**Abstract**

Flow - enjoyed and fully absorbed engagement in meaningful and contextually bounded activities - is widely underutilised in psychotherapy and mental health settings. Two gold standard therapies, Acceptance and Commitment Therapy (ACT) and Dialectical Behaviour Therapy (DBT), while powerful and effective in many ways, would benefit from systematic models that move from initiating positive change to sustaining meaningful change. This chapter introduces 'Values-Flow' – an approach aimed at building commitment and sustainable engagement in psychotherapy and values-based behaviour in working adults struggling with sub-optimal functioning. We first introduce Values-Flow and describe how it may benefit psychotherapy skills practice in everyday life. Next, we discuss why Values-Flow is relevant and enhances the practice of ACT and DBT strategies, helping to sustain engagement and creative practice of values-based actions outside of sessions. We then describe the 'Values-Flow' framework, which incorporates VIVA (Virtue, Involve, Vital, Accepting) and ARIA (Attend, Reflect, Inform, Act) tools that develop commitment for values-based practice in daily life. We conclude with a case-example of how Values-Flow can build commitment and sustainable engagement in homework completion in psychotherapy.

**Keywords:** psychotherapy, flow experience, dialectical behaviour therapy, acceptance and commitment therapy, values-based behaviour

## **1. Introduction**

More than anything else, individuals entering psychotherapy seek to be happy – commonly reaching out for help after a prolonged period of struggling with thoughts that the bulk of their lives have been wasted with efforts to attain happiness via, among other external means, money, power or prestige. Many eagerly enter the therapist's room carrying a sense of futility with their long-term struggles and seem ready to face the fundamental truth of psychological treatment – accepting that happiness and a life of value needs to be prepared for, practiced, and depends

largely on how the challenges of daily living are negotiated within themselves [1–4]. Thus, often the first, (though often not explicitly stated) goal of psychotherapy is to develop an attractive redescription of 'happiness' [5, 6] as an individually resounding appreciation that happiness is a 'circuitous path' [taken] when one is fully involved with every detail of their lives whether good or bad' ([1], p. 2). The current chapter offers a possible way in which sustainable happiness in psychotherapy can be achieved via the psychoeducation and daily psychotherapy skills practice based on the theory and research of flow experiences – a 'leading activity-based theory of happiness, often traced back to the philosophical arguments of Aristotle ([7], p. 10), [8, 9].

We outline both processes and mechanisms that, when integrated with standard clinical psychology approaches, have the potential to sustain positive change within a psychosocial context. The focus is on monitoring and enhancing the experiential – especially optimal experiences of enjoyed absorption – during the process of practicing psychotherapy skills and values-based behaviour. We argue that this focus on understanding the use of attention of the individual is one of the most valuable ways of sustaining 'cognitive flexibility throughout [daily] life and [being] better able to navigate a path of life long learning' ([10], p. 465). Thus, the attainment of happiness – or the improvement of the quality of experience in values-based activity practice – is in many ways the 'ultimate goal' of psychotherapy and the 'bottom line of existence' ([7], p. 376).

### **1.1 'Creativity dialectics' in happiness practice**

As will be elaborated further throughout the chapter, we outline a vision and techniques of sustainable happiness practice via the overriding goal of increasing creative patterns of dialectical behaviour among psychotherapy patients [2, 9]. A dialectical world view has been described to patients as an 'attitude that one can develop…in order to have a direct relationship between one's thought and one's life' ([6], p. 205). Furthermore, the aim is to help patients build a 'psychological complexity…in the person that enable him or her to continually negotiate, and renegotiate, an optimally rewarding self-environment fit' ([9], p. 482). Rooted in the ancient philosophies of Aristotle's 'golden mean' [11] and Hadot's and Foucault's 'spiritual exercises and the [creative] transformation of the self by the self, but also entails a more general configuration of power, knowledge and the techniques of the self ' ([6], p. 207).

