As we have noted in Chapter 4, we found that after several years of working with teens and families, several topic areas arose repeatedly that were not elaborated in the standard DBT skills training manual (Linehan, 1993b). These topic areas included the polarities in behavioral patterns experienced by families with suicidal adolescents; the definition of, rationale for, and application of validation; and the explicit application of learning principles to self and others. We have discovered that these topics fit well together as a unique skills module.
The Walking the Middle Path Skills module is about learning to recognize truths such as the following: Two things that seem like opposites can both be true, and there is more than one way to see a situation or solve a problem. By recognizing such truths, group members can work on changing painful or difficult thoughts, feelings, or circumstances, while at the same time accepting themselves, others, and circumstances as they are in the moment.
Note that the material on dialectics may exceed the length of a typical skills training group session. Leaders can select which points to expand on and which points to acknowledge only briefly, based on the needs and comprehension of group members. As in teaching all DBT skills, remember to make lecture points succinct. Provide frequent examples, and elicit examples from group members.
The goals of this new module are to help group members effectively manage adolescent-family dilemmas by means of the following:
Dialectics: Balancing acceptance and change, and “walking the middle path.”
Validation: Working on acceptance.
Behaviorism: Working on change.
Leaders first draw a deep canyon on the blackboard, with an adolescent at the top on one side and a parent at the top on the other. A skills trainer poses the question to the group:
“On what issues do teenagers and parents find themselves polarized—that is, on opposite sides? How about curfew? How about grades? How about sex, body piercings, smoking cigarettes, drinking alcohol, and so on? Do you find yourselves getting stuck and unable to find a middle path between you? And on what issues do you find yourself flipping back and forth from one position to another? For example, do you ever feel you have been too lax with yourself for a time, and so then jump over to the other side and become overly strict?”
LECTURE POINT: The problem is that when people are in emotion mind, they tend to act in extreme “black-or-white,” “all-or-nothing” ways.
Example: A teenage boy comes home repeatedly after curfew, and his father tells him, “You’re grounded for the rest of the school year!” Or a teenage girl screams at her mother, “You never think about me! You only care about yourself!” because the mother has forgotten to buy the teen’s favorite cereal. Get other examples of extreme behavioral responses from participants at this point.
DISCUSSION POINT: Ask group members to consider what’s being left out when the second adolescent above says, “You never think about me! You only care about yourself!” Generate alternative explanations for the parent’s oversight that are more balanced. If the group fails to generate any examples, leaders may choose to give the following: The teen considers the possibility that her mother was preoccupied with work while food shopping, and at the same time realizes that her mother does love her. This “both-and” perspective synthesizes the “either-or” stance so commonly held by emotionally dysregulated individuals.
LECTURE POINT: A dialectical approach can help us get unstuck. The skills in this module help people learn how to “walk the middle path” in what they think and how they act. This approach takes into account our current viewpoint and an opposing viewpoint, which leads to a synthesis of both perspectives; this is how we get unstuck and change occurs.
Example: One mother of a teenage girl was extremely concerned about her daughter’s romantic relationship with an older boy. She was afraid they were having sex and that her daughter would get pregnant. The first thing she thought to do was to try and break up the relationship. But doing that would alienate her daughter, and that increased her distress. Then she started to ignore the topic of the relationship completely, in order to avoid her emotional distress—the opposite extreme of trying to break up the relationship. Rather than opting for either one of these two extreme positions, she learned to consider both. This led her to find a third option, a “middle path” synthesis: to speak calmly to her daughter about appropriate birth control methods.
LECTURE POINTS: Dialectics teaches the following:
There is always more than one way to see a situation, and more than one way to solve a problem.
The idea here is that there is no absolute truth (at the one extreme) and truth is not completely relative (at the other extreme). Instead, truth evolves over time. Use as examples rules that used to be correct when an adolescent was a child, or when the parents were not divorced or were less experienced as parents, but are no longer true. This is consistent with the DBT assumption “There is no absolute truth” presented in the orientation to the skills training group (see Chapter 10).
All people have unique qualities and different points of view.
This point normalizes and accepts differences among people’s attitudes and behaviors, rather than seeing these differences as cause for conflict. Some people believe that anything deviating from their own point of view is wrong.
Example: A parent insists that a teenage boy begin his homework immediately upon returning from school. The teen insists on watching TV to help him unwind from a long day. The truth from the parent’s perspective is that the teen does not begin his homework until after dinner and then stays up past his bedtime in order to complete the work. This results in his being overtired and less focused the next day. The truth from the adolescent’s perspective is that he is mentally fatigued and requires a break before beginning his homework.
