DBT: How is it working for you?

I'm diagnosed with BPD among several other disorders and I'm on my fourth time of going through DBT with what I feel is very little progress or change. I often wonder what exactly is going on. That's why I'm wondering - for those that have been in/are in DBT, what is your experience? Is it helping at all? Is it not helping?

brokenopen wrote:I'm diagnosed with BPD among several other disorders and I'm on my fourth time of going through DBT with what I feel is very little progress or change. I often wonder what exactly is going on. That's why I'm wondering - for those that have been in/are in DBT, what is your experience? Is it helping at all? Is it not helping?

It is not helping me either (BPD dxed here also). Having been through a course already and getting little or no benefit, it is a combination of factors:

1. Just not practicing the skills at all during the week. I tried to do the mindfulness and can only sustain attention for about 5 seconds. Then it just seems tedious, boring and meaningless. (I can't one-mindfully watch a movie without munching on something, and I can't munch on something without reading!) I guess I feel too emotionally numb to try too hard to focus 'mindfully' and discipline my brain to do what is totally unnatural. Mindfulness is just plain boring - I have 9+ long hours of work, and dammit I don't want to sit and stare at a coffee cup, or wall.

2. Not practicing skills at all during the week but telling my therapist that I am (and lying on the diary card) This just compounds the problem, because there are "adverse consequences" to patients who don't do their homework. For example I know that if my therapist knows the extent of my laziness and real lack of progress, he will be cold and irreverent (irreverance is a DBT strategy designed to condition patients to cooperate). Therefore, the only way out is lying both to the therapist and on the diary card. Unfortunately, this is cumulatively detrimental to treatment, because if the therapist is scolds me for not doing my homework, I can't tell him I'm not doing my homework and thus he doesn't know how to help.

3. The existential emptiness of DBT itself There is nothing particularly warm or comforting about it. Someone mean to you? Practice your skills. Therapist mean? Practice your skills. Get a terminal illness? Practice your skills. It is maddening to think that no matter what life blows are thrown, I'll be reduced to a forced, unthinking, 'mindful' idiot robot who has to sit there and block meaningful thinking in order to put up with life. I don't understand why DBT proponents think adopting such a forced set of behaviors makes life any more tolerable. Yes, it is interesting in theory but in practice? Boooooring.

4. Self-Soothing This has never helped. I don't think telling myself I'm great when I feel unpopular or shunned means anything. Some of the most heinous psychopaths loved themselves. I think I need a little more than forcibly lying to myself. One of the suggested homework in a handout was....MASSAGE YOURSELF. Yeah, get a backscratcher and massage yourself. Or...LIGHT A CANDLE. My therapist actually suggested this as a distress tolerance solution when things were going haywire at work. Some of the suggestions are like a Tic-Tac when you need a cake in order to solve the problem. Sometimes I get the feeling that these concepts were dreamt up by some financially independent tycoon lying on the beach in Waikiki or something. It is either been there, done that or it doesn't work at all.

5. The punitive nature of DBT itself DBT protocol is to reinforce good behavior and give "adverse-consequences" to therapy-interfering behavior, such as not doing your homework, 'being difficult' (whatever that means) or other stumbling blocks such as lack of progress. The adverse consequence can range from the therapist purposely acting cold (to discourage dysfunctional attitude/behavior) or taking a therapy vacation. The problem is, my therapist did this too much, and if I didn't read the book on DBT I wouldn't have known why the hell he was being such a prick half the time. I feel really sorry for DBT patients who have not had access to the DBT manual. How would they know their therapist is just practicing an "adverse consequence" and not hating them, period? No wonder many DBT patients "act out" - it is punitive, crazymaking and pushes all buttons to treat us like kindergardeners or naughty schoolchildren. Do DBT professionals really think the only way we will improve is if we are punished? It is a hot and cold approach that, if not applied correctly could lead to a patient feeling completely alienated from their therapist.

6. Doing homework retroactively The failure of DBT for me what not always the fault of DBT. I just could not be bothered with the homework during the week, and when group came, at the last minute I would come up with a scenario that 'fit'. I don't think I actually ever attempted to practice homework in real life.

