The dialectical behavioral therapy skills I still use

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When I was diagnosed with Borderline Personality Disorder (BPD) in 1990, I was an acute ward patient in a New York City hospital following my second suicide attempt. The plan was to transfer me to a psychiatric hospital in the suburbs of the city, which had a special long-term care unit designed for patients with BPD. This unit was radical because the treatment modality it used was a relatively new therapy called dialectical behavior therapy, or DBT.

I was on that long term unit for 10 months. We lived, ate and breathed DBT, attended daily skill groups and individual coaching sessions, and filled out daily diary cards. And there was informal coaching from the entire staff, if we were having a bad day, were angry, had urges to self-harm, or if we were suicidal.

We went through the four DBT modules – mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance – several times while I was there. I have mastered the skills well. When I was fired, it was because my insurance wouldn’t pay for extra time, not because my treatment team thought I was ready. They thought I was still a danger to myself and their original plan was to transfer me to a state hospital in Queens, NY.

Then my mother stepped in and declared, “No child of mine goes to a state hospital.” A compromise was reached and the insurance agreed to pay for me to stay in a 24/7 guarded home and attend a BPD DBT day program the hospital provided. Many of the inpatient department staff transferred to run the daytime program, which was a new venture. I spent 18 months in the day program and three years in the halfway house.

So it’s fair to say I’ve had a lot of DBT. After I left the daytime program, I was still chronically suicidal, self-harming, and depressed. I saw my therapist from the day program in her private practice. I knew the skills intellectually, but couldn’t take the plunge to apply them when I needed them most. After more than a decade with this therapist, I stopped and went off all my medication and, unsurprisingly, fell into a deep suicidal depression.

Referred to psychiatrist Dr. Lev (not her real name) for a medication consultation, we ended up working together for eleven years. Dr. Lev practiced transference-oriented psychotherapy (TFP), which emphasizes the relationship between the therapist and the client. The work can be intense at times because TFP is a psychodynamically oriented treatment and we have opened numerous painful wounds.

Dr. Lev told me more than once that the DBT skills I learned served as the foundation I needed to get through these intense periods without resorting to self-harm and other self-destructive behaviors. Apparently, something finally clicked.

I still use the DBT skills today. Some of the ones I use most often are:

Radical acceptance. According to Marsha Linehan, who developed DBT, “Radical acceptance rests on letting go of the illusion of control and a willingness to notice and accept things as they are, without judgment.” It is a “complete and total openness to the facts of reality as they are, without throwing a tantrum and becoming angry.”

Radical acceptance is a distress tolerance skill and a difficult one. It’s a process. I remind myself that radical acceptance does not mean forgetting or forgiving, but rather accepting a painful situation. It helped me get through the rough year after my father’s death, which led to deep depression and a subsequent suicide attempt.

© psychology compass

Source: © psychology compass

Wise mind. DBT uses the concept of a logical, emotional, and wise mind to describe a person’s thoughts. The logical mind is driven by reason, the emotional mind is driven by feelings, and the wise mind is a balance between the two. The goal is to learn to use the state of wise mind to improve behavior.

When I find myself feeling like I’m not on track, I remind myself to balance and get into a wise mind. I remind myself that a wise mind is a combination of a logical mind and an emotional mind and it’s not ideal to be too much in either extreme.

mindfulness. According to Psychology todaymindfulness involves two key ingredients: awareness and acceptance. Awareness is the knowledge and ability to direct attention to one’s inner processes and experiences, such as the experience of the present moment. Acceptance is the ability to observe and accept those streams of thoughts rather than judging or avoiding them.I try to practice mindfulness as often as possible. I find it motivates me for a busy day ahead. I admit I’m not perfect; I can’t manage to get it in every day, but I find that when I do it helps.

Self-soothing with the Five Sense. This is one of the emergency tolerance skills. Choose one or two favorite items that correspond to one of the five senses and put it in your “toolbox” so you have it handy. Some of my favorites are a scented candle to smell, a weighted blanket to touch, a special playlist to listen to, a picture of a spectacular sunrise or sunset to see, and single-serve gourmet chocolate to taste.

This is a sampling of the DBT skills I use most often. They each have a different purpose in my life, they help me through the daily and the really tough events. Today, DBT has been expanded for use in numerous populations, including people with substance use disorders, eating disorders, and depression.

Still, it’s important to realize that there are other options for therapy besides DBT. These include general psychiatric treatment, transference-focused psychotherapy (TFP), mentalization-based therapy (MBT), schema therapy, and emotional predictability and problem-solving systems training (STEPPS). If you are interested in any of these therapies, talk to a therapist to determine the best option.

Thank you for reading.


The dialectical behavioral therapy skills I still use

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