DBT Peer Connections

Building Hope, Community and Skillful Means


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Respecting Emotion & Regulating Emotion: An Introduction to Checking the Facts

Emotions are like a sixth sense because like sight, sound, taste, touch, and smell, they give us important information about our environment that we need to survive. What makes emotions so special is that they help us to act quickly when logical thought is too slow for us to engage in problem-solving. (See Situations below.) However, for people who may be unusually emotionally reactive, sensitive, or have learned to judge or invalidate their emotional sixth sense from culture, values, gender roles, parents, family, loved ones, etc., emotions may not always cause the expected effective response. Therefore, dialectical behavior therapy came up with the skill checking the facts to help us figure out if our emotional responses fit the facts and intensity of a situation and whether an unwanted or distressing emotion needs skills toward accepting and changing or skills toward accepting and tolerating.

Situations When Emotions May Be More Effective Than Problem Solving

  • A person walks in front of your car; fear of hurting someone else or yourself causes you to slam on the breaks and veer away from the person without thinking about it. The result is fear saved your life and the life of the person who walked in front of your car.
  • The garbage in your kitchen is piling up; the rotting food and stench is so disgusting you so much you immediately take it out to the dumpster instead of thinking about whether or not you should go on strike and stop taking out the garbage altogether to get your roommates to do their part. Disgust makes sure you do not unnecessarily expose yourself to dangerous bacteria, viruses, parasites, and other disease-causing things that exist in garbage.
  • In a department store, a man twice your size, with huge muscles, and a survival knife strapped to his waist threatens to spank your crying child who just said “F-you!” when you told her she could not have the toy she wanted. You get angry and step between your child and the person, and warn him that if he touches your child, he will be sorry. Anger causes you to protect your child when thinking about it might prevent you from taking on someone who could easily clobber you.

Emotions That Are More Intense Are More Convincing

Although emotions give us valuable information we need to thrive and survive, if we are not mindful of the facts that cause them, we may mistakenly believe that they are always telling us the truth. However, when we check the facts of emotional responses, we can dialectically challenge their intensity through a clear behavioral practice that helps offset dilemmas emotionally intense people often face.

For example, Joe may be emotionally sensitive based on his biology, which causes him to be more reactive and experience emotions more intensely and for a longer duration than most people. Therefore, when prompted by an emotion, it may overwhelm his logical mind so that he automatically believes his emotions are telling him the truth. Every one of us has probably in our life had an emotion feel so intense, we unquestionably believed it to be true. “I just had this gut feeling, that she was lying to me.” The feeling drives the assumption. Checking the facts tests the assumption’s reliability. In dialectical behavior therapy, we realize that wise mind is neither logical or emotional but a synthesis.

The following is a scenario where emotional intensity that is misleading leads to problem behaviors associated with panic disorder and agoraphobia. Robin had a heart attack 10 years ago while in line at a grocery store. Now every time she goes to the store and has to wait in line, she has a panic attack and leaves before she gets to the register. The fear and anxiety are so intense she believes that staying in line is going to lead to catastrophe. Therefore, she responds to it by running away from the danger. Since she had a heart attack in a store line, her fear makes sense because the fear has a cause. However, the fact that her fear is valid does not necessarily mean that her response to the fear is valid too.

To figure out whether Robin’s response to fear is valid, we need to check the facts surrounding it. With fear, we know it is valid when our life or that of one of we care are about is threatened. (See flow charts below.) So let us check the facts. What causes heart attacks? “Most heart attacks happen when a blood vessel supplying part of the heart becomes blocked. When that part of the heart stops getting enough blood and oxygen, it can be damaged, causing a heart attack. Usually, the blockage is caused by a fatty material (plaque) that builds up on the inside of blood vessels and a blood clot.” (Craig, 2011) So now that we know the facts about what causes heart attacks Robin can go about assessing if the cause of heart attacks correlates with her fear of having a heart attack in a store.

