One of the questions we get a lot is what are some of the specific Dialectical Behaviour Therapy (DBT) techniques that we teach clients? I think this is a great question and one that we can answer through some blog posts, so here’s the first one – I hope you like it!
Mindfulness is the at the core of dialectical behaviour therapy – it’s the foundation, if you will, that everything else is built upon. Mindfulness is the practice of being present in the moment, without judgement and without attachment to it. It sounds simple, but it is often very difficult for us to practice in our daily lives.
What are the goals of mindfulness, with respect to DBT, you might wonder? According to Dr. Marsha Linehan, the goals are threefold:
- Reduce suffering and increase happiness
- Increase control of your mind
- Experience reality as it is
The mindfulness skills learned through engaging in dialectical behaviour therapy help clients create their own mindfulness practice. A mindfulness practice involves incorporating different skills into a routine practice that is woven into our lives as a foundation for doing life. This can involve any or all of the skills, meditation, contemplation, and mindful movement.
There are three core mindfulness skills in dialectical behaviour therapy and I want to introduce one of my favourites because it’s one of the ones I’ve found most helpful: Wise Mind.
The Wild Mind
You won’t find this terminology in any DBT books, but it’s what I call the dance between the two extreme states of our minds: logic vs. emotion. In DBT terms, we’d call the two polar opposites Reasonable Mind and Emotion Mind.
Often, we tend toward one or the other especially when we’re under stress. Those of us who are more naturally prone to logic will rely on this part of our mind to make everything rational, logical, and pragmatic at the cost of ignoring emotional content. Others more naturally drawn to emotion will rely on this part of the mind to make everything about mood, feelings, and impulses to do or say things.
As you can probably tell, both of these approaches are likely to create problems because they focus on one area at the cost of ignoring the other. So, what’s the alternative?
The Wise Mind
The concept of Wise Mind within the framework of mindfulness involves combining the two minds, Reasonable Mind and Emotion Mind into a new framework – Wise Mind. Wise Mind balances the Reasonable Mind and Emotion Mind and allows us to follow a middle path.
Another description of Wise Mind is something we often call wisdom. In this case, it’s the wisdom within each of us that combines both our more rational, reasonable mind with the emotion-focused part to create a full picture. This focus allows us to see, and value both reason and emotion, bringing the left and right brains together as one.
I was just remarking to a client that someone once described wisdom to me this way:
“Knowledge is knowing that a tomato is a fruit. Wisdom is not putting it in a fruit salad.”
Apparently, this quote came from Miles Kingston, a journalist and musician, and what I like is that it helps explain the difference between wisdom and knowledge. In our case, knowledge is what each of our minds is telling us – our reasonable and our emotion mind. Wisdom is knowing how to combine that information and knowing what to do with it – our Wise Mind.
How Can I Get Started Using Wise Mind?
Mindfulness takes practice, as does listening to Wise Mind. Here’s an example exercise that you can try right now to see if you can listen to your inner wisdom using Wise Mind. It’s taken from the Mindfulness Handouts in the DBT Skills Training Manual from Dr. Marsha Linehan:
Asking is this Wise mind?
Breathing in, ask yourself, “Is this (action, thought, plan, etc.) Wise Mind?”
- Breathing out, listen for the answer.
- Listen, but do not give yourself the answer. Do not tell yourself the answer; listen for it.
- Continue asking on each in-breath for some time. If no answer comes, try again another time.
This may not come naturally to you at first, in fact, it probably won’t. Repeat this exercise and see if you can allow yourself to enter a mindful space where you can notice what your Reasonable Mind and Emotion Mind are telling you, and then listen to your Wise Mind to see how you can trust your inner wisdom and operate out of an effective, mindful place in your decisions.
If you’d like help with this, we’re always happy to help! Please give us a call or contact us for options!
Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press.
Linehan, M. M. (2015). DBT® skills training handouts and worksheets (2nd ed.). New York, NY, US: Guilford Press.
“You are richer than you think.” This is the current slogan being used by Scotiabank. When I hear this slogan, I think of the clients who are participating in the various DBT groups here at Alongside You. DBT is the short form of Dialectical Behavioural Therapy, created by Dr. Marsha Linehan, who is a psychologist working at the University of Washington in Seattle. This treatment is the gold standard for clients struggling with unstable identity, risky behaviours, chaotic relationships and an inability to regulate emotions and urges. The DBT skills taught in our groups focus on Distress Tolerance and Crisis Management, Interpersonal Effectiveness, Emotion Regulation and Mindfulness. There has been much research supporting this form of therapy that it is now also designated as the gold standard for Borderline Personality Disorder. The skills are also very helpful for clients trying to manage depression, anxiety and substance misuse.
