How can you build trust with clients when integrating MI and dialectical behavior therapy?

1 What is MI and DBT?

MI is a collaborative and client-centered style of communication that aims to elicit and strengthen the client's own motivation and commitment to change. MI is based on four principles: expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. DBT is a comprehensive and structured form of cognitive-behavioral therapy that targets emotion dysregulation, interpersonal difficulties, impulsivity, and suicidal or self-harm behaviors. DBT consists of four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

4 How to use MI skills in DBT?

Another challenge of integrating MI and DBT is using MI skills in a way that is consistent and compatible with DBT. MI skills include open-ended questions, affirmations, reflections, and summaries, which can help you build rapport, elicit the client's perspective, and reinforce their strengths and values. However, you also need to be mindful of how to use MI skills in DBT, to avoid undermining the structure, focus, and effectiveness of the intervention. For example, you may use open-ended questions to explore the client's goals, values, and preferences, but not to invite the client to question or debate the rationale or validity of DBT. You may use affirmations to validate the client's efforts, feelings, and achievements, but not to praise or reward the client for behaviors that are inconsistent or incompatible with DBT. You may use reflections to demonstrate understanding, empathy, and interest, but not to repeat or reinforce the client's statements that are inaccurate, distorted, or unhelpful. You may use summaries to review and highlight the main points, themes, or agreements, but not to ignore or minimize the gaps, discrepancies, or challenges.

5 How to use DBT strategies in MI?

The third challenge of integrating MI and DBT is using DBT strategies in a way that is consistent and compatible with MI. DBT strategies include behavioral analysis, skills training, contingency management, and dialectical strategies, which can help you identify, target, and modify the client's problematic behaviors, emotions, and thoughts. However, you also need to be mindful of how to use DBT strategies in MI, to avoid compromising the spirit, principles, and effectiveness of the approach. For example, you may use behavioral analysis to help the client understand the antecedents, consequences, and functions of their behaviors, but not to impose your own interpretation or judgment on the client. You may use skills training to help the client learn and practice new ways of coping, but not to prescribe or dictate what the client should or should not do. You may use contingency management to help the client shape and reinforce their desired behaviors, but not to coerce or manipulate the client into compliance. You may use dialectical strategies to help the client balance and integrate opposing or contradictory perspectives, but not to argue or debate with the client.

6 How to build trust with clients when integrating MI and DBT?

The ultimate goal of integrating MI and DBT is to build trust with clients, so that they can feel understood, supported, and empowered to change. To achieve this, you must be flexible, respectful, and responsive to the client's needs, preferences, and feedback. For instance, explain the rationale and benefits of integrating MI and DBT to the client and obtain their consent. Additionally, assess the client's stage of change and tailor your approach accordingly. Use MI skills to establish rapport with the client and elicit their motivation, while using DBT strategies to provide structure, guidance, and feedback. Validate the client's emotions, experiences, and perspectives while also acknowledging the challenges of change. Monitor any ambivalence or resistance they may have towards change and explore potential solutions. It is also essential to be transparent, honest, and consistent with your commitments, as well as seek supervision, consultation, and training to enhance your own competence in integrating MI and DBT.

7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?