[Bleufacez]

Anyone ever been to DBT prior dx of BPD? From what I read... it's like a boot camp of all therapies. What can you tell me about it... is it any good?

Pdoc is referring me to DBT in addition of CBT. any concern for conflict? He hasn't said I've got BPD but he's concern of my chronic feelings of emptiness, suicidal ideation and self-destructive behavior. T said I've got too much rational mind & not enough emotional feeling. :::sighs:::

Sometimes I want to feel but I cant. Chest feels congested... it's an emotional constipation. It feels so physical that I can't sleep sometimes. Anyone ever experience this?

Hiya. I was seeing a CBT therapist and they introduced DBT in the region so she reccomended that I give it a shot. I didn't have a prior dx of CBT but she thought I could get some use from it anyway. And... I did! I guess it kinda does look like a 'boot camp' in some respects because of the skills group component and a very structured individual therapy component too lol. Is your therapist DBT trained, do you know? I would say that it would be nice if your CBT therapist was trained in DBT so she could see how you are going with implementing the skills learned in group and stuff like that, but I guess it isn't essential. You guys could both learn along together :-) It isn't that there is conflict exactly... (CBT is a modified form of DBT) it is just that the emphasis is different in CBT than it is in DBT. For example... There is a lot more validation rather than questioning of feelings and that might be just what you need so that you can become aware of your feelings and so that you can learn how to express them.

I think I get what you mean about emotional constipation. I found... That CBT brought that out in me because of all the questioning of my feelings and the focus on changing them all the time rather than simply acknowledging and accepting them.

I really got a lot out of DBT. I hope that you do too :-)

- I - don't do DBT because MY therapy plan is geared towards learning how to let MYSELF feel and express MY feelings instead of passing them off for the unemotional point of view that comes from MY having DID,

but here is a terrific website that explains what is involved with doing DBT. and yea its kind of like attending bootcamp because you are on a strict schedule right down to dietary schedule and all work must be done in order because one skill leads into the next and what you learn in each lesson is carried over into the rest of the lessons and homework.

and At the moment Im a bit confused - your therapist wants you to do DBT to gain and express more feelings because you think from the rational mind instead of the emotional one?

DBT is looking at your problems from a rational nonemotional nonjudgemental point of view mind instead of the emotional one.

Basically with DBT you will be having structured classes in looking at your problems and resulting behaviours from an unemotional point of view and changing those emotional thoughts and behaviors so that you are not so emotional when things don't go right for you.

This link will explain the classes and also has the worksheets and so on that people who are in DBT do with their therapy professional and also do as homework.

http://www.dbtselfhelp.com/

Er...

Different therapists are different and I guess one person could have a good experience in DBT while another person could have a not so good one...

But a couple things you said didn't sound like how DBT is supposed to go:

> you are on a strict schedule right down to dietary schedule and all work must be done in order because one skill leads into the next and what you learn in each lesson is carried over into the rest of the lessons and homework.

To the best of my knowledge the dietary stuff is educational in the sense of encouraging one to pay attention to how eating different kinds of foods (or not eating food) can affect ones mood. The order of the skills is varied by different programs. Mindfulness tends to be done first, but I think that the ordering is somewhat arbitrary.

> with DBT you will be having structured classes in looking at your problems and resulting behaviours from an unemotional point of view and changing those emotional thoughts and behaviors so that you are not so emotional when things don't go right for you.

If that was your experience with it... Then that really sux. My experience was different. Basically... There are always two options. One can accept things or one can attempt to change things. Change is thus only one half of the picture instead of being the total picture (as it tends to be in CBT). I did an awful lot on learning to be non-judgemental of myself (and my alters) so that I could become aware of my / their feelings like sadness and rage without judging myself and feeling even worse... I did a lot of work on being aware of and accepting my / their emotions.

The idea of homework is that learning new skills takes practice. One has to practice when one is in a good place so that when one is in a bad place one is able to use the skills.

I'm sorry you had such a bad experience with DBT myself :-(

[Bleufacez]

This is the DBT definition that I got:

The purpose of the DBT skills in all four skill sets is to help the client get into a state of mind referred to in DBT as wise mind. Wise mind is the middle ground in the dialectic between rational mind and emotional mind. To be too far on the side of rational mind would mean focusing only things such as facts and figures; ignoring and supressing emotion. To be too far on the side of emotional mind would mean being so blinded by strong emotions that one would not be able to consider the facts.

