Courageous conversations about Therapy Interfering Behaviors

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In Dialectical Behavior Therapy, we use the construct of Therapy Interfering Behaviors (TIBs) to discuss issues that get in the way of us providing, or the client receiving, expert DBT treatment. Identifying TIBs is one thing; addressing them is another.
How do you define a Therapy Interfering Behavior? How do you conceptualize it? How do you phrase it in conversation? When do you talk about it? Where do you start? Here are some recommendations

  1. Do some prep work. This is not a conversation to take lightly, and requires some thinking through before executing.

a. Clarify the issue in your mind: What exactly is the problem you want to discuss with your patient? Make it behavioral and objective.

b. Find a compassionate way to understand the behavior. Is this an example of trying to get one’s needs met? Has she been reinforced for this in the past? In DBT we call this phenomenological empathy. Thinking of the behavior in this way can help us to find more understanding and care.

c. Practice stating it in a non-judgmental way. Most of us have negative emotions when we feel judged.

2. Consider timing. Is this a good time to bring up this issue? It is not likely a good time if the behavior is happening in the moment and you haven’t already discussed it.

If you tend toward avoidance, you might want to do it now (no time like the present). If you are a little on the impulsive side, you might want to move more deliberately and consider if there would be a better time to have this discussion.

3. Get Confirmation. Using observe-and-describe skills, share the behavior and why you see it as problematic. This is important: Confirm that the patient understands the problem you defined. Say, “Tell me back what you are hearing me say.” Listen to make certain that the individual is hearing the message you intended to deliver. I find this step to be crucial.

4. Ask for collaboration. Don’t assume the patient wants to change the behavior you find a problem. If willing, collaboratively develop a plan to address the issue .

The notion of addressing difficult behaviors is important to all relationships, not just to therapeutic ones. I use these strategies with my loved ones as well – when a relative makes a comment about my parenting, or my son has left his wet shower towel on the bed (again!). Go forth and have courageous conversations!


About the Author:

Dr. Lucene Wisniewski is an internationally recognized leader in eating disorder treatment and Dialectical Behavior Therapy, with more than 25 years of clinical and training experience. She may be reached for consultation through the "contact" page on this website.