In dialectical behavior therapy skills training, there is a very clear process. “Check the facts and analyze clearly whether your feared outcomes are likely. Observe what is really going on, and ask wise mind whether your feared outcomes constitute a true catastrophe. Cope ahead can be useful for getting better at handling situations that you know precipitate judgmentalness in you.” (Linehan, 2015, p. 159) So if Robin wants to apply this to her own situation. Here is a line of questioning she may use to check the facts. Does standing in store lines cause heart attacks? No. If Robin is going to have a heart attack, will leaving the store before she gets to the register prevent it? No. And if Robin is at risk for another heart attack what are the odds that it will happen again right at the moment she is standing in line at a store? Her odds are probably pretty slim. So, the conclusion is that Robin’s fear makes perfect sense given her past experience and her response of running out of the store before she can get to the register is not valid because checking the facts, it becomes clear there is no real danger. From this point, Robin may proceed to constructing whatever cope ahead strategy suits her dialectical behavior skills knowledge and preference so that next time she is in a store line she may try something different instead of running out of the store when fear arises.  The key is that change transpires through acceptance. When we accept that every behavior has a cause and look for the cause instead of giving into urges to judge or blame, change becomes more possible.

Communicating Emotional Pain: Do You Have to See It to Believe It?

All emotions have a cause and therefore contain validity. When we do not validate or acknowledge emotions, they usually increase in intensity, which likewise may lead to problematic behaviors. Yet when a person’s emotional expression escalates, we often respond by judging the person’s emotions and not listening to them. As such the person’s emotions increase because their expression is not being acknowledged or accepted.

To illustrate the function, let us say that instead of communicating emotion, you were at work and a fire started on the floor you were on, while your co-workers, on the floor above you, had no idea. Your goal is to let your co-workers know about the fire so you can effectively respond and evacuate. If your co-workers did not acknowledge that they believed you or took your message seriously, would you shrug your shoulders and go your own way or would you increase your intensity of communication by raising your voice, becoming more animated, intense? Would you question what you knew to be true about the fire because others did not believe you even though you saw the fire with your own eyes, felt the heat on your skin, filled your nostrils with sulphuric burn of it smoke? Would you trust your own senses more than the social order of majority rules?

Most people would not doubt their senses no matter how fervent or many others might object, and, as such, would likewise intensify their assertion regarding the fire, escalating the message until, at last, it was received. This is the same with communicating emotional suffering. When a person says she feels miserable and the confidant responds by saying, “you have nothing to be miserable about,” or “other people have it a lot tougher than you do,” or “you are always so dramatic about everything,” or “you need to learn to appreciate what you have,” or “Chin up. Life is rough,” or “Get over it,” it is saying to the person needing support that she really does not need support because her pain, is in fact, not real. So while the person in misery may be reaching out for support, instead what she gets is an argument, more distress, and the burden of proof that her misery is true. Finally, after she has pleaded, begged, argued, and still meets disbelief and skepticism, she realizes that words are not enough to communicate her emotional pain, so moves to actions.

When we see a wound, we do not doubt that it causes pain, but the cause of painful of emotions is not something we can see like a scratch or a cut because the wound evolves from personal experience, which cannot be conveyed to others through sight. As such, to validate emotional experience is to trust that emotion, by its nature, is not a thing easily employed in deceit and manipulation because it acts faster than intentional behavior. In other words, when a person has an intense, extreme emotional response, it is rarely, if ever inspired bu ulterior motives. Therefore, it is more reasonable to conclude that self-harm and suicidal behavior are not really acts of manipulation, but rather dysfunctional means to communicate suffering to oneself and others. More simply, it is easier to communicate and accept suffering caused by physical injury than it is to communicate and accept suffering caused by emotional pain. Dialectical behavior therapy’s position is that in the case of emotional pain, you do not have to see it to believe it. You only have to be willing to trust that when someone tells you she is suffering; she is telling you the truth.

Suicidal Behavior Is an Attempt to Communicate Not Manipulate

However, learning to hurt oneself is rarely a result of motivated effort. It is not like learning to read which requires conscious focus and determination. Usually, it is an impulsive act that emerges impulsively when all else has failed. The pattern becomes established when, at last, after the person has inflicted physical harm upon herself, she receives the soothing support she wants, needs.

