Tag Archive for 'Dialectical Behavioral Therapy (DBT)'

Acceptance and My Dear Friend

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In my DBT groups, I teach skills to help clients cope with challenging or distressing situations in their lives, without making things worse. One of the skills that we work on is Radical Acceptance, which means acknowledging reality, accepting it for what it is, without judging it good or bad.  I share with clients that I understand how difficult it can be to radically accept certain things, and that this acceptance is the only way they can let go of suffering.

So now it has come time (yet again) for me to practice what I preach.  I received a phone call this week from one of my dearest friends in the world, and through tears and gasps, she told me that she has been diagnosed with stage IV colon cancer, metastasized to her liver to such an extent that the doctors say they cannot remove the tumors.  This is an extremely healthy and vibrant young mother of a precious 5-year-old, no family history of cancer, no risk factors whatsoever, and she’s one of those friends I can count on one hand – the true ones – so I’m supposed to accept this?

Trying to recover from the shock and wrap my mind around this devastating news, I pull out the “Radical Acceptance” bullet points I give to my clients when I tell them that accepting some things is very difficult…and I start to wonder if they feel as helpless and overwhelmed as I do right now. The first bullet point reads, “Freedom from suffering requires acceptance from deep within of what is. Let yourself go completely with what is. Let go of fighting reality.” Hmmm…I’m not sure I’m ready to accept this from deep within. You see, this is my friend Lea Ann. She is more like a sister to me, she “gets” me – we are so much alike we can finish each other’s sentences, so this feels too close. We’re like Lucy and Ethel, and I don’t remember either one of them ever having cancer. Letting myself accept this somehow feels like giving in, and I seem to remember my clients saying the same thing.

Another bullet point reads, “Pain creates suffering only when you refuse to accept the pain.” Okay, this one makes more sense to me. I’m no stranger to pain, and I’ve learned to feel what I feel when something is painful instead of avoiding it or pushing it away. Pain is there to teach us something, to inform us that we need to pay attention to what is going on, so what is this pain telling me?  I don’t have to search hard for the answer – my pain is there because Lea Ann is vitally important to me. She is the person who came to my side, dragging her husband and daughter, when my grandmother was in the hospital in Kentucky and I needed some answers. She was there with me when my dad died, and flew to be with me when I felt like falling apart a few months later. This pain is reminding me that what she has done for me is be there, and this is what I can do for her now – I can show up. This gives me purpose and something to do, so I start to feel better…slightly.

The last bullet point in the list reads, “To accept something is not the same as judging it good.” Oh…so I don’t have to like what is happening to Lea Ann in order to accept it…this is comforting. I hate what is happening to my friend and how it is affecting her sweet family. I hate what she will have to endure in order to have some hope of a more favorable prognosis. I hate feeling powerless and angry and sad all at the same time, and this radical acceptance thing tells me I don’t have to like it to accept it. So I go to work on accepting…

Radical acceptance reminds me of the Serenity Prayer, and I pray it a lot these days:

            God, grant me the Serenity to accept the things I cannot change,

            Courage to change the things I can,

            And the Wisdom to know the difference.

I know I cannot change my dear friend’s diagnosis nor the challenges she is facing, but I can be courageous enough to be there for her, offering all the support I can in friendship and love, which is exactly what she has always done for me. I am reminded of all the times my clients have been challenged to separate what they can change from what they can’t, and I feel more compassion than ever for how difficult this can be.

Most people aren’t familiar with the rest of the Serenity Prayer. The next lines read:

            Living one day at a time;

            Enjoying one moment at a time;

            Accepting hardship as the pathway to peace.

None of us knows what tomorrow will bring, and we can’t do anything about it until it gets here, so we might as well live in today. My friendship with Lea Ann has been blessed with enjoyable “moments” when we both howled with laughter and silliness – our Lucy and Ethel moments. Racing down Michigan Avenue before our favorite stores closed, betting on the horses at Keeneland with no idea what we were doing, jumping off a ski lift and getting stuck on the highest gondola in Canada, and savoring the times we’ve shared dessert. Such moments are the ones I remember and return to when hardship does come, for I know such is the reality of the ebb and flow of life.

