BUILDING POSITIVE EXPERIENCES AND A LIFE WORTH LIVING: WORKING WITH NEEDS, VALUES AND GOALS

Maslow’s “hierarchy of needs” (Maslow 1943) has been hugely influential in the field of psychology and motivation. Maslow proposed that people are motivated to achieve certain needs and that some needs take precedence over others. When a need deficit has been “more or less” satisfied it will fade in salience, and we then focus on meeting the next set of needs that we have yet to satisfy. These then become our salient needs. Initially it was thought that individuals must satisfy lower-level deficit needs before progressing on to meet higher-level growth needs. Maslow later clarified that not everyone will move through the hierarchy in a unidirectional manner but may move back and forth between different needs. Maslow explained that growth needs stem more from a desire to grow as a person than a lack of something. Growth needs continue to be felt and may even become more salient once they have been engaged with. Maslow noted that the order of needs might vary based on external circumstances or individual differences. For example, he notes that for some individuals, the need for self-esteem is more important than the need for love. For an artist, the need for creative fulfilment may supersede even the most basic needs. Maslow (1987) also pointed out that most behaviour has multiple motivations and noted that “any behaviour tends to be determined by several or all of the basic needs simultaneously rather than by only one of them” (p. 71) (Figure 3.2).

Maslow's hierarchy of needs (1943)

Figure 3.2 Maslow's hierarchy of needs (1943).

Maslow continued to refine his theory based on the concept of a hierarchy of needs over several decades.

In summary

  • • Human beings are motivated by a hierarchy of needs.
  • • Needs are organised in a hierarchy in which more basic needs must be more or less met (rather than all or none) prior to higher needs.
  • • The order of needs is not rigid but may be flexible, based on external circumstances or individual differences.
  • • Most behaviour is multi-motivated, that is, simultaneously determined by more than one basic need.

Needs are also central in the practice of non-violent communication (NVC) (Rosenberg 2001). NVC proposes that all behaviour stems from attempts to meet universal human needs. Further, it proposes that everything we do is in service of our needs. According to NVC, there are seven universal needs - for connection, physical well-being, honesty, meaning, play, peace and autonomy. NVC is based on the following assumptions:

  • • All human beings share the same needs.
  • • All actions are attempts to meet needs.
  • • Emotions tell us whether our needs are met or unmet.
  • • People resort to violence or behaviour harmful to others only when they cannot use more effective strategies to meet their needs.

The aim of NVC is to observe our feelings, identify our needs or values and make skilful requests.

Identifying needs and wants when working with people with mental health problems and/or suicidal thinking is important. Poor mental health is associated with social deprivation and real unmet needs. The concept of “unmet needs” is also central in a cognitive analytic therapy formulation (Ryle 1994).

For example, we all have a need for safety. People whose living situation is unsafe (such as those exposed to domestic violence) are highly likely to be anxious and distressed. However, they may have become habituated to their situation so disconnected from their need for safety and the cost of not having their need for safety for met. Domestic violence is associated with a raised risk of suicide. Addressing and prioritising the person’s need for safety will be critical and an important aim of any SFI with someone currently experiencing domestic violence.

However, there are problems with the “needs” agenda and psychological approaches have shifted their emphasis in the third wave “revolution” within psychological therapies. Third wave therapies prioritise the holistic promotion of psychological and behavioural processes associated with health and well-being over the reduction or elimination of psychological and emotional symptoms. They target the process of thoughts rather than their content, using tools such as mindfulness and acceptance. Third wave therapies also place more emphasis on values (Harris 2009,2019). Unmet needs can be validated but not necessarily filled. Reinforcing the sense that I will be happier or more fulfilled if I get more of something may be part of the problem rather than part of the solution. We can become “attached” to or fuse with our needs. Let me share one example which can illustrate the difference between connecting to values rather than needs. During the early months of COVID-19 lockdown we were all unable to touch each other than those in our immediate household. Touch is definitely a basic human need. What I noticed after three months was that what I missed more was sharing food with others. So perhaps that is more closely aligned to a value than need, the value of sharing and giving. Being connected to values and acting in line with values is also important to one’s mental health. Rather than thinking needs and values are different, they are, of course, closely related; sharing food may be an important way of meeting a need for social connection and could meet that need more deeply than simply talking. See https://www.kindful.com.au/blog/2016/2/27/needs- and-values for an exploration of needs and values. In summary, I would suggest that high-priority needs for housing (shelter) and safety should be addressed with an SFI, but lower-priority needs may be better addressed by working with values.

