**3. The values-flow approach: the what and how of sustainable and creative engagement in psychotherapy**

As discussed above, the Values-Flow approach, aligned with the objectives of Flow 2.0, is to develop applied and sustainable engagement models of change informed by systems theory approaches [2, 30] - focusing on 'WHAT doing' and 'HOW doing', versus what and how to DO. Moreover, the methodology of the 'what doing' doing and 'how doing' modelled on Linehan's [2] approach to teaching mindful skills practice. A key facet of this applied approach to skills practice in psychotherapy is the continuous resolution of dialectical dilemmas inherent in daily life – the ceaseless harmonising of the challenges present in the context and skills available in the process of 'daily doing' that is creative and sustainable.

There are two core skill sets in Values-Flow that are equally shared within both the mindfulness and acceptance traditions of ACT and DBT and the Flow of Consciousness in clinical contexts [18]; 1) *Awareness, Focus and Action*, which are part of the ARIA skills [1, 10] and; 2) *Acceptance, Willingness, and Virtue*, as part of VIVA [1, 22]. We shall now review both the ARIA and VIVA skills in more detail – including the four 'what doing' skills (Attending, Reflecting, Informing, Acting; ARIA) and four 'how doing' skills (pursuing a life of virtue, being routinely involved in Flow activities, experiencing a sense of vital and accepting purpose; VIVA). Of note, these skills are listed on the Values-Flow Cards (see **Appendix 1**), which psychotherapy clients can complete and review in each session.

### **3.1 Awareness and focus**

The first set of skills to consider are awareness and focus, which are part of the ARIA skills, and are fundamental to both routine self-care and happiness practice [2]. These initial skills begin with being observant and descriptive of the dynamic nature of daily life, the routine presence and creative opportunities in routine situational contradictions, and the attentional and psychological skills needed to bring harmony of challenges and skills in daily situations of life. For example, this could involve observing the rhythm of moment-to-moment events during parent–child interactions, with the benefits of observing affective challenges of young children's emotional expression through the lens of opportunities to learn (and model) emotional processing.

These first set of skills follow the acceptance and mindfulness traditions [2–4], are the 'what doing' skills of Values-Flow, and are covered at the outset of contextual psychotherapy. They include developing the capacity to attend to, and be aware of, internal and external challenges by observing and describing them objectively, rather than subjective descriptions of the experience. That is, the Values-Flow approach focuses on the nexus between awareness of daily events and challenges and how to direct one's focus toward responding in structured ways – i.e. using one's ARIA skills. The individual is aiming to structure in adaptive and values-based ways in response to routine life challenges associated with values-based behaviours. Similar to values work in ACT, a core focus of Values-Flow is on the person's sense of meaning and purpose in their daily lives. However, Values Flow approach goes a step beyond by creating a clear structure to remain committed to values-based behaviours in daily life in ways that are creative, and contribute to happiness.

The awareness skills are not just on external challenges, such as busy working schedule or difficulties managing parenting responsibilities, but also the internal anxieties, boredom, and apathy that often occur in daily lives of psychotherapy clients. In short, most clients know that values-behaviour and psychotherapy homework practice is what they should do, but they often fail to follow through. Values-Flow supports them in the process of putting things into play in their everyday life. Being able to contain one's attentional and emotional experiences when they are distracted by previously learned unhelpful patterns of daily functioning is necessary when a new behaviour is being learned. For example, a working adult with severe anxiety may need to commit the ARIA acronym to their memory and their initial goal being only to be able to recall the acronym, without necessarily being able to apply it, in less challenging life situations. According to Values-Flow the first and foremost challenge in daily life of many clients is the ability to remember to use the skills learned in psychotherapy, and hence that is the primary goal of initial phases of Values-Flow. The reason for practicing Values-flow is recurrently highlighted and demonstrated in psychotherapy sessions and that it is possible to 'feel [and discover anew] a sense of exhilaration, a deep sense of enjoyment that is long cherished and that becomes a landmark in memory of what life should look like' ([1], p. 3), [27].

As suggested in **Figure 1**, the establishment of a 'ARIA container' is very similar to DBT and ACT in that when exposed to distressing events, people experience challenging situations, emotions, and information in observant and descriptive ways, rather than actively avoiding or attempting to suppress these experiences. This type of avoidant behaviour, whilst understandable, is the behaviour is targeted by the Values-Flow approach. Utilising the optimal transmission methods inherent in flow theory [9], the focus on experiencing challenges as they are in balanced by a focus on 'groove and rhythm' ([5], p. 80) inherent in previous Values-Flow experiences and life themes.

