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Re: the frustration continues

Posted by gardenergirl on June 2, 2004, at 9:15:33

In reply to Re: the frustration continues fallsfall, posted by crushedout on June 1, 2004, at 18:54:08

I"m sorry that you are feeling so frustrated with this. DBT actually has a very good track record in the programs set up with it. I wonder if I could offer some thoughts/concerns here which may or may not help you understand your frustration?

While I am glad that your T is open to trying new things that may be of benefit to you, I am a bit concerned about this statement:

>and some of it made sense to neither of us (like ratings 6 and 7 for the skills, which we still don't get).

I really think your T should get some education or consulation on DBT before using it. It can be very difficult for a T, not to mention it could be considered to be unethical, to use interventions with a client for which they haven't achieved a certain level of competency. DBT is hard for both the client and the T. That's why the T also has "therapy" in the form of the weekly consultations. In addition, the skills and the diary cards can be hard, and if she is not understanding them, I'm not sure how well she help you with them.

I am just concerned that there is a potential here for more damage to be done to your relationship, just as you are beginning to forge ahead after all of the stress of the past several months with her.

I really liked the way Falls' T did going to a weekly consultation and by having skills training be separate from regular individual therapy. This is how DBT is set up. It is as Dinah said, that skills training should be separate in order to prevent the dual relationship that such very different interventions would set up. At the very least, I believe the skills training should be it's own session, with a skills training workbook, so that your T can "put on another hat" for that sesssion, and can put her regular "hat" back on for your individual session. That way, your frustration with the skills and cards won't bleed over as much into your therapy. Just like you instinctively did, by taking control of your last session in order to get your needs met.

I know when I was doing DBT under close supervision this year, I found it to be a delicate balance. We set it up that a less advanced student on my team conducted the skills training and I did the individual therapy, as we did not have the resources in place to hold a group. Unfortunately, the less advanced student, for some odd reason, did not get adequate supervision (I think due to some miscommunication), and presented the skills training in a way that it did appear childish to my client. It's a fine line to walk, and it takes some extra education and supervision to master this. I attended a workshop at a conference about DBT, which was tremendously helpful. I'm not sure I would have considered using it if I hadn't had that extra work, even with my supervisor's availablility.

I wish you a lot of luck with this. I think there are a number of skills that DBT offers that can be applied to your therapy (i.e. validating much more than CBT, the idea of holding two conflicting, seemingly black and white issues at the same time, etc.) that can be really helpful. But to set up "doing DBT" on your own without supervision or additional training may be a really slippery slope, in my opinion. And that may be why you are feeling so frustrated (and she may be too, from what you have said.)

I wish you the best, crushed. I don't like to appear to be critical of anyone's T, but this is an issue that was beaten into our heads at school...competency, competency, competency. So I am concerned.

Take care and let us know how it continues.





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