Dialectical Behavior Therapy

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Elisa Engman

Navigating Relationships When You Have Borderline Personality Disorder

As I watch the back of my friend disappear into her house, the familiar claw of panic at being alone grips at my chest. My heart is being squeezed into a syrup-like liquid, and my throat is being strangled by an invisible hand. Struggling to get my body to listen to me and put the car in reverse, I hear the familiar “chirp” from my phone that indicates I have a new message awaiting my inquisitive eyes. Prying my hand off the steering wheel, I sneak a quick, but illegal glance at my phone as I’m racing back home. It’s a text from my friend! I have to check this and make sure that she doesn’t hate me and never wants to see me again. I don’t know what I would do if that were the case. Having a moment of clarity during this cascade of thoughts, I wonder if I am having a borderline personality disorder (BPD) episode or if I am being rational. As I conclude that I am being both logical and rational, I ponder checking my phone and decide the doing that wouldn’t hurt anybody and that I should do it. With trembling hands, I unlock my phone, open my texting app, and read what she sent me, “I had so much fun today! We HAVE to get together again sometime soon!!” Just reading that quick text makes my blood run cold. Does she really think that I don’t know she is lying? She hates me and this is the proof. I know she is just texting me like this to make me feel better about how she will eventually drop me out of her life completely. Suddenly, as if coming out of a daze, I notice how my face is dripping with tears and my nose is filled with salty snot. Chucking my phone down on the passenger seat, I hear a crash as it falls to the floor. Then almost as suddenly as I noticed I was crying, I go numb. My body feels foreign, and alien and my emotions are nowhere to be seen. Luckily, I am used to this happening to me and am able to make it home safely. Parking my car in the detached garage, I catch a glimpse of somebody in my rearview mirror. Not recognizing who they are and not knowing their intentions, my emotions start to return, and my chest is clutched by my overwhelming panic again. Sure, this panic has a different source than my earlier panic, but it still feels like an elephant is trying to murder me by sitting on my body. Swinging around in my seat to catch the perpetrator in action, I am struck with a lightning bolt of realization that the stranger is actually me. Swearing at myself and my “crazy” brain, I seize my backpack and mope up the path to my house as fast as my legs let me. As soon as I get inside, I let the white-knuckled grip loosen on my bag and let it tumble to the ground in the middle of my food and dirty dish covered kitchen. Suddenly recalling what started this failure of my emotions, I yanked my previously thrown phone out of my pocket with so much force it almost flew out of my hand. After running up the slippery stairs and diving under the covers on my grimy bed, I unlock my phone and read that terribly mean text again. I’m about to send my best friend in the world a text telling her that I never want to see her again and how I know that she hates me, when I begrudgingly decide to try a dialectical behavioral therapy (DBT) skill before possibly ruining my life. When I first started DBT, I thought it was stupid and only for other people, but as I have been in more and more of these merciless DBT groups, it has started to actually help me. As I make the agonizing walk to the bathroom to take a cold shower, I pull up my favorite playlist to listen to on Spotify while I’m showering. It’s called “Work Drive Tunes” because that is what I made it for, but in reality, I listen to it all the time. It’s full of music with lots of loud drumming and screaming singers, but it always makes me feel better and more in control of myself. Singing and screaming along to these songs while feeling my body be hit with the frigid water, I can feel the tension mix with the water flowing around my body and going down the drain. As I step out of the slippery shower, I reach for my mistreated phone. Opening my text messaging app, I start to type out a reply “OMG I had so much fun also! When are you free next because we need to hang out again soon!!!” Putting on the clean clothes I set out for myself, I think about how I almost ruined my relationship with my best friend due to my BPD. During this, I feel the almost daily occurrence of shame eating me alive. My brain and heart are almost completely devoured when I remembered to try a DBT skill. Piloting my numb body back towards my bed, I pull up a random and mindless game on my phone to distract myself from my distress. Curling up under my blankets, I thought about how I will have BPD for the rest of my life, but I proved to myself and others today that I can cope with the emotions and actions it causes.

Community Voices

Stupid little crisis plan

Today my therapist and I created a shared google doc and began outlining a crisis plan starting by identifying where my baseline is and working up in distress from there. But like, I kind of don’t want to use it… Using it takes effort and a general desire for my well-being. And I don’t really think I’m worth that effort anymore. As long as I just make it through the semester without totally failing my classes, why does it matter how I coped to make it through? It’s stupid but I’m mad about the crisis plan, I don’t want one, I don’t want to fight myself anymore. I’m too done to care. Sure, no one can make me use it. But I feel like I have to because 1) if I continue not to my therapist might have me hospitalized and that’s not happening 2) if my brother or other family members found out I’ve turned back to selfharm it would really stress them out and I don’t want to be a burden to them. So now I have a crisis plan, and a promise that I will try my best to use it and thereby prevent or at least significantly reduce any future relapses. But honestly I’ve lost sight of what the big deal is, I’m not trying to kill myself. Isn’t that enough?