It is important not to see the world in “black-or-white,” “all-or-nothing” ways.
Truths do not have to fall into one extreme or another.
Two things that seem like opposites can both be true.
There is wisdom to be gained from examining the truth in both perspectives. See the examples on Handout C.1: “You are doing the best you can, and you need to do better, try harder, and be more motivated to change,” “You are tough, and you are gentle.”
Change is the only constant.
This idea derives from the dialectical world view (see Linehan, 1993a) and has two major applications to teens and their families. When both teens and adults feel hopeless and think that nothing will ever change, a dialectical philosophy argues that change occurs continually. The world is one large system with many interfacing parts. The sun, the trees, the water, the fruit, the farmer, the grocer, the teacher, the friend, the parent, the sibling—these things are all interconnected and influence one another. So on any given day, things are never the same as the moment before or the moment after.
Meaning and truth evolve over time.
What was true in the past may no longer be true, simply because of changes in the environment and in the person. Thus truth evolves transactionally over time. Parents often look back on the hard work and sacrifices they made to get ahead or succeed when they were young adults, and then impose the same demands on their own children now. However, the meaning of hard work for the parents was learned over time; thus meaning and truth for the teenagers will also evolve over time and are unlikely to be gained from being forced upon them.
Change is transactional.
Each individual influences his or her environment, just as each environment influences the individual. Reciprocity is the key word here. A affects B which alters B, which in turn alters A, and so forth. Each adolescent has a completely different “family” that has a unique impact on his or her life. The “family” can consist of parents, grandparents, siblings, teachers, peers, therapists, coaches, and others. The impact that these people in the environment have on the individual is just as varied as the impact the individual has on those in the environment. The bottom line here is that it takes at least two to tango.
LECTURE POINTS: The points above all help pave the way toward the middle path by helping us do the following:
Expand our thoughts and ways of considering life situations.
“Unstick” standoffs and conflicts.
Be more flexible and approachable.
Avoid assumptions and blaming.
DISCUSSION POINTS: Elicit from the group one or two examples of when people were operating from a nondialectical perspective—that is, when they were “stuck” in an extreme way of seeing things. Why was that a problem? Can anyone generate an alternative position?
Move away from “either–or” thinking to “both–and” thinking. Avoid extreme words: “always,” “never,” “you make me.” Be descriptive.
Example: Instead of saying, “Everyone always treats me unfairly,” say, “Sometimes I am treated fairly, and at other times I am treated unfairly.”
Practice looking at all sides of a situation/all points of view. Find the kernel of truth in every side.
Remember: No one has the absolute truth. Be open to alternatives.
Use “I feel …” statements, instead of “You are …,” “You should …,” “or “That’s just the way it is” statements.
Accept that different opinions can be valid, even if you do not agree with them (“I can see your point of view, even though I do not agree with it”).
Do not assume that you know what others are thinking; check your assumptions (“What did you mean when you said … ?”).
Do not expect others to know what you are thinking (“What I am trying to say is …”).
DISCUSSION POINT: Have group members read the “Practice” examples at the bottom of Handout C.2. Then ask them to circle the statement that reflects a dialectical viewpoint. Next, discuss members’ answers and confirm their understanding of the “both–and” concept.
Example: A parent says to an adolescent, “I want you to rely more on yourself and less on me when it comes to figuring out what you think and feel, and you must ask me before you make plans to go to the city with your friends.” Discuss how the preceding “both–and” statement makes sense and may promote change.
In discussing this handout, make it clear that these dialectical behavioral patterns operate within teens as well as between teens and family members, between parents (e.g., parent vs. parent), and between therapists and teens.
LECTURE POINT: A skills trainer says to the group:
“Do you ever find that you’re going along with a certain way of thinking and acting, and then something hits you and you swing to the other extreme? For example, for the parents in the group, you let your kids do what they want to do, like coming in late, slacking off on homework, or being disrespectful—and then one day, you say, ’That’s it!’ You then switch to the other extreme and say, ’I’ve had it! You’re grounded—no going out and no TV for the rest of the school year!’ Do you think that works? Is that usually an effective way of changing your teen’s behavior? From our experience, and from the research literature, the answer is no. And as you may know from your personal experience, your teens do not respond, and then you revert to your old ways. Teenagers can also swing from one extreme to the other in trying to manage their own emotions and behaviors. Lastly, have you noticed that parents and their teenagers often get stuck in polarized positions? For instance, parents say, ’Come home early!’ and teens say, ’I’m coming home late!’ One of the goals of this module is to help you find the middle path within yourself and in your relationships in order to achieve your goals. If you find yourself landing at one extreme pole or another, you are unlikely to be able to maintain that position. Even if you are, it is likely to be ineffective.”
