What Is Dialectical Behaviour Therapy? – An Intern’s Perspective

What Is Dialectical Behaviour Therapy? – An Intern’s Perspective

What the Heck is DBT?

When I first heard the term, “Dialectical Behaviour Therapy” the concept of it completely went over my head and had me silently swearing that I was never having anything to do with this form of therapy. Chances are, I am not the only one who feels intimidated by this complex approach. I can definitely empathize with anyone for feeling uncertain or overwhelmed by this theory because there’s certainly a lot to it. If you’re curious about DBT and want to learn more about it, then this post is for you!

The goal of DBT is to learn new skills and techniques to transform negative thinking and unhelpful behaviours into positive outcomes.1,2 This approach started out specifically for those with chronic and severe suicidal ideation and suicide attempts, and later for those living with Borderline Personality Disorder (BPD), but has shown to be useful for individuals who struggle with lower thresholds of self-harming, eating disorders, substance abuse, major depression, and more.3

 

What is a Dialectic?

Let’s tackle the first part of DBT – the dialectic. In reference to counselling, a dialectic is finding a balance between two opposites. It’s the understanding that two ideas can be correct at the same time, letting go of black and white thinking, and understanding that there’s no universal truth.4 A real-life example of finding a dialectic would be having to opposing thoughts such as: “I can trust everyone,” or, “Nobody can be trusted,” which then the dialectic would be finding that sweet spot in the middle which would be, “I can trust some people, but not everyone I know,” and coming to terms with the fact that those two opposing beliefs, trust and distrust, can exist at the same time.4

In DBT, we encourage clients to ask themselves, “What is missing from my understanding?” instead of accepting a final answer or conclusion. This is a way of expanding our perceptions of things and understanding and validating another person’s perspective.4

 

What is the Behaviour part of DBT?

The behaviour part of DBT includes learning practical skills and helpful behaviours and letting go of the actions that interfere with our quality of life and personal wellbeing. There are four main modules that are covered in DBT to teach these skills:

  1. Interpersonal Effectiveness: this module includes being able to ask for what we need, reach our goals, and to cope with difficult interactions or conflicts.
  2. Distress Tolerance: this module builds the ability to notice situations that evoke a negative emotional response and to be able to see the impact it has on us. The purpose of this is to be able to make rational decisions about how we want to proceed.
  3. Emotion Regulation: this module encourages noticing our emotional experiences, but not letting the emotion completely take over. Clients learn to use self-soothing techniques to cope with the strong feelings and develop the skills to act mindfully and intentionally while experiencing emotions.
  4. Mindfulness: this module teaches us how to accept and cope with powerful emotions and to be able to notice the present moment we are experiencing, along with the emotions and sensations that come with it with a non-judgmental mindset.

 

What is the Therapy part of DBT?

DBT is implemented through a variety of ways, such as skills training group and individual therapy. The group is typically 6-12 months long and is meant to introduce us to skills that are intended to improve our coping and ability to manage powerful feelings. The individual sessions focus on increasing our motivation and skill application. Individual DBT sessions give us a chance to work towards our personal goals and to apply our skills in our day-to-day life.

 

Final Thoughts

I hope that this article helps you understand a bit more about DBT. It’s certainly been a big learning curve for me, and I’ve come to appreciate the complexity of issues it’s able to address. While it can still be daunting at times, the beauty of DBT is that it can be broken down into bite-sized, practical skills and steps that help us move forward.

If you think DBT could be helpful to you, or you just have some more questions about it, please feel free to give us a call, we’d love to hear from you!

 

Resources

  1. Centre for Addiction and Mental Health. (2019). Dialectical Behavioural Therapy, from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/dialectical-behaviour-therapy
  2. Child Youth Mental Health. (2010, May). DBT Training. Lecture presented at DBT Training, Abbotsford
  3. Gleissner, G. (2016). What Is DBT? Retrieved March 18, 2019, from https://www.psychologytoday.com/us/blog/hope-eating-disorder-recovery/201609/what-is-dbt
  4. Miller, A. L., Rathus, J. H., & Linehan, M. (2007). Dialectical behavior therapy with suicidal adolescents. New York: Guilford Press.
Why Is Therapy So Exhausting?

