"To hold values is to commit our lives to their pursuit"
(Bruner, 1990)
From even our earliest days, we value participation through our want to survive, with our first set of values having their roots in our biological needs; even before we can communicate in a spoken/signed language, we communicate through behaviour and sound to seek security, to feel safe, comfortable and to ease our boredom. Over the course of our development, our values are shaped, enhanced and reinforced by our environment, social influences and culture. The culture that we are immersed in as a child teaching us our beliefs; what our community see as right and wrong, what is important, where we should focus our commitment, how we should act and what we should aspire to be and/or achieve. This in turn, shapes what we consider to be important and what occupations become meaningful to us and therefore, dictating how we prioritise our time, what aspects of performance become important to us and thus, forming how much effort we feel that we should attribute to each of our occupations.
Our values provide more than a set of rules on how to live, they give meaning and a coherence to our life and are a way of defining what matters to us; these personal convictions will be strongly held and influence our sense of self worth. If we are unable to live our life in line with our values, we will feel incongruent and can experience shame, guilt, failure and/or, inadequacy. For example; a Jehovah‘s Witness experiencing difficulties with their mental health, someone passionate about living off grid and with a self sufficient lifestyle, having to move due to a physical disability significantly impacting their function or, someone who is expected to exceed beyond expectations academically, struggling with mainstream education due to a processing disorder.
Our values also bind us to action and as occupational therapists, we must consider the powerful emotions that values evoke in ourselves; a sense of importance, security, worthiness, belonging and purpose. They influence the sense of worth that we obtain from participation and the sense of obligation and/or level of commitment we attribute to our chosen and essential occupations. Our end goal, is to feel competent at doing the things we value and in turn, we tend to enjoy more the things that at which we are accomplished and tend to feel bad when we cannot do the things that we deeply care about.
And finally, our values are not set in stone. They can be challenged by new experiences, exposure to new cultures, education (informal or formal) and age. For example, as we reach retirement and older age, it is common for our value set to shift and change; old age is often met with some form of loss in our capacity and with it a reduction in our personal causation, coupled with the shift in focus from the importance of paid employment, other values such as family, community and leisure become more significant to fill this gap.
So, why is understanding a person's values so important to us as occupational therapists? When we work with people, in order to encourage and promote change, we need to know and understand what motivates them, and why they do what they choose to do. We need to know why these patterns have developed, where these activities take place and with whom and why all these factors are important to the person. When we form a therapeutic relationship with someone, we become part of their social environment and therefore, we should enact interventions that correspond to and support (when safe to do so) that person's values (de la Heras de Pablo et al., 2019). When we work with someone, wether they have low volition or not, we should always consider the complex and interconnected relationship that performance and values have. Those who experience a disability, be it physical or and/or mental health related, often find themselves in conflict with their culture and mainstream values, which often leads to feelings of marginalisation, low self esteem, reduced sense of worth and failure. Values can also encourage an individual to commit to impossible ideals (Fein, 1990) and therefore, drive people towards suboptimal choices or, result in people striving after certain values in the belief that their lives will not be fulfilled if they are not realised. Take, for an example, a teenager chasing after his parent's ideal of following in his father's footsteps as a lawyer and taking over the family firm. He becomes overwhelmed by the demands of the coursework and exams, this results in him becoming withdrawn and isolated and subsequently depressed. Or, someone chasing a promotion at work yet, their progressive condition (Multiple Sclerosis/Parkinson's/Huntington's etc) means that increasingly, they are unable to meet the demands of their job even with appropriate adjustments. By learning more about our patient's and their unique volitional characteristics (i.e., what they value, they find meaningful and also, what does not matter to them, what they enjoy and do not enjoy, and when he/she feels capable or incapable) we can be more strategic in working with the client to enhance performance.
References:
Bruner, J. (1990) Acts of meaning. Cambridge, MA: Harvard University Press
de las Heras de Pablo, C. G., Llerena, V., and Kielhofner, G. (2019) The Remotivational Process: Progressive Intervention for People who Experience Severe Volitional Change version 2.0. Chicago, Illinois: MOHO Clearinghouse
Fein, M. L. (1990) Role Change: A resocialisation perspective. New York: Praeger
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