Cognitive defusion is a relatively new name for an old process that is central to Acceptance and Commitment Therapy (ACT). Based on the idea that taking our thoughts too literally is often problematic, defusion techniques are designed to de-literalize our thoughts, exposing language’s inability to capture the full depth of our experiences or describe our lives and our world with perfect accuracy.
While most of us assume that, if we have distressing or counterproductive thoughts or feelings, those thoughts or feelings need to change for our lives to get better, actually changing those thoughts or feelings in productive ways is not easy. Learning to think more “accurately,” or “positively” about one’s struggles appears to be a viable method of changing human behavior for the better, but it is not the only way—and may not be the most workable way. Cognitive defusion is an alternative approach that allows problematic thoughts or feelings to arise without functioning in problematic ways.
Despite wide applicability and effectiveness, cognitive defusion techniques can be slippery in therapy sessions with your client. Here are a few common pitfalls to watch out for while practicing defusion techniques with clients, along with insight into overcoming them:
1. Defusion techniques can be odd.
Defusion techniques are designed to break the rules of language and loosen the hold problematic rules and narratives have on behavior. In order for defusion to work, some strange or unexpected things need to happen. These techniques, though effective, can be off-putting if not done in the right context.
There are subtle techniques that can be integrated into the conversation fairly naturally in the earlier stages of the therapeutic relationship. Skillful defusion work at these early stages might include verbally (and empathetically!) identifying problematic thoughts like, “I am stupid,” as thoughts during conversation, out loud and in real time. Introducing this kind of conversational convention early on can help to create some distance between clients and their problematic thoughts so the emotions attached to them can be more readily experienced.
When using more overt methods, we should first explain the rationale behind defusion: Namely, the fact that language is suspect, and words (even our own thoughts) often fall short of accurately representing reality. Finally, it is important to not only offer an explanation of defusion but to also ensure that trust has been firmly established in the therapeutic relationship before asking a client to do something extremely odd, like repeat the word “giraffe” over and over again until it loses its meaning.
2. Defusion strategies come with the risk of invalidating clients.
When we help clients learn to defuse from their thoughts, we are helping them see that the stories we tell about our lives and struggles are never the absolute, objective truth. But if we are not careful, clients can wind up missing the general nature of this assertion and feeling invalidated, like we believe their particular story is untrue. Be mindful of the potential for giving the impression that you doubt a client’s ability to identify the facts of her own life. Clients need to know that the misleading character of thoughts is not a personal shortcoming but something we all grapple with, and that their therapist empathizes with that struggle.
Also, be aware of giving the impression that you are trivializing a client’s distress. Asking a client to sing his most challenging thoughts to the tune of his favorite pop song, for example, may result in a deep feeling of invalidation. This is another reason why establishing trust and empathy with the client before engaging in these types of exercises is so important.
3. Defusion strategies, if not executed correctly, may give the impression that the client should change the way they feel. This is not the goal.
We humans have a habit of trying to change the way other humans think about their experiences. The idea that we should think about things with accuracy and reason tends to seep into our therapeutic work even when our approach to behavior change is not aimed at thought change.
For example, we might find ourselves encouraging a client to make sense of an event in her life in a way that provides comfort or helps her move forward constructively. It can be helpful to find alternative ways of thinking about life’s challenges, but it may be counterproductive to send the message that a client must change the way she thinks about them in order to move forward.
Remember that progress does not depend on thoughts changing. Instead, our aim in defusion work is to adjust the way someone relates to troublesome thoughts, so that they do not need to change their thoughts for progress to occur.
4. If the concept of defusion is misunderstood or taken to an extreme, it can lead to a sense of meaninglessness.
If thoughts are not absolute truths, perhaps there is no absolute meaning, no right or wrong, and no point of reference for determining what matters. A client may say that they want to be kind, behave in a fair and compassionate manner, and connect deeply with others. But when they begin to consider that thoughts are not absolute truths, they may begin to doubt whether this value truly matters to them or if it is “just a thought,” devoid of any real substance or meaning. A values statement is a string of words, after all, and words cannot capture absolute truth.
If you find that a client is headed toward this extreme, try to evoke a different way of understanding what matters: the kind of experiential knowing we have when doing things a particular way simply feels right and vital, and matters greatly at a personal level. The client’s values and direct experience of what is meaningful and important to them counterbalance the seeming meaninglessness of life. When clients realize that their minds are not exactly their most trustworthy friends, they can begin to appreciate the importance of relying on this experiential knowing to understand what matters to them. Words can be helpful in assisting those realizations, but they should not be allowed to negate them.
5. It may be hard to tell whether a thought is an evaluation or a description.
Some defusion strategies involve asking clients to place thoughts into one of two categories (descriptions or evaluations) to help them notice the distinction between the visceral experience of physically perceiving things and the ethereal nature of thoughts. The thoughts we label as “descriptions” point to direct, physical experience, such as, “That table is made of wood.” “Evaluations” are any other way we can talk about an experience that is not purely descriptive, such as, “That table is beautiful.” But it is not always easy to determine if a thought is an evaluation or description. Some thoughts are both.
For example, the word “fat” refers to the presence of adipose tissue. But for many, there may also be evaluative baggage added on to its meaning. One approach might be to grant the descriptive component of a word or phrase when it becomes apparent, and then ask the client what it means to have that word apply to him. What typically happens when you do this is that a number of negatively evaluative thoughts about what it means to be “fat” will emerge. Purely evaluative thoughts like these can then be sorted into their proper category.
Remember, the purpose of this exercise is not to help the client determine which category of statements are true and which are false, but rather to practice the categorization process itself, then to draw from direct, exercise-related history of noticing how solid or weightless those thoughts actually are.
For more about defusion, check out our upcoming webinar, Defusion: From Technique to Radical Intervention with Matthew Boone, LCSW, on September 20, 2016. This webinar will help participants better understand the role of defusion in psychotherapy, identify the ways defusion can help to facilitate willingness and values work, and use defusion techniques in sessions with clients.
Editor’s note: This article was adapted with permission by Context Press from Cognitive Defusion in Practice: A Clinician’s Guide to Assessing, Observing and Supporting Change In Your Client by John T. Blackledge, 2015.