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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)

WinterzSenior Contributor05 Apr 2018, 9:13 am AEST

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

I will look it up...

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

AppleblossomSenior Contributor05 Apr 2018, 10:12 am AEST

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

Thank you @Winterz Perhaps we can talk elsewhere on the forum as it is natural and feels right. Loss of your mother when young is a key issue. I agree that griefwork takes a lifetime. I have had more than my fair share. I have started a home thread called "Fragile" you are welcome any time.

I do not want to derail this thread from what I see as an important endeavour. I moved from laughter to tears in a day. Without me exerting excessive control on myself. Thats ok.

I also hope that people do not get side tracked by small differences in viewing what is therapeutic for them. I was wondering whether to delete my post but will let it stand for now and see what happens further with @Phoenix_Rising effort.

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

Unknown userMember05 Apr 2018, 10:21 am AEST

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

I don't know if DBT addresses conflict resolution @Phoenix_Rising but when you have external conflict and do not address it, you can still deal with the resultant internal conflict @Winterz, radical acceptance perhaps being part of it.

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

WinterzSenior Contributor05 Apr 2018, 1:48 pm AEST

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

@Appleblossom
(Sorry I don't know how to tag on this forum yet). Yeah wherever, whenever. I just thought I would offer my support because I understand somewhat and can empathise with those who have lost a loved one.

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

AppleblossomSenior Contributor05 Apr 2018, 2:14 pm AEST

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

I got that @Winterz and you were sensitive enough to respond to me rather than simply pass me by. A lot of people have done that and I do notice the difference. Wherever/whenever is fine. I actually had a great deal of loss that was never deal with in a timely manner by those around me. So the smallest acknowledgment these days is appreciated.

There are always going to be interpersonal stuff arising when there is more than one person ... it is naive not to realise that and it is not always bad. Early on in the forum I wanted to tease out these conflict resolution issues.

Form Norm Storm Perform .. is one approach

I tagged you to "Fragile".

To tag press the @ key and start typing in any names. On any thread most recent posters will automatically come up.

Start new thread by pressing aqua "new discussion" button.

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

Phoenix_RisingSenior Contributor05 Apr 2018, 2:56 pm AEST

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

Good afternoon DBT-ers,

It looks like there may have been a little bit of tricky communication happening around here last night. Oh well, that was yesterday and today is today. Yay for being able to start afresh every 24 hours (as opposed to if we lived on Venus, in which case we would have to wait 5832 hours for a new day to begin!).

@Winterz I'm wondering if perhaps the confusion between us is because you see DBT as focusing more on accepting a situation than on changing it. I totally agree that CBT ignores the whole idea of acceptance. However, I wouldn't say DBT focuses MORE on acceptance than change. Rather, it holds these things in tension - hence the dialectic. For example, Linehan talks about how we should accept that we are totally ok as we are right now, while at the same time, striving for change. The aim of the game isn't to put acceptance ahead of change, or vice versa, but to hold the two in tension.

I confess that I got VERY into DBT when I had to write an essay on it during the clinical psychology subject in my honours year. We had to choose a therapy and critically evaluate it. I super enjoyed delving into the research around DBT and that's what inspired me to buy the treatment manual and the skills training manual and read them for myself. When I get very into something, I do tend to then prattle on about it a lot, so I'm sorry if it felt like I had a "big reaction" to your post.

@Former-Member I really enjoyed reading your post. I totally hear you about needing to examine our motivations in wanting to take a stand. I also super agree that it is important to stay focused on the problem and not the person. The biggest stand I have ever taken was when I sued the church where I was abused. I tried again and again and again to work it through with the church leadership, but I kept getting a "no comment" response. After one final attempt, I knew I needed to choose between walking away, or commencing legal proceedings. I am very comfortable with the choice I made to sue them. It was so totally not what I wanted. What I wanted was to simply talk and to hear them say "we made a mistake and we are sorry." But given that wasn't possible, I am very ok with what I did. I wasn't angry with them, just very very sad. To me, it was a wrong that needed to be made right. The minister who I sued is the same man who I consider my father-figure. I still send him a birthday, Christmas, and Father's day card every year. The fact that I sued him doesn't negate the fact that I love him. My deepest wish is that one day our relationship will be healed, but I accept there is a near-zero possibility of this happening.

