent session. Clients need to reflect on what would happen if they continue to struggle with the concerns that prevent the pursuit of major life goals in comparison to what is possible when they can take steps in order to live closer to their values.

ACT 4 (Setting specific goals): The identification of more specific therapeutic goals will assist employees to put major life goals into action (Kohtala et al., 2017). Counsellors are tasked with facilitating a process in which the client identifies specific goals that relate to their most valued major life goals. When setting specific goals, the employee must be guided to set self-directed, challenging, sufficiently complex, emotionally pleasing, meaningful and practically feasible goals to ensure the required self-efficacy and commitment to achieve such goals (Locke & Latham, 2013; Van Lill, Roodt, & De Bruin, 2020). If the therapeutic goals appear impractical or the client’s expressed intention to pursue the therapeutic goals seem unconvincing, the counsellor should encourage further calibrations to the goals to enhance commitment. Visualising how life might be different when the therapeutic goals are achieved could also increase the client’s motivation.

ACT 5 (Identifying and choosing actions): A clear comprehension of the outcomes to achieve should assist the employee to identify and commit to action strategies that can lead to change. The counsellor should start by considering the client’s previous actions that were unsuccessful in achieving major life goals. Then the counsellor can discuss actions that will expand the client’s behaviour repertoire, also referred to as target behaviours or goal-related behaviours (Scobbie, Dixon, & Wyke, 2011) and guide the client to choose actions they can start implementing over the next week.

If and then statements might be a meaningful behavioural script that clients can adopt, instead of consciously thinking about every next action required to achieve therapeutic goals. An if statement could reflect a situation, to which a then statement would reflect an appropriate behavioural response that will lead to the achievement of a specific and distal major goal. These statements can assist in formulating the when, where and how of implementation intentions to concretise the achievement of goals (Gollwitcher & Sheeran, 2006). For example, if I have the option of an elevator or stairs in a building (when and where related to a situation), then I will walk up the stairs (how). This will enable me to get more exercise at work (specific therapeutic goal) to live a healthy lifestyle (major life goal).

A scene from ACT 5: Generating creative hopelessness is a strategy to help clients to recognise their unsuccessful efforts to control problems in their lives (Hayes et al., 2012). The intention is for the client to realise that letting go of the struggle with the problem is the best way to pursue their values. ’The person in the hole exercise’ could be a valuable intervention to illustrate how digging further will not get the client out of the hole (Strosahl et al., 2004). Instead, to live a life of value, the client needs to invest energy in pursuing major life goals.

Intermission: A homework assignment could include further reflection on the actions discussed during the session and as per Bond’s (2004) recommendation, the client can draft a list of specific actions that will enhance committed action to achieve therapeutic goals.

ACT 6 (Identify barriers to goal pursuit): Barriers could include internal events (e.g. thoughts, feelings, memories and physical sensations) or external events (e.g. feedback from other people, contextual limitations and unexpected events) that undermine goal pursuits. Oettingen, Wittchen and Gollwitzer (2013) recommend a proactive approach to identifying possible challenges to goal pursuit to bolster the employee’s implementation intentions and, consequently, goal achievement. The list of actions, compiled as homework for Session 2, can be extended to include a column of possible barriers that might undermine the achievement of value-directed goals.

ACT 7 (Creating psychological flexibility): The six processes of the hexaflex model should be applied to assist clients in managing their identified barriers. Interventions aimed at facilitating acceptance can create a willingness to make room for barriers whilst continuing with committed action in a value-driven manner. Untangling cognitive fusion, being in contact with the present moment, and developing alternative perspectives on the self (Ruiz et al., 2020; Strosahl et al., 2004) can be utilised to address challenges that prevent intentions from becoming actions. If and then statements (discussed in ACT 5) might also be meaningful way to build contingencies around barriers to goal-directed behaviour.

A scene from ACT 7: The flip card exercise is a defusion strategy that involves the counsellor writing down troubling thoughts on cards and tossing them back to the client (Strosahl et al., 2004). Viewing thoughts that limit value-driven life on cards can create distance and help the client not to buy into the thoughts. Clients can first be asked to fight off the cards tossed by the counsellor and then allow them to fall in their laps to notice the difference between fighting cognitions and creating room for them.

Intermission: The homework assignment for Session 3 focuses on the implementation of the identified behavioural strategies. Counsellors can instruct clients to make specific notes about the effectiveness of the strategies and the barriers that came up and how they attempted to overcome them. This can serve as a feedback loop to revise goals or related action plans.

ACT 8 (Reviewing intervention): The first part of the final session is aimed at reviewing the identified goals and consequent behavioural intervention. There should be an evaluation of the employees’ satisfaction with the progress they made in achieving their goals and the success of their behavioural strategies. The counsellor can inquire about any successes (even small ones) in goal achievement and the consequent impact on the client. Preparing the client for termination will be a segue into the final ACT, which concerns continuation of the gains obtained from counselling.

ACT 9 (Continuing committed action): Depending on the success of the committed action strategies, the counselling process will focus on adapting or expanding on the strategies. Successful implementation of committed action should be celebrated and reinforced, whilst future goals are discussed to extend the gains from counselling and prevent regression to an emphasis on the symptoms of anxiety and depression. Sustained implementable actions are required to continue goal achievement and maintain commitment to value-driven living. If employees have to actively choose a course of action in line with goals every time an alternative presents itself, it might deplete their self-regulatory resources (Oettingen et al., 2013). Work-based counsellors should help their clients to create habits (implementation intentions) that will automate goal-related actions and continue after the counselling process.

A scene from ACT 9: During the session, the counsellor can introduce a combination of breathing and visualisation exercises to encourage awareness, acceptance and non-judgement towards inner experiences (Strosahl et al., 2004). The counsellor can encourage the client to incorporate these exercises as part of their daily routines to maintain a focus on their values and make room for challenging inner experiences.