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Values Clarification in CBT

Often people who have suffered with significant anxiety have lost track of what they really value. They are caught up in doing what anxiety or OCD says they must or must not do every day, and avoiding the things that trigger them while suffering terribly most of the time. If you are a therapist working with anxious clients, this is a familiar picture.

It’s important to remember this because part of getting well involves remembering or often finding for the first time the things the anxiety sufferer values. These values may be very far from what they are doing when they are living a small life bound by anxiety.

For example, I think of a 14-year-old with OCD and depression. When we began working together she was consumed by self-doubt and bullied by kids at school. She was like a walking target for the bullies because she was so easily upset. After we had worked for a few months on behavioral activation for the depression and exposures involving tolerating uncertainty and purposely messing things up or doing things wrong for the OCD, I asked her about her values. She mostly could see who she wasn’t, which was she wasn’t her older sister who she thought was perfect. This gave us a great opportunity for a homework assignment gathering evidence about her older sister, and of course she surprised herself by recognizing that her sister was not perfect! She was wonderful, but not perfect.

I asked her again about her own values – she answered more easily that she valued friendships; being genuine with people; being athletic; and her family. I asked her to make a collage for homework and bring it to a session showing me her values, and she brought in a wonderful keepsake poster filled with her own smiling face being a great friend, athlete, and family member. She wasn’t perfect in those photos – her hair might be messed up, she might miss a goal, but she was genuinely herself. Depression and OCD no longer kept her from what was important to her.

When we finished our work together, I asked her if she felt she was over-all better than she had been when the problem with OCD and depression began. She answered that she was, because she was more resilient, knew her own mind better, and knew that she could be brave. Here mother and I cheered – she is now a strong young woman, ready for the adventures, twists and turns that come with a life well lived.

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