CLARIFICATION OF VALUES IN COUNSELLING AND PSYCHOTHERAPY W.E. Mickleburgh
When an individual acts contrary to personal values, then there is dissonance, with consequences of guilt, anxiety, despair, or alienation. If unresolved and of sufficient strength these feelings may manifest in mental illness. Thus, clarification of values and resolution of value conflict are relevant to counselling and psychotherapy. A framework for the systematic examination of values in therapy is described. Values are classified as personal, social, environmental and sensate. In therapy, goals may be matched for congruence between personal values and overt behaviour. Processes which erode values and ways to maintain integrity of personal value systems are considered. Australian and New Zealand Journal of Psychiatry 1992; 26:391-398 It was twenty years ago that a teacher of English came to me, greatly troubled. Many of the essays and poems of his students showed widespread despair and hopelessness. A typical example was the poem: Don’t turn tny eyes I ’ n i only hlirid Face fear Lost wwider spelt Mistracvd. niisfuced Civmhled in teui’s Your lowg funtustic flight Hus drawin me here I sw’ear I ’ m lost. Surely this was an eloquent cry for vision and direction from a troubled fourth year high school boy. At about that time another boy at the school committed suicide. Nothing much has changed since then, and for many people life has no clear meaning or significance. They have no compelling answers to the questions: “What kind of person am I? What am I for and against? Where
am I going and why? Who cares and does it matter anyway?” Many of these people seek help for mental health problems. But beneath the surface we often find a sense of existential despair. The meaning of existence is derived from relationships formed with the self, other people, nature and the universe. These relationships are woven in terms of bonds, feelings and values. So, meaning has to make sense within a system of values. To form a purpose in life, to earn self-respect, to relate satisfactorily to family, friends, and the larger world, one’s value system must be clear. Only then can one judge actions in terms of their wisdom, justice, courage, moderation, whether or not they uphold the respect of the self and others, whether they cause pleasure or pain, or are harmful, whether they are creative or destructive. These issues of values and meanings form important components of the dynamic processes of mental functioning, and so are integral to mental health. It is for this reason that values clarification is a necessary part of counselling and psychotherapy.
9 Beauchamp Street, Deakin, ACT, 2600 W.E. Mickleburgh BSc, MBChB. DPM. FRCPsych, FRANZCP
When an object or a sentiment is prized and esteemed it is said to possess positive value. Each human
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being develops a system of such values which becomes a personal code of principles and standards of conduct. Values direct andgovern a person’s attitudes, preferences and life goals. They are characteristic of the individual and tend to be stable and enduring. They are the product of thinking, feeling and striving. Through thought there is judgement of the quality of an issue, the relative worth and the preferred choice. A value judgement evokes feelings of goodness or badness, well-being or shame. Also, there is a requiredness about value behaviour, a sense of “ought” which gives impetus towards valued goals. Values have the property of polarity so that for each value there is a corresponding opposite, with a continuum between the extremities of each pole, as, for example, truth is opposed to falsehood, or kindness to cruelty. Another characteristic of values is that they are hierarchical and ranked in an order of importance or worth which may be influenced by the circumstances of each particular situation. Values relate to the whole gamut of human experience: personal, social, environmental, aesthetic, philosophical.
The evolution of values in the species The faculty for valuing has accompanied man’s evolutionary progress. Human behaviour has evolved through processes of selection and survival to serve the purpose of increasingly efficient adaptation to the environment. These processes have physical, mental and social components. In the mental domain there have emerged philosophical and social propensities which are uniquely human and which have proved to be highly adaptive. This has accompanied the increased growth of brain cortex, particularly in the prefrontal regions which has permitted more complex storage and integration of information and controlled inhibition of behaviour .where appropriate, so that primitive protective responses can be delayed. Plans of action and their consequences can be rehearsed in imagination, and suitable choices made. To a greater extent than other species, humans have developed the faculties of feeling and knowing, but one unique attribute has been the development of language, which has allowed communication of thoughts and feelings in word symbols. This has enabled elaboration of more complex modes of thought, and the perception of the thoughts and feelings of others. Through the processes of “imitation, suggestion, and thus the formation of an ego ideal” [ 11,
one appreciates oneself as an individual being and learns to analyse the causes and effects of one’s own behaviour on others. The consciousness of the needs and feelings of other people gives rise to reciprocity in one’s dealings with others, and it is this reciprocity which is the foundation on which humans have built their ethical systems. From one’s relationships with oneself, one’s family and the world at large, one adopts a personally acceptable code of meanings and values. These are reached after a process of searching and self exploration. The values not only have to be acceptable but examined and incorporated and that produces the stuff of conscience. Mukerjee [ 2 ] considers that this code of values, when established and assimilated into belief, faith, conscience and morality, provides an adaptive advantage because it is flexible, communicable and transmissible for the human species. It becomes a powerful adaptive mechanism for social living, and forms the basis for civilisation.
Individual development of values Conventional wisdom held that conscience was an inborn characteristic of the child. The ability to know right from wrong was thought to be present at birth. However, this assumption is now known to have been mistaken. Although an infant at birth has the potential for moral development, both inner purposive activity of the mind and social influences shape the individual pattern of values [ I ] . Kant made a distinction between two kinds of moral response. He coined the term heteronomy for the moral constraints imposed through rules and laws by external authorities, and autonomy for the discipline and limits, freely chosen, which arise from within. Piaget [ 3J recognised these two processes as successive stages in the moral development of the child, and identified the dominance of the heteronomous period of obedience until the age of seven or eight years followed by the autonomous stage, with emphasis on responsibility and fairness, developing from the age of eight to twelve years. Piaget’s seminal studies on the development of moral judgement in the child provide a comprehensive account of the cognitive dimension in the formation of values. Others, notably Kohlberg [4], have further clarified the process of moral development. The contemporary view is that in the infantile state rules and social expectations are external to the self, imposed by parents and those in authority. Conformity is neces-
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sary to avoid punishment. There is a progression through childhood and adolescence to what is termed the conventional phase where society’s rules of conduct are incorporated into the personal system of values. This is an uncritical, dogmatic acceptance of the prevailing mores. It reinforces the need for the approval of the self by society. The mature, principled stage of morality develops when the person is able to differentiate the opinions of the self from the rules and expectations of others, and define values in terms of self chosen ideals [3]. Issues are then judged by principle rather than convention. Healthy development along these lines results in the acquisition of what Hemmings [5] calls a moral language based on commonly held virtues, such as respect for one’s self and others, reverence for life, truth, love, tolerance, personal and social responsibility. The approach of Piaget [3] places emphasis on the development of the internal cognitive process. But also of importance are the social influences, such as the peer group, socio-economic, educational and religious environment. The cognitive and social factors complement each other. There are two basic mechanisms which determine the formation of values, thought and feeling. When we are motivated to make a decision, to choose thoughtfully from available alternatives, we use reason. When we reflect how we feel about that choice, whether we cherish it, whether we are glad about making it, we have to consider our feelings. When using a thoughtful reasoning approach to value determination we often find ourselves employing a principle or rule to guide our behaviours; for example, it is wrong to tell lies unnecessarily. However, one may be able to reason abstractly according to rules and principles, such as truth, goodness and justice, and rigidly adhere to duty yet not show any real care and concern for the people affected. So value choices seem also to involve character traits such as honesty, perseverance, self sacrifice, integrity, compassion and a sense of self or agency that supervises the process of choosing values. Employing our feelings in the determination of values often involves ascertaining whether something is good, right, or ought to be done, whether it receives our approval or disapproval. For instance, do we approve of capital punishment? Our best feelings and sympathies often move us to reflect on and change the rules that we use to direct our behaviours and preferred choice of value, if it can be seen that using a rule might
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result in a situation which compassion and empathy hold to be morally insupportable. Nevertheless, problems can arise if we use only our feelings to decide on value choices. If that were the case, then value and choice would depend on people’s moods, sudden inclinations and desires. It is useful to distinguish between conceived and operative values [6]. Conceived values are the idealised concepts held at an intellectual level, often with strong conviction but not necessarily transferred into positive action, whereas operative values govern the actual behaviour that the individual chooses to perform. Sometimes there is marked discrepancy between the idealised and the real self, with resulting dissonance. In therapy patients explore their pragmatic values, expressed in ordinary daily living, and attempt a closer conformation to the conceptual values, thus reducing value dissonance.
