This excellent workshop wasn't intended as a complete training in DBT, but rather as a way to understand how an experienced practitioner could take parts of the DBT model and incorporate it into their practice. It worked for me! Here are the top 10 things I learnt from the course
1) DBT is Dialectical
Dialectical means accepting and working with opposites and apparent contradictions
- For example, if the thesis is "I need to change!".
- and the antithesis is "I can't change".
- the synthesis could be "Change is difficult. What I have tried so far hasn't worked. I need to work on skills to change, even though this will be difficult".
2) DBT is Behaviorial
The focus is on behaviours that need to be changed for the client to achieve their goals. This provides a very clear focus and can make the complicated and complex much simpler
The therapy focuses on
What am I doing causing me and others problems and what can I do differently?
Below is a summary of some behavioural principles which can help guide a skilful therapist
- Form a plan to change unhelpful behaviours
- Get whole lot of possible solutions
- Give them skills ask them to choose like a smorgasbord then ask which appeals most
- Look at obstacles and how to overcome them
- Shape and reward desired action - if they have done something positive, praise this
3) DBT is Skills-basedForming a plan is a good start, but many people don't have the skills to carry this out effectively. There is a large element of skills training in DBT and this is usually done in Skills groups
Mindfulness - learning to control your mind - here is DBT's version of mindfulness and some free mp3 mindfulness recordings that can be used in DBT
Interpersonal skills -learning how to get your needs met regarding other people - here is information on DEAR MAN GIVE FAST ideas and some handouts on DBT and interpersonal effectiveness skills
As with learning any other skills, homework is key. If people don't do it, this needs to be dealt with.
"Did you think of it or did you forget it?". The failure to do homework is problem-solved.
Here is a really useful free 85 page DBT Skills Booklet that can be used in a group
4) A possibly lengthy assessment phase
A Contract usually a year involving a lot. Asssement will explore motivation and behaviours they want to change. This phase can last up to 6 weeks
5)Telephone coaching is part of the dealIn a DBT group, the client is offered telephone coaching when they need it. This is specifically for help when they are in crisis. The client will form a crisis plan which they have with them
If they ring, you go through the crisis plan with them
"Get them to breathe then walk through plan"
6)Validation and Acceptance of the clientAlthough change is the desired outcome, validation is an extremely important prerequisite for change
There are 6 levels of validation
These range from showing an interest, to validating their emotions and behaviours "It's normal to feel anxious before coming to see a therapist." You are accepting the person, but that doesn't mean you are endorsing unhelpful behaviours.
7) Use of Chaining as a formulation method
Chaining is actually fairly straightforward and involves the following steps :-
- When did you first know that the problem behaviour would arise?
- If you were in situation again what would you do differently?
- What stopped you this time?
- What made you vulnerable at this time
- What happened when you stopped
- What are the consequences?
- What can we learn from this?
8) The Role of individual sessions
9) Wise Mind
Logic is great - but what it would be like to be just in logical mind, like Mr Spock?
We would lose a large part of what it is to be human, what motivates us and what makes us individual. Fear keeps us safe. Anger stops people treating us like a doormat
Wise mind can moderate emotions, its the synthesis of logical mind and emotional mind.
Think of a dilemma
a trap door. Through this trap door is your wise mind, which takes into account logic and feelings. Go through the trap door? What does wise mind tell you is right for you?
Here are useful worksheets and handouts about wise mind
10) Use of Metaphors
- Tigger and eeore
- If you want a decent life you have to experience the pain
- Change your home page
- Thoughts can be like junk mail
- Make a lemonade out of lemons.
- Need to go through pain barrier to get through marathon
Oxford Guide to Metaphors in CBT
Stories and Analogies in CBT