Sunday, December 12, 2010

December 12th - 19th, 2010: Skill of the week

I have read, and/or, heard people comment that DBT doesn't work. My question is, what is it about DBT that doesn't work? Seriously, I am not challenging them at all, I am just wondering what about it that doesn't seem to work. I do however challenge anyone to show me a person that couldn't benefit from learning how to be in the moment that they are in, learning to make balanced wise-minded decision about life in general. What kind of person would you be if you didn't have any need to learn how your emotions work, what emotions accomplish and what can be done if emotions start to take over. Who of us doesn't have any need at all to have assistance with interpersonal relationships? Who out there never has any issues with other people, who can get along with anyone and never has a problem with prioritizing and setting goals. Everyone of us could use a boost in the self-image department, whether it be something that re-enforces what you already know about yourself, or learning how to love yourself. DBT is just so practical for everyone. With or without a mental illness. How much more so for those of us out there that do have a mental illness?

I am certainly not saying DBT is a cure or is the only form of therapy that can help. Obviously there are all sorts of therapeutic ways to handle your mental illness, or life in general. But honestly, DBT is something that can accessorize any persons life. Personally, I feel that it is something that our children should have to take as a class course before being allowed to graduate high school. It has that much of an impact on life skills. I feel that it is so practical to use for a productive life. But that is certainly my opinion. I recognize that. My guess however is, for most persons with a mental illness who are finding that DBT isn't not working, I venture that it is they themselves that is not "working". Ouch, that is a really judgmental statement, right? Not so. I am not judging a single person. When I say that they perhaps are not working, I do not mean that they are not fighting like hell for their life. I am certain they are. They are taking every last vestige of life inside of them and fighting tooth and nail to make it one that is worth living. What I mean when I say they are not "working" is that working the program is a must. This means, practicing, analyzing, assessing, reassessing, record keeping, journaling, goal setting, positive affirmations...DBT is not for the faint of heart.

There is so much work involved in making positive use of DBT that it often gets dumped early on and labeled as "not working" This is a fight for our lives, and it is going to take work, no matter what form of therapy is chosen. The other culprit I believe comes into play when someone feels that DBT isn't working is when they need something more, or different. Someone can be a veteran at DBT and still be very symptomatic with their mental illness. They need more. They either need something altogether different, or something more intense with DBT. Chances are if they have been working with DBT for some time it is something altogether different that is needed. Does this mean they can't use DBT? Absolutely not! Another wager I would make is that with DBT they have probably seen improvements, they just need something to take them the final lap in recovery. DBT is great maintenance and rather than dropping it as something that isn't working, I suggest it be embraced and kept as something that has already helped and will continue to help and complement whatever other therapy that is chosen.

Alright, I will get off of my soap box about DBT. I say all of this because I have spent time with quite a few people that bring on DBT and enjoy the improvement and then they get stuck in their tracks as if someone yanked the emergency brakes when they are introduced to Radical Acceptance.

The faulty piece of reasoning that gets attached to this is people equate approval with acceptance. OK, so radical acceptance is directly connected to mindfulness, as is most everything in DBT. You can start to see why it is that if we do not practice this mindfulness, we will be making things harder for ourselves. So what is radical acceptance? 

Radical acceptance is gaining freedom from suffering by accepting from deep within of what is, it is the only way out of the hell of reality. Pain creates suffering only when you refuse to accept the pain. Deciding to tolerate the pain instead of resisting it is accepting the reality of your situation. You are acknowledging what is when you accept. 

At times, if radical acceptance is not done properly we can trick ourselves into believing that we are in fact accepting reality, but really all we are doing is being willful about our pain. Rather, when we willingly accept what is we decrease our pain. Remember, because we are accepting reality does not mean we are judging it as good. Judgments have no place in a life worth living therefore for DBT to work we need to reduce those judgments, we are not approving of our pain, we are endeavoring to accept it. 

Willingness is understanding that you are part of or connected to the event, it is doing just what is needed in each situation, in an unpretentious way. It is focusing on effectiveness with an attitude that exudes just that. Willingness is listening to your wise mind, acting from your inner self and it is allowing into your awareness your connection to the environment you are in. Whether that be the floor you are standing on, the chair you are sitting in, the earth or even the universe. Willingness is actively participating in reality. 

Where-as willfulness is sitting on your hands when action is needed, refusing to make changes that are needed because it is this or it is that, it is unfair, it isn't your fault, it is so-in-so that is doing this to you etc. Willfulness is essentially giving up to the event because you have deemed it a situation that you have no control over. Willfulness is the opposite of doing what works, or being effective, it is trying to "fix" every situation. You cannot fix everything. It is refusing to tolerate your moment, you may get stuck here because you are more concerned with destroying the moment because of the pain rather than accepting that it is happening and you cannot control the event. 

Next week we will explore radical acceptance more and discuss skills that can be used to turn our minds over from willfulness to willingness to accept what is. We need to dissect radical acceptance in parts, it can be overwhelming and we need to be sure to be kind to ourselves. 

In conclusion, mindfulness won't work without much practice, DBT won't take root without mindfulness, judgments cannot be curbed without radical acceptance, and ... DBT won't work without mindfully resisting judgments! These skills are interwoven and work as a unit, then and only then can you be getting as much as you can from DBT.

The great thing about this information is that if we feel our recovery has stalled or you are just beginning and you feel as though the mountain is too high, you aren't alone and we do have a plan! Having a plan can make all the difference in the world. Practice...and this week, let's take a closer look at radical acceptance in our lives. What areas am I not accepting? Where might I be resisting? Don't bite off more than you can chew, being mindful of where we can improve is not meant to take the wind out of us, it isn't meant to deflate any and all motivation, absolutely not! It is the exact opposite, we have something to do about our situation and that something is just being mindful about this one point. We can problem solve it and make an attempt to work our way through radical acceptance next week.

Take a deep breath, applaud yourself for getting this far, smile at your face in the mirror and let's hear from you about your experience with radical acceptance. 



  1. Radical acceptance took me a long time, because I simply didn't understand. I wrestled with the dandelion story, and then thankfully came across the drinks machine story (in 'High Conflict Couple') which made far more sense. I had to understand what it was to be able to do it. But to understand what it was, I had to keep trying to do it. Phew!

  2. I was in 2 really awfully-run dbt groups...and honestly, if they were my only experience with dbt, I would have said that it didn't work. What I didn't know was that `intensive dbt' is very different when the therapists are good, and the participants are Willing. My ex-therapist is a research lead at UW with Marsha, and she said that a lot of people say `dbt doesn't work', when in fact, they haven't been in an actual dbt program. They may have been getting dbt-informed therapy, but not the skills group and individual. I actually thought it worked when I found a group that was a good fit. God, the first two I tried had clients who were practically zombies. All they did was complain about how nothing worked. Ugh. Oh well, at least I stuck with it and was lucky enough to actually move to Seattle, the `belly of the dbt beast'. ; )


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