DBT equals not talk therapy?!

I saw my new DBT therapist today. Apparently I've misunderstood. I'm not actually supposed to do all that much "processing" or talk therapy with her. She's more of a life coach than a therapist. So my emails over the weekend where I told her all this **** I've been working out in my head.... yeah, that's a no-go. Not supposed to do that.

She said I could do some processing in session but even that is not the point. The point of the emails and phone coaching is just to say "hey I tried these specific coping skills; it didn't work. Which other ones should I try?"

I guess that's good to know but I don't know if I really need that. I mean I have the list of coping skills. If some don't work I can easily try other ones.

Ok so I get this ... kinda. DBT is about learning coping skills, not about processing ****.

But don't I need a therapist too? Don't I need some objective third party to process stuff with?

Maybe not. Maybe this is a message to me that I should try to learn how to stand on my own two feet and not be so reliant on therapists.

I don't know. I have no idea what I'm supposed to do now. I guess I'll try it. No more talk therapy. Just DBT. I work my **** out on my own from now on...

Does anyone else have this type of approach? Is it working? Was it hard to adjust to not having a talk therapist and just having classes on coping skills?

There is a school of thought that you need to learn all these coping skills and become stable BEFORE you can process things. DBT is one of the models of T that does that stabilization. I have heard a lot of people having a separate T for trauma and stuff, but it is hard to stabilize when you are digging stuff up from week to week.

Edited to note: This particular style didn't work well for me.

If I were you I'd stick with talk therapy, then again I've never done DBT. Life coach seems a little lame, talk therapists are like life cheerleaders so I think you'd get more going to one of them than a very specific DBT only one

@Wikid really?? huh. that possibility kinda throws another wrench into the mix now.

Right now I'm thinking I will just do the DBT thing and no more getting all deep and personal with therapists. It just opens the door to heartbreak for me and it's probably not even necessary right now. I'm a smart person. I can figure things out on my own. And if I can't I have 3-4 good friends who are all good at keeping me balanced and telling me when I'm spiraling off in illogical thought patterns.

No more talk therapy for awhile. Just DBT.

I think.

Yes, the point of DBT is that the person is that the person is self-destructing to the point where they're not in a position to process trauma, and in fact it would be dangerous and irresponsible for the thearpist to do this if the person doesn't have the skills to deal with the fallout.

DBT thinks that self-destructive behaviours are because of a deficit in skills- the person has not been taught how to regulate their emotions, tolerate distress, or be effective in interpersonal relationships. It therefore tries to explicitly teach you these skills plus mindfulness (in skills training- often in groups) and then to help you apply ('generalise') these skills to your real life using coaching (usually by phone).

DBT individual therapy deals with problem behaviours in a hierarchy. Life threatening behaviours (suicide ideation, self harm etc) are the highest priority, because if you're not alive, well..! Next come therapy interfering behaviours, because if you're not in therapy you can't change any other behaviours. Next come quality-of-life threatening behaviours (e.g. overeating). You fill in the diary card recording your behaviours and your use of skills. In the individual therapy session, the therapist identifies the most problematic behaviour on your diary card, and you do a behaviour chain analysis to look at what led up to that behaviour, and to look at what skills you could have used at which points to prevent the behaviour.

This is all only 'Stage 1'. At Stage 2, you address the trauma which led to the behaviours.

It sounds mechanistic, and I'm sure a lot of it comes down to how the therapist presents it and how human and empathetic they are able to be within this framework. But it certainly saved my life. My experience was of having 'talk therapy' where I left each week more distressed and out of control and nothing I tried was stopping my escalating and increasingly dangerous behaviour. DBT worked for me.

@minniemouse. Holy crap that was useful!! Thank you!!! You'd think they might explain that to a person just starting out in DBT! How confusing. Why didn't she (my DBT therapist) say any of that?

Lilly, you might like this site:

http://www.dbtselfhelp.com/

Can you say more about how stage 2 of DBT addresses the trauma? I guess I've only heard of stage 1, which is coping skills. It didn't seem to me that DBT went beyond coping skills to healing from and processing trauma. So it is good to hear there is a stage 2. How is the DBT trauma work done once the client has learned the coping skills?

minnie, brilliant explanation! I took DBT for over a year and never realized that - they use those hokey new-age "mood imagining touchy feely" names for each of the "nodules", I never knew wtf we were learning or why or more importantly, the PROGRESSION. My T says, progress, not perfection. btw, I DID find DBT very helpful in teaching me skills I didn't know, skills I didn't know I didn't have! the sentence completion and other such exercises are enlightening. I kept my private "talk T" thruout, my pdoc had suggested the DBT thru the uni where he was resident, so kinda not the usual situation.

The residential trauma program that I have been on the waiting list for is DBT based. I took DBT several years back, and I didn't click with it, but the therapist was going thru a lot of personal problems at the time(her son had cancer). Plus the fact that the group was in the middle of the book and I was a newbie and it was way over my head. I think the program I wait-listed for will be a better fit, if I ever get in.

I see a DBT t, and am in a dbt group. With my t, i get to process stuff, but she'll bring up dbt skills that would be helpful in coping with the stuff I am processing. It's not an all or nothing thing for me.