People who are repeatedly suicidal often get accused of being manipulative because threats or actions toward suicide lead loved ones to act in caring, compassionate way. If a person says he feels manipulated by suicidal behavior. Is he not likewise saying, “I did not want to be emotionally supportive, and she made me do it. She manipulated me into being gentle and compassionate when I really wanted to tell her to quit feeling sorry for herself.” It seems to me the problem is not necessarily that the suicidal person is manipulative or that the loved one is callous and insensitive, it is a fundamental issue of supply and demand. The suicidal person demands more emotional support than a loved one may be able or willing to give. It does not mean either person is bad or flawed. It just means there is a need for balance that is not being met, and judging those involved rarely leads to a reasonable, satisfying, or effective solution.

The Sixth Sense: Exploring Emotions & Myths

In American culture, exerting control over emotional expression is highly valued. And when we are unable to keep our emotions from being expressed, we feel we must apologize for it. How many of you have cried in front of others and not apologized for it afterward? One of the skills I am using to overcome emotional self-invalidation is the DBT skill, no apologies. While the behaviors that follow my emotions may, at times, call for an apology. Emotions are not the problem. It is the response to the emotion that is the problem. Emotions are physiological sensations, not intentional actions. So, here we have a real and true sixth sense that has yet to be acknowledged widely as such.

When emotions are unwanted or unusually intense, accepting, respecting, allowing the experience, instead of judging, suppressing, or denying is the key to overcoming distress. In dialectical behavior therapy, emotions receive the same nonjudgmental regard the other five human senses do. In fact, it emphasizes an intentional effort to distinguish a person’s emotional experience from a person’s emotional response to synthesize the dialectical perspective needed to change extreme behaviors. This is where the dialectical behavioral skill check the facts is particularly useful. By building knowledge of how emotions function one-mindfully, nonjudgmentally, effectively, observing each our own emotional experience, we may combine that experience with logic to access our wise mind.

The following flowcharts show how to check the facts of emotions and offer a variety of solutions that show how to synthesize acceptance and change that is the premise of all strategies and skills employed in dialectical behavior therapy.

References

Craig, Karen Jean. (2011). Heart attack.(Patient Education Series)(Disease/Disorder overview). Nursing, 41(12), 54.

Linehan, M. (2015). DBT skills training manual (Second ed.). New York: The Guilford Press, 159.

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Consultation Team Agreements for DBT Peer Support Specialists

1. DBT Consultation Team Member Agreements
Commitments that must be made before joining a DBT consultation team:

  1. Dialectical Agreement: (to follow a dialectical philosophy); We agree to accept a dialectical philosophy: There is no absolute truth (nor is truth relative). When caught between two conflicting opinions, we agree to look for the truth in both positions and to search for a synthesis by asking such questions as, “What is being left out?”
  2. Consultation to the Client Agreement: (to empower and not fragilize clients); We agree that the primary goal of this team is to improve our own skills as DBT peer mentors, and not serve as a go-between for clients to each other. We agree to not treat clients or each other as fragile. We agree to treat other team members with the belief that others can speak on their own behalf.
  3. Consistency Agreement: (to not insist on consistency, but accept diversity and change); Because change is a natural life occurrence, we agree to accept diversity and change as they naturally come about. This means that we do not have to agree with each other’s positions about how to respond to specific clients, nor do we have to tailor our own behavior to be consistent with everyone else’s.
  4. Observing Limits Agreement: we agree to observe our own limits. As peer mentors and team members, we agree to not judge or criticize other members for having different limits from our own (e.g.: too broad, too narrow, “just right”).
  5. Phenomenological Empathy Agreement: (to find empathic, non-pejorative interpretations of ours and others’ behaviors); All things being equal, we agree to search for non-pejorative or phenomenologically empathic interpretations of our client’s, our own, and other members’ behavior. We agree to assume we and our clients are trying our best, and want to improve. We agree to strive to see the world through our clients’ eyes and through one another’s eyes. We agree to practice a nonjudgmental stance with our clients and one another.
  6. Fallibility Agreement: (to admit to mistakes, humanness and to recognize and let go of defensiveness). We agree ahead of time that we are each fallible and make mistakes. We agree that we have probably either done whatever problematic things we’re being accused of, or some part of it, so that we can let go of assuming a defensive stance to prove our virtue or competence. Because we are fallible, it is agreed that we will inevitably violate all of these agreements, and when this is done, we will rely on each other to point out the polarity and move to a synthesis

2. DBT Consultation Team Orientation

Being a member of a DBT consultation team means assuming certain responsibilities, agreeing to interact in particular ways, and accepting certain foundational assumptions about one’s self as a DBT peer mentor, those served, and consultation teammates. An orientation and commitment process helps new members understand these expectations in advance so that they can make an informed choice about joining a DBT consultation team.

