#dbt skills training

[hauntedselves]

DEAR MAN: Making Yourself Heard

This interpersonal effectiveness skill helps you assert your boundaries, and get yourself heard and understood.

D: Describe

Describe the current situation (if necessary). Stick to the facts. Tell the person exactly what you are reacting to.

Example: “You told me you would be home by dinner but you didn’t get here until 11.”

E: Express

Express your feelings and opinions about the situation. Don’t assume that the other person knows how you feel.

Use phrases such as “I want” instead of “You should,” “I don’t want” instead of “You shouldn’t.”

Example: “When you come home so late, I start worrying about you.”

A: Assert

Assert yourself by asking for what you want or saying no clearly. Do not assume that others will figure out what you want. Remember that others cannot read your mind.

Example: “I would really like it if you would call me when you are going to be late.”

R: Reinforce

Reinforce (reward) the person ahead of time (so to speak) by explaining positive effects of getting what you want or need. If necessary, also clarify the negative consequences of not getting what you want or need. Remember also to reward desired behavior after the fact.

Example: “I would be so relieved, and a lot easier to live with, if you do that.”

M: stay Mindful

Keep your focus on your goals. Maintain your position. Don’t be distracted. Don’t get off the topic.

“Broken record”: Keep asking, saying no, or expressing your opinion over and over and over. Just keep replaying the same thing again and again.

Ignore attacks: If another person attacks, threatens, or tries to change the subject, ignore the threats, comments, or attempts to divert you. Do not respond to attacks. Ignore distractions. Just keep making your point.

Example: “I would still like a call.”

A: Appear confident

Appear effective and competent. Use a confident voice tone and physical manner; make good eye contact. No stammering, whispering, staring at the floor, retreating. No saying, “I’m not sure,” etc.

N: Negotiate

Be willing to give to get. Offer and ask for other solutions to the problem. Reduce your request. Say no, but offer to do something else or to solve the problem another way. Focus on what will work.

Turn the tables: Turn the problem over to the other person. Ask for other solutions.

Example: “How about if you text me when you think you might be late?” “What do you think we should do? . . . I can’t just stop worrying about you [or I’m not willing to].”

More tips

Describe the current interaction.

If the “broken record” and ignoring don’t work, make a statement about what is happening between you and the person now, but without imputing motives.

Example: “You keep asking me over and over, even though I have already said no several times,” or “It is hard to keep asking you to empty the dishwasher when it is your month to do it.”

Not: “You obviously don’t want to hear what I am saying,” “You obviously don’t care about me,” “Well, it’s obvious that what I have to say doesn’t matter to you,” “Obviously you think I’m stupid.”

Express feelings or opinions about the interaction.

For instance, in the middle of an interaction that is not going well, you can express your feelings of discomfort in the situation.

Example: “I am sorry I cannot do what you want, but I’m finding it hard to keep discussing it,” or “It’s becoming very uncomfortable for me to keep talking about this, since I can’t help it. I am starting to feel angry about it,” or “I’m not sure you think this is important for you to do.”

Not: “I hate you!”, “Every time we talk about this, you get defensive,” “Stop patronizing me!”

Assert wishes in the situation.

When another person is pestering you, you can ask them to stop it. When a person is refusing a request, you can suggest that you put the conversation off until another time. Give the other person a chance to think about it.

Example: “Please don’t ask me again. My answer won’t change,” or “OK, let’s stop discussing this now and pick it up again sometime tomorrow,” or “Let’s cool down for a while and then get together to figure out a solution.”

Not: “Would you shut up?” “You should do this!”, “You should really calm down and do what’s right here.”

Reinforce.

When you are saying no to someone who keeps asking, or when someone won’t take your opinion seriously, suggest ending the conversation, since you aren’t going to change your mind anyway. When trying to get someone to do something for you, you can suggest that you will come up with a better offer later.

Example: “Let’s stop talking about this now. I’m not going to change my mind, and I think this is just going to get frustrating for both of us,” or “OK, I can see you don’t want to do this, so let’s see if we can come up with something that will make you more willing to do it.”

Not: “If you don’t do this for me, I’ll never do anything for you ever again,” “If you keep asking me, I’ll get a restraining order against you,” “Gosh, you must be a terrible person for not doing this / for asking me to do this.”

- from DBT Skills Training Handouts and Worksheets (2015) by Marsha M. Linehan, pp. 125-7.

[borderline-clusterfxck]

DBT SKILLS: INTERPERSONAL EFFECTIVENESS Part 2/7: Intro to Assertiveness

Part one

Part two

What are the benefits and skills of learning how to be assertive?

Knowing what you want: learning how to identify what you want, your desires and your objectives

Being able to ask for what you want: learning how to put your needs into words that are clear, non-demanding, and how to ask for specific change

Negotiation: learning how to be open to compromise, ensuring that each person involved gets some of what they want and no one feels as though the other is being unreasonable or demanding

Acquiring information: learning how to find out what the other person needs, their fears and hopes for a situation or request, etc. 

Saying no effectively: learning how to say no in a way that feels respectful and reasonable, and in a way that still validates the other persons desires while setting firm boundaries around what you will and wont do

Acting according to your values and boundaries: learning to set positive intentions and goals and acting accordingly to what you wish to achieve

How to figure out what you actually want

Step one: identify the relationship of concern: who are you currently having an issue with or needing something from?

