Archives for September, 2010
In DBT you are expected to keep a diary card. This is a card on which you track the intensity of your emotions, whether you have engaged in any problematic behaviors and whether you used DBT skills to help get through the week.
Many of us put food into our mouths without really thinking. You may be bored, rushed, distracted or stressed. Whatever the reason, we consume food and calories without tasting the food or having any awareness of its impact on our bodies, our energy level or our health. I used to drink several cups of coffee a day. I’d drink one in the morning, to wake up. A second on the way to work and sometimes a 3rd once at work. I consumed all this coffee mindlessly. It was a ritual and a habit, but I never really stopped to taste the coffee.
I recently had the opportunity to ask Dr. Walsh a few questions about self-injury. Dr. Walsh has written extensively and presented internationally on the topic of self-injurious behavior. He is the author of the book, Treating Self-Injury: A Practical Guide published by Guilford Press (2006) and co-author of the book, Self-Mutilation: Theory, Research and Treatment (Guilford Press, New York, 1988). As the Executive Director of The Bridge of Central Massachusetts, a community non-profit agency, he oversees 40 programs serving children and adolescents with serious emotional, behavioral, and family challenges, as well as adults with mental health, developmental disability, and substance abuse challenges. What is the difference between self-injury and a suicide attempt? Acts of suicide and self-injury are different in numerous ways. They are different as to intent, method, frequency, cognition, aftermath and other features. For example, the intent of most people who attempt suicide is to permanently escape misery, intense, persistent psychological pain. The intent for most acts of self-injury is to reduce emotional distress.
We hear a lot about learning skills in DBT and a lot about learning to manage intense emotions and the problem behaviors that are often maladaptive attempts to manage those emotions. These are primary targets of the first stage of DBT. Often, we don’t hear much about the other 3 stages. In stage 1 of the treatment, therapy is focused on getting behavioral control. People who enter treatment at this stage are actively struggling with life threatening behaviors (e.g. cutting, suicide attempts, excessive drinking), treatment interfering behaviors (e.g dropping out of treatment, hostility towards therapist, skipping therapy) and major quality of life interfering behaviors (e.g. risk of losing housing, being expelled from school, losing marriage, custody of children). The rationale for focusing on gaining behavioral control at this point is that it is assumed that a life lived out-of-control is excruciating. Progress cannot be made on underlying emotional issues until you have the skill to manage emotion without engaging in dangerous behaviors and are committed to the process of therapy.
DBT is becoming more commonly available. With its spread, more people are referred to DBT therapists and groups and are considering entering DBT treatment. But what is it? If you enter treatment, what you can expect? How will your therapist respond to you? What will be the focus of the treatment? There are three primary treatment activities in DBT. These are individual therapy, group skills training and coaching in crisis situations. Individual therapy and the skills training group usually meet each week, while coaching in crisis occurs as necessary. Each of these 3 activities has specific goals and structure, which are usually explained to you at the beginning of treatment. Regardless of whether it’s individual, group or a crisis, DBT treatment is comprised of the following 6 characteristics.