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How Dialectical Behavior Therapy 'Skills Coaching' Helps Me Learn to Accept Help

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Editor's Note

Any medical information included is based on a personal experience. For questions or concerns regarding health, please consult a doctor or medical professional.

If you struggle with self-harm or experience suicidal thoughts, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741741. For a list of ways to cope with self-harm urges, visit this resource.

If you or a loved one is affected by addiction, the following post could be triggering. You can contact SAMHSA’s hotline at 1-800-662-4357.

I have been in many forms of treatment, on and off, over the last decade. Dialectical behavior therapy (DBT) is the only therapy I am aware of that offers the unique component referred to as “skills coaching.” To my surprise, “skills coaching” is a missing ingredient in my recovery, one I wish I had access to years before I knew what DBT was or I even had a diagnosis. Coaching would have helped me prevent suicide attempts, impulsive actions, and self-harm. Coaching would have also helped me to not make a bad situation worse and could have empowered me to create a focused plan to skillfully manage many hard days. While I cannot go back, I can share part of my story and encourage others to consider DBT skills coaching as part of their recovery plan — especially if they’ve already discussed it with a professional.

In dialectical behavior therapy — a common treatment for borderline personality disorder (BPD) — there are usually three components: a skills group, one-on-one psychotherapy, and skills coaching. Depending on where you are located, you may just be able to receive a skills group. Other DBT options include one-on-one psychotherapy only or access to all three parts of DBT. A few months ago, I went back to DBT, which for me includes bi-weekly one-on-one therapy, and more recently, using skills coaching as needed. I also take a psychoeducational DBT class online.

Coaching is unique to DBT. It is not therapy, and it is not a crisis line. It is not access to a soothing voice when you experience feelings of emptiness either. DBT skills coaching is caring, but it is also very practical, clear, and intentional on the part of both the client and therapist. For example, when I call, I am asked “What skills have you already tried?” I am accountable to having first tried my best to be skillful before placing the call.

From my understanding, the purpose of skills coaching in Dialectical Behavior Therapy is to help the client act skillfully in the moment, generalize DBT skills to where they are needed most, and prevent self-harm and other destructive behaviors. Skills coaching creates an opportunity for the client to use skills when they are most needed in order to prevent a negative outcome.

As a DBT client, I have grown to view skills coaching not as a defeat but instead as empowering. No one is forcing me to call. It is my choice — I am choosing to reach out. I have tried skills on my own, and I am accepting help, which is a sign of strength and hope.

Skills coaching involves being clear about my goals, for example: not quit a job or refrain from drinking or self-harm when experiencing intense emotions and harmful urges. Coaching also focuses on what I will do instead — what is possible today, right now, to stay safe and cope effectively with hard experiences. In skills coaching, we focus on what I can do.

Making that call is tough. It means acknowledging that I cannot figure out how to manage alone anymore. However, by calling, I am also following through on my commitment to being skillful and staying alive. For me, this shift to seeing coaching as empowering is about letting go of my need to do it “all by myself” when that could lead to further problems. Sometimes I can manage alone, and that is OK, and sometimes I cannot manage alone, and I need skillful support. In those moments, I need DBT coaching, and that is OK too.

DBT skills coaching can happen anywhere. For example, I recently had coaching in my car while parked in a parking lot! In coaching, we come up with a plan that I can agree to follow through after the call. The plan uses DBT skills I have learned. This doesn’t mean solving all my problems and feeling great, but it does involve me feeling “better” than when I first made the call, and I leave the call with confidence that I can accept my feelings and change what is possible for the day. This has been my recent experience with coaching.

It is hard for me to ask for help. It feels challenging for me because I believe sometimes that I always “should be” thriving and “happy” after so much therapy and hard work. When this thought emerges, I remind myself that recovery is a journey, not a “target.” In my view, recovery is not something we achieve. Recovery is how I live and make meaning. Part of recovery is validating what I need, having awareness of my personal limits, and knowing the value of asking for support.

I am grateful that DBT includes skills coaching. It makes sense — life doesn’t stop happening when a session is over or a group ends.

Calling for DBT skills coaching is not defeat — it’s a chance. Making the call is a chance to act compassionately towards myself by taking steps to improve the struggle I feel now and make choices I won’t regret later. Asking for what I need to get through a crisis is about not giving up on myself. I deserve to have hope and ask for help, and so do you.

Image by Brian Wangenheim on Unsplash.

Originally published: February 1, 2022
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