Example: Sebastian realised that something felt off in his relationship with his mom

Step 2: identify what emotion(s) you are feeling towards the person and/or situation

Emotions are not inherently good or bad, rather there are emotions that are comfortable and pleasant to experience and emotions that are uncomfortable and painful to experience. When we are having an issue with someone, when we need or want something we aren't getting, etc, we are usually feeling an uncomfortable emotion. The list below may be able to help you identify what emotion(s) you are feeling

Comfortable emotions:

Satisfaction 

Excitement

Love / affection 

Sexual attraction 

Contentment 

Joy

Pleasant anticipation

Interest 

Satiety 

Uncomfortable emotions:

Anxiety [for the future]

Fear [of something now]

Anger / frustration / annoyed 

Resentment / jealousy / envy

Sadness

Grief / loss

Hurt 

Anger or disgust with oneself

Embarrassment / shame

Guilt 

Yearning / deprivation 

Loneliness / emptiness 

Example: Sebastian, after looking at the above list of emotions, realised that the emotion that seemed closest to what he was feeling was hurt, with a close seconds being resentment

Step 3: identify your objective/what you want or need

What does this emotion make you want to change about the current dynamic of the relationship? More specifically, what behaviour(s) of the other person would you like to see changed?

Do you want them to do more or less of something?

Do you want them to stop doing something all together?

Do you want them to start showing a new behaviour that could make a difference in how you feel? 

Example: Sebastian could tell that his emotions were in some way related to his moms upcoming visit. His mom planned to come to town for ten days with her new spouse, and in that week and a half time period, she had only asked to schedule a single dinner with Sebastian. He realised that he felt hurt and resentful because he felt as though his mom didn't care about him or wanted to see him as often as he wanted to see her. He wished that his mom would reach out more often to plan times to see each other when she came to town

Step 4: Clarify what you want further

When, where, and how often do you want to see this change?

What exactly would this changed behaviour look like? In what way would this behaviour be expressed?

Example: Sebastian came to the conclusion that he would like to see this change the next time his mom comes to town. For every week that his mom is in town, Sebastian would like to be included in activities at least twice, whether that means having lunch or dinner together and visiting or going out to do something in town. This behaviour could come in the form of his mom calling him or sending a text or email to invite him to something, or a phone call discussing possible plans and ideas of things they could do together

Step 5: Put your thoughts, feelings, desires, and expectations into a few simple, clear sentences

Example: Sebastian simplified his desires into the following: “when my mom comes to town, I would like to see her more often and for her to reach out and include me in activities more often, at least twice for every week she is visiting. I would prefer that she call me, but I am also open to receiving invites or scheduling questions by text or email

How to ask for what you want – the skill of making a request is necessary to taking care of yourself

Step 1: offer a brief justification [OPTIONAL]

Offering a short and simple justification for your request can help the other person understand the impact of the request and what the impact of their help with said request might look like

Some examples of justification: “it’s really hot in here”, “these bags are really heavy for me”, “it’s a long way to walk”

Many situations do NOT need justification, and you shouldn't feel obligated to justify every single request you make; when you do offer a reason/justification, keep in short and simple

Step 2: softening statements

A softening statement can help establish you as a reasonable person who is polite and non-demanding. Generally, you are less likely to encounter resistance when using these methods than with a hard-edged demand

Some examples of softening statements: “can you please help me with…”, “would mind if…”, “I’d appreciate it if you would…”, “could I please have…”, “It would be helpful if you could…”

Step 3: have a simple, specific, and direct request or question

Say what you want clearly and exactly – do not tiptoe around the request out of fear of inconveniencing others, and do not make demands. Try your best to use a polite but matter of fact tone

Keep your question or request short, one sentence if possible – generally, the more you elaborate and explain, the more resistance you'll tend to run into

Step 4: If the other person does fulfil your request, make sure to thank them and [optionally] add an appreciation statement

We all know what it feels like to feel as though our efforts are not appreciated, so its always a good idea to express your appreciation when someone does what you've asked of them. 

Appreciation statements help reinforce the other persons behaviour and it makes them feel valued and lets them know you appreciate what they are doing for you

Some examples of appreciation statements: “I really appreciate your help”, “Thank you for your effort”, “This will really help me out”, “This is going to make my life/time a lot easier”, “This will make a real difference”

Know your legitimate rights

A common issue some people face when it comes to being clear and specific about your desires and requests is that it brings up a lot of anxiety and fear. Unfortunately, lots of people grew up in families that invalidated their needs and made them feel less than for having desires. All their lives, they feel scared to ask for anything, as if it makes them bad people for needing or wanting things, as if they are undeserving or selfish, or as if their feelings and pain have no importance.

You have a right to need things from others, and to express those needs to others

You have a right to put yourself first when you need to

You have a right to feel and express your emotions or your pain

You have a right to be the final judge of your beliefs, your feelings, your needs, and your abilities

You have a right to your opinions and beliefs

You have a right your experiences – even if those experiences are different from others

You have a right to feel differently about an experience than other people who have had the same or similar experiences 

You have a right to protest treatment or criticism from others that feels bad to you

You have a right to negotiate for change

You have a right to ask for help, emotional support, or anything else you need (even though you may not always get it)

You have a right to say no – saying no doesn't make you bad or selfish

You have a right to not justify yourself to others

You have a right to not take responsibility for someone else's problems

You have a right to choose not to respond to a situation

You have a right, sometimes, to inconvenience or disappoint others

And the reason you deserve all of these things is that you are a human being who feels, who yearns for things, who hurts, who struggles, who has needs, who is alive. All of this entitles you to being heard and being respected

Disclaimer: I am not a professional, nor am I qualified to give you an official DBT Skills Training Unit. I’m just some guy with BPD who found DBT very helpful and so I want to impart those same skills onto as many of my fellow BPDers as I can. Should go without saying but this blog DOES NOT count as an official Skills Training Unit.

[pdbti]

Are you a therapist who provides phone coaching within a comprehensive DBT program? Or a client who has received phone coaching within a comprehensive DBT program? We want to hear about your experiences! PDBTI is collecting data on phone coaching practices, experiences of workload, and general demographic information. Our hope is this study will provide useful information for guiding programs in making decisions around phone coaching policies, particularly around balancing clinician workload with client skills generalization. 

