Our values come into play whenever we’re working with our fellow humans. There are values used in both MI (Motivational Interviewing) and ACT (Acceptance and Commitment Therapy). Many of these values overlap and align.
Here, we dive into those alignments and how the two therapeutic approaches can blend and complement each other.
Understanding Acceptance and Commitment Therapy (ACT)
MI and ACT are both dynamic therapeutic approaches. Motivational Interviewing helps empower clients toward behavior change by exploring and resolving ambivalence. ACT is a form of psychotherapy that focuses on accepting the things we cannot change (things out of our personal control) and taking action to enrich our lives.
Both approaches are useful for social workers, therapists, and mental health specialists who may be working with clients in education, law enforcement, those with substance use disorders, or mental health concerns like depression or anxiety disorder. An ACT therapist or ACT practitioner uses the approach to express empathy and help clients find different ways to view their current situation. Sometimes, the idea of change is daunting, but we can reach positive outcomes by taking it in steps, especially when those steps are aligned with our personal values.
It’s clear how the two approaches blend together and how Motivational Interviewers could use ACT values and approaches to enhance the effectiveness of their discussions.
In ACT, therapists encourage their clients to accept feelings, unhelpful thoughts, and emotions rather than fighting them or feeling guilty about them. Instead, they help clients view them as a natural part of humanity and help clients use their feelings as internal motivation, making them active participants in their healing.
ACT therapy is based on six processes:
- Acceptance
- Cognitive defusion techniques
- Being present
- Self as context
- Values
- Committed action
Both MI and ACT focus on values as a tool to help folks identify and clarify their priorities so they can take action and set goals aligned with those values and priorities.
The Integration of ACT Values in MI
In both therapeutic approaches, listening is key. Therapy is a collaborative relationship. The first step when tuning into served persons is to actively listen for implicitly or explicitly stated values. When you hear a value, ask for more about it—encourage people to share, identify, and voice their values.
One of the fundamentals of MI is to help folks identify the discrepancies between their behaviors and broader life goals or values. For example, if a person values being an engaged parent for their children but is struggling with substance abuse, recognition of the discrepancy supports them in moving toward evoking change talk.
Sometimes, people aren’t entirely sure how to “name” their values or elaborate on them. We often hear, “I don’t know how to describe it.”
Pro tip: Service providers need to get in touch with their own values and how to share them. If we as providers don’t get a chance to identify and discuss our values, we likely have less skill and insight to help others talk about their values. It’s in the sharing and voicing that values become concrete and clear, and the recognition of discrepancies surfaces within the person.
By incorporating ACT values into MI sessions, clients have a greater vocabulary to articulate and explore discrepancies. The more we can reflect and understand the impact of values, the more inspired we become to embrace and realize positive change.
Practical Applications of ACT Values in MI
So, what are the practical steps for integrating ACT values into MI?
- Listen for Values: The first step (always and every time!) is to listen to your clients as they share about their lives and themselves. People often tell us what’s important to them, even if it’s implied rather than explicitly stated. As practitioners, we can learn to tune our ears to pick out values as they are shared and then, in a very organic and conversational manner, ask the served person to elaborate on those values.
- Inviting More Discussion: Once a value is identified (whether implied or specific), we can open the door to invite them to discuss it further. MI techniques include asking open-ended questions, encouraging elaboration, and helping draw out and identify discrepancies.
- Exploring Concerns: If discussing discrepancies doesn’t come naturally to the value vs. behavior conversation, then exploring the concerns of others can often get us there. For example, a client may say, “My wife has been on me about my drinking,” and the practitioner could then ask them to describe those concerns that the spouse mentioned. In MI, we term this approach “asking about others’ concerns.” This is one method of supporting a person to internally connect with the discrepancy. This could be a wife, doctor, dentist, other family members, friends, etc. Whomever the person positively values can be a gateway to developing discrepancy.
- Summarizing and Reflection: Once we’ve heard about their values and the discrepancies, we want to summarize it back. For example, we may say, “Your son is really important to you. You want to be part of his life and be more present. You love your son and want him to know that you want to support him, get out, and play with him. Tell me about how drinking supports that.” To be clear, this is very much a right-moment approach. We have to have the right amount of rapport/engagement with the served person and have a sense the person is ready to hear it. Moreover, we have to be absolutely in a place of acceptance. Any snark, hint of judgment, or twitch of an eyebrow can quickly lead us away from engagement and into discord. Be mindful when using this particular path to develop discrepancy.
