第五章：基于价值观的行为（第一部分）

Chapter 5

Values-Based Action, Part 1 In the foregoing chapters we’ve explored how painful emotions trigger both urges to engage in emotion-driven behavior and emotion avoidance (behavior exclusively shaped by the desire to escape pain). Both of these coping responses serve to intensify the emotion and prolong suffering. And both of these reactions lead to chronic emotion disorders and emotion dysregulation. While clients may be getting more skilled at observing and accepting emotions and the urges they trigger by riding the emotion wave, they have yet to identify alternative contextually adaptive behavioral choices to emotion avoidance and emotion-driven behavior. The next two chapters cover the next EET treatment component and skill, values-based action, or VBA. In this chapter, we show you how to help your clients clarify their values across their various life domains and visualize using VBA when they are emotionally triggered. In the next chapter, we show you how to help your clients choose VBA when they are in a triggering situation using a powerful experiential exercise. EET Skill Objective: Observe + Accept with values clarification Values-based action is the basis for a different choice— acting on what matters, on what clients care about—rather than emotionally driven reactions. Once clients have clarified their values in triggering situations, and have learned how to use values-based action, they’ll have new, healthier, adaptive response options. These alternative behavioral choices will provide a counterweight to old, maladaptive patterns. VBA can be defined as behavior that takes one’s life in a direction that matters, that’s in alignment with what feels important and right for the situation. As such, values are not goals, for which a plan is accomplished or completed. Valuesand their expression in values-based action represent directions or paths toward something that matters. Let’s take honesty in a relationship as an example. A goal of telling the truth about unspoken sexual desires is something that can be achieved in a single conversation. On the other hand, the value of honesty with a partner, for example, cannot be accomplished; every day the value is enacted in specific values-based actions, such as expressing authenticity and truthfulness. In other words, values-based action is the result of turning abstract values into behavior. Having the value of being supportive to friends can be enacted or expressed, for example, by helping a friend move or visiting someone who’s sick. Emotion-driven behavior, by contrast, often carries clients away from values and values-based intentions. Straying from one’s values erodes well-being and creates a host of secondary problems such as depression, damaged relationships, a sense of defectiveness, lack of direction, poor choices, and helplessness. The first step toward being able to use values-based action is to clarify what values are. You can describe the advantages of values clarification to clients as follows: Values direct life where one wants it to go. They help life to be about what matters, as opposed to avoiding pain and seeking pleasure. Values provide motivation to make difficult but necessary changes. For example, changing anger- driven behavior can be motivated by a value of kindness or love. Values-based action provides a clear alternative to emotion-driven or -avoidant behaviors. Values help clients make choices that lead to high well- being.Assessing Client Values Provide clients with the Values Clarification Worksheet and ask them to circle their ten most strongly held values. Values Clarification Worksheet Review the list below and circle your top 10 values. Accountability Accuracy Achievement Adventure Altruism Ambition Assertiveness Authenticity Balance Belonging Boldness Calmness Carefulness Challenge Cheerfulness Clear-mindedness Commitment Community Compassion Competitiveness ConsistencyContentment Continuous improvement Contribution Control Cooperation Correctness Courtesy Creativity Curiosity Decisiveness Dependability Determination Devoutness Diligence Discipline Discretion Diversity Dynamism Economy Effectiveness Efficiency Elegance Empathy Enjoyment Enthusiasm EqualityExcellence Excitement Expertise Exploration Expressiveness Fairness Faith Family Fitness Fluency Focus Freedom Friends Fun Generosity Grace Growth Happiness Hard work Health Helping Holiness Honesty Honor Humility IndependenceIngenuity Inner harmony Inquisitiveness Insightfulness Intellectual status Intelligence Intuition Joy Justice Leadership Legacy Love Loyalty Making a difference Mastery Merit Obedience Openness Order Originality Patriotism Piety Positivity Practicality Preparedness ProfessionalismPrudence Quality Reliability Resourcefulness Restraint Results-oriented Rigor Security Self-actualization Self-control Self-reliance Selflessness Sensitivity Serenity Service Shrewdness Simplicity Soundness Speed Spontaneity Stability Strength Structure Success Support TeamworkTemperance Thankfulness Thoroughness Thoughtfulness Timeliness Tolerance Tradition Trustworthiness Truth-seeking Understanding Uniqueness Unity Usefulness Vision Vitality Assessing Values By Domain Now, encourage clients to talk about the selected values and why they’re important. Are