Friday, August 30, 2013

Dealing with the Negative: Keep Positive Yourself and It Will Trickle Down to the Kiddies...

Oscar-canHi Friends,
My Co-author Diane recently discovered a new blog that is focused on the positive. Making wise choices, thinking positive and dealing with the negatives in life in a pro-active way.

With foster parent burn out being a real threat, it's important to be reminded to look up at the sun sometimes.

With this in mind, I wanted to share this particular blog post about Trash Talkers (we have all dealt with them) in hopes it gives you a little pep talk, and maybe gives you some help in talking to your kids about similiar issues in the future.  Enjoy, and check out subscribe to Carrie's blog at : Carrie Jolie Dale

First off, remember the golden rule “If you cant say anything nice don’t say anything at all.”  

But doesn’t that sometimes just feel like you are the one getting short changed?

Doesn’t it just sometimes feel like those mean, negative nellies and neds need to be put in their place, and have one massive karmic review done? 

Trust me when I say, this one was hard for me. I was challenged big time on this one going through a difficult divorce and also making the decision to pursue my love of writing + coaching. 

The divorce situation if almost understandable(albeit frustrating), but why the coaching and writing? Why would people be negative about that?

Why would anyone be negative towards you when you decide to chase your dreams, speak your truth,and  live your passions? 

Because it stirs up their fears, their insecurities, and their wounds. If they are bashing what you are doing, and picking on you—chances are they see you stepping into your light, and they notice how they have allowed their own light to be dimmed.

There are going to be those that try to knock you down—always.
When we, as entrepreneurs—CHOOSE to spread our wings and GO FOR IT—it can stir up stuff in others. 

It’s not you.  It’s not about you.  

And it really doesn’t matter what they think about you. It doesn’t matter if they like you, what you write, or what you are creating.

What they think of you is not the point. How you react to negativity—in any form—is the point.

Read the rest at :

Friday, August 23, 2013

Obsessive Compulsive Disorder or Aspergers? How Can You Tell the Difference?

Hi Friends,
A friend and reader shared this recent article on the similarities and differences between OCD (obsessive, compulsive disorder) and Asperger's disorder, which is a high functioning level of autism.  The two disorders have many similar traits and sufferers display some of the same mannerisms, which often confuses parents and even doctors and counselors.

The below article comes from  It's a little "academic" but the case studies are interesting and you may recognize you own child in some of the stories.  Read on.

Differentiating Between Asperger’s  and Obsessive-Compulsive DisorderBy Fugen Neziroglu, Ph.D.
and Jill Henriksen, M.S.

     In recent years clinicians have continually seen a rise in Asperger‘s Disorder (AD), especially among child and adolescent populations. Whether this rise is due to an actual increase in AD or merely a result of improved definitions and increased awareness is unknown. In 1994, AD was first added to the DSM-IV (Kirby, 2003), therefore, it is only recently that parents and professionals are more aware of this disorder. AD is a complex disorder that resembles OCD in several ways; therefore, it becomes increasingly important to have an understanding of AD so one can better differentiate it from OCD. The purpose of this article is to help individuals, family members, and professionals better understand how these disorders are similar and how they can be differentiated from one another. A couple of case examples will be used to illustrate certain behaviors before we go on to the specific characteristics of the two disorders. For consistency purposes, the male gender is used throughout this paper because males outnumber females in AD. However, one should note that this is not the case with OCD.

Case Example 1
     Matthew is a 9-year old boy.* He performs well academically in school. In class, he pays excellent attention; however, his teachers have noted some underlying anxiety regarding his academic performance. For example, Matthew takes a long time to complete tests and writing assignments. His teachers report that he is well behaved and follows classroom rules, but at the same time, Matthew will report to his teacher when his peers do not demonstrate the same behavior. Additionally, Matthew becomes agitated or upset when he is rushed and is unable to complete an assignment. At home, mornings and evenings are particularly difficult for Matthew.
  He takes a long time getting ready for school, e.g., brushing his teeth a long time, dressing and redressing, going in and out of the room, etc. Also, he gets to bed later than he should making mornings even more difficult. He reports that he is unable to fall asleep because of “certain thoughts” and his bedtime rituals. Matthew’s mother is concerned with her son’s outbursts of anger. These fights usually occur around dinnertime when Matthew does not have his own way, such as, having his plate and silverware washed again before his food touches it. Matthew’s mother has also become increasingly concerned about her son’s peer relationships. She feels that Matthew is having difficulty making friends. As his friends become more interested in sports, Matthew has less in common with them and has started to spend more time alone.

