DBT defines validation as - CSPAR - •Dialectical validation •Practice a lot of V2...

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Transcript of DBT defines validation as - CSPAR - •Dialectical validation •Practice a lot of V2...

  • Validation II Jenna Melman, LICSW

    DBT defines validation as:

    Empathy + Communicating that the client’s experience, thoughts and behaviors make sense.

    Balancing Acceptance & Change

    • Validation is thought of as the core acceptance strategy and yet change is often not possible without validation.

    Biosocial Theory and Invalidation

    +

    =

    Biological Emotional Sensitivity Invalidating Social Environment

    Chronic Emotion Dysregulation

  • Invalidation drives emotional intensity up for all of us.

    • “Calm down”

    • “I’m sure it wasn’t THAT bad”

    • “You’re overly sensitive”

    • “You probably took it too personally”

    • “You’ll get over it”

    • “Just let it go”

    • “You’re a strong person”

    • "It could be worse”

    • “God doesn’t give you more than you can handle”

    • “Everything happens for a reason”

    • “I know exactly how you feel”

    • You make a big deal out of everything.

    • “That didn’t happen”

    • “Stop making things up”

    • I’m not going to talk about this with you.

    • You probably misunderstood.

    • “You’re just over reacting”

    • What’s wrong with that?

    What we know about invalidation…

    • Invalidation leads to a narrowing of perspective (tunnel vision)

    • Increased emotional intensity

    • judgmental thinking

    • heightened action urges

    • increased physiological arousal

    • THE MOST IMPORTANT THING IS THE MESSAGE

    Invalidation makes us lose trust in our experience and makes us feel “CRAZY!”

    • Makes us jump to “my experience must be wrong” or “your experience must be wrong”

    • Intensifies emotion, increases distance and polarizes us

    • Our clients have almost all suffered from chronic invalidation so whether perceived or otherwise, they are primed to feel invalidated by us. It is our job to recognize this in our clients and teach them how to validate themselves to combat chronic invalidation and dysregulation

    Why Validate? • To balance acceptance with change

    • To model & teach self-validation

    • To reduce physiological arousal

    • emotional regulation

    • facilitate the experiencing of primary emotion by helping to cue a more adaptive emotion

    • As an informal emotion exposure protocol

    • To reinforce clinical progress

    • To strengthen the therapeutic relationship

  • What is validation? • Empathy + the communication that a person’s

    responses make sense and are understandable within his/her current life context or situation.

    • Taking your client seriously…BELIEVING your client

    • Finding the kernel of truth in another person’s perspective or situation; verifying the facts of a situation.

    • Acknowledging that a person’s emotions, thoughts, and behaviors have causes and are therefore understandable.

    Validation is not…

    • Necessarily agreeing with the other person.

    • Not approval

    • Validating what is invalid.

    • Against change

    Phenomenological Empathy in DBT

    1. Phenomenological Empathy Agreement: All things being equal, we agree to search for non-pejorative or phenomenologically empathic interpretations of our patients', our own, and other members’ behavior. We agree to assume we and our patients are trying our best, and want to improve. We agree to strive to see the world through our patients' eyes and through one another's eyes. We agree to practice a non-judgmental stance with our patients and one another.

    2. We agree to search for validity

    3. Willingness to feel with our clients


  • Levels of Validation • 1. Pay Attention: Look interested in the other person instead of bored (no multitasking).

    • 2. Reflect Back: Say back what you heard the other person say or do, to be sure you understand exactly what the person is saying. No judgmental language or tone of voice!

    • 3. “Read Minds”: Be sensitive to what is not being said by the other person. Pay attention to facial expressions, body language, what is happening, and what you know about the person already. Show you understand in words or by your actions. Check it out and make sure you are right. Let go if you are not.

    • 4. Understand: Look for how what the other person is feeling, thinking, or doing makes sense, based on the person’s past experiences, present situation, and/or current state of mind or physical condition (i.e., the causes).

    • 5. Normative: ANYONE would feel similarly

    • 6. Show equality: Be yourself! Don’t “one-up” or “one-down” the other person. Treat the other as an equal, not as fragile or incompetent.

    V1: Pay Attention: Look interested in the other person instead of bored (no

    multitasking). • Active listening

    • One mindfully

    • Observing/describing affect, body posture

    • Staying present in face of high emotion

    • “I want to be able to pay full attention, let me finish this one task so I can really listen”

    V2: Reflect Back: Say back what you heard the other person say or do, to be sure you understand exactly what the person is saying. No judgmental language or tone of

    voice!

    • “You’re frustrated that I didn’t understand how hard this is for you”

    • “You’re feeling disappointed that plans fell through and thinking they are wanting the relationship to end”

    • The idea isn’t to “parrot” or just repeat what was said but rather summarize so the person knows you heard them and were paying attention

    • Can buy you time when you’re trying to figure out what else to validate

    • V3: “Read Minds”: Be sensitive to what is not being said by the other person. Pay attention to facial expressions, body language, what is happening, and what you know about the person already. Show you understand in words or by your actions. Check it out and make sure you are right. Let go if you are not.

    • Handing clients a box of Kleenex when tearful

    • You hung your head and are looking down and I’m thinking you’re telling yourself you blew it, is that right?

    • This is the 5th time you’ve mentioned your mom dropping the ball with something really important to you, I’m wondering if you’re thinking, “of course this happened again!”

    • “I’m guessing that when you’re partner said they were busy tonight you felt disappointed”

    • Be okay with getting it wrong! Trust your client’s experience of their emotions and try again.

  • • V4: Understand: Look for how what the other person is feeling, thinking, or doing makes sense, based on the person’s past experiences, present situation, and/or current state of mind or physical condition (i.e., the causes).

    • “Given your history with dogs, it makes sense you would be afraid.”

    • “Given your history with depression, it makes sense you would worry about signing up for something hard in the middle of winter.”

    • “Since you’ve been sick, it makes sense you would want to take it easy today”.

    • V5: Normative: ANYONE would feel similarly

    • Of course you felt scared when that dog jumped out at you! (Anyone would!)

    • Of course you felt anxious before the job interview! Anyone would for something that important!

    • Break-ups are hard and sad!

    • V6: Show equality: Be yourself! Don’t “one-up” or “one-down” the other person. Treat the other as an equal, not as fragile or incompetent.

    • Laughing with a client

    • Self-disclosure

    • Becoming tearful

    • Swearing

    • Acting as an equal

    • Asking things of our client because we believe they are capable

    What to validate • The client’s primary emotion

    • The client’s behaviors

    • observe and label them as they come up in session AND how the behavioral responses outside of session are understandable

    • The client’s thoughts

    • reflect to the client his or her thoughts, assumptions and values

    • Your belief in the client’s inherent validity

    • Without fragilizing, tell the client you believe in his or her ability to attain his or her ultimate goals

  • What to validate when a client is dysregulated

    • The importance of the problem the client is experiencing

    • How difficult it is to problem solve or achieve goal

    • The client’s emotional pain

    • The causes for client’s emotional pain and reasons for feeling “out of control”

    • The validity and wisdom in client’s ultimate goals

    • The client’s location perspective

    What to validate when you can’t find the valid

    • Client’s learning history

    • Facts, logical inferences or accepted authority

    • Be radically genuine; I really want to understand and I know there must be something I’m missing.

    **Don’t forget there is ALWAYS SOMETHING valid**

    How to validate • SEARCH for the valid and ASSUME that there is ALWAYS SOMETHING VALID

    • Be specific to your client

    • think of your case formulation