The Informing and Acting skills comprise the third and fourth 'what doing' skills – focusing on reframing daily challenging events from the 'creativity dialectics' lens and applying these in real time. Firstly, the process of apply verbal labels to current challenges, both internal and external, is essential for self-regulation and communicating with others [2]. Acknowledging and formulating the seemingly contradictory feelings and events clearly are the key initial actions that one takes in daily life in response to challenges they encounter. Secondly, the ability to reconnect with the memories and skills related to previous Value Flow themes in times of challenge can assist in fuelling the willingness to practice negotiating the relevant challenge the individual is facing. Both ACT and DBT help clients to 'observe and describe' challenging events, however provide inadequate structural detail in how to 'participate in [daily challenges] without self-consciousness' ([2], p. 284). For instance, by connecting to areas of current and past discovered life themes [27], the individual has a real-life experience to occasions when, despite the challenges they faced, they were able to exhibit adaptive problem solving, behaviours and flow experiences.

By merging of the Attending and Reflecting with Informing and Acting in the process of balancing the internal challenges of difficult emotions implies a willing participation with daily challenges – or engaging completely in the activities of the current moment, without separating oneself from ongoing events ([2], p. 148). In Values-Flow the process of values-based action is flexible and spontaneous, and the individual is responding to the challenges and demands of the task with awareness, the absence of self-consciousness, and with their full attention on the present challenges as they are. That is, the individual that can routinely apply the ARIA skills are setting the moment-to-moment structure for 'creativity dialectics' associated with the sustainable of values-based behaviour practice in daily life.

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

### **3.2 Core VIVA skills**

The next four skills have to do with the 'What Doing' in the Values-Flow approach – expanding the creativity dialectics and providing a compass for where to take ARIA skills over extended periods of time. They include pursuing a life of virtue (Virtue), being routinely involved in Flow activities (Involve), experiencing a sense of vital (Vital) and accepting (Accepting) purpose over the months and years of their lives.

The first VIVA, or 'what doing', skill is being *Virtuous*. This is a capacity to be true to, and take care of, oneself [6] and to balance the challenges of daily situation and the strengths that are employed. The routine use of character strengths is based on the 'preexisting capacity for a particular way of behaving, thinking, or feeling that is authentic and energizing to the user, and enables optimal functioning, development and performance' ([11], p. 9). Using the Values-Flow approach may enable the process of harnessing one's strengths in sustainable and creative ways, especially in challenging daily situations – a practice with rooted in age-old philosophical and ethical foundations [1, 2, 6]. Applying the skills learned in psychotherapy in routine challenges, especially in virtuously and with dialectical behaviours managing the 'empty spaces' of organising oneself [5] – putting virtues skills into play in daily life is the fundamental premise of Values-Flow.

The second VIVA, or 'what doing', is the *Involve* skill. Within Values-Flow, this involves the appreciation and practice of flow activity – a process which teaches routes of recurrent flow experiences. This is central to the Value-Flow approach, and the objective of Flow 2.0 in calling for more research and practice in applied mechanism of flow experiences. In the process of not only getting and understanding of flow experiences and pathways to their increased occurrence, it is just as important to have a 'groove and feel' of what they are. This requires an in-depth appreciation of the 'creativity dialectics' managing the process of building their therapy skills whilst also finding novel and interesting ways of challenging and refining them. From a Values-Flow perspective, focusing on enjoying the process of daily practice is what DBT calls 'playing the game' or 'doing what works' ([2], p. 147). In the process of 'using skillful means', the individual learns to enjoy being both responsible and irresponsible, depending on the context. It is indeed a known fact that eminently creative individuals routinely engage in 'serious play' ([10], p. 491). In the process of 'letting go' of the need to always be responsible, one can allow themselves to have opportunities for divergent mindsets.

The third VIVA, or 'what doing' skill, is the Vital skill. Values-Flow teaches the importance of taking care of one's physical and mental energy levels – ensuring that psychic energy levels stay at optimal levels over time. The notation of feeling energised by one's work requires that the individual understand that sustainable energy can only occur in the context of regular quietude. In order to sustain flow activity in ones' life in Values-Flow ways, the individual needs to sustain a sense of feeling energised by one's daily tasks. In order to sustain frequent flow experiences, one needs to ensure regular self-care practice, especially good sleep routines, and periods of rest and recharge throughout one's day.

In the Values-Flow approach, there is fundamental belief that working tirelessly for long hours in the context of enjoyment and meaning are possible, but only with equally valued times of rest and recharge. In seemingly contradictory ways, one must learn to harmoniously balance activity and rest – doing objective work in beautiful and inspirational settings and intense periods of work with naps, walks, bike rides, gardening, chopping wood' ([10], p. 489).