In addition to skill building, learning and participating in a group format has many other benefits. I have facilitated groups of various kinds for 40 years and have been witness to so much growth in so many clients that I can say with confidence that a group experience is a very rich one. Dr. Irwin Yalom describes in his book, The Theory and Practice of Group Psychotherapy that the following factors occur when participating in group therapy:
- Instillation of Hope
- Imparting of Information
- Corrective recapitulation of the primary family group.
- Development of socializing techniques
- Imitative behaviour
- Interpersonal learning
- Group cohesiveness
- Existential factors
Dr. Roy Mackenzie in his book, Time-Managed Group Psychotherapy, identifies learning factors such as
- Vicarious learning
- Self-revelation and Insight
As the late famous American poet Maya Angelou says, “we are more alike than we are different.” Why then do we sometimes we feel that we are left behind while others live their life without strife? This is certainly how it may appear on the various social media sites. More and more I see young clients who spend hours daily checking up on friends on the various social media platforms on the internet. It seems to me that it would be much more healthy to call a friend and plan to do an activity together. If we parallel play as young adults we are not growing psychologically. Attending a group is a good start to get back in the game of communicating both verbally and nonverbally with other people. People need people as we are social beings by nature. A group is a microcosm of society in general. When clients feel supported in a genuine way they are likely to experience some or all of the healing factors mentioned above.
Another factor involved in a group setting is the undercurrent explained by the psychoanalyst, Wilfred Bion, in his book Experiences in Groups. Bion says that there are three basic assumptions working alongside any working group. These are mostly unconscious but are helpful for facilitators to consider if a group they are running is starting to struggle. The first basic assumption is the dependency and this happens when leaders are dialectically idealized and devalued. The second basic assumption is pairing in which two group members bond in an attempt to overthrow the leader. The third basic assumption is fight or flight, which happens when the group has a common enemy. It can be a taxing job to be teaching skills as well as observing the group process and the underlying basic assumptions all at the same time. Extra training on group skills is highly recommended when moving from individual therapist role to a group therapist role. I believe that this is one of the reasons our groups are so effective here at Alongside You. We work diligently to create the best atmosphere for people to learn and to grow.
Groups are a dynamic force and when change happens to the individual group members this impacts and creates a vibration which results in changes to the whole group. Systems theory suggests that groups over time tend to develop a self-organizing nature which works to maintain stability and minimize threats. Through this, clients can experience a safe space to explore their challenges and their successes, and learn from, and encourage each other.
My goal when I co-facilitate our Dialectical Behavioural Therapy group is to have clients leave after 24 weeks being even richer than they think they are, as they carry their new tools to help them achieve a “Life Worth Living.” Feel free to contact us to learn more about Dialectical Behavioural Therapy.
When I meet with clients, I often remark that of the 168 hours in their week, I get 1 if I’m lucky. That’s assuming that I get to see them once per week, which is not necessarily the case. Most often I see clients every other week, or even further between sessions. In this case, the hours I don’t get to be with them becomes multiples of the 168. I highlight this because I want to encourage clients that as important as the work we do in-session is, it is truly what they do between sessions that promotes lasting change. It’s not that I discount the importance of what I do, I simply recognize the importance of what my client does day in and day out between our times together.
One thing that I love about Dialectical Behaviour Therapy (DBT) is the emphasis on skill development. In our DBT groups, we focus on both skills and process, but the homework in between groups is heavily focused on skill development. Whether it’s Mindfulness, Distress Tolerance, Emotion Regulation, or Interpersonal Effectiveness they’re working on, there are concrete activities and worksheets clients can follow in between sessions to work on these areas. Clients get all of these resources in a book as a part of the group and the clients who really work at this, come back each week with a well-worn book! It’s wonderful to see clients invested in their process.
One of the questions I am asked a lot is, “Why do you have so many different things at your clinic?” The answer to this is because we believe in a holistic approach to recovery. I’d like to highlight three things you can access in our clinic between counselling sessions that will promote your wellbeing and recovery in those in-between times. The great thing is that all of these also promote things you can do on your own at home that don’t cost more money!