7. The extremely inconvenient and complicated nature of the DBT skills For example, the DEAR MAN portion of Interpersonal Effectiveness and the check boxes of intensity for 'No' responses. I just do not have the discipline to sit there and figure that out. In theory it is interesting but in practice? I suppose I was lazy there again and didn't bother to practice enough to make it second nature. Same with Emotional Regulation. That also has a bunch of check boxes. IF THIS? Do that. Opposite Action in some scenarios and not others (flow chart). I just could not get into it.

8. Consultation-to-the-patient strategy This one was MADDENING. What this means is that except in extreme circumstances, any time you have a problem with your therapist or someone else, you will be told to handle that situation yourself. There is no liaison or go-between. The idea is that if you handle problems with other people yourself rather than asking someone to talk to them for you, it will help you deal with real-world situations. It discourages dependency. Ok, I understand this but it was one of the most frustrating aspects of DBT. For example, I had a problem with my therapist who switched my appointment time around without letting me know. He was on vacation. I tried to get others in the DBT clinic to help, but each of them told me to call him when he gets back. ERRGH that was frustrating.

I do believe the real danger of consultation-to-the-patient is lack of accountability. It gives one person (e.g. therapist) a tremendous amount of power over the patient's care. And what if it goes wrong? You have no one to really help you. And those DBT-bies have a way to save their skins: The Fallibility Agreement (or whatever it's called). The basic idea is that so what if they screw up or are inconsistent (give BAD therapy) - they tell themselves it's more like the real world, which is screwed up and inconsistent. Oh, and the patients have the skills to put up with it. (Therapist a jerk? USE YOUR SKILLS!) Ugh.

That was a very thorough post, I like that. Thanks for your reply. I saw myself in that post in a lot of sections.

1. It's hard for me to practice the skills most of the time because I find them really tedious and boring (especially the section I'm in right now, Emotion Regulation...we are learning about action urges and interpretations of events ) Focusing is also a problem for me, especially when I'm not interested in something.

2. I admit that I'm guilty of just putting things on my diary card most of the time because I hate doing them. I have always hated the diary cards. What are they going to prove, my moods are all over the place, highs and lows. I don't know why they put so much value on them.

3. I'm sick of the fact that they feel that Linehan is some kind of psychiatric "higher power." I told my therapist that I feel anyone with the right amount of training and knowledge could have come up with this stuff. I notice that they think DBT skills are the answer to everything, which also gets sickening. It is fairly robotic, I agree.

4. Self-soothing is okay for me sometimes, but it doesn't help me significantly.

5. I'm a person that will verbally lash out if I feel that my therapist is treating me coldly. I don't like the "adverse consequence" stuff. It's not going to make me want to do anything. I've already been called "willful."

6. I have ever so slightly attempted to practice the homework, but I get so bored with it that I just write something and get it over with. (I see the problem, I'm such a pathological liar when it comes to this stuff...I'm a master)

7. I won't even get started on interpersonal effectiveness because I hate that section, it caused me to drop out of DBT once before. I have intense anxiety and I always make up stuff because I'm afraid to do any of it.

8. I really hate when they expect you to fix everything. I tell them what bothers me and they keep doing it, I try to fix things although I'm frustrated (I've had the change of appointment as well and it makes me angry) They don't return my calls, they wait for days to get back to me, etc...if they expect independence, they certainly aren't helping to get me toward it.

The part that upsets me about the entire thing is that if I don't continue DBT, I don't get any of the other services (the individual therapy that I desperately need, for one...I have several other diagnoses as well) so I'm pretty much stuck in there regardless of whether or not it's helping. They don't get enough funding, so they have to keep taking services away from people. Having a BPD diagnosis is the only thing that's letting me continue services.

