Using Dialectical Behavior Therapy Techniques with Imago and Family Therapy

Girl talking with her therapistI am not formally trained in dialectical behavior therapy (DBT). My knowledge of it comes from texts, watching trained practitioners do it, and gradually incorporating it into my practice. I’m comfortable with its use—due to my background and training in similar modalities—and have found the skills to be valuable for those who have a difficult time with more traditional therapy approaches.

One area in which DBT has been most helpful to me is in couples and family work as a compliment to Imago and traditional family and couples therapy.

Imago’s dialogue draws from communication skills such as “I messages,” mirroring, validation, and empathy. Most family and couples therapy around communication, regardless of modality, has included this skill set for decades. In fact, it’s rare to read a book or manual on family therapy without any of these skills coming up.

Many times, couples and families who come to therapy become dysregulated in their communication and do not have the discipline to put these skills into practice. The “dialogue” does a good job in helping folks get communication on an empathic level but, in my opinion, falls short of helping them understand how to modulate intensity and the practical dimension of effective interpersonal skills.

Lastly, people in therapy often state that the skills seem packaged for “vacuum interactions” and most triggers occur unexpectedly. They do not feel the dialogue is a realistic alternative to their normal way of communicating. This is half true, in my opinion. The skills are useful for giving people in therapy the tools to communicate, but they do not increase or improve real world capacity to regulate this communication.

The Interpersonal Effectiveness handouts in the Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan have been useful in helping couples and families in my practice achieve the following:

  • Understand the building blocks of relationships and interpersonal skill development. Many times, couples and families in therapy aren’t able to recognize the areas they need to be attentive to in order to improve their ability to effectively manage relationships. They can have a hard time explaining why the relationship is breaking down. “The situation for interpersonal skills” handout allows couples and families to organize these components in a way that allows for a more straightforward self-assessment of their relationship.
  • Understanding the purpose of interpersonal skills. Many people in therapy get stuck on meeting the concrete or representative/historical needs at hand. The “Goals of Interpersonal Skills” handout allows couples and families to broaden their understanding to include relationship maintenance and self-respect as equal parts to the communication equation. This handout can allow people to get away from just going after the widget and to consider other, equally important factors in delivering the message.
  • Understanding legitimate rights and factors reducing interpersonal effectiveness. This allows couples and family members to receive “permission” to communicate a need and works to eliminate the barriers to interpersonal effectiveness (also included as a worksheet in Linehan’s manual).
  • Modulating intensity. The “Options for Intensity of Asking or Saying No, and Factors to Consider Deciding” has been the most valuable tool in helping couples and families in my practice. It asks them to consider the intensity they are applying to their communication around a need. It presents 10 items they should account for in a very concrete, guided, and understandable way. Many couples and families assign a number to each of the 10 items to come up with a ball park average on how firm they are going to be in the face of a demand.
  • “DEAR MAN, GIVE, FAST.” I use the Imago dialogue within this framework across all three of Linehan’s communication worksheets. This helps couples understand why the dialogue makes sense while providing them with a way to apply theory to how they communicate in concrete ways.

Of course, going through the skills involves more than just providing the handouts. Much of the information presented may not make sense to everyone. The therapist should really have a strong command of the material before using it and should prepare to spend a full session discussing each handout.

Adding the DBT communication module as a complement to couples or family work can help people feel comfortable in asserting a need effectively. I have found that applying the module significantly lessens the learning curve around communication. This has allowed me to move on to other issues beneath the surface more quickly. This occurs because the module provides people in therapy with a much greater capacity to tolerate or communicate charged material that may be at the core of what brought them into my office.

Reference:

  1. Linehan, M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press.

© Copyright 2011 by John Migueis, LCSW, therapist in Summit, New Jersey. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Robin

    Robin

    August 24th, 2011 at 2:06 PM

    I am trained in DBT but do not do couples work. I think the emotion regulation piece about validation of ones feelings, and that feeling are just feelings and neither right or wrong, would be incredibly helpful for couples too. Great article, thanks!

  • linda

    linda

    August 24th, 2011 at 10:54 PM

    te differences in families seemto be increasing,relationships are deteriorating over the years…I feel it’s mainly coz v r spending lesser n lesser times with our family and partners.thus less communication.

  • samantha.C

    samantha.C

    August 25th, 2011 at 4:11 AM

    it must be difficult in couples therapy as a therapist isn’t it?you are dealing with a couple that has problems.you need to explain things to both of them in a way that each can understand.and also need to understand each one’s personality and react accordingly.whew!how is it doing couples therapy?

  • John Migueis

    John Migueis

    August 25th, 2011 at 8:42 AM

    Robin, that is a good point, making that part of the curriculum prior to going over communication might go a long way. Samantha, I think the key to good couples work is skill development and practice. After we go over concepts and skills I ask couples to practice them to resolve real life issues with each other. I try to only intervene when a skill is not being used where it should.

  • Robert F.

    Robert F.

    December 14th, 2011 at 9:29 AM

    I get the feeling that DBT may only be effective in situations that are not deeply effected by ‘historical’ ‘shadows’ or other underlying ‘structural’ weaknesses in relationship values and ethics that have undermined the core stability of individuals, and have been subsequently projected into their family system.

  • Michelle Logan

    Michelle Logan

    December 10th, 2013 at 4:24 PM

    I am a therapist in an adolescent intensive outpatient program and run multifamily groups and have used Imago dialogue with families. I have gotten incredible feedback and we consider ourselves to be largely DBT focused. I used an old workbook from a weekend seminar my husband and I took together ten years ago. :)

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