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Looking after ourselves

Phoenix_Rising
Senior Contributor

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. Smiley Happy

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. Smiley Happy

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. Smiley Happy

And on that note, let the adventure begin... Smiley Very Happy

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. Smiley Happy

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

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

 

381 REPLIES 381

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

Woohoo @Phoenix_Rising 🙂 Thanks for creating a space for this adventure.

 
I will have a think of where I will start with sharing this adventure over the course of the day, and then probably pull out my laptop to write a kick-off post later.
 
Yay and thanks again!

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

@Phoenix_Rising Little Phoenix is ready to read... Smiley LOL (Zoe not so much Smiley Sad)

@CheerBear if you are wondering who Little Phoenix is - yesterday when I was out I was thinking about our little turtle and what a muddle she was in and there in front of me was this little green turtle - so what else was a little flutterby to do but to buy it and bring it home to look after. Little Phoenix is going to navigate this journey with me - a bit like having my very own Little Turtle right here helping me through Smiley Wink

DBT and Phoenix.jpg

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

I do remember seeing a little phoenix yesterday, but being that I was in a muddle myself I don't know if I clicked like to show you that I love the idea that you too have a little turtle @Zoe7. Very cool.

Have to get going now and get off on a fish adventure. Hope today is better than yesterday was for many.

Super cool that you're joining in too (in whatever way you want/can).

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

Little Phoenix is going to accompany me on my 'adventures' here @CheerBear - just need to get her a little rainbow friend and then both you and @Phoenix_Rising will be right here helping me Heart

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

Good evening, Smiley Happy

Alright adventurers, I have read the first three pages of the introduction, up to the end of the heading "The dialectical world view and basic assumptions." My goal is to write something about this tomorrow morning. Wow, I'm up to page 5 already. That means only another 499 pages to go!!!!! Smiley LOL

By the way, I super love the picture of Little Phoenix with the DBT manual @Zoe7 Smiley Very Happy

 

@Zoe7 @CheerBear

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

Little Phoenix will help me to hopefully start reading tomorrow @Phoenix_Rising - not up to it tonight Smiley Sad 

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

Good morning DBT adventurers. Ok, here is the first bit of the DBT story...

What is DBT?

DBT is SUPPOSED to be a very comprehensive therapy involving group skills training (which is the bit we are playing with here in Forum Land), individual therapy, telephone coaching and a therapist consultation team (i.e. therapists are supposed to have the support of other therapists who are collectively supporting the client). However, I know I have expressed my frustration more than once in Forum Land over the fact that in my experience, most therapists who SAY they do DBT actually only do the skills component. I think the skills are extremely valuable (hence this thread) and indeed, there is a bit of research floating around that indicates the skills alone can super help some client populations. However, it still seems quite clear that for people with very complex muddles (like mine and like that of many other Forumites), the skills alone are never going to actually FIX the muddle. Thus it seems to me that because a lot of therapist reduce DBT to only the skills component, a lot of people with complex muddles are condemned to only ever "cope" rather than "get better." This is a reality that I find crushing and that I still super struggle with. Smiley Sad

The dialectical world view and basic assumptions.

At the start of a DBT adventure, it kind-of makes sense to clarify what is meant by "dialectics." Smiley Happy Ok, I'm going to TRY and summarize what Linehan (2015) says in this section. Now is probably a good time to mention that summarizing isn't one of my strengths - EVERYTHING seems superly duperly important to me. But I will try... Smiley Happy

According to Linehan, there are three key characteristics of dialectical perspectives on the nature of reality and human behaviour:

First, dialectics stresses the fundamental interrelatedness or wholeness of reality. In other words, the whole is greater than the sum of its parts. So in DBT, we super focus on individual thoughts, feelings and behaviours, but at the same time, these are contextualised within the whole framework of the person and their environment. I like this bit that Linehan says; Learning behavioural skills is particularly hard when a person's immediate environment or larger culture do not support such learning (p. 4). To me that validates the reality of so many people; that often the environment is not conducive to healing. However, this isn't an entirely pessimistic story because one of the modules of DBT is "interpersonal effectiveness" which is all about learning skills to shape one's environment to make it more conducive to healing. Smiley Happy

Second, reality isn't viewed as static, but rather, it is viewed as being made up of opposing forces which are constantly pushing against each other and thus shaping a new reality moment by moment. According to Linehan, dichotomous and extreme thinking, behaviour, and emotions are viewed as dialectical failures. I'm not entirely convinced on this point. I think it can SOMETIMES be true, but my personal view is that in a lot of instances things really are much more black and white than is allowed for in our post-modern society. I've spent my entire life being told that I'm "too black and white." I don't actually think I am...but then I'm diagnosed with both BPD and ASD, and black and white thinking is a core feature of both of these diagnoses, so what the heck would I know. Smiley Very Happy Secretly though, these days when people tell me I'm being too black and white, I think to myself, "yeah...or maybe you are just seeing a whole lot of grey that isn't really there." Smiley Happy

Having said all of that, Linehan identifies three areas in which black and white thinking can make DBT skills training difficult: a) The need for the client to totally accept themselves as they are right now, while also recognising a need to change, b) The need for the client to work towards becoming competent, while recognising that once they are competent, the support they get from the therapist will end, c) It is likely that as the client gets better at using the DBT skills, they will feel validated that their struggles had been due to a lack of skill and not because they had been trying to be manipulative or hurtful to others (which is what other people may have told them). On the other hand, people in the client's environment are likely to use the client's improvement to validate their own view that the client was "the problem" all along.

