Interpersonal Effectiveness Skills

Skills Training: Interpersonal Effectiveness

Interpersonal Effectiveness skills can help with taking care of your relationships, balancing priorities (your needs) with other’s demands (other’s needs), balancing wants (things you want to do) with shoulds (things you ought to do), building mastery and self-respect. The skills in this module are broken down into three goals.

  • Objective Effectiveness Skills (using skills to get what you want)
    • DEAR MAN (Acronym)
    • Describe – the situation, stick to the facts
    • Express – feelings/opinions about the situation clearly. Don’t expect others to read your mind. Express how you feel or what you believe about the situation
    • Assert- your wishes. Ask for what you want! Or say no clearly to unwanted request.
    • Reinforce – reward people, who respond positively to you when you ask for something, say no or express an opinion. Sometimes it helps to reinforce people before they respond to your question by telling them the positive effects of getting what you want or need.
    • (Stay) Mindful – keep your focus on your objective. Don’t be distracted onto another topic. (two helpful techniques for staying mindful are: 1. Broken Record. 2. Ignore.
    • Appear confident – Eye contact, confident tone of voice and physical manner.
    • Negotiate - Be willing to give to get. Offer and ask for alternate solutions.  Maintain your no, but offer to do something else or solve the problem another way 
A helpful skill here is "turning the tables." Turn the problem over to the other person, ask for alternative solutions example "What do you think we can do?"
  • Relationship Effectiveness Skills (using skills to maintain/improve a relationships)
    • GIVE (Acronym)
    • Be Gentle - People tend to respond to gentleness more than they do to harshness. Avoid attacks, threats, and judgmental statements.
    • Act Interested - People tend to feel better if you are interested in them, and if you give them time and space to respond to you. Listen to what they have to say (i.e. share the air time).
    • Validate - Be nonjudgmental, out loud. Validate the other person's feelings, wants, difficulties and opinions about the situation. Find the "grain of truth" in what the other person is saying.
    • Use an Easy manner  - Try to be lighthearted. Use a little humor. Smile. Ease the other person along. This is the difference between soft sell and hard sell. People don't like to be bullied, pushed around or made to feel guilty.
  • Self Respect Effectiveness Skills (using skills to maintain your self-respect)
    • FAIR (Acronym)
    • (be) Fair – This means being fair to yourself and the other person in your attempts to meet your objectives. The idea here is that it is hard to like yourself in the long haul if you consistently take advantage of the other person.
    • (No) Apologies - Apologize when apologies are warranted. No overly apologetic behavior. No apologizing for being alive. No apologizing for making the request. No apologizing for having an opinion. Apologizing implies that you are in the wrong. Apologizing when you do not believe you are in the wrong will reduce your sense of effectiveness over time.
    • Stick to values – Don't sell out your values or integrity, just to get what you want or keep the other person liking you. Be clear on what, in your opinion, is the moral or valued way of thinking and acting.
    • (Be) Truthful - Don't lie or act helpless when you are not. Don't exaggerate. A pattern of dishonesty over time erodes your self-respect.

Distress Tolerance Skills

Skills Training: Distress Tolerance

Distress tolerance skills are used when something unpleasant is happening, there is no way to solve the problem or get rid of the stressful situation at this time and you need to cope with it. Distress tolerance should not be used when a problem can be solved. If you can solve the problem, solve it! Goals of distress tolerance include crisis survival and accepting reality.

Crisis Survival Skills

DISTRACTING – A way to remember these is skills is the phrase “wise mind ACCEPTS

  • with Activities - Exercise, engage in hobbies, cleaning or doing chores, call or visit a friend, games, write, etc.
  • with Contributing – Practice generosity, do something for someone else.
  • with Comparisons – Practice gratitude by comparing yourself to others or to a time you were worse off. Count your blessings.
  • with Emotions – Read emotional books (novel) or watch emotional movie (making sure either is OPPOSITE to current emotion), watch cartoons, listen to upbeat music.
  • with Pushing Away – Practice patience by letting go of the situation for a while. Leave situation mentally, build an imaginary wall between self and situation, censor ruminating, put situation on the shelf, box it up.
  • with Thoughts – Count to 10, count colors in surroundings, do puzzles, watch TV.
  • with Sensations - Come down to earth and get grounded by experiencing a very intense sensation. For instance, hold ice in your hand, squeeze a rubber ball, take hot shower, listen to loud music, snap elastic band on wrist.

