What Is Dialectical Behavior Therapy (DBT)?


What is Dialectical Behavior Therapy (DBT)?
A friend of mine is a therapist, working with adults/teens in the Greater Cincinnati area, and one of her specialties in DBT or dialectical behavior therapy. I decided an interview with her would be a great addition to this newsletter. Thank you, Lauren O’Keefe, MS, for sharing your brilliant DBT insights with us.

1) What exactly is DBT?

This is such a common question! My immediate thought, “Um, DBT is DBT, what do you mean!” But, in all seriousness, it refers to “Dialectical Behavioral Therapy.” It is a life changing treatment modality pioneered by the fantastic Marsha Linehan.

DBT focuses on high sensitivity and high reactivity to triggers. It focuses and can address so many things.The main focus is to target parasuicidal and suicidal behaviors. It’s also one of the only effective and research-based treatments for borderline personality disorder and eating disorders. It assists with allowing opposite and dialectical functioning to be true. For an example: “You can be scared AND strong.” Or, “ You can be trying your best AND still need to do better.” DBT is all about acceptance, peace and non judgment.

DBT is effective when the treatment as a whole is being followed. This treatment includes group therapy, individual therapy and phone coaching components.

2) Are therapists all trained in it or is it a specialized modality?

Like most modalities, you can do either. In order to specialize, you must demonstrate proficiency. This includes but not limited to: frequent trainings, research, frequent practice of the skills, etc.

If you decide to certify rather than specialize, the certification process is extensive for this modality. It is one personally I am preparing for. I currently identify as highly specialized, with over 2 years of DBT use and experience.

To certify you must complete all 4-5 separate trainings that are each 1-2 day trainings. You must read the CBT for Borderline Personality Book, and lead a year of DBT groups. Among this, you must ask participate in the DBT consult teams, acquire a letter of recommendation, and sit for the exam. These guidelines can change; but, when I last researched this, this is what I found. As extensive as it is, I respect it. It ensures the integrity of the treatment program and those practicing it.

3) Why should someone consider DBT?

Why wouldn’t you consider it? That’s the true question! Yes, it targets parasuicide and suicide behaviors. It also can address a slew of issues such as: interpersonal instability, distress tolerance, emotion regulation, anxiety of any degree, depression, bipolar disorder, eating disorders, obsessive compulsive disorder. It can also assist with trauma symptoms and providing a large amount of stability skills for those dealing with PTSD. The uses for this treatment are endless. It can be used for just about any clinical problem or concern.

4) How long does it take to notice a therapeutic impact?

This is a very hard question to answer for any counseling approach. The effectiveness and improvement times are determined by client commitment. If you work in sessions and are committed to progress- in and out of appointments- then one can see progress within a few months. But, this is highly dependent on the patient.

5) What is a typical session like?

A typical session is like a traditional therapy session, the only difference is we have a whole binder of skills we weave into the sessions and teach to assist the patient in acquiring, generalizing and strengthening. DBT differs in that it requires group therapy to be effective. The Groups assist with faster skill acquisition and they function as a skill classroom. Without the groups, progress can be slower in my opinion.

6) Do you assign homework to clients?

ABSOLUTELY!!!! DBT group and individual rely heavily on homework and patient accountability. If they don’t commit, progress is stagnant.

As a therapist, we have an easy job so to speak. We teach and guide. Patients have the hard job, they have to put it into action. You cannot expect things to get better if you do nothing to change the circumstances. Homework forces the circumstances to change— and boy do they! Trust the work!

7) What are some goals a client might seek to attain while utilizing DBT?  

One we use as a blanket goal is: “Create a life worth living.”  This leaves it up to the patient to self direct. Trouble with panic attacks? Trouble with maintaining friendships? Trouble with boundaries? Self harming? Done done done! DBT has got your back! You are the driver! You tell us what your perfect life would be, and we help you create and achieve it.

In order to get through hell, you have to go through hell, and once you’re free, you are free. Trust the journey.

Hope this helps!


Please remember:Healing is possible and you are so very worthy of that gift! 

Coming next month: What is Qigong?

What is ART?


What is ART?
ART is the acronym for accelerated resolution therapy . . . and, wow, do I wish I could find a therapist in the Cincinnati area practicing this newfound approach to healing trauma. My research thus far indicates there are currently no practicing ART practitioners in Ohio.
However, the University of Cincinnati Gardner Neuroscience Institute is currently engaged in a study involving the comparison of accelerated resolution therapy (ART) and cognitive processing therapy (CPT).
According to The Rosenzweig Center for Rapid Recovery, accelerated resolution therapy is a form of psychotherapy involving the use of eye movement using a technique called Voluntary Memory/Image Replacement.
During this process, a licensed practitioner guides the client through a series of steps in order to change the way negative images are stored in the brain, by waving a hand in front of the client in order to stimulate eye movement. Old negative images are replaced with new positive images, sometimes resulting in instantaneous results. 

