DBT Therapy
By Beverly Snodgrass, LPC
Being able to regulate emotions is something many people don't have to think about and take for granted. Others struggle a lifetime with it. Austin counselor, Beverly Snodgrass, gives us an overview of DBT therapy, a treatment developed by
Marsha Linehan. DBT offers a solid middle path through an intense emotional landscape.
Emotionally dysregulated people feel emotions more intensely than others, and have difficulty returning to their normal baseline of functioning. They are also more apt to act on impulse, and have more chaos in their relationships.
So what causes someone to have difficulty regulating their own emotions? It is believed that this can be caused by both environment and temperament. The basic recipe goes something like this:
Take one emotionally sensitive child
Place in an invalidating environment
Sprinkle with messages: “your feelings are wrong,” or “don’t feel that way,” or “you aren’t trying hard enough,” etc.
Mix well, repeat
Makes one emotionally deregulated adult
Of course what’s invalidating for one person might not be for the next. In “non-emotional” or “perfect” families for instance, the emotionally expressive child can be told either directly or indirectly that they’re too sensitive. When responding to painful situations or difficulties they may be told that they are trying to manipulate or they “just need to try harder.” Not only are they not taught how to manage emotions, they now face more hurt feelings to manage. And so the cycle continues.
Invalidation isn’t limited to the family, of course. We have countless opportunities to be invalidated everyday in our society. Everything from sexual, physical , or emotional abuse, to a disproportionate focus on achievement can contribute to a general feeling of being “less than.”
Some that have had difficulty managing their emotions may have never learned how to sooth themselves during a crises or control their own train of negative thinking. They may be confused about their own feelings, needs and desires, or have difficulty managing their fear of being abandoned by others. Some may turn to drugs or other impulsive behaviors to temporarily manage their pain. As a result of these things they often find their relationships in chaos.
Enough problems in these areas with enough severity may lead to a diagnosis of Borderline personality disorder. Historically this word has evoked fear among clients and professionals alike, primarily due to a lack effective treatment to address the problem. Thanks to Marsha Linehan that has changed.
When working with people that met the criteria for Borderline Personality Disorder, Linehan found that blending a combination of change and acceptance therapies was the most helpful. She found that overemphasizing a change in behavior could create the same kinds of invalidation that caused the problems in the first place. As a result, the client would often react angrily and the therapist would either back off or push harder. This would eventually result in an impasse, or the client’s quitting therapy altogether. On the other hand, relying solely on supportive or acceptance techniques felt good to clients, but resulted in little change.
DBT Treatment
So in extracting and blending the best from these two worlds, a new therapy was born called Dialectical Behavior Therapy, and the research results are very promising. (See Behavioraltech.org). During my 10 years in offering DBT I have seen quite dramatic improvements in m clients. It isn’t magic, just a solid framework that holds the client safely and securely, while making solid steps toward lasting change.
DBT Group Therapy ~ Austin
The impact of this therapy was measured according to the standard DBT model, which includes among other things individual therapy, and weekly skills group. For a therapist to be adherent in DBT they must also attend weekly consultation groups with other DBT clinicians.
So what are these tools, or skills that so impactfully foster this kind of change. They are divided into four main modules that take at least six months to complete: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
Radical Acceptance
The mindfulness skills are the grounding point from which all the other skills grow. Mindfulness skills include an ability to be more fully aware of the world within and beyond ourselves. This means learning to notice this moment without judgment or distraction.
Interpersonal Effectiveness
From here we move to skills that help enhance relationships. This includes identifying priorities, as well as the thoughts and feelings that get in the way of achieving these priorities. This allows one to maintain self respect, and keep relationships that are important.
Emotion Regulation
The emotion regulation skills are more long term, basic, nuts and bolts skills that help one focus on taking care of the mind and the body, and building pleasure and joy in life.
Distress Tolerance
And for those times when you can’t solve the problem right now, you just need to survive it, distress tolerance skills can help with that.
So in providing a synthesis between the far ends of the spectrum, we have found a solid middle path. This route certainly isn’t without obstacles and detours, but it is less rocky. And for those that had no maps before, it provides a plausible and concrete sense of direction.
Beverly Snodgrass, an Austin counselor, has offered DBT group therapy and DBT treatment consultation to Austin clients and practitioners for over ten years. Visit her website to learn more about her, her practice, and DBT therapy.
