#28: Listener Questions
Today Marielle and Ed answer listener questions.
The first question is from a listener in Sweden about how to cope with anger at others for not taking the COVID-19 pandemic seriously.
Question two is about how to use DEAR MAN to say no.
The final question in this episode is about how to figure out when it’s time to leave a situation.
Show Highlights
- What to do when others don’t seem to care about the danger the pandemic poses
- Ask yourself if your emotion fits the facts
- If your emotion does fit the facts, ask yourself if acting on the emotion is effective
- In order to figure out if your emotion is effective, you need to know what your goals are
- Using some Distress Tolerance can be helpful to bring down strong emotions in order to access Wise Mind
- Distraction and self-soothing when emotions run high
- Radical acceptance: we cannot control or change what other people are doing
- Radical acceptance of what others are doing is not approving of it or saying that it is right or safe
- How strongly you say no to something depends on a lot of different factors
- What’s the relationship between you and the person you are saying no to?
- The different levels of saying no: do you say no with intensity or do you say it more lightly?
- Unpacking the interpersonal myth that it’s not ok to say no or have others be disappointed with us
- Use Wise Mind to weigh options when deciding to leave a situation
- Be reflective about all the factors before taking any actions
- Often times, abruptly leaving a situation comes from Emotion Mind
Links & Resources
DBT Skills Training Handouts and Worksheets, Second Edition
Ask us a Question
We’d love to hear from you! Where are you getting stuck with your skills application? Ask us a question for the chance to have it answered on the podcast. Submit your question here.
Please note that questions, and this podcast in general, are not a substitute for individual mental health treatment.
#28: Listener Questions Transcript
Marielle Berg
Hello and welcome to The Skillful Podcast where we explore DBT and RO-DBT skills to help you reduce emotional suffering, improve your relationships, and become more present in your life. I’m your host, Marielle Berg, a psychotherapist at the Bay Area DBT and Couples Counseling Center.
Marielle Berg
Today, Ed and I are going to be answering listener questions. So thanks for sending in your questions, we’ve been collecting them. And we have a random assortment of questions here that we’re going to answer.
Marielle Berg
And just so listeners can know, in case you want to skip ahead. So the first question is from a listener in Sweden, who has some concerns about coping with COVID 19. So we’ll start with that one. And then we have several more questions that cover different topics that have nothing to do with the current pandemic.
Ed Fowler
And I think that I’m, I’m really excited that people have been sending in questions. And it’s kind of fun to be able to answer the specific questions that people have. Like when Marielle and I are recording the podcast, we’re both talking about things that we think about a lot, and that we enjoy talking about. And it’s nice to reflect on. But it’s really nice to have this interaction with people who are actually listening, and to be able to have a little bit more interaction in that way.
Marielle Berg
Yes, and please continue to send in your questions, and rate and review us in iTunes, if you’re finding this helpful, as those reviews and ratings help other folks find the podcast.
Marielle Berg
And before we answer the questions, just our standard disclaimer, the answers that we provide here are for informational and educational purposes only, and are not a substitute for mental health treatment. So please, if you’re struggling, seek out your own mental health treatment.
Marielle Berg
Okay, so our first question is from a, as I said, a listener in Sweden, who writes: “I participated in a DBT group therapy for 10 weeks during the autumn and winter, after having tried to get help coping with life for about 10 years. This was the first time I ever felt like, wow, this is going to work for me in the long run. The book we worked with is now my Bible. We were recommended your podcast and it’s so very helpful for me. It gives me so much information, practical advice, as well as being soothing and calming. I love that you made a series about coping with COVID 19, as it’s affecting me a great deal, both in my profession as a nurse, and in my private life. My biggest issue at the moment is anger towards all the people out there who just don’t seem to care. Those who go about their everyday lives as usual, who seem to think that there needs to go partying, eating out, going to the gym and whatnot is more important than other people’s lives. I walk around with this extreme anger that is just eating me from the inside. And I really don’t know how to cope with it. So far, I’ve only listened to one and a half episode from your coping with COVID-19 series. So I’m not sure if you’ll address this. But you have any advice about how to handle this? Thank you again for a really helpful podcast.” And we’re not going to read names, obviously to protect everyone’s confidentiality. So let’s let’s see if we can tackle this one. Ed?