Case Example 2
     Eric is a 12-year old boy. Eric’s academic performance is strong. He is currently taking advanced coursework in mathematics and science. Eric’s teachers are impressed with his language ability in these areas. He uses adult words and has an advanced vocabulary surrounding science and history. Recently, Eric has been having trouble in school. More specifically, Eric only wants to read, write, and research specific topics, such as European history. If his teacher asks him to write about something else, Eric becomes very upset and argues with the teacher endlessly. In exasperation the teacher usually allows him to write about whatever he wants. Other times he is sent to the principal’s office. Additionally, Eric becomes irritable when things are out of the routine, for instance if he has to read a book different from the one he had been told to originally. Eric has one or two friends, but does not usually initiate social contact with children. Eric frequently needs to be redirected by his teacher to complete his work. 

In addition, he often requires extra time to complete his exams. Eric often appears anxious in school and when he feels this way he will continually ask the teacher questions and seek reassurance from her. At home, Eric demonstrates difficulty completing his homework assignments. He becomes fixated on one small aspect of his assignment and then runs out of time to complete the rest. After school, Eric can spend hours reading about history and will engage in hours of discussion about the topic. He enjoys comparing one history book to another. He will line up his books in alphabetical order and then analyze each one of them. Eric prefers “sameness”. He enjoys eating the same kind of foods over and over again. He also prefers soft fabrics and puts his clothing on each morning in a particular order.
The first case example is that of OCD and the second of AD. AD is at the mildest and highest functioning end of what is known as the Pervasive Developmental Disorder spectrum. As described by Treffert (1999), the disorder is characterized by normal speech development in childhood (e.g. single words by 2-years of age and use of communicative phrases by 3-years of age). Despite nor- mal verbal development, an individual’s speech may be repetitive or of unusual voice quality. For example, a child may repeat back what you just said, or he may repeat his own words. Furthermore, the child may demonstrate poor turn-taking skills during conversation and may dominate the conversation, especially when it concerns his special area of interest. Nonverbal skills in individuals with AD are also impaired. For example, individuals may not express a full range of facial expressions. At times, it may appear as though the child is looking through you and he evidences poor eye contact. Failure to develop social relations is another characteristic of this disorder. 

Some believe that the insufficient conversational and nonverbal skills lead to poor social relationships. Children with OCD do not lack the social skills as those with AD do. However, in some instances a child with OCD may develop poor relationships with his/her peers. This may occur when a child’s obsessions and compulsions occupy a lot of their time, which can lead to social withdrawal. Furthermore, if the compulsions are severe the child may be unable to hide them from his friends, which could lead to teasing. The child may also develop poor self-esteem because he views himself as being different from other children, but overall children with OCD have normal peer relationships (Fruehling, Johnston, & March, 1998). Children with OCD can follow social rules, but they may adhere to an adult moral code and become upset when their peers do not follow certain rules (Neziroglu & Yaryura-Tobias, 1997).
  Without training, guidance, or instruction AD children will demonstrate difficulty adhering to social rules, such as not talking while others are talking or knowing when to appropriately end a conversation. Many AD children will also demonstrate poor motor coordination and clumsiness.

