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Dialectical Behaviour Therapy

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A comprehensive overview of Dialectical Behaviour Therapy.

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Dialectical Behaviour Therapy

  1. 1. Dialectical Behaviour Therapy By Jeanine Maritz
  2. 2. What do you see? 1 2 5 3 4 6
  3. 3. Did you see…? 1. Man playing a trumpet AND Lady’s face 2. Horse AND Frog 3. Rabbit AND Duck 4. Tree AND 10 Faces 5. Good AND Evil 6. Lady’s face AND flowers with a butterfly
  4. 4. Dialectical Behaviour Therapy (DBT) • Dialectical: The acknowledgement that two different or opposite ideas can be true at the same time. • Behaviour: What we do and the way in which we do it. • Therapy: Learning new skills and changing perspectives through treatment. Example: I can be anxious AND I can deal with this situation.
  5. 5. Why is DBT important? • To reduce suffering - Improving quality of life • To calm and centre yourself in stressful situations - Quietening the body (racing heart, fast breathing, muscle tension, etc.) reduces intense emotions • To reflect on and better understand your emotions - Lowering stress levels reduces impulsive behaviour • To improve self-respect - Validating the way you feel and improving your relationship with yourself leads to higher self-esteem • To improve your communication skills - Avoiding power struggles and taking things personally results in better relationships with others • To be more effective in meeting goals - Mindfulness leads you towards your goals and away from distracting emotional tangents • To make Wise Mind easier to find - Using practical skills that are empirically supported lead to creating healthy habits
  6. 6. Mental States • Feelings based • People oriented • Deep psychological needs • Facts based • Logical Thinking • Cause & effect • Problem solving RATIONAL MIND EMOTIONAL MIND WISE MIND PAUSE • Balance and Integration • Truth and Intuition • Unity (Pederson & Pederson, 2011, p. 28).
  7. 7. PAUSE… Now What?
  8. 8. DBT Skills 1. Mindfulness • What? • How? 2. Distress Tolerance • STOP & TIPP • ACCEPTS • IMPROVE the moment • Self-soothe • Pros & cons • Radical acceptance 3. Emotional Regulation • Observe, identify & describe emotions • Emotional wave • ABC & PLEASE • Opposite to emotion 4. Interpersonal Effectiveness • Barriers to interpersonal effectiveness • FAST • GIVE • DEAR MAN
  9. 9. MINDFULNESS is the skill of: focusing, describing and experiencing the HERE & NOW
  10. 10. Mind full • While driving, you don’t remember the experience or which roads you took. • While having a conversation, you suddenly realize that you don’t know what the other person is talking about. • While reading, you suddenly realize that you’ve been thinking about something else and have no idea what you just read. • While walking into a room, you suddenly forget what you came to get. • While putting something down, you can’t remember where you just put it. Mindful • Watching your favourite TV show, paying attention to the small details. Noticing what the actors are wearing, how the sets are designed and decorated. • You focus on every detail of your breathing, such as what it feels like as the air moves into your lungs and your stomach rises; if you feel a coolness or warmth to your body as you exhale etc. • Listening closely to music, you notice the different instruments and sounds and pay special attention to the lyrics. • While sitting in a room you know very well, you notice details about it that you weren’t aware of before. Mind full vs. Mindful – Examples (Pederson & Pederson, 2011, pp. 36-38).
  11. 11. Mindfulness – What? • Observe - Notice your breath, thoughts, emotions and surroundings - Be curious - Use all your senses (what do you see, hear, smell, feel and taste?) • Describe - Use words and adjectives - Don’t explain or solve • Participate - Get involved and don’t plan what you need to say next (Fulton State Hospital, 2004, p. 15).
  12. 12. Mindfulness– How? • Non-judgementally - Acknowledge and accept - Don’t evaluate, assess, criticize or label - Don’t judge your judging • One - mindfully - Focus on one thing at a time with all of your attention (don’t multi-task) • Effectively - Let go of seeking external validation and do what works (Fulton State Hospital, 2004, p. 16).
  13. 13. is a skill of: crisis management For short-term use to tolerate distress when you cannot make things better right away and want to avoid making them worse by acting impulsively. DISTRESSTOLERANCE
  14. 14. Keys to Distress Tolerance 1. For short-term use when you cannot solve a problem at that time 2. Put an emergency coping plan together now • Let your past be a guide for what is difficult for you • Keep adding more of these skills to your “toolbox” • First, I’ll_____. Next, I’ll _____. Then, I’ll_____. Finally, I’ll_____. 3. Practice the skills when you are not in distress • You can’t expect to hit a home run if you’ve never picked up a bat 4. Acceptance reduces suffering (Pederson & Pederson, 2011).
