Next Wednesday is my last DBT session. The course work has been invaluable but I've hated nearly every moment. The facilitator reminds me of my primary perpetrator. So I got lots of opportunity to work through transference and dealing with triggers. I've actually been able to distribute myself from my family of origin. And having a group of women - however disfunctional - to chat with was nice. Think I'll find a group therapy just to have that kind of space. Twelve months. I'm done.
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Finished With Dbt
- Post starter Crow
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Truthful_Whispers
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Congratulations on completing the course.
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My current therapist is retiring so she is now referring me to a DBT group/therapist. She says she thinks it will be perfect for me and that they will be more qualified to deal with the sort of things I am dealing with. I have only read horror stories on here for the most part about going to these groups. I'm supposed to go for a full year but I'm just afraid I don't have any other options because she hasn't said anything other than about this DBT. I feel stupid because somehow I posted a new thread yesterday and can't remember how to today to post this but with that being said, does anyone have anything positive to say about DBT? I'm getting really nervous about it. Other suggestions or options would be helpful as well.
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Dbt changed the way I interact with people and helps me deal w my panic attacks. It's been a huge blessing. I did not like the year I was in it. The therapist was snarky. I was in a room of near-full blown borderlines. And the homework seemed stupid. But it works.
I will say that I needed regular therapy to process stuff from group. Why not start looking for a new therapist while your current one is ramping down? You can see them at the same time and process your loss?
I will say that I needed regular therapy to process stuff from group. Why not start looking for a new therapist while your current one is ramping down? You can see them at the same time and process your loss?
Wow!
Well done!
The people who DBT was developed for, are the most likely to drop out of therapy.
So, DBT seeks a commitment from the client to attend and to work on the therapy, and a similar commitment from the Ts not to abandon the clients, or to become judgemental and invalidating towards them.
eikram
further to what you asked about whether anyone has anything positive to say about DBT.
I haven't done it. some day I hope to be "providing" is the wrong word, because the Ts participate and undergo therapy themselves as part of the program, to keep them in it and performing to the best of their abilities.
I'd be very interested in your experiences and thoughts if you do go for it.
From what I've read on the forum here, I think a lot of the criticism is levelled at the amount of hard work and the structuring of the sessions. As Crow Feather wrote:
so, in the individual therapy sessions, the T will review your diary card for the week, and if you haven't completed one, they will need to find out why, what interfered with you completing one and how to address that, so that you do complete your diary card.
Then they will address the issues in the diary card, in the order of
Similarly with the groups skills training sessions, the order of priorities is the same.
Again, without being disparaging, I think it is easy to see how that structure and keeping to it could be frustrating for the individuals whom it is designed to constrain to actually keep progressing with therapy.
In Linehan's early trials with DBT, she deliberately asked for the most difficult and most suicidal patients, whom no one else could deal with. Bear in mind that most clinical trials deliberately exclude anyone who is suicidal!
and she demonstrated statistically significant reductions in suicidal behaviour and subsequent hospitalizations for those patients compared to the control group receiving "treatment as usual".
Addition
One of the "dialectics" which DBT seeks to address is "normalizing dysfunctional behaviours versus punishing normative behaviours". and as it is a behavioural therapy. Instances of dysfunctional behaviour, such as a client threatening violence or suicide when they don't get their own way, will result in a behavioural analysis (not a punishment as such, but certainly uncomfortable), rather than the T caving in and rewarding and reinforcing the dysfunctional behaviour.
Again, I can see how that could grate on someone who is used to instinctively using dysfunctional behaviours to achieve their ends.
further to what you asked about whether anyone has anything positive to say about DBT.
I haven't done it. some day I hope to be "providing" is the wrong word, because the Ts participate and undergo therapy themselves as part of the program, to keep them in it and performing to the best of their abilities.
I'd be very interested in your experiences and thoughts if you do go for it.
From what I've read on the forum here, I think a lot of the criticism is levelled at the amount of hard work and the structuring of the sessions. As Crow Feather wrote:
without being disparaging ("diagnosis" is just a fancy word for stereotype!), I think we can all see where that could very easily go, if there wasn't a very strong framework structure to keep within.
so, in the individual therapy sessions, the T will review your diary card for the week, and if you haven't completed one, they will need to find out why, what interfered with you completing one and how to address that, so that you do complete your diary card.
Then they will address the issues in the diary card, in the order of
- Life threatening behaviours (including self harm and self endangerment)
- behaviours that interfere with therapy (no diary card, or not completed, not using telephone coaching between sessions, arriving late, storming out etc)
- behaviours that interfere with quality of life.
Similarly with the groups skills training sessions, the order of priorities is the same.
Again, without being disparaging, I think it is easy to see how that structure and keeping to it could be frustrating for the individuals whom it is designed to constrain to actually keep progressing with therapy.
