Dialectical Behavior Therapy

Dialectical Behavior TherapyDialectical Behavior Therapy is an evidence-based form of counseling that was developed for the treatment of borderline personality disorder (BPD). Marsha Linehan developed the model by combining the commonly used concepts of Cognitive Behavioral Therapy (CBT) with mindfulness and meditation practices. Research has demonstrated that dialectical behavior therapy is an effective treatment for BPD and has contributed to improvement in overall functioning for adolescents.

Dialectical Behavior Therapy – Four Phases

DBT consists of four phases and four modules of treatment. Each phase is focused on a specific area of treatment with the overall goal of decreasing self-harm, improving compliance with counseling, and reducing other high risk behaviors.

Phase one of treatment focuses on establishing safety by reducing self-harm behaviors. Self-harm is viewed as the culmination of a chain of events that begin with powerful emotions. Emotional dis-regulation stemming from an internal or external trigger overwhelms the client leading toward the use of self-harm to stop the unbearable feelings. DBT assists clients in learning to tolerate the overwhelming emotions through the use of more adaptive and less harmful coping strategies.

Phase two of treatment is focused on desensitization of past traumatic experiences and events. Unresolved traumatic experiences and messages are susceptible to present triggers leading toward overwhelming emotions. Once safety has been established and the clients window of emotional tolerance has been widened they are ready to process the experience at the core of the issue.

Phase three of Dialectical Behavior Therapy centers around building everyday life skills and behaviors. This phase focuses on self-respect, individual goals, and the application of new learning to future endeavors.

Phase four of the treatment plan involves the integration of spirituality, acceptance of self, individual goals, coping skills, and future planning. This phase seeks to apply the newly acquired skills to a broader context and looks toward future growth and achievement.

Dialectical Behavior Therapy – Four Modules

The four modules of DBT are interspersed through out the four phases of treatment. These modules are core mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance.

Mindfulness is the practice of  “Paying attention in a particular way; on purpose, in the present moment, and non-judgmentally” Jon Kabat-Zinn.

DBT assists the client in focusing on the experience of all five senses in the present moment. The counselor might ask the client to notice 5 colors, 4 sounds, 3 smells, and 1 taste right at this time. This focus on the present pulls the client out of the overwhelming emotions and into the safety of the therapy room. Mindfulness can be used to increase emotion tolerance and ground oneself in reality when experiencing difficult flashbacks or negative thoughts.

Emotion regulation enhances the client’s ability to regulate oneself in the moment. It focuses on adaptive coping strategies rather than harmful ones. These strategies may involve understanding and labeling emotions, increasing positive emotional experiences to counterbalance negative experiences, and decreasing emotional pain by letting go and taking the opposite action.

Interpersonal effectiveness focuses on enhancing the client’s communication and relationship skills. The main objective is to enhance one’s ability to ask for what is needed and to say no when appropriate.

The fourth module of Dialectical Behavior Therapy is distress tolerance. Sometimes people avoid uncomfortable feelings, in DBT however, the goal is to understand that negative feelings are a normal part of life. Since negative feelings are normal it is helpful to learn to accept these feelings.  DBT teaches adaptive ways of coping with the difficulty in the moment. Distress tolerance skills are distract, self-sooth, improve the moment, and focus on the pros and cons.

Dialectical Behavior Therapy – What next?

DBT is a well researched treatment model that helps adolescents and adults struggling with emotion regulation, self-harm, depression, or anxiety.  If you are looking for a therapist trained to provide DBT go HERE to meet Danielle. If you have questions about getting started in DBT treatment or would like to schedule an appointment Call 217-231-1413.

Additional Links:

Boys and Mindfulness

Goodtherapy.org articles on DBT:

Distress Tolerance,

Interpersonal Effectiveness

References:

Underwood, L.A. & Dailey, F. L. (2017). Counseling Adolescents Competently. Los Angeles, CA: Sage.

Seligman, L. & Reichenberg, L.W. (2014). Theories of Counseling and Psychotherapy: Systems, Strategies, and Skills (4th ed.). Boston, MA: Pearson.

Forgiveness in Marriage

forgiveness in marriageSometimes in marriage counseling we encounter couples that overcome their demon dialogues, create a new dance of intimacy, and rewrite the story of their marriage. Yet, just when it appears they will move to a deeper level of connection one partner brings up a seminal incident that they just can’t seem to “let go”. Susan Johnson describes these hard to let go moments as “relationship traumas” and states that many times they include one partner feeling a profound sense of abandonment. Such incidents may include an overwhelmed husband isolating in his bedroom just after learning about his wife’s cancer diagnosis. Or maybe it involved a wife’s difficulty in showing empathy for the death of her husbands father.