  15. 15. Self-destructive Coping Strategies  Spending a great deal of time thinking about past pain, mistakes, and problems  Getting anxious worrying about possible future pain, mistakes, and problems  Isolating yourself to avoid possible pain  Using alcohol and drugs to numb yourself  Taking your painful feelings out on others  Engaging in dangerous behaviours (e.g. cutting, anorexia, promiscuity etc.) Remember: Sometimes pain cannot be avoided, but many times suffering can. (McKay, Wood, & Brantley, 2007, p. 7).
  16. 16. S – Stop Freeze! Don’t move. Do not just react immediately. T – Take a step back Notice your breathing. Zoom out. Let go. Take a break. See the bigger picture. New perspective. O – Observe Where is my focus? What is happening around me? What am I thinking and feeling right now? What are others doing? P – Proceed mindfully Act with awareness. Consider others before you act. Think about your goals. Crisis Survival - STOP (Linehan, 2014).
  17. 17. Crisis Survival - TIPP T – Temperature Change your body temperature using cold water or ice. I – Intense exercise Walk quickly. Climb the stairs. Jump up and down. Run on the spot. P – Paced breathing Breathe in to the count of 5, hold then breath out to the count of 7. P – Paired muscle relaxation Tense your muscles when breathing in and relax them when breathing out. (Linehan, 2014).
  18. 18. A – Activities - Do something physically or mentally engaging. (e.g. go for a walk, journal, listen to music, read, colour in or build a puzzle – but do it mindfully). C – Contributing - Volunteer to do something for someone else or your surroundings. C – Comparisons - Bring new perspective to your current situation by comparing yourself to other times you’ve dealt with a difficult problem (but don’t invalidate). E – Emotions - P – Push away - Mentally put your distress in a box and put it on the shelf or write down your problem on paper and put it away for “tomorrow’s problem”. T – Thoughts - Mindfully focus on distracting thoughts (remember only one thing at a time). S – Senses - Stimulation is the focus here. Distraction - ACCEPTS (Pederson & Pederson, 2011, pp. 45-49).
  19. 19. Distraction - IMPROVE the moment How to make the here & now better when you are in distress I – Imagery - Your mind is powerful! It can convince your body that you are somewhere else. Concentrate on a scene (e.g. beach, forest, happy place) or use a guided meditation CD. M – Meaning - Validate the cloud and find the silver lining. What is the lesson to be learnt? Look for opportunities. P – Prayer - Seek connection from your higher power/God. Talk to someone who helps you to connect outside yourself. Spend time in nature. Look up at the stars. R – Relaxation - Breathing exercises, self-soothe, progressive muscle relaxation, or anything that calms you. O – One thing at a time - Go back to the most important priority and focus only on the first step. V – Vacation - Take a break (go outside, breathe fresh air, go for a short walk). Just “take a load off”. E – Encouragement - Self-talk (validate your own feelings and encourage yourself like you would a close friend or even a young child). (Pederson & Pederson, 2011, pp. 61-64).
  20. 20. Relaxation - Self-Soothe • Seeing - paintings, clouds, nature, photo, magazines • Hearing - music, just listen, birds, repeat affirmations aloud • Smelling - flowers, perfume, scented candles • Tasting - food or drink, chewing gum, sweets, fruit • Touching - soft blanket, hand cream, stress ball, massage (Fulton State Hospital, 2004, p. 47).
  21. 21. • Pros and cons lead us to Wise Mind decisions Decision-making – PROs & CONs (Pederson & Pederson, 2011, p. 66).
  22. 22. Why? Willingness: Aligns us with the realities of a situation. When we allow everything to be as it is and we commit to active participation within the connectedness of the universe. Willfulness: Pits ourselves against the realities of a situation as we deny our connectedness and refuse to tolerate the moment. Trying to fix every situation. Fighting reality (or anything) rarely creates an effective outcome! (consider what happened the last time you were in a power struggle) So, when faced with a problem… what are you willing to do? WILLINGNESS Where there is a will, there is a way? Where there is willingness, there is a way?   (Pederson & Pederson, 2011, p. 74).  
