The 4 ‘D’s

•  Loss of contact with the present moment takes various

forms. I find the following acronym useful to remember
what they are:
The 4 Ds:
1.  Distractibility,
2.  Disengagement,
3.  Disconnection,
4.  Dissociation

•  NB: There is huge overlap between these categories;

they frequently interweave.
copyright Russ Harris, 2015
 Distractibility
•  To what extent can the client sustain focus on the task or
activity on hand? Is she easily distracted?
•  What important activities or tasks, if any, does she find it
easier to sustain focus on?
•  What important activities or tasks does she find it hard to
sustain focus on?
•  How does she tend to get distracted, and by what? Are
there particular thoughts or feelings that tend to distract
her?

copyright Russ Harris, 2015

 Disengagement
•  To what extent can the client engage in life, engage in
important activities, engage in relationships?
•  Is she easily disengaged (bored, disinterested, apathetic,
inattentive, half-hearted, fused with self-talk etc)?
•  What important activities, tasks, relationships if any, does
she find it easier to engage in?
•  What important activities or tasks does she find it harder
to engage in?
•  To what extent does fusion feed her disengagement; and
with what kind of cognitive content? (E.g. is she fused
with an internal monologue that life is dull and empty?)

copyright Russ Harris, 2015

 Disconnection
•  To what extent can the client connect with – i.e.
consciously notice and acknowledge - different aspects of
present moment experience: thoughts, feelings, actions,
body posture, the external world, what she can see, hear,
touch, taste and smell?
•  Are there any aspects of present moment experience she
finds it hard to connect with?
•  What does the client do that enables her to connect with
other people?
•  What does the client do that makes it harder for her to
connect with other people (e.g. lack of empathy, lack of
curiosity, lack of paying attention)?
copyright Russ Harris, 2015
 Dissociation
•  Does the client dissociate (“split off”, “cut off”, “deny”,
“disown”) from aspects of her present moment
experience? If so, which ones? And to what extent? And
how does this manifest in therapy sessions?
•  Dissociation from feelings and emotions is the most
common clinical presentation. Is there any evidence to
suggest this; e.g. feeling numb or dead or empty in the
body, inability to notice or name emotions?
•  Are there any specific emotions or feelings the client
dissociates from?

copyright Russ Harris, 2015

Need For Attention-Training
•  Does the client need training in:
•  Sustaining attention: maintaining focus on the task or activity at
hand, instead of disengaging or getting distracted?
•  Shifting attention: being able to shift attention to life-enhancing
activities, instead of ruminating, worrying, focusing excessively
on problems? Or to attend to aspects of present moment
experience that are typically not noticed or acknowledged?
•  Broadening attention: expanding awareness, instead of being
rigidly and narrowly focused on dissatisfactory aspects of the
present (e.g. focusing rigidly and narrowly on what is wrong/bad/
unfair/lacking)?
•  Narrowing attention: focusing in on what is relevant to the current
task and activity?

copyright Russ Harris, 2014