Contextual Behavior Modalities for Therapy – Defining Morals, Values & Ideals
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In contextual behavior modalities like acceptance and commitment therapy (ACT), clients learn to identify and commit to their most salient values.
In ACT, values are generally presented as your internal compass—that which moves you toward what’s most important to you. For LGBTQ+ clients seeking to affirm their sexual and gender identity, value-congruent action plans can help solidify a deep sense of self, while also shifting away from transactional and outcome-oriented goals defined by success or failure.
While there are many parts of a client’s self-actualization process that are certainly outcome-oriented, larger life goals such as self-acceptance, self-affirmation, and self-love are not finish lines or races to be one. They are ongoing, ever-evolving processes, which is why values are presented as active verbs and not concrete nouns.
However, much of the literature about value-congruent behavior often presents values as a given tenet, as if what it means to be good or true to oneself is apparent to every client. When exploring personal values with LGBTQ+ clients, it’s important that mental health practitioners do not project their own values onto the client, yet it’s also important not to take the conceptualization of values for granted.
Clients who are beginning to actively affirm their sexuality and gender identity sometimes contend with cognitive dissonance. After all, what happens if multiple things are important to the client, but they’re completely contradictory? What happens when a client doesn’t know if something is important to them, or because they were told it was “supposed to be” important? What happens when a client knows what is good for them, but still feels bad about breaking an internalized rule?
To help clients make sense of their own internal compass, and to navigate the various forces that may push and pull at their conscience, it can be quite beneficial to differentiate between a moral, a value, and an ideal. For some people, morals, values, and ideals are practically synonymous, yet for others, they may clash, generating frustration, confusion, and indecision.
It doesn’t help that morals, values, and ideals all use the same language. Acceptance, for example, can be a moral, a value, or an ideal, yet each frames acceptance and how to actualize it in a different way.
Furthermore, to add yet another layer of confusion, a client’s most salient moral, most salient value, and most salient ideal may also differ. So, when you ask a client what’s most important to them, they may find themselves torn, not knowing which way to go. For example, their morals may say that family is most important, but their values may say that self-acceptance is most important, and their ideals may say that success is most important.
So let’s break down the difference to address the heavy scales LGBTQ+ clients often balance.
What is a (Social) Moral?
A social moral is a culturally agreed-upon principle defining what it means to be good, bad, righteous, or sinful. In English, social morals are often talked about as lessons, like when children are asked: “What’s the moral of the story?”
Since they’re extrinsic, a person’s social morals derive from their culture, society, community, religion, or family. Challenging the assumption of normality, social morals aren’t universal. Subsequently, social morals can be political and patriotic, religious and scriptural, or rooted in the common-sense proverbs handed down from generation to generation.
When social morals pertain to sexuality and gender, they reinforce sexuality and gender norms. Those who exhibit sexuality and gender norms are praised, whereas those who deviate may literally be called “deviants.”
For many LGBTQ+ individuals, this can present an existential dilemma. If the social morality in which they were raised rejects them for their sexuality or gender identity, they may feel like they have to hide who they are to not only belong to their culture, society, community, religion or family, but to remain “good.”
When a client breaks from a social moral, they may feel a sense of guilt or shame with an external directional focus. They may, for example, seem preoccupied with fears of social consequence and worry extensively about what other people will say or do. Their concerns of being alienated, disowned, or excommunicated can be heartbreaking on an emotional level, and bewildering on an ethical one.
The dark side of social emotions may be seen in their body language, too. They may avert their eyes, impulsively hide their expression, or place a hand on their face—their hide response fully engaged. They may even state that they have a strong desire to sequester themselves or lock themselves in the closet to avoid being seen or judged by others.
It’s important to observe and affirm the positive intent in their seemingly avoidant behavior. There is a difference, after all, between wanting to hide because one feels judged, and wanting to hide because of a deep desire to “do right by others” coupled with the deepfelt concern that they may somehow fail in the attempt. Internalized shame is often reinforced by a desire to be praised, to fit in, to be included, or at the very least, a desire not to be singled out or set apart.
When a client adheres to the social morals of their culture, their process remains within that framework. Their guilt may seek atonement. Their shame may seek belonging. This may or may not be achievable or sustainable, depending on the community in question. For many LGBTQ+ clients, their offense against social morality is often their very existence. This presents a therapeutic crossroad—a choice that can only be made by the client—to maintain or reject the social construct of “good.”
Now, it is possible for some clients to make peace with their social morality. Consider clients who were raised in a particular religion and were able to find a more accepting congregation. In this example, the social morality is maintained, but amended or expanded upon to accept, affirm, and empower their sexuality or gender identity.
Yet others may need to break from these preconceived constructs, entirely. To break from one’s upbringing means not only questioning themselves but also questioning everything that was “supposed to be important.” Massive concepts like love, family, justice, faith, loyalty, dignity, acceptance, and honor may need to be re-examined and redefined.
As a client expands their community, they begin to encounter diverse cultures with moral constructs different from those they grew up with. Common sense, it turns out, is not so common. In the West, the “squeaky wheel gets the grease,” but in the East, “the nail that stands up gets hammered down.” The emphasis on independence vs. collectivism, hierarchy vs. egalitarianism, and transactional relationships vs. transformational relationships differ from social group to social group. This means a client may encounter even more communities whose social morals they may or may not align with.
What are (Personal) Values?
Personal values are intrinsic. They derive from one’s personal life experience and inherent sense of self. When a client’s personal values align with their social morals, they may experience a deep sense of belonging, as what they feel to be important is also mirrored in the culture around them.
However, anyone who has ever felt like “the misfit,” “the outcast,” or “the black sheep of the family,” knows what it’s like to have principles that differ from the presiding code of ethics.
