Psycho-Babble Psychology Thread 351645

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DBT making me miserable

Posted by crushedout on May 28, 2004, at 19:04:18


I've been trying somewhat reluctantly to do DBT with my T. I was pleased when she first suggested it because the idea was that we would have an extra session to do it, but that hasn't happened. Instead she just takes over parts of my already-way-too-precious two sessions to do it and I don't even understand what it is we're doing but I also don't want to ask because then we'll just spend more time on it and I'll get more frustrated and upset when there's stuff going on in my life I want to have time to talk to her about. I've explained this to her. But she says that if an organization spends all of its time putting out fires and never plans for the future so that the fires don't start to begin with, then, well, the organization will just spend all of its time putting out fires. That makes sense, but if you have fires going, you gotta put them out and add extra time for the planning if you ask me.


She's given me the diary card to fill out every day but I hate the skills and don't get what they are and can't do them anyway so it just makes me feel like a failure.

I'm so frustrated I want to cry.

 

Re: DBT making me miserable

Posted by gardenergirl on May 29, 2004, at 1:33:00

In reply to DBT making me miserable, posted by crushedout on May 28, 2004, at 19:04:18

crushed,
What an awful situation, wanting to work on something but also having those fires you talk about. I've done DBT with a couple of clients, and it is really hard to do the diary cards, interventions, and skills training in just one session. Let alone combine it with another type of therapy.

On the plus side, it sounds like things with your T have settled down as far as the relationship goes. Does it feel that way to you, too, barring this conflict over having enough time?

And the fact that your T wants to work on skill building and DBT is a sign that she feels you CAN handle at least some of the fires yourself between sessions. Maybe just the smoldering ones for a start? It sounds like you are making good progress.

I hope you can feel that you are, too.

Take care,
gg

 

Re: DBT making me miserable gardenergirl

Posted by crushedout on May 29, 2004, at 8:29:40

In reply to Re: DBT making me miserable, posted by gardenergirl on May 29, 2004, at 1:33:00

gg,

Yes, I do think things have settled down enormously as far as our relationship goes. I worry that I've put them on the back burner (my feelings for her) and that I should be sure to address them because they're going to flare up again. They're still there but somehow they feel less urgent, and the way that I'm dealing with them (i.e., without significantly harming myself or blaming her) makes her happier about being my T. So in general our relationship has improved a great deal. Which is great.

And yes, she thinks I can handle the fires. In fact, she thinks that because we were so focused on talking about our relationship and the problems between us for so long, I've been handling all the other fires by myself for a long time.

Boy, you have an amazing knack for putting a positive spin on things! And making me feel validated at the same time.

 

Re: DBT making me miserable crushedout

Posted by fallsfall on May 29, 2004, at 8:47:59

In reply to DBT making me miserable, posted by crushedout on May 28, 2004, at 19:04:18

I understand your frustration. This is one reason that DBT recommends that a separate skills training session be set up with a DIFFERENT therapist. That makes it easier to see that the skills training session is NOT for putting out fires (just like your dinner hour is NOT for putting out fires - most of the hours in your week are NOT for putting out fires. It just gets really confusing when you are in the same environment where you DO put out fires, and even the time boundaries are "loose".) The ideal is to have a special session that is different in as many ways as possible from your regular sessions, and use that for skills training. These are things that CAN be different, but it sounds like you will need to put up with some of these being the same: Different therapist. Special time JUST for skills training. Different room (perhaps you can do this - a different environment can make it all feel different, even if it is the same therapist). Almost a coldhearted focus on skills rather than crises (hard for the patient, hard for the therapist, too). Lots of structure in the skills training session (10 minute checkin, 30 minute review of homework, 15 minute general discussion of last week's skills, 15 minute break, 30 minute lecture on new skills, 20 minute role play/practice of new skills, 10 minute discussion about homework for next week, 10 minute wind down - I didn't add these times up, Skills training is usually 1 1/2 hours or so).

You need to see that learning new skills will be helpful, and be willing to put your crises on the shelf during skills training time. It is hard to do, but determination on your part will go a long way.