LECTURE POINT: When these polarized positions occur, we call them “dialectical dilemmas.” These behavior patterns can take place within a person (e.g., within a teen or parent) or between two people (e.g., between a teenager and a parent). Three dialectical dilemmas are commonly observed in working with families:
Making light of problem behaviors versus making too much of typical adolescent behaviors.
Forcing independence too soon versus holding on too tight.
Offer brief definitions and examples of each dialectical dilemma as follows: Excessive leniency versus authoritarian control; normalizing pathological behaviors versus pathologizing normative behaviors; forcing autonomy versus fostering dependence (Rathus & Miller, 2000). Note that for use in skills training, these have been reworded respectively as the three dilemmas listed in the previous Lecture Point.
LECTURE POINT: The first dialectical dilemma is called “being too lose versus being too strict.” “Being too loose” refers to having too few demands and limits. The other extreme, “being too strict,” refers to imposing too many demands and limits while being inflexible.
Examples:
A 15-year-old girl insists on getting body piercings, staying up past midnight instant-messaging friends, and sleeping at a boy’s house without permission. The parents insist that she not have a boyfriend or any body piercings until she turns 18, and that she has to be in bed with lights out by 10 P.M.
A high-achieving, perfectionistic teenage boy has been avoiding doing homework for the past several weeks, for a variety of reasons. The teen then gets a poor report card, which propels him into an overly strict response—dismissing all social engagements and leisure-time activities, and focusing exclusively on schoolwork.
Note to Leaders: Some group members might think that one of the responses in either of these examples is an appropriate response. Ask group members whether this is so, and whether this is the most effective long-term strategy.
DISCUSSION POINT: A skills trainer says:
“Now let’s get some examples of these and determine where we all fall along these behavior patterns. Place an X on the line in Handout C.4 that notes where you are right now, and a Y where your family member is right now.
“Can any of you share with the group if you found yourself on one pole or the other? Is there a middle path between these poles that might be a more effective solution?”
Is it your goal to walk the middle path? If so, the following dialectical synthesis could help you achieve your goal: Have clear rules and enforce them consistently, and at the same time be willing to negotiate on some issues.
“For instance, in the example where the 15-year-old girl is insisting on body piercings, sleeping over at a boy’s house, and instant-messaging friends past midnight, the parent could negotiate on some issues while not bending on others. For example, sleeping over at a boy’s house would not be permissible, but she could spend time with a boy (and even boyfriend) during the day. Furthermore, she could earn the privilege of staying up until 11 P.M. (and instant-messaging friends) if she completes her homework and abides by her weekend curfew. However, for this parent, the body piercings would not be negotiable.”
DISCUSSION POINT: Elicit other examples from teens and parents.
LECTURE POINT: The second dialectical dilemma is called “making light of problem behaviors versus making too much of typical adolescent behaviors.” “Making light of problem behaviors” refers to minimizing the seriousness of behaviors that could be maladaptive or harmful. “Making too much of typical adolescent behaviors” refers to overreacting to behaviors that would generally be considered normal.
Example: A well-meaning parent might ignore, for a long period, an adolescent’s increasingly maladaptive behaviors, such as failing grades, spending more time with a drug-using peer group, and greater irritability at home. The parent might give the adolescent the benefit of the doubt, believing that this stage would pass. Then, after the adolescent makes a suicide attempt, the parent begins watching the adolescent like a hawk and interpreting even minor mood changes or request for privacy as signs of impending danger.
DISCUSSION POINT: A skills trainer says:
“Now let’s get some examples of these and determine where we all fall along these behavior patterns. Place an X on the line in Handout C.4 that notes where you are right now, and a Y where your family member is right now.
“Can any of you share with the group if you found yourself on one pole or the other? Is there a middle path between these poles that might be a more effective solution?”
Is it your goal to walk the middle path? If so, the following dialectical synthesis could help you achieve your goal:
Recognize when a behavior ’crosses the line’ and try to get help for that behavior, and a the same time recognize which behaviors are part of typical adolescent development.
“For instance, the synthesis in the example just given could be for the parent to recognize the pattern of deteriorating behaviors and proactively intervening, while inquiring about but not overreacting to the teen’s requests for privacy and minor moodiness.”
DISCUSSION POINT: Elicit other examples from teens and parents.
