• Daniel

So what is DBT (Dialectical Behavioural Therapy) ?

Essentially it is a programme that was written by an American psychologist who herself had BPD. It has been adopted by the NHS through NICE guidelines as the most effective approach to "treating" BPD.

In practice its a pretty good manual for the human condition, but it does need interpreting by an engaging practitioner who can translate what can be very dry, very complicated and very American (!) teaching. I've often said that if you strip out the mental health therapy aspect of it, it's actually a very decent handbook for anybody as it teaches really good life skills, so it's good for mentoring, role modelling or coaching anyway!

This is why we couple it with occupational therapy perspectives, which cover mental health, physical health, environmental understanding and wide psychological understanding, and bring all this together for you. It does not try to simplify or reduced your experience; it embraces the complexity of your life and helps you make sense of it, whether any of it can be fixed or not. Often it's not a case of trying to tackle things that cannot be changed, but shifting your mindset and perspective in a way that you can relate to and accept.

This combination of DBT and OT (along with perspectives from other fields and disciplines) is a very successful approach to is quite a common experience and it really highlights the need for the practitioner to bring it alive for the client--when it's delivered rote it can be a bit draining and not something to look forward to every week...

In general practice the course is delivered over a year, so it's quite a commitment, but this is assessed as to requirement, previous experience, goals and so forth, so a timeline of expectation is discussed with the client.

In a secure hospital it is far more intensive but often because there is a legal or safety imperative attached to the client such as a sectioning order. We don't try to recreate that level of support as it is highly impractical resource-wise; we're not a hospital!

So what do we cover?

Well there are four modules that form the backbone of the course and we use those as appropriate and relate them to how you would use them.

1) Mindfulness--some people immediately whack up huge barriers to this concept, thinking it's modern hippie or snowflake rubbish that does not possibly work for them. We reframe that perspective to a more skill based process. I won't tell you how this is accomplished, otherwise I wouldn't get paid(!), but when you appreciate this approach you'll have a different view on what mindfulness is. It's not just meditation as often that's the last thing you can manage when you're having a crisis!

2) Interpersonal Effectiveness--maximise your goals and minimising damage to others; so essentially understanding how others work and how to negotiate with fellow humans through the complexities of social interactions. Most people never have this training they just fumble their way through it! Indeed as we've discussed in another blog, this module can help you manage your "No!" response when people are draining your empathy, and clients have taken great strength from this module.

3) Distress Tolerance--accepting, but not approving, your situational reality. Essentially your crisis survival strategies; how to manage your emotions, and how to think differently to situations, often putting you in better control of a situation than others might be! This module helps you manage self harm, as well as appreciate why often your depression and anxiety that you may have gone to the GP for can mask what's really going on, and why it keeps happening.

4) Emotion Regulation--understanding what emotions you are experiencing and why you're having them, how to navigate them and how to use them. This can be quite revelatory for people and once they understand what is going on and crucially why, they can start to untangle what can often be complicated responses to complicated situations. Often it's not about avoiding emotions, but embracing them; as long as you have the appropriate ones of course!

You can order various books off Amazon that can take you through the DBT process, but please be warned they are not page turners. They can be confusing, complicated and difficult to apply; you'll understand why as soon as you start them! There is a huge value in having someone guide you because they can bring the material alive, but you need someone who can relate that material to your life and the bigger picture. I guess that's where we come in.... :)

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