HANDOUTS TIPS - see below
H - Handout W - Worksheet PPT - Powerpoint
H - Handout W - Worksheet PPT - Powerpoint
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TIPS
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DIALECTICAL BEHAVIORAL THERAPY
Treatment designed for people with Borderline Personality Disorder, but valuable for all people who desire peace of mind. Created by Marsha Linehan, Ph.D
TIPS - (Random Thoughts About Therapy)
1. Bored With a Client (link)
2. Being Judgmental vs. Having A Right To Your Opinion
When researching how the words “judgmental” and “opinion” are defined there is much overlap, but an opinion is not always negative. For the sake of helping a client distinguish between the two you might define it this way:
o Being judgmental is having an opinion without facts and presuming based on one's own uninformed perspective. You are judgmental. You form an opinion.
o Facts may be distorted or ignored in order to support one's own viewpoint. It is easier to continue with an incorrect judgment than to be open to the truth.
o Judgmental is impulsive and usually based on:
o Rigid standards formed without consideration of variables (unemployed people are lazy).
o Or come from a painful experience and generalized to a larger group (attacked by someone of different ethnicity means that everyone from that group has the potential for violence).
o How one was raised...
o Being judgmental is assuming your facts are the only facts. The lake is too cold to swim in. (Your opinion is based on how your body perceives the water and is sensitive to the temperature.) (vs.) The water’s fine. You’re a wuss if you don’t get in. (Judgmental, and likely if physically perceived the same, would not get in the water either)
3. EMOTIONAL MEMORY
Emotional Memory is defined as recall of emotions stemming from past situations which result in looking back over experiences inaccurately. For someone who has difficulty with thought distortions such as misinterpretations or jumping to conclusions this can happen. People will look back over time and develop “absolute” perspectives, even if many of the previous experiences were proven unfounded. For example: if a woman is unwilling to attempt new friendships because she always feels betrayed or used, it could be that even when she learned that her original thought was false and the moment was healed, she still maintains the memory of the hurt. She now has a long line of hurts that stay no matter what the truth was.
Emotional Memory is especially prominent with people with personality disorders in which their perspectives can be skewed. There always is a foundation of truth but then similar situations will be viewed through the same lens. Another example might be someone in therapy who is easily triggered and sensitive. A therapist can state something in a validating and gentle way but one or two words will be all that is recalled and the thinking that follows results in a wound. They may receive clarification the next session and feel relief but when this happens a few times they establish in their mind a pattern of wounds and develop a faulty belief about the therapist.
4. INCREASING TRUST AND WILLINGNESS
o Validate – Find something you can agree with and show understanding of, help them to know that you get it. How can you help them if they don’t know or believe you understand them? More importantly is the idea that someone is listening without disagreeing and telling them they’re wrong.
o Cheerlead – Prop people up until they gain strength to hold their own weight. You might be concerned about creating dependency or enabling but don't jump to that. If someone keeps looking to you then discuss what it would take for them to not need you for that. You wouldn't let someone in physical therapy fall because their legs should be stronger by now, according to what the averages are for recovery.
o Treat as equal - Be genuine, not canned or corporate. This can be so hard to do as a new therapist because you haven't developed instinct yet for how much to say, the best responses, how far to go with someone. You’re taught rules in school that lump everyone into a mold with the same response due. I can't speak for all schools but I hear things student interns have been told and it's scary at times. (Ex. offering a tissue when someone is crying can be insulting) Quick tip 1
5. RECEIVING GIFTS
A client wants to give you a gift. That’s supposedly a no-brainer, you say I can’t accept gifts. How about if you don’t jump to a global response? If someone put effort into making something or effort into choosing a small purchase, or just came across something that reminded them of you, then how is that rejection going to feel? It’s not easy to feel you are getting so much and not able to show appreciation, even if you are paying. It also will not leave them feeling equal when they have to return home with the rejected gift from the higher-tier human.
If a gift is expensive then it shouldn’t be accepted, but if not, then I tell people that it is not policy to accept gifts while showing appreciation for it "this one time”.