The skills ARE hard. They are hard because you didn't learn them when you were 3 or 4 or 5 like most of the rest of the world. It is much harder to learn these things as adults - we have spent so much time dealing with the world in a different way. Don't expect them to be easy. Don't expect to "get" them immediately. DBT recommends going through 2 full courses of Skills Training (or more) because you WON"T get it the first time. With many of the skills, I find that the first time we talk about them the most I can expect to accomplish is to realize that the world that other people live in is NOT the same as the world I live in. This is always a shock to me. We have to talk about things a second time (not the next week - some longer time later, when I've had time to internalize that the world COULD be different from the way I've always seen it) before I can start to look at what makes my view of the world different and how I could possibly change my view (and then I have to deal with being Brave enough to change, and Wanting to change, and then we get to learning the skills to be Able to change).

I have to go to work. I'd be happy to talk about this more with you later.

I would recommend that you get Linehan's book (the book is more effective for this than the Skills training manual) "Cognitive-Behavioral Treatment of Borderline Personality Disorder", and read the whole thing. I think that, based on what I have seen about the way you approach thing, that you (in particular - this isn't helpful for everyone) would benefit from reading this book (more than once). This gave me a better idea of WHY it was hard, and WHAT was trying to be accomplished.

 

Re: DBT making me miserable fallsfall

Posted by crushedout on May 29, 2004, at 9:04:42

In reply to Re: DBT making me miserable crushedout, posted by fallsfall on May 29, 2004, at 8:47:59


Wow, falls, that's very helpful. I feel relieved to know that my frustration is understandable and that I'm probably expecting way too much of myself.

I cut and pasted your entire post into an email to my T because I emailed her yesterday in a fit of frustration. I'd love to talk to you more about this stuff. I think I will read that book. Thank you for your input.

 

happy to help! :) (nm) crushedout

Posted by gardenergirl on May 29, 2004, at 9:38:30

In reply to Re: DBT making me miserable gardenergirl, posted by crushedout on May 29, 2004, at 8:29:40

 

Re: DBT making me miserable crushedout

Posted by terrics on May 29, 2004, at 17:07:30

In reply to Re: DBT making me miserable fallsfall, posted by crushedout on May 29, 2004, at 9:04:42

Well Crushed, if you figure out how this all works please let me know. I read the linehan book. I am doing dbt with a woman who makes faces at me and belittles me. So far the skills seem silly. I am gonna give it a try because I really want to get better. Maybe there really is something to those skills after all. If you cut, by the way, that is all you get to talk about in therapy and you cannot call for 24 hrs. after you cut. They want you to call before you cut. GOOD LUCK! [Sorry I am very negative] terrics

 

Re: DBT making me miserable terrics

Posted by crushedout on May 29, 2004, at 17:27:29

In reply to Re: DBT making me miserable crushedout, posted by terrics on May 29, 2004, at 17:07:30


(((terrics)))

maybe i missed stuff, but are you sure you don't need a new dbt therapist? belittling is a rotten quality in a therapist i would imagine, regardless of the type of therapy. but i bet someone has already mentioned that to you and there's a reason you're trying to stick with her.

 

Re: DBT making me miserable crushedout

Posted by terrics on May 29, 2004, at 18:01:51

In reply to Re: DBT making me miserable terrics, posted by crushedout on May 29, 2004, at 17:27:29

thank you for caring. I have only been at it 6 weeks. I'll give her a little more time. Please let me know how things worrk out for you. terrics

 

Re: DBT making me miserable terrics

Posted by Dinah on May 29, 2004, at 20:11:15

In reply to Re: DBT making me miserable crushedout, posted by terrics on May 29, 2004, at 17:07:30

I know Linehan puts a great deal of stock in using humor in the work, while also using validation. Perhaps your therapist just isn't cut out for humor and it comes across badly?