Susan Johnson offers six steps to forgiveness in marriage for relational traumas.

The hurt partner speaks his/her hurt

The hurt partner describes the wound without attacking the other. The partner may use words like “I felt…alone, abandoned”. This communication is not about the details of the incident but the feelings and experience of the one hurt. The pain, which in the past had been covered with anger and criticism, is now revealed in honesty and vulnerability.

Presence and Acknowledgement

The injuring partner remains emotionally present as the hurt partner shares their experience. The injuring partner now more fully understands how their actions hurt the other. This new understanding leads to an acknowledgment of hurt and creates the safety needed to move forward.

Risk and Vulnerability

Both partners soften towards the other moving from the defensiveness of “you will never hurt me again” to “I think I can trust you now”. The new position of trust and openness allows for both partners to express emotion surrounding the incident leading to deeper understanding and connection.

Owning the Mistake

The injuring partner is now able to take full responsibility for how their actions impacted the hurting partner. This probably includes a heartfelt apology. The injuring partner is able to communicate deep regret, empathy, validation, and a commitment to “being there” in the future.

Verbalizing Needs

The next step is for partners to communicate with one another what they need in the present. This will most likely include presence, touch, responsiveness, awareness, and connection.

Rewriting the story

The couple is now ready to create a new story surrounding the incident. The new story describes how the incident damaged trust in the relationship. It also highlights what led to the demon dialogues. But, the resolution of the story is shaped by how the couple confronted the pain of the incident and was able to heal through the process of openness, vulnerability, risk, and connection.

Reference:

Johnson, S. & Sanderfer, K (2016). Created for connection: The “hold me tight” guide for Christian couples. New York, NY: Little Brown and Company.

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What is EMDR?

communityI have been getting a lot of calls lately regarding my use of Eye Movement Desensitization and Reprocessing (EMDR). It seems that word has gotten around about the effectiveness of this treatment and that more people are searching for a counselor/therapist that is trained to use it. I am pleased and honored to have gone through eight full days of training in the use of EMDR as well as a period of consultation in its protocols. Although, I am not certified in the technique I have completed levels 1 and 2 of the training.

The EMDR international Association (EMDRIA) described EMDR as “an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma. EMDR is a set of standardized protocols that incorportates elements from many different approaches”

Ok, so what does that mean? Well, The protocols are a set of guidelines that trained practitioners use to assist clients in processing traumatic events and stimuli. The practitioner starts out by establishing a strong relationship with the client so that the client feels safe and cared for. This relationship helps the client to trust that when difficult emotions arise the counselor is there for support and will walk alongside them through the experience. The next step is to identify the specific traumatic event or events that the client would like to process. After identifying this target event the counselor assists the client in recognizing specific thoughts, and feelings about the event that tend to provoke strong emotions or sensations. The client rates these thoughts and feelings on a likert scale (1-10) as a way to measure how effective the processing of the treatment has been. After this “assessment” phase the counselor and client begin to process the trauma using Bi-lateral stimulation (eye-movement). These eye movements, directed by the therapist, allow the client to access memories, thoughts, feelings, and sensations associated with the events to be processed and to desensitize the client to the material. This process results in the client being able to think about the traumatic experience with less emotional difficulty, subsequently decreasing symptoms. The entire process is experienced within the safe environment established by the client/counselor relationship.

The following quote from the EMDRIA website provides a very succinct understanding of what it means to “process” trauma

“Processing does not mean talking about it. Processing means setting up a learning state that will allow experiences that are causing problems to be ‘digested’ and stored appropriately in your brain.”

Again, according to EMDRIA, EMDR has been demonstrated effective for treatment of Post Traumatic Stress Disorder (PTSD). However, it has also been used for other issues such as Panic attacks, complicated grief, phobias, performance anxiety and stress reduction.

The 8 Phases of EMDR treatment are listed below.

  1. History and Treatment planning
  2. Preparation
  3. Assessment
  4. Desensitization
  5. Installation
  6. Body Scan
  7. Closure
  8. Reevaluation

If you are considering EMDR treatment for PTSD or another issue I encourage you to visit these websites to learn more about the treatment

EMDR International Association

Webmd

If you decide that EMDR is the right treatment for you give me a call at 217-231-1413 to schedule an appointment or go to EMDRIA FIND A THERAPIST to find a therapist in your area.