Values and mental health Clear values are relevant to mental health because if intentions and actions are in accordance with the personal values system, then there is no conflict. Self esteem is reinforced, there is satisfaction in chosen endeavours, there is harmony with the environment. However if our actions are contrary to our values then there is dissonance. Self esteem is lowered and there may be feelings of shame, guilt, or anxiety. Eventually we may resort to unconscious mental defences of denial, repression, projection and so on. Such a hypothesis is in accordance with a very large body of work on cognitive consistency theories [7] and also with the clinical experience of humanistic psychologists [8-101. Assigning value is a special case of the cognitive process. Now, cognitive consistency theories assume that a person will strive towards consistency within the self. If conflict does occur, for example if persons hold a certain belief and yet act contrary to it, then they will experience stress and be motivated to reduce the disparity. Values dissonance detracts from the person’s self concept and manifests itself in guilt reactions [ 1 I]. Cognitive dissonance theorists often seem to imply that values are easily malleable, and when there is a discrepancy between values and overt behaviour there may be a tendency to gain consonance by modifying values to conform to actual behaviour. The humanistic psychologists usually favour the proposition that values are characteristic for the individual and tend to
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be stable and enduring, a view strongly confirmed in the University of Chicago Study of Values [ 121. Discrepancy between values and behaviour motivates a move towards consonance by modifying behaviour to conform to the personal code of values. The sources of values dissonance are discrepancy not only between the personal values system and personal behaviour but also between personal values and social or environmental values. For instance, there may be dissonance if a conservationist has to live in a community which practices environmental exploitation and degradation. Furthermore, the source of pathology may be attributed to a faulty personal values system. One could speculate that an individual may be disordered in an ethical sense in three ways: one may violate a humanistic values system, one may lack or possess a weak values system, or one may have a corrupt values system. Any of these conditions may lead to psychological disturbance. In the first case, transgression of personal values, dissonance may be expressed through neurosis with feelings of emptiness, worthlessness, guilt, anxiety, depression or phobic dread. It may be a component in psychosis, with feelings of alienation, derealisation or depersonalisation, or it may contribute to behaviour disorder or delinquency. A common explanation of the disturbance following unemployment or separation from a spouse, for example, is made in terms of the loss of a loved object. Another dynamic factor is that the person is forced into arole which conflicts with the values system, so that the unemployed state or the divorced state causes value dissonance. In the second case, the lack or weakness of a coherent system of values is the hallmark of the psychopath. This is expressed by unconcern for self and others and the absence of appropriate guilt or shame. In the third case, a corrupt values system may lead to the pursuit of misanthropic, cruel, destructive or sadistic behaviour. Individuals with such values tend to find satisfaction through exploiting or inflicting pain on other people and destruction on the environment. Such people could be termed ethicopaths.
Values in therapy To what extent should therapists explore the moral dilemmas of their patients? During the first half of this century many schools of psychotherapy taught that
clarification of values was unjustified interference. The therapist was supposed to be neutral, accepting, non-judgemental and totally insulated from the values underlying the goals of therapy. But this is a deception. Knowingly or not the therapist must reflect back some judgement as the patient chooses goals and, in therapy, works out means to achieve them. Even if the therapist could avoid concern with issues of values, this is the expression of a libertarian position, a value statement in itself which will be conveyed openly or covertly to the patient. Charlotte Buhler [ 131 stated: “Nor can one engage in psychiatry as a therapist without bringing certain convictions about values into one’s work. These convictions may or may not be specifically communicated to the patient but they underlie the therapist’s activity; they help determine the goal he sets for himself and his patient, and they are consciously or unconsciously reflected in his questions, statements or other reactions.”
Freedomof choice and responsibility The importance placed on values in therapy will relate to the patient’s concept of personal freedom and responsibility. If one is free to choose goals and to carry them out. then one can be held responsible for the consequences. If, on the contrary, all decisions are determined by a fate beyond one’s control, then one can not be held accountable for the good or bad results of what one does. These issues can be clarified through the doctrines of determinism, indeterminism, and agency [ 141. The doctrine of determinism asserts that all our actions are foreordained and the inevitable result of previous events. Our conduct is predestined by genetic inheritance, previous life experiences, environmental circumstances, cosmic or supernatural forces. So we are helpless to direct our actions. Our behaviour is inevitable and beyond our control. The doctrine of indeterminism asserts that personal behaviour is not pre-determined and inevitable, or if it is caused by inner drives, then these are not caused. The third doctrine is that of agency which asserts that human behaviour is caused but not every chain of causes is endlessly regressive. Such causal chains have beginnings and sometimes they may be started by the individual (the “agent”) himself. Thus people have freedom to choose within the bounds of certain constraints.
