6 Levels of Validation in DBT: From Awareness to Radical Genuineness
This presentation is an excerpt from the online course “DBT in Practice: Mastering the Essentials”.
- There are six levels of validation in DBT, the highest of which is referred to as radical genuineness.
- Radical genuineness involves the therapist as human and an equal. It involves engaging in an authentic manner, not taking themselves too seriously or ignoring the obvious.
How do you validate when it’s difficult to find the validity? In the book, Doing Dialectical Behavior Therapy, Kelly Koerner describes six levels of validation which can be helpful in referencing when you’re struggling with finding the validity in another person’s point of view. The higher the level, the more intensely we’re validating. And of course, we want to try to validate at the highest level but that’s not always possible.
At minimum on our level, we want to show interest and be awake. Now, this sounds fairly simple but if you’ve ever absolutely disagreed or been irritated with another person to the point that you didn’t even want to listen, you know that achieving level 1 is a pretty magnificent accomplishment. You may have the desire to frown or shake your head or eye roll or put your hands over your ears or walk away even. So the showing interest and being awake involves giving the other person their time and giving them the respect of listening. As a therapist, maybe we don’t have the urge to walk out of the room but we may look at them in a way with our head cocked that looks skeptical. We may project some non-verbals out toward them that says, uhm, I don’t really believe you or come on, give me a break. So at our level 1, we also want to make sure that we’re listening and we’re not checking our phone or writing something down instead of listening intently. And if you’ve ever had, if you’ve been a therapist and you’ve ever had the flu, been sick in some way, been up with a child the night before, staying awake is not a small task. So as long as we’re doing this level 1, showing interest and being awake, we’re at least on the path to our higher levels of validation.
Level 2 is accurate reflection. Now, we need to make sure we’re not only using level 2 in sounding like a parrot or what other people make fun of therapists as sounding like just bouncing back what the other person said without putting any skin in the game and articulating an opinion. At level 2, we are reflecting what the patient is saying but again we’re not only using a level 2. So there are some sender and receiver exercises. I know that the Imago model of couples therapy has some great practices and I use them in training new therapists, new students in how to send a message to, you know, you send a message to your partner and then the partner reflects back exactly what was said. It’s much more difficult than it seems on the surface and I highly recommend practicing this in consult group, practicing the sender-receiver with short small messages to see just how difficult it is. And as you can imagine when emotions run high, our ability to accurately reflect what a person said drops down. So for example, the sender may say, I don’t like it when you forget to take out the trash. And the receiver says, I heard you say that you don’t like it when I forget to take out the trash. Did I get that? And the sender says yes. And then the receiver says, is there more? And the sender may say yes or no. So that would be an example of a practice exercise to use if you’re trying to improve your ability to reflect. And of course, that checking for accuracy is important because we may think we heard something but one word can make a huge difference in the entire message itself.
If we’re moving up in our levels at level 3, we want to put ourselves in the other person’s position and want to be able to read emotions and thoughts and check for accuracy. Imagine what it is like to be them. So we’re getting deeper here. And here’s an example. Since you’re feeling like things aren’t changing, are you wondering whether you made the right decision to even start DBT to begin with? Okay, so with that statement, you can see that we have listened, we’ve shown interest and we’re awake. We’re reflecting back that the person feels like things aren’t changing. They must’ve said this, you know, things aren’t changing. But then we’re going deeper into imagining what it’s like to be them. I mean, if I’m in their situation, I’m feeling like things aren’t changing. It doesn’t matter if it’s in therapy, if it’s in an exercise class, if I’m seeing a physician and I’m feeling like I’m not getting any better, if I’ve got a gardener and they’re trying to rehab my lawn. And if I’m having the thought that things aren’t changing, one of the thoughts that I’m going to have and you’re going to have is did I make the right decision choosing this individual? Did I make the right decision going down this path of potential progress? Should I have gone another route? Implied in that also is should I change paths? So we could even say that. We could say, are you thinking about doing something else? And that puts us at a level 3.
