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,  http://familiesontheline.com/index.html  

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3 comments:

  1. Replies
    1. Thanks for taking the time to comment, Robin.

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