For example, elementary school children with AD may have penmanship problems and experience difficulty with activities during physical education class (Williams, 1995).
As demonstrated by the case examples, there are several similarities between OCD and AD including: shifting, incompleteness, emotions and compulsions. In both disorders the children have strong academic skills. Children with AD often demonstrate strong rote reading skills, calculation ability, and excellent memory (Bauer, 1996). Neziroglu and YaryuraTobias (1997) also report that children with OCD usually have above average academic ability. Both children will rarely feel relaxed and they will spend most of their day feeling anxious. In AD, this is especially true if the child does not know what to expect next or is overwhelmed by stimuli such as loud noises. In OCD, the child is anxious in regards to their obsessive thoughts and whether or not they are performing their compulsions correctly. Both children may experience incompleteness and require extra time to complete assignments at school and home. For the AD child, this is because they are distracted by internal and external stimuli. Therefore, they need an adult near by to redirect them to the task at hand. For the OCD child the reason differs. The child may take a long time to complete a task because they are concerned with perfection and/or doing a task until it feels right (i.e., doing it a set amount of times). Therefore, they may rewrite a paper, erase frequently, or reread the same passage repeatedly.
 Children with both disorders will demonstrate a need for sameness. Usually the child with AD chooses to eat the same food each day, wear the same clothing, or play the same video game, whereas the child with OCD is looking for sameness in his/her daily routines. If the OCD child exhibits the “sameness” of the AD child it is for a different reason. Both children desire control over their environment so that they may perceive it as safe and predictable. However, children with OCD may eat the same foods each day because they are “safe” or not contaminated. In children with AD the reason varies. Children with AD have sensory issues, so they may not like certain textures, smells, fabrics, or sounds (Kirby, 2003). Sometimes children with OCD may also complain of not liking the feel of the seam on their socks, or be concerned with smells that are “dirty”.

    Both children will demonstrate difficulty with shifting or transitioning between tasks. For the OCD child, this is because of the need for symmetry or balance. For example, if a child is working a home- work assignment on the computer and he is called for dinner, he will want to complete the entire assignment before he begins eating. If he does not complete the assignment, he will continue to feel anxious. Another example may include a child in school who has to tap the left side of the desk the same amount of times as he tapped the right side of the desk. Individuals with AD are resistant to change in their routines, prefer “sameness,” and have difficulty transitioning between tasks. For example, the child may like to always have breakfast before getting dressed and then having the parent take the same route to school each morning. An AD child may become overly upset with even the smallest changes in his environment, such as, the teacher switching the types of crayons used in the classroom. Repetitive activities are a defining characteristic of this disorder. These activities are preferred and engaged in at length. Similarly, the individual often has an intense preoccupation with one or two areas (i.e., weather, history, trains, or dinosaurs). Therefore, the child may engage in repetitive play surrounding his area of special interest, such as, lining up his model car collection on the floor. This preoccupation is abnormal in its focus and/or its intensity. In the area of interest, the individual has an incredible capability to memorize facts. Although overall conversation ability is typically poor, when discussing his area of interest, the individual may possess advanced knowledge on the topic (Treffert,1999). However, when discussing his area of interest, the conversation is usually one sided and the child may not pick-up on social cues regarding the other person’s disinterest or know when to stop speaking.
   Since common features of AD include anxiety, repetitive behavior, and fixed habits, it is apparent that this disorder can mimic OCD (Yaryura-Tobias, Stevens, & Neziroglu,1998). Research studies in the psychology literature have focused on distinguishing between the restricted, repetitive, and stereotypic behavior associated with AD as compared to the compulsions found in OCD (Baron-Cohen, 1989; McDougle, Kresch, Goodman, Naylor, Volkmar, Cohen, & Price, 1995). In general, AD is typically characterized by a more severe impairment in social interactions (e.g., poor social reciprocity, poor peer relationships, and poor verbal and non-verbal skills). In addition, individuals with AD tend to have a more restricted pattern of interests and activities than those individuals with OCD. For example, a child with OCD may be obsessed and fearful of contamination and germs, whereas, a child with AD has a positive interest in a particular area. The next section will focus on some of the important differences between AD and OCD that can assist one in further differentiating between the two disorders.

