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Let's do Dialectical Behaviour Therapy (DBT)

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)

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

Perhaps they have a judgement sensitivity @Phoenix_Rising ....

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

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


@Phoenix_Rising wrote:

Mindfulness "How" Skills: Part One - Nonjudgmentally.

Nonjudmentalness
I'm going to preface this section by saying that I don't understand some of this stuff so I'm super hoping someone can help me out. Nonjudgmentalness involves letting go of evaluating and judging reality. According to Linehan (2015, p. 200), there are two types of judgments: those that discriminate and those that evaluate.

Judgments that discriminate.
To discriminate is to discern or analyze whether two things are the same or different, whether something meets some type of standard, or whether something fits the facts. For example, a jeweler discriminates whether a stone purported to be a diamond is really a diamond or not, and a judge discriminates whether an action is against the law or not. Discriminations are necessary.

Judgments that evaluate.
To evaluate is to judge someone or something as good or bad, worthwhile or not, valuable or not. Evaluations are something we add to the facts. They are based on opinions, personal values, and ideas in our minds. Evaluations are not part of factual reality.

Right after telling us to drop the terms "good" and "bad," Linehan argues that it is fine to use positive terms such as "good job." This makes no sense to me at all. She says; positive judgments have far fewer negative consequences than do negative judgments. In general, once we reduce our internal judgmentalness, we can go back to using the phrase "good job" and the like to mean specific things. So...it seems to me that after presenting a whole argument for why we should not use the terms "good" and "bad," Linehan backflips and says that it is ok to tell someone they've done a good job. To me this negates her whole prior argument.

To me, this whole idea that things are not inherently good or bad is a philosophy that I do not totally subscribe to. I believe there is good and bad in the world. I believe that acting in a caring way towards others is a good thing, and that doing harm to others is a bad thing. I will be super interested to hear what others think about this whole idea.

Let go of "should."
According to Linehan, when being nonjudgmental, we let go of saying and thinking that things should be different than they are. We also let go of saying that we ourselves should be different than we are (Linehan, 2015, p. 203). What do people think about this???

So...what do people think about this whole idea of being non-judgmental? Personally, some of this makes a lot of sense to me and some of it doesn't make any sense at all, so I'm super interested to hear what others think.


Hi @Phoenix_Rising and all, thanks for the tag - very interesting topic. I really enjoyed reading it and your thoughts on it.

My intial thoughts on this non-judgemental written piece by Linehan were the same as yours above - that there is good and bad in the world - and indeed there is. You aren't wrong there. What I believe Linehan was referring to as being nonjudgment is knowing the difference between judgments that discriminate and those that evaluate. To evaluate in Linehan's opinion is being judgmental and what we need to let go of. To explain what I thought Linehart was saying further vey briefly:-

For example to discriminate in this instance is to make a sound judgment. Linehart used this example that a judge discriminates whether an action is against the law - whether it is right or wrong according to the law. These type of discriminations are nessecary (in this instance to keep a safe and civil society). But to evaluate whether something or someone is good or bad is being judgemental.

As for example the judge can say that a person before him/her has broken the law and had done wrong - but cannot sum up (evaluate) the reality of the person themselves being "bad". We cannot make a sound judgment of stating that someone or something is good or bad as we don't know the "whole circumstances" or reality of the essence of that person. It can be marred by our own misperceptions, personal judgements, opinions and values.

We can discriminate and discern whether an action by a person, by ourselves or by anything is good or bad, does hurt us, does have good or bad consequences, can harm or do good - this is necessary to discern for safety and growth and is being non-judgmental, but to evaluate that person, ourselves or thing as "good or bad" as the whole of their/our reality is to be judgemental. That's the difference.

That's how I read it. I do think that is a good exercise in being nonjudgmental and I liked it. I am liking this thread a lot and gaining much from it 😊

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

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

Hi @Phoenix_Rising interesting read 🙂

I had an appt today with a psychologist who is a DBT co-ordinator from my local hospital. She assessed me to see if i can do the group therapy. I can but the only problem was that it is on a day that i work. So she suggested that as i have private health funds i can do it at another local hospital (40 mins away) and if at any time my situation changes with work and i have wednesdays off i can contact her and she will fit me in. She explained the time frame of the DBT course (1 yrs) and how it works. it is a very committed on my part and i am ready to commit.

I phoned the other hospital and all i need is a referral from my psych. apart from this hosptial i can go to Melbourne Clinic but that is an hour away from home but the good thing with them is that they do night classes and hubby said he would take me and wait for me. i will see which one i will go to.

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

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

Hi @Former-Member,

Super big thank you for sharing your thoughts about the whole nonjudgmental thing.

My reading of what Linehan says is a bit different to yours. To me, she is saying that good and bad, right and wrong, DON'T exist in the world - that these are evaluations that people put onto things. She doesn't say that a judge determines whether an action is right or wrong according to the law, but rather, the judge only determines whether the action is against the law or not. That is, there is no inherent rightness or wrongness to actions. It is a fact whether an action breaches a law or not, but it does not follow that actions that breach the law are "wrong" or "bad" and those that don't breach the law are "right" or "good."