We estimate the survey will take approximately 15-20 minutes. All responses are confidential and anonymous, and no information will be published that could identify you from your individual responses. Eligible participants will have the option of being entered in a lottery to win a $100 gift card. If you are a client and wish to participate, please visit https://www.surveymonkey.com/r/S28Y3TZ

If you are a therapist and wish to participate, please visit https://www.surveymonkey.com/r/LMSDKRZ

For more information, please feel free to reach out to us!

[upfromtheashessurvivorsblog]

A quote from my DBT Workbook:

"Do not engage in unneeded apologetic behavior. Do not apologize for having an opinion or for your own viewpoints. You are allowed to disagree. Do not apologize for being you. Avoid apologies for things over which you have no control." - The Expanded Dialectical Behavior Therapy Skills Training Manual by Lane Pederson with Cortney Sidwell Pederson

Just thought you ought to know that you do not need to apologize for being human :)

[reasonsforhope]

Workbooks to improve executive functioning

Since the post I made last night about improving executive functioning was so popular, I figured I should pull these out of my comments and give them their own post, in case it's helpful for people.

I have worked with the publishers of all of the books linked below and can vouch for their psychology books. The publisher of most of them, New Harbinger, is an extremely credible evidence-based psychology publisher.

Obvious disclaimer that everyone's brain is different and what works for someone else may not work for you.

Is there evidence that executive functioning can be improved? Yes. This book appears to be a very thorough overview of the field, and contains both advocates and detractors of cognitive training, for a balanced perspective. From the table of contents, I would really recommend jumping straight to Part 3: Developmental Perspectives for executive functioning (EF) writ large.

Certain therapy modalities are specifically designed for skill-building in areas like impulsivity, decision-making, emotional regulation, and cognitive flexibility, all of which are EF skills or very dependent on EF skills. Dialectical Behavior Therapy (DBT) is probably the best field to look at for these - skill-building in those areas is its core goal.

Some DBT workbooks:

The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance

The Dialectical Behavior Therapy Skills Workbook for Teens

There are also a lot of workbooks for ADHD that are sometimes more broad but also can help with executive functioning:

The Adult ADHD and Anxiety Workbook: Cognitive Behavioral Therapy Skills to Manage Stress, Find Focus, and Reclaim Your Life

The CBT Workbook for Adult ADHD: Evidence-Based Exercises to Improve Your Focus, Productivity, and Wellbeing

The Neurodivergence Skills Workbook for Autism and ADHD

General executive functioning workbooks:

The Executive Functioning Workbook for Teens

Executive Functioning Workbook for Adults: Exercises to Help You Get Organized, Stay Focused, and Achieve Your Goals

Hope these are helpful to someone!!

[growing-home]

i spent nearly two decades of my life severely depressed and suicidal and for so long i believed wholeheartedly that it was my fault. i believed that the reason no medication or therapy had ever worked for my depression was because i wasn’t ACTUALLY depressed— i believed i was just lazy, bad, manipulative, and just using depression as an excuse for the inherent badness i thought was inside me. this was a story that was told to me and reinforced over and over again by treatment providers.

this past summer, i tried my 30th+ psychiatric medication, not expecting to see any results. the day i realized it was working was the day i realized that i was…planning my future???suddenly i no longer wanted to stay in bed all day and never go outside. i no longer wanted to isolate. i wanted to see people, talk to people! i started spending more time with friends and facetiming people and talking on the phone, things that i rarely did in the past. when i had been depressed, the only movies/tv shows i could focus on were super intense, fast paced, and scary or disturbing because that was the only way to hold my attention. after starting this medication, i started enjoying SITCOMS! i no longer felt like i was fighting to just get through every single day of my life.

there was such a clear and measurable difference in the quality of my life that i started to question why i believed that my depression had been my fault. it became very clear to me that a large part of my depression had been biological. i had not been lazy or bad. i had been sick. my brain was sick the same way other organs get sick sometimes. this brought up a lot of grief for me— grief for all the lost time that i’d spent trying to find something that worked, grief for how much pain i had been in for so long. but it also brought up sheer FURY at all of the therapists and psychiatrists who had treated me like i just wasn’t trying hard enough to get better.

i had been labeled treatment resistant, of course, and the only recommendations i had received after being given that label were TMS, Ketamine, and ECT. once i had tried all three with no success, i believed i was just a lost cause. i thought i was out of options. i was made to feel that way by so many treatment professionals. i was told that nothing was working because of my complex trauma and that once i healed from that then i would stop being depressed (as if it’s that easy to just fully recover from CPTSD!) i was told that i just needed to do more DBT, i just needed to live and breathe DBT skills and then i would get better, even though i’d done intensive DBT programs for years with no improvement to my depression. (yes, it helped me to change my behavior and quit self harm, but behavior change isn’t necessarily indicative of a change in mood. i could do all the right things all the time and still be in excruciating mental pain.)

i was told that i just wasn’t trying hard enough, or that i must have a personality disorder, or that i just needed to exercise more, or eat less, or eat MORE, or eat differently, or get a job, or get a dog, or do yoga, or acupuncture, or biofeedback, or find purpose in my life— psychiatrist after psychiatrist looked for something to blame everywhere but in the mirror. instead of admitting that they weren’t equipped to help me, they made me believe that it was MY fault i wasn’t getting better. and i believed them. for SO long, i believed them.

