Archive for the ‘Interpersonal Effectiveness’ Category
Barbra Streisand sang that “people who need people are the luckiest people in the world.” People who meet criteria for BPD usually fit within this category, but often find relationships challenging to maintain and enjoy, especially when really upset. They may act like doormats, accepting whatever a friend or lover does in order to avoid abandonment, or blow up relationships in a confrontive rage.
Recognizing the central importance of relationships in our client’s lives, DBT offers several concepts useful in improving them. Here are my three favorites from the Interpersonal Effectiveness module.
First of all, in thinking about assertiveness, it is useful to move beyond considering it like an on or off switch, as either asserting one’s view or not. DBT proposes that we consider it like a dial that is marked with levels of assertiveness from 0 to 6. As we turn up the dial, we act more assertively, based on what seems most appropriate to a given situation. At 0 on the scale, we do not even mention what it is we want; at 6 we insist, and do not take no for an answer. In between we may hint indirectly (1) or openly (2), ask in a tentative manner and accept a no (3), ask firmly and accept a no (4), or ask firmly and resist taking a no (5). A similar scale is presented for saying no to a request; again, it involves a graduated response based on the particulars of the situation.
A second useful concept helps us to decide how strongly to push for what we want or resist what we don’t want. This involves learning to prioritize among three possible objectives in any given interpersonal situation: what you want to pragmatically happen (e.g., it’s your roommates’ turn to do the dishes); keeping the relationship harmonious (having them like you after they do the dishes); and keeping your self respect (feeling good about how you got them to do the dishes). Our priorities in a given situation will influence how hard we push for what we want and how we go about asking or saying no. Sometimes we may ask for less in order to increase harmony (we can “pick our battles”), but if we never push for what we really want, our self-respect goes way down. More detailed criteria for deciding how firmly to assert are explored in the DBT materials.
Third, DBT offers guidelines for accomplishing each interpersonal priority in the most effective manner. To make it most likely that you will get what you want, it is recommended that you start off by Describing the situation objectively, to cue it up in a soft manner; Express the feelings that you have about the situation (it will be more helpful to describe the more primary feelings, like fear and sadness, than the secondary defensive ones like anger); Assert your request about what you want the person to do, and Reinforce their cooperation by conveying what’s in it for them to give you what you want; meanwhile, Mindfully keep on track despite whatever distractions they may raise (ignore attacks, for example); Appear confident that you will be able to obtain your objective in a harmonious manner; and be willing to Negotiate about the details of an agreement to resolve the situation. (This is the famous DEAR MAN acronym in DBT).
For keeping the relationship amicable, DBT recommends the GIVE skills: being Gentle (no attacks, threats or judgments); being genuinely Interested in the other person’s point of view; Validating what you can about that point of view (see the Validation discussion elsewhere in the site); and having an Easy manner, with humor, softness and creativity.
For maximizing self-respect, DBT recommends you be Fair to yourself and the other person, avoid overdoing Apologies, Stick to your values without selling out, and be Truthful about your needs and feelings (don’t act helpless when you’re not, or make up excuses). These are the FAST skills.
As with all the skills, these interpersonal techniques take a lot of practice (with support from a group or therapist) in order in be available in the heat of emotional interactions. The mindfulness, distress tolerance and emotion regulation skills are also needed to enable you to be calm enough to remember and utilize the interpersonal techniques effectively.