Everyday Inspiration; Day 17: A Map As Your Muse

Good Evening, World!!! Today’s assignment is finding your inspiration through a map. Last time I took this course, Finding Your Everyday Inspiration, I decided to have fun with the map assignment and decided to do the same, this time around. Last time, I found a “map” for “career planning” as a way to have the topic of my career goals. This time around, I’ve decided to use “Self Management” to bring up the topic of how I am needing to come up with some goals for my life or least when it comes to my recovery, emotions and behaviors.

We don’t get a “map” for life and choosing to map out my own life can be challenging at times which is why I want to discuss this “Managing Self” (Self Management) map. Self management means different things to different people. For me self management is similar to self care. Self management means that we are the managers of ourselves.

To me self management means being in control of my emotions and behaviors as well as my reactions to other peoples emotions and behaviors. I may not have “control” over all my emotions when my symptoms of my mental health condition are high however I am in control of how I behave and react to them. Self management is not any thing for anyone but everyone’s self management plan looks differently for each individual.

My self management plan right now is to focus on my recovery. I may be in a “middle of a relapse” however I am choosing to continue to be in recovery by focusing on what I need to do to get back to do well. Going to and participating in my appointments and groups is something I am doing to get back to do well. Doing good self care like eating, sleeping (or at least having a good sleep hygiene schedule), showering, taking my meds and so on are is another way I am focusing on my recovery.

I do the above stated things so I can go back to the career I worked my ass of for as well as maybe get an education related to the mental health care field. The educational aspect of my career could and will be helpful for career advancement. Its a matter of figuring out how to fund my education. Or at least looking in grants and/or scholarships.

So, as you can see self management is about reaching for goals. Goals that might be interrupted or detoured due to unexpected events but goals to aim for. The big goals need to have small goals so one doesn’t give up on the ultimate goal. So that what my self management map looks like.

Again thank you for reading. I hope everyone continues having a good day and weekend. Peace Out, World!!!

Everyday Inspiration; Day 14: Recreate a Single Day

Good Morning, World!!! Today’s Finding Everyday Inspiration’s assignment is to recreate a single day. I can think of many day’s I could recreate however, I choose not for various reasons. If I recreate a single day even one of the best days of my life that means I would have to relive some of the worst days of my life.

Don’t get me wrong, I remember and recreate some of the great moments in my life when things get tough especially when PTSD symptoms occur. I just don’t want to recreate a single because everyday has made me who I am today and I wouldn’t trade it for the world. Yes, I would have loved to not experienced the trauma I endured throughout my life however those trauma’s helped shaped who I am today. I most definitely wouldn’t want to recreate the trauma’s I endured. I don’t think anyone would want to recreate the trauma’s they endured.

Yes, I would love to have certain positive moments recreated at the moment especially since I have been struggling as of lately however I know I will get through this despite the doubts I currently have. I guess what I am saying is all the experiences I have had in my life is what made me who I am today. As much as I want to recreate a single day; it means it would recreate who I am at this moment in time.

I should really get going. It’s four in the morning and I haven’t been to sleep yet. I have to be up in three hours. I have to be up in three hours so I can get ready for the day and attend my therapy appointment. A much needed appointment. As I end this post I want to thank you for reading. I hope everyone has a great Hump Day (Wednesday). Peace Out, World!!!

Self-Care Saturday

I’m sitting here trying to figure out what to do now that my laundry is done. I’m not even sure if I am up to going out and about because I’m a lil on edge due to PTSD symptoms. PTSD is quite difficult to deal with as the symptoms can pop up at any given point in time of day or night. It sucks a great deal.

As much as PTSD sucks, I cant let it get in the way of letting me live my life. But then again sometimes my PTSD symptoms acts up a little bit more when I am needing do take a day to do good self-care. I also have be a lil wary to make sure it is a sign to do good self-care because it can be symptoms of other diagnosis trying to sneak their way in.

As I decipher if I am needing to make an extra effort to do good self-care by laying low today, I need to go and do some light grocery shopping. In fact Junior and I are going to go grocery shopping together. We are thinking about staying in this weekend.