there life experiences—either happy or difficult—whereby clients discovered the significance of this value? When have they acted on the value with positive outcomes? Were there times they forgot or failed to follow this value? What were the outcomes then? After discussing several high-ranking values, introduce the Values Domain Worksheet. The assessment process here is more complex, requiring clients to identify the value and specific values-based action for each relevant life domain. In addition, values in each domain are measured in two ways: I—Importance0 = unimportant 1 = moderately important 2 = very important A—Action (how often the intention was enacted in the past seven days) 0 = no action 1 = one or two actions 2 = three or four actions 3 = five or more actions A crucial function of this worksheet is helping clients identify values, and their corresponding values-based action, that are rated as “very important” yet are rarely acted upon. Have these values been avoided or abandoned because emotion-driven behavior is getting in the way? Are clients so often responding to action urges that key values no longer guide their choices? To put it simply: are emotions—not values—running the clients’ lives? This often leads to a difficult but rewarding conversation that can motivate clients to try new ways of responding to difficult emotions. When it becomes clear that emotion-driven behavior is a barrier to being the person they want to be, many clients will respond by asking, “What can I do about this?” Values Domains Worksheet

Intimate relationships Value: I = A = Values-Based Action:
Parenting Value: I = A = Values-Based Action:
Education/learning Value: I = A = Values-Based Action:
Friends/social life Value: I = A = Values-Based Action:5. Physical self-care/health Value: I = A = Values-Based Action:
Family of origin Value: I = A = Values-Based Action: I = Importance A = Action: How much action did you take in the last seven days toward your value? Rate: Rate: 0 = unimportant 0 = no action 1 = moderately important 1 = one or two actions 2 = very important 2 = three or four actions 3 = five or more actions
Spirituality Value: I = A = Values-Based Action:
Community life/citizenship Value: I = A = Values-Based Action:
Recreation Value: I = A = Values-Based Action:
Work/career Value: I = A = Values-Based Action:
Value: I = A = Values-Based Action:
Value: I = A = Values-Based Action: I = Importance A = Action: How much action did you take in the last seven days toward your value? Rate: Rate: 0 = unimportant 0 = no action1 = moderately important 1 = one or two actions 2 = very important 2 = three or four actions 3 = five or more actions Therapist-Client Dialogue Example: Talking About Values This client came into treatment concerned that her anger was damaging her relationships and the lives of her children. Explosions were triggered when she felt ignored, disrespected, or had been denied something she wanted. The therapist, in the following dialogue, first examines the client’s values and then looks at how her emotion-driven behavior impacted her choices. Therapist: [Showing the client the Values Domain Worksheet] Let’s look at this first domain: intimate relationships. Is there a value that guides who you want to be in this part of your life? Client: Caring. I want to be caring with Bill. Therapist: And if you were to turn that value into action—as an intention, or values-based action—what would you do? Client: I’d express concern and interest about some of his struggles—his health, his difficulties at work. I’d appreciate how difficult it is for him to get organized, rather than criticize him. Therapist: How important is this value—on that 0 to 2 scale? Client: Very. Therapist: Okay, let’s write in 2. And how often do you act on your value of being caring with Bill? Client: [Silence] Not so much. Therapist: Once or twice a week? Three or four times? No action last week? What would you say? Client: I don’t think I was very caring last week.Therapist: [Writes in “0”] Sometimes there’s a gap between what we want to do and what we actually do. That’s true for me, too. What about this next domain, parenting? Client: Same thing, I want to be supportive and caring. Therapist: Okay, and if you turn that into specific behavior this week, what would that look like? Client: It would be talking like I cared about them rather than getting angry. Therapist: So your intention would be… Client: Talking with gentleness. With love in my voice. Even when they don’t do what I ask or when they get sassy. Therapist: How important is that value? Client: At the top. Therapist: [Writes in “2”] And how often do you act on your intention? Client: When they aren’t listening or talk back at me? [Therapist nods] Not too much. I pretty much always get upset and start yelling. Therapist: [Writes in “0”] So this is another domain where there’s a gap between what matters and what you find yourself doing. Let’s keep going and look at other domains. [The therapist and the client continue with the worksheet. Some of the domains don’t matter to the client at all: family of origin, spirituality, and recreation. Some had moderately important values: physical self-care (exercise, community life), volunteering at her kids’ school, learning (community