Radically Accepting the Holidays

by Andrew Neufeld | Dec 21, 2017 | Dialectical Behaviour Therapy

It’s that time of year again – time for my annual year-end blog. To say that this year has been a whirlwind, full of unexpected greatness, and unexpected challenges would be a gross understatement. We’ve added more staff in the past 6 months than I ever expected; we’ve expanded our Dialectical Behaviour Therapy (DBT) services to double our groups, expand our individual DBT counselling, and we’re starting a youth DBT group in January; and we’re starting more programs focusing on chronic pain and chronic conditions. We’ve networked with treatment centres and continue development of our Recovery and Aftercare Programs launching in January. Not last or least, we’re opening a new office in South Surrey. All amazing things, that I’m incredibly excited about, and grateful for.

And here I am sitting in the Jim Pattison Outpatient Care Centre on December 20^th, as Meg endures yet another spinal procedure to try to control her pain. I discovered last night that the workstation I have at home from my pro photography days has had both storage hard drives die, and the backup server I used to have copies of all my professional and personal photographs seems to have bit the dust and I’m going to likely have to send drives to a data recovery company and hope that they recover the images of the last 20 years. And I sit here thinking about all of the things I didn’t get done before leaving the office on “vacation,” until the first week of January. And now I’m supposed to relax.

In Dialectical Behaviour Therapy, there’s a concept called Radical Acceptance. It’s a difficult concept to grasp, but essentially, it means having to accept things that are extremely difficult to accept, and often may challenge logic in accepting. Things that occupy our heart, mind, and soul that take up space and challenge our being and wellbeing. Things that are, that we wish weren’t and things that we can’t change, but wish we could.

Sometimes we get caught up or blocked from accepting because we don’t like whatever it is we’re needing to accept. Things like a bad grade in school, a bad review from our boss at work, maybe even events over the holidays with family or friends that we’d rather not go to. The thing is, acceptance does not mean we have to like it, it means we need to acknowledge that it is what it is and we can’t change it, and deciding what to do about it. Radically accepting means to do this with the really big things.

Here are a few tips on how to Radically Accept what you need to accept this holiday season[i]:

1. Observe when you’re questioning or fighting reality – this may come in the form of you saying or thinking, “It shouldn’t be this way!”
2. Remind yourself that your unpleasant reality is just what it is, and it can’t be changed.
3. Practice accepting with your whole self, which may take the form of positive self-talk, relaxation, mindfulness, prayer, or even using guided imagery to go to a place of acceptance.
4. Practice doing the opposite – do the things you would do if you were able to accept these things – you may find that you start accepting them as a result!
5. Acknowledge that life can be worth living, and holidays can be survived, even if there is a pain.

For me, this year, there are a few things I’m having to radically accept in anticipation of and to get through the holidays:

• I can’t fix my wife’s pain, and she continues to have to endure procedures to try to help it in some way
• I can’t fix my hard drives and there’s a possibility that some of the things I cherish over the years in photo form may be lost
• I haven’t completed all of the things I wanted to before the holidays hit

But what does this mean? If I accept these things, how does that change anything? Well, it can relieve some of the stress and tension, or anxiety around trying to change any of these things. The reality is that I can’t change these things even if I want to. I can’t relieve Meg’s pain, but I can be there to support her (and this is the main reason I’m taking as much time off as I am this Christmas) because this is something I am able to do, even if it doesn’t fix her pain; I can’t fix my hard drives, although I can work on making sure there isn’t anything I can do, and I can send it to a company who knows how to recover data and pray for the best; I can’t complete everything I wanted to, but I can pick some times throughout the holidays to get some work done for things that really need doing. Perhaps most importantly, I can be grateful that I have the support in life that I do, an amazing staff (including the lovely Anna Hers who will be in the office through the holidays to take your calls so I can be home!), and we have a community we love and live to serve as best we can, which is why there is so much work to be done!

I’m also well aware that there are many of you who will struggle greatly this year over the holidays for many reasons and many that may make some of the above struggles seem rather trivial. Perhaps you don’t have a family to spend the holidays with, or you lost a family member and that memory will be with you during this time; perhaps you’re struggling with anxiety or depression and now feeling like you have to put on a happy face so you don’t ruin everyone else’s holidays; or maybe you’d simply rather not be here, and the holidays just make it worse.

Holidays can be hard. I didn’t set out to write a downer blog post, but I did set out to write a post that hopefully acknowledges some of the difficulties of life that don’t respect the holiday and give us a break, and some of the difficulties we face specifically because of the holidays. The malls and Christmas carols would like us to believe the world fundamentally changes and everything is glorious because it’s the holidays, but for many people, this is simply not true, or realistic in their life.