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If the doctrine of determinism were to be true, then there can be no moral blame and no virtue ascribed to the person who is helpless to control hisher actions. One can not be held responsible for that which one is powerless to avoid. If this principle is untrue and either the doctrine of indeterminism or agency is valid then the possibility of freedom occurs. If any action depends on a choice of alternatives, then a person is free to decide which to choose and can be held responsible for those actions. Some theories of psychopathology and schools of therapy have a deterministic bias. Classical psychoanalysis, for instance, holds that behaviour is significantly determined by libidinous drives and the processes of psychosexual maturation. Unconscious motivation is a prime determinant of action. This produces a constraining effect on freedom to choose and act, so by implication there is some diminution in personal responsibility for behaviour. Some behavioural therapy rests on the assumption that conduct is largely determined by learned conditional responses; again the individual is constrained by events and mechanisms beyond his power to control, and can not be held responsible. Similarly, biological theories of behaviour are deterministic. If, for example, depressed behaviour is interpreted solely as the result of some anomaly in the function of neurotransmitters across the synapses, then how free is the patient to change? On the other hand there are many schools of therapy which conform to the concept of individual responsibility based on moral judgement and values. The theoretical systems of those methods of therapy can not be discussed in detail but some prominent schools together with a leading exponent can be mentioned: existential, May; person centred, Rogers: gestalt, Perls; transactional, Berne; rational emotive, Ellis; reality, Glasser; logotherapy, Frankl; personal integrity, Mowrer; cognitive, Beck; and personal construct, Kelly. Within all of these frameworks the patient is considered to have the responsibility to choose goals which are true to personal values, are life-affirming, or as the existentialists might say are “in good faith”.
Values clarification in counselling and psychotherapy People develop symptoms of emotional illness for various intrapsychic and social reasons. A part of most
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treatment methods is to help the patient to recognise the various stresses which have contributed to the breakdown and to find ways to change the situation to enable the person to recover. The questions asked are: what caused it? and, how can it be improved? The answers then suggest certain goals. This means that the person has to examine all the options open to him and choose the goals most likely to be satisfactory. When we choose a preferred course of action and say this way is likely to be better than that, then we are making a value judgement. The question we ask is why is this the preferred choice? So it is important to understand clearly the values which underlie the goals we set for ourselves. There is small benefit to be gained in therapy by the discussion of values in an impersonal or general way. The issues have to be relevant to the problems of ordinary people in their daily living. One method of sorting out values is to scrutinise the principles which underlie the motives, means and ends of a particular goal or course of action. Motives arising from the needs and desires of oneself or others can be tested against the standards of a personal code of ethics. Do they conform to justice, truth and other guiding principles? Do they uphold the respect of those concerned? For example, one person may engage in charitable work from a sense of compassion or service. Another may do similar work from a wish for aggrandisement or public approbation. Next, the means of pursuing the goals, the actions necessary to be taken to achieve the goal, are tested. Do they respect the needs, feelings, dignity and integrity of those involved? For instance, marital conflict may lead to many consequences such as abuse, separation, custody battles or property disputes, all of which have important implications for values. Then the ends, the instrumental or terminal goals which result from the actions, are examined. Will they cause pleasure or pain, will they be constructive or destructive, are they consonant with other relevant values? To extend the previous example, what will be the end effect of divorce on children’s care and emotions, and the social relationships and economic circumstances of each partner? As part of the therapeutic approach at Calvary Hospital, Canberra, a values clarification programme has been developed; a description of the general procedure follows. The discussions extend over ten meetings. Each session is flexible but includes an introduction to the
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topic and its scope by the group leader and an openended discussion by group members to produce and develop individual opinions and beliefs about values. Stimulus material may be used in the form of moral dilemma stories, models, illustrative examples in books, films and video, role playing and the card game “Scruples”. Values are recognised and clarified in the examples discussed and most importantly the issues are related to everyday experiences of group members. The group process does not seek to impose any value or belief on individual members. Every one has to choose freely what is right for them after reflection. The reasons for a certain value may be questioned but there is no pressure for the person to conform to some value which to him or her seems wrong. Each person’s set of values and beliefs are respected if they are held sincerely.
The content of the programme Since values affect all aspects of our experience a moral stance is inherent in every choice of human activity. But despite the diversity of the circumstances, whether it be filling in a tax return, disciplining children, procuring an abortion or pursuing some leisure interest, the relevant values underlying the behaviour seem to be drawn from a small but enduring repertoire. Different situations may require changed priorities in the ordering of values but the guiding principles of conduct remain constant. Clinical experience shows that the moral dilemmas raised by patients are commonly dependent upon some of the following bipolar values: Love or its antonym Hate Truth or its antonym Falsehood Honesty or its antonym Deceit Justice or its antonym Inequity Empathy or its antonym Antipathy Respect or its antonym Contempt Responsibility or its antonym Fecklessness Discipline or its antonym Anarchy Sharing or its antonym Acquisitiveness Beauty or its antonym Ugliness Helping or its antonym Harming Tolerance or its antonym Prejudice Co-operation or its antonym Competition Development or its antonym Stagnation of potential To simplify the clarification process, practical issues are dealt with in the four classes of personal, social, environmental and aesthetic values.
Personal values Personal values form the code of beliefs and criteria which mould individual behaviour. They provide standards to guide the way we live, and give meaning and direction to life. Examination of personal values involves scrutiny of the conceptual values which apply to the self. This raises issues such as loving and caring for oneself, being true and honest towards oneself, having respect for oneself, being responsible towards oneself, understanding oneself and so on. In terms of operative values there is concern for behaviour such as seeking insight, caring for personal health through nutrition and exercise, integrity in personal conduct having a positive self image. These issues are raised in therapy through problems of confused identity, conflict between personal rights and responsibilities, loss of self esteem and worth, and many other conflicts of image or purpose.
Social values The source of social values is the human need for association. “People need people”. So because we like to be with other people and they like to be with us, we join with each other in social groups which satisfy the needs for affiliation and serve some common good. Society organises these beneficial groups into formal institutions. and it is the pattern of these institutions which forms the culture. The values of the culture in which an individual exists will have a formative influence on the social values which he develops. C o n s i d e r a t i o n of t h e v a l u e s a f f e c t i n g t h e individual’s relationship to society deals with the conceptual values referred to the social institutions of family, work, education, religion, government and leisure activity. These include the ideals of loving and caring for others, being trustworthy and fair towards others, being respectful towards them, sharing, helping, being tolerant, protective and co-operative, and so forth. In operative terms, the practical values will include issues such as the duty of care towards children, the sick and the aged, the duty to be informed in order to make valid choices and decisions, the duty to resolve conflict, to conserve resources, and to serve others through family, work, or social life. These conceptual and operative values are inherent in all aspects of social living. They underlie the dilemmas presented by patients in therapy which arise from
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family quarrels, infidelity within marriage, abuse of power, industrial disputes, violence in sport and all of society’s many and varied tribulations.