Ed Fowler
Yeah, I think this was a great question. And I love hearing from people who have participated in DBT individual and group therapy, and really understand the power of what DBT has to offer. And what a big change we can experience when we go through this process and have these skills in our toolkit. And this is a good example of like, even with a full set of skills, things come up that can be really, really challenging. And the current pandemic, like is challenging so many people on so many levels, that I’m hearing more and more from people that they’re having to use skills in new ways that they never did before.
Marielle Berg
Yes. And I think particularly for this listener, as a nurse, there’s an added level of potential danger and fear that’s accompanying everyday life. So the first skill that came well, several skills came to mind, but I think the I’m trying to order them in my mind. And I think the first one is Check the Facts. Because as I was reading this, I was thinking okay, so anger here, probably really does fit the facts.
Ed Fowler
Yeah.
Marielle Berg
And so anger fits the facts of a situation when an important goal is blocked, or desired activitie is interrupted or prevented. So we might say that those folks who, and we don’t know, we don’t want to do some mind reading here, but the folks who are going out partying and to the gym, and whatever they’re doing, they might be feeling anger because an important goal of theirs is blocked. But for the nurse writing this, anger also fits the facts when you or someone you care about is attacked or hurt or threatened by others. And so that’s that’s what came to mind for me initially, that there’s, there’s a potential danger here that comes from other people’s actions.
Ed Fowler
And when were using Check the Facts to notice an emotion and kind of sort through what’s going on here, making sure to bring in that Reasonable Mind side of things. What are the facts of the situation that may support this emotion? What we’re trying to do is figure out: okay, so what information am I getting from this emotion? Is this grounded in facts? And then what do I do with this information?
Ed Fowler
And in this case, it’s like, yeah, the anger is grounded in some pretty significant facts that, you know, there is a lot of risk in socializing with such a powerful virus going around. And that that risk has a big impact on health care workers, because they’re the ones who are having to treat people who can be highly contagious. They have to treat people who are in very severe health situations, including life and death situations. So there is a real impact from people seeming to go about life as if they’re not paying attention to caution.
Marielle Berg
Yes, so if the anger is justified, which it sounds like we are both kind of in agreement, that it is, another thing we want to think about: Is the anger effective? And in order to ascertain whether your emotion is effective, you have to know what your goals are in the situation.
Marielle Berg
And so we don’t, we don’t know what your goals are, in this situation, there’s something for you to think about. But if you’re, and this is I’m absolutely generalizing here, but I think that one’s goal could be to live your life and go to work and spend time with loved ones as you can and as feels safe without feeling sort of eaten up inside and kind of in a internal fury all the time, then, your anger may not be effective.
Marielle Berg
If the anger serves to help you become politically active, or take specific actions that are in service of your, your safety and your community safety, perhaps educating people, then we would I would say it is effective. So it’s a hard one to really make a call on here. So it without having more information – and figuring out whether an emotion and acting on it is effective in the moment, it takes, takes some thought.
Ed Fowler
What are my options here does require us to be able to access our Wise Mind. And having really strong anger, and this is the situation where anger can really feel like it’s a response to life and death circumstances, when we have such a strong emotional response, we do want to do the things that will help that emotion to come down.
Ed Fowler
And I think that, you know, in order to do that kind of work, to reflect on what’s going on with this emotion, and what are my options for how to handle it. Do I want to act on it? Do I want to act opposite of it because it’s not justified by the facts or it’s not effective in the moment? Do I want to do something else?
Ed Fowler
So that then we can be reflective about, okay, how do I respond to this emotion. So a little bit of Distress Tolerance, to bring that emotion down so that you can be in your Wise Mind to think about what to do would probably help, especially if the anger is really, really powerful, in any given moment, when you want to reflect on this.
