DBT Interpersonal Effectiveness Skills for Substance Abuse


Private Practice

Key Points

  1. The DEAR WOMAN skill within DBT improves strained relationships by describing the situation, expressing feelings, asserting oneself, reinforcing boundaries, considering the whole situation, observing reactions, and using mindfulness, confidence, and negotiation.
  2. Setting boundaries is essential to maintaining healthy communication and reinforcing positive behaviors.
  3. Validation, and the challenging of black-and-white thinking, allow clients to feel heard and understood while finding a stable middle ground in their personal interactions.
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The DEAR WOMAN skill, developed within DBT, can assist in improving strained relationships with family and friends. Each letter in DEAR WOMAN represents a step in the process.

  1. D – Describe the situation: begin by clearly expressing the specific behavior or situation you want to address. For example, “Dad, I didn’t appreciate the way you spoke to me.”
  2. E – Express how you felt: communicate your emotions regarding the situation. For instance, “I felt hurt when you talked to me like that.”
  3. A – Assert yourself: clearly state your needs or preferences. An example would be, “I’d prefer it if you didn’t speak to me in that manner.”
  4. R – Reinforce: use reinforcement to emphasize your point or request. Repeat your message or boundary, like a broken record technique. “I want you to refrain from discussing that topic.”
  5. W – look at the Whole situation: consider the broader context and other factors that may be influencing the interaction. For example, acknowledge if someone else present may be triggering the situation.
  6. O – Observe: pay attention to how the other person reacts to you. If you receive a negative reaction, take a pause and consider saying, “I wonder if you could hear me out before responding?” or, “You seem upset, would you like to talk about it?”
  7. M – Mindfulness: be mindful.
  8. A – Appear confident: avoid pity or low self-esteem.
  9. N – Negotiate: this phase entails the client going through the aforementioned steps and engaging in dialogue. In Michael’s case, the father could say, “Well, I don’t like it when you attack me so I just attack you back.” Michael could reply, “Okay, I hear that. You know, I apologize. I won’t do that, or I’ll be mindful of that, in future.” So the client is getting feedback, then thinking about what seems true and what works.

It’s essential to encourage dialogue and check in with the other person after each step to ensure a mutual understanding. By challenging extreme black-and-white thinking, clients adopt a more dialectical approach (both-and) and validate their own experiences while still finding middle ground.

Boundaries and Behaviors

Setting boundaries with others and reinforcing positive behaviors is crucial for improving relationships. For example, if Michael’s mother or father call while under the influence of substances, he can set a boundary by saying, “I love you, but I prefer not to speak with you when you’re under the influence. I’m more than happy to talk when you’re clean and sober.” This approach allows him to maintain a connection while prioritizing healthy communication.


Validation plays a vital role in therapy. Many clients, like Michael, have experienced invalidation throughout their lives, leading to increased feelings of being unheard and unseen. It’s crucial to help clients identify triggers from the past and challenge their perceptions of present invalidation. By using both-and thinking, and recognizing their own patterns of black-and-white thinking, clients can broaden their perspectives and find more stable middle ground.

Looking for practical everyday tools? This print-friendly handout is just what you need. Click on the following link to download the PDF:

DBT Interpersonal Effectiveness Skills for Substance Abuse: DEAR WOMAN Skill and Boundaries

This handout explores the DEAR WOMAN skill, an essential component of dialectical behavior therapy (DBT) and its specialized adaptation for scenarios centered on substance abuse. Designed to bolster interpersonal effectiveness, the skill becomes pivotal as clients confront the challenges addiction introduces to personal interactions. Alongside the DEAR WOMAN steps, the material explains the importance of setting firm boundaries, particularly when faced with substance abuse triggers. Furthermore, it underscores the necessity of validation in therapy, explaining its role in developing a harmonized perspective that seamlessly integrates cognitive rationales with emotional acknowledgments. This is especially vital for those with a history of substance abuse.


Before integrating this handout into your therapeutic approach, take some time to study the material comprehensively. Begin by introducing the core principles of the DEAR WOMAN skill during individual and/or group sessions, highlighting its adaptability for substance abuse situations. As clients explore each step, offer real-time feedback, ensuring they understand the nuanced applications. Engage clients in role-playing scenarios related to substance abuse, enabling them to practice boundary-setting and communication skills. Remember to emphasize the importance of validation throughout their recovery journey consistently. Encourage open discussions after each session, ensuring the material resonates with clients and allowing room for adjustments based on individual needs.

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DBT Interpersonal Effectiveness Skills for Substance Abuse

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