We conceive of the term *creativity dialectics* as dialectical behaviours that 'actually manifest by real [and eminent] person's…who were successful on a cultural stage... [and are] modelling optimal developmental trajectories' ([10], p. 484). The role of the therapist in this sense is arguably to help the patient redescribe, via optimal experiences, what it means to be happy, creative, and valuable. Via what Hatch [5] suggests is a pragmatic/hermeneutic process of redescription of happiness, the therapist must include active-interactive demonstrations and actions exemplifying creativity dialectics in the challenges of everyday life, rather than simply psychoeducation of what needs to be happier. A noteworthy point here is that the role of the therapist is to actively re-define terms like 'self-care', which has been widely overused and is frequently meaningless (if not shame inducing) [2], via frequent and interesting discussions of the value of virtuous practice and the ancient lineage and dialectical philosophies of the self-care practice [1, 2, 6]. In doing so, the practice of sustaining happiness, creativity, and values-based behaviour becomes a 'way of being of individuals and realize the whole modification of their whole personality' ([6], p. 207).

### **1.2 Values-flow in practicing a happy, creative, and valuable daily life**

Values-Flow refers to the 'what', 'why', and the 'how' of sustainable values-based behaviour. Mihaly Csikszentmihalyi, the originator of Flow [1] and a co-founder of the popular field of positive psychology [8, 12] is said to have taken a handful of his graduate students to a ranch where they stood together in the open landscape watching Mihaly's dog, Cedric, engrossed in a game of fetch with his owner. Several minutes later, Mihaly announced to the group, 'See even Cedric understands Flow's balance of challenge and skill' ([13], p. 7). The ongoing interaction in the challenges of daily life in ways which are skilful, enjoyable, and build one's valued-behaviour, exemplified in Cedric and Mihaly's symbiosis, is a fundamental tenant of Values-Flow - living a life of value in sustainable and creative ways.

Having passed away at the age of 87 in October 2021, Mihaly left a legacy of nearly a half century of research and collaboration on diverse topics related to emerging positive psychological science [8], including but not limited to creative personhood [10, 14], vital engagement [14, 15] and flow experiences [1, 7–10]. Also called optimal experience, Flow provides an experiential perspective on human development that represents a 'coordinated operation of stabilizing and broadening uses of attention' and is 'genetically based and transcultural' ([10], p. 469). Through the daily practice of self-regulation of these cognitive and affective capabilities, individuals are able to achieve vital engagement*,* which is 'an absorbing and meaningful relationship between self and the world, [which] can be found any sphere of life' ([10], p. 5). Through the 'ability to select, or help others select, a course of action that is optimal for survival and [psychological] growth in insight in regard to relevant life processes' ([15], p. 491), the individual establishes a creative way of routinely manage the challenges of daily life. In this chapter we argue that central to not only psychotherapy, but also to everyday functioning are skills that identify, sustain, and creatively develop values-behaviours in daily life.

In 1990, Csikszentmihalyi argued that; "The tools that make flow possible are common property, and [should be] knowledge recorded in books available to schools and libraries" ([1], p. 127). Yet despite his vast academic achievements, it seems that Mihaly wondered why his work had not, through his graduate students, achieved more prominence in the lives of everyday people [13]. Through the daily absorbed attention and joyful application of cultural information [16, 17], flow experiences represent primarily optimal attentional states that contribute to happiness and a life well-lived [1, 7, 8, 10]. In the realm of psychotherapy, evidence suggests that the use of flow in clinical and psychotherapy settings can assist in symptom reduction and rehabilitation as well as enhancing wellbeing and a life of value [18]. With the exception of Riva et al. (2014), who discussed how flow concepts could assist in psychodynamic therapy approaches, the flow concept has not been effectively translated into everyday lives of working adults, and even less has been incorporated into typical contextual cognitive behavioural therapies including Dialectical Behavioural Therapy (DBT; 2) and Acceptance and Commitment Therapy (ACT; 3, 4).

