One of my favorite things about DBT is how every intervention makes sense for the overall goal of reducing interpersonal chaos and how that goal makes so much sense for the treatment population it was designed to help. I’m not going to get into a debate as to whether it’s the “best” treatment; but I think it is probably the most efficient and “designed with focus” treatments around.
Again, I practice from three different modalities so it’s not like I have a horse in the race. DBT is my preference when trying to help clients develop the capacity for mindfulness because of how practical it is when approaching the topic – within DBT mindfulness has a utility that specifically connects to the core issue driving a problem. No where is this more apparent than in the How Skill – Effectively.
One common approach to teaching any skill in DBT (and CBT for that manner) are parables and, where appropriate, self disclosure. In teaching Effectively I talk to clients about an experience I had back in my 20’s.
I was working at my first management position 2 years out of grad school, saving for a wedding and working for an organization that was going through a merger resulting in a lot of downsizing. On top of all that, I had to deal with the issue of a title change. My office was conveniently located above a Motor Vehicles Agency, which I thought would make the whole thing a breeze. I ended up having to visit the DMV several times and each time I felt I was given the run around which led to me becoming more frustrated each time I had to go.
During the last visit, the agent and his supervisor basically blew me off and informed me that more information was needed, which is what I was told during each of the prior visits. It felt like each time I went, there was some other reason as to why they couldn’t do what I needed them to do which meant using a lunch hour (which was really just an hour of work) to wait on line again. But this time was different. I became so pissed off at the “injustice” and incompetence of the whole thing that I went on a 5 minute stump speech about the evils and incompetence of bureaucracies.
A very loud stump speech.
And I felt justified and right with what I was saying, after all it was their errors that were wasting my time and they took no ownership, they showed no interest or concern that my life was busy and my time was being wasted. At the end of my rendition of “Mr. Smith Goes to Washington”, everyone else there erupted in applause.
Then I was asked to leave and never come back; the manager informed me that I was “banned”.
Initially, it felt good to react in this way and to throw it back in their face. It felt good to have other people applaud me for doing that. Vengeance, vindictiveness and giving someone who deserves it a verbal beat down always feels good, especially when you’re right and everyone else knows you’re right.
But it was ineffective.
In the end, I had to restart the process with another DMV. I could no longer use the DMV that was one floor down from my office. I failed to realize that in a place like the DMV, the folks who work there are as much a slave to their protocols as I am – the only difference being the side of the counter they were on. I failed to realize that bureaucracies are numb to the consequences of their protocols because the protocols are just how its’ done – its not personal.
That is the essence of Effectively, that just because something feels right; just because it IS right doesn’t mean it’s effective. It’s about taming both logic and emotion with the realities of context and acting effectively within that context to get what you need – even if it means having to come back to the table more times than you’d like.
This is a great little app that gives users access to dbt skills on their phone. One important feature is the diary card, which feels intuitive and does a nice job of prompting a user through some of the skills – much easier than the paper version. It also allows you to create a pdf of the diary card that you can email your therapist or print out and bring to session. It’s free but only available on Droid. Get it at Google.
A comparable app for the IPhone is about 5 bucks- DBT Diary Card
I know, I know….I’ve been slacking off on the blog, but the past month has been really hectic and I put some skills into use. One thing CBT and DBT both teach is to be more effective when it comes to time so that you don’t overburden yourself or harm relationships by not following through on commitments. As a result, I had to put the blog on the back burner until I was able to recognize what a normal life looked like again.
Many clients who have experienced negative events in their lives may feel that these events aren’t worth exploring in therapy because, as many would put it …”it’s not like I have flashbacks or anything”.
In order to be diagnosed with PTSD a person has to meet certain criteria, but not meeting criteria doesn’t mean that traumatic experiences don’t have an impact on a person’s life. Trauma is broken down into two categories, the first (“Big T”) includes experiences that meet the formal definition of trauma outlined in the DSM (rape, natural disaster, sexual abuse, war) and the second (Small T) includes events like neglect, job loss, emotionally abusive relationships or historical events that elicited strong feelings of shame or embarrassment.
Folks who experience Big T traumas are more likely to develop symptoms of PTSD, but most people who experience Big T traumas do not develop PTSD. There are certain factors that may make someone more vulnerable to developing PTSD, including:
-Family History of Mental Health Issues or Addiction
-Presence of a Mental Health Issue or Addiction
-Exposure to traumatic experiences in the past
-High Level of distress experienced during the traumatic event
-Lack of Social Supports available to the person after the traumatic event
-Presence of other stressors during the time of the traumatic event (job loss, divorce etc)
-Gender (females are more likely to develop PTSD)
Although I use PTSD as a formal diagnosis when appropriate, I (and a lot of folks who work with trauma) tend to view trauma reaction on a spectrum with PTSD representing the most severe point on that spectrum. A person may not meet the full criteria for PTSD, but may experience some of the symptoms within the disorder or may meet criteria for other disorders.
When it comes to Small T traumas, the popular culture tends to mock associations made between historical events and current symptoms with clichés and stereotypes of therapy as being about a problem in search of either more problems or a scapegoat. Many times, these types of trauma related disorders are more difficult to identify and treat because clients do not always associate the trauma with current mental health symptoms or, because of the cultural context, are ashamed to admit that these events are having a significant impact.
The good news is that the symptoms associated with both types of trauma follow similar treatment protocols, and even if associations to the traumatic event are not identified early on in treatment, most modalities have a way of teasing out these connections and determining validity. Using CBT as an example, I typically work in an exercise around source credibility when identifying core beliefs which involves going beyond the core belief and determining the evidence that a client has historically used as a means of coming to the negative conclusion about themselves. Sometimes the less invasive interventions used in CBT are enough to attack source credibility and extinguish these negative beliefs, other times more invasive interventions (like EMDR or Exposure Therapy) are needed.
Congrats to Kelly A. and Dawn J. (both jersey folks) on getting the goods for this months giveaway. Next month we’ll pick one person out of our WordPress, Facebook, Twitter, LinkedIn, Tumblr or Google+ crowd to get a cap and long sleeve t-shirt.
For now I’ll give you the Cancer Bats covering “Sabotage”. I think they did a great job with the song and the video is just awesome in so many ways. Even if you don’t like the cover, you have to give props on the video if you’ve ever been into the Beastie Boys.
The first time I heard this cover was on my Alma Mater’s radio station WSOU. Coincidentally, there’s a fundraiser going on to get a documentary on WSOU done. If you’re inclined to throw it some coin just hop on over to the Pirates of the Airwaves indiegogo page. You’ll get some cool gear if you donate and if you don’t, you’ll still come away with some background on the best college radio station in the country.