 

Similar to EMDR, which I utilized over a four year period, this methodology uses eye movements, but allows the client to replace images of traumatic events with positive images. It is being used primarily with veterans as a way to combat their post-traumatic stress disorder (PTSD) symptoms.

 

I am optimistic that as we learn more about the brain’s plasticity, meaning its ability to change and rewire itself, these healing modalities will continue to flourish and provide much needed relief for those who have experienced traumatic events. Particularly if those events have resulted in stressful symptoms such as panic attacks, depression, anxiety, and codependency. 

The idea of replacing negative images storied in my memories with positive ones, to be able to “unsee” what haunts me, is a dream come true. EMDR certainly provided me an avenue for processing the pent up negative energy associated with my traumas. However, we became stuck at my highway and bridge phobias. After revisiting all of my traumatic events repeatedly, we still could not identify the trigger for the driving-induced panic symptoms. This ART therapy seems as if it just might be the perfect fit for replacing any negative images associated to highways and bridges with positive images instead. Amazing!

Please remember:Healing is possible and you are so very worthy of that gift! 

Coming next month: What is Dialectical Behavior Therapy (DBT)?
Excerpt from my monthly Hope for Healing Newsletter. Subscribe here! Thank you!

What Is EMDR Therapy?

Following is an excerpt from my upcoming September newsletter. This month I cover: Step 3 in the Defining Resilience series – Utilize Self-Care Strategies; a video on anxiety and panic attack coping skills; information on EMDR therapy; and creating a safe space as a coping mechanism. I would love to have you (or anyone you know who could benefit from my insights) subscribe to this and future newsletters at Hope for Healing Newsletter, as I work to grow my audience.
What is EMDR Therapy?

EMDR Therapy has been life-altering for me. In 2013 I experienced what I reference in my presentations as a “shift”. I was struggling in a toxic relationship, trying to come to terms with my trauma history, and attempting to juggle various personal issues. It was within the confines of Dr. Barb Hensley’s office, at Cincinnati Trauma Connection, where I finally confronted the dark spaces of my traumas and learned to process them, releasing the stored up energy which had been surfacing as severe panic attacks for the previous twenty-five years.

So, what is EMDR Therapy? EMDR is the acronym for Eye Movement Desensitization and Reprocessing. It was initially developed by Dr. Francine Shapiro as a method for helping soldiers, returning from war, combat their post-traumatic stress disorder (PTSD) symptoms. However, it has since been utilized to help hundreds of thousands of patients process traumatic experiences.

More information about the therapeutic technique can be found at the American Psychological Association’s Clinical Practice Guideline for the Treatment of Post-Traumatic Stress Disorder.

My personal experience during sessions included the following:

Sometimes I would use a light bar in my therapist’s office, keeping my head still and allowing my eyes to move back and forth, following a flowing green light stream from left to right and back again. Other times, I would close my eyes (as I was being distracted peripherally) and focus on the vibrating paddles I held in my hands. Those would alternate vibrations, left, right, left, right, left, right, and so on. My eye movements would naturally fall into a rhythmic back and forth movement, similar to the movement experienced during REM sleep.

While following the light bar or hand vibration pattern, I would be prompted to return to one of my traumatic experiences. The vast majority of the time something would instantaneously surface. A body memory. A flashback. A sensation. Something would appear. Sometimes it would be a snippet I had remembered outside of therapy, other times a memory would appear from an unconscious space. It would be filled with specifics I had long forgotten (such as the blue oval-shaped rug, sprawled across the floor next to my black metal-framed bunk beds, in my bedroom in our home in Park Hills, Kentucky- a memory from age four).

Sobbing, shaking, overwhelming emotions, and sometimes the symptoms of a panic attack would arise. The soothing voice of my counselor would be there to assure me that I was safe. It was there I would first learn to “just notice”.

I became aware of my triggers and realized the body memories were there to help me instead of scare me. I started to look forward to the sessions so I could dive headfirst into the chaos in order to find more answers. There was light within the darkness.

We touched upon every known traumatic experience, sometimes returning to an event repeatedly as something would surface later down the road. At first these visits into the past were seen as if I was watching a movie, from a dissociated space. I was watching someone do horrific things to a little girl from outside of myself.

I knew the day I returned to a trauma and saw it happening from within my body, through my own eyes, that I had reached a place of healing. To feel safe within my body as I relived a moment of terror during an EMDR therapy session was truly empowering.

EMDR allowed me the opportunity to process a massively complex history of sexual, physical, and emotional abuse, neglect, exposure to violent crimes, and addiction in my family. I am now panic attack free. While I still experience heightened anxiety in certain situations, I am better equipped to calm my physiological responses, being mindful of my needs and triggers and the coping skills I can utilize to help myself overcome the fear.

Coming next month: What is PTSD?