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Let's do Dialectical Behaviour Therapy (DBT)

Phoenix_RisingSenior Contributor26 Sept 2017, 8:31 am AEST

Let's do Dialectical Behaviour Therapy (DBT)

Good morning Forum Land,

So... @CheerBear @Zoe7 and I have decided to embark on an adventure of working through the DBT skills training manual together but not. That is, we all bought the manual at the same time, but we will probably work through it each in our own muddled puddled confuddled way. Consequently, who knows how this thread will end up looking. That's ok, that's why it's an adventure.

We would super love other Forumites to join us on this adventure if they want to. You definitely don't need to own the manual to join us, though if you want to, this is the book we are working from: DBT Skills Training Manual (second edition) by Marsha Linehan published in 2015. The manual has LOTS of worksheets in it, but happily, you can download those for free from this website: https://www.guilford.com/companion-site/DBT-Skills-Training-Manual-Second-Edition/9781462516995

It is important to be aware that this manual is not a self-help book. This is the manual designed to train therapists in how to deliver DBT to clients. Therefore, it can make for challenging reading at times. Personally, I find it hugely validating reading the way in which Linehan addresses the all-too-common negative and stigmatising attitudes that many mental health professionals have towards clients with Borderline Personality Disorder (BPD). However, others may find it distressing realising just how pervasive these attitudes can be across the mental health profession.

DBT was originally developed specifically to treat people with BPD. However, there is now a strong evidence base showing that is effective across a wide range of mental health issues. This is due to the core focus of DBT being on emotion regulation. DBT has also been shown to be effective in helping non-clinical populations manage their emotions. It may be of particular interest to some people in Forum Land, that DBT skills training has been shown to be effective in helping the carers of those with mental health issues cope with the challenges associated with that caring role.

As I said, I'm really not sure how this adventure is going to pan out...but we will never know if we don't try, will we! The manual begins with an introductory chapter outlining the theoretical basis for DBT. It has lots of nice little subheadings which breaks it up into easily manageable chunks. Thus I'm thinking @CheerBear and @Zoe7, that we could tackle the introduction based on these subheadings. Ideally I would love to do a little bit each day, but given the muddle that is my world, that is unlikely to happen. I expect it is far more likely that some weeks I will have a lot to say, and at other times, weeks may go by where I have nothing to say. I am guessing it will be the same for you...and that is a bazillion percent ok.

I superly duperly hope that some other Forumites decide to join us. But if not, that's ok too. I'm just as happy playing by myself.

And on that note, let the adventure begin...

Finding your way in the DBT adventure.

The following is a bit of a guide to navigating your way around what I anticipate will end up being quite a lengthy thread. The link will take you to the relevant page. Here in Forum Land, there are ten posts per page so you may need to scroll down a little way to find the actual post. The relevant headings are in large blue font to help you find them easily.

What is DBT? (This bit is on this first page so just scroll down).

Understanding Emotion Dysregulation

Are People With BPD Manipulative?

Accepting Our Emotions

The Consequences of Emotion Dysregulation

An Overview of DBT

Orientation, Goals and Guidelines

Pros and cons of learning and using DBT skills

Pros and cons of using DBT skills versus self-harming

Introduction to mindfulness

Mindfulness "What" Skills: Observe

Mindfulness "What" Skills: Describe and Participate

Mindfulness "How" Skills: Part One - Nonjudgmentally

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In response to: Let's do Dialectical Behaviour Therapy (DBT)

CheerBearSenior Contributor27 Sept 2017, 6:20 pm AEST

Re: Let's do Dialectical Behaviour Therapy (DBT)

@Zoe7 - take it as slowly as is right for you 💗

In response to: Re: Let's do Dialectical Behaviour Therapy (DBT)

Zoe7Senior Contributor27 Sept 2017, 6:24 pm AEST

Re: Let's do Dialectical Behaviour Therapy (DBT)