    As previously mentioned, a defining feature of AD is that obsessive thoughts surround involvement in an activity or area of specific interest. For example, an individual with AD may have a restricted interest in the area of trains. The high level of interest in this area may appear obsessional; however, it is important to bear in mind the definition of an obsession. By definition, obsessions are recurrent and persistent thoughts, impulses, or images that cause marked anxiety or distress. Individuals with AD typically do not experience anxiety or distress surrounding their area of interest. In fact, they derive pleasure from it. However, in OCD individuals experience a marked level of anxiety or distress. Therefore, ways to further differentiate AD and OCD is to assess whether the individual experiences anxiety or distress related to his obsessive thought patterns or compulsions. If the individual derives pleasure from the repetitive behavior and not just pleasure from anxiety reduction, then this feature is more likely linked to AD than OCD.
   To minimize or neutralize the distress, an individual with OCD will engage in compulsive behavior. In AD, obsessional thoughts do not have specific compulsions attached to them.
Researchers have hypothesized that individuals with Pervasive Developmental Disorders may be unable to monitor their internal states and report anxiety related to obsessive thoughts (McDougle et al., 1995). Therefore, it is important to also examine the content of the behavior that occurs. It has also been found that some of the more common compulsions in OCD patients, such as checking and hand washing, are rarely found in AD (McDougle et al., 1995). Although, restrictive and repetitive behavior may mimic a compulsion, it is not completed with the intent to minimize anxiety or distress, nor is it specifically associated to intrusive thoughts.
 Distinguishing between AD and OCD is potentially easier when each disorder is occurring on its own. However, as we have seen in our clinical experience, patients present with co-morbid AD and OCD. Co-morbidity is defined as the co-occurrence of two separate disorders at the same time. In these instances, it can be very difficult for clinicians to distinguish between what may be repetitive behaviors related to AD and what may be an OCD compulsion. Exposure and response prevention (ERP) to minimize rituals and restrictive interests in an individual with AD is not very effective because the child does not experience anxiety and therefore there is nothing to “habituate” to (habituation is the process by which anxiety is extinguished). It is through habituation that compulsions are reduced in OCD (there is neuronal fatigue occurring in the brainstem reticular formation). Rituals related to AD provide comfort to the individual and are not anxiety provoking. There is no negative situation to expose the individual to, however, one can limit some of the repetitive activity. If we attempt to strip the individual of this activity entirely, we potentially risk removing one’s positive coping strategy. On the other hand, if a clinician can distinguish between behaviors related to OCD and those that belong to AD, then one can attempt to successfully treat the OCD related symptoms with ERP. If an individual with co-morbid 

Asperger’s and OCD presents with an overwhelming amount of compulsions and ritualized behavior, by treating the OCD with ERP the amount of compulsive behavior that the person engages in can be reduced. After the OCD symptoms are treated, then one can proceed with other treatments to address the AD related behavior. Treatment of AD typically involves social skills training, parent training, and behavior therapy to decrease unacceptable behavior, while increasing more adaptive skills. For example, if a parent wants to increase desirable homework performance in his or her child, then the parent can make activities related to the specific area of interest (i.e., reading history books) contingent upon homework completion. One should note, that targeting undesirable behavior in AD children does not mean changing those behaviors that are considered “odd,” rather interventions should target behaviors such as repetitive questioning, inappropriate homework behavior, or increasing appropriate social skills.
  In summary, individuals with AD or OCD may evidence similar symptoms, including, shifting, incompleteness, anxiety, compulsions, and adherence to rituals. In general, individuals with AD are more socially impaired and demonstrate difficulty forming reciprocal relationships. In AD, individuals may have obsessive thoughts surrounding a restricted area of interest, but these thoughts do not likely cause a marked level of anxiety or distress as they do in OCD. Lastly, compulsive behavior in OCD is completed with the intent to minimize anxiety. In AD, individuals derive pleasure from engaging in these activities.
* To protect confidentiality, case descriptions in this article are based on composite or fictionalized clients.

