Skills training is a dialectical behavior therapy technique used to treat borderline personality disorder. It aims to reduce distress and misery by replacing ineffective and maladaptive behaviors with more adaptive skills. The training covers core mindfulness skills, interpersonal effectiveness skills, emotion regulation skills, and distress tolerance skills. Sessions involve discussion, role playing, and exercises to develop skills in these areas and work towards creating a life worth living.

1. Dialectical Therapy
Skills Training
Overview
Treatment Developed By Marsha Linehan,
Skills Training Manuel For Treating Borderline Personality
Disorder (New York: Guilford Press, 1993)
Presenters Today:
Rick Treadway-Teran, MFT

2. Today’s Agenda
• Orienting to Skills Training
– Overall Goal-To reduce misery and distress
by practice and mastery of new skills that help
us to change behavioral, emotional and
thought patterns.
• Basically, it is the process of replacing ineffective
maladaptive non-skilled behaviors with more
skillful ones.
• Creating a “Life Worth Living” !!!

3. Today’s Agenda
• Through discussion, role play and small group
activities we will be introduced to:
– Core Mindfulness Skills
– Interpersonal Effectiveness Skills
– Emotion Regulation Skills
– Distress Tolerance Skills
– Validation Skills (Not included in The Skills Training Manual
but extensively covered in the “The Text.”

4. Orienting the client to combat the
“Why Should I?”
• Do you have problems saying no…. or do you say no all of the time?
• Do you find it hard to be in relationships, but just can’t stand to be
alone?
• Do you have problems with anger, “over reactions,” lash out, say
you’re sorry a lot?
• Do you engage in unsafe or risky behaviors without thinking first?
• Do you become overwhelmed with other’s opinions, feelings of
emptiness and/or confused about your feelings?
• Do you hurt yourself or other’s?
• Are you plagued by anxiety or dreadful fear without knowing why?
• Would it hurt for you to learn a few more life tools?

5. Before Getting Started:
Assess for Deficits
• Produce a safe, optimal environment for
the behavior being assessed to be
produced. (validationvalidationvalidation)
– If the skillful behavior exists it may need
strengthened for those “not so safe”
environments.
– If the skillful behavior is not in the client’s tool
belt, it needs taught.
– If very skilled, look at the environment.

6. “How To Assess” Skills
• Interpersonal Skills-Do role plays or observe In-
Vivo.
• Distress Tolerance-Explore a past stressful
laden situation and the client’s survival
techniques.
• Emotion Regulation-Interrupt client and ask for
modulation or change of emotion.
• Mindfulness-Is the client able to focus in the
“here and now” without excessive judgments?

7. Mindfulness Exercise
• Purpose: To integrate the emotional mind and
reasonable mind to a “wise mind” state.
– reduce the automatic avoidance of situations based
on emotions
– reduce judgments based on thoughts that are
extreme (black & white)
– Increase awareness of vulnerabilities (physical state,
substances, being tired)
– let go of being right, in favor of achieving goals
– reduce emotion phobia

8. Mindfulness Exercise
• Orient to the bell
• Give instructions of focus and give a
general duration
• Focus on the “What Skills”
• Observe- Just notice your thoughts, be alert and
notice your senses
• Describe- “I just had a feeling of sadness” or “I just
had a thought of my busy schedule today”
• Participate- Let go of willfulness and be present in
this moment

9. Mindfulness Exercise, Cont.
• Focus on the “How Skills”
• Non-Judgmental- Accept things as they are….
– I’m good at this.. Client’s won’t do this.. I am soooo
judgmental~~~~
• One Mindfully-Do one thing at a time. Be in the
moment and if distracted, keep going back to one
thing.
• Effectively- Meet the demands of the situation you
are in: not the one you wish it to be. Do what
works….not what doesn’t.

