About Dialectical Behavior Therapy
DBT uses four skills modules to help clients cope more effectively with intense thoughts, moods, emotions and behaviors. They are mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.
How to Get the Most Out of Therapy
Good therapy is “we” — a collaboration between client and therapist. The therapist is responsible for creating an environment for change to happen. This is an intentional practice that requires a foundation of formal education and years of supervised experience in order to be effective. The client is responsible for showing up and being willing to change and grow.
What is Dialectical Behavior Therapy?
The Bottom Line
Very simply, Dialectical Behavior Therapy, or DBT, is about learning to live a balanced life. More technically, it is an evidence-based therapy designed to help people manage intense emotions, impulsive behaviors and difficult relationships. It was originally developed to help individuals who were suicidal or self-injured, but since then we have learned that DBT skills can help people with a lot of different problems, including those with addiction, eating disorders and emotional dysregulation. DBT skills are practical strategies to help people settle down, communicate more effectively, tolerate distress or discomfort, and better manage their emotions. DBT skills fall under core areas:
Mindfulness – Mindfulness skills teach us to be fully present in the current moment and help us learn to non-judgmentally observe what is happening in and around us.
Distress tolerance – Distress tolerance skills help us to “bear pain skillfully.” They help us manage our emotions and behaviors when we don’t get what we want, or can’t get our needs met right away. These skills are also thought of as “coping skills.”
Emotion Regulation – Emotion regulation skills are those that help us manage our internal and external circumstances, and keep us from being vulnerable to stress and pain. These skills involve getting enough rest, taking medications, eating right, exercising, etc.
Interpersonal Effectiveness – Interpersonal effectiveness skills enable us to communicate our feelings and needs to others in an appropriate and effective way. These skills can improve our relationships and help us feel more connected to other people.
DBT Skills can be taught in individual and group settings. Ideally, people who need to learn these skills will have an individual therapist and a group in which to learn and practice. Generations Counseling Services offers a group in their Greenwood, Indiana office. For more details, call us at 317-743-8202, or email us at: [email protected].
Digging Deeper
While you may not be familiar with Dialectical Behavior Therapy, or DBT, you may have heard of Cognitive Behavior Therapy (CBT). The basic idea of CBT is that our thoughts, feelings and behaviors are interrelated, and if we change one, it will impact the others.
Individuals who use CBT learn to identify negative thinking patterns and core beliefs (called schemas) and then find ways to behave differently. Or, a person decides to behave differently (“fake it ‘til you make it”). These new behaviors create better feelings which result in more effective thinking. Regardless of the order, new ways of thinking and behaving inevitably have an impact on the way we feel.
Here’s an example: let’s say I’m in bed at 6am on a rainy Monday morning. I lay there thinking about how busy my day is and how much I hate the rain outside. I think about how hard it’s raining and I start feeling depressed. The more depressed I feel, the deeper I burrow under the covers. The more I burrow, the worse I feel. The cycle could continue all morning, but let’s say I pick up my phone and read a text message from my Aunt Martha, who’s been confined to bed for a couple weeks. I start thinking about poor Aunt Martha, and my attitude shifts. I think about how grateful I am to be healthy, and how happy I am that both my legs work. I look outside at the rain and think about how green the grass is going to get and how much I enjoy hearing the pitter-patter on my window.
That shift in thinking motivates me to sit up and plop my feet on the floor. I decide to take a shower, and before I know it, I’m feeling more hopeful and positive about my day.
Changing my thinking from dread to gratitude gives me motivation to make a small change in my behavior, which results in a drastic improvement in my feelings. This is an over-simplification, of course, but it is CBT in a nutshell.
DBT is a cousin of CBT. It was originally developed to treat chronically suicidal individuals, many of whom were diagnosed with Borderline Personality Disorder (BPD), and has since become the gold-standard treatment for this population.
How it all began
In the late 70s, a psychologist named Marsha Linehan worked with young women who suffered from chronic suicide attempts, suicidal ideation, and non-suicidal injury (she would later realize these women met the criteria for BPD). Although she was a behaviorist who used the prevailing CBT model at the time, she found traditional treatments to be extremely ineffective for these individuals. They seemed to be getting stuck on the idea of change. This is a problem, because traditional psychotherapy models are focused on helping the client create inner change, which hopefully results in external change. However, when Linehan’s clients were challenged to change their perspective, they reacted by becoming angry or dropping out of treatment. Linehan eventually found that the focus on change was invalidating. Linehan defines invalidation as a childhood environment in which caregiver’s response(s) ignore, minimize, or punish a child’s inner emotional experiences.
Validation is a big deal, because Dr. Linehan found that individuals diagnosed with BPD typically grew up in invalidating environments. (Invalidation can encompass physical, emotional and sexual abuse and neglect, as well as a lack of connection with caregivers. Invalidation can be real or imagined – we know that if a person doesn’t perceive his or her environment as validating, the damage can be just as significant.)
