Matt S. Boone, LCSW, teaches acceptance and commitment therapy (ACT) at the School of Social Work at the University of Arkansas at Little Rock and practices ACT, dialectical behavior therapy (DBT), and other cognitive behavioral therapies at the Central Arkansas Veterans Healthcare System. He is an Association of Contextual Behavioral Science (ACBS) peer-reviewed trainer in ACT, a founder of the ACBS Social Work ACT Special Interest Group, and a recipient of the Boston University School of Social Work Alumni Association award for outstanding contributions to the field of social work.
Here is Matt on how he uses cognitive defusion with clients and personally:
Praxis: How do you first introduce the defusion process to a client in session?
MB: First of all, I try to think functionally about defusion long before I ever facilitate a formal defusion exercise. I do my best to assess how language and meaning-making are undermining the workability of my client’s actions – how words and stories are pulling them away from sensitivity to other important sources of influence, such as values and what’s going on in the present. When I find the right time to pull out a defusion exercise, I have a good idea of what I’m addressing, and I can fine tune the exercise to the client’s unique clinical presentation.
That being said, I start bringing defusion into the conversation pretty early. I subtly introduce a bit of defusion in the process of assessment. I might say something like, “So what I’m hearing is that your mind tells you that you’re no good in social situations, and it encourages you to focus on your own behavior instead of noticing what’s going on around you. Am I getting that right?” If I’m lucky, by the time I introduce defusion more formally in the second or third session, the client has already begun to reference their mind as a thing which is separate from them. They’ve already picked up my little trick of language.
Eventually, I move into more formal defusion exercises, such as “Take Your Mind for a Walk” or writing thoughts on cards. I try to tie the exercise to what the client is currently struggling with, to what’s most on their mind that day. Before jumping into a defusion exercise, I might have them describe a recent struggle and identify a few thoughts that tend to get in their way. We might tease out how their actions are influenced by their thoughts and how allowing that to happen might take them away from what’s important to them.
For example, under the direct influence of their patterns of thinking, where their thoughts tend to dictate their actions, a thought like “I’m not good in social situations” might lead the client to remain silent at a dinner party or a meeting at work. And if building relationships and doing meaningful work are important to the client, then this would be a problem.
I might set up the “Take Your Mind for a Walk” exercise by saying, “I’d like to take you through an exercise in which we are going to relate differently to our minds.” During the exercise, they have a chance to observe their mind as a word generator that constantly spits out predictions, worries, memories, commentary, evaluations, and so on. Afterwards, I would explore what their life might look like if they treated their mind this way and what they might do differently if their mind wasn’t in charge – if they were in charge.
Praxis: Do you have any tips on how to integrate defusion with other ACT processes?
MB: I don’t treat defusion like something we just address in one session and then move on from. People often forget that the six processes of psychological flexibility are not distinct from one another. They are interrelated. When I’m going after other processes, such as willingness or values, I’m also facilitating defusion – explicitly or implicitly.
For example, let’s say I notice that a client has a hard time allowing themselves to be sad about something. They immediately talk themselves out of it or jump quickly to trying to look on the bright side. And maybe it gets in the way of something in their life, such as building relationships. Maybe they have trouble being there for others who are sad. I might help them get present to the sadness, encouraging them to notice what it’s like physically. I might also help them get more willing by encouraging them to welcome sadness as an invited guest.
As I do this, without even addressing defusion directly, I’m likely undermining the influence of narratives about sadness that their mind generates. Maybe it says sadness is dangerous, that if they allow themselves to feel it, it will never end. Or maybe it says sadness equals weakness. Practicing presence and willingness will likely help them get some distance from those narratives, even if defusion is not a process I am explicitly targeting.
Alternatively, it might be that these narratives provide a significant barrier to moving toward presence and willingness in the session. If their mind says it’s dangerous to be sad, then some clients may not be willing to get present with sadness. And they certainly won’t be willing to imagine welcoming it as an invited guest. In these moments, we might have to start explicitly with some kind of defusion exercise.
We might identify all the thoughts that show up around sadness, writing each on a 3 x 5 card and dropping it face-up on the floor in front of us. Then we might notice what it’s like to literally observe these thoughts from a short distance. We might also talk about the history and utility of these thoughts: where have they shown up in the past and what happens when they are in charge? Then, from that place, where the thoughts don’t seem so sticky anymore, the client might be more willing to get closer to sadness with some gentle encouragement from me.
Praxis: What about defusion in your own life? How does it help you?
MB: Defusion is really important to me. Just like my clients, I can get really wrapped up in my mind. I have a lot of little, funny techniques drawn from ACT. For example, I like to sing my thoughts. My mind tends to be quite judgmental. If you were inside my head, you would discover that my mind is constantly interpreting everything in the world as just a little bit off from how it should be. In essence, my mind is always saying that people and things and situations are “doing it wrong.”
So I’ve come up with a little song, sung to the tune of “Taps,” and the whole lyric is “doing it wrong!” The fact that the song is “Taps” doesn’t have any significance; it just happened to be the tune that came out of my mouth one day when I started singing “doing it wrong.” By the time I’m done singing it, I’m usually laughing just a little bit, especially if I sing it with my wife, which I sometimes do. (Her mind also tells her everything is wrong.) Although thoughts in the “doing it wrong” category don’t stop showing up, they have a little less impact on my life. I’m much less likely to act in a “you’re doing it wrong” kind of way by being overtly critical or by going off into my head and stewing on how things could be different.
Praxis: What have you learned about defusion that didn’t occur to you early on in your development as an ACT therapist or trainer?
MB: That’s a really good question. I think I keep learning the same lesson about defusion over and over, despite the fact that I’ve been practicing ACT for nine years and training it for seven. I keep expecting defusion to make my thoughts go away! It seems crazy, right? That’s exactly what we’re not doing with defusion.
But the urge to make discomfort go away is so strong, so automatic, that I will sing the “doing it wrong” song, and I’ll be disappointed that my thoughts didn’t go away. It’s almost automatic. But the defusion I do has exactly the intended effect: it gives me distance; it decreases the impact of the thought; and it reduces the organizing influence of the thought on my behavior, opening up the possibility of more flexible responses.
Ninety percent of the time, that’s what defusion gets me, but I’m still a little sad that it doesn’t make my pain go away. That’s just how we are built. We will go after controlling thoughts and feelings despite our best intentions. It reminds me that “acceptance” is not a place we arrive, but rather a process we come home to over and over again.