DBT Interpersonal Effectiveness skills help individuals improve their relationships with others and assert their own needs effectively. The following are some of the key DBT skills for interpersonal effectiveness:
DEAR MAN: This stands for Describe, Express, Assert, Reinforce, Mindful, Appear Confident, and Negotiate. It involves using clear and assertive language to express your needs, while maintaining respect for others and avoiding aggressive or passive behavior.
FAST: This stands for Fair, Apology, Stick to values, and Truthful. It involves balancing your own needs with the needs of others and finding a mutually acceptable solution to conflicts.
GIVE: This stands for Gentle, Interested, Validate, and Easy manner. It involves being empathetic, non-judgmental, and respectful towards others, and expressing genuine interest in their thoughts and feelings.
Building and Maintaining Relationships: This involves developing and maintaining positive relationships, setting boundaries, and avoiding behaviors that can damage relationships.
Empathy: This involves understanding and connecting with others by imagining what they may be feeling and experiencing.
Self-respect: This involves taking care of one’s own needs and maintaining a positive self-image, while avoiding behaviors that can damage self-esteem.
Conflict Resolution: This involves finding mutually acceptable solutions to conflicts, using active listening, empathy, and effective communication.
The goal is that with practice, and over time, you can integrate these skills into your daily life and use them to improve your relationships, communicate effectively, and assert your needs in real-world situations.
Now we will apply these principles to a hypothetical hospital setting that will be more relevant and specific for resident physicians:
As healthcare providers, we interact with a diverse group of people, from patients and their families to fellow physicians, nurses, and staff. And, in a high-stakes environment like a hospital, it can be challenging to communicate and collaborate effectively with others.
DEAR MAN Skills
That’s why we’d like to share some tips and techniques that you can use to improve your interpersonal effectiveness at work. First, let’s talk about the DEAR MAN skills. DEAR MAN stands for Describe, Express, Assert, Reinforce, Mindful, Appear Confident, and Negotiate. These skills can help you express your needs and opinions clearly and assertively, while also maintaining respect for others and avoiding aggressive or passive behavior.
Let’s use a discrete example. Imagine that you are a senior resident and need to ask your junior resident to remember to update the patient list at the end of the work day. We will assume for this hypothetical situation that updating the list daily is a clear, defined responsibility of this junior resident, and it hasn’t been getting done.
Describe: use clear and concrete terms to describe what you want. The description should be simple. State only facts in your description. You’re not expressing your feelings or emotions about it, just setting up the conversation using facts.
“Let’s touch base about the list – it needs to be updated every day before we head out.”
Express: express how you’re feeling using “I” statements. The purpose of this is to take accountability and prevent the other person from going into a defensive mode.
“I noticed that it hasn’t been updated the past few days.”
Assert: either ask for your need or firmly say no (depending on the appropriateness of the situation). Simply ask what you want in a clear and respectful manner. You should not be “beating around the bush.” People are not mind readers! This is particularly important for people in positions of relative power (e.g. senior residents, attendings) to remember.
“I would like you to confirm that the list is updated each afternoon.”
Reinforce: make sure that the other person knows why they should grant your request – relationships are built on reciprocity.
“I appreciate your help with this. If you have any questions or concerns about it, please let me know.”
Mindful: stay mindful! Stay in the pocket of the argument or request.
This is not about getting notes done on time, or clinic coverage – it’s a straightforward request about coverage of a daily task for the team.
Appear Confident: present yourself in a confident and respectful manner. Maintaining good posture and eye contact, as well as speaking loudly and clearly without mumbling, are helpful for this.
Negotiate: remember that you’re requesting something, not demanding it. If the junior resident isn’t on board, they may either not understand how to do the task or have concerns about being able to do it correctly/on time. This is why keeping open lines of communication is critical – the other person needs to feel like they can express any of their concerns or confusion back to you. Have a conversation and make sure any issues are resolved together. Getting “buy in” from the other person can often make a team work much more effectively.
Next, we have the FAST skills. FAST stands for Fair, Apology, Stick to values, and Truthful. These skills can help you balance your own needs with the needs of others and resolve conflicts in a constructive way. They also promote, importantly, self respect.
