DBT DEAR MAN Skill: PDF Worksheet, Tools and Exercises

Most patients who struggle with interpersonal requests already know, at some level, what they want. What breaks down is the execution: they freeze mid-sentence, drop the ask as soon as the other person frowns, or escalate in ways that derail the conversation entirely. Explaining the DBT DEAR MAN skill verbally is possible, but handing them this PDF worksheet mid-session changes the quality of the work immediately.

Why DEAR MAN resists verbal explanation alone

DEAR MAN is a seven-step acronym from Linehan's DBT interpersonal effectiveness module, and its very structure creates a specific teaching problem: patients hear the list, nod, and then collapse the steps in their actual behavior. The most common collapses are predictable. They skip Describe (jumping straight to the emotional request), conflate Express with blame ("you make me feel..." rather than an "I" statement), and abandon Negotiate the moment they feel mild resistance, interpreting any counter-offer as a defeat.

Without a visual structure in front of them, patients also lose track of which letter they are on under social pressure. The acronym becomes a blur. The same patients who struggle with assertiveness generally often present with this specific gap: they can describe the theory but cannot sequence it in vivo.

A visual support changes this. When the seven steps are laid out spatially, with contrasting correct and incorrect examples side by side, patients can point to where they went off-track rather than relying on memory to reconstruct it. That is exactly what this PDF worksheet provides.

What the fiche contains: a step-by-step visual map

The fiche moves through each letter of the acronym in a dedicated panel, combining a plain-language definition with a concrete positive example and a labelled negative counterexample. For instance, under E (Express), the contrast is direct: "I feel alone when that happens" versus "You make me feel alone". Under M (Mindful), the broken-record technique is named explicitly, with a sample line: "I understand, and I still need an answer about Friday." This is the kind of precision that a verbal walkthrough rarely preserves once the patient is back home.

Beyond the seven-letter breakdown, the fiche includes four reframes designed to address the most clinically common distortions around assertiveness: the equation of assertiveness with aggression, the belief that a "no" requires lengthy justification, and the misreading of negotiation as capitulation. These map directly onto aggressive communication patterns and the schema-level beliefs you are likely already tracking.

Two fully worked examples follow, one on domestic task negotiation, one on refusing an added workload, running the complete D-E-A-R-M-A-N sequence step by step. A Common Mistakes panel names the five most frequent errors (including "Dropping the ask the moment they look annoyed"), and a Plan Your Own section offers one-line writing prompts for each letter, explicitly flagging that "the point is to notice what you'd skip under pressure (usually D, M, or N)." A closing To Discuss in Session block provides three targeted debriefing questions, ready to use the week after.

> To retain: this fiche is a visual support that facilitates the explanation of DEAR MAN in session; the patient leaves with a concrete reference, not a self-administered questionnaire.

When and how to propose it

The worksheet fits naturally in the interpersonal effectiveness phase of a DBT protocol, but it also integrates well in standard CBT work with patients presenting social anxiety, chronic conflict avoidance, or passive communication styles. It is equally relevant when working on I-messages and assertive expression outside a formal DBT frame.

Introduce it after an initial mapping of the patient's interpersonal pattern, once there is enough alliance to examine a specific failed request without activating shame. A straightforward framing: "I want to show you a structure that breaks down exactly what happens in a hard conversation, step by step. Let's go through it together and then apply it to the situation you described."

Go through the seven steps on the fiche together, pausing at whichever letter corresponds to the patient's habitual collapse point. Patients who drop the ask under pressure will need more time on M (Mindful) and the broken-record technique. Patients who avoid the conversation entirely will need assertiveness behavioral practice before DEAR MAN sequencing becomes useful. For those who confuse firmness with hostility, pair the session with a look at assertive body language and communication styles.

Send the patient home with the fiche and ask them to complete the Plan Your Own section before the next session, targeting one real upcoming conversation. The To Discuss in Session questions built into the worksheet structure your debrief directly: which letter did they skip, and what story were they telling themselves when they did?

One limit worth noting: patients with significant distress tolerance deficits may need stabilization work before the DEAR MAN sequence holds under emotional activation. For these patients, the fiche is better introduced as aspirational scaffolding after core regulation skills are in place.

The fiche does not replace the therapeutic framing; it makes the explanation precise and leaves the patient with something to return to between sessions.

Sources

• Linehan, M. M. (2015). DBT Skills Training Manual, Second Edition. The Guilford Press.
• Linehan, M. M. (2015). DBT Skills Training Handouts and Worksheets, Second Edition. The Guilford Press.