The final distress tolerance skill I’ll cover is the DBT skill called coping ahead (Dimeff & Koerner, 2005). When clients know that an upcoming situation will be emotionally difficult, it can be very helpful for them to rehearse their plan ahead of time so they’re prepared to cope in a more skillful way. The following dialogue provides an example:
Helping Clients Survive a Crisis: Distress Tolerance Skills
119 Client: So Christmas is coming, and my sister is having it at her house again this year.
Nothing’s changed with her. She still doesn’t like my boyfriend, and because it’s at her house, I know she’s going to tell me again that I can’t bring Michael.
Therapist: Well Melanie, I know we’ve talked a lot about trying not to go into the future.
But sometimes we can predict how someone is going to behave based on their previous behavior. And when we’re pretty sure we know we’ll be facing a diffi-cult situation, it can really help to plan ahead for it. Have you thought about what you’ll do if your sister invites you for Christmas dinner but tells you Michael can’t come?
Client: No, I don’t know what I’ll do. I get so triggered by her, and nothing ever changes.
Therapist: Maybe now is a good time for us to plan ahead what you can do to help you feel more effective with your sister. Do you want to go to her house for dinner without Michael? Is it worth it to you to make that sacrifice to see your family?
Client: I think I’ve sacrificed enough over the years. For so long, I’ve done everything they’ve asked me to. But I’m sick of being the only one to give, give, give. I want my sister to start respecting me more.
Therapist: Okay, so you aren’t willing to go to Christmas dinner without Michael. If your sister tells you he can’t come, what do you want to say to her?
Client: I want to tell her that she can’t keep excluding him—that he’s part of my life and she has to accept that as my decision. I want to tell her that if he can’t come for dinner, then I won’t be coming either.
Therapist: Okay. That’s a good start, Melanie. Are you willing to not see your family on Christmas, though?
Client: Well, that would be disappointing, especially because my parents are getting older and I don’t know how much longer they’ll be around.
Therapist: That’s understandable. So is there a compromise? Remember, it doesn’t have to be all or nothing. You could tell her you’ll come for an hour before dinner if you have to come alone, or you could refuse to go to her house without Michael and instead spend time with your parents on Christmas Eve.
Client: Yeah, that’s a good idea. I’d like to see everyone, and I’d have to bring the pres-ents over for my sister’s kids anyway, so I could go for a little while before dinner, without Michael. Then Michael and I could have Christmas dinner together at my house.
Therapist: Okay, great. So let’s talk about how you’ll express this decision to your sister if you need to. Think about your assertiveness skills, and talk to me like I’m Anna.
Client: Okay. Anna, I know you don’t like that I’ve chosen to be with Michael. You’ve made that clear in the way you continue to exclude him from family gatherings.
But excluding him from the family is disrespectful to Michael and to me. I would like for you to start working on accepting that he’s part of my life, and if you want me to be a part of your life, you have to accept Michael as well. If you insist that he can’t come with me to Christmas dinner, then I’ll come to your house earlier on Christmas day, but I won’t be staying for dinner. He’s my partner, and I want to spend Christmas with him as well.
Therapist: Great job, Melanie! Now I want you to picture in your mind how you want this conversation to go with Anna. Imagine it in as much detail as you can. Maybe you’re feeling anxious and hurt, but you’re expressing yourself confidently; your voice is firm, but you’re not yelling; and you’re treating your sister with the same respect you want from her.
In this way, clients can cope ahead, preparing themselves for upcoming situations so they can deal with those situations more effectively and skillfully.
WRAPPING UP
In this chapter, you’ve learned about skills that can help clients get through a crisis situation without making it worse. We looked at the cost-benefit analysis, which assists clients in making decisions about harmful or self-destructive behaviors. Then we looked at the various ways clients can prevent themselves from acting on the urge to engage in those self-destructive behaviors using the RESISTT skills: reframing; distracting by mindfully engaging in an activity, doing something for someone else, or generating intense sensations; shutting it out; thinking neutral thoughts; and taking a break.
Finally, we looked at coping ahead, in which clients rehearse acting skillfully in difficult situations before they encounter them. In the next chapter, we’ll look at some information clients need to know about emotions in order to use specific skills that will be introduced in chapters 10 and 11 to help them manage their emotions more effectively.