If there is anything I’ve learned from my friendship with Lea Ann, it is that the most important thing I can do is be present, and live. Show up instead of sitting back, experience instead of analyze, accept instead of worry – say YES to life.

With sincere hope that my journey can inspire,

Debbie

Published on Friday August 13, 2010 in Dialectical Behavioral Therapy (DBT). 0 Comments Tags: , , , .

From Frozen to Fantastic: Ten Tips for Tackling a Child’s Eating Disorder as a Family

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Eating disorders are bio-psycho-social illnesses. They are also very treatable. With the right treatment, in appropriate doses, at appropriate times, and for an appropriate length of time, they are even curable.

But medical limitations, patient reluctance, or even media messages are not the primary deterrent to recovery.

The number one reason patients do not get better faster is a plain and simple deficit of information.

In my more than two decades of treating and supporting both eating disordered patients and their loved ones, I have learned a great deal about the type of information that is needed to effectively mobilize a family around a child who is suffering. This article addresses ten key learnings that can take your family from frozen to fantastic in how you collectively band together to combat a child’s life threatening illness.

The first key learning is – do not blame yourself. And do not blame your child. It is nobody’s fault when the biologically-based illness that is an eating disorder arises, in the same way that it is nobody’s fault when a child develops leukemia or autism, or an adult woman develops endometriosis. What is needed and effective is not blame, but rather action in the form of appropriate professional care and informed family and community support.

The second key learning is – an eating disorder is a bio-psycho-social illness with genetic links. Eating disorders have their underpinnings in a biological brain imbalance that results in the affected individual processing the presence of nutrients differently than someone without that imbalance would. As the National Eating Disorders Association states, “biology loads the gun, and environment pulls the trigger.”  In the thin-obsessed culture we live in today, there is a clear biological reason why not every exposed individual develops a diagnosable eating disorder. Not everyone is at risk, because not everyone carries the genetic linkages that predispose an individual to develop an eating disorder. Those who develop an eating disorder are life-threateningly ill and require prompt and comprehensive care.

The third key learning is – do not panic. Instead, learn all you can.  Getting educated by reading high quality books and visiting nonprofit and medical websites that contain accurate information about eating disorders will help you and your family understand what you are dealing with, in the same way that a diagnosis of breast or prostate cancer might prompt the affected individual and their family to carefully review current treatments, options, success rates, and risks involved. In the case of an adolescent who is affected, the responsibility clearly rests with the parents to do the homework necessary to pick the best course of care. The more you are able to learn about what to expect, the timeline involved in recovery, what works better in which kinds of cases, and who in your area has expertise in treating eating disorders, the less energy you will waste in fear, indecision, self doubt, and frustration with the recovery process.

The fourth key learning is – get help. Do not attempt to self-diagnose or self-treat an ill child or loved one. Eating disorders are the most lethal of all psychiatric-based diseases. They are treatable and even curable – with appropriate professional care. For adolescents in particular, learn as much as you can about newer cutting edge protocols such as Family Based (Maudsley) Method (FBT) or Dialectical Behavioral Therapy (DBT), both of which have shown excellent results in improving symptoms and returning the affected individual to a healthy state.

The fifth key learning is – don’t forget about your own self-care needs. Supporting your child will take an incredible amount of time and energy. There will be times when you will feel hopeless, exhausted, frustrated, confused. To avoid burning out during each leg of the recovery process, remember that you can accept support and you deserve support . You are working as hard as your child, albeit from a different perspective, and you need to apply good self-care or you will not have the stamina you need to see the recovery process through to its successful conclusion. Seek out supportive groups online or in your area – for example, FEAST-ED.org is an excellent parent support site that offers parent-to-parent mentoring via an online forum called “Around the Dinner Table.”

The sixth key learning is – shame has no place in recovery from any illness, including an eating disorder. We have come a long way from the “don’t ask – don’t tell” generation our parents and grandparents labored under. We know so much more now about what causes psychiatric illness and how to help affected individuals and their loved ones navigate the recovery process. Whether it is cancer, loss, unemployment, divorce, or another personal tragedy, no one is a stranger to the need to recover from life’s unexpected challenges. With your acceptance and validation of your child’s illness, you strengthen your child and your entire family to own the challenge ahead as a learning process and a chance to grow stronger. Don’t let shame rob your child and your family of that energizing and motivating gift.

