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I Am Starting Dialectical Behavioral Therapy - the goals

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Dear Folks,
Starting on 12/6, I will be embarking on an interesting experiment
in therapy. My first "module" of DBT -- Dialectical Behavioral
Therapy in a group, at University of Michigan.

See link for full details of how this type of therapy was

It was initially designed for Borderline Personality Disorder which
I do not have, though I have some features, and had more in the
past. BPD is linked to an "Invalidating Enviornment" (which is an
understatment re: my childhood). It has been found helpful in
someone like me who has had "damage" from the past. But it doesn't
FOCUS on the past but the present.

This therapy seems appropriate for MY circumstances and would certainly not be appropriate for many here. My DP/DR seem to be related to a very dysfunctional family background.

It is also influenced by Buddhism. "Mindfulness".... and has been studied in clinical trials for some years. Again, focusing on the present. Clearing the mind of useless thoughts and worries.

In a nutshell...

"Dialectical Behaviour Therapy is based on a bio-social theory of
borderline personality disorder. Linehan hypothesises that the
disorder is a consequence of an emotionally vulnerable individual
growing up within a particular set of environmental circumstances
which she refers to as the 'Invalidating Environment'.

An 'emotionally vulnerable' person in this sense is someone
whose autonomic nervous system reacts excessively to relatively low
levels of stress and takes longer than normal to return to baseline
once the stress is removed. It is proposed that this is the
consequence of a biological diathesis.

The term 'Invalidating Environment' refers essentially to a
situation in which the personal experiences and responses of the
growing child are disqualified or "invalidated" by the significant
others in her life.

The child's personal communications are not accepted as an accurate
indication of her true feelings and it is implied that, if they
were accurate, then such feelings would not be a valid response to
circumstances. Furthermore, an Invalidating Environment is
characterised by a tendency to place a high value on self-control
and self-reliance.

Possible difficulties in these areas are not acknowledged and it is
implied that problem solving should be easy given proper
motivation. Any failure on the part of the child to perform to the
expected standard is therefore ascribed to lack of motivation or
some other negative characteristic of her character. (The feminine
pronoun will be used throughout this paper when referring to the
patient since the majority of BPD patients are female and Linehan's
work has focused on this subgroup)."

The specific, goal-oriented program is based on four "Modules" lead
by an ACSW and supervised by a psychiatrist I will see once a month
as well. I also have unlimited to access to said psychiatrist for
crises, etc. Phone support, etc.

"There are four primary modes of treatment in DBT :

Individual therapy
Group skills training
Telephone contact
Therapist consultation

"Whilst keeping within the overall model, group therapy and other
modes of treatment may be added at the discretion of the therapist,
providing the targets for that mode are clear and prioritised."

Since I'm not Borderline, I am working only in group with the
supervision of a psychiatrist. The full process would include a
monthly meeting with an ACSW which I'm not doing for this first
module. It was determined that this is unnecessary for me at the
time (I've had years of therapy already) and don't have all of the
issues of treatment compliance, and suicidal tendencies of many
with BPD.

The goal is working on THE PRESENT, not rehashing the past, which is far out of my control.

The four Modules (one month each of four 1.5 hour sessions) are as

1. Core mindfulness skills.
2. Interpersonal effectiveness skills.
3. Emotion modulation skills.
4. Distress tolerance skills.

I can take modules over again, and one can join at any level. I'm
starting with Module Four -- Distress and Stress Tolerance -- which
is actually very applicable to my life situation at this time.

The goal is no cure of my DP/DR, but better coping skills, that
again I will be augmenting with Yoga at home. This will help with
my negative black/white thinking, ruminations on the past, fear of
the future, and working on LIVING IN THE PRESENT, one day at a
time. (The Buddhist orientation.)

I am also continuing my meds, and will continue to do so. The
psychiatrist I saw for 1 hour recently is happy with my combo and
doesn't want to mess with it.

My goal here is to try to move out into the world more. To as we
all say, focus OUTWARD. Diffuse anxiety. And by doing that
perhaps lessen my chronic DP/DR.

Part of this, by my own decision, and this won't be easy, will be
to not visit the Board in December. But I WILL report back on how
all of this works -- if it works at all.

What is cool is that this therapy is something I wouldn't have been
ready for years back. I have accomplished a good deal in one on
one psychotherapy, but it wasn't as goal-oriented, it was open
ended. This will force me -- and it won't be easy -- to focus
outward. I really like the Buddhism connection, and the yoga work.

This will take discipline, and it will be difficult, and I'm not
saying I'm going to change my life in a month.

So this is an experiment I will report back on in January.

JC is doing something similar. I think group therapy, even with
people who DON'T have DP/DR is VERY helpful. In my NAMI group I
have met a woman with schizophrenia, one w/BPD, a man with chronic
Clinical Depression (he is the group leader), 2 with anxiety
disorders, etc. This support group is a very good "fit". I've tried several others before finding this one to be very comforting.

OK, enuf. I'll keep you updated.

Take Care all, Wish me luck! I don't expect this to be a cure all, but it's something new I'm looking forward to, though I'm a bit anxious about it.
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