Interpersonal Safety

Safety

As a DBT therapist, maintaining patient safety is a common goal. Risk assessments are performed on a regular basis, crisis plans are developed at the outset of treatment, skills coaching is available 24-hours a day, and unsafe behaviors are targeted and tracked weekly. From an attachment-based perspective, the belief (identified in the article linked above ) that our loved ones will take care of us and the belief that we are worthy of their love/attention are foundational aspects of our sense of interpersonal safety. These core beliefs are commonly tenuous in those who engage in suicidal and parasuicidal behavior. Such self-harming  behaviors allow for the recreation of the life-threatening experience of being unable to securely attach to those we are biologically wired to seek nurturance from. From an evolutionary perspective, we are hard wired to experience an alarming threat to our survival when we are abandoned by the tribe. For those who question their primary attachments and lack the secure base necessary for security in future relationships, suicidal threats and gestures make for ineffective means of “testing” the tribe (family, friends, co-workers, etc…). These behaviors tend to be self-fulfilling and serve to confirm the expectation that those closest to us will eventually fail, abandon, and/or reject us. How do we address these insecure interpersonal connections and negative core beliefs? Firstly, a safe environment is the most essential component to any therapeutic relationship. In this case, the trust in the relationship, genuineness of the therapist, and ability to identify recreations of old patterns are paramount. Once the therapeutic relationship is effectively established and an emotionally corrective experience is provided a new expectation of others, style of interpersonal relatedness, and working model for relationships can be created. At this point, skills can be generalized outside of the therapeutic relationship to more effectively communicate safety concerns in present relationships, observe urges to engage in old patterns of behavior, and view the experiences of the present without using the lens of the past.

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