That is my only speed atm @CheerBear - well maybe 2 speeds - slow and slower lol

In response to: Let's do Dialectical Behaviour Therapy (DBT)

CheerBearSenior Contributor27 Sept 2017, 6:45 pm AEST

Re: Let's do Dialectical Behaviour Therapy (DBT)

Slow or slower it is then @Zoe7 🙂

In response to: Re: Let's do Dialectical Behaviour Therapy (DBT)

Phoenix_RisingSenior Contributor27 Sept 2017, 8:07 pm AEST

Re: Let's do Dialectical Behaviour Therapy (DBT)

@CheerBear and @Zoe7 I am so super glad we are sharing this adventure together but not. I can't hang around here right now because I am a little busy riding the waves. But I wanted to drop by and tell you (and whoever else is reading along) that the whole concept of riding the waves is on pages 404-405 of the manual.

In response to: Let's do Dialectical Behaviour Therapy (DBT)

CheerBearSenior Contributor27 Sept 2017, 8:15 pm AEST

Re: Let's do Dialectical Behaviour Therapy (DBT)

I am so seriously looking forward to getting up to some of the good bits of the manual @Phoenix_Rising (like wave riding) 😄

I feel like I need a close off phrase that's a more appropriate version of "happy surfing" (because that totally doesn't work), but my brain power was lost writing parts 1 and 2 of this adventure novel and I can't think of one right now :S

In response to: Re: Let's do Dialectical Behaviour Therapy (DBT)

Zoe7Senior Contributor27 Sept 2017, 8:22 pm AEST

Re: Let's do Dialectical Behaviour Therapy (DBT)

I'm going to go with "Flippers Up Phoenix" @CheerBear lol @Phoenix_Rising

In response to: Re: Let's do Dialectical Behaviour Therapy (DBT)

CheerBearSenior Contributor28 Sept 2017, 6:38 am AEST

Re: Let's do Dialectical Behaviour Therapy (DBT)

For the next chapter of my novel, I want to share some of the thoughts I have had reading part 1 and reflecting on your post earlier @Phoenix_Rising. (Side note: I am really hoping that when we get to the actual skills practicing part of the adventure, my posts will be less novel-esque and more of the quick share type posts).

It took quite a bit of brain power to get my head around the introduction of the manual, but I think I have a good enough idea of what it is about to be able to move forward with some understanding of what DBT is now. I don't think I can add much to what you have written as you captured it all so well. But I did have some thoughts.

Regarding the point about opposing forces, I can see that we all find grey difficult (you, @Zoe7 and me) but I wonder if that it may be for different reasons. I see the world in grey, but grey feels shaky and uncertain when it comes to me actually making a decision or taking action, which is where I think my black and white thinking can come in. Rather than sit with the uncomfortableness that comes with grey, I can go completely one way or the other because it feels more stable and secure to do so. It is the livng with the paradoxes/contradictions/polarities (whatever the right word is here) that that trips me up when.

It made further sense when I considered that significant dialectic - "The need for clients to accept themselves as they are, and the need for them to change". I too find this a really tricky one. I have found "acceptance" of anything really, really hard as I believe accepting things doesn't change them, and all I want to do so desperately is have them change. Perhaps a key for me in my journey through this will be that maybe if I can work on accepting myself as I am, I will be able to stop fighting myself and the effect of that will be that will be change. (And just like that, the words "stop fighting yourself" said a million times to me from my psychologist, made sense).

My understanding of how all of this equates to something kind of helpful, is that DBT is based on both acceptance skills and change skills that can be used to work through problems. I can definitely see the benefit of incorporating both 'types' of skills in probelm solving. They seem like a great match for tackling the trickiness of grey (as well as other times).

