One final barrier worth mentioning is the fact that it is not uncommon for clients to deny they have any values at all. Often, this is because of the pain associated with having that conversation. Clients who respond like this may be hopeless about the possibility of expressing their values or may find it too painful to contact what they care about most. In these situations, clients are focused on how their situations will turn out and are afraid to step out of the safety zone of “I don’t know” or “it doesn’t matter.” Undermining this type of avoidance means taking the client into the pain of caring. Helpful responses by the therapist
include “What did you value before this cloud descended on you?” and “Is this how you dreamed as a small child that your life would turn out? What did you dream it would look like?” The clinician can ask the client to temporarily set the barrier aside, for instance by saying, “Pretend you were someone who knew what you wanted. What would you want?”
Here is a case that illustrates such an approach. Julie is a thirty-five-year-old female who has an extensive history of sexual trauma, both as a child and as an adult. She works as an exotic dancer and print designer, and is constantly chasing the next dollar to make ends meet. She perceives herself as living on the edge of financial disaster. She has no close friends, and most of her time outside of work is taken up by smoking marijuana, exercise, and masturbation. The few relationships she has are filled with conflict, and she finds herself being chronically angry. She says that, years ago, she gave up hope her life could be better, and now she just wants to know how to get by without getting victimized again. This transcript is from her fourth session.
Therapist: I want you to consider a question I think might be really difficult for you. It’s a central
question for this therapy, if you’re willing to consider it. What I’d like to know is, what do you want to do in your life that you are not doing now?
Client: What? There’s no point in thinking about that. I don’t care about anything anymore. I just get disappointed whenever I hope for something.
Therapist: I can see it is painful to hope for something. You’ve had many experiences of things not
working out. I’m just asking, if you could have it be some other way, what would that be? What would you rather be doing with your life that you aren’t now?
Client: I don’t know. I don’t care anymore. Nothing.
Therapist: You could follow this path out for the next five years, ten years, fifteen years. You could
continue the way you’ve been going. Take a second to picture what that would be like. [long pause] Are you okay with that?
Client: [pause] It’s awful.
Therapist: I can see you feel so hopeless about anything turning out the way you want. Your mind wants
to protect you by saying it’s easier not to care. That’s what you just saw in those five, ten, and fifteen years, yes? And apparently it doesn’t look good … Are you willing to play with me for a minute around this? Let’s pretend, if you were someone who cared, what would you care about? What would you want?
Client: It’s hard to think about. [sighs] I guess, uh … I’d want to have someone in my life whom I could trust. I’ve never had that. [starts to cry]
Therapist: I can see how much you want that, and how much it feels like that is missing from your life.
I want to help you have that in your life.
The client is hesitant to speak about what she might want, not because she hasn’t had ideas about the future, but because it’s painful for her to consider this. Due to chronic avoidance, the client has no idea about what she feels or wants. In such situations, the rest of the ACT model is very much needed to support clients learning to contact their values.
WHAT IS THE METHOD?
The idea of values is usually introduced early in therapy, either in a more limited fashion (as discussed in chapter 2) or perhaps in a more extended manner, depending on the client case conceptualization (chapter 8). Clients are often so focused on their problems that turning their attention to the larger context of their dreams, hopes, and aspirations for their lives can be unexpected. Thus, a bit of introduction can be helpful to orient them to this aspect of therapy. For example, the therapist could say the following:
Therapist: You’ve told me now a bit about your problems, and I feel like I have a good beginning sense
of what those are. Your problems are important, and we’ll certainly respond to them in here, but your life is also more than your problems. I’d like us to spend some time focusing on the larger context of your life, which includes your dreams, your hopes, your aspirations for your life. These are a large part of what makes life worth living, and they are the context in which you experience your problems. What I’m suggesting we talk about is, “What do you really want in life? What do you want your life to be about? What do you want to do? Who do you want to be?” Would it be okay if we spent some time focusing on that?
The breadth, depth, and focus of the initial values work can vary greatly, depending upon the needs of the client and the clinical situation. Sometimes the focus can be as narrow as helping the client specify what he or she values in a given life situation, as might happen in a brief clinical encounter. Or it can be as broad as helping the client specify valued directions across all major life domains, as might happen in more extended therapy.
A more extended values assessment process (see Hayes et al., 1999) can take multiple sessions and include between-session work in which the client writes out descriptions of valued directions and goals in several life domains (e.g., family, couples, parenting, friends/social, work, education, recreation, spiritual- ity, community, self-care), along with discussion focused on clarifying, specifying, and succinctly record- ing in writing the stated value in each life domain, followed by ratings of consistency and importance. Finally, actions would be initiated based on goals developed within each domain (as described in chapter 7). A briefer, relatively unstructured values clarification process can be instigated using the Valued Living Questionnaire (VLQ; Wilson & Murrell, 2004). Based on their work with anxious clients, Eifert and Forsyth (2005, pp. 171–177) described the use of a similarly brief values assessment process. They also discussed a process called the Life Compass (pp. 186–189), which was originally developed by Dahl et al. (2005, pp. 91–111). Several other measures and aids have been developed and are available at the con textualpsychology.org website. Although more or less extensive, each of these processes has in common a number of steps that are important in helping clients define a valued life direction. These common elements are described here.