My different DBT programs

Just as an overview: DBT intensive programs are set up so that clients attend 3 hours of `skills training’ per week, and have a one hour individual session with a DBT-trained therapist.  It’s pretty rigid, and it’s really important to show up.  Not just show up, but be ready and willing to do the work.  Trust me, there will be times you’ll have to search for a kernel of Willingness while you’re brain screams at you alll the reasons you don’t want to go.  “The program sucks, my therapist sucks, mindfulness sucks, I’m not getting better, this is too hard, blah blah blah blah blah”.  It’s just your brain doing what it does, aaand you can ignore it.  I ended up naming this `yelling, bitchy, negative, self-critical thought-machine’ Amy, after Amy Winehouse.  The part of me that found the kernel of Willingness, and Wise Mind in all of this, I called Charlie.  Charles was a professor of mine at University who adored me, and whom I loved unconditionally.  But I wanted a gender-neutral name, so I chose Charlie.  Geeez, how did I get there?  Well, ya know, whatever works. ; )  The bottom line is: if you don’t go to therapy, you can’t get better.  Sucks, I know.  I’d rather take a pill too.

The first time I tried DBT I could only go to the group.  Insurance paid for the group, but not the individual session.  So, I wasn’t doing an `intensive DBT’ program at all.  The therapists who lead the skills group were really lax about how we acted in group, and how engaged we were, which lead to people just saying whatever the hell they wanted, whenever they wanted.  It was chaos.  Negative chaos.  Group is for learning skills, not for bitching.  But most of the time people just bitched.  It was so weird, because I knew that the therapists were actually good one-on-one.  They just didn’t know how to lead groups.  The worst part about all this is that most people ended up leaving the group having given up on DBT.  The truth is that it wasn’t DBT that didn’t work – it was this particular group. Sad.

A year later I went to a group run by a couple of interns.  Once again, I just went to group.  I paid a sliding scale fee for the group, but couldn’t afford the individual therapy. Wow, the difference between this group and the last was immediate and amazing.

First of all, the clients were really engaged.  We had been told that if we didn’t participate we’d have to `problem solve’ with the therapists until we did.  If we were late, we had to `problem solve’ also.  Basically, we had made a commitment to the therapists and to ourselves that we would be fully involved with the group.  If we showed that we weren’t honoring our commitment, why not?  Holding us accountable when we did things that were counter-productive was so, so important.

Also, for some reason, the people were `vital’.  We were really alive, and excited, and were trying so, so hard.  We were rooting for each other to practice the skills and do well.  There were people with various diagnoses in the group – and still it felt really cohesive.

One of the agreements you are asked to make when you join a dbt group is that you won’t form outside relationships with other members.  We changed that to `won’t form relationships that we can’t talk about in group’.  In other words, we were careful not to form relationships that might put our engagement with the group in jeopardy. No flirting, sex, forming cliques etc.  A couple of us became friends and `skill buddies’.  We’d go on walks and keep each other updated about how our skill practice and homework was going.  Having friendship in this group was really helpful – but the only reason it worked was because we were all very careful.  Certain topics were off-bounds.  No talk of self-harm, suicidal ideation, or anything we thought might trigger the other person.  If we asked for advice, we had to take it.  We couldn’t say, `yes, but…’.  Anything about self-harm or Suicidal Ideation went straight to the therapists.  Immediately.  The therapists were available, and wanted to help.  For the first few months we were all so dysregulated, most of the therapist calls were about holding our hands through using the TIPS skills.  I spent quite a few phone calls with my head dunked in ice water to get the `dive reflex’ simulated.  Held my breath under ice-cold water for 30 seconds, cried into the phone for 10, repeat, and again.  This became my go-to TIPS skill.  Not every skill will work for everyone.

I stayed in the group for about 9 months, and really was noticing some changes.  Unfortunately, I had to move.  Fortunately, the place I moved to had an intensive DBT program that I qualified for.  Yaaay!

Finally I was in a program that provided me with both a skills group And individual therapy.  Again, this group was run really tightly.  If you didn’t show up more than a couple of times you were out.  If you were late, why?  I didn’t `gel’ with the people as much, and didn’t become friends with any – but man, did we work the skills!  Well, I should say, “maan, did some of us work the skills”.  Some people were just too dysregulated to stick with the program.  Others had logistical problems.  One was wasted.  Everyone was encouraged and given multiple chances, as long as they didn’t do anything that triggered other group members.  I think about one third left pretty quickly.

I was lucky to have had DBT previously, and to have had experience with zen meditation.  I came into the program knowing that it *could* work.  Many times I wanted to quit.  Or maybe “Amy” wanted to quit.; )  But, I felt like this was my last chance – and actually, a gift.  Thankfully, the therapists stuck with me during my pissiness, anger, self-hatred and self-defeating urges.  I’m sure I wasn’t the most pleasant person to be around.  I’m not a religious person at all….but as many times have I wanted to quit the program, I thanked ‘something’ for giving me the opportunity to participate in it.

Some people call DBT `diabolical behavioral therapy’.  You love it, you hate it.  You love to hate it, and hate to love it.  Part of you wants to leave, but somehow you stay.  The skills might feel weird, and `fake’.  It’s not exciting enough.  It might be the healthiest thing you’ve ever done for yourself, which in itself can feel completely foreign and uncomfortable.  You’ll want to stir shit up.  You’ll get stirred up.  Finally, if you stick with it, your `wise mind’ will kick in, and you’ll just work.  I hope.

To everyone just now starting a program, I hope you always remember why you started it, and keep on going toward whatever goal you and your therapist set for yourself.  A lot of the time your emotions will be so ‘loud’ you won’t be able to see that you’re actually moving toward that goal, but your therapist will.  S/he will drag you back on the path if you fall off.  But you have to be Willing.  Just a little bit.

I’d love to hear from you!  Please leave comments about what aspects of dbt you’d like me to write about, K?  I may be invisible, but I’m rooting for you!



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