kaberett | [DBT] Introduction

[I am using The Dialectical Behaviour Therapy Skills Workbook. DBT is a form of therapy that was developed by Marsha Linehan who would diagnose her 17-year-old self with Borderline Personality Disorder (CN for graphic discussion of self-injury, suicidality, and institutionalisation at that link).]

There are two intended audiences for The Dialectical Behavior Therapy Skills Workbook. The first is people who are in dialectical behavior therapy (either group or individual) and need a workbook to help learn the four key skills. We also wrote this book so it could be used independently by anyone who struggles with overwhelming feelings.

To the surprise of... approximately nobody, I proceeded to have a great deal of difficulty with the very first exercise. The introduction does a lot of modelling provision of appropriate validation (which means a different thing to my previous discussion on the topic, but I intend to write more about that having now significantly clarified my thoughts on the topic via discussion with

sebastienne), which I'm certainly finding interesting to read, but -- then this happens:

The Dialectical Behavior Therapy Skills Workbook is written to make learning easy. The hard part will be making the commitment to do the exercises and put your new skills into practice. Nothing will change by just reading. The words on these pages will have no impact on your life unless you implement--behaviorally--the new techniques and strategies you will learn here. So now is a good time to think about why you are reading this book and what you want to change. Right here, on this page, write down three ways you currently react to your emotions that you want to change. In other words, what three things do you do when upset or overwhelmed that are damaging--and that you are committed to replace with better ways to cope?

... and, well, I have a lot of problems with that framing. Starting with: please do not tell me what the bits I am going to find hard are (as opposed to suggesting what I might find difficult). The statement that "nothing will change by just reading" is a fascinating absolutism that I don't believe (and I'm supposed to be continuing to work on moving away from binary thinking!).

... and most importantly, I really am not happy with treating "three ways [I] currently react to [my] emotions that [I] want to change" as synonymous with "three things [I] do [...] that are damaging", because actually I have done a lot of work here already and I'm incredibly reluctant to unequivocally describe my massive progress and improvement as "damaging".

So I crossed out that sentence, from "In other words" to "damaging", and I decided I was going to modify the exercise, to (a) list three areas of progress I've already made that I'm proud of, and (b) list three things I'd like to improve further.

Which I found remarkably difficult, but what I came up with was this:

PRIDE
1. I'm proud that I'm getting so much better at noticing early-warning-sign type emotions, and identifying their causes.

2. I'm proud that I am managing to identify transient emotions as transient/unrealistic, even while in crisis, and that I manage to avoid treating them as persistent or accurate reflections of reality.

3. I'm proud that the amount of time it takes me to identify things that I can trust, and that would actually materially help, has significantly reduced over the past two years.

4. I'm proud that I'm getting better at trusting other people appropriately. (whoops an extra one)

IMPROVEMENT
1. I already do a pretty good job of identifying -- in the moment -- overwhelming and compelling emotions that are transient and do not reflect my stable understanding of the world, and consequently not actively acting on them. Currently I am managing 45 minutes of crying followed by 20 minutes of angry girl rock in the dark; ideally, I'd be able to ask for (and believe) immediate appropriate reassurance about my misinterpretation, rather than reacting to emotions of loneliness/abandonment/etc by accusing people (even internally) of not wanting me.

2. "This is my fault and I am bad; I should remove myself from people's lives rather than further inconvenience them by having needs/boundaries/panics." This IS a reaction to emotions -- it's feeling guilt and shame about having big, loud emotions that take up space at all.

3. I'd like to improve my emotional permanence -- to be able to reliably believe that people aren't dead/do still like me/etc. It's great that I've reduced the frequency with which I request reassurance, and it's great that I'm mostly able to act on knowledge rather than belief, but... now I'm getting stuck because I think what I'm actually doing here is wishing the emotions away rather than validating them, because my current reactions to said emotions are pretty much ideal, I think, taking as read that The Emotions Are Going To Happen And Aren't Inherently Bad.

3a. Hmm. Shall we try this one again? Okay: not thinking I have to give up on academic things/I'm inherently a failure because I'm struggling with something, or at least, improving my resilience to that and my ability to self-soothe on it. (I think this is importantly different from point 2, because it's about a context not about a people.)

