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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)

outlanderSenior Contributor02 Apr 2018, 5:15 pm AEST

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

thats an interesting point youve brought up @Phoenix_Rising im not sure on that myself but interested in hearing others thoughts too.

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

Sans911Senior Contributor02 Apr 2018, 5:40 pm AEST

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

@Phoenix_RisingYou really are an amazing little turtle to come up with such thoughtful posts.

My take on suicidal ideation and self-harm is that for some people, is an acceptable form of a coping strategy, despite the risks involved. Because sometimes that is all people have and know. Nonetheless, the death of a person from self-harm or suicide is unacceptable, because often there is something, no matter how small or big, that is waiting for those who are suffering intensely.They matter and have something to contribute to society, so it is up to all of us to support, validate, counsel and stand by those that are hurting emotionally. It is up to us to lead them out of the darkness when they are ready. It is up to us to help to be advocates for their own health. And it unacceptable to loose people this way.

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

Phoenix_RisingSenior Contributor02 Apr 2018, 5:55 pm AEST

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

Hi @Sans911,

That's really interesting that you applied my question to the idea of suicide/SH. Personally, when it comes to those things, I believe a person has the right to do whatever they want with their own life, including ending it. Their life, their choice. Don't get me wrong, if someone is super struggling with suicidal ideation, I will do everything I can to support them. But ultimately, I still respect the fact that it is their life to do with as they choose.

It's kind-of ironic that you have expressed those values, given that the situation that I am currently dealing with has pushed me oh-so-close to suicide numerous times over the past four months. The message I have very strongly received is that I don't matter. I'm super glad there are people like you in the world.

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

Sans911Senior Contributor02 Apr 2018, 6:22 pm AEST

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

I also respect that people have choices, and ending your life might be one of them. Similarly, not taking medications is also a choice. As are so many other things. But why do people feel suicidal in the first place? It's often to do with invalidation, unhelpful, stigmatising, judging and uncaring or ignorant people. Shouldn't the communities of the world make the best efforts not to loose these people? Shouldn't those that can challenge ignorance, stigmation & discrimanation by educating and provide resources to help the helpers? People who are suicidal also have a choice and right to effective, holistic, compassionate care to make a choice if that is their thoughts telling them that is what they must do or whether they can accept help to change such thoughts and find a way to live again.

I have been on the brink of suicide more than I can count on my fingers and toes in the last two years. I am not estatic to be alive quite yet, but I am involving myself in suicide/bpd voluntary programs to challenge the world views. Right now, It's helping me to stay alive @Phoenix_Rising

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

CheerBearSenior Contributor03 Apr 2018, 7:08 am AEST

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

Hi @Phoenix_Rising and all

You have given some food for thought with your question Phoenix_Rising. One of the values I have held on to firmly, that sounds kind of similar is "the standard you walk past is the standard you accept". It has given me motivation and direction, and it's helped me make decisions when things have felt tricky. The flip side is that it has been one of the biggest sources of pain and disappointment for me too as I know I can't change lots of things that I believe need changing. I have also found myself burnt out trying to take on things that I don't really have the capacity for at the time and that are much bigger than me, but that I so deeply value or believe in. It's another work-in-progress one for me.

I don't know whether a person standing up or not walking by is failing to accept reality as it is, and if it is that, then this is one point of Linehan's that I would choose to walk by 😆

Whenever I hear the word acceptance now, I think of Linehan making the distinction between acceptance and approval and how accepting something does not mean we approve of it. It's the only way I've come even close to getting my head around the idea of acceptance.

When I think about some of the situations I've encountered or seen, some over the last few months also, I can remember how I have tried to balance acceptance of reality with my want to change things. I have found myself talking to myself in a way that kind of goes like this:

"I do not approve of this but I do accept that I can't change everything and that I have limits. I accept that sometimes it is better for me to walk by or to not say anything, because doing anything other than that has the potential to dangerously overwhelm me. I accept that there are other people better able to stand up (for whatever reason) than I am. I accept that I may try and fail, and that will have to be ok. I accept that different people have different opinions and perspectives on what is ok and what is not. I do not approve of what is happening at all (I think I would say this a bazillionty time) but I accept that right now this is the way it is." Then I quietly add it to an ever growing list of examples of how and why change needs to happen, that I can pull out one day when I am better able to fight harder/louder/more effectively. I try to remember and feel thankful that there are so many people who believe change needs happening too, who are standing up and not walking by in lots of different ways.

I think the short version of my (long) answer is that we can accept something is happening right in that moment, while still be working to change it. It's not a failure to accept reality as much as it's recognising that something is happening that right now, there's not a whole lot we can do to change it.