Once can either be really rational (lacking in emotion) or really emotional (lacking in rationality) and thus, a balance is called the Wise Mind. So... I think pdoc wants me to get in touch with my "feelings" so I won't keep having this emotional constipation.

I'm kinda looking fwd to this therapy since it would be very challenging - as it sounds.

[kimmydawn]

Hi there.

There's a wonderful, informative thread about DBT here:

http://tinyurl.com/yac8c5

Thanks!

KD

"If that was your experience with it... Then that really sux" and "I'm sorry you had such a bad experience with DBT myself :-( "



- MY - post clearly stated that I DONT do DBT so obviously my experience with it doesn't "sux" and I couldnt have had a bad experience with it if I haven't done it.

yes dietary is educational BUT the client is expected to do "homework" on that by instituting what they are learning in the classes into their outside of therapy time at the least during the time that they are in the classes. Many of my friends ARE trying DBT.

Yes order of skills are varied according to the client BUT the client must do thoser skills in the order assigned by the therapist. they can't just suddenly jump all over the place in the classes. The purpose of DBT is to not having your thoughts jumping all over from this topic to that one and then way over here and way over there. The therapist not the client regulates what the client is working on each session until the client learns to look at their problems non emotionally and non judgementally

Accepting things means not being emotionally triggered by the problems anymore and Changing things also means fixing things so the cleint is no longer emotionally triggered by that problem. so yea thats part of it.

Problem getting fired from a job - emotional point of view - that boss hated me the people there are all out to get me ..

DBT point of veiw gets rid of the emotional boss hated me people out to get me and has the person look instead at the physical of why they got fired - job site being downsized, poor workmanship, getting to work late, agency has been sold, government cutbacks results in the agency laying off their workers, and so on.

Problem person having flashbacks - emotional - panic attack thats so gross, I hate that when it happens, it hurts my head, makes my feel sick to my stomach, I just want to cut,

DBT point of view looks at the flashback WITHOUT the client experiences and thoughts of the panic, feeling sick, cutting and so on. It requres the person to look at the flashback as if they are a third neutral person watching the situation unfold with their ADULT awareness mind instead of the emotional right back there again child mind that they were when the original situation happened.

As for - MY - personal therapy program it is geared towards expressing emotions. - I - have what professionals call "lack of affect" meaning - I - don't show emotions very often. - MY - having DID means that all my memories have been separated according to the 5 senses (hearing, taste, smell, touch, how I was touched,) and EMOTIONS. and these memories according to - MY - 5 senses and EMOTIONS have been stored as separate pieces of memories in MY unconscious level of thinking. The only time I show emotion before co consciousness and integration of that memory is when I am dissociated. I can't do DBT because I am already looking at my problems from the non emotional nonjudgemental point of view when aware (not dissociated.) so my therapy program is learning to STIMULATE my 5 senses and EMOTIONS not throw MY emotions aside to look at things.

MY therapy work includes drawing, writing, crafts, feeling different textures, smelling different smells, right down to noticing and expressing when I am feeling angry, happy sad and so on about my flashbacks, panic attacks and so on.

I DON'T do DBT and have never done DBT. Every time I have asked a therapy professional about it I have been told that it is for those that do not have "lack of affect". it is for those that cannot see the problems clearly due to they are too emotional about their problems. It is for looking at things from the non emotional point of view which - I - already do when aware.

So I have never been put on it.

>> "If that was your experience with it... Then that really sux" and "I'm sorry you had such a bad experience with DBT myself :-( "

> - MY - post clearly stated that I DONT do DBT so obviously my experience with it doesn't "sux" and I couldnt have had a bad experience with it if I haven't done it.

Ah. Sorry about that, I'll rephrase: If that was the experience that your friends had with DBT... Then that really sux and I'm sorry they had such a bad experience with it.

> the client is expected to do "homework" on that by instituting what they are learning in the classes into their outside of therapy time at the least during the time that they are in the classes.

Sure. Therapy isn't just about academic learning it is about being able to apply what is learned. That is kind of the point of therapy... To practice new coping skills in therapy and then to try to generalise them to outside therapy so one can lead a more fulfilling life...

> order of skills are varied according to the client BUT the client must do thoser skills in the order assigned by the therapist.

Skills training groups do teach the skills in a particular order. Different skills training groups teach the skills in a different particular order, though, that was what I meant about it being arbitrary. I guess it would be nice if we could sort of absorb the skills holistically, but unfortunately it needs to be taught sequentially...

> they can't just suddenly jump all over the place in the classes.

