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From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may 
download a larger version of this worksheet from www.guilford.com/dbt-  
worksheets .Interpersonal effect Iv eness Worksheet 4   (I. E. Handouts 5, 6, 7)
Writing Out Interpersonal Effectiveness Scripts
Due Date:       Name:                   Week Starting:  
F
ill out this sheet before you practice your DEAR MAN, GIVE FAST interpersonal skills. Practice 
saying your “lines” out loud, and also in your mind. Use the “cope ahead” skills (Emotion Regulation 
Handout 19). Write on the back of this sheet if you need more room.
PrO m PtIng  E vEnt  for my problem: Who did what to whom? What led up to what?
 O
bjEcTI
VES 
IN SI
TUATION  (
What results I want):
 RElA
TIONSHIP  IS
SUE 
(How I want the other person to feel about me):
 SElF- 
RES
PEcT 
IS
SUE (
How I want to feel about myself):
Scr I P t I d EaS  for dEar  man , gIv E FaSt
1. de
scribe  situation.
 
2. Exp ress  feelings/opinions.
 
3. ass ert  request (or say no) directly (circle the part you will use later in “broken record” to stay 
Mindful if you need it).