Barriers to Defusion    163

An Extract From ACT Made Simple (2nd edition) by Russ Harris

Seven Strategies for Hopelessness and Reason-Giving

Many clients—especially those suffering from depression—come into therapy feeling
hopeless. Typically, they fuse with all sorts of reasons why therapy won’t work. And this
reason-giving fre-quently overlaps with many other categories of fusion: the past (I’ve tried
before and failed), the future (It will never work), self-concept (I’m a hopeless case; I don’t
deserve to get better; I’ve always been this way; this is who I am; I’m too depressed; I’m too
anxious; I’m an addict; I’ve got no will-power/discipline/motivation; I’ve been diagnosed with
W; I’ve been permanently damaged by X), judgments (It’s too hard; this is bullshit, my life is Y;
other people are Z; I’m too A; I’m not B enough; therapy is useless), and rules (I can’t do anything
difficult when I feel so bad; I have to feel good before I can take action; I should be able to do this
by myself).
When this kind of fusion shows up at the very start of therapy, it often throws therapists.
After all, you’re just taking a history and building rapport with the client, so how are you supposed
to help her defuse from this? Well, the beautiful thing is, you can introduce defusion even at this
early stage, without needing to be explicit about it. Here are some ideas for how we might do
this. You can use some or all of the following seven strategies, in any combination or order, and
modify them in many different ways, as suits your needs:

Strategy 1: Notice and Name

Luckily, in ACT, we don’t get into challenging the content or validity of cognitions (i.e., assessing
whether they are true or false, valid or invalid, positive or negative, right or wrong, appropriate or
164    ACT Made Simple

inappropriate, warranted or unwarranted). If we had to try to convince clients that their doubts
about therapy are false, invalid, or unwarranted, we’d be in trouble!
Doubts about therapy are perfectly natural, and only to be expected. However, if clients (or their
therapists) fuse with these doubts, it will get in the way of effective work. Thus, such cognitions are
good candidates for defusion, right from the word go. We aim to create, as fast as possible, a context
of defusion: a space where we can allow unhelpful cognitions to be present, and see them for what
they are. We also want to facilitate a context of acceptance, where there is no fighting with or chal-
lenging of thoughts, no trying to invalidate or get rid of them.
A good first step is the simple but effective strategy of noticing and naming: noticing the presence
of cognitions and nonjudgmentally naming them. For example, you might say, “I can see there’s a
bunch of thoughts showing up for you right now about why this won’t work for you.” (Remember to
modify all language to suit the needs of yourself and your clients. Instead of thoughts, you may talk
of concerns, worries, doubts, fears, objections, and so on.)

Strategy 2: Validate and Normalize

As therapists, it’s vital that we validate such cognitions. They are commonplace—among both
clients who are new to therapy and those who have experienced a lot of it. And they are completely
normal and natural thoughts to have. So I tend to say something like “Those are all very common
thoughts (or concerns, worries, doubts, fears, objections, and so on). Many of my clients have similar
thoughts when we first start working. It’s perfectly natural. And to be honest, I expect they’ll crop up
again and again.”
A big part of both defusion and acceptance in ACT is helping clients understand that their mind
is not irrational, weird, or defective; it’s basically just trying to help. This is both normalizing and vali-
dating for clients. You might say something like “These thoughts are just your mind trying to look out
for you, do you a favor. It’s basically trying to save you from something that might fail or go wrong or
be unpleasant. What your mind is saying is Hey, are you sure you want to do this? You might just be
wasting your time, money, and energy. This might even make things even worse for you. And you know,
the truth is, there’s probably nothing I can say that will stop your mind from doing that. It’s just doing
its job—just trying to protect you.”
Note how this spiel plants seeds for caveman mind metaphors that may come later.

