By Chad Drake, PhD, assistant professor at Southern Illinois University
Choices pervade our lives. Much of the time, the act of choosing may be a familiar and mundane non-event, such as deciding whether to pick up the toothpaste before or after you have grabbed your toothbrush. At other times, choosing may have epic repercussions, such as contemplating a job offer, a marriage proposal, or a medical procedure. Of course there are moments when our choices impact our psychological health. Whether or not to accept that drink, express that volatile emotion, consider the perceptions of another, or admit to a mistake may impact how you think, feel, and behave—not just in the next moment but perhaps for days, weeks, or even years.
As a contextual behavioral scientist, I try to understand how choices are a matter of stimulus control. Our perceived options in any given moment are loaded with a variety of stimulus functions, some desirable and some not. We make choices, we experience consequences, and our subsequent choices are influenced by our past experience as well as by our mind’s interpretation of the past and imagination of the future. Over time, our histories may usher us into patterns of behavior, and sometimes a pattern may develop that does not serve our long-term interests.
Our choices are influenced by our past experience as well as by our mind’s interpretation of the past and imagination of the future.
In a clinical context, I want to understand the stimulus functions that drive my clients’ problematic choices so that I may then engage them in conversations and activities that alter those functions and in turn shift their behaviors to more effective and fulfilling directions.
Try This with Your Clients: A Values Card Sort
In my supervision of graduate student clinicians at Southern Illinois University, where we are developing and providing an acceptance and commitment therapy (ACT) protocol, one of our most potent interventions is what we call a values card sort. This activity allows us to assess and explore a variety of stimulus functions with respect to more than 100 cards that represent a range of desirable choices.
As an example, consider this image of a selection of cards by one of our clients in a recent session. These cards were the last survivors of a series of choices, where the client assigned each card to the designations of “very important to me,” “somewhat important to me,” or “not important to me.” Cards that clients classified as very important were resorted again, and then again, until this final collection was all that remained (we usually ask for 12 or less in the final sort).
Notice how this sorting activity involves hierarchical and comparative relations among the cards; cards are categorized under a unifying label designating degrees of importance, and repeated categorizations of the most important cards requires preserving only those cards that are most essential to the client. Some of our clients visibly and audibly struggle with these comparisons. While we expect these final cards to be highly desirable activities for our clients, we have found it informative to ask an additional question about them.
This question is designed to transform the functions of these cards, perhaps radically for those clients who are deeply immersed in a struggle with their suffering. We ask our clients to categorize their final cards on the basis of their workability: “Considering your own experience, which of these cards are things you can readily choose, and which ones do not seem all that easy to control?” This question invites clients to reorganize the cards into two groups on the basis of their hierarchical relation to the labels of “controllable” and “uncontrollable.” Cards classified as both important and controllable are genuine assets for our clients, both in future sessions and in life outside of therapy; looking at these cards that represent valued choices, which clients have identified as very important helps clients more consciously make choices in their lives that move them closer to their values. In other words, this exercise helps clients take values-based action.
Notice in the image that at least two of the cards refer to the behavior of others (e.g., “being loved by someone”), and at least one of them refers to the possession of a particular emotion (e.g., “being happy”). Approximately one-third of this card deck contains content of this nature. By including these “faux values”— ones that unachievable or are out of our control—we create an opportunity to discuss why they’re unachievable with our clients. Most of our clients, when reflecting on their past efforts, acknowledge that these types of priorities have been difficult, if not impossible, to summon at will. Sometimes clients endorse a relatively large number of these faux values or have trouble acknowledging their failure in accomplishing them. In these situations, the card deck can facilitate a rich conversation about the horrible privilege and delightful burden we refer to as making a choice.
Chad Drake, PhD, is an assistant professor at Southern Illinois University, where he serves the Adult Clinical PhD program and supervises the SIU Contextual Behavioral Science Lab. His practicum team is developing Life Skills Modules, an acceptance and commitment therapy protocol.