Therapist fusion?
August 11, 2008 - 9:25pm — laurenungar
I have been thinking about the applicability of ACT concepts to what has traditionally been called “counter transference issues. I wonder if sometimes we as therapists can become fused with the client’s fusion – accepting the emotions the client presents as realities rather than being aware that we are aware of the client, who is having the emotion, and aware of ourselves being aware of the clients.
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Therapist Fusion
I am so glad you posted this because this has been a big issue I have been working on with myself in working with my clients. I am currently at the Intermediate Level of my 3-year training in Somatic Experiencing and have been taking advantage of the slower summer to integrate other therapies to my focus on helping clients utilize somatic tracking to release and discharge traumatized energy.
One of the crucial areas of focus in our training in Somatic Experiencing has been to be aware of joining the client as opposed to merging (or as ACT and you yourself mention, "fusing.")
Usually when we fuse with a client (or merge) it is due to the client's content "hooking us" because of our own personal issues of fused elements.
In Somatic Experiencing, we try to catch ourselves merging or fusing when the following happens:
- Becoming confused or lost during the session
- Having a sudden and strong emotional reaction to the client's content
- Going into the "Freeze" response during client content (i.e., becoming "light-headed", "going numb," etc.)
ACT and Somatic Experiencing focus on our ability to be in the here and now and how trauma makes that hard to do.
So when becoming aware of fusing/merging, we make ourselves aware of going "out of the moment" and into essentially some form of either freeze or cognitive fusion where we get "over-activated" by the client's content and our nervous system responses activate overly quickly (anger and fear of fight and flight). Somatic Experiencing (SE) calls this "overcoupling." ACT calls this, of course, fusion. This is why I have been intrigued with ACT.
So, as therapists we are challenged to practice in these moments the very skills we are teaching and facilitating our clients to do - the main and most important being: to look AT our experience rather than FROM our experience.
In SE, therapists try to:
- Notice instances of merging
- Acknowledge them
- Create some space from the client and their content
- Practice tracking skills of getting back into our bodies
- Look for places in our body where we are NOT frozen or fused
- Practice mindfulness of focusing on bodily sensations to allow the awareness of the energy of the sensations to move and asking ourselves "What wants to happen in my body right now?"
- When you feel yourself coming back to re-orienting to being back in the moment with yourself and your client, then it is a good time to make contact with the client and invite the client to see what they are noticing in the moment
- In SE, we emphasize the role of the therapist to model for the client defusing or moving from merging to joining
- What this usually leads to is an organic prompting of the client to move away from their content and come into the moment with you, the therapist. This is very nice.
These moments were written a great deal about by Jung and are beginning to become more addressed by newer therapies. Gestalt also focused on this and other experiential therapies. Yalom writes a great deal about being in the Here and Now with the client as the core of what he does in therapy.
There is also a wonderful list of 40 things therapists can do when "lost" during a session posted by Dr. Russ Harris in his Advanced ACT Workshop notes. It can be found, I believe by clicking on the Resources for Clinicians link. I find them extremely useful and in resonance with what SE encourages therapists to do
when they sense they are probably fusing with their clients.
I hope that was helpful and would love to continue in a discussion of this topic with others.
-Max Stoltenberg, LPC, CHt