This feature by Donald Nathanson, LCSW-R is Part 2 of 2 in a series about experiential learning in DBT Skills training. In the first part here, Donald began his story and connects it with knowledge and experience as well as the experience of describing. In this section, he continues with his insight on how to guide toward experience.
How to Guide Toward Experience
Admittedly, there is no great one-size-fits-all answer for how we can help someone experience the benefit of a skill in a profound, meaningful way. Given that there is no one right answer or magic bullet, I will instead share the tips that I have used as I have tried to improve as a guide for others and myself.
Orientation – Orientation is always a critical first step in therapy and in DBT skills training. When I use the term here, I mean orienting a client to the fact that the client may not get the full benefit of the skill being taught until they have experience using the skill and see the benefit themselves. It is useful to set expectations from the beginning so one does not make a similar mistake that I did – that having knowledge about the skill is sufficient to be able to use a skill – and can have the motivation to try and continue to practice and use a skill. “Acting as if,” is a phrase that applies here. Clients will buy in to skills use more once they experience the skill in vivo, and, we are asking them to act as if they already have that intrinsic experience and motivation.
Connecting past behavior to DBT coping skills – In part 1 of this blog, I posed the question of if someone could truly understand radical acceptance without having radically accepted something in his, her, or their life. The truth is though, that most likely one has already radically accepted something, but may not be aware or think of it in our DBT language or in the language of skills use. As therapists, we are not the holders of some arcane information that we dispense to our clients due to our largesse and expertise. Rather, we are sharing knowledge and skills that many already use and take advantage of, and in cases have better comprehension than we do ourselves (just ask my 6-year-old client). We can be more effective as trainers by helping point out how many of our clients have already used the skill that we are teaching in the past, from the mundane to the profound instances. The key here is to make a mindful connection between the behavior and the skill and not to co-opt their behavior or correct them. We want to show them the advantages that they themselves yielded for their own goals when they faced their fear – by giving the class presentation or accepting the loss of a loved one, for example.
Skills Coaching – Perhaps somewhat obviously, our chances of eliciting an experience of having used a skill in a meaningful, goal-oriented way are increased when we are coaching clients or ourselves in the moment. This is a great advantage of DBT skills phone coaching, and of coaching that may happen in our office or on a Zoom call. We can be mindful to point out to the client when we see them use a skill in an effective way, and we can help clarify whatever beneficial contingencies that skills use will result in.
Experiential Exercises – Role plays, in vivo, or imaginal practices or exposures are other effective tools that we have to augment our treatment, in tandem with our cognitive strategies in DBT.
As clinicians, we have to do our homework, and know what it is that we are talking about. We want to get our information right, we want to be accurate so that we can be helpful. Knowledge of DBT, its principles, assumptions, and skills is essential. We need expertise, even though part of the beauty of the treatment is that we can always learn something new from anyone, no matter the level of expertise. However skills use, particularly to those who need it, is not much a matter of academic debate or lecturing. Having the mindful goal of “I want to help you experience what I am talking about” from the moment a client logs on to a teletherapy call or walks into my office is essential, and one that I have all too often forgotten throughout my career. Luckily, when I need a reminder, I only need look into a mirror and remember that “it’s red.”
Interested to read more about practical solutions for working with clients in delivering DBT? Read here for this piece on The Value of Multimedia in DBT Phone Coaching.”
Donald Nathanson, LCSW-R, maintains a private clinical practice in Westchester County, NY. He primarily provides Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy to children, adolescents, and young adults. Previously, Mr. Nathanson was clinical faculty at Weill Cornell Medicine and New York-Presbyterian Hospital, where he was the the co-director of the Adolescent DBT Program and clinical director for the Youth DBT Program. Read his full bio here.
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