The skills training groups are structured. Typically... You start with a mindfulness exercise (which could be something like focusing on how a rose looks and smells and feels). Then you talk a little about your diary cards. You don't have to show them to the group, but you are supposed to note what (if any) skills you have practiced each day for the week. Part of the rationale for the diary cards is that it reminds you to practice (at least some) skills daily and practicing them and practicing them and practicing them is the only way to make them automatic. After a while they do become automatic, though, so you don't have to consciously practice them you just find yourself doing them. By keeping the diary cards you can figure out which skills seem most helpful to you so that in times of stress you have things that you know tend to help you so you can consciously apply those skills. It also lets you know if you are over-relying on just a couple of strategies (which commonly tends to happen). One needs to diversify...

Then there is a period of instruction where the new skill for the week is introduced. Then we had a break. Then we got to practice the skill. Then we had one more mindfulness exercise and that was it for the week. In your individual sessions your therapist can jump ahead of the skills group and teach you skills that haven't been covered in group yet. Typically your individual t talks to you about your week and other aspects of your diary card though (suicidal ideation, self harm, drug / alchohol use, eating (especially for people with concurrent eating disorders), sleeping (people tend to have problems with that), flashbacks etc. Your t also checks that you understand the new skill and sees whether you have had any success in applying it.

> The purpose of DBT is to not having your thoughts jumping all over from this topic to that one and then way over here and way over there.

Is it?

> The therapist not the client regulates what the client is working on each session until the client learns to look at their problems non emotionally and non judgementally

There is a hierarchy of topics for individual sessions which goes a little like this:

- suicidal ideation / self harm. Why this first? Because your therapist can't help you if you are dead or in hospital having injuries tended.
- therapy interfearing behaviour. Why this second? Because your therapist can't help you if you don't show up to sessions or if you aren't showing up to group to learn new skills. Your therapist also can't help you if they burn out and so these problems are dealt with second so it is all up front and clear what the expectations / limits are.
- then (I think) it is problems in living. Stuff that has happened during the week. Interpersonal stuff etc.
- then (I think) it is trauma stuff.
- then quality of life (building a life worth living)

The individual therapy session is supposed to be structured so as to start at the top of the hierarchy and work down as time allows. Typically (to start with) people only get down as far as the first three in a session. After the first year the first issue typically doesn't need to be dealt with and there might be nothing to say about the second either so more items on the list are got to in the therapy session. It is structured, yes.

> Accepting things means not being emotionally triggered by the problems anymore

Not necessarily. There could be a problem and one could feel really upset about the problem. One could work on trying to change the feeling of upset by using the skills of emotion regulation, self soothing etc or... One could focus on accepting the feeling by using the mindfulness skills rather than trying to change it.

> DBT point of view looks at the flashback WITHOUT the client experiences and thoughts of the panic, feeling sick, cutting and so on. It requres the person to look at the flashback as if they are a third neutral person watching the situation unfold with their ADULT awareness mind instead of the emotional right back there again child mind that they were when the original situation happened.

In the first year, yes that is right. Say that the problem behaviour is cutting. That will come up at the start of the individual session as self harm does. One thing that is often done is a chain analysis of problem behaviours. The problem behaviour is cutting and so the therapist teaches you how to fill in this worksheet describing what events, thoughts, feelings etc happened before the problem behaviour. The notion is to work out what your triggers are so that when your triggers occur you can use skills instead of coping by doing things like cutting. The ability to do chain analyses of behaviour (from a rational mind, yes) is really important with respect to being able to do chain analyses of problematic events when you get to looking at trauma in the second year.

> I - have what professionals call "lack of affect" meaning - I - don't show emotions very often. - MY - having DID means that all my memories have been separated according to the 5 senses (hearing, taste, smell, touch, how I was touched,) and EMOTIONS. and these memories according to - MY - 5 senses and EMOTIONS have been stored as separate pieces of memories in MY unconscious level of thinking. The only time I show emotion before co consciousness and integration of that memory is when I am dissociated. I can't do DBT because I am already looking at my problems from the non emotional nonjudgemental point of view when aware (not dissociated.) so my therapy program is learning to STIMULATE my 5 senses and EMOTIONS not throw MY emotions aside to look at things.

So you are rational mind. And emotions are something that rational mind can't / won't accept and so emotions are delegated out to an alter. And the same for memories and various bodily sensations.

DBT would be about teaching you skills of acceptance so you can accept bodily sensations and memories and emotions... Acceptance would lead to co-consciousness and eventual integration.

It is the same thing really just different terminology...

