[ScarletPimpernel]

So it's actually going to happen. I'm actually going to go to DBT group. I'm so scared. I have an assessment scheduled for next Wednesday. I won't see their Pdoc for another 4-6 weeks after the assessment. I don't want to be a part of county mental health again. But this is possibly the only opportunity I will have to go to DBT, so I feel obligated to stick it out even if I hate it.

Is DBT really worth the trauma I will experience from being back at county? Has it really helped anyone? Like really helped? In what ways has it helped? I assume it's not a cure all because many who have said that DBT is helpful are still in therapy.

Ugh! I'm shaking so bad, my heart is racing, and feel dizzy. I wish I could take my T with me. I'm having paranoid thoughts that county is going to manipulate the situation to try to keep me as a client. I wish I could have afforded out-of-pocket DBT...

[NowhereUSA]

I think DBT is great and I hate, hate, hate groups. I give my current facilitators hell But, I go because I get something out of it. This time around I get support in the sense of routine and a reminder with regards to the skills.

DBT can't cure me because my depression isn't situational/circumstantial, it's biological and until I get a medication that works, I have to cope. What it *does* do is keep from making things worse and, honestly, has taught me how to interact with what I'm experiencing in a way that is consistent with the person I want to be.

I've found that the group is more like a classroom, mostly skills learning and discussion. There's not a lot of self-disclosure except to talk about how we practiced our skills that week (mine is a weekly group). There are strict rules about discussing suicidal and self-harm (for us, we say "target behavior" when discussing our individual issues within the context of group). The heady stuff is handled in individual therapy.

I'm happy to answer questions about my experience. I went through it about six years ago for the first time and I was a mess in terms of coping skills and emotion regulation. I had a breakdown and was barely functioning and by the end I was functioning again, enough to go back to working a full time high stress job.

So has it helped? Really helped? Yes. I would say that it has.

[guilloche]

Breathe... I know you've talked about how awful county was for you in the past. I think it's amazingly brave that you're willing to face all that to get the DBT training - that's *awesome* and I'm pulling for you, ScarletPimpernel!

I haven't done DBT (but keep seeing things that make me think it's a good idea). Did you see a little while ago, on the BPD boards, someone recently finished a DBT course and got alot out of it... here's the thread:
http://forums.psychcentral.com/borde...57-hurrah.html

And, I think your T is very committed to you, and will have no problem putting her foot down if county tries to "steal" you away. Does that make sense? I'm sure she'd fight to keep you!

Good luck Scarlet... I'm actually really excited for you! I know it's scary and nerve-wracking and insanely difficult, but there's so much possibility there too. I hope you're able to get a lot of great skills and information, so that all the stress ends up being worth it.

When does it start? Is it weekly?

*Good luck!!!!*

[ScarletPimpernel]

Thank you for your response. My Pdoc says my depression is half situational and half chemical imbalance. It seems though that I'm actually stable considering medication wise. My T agrees. But my T says the reason I need DBT is not for the depression and anxiety (she says that's her job), but for the BPD traits.

I only suffer from 1,2,5, and 6 now. Will DBT help with those? My T keeps saying my triats get in the way of my progress of therapy with her. I know my main issue is 1. I just don't see how mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness will help with that. I'm not saying I don't think these skills will be useful. I just don't see how they will help with my fear of abandonment and rejection.
------------------------------------------------------------
1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance
4. Impulsivity
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
------------------------------------------------------------

Yeah. I hate, hate, hate groups too. I've been in a ton. I was in groups when I was at a day treatment center, board and care, crisis house, and clubhouse. I went to a bipolar and depressive support group...it was actually a really depressive group. I went to some women's group...long story short, I really wasn't supposed to be in that one.

When I was in college, I really enjoyed most of my classes. I'm hoping if DBT is more like a class than a group, then I might actually enjoy it. And if self-disclosure is limited, then that will make things easier too. Plus, I will see my own T for individual, and I've already disclosed everything generally to her.

