Dbt and the problem with self care

To be honest, I didn't like the book either, I'm glad I got it from the library and didn't buy it myself.

Those courses that she and Christopher Germer designed on the subject are quite different I think. Maybe the difference is having a teacher who is modelling this self-compassion thing to you. Maybe having group interaction and talking about all those problems around the subject and what is hindering us from treating ourselves with more kindness helps as well. In the course things for me became really alive, whereas the book just felt kind of trite to me, stating the obvious, same old stories...

I disagree. Self care is also taking care of yourself doing exercise which increases endorphins, being kind to yourself, getting enough sleep. Without all of this you could actually die. This is just a small part of self care I am mentioning. You do need self care.

I started a thread about this a while ago on the Borderline Personality Disorder board. Yes, on one level we should have learned to self soothe as infants, but I didn't, and I don't know that a bath or some candles now is going to make a bit of difference.

It feels so dismissing to be told that the answer is self soothing, like it will fix everything. It doesn't. Most times, it doesn't even calm me down. The answer, according to the DBT folks, is to keep practicing. Grrrr.

That exactly was my problem with DBT as well. It felt dismissive, invalidating, didn't take me and my emotions seriously, as if going through the motions would automatically result in emotional wellbeing - or at least feeling better.

Even though there is a grain of truth in this - I often felt reluctant to go for a swim or for a run, only to realize that I felt much better afterwards...

But I don't think that it's an algorithm, but the treatment provider when I was inpatient made it sound like it was: You do A, B, C and as a result there will be D, E, F. Sorry guys, it doesn't work this way, at least not for me...

The self-compassion thing in contrast is not invalidating, and it's not denying the place where I'm at - which can be pretty grim at times. I guess that's the reason it seems to be working so much better for me, because it feels more honest, not denying the things that feel real to me and distress me.

Also I want to second what Pennster said - along the lines that the whole self-care thing all of a sudden makes so much more sense once you approach it with an attitude of self-compassion.

I was so interested in compassion I did my master's thesis on it. In my research what I found is that perhaps less manipulation is better. At this moment I am going through a rough time. I have been trying everything to cope...and now I am exhausted. I am doing less. Maybe this is my starting point.

Until you accept "what is" you can't really embrace it, right? Maybe. I am feeling all kinds of crappy now and my practice is to accept that is where I am. Let myself off the hook.

I am grateful for small kindnesses like a smile from the grocery clerk. I don't go to a therapist. I am not sure if I would care whether or not they made me a cup of tea. It would be more important for me that they were present for the time I was in session, listened, gave feedback and suggestions. I have been in therapy in the past and that is all I really cared about. I didn't want to be hugged or catered to. I just wanted professional presence. Needless to say I am not a big fan of therapy, anyway.

When I want someone to make my coffee I go to Starbucks...

I never have liked the idea of self-care. Things that people suggest (reading a book, taking a bubble bath, going on a walk) never make me feel better. They usually make me feel guilty, like I am wasting my time doing those things when I could be doing something more productive.
I brought this up to my T and she suggested we start with "self-compassion" instead. Working on forgiving myself when I mess up instead of feeling guilty or angry with myself. It's really hard but I can see the merits in it.

I've got some thoughts on this. It seems like the first issue you described was that loving actions from another person are more powerful to you than doing those loving actions to yourself. You asked if anyone else has this issue. Later you asked if anyone started where you were above and progressed to having their own actions be as meaningful to them. You also mentioned DBT and the self-care section of that.

Here are my thoughts, which of course only reflect on me and not on anyone else. I am one of the people you are asking about whose status has changed.

Self-care, self-soothing - that whole idea was useless to me for a long time. I was severely depressed and my brain was wildly out of control with moods and symptoms and nothing I did made a difference. (I had the wrong diagnosis and was getting depression treatment, which probably made my bipolar even worse.) I felt so frustrated and helpless when people would say, "Do something nice for yourself. It'll make you feel better." I wanted to shout back, "NOTHING MAKES ME FEEL BETTER! I can't feel positive emotions! I just feel more empty when I try to do something nice for myself and it doesn't work. I feel hopeless and panicked and a bath doesn't fix that." When someone did something nice for me, I felt like they were just doing it to be nice or to feel like a good person. Over time, there were some exceptions, though - some cousins who I believed loved me, and some other people who I could scarcely believe genuinely liked me. Their actions and words were powerful to me and sustained me.