You are not alone. We see you, and we hear you.

One of our newest staff reminded me in conversation last night of the importance of being seen and heard, and this is especially true this time of year. We can’t always change the struggles in our own lives, or in the lives of others. One thing we can do, however, is show empathy toward others, and toward ourselves.

Our office will be essentially closed over the holidays, but Anna will be in the office. If you’re struggling, please give her a call at 604-283-7827 ext. 0 and she’ll be glad to set up an appointment for you as soon as possible in January. From all of us at Alongside You, Merry Christmas and Happy Holidays. May peace, grace, and love surround you this season, and we look forward to seeing you in the New Year!

[i] Adapted from DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015.

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

by Chantelle Phillips | Nov 22, 2017 | Dialectical Behaviour Therapy

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 (2^nd ed.). New York, NY: The Guilford Press.

Why We Need To Have Dialectical Behaviour Therapy (DBT) Skills to Get What We Want In Relationships

by Andrew Neufeld | Jun 16, 2017 | Dialectical Behaviour Therapy

In Dialectical Behaviour Therapy (DBT) terms, the ability to get what we want in relationships, and to get out of relationships that aren’t good for us, is a skill called “interpersonal effectiveness.” It is one of the four core skills of the DBT program, and one of the skills we teach in our DBT Group as well as in our individual therapy with clients. When I talk about learning how to get what we want in relationships, sometimes people think I’m talking about being manipulative (and perhaps I am). Here’s the thing – we all need to get what we want in relationships. Quite frankly, that’s the reason we have relationships – because we get what we need out of them in a mutually beneficial, symbiotic fashion. Sometimes, however, we have a habit of getting in our own way.

Why is it that we have difficulties with interpersonal effectiveness in our relationships?

Sometimes it’s because we don’t know what we want! Other times our emotions get in the way and even control how we behave. Many times we forgo long term goals and plans for short term benefit. Alternatively, sometimes other people get in our way! Finally, sometimes our own thoughts and beliefs about ourselves and others mess things up.

What are some of the myths that get in the way of achieving our objectives in life? For a lot of people, it’s the mistaken belief that we don’t deserve to get what we want or need. Other times we may see a request as a sign of weakness – that is, we should be able to figure it out, or do it all on our own. Do you ever have a hard time saying, “no,” to people? You’re not alone. Often we get tied up in the belief that saying, “no,” to anyone is inherently selfish, or we should sacrifice our own needs and wellbeing for others.

What about relationships?

One of my favourite stumbling blocks we fall into in relationships is the idea that we shouldn’t have to tell our partners/friends/family what we want, or what we need – they should just know! I don’t know about you, but I haven’t developed the skill of mind-reading yet, and I’m pretty confident that most people haven’t. Yet, especially when we’re under stress this often becomes our implicit, if not explicit expectation of others. Why we do this is a very good question – I believe that it’s because it’s our desire that we are known by those closest to us in such a way that our needs are known and met; sometimes this does happen! Not because we can read minds, but because we have this thing called intuition. The problem comes when we expect this all the time and then believe that we don’t have the responsibility to tell others what our wants and needs are. Ironically, when we are able to relay our wants and needs to others in an effective way, the chances of needs being met skyrocket. Go figure!

One of the important steps to take to be effect in interpersonal situations is to clarify our goals. In DBT terms, we need objectives effectiveness, relationship effectiveness, and self-respect effectiveness. In layman’s terms, we could summarize these three goals as questions:

1) What specific changes do I want from this interaction and how do I get there?
2) How do I want this person to feel about me and what do I have to do to keep this relationship?
3) How do I want to feel about myself and what do I have to do to get there[1]?

In our DBT groups, we teach specific skills that answer these three very important questions. We all want to know how to get what we need from another person, how to keep and improve our relationships, and how to keep and improve upon our own self-respect. In fact, this is why DBT Skills can be great for everybody!

___________________________

If you’d like to learn more about Dialectical Behaviour Therapy (DBT), or just how to get more of what you need in relationships and how to set healthy boundaries for yourself, please contact us, we’d love to hear from you! You can reach us by phone at 604-283-7827 or by using our contact page today!

[1]From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan, 2015.

A New Way of Treating Binge Eating

by Andrew Neufeld | Jun 6, 2017 | Dialectical Behaviour Therapy

A New Way of Treating Binge Eating

By Andrew Neufeld, MC RCC

At Alongside You, we help clients from all over Metro Vancouver deal with various types of eating disorders. Whether it is through the services offered by our in-house Registered Dietitian or through therapies offered by our team of experienced counsellors, we’ve got the answers to many questions on the topic of eating disorders and related health issues.