I got mad/frustrated with my therapist because in the last group session, she said something about "engaging a little bit in the impulsive behavior if nothing else helps." That's so contradictory to me because the class is about NOT engaging in the self-destructive behavior. The example was that if you want to overdose, take two pills instead of the entire bottle. Another was that if you want to self-injure, scrape your arm instead. So I can go around, keep scraping my arm, and it's okay? That's not considered self-injury? That still frustrates me when I think about it and I get angry. I can understand using other sensations to bring the urge down (getting a tattoo was suggested, using ice, drawing on yourself with a red marker, cracking an egg on the area) but to even suggest engaging even a little bit? That's absurd to me because I know that I would engage all the way and I'm sure others wouldn't be able to stop at "two pills" or "one scrape."

brokenopen wrote:That was a very thorough post, I like that. Thanks for your reply. I saw myself in that post in a lot of sections.

1. It's hard for me to practice the skills most of the time because I find them really tedious and boring (especially the section I'm in right now, Emotion Regulation...we are learning about action urges and interpretations of events ) Focusing is also a problem for me, especially when I'm not interested in something.

2. I admit that I'm guilty of just putting things on my diary card most of the time because I hate doing them. I have always hated the diary cards. What are they going to prove, my moods are all over the place, highs and lows. I don't know why they put so much value on them.

I guess they think it will really track progress. The problem is, after reading Linehan's book, I knew that progress would be reinforced and lack of progress discouraged, so there was a huge urge to lower the numbers as the therapy sessions progressed. My moods are now like 3's and 4's still for anxiety and depression but i've been putting 1's, 2's.

brokenopen wrote:3. I'm sick of the fact that they feel that Linehan is some kind of psychiatric "higher power." I told my therapist that I feel anyone with the right amount of training and knowledge could have come up with this stuff. I notice that they think DBT skills are the answer to everything, which also gets sickening. It is fairly robotic, I agree.

My therapist went so far as to suggest I switch jobs. Doing so would be hugely traumatic, as I do not cope well with change. However, he said that once I learn the DBT skills I would become a new person. DBT is not the answer for everything, quite the contrary.

brokenopen wrote:4. Self-soothing is okay for me sometimes, but it doesn't help me significantly.

5. I'm a person that will verbally lash out if I feel that my therapist is treating me coldly. I don't like the "adverse consequence" stuff. It's not going to make me want to do anything. I've already been called "willful."

Same here I did verbally lash out when my therapist was cold, and he said "you can't change a person". I too have been called willful with regard to some medication he insisted I take but refused.

brokenopen wrote:6. I have ever so slightly attempted to practice the homework, but I get so bored with it that I just write something and get it over with. (I see the problem, I'm such a pathological liar when it comes to this stuff...I'm a master)

Ditto

brokenopen wrote:7. I won't even get started on interpersonal effectiveness because I hate that section, it caused me to drop out of DBT once before. I have intense anxiety and I always make up stuff because I'm afraid to do any of it.

8. I really hate when they expect you to fix everything. I tell them what bothers me and they keep doing it, I try to fix things although I'm frustrated (I've had the change of appointment as well and it makes me angry) They don't return my calls, they wait for days to get back to me, etc...if they expect independence, they certainly aren't helping to get me toward it.

And their answer is that if what they do isn't to their patient's liking, well the patient can then practice skills

brokenopen wrote:The part that upsets me about the entire thing is that if I don't continue DBT, I don't get any of the other services (the individual therapy that I desperately need, for one...I have several other diagnoses as well) so I'm pretty much stuck in there regardless of whether or not it's helping. They don't get enough funding, so they have to keep taking services away from people. Having a BPD diagnosis is the only thing that's letting me continue services.

Same here. If no individual therapy, then no group. If no group, then no individual therapy. If neither, then no services except meds.

brokenopen wrote:I got mad/frustrated with my therapist because in the last group session, she said something about "engaging a little bit in the impulsive behavior if nothing else helps." That's so contradictory to me because the class is about NOT engaging in the self-destructive behavior. The example was that if you want to overdose, take two pills instead of the entire bottle. Another was that if you want to self-injure, scrape your arm instead. So I can go around, keep scraping my arm, and it's okay? That's not considered self-injury? That still frustrates me when I think about it and I get angry. I can understand using other sensations to bring the urge down (getting a tattoo was suggested, using ice, drawing on yourself with a red marker, cracking an egg on the area) but to even suggest engaging even a little bit? That's absurd to me because I know that I would engage all the way and I'm sure others wouldn't be able to stop at "two pills" or "one scrape."