If we’re moving up to a level 4, we’re going to validate based on history. Now, this is the history that we know that the patient came in with. We know about their past. And taking their past into consideration, what can we say then? So if we take this same example of since you’re feeling like things aren’t changing, are you wondering whether you made the right decision in even starting DBT to begin with? We can also take it up a notch and validate based on their history. So you could say something like that has to be extremely frustrating considering that you’ve been through five therapists before and none of them have been able to help you and no wonder you’re as angry as you are. Another example if we’re taking another example entirely, we might say, it makes sense you’d be irritated. You don’t like to be told what to do because your abusive father did that. So we know the patient. We’re privy to some of the private information that they’ve shared and we’re taking that into context as we’re validating. I’m giving you the message I know you, I know you, I get you.
Higher than that, we’re going up above, level 5, validate based on current circumstances not just on their history but that the behavior makes sense for anyone. So here’s an example. It makes sense that you’d be irritated. I was being bossy.
Okay, so I hope you can see how this almost radical genuineness which is the level 6, this open, non-defensive therapist acknowledging their part can be super validating because we’re not saying that oh, you’re irritated because you’re a patient or you’ve had abusive experiences. We’re saying you’re feeling this way because it is this way, that that is an extraordinary experience for the person to have their general circumstances validated based on anybody would feel this way. So I started to mention radical genuineness. This is the ultimate, highest level, level 6. It’s not possible that we’re going to be able to validate at the level 6 all the time but when we can, it’s great because radical genuineness involves communicating as you would with someone who is an equal rather than a patient or someone who’s disordered or someone who needs help. If we’re being radically genuine, we might laugh at a joke instead of redirecting it or implying that it’s somehow inappropriate. We might self-disclose how many children we have when a client asks instead of asking, you know, why would you ask that? So we’re going to relate with them like we would with anybody not like we’re afraid of them or not like we are trying to therapize them. We might let tears fall. We might use expletives. We’re going to be our true selves. At this level, we might even confront a client on their BS that is the calling out the elephant in the room. If we’re both sitting here, we both know that’s a bunch of BS and I’m going to say, hey, come on now, that’s some crap and we both know it. Then that can be – It’s speaking to the truth. It’s speaking to the something that you and I both know. Particularly in substance abuse treatment, calling out that elephant in the room and being real is radical genuineness. The point is to be a real live human being not some weird space cadet therapist-y type who they could never be like. When we’re not being genuine, when we’re being false, then the patient has the idea that either something is wrong with them or something is wrong with you like there’s something wrong with them that they could never be this magical angelic person like you are or thinking that you are just a fake and a fraud. And neither one of those options is something that we want to portray. So as long as we’re communicating genuinely, truthfully, then we are more apt to hit that level 6 of validation.
Key points. There are six levels of validation in DBT, the highest of which is referred to as radical genuineness. Radical genuineness involves the therapist as human and an equal. It involves engaging in an authentic manner not taking themselves too seriously or ignoring the obvious.
More DBT In Practice: Mastering the Essentials presentations
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- DBT Emotion Regulation Skills: Emotion Psychoeducation & Mindfulness
- History of DBT: Origins and Foundations
- Mindfulness Skills in DBT: The 3 States of Mind
- Observing Limits, Liability, and Other Concerns in DBT Intersession Contact
- Roleplay: Assessing Life Worth Living
- TIBs of the Therapist: Balancing Change and Acceptance
- Using Validation in Therapy
- Validation in DBT: Basics and Purpose
- Dialectics in DBT: Balancing Acceptance and Change
- The Biosocial Model in DBT: Emotion Dysregulation and Invalidating Environments
- The Structure of Standard DBT: The 4 Skill Modules
- The 4 Stages and Targets of DBT Treatment
- DBT Assumptions About Patients, Therapists, and Treatment
- Stage Targets and Goals in DBT: Creating a Life Worth Living
- DBT Skills Group: Rules and Resources
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- The Role of the Individual DBT Therapist
- Intersession Contact and Telephone Coaching in DBT
- Telephone Coaching in DBT: Applying Skills to Prevent Full-Blown Crisis
- The DBT Hierarchy: Prioritizing Treatment Targets