by: Kira Yanko, MS, LPC | Northwest Passage III Therapist
Nurtured and Nudged…
The first and foremost principle of DBT is dialectics, hence the name. This is the idea that two concepts that seem to be completely opposite from one another can both exist and be true at the exact same time. A person can both love and hate someone. They can seek independence and dependence at the same time. A client can be doing the best that they can and simultaneously need to do better. This isn’t a new idea (and Marsha doesn’t suggest that it is…after all it is the basis of the serenity prayer written in the late 40’s, early 50’s), but for the first time it was encapsulated and formalized it into a therapeutic approach. It is often the belief that only one truth exists that leads to both internal and external turmoil for our clients. If we interact with any of our clients purely from one static vantage point, we present them with opportunities to “power struggle” and this can destroy our alliance – the key aspect of any therapeutic relationship (and I’m not just referring to therapeutic relationship in terms of therapist and client, but in terms of any relationship between two people that can have therapeutic value).
If we only show acceptance of their current situation, there is no encouragement for forward movement. Eventually this acceptance alone could be misinterpreted as enabling and condoning by our clients. They certainly may like speaking with us, but progress is stagnant. Conversely, if we only push our clients to change this can feel invalidating. A client who feels invalidated can withdraw and even resist, possibly dropping out of treatment. It’s pretty hard to make progress with a client who is mute or physically not present. DBT reminds us that both ends of the spectrum must be synthesized and if we do so, if we both nurture and nudge, we can develop strong, therapeutic relationships with our clients.
Little ol’ me?!
DBT requires that therapy must meet five critical functions. (Don’t worry, we aren’t going to go in to ALL of them in detail.) According to Marsha Linehan’s Behavioral Tech website, these are:
- “Enhance and maintain the client’s motivation to change,
- Enhance the client’s capabilities,
- Ensure that the client’s new capabilities are generalized to all relevant environments,
- Enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities, and
- Structure the environment so that treatment can take place.”
The first three and the last are handled within the office doors of a therapy session and through skills group training, phone coaching, homework, and family therapy. The fourth however, is my selfish favorite and the one that could be yours, too! It’s not many a therapy modality that takes care to nurture the clinician to the point that it chiseled in to its commandments. And I’m a therapist so it makes me feel warm and fuzzy that DBT recognizes that I am a human and working with high symptom/high needs clients can be emotionally challenging at times (Little ole’ me, you are going to focus on little ole’ me?!)…and it does something to counteract that – can you say acceptance and change!?
As DBT recognizes that emotional dysregulation can often lead to intense symptoms that have the potential to burn out a clinician, it prescribes weekly consultation team meetings. This serves to help clinicians remain balanced in working with their clients. It also offers support and encouragement for effective therapy. DBT thinks that this piece is so darn important that a therapist is considered to not be meeting the requirements of treatment without this weekly consultation. Leaving the therapist’s office however, clinicians are certainly not the only ones engaging with these often highly dysregulated clients on a regular basis. As such, it seems just as imperative that anyone having an ongoing relationship with a highly dysregulated client also engage in consultation and self care. Regularly examining our responses and interactions and talking with other clinicians or consultants can help maintain our own efficacy. Consultation can help remind us of our accomplishments when sometimes these get drowned out by challenges. And self-care provides an opportunity to “recharge our emotional batteries” in order to continue providing the best services to our clients.