Praxis Blog

Values + Truffle Hunting in Sessions: An Interview with Jenna LeJeune, PhD

Dog hunting truffles in forest

Editor’s note: The following is an interview with Jenna LeJeune, PhD, co-founder and director of clinical services at Portland Psychotherapy Clinic, Research, and Training Center in Portland, Oregon. Dr. LeJeune has trained professionals in acceptance and commitment therapy worldwide.

Dr. LeJeune is presenting a webinar Values: Connecting with Who and What is Most Important​​ on November 1, 2016.

Praxis: First of all, what is the definition of values, from an acceptance and commitment therapy (ACT) perspective?

JL: If you’re looking for a more scientifically precise and technical definition, you can speak of values as “freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself” (Wilson, 2009).

However, as someone who is mainly a clinician and trainer of clinicians, I’m not usually standing in the place where that sort of definition is very useful. I typically talk about values as what you would want your life to stand for if you were completely free to choose. They are qualities of action, the “kind of person” you’d most want to be in this world.

You can also speak about values as more overarching directions you’d want to your actions to be in the service of.  Most simply put, I often speak of values as qualities of living that would lead you to say, at the end of your life, “Ah, now that was a life well lived.”

Praxis: What is the function of values clarification in clinical work, psychotherapy specifically?

JL: From my perspective, values work gives you the “why” in treatment planning and in psychotherapy in general. Without getting clarity on a client’s chosen values, I can’t know what the hard work of therapy is in the service of. If I don’t know my client’s values, I can feel more like a technician, simply administering interventions in what can feel like a pretty impersonal manner. But when my client and I can get clear on what her own chosen values are, the work becomes personal, and in my experience, more vital.

Let’s say that in our work together my client has identified that being loving and present in her relationship with her partner are some values she would hold dear. Then when I am asking her to sit with some really painful memories during exposure work for example, that work is no longer just about getting rid of her flashbacks. Instead, it’s as if her partner and being present and loving in that relationship are metaphorically in the room with us, like a brass ring we are reaching for. For me that is the function of values clarification work; it gives you the brass ring you are reaching for.

Praxis: What is the difference between a value and a goal, or a moral rule for how one should behave?

JL: From where I stand, the difference between values and a moral rule looks pretty clear.

Values, by our definition, are always freely chosen and are not dependent on external consequences. In contrast, moral rules are more connected to a history of how others have responded to you when you behaved in a particular way.

Moral rules tend to be synonymous with “shoulds” and a sense of “right” versus “wrong.” In my experience, there is often a large degree of aversive control associated with moral rules; e.g. you’d better do/not do “X” or you’ll be in trouble.

In contrast, values are intrinsically reinforcing and are, by definition, appetitive. Values are what you would want your life to stand for if there were no prescribed “rules” you were supposed to follow.

In terms of values versus goals, the classic analogy is that values are the direction you are heading (e.g. north) while goals are specific points along the route you try to reach. Goals are achievable and are discrete. Values can never be achieved. Unlike goals, which are always something in the future you are working towards or in the past that you have accomplished, values are available to you in every moment. No matter where you are, you can always take a step north.

But goals and values are, hopefully, interrelated. When goals are linked to valued directions, the goals can serve as a feedback mechanism. They can tell you whether or not you’re on the valued path. For example, if you knew you wanted to head north (value) and you saw that from where you were standing the big oak tree is north of you, then reaching the big oak tree (goal) can let you know that you have indeed been heading north.

Praxis: What are some of the areas where clients tend to get tripped up around values? What are some of the ways that clinicians tend to get tripped up around values?

JL: People playing the role of therapist often get tripped up around the same things that people playing the role of client do. In terms of values, one of the places where we can all tend to get tripped up, in my experience, comes when we start talking about values as “things.”

We (clients and therapists) can get caught up in trying to identify or choose specific value words. Exercises such as a values card sort, or selecting values from some predetermined list, while very helpful in the right context, in my experience can also lead to conversations that lack vitality, vulnerability, and a sense of being alive in the present moment.

I’ve also found that focusing too much on articulating specific values words can lead both me and my client to a place of judgment or evaluation. My client might get fused with “I hope I chose the right ones here,” or “I know it’s good for me to value health so I will choose that one.” In the therapist role, seeing values as words can result in fusion with thoughts like “Well, that’s not the set of values I would choose,” or “I can’t really support that value.”

