Defusion Through Infusion

Defusion is a powerful process; perhaps the most important of all the ACT processes aiming to increase psychological flexibility (along with acceptance, contact with the present moment, and self as context). Why? Because fusion leads to avoidance, loss of contact with the present, and attachment to self-concept. For pragmatic purposes, the ACT model is often presented with 6 processes (adding values and committed action to the list) but fusion is probably the main process of inflexibility, making defusion our best ally in helping clients change. It’s not that contact with the present, acceptance, and self as context are unimportant, but they are instances of defusion rather than fully distinct processes.

When a client is defused, our work becomes much easier. We can mostly focus on skills training, values clarification, and motivation. Remember the three steps of defusion: noticing behavioral sequences (in particular thought-action-consequence), assessing the effectiveness of action in terms of values, and increasing the flexibility of responses to thoughts. If clients are skilled in these three areas, the only remaining main element they still need is a direction (clear values). Working on actions will often require less work if defusion and values are strong because barriers to meaningful living can be much more easily bypassed at this point.

But what if fusion is high?

The steps we explored in the past 3 weeks can help many of our clients make progress, and it is generally through the repetition of defusion techniques (formal exercises or more natural verbal interactions) that change begins to occur. It is said that learning a new move, like a golf swing or a 3 points-shot in basketball, requires hundreds (some even say thousands) of repetitions to be well integrated in our repertoires. A quick search reveals that this is actually more folk belief than scientifically based. After all, haven’t we all noticed times where one metaphor, one exercise, or one question radically transformed a client? But still, change often takes time, especially when habits are old.

Some of our clients are particularly fused. We often call them “rigid”. Don’t be ashamed of this label. It actually captures quite well the feeling of being fused, and we can easily experience that feeling in ourselves too. It becomes hard to look at the world from different points of view, to imagine alternative interpretations, or to let go of an opinion—even when actions based on this opinion are costly or harmful. It feels rigid.

What do you experience when you interact with a “rigid” client? My guess is that it’s not rare that you begin to feel rigid as well. Even with all the compassion and acceptance in the world, it’s hard to stay open when consistently faced with a wall of rigidity, especially when the content of what is said contradicts our own beliefs.

What can we do, then, when a client is highly fused? If you’ve tried to tell a client to “thank his mind for that thought” after he complained of how unfair the world is, you may have noticed that he found many more arguments supporting his original thought that the world is not fair. Fusion didn’t go down, but up. When fusion is high, defusion techniques can easily feel invalidating and fuel fusion. It’s not that defusion is not appropriate here, it’s that it requires patience and a willingness to experience a certain degree of fusion. Fusion? Yes, you read well.

Let me explain this idea with a metaphor. You probably know that tea contains caffeine, and that caffeine is a stimulant. For this reason, a lot of people avoid drinking tea at night, in the same way that we refrain from drinking coffee at the end of the day to avoid sleep disturbances. What is less known about tea is that it also contains tannins, which counteract the effects of caffeine. But to benefit from the effects of tannins, the tea needs to infuse longer. It means that, somewhat counter intuitively, the more you let the tea infuse, the less stimulant effects you will experience.

What if we approach rigidity like tea? It would mean that within fusion is the antidote to fusion. But, if we want this beneficial effect to occur, we need to let rigidity infuse for a while. We need to accompany clients in the stories they tell, at least for a moment.

In ACT we’re often encouraged to drop the story, but perhaps we sometimes need to drop the story that we need to drop the story. Perhaps we need to trust that clients have the strength to defuse, even when they are highly fused. It may be easier to trust our clients’ ability to overcome their difficulties when painful emotions are the primary source of suffering, rather than when rigidity, righteousness, or pliance (and counterpliance) is more central. Yet, even “rigid” clients have tannins within themselves.

So, what are our clients’ tannins? The answer is simpler than we might think. In each story, there is a process. The only problem is, the content of the client’s story can obscure this process, and we end up drowning in or rejecting the story altogether. We don’t let the story infuse long enough. But if we take the time to listen carefully, we’ll hear the cues that articulate the events contained in the story. These cues say everything about the way clients relate to their stories. Those cues are the tannins.

Here is a concrete example. A client says: “I can’t believe they fired me. This doesn’t make any sense. It’s really unfair. Now I’m in big trouble. How am I going to pay my rent? This puts me in a terrible situation. Just because I arrive late often doesn’t mean I should be fired, right? It’s not like I don’t do my job! You know what? I’ll go to work tomorrow. I don’t care that they fired me. I will go and work as usual. It’s unfair and I’m not going to let them waste my life!”

How many times did you think this person was “fused” as you read these lines? I counted at least twice. Granted, we don’t know the whole situation. But, justifying being late for work, and returning to work even after having been fired are not the most defused ways of approaching this situation, right? Yet, the antidote to this state of fusion is also contained in the client’s story. Let’s listen again and this time, pay attention to the cues.

“I can’t believe they fired me. This doesn’t make any sense. [the client expresses confusion]. Now I’m in big trouble. How am I going to pay my rent? This puts me in a terrible situation. [the client expresses worries]. Just because I arrive late often doesn’t mean I should be fired, right? It’s not like I don’t do my job! [the client states rules]. You know what? I’ll go to work tomorrow. I don’t care that they fired me. I will go and work as usual. It’s unfair and I’m not going to let them waste my life!” [the client tries to escape his worries by following the rules].

The cues I point out here correspond to my own way of listening to this story, and there might be other ways. But interpreted with these cues, the story becomes useful in helping the client get unstuck. If I told the client “thank your mind for this thought” or asked him to repeat “it’s unfair” again and again until the words lose their meaning, my guess is the client would not become less fused. Fusion might not drop much either if I asked the client to “look at the situation from a different perspective”. All these techniques are generally helpful, but they can hit a wall when rigidity is high.

What can I say instead? Very rigid clients tend to push our buttons, and in turn we become more distant, judgmental… cold. Remember that for tea to infuse, we need warm water. When we show warmth and support, even when the things we hear are off putting, our clients are more open to a different way of listening to the story.

Concretely, this means:

-          listening to the client’s story, validating their feelings (e.g. “You seem very surprised by what happened” “Are you worried?” “I can understand that you worry”);

-          being curious about the rules (e.g. see what values can be extracted from “It’s unfair!” “It’s not like I don’t do my job!”);

-          exploring with genuine openness the effectiveness of responses to rules (e.g. “What do you think will happen if you go back to work tomorrow? And then what? Do you think it might help you get your job back? Will it bring your closer to what you care about?), and alternative options (e.g. “I wonder if we could explore other options together, just to make sure we’re not missing anything important. What do you think?”)

My advice: try not to contradict clients at this point. Not because you fear their reactions, but because they will be more open to the cues you are helping them see if you show that you are listening to the whole story. Let the story infuse. Let the tannins have their effect. Trust the process.