Why Is Therapy So Exhausting?

It’s finally happening, we have decided to seek out counselling. We go in for our first appointment and talk about what’s been going for us, why we’ve decided to start counselling and answer any questions we might be asked. Eventually, our 50 minutes is up, we leave, and we’re feeling…terrible? Well wait, isn’t counselling supposed to make us feel better? If therapy is supposed to be helpful then why are we leaving our therapist’s office feeling exhausted, vulnerable, and exposed?

This strange contradiction sometimes referred to as a therapy hangover, is a completely normal feeling after counselling. After opening up to our counsellors or processing difficult emotions, we may feel drained, heavy, or not feeling like our regular selves. We often hear that it needs to get worse before it gets better, but no one really explains why that’s the case.

Imagine having a toothache that gets more painful every day and makes it almost impossible to eat and sleep. Eventually, the toothache gets to the point where it can’t be ignored any longer. You go to the dentist who then decides that the tooth needs to come out and therefore, you must go through an uncomfortable procedure of getting the tooth pulled. Upon leaving, the freezing eventually wears off, and there are some pain and a little discomfort but it gets better over the next week. However, the discomfort of healing is easier to cope with than the original pain. Think of the problem as the toothache that won’t go away, it gets worse until we can’t take it anymore and decide to seek help. Then, therapy as the uncomfortable procedure we go through to work through our issue and the difficult emotions that come after sessions as being the pain and discomfort that comes after our procedure.

In sessions, we are being asked to explore our problems in a much deeper and open way and not using any defence mechanisms (such as avoiding, distraction, denial, etc.) that may have been used to protect ourselves prior to seeing a counsellor. We are being asked to express intense feelings and to sit in discomfort which is emotionally draining and sometimes scary.1 This goes against our instinct which is to avoid negative emotions and memories, but in counselling, we are facing these feelings head-on. We’re asked to do this so that we can fully explore our problem which eventually helps us to find insight, a solution, or peace.2 We are going to be uncomfortable sometimes, however, this discomfort is a positive sign that counselling is progressing.1 Counselling is hard work, so it’s understandable that all we want to do after our session is veg out in front of the tv or take a nap.

If we’re feeling like this after our appointments, we need to take care of ourselves by being kind to ourselves and engaging in self-care. Ultimately, only we know what is best for us but some common self-care methods are:

  • Resting
  • Reflecting and journaling about your sessions
  • Going for a walk
  • Treating yourself with indulgence or guilty pleasure
  • Spending time with loved ones
  • Talking to your counsellor

Letting your counsellor know about the ‘hangovers’ can be beneficial. It is helpful for our counsellors to know how we’re feeling after sessions, that way they can provide us with more strategies and options to handle our feelings of exhaustion and vulnerability and to prepare us for what to expect before leaving our session.

If you’re feeling anything like what we’ve talked about today, take heart!  Counselling can be hard, and even exhausting but you’re doing the good work of doing the work. Let your counsellor know how you’re doing, and press on! Feel free to contact us if you feel like to reach out!

 

References

  1. (2016, March 17). Retrieved from https://www.mayoclinic.org/tests-procedures/psychotherapy/about/pac-20384616
  1. Shouldn’t psychotherapy make me feel good? (2008, July). Retrieved from https://www.psychologytoday.com/ca/blog/in-therapy/200807/shouldn-t-psychotherapy-make-me-feel-good
What Is Seasonal Affective Disorder?

What Is Seasonal Affective Disorder?