Instead, I think it can be helpful at times to let go of the idea of focusing on identify values in terms of specific words. I frequently start values exploration with looking for parts of the conversation where the client is most alive, vulnerable, and present. I often use the metaphor of truffle hunting for this type of values work. Truffles are incredibly precious but often they are buried until a bunch of dirt and leaves. So, when you go hunting for truffles, you often go out with a dog who has been highly trained to sniff out the scent of truffles.

As an ACT therapist, I see myself as a truffle dog. I know what values look like and feel like when they are present in the room; I know where they are often buried. Sometimes a client may not be able to see the values because they are buried under a bunch of avoidance and control strategies. Like the truffle dog, my job is to try to sniff out when values might be in the room. Often this isn’t in the form of words at all, but a change in tone, slowing down, or tears. These are clues that a value might be present.

So when I see these things, I am like the truffle dog who has caught on to a scent; I lead my client there and we begin to dig around together to see what values we might unearth in that soil. When you can unearth a value and make it come alive in the room, my experience has been that evaluations tend to fall away. It becomes something incredibly precious to behold and appreciate for both client and therapist.

So as far as getting tripped up, I’d say don’t worry so much about making sure the client can say specific values words, especially in the beginning. Instead, our job together is to help the client come in contact with her chosen values, which often can come in the form of an image, or felt sense long before she can put concrete words around it. Linger there and the words will eventually come.

Praxis: What are some examples of instances that may occur in-session when values work may be called for, and how might a clinician identify such instances?

JL: There are several different cues I look for that would lead me to focus more on values work in a session. Values and pain are two sides of the same coin, therefore, when clients are more numb, feel “empty”, apathetic, or otherwise are not in contact with the cost of the avoidance in their lives, it often signals to me that they are also not in contact with their values either. Focusing on values work in these cases can help the client come into contact with the discrepancy between what they are currently valuing by their behavior and what they would choose to value if they were free to do so.

I will also often turn to values work when it seems like the work of therapy is motivated by avoidance or aversive control. If a client is white-knuckling his way through exposure work or is engaged in therapy as a way to “fix” herself, I’ll often turn to values work to orient us to something we would want our work to move us towards.

Therapists can also get caught up in these same avoidance strategies. When I start seeing my client as a problem to be fixed or I’m working really hard to try to take away some experience he is having (e.g. sadness, anxiety, etc.), my work is under aversive control.

Reorienting both myself and my client to our respective values in our work together can be very helpful in these situations. Values work in these contexts can increase authentic willingness and choice in the therapy work for both client and therapist.

Praxis: Can you give an example of an experiential exercise that a therapist might use to orient a client toward identifying his or her values and moving toward them?

JL: There are tons of really great values exercises out there including the eulogy or tombstone exercises, the sweet spot, deserted island, values card sort, etc., all of which I use very frequently. However, any exercise can fall dead if it’s simply implemented as a technique.

So the way I tend to work is that I focus first on getting values present in the room. To continue with the truffle hunting metaphor, we need to get the scent of the truffle in the room first.

One of the ways I do this is that I will often ask a client as homework to be on the lookout for a specific instance over the course of the week where they would look back on themselves with pride or appreciation, a time where they feel most proud of who they were in that moment. If the person is a parent or is in an intimate relationship, I’ll often narrow it down to the context of those relationships since meaningful relationships are often fertile ground for values. Then, in the next session I’ll do an eyes-closed exercise where I ask the client to visualize and then describe what that scene was like, who they were in that moment, what they felt like, what they were doing, and what they were standing for or saying was important to them by what they were doing. I’ll also ask them to notice, as an observer, how they feel as they look at themselves in this scene of themselves being that kind of dad/mom/partner, etc.

This kind of exercise serves a few different functions. First, it can help the client get in touch with their values. It’s creating a context in which the client can taste the truffle and say “oh, that’s a truffle.”

Second, it can help build flexible perspective taking around values. They are led to look back on themselves as an observer and notice themselves engaging in a valued action. The third function is to help me enter the world of the client’s values. I too get to taste their truffle, to know what it smells like and looks like. Doing so helps me get in touch with my own commitment to the work. I now know what the work is in the service of and I can call that image back to mind when I’m losing my way because of my own fatigue, self-doubt, fear, etc.

Once the client and I both have gotten a whiff of their truffle, only then I will use some of the other exercises like the deserted island exercise or eulogy exercise to help further articulate their values.

For more about values work in psychotherapy, check out Dr. LeJeune’s upcoming webinar: Values: Connecting with Who and What is Most Important.

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