Imagine then, if a therapist (or therapy modality) is invalidating, such as Linehan found CBT to be, the clinician may actually be re-playing childhood trauma in the very environment where the person is supposed to receive help. For obvious reasons, this is not good.
In addition to the invalidation, Linehan also realized that there were some complicated dynamics between the therapist and client. When clients didn’t want to do something, they found a way to get the therapist to “let them off the hook.” Maybe the client would say the work was too difficult, or that no one understood them, or would simply change the subject. Unintentionally, the therapists would stop focusing on change, then the clients would go on having all the same problems. Since chronic suicidal thinking was one of their problems, this was a big deal. In addition to suicidal thinking, Linehan’s clients had a host of other problems as well, and CBT seemed to lack the depth to help them find workable solutions to all these issues.
Thankfully, instead of giving up on these challenging cases, Linehan took the very effective behavioral components of CBT and added two critical concepts: acceptance and dialectical thinking.
Acceptance refers to accepting things as they are, not as we want them to be. It involves learning to accept things we can’t control and accepting the need to change. It also requires a person to learn to be more self-accepting. Practicing self-acceptance, it turns out, is quite validating, and can be a doorway to change.
Dialectical thinking is a philosophical concept that refers to the process of finding truth between two seemingly opposed ideas. Simply put, dialectical thinking allows a person to find a balance between two things that seem like opposites. For example, I can be angry with my best friend for forgetting my birthday, and I can also feel a deep fondness for her at the same time. While these feelings feel like opposites, there are kernels of truth in both. (This is important, because people who have trouble regulating their emotions often think in very “all-or-nothing” ways – they either feel “angry” or “fond of”. It is very difficult for them to feel both, and in fact, trying to manage these opposite feelings tends to create a lot of anxiety.)
Linehan brilliantly integrated acceptance and dialectical thinking into the existing CBT model and created a new treatment model that teaches individuals to think more flexibly and look for ways to solve their own problems.
If you are looking for ways to better manage your emotions, your behaviors and your relationship, DBT may be a great therapy for you. Don’t hesitate to call or email us if we can help.
Need more? If you are feeling stuck and need some outside help in managing your communication, emotions, or relationships, our team at Generations
Counseling is available! Give us a call at 317-743-8202 or email at: [email protected] today.
Photo by Martin Sanchez on Unsplash
Let’s Talk: the Last of our Five Part Series on Better Communication
“I have never told anyone this before…”
“I’ve always wondered if it was my fault.”
“I didn’t think it was a big deal.”
“I wasn’t sure anyone would believe me.”
“I was ashamed…”
“I was embarrassed…”
“I can’t imagine anyone finding out about this…”
It may or may not surprise you to know how often I hear these words uttered in my office. Men, women, children, adults. Age and gender don’t seem to matter. Over and over again I hear the quiet and painful stories of abuse, bullying, name-calling, molesting and more. Secrets people thought they would carry with them to the grave. Things long-buried, semi-forgotten, hidden in the shadows. But then — for no explained reason — these memories intrude upon their lives in the form of flashbacks, nightmares, nausea, fear. Events that cause them to hide from others, numbing their pain, or worse, lash out at ourselves or someone else.
A lot of people think they can handle it, that it’s not a big deal, that they can work through it, or have worked already through it. They don’t want to burden people that love them. They don’t think others will understand. They wonder if it was their fault.
This is not a political post, and I’m not offering opinions about the recent developments in the Christine Blasey Ford testimony, except to say that our inability to talk about terrible things creates enormous personal and societal problems. I can’t help but think how much pain and suffering could be avoided if our culture allowed us to talk about problems when they happen — not decades later. I wonder what our world would be like if girls and women and boys and men could speak up when they are abused or mistreated. If people could be empowered with the tools to care for themselves and others in a timely and healing way.
For a society that is wired and connected and inundated with loads of information, we sure do a terrible job at talking with others about the things that matter deeply to us.
One way you can do this is to be intentional about creating an atmosphere of communication with the people you care about.
Put the phone down. Use current events, television shows and books as springboards for deeper conversations. Be spontaneous as well as scheduled. Carve out time for just being together and put it on your calendar as you would any other important event. Talk over shared activities. Build a fire. Keep board games in the family room. Ask open-ended questions. Good communication takes time — be intentional about investing this time in your loved ones.
At Generations Counseling, we want to support you in your efforts to connect with the important people in your life. To help move all of us toward more talking, more listening, and more helping, we are launching a new event called Second Tuesdays. Beginning November 13, on the second Tuesday of each month, we will host a discussion on events that are important to our mental health and our local community. Our goal is to give people in schools, workplaces and families the tools and information they need to have important conversations.