Environmentalvalues To attain a sense of belonging and “being in the world” a person has to appreciate the significance of his individual existence and relate it to all the systems of the natural order, living, non-living, animal, vegetable, and mineral. In the past, the good of mankind was held to be the highest ethical goal, but the modem position is to recognise that which preserves and protects the ecosystem as the measure of what is good. The conceptual values which apply to a person’s relationship to the environment are similar to those affecting the personal and social relationships. Nurture, care, protection, respect, responsibility, understanding and the like help to define personal relationships with the material environment. The operative values are concerned with the duty to be informed about environmental issues, the responsibility to be involved, the conservation of resources, protection against exploitation, preservation of species, and so on. Such values determine a person’s relationship to the environment and attitudes towards pollution, exploitation, exhaustion of resources, over fishing, over grazing, over population, the greenhouse affect and other calamities. Harmony with the environment helps to protect the mental health of people, because those who find a personally acceptable place in the scheme of things and feel integrated into the natural order are not likely to experience alienation and the consequent existential anxiety or despair.
Sensate values The fourth group of values are the aesthetic ones, those which give pleasure or pain through the senses. They have to do with the perception of beauty, harmony, proportion, colour, sound, movement, taste and smell. The core values which influence personal, social and environmental relationships apply similarly to the aesthetic ones. The conceptual values reflect care about sensate experience and assigning importance to it. There is a requirement to respect aesthetic qualities, to be open and receptive, to be discriminating and fair and to value excellence. The operative values which
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flow from these include the responsibility to seek out the beautiful, the harmonious, and other pleasing modalities and to develop perceptual appreciation. This leads to a commitment to aesthetic development and growth. The sources of sensate gratification are present everywhere and may be experienced, for example through literature, the visual arts, music, drama and nature. Therapeutic discussion often reveals that sensual experience may enhance the quality of life, affect mood and stir emotional responses of pleasure, thrill and wonder. It may evoke memories and enrich experience and enjoyment. Also, it may provide a link with the cultural inheritance.
Changes in social values Values in Westem society are in a period of rapid change. Individual conduct has been greatly influenced by the permissive wave of the nineteen sixties and seventies. Social indicators such as decreased sense of community, drug abuse, increased violence, public acceptance of hedonism, an increase in occult religious practices and others described by Harmon 1151 point towards a fracture in the social order. Certainly the culture of a permissive society has affected the personal values of masses of people during the last three decades. Values clarification in counselling or psychotherapy enables the individual to take off the blinkers imposed by the prevailing mores. One may be alerted to desensitisation and emotional blunting as an accommodation to repeated challenge. Most people can not maintain the initial outrage when they see on television for the tenth time the picture of a child burned by napalm. A sense of powerlessness or futility may lead to psychic blunting. Why distress ourselves about famines and natural disasters if we feel any effort on our part would be minuscule and insignificant? Powerful industrial and political interests may promote advertising and propaganda to condition people to conform to their wishes. At the individual level values may be compromised for the sake of maintaining friendship, employment, or some other social role. Peer group pressures can be a strong influence, for example children at school may be pressured to smoke tobacco or drink alcohol as the price for acceptance within the group. Values may also be changed when personal conduct is modelled on that of an admired leader. Also the craving for supplies of
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drugs by an addicted person may totally subordinate any pre-existing values system. These cultural changes face each person with a dilemma: whether to conform to them or to make a personal challenge. Whatever the choice it will affect the personal sense of identification with the culture or alienation from it, with consequences for mental health.
Integrity of the personal values system If social pressures erode the personal code of values, then dissonance will occur, and measures need to be taken to combat degradation of the values system. Values can be clarified through processes of reflection, incorporation and affirmation. Moral dilemmas can be analysed using the method discussed above. But this requires both time and inclination and it is the task of the therapist to foster interest and commitment by the patient to refurbish values. It will reinforce personal values to discriminate in the choice of friends and to associate with those who share similar principles. Peer group pressure will then be in a positive direction. It is also necessary to be concerned about contemporary social issues and to have informed opinions about them based on personal values. Moreover, values have to be the constant yardstick in matters of daily living. Repeated reference will keep them sharp, and they will not slide into the atrophy of disuse.
Conclusion A values clarification programme is based on the premise that one needs to define one’s values system, and one’s behaviour should be compatible with it if one is to achieve cognitive consistency, self respect, purposeful goals in life, and meaningful relationships with family, friends and the larger world. If one thinks, feels, or acts in ways which oppose the personal code of values, then there is dissonance causing inner conflict and stress which may lead to maladjustment or psychological morbidity. When values have been clarified they are related to the actual experiences and problems of patients: marital relationships, parental behaviour, job choices, environmental issues or any other problem of living. Many schools of psychotherapy in the past have ignored the role of values dissonance in mental illness,
and so their insights are partial and inadequate. The humanistic schools d o recognise the importance of the ethical dimension in mental health and illness. In the introduction to “The Rebel”, Albert Camus [ 161 wrote “If we believe in nothing, if nothing has any meaning, and if we can affirm no values whatsoever, then everything is possible and nothing has any importance. There is no pro and con; the murderer is neither right nor wrong. We are free to stoke the crematory fires or to devote ourselves to the care of lepers. Evil and virtue are mere chance or caprice”. However, if we can affirm our values, then some things acquire meaning and importance and we discover purpose in living which transcends narrow self interest. Such are the conditions for mental growth and health, which rely upon a values system clarified by reason, warmed by feeling, widened by vision and which compels affirmation and action.
References 1. Bull NJ. Moral judgement from childhood to adolescence. London: Routledge and Kegan Paul. 19693.
2 . Muckerjee R. The Dimensions of Values. London: George Allen and Unwin, 1964:15-22. 3. Piaget J. The Moral Judgement of the Child. Harmondsworth: Penguin Books, 1932. 4. Kohlberg L. Moral Stages & Moralization. Moral Development & Behaviour, ed. T Lickona, New York: Holt, Rinehard and Winston, 1976:3 1-53. 5. Hemmings J. Individual Morality. London: Panther, 1970:74. 6. Coleman J C. Contemporary Psychology and Effective Behaviour. 4lh Edn. Glenview, Illinois: Scott Foresman, 1979440. 7. Festinger L. A Theory of Cognitive Dissonance. Stanford: Stanford University Press, 1957. 8. Frank1 V E. The Will to Meaning. London: Souvenir Press, 197 I. 9. Mowrer 0 H. The New Group Therapy. New York: Van Nostrand Reinhold, 1964. 10. May R, ed. Existential Psychology, New York: Random House. 1969. 1 1. Kelman H C and Baron R H. Moral and Hedonic Dissonance. In
S Himmelfarth and A Eagley. eds. Readings in Attitude Change. New York: Wiley. 1974:68.82, 84. 12. Peck R F and Havighurst R Jet a/. The Psychology of Character Development. New York: Wiley, 1960. 13. Buhler C. Values in psychotherapy, New York: Free Press of Glencoe, 1962:1. 14. Frankena W K. Ethics. Englewood Cliffs: Prentice Hall, 1965. 57-62. 15. Harman W W. The Coming Transformation, The Futurist XI (2). 1977:106-110. 16. Camus A. The Rebel, Trans by A Bower. New York: Vintage, 1956.
