Finding the Right DBT Skill for You

Not every DBT skill will work for you, and that is a feature of the system rather than a flaw in you.

People rarely expect this. The skills arrive in a numbered curriculum with worksheets, which makes them look like material to be mastered rather than options to be tested. The curriculum is closer to a catalogue.

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Each one of us has unique skill strengths and skills deficits.

The DBT curriculum is large on purpose. It covers dozens of skills across four modules because the people using it have different nervous systems, different histories, and different situations. A set designed so that every skill works for everyone would be a much smaller and much less useful set.

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The moment where a skill does not land

Most people hit this early, and it is worth knowing it is expected rather than diagnostic.

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When you're learning DBT skills, there might be moments where you're like, hm, this is not a skill that I connect with.

Cold water on the face is transformative for some people and unpleasant and useless for others. A structured request script feels like relief to one person and like a costume to another. Neither reaction says anything about whether the person is doing it right.

The usual conclusion people draw is the wrong one. Not this skill does not suit me, but I am bad at this, which then generalises to the whole treatment. A skill that does not fit is information about the match, not about the person.

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But do not decide after one attempt

There is a specific caution here, and it cuts against the instinct to move on quickly.

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We don't want to say one and done, because sometimes it takes a couple of times to really see if you connect to a skill.

One trial is almost never a fair test, for a few reasons worth naming:

• The first time you use a skill you are also trying to remember the skill, which uses the capacity the skill needs.
• The first attempt usually happens at peak distress, which is the hardest possible condition.
• A skill that does not reduce the feeling may still have prevented an action, and that is a result even though it does not feel like one.

A reasonable rule: try a skill three times, in different situations, before deciding it is not yours.

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The gym

For the overwhelm that comes with seeing the full list, Dr. Finkelstein uses a comparison that most people recognize immediately.

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Whenever anyone is coming to me and asking, okay, these are a lot of skills, I'm a little overwhelmed, it's like going to the gym for the first time. It can be a little overwhelming, but once you get into the practice of learning the skills, applying them, and playing with them, it gets a little easier.

The analogy carries further than it first appears. Nobody walks into a gym and uses every machine. You learn a few, you find out what your body responds to, you build a routine out of those, and the equipment you never touch is not wasted, it is there for someone else or for a later version of you.

Playing with them is the operative phrase. Skills are not a test to be passed. Adapting one until it fits you is the intended use, not a deviation from it.

That adaptation is usually small and specific. Someone who cannot face cold water will use a cold can against the neck. Someone who finds the scripted request stilted will keep its structure and drop its phrasing. The mechanism survives the edit, which is the only part that has to.

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How to run a fair test on a skill

A practical procedure, since most people try skills too casually to learn anything from the attempt:

• Pick the situation in advance, not in the middle of it. Decide now what you will do next time X happens.
• Use it early, before arousal peaks. Almost every skill works better at a six than at a nine.
• Note one thing afterwards: what happened to the urge, not what happened to the feeling.
• Repeat twice more before judging it.
• If it still does not fit, name what specifically did not work. That usually points at the skill that will.

The last step is the one people skip and the one that pays. I could not remember it, I could not do it in front of other people, and it made me feel worse are three different failures, and each of them points at a different replacement.

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Building your own shortlist

The realistic end state is not competence in every skill. It is three or four skills you can reach for without thinking, matched to the situations you actually encounter. Everyone's shortlist looks different, and that is the design working as intended.

A shortlist also solves the problem the full curriculum creates. At high arousal you cannot review options. You need one move that is already decided, and a short list is the only kind you can hold at that moment.

Good places to test: the TIP skills for high arousal, the STOP skill for impulsive responses, and the mindfulness What skills as the foundation. The guide Real Skills for Real Life covers twenty six of them with decision trees for which to use when.

If you want help building a shortlist that fits your situation, Axis Psychological Services offers DBT informed individual therapy in New York City. You can book a free consultation.

If you want help matching skills to your own situations, learn about DBT therapy in NYC, or join the DBT skills group in NYC.