Thank you for your thought provoking question. I too am interested in hearing other people's perspectives. And love your post and words above @Sans911

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

CatcakesSenior Contributor03 Apr 2018, 7:22 am AEST

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

This topic for me is really tricky @Phoenix_Rising because I have very strong emotions about not doing something when I should have.
There were times when I had to accept things were the way they were because I felt powerless. It was about needing to be employed and not having many other choices. How I wish I could have spoken out
Louder than I did.
In the end I ran away...

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

CheerBearSenior Contributor03 Apr 2018, 7:35 am AEST

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

@Catcakes❤

I have had to run away too, from situations that have left me feeling very bad about it. There were a couple of people in refuge that I had to walk away from that I'm not sure I'll ever be properly at peace with. It was about being powerless and not having many options also, and having tried but failed and needing to put must first. It's very painful and I often wonder what happened to those people. That question visits me in nightmares sometimes.

I did what I could do with what I had at the time and that's how I try to see it when pain hits. Maybe you did the same too. That is all we can really ever do I think.

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

Phoenix_RisingSenior Contributor03 Apr 2018, 3:26 pm AEST

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

Hi everyone,

Superly duperly big thank you for all the comments regarding the question I posed.

@Sans911 I agree with you a bazillion percent regarding the idea that as a society, we should be addressing the issues that cause people to feel suicidal in the first place. I find it incomprehensible that I have been pushed so close to the brink over the past four months by a mental health focused organisation. It makes me despair over how we are ever going to change the world. If they can't get it, what hope is there for the rest of society.

@CheerBear thank you for your ~~essay~~ response. Yep, it sounds like your value of the standard you walk past is the standard you accept is very similar to my value of all it takes for evil to prosper is for good men to do nothing. I super like how you frame the puzzle within the idea that acceptance doesn't equal approval.

You know how I went on my world-changing adventure to Melbourne in January? Part of the reason I was asked to be involved in that adventure was because of an experience I had with a particular service about six years ago. Back then, I tried to speak out about the wrong. I got a bit of the way, but when I hit a wall, I didn't at that time have the energy to keep fighting. However, in January, I had the opportunity to stand up and tell a whole room full of people from that same service, about the horrible thing that happened to me within that organisation six years earlier. It felt SO good and my experience will go a long way towards making a very big change in that organisation. I had to let that situation go six years ago and I could never have imagined that down the track I would be able to draw on it to help change the world. I am very much holding onto that thought as I deal with my current muddle.

@Catcakes I agree that it is a really tricky topic. I super like what CheerBear said in response to you. We can only ever do what we can do with the skills, knowledge, energy and resources that we have at the time. I super like the saying; Do the best you can until you know better. Then, when you know better, do better.

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

CatcakesSenior Contributor03 Apr 2018, 4:16 pm AEST

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

Thanks @Phoenix_Rising
I may have to bow gracefully (or not) out of this discussion because trite platitudes can
Make me feel like shit,
Because I did know better, because I could see what was wrong but I still felt powerless to enact change, even when given the chance to speak up
Because I wasn’t one person, I was seven people.
That’s all...😞

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

AppleblossomSenior Contributor03 Apr 2018, 5:20 pm AEST

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

Congrats on your big Melbourne trip @Phoenix_Rising

They are good questions to ponder. I experienced 'when good men do nothing evil occurs', subtly all through my childhood, and it has taken me a long time to reflect on all the different social circumstances I have been in and consider things from an empowered adult point of view.

Differences between acceptance and approval are important and a good tool for me to take into further conversations in my life.

I find the idea of the standard you walk past is what you accept a bit OTT. To me arises possibilities of a lot of meddling or unecessary judgement. It all depends on circs. @CheerBear I dont like to witness abuse and sometimes will quietly get involved, if I think I can have a postive effect, but other times it is not appropriate. I also remember being hurt/ confused by the gaze of passers by when I was a little girl walking on the street with my parents.

@Sans911 I shared similar conversations with my brother and sister. In the end I have come to an acceptance of their suicides, but for a very long time, I was deeply upset by being told to accept, it just triggered the pain and grief. Seemed like people did not care. I am glad you are finding relief and meaning in the voluntary work you do. Partly it helped me putting into perspective our childhood experences and gaining a sense of our trauma load.

I am a bit long in the tooth and have now seen a few fashions in therapy pass by, but I really like the way the forum is engaging about DBT. Discussing rather than passively accepting it as the gold standard I feel too old for it, and it may have been great to have access to it 30 years ago , but it was not available ... I was glad to have access to the various therapies that I did, though also aware now that I was often retraumatised without realising. Clutching at straws for a long time maybe, but enough to make some sort of life raft.

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