 

Linehan book fallsfall

Posted by crushedout on May 29, 2004, at 20:16:48

In reply to Re: DBT making me miserable crushedout, posted by fallsfall on May 29, 2004, at 8:47:59

Falls,

I went to the library today to read the Linehan book (they supposedly had a reference copy that couldn't be checked out) but they couldn't find it. The last record they had of it was in 1996 so they marked it lost. Sigh.

I guess maybe I'll have to cough up some dough and buy it. I'm cheap, broke-ish, and I love the library for those reasons and others.

 

Re: Linehan book crushedout

Posted by Ilene on May 29, 2004, at 21:34:32

In reply to Linehan book fallsfall, posted by crushedout on May 29, 2004, at 20:16:48

> Falls,
>
> I went to the library today to read the Linehan book (they supposedly had a reference copy that couldn't be checked out) but they couldn't find it. The last record they had of it was in 1996 so they marked it lost. Sigh.
>
> I guess maybe I'll have to cough up some dough and buy it. I'm cheap, broke-ish, and I love the library for those reasons and others.

You can get it from another library thru inter-library loan.

I.

 

Re: Linehan book Ilene

Posted by crushedout on May 29, 2004, at 21:38:52

In reply to Re: Linehan book crushedout, posted by Ilene on May 29, 2004, at 21:34:32


unfortunately, i can't (although it's a good suggestion). i asked. it was the only one in the whole system. well, maybe i could get a copy in manhattan -- i bet i could. but i'll have to go to manhattan to get it, and get a library card there, which i could do (i live in brooklyn).

 

Re: Linehan book crushedout

Posted by terrics on May 30, 2004, at 9:54:57

In reply to Re: Linehan book Ilene, posted by crushedout on May 29, 2004, at 21:38:52

I wish I had a way to get it to you. I live very close. Buy used if you can. terrics

 

Re: Linehan book terrics

Posted by crushedout on May 30, 2004, at 9:56:41

In reply to Re: Linehan book crushedout, posted by terrics on May 30, 2004, at 9:54:57


you live close to me, terrics? that's really cool.

 

Re: Linehan book crushedout

Posted by fallsfall on May 30, 2004, at 10:02:57

In reply to Re: Linehan book Ilene, posted by crushedout on May 29, 2004, at 21:38:52

I've been getting into InterLibrary Loan at work this week (I work in a library). My state is considered to be my "Interlibrary loan area". We have a database where we can find all the holdings of the other libraries in the state. A van drives around all the libraries in the state once a week. So once a week we can send books to other libraries, and once a week we get books from other libraries. This means that ILL can take 2 weeks or more - which is really inconvenient when you want the book NOW.

But it is also possible for the patron to pick up an ILL at the library that has the book - as long as the two libraries agree. I had a patron looking for a book on Lawn Mower Maintenance - and we didn't have it. We started looking at the database, and I let him peruse it because he knew what he wanted better than I did. He identified a book that the next town over had, I called that library, they did have the book on the shelf, and we arranged for him to go pick it up either later that day or the next day. I thought that was great (and so did he!). Once I picked up a Psych book 1300 miles away, because there wasn't a copy in my state, and I was travelling to this other area to visit my son. It took a little finagling to get all the paperwork done between the libraries (it is easier between two local libraries than between a tiny library in one state and an state university library in another...), but I got the book.

I've been looking around Brooklyn for the book. Even the colleges in Brooklyn don't seem to have it (!?). Maybe I missed a likely school though - if you can think of a nearby college that has a reasonable Psychology department you could check their library. Your library can do interlibrary loan with college libraries.

$57 is a lot, but I still find the book valuable (and I bought it 9 years ago). Or maybe your therapist has a copy that you can borrow??

 

Re: Linehan book fallsfall

Posted by crushedout on May 30, 2004, at 10:16:46

In reply to Re: Linehan book crushedout, posted by fallsfall on May 30, 2004, at 10:02:57

Wow, fallsfall, you're amazing. I should have known you'd be the library expert. But you go above and beyond the call of duty, which I appreciate intensely. I'm going to check the Manhattan libraries today and if I don't find it there, I'll probably just spend the $57. (You think the Brooklyn Public Library could ILL it from NYU or Columbia??? I would think *they* oughta have it. I haven't checked though.)