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When an individual acts contrary to personal values, then there is dissonance, with consequences of guilt, anxiety, despair, or alienation. If unresolved and of sufficient strength these feelings may manifest in mental illness. Thus, clarification of values and resolution of value conflict are relevant to counselling and psychotherapy. A framework for the systematic examination of values in therapy is described. Values are classified as personal, social, environmental and sensate. In therapy, goals may be matched for congruence between personal values and overt behaviour. Processes which erode values and ways to maintain integrity of personal value systems are considered. Australian and New Zealand Journal of Psychiatry 1992; 26:391-398 It was twenty years ago that a teacher of English came to me, greatly troubled. Many of the essays and poems of his students showed widespread despair and hopelessness. A typical example was the poem: Don’t turn tny eyes I ’ n i only hlirid Face fear Lost wwider spelt Mistracvd. niisfuced Civmhled in teui’s Your lowg funtustic flight Hus drawin me here I sw’ear I ’ m lost. Surely this was an eloquent cry for vision and direction from a troubled fourth year high school boy. At about that time another boy at the school committed suicide. Nothing much has changed since then, and for many people life has no clear meaning or significance. They have no compelling answers to the questions: “What kind of person am I? What am I for and against? Where
am I going and why? Who cares and does it matter anyway?” Many of these people seek help for mental health problems. But beneath the surface we often find a sense of existential despair. The meaning of existence is derived from relationships formed with the self, other people, nature and the universe. These relationships are woven in terms of bonds, feelings and values. So, meaning has to make sense within a system of values. To form a purpose in life, to earn self-respect, to relate satisfactorily to family, friends, and the larger world, one’s value system must be clear. Only then can one judge actions in terms of their wisdom, justice, courage, moderation, whether or not they uphold the respect of the self and others, whether they cause pleasure or pain, or are harmful, whether they are creative or destructive. These issues of values and meanings form important components of the dynamic processes of mental functioning, and so are integral to mental health. It is for this reason that values clarification is a necessary part of counselling and psychotherapy.
9 Beauchamp Street, Deakin, ACT, 2600 W.E. Mickleburgh BSc, MBChB. DPM. FRCPsych, FRANZCP
When an object or a sentiment is prized and esteemed it is said to possess positive value. Each human
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being develops a system of such values which becomes a personal code of principles and standards of conduct. Values direct andgovern a person’s attitudes, preferences and life goals. They are characteristic of the individual and tend to be stable and enduring. They are the product of thinking, feeling and striving. Through thought there is judgement of the quality of an issue, the relative worth and the preferred choice. A value judgement evokes feelings of goodness or badness, well-being or shame. Also, there is a requiredness about value behaviour, a sense of “ought” which gives impetus towards valued goals. Values have the property of polarity so that for each value there is a corresponding opposite, with a continuum between the extremities of each pole, as, for example, truth is opposed to falsehood, or kindness to cruelty. Another characteristic of values is that they are hierarchical and ranked in an order of importance or worth which may be influenced by the circumstances of each particular situation. Values relate to the whole gamut of human experience: personal, social, environmental, aesthetic, philosophical.
The evolution of values in the species The faculty for valuing has accompanied man’s evolutionary progress. Human behaviour has evolved through processes of selection and survival to serve the purpose of increasingly efficient adaptation to the environment. These processes have physical, mental and social components. In the mental domain there have emerged philosophical and social propensities which are uniquely human and which have proved to be highly adaptive. This has accompanied the increased growth of brain cortex, particularly in the prefrontal regions which has permitted more complex storage and integration of information and controlled inhibition of behaviour .where appropriate, so that primitive protective responses can be delayed. Plans of action and their consequences can be rehearsed in imagination, and suitable choices made. To a greater extent than other species, humans have developed the faculties of feeling and knowing, but one unique attribute has been the development of language, which has allowed communication of thoughts and feelings in word symbols. This has enabled elaboration of more complex modes of thought, and the perception of the thoughts and feelings of others. Through the processes of “imitation, suggestion, and thus the formation of an ego ideal” [ 11,
one appreciates oneself as an individual being and learns to analyse the causes and effects of one’s own behaviour on others. The consciousness of the needs and feelings of other people gives rise to reciprocity in one’s dealings with others, and it is this reciprocity which is the foundation on which humans have built their ethical systems. From one’s relationships with oneself, one’s family and the world at large, one adopts a personally acceptable code of meanings and values. These are reached after a process of searching and self exploration. The values not only have to be acceptable but examined and incorporated and that produces the stuff of conscience. Mukerjee [ 2 ] considers that this code of values, when established and assimilated into belief, faith, conscience and morality, provides an adaptive advantage because it is flexible, communicable and transmissible for the human species. It becomes a powerful adaptive mechanism for social living, and forms the basis for civilisation.