The fourth VIVA, or what doing skill is the Accepting skill. The 'Values-Flow approach suggests that in the process of emotion modulation skills are necessary during the process of optimal self-environment fit in daily lives in most adults' lives. When engaged in intense and meaningful work experiences, individuals show they can engage in their work tirelessly for long hours and enjoyed their profession for the opportunities for optimal experience over the status and financial benefit it provides [1, 7–10]. When asked, apart from spending time with family, the tasks work associated with flow experiences are rated as the happiest times in their lives [23]. Developing skills to be at once serious and playful [10] in daily life, resulting in subjective happiness arising from putting psychotherapy skills into practice, largely based on an ongoing sense of acceptance and a feeling that one is being true to one's values. In many ways psychotherapy skills practice takes on a 'spiritual' dimension and becomes an ethical transformation of the self ([5], p. 207]).

### **4. The values-flow approach to homework completion**

To bring this to life, we consider a case example. A client attends psychotherapy for Post-Traumatic Stress Disorder (PTSD) diagnosis, having had previous experiences of completing acceptance and mindfulness therapies. However, whilst their more intense psychiatric symptoms have largely been stabilised, their difficulties have continued. One way of conceptualising the problems is that the patient may know 'what to do' but experiences challenges getting to the root of what is valuable in their life and the how of doing values work'. Despite knowing the various DBT or ACT skills like how to defuse from their thoughts, how to increase physical activation and skilful participation, and engaging in self-care, the key aspects of vital engagement have not been activated. As alluded to before, the soil in which all of their mindfulness and acceptance are embedded is Values-Flow – within which all psychotherapy skills are planted in and flow out to every other part therapy skills and daily challenges. What is needed is needed is both ARIA and VIVA skills that comprise the Values-Flow approach that will provide the 'why, 'what' and 'how' of sustainable engagement in values-based behaviour on a daily basis.

The Values-Flow approach is the key foundation to sustainable flow experiences – the soil – where all the nutrients and everything connects all living aspects together in valuable ways. That is, this approach connects all psychological skills development from DBT and ACT with the creative expression and use of these skills in daily life. We shall now go through the 3 facets the Values Flow approach – the why doing, how doing, and what doing – of our PTSD client. We also note the use of the Values-Flow Card (see **Appendix 1**) which facilitates structured learning, review and practice of ARIA and VIVA skills.

### **4.1 'Why doing' homework discussion**

At the outset of psychotherapy, the value of practice outside of session and homework of skills covered in psychotherapy time should be discussed. The Values-Flow approach to practice is discussed as a process that should be immersive, and have a structure related to human creativity and enjoyment. The Values-Flow Card should be introduced as something that the therapist and client spend time at the start and end of each session discussing and reviewing; highlighting that practice is both valuable in itself and that Values-Flow comes from practice. Incorporating a balance of both playfulness and discipline to homework review and discussion between therapist and clients is a crucial aspect of the Values-Flow approach.

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

The definition of the terms of such as life theme discovery and character strengths use within Virtue section of VIVA are introduced and have specific practice activities which are specified (e.g., for Character strengths use, the first activity is for the individual to complete the free online Character strengths questionnaire, and to examine the challenges and opportunities related to using them in their daily life throughout the week). Being clear about the importance of homework completion and outside of session practice is further established by questions and troubleshooting considerations such as: Do you have any questions about the homework?; Can you see any barriers to that?; How will your work requirements impact your ability to complete the homework practice?, How will you make time for homework when your kids need's often come first?; Can we pre-empt some of these situations prior to our session ending today?

Some key considerations about how to shape the review and homework completion can be undertaken as follows. At the outset of every session, return to the Values-Flow Card and the review of which is done with an interested and encouraging demeanour from the therapist. If the client attempts to speak about other things other than homework completion, this can be briefly acknowledged as something that would be given ample attention, but then redirect the conversation to the priority of 'how did you go with your Values-Flow card, what worked, and what didn't? The therapists approach is to celebrate what was completed, even if this is incomplete or if the homework was only thought about. At the same time, their focus is on shaping skills to overcome the barriers that are observed. Statements such as 'this is wonderful that you started, so proud of you completing that part of the Values-Flow card' are balanced by the shaping and focusing behavior towards desired completion of goals that wasn't achieved. The tasks that were not completed are worked on the Values-Flow card are worked through with trouble shooting – statements like 'something happened to get in the way, I'm really curious, I'm really interested, and this is not a criticism, but I am really wondering what things got the way'.