Open Studio Sessions
One of the things people are most curious about in our clinic is our art studio. People regularly wonder why we have an art studio, but the answer is very simple: because it helps people recover. We do this both through 1:1 sessions, and our Open Studio Sessions. There is a large body of evidence showing the power of creativity and art to help people recover from mental health, chronic conditions, chronic pain, and more; it also helps people connect inter-generationally and with family members and friends. All of these are great things! In our studio, you can learn Mindfulness-Based Art Therapy (MBAT) techniques that you can use at home, and we can even help you figure out what materials you’ll need and give advice on where to source supplies for reasonable prices. Many of our clients come to the studio sessions to learn new techniques and then go home and use them in their daily life. You can come to connect or learn new things, and then work on them on your own at home!
Trauma Sensitive Yoga and Yoga Therapy
The second most surprising thing to people about our clinic is that we have a yoga studio. We have a yoga studio because we saw a need that people had that wasn’t being filled. As you might imagine, not everyone is comfortable with large studio yoga, particularly if they’re struggling with trauma, anxiety, depression, or other difficulties. Further, as wonderful as larger studio yoga is, it’s not specifically designed for people struggling with trauma and mental health, or physical health challenges. Our Trauma Sensitive Yoga (TSY) programs and Yoga Therapy programs are specifically geared toward helping people recover from these things. The techniques are evidence-based and the programs are designed specifically to each client’s unique needs. Once again, the goal is to help you recover and work on your own, in-between sessions. Our certified yoga therapist will work with you individually in our safe, trauma-informed space to design a program specifically for you that once you learn, can be done safely at home on your own. When you want to learn more or brush up on techniques, you can come back in for some sessions. It’s flexible, safe, and geared specifically to you and your unique needs.
Mindfulness has become something of a buzz-word in pop psychology, but that is not a bad thing! Mindfulness is the practice of focusing on the present, allowing your brain and body to calm and be in the here and now. We’ve written previously about it on our blog, and you can look forward to more articles on this in future. It’s a vital practice that supports holistic health in body, mind, and soul. We can approach mindfulness training in a number of ways here: individual sessions with our DBT therapists and the curriculum from the dialectical behaviour therapy programs, one on one sessions in the art studio with Meg Neufeld to learn Mindfulness-Based Art Therapy techniques, or with our yoga instructors using breathwork and yoga techniques. Once again, all of these are skills you can learn and take home with you and practice on your own!
At Alongside You, our goal is to support you both in-session as we provide counselling, and outside of sessions to help you cope, grow, and thrive using holistic methods. This not only increases the effectiveness of your counselling, it also promotes autonomy, choice, and increases the chances of your recovery. Our belief is that all of our clients possess unique strengths and gifts that can be used to journey toward wholeness and resilience, and our job is to help identify these, support them, and encourage you. I hope this article gives you some ideas on how you can support yourself along the journey! If you are interested, feel free to contact us!
My Love-Hate Relationship With Mindfulness… and why you should really, really consider practicing it
Mindfulness has been a buzzword in the health community of late. I’m hoping that after reading this, you’ll have a basic idea of what it is and why it helps.
Western culture is full of busy-ness – depression and anxiety are more common than they’ve ever been. Typically, I like to simplify depression and anxiety somewhat, down to past and future. Anxiety is the uneasiness and even fear of some future threat – generally, one that isn’t exactly easy to define. We might be really anxious about an upcoming presentation, but have a harder time nailing down where that comes from – perhaps it might come from baggage that we carry around from some intense public shame that we’ve felt in the past, and the risk of putting ourselves out there again heightens us to a degree that feels like it doesn’t even make sense (our bodies remember shame a lot more acutely than our minds do). Anxiety is often designed to warn us and protect us against the threat of more hurt like this.
Depression, often, is oriented in the reverse direction – maybe our past experiences have coloured our world in a way that joy is difficult to experience, and it’s hard to believe that we will experience anything different going forward. Depression tends to affect the innate and beautiful sense of curiosity and wonder that comes with being a human being (think of a young child you know interacting with the world around them).
Please understand that these are simplistic definitions, designed to give a basic idea of where mindfulness comes in. Often, depression and anxiety can keep our thoughts in the future or past, which is exhausting. Constant worry or feeling down can lead us to do a number of things that are very adaptive and reasonable in the moment (such as distracting ourselves from a painful experience), but they are exhausting in the long run. Mindfulness brings us to the present. It gives our brain a short break from the constant worry and just brings us into right…now. Young children (for example) are generally really good at being present in the moment.