#Selfharm #CrisisPlan #MentalHealth #CollegeMentalHealth #Therapy #DBT #DialecticalBehaviorTherapy #Anxiety #Depression

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Caitlyn MC

Using Dialectical Behavior Therapy Skills Coaching to Ask for Help

I have been in many forms of treatment, on and off, over the last decade. Dialectical behavior therapy (DBT) is the only therapy I am aware of that offers the unique component referred to as “skills coaching.” To my surprise, “skills coaching” is a missing ingredient in my recovery, one I wish I had access to years before I knew what DBT was or I even had a diagnosis. Coaching would have helped me prevent suicide attempts, impulsive actions, and self-harm. Coaching would have also helped me to not make a bad situation worse and could have empowered me to create a focused plan to skillfully manage many hard days. While I cannot go back, I can share part of my story and encourage others to consider DBT skills coaching as part of their recovery plan — especially if they’ve already discussed it with a professional. In dialectical behavior therapy — a common treatment for  b orderline personality disorder (BPD) — there are usually three components: a skills group, one-on-one psychotherapy, and skills coaching. Depending on where you are located, you may just be able to receive a skills group. Other DBT options include one-on-one psychotherapy only or access to all three parts of DBT. A few months ago, I went back to DBT, which for me includes bi-weekly one-on-one therapy, and more recently, using skills coaching as needed. I also take a psychoeducational DBT class online. Coaching is unique to DBT. It is not therapy, and it is not a crisis line. It is not access to a soothing voice when you experience feelings of emptiness either. DBT skills coaching is caring, but it is also very practical, clear, and intentional on the part of both the client and therapist. For example, when I call, I am asked “What skills have you already tried?” I am accountable to having first tried my best to be skillful before placing the call. From my understanding, the purpose of skills coaching in Dialectical Behavior Therapy is to help the client act skillfully in the moment, generalize DBT skills to where they are needed most, and prevent self-harm and other destructive behaviors. Skills coaching creates an opportunity for the client to use skills when they are most needed in order to prevent a negative outcome. As a DBT client, I have grown to view skills coaching not as a defeat but instead as empowering. No one is forcing me to call. It is my choice — I am choosing to reach out. I have tried skills on my own, and I am accepting help, which is a sign of strength and hope. Skills coaching involves being clear about my goals, for example: not quit a job or refrain from drinking or self-harm when experiencing intense emotions and harmful urges. Coaching also focuses on what I will do instead — what is possible today, right now, to stay safe and cope effectively with hard experiences. In skills coaching, we focus on what I can do. Making that call is tough. It means acknowledging that I cannot figure out how to manage alone anymore. However, by calling, I am also following through on my commitment to being skillful and staying alive. For me, this shift to seeing coaching as empowering is about letting go of my need to do it “all by myself” when that could lead to further problems. Sometimes I can manage alone, and that is OK, and sometimes I cannot manage alone, and I need skillful support. In those moments, I need DBT coaching, and that is OK too. DBT skills coaching can happen anywhere. For example, I recently had coaching in my car while parked in a parking lot! In coaching, we come up with a plan that I can agree to follow through after the call. The plan uses DBT skills I have learned. This doesn’t mean solving all my problems and feeling great, but it does involve me feeling “better” than when I first made the call, and I leave the call with confidence that I can accept my feelings and change what is possible for the day. This has been my recent experience with coaching. It is hard for me to ask for help. It feels challenging for me because I believe sometimes that I always “should be” thriving and “happy” after so much therapy and hard work. When this thought emerges, I remind myself that recovery is a journey, not a “target.” In my view, recovery is not something we achieve. Recovery is how I live and make meaning. Part of recovery is validating what I need, having awareness of my personal limits, and knowing the value of asking for support. I am grateful that DBT includes skills coaching. It makes sense — life doesn’t stop happening when a session is over or a group ends. Calling for DBT skills coaching is not defeat — it’s a chance. Making the call is a chance to act compassionately towards myself by taking steps to improve the struggle I feel now and make choices I won’t regret later. Asking for what I need to get through a crisis is about not giving up on myself. I deserve to have hope and ask for help, and so do you.