There are a diverse challenges which clients encounter relating to homework completion. For instance, the client may have attempted the exercise set for them once and they did not find any enjoyment in doing it. In that case we take an accepting approach and inquire, 'ok how did you do it exactly, what was hard, what was getting in the way'? Another frequent consideration from the therapist is that clients often exhibit magical thinking relating to value of homework exercise, perceiving that the exercises set for them would make an immediate and extraordinary difference in their lives. The primary message to the therapist is the need to spend time clarifying the challenges related to completing the Values-Flow Card and specifying a support structure and skill set to matching these challenges.

### **4.2 In-session modelling of overcoming challenges to homework completion**

What and how attention focused on the completion of the Values-Flow card should be discussed on a weekly basis in psychotherapy sessions. Apart from shaping behaviour, the process of intense focus and creativity of troubleshooting the challenges of practice signals to patients the value of to pay attention of what they did not do. As suggested above, what is completed is celebrated at one instance and in another should include questions like 'something got you undone here, something got in the way, what was it, let's have a look together' are put forward to the client. There should be review of what is not done is done with interest and compassion. Be mindful of body language, facial expression and tone of voice to indicate 'how wonderful it was they completed their homework and how happy you are' whilst also directing the focus toward 'what happened in what did not get

done, something did not happen here and I'm very, very curious, I'm very interested to know what was there?" You may also offer common examples for why homework does not get completed such as: children were crying; there was no money and they had to work extra shifts; the person felt a bit despondent; by the end of the week they got very tired and felt like everything was too much; or the person overused substances.

In Values-Flow the therapist looks at the challenges associated with homework and practice with an attitude and position of curiosity and interest rather than 'this was good and this was bad'. Black and white thinking is not going to encourage people to learn the value of homework completion, let alone help them enjoy balancing challenges with their skills. Rather, by acknowledging the challenges and opportunities that are there, it can guide the client toward a better way of being that is more attuned to their values and best interests.

It is absolutely crucial to work with the parts of the homework that is not done without the view of not furthering their past themes of being punished or shamed. Therapists need to recognise that it is very easy to induce a shame response within client. The aim of Values-Flow is to not engage in criticism that they got from school, parents, or coaches. The process of reviewing Values-Flow homework is a modelling of Accepting skills that are part of VIVA; bringing in an appreciation that life is full of barriers that get in the way of our best intentions.

Sometimes the therapist must practice acceptance skills in session by working on finding out if there was an intention to do the homework that wasn't completed. Practicing Acceptance skills in session provide essential feedback about whether the person 'thought about doing the homework' and/or 'did you feel that it was important?' Understanding the value-system underpinning both intention to, and the behaviour of, homework completion is crucial to the Values-Flow approach. It is through this process that the therapist can understand the transmission of information related to 'the value of doing homework in my daily life'.

Over time, the aim is to develop a collaboration between therapist and client around what is exactly being requested from them in the Value-Flow Card, the 'why are they doing it' and the 'how of accepting of challenges associated with using skills in daily life. As they get become increasingly immersed and understand Values-Flow, there's a deeper understanding of 'What Doing' and 'How doing' of homework.

Simply assigning homework often does not translate into a person's life, primarily because the usual patterns of behaviour take over and carry on life until the next appointment. The use of the Values-Flow Card within sessions models to the client what 'radical acceptance' [12] looks like in relation to daily challenges; radically accepting both the challenges that are liked and manageable and those that are not liked. The key lesson is that accepting 'liking and disliking' as part of Values-Flow is a way to better manage daily challenges and taking them on with an open heart, which ultimately guide the client toward healing and a better way of life.

## **5. Conclusion: The 'what' of values-flow: how to take care of yourself**

The process of accumulating positive experience is like collecting coins over time. The Values-Flow approach aims at helping that process of accumulation by keeping the individual within the creative window as often as possible in daily life. That means that when something difficult happens there is a cushion of accumulated good experiences. These are important because they help us to better tolerate periods in daily life and when energy and enthusiasm become depleted by challenging situation that 'get under our

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

skin'. Hence, the Values-Flow approach is about working on accumulation of positive experiences and paying intense attention to 'good stuff in life'. This might be having a playfulness demeanour that mirrors children playing and being funny. It could be expending the physical energy playing ball in a playful and lighthearted way. It could being mindful and intensely interested in the clouds in the sky for instance. Or any other number of options of building heartfelt positivity into everyday life [31].

At it's core, the collecting positive experiences in Values-Flow is an act of self-care [32]. Practicing collecting the good in your life and being absorbed in these things is crucial to that process – rather than always being too busy solving the challenges all the time. Coming to appreciate that solving the problems of daily life are done more effectively after time and energy is invested collecting positive experiences is fundamental to Values-Flow approach. The challenges that individuals are faced with in daily life are important. However, collecting positive experiences, or moments of happiness, before these challenges are addressed is not running away from them, but rather making space to taking care of oneself and creating a cushion from the hardships associated with them.
