The ACCEPTANCE Paradigm: based in mindfulness utilizes validation strategies.
Linehan (2015) defines VALIDATION as a communication to the person that their responses MAKE SENSE and are understandable given their current life context or situation. This is an important component of DBT when many clients have been frequently invalidated in previous experiences.
Validation is not necessarily agreement, approval, or condoning behavior but is a stubborn refusal to treat a person like they are bad, crazy, or wrong no matter how they are behaving (Vaughn, 2021).
The purpose of validating the client is to (1) balance all the change strategies DBT utilizes, which may be overwhelming at times, (2) model validation so the client can self-validate, (3) develop and maintain the relationship, and (4) help the client de-escalate, label, and regulate emotions (Vaughn, 2021).
Remember —what is validating to one client may not be validating to another. client
The CHANGE Paradigm: based in behaviorism, utilizes problem-solving strategies.
DBT is a therapy driven by the pursuit of outcomes. Essentially, you have to “change behavior, to change behavior” (Swenson & Linehan, 2016, p. 54). These behavioral outcomes or goals are subdivided into specific behavioral targets to be accomplished sequentially. The change protocol begins with a behavioral chain analysis. Both the therapist and client scan for relevant behavior patterns amongst the links in the chain and make hypotheses to explain the patterns (Swenson & Linehan).
A range of possible solutions are then shared utilizing four categories of change procedures: skills training procedures (e.g., for skills deficits), cognitive modification procedures (e.g., for problematic cognitions), contingency procedures (e.g., when maladaptive behaviors have been inadvertently reinforced), and stimulus control and exposure procedures (e.g., for addressing automatic and disruptive emotions (Swenson & Linehan, 2016).
The DIALECTIC Paradigm: utilizes dialectical strategies.
Fundamental to DBT is the opposition of acceptance and change (i.e., dialectics). Starting with an attitude of acceptance, the therapist pushes for a client’s behavioral change based on target outcomes, although inevitably running into a wall (Swenson & Linehan, 2016).
The therapist and client bounce back (e.g., assess the situation), then move forward with a different strategy or a somewhat adapted strategy. However, at some point the push for change may not be working and thus, it becomes necessary to shift into acceptance mode, utilizing a validation strategy and reciprocal tone (i.e., letting go of change and offering acceptance) (Swenson & Linehan, 2016).
Subsequently, the patient feels better understood and the therapist shifts back to change strategies. These shifts between acceptance and change may occur rapidly until just the right dialectical synthesis occurs (Swenson, 2016).