Marielle Berg
That’s a great point with this extreme anger that this listener talks about. You know, for almost all of us, when any of our emotions are really extreme, it’s so hard to access Wise Mind. And in order to be able to access our Wise Mind, we need to sort of calm our nervous system, and a lot of the Distress Tolerance skills are incredibly useful for that. And so in order to, to answer or even begin to reflect on like, is acting on my anger effective right now, and how would it be effective, you have to have access to your Wise Mind.
Ed Fowler
So yeah, so like a little bit of Distraction, or Self-Soothing, or TIP, even, the skills that change our body chemistry, when emotions are high. All of those things are, are usually a good starting point, because it does kind of bring us down a little bit, gets us more into that Wise Mind place.
Ed Fowler
And then it sounds like what what this listener is bringing up is, you know, this is not going to go away, right? Like people are going, there still continues to be a lot of different approaches to how to manage our responses to this very contagious virus. And so there are going to be people who want to be very, very cautious and other people who don’t prioritize that caution, and so that anger is probably going to be coming up. And so being able to get to a Wise Mind place, however you can, and then think about what are my options here.
Ed Fowler
And as Marielle said, you may act on the anger by, for instance, getting involved in some sort of communal activity to educate people, or some sort of political process around this. That could be a helpful use of that anger to motivate you to get involved in something. But then sometimes, like, it’s very hard to act on anger, that’s towards people we don’t know. And this is a situation where it’s like you’re seeing people that you don’t have any relationship with, and you’re feeling really angry at the choices that they’re making. But you don’t really know them, it is much harder to act effectively on that anger with each individual person you might encounter.
Marielle Berg
And I would add to that, that it’s almost always ineffective to be telling off a group of strangers, we can pretty much guarantee that that’s not going to go well, even if you are right. So you have to be very skillful about how you respond to that. And then the other skill I thought of, of course, is Radical Acceptance. So we cannot control what other people are doing. We cannot change what they’re doing. We may be able to skillfully influence what others are doing. But ultimately, we don’t have a say about that. And that’s really, really hard.
Ed Fowler
So yeah, that was, it’s interesting, because Marielle and I did not talk before we started recording about, okay, what’s our answer to these questions, but we’re very much on the same page. Which is, I was thinking, Check the Facts is a good place to start. And then some Radical Acceptance is almost certainly going to be helpful.
Ed Fowler
And I think in the current crisis that we’re all facing, Radical Acceptance is coming up a lot, because there is so much beyond each of our individual control, that may be having negative impacts on us, people we care about, or just the general population. And so having to accept, this is what’s happening. And one of the realities is people are taking different approaches to what does quote unquote, social distancing mean. And so being able to, like put some effort into trying to accept other people are going to make different choices, and what may seem like unwise or uncaring, unthoughtful choices.
Marielle Berg
And just a reminder, that Radical Acceptance doesn’t equal approval. We’re not saying what those other folks are doing is okay, or isn’t dangerous. But it’s fully and completely accepting what’s happening. And when we do that, if we can do that, oftentimes, other options open up. We can think more clearly about what we might do in response to, to what the facts of the situation are.
Ed Fowler
So yeah, I think that, you know, being able to just acknowledge the emotions that we’re having nonjudgmentally. It’s like, so I’m feeling this really strong anger. Being able to come to a Wise Mind place to kind of see, okay, what are the facts here? How much of this anger is justified by the facts? How much is not? Is it effective to act on the anger? Whatever is effective, what might I do with that? And whatever might not be effective, like yelling at a group of strangers? How do I just accept the situation as it is, in order to hopefully open up some more possibilities for myself of how can I respond to this?
Ed Fowler
Because in this situation, I think that anger is really propelling towards some action. The question is, what would be the effect of action? And I think Radical Acceptance is always a helpful starting place of like, this is what’s happening. People are out and about, not seeming to really take precautions. How do I want to respond to that? And then kind of reflecting on that and taking some action when you come to that Wise Mind decision about it.
Marielle Berg
Yes.
Marielle Berg
And I would also, gently encourage this healthcare worker to seek out additional support and counseling, if that’s available, because this is a such a stressful time for everyone, but particularly for someone who’s working in the healthcare field. So you, you might need, you know, a support group or individual help, because you’re not alone with what you’re experiencing. And it’s hard to carry, kind of on your own.