Connecting to our values helps us to do what matters with clear intention, motivation and committed action. Values are like a compass that keep us heading in a desired direction and are distinct from goals. Goals are the specific ways you intend to carry out your values. A goal is something that we aim for and check off once we have accomplished it. Goals can be achieved, whereas values are desired qualities of behaviour: what a person finds to be important; who we want to be in the world; what sort of employee, manager, co-worker, friend or partner we want to be. In this moment now, I can be curious, but I can never achieve “curious”. When we act in line with our values, we never reach our destination; there is always something more we can do. Values are qualities we choose freely. As soon as we start to feel we have to follow a value, it loses its vitality. It stops being a value and starts to be a rule.

Exploring values can be very helpful. When we understand our values, we can gain a better understanding of our goals and what we want from life, the type of person we want to be and how we want to behave. It helps to align our goals with our values, so the things we are trying to achieve are things that really matter to us, that are important and give us meaning. Clarifying someone’s values is important and will help you set therapeutic goals that really matter to that person (Vyskocilova et al 2015). For example, there is considerable evidence that behavioural activation (BA) improves mood (Veale 2008), but increasing activity which is also in line with values will bring more meaning, purpose and motivation than just being more active. Veale gives the example of using BA with someone who identifies one of their key values is to be a good parent. We may then suggest a goal (such as spending a specified time each day playing, reading or talking with their child) in line with that value.

Zhang et al (2018) propose “individuals improve maintenance of longterm health behaviour change through committed acts in the service of chosen values, while acknowledging and accepting the existence of contrary thoughts, rules and emotions as part of themselves but not determinant of their behaviours”. Zhang et al recommend researchers and practitioners design health behaviour change interventions in accordance with ACT (Hayes et al 1999; Harris 2009,2019). ACT promotes wide accessibility of tools and resources to support this approach such as

https://thehappinesstrap.com/upimages/Long_Bull%27s_Eye_

Worksheet.pdf.

Working with values includes:

  • 1. Helping the client identify their own personal values.
  • 2. Exploring how their current choices or actions are in line with their values or not.
  • 3. Choosing goals consistent with values and setting goals from a place of being more connected to one’s values.
  • 4. Noticing how and when the client is acting in line with their values or not and reflecting on this with them.

See https://www.psychpoint.com/mental-health/worksheets/values-self- exploration/.

The aim of goal-setting is to build positive experiences (mastery and pleasure) and a life worth living. Goals may arise when we are co-writing someone’s safety plan. Initially the safety plan should include actions which the person has a good chance of carrying out and will confer likely immediate benefits. However, each area covered in the safety plan (see p...) can also generate longer-term goals. Positive goal-setting (shaping new skilful behaviours) is more likely to motivate us and be effective than goals which aim to reduce unwanted behaviours (such as thinking about, planning, rehearsing or attempting suicide). It is widely held that goals in life generally and health care in particular should be “SMART”, i.e. Specific, Measurable, Attainable, Relevant and Timely. However, with goals in mind (and SMART goals in particular), clinicians may push to specify a goal or to propose specific goals too quickly rather than support the client to articulate their own goals and reasons for change. Goals are much more likely to be followed through if the person identifies and articulates their own goal. Remember you want to elicit change talk.

Use open-ended questions such as Take a moment to think about how things might be different.

What’s important to you here f How would you like to be? If it is a goal you have proposed (such as means reduction), ask if the person would be willing to do that.

See https://www.youtube.com/watch?v=mxJtBkHOJgI.

See Kennedy and Pearson (2020) for how to incorporate CBT with third wave approaches.

 
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