Let's do Dialectical Behaviour Therapy (DBT)

Hi @mentalstuff 🙂 It's nice to 'meet' you. Very cool avatar too!
I am wondering also, as Appleblossom mentioned, whether your psychiatrist may be using a number of techniques from different therapeutic orientations. My experience with mental health professionals has been that many base their practices on one predominant approach, but utilise tools and techniques from others in order to best work with their individual clients 🙂
We are hoping to start getting in to some of the specific skills soon and it would be great to see you join in if you'd like.

Hi @SGde3a. Thanks for sharing your thoughts and perspective. It's really interesting to think about the way different memories may be stored in our body, and how they can be triggered. I like the idea of practicing challenging some of these thoughts and reactions during times when we are not charged/aroused. I have found it to be really helpful to practice some of my tools and strategies when I don't need them, so I they are more effective when I actually do need them.
Looking forward to reading more of your thoughts if you share them.

Hi @Gypsy7. Nice to see you again 🙂
It's so great to hear that you found DBT helpful for you. I think that radical acceptance is going to be something that is really helpful for me also.
I think the idea of being patient with our learning is a really important point to keep in mind. One of the key messages in the reading I have done so far, is that practice is really important as it does take time to learn new skills (and probably unlearn old/unhelpful ones!) and then have them move towards becoming more automatic responses.
Hope you can join as we go, and share your thoughts and experiences (if you'd like)!

Hello to anyone reading along and welcome to anyone wanting to join in

It seems we have arrived at the very exciting "doing" part of this "Let's Do Dialectical Behaviour Therapy" adventure. While I am still not exactly sure how this "doing" will look, I am excited about it and ready to give it a go (even if I am feeling a bit nervous about starting). One of the great things about doing this here is that together we can work it out as we go

With that in mind, it makes sense to have some structure or content to follow, as there is so much in the manual we'd be here forever if we tried to go through it all. The plan is to follow the 24 weeks, Linehan Standard Adult DBT Skills Training schedule, encouraging and supporting each other to gain (and/or better understand) skills and ideas that may assist us through our journeys, and learning together as we go. I definitely have a lot of learning to do! As life has a way of throwing curveballs, it also makes sense to break the 'weeks' into 'steps' as this allows us to take this adventure slowly making sure that it doesn't cause unnecessary stress or pressure - because no-one needs that!

Just a reminder also, that you don't actually need to own a copy of the manual in order to join in and follow along. The worksheets and handouts are all available here https://www.guilford.com/companion-site/DBT-Skills-Training-Manual-Second-Edition/9781462516995. Even without the materials, I have a feeling there will be plenty to learn from each other's thoughts and experiences.

So this is a bit of a heads up post to anyone who might be interested, that (provided everything goes according to plan), the first step will appear here tomorrow and we can see where it takes us from there

Hi @CheerBear @Gypsy7 @SGde3a @mentalstuff @Appleblossom and anyone else reading along. I am super excited that we are going to start doing the doing bit tomorrow. I noticed that @CheerBear posted the link to the website where you can access all the handouts. I just wanted to add that you need to register on the website, which I know can sometimes seem scary. However, I have done it and it was completely painless (and free!!!!!). You just need to put your email address and a password in and hey presto, you're registered.

Only one more sleep until we start doing the doing bit! I'm super excited.

Hi everyone! Let's jump straight in

Orientation, Goals and Guidelines

The first step in the 24 week schedule is an orientation to DBT including a discussion of the general goal of skills training (which can be found in a post here) but to recap is "to change behavioral, emotional, thinking, and interpersonal patterns associated with problems in living".

This step has three handouts:

G1: Goals of Skills Training

This handout enourages us to consider how we can benefit from skills training and what we may be interested in learning personally.

A number of "behaviours to decrease" are presented in this handout as possible goals and we are asked to select those that may be relevant and/or cross out those that are not. They are:

⦁ Mindlessness, emptiness, being out of touch with self and others, judgmentalness
⦁ Interpersonal conflict and stress, loneliness
⦁ Absence of flexibility, difficulties with change
⦁ Up-and-down extreme emotions, mood-dependent behaviour, difficulties in regulating emotions
⦁ Impulsive behaviours, acting without thinking, difficulties accepting reality as it is, willfulness, addiction

There is also a list of "skills to increase" which we are asked to consider. They are mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance (the modules which you can also read about here).