Let’s imagine a scenario where FAST skills can be applied. Imagine that you’re a junior resident and a senior resident approaches you about joining a research study that they’re working on. You have already had a publication this year and are working on a few other projects at the time of this proposition. Imagine that you do not have time or energy to take on additional projects right now.
Fair is about being fair to ourselves and others. It’s about being direct and honest, and treating others how we would like to be treated. You can be fair and honest by responding, “Thank you for the invitation – I already have a few projects I’m working on and would not be able to join this study.”
The A stands for Apologies. Do not apologize unnecessarily! We all do this very commonly and it’s an unhelpful practice. Apologizing for mistakes that are not our own (or apologizing for things that are not mistakes) can reflect unnecessary guilt. You do not need to apologize for being at a point in your career where an additional research study does not make sense for you.
The S in FAST stands for Sticking to your Values. It’s critical that all of us as individuals have a set of values that we stick to. It’s equally critical to know which of your values are negotiable and which of them are non-negotiable. Say that in this situation you value your time and energy as a resident. You value that you have very limited personal or research/academic time and are mindful about putting that towards good use. Certainly during residency training, there is very limited personal or research time. By sticking to your values here, you are protecting your time.
Finally, the T stands for Truthful. One way to be truthful is to avoid exaggerating, making excuses, or lying. You take ownership of your values and your decisions and express them in a confident manner.
We have one last acronym to review for now, and apply to the resident workplace: GIVE. This is helpful for establishing and keeping relationships, regardless of the nature. As residents we have to navigate many complex relationships within a hierarchical hospital structure, including those with coresidents, staff, attendings, and students.
The G in GIVE stands for Gentle. The principle behind this is to be considerate and gentle in your interactions with others. People are much more likely to respond positively to gentleness than harshness! Think of how you would prefer to be approached. You can exemplify this by being mindful of your tone, mannerisms, and language when making a request of a teammate or coworker.
I stands for acting Interested. This calls back to a lot of the core mindfulness skills, and reminds us to stay in the present moment or conversation. Paying attention to the person (even in a fast-paced environment, where our phones, pagers, emails and EMR charts are pulling us in many different directions) goes a long way. And we can show that we are paying attention by maintaining eye contact when possible and allowing people to finish their thoughts (time permitting, and of course if there isn’t a medical emergency going on) without interruption.
The V stands for Validate: acknowledge what the other person is saying. Be nonjudgmental out loud. Examples of validating statements are “I can see that this is very important to you.” Validating others is an under-appreciated skill in the workplace and an easy, doable way to strengthen your relationships with others. Even when you’re a senior resident and the junior residents are voicing their annoyances with junior call, for instance, validation of their experience goes a long way because it feels good to be heard and understood. Just because you survived it, doesn’t mean that their experiences are invalid.
E stands for Easy Manner. A smile or a little humor can go a long way. This helps set the tone for a calm environment and can reduce tension in a stressful work environment. Approaching people with a light-hearted and soft attitude can be much more effective than a hostile or hardened tone.
Putting DBT Interpersonal Effectiveness Skills Into Practice
By using these interpersonal effectiveness skills, you can improve your communication and collaboration with others, resolve conflicts in a constructive way, and enhance your job satisfaction. And, most importantly, you will be promoting your own health and well-being, and can therefore provide better care for your patients.
Emotion regulation is another key aspect of DBT. It involves learning to identify and change negative patterns of thinking, managing emotions, and reducing intense emotions. This can be done through techniques such as positive self-talk, identifying and challenging negative self-talk and beliefs, and using “opposite action”.
Distress tolerance is a module in Dialectical Behavioral Therapy (DBT) that teaches several skills that may prove valuable during residency training. The skills are sometimes referred to as “crisis survival skills” because they can help you navigate perceived or actual crises.
DBT Interpersonal Effectiveness skills help individuals improve their relationships with others and assert their own needs effectively. The goal is that with practice, and over time, you can integrate these skills into your daily life and use them to improve your relationships, communicate effectively, and assert your needs in real-world situations.