Wow that is horrible. We are supposed to feel confident that not engaging at all is OK, but it sounds like your therapist is not validating that.

I’ve been in a DBT group for a few months now and while I’m far from being reformed, I have found it helpful. Sometimes it’s a struggle to remember the skills when I’m going about my day, but the more I practice the more I get out of it.

I’m surprised to hear about therapists behaving cold when patients fail to do home work. I haven’t experienced this in my group. We certainly discuss what went wrong, what our barriers were and what we could have done to avoid those barriers, but I haven’t noticed the therapist behave standoffish toward anyone.

I’m also surprised that they would advise you to engage in impulse-like behavior such as the tattoo or swallowing 2 pills instead of the whole bottle. That just seems counter-productive to me. I wonder if my group therapist is simply approaching DBT differently or if I simply have a different outlook because I haven’t been doing it as long.

There are weeks where I’m lazy; I might do a half-assed job completing my goals, I might fill out my diary card without thinking about the numbers, or I might omit crucial information because I simply don’t want to deal with it. I’ve been trying not to do this because it’s in my best interest to make a sincere effort. Otherwise it would be like paying for a gym membership and not ever going.

cabdriver wrote:Wow that is horrible. We are supposed to feel confident that not engaging at all is OK, but it sounds like your therapist is not validating that.

I argued my point for probably a good 10-15 minutes (group was almost over, I wanted to keep going, once I start, I can't stop until I feel that I'm finished) and my therapist wasn't having it. She said that "engaging in the destructive behavior a bit is better than engaging all the way." Yeah, maybe so, but they shouldn't be teaching that in DBT. To me, it's still engaging, it's still destructive, it's still going against everything they are trying to teach us.

I’m also surprised that they would advise you to engage in impulse-like behavior such as the tattoo or swallowing 2 pills instead of the whole bottle. That just seems counter-productive to me. I wonder if my group therapist is simply approaching DBT differently or if I simply have a different outlook because I haven’t been doing it as long.

I'm glad that there are people that can see what I'm trying to say. That's exactly how I feel, it's counterproductive. I really like my new therapist (so far...I always have that intense "love (admiration)/hate" thing with people) but I don't agree with everything she says and sometimes, I feel that she excuses what people (mostly me) are saying because of studies and things that prove otherwise.

I'll tell you one thing, it's not helping with my anger.

..........

I begin dbt May 4. This will be my first time attending and this is what I think about...

what I feel is very little progress or change. I often wonder what exactly is going on.

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Self-Soothing This has never helped. I don't think telling myself I'm great when I feel unpopular or shunned means anything.

Agree, and this would NEVER work with me. I don't know much about dbt, although I have glanced at the workbook some. I think my initial thoughts are it seems that dbt is trying to manufacture happiness, where it doesn't exist. It's kind of like you cut yourself, place a band aid on the cut, and then try to convince yourself the cut no longer exists. I am trying to keep an open mind though.

I'm 42, and have lived like this for so long I'm not sure if I have the mindset capable of changing. I've been on disability ever since approximately 05. I don't have any close friends, and I isolate, and even when I do go out it's almost as if I can still isolate because I'm so detached and able to block everything out. The only emotions that I really relate to are extreme internal anger, hopelessness, or absolutely nothing at all. At this point in my life I feel that I'm only here to raise my kids, hope they don't turn out like me, and once their raised I could care less what happens to me. They are my life. I don't really see myself married again or having someone that can love me for me. In regards to friends I don't even know if I have a desire to have any anymore. It may be easier and less stressful to not have a any. I've grown tired of the arguments, which eventually develop and then question myself if I was really right or wrong. Also it seems when people found out about my condition in the past that I was thought of differently than everyone else. Everyone needs love a significant other, but for some reason I don't. That for me is really frustrating and creates a lot of anger in me. (sorry for the rant)

I want to write something POSITIVE about DBT incase there are people who have been pinning all their hopes on it and are feeling suicidal at the negativity in this thread so far.......seriously guys.

