Patient values in therapy

Many people often want to reduce or get rid of certain ‘bad’ habits: playing video games, watching TV shows, smoking cannabis. Alternatively, they want to increase ‘good habits’: going to the gym, taking walks, meditation.

However, despite these intentions, change is often difficult – even in therapy. The reason is because all habits offer some level of ‘value’ to a person’s life. If a habit didn’t do anything at all for you, you would probably be able to change it pretty easily.  

Consequently, exploring patient values – ‘life-concepts’ that are personally meaningful to the patient – is an important part of therapy. Values can include a number of different factors and a few commons ones are family, health, activity, and work.

Patient values help drive innate motivation to make changes and acts as a guiding star to determine areas to work on in treatment.

As therapists, we can tell a person what to do; however, the chances are unlikely for a treatment to be successful unless the motivation to change comes from within. Otherwise, the patient may not adhere to treatment work, or they may stop regular practice once therapy is over.

Why values are important in therapy

It is important explore a patient’s values in treatment to ensure that the work that is being conducted closely aligns with their values. This type of work is called motivational interviewing and it is a skill that is often used in therapy to resolve ambivalence about treatment.

For example, a person in insomnia treatment may want to optimize their sleep in order to fall asleep quicker. However, the way to do that in cognitive behavioural therapy is increase pressure to sleep by reducing the amount of time spent awake in bed and regularize the bed/rise times. For some people, they realize they really value their time cozying up in the morning with their partner or sleeping in on the weekends.

These behaviours are incompatible with falling asleep quicker – the patient now is presented a choice based on their values. That is, which is more important – falling asleep quicker or keeping their current sleep habits.

To resolve the ambivalence, the therapist can ask a series of questions to get a sense of their values and allow the patient to come to a conclusion about whether treatment is worth it in a sense.

If the patient decides that optimizing sleep at this time is more important, then they will have resolved ambivalence about treatment and will be more likely to fully commit to the trials and tribulations ahead of them.

How do I bring up values with patients?

There are a few ways to elicit a discussion on values with a patient. One way is by asking a patient in the first session or so: “Why is it important for you to make this change?”.

By asking this question, the patient consciously reflects on the reasons why they are putting themselves through the trouble of coming to therapy. If a person was trying to stop smoking, perhaps reasons they would have might be that their smoking is leading to more coughing, more arguments with loved ones, and that it is costing too much money. In this case, the specific life-concepts or values would be good health, positive social relationships, and financial security.

In some cases, resolving ambivalence about treatment could be directly comparing the pros and cons of making a change or not using a cost-benefit analysis.

In this case, the therapist can work with a patient to determine the pros and cons of making a change or staying the same when it comes to their smoking habits. By directing comparing reasons to stay the same vs reasons to change, the patient can have an explicit document that clearly lays out these values in front of them. Then they can decide on a path that’s right for them based on these values.

An example of discussing values in therapy

Below, I provide an example of using values to support resolving of ambivalence with a patient for depression

Therapist: So, I hear that breaking past your low mood and living a more active is important to you. Can you tell me why it’s important to make a change for you?

Patient: Well, I feel like it’s the right thing to do. Plus, my friends and family are always telling me to get out of bed and do more in my life.

Therapist: It sounds like a big part of the reason you are trying to make a change is because of external pressure, is that right?

Patient: Yeah

Therapist: For me, I find that when reasons to change come from others, it’s sometimes met with resistance because it doesn’t come from ourselves. Do you ever find that?

Patient: Definitely. I wish they would get off my back sometimes. I’m feeling really low, and it doesn’t help that they always bug me about being more active.

Therapist: Exactly right. That’s why I am more interested in your own thoughts about whether change is necessary. Are there any reasons you want be more active for yourself?

Patient: Well, I’ve found that my depression hasn’t really gotten better. Being more active would help with my depression.

Therapist: Great, it sounds like feeling better is something that is important to you. Why is important for you to break past your depression despite how tough it is to even get out of your bed in the morning?

Patient: If I was able to cure my depression, I could spend more time on my hobbies, like painting and cooking, and I would be able to spend more time with friends.

Therapist: Engaging your passions and spending time with friends and family are important to you.

Patient: Yeah. I think being more active would also allow me to better enjoy life.

Therapist: How so?

Patient: Well, I’d be more fit so I could go travel and spend more time outdoors. I would also be able to take care of my kids if I have them in the future.

Therapist: I see. Being more active is a means towards and end – a more fulfilling life and a way to take care of loved ones.

Patient: Yes, exactly.

Therapist: I think this was really helpful in understanding why it’s important for you to make a change. That being said, working to be more active when you’re depressed can be a tough hill to climb because it goes against everything our body and mind is telling us to do. Our body and mind is valuing rest because it is comfortable. Do you think that reminding yourself of these values will support you when your depressing is telling you to rest?

Patient: I know it’ll be tough. But it is important to break free from my depression to live the life that I want. And these things are very important to me.


As you saw in the example, the person’s initial discussion of the reason to change was based on pressure from others, which can lead to resistance and discomfort in therapy.

By directing reasons to change to the patient’s values instead, we were able to come up with innate reasons to engage in therapy despite the fact that making these changes will be tough in the short-term. Clarifying patient values can be a great way to resolve ambivalence about treatment.

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Best wishes,