  23. 23. 1. Change the situation causing you pain • This may involve ending a hopeless relationship or leaving a dead-end job when you are using Wise Mind. 2. Change how you see or what you think about the situation • What is the lesson to be learned or opportunity to be seized as a result of this situation? 3. Radically accept the situation • Acknowledge the facts of your present situation, whatever they are. It is your reality. Be WILLING to experience a situation without trying to change, protest, or escape it. Try to recognize that your present situation exists because of a long chain of events that began far in the past. 4. Stay stuck in suffering until you are ready to accept reality • It is helpful to know that radical acceptance is a process similar to Kubler Ross’s (2005) stages of acceptance, namely: denial, anger, bargaining, depression and acceptance. RADICAL ACCEPTANCE – What are your options? (Pederson & Pederson, 2011, pp. 69-70).
  24. 24. 2. Use a coping statement • I ACCEPT life as it is right now. • I ACCEPT this moment as it is. • I trust in the process. • My feelings make me uncomfortable right now, but I can accept them. • I have survived other situations like this before, and I’ll survive this one too. • This situation won’t last forever. • All the events have led up to now. • It’s no use fighting the past. • The present moment is perfect, even if I don’t like what’s happening. RADICAL ACCEPTANCE (McKay, Wood, & Brantley, 2007, p. 11). ACCEPTANCE Agree ACCEPTANCE Avoid ACCEPTANCE Only look on the bright side ACCEPTANCE IS THE PREREQUISITE TO CHANGE!!!
  25. 25. is the skill of: containment, diffusion & de-escalation Developing a relationship with your emotions to enable the ability to control or influence which emotions you have, when you have them, and how you experience or express them. EMOTIONAL REGULATION
  26. 26. Where Do Emotions Come From? • Do not come out of nowhere • Do not directly follow an event • Are not caused by something that happened • Are not caused by something someone did  Are a result of your PERSONAL BELIEF SYSTEM  Are cause by your INTERPRETATION of what has happened (Pederson & Pederson, 2011, p. 91).
  27. 27. Unhealthy Perspectives on Emotions • There is a right way to feel in every situation. • Letting others know that I am feeling bad is a weakness. • Uncomfortable feelings are bad and destructive. • Being emotional means being out of control. • All painful emotions are a result of a bad attitude. • If others don’t approve of how I am feeling, then I obviously shouldn’t feel the way I do. • Other people are the best judge of how I am feeling. • Painful emotions are not really important and should be ignored. (Fulton State Hospital, 2004, p. 47).
  28. 28. Healthy Perspectives on Emotions • Emotions are not facts. • When a strong emotion is experienced, you do not have to act on the feeling. • Emotions are complex. • Emotions are neither good or bad, nor right or wrong. • Emotions are automatic. • You cannot get rid of emotions because they serve important survival functions. • Emotions do not last forever. • Emotions are the best way to tell you what you are thinking. • Emotions cannot be changed directly. • Emotions are sudden, and they rise and fall. “Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.” – Marsha Linehan (Fulton State Hospital, 2004, p. 40).
  29. 29. Observe Emotions Pay attention to your body and your thoughts to help you understand what emotion you are feeling. For example: • Anxiety: Do you feel a knot in your stomach or have sweaty palms? • Anger: Are your muscles tensing; clenching your fists or your teeth? Notice lower-intensity feelings for early and proactive skill use (Pederson & Pederson, 2011, p. 96).
  30. 30. Identify Emotions PRIMARY emotions: are our most basic emotional responses wired into our systems. * Happiness * Sadness * Anger * Fear * Disgust * Guilt / Shame * Interest * Surprise SECONDARY emotions: are our emotional reactions to an emotion and are learned from others. • Feeling angry when you are fearful • Feeling sad when you are shameful • Feeling fearful when you are angry When you have a secondary emotion, the key is to figure out what the primary emotion, the feeling at the root of your reaction is, so that you can take an action that is most helpful. (Linehan, 2014).
  31. 31. Describe Emotions 1. Name your main (primary) emotion? 2. Rate the intensity of that emotion from 0-10? 3. Prompting event? • What was going on in the environment when you began to have this feeling? 4. Assumptions, beliefs, myths? • What are you telling yourself about this emotion? 5. Describe the sensations in your body? • Comment on your breath, heart rate, face, stomach, chest, legs, throat, neck, head, muscles etc. 6. Action urge? • What do you feel like doing? 7. What do you think would happen? (Fulton State Hospital, 2004, pp. 49-50).
