Tuesday, December 1, 2020

Counseling to help our patients move through all of their “gears”

In counseling, one of the most important ideas and concepts I use to educate patients is attachment, defusion, detachment, and dissociation.

The metaphor I use is the gearbox with the following 4 gears.

1 Attachment to thoughts, and feelings so much that one is too fused with it. This gives intensity of feelings but can be inflexible, “stuck”, and troublesome depending on the quality and helpfulness of those thoughts, feelings, and narratives. This can also give you a lot of empathy but if unchecked, can lead to compassion fatigue and mood issues.

2 Defusing from thoughts, and expansion/making room for feelings so that one can see or feel it “at arm’s length”, observe it, play around with it, and process it. There may be less intensity of “feelings” but it’s now more flexible and workable. It may also allow one to have a platform to have a choice point to consciously attach to certain values and feelings to take action e.g. compassion instead of anger/frustration in some context.

3 Detach from thoughts and feelings so that one doesn’t feel much anymore. It feels neutral perhaps. It’s not good or bad. It may be very useful in some context especially in a role of a judge, lawyer, surgeon, or a police officer.

4 Dissociation or extreme detachment for emotional protection.

Each has its pros and cons like a 4 gearbox system, with defusion and detachment most useful for daily functioning perhaps.

It’s not uncommon to see folks swinging from attached/fusion to detached. It’s harder to get to the “middle ground” of defusion.

Like when first driving a car. One either step on the gas too much or the brakes too much. Cruising at 60km/hour, or driving around in peak traffic at varying speeds is much harder.

How is your gearbox working?

Moving fluidly through all of our “gears”, depending on context is such a tough gig, especially if we don’t know which gear we are in.

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