DBT gives me PTSD

Pachy, you ask some very good questions. You've put into words for me feelings I've been having.

I understand the importance of addressing and mostly living in TODAY. But as Socrates said, "An unexamined life is not worth living." I do get the feeling at times that therapists aren't all that interested in my need to sometimes talk about the past. Like my past is irrelavent to who I am and how I'm feeling & thinking TODAY!

I'm very good at getting myself back into TODAY so I can function and live my life. But when I'm with my T I do feel the need at times to go over my past, for various reasons that I feel are good reasons.

Sometimes I need to share the connection I made between back then and TODAY. Sometimes I simply want the validation of someone who supposedly really understands. Or the absolution for all the bad choices I've made because of my past. I need to be told I'm not a horrible person, but one trying to heal and as I get better I will make better choices. Sometimes I need my T to make connections and observations for me about my past and my present - to bring them to my attention and awareness.

You've made some very good observations in your post. Thank you.

As I understand it, originally the whole point of DBT was to make individual therapy possible for patients who otherwise would be too distracted by all the ongoing crises and triggering in their lives.

To me it didn't (and doesn't) look like it was anything about "feeling a need". The workshop was an exercise (or series of exercises) and that was the format of the exercises. If you didn't want to play by those rules, you were encouraged not to stay for the workshop. As well ask, when you're playing baseball, why does the umpire feel a need to make you run from first to second to third base instead of coming home directly from first? After all, it would be much shorter that way -- though it also wouldn't be baseball.

In the context of the workshop: Having been there myself, I'd say workshop leaders had a great deal of room for participants to experience whatever they experienced and move through it as long as they did so in ways that supported the other participants in doing likewise. They seemed to have seen it all and to be well prepared to take anything in stride and steer it into somehow contributing to what we were there to do.I kept seeing workshop leaders exercising, yes, exceeding care and self-awareness, and not slipping into anything I would've found abusive. Please remember that I'd been around the horn a few times myself when it came to abuse; was at least as trigger-happy as the next guy; and went into the workshop alert for the first hint of anything that might signal I wouldn't be entirely safe there.

Actually, being able to point to something (outside my own imagination, that is) that showed I wasn't entirely safe, would've been just the excuse I was looking for to hunker down and protect myself instead of watching my own stuff come up and dealing with it. I'm quite certain that I wasn't alone in that, and that the workshop leader knew it at least as well as I did.

In the context of DBT: Linehan (whose job, again, is to support therapists in staying on track and doing effective therapy) addresses something along those lines in the passage I quoted earlier:It seems to me, at least, that she's coming from "How do we best get therapists past this?" -- and back to doing good therapy with patients who can (figuratively speaking) sit still long enough to make use of it.

Phoenix, I want to thank you for most of your post but also -- with appreciation, and not the least disrespect intended -- to use something you said as a jumping-off place for something I'd already been looking for a way to say. Let me emphasize: you didn't say anything "wrong"; you just represented more clearly than most, a viewpoint that I'd been looking for the best place and way to respond to.

So, as I said: I thought most of your post was excellent, and here's the part I'm making use of to illustrate my point:

Suppose that somewhere in a parallel universe, someone was having a conversation about their parallel Psych Central something like this:

========= Entering parallel universe. Please watch your step. =========

Omigod, you won't believe this! I just heard of the most awful website. It's full of crazy people and they're always talking about depression and delusions and psychiatrists and crap. Sounds like such a totally depressing place. I am so not going to go look at it. Don't tell your kids about it, they're liable to go there and get ideas how to be crazy. That's so sick! We should talk to somebody, see if they can shut it down.

========= Leaving parallel universe. Please watch your step. =========

My point is that just as the parallel "Psych Central" in that description doesn't really sound much like the one we know -- so the scary picture of DBT and Marsha Linehan that we've pieced together from a few quotes and a whole lot of imagination, may not bear much resemblance to the real thing.