Yes, part of the reasoning of staying in is due to my PTSD symptoms. The other part is that we are wanting to spend some quality time together. Quality time together for us means talking about what’s going on in our lives, discussing current events as well as the books we are reading, watching movies and just plain ole enjoying each others company. If our quality time leads to making love then its a plus. A plus because of the severity of the PTSD symptoms I am having.

Despite the increase of my PTSD symptoms, I am grateful that things are slowly starting to improve. That means my concentration is improving and finally able focus on reading. I’m reading an awesome book called “High Price” by Carl Hart. I am hoping once I’m finished with the book, I will do a book review on it.

I think I need to end this post as Junior is wanting to go grocery shopping so he can make me “something special for dinner.”  Junior is an awesome cook and look forward to whatever he makes. As I end this post, I want to thank you for reading. Thanks!!! Peace out!!!

 

 

The Simple Things In Life

Over the last few weeks, I’ve come to realize that I am needing to focus on the simple things in life. Simple things that many people tend to forget due to their busy lives or just stopped doing because they “grew out” of them.  Things I think as adults we need to learn from children and that’s to enjoy the little and simple things in life.

I may not have had the easiest of childhoods but I do remember some of the simple things I enjoyed as a kid. One, such thing I never stopped doing and seems to be “all the craze” now for adults is coloring.  Coloring is one of those activities that is a makes you think brainless activity. What I mean is that you have to think about what color you are going to use but not really have to do any other brain activity while coloring. Another such simple thing I enjoy is Play-Doh.

Yes, I did say Play-Doh.  Play-Doh helps a great deal with my anxiety. I rediscovered Play-Doh a few years ago when I was at a continuing education class for Peer Counselors. The trainer put out Play-Doh so the attendees could play with it. Needless to say, I had some fun at that training and quickly realized that I learned a great deal from that training, partly due to the Play-Doh. I tend to focus better and learn more when my hands are busy.  I always carry a little thing of Play-Doh with me.

A simple thing I wish I could carry with me everywhere is something I can not carry with me for various reasons. That simple thing is my morning tea with honey and milk in it while reading the news paper in quiet. Yes, I can do this anytime of the day or night but there is something peaceful about drinking tea and reading the paper in the morning.

Mornings as well as evenings are also perfect times to do something else simple. That is taking walks. I attempt to go for a walk both in the morning and the evening as it helps a great deal with both depression and anxiety.

Music is another simple thing that people tend to forget about. A simple thing that has helped me through some extremely difficult times in my life. Music is the one simple thing that I can rely on no matter what is going on and whether or not I am doing well in regards to my mental health conditions.

If it weren’t for the difficulties I have had the last seven or so months as things slowly start to improve, I wouldn’t have been focusing on getting to the point where I am at right now which focusing on the simple things in life. Yes, some of the simple thing in life I enjoy maybe considered “childish” or “just joining the craze” but if it weren’t for those simple things I don’t think things would be improving as they are now. Granted I’m improving as fast as I would like but I am improving.

As things slowly start to improve for me, focusing on the simple things will help out a great deal. As I end this post please take time out and focus on the simple things in your life and how it could help you out. Thank you for reading. Peace out!!!

Weekly Check-In

Good Evening or should I say Happy Friday!!! It is finally the end of a long and stressful work week. Don’t get me wrong I love my job it just was a long week at work.

As you may know that this week was suppose to be a “short” week because of the three day weekend but I went into work on Memorial Day to clean up a messy office that I acquired from my predecessors as well as catching up on the all so lovely paper work that is nesasary as peer specialist. Not to mention that the lovely paper work is required by the state and federal government as well as the lovely insurance companies that pay for clients to seek services. Well, back on topic of work and the stress that goes with being a peer specialist. Besides paper work, myself and my colleagues were informed of three client deaths. I of course can’t say anymore about the client deaths due to HIPPA. It is not easy to hear about a clients death especially multiple in a week.

