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GIVE it a try

Welcome back to the next installment in our Trip Through the Skills Series. We are examining each of the skills taught in DBT and trying to give some real life examples of practicing the skills. Today is the second post in the Interpersonal Effectiveness skills, GIVE. It's another acronym, hopefully to help us remember the pieces better.

GIVE is an Interpersonal Effectiveness skill that focuses on the relationship itself. It’s about relationship effectiveness. As a therapist, this is a skill I have been practicing for a very long time. Again, though, I’ve done a better job of using this skill professionally than personally. So, I’ll start out again by giving you the acronym and then I’ll describe my use of this skill.

G- be Gentle in your interaction with someone. The handout says to, ‘Be nice and respectful.’ That really does go a long way in relationships. There’s a lot more in the book about this part.

I- act Interested. Ooh, I love this part. It’s kind of like that whole ‘appear confident’ thing in DEARMAN. I initially don’t have to actually BE interested, I have to act Interested.

V- Validate the other person. There are 6 levels of validation according to Linehan.

E- Easy Manner. Use an easy manner when interacting with the person. Be diplomatic. Be softer than you may want to be. Use some humor. Smile. Smiling actually helps more than you might think. No harshness or name calling or threatening, etc.

Those are the letters and what they mean. Here’s a few examples of how I’ve used them. I’ve always been a fairly gentle person overall. I do, however, have a sharp edge at times that really throws people off and can make people scared of me. I don’t get violent or throw things or anything like that, and I can make pronouncements that end up having a lot of weight do to my formal position of power and my informal knowledge of many things. It’s something I’ve dealt with since someone in HS told me I was intimidating. I did not used to be open to hearing this about myself, and I am now. So, for me, taking care of a relationship is partly about making sure that I can show up gentle as often as I possibly can. I’m really a gentle person with a lot of compassion, and then sometimes I’m not.

My wife used to be an interior designer (14 years.) She is now a nurse. For my life prior to being married, I cared very little for the design of a space. And it is very important and interesting to her. Well, since I love her and I’ve learned all these skills, it seemed like the thing to do to become at least somewhat interested in things that are important to her. To begin with, when my wife would talk about design, I would listen politely (probably meaning that I did not really listen) and then saying something about what she said being interesting or maybe that it was cool or something. That didn’t work too well in our relationship.

Along comes the GIVE skill and act Interested. So, I decided to try it. As with all DBT skills, doing a skill means really throwing ourselves into it and doing it all the way. So, I acted as I would if I was truly interested in what she was talking about. A strange thing happened. I started to actually BE interested in the design elements she was talking about. Ordinarily, I would see just a chair, but as she pulled up an Eames chair (after I got over the price) I began to see what she was talking about. She told me what made it a classic and what she thought was so beautiful about it. I started to see those things as well.

I will probably never purchase an Eames chair (I cannot imagine spending anywhere close to that for a piece of furniture) and I can still appreciate the beauty and design elements. So, using that portion of the GIVE skill helped my relationship. And there was another, unexpected benefit. Acting Interested created a little more joy in my life. Maybe you can relate to this part. I enjoyed the time spent talking with my wife about that chair. Normally, that’s a conversation to endure because I’m not interested in the stuff we are talking about. I’m doing it for her, but just barely. As I threw myself into the conversation all the way acting interested, I discovered some pleasant emotions and now have another thing that can bring just a little bit of joy to my life if I so choose to use it.

The ‘V’ in give is so big in DBT that I wish it wasn’t sort of buried in an acronym in the IE section of the skills. As therapists, this is one of the core strategies in DBT, validate, validate, validate. As a matter of fact, there’s a saying, “when in doubt, validate,” because it’s huge. I’ll pull back the curtain and let you see the wizard for a minute (just kidding, there’s no wizard, you can know everything in DBT) and tell you that one of our goals for our clients is to provide validation to our clients so that you can find some for yourself. It’s a therapeutic strategy, and also a teaching tool to help everyone we see start doing some validation of themselves.

Validating ourselves is a critical piece of a life that’s worth living. It’s something I’ve had to learn in a balanced way over the years, and I’m still learning it. Validation is, simply put, acknowledging my or another person’s experience as a real thing. It could be thoughts, opinions, emotions, perspectives, memories, etc. Validating does not mean that it is accurate. For instance, I have times when I think I’m worthless. That is not accurate. It’s a real thought that I sometimes think, and it is not accurate. Sometimes I think I’m better than other people (less often than I used to) and that is also not accurate. Again, a real thought, and not accurate at all. Validating says that it makes sense somehow that you have that thought or emotion or experience or perspective, not that we approve or any of it or that it is accurate.

There’s are volumes that could be written about validation, and I will stop there because that’s not really to goal of this particular work.

Here’s my favorite story about validation in my professional work. I had a client a number of years ago whom was highly suicidal. At one point the client ran out of my office yelling that she was going to go kill herself. I was incredibly scared. She did not attempt suicide, in case you were worried. When I went to my consultation team (team of DBT therapists that meet together every week) one of my team said, “you picked up all of her fear.” I asked her to say more about that. She told me I probably needed to validate the fear and sit in the fear with her in order to move things forward. In other words, I needed to treat the fear as a real thing, acknowledge it, and help my client experience it. I almost slapped myself in the forward because it was so obvious at that point. I also did not really want to do it. And I knew that was what was needed.

The next week, my client came in and I said, “I want to apologize for how I handled last session. I think I pushed for change when I probably needed to validate your fear and sit with you in it. So, today, I’m going to do that.” I then proceeded to tell her that I thought she was probably quite scared of her urges and that I was willing to sit with her as she experienced her emotions and to see what happened. We had a great session (yes, that is judgment) and that ended up unlocking her treatment. I cannot say that things were smooth sailing from that point on. They certainly weren’t, and I can say that seemed to be a turning point in the treatment. Several years after this occurred, that client reached out and told us how much her treatment at LifeWork meant to her.

It is also super powerful to be able to validate ourselves and it is crucial. We need validation from inside and from outside. If we cannot find any inside, a life that we want to live is near impossible. There are 6 levels that you can practice with yourself and with others.

  1. Just pay attention. Eye contact, interested body posture, doing one thing at a time

  2. Accurate reflection of what is said. Repeat back to someone what they have said. Repeat back to yourself something that you thought or a feeling you had.

  3. Guess the emotion. Make a guess (based on careful observation) about what the emotion is that someone is feeling or pay attention and call out your own emotion.

  4. Makes sense based on experience or symptoms. My emotion or reaction makes sense based on my past or based on a mental illness I might have.

  5. It’s reasonable for anyone. Anyone in my position would feel the same or at least have some reaction to what I’m going through. We can say this to someone else or to ourselves

  6. Radical genuineness. Just being human. Mostly practiced with other people. I think we can also practice with ourselves by letting go of the ‘shoulds’ or what I’m ‘supposed to be’ and just acknowledge what is. I think this would be acknowledging that we are real people with wants and needs, etc.

Using an Easy Manner sometimes comes very naturally to me and sometimes I have to put it on on purpose. When the relationship is the most important thing in an interaction, The examples that come to my mind of me using this part of the skill in particular are with clients that I’ve struggled to make connection with. In most therapies, the therapeutic relationship is very important. In DBT, it is crucial. In time where I think there is risk of dropout, easy manner and validation can mean the difference between therapy continuing or ending.

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