10 Tips For Defusion in Trauma - Ebook - Updated 2022
10 Tips For Defusion in Trauma - Ebook - Updated 2022
10 Tips For Defusion in Trauma - Ebook - Updated 2022
Trauma
PRACTICAL TIPS FOR ACT THERAPISTS
Now I’m about to give you ten powerful tips for defusion in trauma, but first
things first. Before we even look at getting to defusion, make sure you
know...
Whatever the client's emotional goals are (stop feeling PQR, feel more
XYZ , get rid of thoughts, feelings, memories ABC), we reframe them as
behavioural goals: ‘learning new skills to handle difficult thoughts and
feelings more effectively so they have less impact/power over you’.
Then we take the time to do our best to establish behavioural goals. The
sooner we do this, the sooner we can use the concept of workability as
‘leverage’ for defusion: If you let this thought control what you do, will it
take you towards or away from those goals?
And if you can’t establish behavioural goals initially, because the client’s
fusion is so extreme, then at least get an agreement that you are:
a) working together as a team
b) to build a better life and deal more effectively with your current problems
c) learning new skills to handle difficult thoughts and feelings more
effectively
If you can’t get agreement to that, then clarify: What does the client want
from therapy? If they just want supportive counselling (i.e. they get to talk
about their issues and you get to listen, validate, and empathise) and that's
all they want, nothing more - then they won’t be open to ACT.
Also, keep in mind that we aim to always have the utmost respect, empathy
and compassion for the client. If you take it out of that context of radical
respect, validation, empathy and compassion, then any suggestion in this
e-book could easily backfire or invalidate. And if you are concerned that
anything in this book may not be appropriate for the unique client in front of
you, then trust your clinical judgement, and err on the side of caution.
5. Introduce the idea early that "self-control" comes from learning new ways
of responding to these thoughts when they arise, so that the thoughts no
longer ‘push you around’ or ‘control you’. Emphasise: we can’t stop
these thoughts from showing up, but we can learn to unhook from them,
take the power out of them, respond differently to them so they don’t
control us.
Most of the time, it’s only later, once dropping anchor and simpler
defusion skills are in place, that you would turn to meditative exercises
that involve directly observing your thoughts, such as ‘leaves on a
stream’. That’s because, for most people, directly observing thoughts is
a much harder skill than focusing attention on something (e.g. the breath
or the body or the raisin in your mouth) and then recognizing you’ve been
‘hooked, and then ‘unhooking’ yourself and refocusing on the object of
attention.
The therapist writes the thought down, and also says it out aloud. (Note:
If the client’s self- judgmental thought is ‘You are an idiot’, the therapist
writes down and reads out ‘I am an idiot’.)
We can then ask the client to do things such as ticking the thoughts with
a pen each time they recur. If you're not familiar with this method, read
this eBook on "Pre-empting The Mind."
First, we would drop anchor. Then we’d write these down as in point 9,
and speak them aloud, and acknowledge they are present and not likely
to disappear.
And if the client says “These aren’t thoughts, they’re facts!” or “But
this is all true!”, then we say, “Okay, so all these things your mind is
saying right now, let’s write those down too.”
And then...
Then we’d get the client to do things such as: mindfully stand up and
stretch, mindfully walk around the room, mindfully drink a glass of
water, mindfully look out of the window, mindfully listen to some music,
mindfully read a passage from a book, mindfully smell some flowers in a
vase, mindfully massage their own neck.
And we do all this while in the presence of the thought, which is written
on that sheet of paper. This is even more powerful if the client has the
paper tucked into her belt, or sticking out of her pocket, or resting on
her lap.
During and after each activity, the therapist highlights: “So notice, the
thought is present but it does not stop you from taking control of your
actions, and engaging in what you are doing. You can choose what you
do, even with that thought present.”
Run again through the informed consent process for ACT: is the client
interested in anything you have to offer – e.g. learning new skills to handle
thoughts and feelings more effectively so they have less impact and
influence, taking action to make life better?
If not, what do they want from therapy? Do they want a different model, such
as supportive counselling?
If the client is interested in some of these things that ACT offers, we can
ask, compassionately: “Would you be willing to try some of these things I
have suggested – even though it seems a bit odd, and feels a bit awkward
-‐ because it seems to me you are very, very stuck right now, and this really is
the best way I can think of right now to help you get unstuck?”
*****
Of course, there is much, much more to defusion in trauma than this; we are
barely scratching the surface. However, I hope these tips have given you
some food for thought.