Wow, that's pretty surreal that they would not explain anything about DBT and then expect people to know what's going on! DBT is confusing and different from what people typically think of as psychotherapy, so it seems especially important to get people's informed consent...

sunrise, yes, DBT actually has four stages. This page has a pretty good description at the bottom:
http://www.sfdbt.com/DBT.htm

You're right that the DBT model is pretty underspecified for Stage 2 onwards- it doesn't articulate how to process trauma, for example. The therapist needs to get create here and use whatever other models and frameworks while still holding the overall ethos of DBT in mind. My T and I are using Schema Therapy at stage 2.

In my experience, most DBT services focus on Stage 1, and when people talk about DBT they are generally talking about Stage 1. Particularly in these cash-strapped times, it's easy for services to fous on reducing dangerous behaviour but then not follow through. Stage 1 is important of course as it's about saving people's lives, but I do feel it's important not to leave people in a state of 'quiet desperation' (as DBT calls it)- it's too difficult to maintain new skilful behaviours long term if the PTSD isn't addressed and if the client's life doesn't actually become more worth living.

Thank you, MM. That link you gave explains DBT really clearly. All it says RE trauma work in stage 2 is "Targeting and decreasing symptoms of Post Traumatic Stress Disorder (PTSD) and other Anxiety or Depression related symptoms." It sounds like one does trauma treatment after one has the DBT coping skills on board. So I guess the therapist would then use EMDR, CBT-focused trauma therapy, somatic re-experiencing, schema, etc. or whatever his favorite way of treating trauma is. I had been thinking maybe DBT had a trauma treatment embedded in it, but I guess not. It seems like a valuable prelude to trauma work, though. The coping skills can be used whenever the trauma work gets intense and triggers emotions that need managing.

Wise, wise words. People want to heal from trauma. Adding trauma work after stage 1 DBT gives them a chance for that. With DBT only, there is no healing of the original trauma wounds, just coping with trauma fallout using the learned skills (which is no small accomplishment).

At this point DBT is developed through Stage 1. Marsha Linehan is currently working on developing stage 2 for DBT. The current suggestions are for in sage 2 the therapist to use some sort of exposure based therapy that is empirically based.

That's very exciting, googley. Thanks for sharing that. Linehan came to talk to one of my classes once and she was so very thoughtful about her work. I look forward to seeing what she comes up with for dealing with trauma in stage 2. I have been reading about trauma therapies and have been very impressed with CBT-focused trauma therapy (or is it trauma-focused CBT?). In particular for children and adolescents. It has some good exposure-based components to it.

I haven't read the thread just the original post so if this was replied to already sorry!

DBT has different phases.

Stage 1
Decrease life-threatening behaviors
Decrease therapy-interfering behaviors
Decrease quality of life interfering behaviors

Stage 2
Decrease posttraumatic stress responses - therapist may use any trauma model of their choice (TF-CBT for example)


Stage 3
Increase self-respect /Achieve individual goals

Stage 4
Freedom / Joy in Life

In DBT you are required to be appropriately stable, have no more interfering behaviors before you can move on to the next phase. They find it is not helpful to move into any sort of trauma or "traditional therapy" work if there continues to be the above issues.

Interesting...so when I went through DBT with my first T, I only did stage one. It took me a year of changing drug regimen and six months of DBT to get to the place to do a year of CBT. Never healed trauma, wasn't really interested in my past.

It seems like DBT can lay a good foundation for so many types of work.

Interesting.

I think it was a mistake that I got put into DBT. I don't have much trauma to heal first off (except the trauma of my T. leaving me in the middle of a suicide attempt). Second, while I'm not perfect and I'd say that I do tend to feel things a little more intensely than others seem to, I don't generally have a problem managing those feelings in daily life. I could benefit from re-focusing on healthy coping skills, sure, but who couldn't?

Sorry this is off-topic but I gotta process a bit:

I think, for me, what happened is my T. was distracted by personal problems at the same time I was going through a rough patch, so he suggested I get back on the anti-depressant, I did, all hell broke loose, I freaked out, he freaked out and didn't want a suicidal patient on his hands and said go do DBT.

I freaked out more over him leaving, and meanwhile the pdoc was saying "here try this drug, no, try this one, add this drug too".

No one was keeping their head about them and remaining sensible about the whole thing until I decided that ****it, no one was going to save me and if I didn't do something QUICKLY I was gonna fall through the cracks in the system and possibly DIE so screw the doctors I'm getting off the anti-depressant, trying to find a new therapist, maneuvering my way through all of this with no insurance and no guidance from a professional just my own wits and natural skepticism and open-mindedness so i said sure, I'll try the DBT stuff and I'll try on your borderline label too to see if it fits.

I seriously considered the possibility that I had BPD but ultimately in the end, no, I don't have it but DBT is kinda useful (or at least not harmful).

And let's face it, I wouldn't have ended up here if it hadn't been for an unfortunate confluence of extreme events but now that I'm here I'm going to get what I can out of the class, maybe try to find a new talk therapist (but maybe not) and slowly start putting my life back together.

Mistakes were made, as they say. I need to get over it and get on with my life.

yea, I get that Lilly. Sometimes the mental health system can be like a giant vacuum.