Fugen Neziroglu, Ph.D., is a board certified Behavior and Cognitive psychologist involved in the research and treatment of OCD for 25 years.  She is the Clinical Director of the Bio-Behavioral Institute in Great Neck, NY and Professor at Hofstra University.  Jill Henirksen, MS, is a school psychologist who works with children and adolescents and interned with Dr. Neziroglu at the Bio-Behavioral Institute.
image by
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Monday, August 19, 2013

Walking the Thin Line: How to Transition a Suicidal Foster Child into Your Home

by John and Diane

I recently posted a blog with some information on working with foster kids who threaten to hurt themselves or are suicidal.  I have been working with a child like this and it has been a delicate balance that I have been struggling with.  I wanted to share my journey with all of you, in hopes that you might give some advice, or perhaps learn something from my struggles.

I got this foster child we will refer to as Mary as a young teen, with a history of self- abuse and a recent suicide attempt.

After release from the hospital Mary came to my home in a delicate mental state. Although she was receiving some counseling, after a few days in my care, she seemed to be adjusting well to my home and the other children. She had a "boyfriend" at the time, whom she relied on heavily, but there was no physical intimacy between them.  I allowed continued, monitored interaction as I felt it was necessary for Mary to have some support and a sense of continuity in spite of the new living situation.

I admit, I was nervous about Mary's history and although I usually go into "Jesus Mode" with my incoming foster kids, learning their history and gaining their trust, ( Read more about Jesus Mode in " Tantrums and Trust Disorders" )  I just didn't know how hard I could push Mary, how strict I could be with her regarding following house rules and how much I needed to restrict her.  I felt like I needed to coddle her a bit more at the beginning, as she had extreme self-worth and self-esteem issues, was extremely sensitive to redirection or correction and quickly fell into "dark moods" and depression that worried me.

I spent a few weeks attempting to build Mary's self-esteem, confidence and self-worth.  I gave her opportunities to feel part of a family unit, to express her self and feel safe within boundaries. I spent a great deal of time counseling Mary and building a trust bond with her.

During this time however, I saw Mary becoming more manipulative, using her depression as a way to get her way.  I was worried about this. Was I seeing this correctly? Could I correct this behavior? If I began to set stricter boundaries, what would happen? Would she retreat into self-harm?

I had a heart-to-heart with Mary one day when she was trying to push her limits. I told her that it didn't seem like I could make her happy in my home. No matter how much I did for her, it seemed like she needed more and more to make her happy. That was not going to work for me. We talked about all of the things I felt, the manipulative behavior, and I was straight with her, outrightly telling her I felt manipulated. I am not one to beat around the bush. She didn't have much to say.

Diane, my co-author and I consulted on all of this and came to the conclusion that it was a good time to start setting some boundaries and making trust a two-way street.  A common practice amongst therapists is to make a contract with patients who have suicidal tendencies.  The contract is a promise from the patient to the counselor that the patient will not harm themselves.  Creating a contract like this between Mary and me would be a great start in building trust between us and removing part of my fear. It would also give me an opening to discuss how I would need to begin putting some boundaries on Mary, and begin treating her like more of the family. During this discussion Mary officially moved from her "Jesus Mode" status to a more regular member of the household.

It's difficult to know when it's right to move a child forward, but I guess instinct and experience must be relied upon, as well as consulting with your treatment team. You, as primary caregiver though, know the child the best, and must do what is best of the child and the family unit.

Attribution Some rights reserved by B.Riordan.

Tuesday, August 13, 2013

How Do I Deal With: Kids Who Hurt Pets

Hi Friends,

We have talked a lot about kids and pets here on FPR, and we have mentioned many times about how necessary it is to supervise foster kids with pets during pet therapy or as you are just getting to know your "new" kids, as many times abused or traumatized children will act out, or children with RAD or attachment disorders may need coaching when interacting with animals.   Yes, we have kind of danced around the topic, but we aren't dancing anymore.

We recently got an email from a friend and reader asking a very straightforward question, and although we have a lot of information on the topic, we didn't have a straight-enough answer for her.  We thought we should go ahead and talk about the topic of kids who hurt or abuse pets or animals and what you should do about it.  (imagine us shifting uncomfortably in our chair.)

First, the question from our reader:

Q:  Recently our little guy has really been picking on our dog. He's getting worse and worse little by little. We have a no touching animals rule in the house, but he disregards that rule despite the consequences. Any ideas?  [ the child has shown evidence of RAD or an attachment disorder.]