Andrew Lampe

How Radical Acceptance Helps Me Accept My Life With BPD

This morning I journaled a really difficult, painful week. Instead of simply doing a recount of events, people, and problems, I decided to try to write from where the pain was really coming from. I took inspiration from a New York Times article on Marsha Linehan’s own personal experience of the most unbearable psychological pain caused by “the gulf between the person she wanted to be and the person she was [which] left her desperate, hopeless, deeply homesick for a life she would never know. That gulf was real, and unbridgeable.” And this is what I came up with about my own 10 current gulfs which also left me desperate, hopeless, and desperately homesick for a life I don’t know: 1. The gulf between who I wanted to be and who I actually am. 2. The gulf between my vocation and my calling. 3. The gulf between the loving romantic relationship I wanted to be in and its absence. 4. The gulf between my gifts, personal magnetism, and my condemnation of my worth. 5. The gulf between my attractiveness and how deeply unattractive I feel. 6. The gulf between the strength of my feeling for others and the strength of their feeling for me. 7. The gulf between how easy things appear for others and how excruciating they are for me. 8. The gulf between the impact I want to have and the tepid response I get. 9. The gulf between the validation I am desperate for and the invalidation I have received in my past. 10. The gulf between how I appear and how I am. Where does the gulf come from and how did it develop? I can’t speak for others who experience such a gulf but for me, my answer is twofold. This past week, a message from my ex-boyfriend catapulted my gulfs back to the surface and made the pain overwhelm me. While the pain of a breakup is nothing to be messed with, the real source of the gulf between who I wish I was and who I feel I am goes much further back. I have previously written about the sources of my unstable sense of self and abandonment. I believe the shameful invalidations from some of my childhood and my difficulty reconciling my gay and Christian identities certainly are at play here. They created defectiveness and shame at my very core at crucial developmental times. So as a young adult when setbacks happened, where my dreams were not immediately actualized, I reacted in a very all-or-nothing way, with all being the realization of my dreams and nothing being a pervasive sense of failure and the manifestation of my core gulf. This setback interpretation and reaction led to my first episode of depression and undiagnosed borderline personality disorder (BPD). Much later, when I read about schema therapy, I immediately recognized the maladaptive core belief schema of unrelenting standards as being a further cause of the irreconcilable gulf. The gulf between what I wanted to achieve and had not achieved was severe and punitive — another maladaptive core belief. The quotation from the movie “Magnolia” rings true: “We may be through with the past but the past ain’t through with us.” What is the best way to treat the gulf? It is no accident that Marsha Linehan designed a therapeutic technique for people who experience such gulfs rooted in her own experience while locked up in a secluded hospital unit, self-harming and wanting to die, so devastating was the gulf in her own life. For me, the dialectical behavior therapy (DBT) skill that most directly addresses the gulf is radical acceptance. When I did DBT, it was the skill that I found the toughest but also had the most profound results unlocking the most breakthroughs. It went to the center of many of my wounds. And with the gulf of imagined versus reality, it goes right into the wound’s core. Through skills such as turning the mind, letting go of past wrongs or devastations, and willingly coming into the now by accepting the present moment, the gulf between two states can be addressed. It is guaranteed to be painful, you may be kicking and screaming against accepting the now for what it is, not for what you wished it was. And you may also be kicking and screaming to let go of your idealized view of who you were in the past, or alternatively the past dream of what your current reality would be. You have to let go of how you imagined your life would turn out and accept that your life is a very worthy life as it is now, and even that it could get better. Here is how I would apply radical acceptance to my current gulfs: 1. Gulf between who I want to be and who I actually am. This is tough! I want to be more successful in my career. I want to suffer less and be less reactive. But who I currently am is a beautiful thing too. 2. Gulf between vocation and calling. Certainly, there is a gulf between what I am currently doing and what I want to be doing. But let go of pity and take steps toward that calling in the now, even if it is tough in the beginning. 3. Gulf between a romantic relationship and being single. It takes time to heal past hurts. And then, when ready, try again. It is still possible. 4. Gulf between gifts, talents, personal magnetism, and my condemnation of my worth. Again, this is so tough to overcome that punitive self-critic. But give grace, be forgiving, focus on the affirmations of others, and do not discard them. Read them again. Accept all compliments. Challenge your punitive critic and expose him for the judge he is and the lack of evidence he uses. 5. Gulf between attractiveness and feeling unattractive. Many people comment on this about me and yet I often look in the mirror and can’t connect with what I see. I also counter that we as a society focus too much on physical attractiveness. Again, accepting affirmations and compliments from others is crucial. See ourselves the way others see us. 6. Gulf between my feeling for others and their feeling for me. This is classic BPD and can easily lead to splitting on loved ones if we are not self-aware. Again, we need to give people grace and the consideration that people’s depth of feeling for us may be as worthy as ours for them. Also, it is not a competition. 7. Gulf between things being easy for others but excruciating for me. This is easy to dispel. How do we really know how things are for others when still in most societies we are discouraged from saying how we really are? And what about those who are desperately unhappy but cannot bear to be vulnerable with anyone? Most people are struggling. 8. Gulf between the impact I want to have and the tepid response I get. Full disclosure: Sometimes I feel like this with my published Mighty articles. For a time, I will feel validated by the comments and likes but then other times I feel that if I had written and published a book, I would have had more impact. The solution is to keep writing for myself and keep doing whatever it is you love for everyone else. 9. Gulf between the validation I am desperate for and the invalidation in my past. This needs radical acceptance. We must deal with our past invalidations, for sure, but then we also need to let go of them, to the extent we can and come into the present to open ourselves willingly to receive new validations. 10. Gulf between how I appear and how I am. This is really difficult and not limited to BPD . The way we present a good, happy, brave face to others versus the deep pain we are in privately. I still really struggle with this. In fact, when I was in the hospital recently, I was told I was always so perky, which showed me I still have this gulf. The main solution is to try and show more how we really are or answer really honestly when someone asks how you are or how your day has been, especially if they are wanting to genuinely know.