As my bipolar has gotten more correctly medicated, as my symptoms are getting more under control, I'm better able to feel content and stable by myself. My therapist would probably call this a "shift in the lotus of control." (or is it locus?) He says the lotus of control is where we have the power. When my lotus of control is external, I need my approval and encouragement and compassion and all that to come from outside, like from him or my spouse or my family. And believe you me, I need a LOT of encouragement, comfort, approval, and kind words from others. I write down people's compliments and keep them in a book. That's how extreme this is.

When my lotus of control is internal, then I'm able to provide myself that compassion, soothing, and encouragement. My lotus of control shifts from internal to external depending on factors, but I'm doing a little better (now that I'm not in constant depression) at giving myself the soothing words or actions and having the power be there in me doing it for myself. Sometimes, when I'm chemically good bipolar-wise, someone says something nice and I just kinda shake it off because it's not a big deal and I don't need it from them because I already feel good about myself inside.

Self-care with an internal lotus of control would be effective, I think. It wouldn't be so different for someone else to be kind than it is for me.

Anyway, those are my thoughts.


Now, a note on DBT:

I LOVE DBT SO MUCH! It saved and changed my life. It gave me skills to cope with emotions where I had none before. I still use DBT every single day, and that's 5+ years after I took the course. And since you already know DBT, I'm sure this might sound repetitious, but since several people have been discussing this, I will too.

Strict DBT therapists I imagine would push self-care and self-management stronger than regular therapists. Though in DBT skills coaching is available, one is only supposed to use if after they have tried everything else. DBT skills coaches often ask, "What have you already tried?" when they answer a skills coaching call. Also likely due to BPD, most people learning DBT have issues respecting boundaries in relationships, so therapists are more likely to try to keep a strict distance with those clients.

Therefore, self-care and self-management are skills that (especially DBT) therapists are trying to build in (especially BPD) clients.
(These are generalizations and don't apply to everyone.)

Back to self-care.

In DBT, I think self-care as a general idea is involved in three ways.

Using the DBT emotion regulation skills is self-care in a way because we are reducing negative emotions and managing our lives better, which makes our lives more worth living. We are taking care of ourselves by making us feel better. Someone on this thread mentioned writing their therapist and saying that they were really struggling, and the therapist replied to use their self-care. Perhaps the therapist was saying not "do it by yourself, I don't care" but rather "utilize the skills you have inside and available to you."

Another section of DBT is physical self-care - the PLEASE skills. Someone else on the thread talked about that, saying that they think self-care is physical self-care like eating and sleeping and exercise. Those activities are indeed caring for ourselves, because when our bodies aren't taken care of, we are more susceptible to negative emotions.

The kind of self-care that most people seem to be describing - warm baths, candles - is like the distress tolerance self-soothe box of DBT. When we are so distressed that we can't think, then we self-soothe to reduce the negative emotions to a point where we can do something productive about them. I think this is what most people are thinking about when they say, "self-care," and I'm guessing this is what the OP was referring to.

My best self-soothing thing is snuggling with my husband. That's the most effective, and that's not even ME self-soothing. That's someone else helping me soothe.

My other distress tolerance self-soothing helps me too (look at beautiful scenery, a soft blanket, intense burst of physical activity), but distraction is my most effective distress tolerance skill. With bipolar in particular, I know that my moods are chemical and that they will change, because that's what happens in bipolar. Cyclical chemical changes. If I'm down, I'll come back up, and I just need to distract myself until that happens. I usually watch TV or do a craft project or something.


I don't know which kind of self-care the OP or others have been referring to, but maybe folks can clarify in further posts what kind of self-care they're referring to, since it's a pretty general phrase?

I think I often confuse self soothing and self care but I do get it now. I have trouble with both. Lots of work left to do!!