  A) DBT Consultation Team Functions as They Relate to Peer Support:
  1. DBT peer support is defined herein as a community of former, current, and/or future DBT clients who encourage, cheerlead, validate, and nurture each other as they work to build skillful means and improve their lives.
  2. DBT peer mentors provide leadership in the course of DBT peer support by sharing their DBT experience and skills knowledge NOT by overtly instructing their peers on how to solve their problems. Although a DBT peer mentor may be tempted to help alleviate a mentee’s distress by intervening in a problem, it is his or her job not to teach their mentee how to eliminate distress, but rather how to tolerate and move through it by using skillful means, otherwise referred to in DBT terms as the consultation to the client strategy.
  3. A consultation team is composed of members who apply dialectical behavior therapy (DBT) assumptions, principles, strategies, and skills, as defined by Marsha Linehan, the creator of DBT, to a population of people who are learning to use DBT skills to achieve their individual goals and improve health and wellness. The team generally meets once a week for 1.5-2 hours.
  4. Because consultation team members often work with persons who have extremely distressing lives, behaviors, and/or tend to make slow progress toward goals, the primary function of a DBT consultation team is to increase the motivation and capability of its members in order to minimize the risk of burn out and increase adherence to DBT.
  5. When joining a team, members agree to be responsible for the outcomes of ALL peers who interact with the team. It is not a minor responsibility to provide DBT peer support and to agree to be a full-fledged member of a DBT consultation team. Therefore, by extension, when a person a team member interacts with commits suicide, all team members will say “yes” when asked if they have ever had a person whom they provided support to commit suicide.
  • B) Definition of a DBT Peer mentor – A DBT peer mentor is someone who:
    1. Has gained control over the following DBT stage 1 targets:
      • a) Behaviors that are life-threatening and/or harmful to themselves or others
      • b) Behaviors that interfere with DBT (get in the way of learning/using skills, attending appointments, working with others, etc.)
    2. Has had a minimum of 1 month free from self-identified problem behaviors
    3. Has a certificate of completion of DBT skills training from one of the following :
      • a) a formal, face-to-face, therapist-led DBT skills training group
      • b) 1-on-1 DBT skills training sessions with a therapist
      • c) Through professional DBT skills training for therapists offered by Behavioral Tech
      • d) Through DBT Peer Connections Free E-course
    4. Is willing to share his or her story of recovery with others in order inspire hope in peers, educate the public and combat prevailing mental health stigma, and to advocate for the continued development of compassionate, evidence-based mental health treatments like DBT.

3. DBT Consultation Team Commitment Session for New Members

All new DBT team members should meet with the team leader, a team member, or, in some cases, the entire team, for a commitment session before they join the team. The strategies used in this meeting are identical to those used in commitment sessions with new clients in DBT, including, for example, orienting to DBT team, all of the commitment strategies, troubleshooting, etc.

  • A) assessing DBT Peer Mentor Readiness – Before joining a consultation team, prospective DBT peer mentors should answer the following questions.
    1. What are the names of the 4 DBT skills modules and do you know all the skills well enough to provide personal examples of their use?
    2. When you are distressed are you more likely to use skills or resort to problem behaviors?
    3. When an interpersonal conflict arises, are you able to regulate anger, urges to attack, blame, judge, or reject others effectively?
    4. Are you comfortable talking about your mental health problems with others?
    5. Are you willing to share your recovery story publicly?
    6. In your own words, explain what recovery means to you.
    7. What are some DBT skills that you do daily to maintain your gains in mental health recovery?
    8. What is the most important goal that you are working on right now?
    9. What may get in the way of you being an effective DBT peer mentor?
    10. What are signs that you need DBT peer support?
  • B) Commitment Session Tasks – The following items are reviewed during the commitment session with the emphasis on assuring that the potential new consultation team member understands:
    1. What a DBT consultation team is and how the team functions.
    2. What the obligations of team members are.
    3. The ramifications of each commitment that is made (i.e.; the upside and downside of each commitment).
    4. That participation in a DBT team must be voluntary, but that once a commitment is made, there will be every expectation that the member abides by the commitments made.