Community Voices

Hi everyone,
I have borderline (bpd) and I’ve been doing some serious work but I only meet with my therapist once every 2 weeks. I’m on my own.
I have brought up memories of things my mother did to me when I was growing up. I blocked them, probably because I have needed her in my life codependantly. We’ve been close. She’s the first one I called when I was diagnosed with cancer.
I don’t want to talk to her right now, maybe never again. But I’m aware of my black and white thinking and dialectics.
I was just about to block her cell number when I decided to reach
I’m alone with my crazy head. I don’t have any friends to talk to ( I don’t do relationships) so this is the best option.
Does anyone know what I should do? I am open to anything and I would appreciate it so much.

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Community Voices

Therapy Thursdays

<p>Therapy Thursdays</p>
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Community Voices

Let's talk about therapy. Ending the stigma by having the conversation.

<p>Let's talk about therapy. Ending the stigma by having the conversation.</p>
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Community Voices

Done with DBT groups #CheckInWithMe

I decided to leave the DBT group I signed up for a few weeks ago. And for weeks it’s started later than it should and a few participants were very triggering and annoying. It’s hard when you’re doing it via Zoom because of the technical issues and not everyone can hear each other. I was sick of how unorganized it was so now I’ve decided to find a therapist who can help me re-learn the skills again in person and without the aggravation.

#MentalHealth #Anxiety #Depression #DialecticalBehaviorTherapy

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Community Voices

Long, difficult weekend

On Saturday, I had a psychiatrist appointment over the phone. I spent the entire morning preparing, making sure I was physically taken care of, mentally and emotionally calm, using my breathing techniques, and had all my notes and safety objects around me. He called, assessed me, and it was over. He concluded that I "don't have a psychiatric disorder", which I think is an oversimplification but it is the answer I was looking for. I need my medical charts to focus on my yet-to-be-diagnosed physical health symptoms, not the already-managed mental health symptoms, and this is a great first step towards that.
[In reality, I experience symptoms of #CPTSD every day, but due to effective practicing of skills, the psych assessed that this no longer causes me significant dysfunctioning, and therefore he considered me clinically well.]
The emotional aftermath of this appointment was incredibly messy, with initial intense excitement, followed by paranoia about being "found out" (for what I'm not clear on), followed by an extreme exhaustion. I had trouble falling asleep, experiencing panic while lying in bed, as I often have in the past.

Then yesterday I saw my mom. It was another emotionally draining experience. I have to practice deep listening and loving speech so carefully, and use meditative thought to protect myself from emotion or concepts that have the potential to cause me harm. It is better, both in the moment and in the end, than the alternative, but exhausting work nonetheless. I woke up twice in the night with racing heartbeat and panic feelings.

I have also started cutting back on my medication recently. Although I've experienced a lot, I believe my increased difficulty at night has more to do with the dosage change. I have a lot of trouble at night during the winter, when the daylight is so scarce, so I have tools I can use when I'm not sleeping well. I can ask my roommates to bunk with me, use aromatherapy, set a bedtime routine, and I have a bedtime medication I use sparingly. If I'm up in the middle of the night, I can meditate, read, play or watch one of my safety games or shows, come on The Mighty, and I can get my roommates if I need help calming down. All that being said, I'm hoping my nights improve as my mindbody adjusts to the lower dose of meds and I continue to practice my skills.

#Meditation #CognitiveBehavioralTherapy #DialecticalBehaviorTherapy #5MindfulnessTrainings #Selfcare #CommunityCare

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Community Voices