Note to Leaders: To help group members recognize which behaviors cross the line and which are typical adolescent behaviors, introduce What’s Typical for Adolescents and What’s Not (Handout C.5). This handout offers some examples of normative adolescent behaviors, as well as those adolescent behaviors that should raise a flag for concern. Not every possible behavior of concern is listed here. When parents are unsure whether a behavior crosses the line, they should consult with a professional or with an objective friend or family member.
DISCUSSION POINT: Elicit examples from teens and parents, using Handout C.5 as a starting point.
LECTURE POINT: The third dialectical dilemma is called “Forcing independence too soon versus holding on too tight.” “Forcing independence too soon” refers to cutting the strings prematurely. “Holding on too tight” refers to restricting moves toward independence.
Example: The parents of a 17-year-old daughter have spent the past several years rescuing and protecting her from any negative consequences of her actions (e.g., problems with school, peers, after-school jobs). Then, when the daughter becomes pregnant, they switch to the other extreme and demand that she move out of the house immediately and find a way to support herself.
DISCUSSION POINT: A skills trainer says:
“Now let’s get some examples of these and determine where we all fall along these behavior patterns. Place an X on the line in Handout C.4 that notes where you are right now, and a Y where your family member is right now.
“Can any of you share with the group if you found yourself on one pole or the other? Is there a middle path between these poles that might be a more effective solution?”
Is it your goal to walk the middle path? If so, the following dialectical synthesis could help you achieve your goal: Give your adolescent guidance, support, and rules to help the teen figure out how to be responsible for his or her life, and at the same time slowly give your adolescent greater amounts of freedom and independence while continuing to allow an appropriate amount of reliance on others.
“For instance, a synthesis for the example just given could be for the parents to have held the teen more accountable for her actions earlier in her life. At the same time, now that she is pregnant, they could begin to wean her from their care more slowly and encourage her to take on greater responsibility for herself.”
DISCUSSION POINT: Elicit other examples from teens and parents.
Note to Leaders: Other types of dialectical dilemmas may arise in your interactions with families, such as overindulging versus withholding/depriving, being overly intrusive versus overly distanct, and others. Should you note such patterns in discussions with clients, you can similarly point out the extremes in each position and ask group members to help generate a synthesis.
There is a take-home practice exercise for the dialectics segment of this module (Handout C.6). This handout asks group members to identify one personal example of not thinking or acting dialectically (i.e., getting stuck at one pole of a dialectical dilemma) and one personal example of not-thinking or not-acting dialectically. This assignment requires therapists to help participants by employing the secondary treatment targets described in Chapter 5 (and included in simplified form in Handout C.4).
Example: For being too loose versus being too strict, the secondary targets include (1) increasing authoritative discipline and decreasing excessive leniency, and (2) increasing adolescent self-determination and decreasing authoritarian control. In practical terms, the parents are encouraged to employ an authoritative parenting style rather than a laissez-faire or authoritarian style, which involves discussing and possibly negotiating house rules with their teenagers and being firm yet flexible. In so doing, the parents are more easily respected (neither feared nor ignored), and the adolescents feel a greater sense of self-determination in that they have some input (neither all nor none) into their lives.
Introduce the topic of validation with a vignette illustrating invalidation, such as the following:
“Johnny is sitting in class, trying to pay attention, and he accidentally knocks his notebook off his desk, making a loud noise on the floor. The peers next to him chuckle. The teacher stops in her tracks and says, ’There you go again, Johnny, disrupting the class, trying to get attention … I am really getting tired of this behavior!’ Johnny feels extremely embarrassed, hurt, and angry, since he’d been making a true effort to focus and behave more skillfully. He later goes home and recounts the story to his mother, who replies, ’Why do you keep doing this to yourself? You’re never going to get into college at this rate. You’d better shape up!’”
Ask group members what they think Johnny must have felt after his teacher’s and mother’s responses. Why were these responses so hurtful? What was missing from their responses?
Note to Leaders: At this point, introduce Validation—What Is It? (Handout C.7). Invite a group member to read the definition of validation there. “Validation communicates to another person that his or her feelings, thoughts, and actions make sense and are understandable to you in a particular situation.”
DISCUSSION POINT: Now ask group members: “What would be a validating thing the teacher could have done?” A reasonable response here would be for the teacher to have simply ignored the dropping of the notebook, since ignoring it would have implied that it was insignificant and nondeliberate. Next, ask: “What would be a validating response the mother could have given?” If group members have trouble generating a validating response, then offer an example of one, such as “Oh, Johnny, that must have been so upsetting and frustrating for you, especially since you were really trying your best to pay attention and behave appropriately.” If teens say that this sounds too “sappy,” encourage them to put into words a validating response they would welcome from their own parents.