4. DBT Consultation Team Member Behavioral Agreements
DBT Peer mentors who agree to become full-fledged members of the consultation team agree to do the following:

  1. Be committed to demonstrating compassion, non-judgment, mindfulness and dialectical thinking in their actions
  2. Be engaged in team meetings and not be silent observers or focused only on their own work
  3. Treat the meeting as vital to the DBT process
  4. Avoid distractions and/or meeting cancellations
  5. Complete agreed upon homework
  6. Come to meetings prepared
  7. Be willing to give advice to team members with more DBT experience
  8. Assess problems before giving solutions
  9. Practice humility by admitting and learning from mistakes
  10. Be willing to undergo chain analyses for problem behaviors that cause mistakes
  11. Call out the “elephant in the room” and describe it in nonjudgmental detail
  12. Prepare for and repair after missing team meetings
  13. Speak up when concerned or frustrated by the team process
  14. Carry on and/or take brief time-limited breaks when feeling so burned out, frustrated, tired, overworked, under-appreciated, hopeless, that it is difficult to use interpersonal effectiveness skills

5. Roles during DBT Consultation Team Meetings
Members agree to assume any one of the following roles (as needed) at each meeting.

  • A) DBT Consultation Team Leader.
    1. In charge of making sure the consultation team sticks to the consultation agreements.
    2. Responsible for setting up the agenda and having the team stay mindful to time & agenda during the meeting
    3. Staying up-to-date with the latest research in DBT (and keeping the team aware of this research).
    4. Helping the team stay away from the “all-or-nothing thinking or behavior”
    5. Helping the team stay away from staff-splitting,
    6. Pointing out dialectical dilemmas when he/she notices it and moving the team towards synthesis.
    7. Although teams may have a member who is considered a leader based on DBT experience, the role of meeting leader is generally rotated.
  • B) Team Observer
    1. Is mindful of deviations from Team Agreements and other ineffective behaviors during the meeting.
    2. Brings the team’s attention to ineffective behaviors as they arise.
  • C) Note Taker – takes notes on the content of the meeting, including issues brought for consultation and advice given by the team.
  • D) Member – Actively participates in assessment of issues brought for consultation, including defining the problem behaviorally and helping to formulate solution strategies.
    1. Each member has an opportunity to bring up any problem he/she is having with a particular person during this meeting. The member should let the team leader know about this before the meeting so the team leader can add this to the agenda.
    2. Other members of the team may be allocated the responsibility of setting the agenda or maintaining mindfulness to the agenda. When this was done, it was done on a rotating basis between members of the group. This identified member who will be setting up the agenda and being in charge of having the team stay mindful to this agenda should be identified before the previous group has adjourned.

6. Structure of DBT Consultation Team Meetings
Meetings happen weekly and for at least 60 minutes – ideally for 90-120 minutes. Generally, meeting activities occur in this order:

  1. Mindfulness practice;
  2. Agenda Setting (an agenda template is available [here: DBT CT Agenda Signup.doc]);
  3. Case Consultation (based on hierarchy of targets and urgency rating);
  4. Teaching