Hearing about the clients deaths brought up my own grief and loss issues. Not just over loosing clients but that of the miscarriages I have dealt with. It is still quite difficult dealing with the miscarriage loss’s. Loosing a child(ren) is the toughest thing a person can deal with. So tough at times that at the moment I rather change the subject.

So let go on to the subject of earlier this evening. After work I went and got my second tattoo. I got a butterfly tattoo. I hope to blog more about it tomorrow with a picture or two. Getting the tattoo was quite relaxing and am grateful that I got it. So far the people who have seen the tattoo like it.

I hope to blog more about my tattoo tomorrow (Saturday) morning. Have a great weekend everyone. Peace out!!

Celebrating Three Years

Happy Earth Day!!! Today marks three years since Junior and myself starting dating. Who knew that when Junior and myself met fifteen and a half years ago that we would be engaged to be married.

I of course don’t remember the first time we met. The first time we met was one of the darkest times in my life. I had attempted suicide and a housemate had found me and called 911. Junior happened be one of the first responders that responded to the 911 call of my attempted suicide. As much as I was pissed off that I was saved that particular time and many other times, I am now grateful that my life was saved.

If my life wasn’t saved from the multiple suicide attempts, Junior and I wouldn’t be on a romantic get away to celebrate our three year anniversary. Celebrating my three year anniversary with Junior is another positive sign of me being in recovery with a mental illness.

Being in recovery is awesome and am happy to be celebrating three years with Junior. Junior and I left on our get away when I got off from work. We are celebrating out of town in hotel on the waterfront of a navel town. The first thing we did when we checked into our room we had tested out our jetted tub. We had some very intense and enjoyable adult fun in the tub which continued for another couple hours and ended in our nice king size bed. We then cuddled for another hour before we went out for dinner. After dinner we came back to the hotel and had more pleasure moments.

Now we are watching television as we cuddle and I blog. This getaway is much needed for the both of us and am looking forward to spending some quality time with Junior. I am sure we won’t be leaving the hotel room much due to having multiple and/or continued pleasurable moments.

Speaking of quality time, I think I should be going so I can spend time with Junior. Have a wonderful weekend everyone and Peace Out.

Dialectical Behavior Therapy (DBT)

Happy Friday!!! It being Friday, that means it is time for me to do my educational feature. I have decided to do the topic of Dialectical Behavior Therapy (DBT). The reason being is because I did the topic of Borderline Personality Disorder (BPD). I got the following information off of the  Linehan Institute; Behavior Tech at:   http://behavioraltech.org/resources/whatisdbt.cfm

What is DBT?

Overview

Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.

What are the components of DBT?

In its standard form, there are four components of DBT: skills training group, individual treatment, DBT phone coaching, and consultation team.

  1. DBT skills training group is focused on enhancing clients’ capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework for clients to practice using the skills in their everyday lives. Groups meet on a weekly basis for approximately 2.5 hours and it takes 24 weeks to get through the full skills curriculum, which is often repeated to create a 1-year program. Briefer schedules that teach only a subset of the skills have also been developed for particular populations and settings.
  2. DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for as long as the client is in therapy and runs concurrently with skills groups.
  3. DBT phone coaching is focused on providing clients with in-the-moment coaching on how to use skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.
  4. DBT therapist consultation team is intended to be therapy for the therapists and to support DBT providers in their work with people who often have severe, complex, difficult-to-treat disorders. The consultation team is designed to help therapists stay motivated and competent so they can provide the best treatment possible. Teams typically meet weekly and are composed of individual therapists and group leaders who share responsibility for each client’s care.

What skills are taught in DBT?

DBT includes four sets of behavioral skills.

  • Mindfulness: the practice of being fully aware and present in this one moment
  • Distress Tolerance: how to tolerate pain in difficult situations, not change it
  • Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
  • Emotion Regulation: how to change emotions that you want to change

There is increasing evidence that DBT skills training alone is a promising intervention for a wide variety of both clinical and nonclinical populations and across settings.

What does “dialectical” mean?