I'm glad it has helped you. I really hope it helps me. I'm just scared. I'm scared of new situations, new people, being around people, and of county itself. But my T and Pdoc have never given me bad advice and when both agree with something, it's my cue to get ready for the ride

I would ask you questions, but I wouldn't even know what to ask. According to my T and Pdoc, I'm not even supposed to know what the four modules are yet. They don't want me "being prepared". I even bought the workbook, and my T told me not to read it. I understand why: so I remain present and focused while learning and practicing. But it makesthe unknown even scarier.

To be honest though, I think a county Pdoc scares me more than group. I finally, after 14 years of trial and error, am stable on my meds. Majority of us know how difficult meds can be. I don't want them coming in and saying "I don't agree with this med". Or they want to switch me because they have a deal with a certain pharmaceutical company. Both have happened to me when I was at county last time. Most Pdocs don't like patients on benzos. I just hope the fact that my T and Pdoc (and insurance) are arranging this, that the county Pdoc will take a back seat.

Originally Posted by NowhereUSA

I think DBT is great and I hate, hate, hate groups. I give my current facilitators hell But, I go because I get something out of it. This time around I get support in the sense of routine and a reminder with regards to the skills.

DBT can't cure me because my depression isn't situational/circumstantial, it's biological and until I get a medication that works, I have to cope. What it *does* do is keep from making things worse and, honestly, has taught me how to interact with what I'm experiencing in a way that is consistent with the person I want to be.

I've found that the group is more like a classroom, mostly skills learning and discussion. There's not a lot of self-disclosure except to talk about how we practiced our skills that week (mine is a weekly group). There are strict rules about discussing suicidal and self-harm (for us, we say "target behavior" when discussing our individual issues within the context of group). The heady stuff is handled in individual therapy.

I'm happy to answer questions about my experience. I went through it about six years ago for the first time and I was a mess in terms of coping skills and emotion regulation. I had a breakdown and was barely functioning and by the end I was functioning again, enough to go back to working a full time high stress job.

So has it helped? Really helped? Yes. I would say that it has.

[ScarletPimpernel]

"Breathe..." My T tells me this ALL the time

I don't really spend much time anymore on the BPD boards. I always felt like I fell into the middle: functioning, but not high functioning. Plus, it's difficult to find support concerning DBT. Everyone wants to summarize the modules for me, and I'm not supposed to learn them yet. I kind of want to know what it's like during and what changed afterwards, but not what is actually being taught.

I know I'm just having paranoid thoughts due to fear and the unknown. I know I have my T's and Pdoc's full support. I know they won't let anything happen to me. And technically, county can't piss off my Pdoc because they are currently in a deal process to allow each other's clients have access to each other's facilities. County clients will have access to medical care and my Pdoc's clients will have access to groups. And since my insurance is working one-on-one with my T, they can't piss either of them off either.

I think I will feel better once I know what's going on and who everyone is.

I don't know any information about the group yet. I have an hour long assessment this Wednesday. I'm not worried about that. I talked to the woman on the phone and she seems nice. And I already have experienced multiple assessments. I actually find this assessment hilarious. Like what are they going to assess? Hmm, that I have BPD, depression anxiety, I need medication, individual therapy, and DBT?

After the assessment, it will take 4-6 weeks to see the county's Pdoc. I guess after that I can start group? I don't know when the group is, where it is, how many people, what module they're on, etc. I'm only supposed to go for 3 months, though it is my choice (I think) to stay longer. I'm hoping to do the mindfulness and/or distress tolerance above the other 2. But I just don't know how any of this works. Which sucks because right now I depend on my fiance toget me places, so hopefully it won't interfere with his work schedule. I wish someone would tell me something. Being able to plan would reduce some of the stress.

Originally Posted by guilloche

Breathe... I know you've talked about how awful county was for you in the past. I think it's amazingly brave that you're willing to face all that to get the DBT training - that's *awesome* and I'm pulling for you, ScarletPimpernel!

I haven't done DBT (but keep seeing things that make me think it's a good idea). Did you see a little while ago, on the BPD boards, someone recently finished a DBT course and got alot out of it... here's the thread:
http://forums.psychcentral.com/borde...57-hurrah.html

And, I think your T is very committed to you, and will have no problem putting her foot down if county tries to "steal" you away. Does that make sense? I'm sure she'd fight to keep you!