and now after finding a medication that works for me, i see everything so much more clearly. psychiatrists need to put their enormous egos aside and actually treat patients with treatment resistant depression instead of blaming us for suffering from a (partially at least) biological illness. if you’re a doctor and you know that a patients illness is outside of the scope of your abilities, either do more research and get more training to help them or refer them to someone who specializes in what they need. don’t keep them around letting them pay you thousands of dollars while you make them try the same thing over and over and over again and expect to get a different result. people act like things like ECT are a last resort option, and in doing so make people believe that if it doesn’t help then you’re out of options. but nobody ever tried me on tricyclics. nobody tried me on MAOIs. nobody told me about how some dopamine agonists like Pramipexole have had some success in treating treatment resident depression. instead i was made to feel like asking to not be suicidal daily was asking for too much. if you’re a clinician who thinks that’s asking for too much, you’re in the wrong profession. we can do better than that. we NEED to do better than that.

in my experience, out of every profession, doctors have some of the biggest egos i’ve ever seen. i say this as someone who is both mentally ill as well as physically disabled. many doctors HATE it when you do your own research. they HATE it when you have suggestions, or when you ask for what you need. it’s almost as if they feel threatened by it, like they need to believe that they are superior to their patients because of how much time and money and energy they put into going to med school— they need to believe they hate their hard work was worth it so they have a tendency to dismiss any ideas their patients might have. i don’t care how many years you’ve been in school. you do not get to tell your sick patients that it’s their fault they’re sick to justify your laziness and refusal to learn new things. put away your god complex and actually listen to your patients.

and the strangest part to me is that the longer you have been suicidal for, the less seriously they take it. the same way that the more chronically ill you are the less people believe you. it’s bizarre— when people see pain that is beyond what they can fathom, instead of feeling empathy, they tell you you must be faking it or that you must be looking for attention. i’ll never understand this. it’s as if they think that suicidality doesn’t need to be taken seriously unless the patient has successfully completed suicide. and i think it’s very clear how that logic is flawed. i was treated like i just wanted attention whenever i asked for help with my chronic suicidality and it made me terrified to ask for help with ANYTHING. i still constantly am afraid that if i’m too honest with clinicians then they’ll think i just want attention. attention isn’t a bad thing to want, all human beings need some degree of attention, but regardless that doesn’t negate the severity of a person’s suicidality. i wasn’t attention seeking by asking for help. i was STRONG. i was really fucking strong, far stronger than i should’ve had to be. i fought for my life every single day and i am lucky to still be here but it’s not luck that got me here. it’s ME that got me here.

i don’t want to make it sound like i speak for everyone who has suffered from TRD, because i don’t think that would be fair. i can’t tell you if there’s a med out there that’ll work for you. all i can tell you is that most psychiatrists prematurely tell chronically suicidal patients that there is nothing they can do to help them or that they’re out of medication options. if you’re a psychiatrist or doctor and you feel yourself getting defensive while reading this, i invite you to get curious about where that activation is coming from.

and if you are someone with treatment resident depression or chronic suicidality reading this, i am telling you now: your illness is not your fault. i don’t know if it’s going to get better or not, but i can promise you— it is not your fault and it never has been.

[tears-of-amber]

If you are like me and live with BPD, I’m sure you may have at least heard of DBT. Dialectical Behavioral Therapy is the type of therapy that has really turned my life around, so I’d like to make a Masterlist of resources both free and with cost.

FREE RESOURCES FOR LEARNING DBT:

A great website that teaches the skills is ⬇️

A great YouTube channel that has videos of Marsha (the creator of DBT)

A great podcast that teaches and discusses the skills is:

DBT RESOURCES THAT COST MONEY:

This is a great easy to learn card deck with the skills explained in concise ways.

This is a great workbook. It was made BY the lady who CREATED DBT.

This is a great book that delves into DBT at its core (and isn’t so much activity focused vs. explaining each skill)

That’s it! I’m not saying this type of therapy is FOR SURE going to be the right therapy for you, but it’s SO worth trying if you have Borderline Personality Disorder like me.

Hopefully this helps someone!

-Velvet Rose Kthonia 🥀

[slowlyfoggydestiny]

While i'm thinking about the topic and being nerdy about it (the 911 team probably didn't think it that much) Frank might be CBT focus and i think both Buck and Eddie can benefit from it but also i think some ACT would be good for Eddie , he has a lot of cognitive fusion (when we become fused with certain thoughs believing not only that they are truth but that we are our thoughts) and verbal rules (specially pliance which means you follow certain “rule” behavior because someone told you to and is reinforcing you to keep doing it to avoid certain consequences that you might never experience yourself) also he deserves some self compassion (lots if I’m being honest ) and for Buck actually CBT can be very good for all the belief and cognitive distortions he has about himself and others but also i would do some DBT for him , lets get you some emotional regulation my dude (and maybe some of the other skill training )

[embracing-the-ineffable]

Twenty Questions

Thanks for the tags, @eybefioro, @goodoldfashionednightingale, and @hoarder-of-dragons! I picked my favorites from the posts you tagged me on, and added a few more of my own:

Currently consuming: Good Omens everything

Currently consuming: Good Omens everything (it's worth repeating!)

First ship: I'm not sure. I think I was introduced to the concept of ships through Thomas Sanders' Sanders Sides

Do you have kids? Yes, birth and foster 🥰

What sports do you play/have you played? Dance, horseback riding, and martial arts

Are you more likely to be sincere or sarcastic? Sincere

How many tabs are open on your browser? Over 3,000, because Session Buddy doesn't work on mobile yet 😅

What's your favourite colour? There's no way I can choose! I love the play of different colors with one another. I tend to wear a lot of purple, burgundy, and teal jewel tones, especially in the autumn and winter.

Favorite drink: Hot cocoa with marshmallows and herbal tea for the winter

Last movie: Nothing Lasts Forever and Pride and Prejudice (Those of you as obsessed with Good Omens as I am might recognize a theme here 🤩 )

Scary movies or happy endings? Feel good media with happy endings, please! The world is already full of too many sad and awful things.

