The ACT for OCD Toolbox: A Guide for Therapists

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Values Exercises in ACT for OCD

By Kate Morrison, Ph.D.

This presentation is an excerpt from the online courseThe ACT for OCD Toolbox: A Guide for Therapists“.

Highlights

  • There are a variety of formal and informal ways to connect clients with their values.
  • Some formal practices can be completed in the session.

 

Transcript

Now, let’s go through some of the practices and exercises you can do with clients to be able to clarify their values and really get in touch with what is important to them.

There’s a variety of ways to go about this and there’s formal and more informal practices. You can find the style that works for you. I find that when learning ACT, I went more toward the formal practices and then you can ease into more informal as you learn the concepts and learn how to navigate this with clients.

References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

Some of the more formal practices are things like the Valued Living Questionnaire. There’s a first version and a second version of that. You can go to more in-depth with this particular one where there’s a lot of content and questions that you can be asking about different areas of life and you can ask how important it is to them, how consistent they are with living this value. But what I find is I will do a briefer version of this and really just ask those two main questions that I said there.

References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

I say, “Okay, family is important to you. Scale 0 to 10, how important is your family to you?” And this person might say, “Oh, they’re an 8.” I say, “Okay. When you think of the ideal way of how you would be living this value, how consistent are you with that right now? Same 0 to 10. Like let’s maybe look on the past two weeks. Like how consistent have you been with this value of family particularly on how you want to be within it?” They might say, “You know, I’ve been really probably about a 3.” And then you can say, “Okay. Well, this one’s really important to you but maybe your behavior isn’t matching that as much.”

References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

You can walk through this with all of the values that are listed in the Valued Living Questionnaire. Some might be of no importance to the person and that’s okay. I will give you a warning here that for some people this can be a pretty painful exercise to walk through if they see like this is important to me, but I am not behaving in that way. And I really look to normalize this and make sure people understand something can be very important to you and your behavior cannot match with that because we all experience that.

References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

And I think there’s this idea out there that because we care about something we act on it, and I mean as therapists and as behaviorists we know that’s not how the world works. And so make sure that your clients know that and really validate their experience here while still saying, “Hey, we can still do something about that. We can increase the amount of time that you devote to this value if it’s this important to you.”

References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

The Values Bull’s Eye is another more formal practice. It’s a similar concept but what it is is as it sounds. It is a bull’s eye, and you have quadrants or sections of this bull’s eye that are devoted to a particular value.

References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

And then you have them put a mark on there to say, how close are you to being dead center on the mark with this value? So it’s the same idea of saying, how consistent are you with this? And if you’re living very consistently with it, you put that in the center. And if you’re really far away from where you want to be with this one, that dot or that x would go further out. And it’s a nice visual way for clients to see how they’re doing in certain areas of their life.

References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

And honestly, both of these are forms of assessment as well. You could do this early on in treatment and then come back and do it later. And it can be a way that also a client can guide themselves week to week to say like, “Hey, how am I doing with this?”

References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

There’s also something called the Values Card Sort. This has come from motivational interviewing but there have been versions that are adapted to match with ACT language and the ideas of ACT.

This is a stack of cards that has a particular value on each card and the client gets to place those in very important, important and not important categories.

References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

And then they can look and see at the ones that are most important to them and really narrow it down. What I like about this one in particular is that the values listed tend to be characteristics more so than areas of life. So instead of it being like family is important to me, it might be something like being honest or being giving. It might be characteristics that a person wants to be that might impact multiple areas of their life like family, work, relationships, learning. They might be a giving person in all of those areas.

References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

For some clients, I do a combination of these depending on the time that we have and want to devote to this and how much kind of assistance they need with this practice. Ultimately, one of my favorite quick practices to use in this area is asking someone, “If you’re at your 80th birthday and you are reflecting back on your life, would you be pleased with what you see? Are you going to be proud? Are you going to be excited? Are you going to see this as a rich and meaningful life that you’ve been living?”
 
References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

And I think this really puts it into perspective for people that this is a long-term game and the decisions we make moment to moment have an impact on that bigger picture. And if people are unhappy with that picture that they see when they imagine themselves being 80 years old reflecting on their life, it can really provide this incentive to say, okay, let’s do something different about that now because it takes time to form these larger patterns of behavior.

References

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

The key points here are that there are a variety of formal and informal ways to connect clients with their values and some of the formal practices that can be completed in session include the Valued Living Questionnaire, the Values Bull’s Eye and Values Card Sort.

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