As LGBTQ+ clients explore their identity and begin to articulate what’s most important to them, they may question both the definition of certain values and their priority. Consider the phrase “family values.” Obviously, there are many diverse family structures with different sets of caregivers, siblings, birth order, living arrangements, extended family, families of origin, families of choice, and so on.
Yet there’s even more diversity to a family than their genogram. Even if a family accepts a client’s sexuality or gender identity, conflict can still arise when everyone shares a value, but has a different definition of that value. Hypothetically, a client’s family of origin may say that family is supposed to embody loyalty, obedience, and honor, whereas the client’s personal values may define family as an embodiment of acceptance, trust, and mutual respect.
Differences in value priority are also quite common, in which case a client may be told that they’re supposed to find something important, but they don’t. One of the most classic examples of this is when values of artistry and self-expression clash with expectations of industry and career.
While everyone determines what’s most important to them in due course, LGBTQ+ clients often find themselves on the road less traveled, either because of social exclusion, socioeconomic status, or because they do not see themselves in a heteronormative society. Miller et al. developed the Personal Values Card Sort, consisting of a deck of one hundred values clients can prioritize for themselves. For more on how to apply this exercise to LGBTQ+ clients, see Contextual Behavior Therapy for Sexual and Gender Minority Clients by Matthew Skinta, PhD.
It can also help to pay attention to a client’s use of language, since “I should” statements and “I’m supposed to” statements tend to reflect expectations that the client may have internalized. By mindfully drawing their awareness to the present moment, clients can identify what their needs are, and subsequently which values are being called to action to meet those needs.
When a client goes against their own personal values, they often feel like they’ve wronged themselves. Value-incongruent behavior “doesn’t feel right,” which is why clients may present as restless or unsettled. Though they may be concerned about what other people think on some level, their community standing is secondary to their conscience. Their drive to make amends, resolve the situation, or do better stems from intrinsic self-correction, so they can look themselves in the eye.
While internal conflicts between social morals and personal values can be very confusing, clients can also be torn between a personal value and another personal value. Since LGBTQ+ clients often have to balance their physical, emotional, and psychological well-being in hostile social environments, they may find that their survival values, like safety and self-preservation, obstruct their self-actualization values, like authenticity and honesty. Instead of pitting their needs against each other, or forcing their values to compete, contextual behavior modalities present a unified path to help clients brainstorm how best to maintain their safety as they affirm and empower who they are. This, of course, looks different in each case, since some clients may need to remove themselves from a hostile environment or improve the environment through social change efforts.
It must be said that values are not lofty virtues. Not every LGBTQ+ client aspires to be heroically courageous, altruistically forgiving, or an outgoing advocate, though more power to them if they do. Sometimes a client may value privacy, safety, comfort, or humility.
Value congruence is highly individual, and it requires deep self-reflection to be very real about what’s actually important to them in the here and now.
What are (Aspirational) Ideals?
An aspirational ideal is the epitome of what a client desires. There’s nothing wrong with having aspirations, and many LGBTQ+ clients aspire to many wonderful things, from starting their own careers to starting their own families to going through gender-affirmative treatment.
However, unlike social morals and personal values that exist in the present, ideals have a certain level of unreality to them. They’re a dream of what could be. Even the phrase “they’re being idealistic” connotates that one is being less grounded and more in their head, or less realistic and more perfectionistic. The reason for this is that ideals tend to be future-focused or based on a provisional reality. They spotlight what a client wants to do, say, or be once a certain milestone is achieved, or once certain conditions are in place. Hence the statement: “Ideally, I would be able to____.”
Ideals can be based on both extrinsic social morals and intrinsic personal values, yet they take both to the next level and tend to be unsustainable. If a social moral reflects what a client’s community taught them was important, then a social ideal reflects how they would be if they followed this standard to the letter, or how utopian society would be if there were no extraneous factors.
In turn, if a personal value reflects what’s most important to the client, then a personal ideal reflects a version of them that is better in some way than who or what they are now. This creates a conundrum, as the more a client grows, the more their potential grows, and so they chase an idealistic version of themselves up an endless staircase.
This comparison to an always better version of events, performances, or even self-identity can often be very deflating, as it favors outcome over effort. Idealistic mindsets can sometimes contribute to a persistent sense of disappointment in oneself or others. Even if a client is doing well, in their mind, they could “still do better.”
Idealistic mindsets can also revert to all-or-nothing thinking, oscillating between a high standard and completely rejecting that standard. To quote the late comedian George Carlin, “Scratch any cynic, and you will find a disappointed idealist.”
Conclusion: Contextual Behavior Modalities in Therapy
In session, there are several exercises and techniques that contextual behavior therapists can employ to help clients explore their social morals, personal values, and aspirational ideals.
In ACT for Gender Identity: The Comprehensive Guide, by Alex Stitt, LMHC, gender-questioning and gender-diverse clients organize a list of descriptions into what I am (values), what society wants me to be (morals), and what I aspire to be (ideals). The “Bulls Eye Worksheet” by Tobias Lundgren, PhD can also help clients clarify and commit to their personal values.
Structured exercises of this kind can help take seemingly large, philosophical constructs and lay them out in both a visual and pragmatic way. That said, combining these techniques with an affirmative therapy model is vital, as clients need to be able to explore, question, re-examine, redefine, identify, and empower what is most important to them.
Alex Stitt, LMHC
Writer & Contributing ExpertAlex Stitt is a nonbinary author, queer theorist, and licensed mental health counselor living in Hawaii. As a proud Queer Counselor, they work to educate professionals in the mental health field interested in working with LGBTQ+ populations. Their textbook, ACT for Gender Identity: The Comprehensive Guide, demonstrates how to apply Acceptance and Commitment Therapy to gender self-actualization.