When I began seeing my first few patients years ago as part of my graduate training, I expected therapy would go something like this: Meet patient. Talk about problems. Identify solutions. Try solutions. Patient gets better.
I quickly learned the reality of therapy is pretty far afield from that initial idea. And it doesn’t take long for many young therapists-in-training to come to similar conclusions. We therapists are not omniscient fountains of wisdom. I have solutions to problems, of course, but so do many, many other people. And it turns out my solutions often don’t look that much different than theirs.
The more interesting lesson that followed was learning about what falls in between the bookends of meeting my patient and watching my patient get better. Certainly therapy involves talking about problems, identifying solutions, and trying them out, and there is so much more that happens. The reality is often that my patients are incredible problem-solvers, with a good number of tools at the ready. They did not come to me to have me tell them what they should do.
Most mental illnesses block the sufferer from living the life that they want to live, and the reality of the treatments for most mental illnesses is that they require incredibly hard work – work that is so hard, in fact, that the difficulty of the journey blocks the sufferer from making movement toward their desired destination. With depression, everything feels too hard and too tiring; with anxiety, everything feels too scary and too daunting. This difficulty is only further compounded with many of the mental illnesses that are categorized as eating disorders, where the physiologically and psychologically rewarding nature of the illness further impedes motivation for change. Why get better if your illness paradoxically makes you feel good?
As a treatment provider for patients who often suffer from both an eating disorder and co-occurring mental illnesses, I am thankful to have values work at the ready. There is ample research that shows connecting with your values can assist with motivation for change, and in turn, lead to a happier and healthier life.
So how does one go about connecting with values? Typically, values work with my patients begins with a values assessment across life domains – Who do you want to be as a student? As a sister or a daughter? As a spiritual being? As a member of your community? The assessment then continues by looking at the areas in my patients’ lives where they feel they are living most incongruously with their values. For example, my patient wants to be a good friend, but he has stopped returning phone calls, texts, and e-mails.
Once I have identified with my patients the areas they most want to change, we set an overarching values goal (“I want to be a responsive, communicative friend”) and identify smaller, achievable concrete actions that are consistent with this goal (“Call a friend,” “Send a text,” “Schedule a time to see a movie”). At this point in the values work, my patients are ready to put their preparations into action. We start tracking their engagement in values-based activities over time and begin to examine a number of important questions. Are they doing the values-based activities? If so, what are their feelings about them? If they are not doing these activities, did we focus on a value that is not important at this time? Or, are there barriers getting in the way? As the continuous dance of assessment and action plays out over time, I find my patients not only start feeling better, but actually start getting better as well.
The well-known business consultant and author Idowu Koyenikan once said,
“A highly developed values system is like a compass. It serves as a guide to point you in the right direction when you are lost.”
I hold hope for each of my patients that they will find their compass and, in turn, their path toward recovery. I am honored to join them on that journey.
Associate Clinical Director, Veritas Collaborative