Interview with Jenna LeJeune, PhD on Values Work

I was recently interviewed for the Praxis blog about values work in ACT  in conjunction with the upcoming webinar I’ll be offering through Praxis called “Values: Connecting with Who and What is Most Important.” We covered a lot of ground in the interview, from how I might define values from an ACT perspective to looking at some of the most common difficulties therapists seem to have when working with clients around values.

One of the ways I think people struggle with values work is when we start talking about values as “things” or “words” that occur out there/then. In talking about the need to have values be present in the room when doing values work, I talked about the metaphor of the truffle dog I often use when talking about values work. As an ACT therapist, part of my job is to “sniff out” when values may be present, much like a truffle dog uses his nose to find the precious delicacies underneath the dirt and leaves. When the client and I are able to unearth a value that is present in the room, it comes alive and is something quite precious for both of us to behold and appreciate.

Below are some excerpts from the interview.

On the function of values clarification in psychotherapy:

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.

On the ways that clients and clinicians get tripped up around values:

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.

On identifying instances when values work may be called for:

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.

You can read the entire interview here.

If you’re interested in learning more about incorporating values work into your sessions, you can sign up for the Praxis webinar  “Values: Connecting with Who and What is Most Important.”

Jenna LeJeune, Ph.D

Author: Jenna LeJeune, Ph.D

Jenna is a clinical psychologist who specializes in working with people who struggle with relationship and intimacy difficulties and with those who have a trauma history. Her research focuses on developing compassion-based interventions targeting stigma, shame, and chronic self-criticism.

The 5-Minute Guide to ACT: A Visual ACT Elevator Pitch

The 5-Minute Guide to ACT: A Visual ACT Elevator Pitch

The challenge of explaining ACT

As an ACT trainer, one of the most challenging things for me is when someone who isn’t familiar with ACT says “What’s this whole ACT thing about?” Let’s just say my ACT elevator pitch needs some work! It’s tricky to try to describe something that is supposed to be an experiential therapy. And then there is the whole conundrum of trying to use language to explain a theory that holds that language is at the heart of the problem. But I find that “you just have to experience it” is the trainer equivalent to “because I said so” and is equally unsatisfying (and also not very helpful). So this week I was thrilled when I got another tool in my “what is ACT” arsenal thanks to ACBS member Dov Ben-Yaacov and the 5-minute Guide to ACT Pictogram he created.

The 5-Minute Guide to ACT Pictogram (click on picture to download)

This isn’t something I would necessarily share with clients. However, I do think this simple, yet surprisingly comprehensive pictogram could be very helpful in orienting students and those learning ACT to the general gestalt of how ACT, RFT, and Functional Contextualism fit together.

Another example of the generosity in the ACBS community

One of the things I most love about the Contextual Behavioral Science community is how incredibly generous the community is. I can’t imagine how much time it took Dov to create this. And then he just went ahead and posted it for anyone to use it for free. So it’s with much gratitude to Dov Ben-Yaacov that I pass this along to you. Please use it as it is helpful and also continue to credit Dov Ben-Yaacov as you do so. 

Jenna LeJeune, Ph.D

Author: Jenna LeJeune, Ph.D

Jenna is a clinical psychologist who specializes in working with people who struggle with relationship and intimacy difficulties and with those who have a trauma history. Her research focuses on developing compassion-based interventions targeting stigma, shame, and chronic self-criticism.

Harnessing the Power of the Therapeutic Relationship

“Dealing with others is dealing with ourselves, dealing with others.”

–Norman Fischer

Creating intense and curative therapeutic relationships is a fundamental skill for meaningful therapy. Strong relationships like this can engage people in ways that challenge and can perhaps even frighten them.  This means that therapy can involve exposure to avoided thoughts, emotions and sensations for the client AND the therapist.

“Exposure therapy typically elicits a temporary increase in patients’ negative affect in order to facilitate new learning. This may in turn increase therapist discomfort as therapists interact with the patient and are confronted with their own uncomfortable subjective experiences.” (Scherr, Herbert and Foreman, 2015).