Being mindful can help ease stress
Mindful meditation might involve focusing on our breath, the food we’re eating, the physical sensations in our bodies, or the sounds outside. It is inviting ourselves to experience the present moment for what it is – without judgment. I have a lot of tension on my shoulders, for example. I carry it with me everywhere, and I really hate having it around. But when I’m mindful, I’m not focusing on how much I wish it weren’t there. I’m just noticing it and training myself to be OK with it, just for a minute. Or, I’m noticing the sounds of the traffic outside, and I’m not thinking any thoughts at all – just experiencing the present for whatever it is. This is really hard – especially at first, and even more so when we are experiencing physical or emotional discomfort.
If you’d like to know the why behind things, I’d like to tell you about the work of two people I admire (who are just like you and me, and also happen to have a long list of impressive credentials that I won’t outline here) named Jon Kabat-Zinn and Dan Siegel. They’ve spent a lot of time researching and exploring mindfulness, and their work is very impressive.
Benefits of mindfulness
One of the main things mindfulness does is increase left forebrain function. This increased brain activity fosters that beautiful curiosity I was talking about. If we can notice and be curious when we’re stressed, we’ve already won. We start seeing ourselves from an outside perspective, with more grace and compassion (have you ever wished you could see yourself the way you see somebody you care about?). We can learn to calmly respond to things that otherwise would have sent us into a frenzy.
I could talk forever about this, but I’ll just give you a quick list of the amazing benefits you can find in mindfulness:
- Direct help with physical symptoms such as chronic inflammation and pain
- Reduced anxiety, stress, and depression
- Improved immune system function and mood
- Healthier coping – an increased ability to bounce back after one of the hard experiences that are so common in life
Sounds too good to be true, right? It is sort of. It’s not a pill – it takes the effort to be mindful. I hate it, actually. In many ways being regularly mindful is a primary component of my job, and I still suck at it. But, I’m getting slowly better – then worse – then better again. But even a little bit helps – if you can manage even 20 seconds a day, you will notice a difference.
If you want to read more about this, the works of Jon Kabat-Zinn and Dan Siegel are a great place to start. Jon Kabat-Zinn has a website and a variety of videos on YouTube that are really interesting. I’ve provided a few links below to get you started.
If you want to get started with a mindfulness practice of your own, there are quite literally endless free resources online in both video and audio format, but I recommend the Headspace app. It teaches you the basics and gives you easy, situation-specific guided meditations.
If you want more information on how to actually do the thing, here’s a Harvard blog that covers the basics pretty well:
Here’s Jon Kabat-Zinn on making what you already do in the morning into a mindful practice (this way, you don’t even need to learn to do anything new!):
Lastly, if you want to fact check my claims, I have a resource list of academic papers I’d be happy to share with you. Here’s one I really like (you may need access to an academic database to read it):
Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., . . . Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564-570.
I hope this has been helpful for you. Sometimes we love what helps, sometimes it’s aggravating; one thing is for sure – mindfulness helps us keep calm, be present, and cope. If I, or anyone else on the team at Alongside You can be helpful in working through this with you, please contact us and give us a call.
If you’ve tried a meditation practice you probably know how challenging it is to quiet our minds. You may have even experienced the incessant chatter that is the background to our everyday lives. Most people exist in this constant state and find it difficult to shift out of it, into the “rest and digest” parasympathetic mode.
Essential to our health and well-being is the ability to find periods of quiet, stillness and calm. Creating quiet space balanced with activity is important to create equilibrium. Once you experience, and practice becoming still and quiet, you stop missing the special moments in life, you see life in a whole new way – the mindful way. The results of being mindful stay with us after our practice, including better mood, less stress and anxiety, and more focused brain function. We are able to make better choices with more effective problem solving and be proactive rather than reactive in everyday life. We’d love to help you find your way toward mindful living and authentic engagement with the world, because your health will benefit!
Join us at our introductory workshop on Mindfulness where you’ll learn core skills, and build your own practice.
“The quieter you become, the more you are able to hear.” – Rumi
Location: Alongside You – #205-4840 Delta Street Ladner
Time: Friday July 28th 8:00-9:45
For more information please contact: Brenna Jacobson (Pelvic Floor Specialty) (RYT 250) Pre-post Natal Consultant.
Phone: 604-283-7827 Ext 709 Email: email@example.com