When was the last time you cried? I don't remember, but it was probably induced by sleep deprivation and stress. Or really big feelings.

Any talents? Photography! And I love to nurture things. Sometimes that means cooking for loved ones, or growing a jungle of plants in my living room, or organizing gatherings for an extended circle of friends and chosen family

Talent you wish you had? Drawing

What are your hobbies? Right now, the only honest answer is Good Omens 😅

Do you have any pets? Yes! I've shared my life with a whole zoo full of cats, dogs, fish, and reptiles, including an adventure cat, a part-bear part-muppet therapy dog, and a tegu lizard that I trained to walk on a leash and harness.

Super power you wish you had? Reading minds

Dream job? I don't know! I've had so many, and they've all been valuable stepping stones on the path of my life. The jobs where I get to teach and help people - especially kids - are my favorites.

Dream vacation? Seeing the northern lights in person is high on my list. Also, a wildlife photo safari in Africa.

How would you change the world if you could? (Or, what are you passionate about?) I would teach everyone the skills of DBT (helpful for absolutely everyone who has ever had a strong feeling or a connection to another person) and then I would give everyone universal healthcare and a universal basic income with an aim to eliminating poverty, especially among children, plus all the other long term benefits that would stem from that. (Read more from WaPo about UBI here if you're interested.)

Currently working on: Solving the ineffable mystery with the lovely people at the @ineffable-detective-agency, and finishing a new fanfic for the Good Omens Minisode Minibang. Hopefully I'll be ready to post that later this weekend!

No-pressure tags for a few mutuals who might be into tag games, and an open invitation to everyone else!

@gallup24 @averywiseanimatedcat @procrastiel @commonmexicanname @crowleybrekkers @stumblingoverchaos @dunkthebiscuit @red-sky-in-mourning @im-not-a-virgo-im-a-lesbo @tragic-cosmic-magic @crowleybrekkers @lil-king-trash-mouth @celticseawych @phoen1xr0se @lemonic-whimssyy @ineffably-poetic @red-sky-in-mourning @weasleywrinkles

[thistlecatfics]

Harry Potter characters in therapy with me

(as a EMDR-trained therapist specializing in trauma primarily working with older teens and young adults)

Dumbledore

If he’s an adult, I refer him out. I very rarely work well with adult men (or older adults in general), and I think he’d be particularly difficult. 

Teenage Dumbledore though???

Slow, slow, slow relational psychodynamic trust building to start. Let him try to dazzle me, acknowledge it, and acknowledge he doesn’t have to. Unconditional positive regard goes a long way.

When he admits he still loves Gellert and it’s safe to say that in therapy, I leave the session and immediately burst into tears because I’m so proud of him. 

EMDR around the memory of Ariana’s death + any associated memories around the core belief “It was my fault” and moving towards “I did the best I could.” 

Harry

Ok let’s say it’s in his early 20s, and he’s lost without his saviour identity and also his PTSD (/CPTSD) is really starting to wreck havoc in his life

Start with some grounding and stability around dealing with PTSD symptoms - lots of DBT skills

Honestly I think EMDR might not be a good idea because everything is fractured and hanging on by a thread but I would never raise the possibility to him because he’d be like “no I want to do the fastest most intense way to get through this” immediately. There would be such a therapeutic rupture around this if it came up, and I think he’d stop going to therapy for a couple months. 

IFS!! His very loud protector parts need some thanking and acknowledging and re-directing. 

Cho

Very much My Type of Client

I’d seek supervision around traumatic grief because I feel like I don’t have enough experience with it and would be super insecure, and my supervisor would be like “you go this.” 

Start with some grounding skills but in a very careful and client-directed way so as to not add onto the shame of having feelings

Lots of validating feelings

Practicing viewing feelings nonjudgmentally 

Potentially EMDR around the memory of Cedric’s death and her thought that she should have somehow been able to stop it. I think she’d be super into EMDR as soon as she clears the first memory. 

Ginny

A CSA survivor (because I think that’s the best equivalent of her experience with diary Tom) who goes on to be a high achiever super athlete savior type? totally my type of client lol

Trust building stage is deceptively long because obviously she wouldn’t talk about the diary for a long time, and she’s theoretically only coming in to help her quidditch performance lol. It takes a year to mention Fred and then YEARS before she mentions the diary.

Family is SO complicated -- very much would be defensive of any possible criticism of her family, and so I’d tread very carefully there, and let her be the one to say anything that might be critical. 

She’s absolutely a chatty, shoot-the-shit kind of client, and I’d probably let her get away with that for a year before I start to push her on it. 

A lot of unconditional positive regard and harm reduction talk around her chaotic substance use. 

Please ask me more <3 <3 (feel free to add an age + motivation for seeking services if you want) 

[unwelcome-ozian]

THEORETICAL APPROACHES AND TREATMENT MODELS (listed alphabetically)

Practitioners who are unfamiliar with dissociative disorders or to working with DID may prefer to start with texts that are based on their core models or familiar ways of working. Survivors can also expect to come across and be offered a variety of theoretical approaches, summarised below, although none have the monopoly on healing. It is more important that professional help is trauma-informed and based on a collaborative and companionable approach to finding what is best for each individual’s journey.

Attachment-based Psychotherapy – focuses on relationships and bonds between people. It emphasises the developing child’s need to form a healthy emotional bond with at least one primary caregiver for positive social and emotional development.

Doing Psychotherapy: A Trauma and Attachment-Informed Approach, (2020) by Robin Shapiro

Nurturing Children: From Trauma to Growth Using Attachment Theory, Psychoanalysis and Neurobiology, (2019), by Graham Music (See description in Working With children & Adolescents)

Trauma and the Avoidant Client: Attachment-Based Strategies for Healing, (2010), & Trauma and the Struggle to Open Up, (2019) by Robert Muller

Working with the Developmental Trauma of Childhood Neglect, (2022), by Ruth Cohn

Cognitive & Behavioural – theories and therapies elaborate the interplay between mind, thought, behaviour and action, and demonstrate how they can provoke emotions and contribute towards the maintenance of problems or towards recovery.

