How do you give negative feedback, or confront maladaptive behavior, without hurting or alienating the client?

By Sheri Van Dijk, MSW

Clients come to therapy because they require objective feedback that others are unable to give them (or that they are unable to accept from others). The very nature of our work is confronting maladaptive behaviors, but we need to do so in ways that are acceptable to the client, even when the feedback we must provide is painful.

The tool that I have found most helpful in this respect is validation. One of the core ideas in dialectical behavior therapy is that we have to balance acceptance with change. In other words, we teach clients that they need to accept themselves as they are, and at the same time continue to work toward changing. For example, in my work with a client with borderline personality disorder who has intense abandonment issues, I regularly validate her fears of being abandoned, and I balance this with a reminder that these fears are no longer helpful, and actually push people away from her: “It makes sense that you would feel this way, because you didn’t receive protection and support from your family when you were growing up. At the same time, you’re now an adult and you’re not in that situation anymore. As you work on using skills to help you tolerate the anxiety, it will gradually lessen.”

All clients need validation, some more than others. When you can convey the message that you understand, that their behavior, feelings, or thoughts make sense even though those patterns are no longer helpful, most clients will be open to your feedback and to working on changing their problem behaviors.

Sheri Van Dijk, MSW, is a psychotherapist in private practice and at Southlake Regional Health Centre in Newmarket, ON, Canada. She is author of The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder, Don't Let Your Emotions Run Your Life for Teens, Calming the Emotional Storm, DBT Made Simple, and the recently published Relationship Skills 101 for Teens, as well as coauthor of The Bipolar Workbook for Teens. In September 2010, she received the R.O. Jones Award from the Canadian Psychiatric Association for her research on using dialectical behavior therapy (DBT) skills to treat bipolar disorder. Sheri presents internationally on using DBT to treat mental health problems.