Good luck Scarlet... I'm actually really excited for you! I know it's scary and nerve-wracking and insanely difficult, but there's so much possibility there too. I hope you're able to get a lot of great skills and information, so that all the stress ends up being worth it.

When does it start? Is it weekly?

*Good luck!!!!*

[NowhereUSA]

Originally Posted by ScarletPimpernel

------------------------------------------------------------
1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance
4. Impulsivity
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
------------------------------------------------------------

Yes. I can actually think of several skills for each of the bolded ones that would be useful.

I can understand why they don't want you reading ahead. The workbook for the most part gives a summary of the skills and yet some of them, if you just read them, don't make complete sense and for others you can bring an interpretation to them that isn't accurate. Having someone walk through them is incredibly helpful for really getting what's being said.

One of the things I've appreciated about DBT is the positive attitude towards me. In my particular group, we were told at the beginning that the therapists running it believed we were doing the best we could with what we had. No judgments. In fact, that non-judgmental attitude is core to DBT. It's not falsely affirming, but when people have believed the worst about you, it's refreshing to have people believe the best even if you're a complete mess. I've felt incredibly safe myself because I don't have to self-disclose what I don't want to (and my unsafe behaviors aren't to be disclosed anyway), and my boundaries are respected in that. I've had weeks where I've shared homework and I've said, "I don't really want to go into details. This skill helped me ride out my urge to do my target behavior and I think it helped." or "I don't really want to go into anymore detail, but I had trouble with this skill. I tried it and I ended up doing my target behavior." Then usually I'll get some feedback, maybe some general clarifying questions about my skill use and often times at the very least a "Thanks for being willing to try."

I will say the skills aren't easy. It really does take time, but I do think they're worth it. Idk. It's like... it's like people my whole life would be like, "Just don't worry."

How the hell do you not worry? I didn't even grasp how to function with my high anxiety. It felt a lot like people telling me not to think of a pink elephant.

What DBT has done has helped me get more in touch with what I'm feeling so I'm aware of it and know how to function with it.

I'll avoid answering any specific skills/module questions but if you have general questions I can help there.

The important thing is to be willing. Even if you struggle through that, hell I still struggle with it, if you can go in with a sense of willingness to try try and try again, you'll get the most out of it.

[ScarletPimpernel]

My T and Pdoc mostly want me going in w/o prior knowledge because they say I already know toomany skills, but I don't use them when I actually need to So they're hoping by learning these skills and using them at the same time, I'll use them more often. They also want me to go to DBT just to socialize

So I did think of a question... You got to group and are taught skills. You talk about your homeworks in group? And then you're given more homework. And you process group with individual T? Is that right? If that's right, then I only have to disclose to my own T? That would be awesome considering she already knows everything about me and I know for sure she won't judge me.

One of my fears about disclosure is my suicidal ideation. People tend to over react. It still worries my T, but she knows I will reach out before things get bad. County doesn't know me, and I fear them over reacting and sending me to the hospital.

I also have other questions... How was everyone seated? In desks? Chairs? In a circle? Could you sit away from people if you wanted? How many people were in your group? Men and women? Was the T an actual T? Does it have to be an actual T or could it be an intern? Are you expected to touch? Like some groups hold hands and say some sort of mantra.

How long was the group session? How long does a module take? My Pdoc is on maternity leave so I kinda have 3 months unless I choose to stay longer. Can you join in the middle of a module? Is everyone on the same module? I'm guessing there's no "fast track"

Was a Pdoc part of your group treatment team? If so, did you have to see him/her before starting group? They said I won't see their Pdoc for another 4-6 weeks. But it's not like I personally need to see the Pdoc since I'm already stable on my meds.