Cognitive Behavioural Approaches to the Understanding and Treatment of Dissociation, (2013) edited by Fiona Kennedy, Helen Kennerley & David Pearson

DBT Skills Training Handouts and Worksheets, Second Edition, (2014) by Marsha Linehan

Reinventing Your Life, (Schema Therapy-updated 2019) by Jeffrey Young & Janet Klosko

The Compassionate-Mind Guide to Recovering from Trauma and PTSD: Using Compassion-Focused Therapy to Overcome Flashbacks, Shame, Guilt, and Fear, (2013), by Deborah Lee & Sophie James

Trauma-Focused ACT: A Practitioner’s Guide to Working with Mind, Body, and Emotion Using Acceptance and Commitment Therapy, (2021), by Russ Harris

Creative Therapies – use arts-based models and interventions, including music, drama, movement, art or play, with support from a trained professional. Individuals of all ages may find them helpful because they address issues and support expression without the need to talk or focus on the physical self.

A Therapeutic Treasure Box for Working with Children and Adolescents with Developmental Trauma, (2017), by Karen Treisman

Trauma and Expressive Arts Therapy, (2020), by Cathy Malchiodi

Integrative Therapy – affirms and blends different models of therapy with consideration given to what works and why.

Dissociation and the Dissociative Disorders, (2009), by Paul Dell & John O’Neil (Eds)

Mindsight: Transform Your Brain with the New Science of Kindness, (2011) by Daniel Siegel

Neurobiology and Treatment of Traumatic Dissociation: Towards an Embodied Self, (2008) by Ulrich Lanius, Sandra Paulsen & Frank Corrigan

Working with Voices and Dissociative Parts – A Trauma-informed approach, (2019) by Dolores Mosquera. (See description in Treatment Books)

Internal Family Systems Therapy – elaborates the relationships between parts of self or psyche and demonstrates how separation or division between parts can cause suffering.

Internal Family Systems Skills Training Manual: Trauma-Informed Treatment for Anxiety, Depression, PTSD & Substance Abuse, (2017) by Frank Anderson, Richard Schwartz & Martha Sweezy

Internal Family Systems Therapy, 2nd Edition, (2019) by Richard Schwarz & Martha Sweezy

Mindfulness – a meditative practice that reconnects individuals to the present moment; purposefully drawing attention and focus to moment-by-moment, internal and/or external awareness.

Dissociation, Mindfulness, and Creative Meditations: Trauma-Informed Practices to Facilitate Growth, (2017), by Christine Forner

Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing, (2018), by David Treleaven & Willoughby Britton

Polyvagal Theory – explains the importance and value of interpersonal neurobiology in recovery from trauma, and the effect of trauma on the body and the brain. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation, (2011) by Stephen Porges The Polyvagal Theory in Therapy, (2018) by Deb Dana

Psychoanalytic – theories and therapies that aim to treat mental disorders and distress by investigating the interaction of conscious and unconscious mind.

The Dissociative Mind in Psychoanalysis: Understanding and Working with Trauma, (2016), by Elizabeth Howell & Sheldon Itzkowitz

Trauma, Dissociation and Multiplicity: Working on Identity and Selves, (2010) edited by Valerie Sinason

Psychodynamic – based on the theories and principles of psychoanalysis, but with an increased emphasis on an individual’s relationship with their external world; seeks to understand conscious and unconscious processes that influence emotions, thoughts and behaviour patterns.

Easy Ego State Interventions: Strategies for Working with Parts, (2016) by Robin Shapiro

Somatic (Body-Oriented) Resources – recognise that trauma and its effects are stored within the body, and cause dysregulation and restriction to movement and/or emotion.

EMDR Eye Movement, Desensitisation & Reprocessing – a psychotherapeutic approach that uses visual, auditory or tactile stimuli bilaterally, (from side-to-side of the body), in a rhythmical pattern, to enable reprocessing of memory and its effects. Care needs to be exercised with RAMCOA survivors, since similar techniques have been used in some survivors’ abuse, and EMDR may prove triggering or breach the therapeutic relationship.

EMDR and Dissociation: The Progressive Approach, (2012) by Anabel Gonzalez & Dolores Mosquera

EMDR Toolbox: Theory and Treatment of Complex PTSD and Dissociation, 2nd Edn, (2018), by James Knipe

Sensorimotor Psychotherapy – an evolving “body-oriented talking therapy”, helps individuals stabilise, discharge and resolve physiological symptoms of trauma and adverse experiences.

Sensorimotor Psychotherapy: Interventions for Trauma and Attachment, (2015) by Pat Ogden & Janina Fisher

Trauma and the Body, (2006) by Pat Ogden, Kekuni Minton & Clare Pain

Additionally: The Body Remembers Volume 2, (2017) by Babette Rothschild 8 Keys to Safe Trauma Recovery, (2010) by Babette Rothschild

Somatic Experiencing – focuses on the body and perceived body sensations, to express and relieve mental and physical traumatic stress-related conditions.

In an Unspoken Voice, (2010) by Peter Levine

Waking the Tiger, (1997) by Peter Levine

[borderline-clusterfxck]

DBT SKILLS: INTERPERSONAL EFFECTIVENESS Part 1/7: Introduction

Part one

Part two

What is Interpersonal Effectiveness?