(Phoenix, thanks again!)

yes I must admit fool zero I played with that paragraph for a while because I couldnt quite say what I wanted to - I didnt think it was clear and of course there is no offence taken

First I actually like the parts of DBT that I have been exposed to - like I said my T takes parts from everything and uses what works for each individual client and that works for me

The idea of saying to a suicidal patient - so why dont you do it in an agressive tone - does make me angry - (in an understanding tone t may elicit a different response) where it would work for some - for others I think it would push them over the edge - it would have me - I would have been a "right I'll show them"" kinda girl! (ok I know thats acting like a 12 year old...2 year old? lol ) - so I guess it comes down to perception - I could say to you - you'd like some icecream!!!! or I could say- you'd like some icecream - same words interpreted differently because of tone and delivery or just our own interpretations....

I have watched Marsha on a video and did get angry over ...acutally a suicide remark - it was acutually an innocent remark when put in contect but I was dealing with those thoughts at the time and maybe thats why it sparked me off - (I am a phoneix after all! )

but I always try to look into the face of my anger (when I have calmed down usually ) and try to see what has set me off - and I realised I was not taking the info at face value but colouring it with my views - maybe like I was colouring the book with the views of others instead of deciding for myself - and when I watched the video a second time without .... hmmm with just listening to the words and what they meant..... I actually agreed with most of it. (its hard to do though) just observing an emotion when the emotion is telling you to run for the hills is soooooo hard. And i am really trying the mindfullness thing - I want to be alive and participate... thats really hard too....

I'm prob confusing matters....... but hey I have a head injury ok ! lol (just how long can I use that excuse I wonder!)

take care all - be safe be happy be well P7

oooh and the thing about the psych central - thats a very good point - interpretation and perception of facts taken in different ways can change how we look at things.

foolzero - i appreciate your trying to challenge our thoughts here, but the thingy on PC kind of falls flat for me. with your parallel universe argument, PC is being misrepresented. with the quotes we've taken from Linehan - most aren't misrepresentations, they are direct quotes and paraphrases of what we've read.

being deliberately provocative to a client who is suicidal and whom you've just met is callous and arrogant. this is one of the elements i have come across in linehan's approach which does not sit well with me.

when we strip back her contributions, however, and are left with simple theories and practices such as mindfulness - then i have no problem! but most of these theories/practices have been around for decades, if not millenia, so i don't really see any original contribution of linehan in them.

i was actually talking to my T about this yesterday. he mentioned he does DBT with almost every client that he sees. i told him i thought linehan is a crazy devil woman. he asked me if i had watched her in interview (i hadn't - only read her journal articles and books), and he encouraged me to do so. he says she's even scarier in the flesh. and that everyone he's spoken to thinks she's a crazy woman also. haha.

he did say that some of her theories were very useful though, basically because they are so simple and unoriginal. unoriginal is a good thing - it means it's been around for ages and persisted as a practice because ppl have found it beneficial. i tried to talk about how manipulative i found some of the things she suggested, but i couldn't bring up proper examples (doh!), and he seemed a bit confused about what i was getting at. he did say he would only use some of those interpersonal therapeutic techniques with certain people, though. i.e., that DBT has a wide application when you strip interpersonal style away.

i will probably bring it up again next time, because i dont want him to try DBT with me. he's already tried some stuff which i am red flagging, because i thought it could've been manipulative (if he didn't mean it; stupid if he genuinely believed in what he was saying), but i'm trying to keep an open mind until i'm able to clarify.

Pomegranate: I understand the importance of addressing and mostly living in TODAY. But as Socrates said, "An unexamined life is not worth living." I do get the feeling at times that therapists aren't all that interested in my need to sometimes talk about the past. Like my past is irrelavent to who I am and how I'm feeling & thinking TODAY!

A thought or two...