The seventh key learning is – remember that your child and your child’s illness are not one and the same. Your child is a unique, wonderful individual with endless promise and potential. Your child’s illness is something that he or she struggles with that requires appropriate treatment to overcome. They are two different things. It is important to start immediately to emotionally separate out who your child is from what your child is struggling with. Love the child, treat the disorder – they are not one and the same.

The eight key learning is –DO NOT WAIT.  An eating disorder will not suddenly get better or go away if ignored. Pretending the disorder is not there may cause the child to hide the symptoms out of shame or fear, but disappearance of symptoms is cause for increased rather than decreased concern. Act immediately the moment you see the first sign of symptoms. Research has shown that the sooner an eating disorder is intervened upon, the faster and shorter the recovery period will be.

The ninth key learning is – make sure the treatment you choose is evidence-based. What this means is that, with the wealth of options available today, it is easy to get confused about what is the best choice for your child. Go with where the evidence is. Interview medical professionals and ask for success rates. Contact nonprofit and professional organizations and ask to read recent medical journal and research reports concerning treatment protocols you are interested in pursuing.  Talk with other families about what worked for them. Ask medical professionals for references and call those references to find out what their experiences have been like. Most of all, seek a treatment protocol for your child that is well researched and shows consistent positive results. Treatment is expensive no matter what route you choose, so go for what works.

The tenth key learning is – never discount the transformative power of unconditional love. As the disease takes hold, you may find yourself thinking, “Is this my child?” The answer is “No.” The voice of the disorder at work within your child’s brain may create a different relational dynamic for awhile, as her relationship with food and fear changes and then changes again throughout each phase of the recovery process. Fear is a powerful agent, and may produce bouts of rebellion, resistance, even rage. But underneath any show of resistance, bravado, or anger is a frightened child who is doing her best to understand what is happening and figure out what to do about it. It is no different than the brain changes a bout of chemotherapy or radiation might cause – it is temporary, and reversible with application of proper nutrient levels that produce brain re-balancing with a corresponding return of emotional stability. Love your child, treat the disease, fight it together as a family.

At Southlake Counseling, we have more than two decades of expertise in treating adolescents and families affected by eating disorders. Our specializations include Family Based (Maudsley) Training (FBT) and Dialectical Behavioral Therapy (DBT). Our founder and staff received training directly from Dr. Nancy Zucker, the director of the Duke University Eating Disorders Program, which incorporates both FBT and DBT protocols in their highly successful family-based treatment program. Our clinical director has also received training directly from Dr. Locke and Dr. Le Grange, authors of Helping your Teenager Beat an Eating Disorder. At Southlake Counseling, we have seen firsthand how families that recover together grow closer and stronger together. We encourage you to reach out for help and experience the difference expert, compassionate professional care can make in your family’s life. Visit us today at www.southlakecounseling.com to learn more.

Be Well,

Kimberly

Published on Monday August 2, 2010 in Eating Disorders. 0 Comments Tags: , , , , .

Your “Say Yes to Life” Monday Motivator: Staying Away From the Borderline

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May is Borderline Personality Disorder Month. This month, in honor of this important topic, we began a new blog series that focuses on the nuts and bolts of borderline personality disorder (BPD), and each week in May we will address a different aspect of recovery from this highly treatable disorder.

This week, we look at the role of the professional in the recovery process.

Perhaps no other disorder has been so extensively misunderstood, misdiagnosed, or misrepresented as BPD, so much so that mental health professionals are often reluctant or downright resistant to working with BPD sufferers. “I stay away from the borderlines,” one professional was heard to say at a recent conference.

Three decades ago, before the creation of Dialectical Behavioral Therapy (DBT) by Dr. Marsha Linehan, a response like this would have been more than understandable. However, in light of all the resources professionals have at their disposal today to treat BPD sufferers, hearing this at a conference in 2010 is puzzling.