We suggest that traditional attempts to apply flow among working adults, which we call Flow 1.0, have prescribed the benefits of optimal transmission of cultural information for everyday survival and the 'what' and 'how' of structuring optimal attention and experience [10]. This information remains highly valid, particularly as contemporary society makes it harder to focus attention in daily life. In many ways, Flow 1.0 efforts have been static and rigid translations of Flow theory, lacking the transforming impact for typical working adults – especially individuals of various

socio-economic and cultural backgrounds seeking the assistance of psychotherapy tools. That is, applications of flow have focused on the prominence of theoretical translations rather than using practice-based evidence frameworks from established psychotherapy traditions. Similarly, DBT, as a domain with a strong evidence base and applied focus, has faced similar 'information transfer' challenges [2]. We hence argue that ACT and DBT approaches are best positioned to bring flow to life to the everyday person seeking psychological assistance, with or without psychological dysfunction.

The Values-Flow approach represents the integration of clinical psychology practices – as specified by acceptance and mindfulness approaches [2–4] – with flow and creativity theory [1, 10, 16, 17]. In this chapter, we propose the flow tools that may encourage flexible and values-based application in clinical psychology skills, especially values-based behaviour practices during psychotherapy. Just like any service that is provided to the general public, therapists often struggle to engage the 'full self" of the (working) adult attending psychotherapy, especially outside of therapeutic sessions. The aim of the Values-Flow approach is to focus on sustainable engagement and creativity within the process of psychotherapy skills practice, especially as it relates to between session practices [2, 10]. Moreover, when the individual presents with clinical level symptoms, moments of Values-Flow, which we discuss below, may expand on what is meaningfully and practically possible in terms of psychotherapy skills application. We hence introduce Flow 2.0, which is an attempt to push past the generic prescriptions of what and how of the flow zone by bridging what's known with sustainably applicable in terms of flow theory amidst daily challenges.

## **2. The importance of values-flow**

The Values-Flow approach integrates flow and creativity theory to expand the reach of standard contextual psychotherapy skills. Recent studies show that up to 50% of therapy clients do not show clinically significant change. One possible reason is that less than 1 in 4 therapists are setting homework in systemic ways [19] – failing to set the conditions for sustainable engagement and creativity in everyday homework practice [20]. Ignjatovic, Kern, and Oades [21, 22] investigated a population sample of Australian teachers – an occupation with high levels of stress nationally and internationally – to investigate the dynamics of sustainable engagement over months and years. Instead of examining the mechanics of pathology and weakness, the objective was to understand the mechanics of sustainable flow experiences in challenging settings. Despite being a profession of great stress, there were seemingly contradictory findings that flow in educational personnel occurred at a rate of 3 times the general population of working adults [23]. Additionally, Ignjatovic et al. [21] showed that school staff were periodically using personal strengths to experience flow in their work, even amidst the routine challenges of everyday life. Ignjatovic et al. [22] subsequently provided evidence of a processes of vital engagement in working adults over a three-year period, showing that sustainable engagement in values-based behaviour of character strengths use, daily vitality, and acceptance. These works offer promising research foundations to Valuesflow- or sustainable engagement and creativity in values-based skills practice inside and outside of psychotherapy, which we build upon in this chapter.

