DBT in Practice: Mastering The Essentials

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Last Updated Nov 30, 2022|

3 Types of Validation in DBT: Emotional, Behavioral, and Cognitive Validation

By Stephanie Vaughn, PsyD

This presentation is an excerpt from the online course “DBT in Practice: Mastering the Essentials”.

Highlights

  • The three types of validation are emotional, behavioral, and cognitive.
  • Do not use validation immediately following problem behaviors which are maintained by validation.

 

Transcript

Using Validation in Therapy

There are many things that are important to consider when using validation in therapy but number one, we want to consider timing. You don’t want to use validation immediately following problem behaviors that are maintained by validation. In other words, the behavior is continuing because validation is the fuel. We don’t want to accidently reinforce so we’ve got to be aware of how validation is being received and what’s happening with the behavior. Is it increasing, decreasing, staying the same over time?

You want to know when to use it and when to stop. As you learned from the last video, it’s not necessary to validate everything. And while we need those validation strategies to balance out the change strategies, in the beginning, we’re going to be using a lot more validation but over time, we’re going to fade that. It has to be faded over time or else it’s like keeping the training wheels on a bicycle. We’ve got to be able to take that away so that the person ultimately learns how to validate themselves.
So validation can be a comment like that makes sense or it could be the context for an entire session. I once spent an entire session validating a patient who came in. It was my very first patient when I was doing my internship. And the patient was extremely angry with the front desk staff because they had messed up scheduling. This was not my fault and at the same time saying that it was not my fault was going to make no difference in the world other than making the problem worse. So I settled in. I had had some training on validation recently and decided that that was going to be my training for the day, was practicing validation no matter what. So I validated the entire session other than up to the last 10 minutes in which the patient apologized for complaining throughout the whole time and we went on to work together very effectively from there on out. So optimally, you’re not going to need to validate for an entire session because we do need to be able to use some of those change strategies but also it is possible to validate for an entire session.

So the different types of validation, we have emotional and behavioral and cognitive validation.

For emotional validation, that involves validating without escalating the emotion. And the way to do this is to focus in on the primary emotions that the patient is experiencing. So we talked about primary versus secondary emotions. Anger is a pretty common secondary emotion that’s reported. People will feel angry. They will have a little more difficulty recognizing sadness or hurt or loss underneath. So when we validate, we can try to identify those underlying emotions as a way of de-escalating the emotional response. If we’re validating the anger, that might be helpful but even more, validating the underlying hurt can really shift the feel for the patient and allow them to pay attention to the nuances of all of the different emotions that they’re experiencing helping them improve their ability to identify a variety of emotions in any given situation. We want to identify the emotions non-judgmentally and we’re helping to give them the language of primary and secondary emotions. So that would be something we would explicitly teach.

For emotional validation, it will also allow them to express emotions. The simple allowance of letting someone cry or letting them express themselves while you’re listening, clarifying and identifying emotions. So we’re not trying to change them all the time. We’re not giving them the message that they need to stop or they need to feel better or they need to regulate themselves. DBT therapists need to be flexible in that regard because yes, at times, we are helping them to ground and regulate particularly in the beginning but we’ve got to be aware, acutely aware of those times when expressing emotion and feeling it deeply within session is adaptive and it’s a normal experience. So we don’t want to constantly be on the lookout for making them feel better.
Emotional validation is something we can do when we accurately read their emotions. We can imagine being the patient in a similar circumstance. One of the questions that I ask is, in my head, I ask, have I been in a situation similar to this in some way? If it’s not, don’t look so much at the content as you do the situation itself and the circumstances. Leaving the content aside, can you imagine being in that same position? How did they feel? Based on what you know about what they likely think and how they feel, can you communicate that their perspective is understandable? Can you in essence read their mind? And of course, we’re not mind readers. And in DBT and in any circumstance, we can often put ourselves in the other person’s position and imagine what thoughts are going through their head or what feelings they have. And then we can articulate those and check for understanding, check that we’re understanding things correctly, that we get it. We can directly say things like that makes sense or I can see that. And that would be an example of emotional validation.

Self-disclosure. Now, self-disclosure is not like telling a story about how things have happened to you. There’s nothing wrong with that per se. But when we’re talking about emotional validation, self-disclosure might be laughing when a person tells a story that’s funny or crying, letting a tear fall when a person tells a very emotionally heart-wrenching story that anyone, you would have to be a hard-hearted Grinch to not have some emotional experience while listening to it. So those emotional expressions are actually self-disclosures and that’s a type of emotional validation.

Next is behavioral validation. And we use behavioral validation in every session. We use it when we’re looking over the diary card. So we get the diary card in the beginning of session and we’re going through the patient’s behaviors and we’re getting a description of what’s happened over the past week, a description of what behaviors they’ve engaged, adaptive and maladaptive. And we’re communicating regardless of whether they are skillful or unskillful that they’re understandable. For example, it makes sense that you would cut yourself before the interview because you really needed to be focused and it’s worked before.

So again, there’s the fine line between reinforcing and validating. It’s important that you don’t reinforce. At the same time, it’s really important that you don’t invalidate to the degree that the patient is unwilling to share things with you and thinks that you just don’t get it and maybe afraid to tell you things or misrepresent themselves on the diary card. So you’ve got to be able to communicate to them that you are a person who gets it. Describing their behavior non-judgmentally without assuming intention can be validating in and of itself. So just being very matter of fact and practical, saying something like okay, so you used an emergency razor that you kept in the glove box, not getting too overly intense or trying to make something of it, just simply repeating back what the facts of the situation are, that can be a type of validation, behavioral validation.

Next is cognitive validation. This is when the therapist recognizes and identifies the underlying assumptions, beliefs, rules and expectancies of the patient and we then articulate them and find the validity.

This again involves reading minds. And we’re also looking at patterns that we may have picked up on over the course of time in treating this person or just patterns that we know about human beings in general. So an example, if we’re using the same interview example, you didn’t go for the second interview because you felt like you didn’t deserve it after all that. So that would be reading minds based on what this therapist knows about the patient from the past that they have issues related to feeling like that they deserve things. Or the therapist could respond, are you feeling like giving up? So we’re imagining what it would be like to have had an interview, to have had a history of self-harm and struggling emotionally, to have been excited about this interview but to have felt so nervous and emotionally dyregulated that you needed to do something. And so even though we’re “not supposed to be” doing this thing, we have these two alternatives. We’re either going to lose out on our future, the job that we want, this interview or we’re going to fall back on some old maladaptive behaviors.
It makes sense that you go back to what you know. So then you go and self-harm and then immediately as we know the regret comes or the feeling of failure and then the self-talk of something to the effect of wow, you really cut yourself right before an interview and you think that you deserve this job. Why don’t you just wrap it up and go on home? So we can imagine those sorts of things. If we have that sort of information about the patient from previously, that these are the types of patterns that would occur, then we can guess what they would feel like next. Yeah, they would feel like possibly giving up and just resigning themselves to never being able to get a job or even to feeling suicidal.

So the dialectic that we’re using here with validation is we’re using validation and change. So as the therapist, we’re thinking, we’re validating that yes, I could see that this is what you would be thinking. And I’m thinking there may be some other things we could try that will get you focused without needing to cut yourself. Could we talk about a couple? So you can see how we’re validating and then we’re moving toward the possibility of change. In the next video, I’ll discuss the six levels of validation. And in theory, it’s possible to validate anything at one of these six levels.

Key points.
The three types of validation are emotional, behavioral and cognitive.
Do not use validation immediately following problem behaviors which are maintained by validation.

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