Interpersonal effectiveness skills give you the needed tools to better express and seek out your needs, set limits, and negotiate conflicts – all while protecting your relationships and without anger or coercive efforts for control. The main goals of learning interpersonal effectiveness skills include: 

Being skillful in getting your needs met:

Get others to do things you would like them to do

Get others to take your opinions and feelings seriously

Effectively say no to unwanted requests

Building healthy relationships and end destructive ones:

Strengthen current relationships

Don't let problems and hurt build up

Use relationships skills to fight problems head on

Repair relationships when needed

Resolve conflicts before they get overwhelming

Find and build new relationships

End hopeless, destructive, or unhealthy relationships

Walking the middle path:

Create and maintain balance in relationships

Balance and accept changes in relationships

Passive VS Aggressive Behaviour and Communication Styles

The way in which you communicate your needs and feelings to the people in your life plays an important role in the health of your relationships. A more passive communication style can result in your needs not being met and feelings not being heard, while a more aggressive communication style can result in the other person feeling judged, unwanted, fearful, and unsatisfied with the relationship. Patterns of unhealthy communication will end up being very painful for both you and the other person.

Passiveness: 

You consistently give in to others and abandon your own needs, creating frustration and resentment that builds inside of you

You believe you are protecting your relationships in the short term by going along with what the other person expects; long term, however, the relationship takes a shape you can't stand – and you have to destroy it to stop the pain

Aggressiveness:

You tend to care about meeting your own needs and goals first, regardless of the needs of other people

You can be verbally aggressive when communicating with other people and you try to control others. This leaves other people feeling intimidated, hurt, or bitter

Passive-Aggressiveness:

You may tend to express your emotions, thoughts, and needs in indirect ways, and you may not express your anger in a clear way

You might use sarcasm or the silent treatment

This style can leave other people confused or feeling like they've been manipulated

What is your communication style? DBT EXERCISE

Figuring out what your main communication style is can help determine which areas of communication you most need to work on. For each section below, check off each option that you feel accurately describes you. The style for which you have the most checks is the communication style you most often use:

The “I Want–They Want” Scale

Every relationship consists of two people trying to get what they need and want. Sometimes those two people need the same thing (ex: companionship, affection, calm) and it's easy. But when those people need different things at the same time, or when one of them needs something the other doesn't want to give, conflict starts. If the “I want-they want” scale is unbalanced, your relationship becomes unstable and deteriorates. For a relationship to succeed, both parties must be able to do the following:

Know what you need out of the other person. This is easier said than done, but it is a vital part of maintaining a relationship

Notice cues that signal what the other person needs, listen to the other person when they express their needs, or actively seek out knowledge of what they need

Negotiate compromises so that you can get at least some of what you want

Negotiate compromises so that you can give the other person at least some of what they want

Your Interpersonal Values – DBT EXERCISE

Your interpersonal values are, for lack of a better term, your heart's deepest desires for how you want to behave in relationships. They dictate your expectations for how you and others deserve to be treated and are the foundation for setting interpersonal goals and boundaries with yourself and others. 

To determine your interpersonal values, ask yourself:

Things to keep in mind and to practise:

1: Relationships require attention and commitment

Whether its a friend, coworker, or partner, maintaining a good relationship depends on noticing the other person's feelings and reactions

Paying attention means staying in the here and now – not thinking about what you want to say next or focusing on a past memory. It’s important to remain present and to focus on what you see, hear, and sense emotionally from the other person

When you pay attention, you are more likely to notice a problem or conflict arising before it overwhelms you, and also gain time to ask clarifying questions that can help you correct misconceptions

2: Observe and Describe

Observe the other person's facial expressions, body language, tone of voice, and choice of words during a conversation to get a fix on the mood and state of the relationship. This can sometimes be challenging, especially if the person in question is not very expressive or for example if they or you are autistic. It's okay if you can't always tell by body language and it’s also okay to directly ask someone how they are feeling towards you and your relationship if you are unsure of the current situation

3: Watch your own experiences in relation to others

Pay attention to what you are feeling and needing. Do you need something from the other person (ex: more attention, some help, some space)? Do you need to change some element of the process between you (ex: critical comments, demands, or intrusive questioning)? Are you experiencing feelings that may help signal something important that you need (ex: feeling hurt, sadness, loss, shame, or anxiety)?

Being able to sit down and notice your feelings can help you identify what needs to change in a relationship before you blow up or run away

4: Be aware of the costs of not paying attention

Not paying attention to both yourself and the other person is a major cause of many issues in a relationship. You may miss vital cues about the other person's needs and feelings, you may inaccurately project your own fears and feelings onto the other person, or you may blow up when caught off guard by a response that could have been predicted 

Disclaimer: I am not a professional, nor am I qualified to give you an official DBT Skills Training Unit. I’m just some guy with BPD who found DBT very helpful and so I want to impart those same skills onto as many of my fellow BPDers as I can. Should go without saying but this blog DOES NOT count as an official Skills Training Unit.

[drdemonprince]

You answered an ask a few days ago about “curing” unwanted autistic traits and your reply really connected the dots on something for me. There is so much neurotypical focus on eradicating unwanted traits and in addition to how abusive aba is, that focus really decreases quality of life for us by denying us opportunities to simply learn how to live happily WITH autism. for instance, you mentioned that dbt has been helpful for your emotional regulation, and I have found the same thing- dbt has vastly improved my life and I’m still autistic. It has actually allowed me to revel in and enjoy and discover autistic traits that I love, now that I’m not totally overwhelmed all the time. Key to this is the fact that I dont have an official diagnosis and thus have been given enough respect and compassion by practitioners to actually benefit. At the same time I actually prefer to use tools like dbt on my own- so i can skip over the sections about using appropriate facial expressions etc. obviously you know this and have written a lot about it but its really interesting to think about how many other tools are being geared towards neurotypical/allistic people and if only autistic people were seen as actual complex people we could benefit so much.