Working adults comprise one of the most important subsection of every society. Even as working adults have a significant impact on economic and socio-cultural aspects, they are increasingly exhibiting frequent, intense, and symptoms of

### *Values-Flow in Contextual Psychotherapy: The 'What', 'Why', and 'How' of Sustainable… DOI: http://dx.doi.org/10.5772/intechopen.106594*

depression [24] insomnia [25] and post-traumatic stress [26], among other psychiatric conditions. Third wave psychotherapies, including DBT [2] and ACT [3, 4], are among the evidence-based treatment for both ill-health and psychological symptoms management as well as developing a life of value. However, despite the effectiveness of these psychological treatments, Hayes suggested that when it comes to commitment-based aspects of ACT 'the hard work [has been] elsewhere' ([3], p. 310). Hayes further suggested that a more detailed functional structure is needed to fill the 'content vacuum' in bringing values work into the realm of sustainable behaviour change ([3], p. 311). In treating therapy interfering behaviours (especially lack of commitment to therapy skills practice), Linehan argued that 'behaviour therapists have given 'little empirical attention to the treatment of behaviours that interfere with therapy' ([2], p. 21). Currently, the 'response functions' within daily challenges and stressors of executing the skills of psychotherapy are not well specified and are left up to 'the creativity of therapist and the spontaneous comments [and/or actions] of the client' ([3], p. 311), arguably perpetuating low rates of continued practice of skills learned early in psychotherapy [19, 20].

If it is indeed the case that creativity and flexibility is required within psychotherapy execution, then it makes sense to establish clear components for 'creative response functions' [3, 10] that can be 'extracted, from the sociocultural milieu' ([27], p. 47) surrounding the patient, therapist, and the psychotherapy process. To fuel human development, this chapter aims to further specify the patterns of symbolic interactions that allow a person to use cultural models for building a creative personal history [16, 17, 27]. We introduce the Values-Flow approach as the soil from which the goals and skills-based therapy practice grows and rises from. Much like fertile soil from which all living things must grow, Values-based behaviours –a commitment to 'live in accordance with what they care most deeply about' ([28], p. 245) – are what connect everything together and through which all else flows out from.

Moreover, the specific mechanisms and processes underpinning the optimal development of values over time are currently not well understood [29, 30]. We argue that the studies by Ignjatovic et al. [21, 22] on flow and vital engagement provide promising frameworks for establishing the mechanisms and processes of the Values-Flow approach in psychotherapy with working adults. Because the focus is on establishing the structural and developmental conditions of creative and adaptive behaviour [10], Values-Flow in psychotherapy may guide both therapist and clients in the sustainable engagement in psychotherapy and homework practice [2, 4].

To illustrate the mechanisms and processes of Values-flow in vitally engaging psychotherapy skills practice, we first contextualise our discussion within the concepts self-regulation, creativity dialectics, the VIVA (Vital, Involve, Virtue, Accepting, VIVA) or the ARIA (Attending, Reflecting, Informing and Actualising) models, before turning to how these processes might guide sustainable engagement in psychotherapy treatment.

### **2.1 Working adults'optimal development: the potential of self-regulation**

A major premise of both DBT and ACT is that gaps in skills related to emotional and cognitive regulation systems are key contributors to the dysfunctional behaviours and interactions that occur within social and cultural experiences. For instance, 'invalidating environments' in childhood fail to teach skills related to label and regulating arousal, tolerating emotional distress, and trusting emotional responses as reflections of valid interpretations of everyday events ([12], p. 42), which lead to

ongoing dysfunction in adulthood [6]. Biosocial theories suggest that personality, human development, and self-regulation of one's experience have important roles to play in healthy development. Similarly, Rathunde and Csikszentmihaly argued that flow theory is a 'development [that] unfolds in time and is emergent phenomena… unfolding and provides a holistic level of integration between biology, person, and the cultural environment' ([6], p. 471). Unlike both Hayes' [11] and Linehan's [12] perspectives, Csikszentmihalyi and Rathunde focus on the descriptions of how competent and highly creative persons 'continually negotiate, and renegotiate, an optimally re-warding self-environment fit'([6], p. 482). The Values-Flow approach integrates these perspectives and provides an applied approach to ongoing selfregulation in optimal and sustainable ways, as illustrated in **Figure 1**.