The term “dialectical” means a synthesis or integration of opposites. The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. For example, DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals. In addition, all of the skills and strategies taught in DBT are balanced in terms of acceptance and change. For example, the four skills modules include two sets of acceptance-oriented skills (mindfulness and distress tolerance) and two sets of change-oriented skills (emotion regulation and interpersonal effectiveness).

How does DBT prioritize treatment targets?

Clients who receive DBT typically have multiple problems that require treatment. DBT uses a hierarchy of treatment targets to help the therapist determine the order in which problems should be addressed. The treatment targets in order of priority are:

  1. Life-threatening behaviors: First and foremost, behaviors that could lead to the client’s death are targeted, including all forms of suicidal and non-suicidal self-injury, suicidal ideation, suicide communications, and other behaviors engaged in for the purpose of causing bodily harm.
  2. Therapy-interfering behaviors: This includes any behavior that interferes with the client receiving effective treatment. These behaviors can be on the part of the client and/or the therapist, such as coming late to sessions, cancelling appointments, and being non-collaborative in working towards treatment goals.
  3. Quality of life behaviors: This category includes any other type of behavior that interferes with clients having a reasonable quality of life, such as mental disorders, relationship problems, and financial or housing crises.
  4. Skills acquisition: This refers to the need for clients to learn new skillful behaviors to replace ineffective behaviors and help them achieve their goals.

Within a session, presenting problems are addressed in the above order. For example, if the client is expressing a wish to commit suicide and reports recurrent binge eating, the therapist will target the suicidal behaviors first. The underlying assumption is that DBT will be ineffective if the client is dead or refuses to attend treatment sessions.

What are the stages of treatment in DBT?

DBT is divided into four stages of treatment. Stages are defined by the severity of the client’s behaviors, and therapists work with their clients to reach the goals of each stage in their progress toward having a life that they experience as worth living.

  1. In Stage 1, the client is miserable and their behavior is out of control: they may be trying to kill themselves, self-harming, using drugs and alcohol, and/or engaging in other types of self-destructive behaviors. When clients first start DBT treatment, they often describe their experience of their mental illness as “being in hell.” The goal of Stage 1 is for the client to move from being out of control to achieving behavioral control.
  2. In Stage 2, they’re living a life of quiet desperation: their behavior is under control but they continue to suffer, often due to past trauma and invalidation. Their emotional experience is inhibited. The goal of Stage 2 is to help the client move from a state of quiet desperation to one of full emotional experiencing. This is the stage in which post-traumatic stress disorder (PTSD) would be treated.
  3. In Stage 3, the challenge is to learn to live: to define life goals, build self-respect, and find peace and happiness. The goal is that the client leads a life of ordinary happiness and unhappiness.
  4. For some people, a fourth stage is needed: finding a deeper meaning through a spiritual existence. Linehan has posited a Stage 4 specifically for those clients for whom a life of ordinary happiness and unhappiness fails to meet a further goal of spiritual fulfillment or a sense of connectedness of a greater whole. In this stage, the goal of treatment is for the client to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.

How effective is DBT?

Research has shown DBT to be effective in reducing suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, anger, and depression and improving social and global functioning. For a review of the research on DBT, click here. In this video, DBT Developer and Behavioral Tech founder Dr. Marsha Linehan describes the amazing changes she’s seen in people who have received DBT and gotten out of hell.

Dive Deeper

Philosophy and Principles of DBT

DBT is based on three philosophical positions. Behavioral science underpins the DBT bio-social model of the development of BPD, as well as the DBT behavioral change strategies and protocols. Zen and contemplative practices underpin DBT mindfulness skills and acceptance practices for both therapists and clients. DBT was the first psychotherapy to incorporate mindfulness as a core component, and the Mindfulness skills in DBT are a behavioral translation of Zen practice. The dialectical synthesis of a “technology” of acceptance with a “technology” of change was what distinguished DBT from the behavioral interventions of the 1970s and 1980s. Dialectics furthermore keeps the entire treatment focused on a synthesis of opposites, primarily on acceptance and change, but also on the whole as well as the parts, and maintains an emphasis on flexibility, movement, speed, and flow in the treatment.