Strategy 3: Declare “No Guarantees”

You could then go on to say something like this:
“You know, there’s a part of me that really wants to reassure you; to say, ‘Hey! This will work for
you!’ But the truth is, I can’t guarantee that it will work. And if you ever go to any type of health
professional who guarantees you ‘This will work!’—my advice would be don’t go back, because they
are either lying or deluded. Because no one can ever guarantee that.
 Barriers to Defusion    165

“I mean, sure, I could show you all the research. There’s over a thousand papers published on the
ACT model; it’s helped hundreds of thousands of people around the world. But that wouldn’t guar-
antee it will work for you. And I could tell you about all my other clients it’s helped—but again that
won’t guarantee it will work for you. But there are two things I will guarantee. I guarantee I’ll do my
best to help you. And I guarantee, if we give up because your mind has doubts, we won’t get any-
where. So even though your mind will keep coming up with reasons why this can’t or won’t work for
you—can we go ahead with it anyway?”
By this point, many clients will be unhooking from their doubts, concerns, objections, and other
barriers to therapy. But what if this isn’t happening? What if the client continues to insist that
therapy can’t or won’t help? We’ll explore that shortly, but first, two important cautions to keep in
mind:

• First, as for any type of intervention in any model of therapy, the therapist must be compas-
sionate, respectful, and incredibly validating of the client’s experience. If the techniques that
follow are delivered in a dismissive, impatient, uncaring, or otherwise invalidating manner,
this will obviously offend or upset the client.

• Second, there is not one intervention in any model of therapy that works predictably and
favorably with all clients. So if you apply anything from this book (or from any other ACT
textbook or training) and it’s not having the effect intended, then be flexible. Consider: do
you need to modify what you’re doing in some way? Or are you better to cease doing it and
do something else instead?

Strategy 4: Write Thoughts Down

If the previously mentioned strategies fail to help the client unhook from her objections, doubts,
concerns, or other cognitions that act as barriers to therapy, a good next step is to write those
thoughts down. Doing this usually makes it a whole lot easier for any of us to “take a step back” and
“look at” our thoughts, instead of “getting caught up” in them.
I recommend you ask for permission to write the thoughts down: “So you have some real and
valid concerns about whether this will work for you. And I think we need to address these concerns
right now, or we’re not going to get anywhere. So is it okay if, as a first step, I quickly jot them all
down, so I can make sure we address them all?”
The therapist now writes the thoughts down—every objection or concern the client has about
why this won’t work: I’ve tried before, I can’t do it, and so on.
As the therapist is doing this, ideally she’ll repeat some of her previous comments: “I just want to
reiterate, these are all very common… Many of my clients have similar thoughts when we first start
working… It’s perfectly natural—your mind is trying to help, to save you from something that might
be unpleasant… So really, we can expect these kinds of thoughts to keep cropping up, again and
again.”
166    ACT Made Simple

Strategy 5: Refuse to Convince

It’s often useful to say something like “You know, I don’t think I’ll be able to persuade you or
convince you that this approach is the right one for you. In fact, my guess is, the harder I try to con-
vince you, the more those thoughts are going to show up. What do you think?”
At this point, most clients will reply along the lines of “Yeah, I guess you’re right.” Often there’s
a hint of amusement in this response, which is usually indicative of some defusion. The door is now
wide open to usher in the concept of workability: the client has choices about how to respond to
these thoughts, and some of these choices are more workable than others.