DBT only works when you put in the effort to make it work. If you want to change your life then you have to WILLINGLY attempt everything that is asked of you. Unless you're prepared to do that then of course nothing is going to change, that's obvious.

Yes it's difficult.....it takes 2 to 3 years at the very least. i've had nearly 2 years and I'm doing OK with it, and will probably stop after the summer. But mine is a bit different to the "official" sounding DBT you guys are talking about. I'm in Scotland and we're not actually supposed to call it DBT because the therapists aren't officialy Linehan trained. But they do a bl**dy good job regardless. 9 started at the beginning, 5 of which stuck with it. Of those 5, 4 are still struggling on their 3rd attempt, 1 has left because she's learnt the methods and now it's up to her to use them in her life. I joined later on and, after 2 years, I feel as ready as I'm going to that I can use the skills in my day-to-day life.

I'll try to tackle some of the problems that have been pointed out.

Mindfulness - yeah....it sounds a bit pointless and it IS hard. We're not used to doing it, so it is hard. Nobody has ever said though that being mindful will cure your BPD. It's simply a tool that some people might find helpful. I know one of my group uses mindfulness skills when she has to go out the house. She is seriously anxious about leaving home but can walk around town now, paying attention to street signs, colours of cars etc., to get her through it. Not ideal, but better than being stuck in her house forever. I don't practise mindfulness at all because I find it doesn't really work for me....but I do the homework when we're given it. You've got to try - lets face it, even if you spend 5 minutes staring at a raisin and think "this is stupid, this is pointless" for those 5 minutes, at leasat you've not spent the time thinking "i hate myself, i can't get anything right". You only need to be mindful for tiny periods of tim and build up on it.

Doing the homework - you've GOT to get into the habit of looking at your work every day/night. Set yourself a 10 minutes every day, write it in your diary. You wouldn't skip homework if it were for a university degree, would you? this is the university of life - wouldn't you like to graduate? However pointless or difficult it seems, you've got to at least try. And if you find it too hard, think about WHY it is too hard. This week none of us did our homework properly (Interpersonal Skills - our least favourite). So we spent the whole session discussing the difficulties we had and have now come up with a much better way for this part of the course to be delivered to future groups. Do'n't be scared to say you haven't dont ie - lying isn't going to help anyone and I bet you anything you like that your therapist will know you've lied....they can tell if you've made up a scenario. If you can at least identify WHY you find it hard, you're making progress.

Self-soothing - difficult I know because a bubble bath isn't likely to bring us down from our extreme emotions....but if it takes us down a little bit then again it's worth a shot. Sometimes it seems a bit stupid to make us write coping thoughts, self-soothing ideass, distraction techniques on flashcards or post them around the house, but do keep a list somewhere. If you've got options then you can use them - if you haven't bothered to come up with any because you "think" it's stupid then you aren't giving DBT a chance to work.

YOU have to be prepared to CHANGE otherwise you're just wasting everyones time and taking up a valuable space that someone else who IS prepared needs.

That will sound like a lecture but I'm not wanting other people to lose hope by all this negativity. you sound like a bunch of schoolkids in places. DBT isn't easy - of course it's not. We're learning new ways of thinking and learning how to identiy what we're feeling....that's going to take time and EFFORT. And it won't work overnight.....you have to gradually introduce the techniques that work FOR YOU into your life and the more you use them, the more useful and natural they become. 2 years down the line I now no longer say "you can't do anything right" when I spill milk.....might not sound like a lot but it really is. Without DBT I would be dead, no 2 ways about it. But now I have a toolkit of techniques that I can try in different situations and I don't even have to think about using them....they just happen now. Because I have dedicated the last 2 years of my life to learning them so I can live a better life.

I am starting a DBT group in about a month, but so far all I've had to work from is a DBT workbook. In relation to what most of the people in this thread have said, all I can do is shake my head. Of course it's hard. ###$. If you aren't willing to work hard to get better, then I can't fathom you. This life is hell, and working hard to get better is NOTHING compared to how bad it is if you do nothing. With just a workbook and effing determination, I've made loads of progress. I'm not saying, "Oh, I'm special" -- I'm saying I actually want to get better.

I am sure the actual DBT group I'm starting will only help more.