The Road Less Rocky
Dialectical Behavior Therapy’s More Solid Middle Path
Even the most balanced person has had times when they have felt out of control. Like riding a bike downhill, we see the obstacles ahead of us, and are aware of the pain the crash will cause, but can’t seem to stop. This happens more frequently and more intensely for people with emotion dysregulation. Emotionally dysregulated people feel emotions more intensely than others, and have difficulty returning to their normal baseline of functioning. They are also more apt to act on impulse, and have more chaos in their relationships.
So what causes someone to have difficulty regulating their own emotions? It is believed that this can be caused by both environment and temperament. The basic recipe goes something like this:
Take one emotionally sensitive child
Place in an invalidating environment
Sprinkle with messages: “your feelings are wrong,” or “don’t feel that way,” or “you aren’t trying hard enough,” etc.
Mix well, repeat
Makes one emotionally deregulated adult
Of course what’s invalidating for one person might not be for the next. In “non-emotional” or “perfect” families for instance, the emotionally expressive child can be told either directly or indirectly that they’re too sensitive. When responding to painful situations or difficulties they may be told that they are trying to manipulate or they “just need to try harder.” Not only are they not taught how to manage emotions, they now face more hurt feelings to manage. And so the cycle continues.
Invalidation isn’t limited to the family, of course. We have countless opportunities to be invalidated everyday in our society. Everything from sexual, physical , or emotional abuse, to a disproportionate focus on achievement can contribute to a general feeling of being “less than.”
Some that have had difficulty managing their emotions may have never learned how to sooth themselves during a crises or control their own train of negative thinking. They may be confused about their own feelings, needs and desires, or have difficulty managing their fear of being abandoned by others. Some may turn to drugs or other impulsive behaviors to temporarily manage their pain. As a result of these things they often find their relationships in chaos.
Enough problems in these areas with enough severity may lead to a diagnosis of Borderline personality disorder. Historically this word has evoked fear among clients and professionals alike, primarily due to a lack effective treatment to address the problem. Thanks to Marsha Linehan that has changed.
When working with people that met the criteria for Borderline Personality Disorder, Linehan found that blending a combination of change and acceptance therapies was the most helpful. She found that overemphasizing a change in behavior could create the same kinds of invalidation that caused the problems in the first place. As a result, the client would often react angrily and the therapist would either back off or push harder. This would eventually result in an impasse, or the client’s quitting therapy altogether. On the other hand, relying solely on supportive or acceptance techniques felt good to clients, but resulted in little change.
DBT Treatment
So in extracting and blending the best from these two worlds, a new therapy was born called Dialectical Behavior Therapy, and the research results are very promising. (See Behavioraltech.org). During my 10 years in offering DBT I have seen quite dramatic improvements in m clients. It isn’t magic, just a solid framework that holds the client safely and securely, while making solid steps toward lasting change.
DBT Group Therapy ~ Austin
The impact of this therapy was measured according to the standard DBT model, which includes among other things individual therapy, and weekly skills group. For a therapist to be adherent in DBT they must also attend weekly consultation groups with other DBT clinicians.
So what are these tools, or skills that so impactfully foster this kind of change. They are divided into four main modules that take at least six months to complete: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
Radical Acceptance
The mindfulness skills are the grounding point from which all the other skills grow. Mindfulness skills include an ability to be more fully aware of the world within and beyond ourselves. This means learning to notice this moment without judgment or distraction.
Interpersonal Effectiveness
From here we move to skills that help enhance relationships. This includes identifying priorities, as well as the thoughts and feelings that get in the way of achieving these priorities. This allows one to maintain self respect, and keep relationships that are important.
Emotion Regulation
The emotion regulation skills are more long term, basic, nuts and bolts skills that help one focus on taking care of the mind and the body, and building pleasure and joy in life.
Distress Tolerance
And for those times when you can’t solve the problem right now, you just need to survive it, distress tolerance skills can help with that.
So in providing a synthesis between the far ends of the spectrum, we have found a solid middle path. This route certainly isn’t without obstacles and detours, but it is less rocky. And for those that had no maps before, it provides a plausible and concrete sense of direction.
Beverly Snodgrass, an Austin counselor, has offered DBT group therapy and DBT treatment consultation to Austin clients and practitioners for over ten years. Visit her website to learn more about her, her practice, and DBT therapy.
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