7. DBT Consultation Team Meeting Check List

  • A) The Team designated:
    1. A Team Leader (TL)
    2. An Observer
    3. A Note Taker (NT)
    4. The TL led a mindfulness practice
    5. The TL read one of the Consultation Team Agreements
    6. The NT read the notes from last team meeting
    7. The TL Identified a Dyad of the Week to discuss
    8. The TL checked if anyone was going out of town
    9. The Team identified back-up coverage
    10. No peer mentor expressed plans to go out of town
  • B) The TL asked for updates to the emergency contact sheet
  • C) The TL checked if anyone had clients with:
    1. Life-Threatening Behavior (including imminent risk)
    2. Therapy Interfering Behavior (including approaching 4 misses)
    3. Serious Quality of Life Interfering Behavior
  • D) The TL checked if any peer mentors were engaging in:
    1. Unethical, severely irresponsible behavior
    2. Team interfering behavior
    3. Therapy Interfering Behavior
  • E) The TL checked if any peer mentors were approaching burnout
  • F) The TL rang the bell to end the meeting

8. General Consultation Team Process

  • A) the team discussions focused on primarily PEER MENTOR behavior vs. client
  • B) highlighting, targeting, and problem-solving conducted with easy manner
  • C) a strong position was expressed about a clinical or related issue
    1.  Someone on the team brought up an opposing issue
    2.  The dialectic or tension was highlighted
    3.  The team worked to achieve synthesis
  • D) The team meeting involved a balance of acceptance and change-based styles

9. DBT Consultation Team Member Task Examples

  • A) Meeting Leader Tasks (same as mindfulness leader):
    1. Develops agenda with team members
    2. Determines the order of the agenda
    3. Manages time
    4. Reads one of the Dialectical Agreements
  • B) Observer Tasks (leader from previous week) observes and rings bell lightly when:
    1. A dialectic is unresolved
    2. Anyone (client or peer mentor) is treated as fragile (is an elephant in the room?)
    3. A judgmental/non-compassionate comment is made
    4. Defensiveness arises, forgetting that we are all fallible
    5. Non-mindfulness, doing two things at once appears
    6. Solutions given before the problem is assessed
    7. Treatment recommendations/comments violate DBT principles
    8. Consultant-to-the-team/DBT team leader intervening, doing rather than teaching
  • C) Note Taker Tasks (next up as meeting leader):
    1. Distributes and/or sends notification of agenda to members (if developed prior to meeting)
    2. Peer mentor-client dyads discussed
    3. Problems brought up
    4. Advice given
    5. Topics unaddressed due to time
    6. Issues/agreements for follow-up at next meeting
  • D) Consultation Member Tasks:
    1. Participate, remembering that peer mentors always have something to say, i.e.: staying silent throughout an entire consultation meeting is not participating
    2. Consult with members who want consultation:
      • a) Get agreement on problem presented and get it defined behaviorally (client behavior is problem; peer mentor behavior is problem; peer mentor wants to summarize and get validation/cheerleading/sympathy
      • b) Assess problem behaviorally:
        1. Look for reinforcers
        2. Look for aversive consequences
        3. Look for inadequate or inappropriate stimulus control
        4. Consider skills deficits
        5. Ask about secondary targets that might be contributing
      • c) Suggest strategies based on assessment/formulation
      • d) Check if more help is needed
        1. Give feedback to and coach team members who fall out of DBT in their therapy or during the meeting
        2. Highlight “elephants in the room” and topic avoidance when they arise
        3. Listen to and validate (when appropriate) members who wish to share or process experiences with clients or other team members.

10. Behaviors Observed During Consultation Team Meetings:

  • A) A peer mentor was doing 2 things at once (i.e.: reading and listening, talking on the telephone, chatting out of turn with other members)
    1.     The Observer range the bell
    2.     The behavior was highlighted and blocked by the team
  • B) A peer mentor was treated as fragile. An obvious issue came up that needed to be targeted (i.e.: defensiveness, judgmental talking, lateness) that was not highlighted or discussed by the team. Or, feedback clearly was needed, but was not provided.
    1.     The Observer range the bell
    2.     The behavior was highlighted
    3.     The team discussed the avoided issue or provided the needed feedback
  • C) A peer mentor displayed defensiveness in response to feedback
    1.      The Observer range the bell
    2.      The behavior was highlighted
    3.      The peer mentor was asked to rephrase the statement
  • D) A peer mentor offered solutions before the problem was defined
    1.      The Observer range the bell
    2.      The behavior was highlighted
    3.      The problem was clarified
  • E) A peer mentor engaged in self-invalidation (denigrating self, judgmental toward self, presenting as incompetent)
    1.      The Observer range the bell
    2.      The behavior was highlighted
    3.      The peer mentor was asked to rephrase the invalidating statement
  • F) A peer mentor spoke in a judgmental or derogatory manner about his or her peers
    1.      The Observer range the bell
    2.      The behavior was highlighted
    3.      The peer mentor was asked to rephrase the judgmental statement
  • G) A peer mentor was late for the meeting
    1.      The behavior was highlighted
    2.      A chain analysis was conducted
    3.      Solutions were agreed upon
    4.      A commitment to implement a solution was elicited
  • H) A peer mentor was obviously unprepared
    1.      The behavior was highlighted
    2.      A chain analysis was conducted
    3.      Solutions were agreed upon
    4.      A commitment to implement a solution was elicited
  • I) A peer mentor did not speak during the meeting
    1.      The behavior was highlighted
    2.      A chain analysis was conducted
    3.      Solutions were agreed upon
    4.      A commitment to implement a solution was elicited