[Ilene: I feel bad for dismissing your suggestion earlier. I thought I had fully explored this ILL option but apparently I had not. I'm a silly girl.]

My therapist loved your post, btw, falls. She emailed me this morning about it. Also, she thinks reading the book is a great idea.

 

That's okay crushedout

Posted by Ilene on May 31, 2004, at 12:06:25

In reply to Re: Linehan book fallsfall, posted by crushedout on May 30, 2004, at 10:16:46

> [Ilene: I feel bad for dismissing your suggestion earlier. I thought I had fully explored this ILL option but apparently I had not. I'm a silly girl.]
>
That's okay, sometimes you have to be persistant.

I thought the book was a little strange, but I took it on faith that DBT was effective. (I'm interested in DBT as an improvement over CBT.) My pdoc was using the techniques for a little while, but then we got sidetracked into medication issues. Seems like the efficacy depends as much on the therapist as on the technique, which worries me.

 

Re: That's okay Ilene

Posted by crushedout on May 31, 2004, at 12:13:22

In reply to That's okay crushedout, posted by Ilene on May 31, 2004, at 12:06:25


What did you think was strange about it? I think I'm going to find it "strange," too. From what I've read of the manual that my T has photocopied for me.

 

Strangeness of DBT crushedout

Posted by Ilene on May 31, 2004, at 13:14:23

In reply to Re: That's okay Ilene, posted by crushedout on May 31, 2004, at 12:13:22

>
> What did you think was strange about it? I think I'm going to find it "strange," too. From what I've read of the manual that my T has photocopied for me.

Linehan and her colleagues developed it partly to overcome some of the problems w/ CBT, but it seems to have a completely different approach--CBT is very direct and logical, and there's an obvious point to each element of it. I didn't understand the point of some of Linehan's exercises, and what they are supposed to do to help you.

What really appealed to me was the stuff about emotion dysregulation--I don't think CBT deals with this at all--and the invalidating environment.

I borrowed the book and don't have it anymore, so I can't be any more specific.

I.

 

Re: Strangeness of DBT Ilene

Posted by crushedout on May 31, 2004, at 13:43:27

In reply to Strangeness of DBT crushedout, posted by Ilene on May 31, 2004, at 13:14:23


Yeah, I think I'm having a hard time understanding the point of some of the stuff, too. And she uses a lot of weird jargon-y sounding language which turns me off. But I think her heart's in the right place, and I trust her ideas are good. I wish she was a little better at communicating them in plain English.

 

Re: Strangeness of DBT crushedout

Posted by Ilene on May 31, 2004, at 13:46:14

In reply to Re: Strangeness of DBT Ilene, posted by crushedout on May 31, 2004, at 13:43:27

>
> Yeah, I think I'm having a hard time understanding the point of some of the stuff, too. And she uses a lot of weird jargon-y sounding language which turns me off. But I think her heart's in the right place, and I trust her ideas are good. I wish she was a little better at communicating them in plain English.

I think she's influenced by Zen or something similar.

I.

 

Re: Strangeness of DBT Ilene

Posted by crushedout on May 31, 2004, at 13:47:37

In reply to Re: Strangeness of DBT crushedout, posted by Ilene on May 31, 2004, at 13:46:14


Yeah, she's definitely into some types of Eastern meditation stuff.

 

the frustration continues

Posted by crushedout on May 31, 2004, at 20:33:48

In reply to Re: Strangeness of DBT Ilene, posted by crushedout on May 31, 2004, at 13:47:37


I don't think this is working out for me. Every time I try to fill out the diary card, I can feel my blood pressure skyrocket and I end up wanting to cry. I don't even know what the skills are, can't remember if I did them, and for the most part, think I haven't, so I put zeros down on all of them and then just feel like sh*t about everything in my life (about which I felt just fine before I picked up the diary card).

