As a therapist, it is important to keep in mind that defusion as a process does not refer to any particular form of behavior. Considered in isolation, there are no defusion techniques, metaphors, or exercises in and of themselves, any more than a piece of candy on the table is a reinforcer, or the word “good” is praise. Defusion is a functional concept that requires attention to tact, timing, pacing, and context. Key among these is therapists’ awareness of clients’ behaviors that indicate when defusion is needed.
Working with clients can be a bit like traveling through a dense thicket. It is easy to lose direction, get caught on a bramble, or get stuck. When a session becomes thick with reasons, justifications, and stories, therapists can sometimes find some “air” by asking themselves, their clients, or both, questions that focus on the functional utility of talk through questions such as (Hayes et al., 1999):
>
“And what is that story in the service of?”>
“Is this helpful, or is this what your mind does to you?”>
“Have you said these kinds of things to yourself or to others before? Is this old?”>
“Okay, let’s all have a vote and vote that you are correct. Now what?” (p. 164)Another way to cut through literality is to help clients contrast what their minds say will work with what their experience says about what has worked. This can often serve as a way of cutting through exces- sive literal thinking. An ACT therapist might say, “I don’t want you to see this as a matter of belief, but to examine it against your experience,” or “What does your experience say?” The goal of these types of questions is to move clients out of literal, evaluative thinking and into a stance that is more oriented to the opportunities afforded by their environment and directed by the practical considerations of their values.
Another way is to acknowledge the situation directly. “Hmm. Have you noticed it’s getting awfully ‘mindy’ in here?” or “I notice I’m fighting here, trying to figure it out and persuade you. Is it okay if we just take a deep breath and notice we’re still both just here in this moment, each with our chattering minds?” or “I have no idea what to do or say next. My mind is being pretty harsh on me for saying this—I guess therapists are ‘supposed’ to know. It’s the truth, though. Do you have thoughts about how to proceed?”
EXERCISE: DEFUSION, PART 2
Go back to the three thoughts you listed at the beginning of this chapter. Now that you have read about the defusion techniques, consider one technique you could use for each of the thoughts you recorded before. Describe these below.
Thought 1: Thought 2: Thought 3:
CORE COMPETENCY PRACTICE
This section is intended to provide practice in using defusion techniques in response to sample transcripts based on ACT sessions. Listed here are the ten ACT core competencies for defusion. For each core com- petency, you are presented with a description of a clinical situation and a section of a transcript. The transcript ends after a client statement, and you are asked to provide a sample response that reflects that competency. The model responses at the end of the chapter are not the only right responses; they are just examples of ACT-consistent responses. If you disagree with the responses or want to double-check your response or talk more about it, you can post a question to the bulletin board at www.learningact .com/forum/. Again, try to generate your own responses before you look at the samples at the end of the chapter.
CORE COMPETENCY EXERCISES
COMPETENCY 1:
The therapist identifies the client’s emotional, cognitive, behavioral, or physical barriers to willingness.EXERCISE 3.1
The client is a thirty-four-year-old female who has panic attacks, particularly in social situations. She wants to go back to school, but feels she’s “too anxious.” This transcript occurs in the third session, following a discus- sion in which she has related how hard it is for her to participate in class, particularly in terms of raising her hand in class.
Therapist: What stands in the way of your raising your hand in class?
Client: I just can’t do it. When I even think about it, I get scared.
Therapist: Okay, you have the thought “I can’t do it” and the feeling of being scared. What else stands in
the way of your raising your hand?
Client: I’m afraid I’ll panic.
Therapist: Anything else?
Client: No. Isn’t that enough?
Write here what your response would be (remember you are using competency 1):
COMPETENCY 2:
The therapist suggests that attachment to the literal meaning of these experiences makes willingness difficult to sustain (helps clients to see private experiences for what they are, rather than what they advertise themselves to be).EXERCISE 3.2
This transcript continues with the same client as in competency 1.
Therapist: [gives the response found in Sample 3.1b, in the model response section at the end of this
chapter]
Client: I guess, but I just can’t do it. I’d be too scared. I’d just end up embarrassed.
Write here what your response would be (using competency 2):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 3:
The therapist actively contrasts what the client’s mind says will work with what the client’s experience says is working.EXERCISE 3.3
This transcript continues with the same client as in competency 2.
Therapist: [gives the response found in Sample 3.3b in the model response section]
Client: But I can’t do it. I know that if I raise my hand, and I haven’t been able to get my breathing
under control, I won’t be able to say anything when he calls on me. If I could just get my breathing under control, I could probably do it without panicking.
Therapist: So, let’s check this out. Your mind says, “I need to get my breathing under control.” Right?
That’s a thought. Is that a familiar one?
Client: Yeah.
Therapist: Now, let’s look at what your experience has to say about this. How long have you been
following what that thought has to say?