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FREE DBT Skills Training Online! Participate in IRB Approved Research!

Do you want to take part in a free 6-week DBT skills training course? There is still one week left to get your name on the research participant interest list. All you need to do is fill out the form below. if you fit the study criteria, you will receive a formal invitation to join via email between 09/01/2015 and 09/15/2015. Thank you for support and interest. Please share this post!

Rachel Gill, Primary Researcher

 


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Dialectical Dilemmas of Extreme Emotional States in People with BPD

A defining feature of borderline personality disorder (BPD) is extreme, intense, and long-lasting emotions and an inability to recognize, label, and process such emotions. Therefore, people with BPD tend to move back and forth between extreme emotional states that leave them and those around them exhausted, overwhelmed, and uncertain of how to resolve unending crises.

Dialectical Dilemmas of Extreme Emotional States

The following describes 3 common sets of emotional extremes people with BPD vacillate between. The term dialectical dilemma refers to the ongoing goal for the affected and willing person with BPD is to synthesize a balance between each extreme state as they occur.

  • Vulnerability versus Self-invalidation
  • Unrelenting Crises versus Inhibiting Emotions
  • Active passivity versus apparent competence

Definitions

  • Active Passivity – Feeling helpless, wanting and/or asking others to solve one’s problems
  • Apparent Competence – Excessive independence, not seeking help from others or admitting to needing it
  • Inhibiting Emotions – Blocking/invalidating expression and/or denying acknowledgment of unwanted emotions
  • Self-Invalidation – Judging, punishing, questioning and/or denying acknowledging one’s emotional experience
  • Unrelenting Crisis – hyper-alertness to unwanted emotions that, in turn, increases their intensity/duration
  • Vulnerability – Expressing/communicating emotional experience/urges to self or others

Definition Examples

  • Active Passivity – “I can’t get through this on my own.”
  • Apparent Competence – “Don’t worry about me. I’m fine and have everything under control.”
  • Inhibiting Emotions – “If I just ignore my emotions, they will go away.”
  • Self-Invalidation – “I should not feel this way. I am too sensitive and emotional about every little thing.”
  • Unrelenting Crisis – “When I can’t stop feeling sad, I just drink until I black out.”
  • Vulnerability – “I will kill myself if he leaves me because I can’t live without him.”

BPD Dialectical Dilemmas by Rachel Gill


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My Story: In Honor of May Being BPD Awareness Month

Some may think that having the label of borderline personality disorder (BPD) is a mark of shame. However, I can honestly say that receiving the diagnosis was one of the best things that ever happened to me because it ultimately led me to dialectical behavior therapy (DBT). In fact, after 10 years of futile attempts to find the correct diagnosis and treatment, I was so appreciative of the label, I did something that often puzzles those whom I tell my story; I sent the social worker who correctly diagnosed me a bouquet of flowers and a thank you card. 

What is more, when Dr. Marsha Linehan, the founder of DBT came out about her struggles in youth with suicide and psychiatric institutionalization, it instantly changed my views of my own experiences in youth with suicide and psychiatric institutionalization. Most importantly, it reversed all the doubts I had about what I could achieve as a person in recovery from BPD. I realized that If Marsha Linehan can overcome BPD to become one of the most respected and important clinical psychologists of her time, it is possible that I can overcome BPD and do amazing things too. Thus, I am inspired to follow Dr. Linehan’s example and have made a lifelong vow to help others find a way out of BPD hell.

