Validation and Radical Genuineness in DBT for Trauma

Meet Your Instructor: Kirby Reutter, Ph.D., DBTC, LMHC, MAC

United States Department of Homeland Security

Key Points

To heal, clients with PTSD need to radically accept the trauma itself, the symptoms of the trauma, and the ways trauma has impacted their lives. Radical acceptance doesn’t mean to approve of or to agree with. It means to acknowledge and embrace.
Not radically accepting leads to even more pain, whereas radical accepting leads to healing. The DBT skills of meaning, prayer, and spiritual mindfulness can provide additional tools to help clients learn to radically accept.
Trauma is invalidating and invalidation is traumatizing. Therefore, validation is a critical DBT intervention. Validation involves both reflecting and normalizing a client’s experience.
The highest level of validation is radical genuineness, which sometimes includes irreverence. Irreverence is when a therapist reflects a client’s reality in a way that is jolting to the client but for the client’s benefit. Clients can learn the DEAR Self skill to further process and self-validate the effects of trauma.
Ironically, many trauma symptoms, such as dissociation, addiction, and suicidal behaviors, are contraindicated for many trauma models. DBT provides the therapist and the client with the necessary tools to help clients sufficiently stabilize and self-regulate to proceed with deeper trauma work.
Most trauma models can be categorized as either predominantly top-down or primarily bottom-up. Not surprisingly, DBT can be dialectically conceptualized as both a top-down and bottom-up model, which makes DBT an optimal foundation for subsequent trauma work.