LECTURE POINT: Remember, validation does not equal agreement. Validation does not necessarily mean liking or agreeing with what the other person is doing, saying, or feeling. It means understanding where the other person is coming from. A therapist might validate an adolescent client’s desire to get high with friends by saying, “I do understand that it makes you feel good to spend time with your friends, including when you are getting high. Frankly, however, I think it is a bad idea for you to get high right now, given your depression and recent suicidal urges.”
DISCUSSION POINT: Many people get this point confused.
Example: Most parents struggle in the attempt to validate their teen who asks for a later curfew, because they don’t agree with a later time—so they simply say “No!” Is there a way to validate the desire for the later curfew without agreeing with the teen? If group members cannot generate examples, leaders can provide one, such as saying, “I get that you want to stay out later, since you’re having fun with your friends. Yet we agreed this would be your curfew time until you got back on track with your schoolwork.”
DISCUSSION POINT: Some people may raise the point that they do not see how they can validate when they simply do not understand the other person’s point of view. That is, the other person’s feelings or behaviors make no sense to them at all.
Example: Some parents might say that they cannot in the least understand their adolescents’ suicidal behaviors. A leader might then say to such a parent, “I can understand how that might be difficult for you to understand.” (The point is, as a leader, to model the concept being taught at any point—in this case, validation.) The leader can then say that because the adolescent is in tremendous pain and cannot see any other way out, suicidal behavior is logical and valid to the teen in that moment. If a parent still does not “get” the suicidality, a leader can respond: “Could you say to your teenager, as a first step, ’I can see that you are obviously in a lot of pain,’ even though you don’t understand the choice of suicide as a solution?” In this case, leaders can explain, the parent is validating the emotion, though not the behavior. This is important, because the teen will feel as if the parent understands at least one aspect of the teen’s experience. An alternative strategy that can be very effective is to say “I know you want me to understand this, and, believe me, I want to understand this, but I just can’t get it. Let’s keep talking. Tell me again.” The parent might want to get the adolescent to think of times he or she has had a lot of trouble understanding something in school that everyone else seemingly understood (such as algebra), but with persistence finally “got it.”
This type of communication, presented in a nonjudgmental way, communicates that the parent’s lack of understanding is the problem in this conversation, not the invalidity of the adolescent’s emotions or behavior. It also communicates deep interest in the adolescent’s difficulties. This leads logically to the next two sections of Handout C.7, on what and why we should validate.
LECTURE POINT: Ask someone to read the “What should we validate?” section of Handout C.7 aloud. As stated there, we should validate:
Feelings, thoughts, and behaviors in ourselves and in other people.
Leaders or group members can give examples of each, or can refer back to the example of Johnny, above.
Note to Leaders: One exercise that can be used to emphasize “What should we validate?” is the following: Invite group members to practice talking about something, and have the rest of the group first pay close attention. Then, on cue from the leaders, the group members should act completely uninterested. What happens is that people can speak coherently when being listened to and then become incoherent when ignored.
LECTURE POINT: Ask someone to read the “Why should we validate?” section of Handout C.7 aloud. As stated there, validation improves relationships. Specifically, it can show that:
We are listening.
We understand.
We are being nonjudgmental.
We care about the relationship.
Conflict is possible with decreased intensity.
In addition, validation can result in a communication partner who is:
More calm.
Less angry.
More receptive to what we have to say.
DISCUSSION POINT: Can group members think of a time when they felt invalidated and contrast that to another time when they did? How were the two times different? How did they feel each time? How did it affect their behavior each time?
Now introduce “A ’How To’ Guide to Verbal and Nonverbal Validation” (Handout C.8). Emphasize that these points are not listed in order of importance or in order of how types of validation should be carried out. Rather, when people are familiar with various forms of validation, they have a choice of which they can use in each situation. Read through the “How can we validate others?” points.
Actively listen. Make eye contact and stay focused.
After reading this point, a leader might pause and leave a moment of silence, which will result in group members’ looking up expectantly at the leader. The leader can say, “This is Step 1 in validation—you are doing it. I can tell you are looking and listening right now.” Note that culture has to be considered with regard to this point, as in some cultures (e.g., certain Hispanic subgroups and Asian cultures), maintaining eye contact may be considered disrespectful and thus invalidating.