... which was hard work not just because of coming up with the items, but because I was having to self-soothe about the second-guessing about, basically, Being Non-Compliant: if I resist the exercises, or refuse to do them, or rearrange them to make them more comfortable, am I actually going to make any progress? Is this arrogant self-sabotage?

And I think the answer is: no, I'm thinking carefully and critically, and taking into account the fact that the target audiences for this book are people who (a) are allistic, and (b) have done much less prior work/reading/research than I have.

This conclusion is supported by the part where, 18 pages later, the book says that one of the basic distress tolerance skills you can use is in fact temporarily removing yourself from the situation while you calm down enough to deal with it constructively -- and I don't think it's fair or reasonable to ask me to describe as unequivocally damaging a behavioral modification they actively suggest as being "sometimes the best thing you can do". Like: I don't think it's ideal, not least because of its intersection with other people's problems, and I do want to get better and handling it in specific identifiable ways, but I... am glad I trusted my gut on balking at, as I say, explicitly calling out as "damaging" a behaviour about which they later say "Sometimes the best thing you can do is leave."

Of course I'm still second-guessing myself about non-compliance, but (I'm most of the way through chapter 1 and will write that up next, though possibly not today) again, I think -- this is yet another thing where I'm a weird edge-case, and I'll make much more progress with sensible adaptations to my actual situation than I will gritting my teeth and doing exactly what the book tells me to. I am going to check in about this with my counsellor (which feels a bit like asking an external authority for permission to trust myself, but is actually, I think, rather closer to asking an expert to check I'm not barking up completely the wrong tree) when next I see them, is the plan.

But to start with: I am proud of myself for sticking with this exercise, even though it was difficult, and for genuinely trying to think through both reasonable adaptations and my answers -- and for spotting when an answer I was writing boiled down to "I want to stop having these emotions", which is not even remotely the point.

First steps.

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From:

davidgillon

It sounds to me like you are taking an extremely sensible approach. As you've identified, you aren't typical of this book's target audience, being both neurodiverse, and having a degree of self-introspection/analysis/understanding that's extremely rare. It's written for someone who isn't you, and modifying it to fit is entirely appropriate.

It's no different than listening to a physio telling you 'You need to do X', while not listening to bendy specifics, and modifying it to X* when you get home to take account of individual needs. I've certainly done that, and I've no doubt you will have as well.

And as you say, it's taking a rather absolutist, binary approach to things it wants you to do, whereas the description of Marsha Linehan's work in the article seems much more about adapting to meet the patient half way and then working from there.

And if it does turn out a variant approach you take isn't entirely working, then you get to learn from that and try again. This isn't something with wrong answers, merely answers you learn greater or lesser amounts from.

Remember, non-compliance is a social skill ;)

I think you should be deservedly proud, and it's good to see you writing about stuff again.

From:

shehasathree

Hah. *offers high five of solidarity*
I have been (very very slowly) working through this with my psychologist who specialises in working with autistic women and girls, and there are definitely things in it that i find helpful. And yeah, turns out that actually doing the exercises works better than knowing about how they're supposed to work; go figure. I still take offense at that framing of the first exercise for exactly the reasons you have a problem with it, and a lot of the exercises i literally cannot do until i have corrected and qualified the framing or other assumptions, or figured out how to get at the essence of what the exercise is trying to do, and tweaking it for my bodymind.

It's sort-of a black-and-white perfectionist thing, because I need things to be CORRECT, or ...at least not empirically incorrect? But otoh, what that generally means, in practice, is "screw your oversimplification, imma fix this by modifying [in x, y and x ways]. Ooh, now it works! \o/".

So ... yeah. *all the solidarity*

<333

From:

kaberett

yeah I am doing a LOT of correction, and skimmed the PDF and then realised I genuinely did need to drop £15 on a physical copy so I could SCRIBBLE REMARKS IN IT (it's okay to write in books in pencil if they were explicitly bought for the purpose, you see) -- but, yes, thank you SO MUCH for the solidarity, and for the feedback that your trained professional thinks this is a sensible approach for you/us to be taking, and so on. yes. thank you. <3

only by balancing move

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