What To Expect In A DBT Skills Group

What To Expect In A DBT Skills Group

Expectations, whether based on fact and experience, or our own assumptions and interpretations, have the tendency to either prepare or disappoint. Because of this, it’s important to understand what differentiates DBT skills groups from other therapeutic groups, so that you can make an informed decision about whether participating in a DBT skills group will be beneficial for you. Joining a DBT skills group is a 24-week commitment and although this experience can prove highly effective, it may not be a good fit for everyone.

 

How Are DBT Groups Different?

 

A common misunderstanding of DBT skills groups is that they are comparable to other therapeutic groups, such as process groups or support groups. Although the DBT skills group atmosphere often fosters feelings of peer support and understanding, the primary purpose of these groups is to learn effective skills.

 

The DBT skills group format allows for the sharing of personal information at the discretion of each group member, however, the majority of information shared within the DBT skills group is done in relation to the use of the DBT skills. This practice ensures that any difficulties implementing the skills may be addressed, by both the facilitators and group members. Although DBT skills groups encourage group member interaction and input there is a classroom-like component, as each week a new skill is taught. One of the benefits of participating in a DBT skills group is that each group member brings their own experiences and unique approaches to particular skills and situations. This opportunity the learn together, and from each other’s experiences helps us learn innovative ways to approach the skills.

 

A DBT skills group is an essential component of Dialectical Behaviour Therapy. While combining individual therapy and the DBT skills group is not mandatory, it is important to recognize that the main goal of a DBT skills group is to teach and support group members in effectively using new skills. The emphasis on teaching new skills – and the very nature of a group setting – allows for less 1-on-1 attention for each group member and is a reason that supplementing DBT skills group with individual therapy is recommended.

 

What Does a DBT Skills Group Session Look Like?

 

Each DBT group session will begin with mindfulness practice. Mindfulness can take many forms, ranging from mindful colouring to guided visualization, and is incorporated for both personal practice and group benefit. This practice can help group members become present and ready to engage and learn in a group.

 

Following mindfulness, each group member is given an opportunity to check-in and let the rest of the group know how their week has been, with an emphasis on skills tried and used. This can be an opportunity for group members to troubleshoot skills that were not as effective as they’d hoped or suggest alternate skills that may have been effective for the given situation or particular struggle. Group interaction and insight can be a particularly helpful addition to check-in. This can also be a time to review any homework or questions from the previous week’s group.

 

After a short break, the second half of the DBT group session is dedicated to learning a new skill. All DBT skills are separated into four main modules: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. These skills are taught with an emphasis on being effective in everyday life. Oftentimes real-life examples can be used to illustrate how each specific skill can be effective; group members are welcome to present a relevant personal situation where a skill may be useful to see its specific application if they so choose. As the founder of Dialectical Behaviour Therapy, Marsha Linehan would say, the goal of DBT is to create “a life worth living.” Through the learning of skills and the support of the group, clients can be supported in gaining control of their lives and moving toward a life worth living.

Click here to learn more about our youth and adult DBT groups!

Emotionally Focused Therapy with Diverse Couples

Emotionally Focused Therapy with Diverse Couples

With an increasingly multicultural society, it is becoming more important than ever for therapists to consider the impacts of these different cultural aspects on their clients4. Today’s couples are becoming more diverse in terms of culture, socioeconomic status, ability, ethnicity, and religion, just to name a few. This means that we as therapists to adjust our practice appropriately. In this blog, we’ll look at how therapists can support diverse couples in relationships from different religious or faith backgrounds in a therapeutic setting.

 

The Challenge

 

Interaction among different religious, cultural, and ethnic groups has been shown to be beneficial in platonic relationships when the interactions are “amicable, positive, and voluntary”, but romantic relationships may present a greater challenge. Separately, marriage has been shown to positively correlate with physical and psychological health and religion has proven to be a protective factor for many; together, marriage and religion can spur additional external stressors. Differences in religion can often mean differences in culture, tradition, and ethnicity, which has the potential to create additional stress on the relationship. These external stressors often come in the form of extended family, or society as a whole, when traditions appear altered or compromised. Research has shown that these factors can have a detrimental impact on the psychological well-being of couples with different religious backgrounds.