BPD is essentially a disorder of relationships. As such, understanding the nuts and bolts of how the disease arises and what sufferers need to overcome its effects can go a long way towards reducing stigma and offering sufferers the type of professional treatment they need to get better.

According to the National Education Alliance for Borderline Personality Disorder (NEA for BPD), representative BPD symptoms include:  fears of abandonment, intense mood shifts, impulsivity, problems with anger, recurrent suicidal behaviors or self-injurious behaviors, and patterns of unstable and intense relationships that often create chaos in the lives of sufferers and their families.

In short, individuals with DBT can’t stand to be with themselves, inside their own intensely emotionally-charged skins, but through their behaviors they often recreate the very relational abandonment they fear, which exacerbates their symptoms, and so on and so on. It is thought that the stage is set for BPD, which is often diagnosed in early adulthood and primarily in females, through early emotional invalidation with a possible genetic biological component.

What is most important for professionals to know, however, is that it is highly treatable.

Even with this awareness however, one initial challenge treating professionals will face is to separate out BPD symptoms from other frequently co-occurring disorders. As the NEA for BPD reports, borderline symptoms rarely occur in isolation, and are frequently exacerbated by other concerns such as substance abuse, eating disorders, depression, anxiety, and bipolar disorder. While individuals suffering from BPD symptoms are often medicated, it is also important to know that no medication has been specifically approved for use to treat BPD symptoms as of yet.

Additionally, there are many ways in which the core symptoms of BPD can manifest, and those symptoms may vary based on each individual’s background, life experience, and prior treatment experiences. With an estimated 2% of the population suffering from BPD symptoms, it can quickly become a source of professional frustration to find one method to treat so many individual cases.

This is where Dialectical Behavioral Therapy (DBT) comes in. Dr. Marsha Linehan, the founder of DBT, categorized the six major categories of BPD symptoms into four skills-building modules. These four core modules include Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. DBT, while used today to treat a variety of mood-based disorders, was created specifically to treat individuals with borderline symptoms, and is scientifically proven to be a highly effective and lasting treatment approach.

Dr. Linehan’s goal when developing DBT was not to separate out, categorize, and individually address all 200+ permutations of the core BPD symptoms. Rather, she aimed to – and succeeded at – identifying instead the four core areas of coping skills that were missing from each BPD sufferer’s internal life coping toolkit. BPD sufferers all struggle to maintain mindfulness about who they are and how they fit in with others. BPD sufferers all wrestle with regulating their emotions and managing feelings of distress. BPD sufferers all have trouble developing trust-based, healthy relationships with themselves and with others in their lives.

In summary, BPD sufferers can all benefit from the four core modules taught through DBT.

For sufferers, loved ones, and referring or treating professionals, DBT is a bright light of practical hope amidst the darkness of a struggle against BPD symptoms.

At Southlake Counseling, we have more than two decades of clinical expertise in treating individuals with BPD symptoms through our DBT outpatient programs. Our combination of individual and group support, with additional phone support if necessary, puts BPD sufferers on the road to lasting recovery. We are happy to talk with loved ones and referring professionals about how DBT skills-building treatment can positively intervene in the life of someone struggling with BPD. We have expertise with adolescents, females, and males and offer individual and group support for individuals at each stage of the recovery process. Visit us at www.southlakecounseling.com – we look forward to hearing from you.

Be Well,
Kimberly

Published on Monday May 24, 2010 in Borderline Personality Disorder. 0 Comments Tags: , , , .

Your “Say Yes to Life” Monday Motivator: Making It Across the Borderline

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May is Borderline Personality Disorder Month. Last week, in honor of this important topic, we began a new blog series that focuses on the nuts and bolts of borderline personality disorder (BPD) and each week in May we will address a different aspect of recovery from this highly treatable disorder.

This week, we look at the role of the family in the recovery process.

If your loved one has been diagnosed with borderline personality disorder (BPD), you probably reacted initially with equal parts relief and consternation.

The relief? “Well thank goodness we at least have a name for ‘it’ now!”

The consternation? “What can we do to help?”