Client: A long time …
Write here what your response would be (using competency 3):
COMPETENCY 4:
The therapist uses language tools (e.g., get off your “buts”); metaphors (e.g., Bubble on the Head, Passengers on the Bus); and experiential exercises (e.g., Thoughts on Cards) to create a separation between the client and the client’s conceptualized experience.EXERCISE 3.4
A forty-four-year-old male client is struggling with alcohol addiction. One of his biggest triggers of alcohol use is when he is alone at home. He was on disability for a long time and spent a fair amount of his life simply sitting at home, drinking and watching TV. He has been sober for the past two months and just started a new job for the first time in several years. He’s beginning to question his commitment and wondering if the job is really worth the stress. The therapist and the client discussed the bus metaphor in a previous session; this transcript is from the sixth session.
Client: It’s just that I go to work and they don’t pay me enough, so it’s stressful. I feel like I screw up
and don’t work fast enough. I’m not sure it’s really worth it. I get home at the end of the day, and there’s no one there. I want to do better, but I just want a drink … so badly.
Write here what your response would be (using competency 4):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 5:
The therapist works to get the client to experiment with “having” difficult private experiences, using willingness as a stance.EXERCISE 3.5
This transcript continues with the same client as in competency 4.
Therapist: [gives the response found in Sample 3.4b in the model response section]
Client: I feel lonely. I feel anxious, like I need to do something.
Therapist: So lonely shows up. Anxious shows up. If those passengers could speak to you, what would
they tell you to do?
Client: They would tell me to just have a drink. Just take the edge off.
Therapist: So these are old passengers, ones who are very familiar. You know them well. What do they
say they will do if you just do what they’re asking you?
Client: They say they will go away, they’ll shut up for a while. And they do.
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
EXERCISE 3.6 (continuing with competency 5)
This transcript continues with the same client.
Therapist: [gives the response found in Sample 3.5b in the model response section]
Client: I don’t know if I could do that.
Write here what your response would be (using competency 5):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 6:
The therapist uses various exercises, metaphors, and behavioral tasks to reveal the hidden properties of language.EXERCISE 3.7
The client is a depressed forty-year-old male who constantly compares himself with others in social situations and often sees himself as worth less than others. A common pattern for him is being in a conversation with someone and simultaneously thinking, “This person seems to have it pretty together. If he knew how much of a loser I am, he wouldn’t want to be friends with me. He can’t really be as together as he seems. I’m sure there’s some way in which he has problems. I don’t know what it is, but I’m sure I’ll find it eventually.” The client is talking about this situation in the fourth session.
Client: I’m just so sick of comparing myself with others, feeling bad, and then tearing them down.
Therapist: What’s the thought that is most troublesome? That you’re bad?
Client: Hmm. I guess it’s that I think, “He’s better than me.”
Therapist: He’s better than me. And that makes you …
Client: Bad. Worse.
Therapist: Which one feels more at the heart of it?
Client: Hmm. Bad.
Therapist: So, are you willing to do a little exercise with me around this thought that shows up for you,
“I’m bad”?
Client: Sure.
Therapist: So, what I’d like us to do is play around with this thought a little. Let’s try something out. How
Client: [in a high, funny voice] Uh, “I’m bad, I’m bad. I’m the worst there is.”
Therapist: And, let’s do a duet of it … [sings a few more rounds with the client] So, tell me, what was
your experience of that?
Client: Well, at first it was pretty weird. I didn’t like making fun of something that felt so personal. But
then it just got a little lighter; it wasn’t such a big deal. Write here what your response would be (using competency 6):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
COMPETENCY 7:
The therapist helps the client elucidate the client’s story and helps the client make contact with the evaluative and reason-giving properties of the story.EXERCISE 3.8
This transcript continues with the same client as in competency 6.
Therapist: [gives the response found in Sample 3.7a in the model response section]
Client: Yeah, but it seems really solid when I’m there. It’s like I think that’s really true about me. I feel
like I really am bad in some ways. It’s like believing something else would be a lie. Write here what your response would be (using competency 7):
What are your thoughts in saying this? What are you responding to and what are you hoping to accomplish?
EXERCISE 3.9 (continuing with competency 7)
This transcript continues with the same client.
Therapist: [gives the response found in Sample 3.8b in the model response section]
Client: I guess. But, I’m not sure how.
Therapist: I want to have us take a little look at something I think is part of what holds all this together.
I propose that we all have a story about how we are the way we are. Right? I have mine, you have yours. We all have this narrative we piece together from the memories of all the events in our lives that we can remember. I’d like us to spend a moment getting in contact with your
story about this depression. What happened in your past—when you were a kid or an adult, whenever—that resulted in your being depressed?
Client: Well, I think it started with my parents. I felt they never cared about me. Maybe it’s genetic,
too, like I have a chemical imbalance.