In my family of origin I can recall a period of time wherein every time the family would gather, the topic of the past would inevitably come up. I took part in those conversations for a number of years but there came a point when the conversation ceased to hold any attraction for me. Instead, I found myself not looking forward to family gatherings because I knew the topic would come up and I was tired of going there. 'There's nothing we can do about what happened,' I would think to myself, 'so what's the point of dragging all this old stuff forward once more?'

Essentially what seems to have happened is I reached a point where I was ready to move on and let go of the past, but other family members weren't ready to do so.

It's almost as if there is some kind of magical line that we (hopefully) all cross at some point but the difficulty is, you don't know where it is, you can't impose it upon another and no one can impose it upon you -- even if they try really hard to do so. You cross that line when you cross it and not a moment before. However, you do know that you're broaching that crossing at the point that you get tired of talking about what was and begin to become more excited by the thought of what could be.

I need to be told I'm not a horrible person, but one trying to heal and as I get better I will make better choices.

One of the pieces I stumbled across in my own period of intensive healing went like this...

To a certain extent, this is what tonglen practice also addresses. Sometimes we are more capable of extending compassion to others than we would to ourselves but tonglen helps us understand that we are also human beings, who are also deserving of our own compassion. To a certain extent, compassion for the self is akin to self-mercy. This is not the same as self-pity for the former always contains a seed of judgment whereas self-mercy allows you to acknowledge that sometimes, it's difficult to be human.

~ Namaste

deliquesce: i was actually talking to my T about this yesterday. he mentioned he does DBT with almost every client that he sees. i told him i thought linehan is a crazy devil woman. he asked me if i had watched her in interview (i hadn't - only read her journal articles and books), and he encouraged me to do so. he says she's even scarier in the flesh. and that everyone he's spoken to thinks she's a crazy woman also. haha.

*scratching head*

Well, you know... sometimes I do think it's of enormous value to look those "crazy devils" in the eye and I still don't feel I have a good grasp on DBT or Marsha Linehan (Thanks for noting the correct spelling, pachyderm) but I'm also wondering if maybe some of the objection is that we might be looking at things from outside of the therapeutic container. Only a few contributors to the thread seem to have had the actual experience of DBT and all of them seem to identify some aspect of it that was personally therapeutic or beneficial to them -- but all of them also experienced that within the borders of a therapeutic relationship.

Perhaps part of what makes DBT valuable is that it can bring up triggery points but isn't the whole point of therapy to be able to move beyond being triggered? Perhaps therein lies the value of looking our devils in the eye. It's frightening and sometimes we might need to be prodded, provoked, encouraged or otherwise challenged to do so. In fact, it's possible that those who would insist on sheltering us might actually be holding us back through their own need to protect.

By the same token however, I still wouldn't say anyone must or should give DBT a shot or any other form of therapy that doesn't "fit" for them. If someone doesn't feel it would be beneficial and they're not willing to go there... from a therapeutic perspective it could only be harmful to attempt to force them. But sending out an invitation from time to time isn't necessarily a bad thing.

As an additional note it occurs to me that healing is a process which often unfolds in stages (which may or may not be well-defined). Take grief, for example. In the earliest stages of grief our pain is most intense. If someone were to come to us when we're in that stage and say, "You know, one day it will get better," their words might seem heartless, cutting, cruel or out of touch. Our pain can be so great in that stage, we can't imagine a time when it won't be with us. But given a year or two, or seven or twelve, or however long it takes, we might one day find ourselves in the position of saying to someone in the earliest stages of grief, "You know, it really does get better..."

When I reflect upon my own experience in regard to trauma, there was a stage of confusion and denial, followed by partial acceptance, followed by intense mourning, followed by full and then fuller acceptance and eventually... things were okay. Life got better. The past was behind me. The future was ahead.

What I needed at each stage differed and I wasn't necessarily open to or capable of hearing what someone in a different stage might have to say to me, even if it might have been helpful. I was only capable of doing what I was capable of doing in that particular moment.