6. HIDDEN BRUISES
People often don’t understand the reactions of sensitive people. They will act with surprise and irritation at a response that appears to be out of proportion. You might hear “chill out”, “what’s the big deal”, “calm down”, “drama queen”, etc. When people don’t know your triggers and that your reaction isn’t just about what they did or said, they obviously can’t understand the intensity. If you had a bruise on your arm, under your sleeve, no one would know that a light touch would be capable of causing pain. They might come up to you and say - Hey buddy and give you a fist bump right on your bruise which would make you jump back yelling ouch. They know they didn’t hit you hard at all; and this can escalate if now you’re mad at them and they don’t feel like they did anything wrong.
7. THAT’S NOT APPROPRIATE
Please don’t ever say – ”That’s not appropriate.” There may be rare times when that is the best choice but otherwise it is not helpful and comes across as condescending. Clients may not have proper social skills or an understanding of the boundaries between clinician and client and as a result act inappropriately. You give the message that it is not appropriate when they pat you on the head and tell you your hair is pretty, but not why. It is not a learning experience that they will be able to generalize. It is possible that they will be offended and never touch you again and it will seem learned, but it’s not the same. If they’re not offended, the next session they might not dare to touch your head, but might lean over and kiss you on the cheek to say thanks. If you explain that the therapeutic relationship is different than a friendship and other than an occasional hug if there’s good news, you are not comfortable with physical contact (in whatever words you choose) than they will learn something.
Language is another area that can be deemed inappropriate. There is very little that I won’t allow in my office. I don’t care about swearing but I do care about discriminatory words used for ethnic groups, gay people, disabled, etc. If someone is raging or psychotic I will likely let it pass as it not the priority. For other times I will ask people to please not use the word and if the timing is right use it as a therapy moment.
8. (BRIEF TIP 1) TO DEMONSTRATE NEUROPLASTICITY
Ask client to put their hands together entwining fingers. Have them notice the order of their fingers and then have them switch so if their right thumb is in front, place it in back and move the other fingers accordingly. Explain that if they held their hands in this order long enough that it would begin to feel normal.
9. (BRIEF TIP 2) SHAME-COLORED GLASSES
This term can be used when trauma clients interpret situations or view themselves in a way that stems from their previous experiences and lack of self-worth.
MORE TIPS COMING SOON
2. Being Judgmental vs. Having A Right To Your Opinion
When researching how the words “judgmental” and “opinion” are defined there is much overlap, but an opinion is not always negative. For the sake of helping a client distinguish between the two you might define it this way:
o Being judgmental is having an opinion without facts and presuming based on one's own uninformed perspective. You are judgmental. You form an opinion.
o Facts may be distorted or ignored in order to support one's own viewpoint. It is easier to continue with an incorrect judgment than to be open to the truth.
o Judgmental is impulsive and usually based on:
o Rigid standards formed without consideration of variables (unemployed people are lazy).
o Or come from a painful experience and generalized to a larger group (attacked by someone of different ethnicity means that everyone from that group has the potential for violence).
o How one was raised...
o Being judgmental is assuming your facts are the only facts. The lake is too cold to swim in. (Your opinion is based on how your body perceives the water and is sensitive to the temperature.) (vs.) The water’s fine. You’re a wuss if you don’t get in. (Judgmental, and likely if physically perceived the same, would not get in the water either)
3. EMOTIONAL MEMORY
Emotional Memory is defined as recall of emotions stemming from past situations which result in looking back over experiences inaccurately. For someone who has difficulty with thought distortions such as misinterpretations or jumping to conclusions this can happen. People will look back over time and develop “absolute” perspectives, even if many of the previous experiences were proven unfounded. For example: if a woman is unwilling to attempt new friendships because she always feels betrayed or used, it could be that even when she learned that her original thought was false and the moment was healed, she still maintains the memory of the hurt. She now has a long line of hurts that stay no matter what the truth was.