You also mentioned an important point for me in your part c) that I have been really wanting to share. I have had a huge reluctance to try to move forward things through the use of certain skills or techniques, as I have felt that if I did make progress it could "prove" or "demonstrate" to others (who would then reiterate this to me), that all along I have actually been the problem. I found that having this realisation about myself was really uncomfortable but helpful because it gave me someting to work with. As I have mentioned a number of times before, I seriously struggle with some approaches to psychotherapy as I feel we need to change the problems of the world, not the people who are having problems living in the world. A turning point for me in this stuckness, was when I came across the detailed discussion of presenting DBT assumptions later in the book (I realise I may be jumping ahead here but I feel it is worth mentioning now) that stated that People may not have caused all of their own problems, but they have to solve them anyway (Linehan, 2015, p.53). This sentence really changed the way I saw things as I felt I shifted from a notion of needing to 'fix myself as the problem', to one that feels more like needing to live more effectively with life circumstances that have been problematic. From this place, I became really keen on learning anything that may help me solve the problems.

I really hope I haven't added any confusion to this adventure, as I am aware I have a bit of a habit of doing so. I'm also rambling but I appreciate having a space where (I hope) it's ok to ramble like this, that I can revisit as I go along. Looking forward to some skills!

In response to: Re: Let's do Dialectical Behaviour Therapy (DBT)

Faith-and-HopeSenior Contributor28 Sept 2017, 2:09 pm AEST

Re: Let's do Dialectical Behaviour Therapy (DBT)

Okay .... hi guys ....

I would like to inject something here that I hope you will all find helpful .... just from a moseying around in the bachground perspective ....

Instead of grey per se, can you consider the span in between black (as one polarisation) and white (as the opposite and equal polarisation) as a colour spectrum.

Black and white appear safer, because all the colour adds a kaleidoscope effect that you are viewing as confusing rather than beautiful .... which is natural to some people, and not a "fault".

Think of it more like the colours in @CheerBear's coloured crocheted rug .... without an understanding of how the pattern comes together, it feels daunting .... so a monochrome rug with a rigid, simplified pattern is easier to adhere to. Neither is wrong ... and both can be appreciated with acceptance of their own value.

So, it terms of the conundrum of "accepting yourself as you are while simulateously accepting the need to change" .... it might be useful to think of ourselves as a crocheted rug, that is at once complete as it is, but incomplete in terms of what it can become .... a work in progress in other words,

💜

If this is confusing or unhelpful, I am happy to remove the post.

In response to: Re: Let's do Dialectical Behaviour Therapy (DBT)

DeterminedSenior Contributor28 Sept 2017, 3:44 pm AEST

Re: Let's do Dialectical Behaviour Therapy (DBT)

In response to: Re: Let's do Dialectical Behaviour Therapy (DBT)

AppleblossomSenior Contributor28 Sept 2017, 5:05 pm AEST

Re: Let's do Dialectical Behaviour Therapy (DBT)

Hello @Determined@Phoenix_Rising@Faith-and-Hope@CheerBear@Zoe7

I was delighted when I saw @Phoenix_Rising intention to make this a thread.

I hope I can pop in and out as a friendly, interested but not committed bystander.

I respect Linehan's work in developing all the worksheets and will probably try a few if time permits. I wont buy the book tho, as I have to be careful not to overburden my bookshelves. It would be sad if the wood bowed under its weight.

@Phoenix_Rising Great summary. Love it. Makes sense to me. I started off reading Marxist theory and the Helgelian dialectic and the Socratic dialogue methods in political theory and philosophy. Then read theology to try and sort out all the complications of a religious and atheistic dialectic going on in my extended family. I am more of a waffler or circumlocution type than a B&W thinker though I can do the latter. Talk about opposing forces, but do we really want to dob in all that is not "me" or "we" or "us" as bad or evil. Hmmmm Thank God we have moved on from some B&W thinking!

B&W thinking is often a function of an extreme situation, though not always ...

@CheerBear You paraphrased that last point fabulously.

You GO Ladies.

Brilliant.

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