In the end, my BPD label is the key that unlocked the door to DBT and my path to recovery. I may have borderline personality disorder, but borderline personality disorder does not have me, and above all, I am not ashamed. In fact, I am proud of the progress I have made on my difficult journey to emotional wellness. Therefore, I want people to know my story so the world can see we with BPD are not monsters who need to be controlled, avoided, or caged psychiatric jails. We are people who are capable of achieving great things. However, in our communities, we need acceptance without judgment, compassion, and access to evidence based treatments like DBT that work. 

Rachel Gill (aka Pinki Tuscaderro)

DBT Peer Mentor, BPD Peer Advocate

ilovedbt.com

About Rachel Gill

I am a proud member of the Spokane Tribe of Indians, a mental health advocate & peer mentor recovering from borderline personality disorder. Currently, I am in phase 3 of DBT at Portland Dialectical Behavior Therapy Institute. Having gained some mastery, I recently started a closed Facebook group, Dialectical Behavior Therapy Skills Connections, where I enjoy coaching my peers in DBT skills, and building a community of hope that is now 3000 members strong and growing.

 
 

As for education, I am a senior undergraduate studying toward a Bachelor of Science in Social and Behavioral Sciences. I will go on after earning my Bachelor of Science to study toward a Ph.D. in clinical psychology with respective emphasis on: 

  • Dialectical behavioral therapy phases 2-4 group skills research & development 
  • Web-based mental health services research & development
  • Peer-delivered mental health services research & development 

 

In my free time, I like to add content to my DBT Peer Connections website at ilovedbt.com. I also enjoy creating DBT worksheets, videos, articles, essays and collecting DBT research literature, clinical manuals, and all things DBT that I exclusively share with my closed Facebook group, DBT Peer Connections at https://www.facebook.com/groups/dbtskills/. We now have over 3000 terrific DBT peer members, nearly 20 group leaders, and we continue to grow. In addition to my DBT hobbies, I am also an active artist and write, produce, and publish original musicpoetry, and multimedia creations under the alias Pinki Tuscaderro.   

Dialectical Behavior Therapy Related Training Certificates*

  1. DBT Standard Program: Client Certificate of Completion, Portland DBT Institute
    Dec.2010 (1 cycle = 27 weeks or 67 hours note: completed skills training 2.25 cycles)
  2. Mindfulness with Marsha M Linehan: Practicing Willingness & Acceptance Behavioral Tech, LLC
    (12.5 CE) April 22-23 2013 

  3. DBT Chain Analysis Training Behavioral Tech, LLC
    (8 CE) September 2013 
  4. DBT Introduction to Trauma: Client Certificate of Completion, Portland DBT Institute

    (12 weeks =18hrs) October 2013 

  5. DBT Validation Principles & Strategies (3 CE) July 2014 Behavioral Tech, LLC
  6. DBT Peer Exposure Group, Portland DBT Institute
    (in process)

* Training Certificates are different from DBT Certification.
Training Certificates attest to attending a time-limited training. DBT Certification is a professional accreditation process managed by the DBT-Linehan Board of Certification https://dbt-lbc.org
. It is a more involved assessment demonstrating the application of knowledge to the performance and delivery of the treatment. It requires more than an attestation statement. The option to become DBT Certified is only available to licensed therapists with doctorate level degrees and supervised experience in a fully implemented DBT program.

ABC PLEASE Skills

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This video covers dialectical behavior therapy emotion regulation ABC PLEASE skills, which are particularly aimed at reducing vulnerability to emotion mind. The skills covered are taught from a peer perspective.

Behavior Chain Analysis & Generating Solutions

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Continuing with the emotion regulation skills module, this dialectical behavior therapy training video provides viewers the rationale behind behavior analysis and a step by step guide on how to conduct a behavior chain analysis, generate DBT skills based solutions, make repairs, overcorrect harm, and create prevention strategies for problematic behaviors.