Ed Fowler
Yeah, and I would say that, I think that I’ve heard from other health care workers, this exact same phenomenon. It’s actually a pretty common thing around, among health care workers that I talked to, of going into work and having to do all kinds of hard demanding work, and then seeing other people not taking the precautions that are being recommended and feeling a lot of anger and frustration about it.
Ed Fowler
So you’re not alone. And I really admire how much you’re trying to be thoughtful and skillful about it. And so you keep working on it, and seek support so that you don’t have to feel alone in figuring out how do I respond to this.
Marielle Berg
Alright, shall we move on to our next question?
Ed Fowler
Sounds good. Our next question says, “Hello, Marielle and Ed, I have been loving your podcast.” I will say, thank you. “I’ve learned so much about my own emotions, and I have been finding the skills you’ve talked about so helpful in my own life. I especially found the episode about the DEAR MAN framework helpful and asking for what I want, which is really difficult for me. I’m wondering if you could give a real life example of using the framework to say no, as this is something I really struggle with.”
Ed Fowler
So I think this is a great question. And when we are looking at the DEAR MAN framework for Interpersonal Effectiveness, which, DEAR MAN is an acronym for how we approach either asking for something important in a relationship or saying no to something, or sometimes just trying to state our opinion or get our opinion heard.
Ed Fowler
But being able to use that DEAR MAN framework for saying no, is one of the most helpful functions, and kind of a different approach than using DEAR MAN to ask for something. Maybe what I’ll do is just a really quick reminder of what the DEAR MAN acronym stands for.
Ed Fowler
So the DEAR part is basically what we say. And the MAN part is how we say it. So DEER stands for Describe what’s going on, why we want to have this conversation, Express our feelings and opinions, Assert what we want, so ask for what we want or say no, and then the R is for Reinforce what’s in it for the other person to give us what we want.
Ed Fowler
And then the MAN stands for staying Mindful of our goals, as we’re going into this conversation, so not getting sidetracked by side arguments or attacks or anything like that, but staying focused on what we’re asserting, the A in man stands for Appearing confident, so really trying to come into the discussion with from a place of confidence. And the N stands for Negotiate, so negotiating, and it’s the last letter in this whole thing. So if we’re not getting any traction on what we’re asking for, or saying no to, then we open the possibility of negotiating, and really, sometimes involve the other person and ask them: how do you want to solve this situation?
Marielle Berg
Yes, and as you were reviewing the DEAR MAN acronym I was thinking about, okay, so this listener would like a real life example of saying no, and I have different ideas that are coming to my mind. But every one I come up with, I feel, there’s a caveat, because it varies based on so many different factors. So we have this wonderful acronym, which is our template, but then the intensity with which we say no, and the intensity with which we pursue negotiation, varies on all the particulars of the situation.
Marielle Berg
And so while we’re reviewing the Interpersonal Effectiveness module, in the groups that we lead, we spend a lot of time thinking about different factors to consider. Because when you say no to something, you can say no, tentatively or gracefully, confidently. You can say no, very firmly. You can resist negotiation. So there’s a whole bunch of levels of intensity in which you can say no for something. And how strongly you’re going to say no to whatever’s being asked, is going to depend on a whole bunch of different factors.
Marielle Berg
Like, what’s the relationship between you and the person that you’re saying no to? What’s, what’s the history there? Is there a dynamic that has to do with authority? Is this person in charge of work that you do, for example? Timing is another factor. Give and take in the relationship. So there’s a lot to think about. So I probably have just complicated the situation. But it’s not it’s not so cut and dry.
Ed Fowler
I think that that’s a really important point for any kind of Interpersonal Effectiveness is that there is not a one size fits all. So the demand framework is like really valuable as our starting point. And how we apply it really depends on the situation. We we can apply it, and do apply it, frequently, when we need to say no. And for like this listener and for me, saying no can feel really challenging.
Ed Fowler
We talk in Interpersonal Effectiveness, often in our groups about myths that can impact our ability to act effectively in relationships. And one of those myths that comes up for me and for a lot of people is, I’m not allowed to say no. Saying no is is disrespectful of the other person. I should always try to say yes, whenever I can. And the reality is sometimes we really do need to say, no. It’s going to be harmful to us long term and harmful to relationships. If we don’t say no when we really don’t want to do something.