Be mindful of both nonverbal and verbal reactions in order to avoid invalidation (e.g., rolling eyes; sucking teeth; walking away; saying, “That’s stupid, don’t be sad” or “I don’t care what you say”).
Leaders can illustrate this point by sighing and rolling their eyes while a participant is reading, and then asking what this experience was like. The main point here is that a person who is trying to validate someone must be careful to avoid in validating with both verbal and nonverbal behaviors.
Observe what the other person is feeling in the moment. Look for a word that describes the feeling.
For example, as a start, a person can say, “I can see that you are really disappointed.”
Reflect the feeling back without judgment. The goal is to communicate that you understand how the other person feels (e.g., “It makes sense that you are angry,” “I understand that you are having a tough time right now;” for self, “I have a right to feel sad.”).
Take an example from one of the participants’ earlier comments or homework reviews in which they had expressed distress (e.g., a teen’s earlier expression of being in “a bad mood” today because of a conflict with a peer), and then ask each group member to make one validating comment to this group member. This illustrates that there are many possible validating responses.
(a) Show tolerance! Look for how the feelings, thoughts, and actions make sense, given the other person’s (or your) history and current situation, even if you don’t approve of the behaviors, emotions, or actions themselves. For example, a teenager might report her unwillingness to attend this treatment, due to the fact that none of her prior therapy experiences were helpful. Ask each member of the group to offer a validating statement, taking history and current situation into account. For example, one validating response might be “I don’t blame you for feeling hopeless about this, given your past experience.” (Leaders should use a relevant example generated from within the group whenever possible.)
(b) Look for how the feelings, thoughts, and actions make sense given the current situation. This type of validation is at the heart of DBT. Validating in terms of the current situation means looking for how the person’s behavior makes sense because it is a reasonable or normative response to a current situation. For example, Sharon is sometimes shy in groups. Now she is attending the DBT multifamily skills training group with her mother, and when she occasionally speaks up in group, another girl on the other side of the table gives her an angry, threatening look. On the way home, Sharon says to her mom: “That kid across the table was really mean to me. I don’t want to sit near her next time.” A response that would validate Sharon in terms of what actually happened would be “Boy, I really understand, and I wouldn’t want to sit near her either. She gave you quite a look when you spoke up,” A perhaps equally honest but invalidating response would be Sharon’s mother saying to her, “I know you’re shy, and it’s hard for you to speak up in group.” When a behavior is supported by current events, implying that it is caused by past events can be invalidating.
Respond in a way that shows you are taking the other person seriously (with or without words).
Sometimes words are not necessary to convey validation. For example, if someone is crying, a validating response is to give a tissue or a hug. Or if a person says “I’m thirsty,” giving him or her a glass of water communicates validation. Or if a friend or family member says, “I have a serious problem,” it may be validating to dive in with efforts at problem solving without saying, “Wow, it sounds like you’re having some serious problems and you’re upset.” Be careful in this latter case, however; depending on what the person wants in the moment, problem solving can be experienced as invalidating. Sometimes merely listening is sufficient validation. It may pay to ask, “Do you want me to help solve this problem, or do you just want to talk about it?”
LECTURE POINT: Leaders now shift gears and begin talking about how to apply validation skills to oneself. What is self-validation, and why is it important? Self-validation involves perceiving one’s own feelings, thoughts, and actions as accurate and acceptable in a particular situation. This is important, because many suicidal adolescents have the tendency to invalidate themselves. Examples of self-invalidation are “I shouldn’t feel sad about this,” or “it’s stupid that I got that upset.” The important point is the unaccepting or judgmental stance toward one’s own experience. Self-validation relates to other-validation. It is important for parents to help their adolescents self-validate, particularly if their adolescents are constantly asking their parents for reassurance. Sometimes the self-invalidation comes from modeling the responses of an invalidating environment. Sometimes it comes from looking at the world through the lens of a person who is depressed. Regardless, it is important to learn how to validate oneself, because self-validation:
Helps reduce emotional and physical arousal (i.e., it is calming).
Reduces vulnerability to emotion mind.
Helps in the processing of new information, which in turn permits more effective responses.
To return to the earlier example of Johnny, after the teacher accuses him of deliberately causing a distraction and trying to get attention, he second-guesses his own good intention to pay attention and behave well. He also thinks to himself, as he feels his eyes well up with tears, “This isn’t such a big deal—why am I getting so upset?” This dual self-invalidation results in an intensification of his negative emotions, and impairs his ability to stay focused during the remaining class time.
