joanne dahl university of uppsala, sweden jennifer plumb university of nevada reno, usa a workshop...
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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
Ow
n
time
Health
work
present, loving with myself
pliance, satisfying others at my own cost
Giv
ing
myse
lf what
I need
Disre
gard
ing
myse
lf
Taking care of my physical needs
Disregarding my needs
bein
g u
sefu
l
Bein
g u
sele
ss
10.....................0
0..............1
01
0...........0
0...........10
Relationships
Ow
n
time
Health
work
present, loving with myself
pliance, satisfying others at my own cost
Giv
ing
myse
lf what
I need
Disre
gard
ing
myse
lf
Taking care of my physical needs
Disregarding my needs
bein
g u
sefu
l
Bein
g u
sele
ss
10.....................0
0..............1
0
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:
joanne.dahl@psyk.uu.se jcplumb@gmail.com
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