I also am frustrated because I know much of our session tomorrow will be "wasted" on talking either about what I put down or my frustration around it, and I have other things that I really need to talk about. If we're going to do this DBT stuff, we need to *add in* time to do it, which I don't really even think I have anymore. And I'm not sure it's something I want to do, anyway. I'm really not convinced it's helpful, not in this format, in any case. Not for me, that is.

 

Re: the frustration continues

Posted by fallsfall on June 1, 2004, at 7:30:48

In reply to the frustration continues, posted by crushedout on May 31, 2004, at 20:33:48

The diary cards are hard to fill out. It is hard to remember to do it. It is hard to be honest on paper. You are just learning the skills, so of course you are a bit confused about them. If you knew all the skills and did them all the time, you wouldn't need DBT. But you don't know all of them. Give it time.

"Standard" DBT includes one individual session (45-50 minutes) and one group skills session (1 1/2 hours). Please do talk to your therapist about the time - this does seem to be an issue for you.

Since you are doing this individually, she should be able to pace it so that you feel more comfortable. Can you divide up the diary cards, and only fill out part of them for now (i.e. the part you understand)? Then you can add more in as you feel comfortable with it.

Don't minimize the difficultly of being honest on paper. It is really hard to look at yourself objectively. It is really hard to write down when you have "failed". But it also does really feel good when you can write down a success. I found that it was really valuable to have notes from each day. My memory is terrible. This allowed me to have a record of how the days were, and I put a short (4 sentances) summary of what went on that day in, too. It let me have a way to look back and see the patterns, and see the progress, and see when I was slipping.

The diary cards were as much for me as they were for her. Sometimes they were a good way to introduce a topic that I knew we needed to talk about, but I didn't want to bring up ("Gee, I was feeling suicidal this week - look at those numbers! Usually it isn't this bad" - and recognize that things DID change, and to be aware of how they were changing). It gave me a better understanding of my own ebbs and flows.

OK. I just went to get my Skills Training Manual to look at the diary cards. There are two sides: the front talks about alcohol, meds, suicidal ideation, misery, self harm. The back talks about the skills.

Since you have just started, of course you don't know what the skills are - that is what you will be learning over the next 6 months. Have you talked about Wise mind yet (P.S. this was the HARDEST skill for me - still is)? After you talk about wise mind, and have a chance to do the homework on that, then that one skill should start to be clearer for you. You can't say whether you have done a skill if you don't know what it is. So, you shouldn't fill out the skill section for skills that you haven't learned yet. Maybe at this point you don't even understand wise mind (I don't...). So, maybe you aren't ready to fill out the second side - or maybe you can only tell if you have worked on one skill, or two (because that's all you have learned). You can just leave the rest blank. You'll use it later.

You should be able to fill out the front. This is not pleasant to do - and that makes it hard. But this is where you can see what is going on in your life and identify things you want to work on. For instance, you might decide that you want to reduce self harm. You won't succeed every day, perhaps. But you will be able to see your progress by watching either the "urges" rating go down, or by seeing that even though you have the urges that you are not acting on them. This is why I included a short part on what went on that day. It helped me to recognize what kinds of things were triggering the urges etc.

Maybe even the front of the card is looking hard to you. But the drugs and alcohol columns should be OK to fill out (see filling these out as a reward for your hard work). Maybe you need to add the other columns more gradually.

So maybe, right now, the front of the card is (more than) enough to be filling out (and you can even forget the last column, since you don't know the skills yet, so it is really hard to use them). Or the front, plus one or two skills that you understand. The idea of the cards is to make the things that are happening in your life more obvious to you and to your therapist. The idea of the cards is NOT to frustrate you.

There has often been talk on Babble about doing DBT here as a group. Maybe you will be the catalyst for that! If you tell us about the skills you are trying to learn, we can talk about it here, and maybe things will get clearer for both you and the rest of us! Many of these skills are REALLY hard - requiring you to change the way you see the world or the way you deal with it. Don't expect it to be easy. It would be good for me to review all of this - because I certainly didn't get it all the first time around.

So I look forward to the new continuing "DBT Saga" thread!


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