Dialectical behavior therapy (DBT) combines cognitive and behavioral therapies with Eastern mindfulness practices. Developed by psychologist Marsha M. Linehan, DBT is useful in treating individuals with a wide variety of issues, including depression, anxiety, bipolar, self-injury, eating disorders, substance abuse, and relationship conflict. The goal is for clients to learn to manage their emotions and develop healthier coping skills, while also practicing self-acceptance.
The term dialectical refers to the goal of synthesizing the rigid “black and white” thinking of many clients who have trouble regulating their emotions. Additionally, a key dialectical within DBT is the principle of accepting the client as he or she is, and offering validation, while also helping him/her learn change strategies. Validation in DBT refers to offering the client verbal and nonverbal support and confirmation.
The emphasis on validation in DBT grew out of observations in the late 1970s that many clients experienced behavioral therapy as invalidating; this led to resistance and sometimes withdrawal from therapy. Clients’ resistance often manifested in behaviors that sabotaged the effectiveness of individual therapy. These observations led to some of the core features of dialectical behavior therapy, including radical acceptance and validation of the client’s current level of emotional and behavioral functioning. This balancing of acceptance and change is important not only within individual therapeutic interactions, but within the overall treatment. While the client learns skills to improve self-acceptance, the therapist employs validation strategies, including the following:
Methods of Validation
- Focus on listening with empathy and genuine concern, being careful to stay in the moment. Display interest through verbal and nonverbal cues: Nod and maintain eye contact, and use verbal replies such as “Uh-huh” and “What else are you feeling?”
- Respond with accurate reflection, summarizing what the individual had shared. For example, “It sounds like you are angry that your wife made these plans without consulting you.” Check for accuracy by asking, “Is that right?”
- Observe and articulate the individual’s unspoken emotions, based on what he or she says and nonverbal cues. Ask if your observations are correct. For example, “So you think it is unreasonable that she expects you to show up at this event without asking you. Is that correct?”
- Validate and restate the person’s feelings and behaviors in relation to past and present situations and issues. Acknowledge that his or her current emotions are understandable in light of past experiences and/or present circumstances. For example, “Considering that your mother was so controlling when you were growing up, it makes sense that you would feel resentment in this situation.”
- Focus on destructive behaviors that stem from prior history, and point out why the current response is not constructive. Restate the past experience and link it to the individual’s current issue and behavior choices. For example, “Because your mother tried to control your time and activities, it is understandable that you are feeling angry in this situation. However, refusing to speak to your wife does not help her understand why you are so upset.”
- Focus on empowering the individual and treating him or her as an equal. While acknowledging the client’s struggles, express hope and optimism that the person is capable of positive change. For example, “I can see that you are working hard on making changes, and I think you are going to see some progress and start feeling better.”
In working with clients, DBT therapists are careful to avoid invalidating behaviors and responses that dismiss, reject, or criticize the client’s emotions and behaviors. Examples of this would include statements that the client should not “feel that way,” that their assessment of the situation is inaccurate, that the issue is not important, or that the client is to blame for the problem.
Dialectical behavior therapy is a support-oriented approach. As clients learn coping skills to better handle intense emotions and distress, they also identify their strengths and are able to make healthier behavior choices. Validation is a critical component in DBT, not only to help clients build their self-esteem, but to encourage their active participation throughout the therapeutic process.
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