Thank you so much for sharing! I'm so glad you're on this path, it seems to really be working for you. I just got off a zoom call with Fern Brady (an Autistic stand up comedian from the UK for those who haven't heard of her, we were talking about her book Strong Female Character), and she shared that she has this great therapist who doesn't try to cure or treat her Autistic traits, but instead helps her game out getting her needs met in ways that don't make her more vulnerable. For instance, she really gets sensory issues from all the intense hair spray and makeup that gets put on her before a TV broadcast. Her therapist helped her practice lying and saying that she gets migraines, so that she doesn't have to tell her makeup artist that she's Autistic (the person might not even know or respect what that means anyway).

So many resources for Autistic people are targeted at training us to be more neuro-conforming or imitate neurotypical people, from social skills groups (we already have social skills) to ABA to all manner of professional and dating advice. it's refreshing to see resources that instead just empower us to do our own damn thing the best ways for us.

[compassionatereminders]

OH NO i think i sent the reactions to emotion ask off anon, please don't publish it if it's off anon, i had it copied so here again on anon: i wish it was easier to find information on how to regulate emotions better other than like exercise and eat well (like they recommend to everything????). everyone says you can't control your emotions but you can control your reactions but we don't talk enough about how much work that takes and sometimes. i really don't know how to train myself to react better, this is just a vent but if anyone has books or other sources about it, i wouldn't say no at all. i don't want to hurt anyone but it's really hard to control myself sometimes.

I posted it before seeing this addition, but I took it back down. Here's a copypaste of my answer:

I don't personally collect resources, but I can recommend that you look into DBT. It's a therapy form developed by a woman with BPD for people with personality disorders, and there are a lot of different DBT skills and exercises out there about managing your emotions in a healthy way. I know the person behind @borderlinereminders knows and writes a lot about them!

[minmos]

hi, i have bpd and i was wondering if you have any advice since i saw your tag about no longer having bpd. this is my goal as well but im older than you and have been in intensive therapy for a long time (i have gotten a lot better but i still struggle with symptoms so i feel a little frustrated) so i wanted to ask, is there anything like a mindset or something that changed things for you besides just going to a lot of DBT? or just like any advice you have would be cool. if not, thank you anyway :)

first off, congrats on improving, that's huge!

as for advice, i do have some Thoughts! fwiw i've been in therapy since i was around 14, it took a really long time to get to a point where i was a lot more stable :) (people who followed me in like 2014/2015 Know.... i was very publicly not well LOL)

i think theres a number of things that helped me a lot. none of them were cures, but i do think they all contributed to me eventually being able to complete therapy:

having a kind, non-reactive support system. this one kind of sucks because it's not something that's always in your control. but i think it truly is important to find people to talk to who won't like, freak out and egg you on. there are people out there who are good for you to be around! being able to just sit there and talk to someone without them criticizing you or being judgemental is critical to everyone's mental health.

having a therapist who you vibe with. i have had some dogshit therapists and ive done some dogshit modes of therapy that did nothing for me. you know what? sometimes you just don't like your therapist. it happens. i found it hard to engage in therapy until i found someone that i had picked who i liked. (i think part of the struggle for me was that, as a minor, my mom was trying to refer me to more "holistic" therapists which i personally was not a fan of.)

this is a common stumbling block for a ton of people - if you're struggling in therapy, be honest with your therapist! some approaches just don't work for some people. sometimes therapists will make mistakes and hurt your feelings without meaning to. when an issue shows up, it is ridiculously easy to withdraw. but before you hit the bricks, it's really worth mentioning to your therapist first to see if it's something that can be worked through. in a lot of ways, therapy can operate as a training ground for interpersonal skills. being able to go through a rupture-repair process with a therapist like this can prepare you for times when rupture-repair happens in situations with higher interpersonal stakes, like with close friends or loved ones.

if i think of anything else i'll add onto this but these are my initial thoughts :)

[never-not-ever]

The only time I go out is for psych appointments.

I had to go pick up my meds at my PACT office. I’m home now and I feel so… like I’m getting worked up right now typing this trying to explain how I’m feeling and I can’t name it-I just, something isn’t right. I feel like I want to a punch a wall or scream or cry or all three.

I’m scared something bad is going to happen but I can’t lose control because I have plans this week that I’m forced by guilt to attend.

I’m supposed to see my Nana’s sister tomorrow. Yes I could say “Aunt”, technically “Great Aunt” but I don’t have a relationship with her, in fact the last time I saw her she was standing over my ICU bed praying 10 years ago after my suicide attempt. Since then she’s always “sent her love” when she talks to/sees my Nana. Which has been a lot lately cause her husband just passed away. So my Nana’s been spending a lot of time with her and my “Aunt” is always asking to see me. I finally said yes to tomorrow… which I regret and want to cancel.

Then on Thursday I’m meeting up with these two girls from inpatient. We were close back then and we’ve stayed in touch and they’ve been super supportive. Ever since I discharged they’ve been wanting to meet up and I just distance myself in the group chat. But last week when I was in my drunken Ativan state I sent them a long text apologizing and thus plans to meet up were made. And now I deeply regret it. I can’t keep canceling so I have to go on Thursday.

Then on Friday I’m supposed to start DBT skills training with my therapists intern.

All I want to do is take the 2 Ativan I have left, have a drink or two and numb out. But 1- it’s too early in the day and 2- I’m worried about what I’ll do when I’m in that state again.

Ughh I feel like such an asshole. I just reread one of the girls reply in our group chat and like she’s so amazing and I’m so lucky to have them. Maybe Thursday won’t be so dreadful after all.

It’s true though. That girl has so much wisdom. She wrote a piece on addiction and it hearing her read it made me cry. Like I’ve never heard something so relatable before. I asked her to send it to me and reading it makes me feel more understood.

Okay. Thursday will be good.

Still feel like crap right now though.