The authors of this study found that therapists with high levels of avoidance tended to avoid doing exposure therapy. Powerful therapy requires us choosing to lean into risking vulnerability instead of leaning back and doing therapy to the client.   Easier said than done. Doing therapy can be disturbing and we rarely receive explicit training on what to do when we are struggling. When we find the courage to open up about our challenges in consultation, we might hear solutions, be given articles to read, or have our behaviors analyzed by the other clinician. Rarely do we hear, “Yeah, me too. As a matter of fact, about an hour ago.”

Thankfully, two third wave behavioral therapies (Functional Analytic Psychotherapy and Acceptance and Commitment Therapy) blend quite nicely and give us clear guidance on how to continue to move toward that vulnerable edge of growth.  With them, we can accept our own human urge to avoid distress and stay the course, especially when deep pain arises in the therapy.

Functional Analytic Psychotherapy (FAP)

Bob Kohlenberg and Mavis Tsai, at the University of Washington developed FAP. As behavior analysts, they noticed some clients improved much more than others.  They found that in sessions where the client experienced great change, the relationship was pivotal. FAP focuses on interpersonal flexibility.  The power of FAP is responding to our client’s behaviors moment-to-moment in session. To do this, we need to consider our clients in the context of their lives and their histories.  For example, consider a client with a pervasive and persistent pattern of complaining which affects his relationships. Telling us that they don’t like something about the therapy could be an instance of that unworkable behavior.  For another client, it might be a risky move toward intimacy.  FAP terms these ‘clinically relevant behaviors’ or CRB for short.

FAP gives a framework for how to be most effective with our clients through a set of rules or guidelines. When we follow FAP rules with our clients, we can find ourselves risking and challenging ourselves to engage in an honest and undefended way.

Here’s a simplified version of those rules:  Be aware, courageous and loving with our clients. Again, easier said than done.

Acceptance and Commitment Therapy (ACT)

ACT was developed by Steve Hayes at the University of Reno, and focuses on intrapersonal flexibility. Humans don’t like risk, so we need something to help us when we are in that shaky ambiguity of pushing our comfort zones.  ACT helps us find our ground as we engage in emotionally vulnerable ways with the people we serve.  As human beings with our own histories, it’s certain that we will have painful reactions in the therapy session.  Accepting this as normal, staying in the present moment with those reactions, touching into our values and taking action allows us to follow the FAP rules of engagement.   ACT helps us hold a stance of open curiosity, so that we can engage in the messy work of human intimacy.

Doing effective and meaningful work as a therapist is not easy. Thankfully, Steve Hayes, Bob Kohlenberg and Mavis Tsai have given us tools that provide a scaffold for us to create transformation with our clients.   I’m excited to share how you can get the most out of these two therapies and make your work more powerful.  We’ll be working in depth on blending these two powerful therapies and applying them to your most challenging clients.  Come join us.

 

Harnessing the Power of the Therapeutic Ralationship Using ACT & FAP

  • 2-day workshop led by Joanne Steinwachs, LCSW
  • March 4 – 5, 2016, from 8:30 am – 4:30 pm
  • sponsored by Portland Psychotherapy


Joanne Steinwachs LCSWJoanne Steinwachs LCSW is a social worker in private practice in Denver, CO. She is a peer reviewed ACT trainer and a recognized FAP trainer. To learn more about her training and therapy practice, go to www.joannesteinwachslcsw.com.

 

 

Creating a Peer-Led Acceptance and Commitment Therapy Consultation Group: The Portland Model

Creating a Peer-Led Acceptance and Commitment Therapy Consultation Group: The Portland Model

In 2005, the clinic directors (Jenna LeJeune, Ph.D. & Jason Luoma, Ph.D.) at Portland Psychotherapy helped found a peer-consultation group to provide a place for local therapists to learn and practice Acceptance and Commitment Therapy (ACT) and to build supportive community of like-minded practitioners.