Strategy 6: The “Three Choices” Strategy

The therapist could now say something like:
“So here’s the thing. These thoughts (pointing to the thoughts written on the paper) are going
to show up again and again and again as we do this work together. I have no idea how to stop that
from happening. And each time they do, we have a choice to make about how we respond to them.
One choice is: we give up. We let your mind call the shots. Your mind says This won’t work, so we go
along with that—we call it a day and we pack it in.
“A second choice is: we get into a debate. I try hard to convince your mind to stop thinking this
way; I try to prove your thoughts are false and to convince you that this approach will work. The
problem is, that kind of debating will eat up our valuable session time, and I can pretty much guar-
antee your mind will win the debate anyway—so we won’t be any better off.
“A third choice is: we can let your mind say this stuff, and we can just carry on…we just keep on
working together as a team…working away here, to help you build a better life…and even though
your mind will keep saying all this (pointing to the thoughts on the paper), we just keep on working.”
Finally, the therapist asks, “So which of those options would you prefer?”
If the client now agrees to option three, well, that’s defusion, right there: the thoughts are present,
but they are no longer dominating the client’s behavior in self-defeating ways. And the client is also
consciously allowing the thoughts to be present: a gentle first step toward acceptance. If our client
later comes up with more objections, we can add them to the list, and then repeat the same three
choices.
If our client tries to debate, we can notice and name it: “So it seems like you want me to debate
this with you. But there’s just no point. I won’t win. I won’t convince your mind. I won’t be able to get
rid of your doubts or concerns. We really have just two choices here: we give up and pack it in
because your mind says it won’t work, or we let your mind say all this stuff and we carry on working.”
If the client now agrees to option three—again, that’s defusion, right there!
I’ve only ever twice had a client choose option one. Both times, I replied, “Okay. I get that’s the
choice you’d like to make. But given that you’re already here, it seems a shame to give up now. Can
we at least finish this one session, given you’re here? And for this one session, can we not get into a
debate about these thoughts? Can we just let your mind say this stuff, and carry on?” Both times, the
 Barriers to Defusion    167

client agreed. (Obviously, this strategy may not work with a mandated client, but that’s a different
issue, beyond the scope of this textbook. I discuss how to work with mandated clients in my advanced-
level textbook: Getting Unstuck in ACT [Harris, 2013].)

Strategy 7: Acknowledge Recurring Thoughts

The therapist can now use the above methods for ongoing defusion and acceptance, throughout
the session. For example, when new objections occur, the therapist can write them down and again
ask the client to choose how to respond. But when a previously noted objection recurs, the therapist
can respectfully and compassionately acknowledge it and point to the paper: “We’ve got that one
down already. So again, there’s a choice to make here…”
Alternatively (and more powerfully, in my opinion), you give the sheet to the client with a pen,
and ask her to mark each thought as it recurs. The therapist can respectfully and compassionately
acknowledge it each time: “Keeps showing up. So do we give up, or waste time debating, or do we
acknowledge the thought just popped up again and carry on?”
If you’re using this strategy, it’s often helpful for you to keep the paper, and on the next session,
present it to the client: “I expect these will all show up again today. Any of them showing up right
now? Most of them? Cool. Can we let them be there, and carry on? Great. And let’s see if your mind
comes up with any new ones today.”
Note just how much we’ve covered here in terms of defusion. We now have a wealth of strategies
to draw on repeatedly and develop further in subsequent sessions. And all of these strategies involve
some combination of the “three Ns”: noticing, naming, and neutralizing. (Remember, the easiest step
in neutralizing is to look at thoughts in terms of workability: if you let this thought dictate what you
do, where does that get you?) Note too that all of this could be done on the very first session if neces-
sary—yes, even as we’re getting to know the client and taking our initial history.
Therapists often see fusion with hopelessness and reason-giving as a barrier to therapy. I hope
that you will now reframe it: it’s not a barrier to therapy but a golden opportunity to actively DO
therapy. It gives us the chance to actively build defusion skills in session (instead of just talking about
them).

Adapting These Strategies to Other Cognitive Processes

With a little imagination, you can easily adapt strategies 1, 2, 4, and 7 outlined above to deal with
just about any problematic cognitive process that interferes with progress in a session: blaming, rumi-
nating, obsessing, revenge fantasies, worrying, catastrophizing, and so on.
For example, suppose a client keeps blaming everyone else for her problems. Strategy 1 is notice
and name, so we might say, “Do you notice what your mind is doing here? There are a lot of people
in your life who aren’t behaving the way you want—which is really upsetting for you—and your mind