The good news is that effective treatment is available. Two decades ago Dr. Marsha Linehan developed a (then) new therapeutic process known as “Dialectical Behavioral Therapy” or DBT. DBT was specifically created to effectively interrupt the BPD emotional cycle and replace those thoughts and behaviors with new coping skills. Students of DBT learn new skills in four core modules – Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. While DBT is used to treat a variety of mood-based disorders today, it was specifically designed to dramatically improve the lives of those diagnosed with BPD.

Family members and loved ones are also an important part of the individual’s recovery process, and knowing how to effectively participate can go a long way towards ensuring eventual full recovery.

In the absence of guidance, it can be tempting for family members and loved ones to pull away, thinking that less is more, and at least the person will not be harmed by the wrong kind of support.  However, this will be perceived by the individual suffering from BPD as yet another instance of abandonment, exacerbating symptoms and delaying recovery.

What is needed instead is a two-pronged approach beginning with the realization that no family member or loved one, no matter how well-intentioned, is equipped to manage the recovery process of an individual diagnosed with BPD. BPD is a serious, potentially fatal disease, and is worthy of both the highest respect and comprehensive professional treatment. BPD is not a self-willed disease – in other words, the sufferer cannot help their behavior outside of the intervention of trained professionals who know how to help break through the emotional gridlock inside and guide the sufferer to safety.

So the first step to take as a concerned family member is to ensure your loved one is receiving appropriate and adequate professional medical treatment.

Once this first step has been addressed, family members are now able to join in to support the individual through the recovery process. The National Education Alliance for Borderline Personality Disorder (NEA for BPD) has issued specific guidelines to help family members and loved ones participate effectively and constructively. A brief overview of these guidelines is found below and more information can be obtained on the NEA for BPD website at www.borderlinepersonalitydisorder.com.

The first recommendation is to “go slowly”. In other words – in the initial stages, fear of change and fear of abandonment through change is very high in the mind of the sufferer, who may exhibit resistance to treatment and change for precisely these reasons. This is not unique to a BPD sufferer – family members can build their “patience muscles” by considering areas of their own lives where change is both needed and feared. The NEA for BPD also advises family members to refrain from encouraging the sufferer with “you can do it” messages – these may increase anxiety and slow actual progress. Rather, family members are encouraged to eschew overt praise at noticeable progress and instead validate the hard work involved while still empathizing with how difficult the change process must be. Wrapped in with this is an encouragement to avoid discussion of achieving big goals – again, family members can flex their patience muscles by contemplating how desired change has happened in their own lives, and by setting small, realistic goals for the sufferer with the help of the professional treatment team.

The second recommendation is to modify the home environment in any way necessary to achieve what the NEA for BPD calls a “calm and cool” environment. This may mean something as simple as maintaining predictable daily family routines. Other ideas that are effective are making efforts to moderate intense emotional displays (whether positive or negative), minimize defensiveness in response to the individual’s thoughts and behaviors, and set limits on what will and won’t be tolerated to preserve the sanity and safety of the family unit.  Becoming educated about BPD symptoms and fears – for example, intolerance of being left alone, inability to discern “grey” emotional areas, and inability to self-sooth – will also assist family members with developing patience, compassion, and appropriate responses throughout the recovery process.

Finally, the NEA for BPD urges family members to seek prompt professional attention for BPD-related behaviors, such as self-harming, self-medicating through alcohol or other substances, or suicidal thoughts or behaviors. These behaviors are serious and reflect an intolerable inner environment that requires immediate professional intervention. Getting the sufferer prompt attention preserves not just safety and sanity but paves the way for development of secure emotional bonds that lead to eventual full recovery.

At Southlake Counseling, we have more than two decades of clinical training and experience implementing DBT-based treatment programs. Our wealth of individual and group support for males and females, adolescents and adults is unique in the Davidson area. If you or someone you love is exhibiting borderline personality disorder symptoms, contact us today at www.southlakecounseling.com to find out how DBT-based treatment can help.

Be Well,

 Kimberly

Published on Monday May 17, 2010 in Borderline Personality Disorder. 0 Comments Tags: , .

Your “Say Yes to Life” Monday Motivator: On the Borderline

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May is Borderline Personality Disorder Month.  In honor of this important topic, we will spend the month of May addressing different aspects of recovery from this highly treatable disorder.