10. Create Mindfulness Exercises
• Beach waves coming in and out
• Clouds moving overhead
• Automobiles on the freeway
• Eating
• Walking
• Develop times to be mindful with others
– Passive, Active or Interactive

11. Take A Vacation
10 minutes

12. Interpersonal Effectiveness
• Primary Goals Are
– Meeting Our Desires of Change (Objective Effectiveness)
– Getting and Keeping Relationships With
Others (Relationship Effectiveness)
– Having Ongoing Self-Respect
• The problems arise when what one person
wants/values comes in conflict with what another
person wants/values. This can lead to intense
passivity or dominance…and the chaos follows.

13. Discussion of “Blow Ups”
Attending, Balancing and Building
• Identify any left over hurts, hopelessness.
• Are there too many or too few demands in
your life?
• Have you fallen into the “shoulds” and
forgotten about the “wants” or reversed it?
• Did you feel “walked on” or
“disrespected?”
• Did you defend yourself in a way you feel
proud of?

14. Specific Areas That Reduce
Interpersonal Skills
• No skills to call upon = Modeling
• Faulty Thinking and Beliefs =Challenging
Myths and Cheerleading (pg 118,119)
• Emotions Become Overwhelming
=Staying Mindful
• Being Ambivalent (helpless or
extreme)=Assertiveness Training
• Environment Won’t Allow for Skills=Accept
or Leave

15. Practice Exercises
• DEAR MAN translates to the skills of:
Describe the situation (Facts Only).
Express your feelings and opinions with “I.”
Assert yourself by asking for or saying no.
Reinforce through consequence (pos and neg).
Mindful-Ignore attacks and stay calm
Appear confident- voice volume and eye contact
Negotiate-Give a little or collaborate

16. Practice Exercises
• GIVE FAST translates to the skills of:
Gentle- No attacks, threats or judging
Interested- Be open to the other persons views
Validate- Let them know you “get it”
Easy Manner- Humor.. It’s not the end of the world
Fair-Look out for you and the other person
Avoid Apologies- You are allowed to be and do
Stick to your personal values and self respect
Truthful-Don’t lie, deceive or exaggerate to win

17. Therapist Interpersonal
Effectiveness (Group exercise)
• Know and List Your Basic Values
• Know Your Pet-Peeves (What irks you?)
• Push your limits and know your edge
• Are you balancing Acceptance –vs-
Change?
• Can you apologize to your clients without
fearing “backlash?”

18. Emotion Regulation
• Primary Goals Are
– Identify emotions and learn the value of
them
– Reduce vulnerability to negative emotions
and increase positive ones
– Change painful emotions and let go of
action drive

19. Describing Emotions
• Learning the Emotions
– Naming Emotions
– What Activates Emotions
– Experiencing Emotions
– Expressing Emotions
– Effects of the Emotions
Becoming skilled with Love, Joy, Anger,
Sadness, Fear, Shame and keep building

20. Emotion Regulation
• Client’s will need to be encouraged to value
painful or negative emotions due to inhibited
grieving and emotion-phobic reactions.
– Use examples or evolution as fight or flight
– Use examples of cohesion for loneliness
– Use examples of intuition and it’s proper use
• Groups can develop validation lists for each
emotion (Reasons we want and avoid)
• Practice Hand Out and Give Feedback (pg 136)

21. Emotion Regulation
• PLEASE MASTER translates to the skills
of:
Treat PhysicaL Illness
Balance Eating
Avoid Mood-Altering Drugs
Balance Sleep
Get Exercise
Build MASTERy

22. Emotion Regulation
• It may seem simple, but don’t forget that
client’s need to engage in activities of
pleasure that stimulate pleasurable
emotions.
• This can be a goal for the individual as
well as couples and families.
– This can be a diary card item or weekly
planned “home work.”