IMPROVING the MOMENT - "IMPROVE"

  • With Imagery – Imagine relaxing scenes, imagine secret room inside yourself and see how it is decorated – go in and close the door, imagine everything going well, imagine coping well, make up a fantasy world that is calming and beautiful and let your mind go with it, imagine hurtful emotions draining out like water out of a pipe.
  • With Meaning - Find purpose or meaning in pain, read about, remember or listen to spiritual values, focus on positive aspects of situation and repeat them over and over, make lemonade out of lemons.
  • With Prayer - Open the heart to great wisdom, the universe or a higher power – either God or your own wise mind. Ask for strength to bear pain in the moment. Turn things over to a higher power.
  • With Relaxation – Tense and relax muscle groups starting with hands and arms going to top of head then working down, listen to relaxation tape, exercise hard, take hot bath, drink hot milk, massage neck, scalp, hands, calves, breathe deeply, half-smile, change facial expression.
  • With One Thing in the Moment – Focus entire attention on what you are doing right now, keep in the very moment you are in, stay in the present, focus entire attention on physical sensations that accompany tasks that require little thinking, such as walking, doing dishes, playing sports, cleaning, be aware of how body moves, do awareness exercises.
  • With a brief Vacation - Go to bed for 20 minutes, pull up covers, lie around with magazine or newspaper, get in bed and eat chocolates while reading, unplug the phone, take one hour break from things that must be done.
  • With Encouragement – Cheerlead yourself: “I can stand it!”; “It won’t last forever”; “I will make it out of this”; “I’m doing the best I can!”

SELF - SOOTHING -  with the 5 senses

  • Vision – Look at flowers, light a candle and watch the flame, go out and watch stars, look at beautiful pictures, be mindful of all sights- not lingering on any.
  • Hearing – Listen to beautiful, soothing, or exciting music, listen to sounds of nature, sing, hum, play instrument, call 800 numbers to hear human voice – be mindful of sounds, letting them go in one ear and out the other.
  • Smell – Perfume, lotion, scented candles, oil furniture, potpourri, boil cinnamon, bake cookies, chew gum, suck on a peppermint, smell flowers, walk in wooded area and breathe mindfully.
  • Taste – Have a good meal, favorite soothing drink (no caffeine or alcohol), dessert, get a special good treat, eat mindfully.
  • Touch – Take a bubble bath, clean sheets, pet dog or cat, get a massage, soak feet, lotion entire body, put cold compress on head, feel silky clothing/furry clothing, brush hair for a long time, hug someone, experience whatever you are touching, notice touch that is soothing.

Mindfulness Skills

Skills Training: Core Mindfulness

What is "wise mind"?

Wise Mind is that place where reasonable mind and emotion mind overlap.  It is the integration of emotion mind and reasonable mind. “Wise mind adds intuitive knowing to emotional experiencing and logical analysis” (Linehan, 1993, p. 214). Linehan states that we all have wise mind even if we have never experienced it. Some people experience wise mind following a crisis, the calm that follows the storm. “It is the experience of suddenly getting to the heart of the matter, seeing or knowing something directly and clearly” (p.215). It is where the person knows something to be true or valid. I personally have felt wise mind when I have made a decision that I absolutely know is the right thing to do. I know I am in wise mind because I don't have any sense of dread or anxiety. I just "know" I am doing the right thing.

How do we get to "wise mind"?  Mindfulness practice of  "what" and "how" skills.

Taking hold of your mind "What" skills

  • Observe - Just Notice

  • Describe - Put Words On

  • Participate - Become one with your experience

Taking hold of your mind "How" skills

  • Non-Judgementally - Don't Evaluate

  • One-Mindfully - One thing at a time

  • Effectively - Focus on what works

DBT as Frame: Assumptions

DBT as Frame: Assumptions about Clients 1.      Patients are doing the best they can.