Funny you mentioned the pink elephant. My T taught me a little about ACT and how you don't fight thoughtsand feelings, but acknowledge them. So I went out and bought a little pink elephant and put it on a bracelet to remind me to acknowledge the pink elephant

I'm not worried too much about the learning part. The only thing is that I tend to quit things if I don't do them perfectly. But I'm sure my T will help with that. She's always reminding me that I don't have to be an A student in any area of life (she's a teacher ). But I am willing to give it 100% effort with learning the skills. I mean, what's there to lose? You always gain when it comes to learning, even if you decide you don't agree. And DBT is "supposed" to ve really beneficial for my symptoms. And I also have an appreciation for Buddhist concepts.

I think I'm just worried about the environment and the people. I worry about not feeling safe. And I worry about respect: respect for my boundaries and respect for my T and Pdoc. While I might be a client of the county, my treatment isn't them...it's my T and Pdoc. I also worry that because it's county that they won't be doing DBT appropriately.

I actually just need this group to start already, so I can stop worrying and know what I'm dealing with. Then I'll be able to cope and make decisions instead of sitting here coming up with the worst scenarios. I hope the lady who does my assessment will answer some of my questions. The good thing about seeing her is that it has given me something to do. I have already printed up my entire mental health history, as well as, current information. And I picked up a packet of paperstoday that she wants filled out for when I see her. I just need an active role.

Well, I think I came up with a "few" questions I appreciate you helping me with this. It's scary to go into the unknown. And for me, it's scary to be around people and at county. Explaining your experience and just being able to express my concerns is somewhat comforting.

Originally Posted by NowhereUSA

Yes. I can actually think of several skills for each of the bolded ones that would be useful.

I can understand why they don't want you reading ahead. The workbook for the most part gives a summary of the skills and yet some of them, if you just read them, don't make complete sense and for others you can bring an interpretation to them that isn't accurate. Having someone walk through them is incredibly helpful for really getting what's being said.

One of the things I've appreciated about DBT is the positive attitude towards me. In my particular group, we were told at the beginning that the therapists running it believed we were doing the best we could with what we had. No judgments. In fact, that non-judgmental attitude is core to DBT. It's not falsely affirming, but when people have believed the worst about you, it's refreshing to have people believe the best even if you're a complete mess. I've felt incredibly safe myself because I don't have to self-disclose what I don't want to (and my unsafe behaviors aren't to be disclosed anyway), and my boundaries are respected in that. I've had weeks where I've shared homework and I've said, "I don't really want to go into details. This skill helped me ride out my urge to do my target behavior and I think it helped." or "I don't really want to go into anymore detail, but I had trouble with this skill. I tried it and I ended up doing my target behavior." Then usually I'll get some feedback, maybe some general clarifying questions about my skill use and often times at the very least a "Thanks for being willing to try."

I will say the skills aren't easy. It really does take time, but I do think they're worth it. Idk. It's like... it's like people my whole life would be like, "Just don't worry."

How the hell do you not worry? I didn't even grasp how to function with my high anxiety. It felt a lot like people telling me not to think of a pink elephant.

What DBT has done has helped me get more in touch with what I'm feeling so I'm aware of it and know how to function with it.

I'll avoid answering any specific skills/module questions but if you have general questions I can help there.

The important thing is to be willing. Even if you struggle through that, hell I still struggle with it, if you can go in with a sense of willingness to try try and try again, you'll get the most out of it.

[NowhereUSA]

Originally Posted by ScarletPimpernel

So I did think of a question... You got to group and are taught skills. You talk about your homeworks in group? And then you're given more homework. And you process group with individual T? Is that right? If that's right, then I only have to disclose to my own T? That would be awesome considering she already knows everything about me and I know for sure she won't judge me.

One of my fears about disclosure is my suicidal ideation. People tend to over react. It still worries my T, but she knows I will reach out before things get bad. County doesn't know me, and I fear them over reacting and sending me to the hospital.

One of the rules of DBT group is no discussion of suicidal or parasuicidal behaviors past or present. What I've been told through DBT is that learning can't happen for a period of time during a high emotion state and so they want to avoid anything triggering. We can't even mention alcohol use. Everything is referred to as a "target behavior" and it can vary from person to person what that behavior is and it's something you would process with your individual therapist.

So no, you wouldn't disclose suicidal ideation at any point to the group and you wouldn't (and shouldn't) have anyone else disclose that either. That's not the kind of therapy group DBT is.

