The Business of Practice

Validation in DBT

Dialectical behavior therapy (DBT) is a form of therapy effective for treating many disorders. DBT teaches clients two seemingly opposing strategies to help improve their functioning. One is that clinicians teach clients that their experiences, emotions, and behaviors are valid through acceptance and change strategies. Second, it teaches that positive change is necessary to manage their emotions and behaviors to move forward. The biosocial theory denotes an invalidating environment creates problems for an emotionally sensitive individual; therefore, it is reasonable that a validating environment will be part of the treatment.   

Validation in DBT

 

How Do Clinicians Use Validation?

Clinicians put themselves in the position of the client. Clinicians work to see a situation the way their client does.
  • Communicate that a client’s response makes sense and is understandable for the given situation.
  • Demonstrate respect for the client and their point of view.
  • Refuse to treat a person negatively for how they are behaving.

Why do Clinicians Validate?

When clinicians validate a client, they are modeling how the client can validate themselves:
  • Labeling emotions through validation helps clients de-escalate their behavior and regulate their feelings.
  • Clients are more likely to trust someone who understands where they are coming from.

Timing

It is crucial to consider the timing of validation.

Clinicians should not use validation immediately after a problem behavior, as validation could maintain the behavior. Instead, clinicians must be aware of how validation is received and subsequently how it impacts behavior, i.e., increasing, decreasing, or maintaining it.

Types of Validation

There are three main types of validation in DBT.

Emotional Validation: Validate without escalating an emotion. Emotional validation focuses on the primary emotion and requires a non-judgmental stance. 

  • For example, clients will often express anger (a secondary emotion) and not realize that they are angry because they are sad or hurt. 
  • Validating the underlying emotion can help clients improve their ability to identify several emotions in a given situation.  

Behavioral Validation: Communicate that their behaviors are understandable. Behavioral validation is used in every session when looking over a diary card. Whether a behavior is adaptive or maladaptive, clinicians communicate that it is understandable. 

  • For example, if a client engages in self-harm to reduce an overwhelming negative emotion. Behavioral validation will let the client know that it makes sense they cut themselves when they were distressed because, in the past, that has helped them feel less overwhelmed. 
  • It is essential to understand the fine line between reinforcing and validation. Clinicians should not invalidate clients when they share that they have engaged in maladaptive behavior, and at the same time, clinicians do not want to reinforce the problematic behavior.

Cognitive Validation: Articulate the underlying assumptions, beliefs, rules, and expectancies of the clients and find the validity in them. This type of validation requires clinicians to be aware of a client’s and human behavior patterns.

  • For example, when clinicians have information about the types of patterns that occur when a client is thinking something specific, clinicians can guess what the client would feel like next and help the patient see the pattern based on their previous experience. 

Levels of Validation

Five levels of validation include:
  1. Being awake to the communication of the client (listening, communicating that you hear and understand).
  2. Accurately reflecting what you have been told. Restating without parroting and without distorting or adding to what was said.
  3. Stating the unarticulated. Mind reading what the client is not saying. State as a question and be willing to be wrong.
  4. Validating through the client's personal history or biology. Behavior is understandable (not necessarily acceptable or effective) given what the client has experienced in the past, their learning history, or their physiology.
  5. Normalizing the client's behavior. The client's feeling or behavior is typical of what anyone would experience or do.
  6. Radical Genuineness. Use a manner and tone that is not condescending, fragilizing or rule bound. Respond to the client as you would to anyone else.

Tips for Validation

Clients may have a lot of therapy-interfering behaviors, and validation may not come naturally. Therefore, clinicians must search for something to validate and balance validation with change strategies.
In the beginning, validation will be used more often, and over time, it will fade.
  • Relationships are easier to build when someone is being validated. Validation will help the relationship develop and maintain it.
  • Become aware of how much validation a patient will require, as the need for validation fluctuates from patient to patient.
  • When clinicians validate a client, they are modeling how the client can validate themself.
  • Validation can be influential through non-verbal communication (eye contact, head nodding, smiling), so clinicians should use both words and actions to validate.
  • Be aware of barriers experienced by the client and the clinician: 
    • Lack of skill 
    • Strong emotions 
    • Unwillingness 
    • Fear of worsening a behavior
  • Know the receiver – they will ultimately be the one who determines if something is validating or not. It is essential to pay attention and keep the whole person in mind.

 

What Validation is not!

  • Simply trying to make the client feel better
  • Agreeing with whatever the client says
  • Patronizing or condescending behavior or speech
  • Justifying harmful and maladaptive behaviors
  • Normalizing a thought, feeling, or behavior that is not normal
  • Venting to the client
  • Reframing what the client says into something positive
  • Telling the client that they should not feel a certain way

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