2.      Patients want to have lives worth living.

3.      Patients need to do better and gain motivation to change

4.      Patients must learn new behaviors in all relevant contexts.

5.      Patients cannot fail in DBT.

6.      Patients may not have caused all their own problems but they have to solve them anyway.

7.      The lives of suicidal individuals are unbearable as they are currently being lived.

DBT as Frame: Assumptions about Therapy

1.     The most caring thing a therapist can do is to help patients change in ways that bring them closer to their own ultimate goals.

2.     Clarity, precision, and compassion are essential

3.     The therapeutic relationship is a real relationship between equals

4.     Principles of behavior are universal, affecting therapists and patients

5.     DBT therapists can fail.

6.     DBT can fail even when therapists do not.

7.     Therapists treating multi-problem patients need support.

Ways to think and act dialectically

Dialectics teach us that there is always more than one way to see a situation and always more than one way to solve a problem. It considers all people to have unique qualities and different points of view.  It points out the only change is constant and stresses the importance of  NOT looking at the world in absolutes - black and white, all or none. It can help us find our way to the middle path.  The concept of "Middle"  in Buddhism means neutral, upright and centered.  Two things that seem like opposites can both be true. For example you are doing the best you can (acceptance) AND you need to do better, try harder, and be more motivated to change (change).

Ways to think and act dialectically:

1. Practice looking at other points of view. There are multiple sides to story. Try to find the kernel of truth in more than one side.

2. Remember that no one has the absolute truth

3. Use "I feel ______" statements. Instead of  "you are this way or that way" statements or "that's jus the way it is" statements. Be descriptive.

4. Do not assume that you know what is in someone else's head. Check out your assumptions. For example, "Why did you say that?" " What did you mean by that?" Do not expect that other people can read your mind. For example, "What I am trying to say is...... I feel ______ about ...."

5. Accept that different opinions can be legitimate (although you do not have to agree with them). Understanding someone's point of view is not approval. For example, "I see your point of view even though I do not agree with it."

6. Move away from "either-or" thinking to "both-and" thinking. Avoid words like "always" or "never". Be descriptive. For example, instead of saying, "everyone always treats me unfairly," say, "sometimes I am treated fairly AND at other times I am treated fairly".

Biosocial Theory

Biosocial Theory (Emotional Vulnerability)

  1. High sensitivity
  2. High reactivity
  3. Slow return to baseline

Biosocial Theory (Invalidating Environment)

  • Pervasively negates or dismisses behavior independent of the actual validity of that behavior
  • Characteristic of Invalidating Environments
  1. Indiscriminately rejects communication of private experiences and self-initiated behaviors
  2. Indiscriminately reinforces escalation of emotional responses and displays
  3. Over-simplifies ease of problem solving and meeting goals

What does "dialectic" mean?

Dialectics” is a concept rooted in philosophy and science. I won’t go into a philosophical lecture on the meaning and history of the term but will attempt to explain a dialectical perspective. Three primary principles frame a dialectical perspective on the nature of reality and human behavior. 1.     Principle of Interrelatedness and Wholeness

This is a systems perspective on reality (i.e. Identity is relational). Under the guidelines of this principle the value of analyzing a part of a system is of limited value unless it is clearly relates the part to the whole. This basically means everything is connected to everything else and to understand a part you need to understand the whole.

2.     Principle of Polarity

Reality is not static but is comprised of internal opposing forces out of which synthesis is achieved and a new set of opposing forces emerge. Stated differently opposites can be integrated to form a closer approximation to the truth, which is always evolving.

“Contradictory truths do not necessarily cancel each other out or dominate each other, but stand side by side, inviting participation and experimentation” (Goldberg, 1980, p. 295).

3.     Principle of Continuous Change

Change is constant and inevitable. Therefore everything is changing and nothing is static. Change or process, rather than structure or content, is the essential nature of  life (Linehan, 1993). The dialectical point of view acknowledges the role of conflict and opposition in the process of growth and change.

Dialectic therapy  values the tension of holding opposites in our minds simultaneously and works on the assumption that this tension is a vehicle for change and transformation. It creates the conditions for Synthesis, Integration and Balance.

References:

Goldberg, C. (1980). The utilization and limitations of paradoxical intervention in group psychotherapy. International Journal of Group Psychotherapy, 30, 287-297.

Linehan, M. M. (1993).  Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press