Our first topic is Family & Politics: Tips for Surviving the Holidays in a Hostile Climate. Yikes, I know. It’s a tough one. But we need to talk about it. We will be offering tips and strategies for navigating relationships with people we may love, but don’t agree with. We share ideas for learning to communicate more thoughtfully, more helpfully, more respectfully, and hopefully help avoid some of the family drama that always seems to accompany the holidays.
This is a free event, open to the public. We would love to have you join us.
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P.S. To sum up all the info in our communication series, we’ve created a free download.
To get yours, click here.
Need more? If you are feeling stuck and need some outside help in managing your communication, emotions, or relationships, our team at Generations Counseling is available! Give us a call at 317-743-8202 or email at: [email protected] today.
Another Simple Thing You Can Do to Have Less Conflict & Better Relationships (Communication, 3/5)
Have you ever found yourself in a ridiculous conversation that devolved into a completely irrelevant topic — so much so that you couldn’t even remember what you were arguing about in the first place?
Yes. Yes you have.
Joe: I told you on Tuesday that we had this dinner appointment — you never listen to me and now we are going to be late!
You: You did not tell me on Tuesday! 10 minutes ago was the first I heard of it.
Joe: I distinctly remember telling you. You had just hung up the phone with your mother and you were mad at her which is why you didn’t pay attention to a word I said. You never pay attention to me!
You: I didn’t even talk to my mother all day on Tuesday. The last time I talked to her was on Sunday, and I know that’s true because she called me yesterday and she said she hadn’t talked to me for three days.
Now. What was the problem?
It happens so often, this conversation pattern is a ‘thing’. I’m not sure what the experts call it, but I call it exhausting.
It’s so easy to do. We find ourselves sucked into purposeless conversations that leave all the parties completely worn out and unable to address the real problem.
So many families/couples/individuals come into my office and simply say, “I’m tired. I’m exhausted. We have the same conversations, over and over, and I can tell you exactly how they’re going to go.”
I don’t have a magic wand for this one, but I can share a tool with you that you may not have tried.
Seriously. It will be so easy you will wonder why you didn’t think of it. (You didn’t, because you’re tired.)
The way to work smarter instead of harder in communication is simply this:
Focus on the process, not the content.
What do I mean by that?
Let’s look at the conversation you and Joe just had.
Joe: I told you on Tuesday that we had this dinner appointment — you never listen to me and now we are going to be late!
You: You did not tell me on Tuesday! 10 minutes ago was the first I heard of it.
Joe: (because he’s done a lot of work in this area he can now say…) Well, I thought I told you Tuesday, but maybe I just imagined it. Anyway, I’m feeling frustrated now, because it really means a lot to me to introduce you to my boss, and now I’m worried we’re going to be late for dinner.
You: (because you’ve been reading this blog you can now say…) Shoot, I am really sorry. I’ve been looking forward to meeting your boss, and I definitely don’t want to make you late. How about you drive and I’ll put some makeup on in the car?
And later….after dinner….you can say, “And Joe, you know earlier, when you said I never listen to you? I felt really defensive after that, because even though I know I sometimes tune you out, the word ‘never’ really gets to me, because I can think of times that I do listen to you. I feel like you make generalizations when you’re angry and everything I’ve ever messed up on in our relationship gets thrown in the pot…”
And so on.
Now I know this isn’t magic, but it does work. I can tell you that it works, because I’ve done it myself, and I’ve taught my clients to do it as well.
Focusing on the process over the content ignores the “who, what, where, when” arguments that we seem to be determined to have. Those arguments that make us feel picked apart and exhausted. The ones that get us no where and leave us feeling like every conversation we have is the same song, second verse.
By focusing on the process (Use the formula: “When you…I feel…I need….”), we give the other person a little more space to think through what they feel and they need, rather than putting them on the defensive and trying to figure out how to prove us wrong.
Process communication focuses on what’s happening beneath the surface, not the minor, annoying details. Process communication gives the people we care about a chance to catch their breath, and gives us a chance to be heard. It’s subtle way of doing things differently. Instead of driving endlessly on a country road trying to figure out where we’re going and how we’re going to get there, process communication provides a map — a sense of context and a destination.
All the parties involved may not agree exactly on how to get there, but at least there’s a reference point.
The hardest part about doing process communication is that we have to do two things at once:
- we have to focus on how we feel, on how the interaction is affecting us and
- we have to step away from that emotion and share it in a non-defensive, grown-up way
There’s actually a third thing. We also have to be aware of what we need, and learn to ask for that in a way that doesn’t put the other person on the defensive.
In process communication we have to let go of our right to be right, and focus on the other person’s right to be heard. We have to validate the other person’s feelings as valid — not because we understand them or agree with them, but simply because another person has them.