DISCUSSION POINT: What could Johnny have said to validate himself? How would that affect his thinking, feeling, and behavior? If group members have trouble generating responses, leaders can give the following alternative outcome: Johnny could have said to himself, “I know this was not intentional. I know I am trying to pay attention to what the teacher is teaching, and I’m doing the best I can. But she didn’t see that—no wonder I feel so upset! I’ll just keep paying attention, and talk to the teacher after class to explain this.” Then group members can be asked to offer one quick example of self-validation, based on events of the past day.
Note to Leaders: Begin by introducing Behaviorism—What Is It/Ways to Increase Behaviors (Handout C.10). Ask a group member to read the definition of behaviorism there: “Strategies or principles used to increase behaviors we do want and reduce behaviors we don’t want (in ourselves or others).”
DISCUSSION POINT: Ask the group, “Are there behaviors you would like to change in yourself or other people? If so, what are some of these?” Elicit brief examples from two or three group members. For others, these behaviors might include getting someone else to nag less, listen more, clean up his or her room more, obey curfew more, give more privileges, or do homework more often. For oneself, these might include exercising more, eating less, yelling less, listening more, engaging in more pleasurable activities (music, sports, etc.), or procrastinating less.
DISCUSSION POINT: Now ask the group, “Can all of us identify and share one behavior we would like to increase in ourselves?” Go around the room and elicit examples.
LECTURE POINT: A skills trainer says:
“An important way to increase a behavior is to provide ‘reinforcers’—that is, consequences that result in more of the behavior. Reinforcers provide information to a person (or yourself) about what you want that person to do.
“Remember, timing is very important: The reinforcer should follow the desired behavior immediately. If you wait too long, the reinforcer won’t be connected with the behavior. For example, you are trying to improve your backhand in tennis, and your coach is observing 30 swings. Would you prefer your coach to tell you, ‘That’s the swing! Nice job!’ immediately after you use the right form, or would you prefer the coach to wait until you are done and then say, ‘Your 14th swing—I liked that one’?
“Also remember to choose motivating reinforcers, for yourself and others. A fresh plate of broccoli normally won’t do it for most people. Some examples of motivating reinforcers might include a nice dinner in a special restaurant, or downloading some new music after the completion of a major project.”
LECTURE POINT: There are two different types of reinforcement: “positive reinforcement” and “negative reinforcement.” Positive reinforcement increases the frequency of behavior by providing a rewarding consequence (e.g., praise, a privilege, an A on an exam, a satisfying outcome to an interpersonal situation).
DISCUSSION POINT: Ask group members, “What would be a positive reinforcer for the behavior you identified that you would like to increase? What would make you likely to do it?”
Note to Leaders: Guide group members in their responses to keep reinforcers small, realistic, safe, and age-appropriate (e.g., teens should not choose cars, large amounts of money, drinking alcohol, or staying out all night with friends). Also encourage participants to search for meaningful reinforcers beyond just money, such as time spent with a parent. In addition, discuss the concept of satiation: Something that is reinforcing may not be a reinforcer and may even be aversive when given too much.
Examples: Food is not a reinforcer after a really big meal; affection is not a reinforcer if one receives plenty of that; and so on. Something is only a reinforcer if it is given in appropriate doses. This is also true with praise. Elicit examples, particularly from adolescents.
LECTURE POINT: The best way to remember the principle of negative reinforcement is to associate it with the word “relief.” A more technical way to understand it is that negative reinforcement increases the frequency of a behavior by removing an aversive condition.
Examples: Taking aspirin to get rid of a headache, doing homework to get Mom to stop nagging, or cutting oneself to decrease negative feelings (although the skills taught in group are better ways of managing such feelings). First, leaders can share an example, such as having back pain that gets relieved by receiving a massage. This reduction in pain increases the likelihood of seeking another massage in the future.
DISCUSSION POINT: Next, leaders ask group members to identify a negative consequence or source of discomfort that they would like relieved or removed.
Example: A teenage girl might mention a parent’s nagging her to clean her room. What new behavior might help reduce this discomfort? For instance, if the teen’s cleaning her room led to a reduction in the parent’s nagging, the adolescent might be more likely to pick up after herself in the future. Elicit one or two other examples from the group.
Note to Leaders: Emphasize that positive and negative reinforcement can be applied in adaptive or maladaptive ways. For example, one can positively reinforce oneself for a desirable behavior by buying a new CD versus getting drunk. Or one can negatively reinforce oneself (e.g., get relief from emotional pain) by taking a long bath versus cutting oneself.
