Nightmares Suck Shit; In Need of Being Creative

Ugg!!! Its 1:59 in the morning and I woke up from a stupid ass nightmare. A nightmare that scared the shit out of me.

After the nightmare I made me some tea and decided to blog. Blog about the struggle of having a nightmare. In fact I hope that blogging helps me get into a creative space.

A creative space that helped me several times in the last twenty-four hours. Creativity that helps me get into a better head space that I am currently in. I think I’m going to be collaging once again. Collaging pictures and words. Words that end up in poems. I’m really enjoying the collaging aspect of art.

As I create art and poetry I will of course be listening to music. Music that helps soothe me. Music that helped save my life. In fact if it wasn’t for music, I would have dropped out of high school. I was in the marching and concert band in high school. If it wasn’t for band I would have dropped out. As you can tell, music has helped me in many aspects of my life. Its helped me stay in school so I could graduate as well as helped me stay alive by not dying by suicide and to stay in recovery.

On that note, I should get going  so I can be creative. Hopefully,  I will be able to get some sleep. I hope everyone is sleeping well or at least did sleep well. Have a good night. Peace Out!!!

Weekly Check-In

I’m going to keep this weekly check-in brief. I’m not feeling all that well and don’t really feel like blogging at the moment. Lets start with why I am not feeling well. I woke up extremely early this morning with right flank pain. (That’s pain in my back on the right side in the kidney area.) So, I took the bus first bus of the morning to go to the hospital. To find out, I have a double kidney infection with kidney stones added on top of a Urinary Tract Infection (UTI). UTI’s and kidney infections are nothing new to me but this is only the second time I’ve had kidney stones.  Not my idea of a fun weekend but it reminds me that I need to drink more water.

Since we are on the topic of health, I say my doctor almost two weeks ago to get blood test done to make sure nothing medically is causing my depression. To find out that I’m lacking Vitamin D which isn’t exactly helping with the depression. Its not 100% why my depression is acting up but it part of the reason why it is acting up so I am taking a once weekly Vitamin D supplement of 50,000 units. Yes, you read right; 50,000 units

On a plus note in regards to my depression, I started Dialectical Behavioral Therapy (DBT) yesterday. I’m looking forward to what DBT has to bring. I love the fact that its strict. Not as strict as the two year intensive outpatient DBT program I was in several years ago but strict enough to what I need. I’m glad that homework is a requirement. It will give me something else to focus on when I am struggling.

Speaking of struggling, I am struggling a little bit with both my depression and posttraumatic stress disorder (PTSD) at the moment. I’m realizing the I am hungry and need to eat something. Making sure I eat on the regular basis and at least semi-healthy foods always seem to help even if its only a tiny bit. After I eat, I will do some of my DBT homework.

As I end this post I want to thank you for reading. I appreciate each and everyone of you even if it seems that all I do as of lately is bitch and complain. Again thank you for reading my blog. Peace Out!!!

4th of July, 2017

Happy Fourth of July!!! Today, is Independence Day here in the United States. Independence Day in the United States is where we celebrate the birth of our country after declaring our independence from England.

As Americans celebrate Independence Day, I can’t help but think about the contentious political climate especially with the current administration. Many Americans are quite passionate about many things including their views on politics. Unfortunately, many Americans fear that this could be one of the last Impendence Day celebrating their freedom (and independence) due to the current administration.

With the current political climate that’s why the 4th of July celebration I am going to at a friends house, politics won’t be discussed today. This coming from a friend who loves to discuss politics. Anyway, I’m going to be going my friend’s 4th of July celebration later on today with Junior. Like any summer holiday, there will be food and lots of it. I’m looking forward to it because it will get me out of my head as well as spending time with good friends. Friends who have been there for me during this very long patch of distress.

