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Author Topic: BEHAVIORS: Irreverent communication style. What is it exactly?  (Read 8290 times)
Kwamina
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« on: January 27, 2015, 01:59:28 PM »

Hi there

I was wondering if any of you are familiar with the so-called 'irreverent communication style'? This is a form of communication that can be used by therapists in Dialectical Behavior Therapy (DBT). Do any of you have experience with this style of communication? Have you perhaps at times tried to apply this style yourself as you deal with the people with BPD in your life?

Here's some information about this style of communicating:

DBT balances two quite different styles of communication that refer to how the therapist executes other treatment strategies. The first, reciprocal communication, is similar to the communication style advocated in CCT. The second, irreverent communication, is quite similar to the style advocated by Whitaker (1975) in his writings in strategic therapy. Reciprocal communication strategies are designed to reduce a perceived power differential by making the therapist more vulnerable to the client. In addition, they serve as a model for appropriate but equal interactions within an important interpersonal relationship. Irreverent communication is usually riskier than reciprocity. However, it can facilitate problem solving or produce a breakthrough after long periods when progress has seemed thwarted. To be used effectively, irreverent communication must balance reciprocal communication, and the two must be woven into a single stylistic fabric. Without such balancing, neither strategy represents DBT.

Source: Clinical Handbook of Psychological Disorders, Fifth Edition: A Step-By-Step Treatment Manual

The primary style of relationship and communication is referred to as 'reciprocal communication', a style involving responsiveness, warmth and genuineness on the part of the therapist. Appropriate self-disclosure is encouraged but always with the interests of the patient in mind. The alternative style is referred to as 'irreverent communication'. This is a more confrontational and challenging style aimed at bringing the patient up with a jolt in order to deal with situations where therapy seems to be stuck or moving in an unhelpful direction. It will be observed that these two communication styles form the opposite ends of another dialectic and should be used in a balanced way as therapy proceeds.

Source: An Overview of Dialectical Behaviour Therapy in the Treatment of Borderline Personality Disorder by Barry Kiehn and Michaela Swales


I would be very interested in hearing any information or insights you might have regarding 'irreverent communication'. Thanks in advance for anything you can share here! Smiling (click to insert in post)
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livednlearned
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« Reply #1 on: February 13, 2015, 11:31:58 AM »

This is so interesting. I never thought about my therapist having a style -- I picked her because she came highly recommended from someone I knew and trusted. But reading your description, I can see that my T has a much more irreverent communication style, and that has worked really well for me. If I remember correctly, she was very warm and nurturing in the beginning, but eventually my sessions became what I described as "action-oriented." She can now say some very blunt and direct things, and I can tell her that she is irritating me  Smiling (click to insert in post) and we seem to have a good rapport. At first it was hard because I felt very beaten down by strong personalities, and she seemed so strong. When I was in group therapy, she was there with another therapist, almost like good cop bad cop. Maybe purposeful?

Neither of those Ts do DBT, though. Maybe it's a style of communication that has a legacy predating it? Similar to how DBT builds on CBT and mindfulness.

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eyvindr
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« Reply #2 on: February 13, 2015, 12:27:31 PM »

Sounds cool. I'm all for calling crazy crazy. Seems that in pretty much all important areas of life -- r-ships, work, politics, education, parenting (!) -- we've become pretty accommodating to a watering down of the language. We have words for a reason -- and the English language is one that has a lot of words -- so we can use them very precisely to convey subtleties of meaning in various contexts. Anymore -- at least here in the States -- people are downright lazy about how they use our language. Very frustrating.
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Kwamina
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« Reply #3 on: February 20, 2015, 03:43:21 PM »

Hi livedlearned

I can see that my T has a much more irreverent communication style, and that has worked really well for me.

Why do you think this style has worked so well for you? Do you feel like her initial warm and nurturing approach was perhaps less effective? Or perhaps that every stage of therapy might require a different approach and in this case a different style of communicating?

Do you remember at what point your sessions started to get a somewhat more 'irreverent' character? Was this perhaps after a bond of trust had already been established between you and your therapist?

Neither of those Ts do DBT, though. Maybe it's a style of communication that has a legacy predating it? Similar to how DBT builds on CBT and mindfulness.

This is a good point. I think it's probably true that being irreverent predates DBT. This is also true for being welcoming and nurturing. What I do find so interesting about irreverent communication though, is that it sounds quite difficult and you really got to know what you're doing otherwise you might only make things worse.

Sounds cool. I'm all for calling crazy crazy.

Hi to you too eyvindr

This is also a way of looking at it I guess  I think the point of irreverent communication is not so much to call it like it is, but more a sort of what I call 'verbal shock therapy' to get the patient off guard by doing or saying something totally unexpected. This to me doesn't seem like an easy thing to do though and could backfire if you're not careful. But if done properly, I do think irreverent communication can be very valuable and effective.

Seems that in pretty much all important areas of life -- r-ships, work, politics, education, parenting (!) -- we've become pretty accommodating to a watering down of the language. We have words for a reason -- and the English language is one that has a lot of words -- so we can use them very precisely to convey subtleties of meaning in various contexts. Anymore -- at least here in the States -- people are downright lazy about how they use our language. Very frustrating.