True to dialectics, DBT strategies are designed in pairs representing acceptance (validation, reciprocal communication, environmental intervention on behalf of the client) and change (problem solving, irreverence, consultation-to-the-patients about how they can change their own environment). Strategies are further divided into procedures; a set of principles guides the selection of strategies and procedures depending on the needs of the individual client. Clients are also taught a series of behavioral skills designed to promote both acceptance and change. A focus on replacing dysfunctional behaviors with skillful behaviors is woven throughout DBT.

DBT is a principle-based treatment that includes protocols. As a principle-based treatment, DBT is quite flexible due to its modular construction. Not only are strategies and procedures individualized, but various aspects of the treatment, such as disorder-specific protocols, can be included or withdrawn from the treatment as needed. To guide therapists in individualizing priorities for targeting disorders and behavioral problems, DBT incorporates a concept of levels of disorder (based on severity, risk, disability, pervasiveness, and complexity) that in turn guides stages of treatment and provides a hierarchy of what to treat when for a particular patient. In contrast, skills training is protocol based. Once a skills curriculum is determined, what is taught in a session is guided by the curriculum, not by the needs of a single client during that session.

The Development of DBT

In the late 1970s, Marsha M. Linehan attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, and non-suicidal injury. Trained as a behaviorist, she was interested in treating these and other discrete behaviors. Through consultation with colleagues, however, she concluded that she was treating women who met criteria for Borderline Personality Disorder (BPD). In the late 1970s, CBT had gained prominence as an effective psychotherapy for a range of serious problems. Dr. Linehan was keenly interested in investigating whether or not it would prove helpful for individuals whose suicidality was in response to extremely painful problems. As she and her research team applied standard CBT, they encountered numerous problems with its use. Three were particularly troublesome:

  1. Clients receiving CBT found the unrelenting focus on change inherent to CBT to be invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop-out rate. If clients do not attend treatment, they cannot benefit from treatment.
  2. Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. For example, the research team noticed through its review of taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, emotional withdrawal, shame, or threats of self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they did not want to discuss to one they did want to discuss.
  3. The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients (suicide attempts, self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, and more) and have session time devoted to helping the client learn and apply more adaptive skills.

In response to these key problems with standard CBT, Linehan and her research team made significant modifications to standard CBT.

They added acceptance-based or validation strategies to the change-based strategies of CBT. Adding these communicated to the clients that they were both acceptable as they were and that their behaviors, including those that were self-harming, made real sense in some way. Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal,” helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves. The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: clients must change if they want to build a life worth living.

In the course of weaving in acceptance with change, Linehan noticed that another set of strategies – dialectics – came into play. Dialectical strategies give the therapist a means to balance acceptance and change in each session. They also serve to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviors that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD. Dialectical strategies and a dialectical world view, with its emphasis on holism and synthesis, enable the therapist to blend acceptance and change in a manner that results in movement, speed, and flow in individual sessions and across the entire treatment. This counters the tendency, found in treatment with clients diagnosed with BPD, to become entrenched in arguments and polarizing or extreme positions.

Significant changes were also made to the structure of treatment in order to solve the problems encountered in the application of standard CBT.

In her original treatment manual, Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993), Linehan hypothesizes that any comprehensive psychotherapy must meet five critical functions. The therapy must:

  1. Enhance and maintain the client’s motivation to change
  2. Enhance the client’s capabilities
  3. Ensure that the client’s new capabilities are generalized to all relevant environments
  4. Enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities
  5. Structure the environment so that treatment can take place

As already described, the structure of DBT includes four components: skills group, individual treatment, DBT phone coaching, and consultation team. These components meet the five critical functions of a comprehensive psychotherapy in the following ways:

  1. It is typically the individual therapist who maintains the client’s motivation for treatment, since the individual therapist is the most prominent individual working with the client.
  2. Skills are acquired and strengthened, and generalized through the combination of skills groups and homework assignments.
  3. Clients capabilities are generalized through phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.
  4. Therapists’ capabilities are enhanced and burnout is prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheerleading the therapist in applying effective interventions.
  5. The environment can be structured in a variety of ways. For example, the home environment could be structured by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviors or punished for effective behaviors in the home

