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Emotional Dysregulation and Validation

In addition to using the theoretical tenets of behavioral theory, DBT uses behavioral techniques, including a form of exposure therapy in which the client learns to tolerate painful emotions without enacting self-destructive behaviors (Linehan, 1993b). Therapy does not focus on maintaining a stable, consistent environment but rather aims to help clients become comfortable with change. In DBT, clients are asked to change. Clients track and record their problem behaviors with a weekly diary card. They also attend skills groups, complete homework assignments, and role play new ways of interacting with people when in session with their counselor. In addition, clients work with their counselor to identify how they are rewarded for maladaptive behavior or punished for adaptive behavior. They expose themselves to feelings, thoughts, or situations that they feared and avoided, and they change self-destructive ways of thinking. The fundamental assumption is that clients are experiencing a dialectical conflict between themselves and their environment. Dialectical behavior therapy assumes that the potency, duration, and expression of the emotions trigger the resulting destructive behaviors. Counselors use DBT to help clients recognize how their attempts to reject, evade, and flee strong emotions paradoxically make those emotions more intense. By helping clients accept their emotions, facilitating the development of strategies for emotional recognition and regulation, and decreasing emotional avoidance, counselors help clients improve their ability to cope with stress and regulate their emotions.

As noted earlier, cognitive-behavioral therapy techniques were not enough to help clients who were suicidal and chronically self-harming in the context of BPD. It is not that the techniques were ineffective; it is just that as stand-alone interventions they caused distress. Clients found the pushing for change invalidating. It could be compared to asking someone with a back injury to carry bags of concrete to help the person's back get stronger. Telling the person just not to think about the pain even though every effort was painful is not effective. This is further complicated by routine feelings of depression.

Linehan (1993a) and her research team verified that when a counselor combined an emphasis on validation with an equal emphasis on change, clients were more likely to be cooperative and less likely to become disturbed and introverted. Validation for clients is not linear in nature. For instance, a counselor could understand that a client overeats to combat feelings of isolation and loneliness. Then, in response to self-loathing after bingeing, the client may make impulsive decisions that may lead to self-harm. The counselor could validate that the behavior makes sense as the only way the client has effectively decreased her or his anxiety. The counselor validates that the binge eating makes sense given the client's history and worldview, yet the counselor does not have to agree that overeating is the best approach to solving the client's anxiety.

In DBT, there are several types and levels of validation. The most fundamental level is staying attentive to the other person. This means being respectful of thoughts, feelings, and behaviors. Other levels of validation involve helping the client regain confidence by assuming the behavior makes sense and by treating the client with dignity and respect (Holmes, Georgescu, & Liles, 2006). In DBT, just as clients are taught to use cognitive- behavioral strategies, they are also taught and encouraged to use validation. In treatment and in life, it is important to learn to recognize what has potential for change and what about oneself one must accept as is.

Dialectical behavior therapy takes a contextual approach to the human experience. Rather than viewing thoughts or behaviors as if they were independent variables that can be changed or controlled, a contextual perspective suggests that personal experiences can only be understood meaningfully in the context in which they occur. From this perspective, the function rather than content of thoughts is the primary focus of the therapeutic process. This perspective considers thoughts as dependent variables in need of explanation. For example, a student thinking about the concept of empathy when taking a counseling exam has a very different function or meaning than a person being preoccupied with this concept while attending a meeting at work about individualizing treatment goals.

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