Concern about Poor Relationships
Distressed or challenged interpersonal relationships are a struggle most will face during a lifetime. Some will choose to seek therapy, and others will adjust and manage without clinical help. For those seeking therapy or treatment for distress related to strained relationships, Dialectical Behavior Therapy (DBT) may be a suitable treatment solution. DBT is most commonly used to treat patients with borderline personality disorder (BPD), characterized by impulsivity, emotion dysregulation, a fragile self-identity, and strained interpersonal bonds. With the goal of better understanding the use of DBT in combating interpersonal difficulties, two researchers (Choudhary & Thapa, 2011) formulated the hypothesis that “validation and acceptance strategies can lessen rejection sensitivity and negative feelings that make interpersonal situations chaotic” (p. 46) and carried out a study that tested their hypothesis.
Dialectical Behavior Therapy
DBT, developed by Linehan (1993) is an off-shoot of Cognitive Behavioral Therapy (CBT) with a focus on four modules: mindfulness, emotion regulation, distress tolerance, and interpersonal skills improvement. Typically, DBT consists of a year-long intensive treatment schedule consisting of weekly individual therapy, weekly group skills-based sessions, telephone consultations as necessary, and clinical team meetings designed for clinicians to seek support in continuing effective treatment. To better understand the interpersonal relationships module, Choudhary & Thapa (2011) endeavor to highlight some criteria of healthy and un-healthy interpersonal relationships.
The investigators cite the following positions taken by Jourard and Landsman (1980) on good interpersonal relationships and by Hamachek (1982) on problematic ones. The four components of a healthy relationship, according to the former, are “… (1) open, honest, communication, (2) reasonable expectations or demands of each other, (3) concern about the other’s well being, and (4) freedom for both to be themselves” (Jourard & Landsman, 1980, p. 46). In order to maintain these components of a relationship, a delicate balance must be achieved between group needs and the needs of the individual. Hamachek (1982) says that problems may arise in the relationship if, for example, “… we underestimate the changes we need to make but push too hard for other people to change.” Another stumbling block may be that we dislike ourselves, an aspect that is generally correlated with dislike of other people. Shyness is a third potential barrier to a good relationship, because it can inhibit closeness and intimacy with another. Finally, jealous behavior, deceit, and engaging in selfish or egotistical ‘games’ are some of the actions likely to make others reject us (Hamachek, 1982; Choudhary & Thapa, 2011, p. 46).
Role of DBT
The approach of DBT to remedy interpersonal problems assumes that practicing awareness of others and self and adjusting maladaptive behaviors in relationships will inevitably, over time, produce a change in the way a client thinks about his/her relationships and attachments. A DBT therapist will work to validate and strengthen clients’ healthy responses, generalize the skills required to do so to everyday life, and encourage clients to continue to use skillful alternatives to reduce problematic situations in relationships and associated distress (Choudhary & Thapa, 2011).
Skills to Enhance Relationships
In terms of the dialectical approach, the interconnectedness, opposing forces, and change associated with reality are stressed. Dialectical means that two seemingly opposing ideas can both be simultaneously true (Choudhary & Thapa, 2011). Thus, contradictory emotions, cognitions, and behaviors are explored in an attempt to illustrate the process of seeking a balanced middle ground, a skill necessary to deal with the constant transition related to life. Mindfulness and acceptance techniques are added with an aim to allow clients to accept the emotional discomfort that often comes along with any relationship. Interpersonal effectiveness training is thus introduced to “help clients interact with others in ways that allow them to improve relationships while simultaneously maintaining their own personal values, self-respect, and well-being” (Choudhary & Thapa, 2011, p. 49). Weekly chain-analysis is conducted during therapy sessions, consisting of a detailed recollection of events and circumstances that led to maladaptive behavior or to successful alternative behavior. This helps to promote acceptance of emotions, while simultaneously empower clients to recognize and predict negative emotions/behaviors and choose alternatives in advance of a personal or interpersonal crisis.
Choudhary, S. & Thapa, K. (2011). Dialectical behavior therapy for managing interpersonal relationships. Psychological Studies 57(1), 46-54.
Hamachek, D. (1982). Encounters with others. New York: Holt, Rinehart & Winston.
Jourard, S. & Landsman, T. (1980). Healthy personality: An approach from the viewpoint of humanistic psychology, 4th ed. New York: Macmillan.
Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.