Валидация и принятие
cognitive behavioral therapy techniques are not enough to help clients who were suicidal and chronically self-harming in the context of Borderline Personality Disorder (BPD). It’s not that the techniques were ineffective; it’s just that as stand-alone interventions, they caused clients a great deal of distress. Clients found the pushing for change invalidating. In a simple example, it’s as if therapists were saying to someone with severe burns on the soles of their feet, “just keep walking and your feet will get stronger…try not to think about the pain,” though each step was excruciatingly painful, and the patient was depressed and had no experience with keeping her mind off severe pain. Linehan and her research team discovered that when the therapist weaved an emphasis on validation with an equal emphasis on change, clients were more likely to be collaborative and less likely to become agitated and withdrawn. So what is validation? It means a number of things. One of the things it does not mean, necessarily, is agreement. For instance, a therapist could understand that a client abuses alcohol to overcome intensive social anxiety, and yet realize that when the client is drunk, he makes impulsive decisions that may lead to self-harm. The therapist could validate that: a) her behavior makes sense as the only way she’s ever gotten her anxiety to go down; b) her parents always got drunk at parties; and c) sometimes when she’s drunk and does something impulsive, the impulsive behavior can be “fun.” In this case, the therapist can validate that the substance abuse makes sense, given the client’s history and point of view. But the therapist does not have to agree that abusing alcohol is the best approach to solving the client’s anxiety. In DBT, there are several levels and types of validation. The most basic level is staying alert to the other person. This means being respectful to what she is saying, feeling, and doing. Other levels of validation involve helping the client regain confidence both by assuming that her behavior makes perfect sense (e.g. of course you’re angry at the store manager because he tried to overcharge you and then lied about it) and by treating the other person as an equal (i.e., as opposed to treating her like a fragile mental patient). 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 know what about ourselves we can change and what about ourselves we must accept (whether short term or the long term). For that reason, acceptance and validation skills are taught in the skills modules as well. There are four skills modules all together - two emphasize change and two emphasize acceptance. For example, it is extremely important that clients who self-harm learn to accept the experience of pain instead of turning to self-destructive behavior to solve their problems. Likewise, clients who cut themselves, binge and purge, abuse alcohol and drugs, dissociate, etc., must learn to simply “be with” reality, as painful as it may be at any given moment, in order to learn that they “can stand it.” DBT teaches a host of skills so that clients can learn to stand still instead of running away. DBT also teaches clients how to work to understand why their lives are so hard.