However, it is mentioned that these goals can be adapted and developed to suit the group and individual clients. As the forum population is so diverse, it may be useful to consider and share our own personal goals, which this handout also asks us to do. We are asked to consider our own personal goals of skills training in terms of "behaviours to decrease" and "skills to increase".

Worksheet 1: Pros and Cons of Using Skills accompanies this handout. This worksheet asks us to consider the pros and cons of practicing skills, as well as the pros and cons of not practicing skills. To do this we are asked to describe a situation or problem, our goal in this situation, and then list the pros and cons of both practicing and not practicing skills. While it may initially seem like doubling up by focusing on both the pros and cons of both options, often it is not and a tip we are given to make this more of an effective approach is to focus on what does rather than does not happen for each option when writing our list.

G3: Guidelines for Skills Training

In a typical skills training group, guidelines relating to attendance, confidentiality, in-session discussions, and relationships are agreed upon in order to allow the group to run smoothly. There is also an opportunity to add these guidelines.

While our group is not exactly a typical skills training group (and therefore some of the guidelines are not relevant and do need adjusting), we have community guidelines available here that we need to be aware of and follow. In addition to our guidelines around anonymity, we have guidelines that pertain to safety and respect, all of which are included in skills training orientation.

G4: Skills Training Assumptions

While guidelines are standards of behaviour, assumptions are beliefs and the last handout for step 1 is a list of the assumptions that underpin DBT. These are:

* People are doing the best they can
* People want to improve
* People need to be better, try harder, and be more motivated to change (with a note to say that this is not always true, particularly in cases when people are making progress)
* People may not have caused all of their problems, but they have to solve them anyway (with a note that this is also not always true, especially in the case of children, adolescents and some people living with a disability/ies)
* New behaviours must be learned in all relevant contexts
* All behaviours (actions, thoughts and emotions) are caused
* Figuring out and changing the causes of behaviour works better than judging or blaming

That might be a lot to take in (it was for me!). If I was reading along at the moment, particularly if I was new to the forum, I think I'd be feeling a bit overwhelmed or unsure about where to start, or questioning whether I even if I wanted to join in. If there is anyone out there feeling this way that's totally ok and I highly doubt you're alone . You're more than welcome to say a simple hi, introduce yourself, or share any other thoughts you may have. You could also dive right in and share as much as you'd like in bits and pieces or all at once. I don't think there will be a 'wrong' way of doing this (bearing in mind the community guidelines ).

Some questions to consider and discuss that may be relevant to this step are:

⦁ Are there any goals you have in mind or hopes you have in participating (in whatever way that may be) in this 'adventure'?

⦁ Is there a set of skills (module/s)that you are most interested in exploring and learning from?

⦁ What may be the pros and cons of using and not using skills for you?

⦁ Are there any additional guidelines you feel might be relevant for our group here in the forum?

⦁ Do you have any thoughts on the assumptions? Are there any that sit more comfortably with you than others?

If anyone has any they'd like to add, please do so!

That's it from me for now. I will share my goals, pros and cons list and some other thoughts in another post soon.

Thanks for reading, looking forward to hearing from you and happy adventuring!

@@Sherry and again. I'll leave you alone now.

@Former-Member .....

Thanks @Maggie, I will have a read. Thanks @Faith-and-Hope

Hi @SGde3a @Gypsy7 @mentalstuff @CheerBear @Appleblossom and anyone else floating around.

@mentalstuff I super like your avatar. We started off this thread with an introduction to DBT. Was that helpful in giving you a sense of what DBT is all about? If you have any more questions about it definitely just jump right on in and ask them

Ok, so it seems like we are up to the actual doing bit of this adventure now, thanks to CheerBear. I think I'm going to start doing the doing bit by reflecting on what CheerBear has written...

Behaviours I would like to decrease

I would superly duperly like to reduce the amount of interpersonal conflict I seem to get myself into. I spend most of my time not being able to either make myself understood or understand what others are saying. Consequently, I get into a LOT of social muddles.

I would also super like to be able to cope with change better.