There are particular factors within religiously diverse couples that can tip the scales in either a more positive, or more challenging direction. First, couples vary on how strongly they use religion to define a relationship. Religion may enforce particular “rules” to determine how interpersonal or family challenges are addressed, such as sexuality, parenting, or power. Second, religiosity exists on a spectrum, so factors such as religious practice, involvement, activity, and belief intensity all contribute to potential stress in a relationship; both individuals in a relationship can even be of the same religion and differ in the strength of religious faith or religious motivation. Third, underlying values may overlap in different religions allowing couples to find common ground; for example, many religions view extramarital sex as unacceptable. Couples from different religious or faith backgrounds can be successful if differences are addressed, understood, and respected; if left unaddressed these differences can become conflictual and threaten the relationship.

 

How Can We Help?

 

From a therapeutic perspective Emotionally Focused Therapy (EFT), a form of couples counselling has shown to be effective for addressing distress in relationships. EFT believes that relationship distress stems from perpetuating negative interaction cycles, which often result from unmet needs. For example, this could be shown in how a couple manages conflict; is the conflict discussed and resolved or does an argument ensue that leaves both parties angry and resentful? The goal of EFT is to develop secure attachment through identification, experience, and expression of emotional and attachment needs. The basis of EFT in the attachment is a leading reason why it is thought to be so successful as a couple’s therapy. From a diversity perspective, the ability to adopt EFT to accommodate different religious or faith backgrounds is why this form of therapy can be successful for a multitude of different couples.

There are three main stages to the EFT model of couples therapy: de-escalation, restructuring attachment interactions, and consolidation and integration. De-escalation involves learning about and understanding negative interaction cycles that are perpetuating distress in the relationship. This can relate back to the previous example; when conflict occurs in the relationship is there one party who actively wants to resolve the situation and one party who chooses to remove him or herself? Restructuring attachment interactions are all about shaping new core emotional experiences and interactions to lead to a more secure attachment. Change in EFT is not achieved through insight, catharsis, or improved skills, but rather from formulation and expression of new emotional experiences as it pertains to attachment needs and emotions. What does each partner need to feel heard and understood? Consolidation and integration are the final of the three stages in EFT and can also be referred to as withdrawer re-engagement. During this stage, the partner whom previously avoided conflict and engagement with their partner openly expresses attachment needs and is more open and responsive to their partner.

The rooting of EFT in emotion and attachment makes it very flexible and therefore adaptable to couples of many diverse backgrounds. At Alongside You we love working with couples from diverse backgrounds and we have specific training in Emotionally Focused Couples Therapy. If this article resonates with you and we can be of help, please let us know, contact us, and give us a shout

 

Suicide: Stigma and Warning Signs

Suicide: Stigma and Warning Signs

Suicide. To most this can be a feared word, much like, “He Who Must Not Be Named,” but as Hermione Granger would say, “fear of a name only increases fear of the thing itself.” 1 While a helpful illustration, we shouldn’t let the Harry Potter quote take away from the gravity of the subject of suicide. With knowledge comes power and although there are things in life that may ultimately be outside of our control, it is important for us to be informed.

One author writes, “stigmatization of…mental health disorders is alive and well,” and perpetuated by misinformation, miscommunication, and media sensationalization, despite the best efforts of good intentioned campaigners. 2 Those with mental health disorders are often painted as “crazy,” “violent,” or “untrustworthy,” but could these descriptors not also be attributed to those without mental health disorders? I am certain that most of us could think of someone in our life that we have a colourful moniker for, much like those aforementioned, that does not have a mental health disorder. The truth of the matter is that research shows that individuals living with mental illness are more likely to harm themselves than others.2 Stigma can produce profound impacts, including social disgrace and shame, which then serve as obstacles to identifying and acting on warning signs of suicide.3 Individuals may recognize warning signs for suicide as easily as they do those for physical ailments (e.g. heart attack or stroke) but tend to respond less urgently.3 All this to say, if we want to do something to reduce suicides, we need to reduce stigma, and be aware of the warning signs.

Determining the risk of suicide for an individual with one hundred percent accuracy is impossible. Suicide assessments consider a complex interplay of variables encompassing risk factors, protective factors, and warning signs. Due to these complexities, it takes much training, supervision, and experience to thoroughly conduct suicide risk assessments and should only be done by an experienced professional.