I also have other questions... How was everyone seated? In desks? Chairs? In a circle? Could you sit away from people if you wanted? How many people were in your group? Men and women? Was the T an actual T? Does it have to be an actual T or could it be an intern? Are you expected to touch? Like some groups hold hands and say some sort of mantra.

We do a mindfulness activity at the beginning but no touching (like we do a breathing exercise). I haven't had to touch a single person ever in group LOL. We have tables (like the folding ones) and we sit in a "circle" (it's a square but same difference). There's no assigned seating and I sit wherever I want to. I like to change it up The size of my group has varied anywhere from four to ten. I think they try to keep a certain size but I don't know what that size is.

Official DBT is strictly regulated as far as I'm aware. There are rules that agencies and therapists have to abide by in order to be officially DBT. My groups are run by therapists. My individual T runs a group as well but it's an inconvenient time so I go to another one in the same agency run by his colleagues. All the DBT groups I know of have two facilitators so that, if need be, one can be pulled out if someone is having a hard time. I was in my T's group six years ago and now I'm in this group.

How long was the group session? How long does a module take? My Pdoc is on maternity leave so I kinda have 3 months unless I choose to stay longer. Can you join in the middle of a module? Is everyone on the same module? I'm guessing there's no "fast track"

We meet weekly although I know other agencies sometimes do more intensive DBT. I had a friend who had a group meeting twice a week, so it was six months instead of 9 months-a year. We meet for two hours, the first hour goes over homework, the second goes over skills. The modules vary in length with emotion regulation being the longest. After each module, you go back to mindfulness (so a unit is mindfulness + distress tolerance, mindfulness + emotion regulation, mindfulness + interpersonal effectiveness). Mindfulness usually lasts 2 weeks for us (although I argue we could do it in a week. No one listens to meeeeeee... LOL). Then I think the rest probably take up to 6-8 weeks. The goal in mine is to go through each module twice. I'm actually staying a bit longer to get through the winter but I would technically be done in mid-February and I started the first week of April last year.

Usually they have you join at the beginning of a module.

But no, no fast track

Was a Pdoc part of your group treatment team? If so, did you have to see him/her before starting group? They said I won't see their Pdoc for another 4-6 weeks. But it's not like I personally need to see the Pdoc since I'm already stable on my meds.

My T is really the primary go-to. I see my Pdoc monthly but we're trying to find meds still. He doesn't really have anything to do with DBT.

I'm not worried too much about the learning part. The only thing is that I tend to quit things if I don't do them perfectly. But I'm sure my T will help with that. She's always reminding me that I don't have to be an A student in any area of life (she's a teacher ). But I am willing to give it 100% effort with learning the skills. I mean, what's there to lose? You always gain when it comes to learning, even if you decide you don't agree. And DBT is "supposed" to ve really beneficial for my symptoms. And I also have an appreciation for Buddhist concepts.

What's helpful to remember with DBT is you can't fail. And you can't be perfect. It's impossible on both ends The way I think of it, it's like learning to walk. Is my toddler "failing" because he falls over? Does anyone think, "I give that one year old an F for falling!" No, because we realize that falling is part of the learning process. As he gets bigger and practices more, he'll fall less. But he wasn't failing. He was just learning.

I did DBT six years ago and I've stayed and worked with my T since then and now I'm going through it again for a refresher. My T tells me I'm very skillful and yet, I can tell you that I'm still learning and that while I've got a lot of these skills down, I always find more ways that they can be applied in my life and areas where I can improve. I wouldn't be surprised if in five years I go through it a third time just because I gain new insight each time.

[Jordy]

I probably won't be that helpful as my experience with DBT group was different then yours will be: it was held by my T/Pdoc and all other participants were her clients too. There was no second therapist involved except her supervisor, but we've never met him.
Also except for suicidal ideations we were allowed to talk about anything and did it relatively openly. But don't worry that really happenned over time, I didn't disclose much for 6 months or so. Also because T knew everyone of us so well, she really tailored DBT to our needs.

I was really terrified to go at first, and wanted to find a way out, but in the end I'm glad I did it and never missed a session.