“I love that it gets dark at 3 pm, that it’s pouring rain constantly, and that I haven’t seen the sun in 4 months!” said no one ever. Although some people may prefer the cold winter weather, there are a lot of us who are counting down the hours until patio season starts up again (okay, maybe that’s just me). So, until then, we are binge-watching TV, sleeping in, indulging in comfort foods, and pretty much avoiding the outdoors unless we absolutely have to go outside. The different seasons and the weather impact what we do and how we feel, which is why many of us prefer indoor activities during this time of year and for the next few months to come. However, on a rare day that the sunlight does shine through or when summer finally rolls around, we are quick to get outside and enjoy the sun. We may notice that our mood improves when the sun comes out and it can be a bit easier to get things done. Other times, we notice that when it’s dark and rainy, it’s a little harder to get out of bed, be alert, or even feel happy.

If you’re relating to this post right now, you’re not alone! Approximately, 17% of Canadians are also feeling pretty low during the winter months (CMHA, 2013). You can thank Seasonal Affective Disorder (SAD) for these mood changes, which is a form of depression that occurs at certain times of the year, specifically between September/October and April/May. It affects anyone and everyone but is more common amongst women, individuals between 15-55, people who live further up north or farther down south away from the equator, or individuals with a family history of SAD or other types of depression (HealthLinkBC, 2017).

 

How Do I Know If Seasonal Affective Disorder is affecting me?

 
You may be experiencing Seasonal Affective Disorder if you identify with these statements:

  • I feel sad, moody, or anxious
  • I feel tired or slowed down all the time
  • I’ve lost of interest in work, friends, or interests
  • I’m gaining weight
  • I’m craving carbohydrates such as “comfort foods” like bread or pasta
  • I’m having trouble concentrating
  • I’ve been experiencing changes in my sleep, such as sleeping too much or not enough

(CMHA, 2013; HealthLinkBC, 2017)

 

Why Do We Struggle With SAD?

 
But why is SAD even an issue to begin with? It is thought that the lack of sunlight creates a change in the chemicals in our brain, specifically serotonin, which is responsible for regulating our mood. Additionally, because it is darker, it can signal to our brain that it’s time to sleep which can cause an increase of melatonin in our brain, which is responsible for regulating our sleep/wake rhythm. The truth is that we’re not completely sure why it happens, just that it does, and to many people in our community.

 

What Can I Do About SAD?

 
It’s great to identify if we have SAD. One of the main ways to help yourself if you’re struggling with SAD is to increase your exposure to the right wavelength of light. This can include:

  • Spending more time outside during daylight hours
  • Opening the curtains or blinds during the day
  • Rearranging the space that you are in to allow more sunlight to enter
  • Arranging office/household furniture so you can sit close to a window
  • Adding lamps into your space
  • Using a SAD Lamp

(CMHA, 2013)

Counselling can help with the symptoms of Seasonal Affective Disorder by giving us a better understanding of how SAD affects us as individuals and helping us to cope with the effects that come about during this time of year. It can also be useful in helping us to look at our thoughts, feelings, and behaviours and how they influence our mood and can aid us in creating strategies for making changes in these areas. In addition to this, being able to talk to someone who is able to empathize and listen to us can be very beneficial.

If you’re struggling with Seasonal Affective Disorder, you’re not alone and you don’t have to go it alone. Seeing a Registered Clinical Counsellor or one of us counselling interns can be a great help!

If you’re not sure if what you’re struggling with is Seasonal Affective Disorder (SAD), please go to your family doctor who can help you determine if this is what you’re dealing with, and can refer you to a specialist if needed.

In the meantime, we’re here and we’d love to support you until the sun comes back! Feel free to contact us!

 

References:


Find Help Now. (2013). Retrieved from https://cmha.bc.ca/documents/seasonal-affective-disorder-2

Seasonal Affective Disorder (SAD). (2017, May). Retrieved from https://www.healthlinkbc.ca/health-topics/hw169553

How Can I Support Someone Who Is Grieving?

How Can I Support Someone Who Is Grieving?

It can be difficult to know what to say or do when someone has experienced a loss. It is a delicate subject to approach since we do not want to say the wrong thing or come off as intruding or prying towards someone who is grieving. We don’t want to add to anyone’s pain, so sometimes we go back and forth between being present and supportive, to taking a step back and giving a person their space to cope. Both of these can be beneficial for the other person, but our uncertainty about how to respond can make us feel unhelpful or that we are adding to their pain. When it comes to offering support, however, being present and available to help or spending time with them can be healing.