However, the biggest thing for me out of that list that CheerBear gave us is definitely emotion dysregulation. I would oh so badly like to not get such big feelings. I am curious to know how others experience emotion dysregulation. For me, big feelings are intensely physically painful such that I will drop to the floor and just start screaming with the pain of it at times. I also make a lot of weird noises (which would more formally be termed verbal stimming). When I'm in that level of distress, I will also often engage in a particular form of SH as a means of dealing with the pain. To me, these behaviours are not the thing to be "fixed." The thing to be fixed is the emotion dysregulation that drives them. To me, the behaviours are simply a consequence of the cause, which is the emotion dysregulation.

Skills to increase

I super want to get better at all four of the DBT modules (mindfulness, interpersonal effectiveness, emotion regulation, distress tolerance). I guess that's why I've embarked on this adventure.

Skills training assumptions

I really like the assumptions that DBT is based on. This is because they are SO different to the assumptions that most people have about those of us with BPD (and probably about people with mental health issues in general too). I particularly like the assumptions that people are doing the best that they can and that they want to improve. So many people across my life have told me that I'm demanding and manipulative and utterly selfish and difficult and annoying and exhausting to be with and scary. It hurts so much because I know in my own heart that I really am always trying my very best - even when my very best looks like utter chaos to those around me.

I have to say, I think in a "real" DBT group, the facilitator would have to be very sensitive in the way they discussed the idea that people need to be better, try harder, and be more motivated to change. I like that CheerBear included the note in there clarifying that statement. I don't know about anyone else, but that statement does not sit well with me. As I said, I know I am always doing the very best that I can. Methinks I would not respond well if a therapist said that statement to me.

My ultimate goal is to gain and sustain employment and thereby get off welfare. Right now I'm not entirely sure how realistic that goal is, but it is still the goal for now. I know that the two biggest barriers to me being in employment are the way I struggle to communicate effectively in face-to-face interactions and the very severe emotion dysregulation. Thus if I could fix that, that would be super.

Ok, well those are my thoughts. I will probably write some more over the next couple of days, but I think that will do for now.

Emotional dysregulaion.Its great the detail and care that you both bring to this discussion @Phoenix_Rising @CheerBear

@Phoenix_RisingSome of your stimming behaviours remind me of my primal therapy days where lots of emoting was encouraged but within therapuetic confines. Or my bedroom, but when grief set in I did not have reasonable control for over 20 years I was very LEAKY and exhuasted.

I am just going to have a little whinge about Emotional Dysregulation.

I hope it is relevant and not too long.

I am also a classical musician and pianist. We get to develop a lot of self control, depth, and quick changes of emotion. Teaching we need to be sensitive to see the feelings of others.

One psychologist started slipping into our sessions ... you are angry ... or ... you can be more authentic ... into our sessions without better nuanced discussion than that .. I had contained many emotions that did not mean I was not authentic about expressing myself. I was a good girl and continued sessions but ....she lost my respect. I had had plenty of discussion both admitting and channelling my anger and it seemed petty. She had not even as many quals or children as me but she was charging $100 to sit in a fancy room and have me open my soul .. for what ... it was a discount, but still costing me $30. I started thinking what the hell are they being paid by Medicare for. I saw her for 3 years and hoped she would work with me and help me nut stuff out. Nah. She simply did not have the equipment.

I pleaded with my GP to refer me to a psychiatrist so I could have more intelligent conversations. He knew me well, we could joke about maths together. He was wary and resisted warning me about all the new psychiatrists settng up new clinics in the area. He did not want me to get lost in their INDUSTRY. He became sick and no longer practises, but I was grateful to his medical protection of my son and I. I was desperate when I joined the forum as the doctors kept moving around.

My point is that I can access many emotions in many ways. In reading Shakespeare. We need to depth. In singing and playing we need to depth. It is in the depthing that we regain our primal energies that are so essential for a spiritual connectedness and enjoyment in life. I am sure many on the forum can do similar things. I had been very open. I was shocked with her "slap in my face". Now I feel I should be able to choose who I show what and how much to. (Apart from forum readers ... they know all my secrets.)

I really like the steps and discussions in the DBT workbook, but I think that SO many out in the community who consider themselves normal could benefit from the work too.

Then you might have less social muddles, @Phoenix_Rising

You guys have the equipment. Pleasure to know you.

My social muddles could be fixed if others read this stuff more. I am going to start being ruder .. lightly ... but letting out verbal snippy comments when it seems appropriate to ME and not being so naive or nice.

Thanks for reading.

Apple