college writing class). Finally the conversation circles back to domains where a gap exists between a value’s importance and frequency of action.] Therapist: Could we go back for a moment to your relationship with Bill? The value of caring wasimportant, but the intention of expressing interest and concern, or validating his difficulties getting organized, was hard to do. What gets in the way, do you think? Client: It drives me nuts when he doesn’t get things done. And I’m tired of hearing about work. It’s the same problem, he’s disorganized. So…I get upset and kind of lay into him. Therapist: So your frustration leads to anger, and then what? Client: You know what. We’ve been talking about action urges. I have an urge to yell at him and…blame him. Therapist: So the urge to yell—your emotion-driven behavior when you’re angry—is a barrier to the value of being caring. Client: [Looks angry] I don’t like it when you say it that way. But…yes. Therapist: This is hard. It’s painful to look at. Would you be willing to examine that other domain—parenting— where you felt being caring was important? Values Domain Worksheet (Client Sample)
Intimate relationships Value: Caring I = 2 A = 0 Values-Based Action: Express concern, interest re: difficulty getting organized
Parenting Value: Supportive I = 2 A = 0 Values-Based Action: Talk with gentleness/love when they didn’t listen or are sassy
Education/learning Value: Learn how to write I = 1 A = 0 Values-Based Action: Enroll in community college class4. Friends/social life Value: Listen I = 1 A = 2 Values-Based Action: Ask about what’s going on, be interested. Don’t interrupt or judge.
Physical self-care/health Value: Healthy stamina I = 1 A =1 Values-Based Action: Cardio exercise 3x week
Family of origin Value: I = 0 A = 0 Values-Based Action:
Spirituality Value: I = 0 A = 0 Values-Based Action:
Community life/citizenship Value: Volunteering I = 1 A =0 Values-Based Action: Help at children’s school
Recreation Value: I = 0 A = 0 Values-Based Action:
Work/career Value: Support co-workers I = 2 A = 2 Values-Based Action: Ask how their projects are going Accessing Values During Distress Next, you will help clients identify frequent triggering situations where strong, negative emotions get activated. The goal here is to match these emotional triggers with a value/intention that clients wish to be guided by. Start by brainstorming with your clients as many triggering situations —eight to twelve—as you can think of.As an example, the client listed the following situations that were emotionally activating triggers: Bill doesn’t get something done that he promises to do. Bill can’t get organized around some job at work or home. Bill looks confused and out of it. My kids ignore what I ask. My kids get loud. My kids make fun of the way I talk. My kids whisper together, laughing at something I think they need to do. My boss says for the umpteenth time that our department is underperforming. My boss looks at his shoes, which means he isn’t listening to me. My friends talk about their problems—which are nothing close to what I’m facing right now. My father’s weekly call. Dealing with my son’s teacher—who doesn’t get him and doesn’t care what he needs. Now, with a list of triggers, ask clients what value/intention they want to act on in each situation. Typically, they’ll focus on one or two key values—kindness or honesty, for example. If clients are having trouble identifying key values, ask who they want to be in the situation. You can say, “You’re extremely upset. X, Y, and Z have happened. You’re feeling , and the emotion is driving you to . Notice the power of that urge. Notice the pain and how it pushes you to do something to feel better, to feel free of the hurt. Now you willhave a choice: act on your emotional urges or be who you want to be. Tell me about that choice.” For example, the client identified the following values and intentions/values-based actions that could guide her during emotional triggers: Kindness: awareness of others’ pain and validating their struggles Truthfulness: saying what I feel without blaming people for it Caring: supporting people rather than causing pain These three values became a touchstone for the choices the client made. They were an adaptive alternative to her emotion- driven aggression. Barriers to Values Clients know how often they don’t act on values. They are acutely, painfully aware of this failure. What they may not know is why. An essential step in this treatment is to validate the pain and the enormous challenge in shifting to making choices based on values. There are three huge barriers to living one’s values: A lack of clarity about values-based action in the moment. The client doesn’t clearly recognize the two choices during emotion activation: values-based behavior versus emotion-driven responses. This is often the result of an incomplete values-clarification process. Either the client hasn’t fully explored his or her values and intentions, or the values have never been applied to triggering situations. The client may have no idea what to do when faced with strong emotions. A hardwired drive to control painful emotion. The stronger a negative emotion, the stronger becomes theurge for emotion avoidance and emotion-driven behavior. Clients