What else can we do to be supportive during this difficult time? Here are a few practical ideas of how to help a friend or family member who is grieving:

 

  1. Know what “normal” grief is and how to respond check out my last article for a primer
    • Know that there is no one right way to grieve, every response and emotion is valid; people who are grieving may feel relief, guilt, anger, emptiness, sadness, etc. These emotions may be intense or extreme or they may be more mild. Be prepared for any reaction, and know that the reaction isn’t about you, it’s a response to pain.
    • There is no timeline or linear process to grief; each grief process is unique. People will cope in whatever way feels right for them and will take as long as they need.

 

  1. Expressing support
    • Be empathetic by acknowledging the bereaved individual’s feelings (e.g. I can’t imagine how difficult this must be for you). Showing acceptance and support of their emotions, whether it’s anger, sadness, or otherwise, can provide a safe space for the person to experience their emotions openly.
    • Give them space to tell their story. The person may want to discuss the details of their loss repeatedly or in detail as a way to come to terms with what has happened.
    • Reach out to the person who is grieving whether it be through a phone call or an in-person visit. Remember them as time goes on and check in. Many times, people respond immediately and then support fades quickly.
    • Avoid saying things like: “Everything happens for a reason”, “They’re in a better place”, “At least…”, “It’s time to move on”, “I know how you feel”, “You can always have another child/get another job/get remarried”, “Time heals all wounds.” Avoid finding a silver lining to the loss or trying to fix what’s happened.
    • Instead, say things like: “I’m here for you.”, “I don’t know what to say, but I care.”, “I’ll call you/visit in a few days.”, “What can I do?”, “I can’t imagine what you must be going through.”
    • Saying nothing and just listen. It’s okay to listen or just be present with the other person. Sometimes there’s nothing at all that we can And certainly, whatever we say is unlikely to make the situation better.

 

  1. Providing practical support can be very helpful, such as offering to:
    • Help with arrangements related to the loss, such as funeral arrangements, packing, finding a new place to live, etc.
    • Complete household chores or run errands
    • Cook or drop off meals in non-reusable containers so they don’t have to worry about washing your dishes and getting them back to you
    • Watch their children or pets if needed, giving them time for themselves
    • Help with insurance or other paperwork
    • Answer or make phones calls or for them
    • Take them out for a meal or a movie

 

  1. Watch for signs of depressed feelings or complicated grief
    • We’ll take as long as we need to cope with our loss, but we do need to eventually come to terms with what has happened. Over time, we’ll adjust to a new normal and be able to move forward. However, sometimes we don’t move on and get stuck, which is called complicated grief which involves:
      • Being unable to move on from the loss
      • Being unable to carry out daily routines
      • Isolating ourselves
      • Having feelings of intense loneliness, numbness, or sorrow
      • Wishing to be dead with the loved one who has passed

 

Depression can also occur and is often a part of complicated grief. The challenge with depression and complicated grief is they can be hard to tease apart, and often co-exist. Both can come in waves, or be constant companions.

If you’re noticing a complexity in the grief of a loved one, or signs of depression, then it’s best to encourage your loved one to seek out mental health support such as counselling. This can provide a space for emotions and thoughts related to the loss to be processed and allow for healing to occur. It can also provide an invaluable resource for depression and trauma screening by experienced professionals who can direct care most appropriately.

A loss isn’t something that can be fixed or repaired; it is something that has to be lived with. The pain cannot be taken away, so instead, we can help others by sitting with them in their pain. It is okay not to know what to say or how to help; if we can show up, listen, and be present, then that’s enough, and is valuable!

 

 

 

References

Complications of Grief. (2017). Retrieved from https://www.healthlinkbc.ca/health-topics/aa129291

Grief and Loss Resources. (2017). Retrieved from https://livingthroughloss.ca/

Helping Someone Who’s Grieving. (2018). Retrieved from https://www.helpguide.org/articles/grief/helping-someone-who-is-grieving.htm

What Is Grief?