A: FPR:   This is basically what is happening:  RAD kids don't know how to show love, and so when they try to show the dog affection, they try to control the dog (which is the only way the child knows how to deal with people and animals..thru control) and so eventually the dog revolts against it and struggles against it, so the child gets rough.  Now the relationship between pet and child is damaged.

 So, you have to show the child how to rebuild the relationship with the dog.  Give him treats to give the dog and teach him how to interact properly with the dog.   Also, only supervised play with the dog until you are sure that the child has learned how to interact with the animal.

The no- touching the animals rule isn't going to work. You have to spend time teaching them how to play with the dog and have only supervised time with the animalsA No touching rule is impossible, you might have a "no picking up rule," "no hitting the dog rule" is okay, but you have to take control of the dog and keep them separate.

 Let me know how it goes and keep up with it even if you think that they have learned it...
sometimes they can trick you and revert to the bad behavior. 

Now, my advice comes from my own experience working with RAD kids and my families own pets.  I have had the same issues with kids being too rough with pets, mistreating them, and I have cameras in my house, I feel like I supervise the kids as well as anyone can.  And I lost a pet. A small breed dog under unfortunate circumstances- most likely from one of the kids hugging the struggling dog too roughly.   It was devastating.  The RAD child then acted as if nothing bad had happened. He had to learn to allow others in the house to grieve the loss of the pet, I had to accept it, and counsel the child through the event, to try to discover what had happened, without allowing my own personal feelings to come out, or to take them out on the child, ... it was terribly, terribly difficult.

In the end, I guess it helped build trust between this boy and myself. He was sure he'd be kicked out of the house for the incident, and I didn't kick him out.  I tried to get to the bottom of the situation, and we continued to work on his skills with pets, and worked and worked on it.  He has come a long way and I do believe he will be a success story yet.  Time will tell.

Here are some other resources for you. Some very interesting articles here I encourage you to read if you are dealing with this problem. 


Children Who are Cruel to Animals: When to Worry

Children Abusing Animals

 Cruelty to animals a sign that heeds attention

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Wednesday, August 7, 2013

Dialectical Behavioral Therapy: Sounds Scary, but You Are Probably Doing It Already...

by John and Diane

Dialectical Behavioral Therapy (DBT) is a cognitive/behavioral therapy and a term you might hear being thrown around if your child deals (and your family) deals with obsessive compulsive disorders, borderline personality, or bi polar personality disorder (to name a few.) 

It sounds intimidating, but a lot of the principles it uses are most likely things you are doing already with your foster, adopted or bio. kids who have behavioral issues that stem from wrong-self perceptions and exagerrated sense-of selves and importance.  

Basically, this type of therapeutic approach is used on people who have extreme emotional reactions to situations that most people would not, and would take more time to "level out." 

Now, I realize the below information may seem overwhelming, or you may think to yourself, "well, I won't be able to get this kind of therapy for my child..." 
I get that.

However, I wanted to bring you all this information so that you can either, mention it to your team, if you think it's applicable to your child, OR, put some of the principles into use on your own if you think some of the approaches might help your child, no matter what his or her diagnosis.  Any therapeutic intervention is basically a way of interacting and talking with your child... you can do that.  Just read through the material and read  more about it.  You can do it. 

As always, we encourage you to run your ideas past your counselors, physicians or social workers if you have those people at your disposal.  

Here is an overview from PsychCentral: 
People who are sometimes diagnosed with borderline personality disorder experience extreme swings in their emotions, see the world in black-and-white shades, and seem to always be jumping from one crisis to another. Because few people understand such reactions — most of all their own family and a childhood that emphasized invalidation — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

Characteristics of DBT

  • Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.
  • Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.
  • Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.
Generally, dialectical behavior therapy (DBT) may be seen as having two main components: Weekly individual sessions and weekly group sessions.

The Four Modules of Dialectical Behavior Therapy

1. Mindfulness
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

If you are working, living or loving a person with borderline personality disorder, check out this website,  


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