By the same token, maybe those who find DBT or Linehan's approach to be helpful and beneficial and those who don't, are simply at different stages in their own process. It can be helpful and hopeful to know that people can pass through intense forms of crisis so we shouldn't lose sight of that possibility, but we also need to remember to honor where we are.

I really do not know that much about Linehan, but in reading the interview transcript with her, she stresses that her contribution was to combine mindfulness (acceptance) with the desire, and tools, to change. Some advocates of mindfulness, or at least meditation, seem to promote acceptance of everything as it is, and no attempt to make any changes. Just agree with whatever is. She does not find that useful. She used an example of someone with extreme skin burns, in agony, not finding it particularly useful to just tell the person to "accept" the horrible suffering. Doing something to try to reduce the pain and to replace the damaged skin is also necessary.

I understand and I hear you.

Ironically, the main thing that I like in DBT is the emphasis on validating. The T should find the truth in whatever it is that the patient is saying, no matter how far out there it may be, because anything that someone says has some truth in it, and some meaning for them. I find reading Linehan's books validating because I feel that she understands what it is like for me.

I just read through this thread, and I have so many things that I would like to say and probably won't even if just because I can't keep track of all of it. It is an interesting discussion. People don't seem to have neutral reactions to DBT. They hate it or they love it, most of the time. It's not a neutral kind of therapy. Dialectics deal in balancing extremes, so it goes to the extremes - both sides of them - and then synthesizes them.

I'm triggered right now, and it isn't all from this thread. I've been triggered and spaced out for most of this week, over something not too huge, but I feel powerless. A few days ago, my husband cornered me in the bathroom and I felt trapped, and told him I felt trapped, and tried to dodge around him to get through the door, and he wouldn't let me, and I think he was trying to make the point that I didn't ask properly to be let out. I didn't think that I should have to ask to be let out of the bathroom. And DBT would say to do what is effective, which is probably to ask him to let me go, even though I don't think he should make me like that. To intensify it, I just dreamed that T did the same thing my husband did, trapping me in a corner and not letting me out, and that I shoved her rather than asking her to let me go.

I wanted to share something about manipulation, from DBT. People with BPD are often accused of being manipulative, and Linehan suggests that it is the unskillfulness at manipulation that others perceive as manipulativeness. We all manipulate the environment - everyone. Manipulation means to change something. When manipulation is skillful, as in assertive communication, others feel that they choose to do what you ask them to do (or not), rather than feeling like they were coerced. If I had been able to ask my husband to step aside and let me through, he wouldn't have felt manipulated, as he probably did when I darted back and forth, tried to get around him, and eventually cried. Then he lectured me about crying over it. So, Linehan says that we need to learn to be manipulative more effectively.

I do DBT groups. I'm interested in DBT, and want to learn more about it, because these are skills that I need and don't have. And because most of DBT feels like a good fit for me. The skills from the skills groups are not original, but they are the skills that people like me don't have. They are drawn from mindfulness and meditation and Zen practices, as well as from what people who live effectively in the world know how to do and don't have to be told. A lot of it is intuitive, but some of us need to be taught it because we haven't thought of it on our own. That might be why some people can feel talked down to.

I don't know if I ever could do the irreverence and some of the strategies that Linehan teaches therapists to do. They are pretty far removed from me now, and I'm not sure that I can see myself being assertive to that extent, which does feel like it borders on aggressiveness. I still want to learn more though. One thing I have learned is that assertiveness feels like aggression to people like me who are used to being very passive. I'm not sure how clearly I can see it yet. But there are things in DBT that I like and know I can benefit from. Probably most people could find things that they agree with, as well as things that they don't like. That would probably be true of almost anything that has thousands of pages written about it.

Rapunzel, why in the world would your husband do this?

because i am passive and weak and powerless, but i didn't mean to hijack this thread. sorry.

Many animals (husbands and other people too ) seem to be triggered into an attack mode by seeing weakness. For some humans, it makes them feel their own weaknesses, I think, and in an effort to avoid realizing that, they attack.