In Linehan's early trials with DBT, she deliberately asked for the most difficult and most suicidal patients, whom no one else could deal with. Bear in mind that most clinical trials deliberately exclude anyone who is suicidal!
and she demonstrated statistically significant reductions in suicidal behaviour and subsequent hospitalizations for those patients compared to the control group receiving "treatment as usual".
Addition
One of the "dialectics" which DBT seeks to address is "normalizing dysfunctional behaviours versus punishing normative behaviours". and as it is a behavioural therapy. Instances of dysfunctional behaviour, such as a client threatening violence or suicide when they don't get their own way, will result in a behavioural analysis (not a punishment as such, but certainly uncomfortable), rather than the T caving in and rewarding and reinforcing the dysfunctional behaviour.
Again, I can see how that could grate on someone who is used to instinctively using dysfunctional behaviours to achieve their ends.
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Hmm... I see.
Well I definitely plan on going for it. I'm at a point where I'm pretty desperate for help.
To be completely honest, I've always done much better in structured environments so the structure and rigidness of the program doesn't necessarily worry me.
I think what I'm worried about the most is it making me worse and kind of go off the edge. I also worry about some of the other people that might be in the group because of what CrowFeather said. But at the end of the day I will only be going for myself and not them.
I have my last therapy appointment Monday so I will be sure to ask her about the possibilities of it making me worse and what my options are if DBT doesn't work out. She is FINALLY setting me up with a better doctor before she retires, as well.
She also said that the woman from the DBT group should be calling me at some point to hopefully schedule an interview.
I've read online about how some programs are certified and some aren't. I'm not sure if this one is or not, do you happen to know anything about the differences of the certified and non certified programs?
I will definitely be sure to post about my experiences and kind of journal my thoughts and everything on the program when I start and as I go along.
CrowFeather, you said it helped with the way you interacted and dealt with your panic attacks. I'm hoping that it can do the same for me. It may sound weird but I never noticed how much my behavior and my problems affected others until my boyfriend and I moved in together. It's been a big wake up call but it's definitely got me up and ready to get help fast.
It should be closely supervised and with ground rules.
For example, any talk of feeling suicidal or self harming is strictly limited to the individual therapy sessions.
The group skills training sessions will (or should be) closely supervised, and consist of things like role play exercises.
The skills workbooks are available to buy, if you want to get a preview first.
I've got the Linehan one http://www.bookdepository.com/DBT-Skills-Training-Manual-Marsha-Linehan/9781462516995 , but haven't got into it yet, I'm still working through Miller, Rathus and Linehan's text on DBT for suicidal adolescents. Just working through the skills is not shown to be as effective as the combined skills and individual therapy.
Incidentally, you do know that if Marsha Linehan who developed DBT, was a young person today, she would almost certainly have been diagnosed with BPD? She knows what it is like from the inside. http://www.nytimes.com/2011/06/23/health/23lives.html?pagewanted=all&_r=0 I only know the outside, even if can relate to the PTSD aspects.
I'm hugely sceptical about paper credentials. It may be that an off-ticket provider could be giving better service than a credentialled one - remember that there is a 1 in 2 chance that the practitioner in front of you was in the bottom half of their class;)
Oops I tried to post this and wasn't logged in so it may show up twice
But that makes more sense.
I've tried to do more research on my own and actually did read that article you put in your last response. Very very interesting article about Linehan. I do like how she focused more on suicidal people because as you said earlier that definitely isn't done. Hopefully it will help me to not be so embarrassed of certain things like that. I'm just so new to all of the ptsd stuff.
I hope you don't mind me asking, but if you have received any type of treatments, what have you tried and what has or hasn't worked for you?
StellaBlue
Gold Member
Congratulations @CrowFeather! I hope you have a wonderful last group - and that you give yourself some sort of reward!
I completed my DBT skills group earlier this summer. It took a little over two years to go through the modules twice (my group leaders liked to take their time). The length of time it took was a real point of dissention for me (I felt they misrepresented how long their program lasted). That said, it was amazingly helpful and I use my skills every day.
My group was not primarily "borderline" folks. I was initially very reluctant to join because I feared that the group would be mostly folks with BPD - I too am not trying to be disparaging (and I think that diagnosis has been handed out like candy any time a client [especially a female client] is deemed to be "difficult"), but, having lived with someone diagnosed with BPD, there was no way I was going to subject myself to that for a couple of hours a week.
While I loved my DBT group (most of the time), I don't feel the same way about DBT-focused individual therapy. Because (as @Anarchy has pointed out), the model was designed for severe BPD, I found the two DBT therapists I saw to be very much married to the model. I think at my lowest point (when I was very depressed and having a lot of PTSD symptoms), the structure may have been helpful (I wasn't seeing a DBT therapist then) - and the diary cards were a good way to keep track of things...but, I found the model used in individual therapy (which is very entrenched in behavioral therapy) to be rigid, condescending, infantilizing and actually harmful. Again, this was my experience and I only saw two DBT therapists.