That said, in asking about the connection between unhealthy behavior and their values, we can help people identify and understand the discrepancies. This client-centered approach helps people find their own reasons to take steps toward personal growth and positive change.
Addressing External Blame and Facilitating Internal Reflection
We may hear clients blame external factors and outside people for their problems. This is a natural reaction and defense mechanism. It requires us as MI practitioners to help clients move beyond the blame and empower themselves to focus on how they have control of their values and, thus, behaviors.
It’s important to recognize that MI isn’t a Jedi mind trick or a manipulation. It’s real, genuine, organic conversation. It requires time and rapport. Trust comes through empathy, and we may need to empathize with our clients’ sustained talk (resistance to change). The skills of MI are built on the collaborative approach to helping people identify their own intrinsic motivation and values.
If they keep blaming others, we can help gently guide them toward self-reflection. In the example of the client who blames their spouse for nagging them about drinking, we might say, “Your wife seems to be really on your back about drinking. What do you make of that?”
This approach helps the client consider their perspective on the issue rather than staying focused on only the external pressures.
In MI, we focus on compassionate accountability—observing in an accepting and compassionate way. It’s not compassionate to continue allowing someone to do something harmful to themselves and others.
Often, developing discrepancy takes time. It isn’t a place we get to right away. Sometimes, people just need to vent to get to the place where they realize the impact of their behavior. Using a compassionate accountability approach, we might say something like, “I need to make an observation, and I’m not sure what you’ll make of this. I’ve noticed you have a lot of energy towards your wife and how she feels about drinking. I’m curious, though, what do YOU think about your drinking? We can’t do anything about your wife’s perceptions—we aren’t with her here, but what are your thoughts about drinking in regards to your own personal values?”
This can help bring the conversation back to the impact on themselves and others in a more curious and open manner. We’re reflecting back the information they’ve shared. Reflecting is favored for effectiveness in therapy because reflection helps people feel heard and safe. People don’t always listen to themselves when they’re talking. When it’s mirrored back to them, they often hear it differently and gain more perspective.
Using Values Sort Cards
When working with children, those with cognitive challenges, neurodivergent folks, and others needing assistance articulating, value sort cards can be a helpful tool. The cards are essentially the list in card form.
Values sort cards are a practical tool for integrating ACT values in MI. On each card, there’s a value. We give the client the deck and have them sort through the cards, identifying their most important values.
From there, they can sort the values by importance, prioritizing them and viewing them in a tangible way. It can be easier for people than following prompts or needing to come up with something from scratch. The activity can make the abstract concept more concrete.
The Connection Between Values and MI
Integration of values into MI isn’t a theoretical exercise or concept. It’s a practical and essential component of an effective therapeutic approach. Helping clients identify, articulate, and reflect on their values deepens their sense of self-awareness and helps them find more motivation for positive change.
A values-based approach aligns with the principles of both approaches—MI and ACT. As practitioners, we want to emphasize acceptance, compassion, and a commitment to positive action.
We create a motivating and supportive environment by actively listening for values and inviting clients to discuss them and explore discrepancies. Tools like values lists and values sort cards can offer guidance and help us “brainstorm” ideas with our clients together. This can lead them toward value-based action to address personal challenges.
Share Collaborative’s Experience
We like to walk the talk of what we share here. These personal check-ins from us are intended to demonstrate that in real time.
We have five MINT Members on our team. While we are all unique artists in how we teach MI, we have a common structure for sharing. In our Initial Skills MI Training, in the very first session, we move through a series of brief conversations. We begin by going to the listening gym, where we invite participants in pairs just to listen.
Then we move onto a values conversation where we invite learners to respond with the OARS to keep the person talking about their values. From there, we dive into developing discrepancies and identify them as a primary way that 40+ years of science, our own direct experience, and the direct experience of other practitioners show that MI works. We simplify the concept of discrepancy by defining it as a collision. The served person has a positive and healthy value that is in collision with an unhealthy behavior. This results in a more organic rather than technique-y approach, which our learners really appreciate. This is especially true of the nonclinical providers (case managers, youth mentors, employment specialists, teachers, and on) whom we often teach MI.
If you’re looking for more ideas on enhancing your MI approach and therapeutic practice, we offer explorations, discussions, and trainings that can help. Reach out today to learn more about how we can help facilitate the next steps on your journey.