Defining Binge Eating Disorder (BED)

First of all, it is important to define what binge eating is and what it is not. This way, if you are suffering from this condition, you can get the proper help you need to get back to healthy eating habits. Binge eating is not simply emotional eating. Binge eating is done to sooth oneself during a period of emotional dysregulation or other stressors. While certain emotional states can cause binge eating, not all situations where emotional eating is involved would lead to binge eating. Binge Eating Disorder (BED) is one of the newest eating disorders recognized by the DSM5

The formal criteria for diagnosis of Binge Eating Disorder, from the DSM5 are:

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
  • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
• The binge eating episodes are associated with three (or more) of the following:
  • Eating much more rapidly than normal.
  • Eating until feeling uncomfortably full.
  • Eating large amounts of food when not feeling physically hungry.
  • Eating alone because of feeling embarrassed by how much one is eating.
  • Feeling disgusted with oneself, depressed, or very guilty afterward.
• Marked distress regarding binge eating is present.
• The binge eating occurs, on average, at least once a week for 3 months.
• The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

We’re very happy that BED is getting the recognition it deserves as a separate diagnostic category for many reasons, not the least of which is that it is gaining more recognition as a specific condition. Further, it will hopefully help in finding more methods of treatment, as well as accessing funding for clients and treatments because now it has its own DSM5 classification.

We offer a number of services aimed at eating disorders, and BED specifically, including our Registered Dietetics, Individual, Couples, and Family Therapy, Neurofeedback, and Therapeutic Yoga but I want to highlight one specific modality today that has great efficacy with eating disorders: Dialectical Behaviour Therapy.

A Ray of Hope – Dialectical Behaviour Therapy

Dialectical Behaviour Therapy (DBT) was originally created to help people who were struggling with chronic suicidal thoughts and attempts. However, that was not the sole reason Dr Marsha Linehan developed this method of therapy. The main goal of DBT can be summarized in just one sentence: “To have a life worth living.”

DBT places importance on understanding and working with various emotions. As part of the DBT model, we believe that the problematic behaviours in question are results of the inability to manage strong emotions. To treat binge eating, it is important to address the emotions in play. This is where DBT can truly shine.

The four pillars of DBT can help people struggling with binge eating in the following profound ways:

• Mindfulness: People with binge eating disorders often find it hard to stay in the moment. It can “trigger” people when they connect emotions with food. Some people are not aware of what exactly triggers their binge eating symptoms (chain analysis can also help with this). Since it is difficult to treat anything without being aware of what exactly it is, mindfulness skills become extremely important when it comes to managing binge eating disorders. One of the skills taught is the concept of mindful eating, which makes the eating experience intentional, rather than making eating a reaction or means to calm emotional turmoil.
• Interpersonal Effectiveness: People suffering from binge eating disorders often find it difficult to assert their needs and to say no. This could be due to fear of rejections and feeling of shame. When we do not have proper boundaries, feel taken for granted or feel we are treated like a doormat, we experience negative emotions that lead to ineffective behaviours. Interpersonal effectiveness helps us ask for what we need in relationships and how to say no to others for the right reasons.
• Emotional Regulation: As described above, people who have binge eating disorders often have problems dealing with their emotions. Instead of suppressing or getting rid of their emotions, this skill set helps people reduce their vulnerability to negative emotions, as well as connecting with positive emotions.
• Distress Tolerance: This set of skills help people who are going through crises, in this case binge eating. It helps steer people away from actions that would worsen their current situations. Through Crisis Survival Skills and Reality Acceptance Skills, sufferers of binge eating disorders learn to tolerate their distress and make lasting changes in their lives.

If you feel that you are struggling with binge eating, it is important to seek help. A properly designed DBT program can help people who have binge eating disorders to stop binging. They will gain insights and learn skills to regulate their emotions and eliminate the habit of using eating to deal with problems.

At the individual therapy and group therapy programs at Alongside You, our clients get to learn the role binge eating play in their lives. In turn, they can put the newly learned skills in place to handle challenges life throws at them. They find harmful behaviours, such as binge eating, no longer useful to them when it comes to regulating emotions.

If you would like to learn more about the connection between food, diet, eating and mental health, please contact your registered dietitian. Your counsellor and dietitian can also work together as your team of family health advisors – they can come alongside you to create the most optimal health plan for you and your family.

If you have any questions, please call 604-283-7827 and reach Andrew Neufeld MC, RCC at extension 701 or Annie Tsang RD at extension 712.

If you are interested in joining a DBT program or individual therapy program to treat potential binge eating disorders, please call 604-283-7827 and reach Kelly Williams at extension 710. We will begin by identifying any symptoms of potential problematic eating. Then we will direct you to the most appropriate program that will help you turn around the situation.