**Figure 1** illustrates that the variability of emotional regulation in daily practice of creative functioning using Values-Flow skills – specifically focussing on the sustainable flow experience centre. According to the creativity window, the capacity to sustain flow experiences results from an 'active-interactive' participation with challenging daily contexts via the 'negotiating a better fit or synchrony of self with environment' ([10], p. 481). In doing so the individual is said to possess the affective, cognitive, and behavioural skills to observe, describe, and participate in creative ways even during periods of higher (hyperarousal) or lower (hypoarousal) arousal. The ARIA skills (discussed below) are 'containers' of the variations of hyper or hypo arousal during efforts to sustain creative skills practice. However, the VIVA skills (discussed below) act as the re-entering process to values-based behaviour in sustainable ways.

### **2.2 Creativity dialectics practice in working adults**

Csikszentmihalyi suggested that creativity occurs 'when a person makes a change in a domain, a change that will be transmitted through time' ([17], p. 115). Whilst creativity is often viewed as an individual trait, it is the interactions of people with their culture and social groups – indicating the biopsychosocial nature of ongoing flow experiences. From the Creativity in Later Life study of eminent creators and innovators [16, 17], the daily practice of finding flow experiences was a recurrent theme. Although Csikszentmihalyi [16] cautioned that achieving creativity exhibited *Values-Flow in Contextual Psychotherapy: The 'What', 'Why', and 'How' of Sustainable… DOI: http://dx.doi.org/10.5772/intechopen.106594*

by notable examples required extended periods of time and great access to the rules of extant domains, he nonetheless provided suggestions on how creativity processes could be encouraged in everyday people seeking to lead a more creative life.

In this chapter, we term 'creativity dialectics' to denote the 'polarities that reveal the capacity for finding optimal experiences through a process of differentiation and integration' ([10], p. 484). Sustainable engagement in creative practice involves several components. As illustrated in **Figure 2**, creative dialectics first require the ability to either 1) respond to 'new challenges with skills building rather than a retreat to familiar methods that alleviate anxiety without transforming the problem that it creates', or 2) responds to the conditions of monotonous ease and comfort by finding challenge that focuses attention in a transformative direction ([10], p. 473). Secondly, as per Linehan, there is a focus on the dialectics associating with human functioning – 'or a reconciliation of opposites and continual process of synthesis' ([2]. p. 19). Thirdly, infusing contextual psychotherapy with a focus on the creative developmental histories that are part of the individuals discovered life themes and flow activity [27] of flow activity. Of note is Csikszentmihalyi's clear delineation between flow experiences – or forms of enjoyable experiences of immersion – and the function of flow activity – or 'sequences of action that make it easy for people to achieve optimal experiences' ([7], p. 31).

**Figure 2** illustrates the eight polarities of sustained flow activity and experience, or the application of the mechanisms and processes of Values-Flow approach to psychotherapy – i.e., the ARIA and VIVA skills. We argue that the most fundamental dialectic is the necessity of accepting the challenges just as they are within the context of trying to change them with the developing skills [10] – namely the active balance of skill building and challenge finding (and accepting). This is similar to Linehan's central dialectic of acceptance and change which is the 'moment-to-moment changes in the use of supportive acceptance versus confrontation and chance strategies'

**Figure 2.** *Creativity dialectics.*

([2], p. 19). The term 'creativity dialectics' suggests the ability to 'instigate development by flexibly working at the edges of order and novelty, without letting one or the other dominate' ([10], p. 482). In other words, creativity dialectics help to educate psychotherapy clients of the pathways to attaining optimal self-regulation, and thereby more memorable moments of happiness, in the process of balancing the periods of both order and novelty in their daily lives.

We shall briefly review the dialectical dimensions of 'psychological complexity' as they provide a basis for further elaboration of the Values Flow approach to psychotherapy.


*Values-Flow in Contextual Psychotherapy: The 'What', 'Why', and 'How' of Sustainable… DOI: http://dx.doi.org/10.5772/intechopen.106594*
