Validation in Dialectical Behavioral Therapy (DBT)

This is the main dialectic in DBT: balancing pushing clients to make changes in life while at the same time accepting the way they are and the life they’re leading, as well as encouraging them to accept themselves. If the therapist pushes too hard for change and doesn’t focus enough on acceptance, the client will feel invalidated and will be unable to work effectively in therapy. But too much acceptance and not enough push for change will create a sense of hopelessness, which will also result in an inability to work effectively in therapy.

Linehan (1997) outlines six different levels of validation:

Listening and observing: The therapist actively tries to understand what the client is saying, feeling, and doing, demonstrating genuine interest in her and actively working to get to know her. This entails paying close attention to both verbal and nonverbal communication and remaining fully present.

Accurate reflection: The therapist accurately and nonjudgmentally reflects back the feelings, thoughts, behaviors, and so on expressed by the client. At this level, the therapist is sufficiently in tune with the client to identify her perspective accurately.

Articulating the unverbalized: The therapist communicates to the client that she understands the client’s experiences and responses that haven’t been stated directly. In other words, the therapist interprets the client’s behavior to determine what the client feels or thinks based on her knowledge of events. The therapist picks up on emotions and thoughts the client hasn’t expressed through observation and speculation based on her knowledge of the client. This type of validation can be very powerful because, while clients often observe themselves accurately, they can also invalidate themselves and discount their own perceptions because of the mistrust fostered in them by their environment.

Validating in terms of sufficient (but not necessarily valid) causes: The therapist validates client behavior in relation to its causes, communicating to the client that her feelings, thoughts, and behaviors make sense in the context of her current and past life experience and her physiology (e.g., biological illness). This level of validation goes against the belief of many clients that they should be different in some way (for example, “I should be able to manage my emotions better”)”

Validating as reasonable in the moment: The therapist communicates that the client’s behavior is understandable and effective given the current situation, typical biological functioning, and life goals. It’s important for the therapist to find something in the response that’s valid, even if it’s only a small part of the response (for example, letting a client know that it’s understandable she would resort to cutting herself because it provides temporary relief, even though it doesn’t help her reach her long-term goals).

Treating the person as valid—radical genuineness: The therapist sees the client as she is, acknowledging her difficulties and challenges, as well as her strengths and inherent wisdom. The therapist responds to her as an equal, deserving of respect, rather than seeing her as just a client or patient, or, worse, as a disorder. Linehan (1997) points out that level 6 validation involves acting in ways that assume the individual is capable, but that this must come from the therapist’s genuine self, and that at this level, almost any response by the therapist can be validating: “The key is in what message the therapist’s behavior communicates and how accurate the message is”

Sources: DBT Made Simple

Vignette of The Past

Vignette of The Past

I sit at the end of the bar,
A tattered copy of Percy Bysshe Shelley before me,
An ashtray overflowing with Camel Straight cigarette butts,
The fifth double Vodka-Tonic of the night resting upon a stained coaster,
Three shots of Jamison Irish Whiskey in a rocks glass,
I down a swallow of the whiskey, followed by a gulp of Vodka-Tonic,
And finally a slow drag from my cigarette,
Silent pleasures of a life already lived.

Mental Illness and Self-Harm / Self-Punishment

Mental Illness and Self-Harm / Self-Punishment

When you hear of mental illness and self-harm most people immediately jump to thoughts of cutting or burning. The simple fact though is there are so many other ways people punish themselves, punishing yourself day after day because you feel like you are deserving of that because you truly believe you need to be punished.

Self-punishment has a lot of shapes and forms. It can go from not taking an umbrella when it rains because you feel like you don’t deserve to be dry, writing 100 lines saying “I am worthless and the world is better without me,” not adjusting the thermostat when it’s freezing cold or overwhelmingly hot, or walking two more miles because your legs don’t ache enough yet. It’s choosing chocolate over vanilla because you prefer the vanilla one, or writing an essay by hand because typing would be easier. It’s not allowing yourself to sleep, or to take your medication or go for a relaxing walk. It’s putting yourself in dangerous situations but it’s also is not taking that shower because you feel like you are so incredibly undeserving of kindness towards yourself.

You are enough just the way you are, and you deserve help coping…

#MentalIllness #MentalHealth #EndStigma #SelfHarm #SelfPunishment

Cutting: A Love Story

I wrote this eight years ago in an attempt to explain the love/hate addiction to cutting. The impulse when I felt so numb that the pain of the razor blade slicing my arms and the blood trickling down to my open palm was preferred to feeling nothing at all:

Cutting: A Love Story

Long ago you made the choice, that first cut,

You found the pain incredible, the blood a release,

The cuts were shallow, hardly scratches really,

They healed quickly, not even a scar left behind.

A choice, a choice to isolate, a life in constant shame,

You lie to those closest and dearest to your heart,

Sometimes now they take months to heal,

Scars carved into your flesh for all to witness.

You’ll define your life as before and after cutting,

Terrified you’ll fear the touch of a friend,

Skin burning from the sweet release of your blood,

Wincing you’ll fear the tender touch of a friend.

The cuts spread, no longer constrained to your arms,

Deeper they grow week by precious week,

You’ll realize you’re losing all self-control,

Fear your next cut, love it, how deep will it be?

Your life revolving around the next chance to cut,

A razor blade hidden away in your wallet,

Will today be the day you cut too deep?

A day when the blood won’t stop, gasping, shaking.

Blood won’t stop flowing, ever down your arm,

Fearful, terrified a panic attack chokes your heart,

Alone, always alone, you’ll swear you’ll stop,

A sweet lie as the blood pools in your hand.

This is just the beginning of the romance,

You’ll learn to take care of your one true love,

Antibiotic cream, bandages, medical tape,

The cuts will grow wider, grow deeper.

Watching, hoping to find someone who understands,

Searching, the signs will be everywhere and nowhere,

Long sleeve shirts, bracelets, wristbands,

But their skin will be untouched, perfect, and flawless.

Isolating more and more, alone, always alone,

Your last cuts deeper, burning through the shame,

The relief doesn’t last nearly as long anymore,

You know you need to cut deeper, wider.

You dream of cutting, or just letting one person know,

You love, you hate the day you made the first cut,

Each time you pray for the strength to push harder,

Rolling up your sleeve, face-to-face with your one true love.

#MySchizLife #Cutting #SelfHarm