  32. 32. Surf the Waves of Emotion 1. Observe your emotion • Notice your breath. Step back. Get unstuck. 2. Experience your emotion fully • Like a wave washing over you, ebbing and flowing. 3. Remember that you are not your emotion • Do not act on the urge. Remember when you felt different. Notice other feelings you have at the same time. 4. Practice respecting and loving your emotion • Do not judge your emotion. Radically accept it. There is no need to eliminate your emotions, just tune into them and ride the wave using your breath as the surfboard. “Even world-class surfers stay off of the waves if they are too intense and unsafe” (Pederson & Pederson, 2011, p. 57). (Fulton State Hospital, 2004, p. 57).
  33. 33. Overcome barriers to healthy emotions • What’s the worst that can happen? And based on my experience, and NOT on my emotions, how likely is that to happen? • Feelings are sometimes painful, but are time-limited. • I can feel scared AND deal with this situation. • My success is measured by taking skilful action, not by whether I was anxious when I did it. • Feeling I can’t do it is NOT the same as not being able to do it. Stick to the plan. • Good job—I’m staying in the situation, even though it’s difficult or challenging. • It’s a sign of strength to ask for help in an effective way. • I am a unique person, and I have unique reactions. Only I can determine how I should feel in any given situation. • My feelings are not right or wrong, they just simply ARE. • A feeling of certainty is not the same as the truth. • My painful emotions happen for a reason and are an important source of information and direction for me. (Fulton State Hospital, 2004, p. 48).
  34. 34. Healthy habits that are specific & realistic are an important part of managing mood swings, depression, anger or irritability. Reduce Emotional Vulnerability PLEASE P – Physical pain (reduce) L – Illness (reduce) E – Eat balanced meals A – Avoid mood altering drugs S – Sleep patterns (regulate) E – Exercise regularly ABC A – Accumulate Positives Actively participate in positive and pleasant experiences. B – Build Mastery Do something challenging and stimulating to achieve a sense of accomplishment. C – Cope ahead of time Visualize/Rehearse in advance to cope efficiently in emotionally challenging situations. • Positive self-talk • Use coping thoughts • Non-judgmentally (McKay, Wood, & Brantley, 2007).
  35. 35. Increase Positive Emotions BUILD POSITIVE EXPERIENCES Short Term: Do pleasant things that are possible NOW. • Make your own list of joyful experiences that you can have every day (pick small tasks for when you are in a low mood). • Do at least one or two of these experiences MINDFULLY each day. Long Term: Make changes in your life so that positive events will occur more often. ACCUMULATE POSITIVES Work toward goals • Make a list of positive events you want. • List small steps toward goals. • Take the first step. ATTEND TO RELATIONSHIPS • Repair old relationships. • Reach out for new relationships. • Work on current relationships. AVOID AVOIDING Avoid giving up. (Fulton State Hospital, 2004, p. 55).
  36. 36. What’s the Difference? Read the items to your left. For each item, circle the correct category to the right. (Fulton State Hospital, 2004, p. 44).
  37. 37. Opposite to Emotion - Change Emotional Responses 1. Name your primary emotion? 2. Rate the intensity of that emotion from 0-10? 3. Prompting event? 4. Assumptions, beliefs, myths? 5. Describe the sensations in your body? 6. Action urge? 7. What do you think would happen? 8. Is there another behaviour that would work better? 9. What do you think the outcome would be of that behaviour? (Fulton State Hospital, 2004, p. 59).
  38. 38. Emotional Regulation Skills • Observe, identify and describe emotions - without judgement • Understand and explore the emotion like a wave washing over you • Reduce emotional vulnerability with ABC & PLEASE • Overcome the barriers to healthy emotions by using coping thoughts • Increase your positive emotions • Regulate with the opposite emotion E.g. Sadness – get active, do things that make you feel competent & self-confident Remember: You can’t always control what you feel BUT you can control your reaction to those feelings. (Linehan, 2014).
  39. 39. Inter + person = interaction between person to person Is the skill of: Improving relationships, self- respect & balancing what we want with the demands placed on us INTERPERSONAL EFFECTIVENESS
  40. 40. Barriers to Interpersonal Effectiveness 1. Discounting: The message to the other person is that their needs or feelings are invalid and don’t have legitimacy or importance. 2. Withdrawing/ Abandoning: The message is “Do what I want or I’m leaving.” 3. Threatening: The message is “Do what I want or I’ll hurt you.” 4. Blaming: The message is that the problem, whatever it is, becomes the other person’s fault. 5. Belittling: The strategy here is to make the other person feel foolish and wrong to have a particular need, opinion, or feeling. 6. Guilt-tripping: The message to the other person is a moral failure, that their needs are wrong and must be given up. 7. Derailing: This strategy switches attention away from the other person’s feelings and needs. 8. Taking away: This strategy is to withdraw some form of support, pleasure, or reinforcement from the other person as punishment for something they said, did, or wanted. (McKay, Wood, & Brantley, 2007, p. 190).