Therapist: You have some memories and thoughts about being neglected by your parents, and then more
thoughts about causes: maybe it’s genetic, a chemical imbalance.
Client: Right.
Therapist: So, can I set aside the chemical imbalance part just for a second and focus on the part about
your parents not caring about you as what might be causing you to be depressed?
Client: Sure.
Therapist: So, you had an evaluation first: you were mistreated by your parents. And then you also had
the thought that this caused you to be depressed. Is that fair to say?
Client: Yeah, I guess. But I think that’s really what happened, not that I had a thought.
Therapist: So, let’s say I agree you were neglected by your parents. It can be true, or not true in a literal
sense—that’s not in dispute. I’m not arguing with you. And that treatment was associated with a lot of pain. Your pain. Now, kids do the best they can, so I’m absolutely not blaming you. Still, I would like to ask you this: As an adult now looking back, could you have reacted differently in any way to what they did or didn’t do? And even now, in this moment, do you have any choice in how you respond to this painful memory?
Client: Sure, I guess. I could have been angry. I actually am angry sometimes. I guess I could have
said, “Screw them,” and found someone who cared about me. I actually did try to do that, but it didn’t seem to help.
Therapist: You’ve actually had a whole host of reactions to it. Let me propose two things that might be
there: one is your reaction to what they did, and the other is your feelings of depression. Now, if they actually neglected you, is there anything you can do about what happened in the past?
Client: No, of course not.
Therapist: So get this. If the reason you are depressed is that your parents neglected you, then you’re
stuck. The only way you can be is depressed. Do you see this? Your mind gives you this as the reason you are depressed. If it is literally true that this is the reason, can you change the past?
Client: No.
Therapist: So, if it’s the case that this literally is what caused you to be depressed, then we might as well
throw in the towel. You’re going to be depressed the rest of your life.
Client: Okay, I think I see where you’re going. You seem to be saying it’s actually my fault I’m the way
I am.
Write here what your response would be (using competency 7):
COMPETENCY 8:
The therapist helps the client make contact with the arbitrary nature of causal relationships within the story.EXERCISE 3.10
This transcript continues with the same client as in competency 7.
Therapist: [gives the response found in Sample 3.9b in the model response section]
Client: Well … I guess I don’t have to feel so bad about being depressed. It’s not my fault.
Therapist: Right, so it helps you to feel a little better. You don’t need to feel so guilty about lying in bed
all day or dropping out of school … [sarcastically] It really helps, right? You feel great! [laughs with the client] And how does it cost you?
Client: Well, I’ve got to stay depressed.
Therapist: And you can’t …
Client: I can’t be happy, I can’t connect with people. I can’t hold down a job.
Therapist: Let me ask it another way. If you were to suddenly get better and no longer be depressed, who
would be made wrong by that?
Client: Huh? [Clients are often confused by this question.]
Therapist: If you were to suddenly just go out and no longer live a depressed life, who would be made
wrong by that?
Client: I guess me?
Therapist: [compassionately] Yeah, you. Here you have a story that says your parents caused you to be
depressed. You’d have to let go of that. In order to do that, you’d have to stop being right about it. The question I have for you is this: Would you rather be right about how your parents’ neglect made you depressed or would you rather have your life back? In order to get your life back, you’d have to let go of this story.
Client: I want my life back, but they weren’t there for me, and I can’t change that. And I have been
depressed ever since then.
Therapist: Right. Absolutely. You can’t change what they did. And being depressed is descriptive of how
you’ve lived your life. Let me ask you this: Do you have to stay depressed to still think you are right that they shouldn’t have done this? Would it be possible to have that story, as a story—not right, not wrong—and move on with your life, reclaim your life? Do you need to change the story for you to move forward with your life or can you just let it be there, as a story, as a thought, and move forward? Notice how now it serves as a reason for your acting depressed.
Client: Okay, I see what you are getting at, but I just can’t seem to get beyond it.
Write here what your response would be (using competency 8):
COMPETENCY 9:
The therapist detects mindiness (fusion) in session and teaches the client to detect it, as well.EXERCISE 3.11
The client is a fairly intellectual female in her forties who is considering leaving a distant relationship with her spouse, Rebecca, whom she describes as alternating between withdrawing and being verbally overbearing and critical. The client has read dozens of self-help books, spent years in counseling with other therapists, and dis- plays a lot of insight into her own and her partner’s problems. Nevertheless, she continues to be very passive in her relationship and avoidant of conflict. This transcript picks up fairly close to the beginning of the seventh session, after the client has been talking for several minutes about what her partner did that week to intimidate and bully her. The therapist has noted that the conversation feels very lifeless, old, and stale.
Client: I just don’t know what to do. I’ve been thinking about leaving, and yet I know if I leave, it also
means I’ll lose the kids. I just feel so stuck. What do you think I should do?