Dialectical Behaviour Therapy

A mini-blog/reflective journal from a self-confessed air head (most of the time)

Dialectical behaviour therapy, and why I think it could be helpful for me.

Photo: Shirish Suwal

The short answer is that I didn't get along with cognitive behaviour therapy.

There, that's it, blog written, time for feet up in front of the TV!  (Just kidding, obviously.)

Now first off, despite having an interest in psychology I've never formally studied it - I'm not a doctor, I'm not a medical professional, I am not attempting to diagnose anyone (not even me -- self-diagnosis not a good idea) and all the usual other disclaimers.  I also do not have a diagnosis of emotional dysregulation disorder - instead I suffer with generalised anxiety (with a degree of depression, secondary to a chronic physical health condition, thrown in).  I do relate to some of the symptoms of the disorder, however.

I read or otherwise learned about DBT somewhere which I now can't recall, as it was a while ago. And immediately that word dialectical attracted me for some reason best known to my subconscious.  

Image: Nick Coleman

Actually it's possible I misread it as diabolical and thought it was amusing! (Just kidding. Kinda.)

I'd attended a couple of sessions of CBT when I was younger (not long out of university).  And I can recall: Just. Not. Getting it.

On a logical level I could understand well enough what was being asked of me in conversations such as the following:

Me: I worry about using public transport, I find it very daunting and overwhelming

Therapist: What worries you about using public transport to make it daunting & overwhelming for you?

Me: I worry about all the things which could go wrong; for example what if I stumble while boarding in front of all the other passengers or I drop my wallet and all my cash spills out everywhere

Therapist: And what do you think would be the consequences if that situation were to occur?

Me THINKS: I'd be mortified and want to run home to hide under the duvet or something! But I know that's not the response they're looking for

[In fact, the above exchange was rather more protracted in reality but wouldn't make for exciting reading]

Me, ultimately, SAYS: ... [nothing]

Me, subsequently: attended a maximum of about two sessions before the prospect of continuing this therapy became a massive source of anxiety in and of itself, and I became a no show.

It's difficult to put into words, because it's kind of that when you're an anxiety sufferer you just feel anxious.  You feel anxious about things which other people take in their stride when you have generalised anxiety.  Someone can explain to you or painstakingly lead you yourself to admit aloud that, even if you were to stumble (or otherwise clutz everywhere), it's not going to physically be the cause of your death.  They can explain and expound that concept until they're blue in the face. 

Photo: Anastasiya Romanova

I'm sure most of us sufferers do actually realise that's the case on a logical level.  But knowing that on the logical level doesn't make the anxiety being experienced by the lizard brain miraculously go away.  (At least, it didn't for me.)


Don't get me wrong, I do realise that the above is very much an oversimplification and that therapy is a process; one isn't going to be 'cured' in just two sessions.  But I recall feeling such embarrassment in those therapy sessions, as though my perceptions of my daily stressors were being looked down upon or shamed.  And as a relative youngster embarrassment was most certainly not the kind of emotion which was going to encourage me to embrace or engage with any process.

I tried to seek a simple unstructured talking therapy or humanistic counselling, but back then in my area there appeared to be no such thing available (ironically, later on when I was a bit more mature and felt I could actually engage with CBT finally, all that was on offer in my area by then was the simple humanistic talking therapy!)

Photo: MIO ITO

So, having had such a negative reaction to CBT (and being just a really contrary person on a base level -- my mother would tell you, I should've been named Mary!) perhaps my becoming interested in a thing named dialectical behaviour therapy was a natural outcome.

I think DBT appealed to me when I heard about it because, a bit like Emotional Freedom Technique, you're "allowed" to focus on the negative thing you're experiencing as a part of the process.  With EFT, the first two steps of the process are to identify and focus on the issue which one's experiencing.  My brain can't help but ruminate on the issue, so it's nice when it's "allowed" (at least at the outset).

Photo: Steve Johnson

With DBT, the basic idea (in a very brief nutshell) is that two things can be true at once -- so at the same time there's anxiety and things suck, but with DBT techniques one can cope better with the anxiety and the sucking.

Although I'm being a bit flippant here for levity, I did ponder the merits of DBT for a while and concluded that I wished it were available where I live (though it wasn't a strong enough wish to seek out a private practitioner, since making finances stretch that far would have been very difficult, and (ha!) stress inducing).

I also read that the developer of DBT, Dr. Linehan, approaches her work from an approach based in spirituality, and there are aspects of Zen which have therefore come through into the DBT approach. So this was another reason for it to appeal to me.

Photo: Mitchell Luo

On the other hand, from what I've read latterly a large part of DBT involves regular group sessions.  Whilst I'm not at all opposed to group therapy, I've run up against this particular obstacle -of attendance being required- before and it's actually pretty prohibitive for me, in my circumstances.

Photo by Cris Saur

For example, I was offered a place at the chronic fatigue clinic (which was pretty exceptional, since you're only offered a place if you have a diagnosis of CFS and I don't actually have such a diagnosis). And I had to turn down the place since it involved weekly group sessions on weekday mornings.  I asked if there were places available on a weekend or evening session so I could fit my attendance around work (since I do somehow manage to work full time despite the fatigue).  But I was advised that their patients don't have the energy to attend sessions in evenings or on weekends.  And I get that...

Photos: kates.sade / Jesus
Hilario H. / Savannah Wakefield

...but for me, this would therefore have meant: taking time off work, travelling to and participating in the group session and then heading from there to work for the rest of the day.  Plus making up the time taken off work, at a later date (or else using my annual leave allocation to attend the clinic sessions instead of for R&R).  So, it was prohibitive for me.


And so I know that I'd find the group sessions involved with DBT prohibitive too, even if it were available where I live (which it isn't, so far as I can ascertain -- at least not on the NHS, anyway).  I'm aware there are various other types of therapy in existence, but I'm also aware that there's only limited NHS provision in my area and so far as I know it's CBT or nothing.

So for now it'll be neither CBT nor DBT (nor any other type of T); I'll be endeavouring to explore the world of emotional intelligence and healing independently (with the help of some of those apps I blogged about in my #4 post).  And I might just look into TAT (Tapas Acupressure Technique) before too long, too.  There may then be a blog post for that later in the alphabet if so, so watch this space.

Photo: Lesly Juarez

Resources


Websites

• https://behavioraltech.org/about-us/founded-by-marsha/ - developer of DBT

• NHS.uk

• Mental Health Foundation

• Mind

• Samaritans

Journal article(s)/specific webpages

• https://www.heretohelp.bc.ca/q-and-a/whats-the-difference-between-cbt-and-dbt

• The Course and Evolution of Dialectical Behaviour Therapy (American Journal of Psychotherapy)

• Mind DBT section

• Psychology Today item

Photo credits: all photos from Unsplash


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