((((Orange Blossom)))) I can't wait until your profile get fixed so I can pm you!

Yes some other people have pm'd me and said they thought it was an interesting and thoughtful discussion, but very confusing. It's too bad they don't offer the option of sorting these conversation by time or just as is when people write & post them.

Trying to read and understand this discussion without putting it in chronological order is very hard.
Also having the option that would show the whole thread all at once would be nice. I keep hitting the *read more below* links and get lost. Maybe I'll suggest these things to Doc John or a moderator.

They do, they do! At the right of the blue bar just above where you're reading this, there should be a pulldown marked "Display Modes". I've had mine in "Linear" all along and have been assuming everyone else did, too. It sounds like you're reading in one of the other modes, though.

When I'm in "linear mode", ten posts are displayed on each page. At the top and bottom of each page is a navigation tool for going to other pages. Sometimes I'll have two or three pages open at the same time in different browser windows or tabs, and be able to jump quickly between them without losing the place where I'm replying.

I'm delighted to see you still hanging in here. There are some interesting points you've raised in the last couple of days that I'm still planning to address (eventually).

-----------------------
Oh, and: In that same blue bar is another pulldown called "Thread Tools" that offers a printer-friendly view of one page (ten posts) at a time. In a thread I'm especially interested in, I'll sometimes print out a few pages of posts to take with me and reread over lunch. In fact I have some sitting in the printer right now that I shouldn't forget.

(((Rapunzel)) I hope you are safe

((((rapunzel))))

thank you for sharing your experiences! i agree that there are many useful components to DBT and i'm glad you've found it useful.

i guess i have been more worried about those "aggressive" aspects that you mentioned that Linehan encourages therapists to use. that is something i won't stand for, especially coming from a therapist. it is like what you said: everyone manipulates their environment, but some of those manipulations leave us feeling like we have a choice, and others feeling like we've been coerced. aggressive behaviour, to me, falls into the coercive camp. there is a definite boundary between being aggressive and being assertive. so many anger-management courses are focussed on this boundary, so i'm surprised that Linehan does encourage it to an extent.

as for the "life skills" that she talks about - i agree that they are all useful!! i think i already have many of them, but i can't identify what they are, and sometimes i think it would be useful to be able to label them, so i could choose which skill to use in a given situation.

as for what your husband did, sweetie, i don't understand either . he was trying to intimidate you (at least that how it reads to me), and quite frankly i don't give a rat's arse about whether he felt manipulated when you tried to leave without asking. you told him you felt trapped, and then you tried to leave. that to me is assertive behaviour. if you had "asked", the way he wanted you to, it would've reinforced his idea that it's up to him whether you are allowed to leave a bathroom or not. he has no right or place in trying to control you like that.

i'm sorry you're feeling triggered - i would be too . i hope you're keeping safe right now. do you think you'll address what happened with your husband directly, or in therapy? i hope you get a chance to sort it out .

pachy - thanks for your post about linehan's contribution . i've read her say the same thing as well. i guess i just disagree with her assertion that it was her (unique) contribution to combine those two aspects. it's not really a novel idea (change where change is warranted; acceptance when things cannot be done) but if she wants to claim it was her idea, then eh. i guess it might have increased awareness of the idea, but mindfulness has been incorporated into many therapeutic models for a while now (e.g., mindfulness based CBT) so i don't think it was unique.

the only really novel aspects that i see in her theory are her therapist-interaction-stuffs, but i find that a repulsive contribution to make to the field of psychology.