Individual development of values Conventional wisdom held that conscience was an inborn characteristic of the child. The ability to know right from wrong was thought to be present at birth. However, this assumption is now known to have been mistaken. Although an infant at birth has the potential for moral development, both inner purposive activity of the mind and social influences shape the individual pattern of values [ I ] . Kant made a distinction between two kinds of moral response. He coined the term heteronomy for the moral constraints imposed through rules and laws by external authorities, and autonomy for the discipline and limits, freely chosen, which arise from within. Piaget [ 3J recognised these two processes as successive stages in the moral development of the child, and identified the dominance of the heteronomous period of obedience until the age of seven or eight years followed by the autonomous stage, with emphasis on responsibility and fairness, developing from the age of eight to twelve years. Piaget’s seminal studies on the development of moral judgement in the child provide a comprehensive account of the cognitive dimension in the formation of values. Others, notably Kohlberg [4], have further clarified the process of moral development. The contemporary view is that in the infantile state rules and social expectations are external to the self, imposed by parents and those in authority. Conformity is neces-
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sary to avoid punishment. There is a progression through childhood and adolescence to what is termed the conventional phase where society’s rules of conduct are incorporated into the personal system of values. This is an uncritical, dogmatic acceptance of the prevailing mores. It reinforces the need for the approval of the self by society. The mature, principled stage of morality develops when the person is able to differentiate the opinions of the self from the rules and expectations of others, and define values in terms of self chosen ideals [3]. Issues are then judged by principle rather than convention. Healthy development along these lines results in the acquisition of what Hemmings [5] calls a moral language based on commonly held virtues, such as respect for one’s self and others, reverence for life, truth, love, tolerance, personal and social responsibility. The approach of Piaget [3] places emphasis on the development of the internal cognitive process. But also of importance are the social influences, such as the peer group, socio-economic, educational and religious environment. The cognitive and social factors complement each other. There are two basic mechanisms which determine the formation of values, thought and feeling. When we are motivated to make a decision, to choose thoughtfully from available alternatives, we use reason. When we reflect how we feel about that choice, whether we cherish it, whether we are glad about making it, we have to consider our feelings. When using a thoughtful reasoning approach to value determination we often find ourselves employing a principle or rule to guide our behaviours; for example, it is wrong to tell lies unnecessarily. However, one may be able to reason abstractly according to rules and principles, such as truth, goodness and justice, and rigidly adhere to duty yet not show any real care and concern for the people affected. So value choices seem also to involve character traits such as honesty, perseverance, self sacrifice, integrity, compassion and a sense of self or agency that supervises the process of choosing values. Employing our feelings in the determination of values often involves ascertaining whether something is good, right, or ought to be done, whether it receives our approval or disapproval. For instance, do we approve of capital punishment? Our best feelings and sympathies often move us to reflect on and change the rules that we use to direct our behaviours and preferred choice of value, if it can be seen that using a rule might
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result in a situation which compassion and empathy hold to be morally insupportable. Nevertheless, problems can arise if we use only our feelings to decide on value choices. If that were the case, then value and choice would depend on people’s moods, sudden inclinations and desires. It is useful to distinguish between conceived and operative values [6]. Conceived values are the idealised concepts held at an intellectual level, often with strong conviction but not necessarily transferred into positive action, whereas operative values govern the actual behaviour that the individual chooses to perform. Sometimes there is marked discrepancy between the idealised and the real self, with resulting dissonance. In therapy patients explore their pragmatic values, expressed in ordinary daily living, and attempt a closer conformation to the conceptual values, thus reducing value dissonance.
Values and mental health Clear values are relevant to mental health because if intentions and actions are in accordance with the personal values system, then there is no conflict. Self esteem is reinforced, there is satisfaction in chosen endeavours, there is harmony with the environment. However if our actions are contrary to our values then there is dissonance. Self esteem is lowered and there may be feelings of shame, guilt, or anxiety. Eventually we may resort to unconscious mental defences of denial, repression, projection and so on. Such a hypothesis is in accordance with a very large body of work on cognitive consistency theories [7] and also with the clinical experience of humanistic psychologists [8-101. Assigning value is a special case of the cognitive process. Now, cognitive consistency theories assume that a person will strive towards consistency within the self. If conflict does occur, for example if persons hold a certain belief and yet act contrary to it, then they will experience stress and be motivated to reduce the disparity. Values dissonance detracts from the person’s self concept and manifests itself in guilt reactions [ 1 I]. Cognitive dissonance theorists often seem to imply that values are easily malleable, and when there is a discrepancy between values and overt behaviour there may be a tendency to gain consonance by modifying values to conform to actual behaviour. The humanistic psychologists usually favour the proposition that values are characteristic for the individual and tend to
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be stable and enduring, a view strongly confirmed in the University of Chicago Study of Values [ 121. Discrepancy between values and behaviour motivates a move towards consonance by modifying behaviour to conform to the personal code of values. The sources of values dissonance are discrepancy not only between the personal values system and personal behaviour but also between personal values and social or environmental values. For instance, there may be dissonance if a conservationist has to live in a community which practices environmental exploitation and degradation. Furthermore, the source of pathology may be attributed to a faulty personal values system. One could speculate that an individual may be disordered in an ethical sense in three ways: one may violate a humanistic values system, one may lack or possess a weak values system, or one may have a corrupt values system. Any of these conditions may lead to psychological disturbance. In the first case, transgression of personal values, dissonance may be expressed through neurosis with feelings of emptiness, worthlessness, guilt, anxiety, depression or phobic dread. It may be a component in psychosis, with feelings of alienation, derealisation or depersonalisation, or it may contribute to behaviour disorder or delinquency. A common explanation of the disturbance following unemployment or separation from a spouse, for example, is made in terms of the loss of a loved object. Another dynamic factor is that the person is forced into arole which conflicts with the values system, so that the unemployed state or the divorced state causes value dissonance. In the second case, the lack or weakness of a coherent system of values is the hallmark of the psychopath. This is expressed by unconcern for self and others and the absence of appropriate guilt or shame. In the third case, a corrupt values system may lead to the pursuit of misanthropic, cruel, destructive or sadistic behaviour. Individuals with such values tend to find satisfaction through exploiting or inflicting pain on other people and destruction on the environment. Such people could be termed ethicopaths.
Values in therapy To what extent should therapists explore the moral dilemmas of their patients? During the first half of this century many schools of psychotherapy taught that
clarification of values was unjustified interference. The therapist was supposed to be neutral, accepting, non-judgemental and totally insulated from the values underlying the goals of therapy. But this is a deception. Knowingly or not the therapist must reflect back some judgement as the patient chooses goals and, in therapy, works out means to achieve them. Even if the therapist could avoid concern with issues of values, this is the expression of a libertarian position, a value statement in itself which will be conveyed openly or covertly to the patient. Charlotte Buhler [ 131 stated: “Nor can one engage in psychiatry as a therapist without bringing certain convictions about values into one’s work. These convictions may or may not be specifically communicated to the patient but they underlie the therapist’s activity; they help determine the goal he sets for himself and his patient, and they are consciously or unconsciously reflected in his questions, statements or other reactions.”
Freedomof choice and responsibility The importance placed on values in therapy will relate to the patient’s concept of personal freedom and responsibility. If one is free to choose goals and to carry them out. then one can be held responsible for the consequences. If, on the contrary, all decisions are determined by a fate beyond one’s control, then one can not be held accountable for the good or bad results of what one does. These issues can be clarified through the doctrines of determinism, indeterminism, and agency [ 141. The doctrine of determinism asserts that all our actions are foreordained and the inevitable result of previous events. Our conduct is predestined by genetic inheritance, previous life experiences, environmental circumstances, cosmic or supernatural forces. So we are helpless to direct our actions. Our behaviour is inevitable and beyond our control. The doctrine of indeterminism asserts that personal behaviour is not pre-determined and inevitable, or if it is caused by inner drives, then these are not caused. The third doctrine is that of agency which asserts that human behaviour is caused but not every chain of causes is endlessly regressive. Such causal chains have beginnings and sometimes they may be started by the individual (the “agent”) himself. Thus people have freedom to choose within the bounds of certain constraints.