The ACT peer consultation group underwent a number of iterations in the years that followed. It took several years for the group to find its feet, and there was process and evolution in creating a workable structure and set of roles to help guide the meetings.

Recently, several of us got together and wrote a paper describing the process of creating an ACT peer consultation group and the structure we created. We’d run some workshops demonstrating (e.g., role-playing) the model—we called “The Portland Model”—and found that clinicians around the world were very interested in learning how they could start their own ACT peer consultation group. After running some workshops, we agreed we were ready to write up our experiences in order to reach a larger audience. We each contributed a section of the paper, and I took on the role of editing and putting it all together.

And it’s finally available! The paper was published in a 2015 issue of the Journal for Contextual Behavioral Science (JCBS). If you’re a member of the Association of Contextual Behavioral Science (ACBS)—the core organization behind ACT—you can access and download the paper for free by logging into the ACBS website. Under the “Resources” tab, click on the “Journal for Contextual Behavioral Science” link. There is a list of issues. Our paper was published in “Volume 4 (2015) Issues 3-4.” The Science Direct link is here.

If you’d like to find out more about the Portland ACT peer consultation group, you can click on this page to find out about meeting times, as well as download copies of the mission statement, meeting structure, and a description of the roles.

The main point I’ve tried to emphasize to people in workshops is that our model is just one way of structuring the meetings—the most important thing is to have some sort of structure. Once you agree upon a structure, only then can you evaluate what is and is not working. Feel free to drop me a line if you’d like some consultation for how to get your own group started.

Article (Portland Psychotherapy authors bolded): Thompson, B. T., Luoma, J. B., Terry, C., LeJeune, J., Guinther, P., & Robb, H. (2015). Creating a Peer-Led Acceptance and Commitment Therapy Consultation Group: The Portland Model. Journal of Contextual Behavioral Science, 4(3), 144-150.

Brian Thompson Ph.D.

Author: Brian Thompson Ph.D.

Brian is a licensed psychologist and Director of the Portland Psychotherapy Anxiety Clinic. His specialties include generalized anxiety, OCD, hair pulling, and skin picking.

ACT for Social Anxiety – A Great Self-Help Book and Treasure Trove of Resources

ACT for Social Anxiety – A Great Self-Help Book and Treasure Trove of Resources

I’ll make a confession here: I’m a failure at bibliotherapy. By bibliotherapy, I mean assigning a self-help book to a client and following it along with the client in order to guide treatment. For clients who are interested in self-help resources, I’ll make recommendations for books that clients can read on their own as a complement to treatment, but I feel stifled at the idea of using the book to guide treatment.

The authors of Mindfulness and Acceptance Workbook for Social Anxiety & Shyness have made things much easier for therapists like me. The book is based on a group treatment for social anxiety that has been studied in two published research studies—an initial pilot followed by a randomized controlled trial.

On their website (www.actonsocialanxiety.com), the authors offer a downloadable treatment manual based on their book. The manual is an adaption of the group treatment manual they (Jan Fleming, MD and Nancy Kocovski, PhD) used in their research studies. It includes copies of the handouts, so you don’t have to press your book against the photocopier—which I find a bit of pain to do in the digital age.

If you visit the publisher page on the New Harbinger website and register, you can also download audio files of the exercises (e.g., mindfulness exercises) and a separate collection of the handouts.

I’ve not had a chance to use the book in therapy yet, but I’ve read through it and am very impressed with it. The book is engagingly written, includes interesting exercises, and is relatively concise (I prefer brevity in a self-help book).

For all these reasons, I highly recommend Mindfulness and Acceptance Workbook for Social Anxiety & Shyness. You can find additional resources at the authors’ website and on the publisher’s website (under the “Accessories” tab—but you must register). Check it out—it’s one of the better self-help books I’ve read and the resources the authors provide are extremely generous.

From Our Blog

UPCOMING TRAINING EVENTS