> MY therapy work includes drawing, writing, crafts, feeling different textures, smelling different smells, right down to noticing and expressing when I am feeling angry, happy sad and so on about my flashbacks, panic attacks and so on.

Sounds like the mindfulness exercises that are a frequent part of DBT individual and group sessions.

> Every time I have asked a therapy professional about it I have been told that it is for those that do not have "lack of affect"...

Hmm. That is a shame really. Linehan writes about how the 'stereotype' of BPD is over expression of negative emotion but how in her experience often clients present with underexpression of emotion because they think their emotions are bad or wrong or that their emotions are unacceptable so they numb out and can't / won't feel them. The mindfulness exercises are supposed to be about learning how to be kind to yourself / to all aspects of you including your bodily sensations and thoughts and feelings etc. If one can be kind to oneself (and if ones therapist is kind so one learns to see oneself similarly) then one can start to become aware of and accept the feelings...

> It is for looking at things from the non emotional point of view which - I - already do when aware.

DBT is about accessing wise mind (aka integrated / co-conscious mind) rather than rational mind (which cannot feel) and emotional mind (which cannot think). wise mind is a gestalt of BOTH rational and emotional mind and it is greater than the sum of its parts...

> So I have never been put on it.

If your therapy is working for you then that is great :-)

Sometimes I think... A lot depends on the therapist / client fit...

I haven't hqad a chance to read the whole post but scanning it one thing stands out -

"So you are rational mind. And emotions are something that rational mind can't / won't accept and so emotions are delegated out to an alter. And the same for memories and various bodily sensations"

No I don't "delegate out" my feeings to my alters. I have no control as to which alter gets which memory or type of memory.

The brain automatically stored any memories abuse or not in the brain as electrical impulses according to the five senses and emotions. professionals know this by probing a persons brain when they are getting prepared for brain surgery. The patient is kept awake while the treatment team uses probes to touch various parts of the brain and in turn the patient raises their arm, leg, tells the team what they taste, hear see, smell feel emotional wise. So professionals know that the way memories are stored is just how the brain automatically works. I cant sit here and have someone hit me and say ok "Mary" you will now have the memory of my being hit. the brain automatically matches the getting hit with a memory that is already stored in the brain of previously getting hit and stores that new situation of getting hit with the old memory of getting hit. I cant "delegate" delegate means I am making a conscious choice. I cant do that the brain automatically does that according to what memory gets triggered by matching.

FOR ME it isn't a situation of my rational mind not being able to accept emotions. It is the fact that emotionally I could not handle the abuse that I went through so my brain instead of storing those pieces of memories according to the 5 senses and emotions in the conscious level of thinking my brain stored them at the unconscious level of thinking.

Its a kind of amnesia. I don't have any memory of those emotions so I cannot express them. Its not a matter of rational vs emotional. MY brain automatically stored MY emotions at the unconscious level. Unconscious level of thinking has both rational and emotional thinking areas just like the conscious level of thinking. for example when someone you are breathing and heart is beating that is a rational unconscious brain activity the person has to breath and have their blood circulating through the body or they die. and on the on the emotional level there are many people who cannot remember being sad, happy and so on because of the abuse situation that they went through but yet when they are triggered they act out these unconscious emotions otherwise called alters.

For ME its not rational vs emotional its that my memories - all memories, have been separated and stored at the unconscious level and I have to connect with those unconscious memories and stimulating my 5 senses and emotions is the way to go for ME. DBT requires separareness of emotions and rational to look with the adult mind instead of the emotional child mind of a suation MY goal is integration of all aspects of each of my memories at the same time - co consciosness and integration of MY memories.

I know its hard to understand someone choosing to remember and experience their forgotten memories including emotions instead of just being a third party unemotionally watching the memories unfold but that is what I have choosen to do.

Im glad DBT can help others but it is not the way for ME.

> No I don't "delegate out" my feeings to my alters.

Not consciously sure, I grant you that. But your unconscious processes did. That was what I was getting at.

There is this paradox of how repression is possible...

I won't get into it but basically... The thought on repression is that it goes a little like this... Tiny little aspects poke through to conscious awareness and we can either allow them to surface or we can push them back down. That is a conscious decision. It might not be a consicous decision (one might do it automatically) but it is something that you can learn to become aware of. Usually we aren't aware of those kinds of things because it is too frightening etc. That is why it helps to work on being able to accept feelings / memories / thoughts etc. In order to be able to accept them you need to be able to cope with them. That means having distress tolerance and emotion regulation skills. The acceptance skills aren't about trying to change anything... They are about accepting your mental processes. Learning skills of acceptance is about learning how to accept your mental processes. And as you are able to accept them as part of you you are working towards co-consciousness / integration.

