Demystifying ACT: A Practical Guide for Therapists

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Values Clarification for PTSD: Pliance, Priorities, and Pain

By Sonja Batten, Ph.D.

This video is part of our upcoming online course about ACT for PTSD.

Highlights

  • During the initial values clarification, help the person connect experientially to the things that are important. 
  • Ensure that the person is identifying what’s truly important to them.
  • Values can also be identified by looking at the flip side of pain.

 

Transcript

So, for some people, starting the conversation about values in a direct way can go really smoothly. You can describe the process, perhaps give the compass metaphor, and maybe they’re ready and they know what’s important to them.

But with trauma survivors oftentimes, there can be more challenges than that. So, I’m going to talk to you now about some common difficulties that therapists may encounter when they’re working with values clarification in the context of posttraumatic stress disorder or other posttraumatic problems in living.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

And so with certain clients, for example, one challenge that you might find is that you need to watch the process carefully to make sure that the client isn’t overintellectualizing values to the extent that the heart of the process is being lost.

So, if you have a client who is highly verbal and seems more focused on providing the exact, technically perfect description of his values, that can be an opportunity to notice the process and maybe point out that the idea isn’t to get the exact, perfectly written description.

The idea is to get a description on paper that speaks to the person and helps orient them and remind them what’s important.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

Or maybe you’re giving the tombstone exercise and the client dissects the description of that exercise and picks apart the logic of it or dissects the descriptions of values versus goals that you were talking about in a way that makes it difficult to engage with the process.

That can be a sign that the person is overintellectualizing the process. And maybe you need to find a way to get to it more directly and point out that the words are not what’s important here. It’s connecting with what’s important.

Values clarification is really less about getting the most beautiful description of a life value and it’s more about getting to the heart of what would make the client’s life worth living.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

It’s also really important for the therapist to intervene to prevent the client from just identifying values based on what he or she believes will lead to approval by others.

So, some clients may be used to trying to get approval from their parents or their culture, their religious institutions, or even the therapist. We call this term, in behavioral psychology, pliance. Think about the word “compliance,” for example.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

Pliance is the word that we use to describe rule-governed behavior where an individual follows a rule because they’ve been reinforced by others for following rules in the past.

And so, if somebody has been, in their life, reinforced for following rules in a variety of ways, then they may be more likely to identify values that they think would be important to others, to follow those social rules about how one is supposed to live life.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

An example from a client that I worked with is that we’re working on this process and she kept saying that she wanted to go to college and get a degree. And so each week, we would identify a step that she could take in order to start to sign up for a community college class as a first step. And each week, she would come back and she would have a reason why she didn’t get around to doing that, that it didn’t happen. Week after week of her setting this goal and saying this was her value but then not following through…

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

…I finally said, I think, in a moment of sort of frustration, something to the effect of like, “Oh, it kind of seems like it’s not really something that you even want to do.”

And she then was able to identify that in fact, she’d only been setting that goal primarily because she looked up to me and she thought it would be something I would want her to do. In fact, it probably was something that I wanted her to do. I wasn’t asking her to do it.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

This was something she was choosing, but she was choosing it out of pliance and trying to please someone else as opposed to truly connecting with what was important to her. Once we let go of those goals, we were able to focus on things that were more connected for her and that she was, in the end, more successful with.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

One thing to realize about values is that priorities change over time and you have to balance them over time.

And there are times when certain values that you have may come into conflict with one another. Being an engaged parent and being a strong worker at work, well, sometimes, you’re not going to be able to do both of those things at the same time. And that’s normal. And so it’s okay to work on shifting priorities and shifting the balance between those things. It doesn’t mean that one or the other isn’t still important. It’s just that sometimes you have to shift your attention and your energy.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

A metaphor for this is that in order to live, both swallowing and breathing have to be important. But you can’t do them both at the same time. And so, you have to learn how to—sometimes you focus on swallowing and then in the next moment, you focus on breathing. And you can shift naturally back and forth between both. And they are both equally important to being able to survive.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

It’s also possible that in some circumstances, the client’s values may be significantly different from those held by the therapist. The client gets to choose what’s important to them. It’s not up to us. So, it may be very different from what I may find to be how I want to live my life or how I even would like that person to live their life based on what I can see. And it’s not up to me to decide. It’s up to the client.

In general, it’s not a tremendous problem when the client and the therapist hold different values as long as you can look at it for what it is, which is that person’s life, and they get to live in the way that’s important to them. And when I introduce values, I point that out to the client like, “You get to decide your values. It’s not up to me. And as long as it’s not focused on hurting yourself or someone else, I am here to support you.”

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

And so although building a valued life is a positive constructive aspect of ACT, the work of values clarification can also be painful for some people.

In fact, pain is one of the places that we can find values. It’s not the case that values are found primarily by chasing positive affect like happiness or joy or satisfaction.

Actually, finding our pain points may also help us identify the things that are important to us. If they weren’t important, then they wouldn’t cause us pain and distress when they’re violated. And this is an important thing to recognize with trauma clients.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

For example, anxiety around intimate connections can show that the person values safe connection and trust. Or anger can point to values of respect that have been disregarded. Or distress around traumatic memories for a child abuse survivor can show just how important the person believes it is that children should be able to grow up in a safe environment.

Reference

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

And it can be really important to look at the flip side of this pain to identify what values are there because, although a client can never go back in the past and change what’s happened, it’s important to listen to that pain—not just in the sense of what the person wants to avoid, but what they want to give their energy to going forward. And there are some real lessons to be learned from that pain in terms of the values that are important to the person.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

This way of moving into values identification can be especially useful for a client who has relatively low levels of positive affect or when you have somebody who’s relatively unexpressive or flat or emotionally disconnected.

It may be harder to do the direct, just sort of querying for values clarification.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

And as a side benefit to this way of exploring values with trauma survivors, it may also help the client make meaning at some level from the experience. I mean, I don’t subscribe to an “everything happens for a reason” philosophy, but I do believe that we can find or create meaning from every experience. By using the pain of a client’s history to identify values and what’s important to them, he or she can also create additional meaning that they’re choosing to gain from the experience. And then that’s one of the actions that can move an individual from being a victim to being a survivor.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

LeJeune, J., & Luoma, J. B. (2019). Values in therapy: A clinician’s guide to helping clients explore values, increase psychological flexibility, and live a more meaningful life. New Harbinger Publications.

So, to review the key points:
During the work of initial values clarification, it is important to help the person connect experientially, not just intellectually, to the things that are important to him or her.

It’s also important to ensure that the person is identifying what is truly important to them as an individual, not just parroting the things they think you want to hear or what their parents or society or religious institutions would generally want them to say.

Values can be identified not only by the things that bring joy and satisfaction but also looking at the flip side of pain.

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