I find this stuff tricky. For example, it is super hard for me to understand the concept that I'm ok just as I am...but I need to change. That doesn't make sense to me at all. I would be super interested in hearing what others think about this.

The third key characteristic of dialectical perspectives that Linehan identifies is that the fundamental nature of reality is change and process rather than content or structure (p. 5). That is, she thinks change is a good thing. Yeah...I'm not a fan of change. Linehan says, therapy does not focus on maintaining a stable, consistent environment, but rather aims to help the client become comfortable with change. I would SUPER love to find a therapist who could help me become comfortable with change!!!! Reading this caused me to reflect on whether the autistic experience of struggling with change is quantitatively different or whether it is qualitatively different to the neurotypical experience of struggling with change. That is, does it differ only in strength, or is it a fundamentally different experience? I don't know the answer to that and I would super like to find someone who could help me unpack that puzzle.

Wow, that was really long and kind-of intense wasn't it. Don't worry, there are only 499 pages left to go in the manual. Smiley LOL If it helps, there are only 13 pages left in the introduction, and then we get onto the actual doing bit...unless @CheerBear super busting can't wait and just dives in right now with what she has been playing with in the manual...and that would be a bazillion percent ok. Smiley Very Happy

 

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

CheerBear is super busting to share where I am up to, but has been quietly waiting in the background knowing that you were always going to do an amazing job at capturing the really important other bits in a way that I couldn't have done. You have done awesomely @Phoenix_Rising. Thank you for sharing all of what you have.

 

I have a heap of thoughts on all of this so I am setting myself a challenge of the day to take them from my head where they kind of look like this:

9-05-00-1.png

To paper, where I hope the process and outcome will look more like this:

-09-07-25-1.png

 

Today is a quiet home day before a few very not quiet out days, so I really want to do this today. Let's see how I go 🙂

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

I've split my reply in 2 parts, partially because I think it makes sense, and partially because it would be a novel otherwise (and also because I have been so slack with housework today and need to break up my little 'rewards' for jobs completed).

I thought I would start my part of sharing this adventure with a little about how I started once my book arrived, and why I am off on this adventure, as maybe it will help anyone reading along but feeling a bit intimidated by this (as I seriously did when the book first arrived).

The book is organised in a way that has two parts - the first being a heap of information about DBT with an emphasis on how and why to conduct DBT skills training. Part 2 of the book are the "teaching notes" for the modules of DBT. The modules are what I feel are 'meaty parts' of the DBT sandwich, though to make the sandwich there are other very important ingredients, like the underlying assumptions of DBT that @Phoenix_Rising has written about. As mentioned in the first post of this adventure, all of the worksheets, handouts and teaching notes are online and easily available for download, making pretty much the whole second part of the book available, which means it might not be too hard for anyone to join along in this adventure if they'd like. I think it would be really cool to for others to join in too, but like you are phoenix_rising, I am happy playing along on my own as well.

I got a bit (a lot) tripped up when my book first arrived because of the sheer volume of it, especially when combined with the additional resources that accompany the book. It took me a while to work out exactly how to approach all of the material. I began by working my way through the reading of part 1, then planned on working through a list of certain skills in a particular order, but I am now working my way through part two in the order it is in the book. This is likely to change soon as I really want to get to a certain part of the skills but for the moment, it is where I am at. I have also decided to use a lever arch folder to store all of the handouts and worksheets (which I am printing off module at a time), a smaller easier to carry folder with the worksheets I have selected to use myself, and a note book that I am taking and keeping lots of notes and reflections in.

As for my rationale for setting off on this adventure, I've realised (a lot due to spending time in forumland), that many of the strategies and coping skills I use are/are similar to/are based on DBT skills. This is perhaps a combination of years of working with a CBT psychologist with an interest in DBT, the study I have done and the people I have been around. I want to understand the skills more and refine them, so I can more effectively use them. I really hope to gain a better awareness of what skills may be helpful in what contexts, as I feel it is one thing for me to have a big box of skills, and another for me to understand what may work best and when. I am also keeping a copy of all of my material as I think this could also be a really valuable resource for my working life one day as well, especially if I have practiced and lived the skills myself.

Now that part is done, I will add my thoughts about the introduction a bit later (as a reward for doing the rest of the housework I don't want to do).

Oh also - here's a link to a sample chapter, which happens to be the introduction chapter if anyone wants it

https://www.google.com.au/url?sa=t&source=web&rct=j&url=https://www.guilford.com/excerpts/linehan7.p...

🙂
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