> Im glad DBT can help others but it is not the way for ME.

Typically... One has to try something before one knows what will and will not work for one. Though of course if you have made up your mind already then you can always MAKE it true as a matter of self-fulfilling prophecy...

No the way my therapists in the field of DID explained it to me I neither consciously nor unconsciously chose my memories to be separated and stored the way they have been. The word delagating means the person is choosing who does what when and so on. A president delegates jobs to his vice president. A boss deligates jobs to his employees.

I do not consciously nor unconsciously deligate anything as to my alters and how my memories have been stored. That is a physical part of the automatic system within the body - the brain heart rate breating rate and so on that I have no choice in "deligating" not consciously nor unconsciously.

A person does not choose to be DID consciously nor unconsciously and how their memories are stored consciously and unconsciously cannot be delegated. It is a part of the automatic system within the body - the brain, nerves, heart rate breathing rate blood pressure and so on.

I did not consciously nor unconsciously choose to be DID ( in other words I did NOT choose that my memories and emotions be separated and stored at the unconscious level of thinking.

> The word delagating means the person is choosing who does what when and so on.

Right. The word 'delegated' is a person level term. It implies that there is an agent who gets to choose.

Sometimes people use person level terms (like information processing and delegating) to describe subpersonal (unconscious) neural processing, however.

That is how your memories have been stored by the unconscious neural processes of your brain. Another way of saying the same thing is to say that your unconscious has delegated your memories.

You don't choose where your neural processes delegate your memories and your thoughts and your feelings and your bodily sensations...

But you do have moments of person level conscious awareness of such things. Or at least... You could learn to have moments of person level conscious awareness of such things. And as you have moments of person level conscious awareness of such things then there are a few things you can do with your newfound person level conscious awareness of such things:

1) Repress them (aka 'numb out' aka 'focus on other things' aka 'allow yourself to become distracted by other things'

2) Get upset. Which will probably lead to 1.

3) Accept them. Which will lead to even more moments of awareness... Which will lead to co-consciousness... Which will lead to integration.

4) Change them. What is paradoxical about change (as it is being used here) is that one actually needs to accept them before one is able to change them (one has to acknowledge a problem before one can do something about it). If one doesn't accept it first then it is likely to lead to 1.

____________________________________

There are many ways of teaching what is essentially the same process... One needs to learn how to accept.

Dissociation / repression is a learned strategy. People learn how to do 1 though there is probably an innate disposition that comes into play too because not all people seem capable of it...

And what one needs to learn to do is instead of to dissociate / repress one needs to learn to accept.

But it all starts with being conscious of what was an automatic and unconscious process...

I'm not saying that this is a part of DBT by the book... But it was one application of it that I worked out with my therapist and it certainly got the ball rolling on my recovery after all the challenging of cognitions which had gone before that only (truth be told) made me dissociate from my thoughts even more...

Not according to what my treatment professionals have told me in regards to MY having DID and MY therapy program. This thread is about DBT not tearing apart other peoples personal experiences in how their own brain has stored their own memories. If that is how you believe YOUR memories and experiences have been stored that is up to you. now this thread is about DBT. And I have explained more than once that I cannot do DBT and do not do DBT. If you are able to do so that is fine now I personally believe it is time to get back on the topic of DBT not on whether or not your veiws of how MY memories have been stored differently then what I have been told. Thank you for your input on how MY memories have been stored in YOUR opinion.

> This thread is about DBT not tearing apart other peoples personal experiences in how their own brain has stored their own memories.

I was talking about how DBT can be applied to dealing with emotions, memories, thoughts, and bodily sensations that the person isn't aware of experiencing (whether or not they are aware of them when they are in certain states). I was not at all attempting to 'tear apart other peoples personal experiences in how their own brain has stored their own memories'.

Firstly, because I'm talking about subpersonal experiences, not personal experiences.

Secondly, because I was talking about how this conceptualisation (which can be developed out of DBT) is CONSISTENT with what you were saying. I wasn't disagreeing with you. You were taking part of my posts out of context (as you said you 'skimmed' and chose which part to focus on).

I also thought the topic of this thread was about the person who started this thread and how DBT might be able to help them given the problems they mentioned. You introduced the idea of different parts storing emotions and so the discussion turned into a discussion around how DBT can help access emotions that the person is unaware of.

I'm sorry you are feeling defensive around this...