Linehan doesn't seem to just be saying that we should avoid calling people "good" or "bad," but also she seems to be saying that we shouldn't call actions "good" or "bad." At least, she says this and then seems to shift her position. This is the bit where I think the argument implodes. I totally get the idea that a person doing a "bad" thing and the person being "bad" are not one and the same concept. I get that doing a "bad" thing doesn't make someone "bad" (and thus, by extension, doing a "good" thing doesn't make someone "good". However, I DO believe there are good and bad, right and wrong, actions.

I am super enjoying trying to unmuddle this muddle. I figure if we can't work it out here, I'll ask TTT to help with it. Yay for finally finding a helpful helping person!!!!

@BlueBay I look forward to hearing how your real-life DBT adventure goes. You've done DBT before haven't you???

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

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

Hi @Phoenix_Rising

Your welcome and thanks for the reply. It has me thinking - we read it different as to discriminate is to make sound judgement on a right or wrong way of doing things or if an action is right or wrong according to law - that is what is determined. So I am stumped. I certainly agree with you that there are right or wrong actions - those of us on the receiving end have no doubt. Nothing else would make sense and I can understand your dilemma on this. Thanks for the discussion and challenge - I have enjoyed it. I look forward to the next chapter 😊

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

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

@Former-Member, thank you for sharing your further thoughts. I think Linehan's argument comes down to how language is used and that this is why this stuff is tricky. I think she messes around with different ways in which the terms "good" and "bad" can be used and that when you really unpack it, the argument is more a play on words than anything.

There is a cool kids book called The Gruffalo. You can listen to it here: https://www.youtube.com/watch?v=ADqon006eRY :smileyvery-happy: A bit of it goes like this:

My favourite food, the Gruffalo said,you'll taste good on a slice of bread!

Good, said the mouse, don't call me good! I'm the scariest creature in this wood.

To me, this is a play on words. In the first line, the word "good" is used by the Gruffalo to describe how he likes the taste of mice, whereas in the second line, the mouse is using the word "good" in the moral sense of good vs bad. I think this is the sort of thing that lies at the heart of Linehan's argument. I believe, as it sounds like you might @Former-Member, that to say no actions are inherently good or bad is absurd. I'd love to know what others think.

Ps. @CheerBear @Former-Member are you super impressed that I could draw together ideas from The Gruffalo and the DBT manual?

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

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

Hi @Phoenix_Rising .....

I use the terms “good” and “bad”, and “right”and “wrong” .... but generally amongst people with a similar belief system or outlook on life, and even then within a context.

For example:

”That is a good food choice to make towards supporting your health nutritionally”

”Might be a bad idea to go to bed each night without cleaning your teeth if you want to keep them in good condition”

Yes .... they are value judgements I am placing over choices and actions / non-actions.

I found the word amoral interesting ..... as in “fire is amoral” ..... it burns in the hearth to cook food (“good”) but a wildfire burns everything in its path without discriminating (“bad”).

It’s not that things are allowed to be amoral .... they just are.

People being amoral can cause greater problems within society where we need boundaries (law) to try to care for everyone’s needs. Therein we create a scale of reference ..... therein comes a perception of right or wrong according to the scale of reference .... and therein comes a perception of good or bad according to the affects on other people or property owned / used by other people.

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

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

ive finally had the chance and the right headspace to really read through this entire thread! firstly im sorry for all the likes- i forgot we geet notifciations for each like so you all probably have an inbox full!

i found this really helpful! ive taken down alot of notes more so the exercises, how to do them, what they are etc and have around 17 pages worth so it was well worth reading everyhting written here

thank you @Phoenix_Rising@CheerBear for constantly updating this thread full of information and thank you to all members who are participating. it makes for an interesting read on everyones views!

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

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

Hi @Phoenix_Rising

I loved how you drew together ideas from the Gruffalo and the DBT manual - brilliant. I am so enjoying this thread, I am a fan - it's the first I look at now. Look forward to reading more 😊 Have a great day @Phoenix_Rising and everyone who is reading

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

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

@Phoenix_Rising

I am afraid I feel there is too much philosophical stuff in relation to the existence of good and bad well beyond my level of understanding, suffice to say I believe good and bad do exist.

That being said, I have put my attention to the practical task of not using the words of good and bad in conversation and have done so relatively successfully in written form (e-mail, text, forum posts) but not in speech. However in doing so I am still evaluating. A recipe I tried was delicious, I appreciated advice given as it was helpful etc.

Whilst I think praise is a reward, encouraging someone genuinely motivates people to better things or to continue with something you may see as worthwhile. To be able to encourage requires evaluation to some extent to be able to give appropriate feedback. I don't have a problem with evaluating - if I try a new recipe I want Mr D to tell me if he did or did not enjoy it, knowing this will help me decide if it is worth making the dish again or not; I do not want to make things he, we or I do not enjoy eating.

Describing a trait I don't like in myself:
I know I can come across as sounding confrontational if I am worried or do not understand something. I do not realise that my tone has changed. I do not like that this happens. I do not know how to change this.

Darcy
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