How to Use Story to Teach DBT Skills

Incorporating story-based interventions can help clients to learn and generalize DBT skills. For the purposes of this article, I will use "story" as an umbrella term that encompasses a range of story-based interventions, including metaphor, poetry, and narrative.

In the previous article of the Action-Based DBT series, you learned “what” is effective about story: It helps clients gain new insights, creates a safe space for learning, and increases engagement. In this post, you will learn “how” to incorporate creative story-based interventions in your own clinical work.

(P.S. Shout out to any DBT lovers who got my little mindfulness “what” and “how” skills joke! I will now practice a non-judgemental stance and refrain from judging myself for calling out my own comedy.) Okay, onto the important research.

In this post, I will discuss how story can be used to teach the DBT skills of Willingness and Radical Acceptance, and how creative approaches like story can increase cohesion in group settings.

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Willingness

Willingness is a DBT skill that involves actively accepting and participating in the present reality without judgment, resistance, or avoidance.

One way to help clients practice Willingness is to support them in identifying moments of Willfulness, or the moments when they are resisting reality. In my experience, I have found that when I ask clients to provide me with examples of Willfulness, however, I am usually met with crickets. There can often be shame associated with identifying willful moments.

Story can be used to help clients access willfulness. For example, you can prompt your client to create a fictional story that demonstrates a character acting willfully.

Imagine this scenario: You are running a DBT skills group and you assign clients the homework assignment of writing a story about a willful character. When you arrive to session the following week, you experience the following:

Group members volunteer to share their homework, and the room is filled with many stories. Protagonists include wizards, “the popular girl,” a tornado, a puppy, and “Mr. Willful.” You watch as the clients share these stories with one another — you overhear dramatic, humorous, and personal elements across the narratives. As you prompt the group to come back to the circle, you notice relaxed body language and smiles on the participants’ faces. As you relate these stories to the DBT skill, you notice that you are sitting back, while the group members are prompting one another and the discussion flows. When a client who has never spontaneously spoken offers that she feels she is “always willful,” you notice the group provides support and understanding.

Fictional narratives become the platform on which members not only gain insight and perspective into their own lives but also delve deeper into the group process as they experience connection with others and enhanced empathy. Additionally, the process of sharing stories can be really fun! As drama therapist Dr. Renee Emunah (2019) puts it, storytelling can activate positive emotions, encouraging clients to participate more fully in the therapeutic process.

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Radical Acceptance

Many clients (and clinicians!) struggle with Radical Acceptance, a DBT distress tolerance skill that encourages acceptance of reality as it is (Linehan, 2015). This means accepting uncomfortable or unfortunate realities – which isn’t always easy.

In my Action-Based DBT groups, I use numerous drama therapy interventions to support clients in understanding and applying the concept of Radical Acceptance to their own lives. Here is an example of a story-based intervention:

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You provide clients with the text “Welcome to Holland'' by Emily Pearl Kingsley, which proposes a metaphor of Italy as the previously desired reality and Holland as the current reality. You then ask the group members to complete the following prompts: My “Italy” is… and My “Holland” is… You give each client the opportunity to verbalize a response to the prompts. Group members are then encouraged to create a sound-and-movement to represent their “Italy” and a sound-and-movement to represent their “Holland.”

The “Welcome to Holland” example models several benefits that can be reaped through the use of story:

Normalization: Using story in this context validates the sadness and disappointment associated with letting go of, or radically accepting, the loss of a hoped-for reality. When clients hear other examples of individuals, such as the author Emily Pearl Kingsley, the facilitator, or fellow group members, it normalizes their experience and can reduce feelings of shame.

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New Insights: When you blatantly ask a client what they are not accepting, you may be met with defenses, as this question requires a vulnerable response. The metaphor can help the client discover what is underneath the defenses, and may even result in behavioral change.

Deeper Processing: In addition to increasing right-brain activity through the decoding of the metaphor, story can also trigger right-brain processes by bringing about emotional responses from the client (Dwivedi, 2010). Because the concept is processed at a deeper and more meaningful level, the client is more likely to retain the information.

Conclusion

Whether through creating fictional narratives to access Willingness or using metaphors to understand Radical Acceptance, integrating story-based interventions can significantly impact the therapeutic process. By incorporating these story-based strategies, therapists can help facilitate a better understanding of new concepts and create a safe and engaging environment that encourages clients to participate more fully in their own healing process.