Comparing ACT and CBT: Defusion vs. Restructuring

When using any technique that involves helping clients to untangle themselves from the stories they tell about their lives and their struggles, and to realize that their thoughts are not absolute truths, you run the risk of invalidating their subjective experience.

Helping clients defuse from their thoughts, if not conducted in proper fashion, can be easily misinterpreted to mean that you think your client’s particular story is not true. When you are just getting familiar with a client, giving her the impression that you, a veritable stranger, doubt her ability to correctly identify the facts in her own lived life typically does not lead to success.

Defusion techniques can seem to trivialize a client’s distress if used in a cavalier fashion. Imagine asking a client, in the first session, to sing his most distressing thoughts to the tune of his favorite pop song. A deep sense of invalidation might well result. The effectiveness and appropriateness of more invasive defusion techniques depend on a good therapeutic relationship, in which the client knows that the therapist empathizes very well with him.

Clients should understand the rationale behind the idea that it’s important to defuse from their thoughts. They should understand that the misleading character of words and thoughts is not a personal shortcoming, but is something we all grapple with.

Attempting to change the way another person thinks about his experiences tends to be a default mode for human beings. We are all taught from a young age to try to think about things accurately and rationally, and this sensibility may seep into our therapeutic work even while using a theoretical approach to treatment that does not explicitly aim at thought change.

One example of this tendency is when we encourage a client to “make sense” of what has happened to him in a way that either provides comfort or that “allows” him to move forward in a constructive manner. While it is certainly nice to find an “accurate” and relatively constructive way of thinking about your difficulties, it can be counterproductive to send the message that you must arrive at such a way of thinking to move forward. From a defusion perspective, thoughts do not have to change in order for constructive movement to be made. They simply need to be held lightly.

A similar example involves clients believing they must have insight into exactly why they have their current psychological problems before they can rise above them. While knowing some causes of our problems can be beneficial (for example, when an ongoing contributor to distress and disability can be identified and changed), often the perceived causes are distant and immutable. Generally, we believe that we must have thoughts that accurately describe the cause of our current situation, yet from a defusion perspective, many of these thoughts are simply part of a semi-fictional narrative—which may make sense, but which is unnecessary for moving forward through our current problems.

Regardless of which variation of the “need“ to have the “right thoughts” arises in therapy, these “needs” should explicitly be held lightly by both therapist and client if defusion strategies are in use. Otherwise, the central message that defusion is intended to convey—that the problematic and distressing thoughts we struggle with are not absolute truths and do not need to change—can be undermined.

For more, check out Cognitive Defusion in Practice: A Clinician’s Guide to Assessing, Observing, and Supporting Change in Your Client.