  41. 41. Balancing the Building Blocks for Relationships 1. What is needed in this interaction to maintain or build my self-respect? (FAST) 2. What does the other person need in this interaction? (GIVE) 3. What do I need in this interaction? (DEAR MAN) GIVE DEAR MAN FAST (Pederson & Pederson, 2011, p. 133).
  42. 42. Priorities, Goals & Values – Focused - FAST What is needed in this interaction to maintain or build my self-respect? F– Fair: To yourself and to the other person. (Non-judgemental) Avoid extremes. Others do not need to earn you respect. A– Apologies: No overly apologetic behaviour. Avoid apologies for things over which you have no control. Chronic, unnecessary apologies erode self-respect and devalue apologies that are genuinely needed. *Note this does not apply to situations that require an apology (e.g. hurting someone). S– Stick to values Identify what is important to you and stick to it. T– Truthful Don’t lie, exaggerate or make up excuses. Don’t act helpless when you are not. (Fulton State Hospital, 2004, p. 25).
  43. 43. Values Application Acceptance Achievement Assertiveness Awareness Ambition Availability Balance Belonging Bravery Caring Charity Cleanliness Comfort Closeness Commitment Confidence Consistency Courage Dependability Dignity Duty Drive Discipline Empathy Encouragement Enjoyment Endurance Enjoyment Excellence Effectiveness Fairness Faith Family Friendship Freedom Fun Financial independence Fidelity Generosity Grace Gratitude Giving Happiness Health Honesty Honor Humor Imagination Independence Integrity Intelligence IntimacyJoy Kindness Knowledge Leadership Learning Love Loyalty Mindfulness Modesty Motivation Neatness Openness Optimism Order Passion Peace Persistence Playfulness Practicality Privacy Professionalism Prosperity Relaxation Religion Resilience Respect Restraint Sacrifice Security Self-control Self-reliance Sensitivity Service Sharing Structure Strength Trust Teamwork Truth Warmth Willingness Wisdom 1. Identify a value that is important to you. 2. Describe 3 specific behavioural ways you can live this value. (Pederson & Pederson, 2011, pp. 136-137).
  44. 44. Other-Focused - GIVE What does the other person need in this interaction? G – Gentle: Be courteous. No verbal/physical attacks. No manipulating. No moralizing (“you should..”) I – Interested: Listen to the other person’s point of view, opinion or reasons for saying no. No interrupting or talking over them. V – Validate Acknowledge the other person’s feeling, wants, difficulties, and opinions about the situation. Be non-judgemental out loud (I can understand that you feel…) E – Easy manner Smile. Allow space for others. Treat them with kindness and a relaxed attitude. “You catch more flies with honey than with vinegar.” (Fulton State Hospital, 2004, p. 24).
  45. 45. Validation - GIVE • What is validation?  Acknowledging that a person’s emotions, thoughts and behaviours are real and understandable  It is not necessarily agreeing with that person • Self-validation? - Stop ‘should-ing’ on yourself. • Why is it important? - It improves our relationships by showing that we are listening and that we understand - It reduces pressure to prove who’s right or wrong - It also reduces negative reactivity and a nger - It makes problem solving, closeness, and support possible - Invalidation hurts (Fulton State Hospital, 2004, p. 10).
  46. 46. Validation Cont. – How to do it? • Pay Attention: Look interested, listen, and observe. Make eye contact. Stay focussed. Nod occasionally. Respond with facial expressions. • Reflect Back: Say back what you’ve heard or observed to be sure you understand what the person is saying (without a judgmental tone of voice). Have an open mind. Try to understand what the person feels or thinks. Use a tone of voice that allows the person to correct you. • Observe: Be sensitive to what the person in not saying. Pay attention to facial expressions and body language. What is happening? What do you know about the person already? Be open to correction. • Understand: Look for how the person feels and if he/she is making sense given the history, state of mind, or current events – even if you don’t approve of the person’s behaviour, or if his/her belief is incorrect. • Acknowledge the valid: Without feeling that you have to agree or approve of the experience, find a piece of it that makes perfect sense, and validate this. • Show equality: Be yourself! Treat the other person as equal, not as fragile or incompetent. (Fulton State Hospital, 2004, p. 11).