Emotional Memory is especially prominent with people with personality disorders in which their perspectives can be skewed. There always is a foundation of truth but then similar situations will be viewed through the same lens. Another example might be someone in therapy who is easily triggered and sensitive. A therapist can state something in a validating and gentle way but one or two words will be all that is recalled and the thinking that follows results in a wound. They may receive clarification the next session and feel relief but when this happens a few times they establish in their mind a pattern of wounds and develop a faulty belief about the therapist.
4. INCREASING TRUST AND WILLINGNESS
o Validate – Find something you can agree with and show understanding of, help them to know that you get it. How can you help them if they don’t know or believe you understand them? More importantly is the idea that someone is listening without disagreeing and telling them they’re wrong.
o Cheerlead – Prop people up until they gain strength to hold their own weight. You might be concerned about creating dependency or enabling but don't jump to that. If someone keeps looking to you then discuss what it would take for them to not need you for that. You wouldn't let someone in physical therapy fall because their legs should be stronger by now, according to what the averages are for recovery.
o Treat as equal - Be genuine, not canned or corporate. This can be so hard to do as a new therapist because you haven't developed instinct yet for how much to say, the best responses, how far to go with someone. You’re taught rules in school that lump everyone into a mold with the same response due. I can't speak for all schools but I hear things student interns have been told and it's scary at times. (Ex. offering a tissue when someone is crying can be insulting) Quick tip 1
5. RECEIVING GIFTS
A client wants to give you a gift. That’s supposedly a no-brainer, you say I can’t accept gifts. How about if you don’t jump to a global response? If someone put effort into making something or effort into choosing a small purchase, or just came across something that reminded them of you, then how is that rejection going to feel? It’s not easy to feel you are getting so much and not able to show appreciation, even if you are paying. It also will not leave them feeling equal when they have to return home with the rejected gift from the higher-tier human.
If a gift is expensive then it shouldn’t be accepted, but if not, then I tell people that it is not policy to accept gifts while showing appreciation for it "this one time”.
6. HIDDEN BRUISES
People often don’t understand the reactions of sensitive people. They will act with surprise and irritation at a response that appears to be out of proportion. You might hear “chill out”, “what’s the big deal”, “calm down”, “drama queen”, etc. When people don’t know your triggers and that your reaction isn’t just about what they did or said, they obviously can’t understand the intensity. If you had a bruise on your arm, under your sleeve, no one would know that a light touch would be capable of causing pain. They might come up to you and say - Hey buddy and give you a fist bump right on your bruise which would make you jump back yelling ouch. They know they didn’t hit you hard at all; and this can escalate if now you’re mad at them and they don’t feel like they did anything wrong.
7. THAT’S NOT APPROPRIATE
Please don’t ever say – ”That’s not appropriate.” There may be rare times when that is the best choice but otherwise it is not helpful and comes across as condescending. Clients may not have proper social skills or an understanding of the boundaries between clinician and client and as a result act inappropriately. You give the message that it is not appropriate when they pat you on the head and tell you your hair is pretty, but not why. It is not a learning experience that they will be able to generalize. It is possible that they will be offended and never touch you again and it will seem learned, but it’s not the same. If they’re not offended, the next session they might not dare to touch your head, but might lean over and kiss you on the cheek to say thanks. If you explain that the therapeutic relationship is different than a friendship and other than an occasional hug if there’s good news, you are not comfortable with physical contact (in whatever words you choose) than they will learn something.
Language is another area that can be deemed inappropriate. There is very little that I won’t allow in my office. I don’t care about swearing but I do care about discriminatory words used for ethnic groups, gay people, disabled, etc. If someone is raging or psychotic I will likely let it pass as it not the priority. For other times I will ask people to please not use the word and if the timing is right use it as a therapy moment.
8. (BRIEF TIP 1) TO DEMONSTRATE NEUROPLASTICITY
Ask client to put their hands together entwining fingers. Have them notice the order of their fingers and then have them switch so if their right thumb is in front, place it in back and move the other fingers accordingly. Explain that if they held their hands in this order long enough that it would begin to feel normal.
9. (BRIEF TIP 2) SHAME-COLORED GLASSES
This term can be used when trauma clients interpret situations or view themselves in a way that stems from their previous experiences and lack of self-worth.
MORE TIPS COMING SOON