Ed Fowler
So an example of of saying no, using a DEAR MAN framework would be for instance, if someone was to invite me over, to hang out when we’re supposed to be sheltering at home at this point, I would probably need to use DEAR MAN in order to say no. And I’ve had this happen, where people have been like, oh, maybe we could hang out. And I’m like, absolutely not. That’s my perspective.
Ed Fowler
At this point, and I know from talking to people that especially a couple of months in, a lot of people are thinking I can’t sustain lack of contact, I need to figure out ways to interact with people. So if I needed to say no to an invitation to hang out during this time, using DEAR MAN, what I would say is the D, describe what I want to talk about, like you’ve asked me to come over, and I’ve really thought about it. The E would be to express my feelings, opinions. So while I understand that, that you really want to hang out, and I would love to hang out with you, I’m also trying to be very cautious during this time, because there is so much risk. And then the A would be to assert, so in this case, to assert my no. To say, I’m going to need to say no to hanging out at this point. And then the R would be to reinforce what’s in it to them, for them to accept my no. The R would be, as soon as things kind of open up a little bit, I’d like to strategize around how we might hang out together. So that would be an example of how you might use the DEAR framework to say no.
Marielle Berg
So that’s great. And that’s an example was something that, for you, as you feel pretty, pretty clear about that that’s at least at this point, while we’re recording this, that’s a pretty firm no for you. And I think some of the complications or the trickiness or the nuance comes up when it’s something that maybe is not quite as clear cut, or it’s something that you could do.
Marielle Berg
Like giving someone a ride home, this is pre-pandemic, or maybe loaning someone someone money or doing a favor for them. And you could do it, but you don’t really want to. And I, and again, I think looking at some of the myths we have about saying no and Interpersonal Effectiveness in general, can be useful. Because often, if someone is struggling to ask for what they really want in a situation, which could be saying no, there might be some underlying beliefs around it not being okay to have your own needs. It not being okay to disappoint others, a belief that that will make other people not like you. So that’s something to dive into a bit more.
Ed Fowler
So yeah, I think that absolutely DEAR MAN can be a helpful framework when we need to say no, and there’s lots of factors to consider. And that’s where having, you know, therapy can help to talk some of that stuff through or talking it through with friends or family to kind of say, here are my priorities, here’s what I want to do, what are some some ways I might do that effectively?
Marielle Berg
And for someone who’s really struggling with saying no, or asking for what they want to need, if you have a person who feels relatively safe in your life, you can even let them know like, I’m gonna practice saying no. So you can say no to low level things, like do you want XYZ for dinner? Practice saying no to something that doesn’t have a lot of impact, just so you can sort of begin to feel it in your bones and get more comfortable with it.
Ed Fowler
Yeah. And I would say that, for as someone who has struggled to say no at times, yeah, I think it’s really helpful to like talk to other people, acknowledge that, own it with people who are safe, so that then you have a little bit more support in trying to work on this thing that can be so hard for so many people.
Marielle Berg
And I wouldn’t don’t identify as myself as someone who struggles with saying no, but I certainly have several people very close to me who do struggle with that. And so on the receiving end for what it’s worth, I love when they tell me no, and I get more challenged when I find them to be evasive or I’m sensing they want to say no, but they’re not saying it. So I really appreciate a clear no because that matters to me. Their wants and needs actually really matter. And I get to show my love and care for them by honoring that no.
Marielle Berg
So let’s move on to the next question. “Hello Marielle and Ed, thank you for your wonderful podcast. Here’s my question. Even if you’re practicing emotional regulation, and all the other DBT skills, how do you know when it’s time to leave the situation that is causing the distress?”
Marielle Berg
So this is, we, I’m flabbergasted. You’re like, I need so much more information. I feel like this, you know, I really want to know what’s going on in order to be able to accurately answer that, so it’s such a tough one. This again, is going to is going to vary based on the individual situation, but we can provide at least some parameters or, or at least provide some things to begin to think about to make this kind of important decision.