While I'm not sure certification is necessary, I believe that if you want the full benefit of a skills group, you want someone who has been thoroughly trained. Again, as @Anarchy pointed out, groups can swing way off course very quickly unless the facilitators are trained in the module and firm with the boundaries. Skills group is supposed to be more of a class - typically, you start with a mindfulness exercise, proceed to homework review, then learn the next skill. Any personal issues that come up should be addressed in individual therapy. That's not to say that it has to be entirely impersonal, but it's not a therapy group per se.
I have talked to folks who have been in DBT groups that are more "group therapy" oriented. While this may or may not work for them, it really isn't what a skills group was designed to be.
And finally (I have rambled on here!) - the new skills workbook is great - but it is not set up in a way that is intuitive to follow...and there is a TON of information - so I would caution that it might appear overwhelming. For my learning style, it really did help to have a group to learn the skills. (Oh, and all of the handouts and worksheets can be downloaded at the publishers website - you just need to be a little clever in finding the access [hint - look at the first couple of pages of the book at google books])
I completed my DBT skills group earlier this summer. It took a little over two years to go through the modules twice (my group leaders liked to take their time). The length of time it took was a real point of dissention for me (I felt they misrepresented how long their program lasted). That said, it was amazingly helpful and I use my skills every day.
My group was not primarily "borderline" folks. I was initially very reluctant to join because I feared that the group would be mostly folks with BPD - I too am not trying to be disparaging (and I think that diagnosis has been handed out like candy any time a client [especially a female client] is deemed to be "difficult"), but, having lived with someone diagnosed with BPD, there was no way I was going to subject myself to that for a couple of hours a week.
While I loved my DBT group (most of the time), I don't feel the same way about DBT-focused individual therapy. Because (as @Anarchy has pointed out), the model was designed for severe BPD, I found the two DBT therapists I saw to be very much married to the model. I think at my lowest point (when I was very depressed and having a lot of PTSD symptoms), the structure may have been helpful (I wasn't seeing a DBT therapist then) - and the diary cards were a good way to keep track of things...but, I found the model used in individual therapy (which is very entrenched in behavioral therapy) to be rigid, condescending, infantilizing and actually harmful. Again, this was my experience and I only saw two DBT therapists.
While I'm not sure certification is necessary, I believe that if you want the full benefit of a skills group, you want someone who has been thoroughly trained. Again, as @Anarchy pointed out, groups can swing way off course very quickly unless the facilitators are trained in the module and firm with the boundaries. Skills group is supposed to be more of a class - typically, you start with a mindfulness exercise, proceed to homework review, then learn the next skill. Any personal issues that come up should be addressed in individual therapy. That's not to say that it has to be entirely impersonal, but it's not a therapy group per se.
I have talked to folks who have been in DBT groups that are more "group therapy" oriented. While this may or may not work for them, it really isn't what a skills group was designed to be.
And finally (I have rambled on here!) - the new skills workbook is great - but it is not set up in a way that is intuitive to follow...and there is a TON of information - so I would caution that it might appear overwhelming. For my learning style, it really did help to have a group to learn the skills. (Oh, and all of the handouts and worksheets can be downloaded at the publishers website - you just need to be a little clever in finding the access [hint - look at the first couple of pages of the book at google books])
Only relationship counselling
It was the relationship counsellor who spotted that I flash back and dissociate (I thought everyone did) and isolate. He suggested PTSD, I thought it was BS and never went back, I've since been separated from my ex wife for about five years.
It was only in the summer of 2014 that I began to understand that there is more to PTSD than military style shock trauma and that I have several candidates for "critereon A". I don't have and don't want a diagnosis. In the past, my work has involved things like rock blasting, so I'm not keen on some bureaucrat saying that I can't do it anymore because of a diagnosis - when I have a track record of doing it without risk.
Since making those connections and joining the forum here, I haven't had any money for therapy, and I spent 6 months of that time on the road and sleeping on friend's floors. (I'm not making any causal connection there :rolleyes:). I isolate, I'm avoidant and I have huge trust issues.
I'm on friendlier terms with my ex, now that we are apart and separated by sea... she has introduced me to mindfulness, which was new to her, despite her being PhD level cognitive psychologist and licensed for clinical work!
She used to think she had BPD, and was chronically suicidal, she has actually been much better since she finally managed to get off SSRI anti depressants, and her current T doesn't think she would meet a formal BPD diagnosis. Our personal demons do still fight when they meet each other though.
I'm picking up tips from all over. There are some great people here, who work very well as reality anchors, to catch any spirals of increasingly drastic thinking.
in terms of interesting stuff to watch on youtube, try watching Bessel van der Kolk, Cristina Balfe and Anita Sawyer's contributions to the NEA BPD conference, and the round table forum of all of them. Make sure you have plenty of tissues for Anita Sawyer's presentation, I cry whenever I watch it.
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