Friends who will help me through today. The 4th of July is usually difficult for me in regards to Posttraumatic Stress Disorder (PTSD) due to trauma I experienced as a child. My friends are awesome and have helped be through some tough moments. Some of those moments have been severe depressive episodes while other have been during PTSD flashback or after nightmares. I have some pretty supportive friends who won’t give up on me or let me give up on myself. I just wish everyone had a good support system like I have.

As I end this post, I would like to thank you all for being a part of that support system. You all are a support even if you don’t realize it. You’re a support because you read and/or follow my blog which means a great deal to me. Have a good 4th of July. Peace Out!!!

Nightmares Suck Shit

I woke up from a nightmare. Anyone who has PTSD know all too well on how much nightmares suck shit. It wasn’t the worst nightmare I have had but it was one of the most difficult nightmares I have had.

I am beyond grateful that Junior is a major support for me. He is always willing to stay up with me if I am unable to go back to sleep after a nightmare. For instance he is up with at this moment in time. He turned on some music which he knows helps me a great deal especially after a nightmare. Now he is warming up some brownies he made for dessert. Junior added chocolate chips to the brownies when he baked them so they would be more chocolatey. He knows how much I love chocolate. He just brought me some milk to go with the brownies. There is nothing like the person who loves you helping you through a difficult moment.

I think I’m going to end this post to cuddle with Junior while listening to music and eating brownies and drinking milk as he supports me after a difficult nightmare. Thank you for reading!!!

Sleepless In Seattle, Once Again

Good Morning, World!! Normally, I would be getting ready for a job I love with a passion however I am not going into work this morning. I am not feeling well. Mainly because I didn’t sleep all that well last night. My insomnia was not helping so much. To make it worse every time I did attempt to fall asleep, my PTSD would rear its ugly head with flashbacks, nightmares and body memories. Too make things worse is I had nightmares about the miscarriages I had. Nightmares that included four faceless babies saying they miss me and love me and then tell me I killed them. Its difficult to sleep after that. I wish my depression symptoms from the grief of losing two sets of twins is setting in once again. Plus the normal PTSD shit that doesn’t help matters much with the nightmares of being abused. Anyway due to the lack of sleep due to grieving over my two miscarriages as well as PTSD shit from my childhood, I have decided to call into work sick today. A job I love with a passion.

Weekly Goals

Happy Monday!!! Its a start of another work week and we all know what that means; time for me to do another set of weekly goals. So I will say how I did with last weeks goals.

1)  Read Speaker of the Dead by Orson Scott Card. I was able to spend about an hour in one sitting this week to read which is a rare occurrence. I was able to read twice for an hour so I am a happy camper.

2)  Work on jigsaw puzzle. Spent about fifteen minutes a day doing the puzzle. It is taking some time to do.

3)  Color. Did some coloring but not much.

4)  Finish Writing 201: Poetry. I finished the course and hope that you all enjoyed my poems.

5)  Work on a self-help workbook; The Dialectical Behavior Therapy Skills Workbook by Matthew McKay, PhD., Jeffery C. Wood, PSY.D., and Jeffrey Brantley, MD. Yup I worked on an entire chapter.

Now on to this weeks goals.

1)  Read Speaker of the Dead by Orson Scott Card. I will finish this book eventually.

2)  Work on jigsaw puzzle. The jigsaw puzzle is getting done slowly but surely.

3)  Color. Looks like I could be finishing up one coloring page here in the next week or two.

4)  Work on a self-help workbook; The Dialectical Behavior Therapy Skills Workbook by Matthew McKay, PhD., Jeffery C. Wood, PSY.D., and Jeffrey Brantley, MD. I’m hoping to get another chapter done this week.

5) See my therapist. I see my therapist on Wednesday. We will most likely be discussing ways to cope with getting my yearly done.

6)  Go to my doctor’s appointment. I have my annual female exam on Thursday. I have a difficult time with these particular appointments because of all the trauma I have been through.

Well, those are my weekly goals for this week. Please don’t hesitate to take a look at the blogging event over at: http://greenembe.rs/2015/10/19/building-rome-week-42-for-2015/ Have a wonderful week. 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!!