True to dialectics, DBT strategies are designed in pairs representing acceptance (validation, reciprocal communication, environmental intervention on behalf of the client) and change (problem solving, irreverence, consultation-to-the-patients about how they can change their own environment). Strategies are further divided into procedures; a set of principles guides the selection of strategies and procedures depending on the needs of the individual client. Clients are also taught a series of behavioral skills designed to promote both acceptance and change. A focus on replacing dysfunctional behaviors with skillful behaviors is woven throughout DBT.

DBT is a principle-based treatment that includes protocols. As a principle-based treatment, DBT is quite flexible due to its modular construction. Not only are strategies and procedures individualized, but various aspects of the treatment, such as disorder-specific protocols, can be included or withdrawn from the treatment as needed. To guide therapists in individualizing priorities for targeting disorders and behavioral problems, DBT incorporates a concept of levels of disorder (based on severity, risk, disability, pervasiveness, and complexity) that in turn guides stages of treatment and provides a hierarchy of what to treat when for a particular patient. In contrast, skills training is protocol based. Once a skills curriculum is determined, what is taught in a session is guided by the curriculum, not by the needs of a single client during that session.

  1. Clients receiving CBT found the unrelenting focus on change inherent to CBT to be invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop-out rate. If clients do not attend treatment, they cannot benefit from treatment.
  2. Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. For example, the research team noticed through its review of taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, emotional withdrawal, shame, or threats of self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they did not want to discuss to one they did want to discuss.
  3. The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients (suicide attempts, self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, and more) and have session time devoted to helping the client learn and apply more adaptive skills.
  4. In response to these key problems with standard CBT, Linehan and her research team made significant modifications to standard CBT.

They added acceptance-based or validation strategies to the change-based strategies of CBT. Adding these communicated to the clients that they were both acceptable as they were and that their behaviors, including those that were self-harming, made real sense in some way. Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal,” helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves. The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: clients must change if they want to build a life worth living.

In the course of weaving in acceptance with change, Linehan noticed that another set of strategies – dialectics – came into play. Dialectical strategies give the therapist a means to balance acceptance and change in each session. They also serve to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviors that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD. Dialectical strategies and a dialectical world view, with its emphasis on holism and synthesis, enable the therapist to blend acceptance and change in a manner that results in movement, speed, and flow in individual sessions and across the entire treatment. This counters the tendency, found in treatment with clients diagnosed with BPD, to become entrenched in arguments and polarizing or extreme positions.

Significant changes were also made to the structure of treatment in order to solve the problems encountered in the application of standard CBT.

In her original treatment manual, Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993), Linehan hypothesizes that any comprehensive psychotherapy must meet five critical functions. The therapy must:

  1. Enhance and maintain the client’s motivation to change
  2. Enhance the client’s capabilities
  3. Ensure that the client’s new capabilities are generalized to all relevant environments
  4. Enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities
  5. Structure the environment so that treatment can take place

As already described, the structure of DBT includes four components: skills group, individual treatment, DBT phone coaching, and consultation team. These components meet the five critical functions of a comprehensive psychotherapy in the following ways:

  1. It is typically the individual therapist who maintains the client’s motivation for treatment, since the individual therapist is the most prominent individual working with the client.
  2. Skills are acquired and strengthened, and generalized through the combination of skills groups and homework assignments.
  3. Clients capabilities are generalized through phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.
  4. Therapists’ capabilities are enhanced and burnout is prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheerleading the therapist in applying effective interventions.
  5. The environment can be structured in a variety of ways. For example, the home environment could be structured by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviors or punished for effective behaviors in the home.

DBT has personally saved my life and am grateful to have had the opportunity to take an intensive outpatient DBT program. DBT is awesome and it is one of the best decisions I have made in my life. Have an awesome Friday and Peace Out!!