Psycho-Babble Psychology Thread 351645

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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!

 

Re: the frustration continues » crushedout

Posted by terrics on June 1, 2004, at 15:50:58

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

Hi Crushed, I am having a horrible time of it too. It almost seems childish. If you are going to do it your T. needs to give you a skills manual and teach you the skills. Supposedly DBT has a high success rate with borderlines if you really work it and if you really want to get well. I am going to give it 2 months and then decide if I am going to stay with it. You are supposed to have a group session also. So not having a group skills trainer makes things even harder. They just found me a group. If you really want to do this, there is a place not far from you where I am doing it. Let me know and I'll give you the info. As usual GOOD LUCK! terrics

 

Re: the frustration continues » fallsfall

Posted by crushedout on June 1, 2004, at 18:54:08

In reply to Re: the frustration continues, posted by fallsfall on June 1, 2004, at 7:30:48


Falls,

I find your input on this really helpful. Where did you do all this DBT stuff? With your old T? I didn't know till recently that you knew so much about it.

Last week, my T and I had already decided to scrap the regular diary cards because so much of it was not relevant to me (like drugs and alcohol -- I don't do them or get urges to do them anymore) and some of it made sense to neither of us (like ratings 6 and 7 for the skills, which we still don't get). So my T made up a totally new diary card designed just for me, and while it was an improvement on Linehan's, I think she still made it too challenging for a beginner.

Today I tabled our discussion of the DBT stuff and took control of the session (which was very healthy of me) because I needed to talk about other stuff. We spent the last few minutes on my frustration with the stylized diary card and how every time I look at it, my blood pressure goes up and why. My T said I should just cross out with very dark pen the ones that I don't understand and just do the ones I do. She said the point of it is not to give me a heart attack. I said, yeah, I think we went too fast with this. I need to understand this better for it to feel helpful. She was very supportive (and made suggestions similar to what you're making here, falls). So I feel hopeful that we'll find a balance and a lot less frustrated (especially because I took control of the session, I think).

Although I didn't bring up the time issue (partly because I'm not sure I have extra time in my life to spare anymore), she mentioned an extra session for next week just as I was leaving (God, it's weird how she always seems to offer just when I think I can live without it). So we may have three sessions next week, which will make me feel more comfortable spending time trying to understand the skills.

Yeah, I also find Wise Mind extremely difficult. We've talked about it but I still don't feel like I understand (I'm honestly not sure how good of a skills trainer my T is -- she seems to "get" things but is not always great at explaining them to others). I think Wise Mind is what makes my blood pressure rise more than anything. I want so much to understand what it is and do it, but I have no idea whether I have or not. Argh.

I guess I'm not doing any equivalent to the front section anymore (since she stylized my card). I wonder why. I guess I should ask her.

>The idea of the cards is NOT to frustrate you.

Yeah, that's what my T said today. Phew.

I think doing DBT as a Babble group is a great idea! I'll try to come up with some simple ways to get us going. Or anyone else should feel free to jump in and get us started.

Thanks, falls.

 

Re: the frustration continues » terrics

Posted by crushedout on June 1, 2004, at 19:18:55

In reply to Re: the frustration continues » crushedout, posted by terrics on June 1, 2004, at 15:50:58


Thanks, terrics. I'll let you know. I assume you have to pay for the group? To be honest with you, the idea of it makes me cringe in pain.

 

p.s. » terrics

Posted by crushedout on June 1, 2004, at 19:19:51

In reply to Re: the frustration continues » crushedout, posted by terrics on June 1, 2004, at 15:50:58


I think I know what you mean about it seeming childish.

 

Re: the frustration continues » crushedout

Posted by Dinah on June 1, 2004, at 21:10:21

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

I like DBT, but when I discuss it with my therapist I am always clear that I want to do what I do on my own. I don't want him to be the mean mommy checking to see if I do my homework. And I don't want to resent him in a new role.

It would be nice to have a regular therapist, and a separate skills trainer. That way there wouldn't be those dual roles that I know darn well in advance that I would not handle graciously.

 

Re: the frustration continues » crushedout

Posted by fallsfall on June 2, 2004, at 8:52:31

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

My therapist was CBT. She diagnosed me as BPD, and I went to the bookstore and found the skills training manual. I brought it to her, she hadn't seen it before (It was 1996 or 1997), but liked it. Then she got a flier about a DBT Skills class being held in town. I signed up. She went to the weekly therapists meetings (and didn't charge me - I think she saw it as education for her. Worked well for both of us). I went to 6 months of Skill Training. We started with 6 or 8 people, but all but N. and I dropped out. So it ended up being a group of 2.

I looked up my diary cards. I remember them as being helpful in giving me a place to record what happened and how I was feeling. The cards I filled out were NOT like Linehan's. Mine looked like this:

Today I felt (0-9):
Good, Happy
Anxious, Tense
Angry
Depressed
Hopeful
Empty, Alone
Unreal, Disconnected
Physically bad

Today I felt an urge to (0-9):
Kill myself
Binge or purge
Drink or take drugs
Injure myself
Overdose
(also * if I acted on the urge on that day)

Activities for each day

There was a chart for the "I felt" and "Urges" sections - each day I rated each item (i.e Good, happy was a 4, injure myself was a 0).

In the activities section I had a list of things I did:
Slept very poorly
3 kids on the bus
Read
Color
Solitaire
Take daughter to Dr. for urine test
Take her to Volleyball
Xstitch
Solitaire

2 cookies (I was trying to control my junk food intake...)

2 ativan (I recorded PRN meds, or if I forgot my meds)

On the back, I wrote a short paragraph on the day:

Slept really poorly (tried relax tape at 5AM...) If I sat on the couch I would fall asleep. Rested all day. Really didn't think about anything. Comforted by remembering that T said I did a good job. I feel better now than this morning. Junior Coaching starts tomorrow. I hope I have enough energy. Haven't had skates on in 6 months. Hope they fit, hope I can skate.

I will email you (or others) a week's chart filled out if you want.

I'm glad that your therapist is being flexible. That is important. Has she done DBT with other patients in the past? If there is a group nearby, I really do recommend doing the skills training in a group.

Don't get "stuck" on a skill that you don't get. Give it a reasonable amount of time and effort, and then go on. Being in a group helps this, because you aren't tempted to keep working on something for an individual since the group has to go on. You can always go back to things later. It is important not to get too frustrated and if you keep moving on, then maybe the next skill will be easier for you. You may need to go through ALL of the skills multiple times (Linehan "requires" 2 6 month Skills sessions - or more). But doing the course in 6 months and the repeating the whole thing in the next 6 months is MUCH better than doing the course in 12 months (due to the frustration factor). The first time through may end up being more of "These are the things that we want you to learn, just get used to the idea that these skills would be helpful for you. Learn the ones that are easy for you." The second time perhaps would be more "Practice the ones that were easy, and learn some new ones".

I really think it is worth sticking it out.

Let me know if you have other questions, either by posting or by emailing.

 

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

Crushed,
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 it...by 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.

gg

 

Re: the frustration continues » crushedout

Posted by terrics on June 3, 2004, at 14:30:05

In reply to Re: the frustration continues » terrics, posted by crushedout on June 1, 2004, at 19:18:55

Hi Crushed, My insurance covers group and individual. Do you have insurance? I think this DBT has a little brain washing aspect to it. Keep posting. terrics ps The one good thing is that the T will take calls til ten, seven days a week.


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