Now I know this is easier said than done, but if you have had the same conversation over and over again only to land at the same place, it might be worth a shot to do things differently.
Need more? If you are feeling stuck and need some outside help in managing your communication, emotions, or relationships, our team at Generations Counseling is available! Give us a call at 317-743-8202 or email at: [email protected] today.
Stop Fighting. Start Communicating: #1 in a 5 Part-Series on Really Improving Your Communication
Joe and Suzy have been married for 15 years. Lately, Joe has been spending more and more time at work, and Suzy says he’s being a selfish workaholic. She even wonders if he is having an affair. Joe agrees — he has been spending more time at the office — but he says Suzy’s nagging and complaining has left him with no other choice. Joe says the office is just a welcome respite from the strife at home.
Sure, Joe and Suzy have a marriage problem, but more specifically, they have a communication problem.
In relationships, communication is everything. And as you well know, communication isn’t just what we say, it’s how we say it. It’s also what we don’t say. As therapists, we are trained to look at and interpret non-verbals — but let’s get real — if you have a relationship with anyone in your life, you are probably pretty good at cueing in on those non-verbals as well.
Improving communication is a worthy goal; however, it is MUCH easier said than done.
But don’t lose heart–it can be done. Over the next couple weeks, I’ll be sharing a 5 part series with some really practical tips that you can begin using immediately to improve your communication with your spouse, your kids, your boss, or anyone else that is driving you nuts.
One of the biggest problems with talking to other people — especially talking to people we love about issues we care about — is those pesky things called “emotions.” Have you ever started a conversation with the intent to be calm, cool and collected, only to have the whole thing devolve into a ridiculous argument in the matter of seconds?
You’re not alone. The problem is your emotions. When we imagine ourselves calmly talking about a difficult topic, we often fail to factor in the possibility that we are going to be “triggered” by the other person’s verbals or non-verbals. Even a slight tilt of the head, the smallest roll of the eye or the teeniest hint of a sigh can send us reeling and completely derail our communication.
The reason this happens is probably about the past — you have either experienced this same scenario with this same person a hundred times, or, you have experienced the same scenario with a DIFFERENT person a long time ago. Our brain doesn’t really stop to evaluate the current scenario. With that one little cue, our brains scan our memory files for every other time in our lives we encountered tilted heads, rolled eyes and testy sighs and responds to all of those events all at the same time.
This is called “flooding” — our systems become flooded, or overwhelmed with emotion, and we start thinking all kinds of things and drawing all sorts of conclusions about why this time or this person is just like all the others. Then, rather than reacting to what is actually happening in the current moment, we react to what we think the other person is thinking, feeling or doing.
And that’s really where communication breaks down.
So my first tip in improving communication is this: change your PERSPECTIVE. When we lose our cool in conversations, it is very likely that we have also lost perspective. We are either flooded with memories from the past, or catapulting ourselves into some horrible outcome in the future.
Taking on a new perspective involves some practice and self-discipline, so don’t get discouraged if it doesn’t come naturally. Here are some things you can try:
1. Focus on the big picture – what does this person mean to you? How would you feel if you knew this was the last conversation you’d ever have? What are your long-term goals for this relationship?
2. Focus on what you have in common – you and your spouse may not agree on how to discipline the kids, but you do agree that you want them to learn from their mistakes, or that you want them to grow up to be productive adults. Rather than zeroing in on the areas where you disagree, look for the things you both want.
3. Think about when you have been successful in the past – If this is a long-term relationship, try to think about times in the past when you have had productive conversations with this person. What went well? What was different about that time? Did you do anything differently? If this is someone with whom you don’t have a history, think about times in the past when YOU have been effective in your communication. What did you do that was so useful?
4. Think about how you would like to feel about this tomorrow – When you look back on this conversation, what do you want to remember? Do you want to spend time beating yourself up for losing your cool — again — or would you rather feel a sense of satisfaction at having handled yourself well?
5. Put yourself in their shoes – ugh — easier said than done, I know, but it can be helpful to legitimately allow yourself to consider where the other person is coming from. What about them don’t you know? (Maybe it’s a sales clerk who had a horrible day. Maybe your spouse just got chewed out at work, or has spent the afternoon with a grumpy teenager). No matter how well you know the person, or how well you think you know the situation, there may be information you don’t have. How might that information impact this conversation? If you are really up for a challenge, try a bit of a role reversal. Switch roles with whoever you’re talking to — have them take your perspective, and you take theirs. How does it feel to have this conversation from another point of view?
Remember – this takes practice — but changing your perspective can have a dramatic impact on your communication. And if you get this one mastered, stay tuned for our next fun topic: validation.
Need more? If you are feeling stuck and need some outside help in managing your communication, emotions, or relationships, our team at Generations Counseling is available! Give us a call at 317-743-8202 or email at: [email protected] today.