So if suicide risk assessments can only be completed by trained professionals what can you do? If you are concerned about a family member, friend, or colleague there are ten common warning signs to be aware of6 :

 

  1. Ideation or communication about suicide
  2. Substance abuse
  3. Purposelessness
  4. Anxiety or panic
  5. Trapped feelings
  6. Hopelessness
  7. Withdrawal from social groups
  8. Agitation or irritability
  9. Reckless behaviour
  10. Mood changes

 

An important thing to remember is that nothing is certain. Warning signs are just that, signs. The presence of a warning sign does not automatically mean that an individual is suicidal, just as the lack of warning signs does not automatically mean that an individual is not suicidal. The purpose is to recognize the signs and start the conversation, get more information, or seek the help of a professional. Let’s start treating mental health like physical health and take preventative measures to ensure the health and safety of our loved ones.

 

Resources

 

Crisis Intervention and Suicide Prevention Centre of BC

Anywhere in BC 1-800-SUICIDE: 1-800-784-2433

Mental Health Support Line: 310-6789

Vancouver: 604-872-3311

Sunshine Coast/Sea to Sky: 1-866-661-3311

Seniors Distress Line: 604-872-1234

Online Chat Service for Youth: www.YouthInBC.com (Noon to 1 am)

Online Chat Service for Adults: www.CrisisCentreChat.ca (Noon to 1 am)

 

S.A.F.E.R (Suicide Attempt Follow-up Education & Research)

8:30 am to 4:30 pm Monday to Friday             Call: 604-875-4794

 

Aboriginal Wellness Program (AWP) Vancouver

Call: 604-875-6601

In an emergency call 9-1-1.

 

 

References

 

[1] Rowling, J. K. Harry Potter and the Philosopher’s Stone. (1997). London, England: Bloomsbury Publishing Plc.

[2] The Lancet. (2013). Truth versus myth on mental illness, suicide, and crime. The Lancet, 382(9901), 1309. doi:10.1016/S0140-6736%2813%2962125-X

[3] Rudd, M. D., Goulding, J. M, & Carlisle, C. J. (2013). Stigma and suicide warning signs. Archives of Suicide Research, 17(3), 313-318. doi:10.1080/13811118.2013.777000

[4] Fowler, J. C. (2011). Suicide risk assessment in clinical practice: Pragmatic guidelines for imperfect assessments. Psychotherapy, 49(1), 81-90. doi:10.1037/a0026148

[5] Granello, D. H. (2010). The process of suicide risk assessment: Twelve core principles. Journal of Counseling & Development, 88(3), 363-371. doi:10.1002/j.1556-6678.2010.tb00034.x

[6] Wu, R. (2017). Individual Appraisal for Counsellors in Practice. Suicide risk Ax. [PowerPoint slides]. Retrieved from https://adler.hotchalkember.com/courses/15984/files/743942?module_item_id=36008

 

What I Have Learned About DBT: A Student’s Perspective

What I Have Learned About DBT: A Student’s Perspective

You may have heard talk of DBT but have absolutely no idea what it stands for after all psychology loves its acronyms. DBT stands for Dialectical Behaviour Therapy, a newer therapeutic orientation that shares some similarities to CBT, or Cognitive Behavioural Therapy, but with many substantial differences. Originally developed by Marsha Linehan, DBT was first and foremost meant as an effective method of treatment for individuals with Borderline Personality Disorder (BPD) 1, 3. The scope of usefulness of DBT has expanded, incorporating primarily eating disorders, anxiety disorders, and mood disorders 1.

I have been lucky enough to be able to learn about and experience DBT through Share Forde and Kelly Williams at Alongside You 4. One thing that has become apparent to me throughout this learning is that everyone could benefit from the skills taught in DBT. Heck, I’m sitting there thinking, “Wow, I don’t even know how to handle these situations…” Dialectical Behaviour Therapy isn’t just for people with BPD, but rather for anyone and everyone looking to improve their coping and interpersonal skills.

The basic premise of Dialectical Behaviour Therapy is dialectics, which pays tribute to the philosophical principle of opposite truths 2. This idea posits that an individual can hold opposing viewpoints simultaneously while looking for truth in both positions; opposite views can exist in one person at the same time 3. This concept can often ring true in individuals struggling with suicidal ideation. It is entirely possible that an individual can both want to die and want to live while finding truth in both of those contradicting statements 3. These opposing viewpoints lead to tension and conflict, which may be necessary to bring about change 3. Dialectics identify multiple truths inherent in any situation and promote flexible thinking, a nonjudgmental stance, and active application of mindfulness 2.