I'd love to read/hear/watch where Linehan said that and especially, in what context. So far it sounds completely at variance with what she says in her book (Cognitive-Behavioral Treatment of Borderline Personality Disorder) about dealing with suicidal patients. Starting on p. 468, she spends about 25 pages on suicidal potential and behaviors with only one brief excursion into SI that I noticed. This comes as close as anything else I found to the subject of "calling the patient's bluff" but it's 180 degrees from the other statement(s) you're attributing to her:(Straight from the devil woman's mouth, as it were, pp. 484-485)

If anyone comes up with an interview where Linehan says otherwise, would you (pretty please! ) see if you can find a transcript? I use a dialup connection and I'm really not looking forward to downloading any hour or even half-hour videos.

it's bee a while since i read it, but i will try to dig it up later tonight if i can (hope the gods of google are able to help me out).

thank you for sharing that quote, fool zero. i am glad we can both agree to call her a devil-woman, even if she doesn't have devilish things to say .

Thought balloon:
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Officially not posted by Fool Zero:

I wonder which would really be more invalidating
to Rapunzel: to buy her self-evaluation, or to call
******** on it.

oooooooooooooooooooooooooooooooooooooooooooo

Thanks for stopping by, Rap, take care of yourself, and I hope you feel better soon.

Well, my T (who doesn't primarily use DBT) generally responds to me acting passive by herself acting even more passive until I give it up. Something tells me Marsha Linehan would approve of that method of calling my bluff.

Yes, this incident, especially with the dream which intensified the whole thing times 5, is on my agenda for therapy tomorrow, um, actually I guess that's today, actually. As would also be avoiding the husband by not going to bed even though I will continue to be sleep-deprived on a day with 5 hours of driving to do. Uh huh, this is going to be a fun one, isn't it?

In DBT terms, once again, there is a balance between acceptance vs. change strategies. Quite a touchy one. Validation of the way that things are is helpful to a point, but validation that "yes, you are passive and helpless and weak" would turn out to be invalidating. Sometimes irreverence may be called for. It all comes down to the context.

Yes, I'll be ok. I've been a bit off today (yesterday?), but I made it through the day, and for once I have therapy scheduled right at about the right time.

I was going to say something else. What was it? Oh yes, assertiveness is the only communication style that doesn't tend to feel manipulative. Passive, aggressive, and passive-aggressive all tend to feel that way, whether or not the person acting passively, aggressively, or passive-aggressively actually gets what they want. There's that balance thing again.

DBT is a very structured method of therapy. If anything drives me nuts about it, that's probably it. And I know that Marsha Linehan wouldn't claim that DBT is for everybody. I have listened to a recording of her speaking about evidence-based therapy in which she talked about research (her own and others' also) on other evidence-based therapies for BPD. She recommended three options, actually. DBT; Mentalization-based therapy (which is a psychodynamic approach with good evidence); and "treatment by experts," which is simply treatment by someone with experience and a good track record, no matter what their method or orientation. All of these three, according to Dr. Linehan, were emperically shown to be effective treatments for BPD. There is some overlap in symptoms between BPD and PTSD, and some emperical basis for expanding the target population, but I'm less familiar with that evidence. Personally, I'm using DBT skills groups and some DBT strategies with teenaged boys with addiction and criminal behavior. Most of them don't have BPD (in fact, I'm not aware of any of them with BPD), but some of my clients with PTSD are responding to DBT very well. There are also some (especially kids with Oppositional Defiant Disorder or Conduct Disorder) who hate DBT. But then, those same kids seem to hate pretty much anything we try.

In that talk by Dr. Linehan, she also mentioned that after 2-3 years of DBT, some patients benefit from followup with psychodynamic therapy. She seems pretty inflexible at first glance, but she also seems more open to other methods than one might expect. I don't know if I'll ever practice strict DBT. I keep finding other methods that I want to draw from also. And I'm not entirely clear on how much I could do that if I were calling myself a DBT therapist. But EMDR has its place, and I've always liked psychodynamic therapy too, among others.

This post brought to you by Rap's other personality fragment, the academic/professional, who took over after Rap's previous post by "the whiner." Rap needs to give her ego fragments better names. These seem more functional than the numbering system originally proposed by Rap when T asked what Rap wanted to call them, tho.

I have some names - Teacher and deserves support you are NOT whiny