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Re: my T's bargain with me crushedout

Posted by fallsfall on June 5, 2004, at 14:18:47

In reply to my T's bargain with me, posted by crushedout on June 3, 2004, at 21:46:00

> OK, so today she offered me a "deal": If I do my DBT homework every week sincerely and with effort and then spend the first 15 minutes of my Thursday session talking about the skills with her, then I get to have a third session the following week. Each week it will be at a different time and it will always be conditional on me doing the DBT stuff. (She said this makes the third session "worth it" for her. Weird choice of words.)
>
*** I may not be remembering all your details, so correct me if I'm wrong. I don't remember hearing about *you* resisting learning or working on DBT skills. I know you don't understand them all, I know you feel like you have too many crises to "give up all your time" to skills training (what borderline patient doesn't?). Have you refused to cooperate with her in the past? I guess I'm not quite sure why she feels the need to "make" you work on this stuff. You have always sounded self-motivated to me.

As I read her books, I read that Linehan thinks that homework practice is very important. Her tact seems more to be to figure out what the obstacles are to getting people to do the homework, and to resolve those obstacles (this lets the therapist put pressure on the client to do the homework without the therapist appearing punitive. The therapist is always appearing in a "helping", "facilitating" role.)

There *are* rules in DBT designed to force compliance (like if you don't go to skills training you get kicked out of individual therapy, too) - and these could be seen as models for your therapists "deal", I suppose.

The only thing I found in her books that seemed relevant was "It is, of course, important that the leader resist the temptation to collude with a client in punishing herself for not practicing". ("Skills training manual for treating Borderline Personality Disorder" p. 20)

>
> Anyway, here's what I think: Of course I'm gonna agree to that! I mean, I want this third session so badly!

*** Of course you do!
>
> But here's what else I think: 15 minutes???? per week??? is that really enough time to do DBT?
>
*** Why don't you spend the whole Thursday session on skills training? That way it would be clearer what was Skills time, and what was Individual time. 15 minutes is not enough time to review skills and learn new ones. If she hasn't done skills training before, she will need to do some work before each session to prepare - is she willing to do this? I would strongly recommend that you try to allocate one complete session for skills and have two for individual. Are you committed to learning the skills? Any client in DBT will have certain weeks or certain skills that just don't go right. That is why Linehan puts the emphasis on figuring out what prevented the homework, and finding a solution so that the same thing doesn't cause a problem again. So I am a little nervous that she will "punish" you for doing what a Borderline client can be expected to do.

> And I feel sort of like I'm being treated like a child or a dog or something with the reward system she's using. I dunno. It's just making me feel kind of funny. But I'm not mad or anything. I'm just not sure what to make of it. I'm psyched because I have three sessions next week (since we spent 15 min. on DBT today).
>
> Any thoughts out there?

*** It sounds a little weird to me, but *you* could make it work well, if you really want the skills training. As long as she won't NOT give you the 3rd appointment if you were honestly trying, and just having "normal" Borderline difficulties. I definately think you should try to get a whole session for skills (sit in different chairs, or borrow someone else's office so it is clear to both of you that this is the "skills" session). And don't let her or you slide into crisis managment on those days - you'll have the other two sessions for that.

Just my 2 cents.

 

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poster:fallsfall thread:351645
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