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If the doctrine of determinism were to be true, then there can be no moral blame and no virtue ascribed to the person who is helpless to control hisher actions. One can not be held responsible for that which one is powerless to avoid. If this principle is untrue and either the doctrine of indeterminism or agency is valid then the possibility of freedom occurs. If any action depends on a choice of alternatives, then a person is free to decide which to choose and can be held responsible for those actions. Some theories of psychopathology and schools of therapy have a deterministic bias. Classical psychoanalysis, for instance, holds that behaviour is significantly determined by libidinous drives and the processes of psychosexual maturation. Unconscious motivation is a prime determinant of action. This produces a constraining effect on freedom to choose and act, so by implication there is some diminution in personal responsibility for behaviour. Some behavioural therapy rests on the assumption that conduct is largely determined by learned conditional responses; again the individual is constrained by events and mechanisms beyond his power to control, and can not be held responsible. Similarly, biological theories of behaviour are deterministic. If, for example, depressed behaviour is interpreted solely as the result of some anomaly in the function of neurotransmitters across the synapses, then how free is the patient to change? On the other hand there are many schools of therapy which conform to the concept of individual responsibility based on moral judgement and values. The theoretical systems of those methods of therapy can not be discussed in detail but some prominent schools together with a leading exponent can be mentioned: existential, May; person centred, Rogers: gestalt, Perls; transactional, Berne; rational emotive, Ellis; reality, Glasser; logotherapy, Frankl; personal integrity, Mowrer; cognitive, Beck; and personal construct, Kelly. Within all of these frameworks the patient is considered to have the responsibility to choose goals which are true to personal values, are life-affirming, or as the existentialists might say are “in good faith”.
Values clarification in counselling and psychotherapy People develop symptoms of emotional illness for various intrapsychic and social reasons. A part of most
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treatment methods is to help the patient to recognise the various stresses which have contributed to the breakdown and to find ways to change the situation to enable the person to recover. The questions asked are: what caused it? and, how can it be improved? The answers then suggest certain goals. This means that the person has to examine all the options open to him and choose the goals most likely to be satisfactory. When we choose a preferred course of action and say this way is likely to be better than that, then we are making a value judgement. The question we ask is why is this the preferred choice? So it is important to understand clearly the values which underlie the goals we set for ourselves. There is small benefit to be gained in therapy by the discussion of values in an impersonal or general way. The issues have to be relevant to the problems of ordinary people in their daily living. One method of sorting out values is to scrutinise the principles which underlie the motives, means and ends of a particular goal or course of action. Motives arising from the needs and desires of oneself or others can be tested against the standards of a personal code of ethics. Do they conform to justice, truth and other guiding principles? Do they uphold the respect of those concerned? For example, one person may engage in charitable work from a sense of compassion or service. Another may do similar work from a wish for aggrandisement or public approbation. Next, the means of pursuing the goals, the actions necessary to be taken to achieve the goal, are tested. Do they respect the needs, feelings, dignity and integrity of those involved? For instance, marital conflict may lead to many consequences such as abuse, separation, custody battles or property disputes, all of which have important implications for values. Then the ends, the instrumental or terminal goals which result from the actions, are examined. Will they cause pleasure or pain, will they be constructive or destructive, are they consonant with other relevant values? To extend the previous example, what will be the end effect of divorce on children’s care and emotions, and the social relationships and economic circumstances of each partner? As part of the therapeutic approach at Calvary Hospital, Canberra, a values clarification programme has been developed; a description of the general procedure follows. The discussions extend over ten meetings. Each session is flexible but includes an introduction to the
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topic and its scope by the group leader and an openended discussion by group members to produce and develop individual opinions and beliefs about values. Stimulus material may be used in the form of moral dilemma stories, models, illustrative examples in books, films and video, role playing and the card game “Scruples”. Values are recognised and clarified in the examples discussed and most importantly the issues are related to everyday experiences of group members. The group process does not seek to impose any value or belief on individual members. Every one has to choose freely what is right for them after reflection. The reasons for a certain value may be questioned but there is no pressure for the person to conform to some value which to him or her seems wrong. Each person’s set of values and beliefs are respected if they are held sincerely.
The content of the programme Since values affect all aspects of our experience a moral stance is inherent in every choice of human activity. But despite the diversity of the circumstances, whether it be filling in a tax return, disciplining children, procuring an abortion or pursuing some leisure interest, the relevant values underlying the behaviour seem to be drawn from a small but enduring repertoire. Different situations may require changed priorities in the ordering of values but the guiding principles of conduct remain constant. Clinical experience shows that the moral dilemmas raised by patients are commonly dependent upon some of the following bipolar values: Love or its antonym Hate Truth or its antonym Falsehood Honesty or its antonym Deceit Justice or its antonym Inequity Empathy or its antonym Antipathy Respect or its antonym Contempt Responsibility or its antonym Fecklessness Discipline or its antonym Anarchy Sharing or its antonym Acquisitiveness Beauty or its antonym Ugliness Helping or its antonym Harming Tolerance or its antonym Prejudice Co-operation or its antonym Competition Development or its antonym Stagnation of potential To simplify the clarification process, practical issues are dealt with in the four classes of personal, social, environmental and aesthetic values.
Personal values Personal values form the code of beliefs and criteria which mould individual behaviour. They provide standards to guide the way we live, and give meaning and direction to life. Examination of personal values involves scrutiny of the conceptual values which apply to the self. This raises issues such as loving and caring for oneself, being true and honest towards oneself, having respect for oneself, being responsible towards oneself, understanding oneself and so on. In terms of operative values there is concern for behaviour such as seeking insight, caring for personal health through nutrition and exercise, integrity in personal conduct having a positive self image. These issues are raised in therapy through problems of confused identity, conflict between personal rights and responsibilities, loss of self esteem and worth, and many other conflicts of image or purpose.
Social values The source of social values is the human need for association. “People need people”. So because we like to be with other people and they like to be with us, we join with each other in social groups which satisfy the needs for affiliation and serve some common good. Society organises these beneficial groups into formal institutions. and it is the pattern of these institutions which forms the culture. The values of the culture in which an individual exists will have a formative influence on the social values which he develops. C o n s i d e r a t i o n of t h e v a l u e s a f f e c t i n g t h e individual’s relationship to society deals with the conceptual values referred to the social institutions of family, work, education, religion, government and leisure activity. These include the ideals of loving and caring for others, being trustworthy and fair towards others, being respectful towards them, sharing, helping, being tolerant, protective and co-operative, and so forth. In operative terms, the practical values will include issues such as the duty of care towards children, the sick and the aged, the duty to be informed in order to make valid choices and decisions, the duty to resolve conflict, to conserve resources, and to serve others through family, work, or social life. These conceptual and operative values are inherent in all aspects of social living. They underlie the dilemmas presented by patients in therapy which arise from
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family quarrels, infidelity within marriage, abuse of power, industrial disputes, violence in sport and all of society’s many and varied tribulations.