typically arrive in therapy with a long history of trying to control difficult emotion. But the effort to control emotional pain has the unintended and parallel consequence of carrying clients farther from values-based action. Instead, at the moment of choice, clients struggle with urges to act on and control emotions, and their awareness of values can literally disappear. Emotion avoidance and emotion-driven behavior feel good in the moment. They are also negatively reinforced. The immediate reward for emotion-driven behavior makes it seem like the better, easier choice. Emphasize to clients that acting on values will be challenging for all of the above reasons. Appreciate that there will be times when emotional triggers obscure the moment of choice, or make values seem unreachable. But while acting on values won’t always be possible, knowing what matters will increase the opportunity for more-conscious decision making. Values-Based Action Values-based action—in the face of emotional triggers—is only made possible by recognizing the moment of choice, which can be found using the following sequence: Noticing painful emotion, including the components of feelings, thoughts, and sensations; observing the action urge; remembering situation-relevant values/intentions; and deciding to act (on values/intentions or emotion-driven urges). An authentic moment of choice requires that clients use steps 1 through 3 rather than merely reacting. All the earlier workwith emotion awareness and mindful acceptance will come into play—the clients are more skilled at observing feelings; they have been developing the habit of observing and accepting before acting. Once the moment of choice has been identified, there’s no guarantee that clients will choose values-based action. The reinforcement for emotion-driven behavior will still be strong. But you can increase motivation by using the Benefits of Values-Based Action Worksheet. This simple exercise helps clients identify positive outcomes from acting on values across multiple domains. Benefits of Values-Based Action Worksheet Now that you’ve identified your values—and you understand that the moment of choice presents an opportunity to make a helpful decision about how to respond in an emotion-filled situation—let’s explore possible reactions. Answer the following questions about your values, your intentions, and your actions around your values. How does values-based action affect my relationships with friends and family? How does values-based action affect my relationship with my spouse or partner, or my living situation? How does values-based action affect my relationships when I am emotionally triggered? How does values-based action affect my work or school? How does values-based action affect my financial situation? How does values-based action affect my health? How does values-based action affect my long-term goals? How does values-based action affect my safety and security? Therapist-Client Dialogue Example: Benefits of Values-Based Action The client and her therapist explored the benefits of values- based action in the following dialogue:Therapist: Let’s look at the Benefits of Values-Based Action Worksheet. In terms of your children, the values were gentleness, caring, and love. How would acting on those values affect the relationship to your children? Client: They would feel protected. They’d see that I care rather than seeing me blow up. They wouldn’t be so wary of me, and I think I’d enjoy being with them a lot more. Therapist: [Knowing the importance of putting this in writing] Could you capture those thoughts on the worksheet? [Pause] And what about with Bill? Would a caring response to his not being organized or not getting things done have benefits in that relationship? Client: [Long pause] Yes, but I feel embarrassed to say… I think our sexual relationship would improve. He gets hurt and kinda withdraws from me. I think there would be more affection and sweetness between us instead of distance. Therapist: Let’s get that down, too. It feels important. [When the client finishes the Benefits of Values-Based Action Worksheet, a look of sadness comes over her. She reads it over a second time.] Client: I need to make some changes. Your clients now have the tools they need to identify the moment of choice, identify a VBA, and visualize using the VBA during emotion exposure as part of their skills practice outside of session. Clients will continue the practice of choosing VBA in the next session, described in the next chapter. Summary Following is a synopsis of content covered in chapter 5:Values-based action (VBA) is defined as any behavior that is in alignment with or expresses value for the context of the situation. VBA is an alternative to acting on painful emotions. Clarifying values across life domains is the first step to being able to identify VBA in the moment of choice. Lack of clarity about values; a hard-wiring to avoid pain; the habit of acting on emotion; and short-term reinforcement for acting on emotion-driven behavior, or emotion avoidance, are barriers to choosing values- based action in the moment of choice. Understanding the benefits of VBA can increase motivation to choose an action based on values in the moment of choice instead of an emotion-driven behavior.