ACT for Burnout: Unfolding the True Values

ACT interoceptive exposure

Key Points

  1. We can draw values from family, culture, faith, and society, which may at times conflict with what is personally important to us.
  2. The 80th birthday exercise provides information about values, as well as creative hopelessness, by exploring what the client would want to be said of them on that day, and what that tells them about how they live their life now.
  3. If a client has difficulty with visualization exercises, you can suggest such alternatives as listening to an imaginary voicemail or reading an imaginary card received on their 80th birthday.
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The Origin of Values

We draw values from many places, including families, cultures, faith practices, education, and socialization. Sometimes values sourced externally align well with what’s important to us personally. But at other times there are conflicts. Our culture or family system values something that, when we stop to think about it, doesn’t matter to us.

Often, when values aren’t derived from or deeply connected to the client, they describe them differently. It feels or sounds different, not consistent with the client’s norm somehow. And the therapist might acknowledge this. “You seemed really animated when you were talking about volunteer work / your friend group / travelling, but when you talked about this, your tone changed. And so I’m just wondering where that value originated from.”

You might hear “should” behind what a client is saying, like they should or must care about something. You can check on that, ask if you’re off base or accurate, and listen for more “shoulds” and “supposed to’s”. They’re indications that a value isn’t coming from within but from someone else’s belief system. We can respect that system, particularly if it’s connected with someone important to the client, but that doesn’t make it the client’s value.

Values conflicts can be difficult for clients. But it’s okay if something we were taught or raised on, said to be of the utmost importance, isn’t important to us. It doesn’t mean we think it’s terrible, or hate or reject the people or place it came from. It’s just not the guiding force in our lives right now. Respect is a value for many people. How can we respect what’s important to our parents, faith group, culture, tradition, or upbringing but not to us? We simply understand that we can respect those differences and other values while still making the space to live our own lives.

The 80th Birthday Exercise

If your client is an older person you’ll have to adjust this exercise or consider an alternative. It involves asking a client to close their eyes, take a few breaths, and center and ground themselves. Have them imagine that they’re at their 80th birthday event. They’re wherever they want to be, surrounded by whoever is important to them. This includes pets, parents, or others who would have passed by that time in reality, but imagining they’re still there to join in.

Have them really think through where they are. A dream home? Their favorite restaurant? Out in nature? And who showed up? Pause and really develop a picture of what the client might look like at 80. That may tap into health-related values. They’re not in bed hooked up to machines, they’re able to walk around, feeling strong, for example.

Then they picture someone important to them standing up and giving a toast. What would they want that person to say? This is not what the client thinks they would say. If they feel down or disconnected they may have negative ideas. Jack may think, “My wife says she never got to be with me as I was working.” If he connects with his values then goes through life that way, what would he want her to say about their time together or what he meant to her?

Once the client has shared what they’d want that person to say, ask them to pick someone from a different domain of their life, such as a friend, mentor, parent, co-worker, employee, or a child they’ve had or haven’t yet had.

Which people the client chooses and what they imagine people saying can highlight what’s important to them. So when the exercise ends, have a debrief. What was it like to get to that point? How might you live life in order to get there? What would it be important to focus your attention on? Can you get there by living as you do now? This both highlights creative hopelessness and is a starting point for exploring values more deeply.

For clients who struggle with visualization exercises, you could ask them to try hearing voices. They could “listen” to an audio recording of the toasts instead of watching them, or to someone important to them leaving a voicemail on their phone. Perhaps someone wrote them a message in a card they’re “reading”. The main thing is to find a way to explore this: if they live life in a way that’s meaningful to them, what might that look and feel like when they’re 80?

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ACT for Burnout: Unfolding the True Values