Please note: All handouts are courtesy of Marsha Linehan, in her book “Skills Training Manual for the Treatment of Borderline Personality Disorder”. She retains the copyright.
As I now have a little more time on my hands I am resurrecting my review of the book “Skills Training Manual for treating Borderline Personality Disorder” by Marsha Linehan.
This blog post is a discussion on chapter 8, on interpersonal effectiveness (an area I struggle most with!). It will be broken down into several parts, as you will see.
Interpersonal effectiveness skills can be described as not being a standalone module, rather that they also stretch over the other modules of DBT (Core mindfulness, emotional regulation and distress tolerance). A lot of borderlines do have good interpersonal skills, they just have trouble working out how to apply them, and DBT helps with this. Interpersonal effectiveness helps the borderline to be effective in getting what they want, to say “no” to things they don’t want and to improve and maintain all types of relationships. They give the borderline the ability to approach interactions with others in a thoughtful and rational manner, allowing them to maintain and improve relationships with others which may otherwise be damaged by behaviour driven by strong emotions or lack of interpersonal skills. I am a strong believer that those with BPD are born without the necessary interpersonal effectiveness skills to see them through life safely, sometimes compounded by being provided with parenting which does not help the problem. However, there are also several factors than can reduce interpersonal effectiveness. These are:
1) Lack of skill (Self explanatory, and I believe this is my biggest problem). You simply don’t know how to interact with others to get what you need/get your point across. As I result I ended up either flirting/coming on to people (led to into several very awkward and difficult situations) or appearing rude or strange.
2) Worry thoughts (such as bad consequences to the interaction, like “she won’t like me, she won’t want to speak to me any longer”, worries about whether you deserve the outcome you want “I don’t deserve it because I am a bad person”, worries due to self doubt such as “I can’t do it” or “I’ll do it wrong”)
3) Emotions (Overwhelming emotions such as anxiety, sadness or anger controlling your actions rather than skill). This can sometimes be the result of conditioning/previous trauma.
4) Indecision (You are ambivalent about what you want, which can sometimes be caused by the feelings of helplessness or indifference, a symptom of borderline itself)
5) Environment (This is where you have the skills, but they simply won’t work. For example, other people have their own issues or agenda)
The four main areas where interpersonal effectiveness skills can be applied are:
1) Attending to relationships (not letting problems build up, using learnt skills to negotiate through problems, ending relationships that are harmful or unhealthy and resolving conflicts, maintaining relationships in all areas of life)
2) Balancing Priorities and demands (Prioritising demands on your time and attention to make sure high priorities tasks are completed, without allowing oneself to become overwhelmed, asking for help, saying no if necessary, seeking out activity and responsibility if needed).
3) Balancing the wants-to-shoulds (learn to get a balance of the things you “want” to do and the things you “should” do, learn to delegate, learn to say no
4) Building mastery and self respect (learn to become confident and articulate particularly when interacting with others, stand up for yourself and your principles, use wise mind, maintaining your self respect and self esteem whilst sticking to your principles and beliefs)
There are three main goals of interpersonal effectiveness during an interpersonal exchange:
1) OBJECTIVES EFFECTIVENESS (Getting your objectives or goals in a situation)
- Obtaining your rights
- Getting others to do as you request
- Refusing requests from others
- Resolving interpersonal conflicts
- Getting your point of view taken seriously
Questions to ask: What result to do I want to get from this interaction? What do I have to do to get that result?
Note: Even the most skilled person may not always obtain their objective, so it is important to also have distress tolerance – radical acceptance skills in place if you fail and begin to feel shame or hopelessness.
2) RELATIONSHIP EFFECTIVENESS (Getting or keeping a good relationship)
- Behaving in a way that encourages others to like and respect you
- Balancing immediate goals with long term relationships
Questions to ask: How do I want the other person to feel about me after this interaction? What do I need to do to maintain this relationship?
Note: One of the traits of the borderline is to do whatever they can to maintain a relationship, at whatever cost. It is important to note that when you sacrifice your own wants and needs to maintain a relationship, it doesn’t work – it always causes problems at some point further down the line, normally a “blow up” of undesirable behaviours, thoughts or feelings.
3) SELF-RESPECT EFFECTIVENESS (Keeping or improving self respect and self esteem)
- Respecting your own values and beliefs and reflecting them in your behaviour
- Behaving in a way that makes you feel confident, respected and effective
Questions to ask: How do I want to feel about myself after the interaction? How do I have to behave to feel that way?
Notes: All three types of effectiveness need to be considered during each interaction, although the priority or importance of each will vary depending on the situation.
There are several myths about interpersonal effectiveness. There are two ways to deal with myths: counteract them logically, and try them out in the real world. I have attached the handout that you can save and then fill in yourself below.
Here are my answers, using the literature from the book to help: (Please note, these are my own answers so you may not agree with them).
1. I can’t stand it if someone gets upset with me.
Challenge: Although it will be awkward and uncomfortable if someone is upset with me, we will both be fine eventually.
2. If they say no, it will kill me.
Challenge: Someone saying no will not kill me. It might be difficult for me to accept, but that is their prerogative and life will continue.
3. I don’t deserve to get what I want and need.
Challenge: I am a good person and have just as much as anyone else to get what I want and need.
4. If I make a request, it will show that I am a very weak person.
Challenge: Everyone needs help at some point and asking for help is not a reflection on how weak or strong I am.
5. I must be really inadequate if I can’t fix this myself
Challenge: See challenge #4!
6. I have to know whether a person is going to say yes before I make a request.
Challenge: People can make their own decisions, and if you don’t ask you don’t get.
7. Making requests is really pushy (bad, self-centred, selfish) thing to do.
Challenge: If you don’t ask, people won’t know what you want.
8. It doesn’t make any difference, I don’t care really.
Challenge: Then why are you thinking about it? It obviously matters, even a little bit.
9. Obviously, the problem is just in my head. If I would just think differently I wouldn’t have to bother everyone else.
Challenge: Teamwork is key. Sometimes you need the advice of other people to help you think differently, and that is not necessarily a bad thing.
10. This is a catastrophe (is really bad, is terrible, is driving me crazy, will destroy me, is a disaster)
Challenge: This too shall pass and I will be fine.
11. Saying no to a request is always a selfish thing to do.
Challenge: I have my own boundaries and principles and I need to stick to them. I have a right to say no if I so wish.
12. I should be willing to sacrifice my own needs for others.
My needs are just as valid as anyone elses.
Interestingly, there are also statements known as “cheerleading statements” which can help bust the myths that some people hold about interpersonal effectiveness. These are things that you can say to yourself to in effect give yourself permission to ask for things, to say no or to act effectively. There are different types of cheerleading statements:
1) Statements that encourage acting effectively
2) Statements which prepare you to be effective in any given situation
3) Statements that counteract myths
To practice cheerleading statements, you can use “imaginal practice” (imagining a scenario and which statement you would use) or “thinking out loud” practice (talking about the scenario and choosing a statement).
Here are some cheerleading statements you can use, for a variety of situations:
1) It is OK to want or need something from someone else
2) The fact that someone says no does not mean I shouldn’t have asked in the first place.
3) I can insist on my rights and still be a good person.
4) I may want to please people I care about, but I don’t have to please them all the time.
5) I am under no obligation to say yes to people simply because they ask a favour of me
6) The fact I say no to someone does not make me a selfish person.
This handout details quite a few more:
I will continue on the next post with skills relating to interpersonal effectiveness. Watch out for that soon!
Skills training manual for treating borderline personality disorder by Marsha Linehan