Environmentalvalues To attain a sense of belonging and “being in the world” a person has to appreciate the significance of his individual existence and relate it to all the systems of the natural order, living, non-living, animal, vegetable, and mineral. In the past, the good of mankind was held to be the highest ethical goal, but the modem position is to recognise that which preserves and protects the ecosystem as the measure of what is good. The conceptual values which apply to a person’s relationship to the environment are similar to those affecting the personal and social relationships. Nurture, care, protection, respect, responsibility, understanding and the like help to define personal relationships with the material environment. The operative values are concerned with the duty to be informed about environmental issues, the responsibility to be involved, the conservation of resources, protection against exploitation, preservation of species, and so on. Such values determine a person’s relationship to the environment and attitudes towards pollution, exploitation, exhaustion of resources, over fishing, over grazing, over population, the greenhouse affect and other calamities. Harmony with the environment helps to protect the mental health of people, because those who find a personally acceptable place in the scheme of things and feel integrated into the natural order are not likely to experience alienation and the consequent existential anxiety or despair.
Sensate values The fourth group of values are the aesthetic ones, those which give pleasure or pain through the senses. They have to do with the perception of beauty, harmony, proportion, colour, sound, movement, taste and smell. The core values which influence personal, social and environmental relationships apply similarly to the aesthetic ones. The conceptual values reflect care about sensate experience and assigning importance to it. There is a requirement to respect aesthetic qualities, to be open and receptive, to be discriminating and fair and to value excellence. The operative values which
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flow from these include the responsibility to seek out the beautiful, the harmonious, and other pleasing modalities and to develop perceptual appreciation. This leads to a commitment to aesthetic development and growth. The sources of sensate gratification are present everywhere and may be experienced, for example through literature, the visual arts, music, drama and nature. Therapeutic discussion often reveals that sensual experience may enhance the quality of life, affect mood and stir emotional responses of pleasure, thrill and wonder. It may evoke memories and enrich experience and enjoyment. Also, it may provide a link with the cultural inheritance.
Changes in social values Values in Westem society are in a period of rapid change. Individual conduct has been greatly influenced by the permissive wave of the nineteen sixties and seventies. Social indicators such as decreased sense of community, drug abuse, increased violence, public acceptance of hedonism, an increase in occult religious practices and others described by Harmon 1151 point towards a fracture in the social order. Certainly the culture of a permissive society has affected the personal values of masses of people during the last three decades. Values clarification in counselling or psychotherapy enables the individual to take off the blinkers imposed by the prevailing mores. One may be alerted to desensitisation and emotional blunting as an accommodation to repeated challenge. Most people can not maintain the initial outrage when they see on television for the tenth time the picture of a child burned by napalm. A sense of powerlessness or futility may lead to psychic blunting. Why distress ourselves about famines and natural disasters if we feel any effort on our part would be minuscule and insignificant? Powerful industrial and political interests may promote advertising and propaganda to condition people to conform to their wishes. At the individual level values may be compromised for the sake of maintaining friendship, employment, or some other social role. Peer group pressures can be a strong influence, for example children at school may be pressured to smoke tobacco or drink alcohol as the price for acceptance within the group. Values may also be changed when personal conduct is modelled on that of an admired leader. Also the craving for supplies of
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drugs by an addicted person may totally subordinate any pre-existing values system. These cultural changes face each person with a dilemma: whether to conform to them or to make a personal challenge. Whatever the choice it will affect the personal sense of identification with the culture or alienation from it, with consequences for mental health.
Integrity of the personal values system If social pressures erode the personal code of values, then dissonance will occur, and measures need to be taken to combat degradation of the values system. Values can be clarified through processes of reflection, incorporation and affirmation. Moral dilemmas can be analysed using the method discussed above. But this requires both time and inclination and it is the task of the therapist to foster interest and commitment by the patient to refurbish values. It will reinforce personal values to discriminate in the choice of friends and to associate with those who share similar principles. Peer group pressure will then be in a positive direction. It is also necessary to be concerned about contemporary social issues and to have informed opinions about them based on personal values. Moreover, values have to be the constant yardstick in matters of daily living. Repeated reference will keep them sharp, and they will not slide into the atrophy of disuse.
Conclusion A values clarification programme is based on the premise that one needs to define one’s values system, and one’s behaviour should be compatible with it if one is to achieve cognitive consistency, self respect, purposeful goals in life, and meaningful relationships with family, friends and the larger world. If one thinks, feels, or acts in ways which oppose the personal code of values, then there is dissonance causing inner conflict and stress which may lead to maladjustment or psychological morbidity. When values have been clarified they are related to the actual experiences and problems of patients: marital relationships, parental behaviour, job choices, environmental issues or any other problem of living. Many schools of psychotherapy in the past have ignored the role of values dissonance in mental illness,
and so their insights are partial and inadequate. The humanistic schools d o recognise the importance of the ethical dimension in mental health and illness. In the introduction to “The Rebel”, Albert Camus [ 161 wrote “If we believe in nothing, if nothing has any meaning, and if we can affirm no values whatsoever, then everything is possible and nothing has any importance. There is no pro and con; the murderer is neither right nor wrong. We are free to stoke the crematory fires or to devote ourselves to the care of lepers. Evil and virtue are mere chance or caprice”. However, if we can affirm our values, then some things acquire meaning and importance and we discover purpose in living which transcends narrow self interest. Such are the conditions for mental growth and health, which rely upon a values system clarified by reason, warmed by feeling, widened by vision and which compels affirmation and action.
References 1. Bull NJ. Moral judgement from childhood to adolescence. London: Routledge and Kegan Paul. 19693.
2 . Muckerjee R. The Dimensions of Values. London: George Allen and Unwin, 1964:15-22. 3. Piaget J. The Moral Judgement of the Child. Harmondsworth: Penguin Books, 1932. 4. Kohlberg L. Moral Stages & Moralization. Moral Development & Behaviour, ed. T Lickona, New York: Holt, Rinehard and Winston, 1976:3 1-53. 5. Hemmings J. Individual Morality. London: Panther, 1970:74. 6. Coleman J C. Contemporary Psychology and Effective Behaviour. 4lh Edn. Glenview, Illinois: Scott Foresman, 1979440. 7. Festinger L. A Theory of Cognitive Dissonance. Stanford: Stanford University Press, 1957. 8. Frank1 V E. The Will to Meaning. London: Souvenir Press, 197 I. 9. Mowrer 0 H. The New Group Therapy. New York: Van Nostrand Reinhold, 1964. 10. May R, ed. Existential Psychology, New York: Random House. 1969. 1 1. Kelman H C and Baron R H. Moral and Hedonic Dissonance. In
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