DBT Consult Agreements
E Ulland, MD
One of the important parts of dialectal behavioral therapy is that the treatment meets in consultation team. This team is where staff meet to review issues they may be having at providing treatment or staying within the model. The group helps to improve our abilities. In order to improve the success of such meetings, there are several agreements that are agreed upon. The following is a list of these agreements. Emotionally reactive individuals are highly sensitive to health of communication, making the agreements below necessary for recovery. In addition to utility for treatment providers, they help with healthy communication and more connection in relationships.
Dialectical Agreement:
We agree to accept dialectical philosophy. Examples of dialectical philosophy are that everything is connected, change is the only constant, everything has it’s opposite, etc. When we notice conflicting opinions, we agree to look for the truth in both positions and a search for synthesis by asking ourselves questions like, "What is being left out?" We will seek kernels of truth in each position. There are valid pieces in each position and we can bring those pieces together. There is no absolute truth. We will work to be less "black or white" but more "black and white”—like a checkerboard and not a grey world.
Consultation to Our Child Agreement:
We will not serve as a go-between clients and others. This means that each of us will resolve conflicts between our self and others directly. We agree to treat others with the belief that others can speak on their own behalf. This is our stance against triangulation of communication. We agree that we will not treat each other as fragile.
Consistency Agreement:
We agree to accept diversity and change as necessary when challenges are present in life and families. Therefore, we do not have to agree with each other's positions about how to respond to change in relationships. We don't have to tailor our behavior to be consistent with everyone else's behavior. There is no single right way to respond. However, there are some guiding principles of validation, connection, and accountability.
Observing Limits Agreement:
We agree to observe our own limits. We agree not to judge others for having different limits from our own. We will not judge others’ limits as being too broad, or too narrow, while believing ours are "just right." We also set limits for ourselves, while expressing our own emotions, needs, wants or desires. When not a safety concern, and when possible, we do not set limits for others because we think it is "in their best interest."
Phenomenological* Empathy Agreement:
Whenever possible we agree to search for non-pejorative and phenomenological, empathic interpretations of our own and other’s behaviors. We strive to see the world through other’s eyes as well as our own. We practice a nonjudgmental stance with others as much as possible. We agree to assume that all are doing their best in each moment and want to improve. We will be willing to give the benefit of the doubt and be generous in our assumptions should they occur.
Stretch Limits Agreement:
We agree to continue to stretch our limits as a response to uncertainty. We will attempt to hold less tightly our need for control. We will work to accept the truth that uncertainty will always be part of life.
Fallibility Agreement:
We agree that we are each flawed and make mistakes. We agree that we have probably done, at least in some small part, whatever problematic thing to which we are being asked to be accountable. This is how we let go of assuming a defensive stance to prove our own point of view so we can appear competent. Because we are fallible, we agree that we will inevitably violate all of these agreements, and through feedback, others can point out this polarity in points of view. Together we will move towards a dialectical synthesis. This also means that we will continue to accept feedback without arguing or becoming stuck in shame. We will learn best by having “skin in the game” and receiving feedback in the moment. This works best if we are accepting of feedback, and know we are doing our best and can do better.
Effort Agreement:
We agree a primary goal is to improve the use of skills. We will practice dialectical behavioral therapy skills and provide positive reinforcement for the efforts of others being skillful. We agree to invest in our ability to accept feedback, knowing it is difficult and for the benefit of our relationships. We agree to become even healthier than before in how we communicate and become more accountable to our own emotions and effects on others.
Phenomenology refers to a philosophical style of thought that is an open and continually re-evaluated experience that may offer different results, depending on each individual. It is a study of how another mind perceives. The first principle is valuing the thoughts, emotions and perceptions of an individual in one moment. Secondly, it believes that analyzing an individual’s current behavior can provide a greater understanding of nature. Through these first two principles giving inherent value to internal states of others, individual human experience must be explored. Through this we understand how people reflect the environments within which they interact. The fourth principle is that one seeks to understand conscious experience and value it more than traditional data about reality. Finally, the philosophy is oriented toward discovery, allowing for more flexibility in gathering information. It is based on inductive reasoning and uses intuition to generate multiple possibilities that may be equally valid to another’s experience. In essence, “What else could be going on?” “What is being left out?”