05/01/2015

Skill Use on the Job: Dialectical Behavioral Therapy Skills and Career Counseling

Jenny Bell Martin and Debbie Corso De Marco

Dialectical Behavior Therapy (DBT), developed by Marsha Linehan (1993), was originally created to specifically treat those with borderline personality disorder in a clinical setting. However, it also has far reaching applications, including in career counseling with clients experiencing a variety of issues and diagnoses that include episodes of emotion dysregulation. Dialectics is the idea of holding two opposing views simultaneously. For example, a client both accepts that they are doing the best they can, while at the same time accepting that they can do better. The DBT model includes validating where an individual is while working towards cognitive behavioral changes. DBT Skills were created as easily accessible coping techniques that individuals can use in the moment and for future planning.

Unplanned Happenstance
The integration of career counseling and DBT occurred by happenstance. When first introduced to our residential treatment program, we all questioned the possibility of its use in the Career and Volunteer Department. A participant was becoming dysregulated in the office, so a career counselor implemented a breathing technique learned recently at a mindfulness training. The outcome was positive. This became a catalyst for the integration of specific DBT skills-training within the department. All career counselors began attending DBT trainings and skills groups to gain a better understanding of the application and started with basic skills coaching to get them more comfortable with using the skills. The DBT skills are concrete, direct, and effective which blends seamlessly into the work done in the department. 

Drawing from the four modules of DBT: Mindfulness, Interpersonal Effectiveness, Distress Tolerance, and Emotion Regulation, participants in our programs are equipped with skillful options for responding to stressful work-related areas, including application completion, mock interviewing, interviewing, and on-the-job issues. The process starts with exercises in career counseling sessions, where clients learn to initiate a mindful pause when anxiety increases, or when they work through a pros and cons list during moments of emotional distress. These skills have truly transformed the way we work with our clients.

Clinical Example
A young male, diagnosed Asperger’s syndrome, depression, and anxiety, entered our program for “failure-to-launch” issues. These included difficulty at his part-time, remote data entry job. Various obstacles impeded his movement on the project, and despite specific structure that his parents were imposing on him daily, he wasn’t making progress. While their intention was to be attentive, part of their strategy was to hover, essentially micro-managing his activities; he did not respond well to this approach.

The staff integrated skills-coaching as part of his scheduled work time in the office. Structured work times were set up at our program to mirror his parents’ schedule. He made his own choices regarding the utilization of his scheduled time, and we observed that every so often he would stop working and rest his head on the desk or just completely zone out. Our staff did not comment about his behaviors during this time, and after a few appointments, he started to open up about what he was feeling and going through. Mindful observation of this young man, in the absence of judgment and assumptions, led to creating a space in which he felt safe to work on his issues. DBT skills not only benefited the client, but also empowered staff members to skillfully approach clients in a very individualized way.

Skills Coaching Integration
Here are a few examples of how skills coaching was integrated into our work with this client:

• When he was having trouble with concentration and racing thoughts, he was guided through meditations and mindfulness activities.
• When he was having self-deprecating thoughts, skills such as pros and cons, cheerleading, and checking the facts were utilized.
• One of his passions is music, so he was encouraged to pick the background music, which allowed him to self-soothe through sound, effectively reducing his anxiety.
• He had trouble asking for things, so he was coached to use Interpersonal Effectiveness Skills such as DEARMAN, FAST, and GIVE. He also created scripts, as needed, to encourage himself to effectively cope ahead. 

Interpersonal Effectiveness Skills

Below are the guidelines for using DEARMAN, FAST, and GIVE, with links to corresponding videos.

Using Objectiveness Effectiveness: (Dear Man)
D Describe
E Express
A Assert
R Reinforce
M Mindful
A Appear Confident
N Negotiate
https://www.youtube.com/watch?v=SYtO64Wyjls

Using Relationship Effectiveness: (Give)
G Gentle
I Interested
V Validate
E Easy Manner

https://www.youtube.com/watch?v=Lh1YA95S9bA

Self-respect effectiveness: (Fast)
F Fair
A Apologies (no Apologies)
S Stick to value
T Truthful
https://www.youtube.com/watch?v=dMmraDP0-7g

At the Optimum Performance Institute, DBT concepts and skills coaching are at the core of our work with young adults facing failure to launch issues and have empowered our Career and Volunteer Department to counsel more skillfully, in the moment, with more effective outcomes.

Reference
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.

Jenny Bell Martin, MS, is the Director of Volunteer and Career Services at the Optimum Performance Institute. Jenny previously worked within the Los Angeles Community College District as a Career Guidance Counseling Assistant in the Job Placement Center, Disabled Student Services, and EOPS office, all which provided a strong foundation for working in treatment. Jenny earned her Master's of Science degree in Counseling and Guidance, College Student Personnel from California Lutheran University, a Multiple Subject Teaching Credential from California State University, Northridge, and a Bachelor’s degree in Liberal Studies from San Diego State University. She can be reached at jbmartin@opiliving.com

Debbie Corso DeMarco, BS, is a mental health blogging pioneer, having chronicled her journey of her diagnosis of Borderline Personality Disorder (BPD), through her treatment and ultimate recovery, publicly at healingfrombpd.com.  She no longer meets the criteria for BPD after learning and integrating Dialectical Behavior Therapy (DBT) skills into her life.  She graduated from New York Institute of Technology with a Bachelor of Science degree in Interpersonal Effectiveness: Behavioral Science, Communication, and English and holds a certification in Early Childhood Development.  In addition to serving as the Director of Media Development and Management at OPI, she founded DBT Path, an online psychoeducational school where she co-facilitates weekly DBT skills classes with a licensed therapist to learners around the globe. Debbie can be reached at ddemarco@opiliving.com