I find it very interesting what you say here. We could even start a whole new thread about this topic  Words can be very powerful and making proper use of all the subtleties you mention can really help in accurately describing situations, thoughts and emotions. It can also really help in getting through to people. Thanks for bringing this up Doing the right thing (click to insert in post)
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livednlearned
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« Reply #4 on: February 20, 2015, 04:08:33 PM »

Hi livedlearned

I can see that my T has a much more irreverent communication style, and that has worked really well for me.

Why do you think this style has worked so well for you? Do you feel like her initial warm and nurturing approach was perhaps less effective? Or perhaps that every stage of therapy might require a different approach and in this case a different style of communicating?

Do you remember at what point your sessions started to get a somewhat more 'irreverent' character? Was this perhaps after a bond of trust had already been established between you and your therapist?

Looking back, I can see that she was irreverent in the beginning, but then it became much more warm/nurturing. When I started to waffle back and forth about whether to leave my marriage, she started to become irreverent every time I saw her. She later told me that the "confrontational" approach she used when we first met was to determine if I had a personality disorder. She gave me feedback that was difficult, and I took it and looked at it, and wanted to know more. (I passed the test  . She had been sued twice by women who were BPD and this is one of the ways that helped her determine whether a client had BPD. I also had a period in my early 20s when I went through "exercise bulimia" where I was training for long-distance events, and felt there was something psychological about my compulsion to train all the time. So she probably had a reason to be on high alert.

She was much more warm and nurturing, very supportive as I tried to work through stuff with my family of origin. Once I got into that pretty deep, when things came up that were connected to my current relationship dynamics, she was much more confrontational. I was also in group therapy at the time, so sometimes we would discuss what happened in those sessions, and she was very irreverent and direct -- probably because by then it was very obvious to both of us what the dynamics were, because we were both in the same room when they were happening with other people.

Neither of those Ts do DBT, though. Maybe it's a style of communication that has a legacy predating it? Similar to how DBT builds on CBT and mindfulness.

This is a good point. I think it's probably true that being irreverent predates DBT. This is also true for being welcoming and nurturing. What I do find so interesting about irreverent communication though, is that it sounds quite difficult and you really got to know what you're doing otherwise you might only make things worse.

I was so ready for it. Prior to this T, I had experienced 3 other Ts throughout a period of 15 years or so. One was in college - not at all effective. I saw him maybe 6 times. The second was later in my 20s over the exercise bulimia. After a few visits of her just nodding her head the whole time, she sent me to a psychiatrist for Prozac. That went against my values, I guess. The pscyhiatrist said I suffered from reactive depression to a life event and in 15 minutes wrote a scrip and sent me on my way. The third T was in my 30s and she spent a lot of time talking about herself.    So I didn't have a very good impression about therapists, and couldn't figure out if I had just been unlucky, or if they were all like this. Then I experienced an episode with N/BPDx and my boss, a very astute and strong yet kind, nurturing person, asked me if I was ok. She had been with an abuser (something I would never have guessed) and she recommended the practice where I found my therapist. It actually appealed to me to have someone be so direct right off the bat like that. I felt I was ready for it, and it actually made me trust her. In the years since I've been seeing her, there is not one thing she has said that I wasn't willing to hear. And eventually, I was able to even push back when she recommended things I knew I wasn't ready for, and she would say she was proud of me  Being cool (click to insert in post) even though she disagreed.

I will say that she has never been rude or insulting, and she also doesn't raise her voice or any of that. It's just... .direct. She used to talk about the word "confrontation" and broke it down into its Latin components, sort of turning the word on its head so it didn't have a negative connotation. It's possible this is its own therapeutic approach and maybe I'm confusing it with irreverent.

You made me wonder if perhaps she is validating me in important ways before being irreverent or confrontational, and perhaps that is why I feel less guarded or defensive with this approach. I'll have to watch for it next time I see her.

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Kwamina
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« Reply #5 on: February 26, 2015, 09:57:45 PM »

Hi again

When I started to waffle back and forth about whether to leave my marriage, she started to become irreverent every time I saw her.

I see, the so-called sledge hammer approach Smiling (click to insert in post)

She later told me that the "confrontational" approach she used when we first met was to determine if I had a personality disorder. She gave me feedback that was difficult, and I took it and looked at it, and wanted to know more. (I passed the test  . She had been sued twice by women who were BPD and this is one of the ways that helped her determine whether a client had BPD.

Interesting, being confrontational as a way of screening clients for BPD. I guess being sued twice has really made her concerned about treating clients with BPD.

It's possible this is its own therapeutic approach and maybe I'm confusing it with irreverent.

You made me wonder if perhaps she is validating me in important ways before being irreverent or confrontational, and perhaps that is why I feel less guarded or defensive with this approach. I'll have to watch for it next time I see her.

Another classic approach, buttering you up before delivering the hard truth  Whether it can be officially classified as "irreverent communication" or not, I do see certain parallels:

To be used effectively, irreverent communication must balance reciprocal communication, and the two must be woven into a single stylistic fabric. Without such balancing, neither strategy represents DBT.

Source: Clinical Handbook of Psychological Disorders, Fifth Edition: A Step-By-Step Treatment Manual

Your therapist too seems to balance different styles of communication.
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