Praxis Blog

Three Ways to Introduce Defusion in Session

marbled ink paper

In acceptance and commitment therapy, defusion was originally called “deliteralization” because when we have thoughts—especially compelling ones—we tend to take them literally. We assume that they adequately capture reality, and then we behave accordingly. When we “fuse” with our thoughts, we buy into them hook, line, and sinker.

When left unchecked, this process of taking our thoughts literally, or fusing with them, happens so quickly that we don’t even realize we’re doing it. Our thoughts—which we accept as whole truths—dictate our behaviors to the point that we lose our ability to act in accordance with our values. This is why we teach defusion to clients.

Therapists who are new to defusion tend to have a hard time introducing the concept and teaching the skills effectively. Attempts to introduce defusion that do work typically focus on helping clients to identify thoughts as thoughts, and highlight just how inadequate thoughts are in capturing the full truth of direct experience.

Though it can be slippery in sessions, defusion is one of the most important processes in developing psychological flexibility. Here are just a few ways you can get started with it in sessions.

1. Start with the negative thoughts

One of the less invasive ways to introduce defusion techniques is to subtly identify thoughts as thoughts or simply products of the mind. If a client says, “I’ve always felt like I don’t belong,” for instance, you might respond by saying, “so you’ve had this thought, ‘I just don’t belong.’”

This subtle technique helps to build a context of defusion within treatment that allows the client to more consistently see her thoughts as just thoughts.

Keep in mind that the goal is not to get the client to defuse from all thoughts, but from those that cause problems when taken literally. Focus first on troublesome, evaluative thoughts. Eventually, clients will learn to hold all thoughts more lightly, but when they’re just getting started, it’s best to stick with the problematic ones.

Needless to say, you should express empathy while doing this technique so as not to seem invalidating.

2. Use the client’s own experience  

Consider a client with anger issues who shares a story about berating and criticizing his wife when he could not find his keys, only to find that he himself had left them at the gym. In therapy, he expresses his mistrust of his suspicious thoughts in such situations.

This is an opportunity to leverage the client’s story to highlight the way we all fall into the trap of believing things very strongly that we later find out are not true.

As you do this, be sure to employ empathetic and validating language, staying level with the client and reminding them that you’re in the same boat, so-to-speak. Ask the client if he can think of other times when this may have happened.

Lastly, you might ask is he’d be willing to investigate and challenge thoughts that come up in other areas of his life that he struggles with.

3. Use physical props

Steve Hayes and colleagues came up with a technique called “looking at vs. looking from” to offer clinicians a concrete way of introducing defusion to clients.

Dr. Chris McCurry, who specializes in doing ACT with children and adolescents, later adapted the exercise to use physical props. One way to do this is by bringing a pair of safety goggles with yellow lenses into a client session. Ask the client to put them on and tell you what color the room is. When the client says yellow, question whether the room has actually turned yellow. Allow the client to clarify that in fact the glasses are simply making the room look yellow.

Then, you can begin to discuss the idea of “psychological goggles” that may skew or distort the client’s vision in life. The client may identify with wearing anxiety goggles, inadequacy goggles, anger goggles, and so on. All of which alter his ability to see the full truth in a distressing situation.

This exercise helps drive home the message that thoughts, in general, are not to be taken at face value.

Remember to stay flexible

There are many, many ways to introduce defusion in sessions, and the techniques listed here are just a few ideas for getting started. While you’ll likely develop a primary technique or strategy for introducing defusion, each client is different and addressing their unique needs will require flexibility on your part.

Some defusion techniques—no matter how many times they may have worked in the past—simply won’t work with certain clients. It’s a good idea to practice using more than one of these techniques so if one falls flat, you’ll be prepared to try something else.

This article has been adapted from Cognitive Defusion in Practice: A Clinician’s Guide to Assessing, Observing, and Supporting Change in Your Client, a book by John T. Blackledge, PhD.

For more on ACT fundamentals, check out our upcoming ACT BootCamp. This experiential workshop has been the foundation of ACT training for thousands of practitioners, and whether you’re hearing about ACT for the first time or already have formal training, ACT BootCamp can take your skills to the next level.