Ed Fowler
I think that obviously, this is coming up because this listener or someone they know, is in a situation that feels like: You know what the situation I’m applying lots of skills in, the situation isn’t changing. At what point is a time to say, okay, this, for instance, this relationship isn’t going to be worked out, and I need to move on. Or this job isn’t going to be worked out, or whatever it might be.
Ed Fowler
And so I do think the bottom line of all of this really would be to be reflective, and kind of use skills to access Wise Mind and reflect on what’s going on in the situation. What’s, notice the emotions. What’s causing me to feel like this isn’t going to work? What’s the focus of, you know, what’s driving my distress? What are my options? What have I already tried? Who have I talked to about this to get some support and advice or suggestions about how to handle it? To really, I would say most important be reflective, access your Wise Mind, be reflective about all the factors before making any decisions or taking any actions.
Marielle Berg
Yes, because when someone is sort of mulling over the decision to leave a situation that’s causing distress, and, and we don’t know if this is an intimate relationship, or a friendship, or a job or a living situation, it could be a whole bunch of, it could be a myriad of things that this listener is asking about. But if we are feeling increasingly frustrated, and perhaps hopeless, we might decide kind of all of a sudden, to leave. So quit the job or walk out, or declare you want a divorce.
Marielle Berg
And oftentimes, that’s coming from Emotion Mind. So you really want to think about ways to bring your level of distress down enough. So not just Emotion Regulation skills, but also the Distress Tolerance skills to really access your Wise Mind, and to sit with it for a while. I know I have asked my Wise Mind, you know, different questions that have felt like they were quite weighty. And usually in the beginning, I don’t always know the answer. It’s something I have to come back to over and over. Like, is it a Wise Mind decision to leave the situation, or not?
Ed Fowler
And again, I think that the focus of the questions seems to be, if you’re applying skills and things in the environment are not changing, then at what point do you say, I need to make a change? So that’s where, you know, like one of the Interpersonal Effectiveness, we have a whole set of techniques for troubleshooting, if our application of Interpersonal Effectiveness skills isn’t working.
Ed Fowler
And so you might kind of reflect on some troubleshooting ideas about: What are my goals in the situation? And am I clear about my what my goals are? What skills have I tried? Are there skills I’ve thought about using in the situation that I haven’t applied and maybe I need to give that a shot? Am I being guided by myths about how I should be in the situation or how the other person should be? So kind of reflecting on some of those things.
Ed Fowler
Looking at, if you if you have the DBT Skills Training Handouts and Worksheets that’s used in DBT skills group, looking at the worksheets on troubleshooting, which would be Interpersonal Effectiveness Handout 9. And then there’s also one of the things that we don’t often cover in our skills group that can be really helpful in the skills workbook is a handout on ending relationships. So it gives some guidelines around things to consider things to keep in mind around ending relationships, which would be Interpersonal Effectiveness Handout 13.
Marielle Berg
And one, the thing that’s suggested there is making a Pros and Cons list about ending the relationship. And so, you want to do that in your Wise Mind. And thinking about, you know, obviously, all the benefits, because there are probably reasons why you’re staying, and then all the downsides. And then maybe, you know, letting that marinate for a while before you make your decision.
Ed Fowler
And I have a feeling that all of the answers to our questions today are going to involve: seek support. So this, this, I mean, I don’t we don’t know details about the situation. But if it feels like you use a lot of skills and things aren’t changing in your environment, you’re probably going to need some help on what to do and some support and people to turn to so that you don’t have to do this by yourself.
Marielle Berg
So those are just a handful of questions that we got to answer during this episode. We have some more, and I’m sure we’ll be recording another episode answering listener questions. So please keep those questions coming. And we’re wishing everyone skillful means.
Ed Fowler
Yes. I really love seeing the questions, so feel free to send them in. And no matter what, keep practicing the skills and keep reaching out for support.
Marielle Berg
Thanks for listening to today’s episode. To learn more or if you’re in the Bay Area and want to get started with therapy you can find us online at bayareadbtcc.com. That’s bayareadbtcc.com.