LECTURE POINT: “Shaping” is a special form of reinforcement. It means reinforcing small steps that lead toward a bigger goal
Example: One can take small, reinforced steps toward overcoming school anxiety (by attending for 1 hour on Monday, 2 hours on Tuesday, etc., until attendance all day every day is achieved) or toward increasing abstinence from self-harm behavior.
Sometimes our expectations of ourselves and others set us up for disappointment and potential failure.
Example: If teens think, or their parents think, that the teens can achieve abstinence from self-cutting instantly, they are probably going to be disappointed with themselves, each other, and the treatment. So the principles of shaping need to be brought into the discussion of all new goals.
DISCUSSION POINT: Note that each successive approximation or step toward a larger goal needs to be reinforced, to increase the chances of continuing to work toward the goal.
Example: Has a parent ever been frustrated with a child for not starting a large school project until the night before? How would shaping apply? Discuss. Group members’ examples might include approaches such as saying, “Why don’t you sit down and outline the paper the week before the due date? Once that’s done, you can go watch TV.” Step 2 would be to write the introduction and provide a small reinforcement for that, and so on.
LECTURE POINT: Two learning principles that can be used to decrease or stop behaviors are “extinction” and “punishment.” A skills trainer says:
“Extinction is the reduction of a behavior because reinforcement is withheld. That is, you might ignore the unwanted behavior when attention to it will cause it to continue to happen. However, make sure you reinforce other, adaptive behaviors in the process.
“For example, if a little boy begins to throw a tantrum in the supermarket because he wants a candy bar, a parent is likely to give in to stop the escalation of the tantrum. This giving in, however, reinforces the tantrum behavior and makes it more likely to occur during the next visit to the supermarket. By contrast, if the parent withholds reinforcement—that is, does not buy the candy bar—the tantrum is likely to escalate in the moment (making everyone unhappy!). However, if the parent holds the line during this and subsequent shopping trips—that is, tolerates the ’behavioral burst’ (escalating tantrum) by not giving in, while positively reinforcing any efforts to walk calmly through the store—the tantrum behavior is likely to extinguish over time.
“Note that if the parent says no the first three times, but the fourth time gives in and buys the candy bar, thinking, ’It’s just this one time,’ the parent now has a real problem. This is called ’intermittent reinforcement,’ and an intermittently reinforced behavior is the most difficult to extinguish. So don’t give up in the face of a behavioral burst—you have to ride it out. Also, don’t forget to orient the person that you are beginning to work to extinguish the behavior, so that it does not seem arbitrary or punitive. And, again, don’t forget to reinforce alternative, adaptive behaviors.”
DISCUSSION POINT: Elicit some examples from group members of behaviors that might be reduced or eliminated through extinction. For each example, note also what alternative behaviors might be reinforced and how behavioral bursts might be handled.
LECTURE POINT: A skills trainer says:
“The difference between extinction and punishment is that extinction involves taking away a reinforcer for a behavior, but punishment involves adding something that is negative or aversive. That is, punishment means giving a consequence that results in a decrease in behavior. It tells another person what you don’t want that person to do.
“For example, let’s say that you’re a parent and your teenage daughter harasses you to let her stay up later at night by nagging, criticizing, or ’guilt—tripping’ you. Extinction of this harassment would involve defining this behavior for the girl as harassment and then never, ever giving in to it. Punishment of it might involve sending the girl to her room even earlier than usual.
“Punishment can be either effective or ineffective. One type of effective punishment is just to let natural consequences happen. For example, let’s say you’re a teenager who stays up all night. As a result, you may be too tired to focus in school, may fail a test, and may get in trouble for failing. If a behavior doesn’t have natural consequences, the punishment should be specific and time—limited, and it should fit the ’crime.’ For instance, if you’re a teen who misses curfew, you might be punished by losing the chance to go out the next day. In contrast, an ineffective punishment is one that isn’t specific, lasts too long, and/or doesn’t fit the behavior. For instance, if you miss curfew, your parents might ground you for 2 months, take away your cell phone, and remind you of the mistake constantly.”
Note to Leaders: Emphasize that punishment may make a person stay away from the person who punishes, hide a behavior, or suppress the behavior when the punisher is around. Punishment may at times be necessary, but it is essential to keep it specific, time-limited, and appropriate to the “crime,” as well as to reinforce an alternative behavior. Otherwise, punishment will not work. Punishment by itself does not teach new behavior, and it may even lead to self-punishment.
DISCUSSION POINT: Elicit some examples from teens and parents of behaviors that appear necessary to punish rather than extinguish. For each example, debate the possible advantages versus disadvantages of punishment.