DBT therapy is comprised of four main modules: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation 1.

 

Mindfulness


Mindfulness is the first core skill taught and one might say the most instrumental; without mindfulness, the other modules may prove ineffective. One of the main concepts of mindfulness first taught is “wise mind”. This is a construct that is returned to time and time again throughout skills training. Wise mind is the idea that every individual has a “rational mind” and an “emotional mind”, with the wise mind being a healthy balance of the two. If an individual is too far into rational mind then they are not experiencing any intuition, if an individual is too far into emotional mind they may not be able to make sound decisions. Returning back to the idea of dialectics there are truths inherent in both rational and emotional mind and it is important to learn to balance the two. The function of mindfulness is to train an individual to bring nonjudgmental awareness to the present moment 1. This is achieved by activating wise mind, where an individual can effectively observe, describe, and participate without judgment 1.

 

Distress Tolerance


Distress tolerance can also be viewed as “crisis skills”. With distress tolerance skills training participants are given tools to aid in tolerating strong dysregulated emotions when a solution to a problem is not immediately presented 1. Some skills taught in this module are distracting or self-soothing activities, with a later emphasis on willingness and radical acceptance 1. Willingness and radical acceptance can be viewed as more difficult skills to learn, but tend to lead to more enduring life changes 1. Let me tell you, after learning about radical acceptance I can say without a doubt that it is one of the toughest skills and I will be hugely proud the day I can effectively utilize this skill. Radical acceptance is not saying something is right, fair, or permissible, but rather saying that what is, is and that it is outside our power to change in the moment.

 

Interpersonal Effectiveness


Relationship skills are divided into three sections: reaching goals, making and maintaining relationships, and maintaining self-respect 1. A common challenge to this module is the complaint that the skills taught are less effective when the other party is unwilling to engage in these techniques. If an individual is learning these skills so that they might better interact with family, friends, or partners, it stands to reason that the other party being privy to these skills would prove beneficial.

 

Emotion Regulation


Like all skills modules, it is imperative that mindfulness skills are constantly applied throughout training 1. Learning self-validation, naming, identifying, and triggering of emotions allows individuals an opportunity to become aware of the link between accompanying body sensations, thoughts, and actions 1. My favourite part of Dialectical Behaviour Therapy thus far is the idea of self-validation around emotions; no emotion an individual feels is “wrong”, but perhaps the way they are expressing it can be attended to. In other words, there is nothing wrong with feeling angry, anger is a natural emotional reaction to certain situations, but the purpose of DBT skills training is to ensure that the resulting behaviour of an emotion is effective. Whether or not an action is effective can be measured by whether it brings us closer to, or further away from, what we want (K. Williams, personal communication, January 18, 2018).

All in all, the more I learn about Dialectical Behaviour Therapy the more I find myself thinking, “it all makes so much sense!” The validation inherent in DBT provides a sense of not being broken, but rather just needed to make a few adjustments. As a student I balance dialectics every day thinking, “I can do this” and “there is no way I can do this”; this is all part of the learning process that I intend to keep following, because at the end of the day if we stop learning, we stop living.

 

Please call us at (604) 283-­7827 if you have questions about what our DBT Group is about and if it’s the right fit for you.

If you’d like to learn more, please contact us.

 

References


[1] Lenz, A. S., Del Conte, G., Hollenbaugh, K. M., & Callendar, K. (2016). Emotional regulation and interpersonal effectiveness as mechanisms of change for treatment outcomes within a DBT program for adolescents. Counseling Outcome Research and Evaluation, 7(2), 73-85. doi:10.1177/2150137816642439

[2] Long, B., & Witterholt, S. (2013). An overview of dialectical behavior therapy. Psychiatric Annals, 43(4), 152-157. doi:10.3928/00485713-20130403-04

[3] Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2013). An overview of Dialectical Behavior Therapy for professional psychologists. Professional Psychology: Research and Practice, 44(2), 73-80. doi:10.1037/a0029808

[4] Linehan, M. M. (2015). DBT skills training handouts and worksheets (2nd ed.). New York, NY: The Guilford Press.

 

Humour and Mental Health: Can You Really Just Laugh It Off?

Humour and Mental Health: Can You Really Just Laugh It Off?