What Is Grief?

Grief is a normal emotional process that happens when adjusting to a loss or change. It happens not only when someone has died, but also after things like a job loss, the ending of a relationship, or while anticipating a future loss. Grief is a complex process that has no concrete roadmap, but there are some common factors that influence the process we go through. Some of these factors are:

  • Our relationship with the individual who is gone
  • The circumstances surrounding the loss
  • Our current coping mechanisms and how past emotional distress has been handled
  • The availability of support networks while we grieve

(Living Through Loss, 2017)

No matter what we are grieving, it is difficult, painful, and exhausting.

Part of the difficulty in grief, as I alluded to above, is that the roadmap isn’t clear. What we do know, however, is that there’s no right or wrong way to grieve. It is okay to feel relief, emptiness, or nothing at all when coping with a loss. It’s also okay to cry, feel physically exhausted, be angry, or struggle with feelings of guilt. Grief is a process that is unique to each person and so our bodies and our minds will respond as best they can in whatever way they feel is best for us to move on; in other words, they do the best they can at the time, with what they have to work with.

Sometimes the timeline of grief can be a challenge. Often, we expect ourselves, or even others expect us to move through the grieving process more quickly than we’re able to. It’s important to know that it’s okay to take as long or as little time as we need to move forward. Given the popularity of the five stages of grief (denial, anger, bargaining, depression, and acceptance), many people believe that they need to go through these five stages linearly to move forward (Living Through Loss, 2017). That may be the case for some people, but it is not for everyone. As mentioned above, people experience a wide range of emotions and experience grief in different ways so their grieving process may not always be forward moving. Sometimes we get stuck, sometimes we go backwards, or sometimes we’re all over the place and have a mix of good days and bad days, which sometimes ends up looking like a mess.

How do we manage while all of this is happening? With how intense and exhausting grief can be, it is vital that we take care of ourselves. Often, we’re so overwhelmed we can’t even think of how to take care of ourselves. Here are some suggestions for ways you can practice self-care while going through the grieving process:

  • Avoid drugs and alcohol since they may make you feel worse
  • Avoid isolating yourself and find support from a friend or counsellor
  • Get lots of rest. Grieving is exhausting, so you will likely be more tired than usual
  • Drink lots of water and try to eat the best you can, and try to avoid sugar and caffeine
  • Exercise, even if it’s only going for a walk around the neighbourhood
  • Give yourself time and permission to mourn as often as needed
  • Do things that make you feel good such as journaling, art, listening to music, reading
  • Be kind to yourself. You’re doing the best you can

(Living Through Loss, 2017)

 

After some time, we will adjust to our losses. It’s hard work and takes time, but eventually, we can come to terms with what has happened, grieve and mourn our loss, and move forward. However, some people find themselves stuck. This experience has been described as something called Complicated Grief. Some of the signs of complicated grief are:

  • Being unable to move on
  • Being unable to carry out everyday routines
  • Isolating yourself
  • Feeling intense loneliness or numbness
  • Feeling extreme sorrow, pain, or depression
  • Feeling that life has no purpose
  • Ruminating or experiencing intrusive thoughts about your loss
  • Wishing you died with your loved one

(HealthLinkBC, 2017)

If you notice that you or someone you care about are experiencing any of these symptoms, then may be time to seek out professional help such as counselling. Therapy can give you a space to talk about your loss and help you to work through your thoughts, feelings, and memories relating to your experience. Counselling can also help to identify and work through any potential trauma relating to the loss and helping you to adjust to this change.

I hope this article has been helpful if you’re experiencing grief and loss. We’ve all been there, and some of us are there right now with you. If you could use some help as you walk through this journey of grief, we would love to talk to you. Please give us a call or contact us anytime, we’re here.

 

References

Complications of Grief. (2017). Retrieved from https://www.healthlinkbc.ca/health-topics/aa129291

Grief and Loss Resources. (2017). Retrieved from https://livingthroughloss.ca/