I went to the DBT Center yesterday for my diagnostic. I wasn’t quite sure what to expect, my goal was to get into the group classes for DBT now that it is available in my city. I spent 4 hours with a really lovely counsellor named Trisha whose entire work focus is DBT for BPD, who took me through a lot of questions ranging from my childhood all the way through to what I saw as a future, the goal being through these questions to see if I did meet the tenants for BPD. I thought it kind of ironic that I passed with flying colours yet was hoping to fail, maybe there was this tiny chance I didn’t have it? Nope, not a chance. In addition to it, she added on that I possible could be bi-polar IN ADDITION to BPD, which I did not think was possible, I though it was a one or the other type situation but upon looking it up, borderline is a PERSONALITY disorder and bi-polar is a MOOD disorder. How lovely to think I may have both!
At a certain point as she was going through the criteria we all know, I said “I don’t really know who I am”. It was the biggest Oprah AHA moment I have seen. If she could have said AHA she could have but instead she said “That’s it! (pointing her pen at me) Thats the hallmark of BPD, we don’t even need to go through the rest of the criteria”. I’m a real live one.
I want to quickly digress and say I was telling Hugh about it in the evening and mentioned that I couldn’t see future, I couldn’t see my future, because I don’t know what’s going to happen to me. When I plan a future the bubble always bursts, I fail, and I try and not envision one to not fail myself. Of course I have my Disney fairy tale future, where Prince Charming arrives and understands BPD me and still loves me and we live happily ever after in a tropical place and he will never leave me or let me run away. Ok, maybe it’s Disney on crack or LSD. I didn’t explain too well because then he asked how he could see a future with me if I couldn’t see one… at that point I knew I couldn’t explain so I just quieted up.
The time flew by and having these questions come at me again made me realize just how much work there is ahead because though I can make it through the days, it still is a lot of work to reel the emotions in and package them so I don’t fall off the path. There are days where I teeter on the tight wire over the smallest text that I have read wrong, wildly flailing my arms for balance.
I did not realize the course was so long, 6 months, once a week for 2 hours. Wow. Like going back to school. I also admit I am a little scared, this is the first time I will walk into a room and everyone will know me, the me as I am. Though this is not a counselling group, its a skills training group, we will all know that we suffer. Like coming out of the BPD closet.
So I thought I would re-cap what DBT training is about:
The Four Modules of Dialectical Behavior Therapy
The essential part of all skills taught in skills group are the core mindfulness skills.
Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?”
Non-judgmentally, One-mindfully, and Effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?”
2. Interpersonal Effectiveness
Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.
Borderline individuals frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioral sequence when analyzing her own situation.
This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
3. Distress Tolerance
Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by religious and spiritual communities and leaders. Dialectical behavior therapy emphasizes learning to bear pain skillfully.
Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.
Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.
4. Emotion Regulation
Borderline and suicidal individuals are emotionally intense and labile – frequently angry, intensely frustrated, depressed, and anxious. This suggests that borderline clients might benefit from help in learning to regulate their emotions. Dialectical behavior therapy skills for emotion regulation include:
- Identifying and labeling emotions
- Identifying obstacles to changing emotions
- Reducing vulnerability to “emotion mind”
- Increasing positive emotional events
- Increasing mindfulness to current emotions
- Taking opposite action
- Applying distress tolerance techniques