Therapy Tuesday: DBT Part 4B – Interpersonal Effectiveness

The second set of skills learned in DBT therapy is grouped together and called “interpersonal effectiveness.” I’ll be posting some images of the worksheets at the end of the post, in case anyone wants to use them. These are also readily available online, if you need copies.

dbt1

As this sheet shows, there are reasons why interpersonal effectiveness needs to be broken down into sub categories. The first part may sound like it’s teaching people how to manipulate others into doing what is wanted. In fact, it’s the opposite. It’s learning how not to use manipulation, and not to fall prey to it. It’s also learning about establishing boundaries and using the right to say “no” to requests for whatever reason.

The second part builds on this and expands it to stabilizing and preserving relationships. This does come with a caveat, though. Not every relationship is healthy. It’s during this stage of learning that a surprising thing happened to myself and to others who were in the group with me. As we began to use the skills in the first segment, the people around us became, well, disenthused. They didn’t like being told no. They didn’t like reasonable requests being made of them.

The reason isn’t that people who care about someone are going to abandon them during therapy. It’s that as we learn healthier skills and begin to use them, we become aware of unhealthy relationships. The impact begins to be seen as we move into the second stage because we’re actively evaluating relationships. These evaluations aren’t based on one interaction, but on a history of interactions and on the attempts at a different mode of interacting. The therapy focuses on preserving relationships, but the experiences we had left us each bewildered.

If one of us had said no to a request from someone for the first time, we rapidly learned just how angry someone can get when they feel we don’t have that right. The friend who always needs a ride, the parent who expects everyone to drop everything and do what they want to do, the partner who makes demands that interrupt schoolwork or the routines of the children, each are examples of people who became irate at being told no. That was where the second part came into play.

Sadly, what we found was that before we had a chance to resolve conflict, or determine the worth of a relationship, the other party had decided that as they could no longer make unreasonable demands, they were through with us. I’ve spoken with many people in the intervening years who described the same shedding of relationships while they worked through therapy as well. Rarely was it by the choice of the person receiving therapy.

If you’re in therapy, be prepared for this. Unhealthy relationships can be transformed, but only if both people want this. Even your closest friends and family may be displeased that you’re learning to maintain normal, healthy boundaries.

If you know someone who is in therapy and they start to exercise those boundaries, step back and consider that just because they never said no or made requests before it doesn’t mean they’re not within their rights to do so, just as you are. Don’t trash a relationship just because it’s shifting. The end result is a healthier, stronger relationship that is worth keeping.

That also leads to the third part. In the final component, we learn that how we feel about our interactions with others is valid and meaningful. We learn that we actually do have control over how we react, how we want to feel, and that the previous two segments have led us to a place where, with practice, we can learn to make requests, deliver rejection, maintain personal boundaries, and still feel good about ourselves – all while maintaining relationships with others. For those who have been subjected to codependent relationships all their lives, this is an eye-opening moment.

The process of being able to ask for what we need, maintain our boundaries, keep our relationships, and feel good about how we’ve done it is broken down into acronyms. These are DEAR MAN / GIVE / FAST. I’m simply going to place the worksheets for how they work below, rather than write it all out. These explain what the steps are, and how to move through that process.

dbt2dbt3As dbt4

With these sheets, it will be evident that the mechanisms are not conducive to manipulation, and are based on simple, healthy ways of interacting. This whole segment of DBT therapy is one of the longest, but I feel it must be the most important. Without the ability to interact and maintain boundaries, any progress made in therapy will fall away as old relationship patterns and old ways of interacting will simply slip back into place. That will eventually return a person to the patterns that led to them seeking therapy to begin with. This section, once practiced a few times, will lead to healthy, supportive relationships where a person is able to be themselves.

 

 

 

 

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