Enhancing Psychotherapy with Values: practical tools

JoAnne DahlUniversity of Uppsala, Sweden

Jennifer Plumb University of Nevada Reno, USA

A workshop presented June 22, 2010at ACBS World Conference VIII, Reno, NV

What is difficult about doing values work? What does “values work” mean to you?

Values can: Help clients define what matters to them Create a sense of meaning and purpose Provide a framework for setting specific

goals Provide a context in which contacting

uncomfortable experiences is worthwhile Help clients practice direct experience of

valued activity, sustaining desired behavior patterns

1. Unwanted experiences

2. A narrowed lifeLACK OF VALUES CONSISTENT BEHAVIOR

What are some ways in which your clients have narrowed their lives?

SymptomsTake too much timeThoughts dictate impossibility of valued

living in some way Avoidance

Of discomfort that comes from doing certain things – very often things that matter

Early on, discriminating in the body – vitality and not (Exercise)

Moving from symptom reduction to creating a life worth living

Validate the client’s experience in wanting to reduce the ‘problem’

Think about what you care about most… At any moment in time, have you really

achieved it?

Most things we care about involve temporally distant consequences

We can value things we never directly experienceWorld Peace, Healthy Environment

The upside of language abilities!

Transformation of functions Process by which language can control our

behavior A good thing, in certain contexts

Rule-governed behavior Values are a form of self-directed rules In non-technical language, freely chosen Pliance

Beh under control of reinforcement from social community for rule-following

Tracking Beh under control of coordination of the rule and

the natural consequences in environment “Wear a coat, it’s cold!”

I wear it because I have kept warm in the cold by wearing coat in the past.

Therapeutic Role Play

Chronic pain patientLife Compass: 0 on intimate

relations/friends

The quick and dirty model of valuing

Identify a Valued DirectionLook at FunctionChoose Goals in Service of ValuesEvaluate ChoicesEstablish a Pattern

In your pain you find your values, in your values you find your pain

Group Activity: Turning Over Suffering: What Matters?

Which Master do You Serve? Appetitive vs. aversive

Living in Service of Experiential Avoidance Valuing can be scary!! Uncertainty Fear of certain outcomes When we care, ‘real’ risks occur

Striving for Secondary Reinforcers Show me the MONEY!

Keeping Up Appearances Looking good, feeling empty

In RFT: Pliance or avoidance versus tracking

An exercise to use throughout therapy

Applied example available in Values book

1. Identify valued direction – suggestion, use self-compassion first

2. Examples when turned away from self-compassion (painful events in life)

3. What rule was learned? 4. Ask client to experientially identify when

on line towards self-compassion and when turned away from self in experiential avoidance, etc.

5. Practice moving toward self-compassion even when get pulled into circles off the line

Marriage of mindfulness and values

Anything can become aversivePracticing attending to values in activity

Landing in the positive reinforcementPaying attention – what matters to you

here? Can you approach the situation from that

place rather than a “Have To” place?

I miss Mom. I call Mom. She’s mad I haven’t called in a few

weeks. I feel bad. AND I lived my values. Will I do it again?

Where’s the reinforcer???= Values-Consistent ReinforcementBecause sometimes the environment

doesn’t support valuing!!

Relationships

loving, open, caring towards myself

caring , open and honest with my family

caring and open with friends

seeing, listening and showing respect to those I work with

Treating everyone I meet with respect and kindness

Goals

Values

Health

Listening to what my body needs and taking best possible care, no matter what condition

taking walks every day

go to yoga classes

play tennis once a week

Eating nutrias foods, exercising regularly, sleeping properly

Goals

Values

Work

Being useful, contributing in any context

Remembering why I wanted to become a teacher

being present in my job

Being a caring teacher

Goals

Values

Own Time

Creating a space for me to be alone with myself

Getting into contact with my own voice

Being willing to sit with my restlessness, loneliness

Painting, dancing, writing, meditating

Goals

Values

Life Line

Values Compass*

Trying On a Value

Bulls Eye

Valued Action Plans

Looking for Value Inside Aversives

Trying on a Value (handout)Use when impoverished history with valuing,

need to build commitment patterns, highly fused (right/wrong)

Considerations: Seems arbitrary, requires some present moment skills to track reinforcement and attention to commitment

Values CompassUse throughout therapy, attends to many

valued domains, encourages attention to function

Considerations: Can be overwhelming for clients to do all at once, or if clients have difficulty clarifying values -- use in small doses over sessions, pick one domain

Relationships

Own tim

e

Health

work

present, loving with myself

pliance, satisfying others at my own cost

Giving myself what

I need

Disregarding myse lf

Taking care of my physical needs

Disregarding my needs

bein

g u s

e fu l

Bein

g us

eles

s

10.....................0

0............. .1010...........0

0...........10

Relationships

Own tim

e

Health

work

present, loving with myself

pliance, satisfying others at my own cost

Giving myself what

I need

Disregarding myse lf

Taking care of my physical needs

Disregarding my needs

bein

g u s

e fu l

Bein

g us

eles

s

10.....................0

0............. .10

0...........10 Balance

10...........0

Bulls Eye (handout) Simple (uses common life domains), has many

uses Each session, weekly process measure, ‘outcome’

measure Easily see progress

Valued Action Plans Best if establish short, middle, and long-term goals Use of “team”: Brings in social

reinforcement/accountability Attends to incremental behaviors Considerations: Be specific, identify internal and

external barriers (and internal barriers inside external barriers)

Looking for the Value in Aversives Unpacking anger and judgment

What value may have been transgressed? Can you let go of judgment and move toward the

value?

Looking at ‘unpleasant’ activity – reconnecting to vitality So much of what we do doesn’t ‘feel good’ in the

moment Is there vitality inside why you do this?

Caution: Not about reframing (for it’s own sake), cheerleading, or asserting that we should seek to feel vital in all things

Your clinical examples…

Early in Therapy

Mid-Therapy

Later in Therapy

In the Therapeutic Relationship itself

File Drawer (see Values DVD in ACT in Action Series)

Turning Over Suffering: What Matters?

Unpacking Anger & Judgment

Postures - Non-verbal way of getting values into therapy Can you recall a time when you felt completely alive,

nothing was missing? Show me a posture that demonstrates this.

How about a time when you felt like your mind was trying to protect you from getting hurt? What is that posture?

Can we make treatment about having more moments like A versus B?

All can be clinical tools, exercises for yourself, used in supervision

Not about ‘right’ or ‘wrong’ Is doing X, Y or Z the most effective way to

live the life you want? Self-injury Compulsive behavior

If not, what could you do differently to move toward your values?

What shows up in committing to doing that? Opportunity for mindfulness (acceptance,

defusion, etc.) Flexibility to persist or change

What do I care about most in my life? What is difficult about living consistent

with these values? How do my values show up inside what I

do in my larger life, and in therapy? How can I model valuing in the room?

Handout: Parallel Process Questions

Discrimination training Process vs. outcome

Building attention to positive reinforcers Present moment awareness

Transformation of function Reinforcement comes from values-consistent

living Vitality inside aversives?

Willingness = All or Nothing Fully engage (acceptance for imperfection likely

to arise), regardless of outcome

Slides will be posted online

Contact us anytime:

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