23. Emotion Regulation
“Let Go of Suffering”
• Detach and observe the emotion
• Feel it without pushing it away or clinging
to it
• Don’t dramatize it…Talk about it
• Fearlessly accept your emotion

24. Emotion Regulation
“Changing Unreasonable
Emotions”
• FEAR-Approach the task, activity or
person. Use exposure systematically
• GUILT or SHAME-If clearly reasonable,
repair and avoid repeating.. If
unreasonable.. Do it over and over again
• Sadness and Depression-Become
active, approach, become involved
• Anger- Imagine empathy, do a nice thing
as opposed to attack or simply avoid

25. Distress Tolerance
• Primary Goals Are
– Survival
– Accept Pain and Distress as Part of Life
– Reduce Impulsive Reactions
– Reduce the Risk of Making Things Worse
– Radical Acceptance to Reduce the Risks of
PTSD and Inhibited Grieving
– Learn Reasonable Distraction and Avoidance

26. Distress Tolerance
“Distract”
• ACCEPTS translates to the skills of:
Activities-Do Something Else
Contribute-Do For Others
Compare-Others May have it Worse
Emotions-Develop Opposite Emotions
Pushing Away-Leave situation or block awareness
(Dissociate in crisis)
Thoughts-Distract from situation
Sensations-Use other sensory stimulus

27. Distress Tolerance
“Self Soothe”
• Five Senses translates to the skills of:
– Vision
– Hearing
– Smell
– Taste
– Touch

28. Distress Tolerance
“Make the Moment Better”
• IMPROVE translates to the skills of:
Imagery-Create relaxing mental pictures
Meaning-Make lemonade out of the bitterness
Payer-Open your heart and surrender the pain
Relaxation-Bath, Massage, Lotion, Breathe
One Thing in the Moment-Use Mindfulness
Vacation-Take a brief or longer break.. Make it
good
Encouragement-”This too shall pass”

29. Distress Tolerance
• Some Other Acceptance Exercises to
Learn and Teach
– Observe the Breath (pg 170-171)
– Half Smile (pg 172-173)
– Focus Awareness (pg 174-175)
Reinforce the choice to radically accept what is
and be willing to ride it out without actions of
self or other destruction.

30. Validation: The Primary Ingredient
for Change
• Validation is akin to sugar in a cake…It is
not required to make a cake…It is
necessary, however, to make it more
palatable…even desirable and sought
after.

31. Validation
Linehan, MM (1997). In A. Bohart & L. Greenberg (Eds.),
Empathy Reconsidered: New Directions in…Washington,
DC: APA
• Level One: Listen and Observe
– Stay present and attuned
– Ask for clarification
– Be a participant and observer (use wise
mind)
– Reinforce that you hear the client in the
present and have heard him/her in the past

32. Validation
• Level Two: Accurate Reflection
– An agreement between two that what was
said was accurately understood
– “Matter of Fact” tone
• Listen to the content of The Highly Emotional
Client
• Listen to the emotion of The Highly Reasonable
Client

33. Validation
• Level Three: Saying the Unsaid (MIND
READ)
– This level conveys the human understanding
or empathy of an experience.
– Be willing to be wrong or at least too soon for
the client’s acceptance.
– This is the idea that there is more going on
than is expressed…or in the grasp of
awareness

34. Validation
• Level Four: Behavior is caused and can
always be understood even if not skillful
(Counter the “Shoulds”)
– Historical-With the past experiences of a
person, it’s clear why they do….
– Current-There could be wrong information
from inside or outside.
– Biological or learning disorder

35. Validation
• Level Five: Reasonable in the Moment
(Cutting, erratic, drugs, alcohol, etc)
– There are facts, if known, that clearly support
the behavior
– Just Noticeable Progress to attaining a LT
goal
– Normal and ordered not necessarily pathology
– Makes sense for attaining ST goals but
seriously impedes LT goals.

36. Validation
• Level Six : Radical Genuineness
– Accepting the client as a person with value
– Seeing the persons strengths and
weaknesses with a dialectical balance.
– Leaving the diagnosis behind

37. Open Discussion and Questions
• Rick Treadway-Teran, LMFT