Taking a stand is SO HARD, and I will never ever understand why people can't simply talk things through.

Oh by the way @Former-Member, yep, DBT does address conflict resolution. The last module we will do is "interpersonal effectiveness." Given the rate we are moving at, we should get up to that module sometime in the year 2050.

@Teej Super big thank you for sharing your thoughts. I think maybe we aren't on quite the same page regarding what it means to accept reality (and that's a bazillion percent ok ). In your retail store example, I would see arguing that I shouldn't have to pay, as a failure to accept the reality of needing to pay. Having accepted the reality that I need to pay, my options are then to a) pay and receive the goods, b) not pay and not receive the goods, c) not pay and potentially get arrested for shoplifting.

Regarding the next bit, yep, I agree the reality could be that a person has been harmed by someone and as you say, we can't turn back time. Then, as you say, the person can choose how they will deal with the situation from that point on. It sounds like we agree there!

In instances where I have been harmed (e.g. the abuse I experienced at the church), the way people have responded to the harm has been a bigger issue than the harm itself. For me, the fact that the minister told me to "confess any sin involved, then put it behind you and move on" has always been a much bigger issue than the actual act of abuse. I think part of the reason I find this so hard is that this ISN'T something that is in the past. At ANY point, that minister could call me or email me and tell me he is sorry that he responded in that way. That would super help to heal the harm done. Alas, after more than two decades, methinks that is never going to happen. But yeah...I think I find it much harder to accept it when people persistently choose to take a "no comment" stance, because this can always be changed, at any moment, they simply choose not to. For me that is bewildering and heart breaking. We can't undo the past, but we can still take steps to heal it. I will never understand why it seems so hard for people to do that. But it is what it is - and that is what I need to keep working on accepting. I do not understand it, I do not agree with it, but it is what it is.

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

WinterzSenior Contributor05 Apr 2018, 4:46 pm AEST

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

Hi Phoenix Rising.
Well similarly I studied Psychology but with CBT as one of my subjects . I have also had intensive CBT therapy AND DBT therapy personally. So I surely must have learned something, I do wonder why you appear to keep trying to correct me and offer your own insights though, ....
Admittedly I was unaware of the CBT book by Marsha, but It's existence doesn't prove that DBT and CBT can be quite different in focus.
What I think might be happening is that you may be interpreting some of these ideas differently.
For example , You mention Marsha says change is important right? I never disputed that but I think she is probably referring to generally changing as a person NOT specifically a change of perception(the focus of cbt). You disagree that DBT is more about acceptance but the thing you might not realise is , I'm talking about more than acceptance of a thought (for example) . Acceptance in DBT refers to so much more than thoughts, It's acceptance of feelings, It's accepting and being in the present moment, as you would surely know,Mindfulness is a massive component of DBT and a big part of being mindful is just accepting your feelings, thoughts, etc without judgement. So I don't understand how you can not see the major relevance there for acceptance.. Anyway, this arguing is getting tiring and silly. It just feels like a silly ego contest , when it should be about supporting one another and stuff..peace

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

Phoenix_RisingSenior Contributor06 Apr 2018, 6:17 pm AEST

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

Hi @Winterz,

I'm hearing that perhaps I have caused offense in some way. I'm super sorry about that. I don't have any sense at all that we were arguing. From my perspective, I was trying to clarify what I was saying and also understand what you were saying. I'm really sorry if that came across as argumentative.

You are definitely not the first person to experience me as argumentative (and I seriously doubt you will be the last ). I'm afraid I don't understand what it is about me that makes me come across that way, so all I can do is apologise. Zoe7 made me a warning label for when I find myself in situations like this (which tells you something about how often I find myself in situations like this ).

I hope you have a great weekend.

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

skuapositiveContributor17 Apr 2018, 3:53 pm AEST

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

Nice guide and source of infomation.

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

Faith-and-HopeSenior Contributor17 Apr 2018, 4:02 pm AEST

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

How is our aspie turtle @Phoenix_Rising ....?

We know you don’t mean to be argumentative ..... it’s just very black and white for some people, and a bazillion shades of grey in between for others .....

👋 I’m a greybie.....

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