Using DBT to Cope with Caregiver Stress: Relationships

Living with Parkinson's disease, mental health challenges associated with PD and/or being a care partner can involve dealing with challenging relationships during periods of ongoing stress or crisis. How often, during medical appointments, have you wished you had the language or skills to speak up to the doctor you felt was not understanding your questions or overall concern? Have there been moments with your loved ones when you've wished to set a gentle but firm boundary and have struggled? Perhaps you're feeling overwhelmed with a friend who is trying to be helpful but consistently demonstrating a lack of compassion and understanding.

Dialectical Behavior Therapy, or DBT, can help individuals build skills in interpersonal relationships. As noted in a previous article, DBT has been taught to and used with care partners of individuals with dementia.¹ When working with clients in my private practice, I've found it's common sense strategies to be useful in helping individuals build skills, including assertiveness, in relationships.

In building interpersonal effectiveness skills, it can first be beneficial to learn what factors may interfere with relationships. Commonly, there are six areas of challenge:²  

1. Not having the skills to get what you need.
2. Having the skills but emotions interfering.
3. Being unable to keep in mind your long terms goals and considering only short-term rewards.
4. The environment, including other people getting in your way.
5. Negative beliefs and thoughts that you don't deserve to get what you want or worries about negative consequences of getting what you want.

Can you relate to any of these challenges? Most of us can. Perhaps you are desiring to ask your doctor about one of the newer treatments you heard about for PD in your support group but are worried your doctor may not hear you out? Another challenge may be avoiding talking with your loved one because every time you attempt to bring a topic of importance up you start to become very tearful and forget what you want to say.

Relationships can be tricky, especially when dealing with the overall stress of PD. Thankfully, there are multiple skills in the Interpersonal Effectiveness segment of DBT that care be of use. The one we will highlight here is designed to help improve effectiveness in getting what you want and can be useful for improving assertiveness. It goes by the acronym: DEAR MAN.²

1. Describe: By sticking solely to the facts, tell the person what you are responding to.
2. Express: Go over your feelings about how you feel so the other person can understand your emotional reaction using phrases such as "I want" versus "I should".
3. Assert: Clearly say no or ask what you want by not automatically assuming that the other person knows what you're thinking.
4. Reinforce: Tell the person, or reinforce, what the positive impact of what you need would bring to them.
5. Mindful: Make sure you keep the focus on your goals, be a broken record if necessary.
6. Appear confident: Stand tall, let your voice be strong and don't retreat.
7. Negotiate: Consider what you may be willing to give in order to get what you want.

This skill can be quite effective especially when practiced first in a low-stress environment and then moved into a more serious one. Practicing DEAR MAN can be done at the grocery store, out shopping, during a medical appointment, or in a conversation with your loved one.

How do you typically handle challenges that come up in relationships? Can you imagine any relationship issue that may benefit from using a skill such as DEAR MAN?