  47. 47. Invalidation – The Misunderstood Friend Watch this example at: https://www.youtube.com/watch?v=dfaD_JP4rFo By: Menu, M. (2014, October 18). Misunderstood Friend [Video file].
  48. 48. Validation – The Validated Friend Watch this example at: https://www.youtube.com/watch?v=V7yY0hNJqH4 By: Menu, M. (2014, October 18). Validated Friend [Video file].
  49. 49. Self-Focused - DEAR MAN What Do I need in this Interaction? D – Describe the situation: Clearly and specifically state what the problem is Tell the person exactly what you’re reacting to using only the FACTS E – Express you feelings and opinions about the situation clearly: Clarify why the issue is important to you and how you understand the problem. Assume that people cannot read your mind. A – Assert yourself Be specific and direct. ASK for what you want. SAY NO CLEARLY when appropriate. R – Reinforce Reinforce or reward the person ahead of time by explaining the CONSEQUENCES. In other words, tell the person the positive of getting what you want. If necessary, tell them the negative effects of not getting what you want (this does not mean blackmail) (Fulton State Hospital, 2004, p. 21).
  50. 50. What Do I need in this Interaction? M - Mindfully Keep your focus ON YOUR OBJECTIVES Think about timing A - Appear confident Use a confident tone of voice and physical manner; make good eye contact. Try not to stutter, whisper or star at the floor N - Negotiate Be WILLING to GIVE in order to get State a possible solution in clear, specific, behavioural terms Offer and ask for alternative solutions to the problem Reduce your request Maintain your ‘no’ but offer to do something else or to solve the problem in another way Focus on what will work Self-Focused - DEAR MAN (Fulton State Hospital, 2004, p. 22).
  51. 51. DEAR MAN Bill of rights  I have the right to be treated with respect.  I have the right to my own opinions.  I have the right to express my feelings.  I have the right to stand up for my values.  I have the right to disagree with others.  I have the right to ask for information.  I have the right to understand a request before agreeing.  I have the right to say no without guilt.  I have the right to ask for my wants and needs.  I have the right to set healthy boundaries with others.  I have the right to disengage from conflict.  I have other rights related to my needs and wants. Self-Focused - DEAR MAN (Pederson & Pederson, 2011, p. 151).
  52. 52. DEAR MAN Role Play Watch this example at https://www.youtube.com/watch?v=SYtO64Wyjls By: Roanne, R. (2014, December 20). DBT: Getting what you want using DEAR MAN skills [Video file]
  53. 53. Which Interpersonal Skill Should I Use? Getting what I WANT/NEED is the most important Maintaining the RELATIONSHIP is the most important use GIVE DEAR MAN FAST WHAT IS MOST IMPORTANT TO ME? use
  54. 54. Formula • I think: Your factual understanding of what’s happening • I feel: Starts with “I” because it’s about you and your particular feelings • I want: Ask for one specific and concrete behavioural change at a time that can be changed now • Self-care: Tell the person what you’ll do to take care of yourself if they don’t comply with your request Example • I think: “I’ve been working against a deadline tonight and haven’t had time to cook dinner.” • I feel: “I’m pretty anxious and overwhelmed that I might not get this done.” • I want: “Could you whip something together from leftovers so I can keep going?” • Self-care: “If that doesn’t work for you, I can order a pizza.” Interpersonal Effectiveness Integration (McKay, Wood, & Brantley, 2007, pp. 205-208).
  55. 55. References Fulton State Hospital. (2004). Dialectical Behavior Therapy Skills Handbook. Adapted for use from Linehan, M.M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press. Linehan, M.M. (2014). DBT® Skills Training Manual. Guilford Publications. McKay, M., Wood, J. C., & Brantley, J. (2007). The dialectical behavior therapy skills workbook (p. 190). Oakland: New Harbinger. Pederson, L., & Pederson, C. S. (2011). The Expanded Dialectical Behavior Therapy Skills Training Manual: Practical DBT for Self-help, and Individual and Group Treatment Settings. PESI Publishing & Media.
  56. 56. Feedback Jeanine Maritz • Email: jm9473371@gmail.com • LinkedIn: https://za.linkedin.com/in/jeaninemaritz

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