Growing up I remember hearing colloquialisms such as “suck it up”, “rub some dirt in it”, or “laugh it off.” These phrases seem automatic and designed to negate any potentially uncomfortable discussion of how a person might truly feel in a given situation. For myself, this brings up concerns that we are teaching children how to repress and avoid their emotions. Do some of these phrases actually serve a purpose? Can someone really just “laugh it off,” if they are sad, hurt, or even depressed? The answer is no, but fear not, there is a time and place for humour!

 

Resiliency

Humour serves as an important tool to mediate embarrassment or discomfort, to distract, to entertain, and, apparently, to develop resiliency [1]. Although humour is the not the “cure-all,” answer to mental health, it can serve as a protective factor and help to develop resiliency. Protective factors simply refer to qualities, characteristics, or circumstances which allow a person to develop a support system of coping skills, resources, and people to rely on in times of need. In other words, think of humour as a preventative tool in your tool belt; humour may not fix a situation, but it may help to mediate some of the more negative effects.

 

Trauma

Trauma is becoming much more of a frequent topic of conversation, news media, and professional circles. It seems that the main topic surrounds why some people react differently to the same or similar experiences. Why do two soldiers return from the same combat zone, having had similar experiences, but only one soldier experiences post-traumatic stress?

There is now talk of something called post-traumatic growth (PTG), which is a phenomenon where people are able to grow in positive ways after experiencing trauma [2]. Of course, this phenomenon has those of us in the mental health field wondering how we can predict PTG and what we can do preventively to resource people before they experience trauma. What factors buffer the potentially devastating impact of trauma? While it’s a complex question without one answer, humour can be a resource. Humour can be a tool through which people are able to view a painful reality with a defiant attitude and a bit of a buffer [2]. Humour has the unique capacity to transform a negative situation into something positive; however, there needs to be an understanding that humour is multidimensional and not all humour elicits positive effects [2].

 

Benefits for Counselling

There are four types of humour: affiliative, self-enhancing, aggressive, and self-defeating. Whereas benign types of humour, such as affiliative and self-enhancing have shown positive effects in lowering incidence rates of depression, anxiety, and stress, aggressive and self-defeating humour has shown to have negative effects [2]. Affiliative humour refers to the tendency to say funny things, tell jokes, and exchange witty banter, whereas self-enhancing references a humourous outlook on life [3]. One study by Sirigatti and colleagues (2017) has shown positive correlations between self-enhancing humour and overall life satisfaction, self-esteem, optimism, happiness, and psychological well-being.

So we have determined that like all things there is a balance. Some types of humour can create a more positive mindset and overall feeling, while more negative, self-deprecating humour does the opposite (Gladding, Wallace, & J, 2016). Some humour can hurt instead of fostering healing [4]. However, let’s focus on the positive. There is some truth in the saying “laughter is the best medicine.” Although laughter definitely is not “medicine,” nor a curative remedy, it leads to strengthening physical and mental well-being and is positively correlated to longevity. Humour can help with the constructive expression of strong feelings, offer perspective and balance, and assist in coping [4].

 

In conclusion, no, you can’t just “laugh it off,” but like with anything in life, our outlook can greatly affect how we deal with the obstacles that arise. Can positivity and optimism really hurt too much? If you’re having a tough day, week, or even if you’re not, just remember to take a second to enjoy yourself and laugh.

 

Q: What do you call a cow on a trampoline?

A: A milkshake!

 

 

References

[1] Tucker, T. M. (2017). Resilience development through humor. Dissertation Abstracts International, 78.

[2] Boerner, M., Joseph, S., & Murphy, D. (2017). The association between sense of humor and trauma-related mental health outcomes: Two exploratory studies. Journal of Loss and Trauma, 22(5), 440-452. doi:10.1080/15325024.2017.1310504

[3] Gladding, S. T., Wallace, D., & J, M. (2016). Promoting beneficial humor in counselling: A way of helping counselors help clients. Journal of Creativity in Mental Health, 11(1), 2-11. doi:10.1080/15401383.2015.1133361

[4] Sirigatti, S., Penzo, I., Giannetti, E., Casale, S., & Stefanile, C. (2016). Relationships between humorism profiles and psychological well-being. Personality and Individual Differences, 90, 219-224. doi:10.1016/j.paid.2015.11.011

 

 

 

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