A recent review of ACT adherence and competence rating systems (Plumb & Vilardaga, 2010) recommended a functional rating method in which specific ACT processes and contraindicated processes are evaluated for their frequency of occurrence and depth of coverage and all of these items are then considered in an overall rating of adherence and competence. Five ACT targets (willingness, values, committed action, workability, and defusion), two nonspecific targets (stigma/shame discussion not related to ACT processes, therapeutic relationship), and four processes contraindicated by ACT (promoting experiential avoidance, challenging cognitions, suggesting thoughts or feelings cause actions, evaluating the accuracy of thoughts) were evaluated on a 1–5 scale. Ratings of 1 and 2 indicated that the target process was not seen (1) or was seen but not addressed in depth (2). Ratings of 3 and 4 indicate that the process was addressed in moderate depth and was seen during the segment either several times (3) or with high frequency (4). A rating of 5 indicated that the process was addressed frequently and in great depth. Overall adherence and competence ratings were then taken, considering