This week we will focus on the nuts and bolts of what borderline personality disorder (BPD) is, what treatments are available, and recommendations for finding support for yourself or a loved one.

Just hearing the phrase “borderline personality disorder” can strike fear into the hearts of the most resilient loved ones.

But for the individual who is diagnosed with borderline personality disorder (BPD), there is probably just a question mark where comprehension should be. This person is probably thinking, “BPD? What is that? This is just how I am!”

Therein lies the difficulty in accurately diagnosing, assessing, and treating BPD. To the professional untrained in BPD treatment, a sufferer can seem like an exercise in unpredictability, not to mention a source of continual professional self-doubt and frustration.

To the loved ones, often unwittingly caught in the disease’s trap along with the sufferer, BPD can appear as a nightmare of confused interpretations that never ends.

To the sufferer, it is just another day in a life filled with emotional pain.

Statistically-speaking, studies indicate that 2% of the population is thought to suffer from BPD. Additionally, up to 20% of all psychiatric hospitalizations stem from BPD. It is thought that nearly three-quarters of all sufferers are female, which is why current research and treatment continues to focus on females.

But what is it? What does “borderline personality disorder” even mean?

Simply put, BPD places the individual at odds with her own emotions. Emotional ups and downs are experienced as equally painful, chaotic, and unmanageable. Any other symptom traditionally associated with BPD can be traced back to this internal emotional war. Because the emotional instability is so severe, BPD is considered both serious and life-threatening. Self-harming and suicidal thoughts and behaviors are common. Relationships are a continual challenge due to continual mood swings and poor sense of self-identity. Treatment is a must – for the sufferer’s sake, and for the sake of those around them.

What causes BPD? While research is not yet able to pinpoint the exact causes, one thing is clear – it is not a self-willed disorder, and it is not the sufferer’s fault. Newer scientific evidence strongly points to a dual dance of biology and environmental triggers. For instance, while studying the brains of individuals diagnosed with BPD, researchers noted higher activity in parts of the brain that control emotional expression and experience, including the limbic system, the brain’s emotional processing center. For these and other reasons, it is widely thought that BPD-predisposed individuals’ brains differ not just in function but also in structure. This evidence also illuminates one possible reason for the tendency the disorder has shown to run in families.

Environmentally, an individual is considered at higher risk for developing BPD after experiencing childhood trauma or an invalidating emotional bond with early caregivers – or both. Since the disorder tends to first show itself in early adulthood, environmentally it appears that an earlier experience of traumatic emotional invalidation is a key factor in determining who is at risk for BPD later on in life.

But while it can be tempting to spend vast amounts of time digging into a sufferer’s past for clues as to why BPD has developed, the most important call to action is to get that person HELP.

Up until a few short decades ago, treatment options were scarce. But thanks to the pioneering work of Dr. Marsha Linehan, the founder of Dialectical Behavioral Therapy (DBT), there is much hope for successful treatment of this persistent and often resistant disorder. Dr. Linehan developed DBT specifically for the treatment of individuals suffering from BPD after studying their symptoms extensively and determining a range of four core building blocks needed to successfully overcome the disorder.

This is good news for sufferers, loved ones, and professionals. Sufferers who become students of DBT learn key coping techniques in Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. These four core modules are introduced over a period of time in an atmosphere of comprehensive individual and group support, including extra phone support if needed. The end result is an individual who is equipped with all the tools and resources she needs to combat her tendencies toward emotional overextension and self invalidation. Since the instruction is done in a nurturing and emotionally-validating environment, the individual is repairing old hurts while learning new skills, and emerges a stronger, more confident person within herself and in her interpersonal relationships.

If you or someone you love is exhibiting signs and symptoms of BPD, it is important to seek help immediately. BPD is a serious disorder and deserves the highest respect. Do not attempt to manage symptoms of BPD for yourself or a loved one. The professionals at Southlake Counseling have dedicated more than two decades to proficiency in supporting individuals with borderline symptoms through the recovery process. We are here to help. Southlake Counseling offers a wide variety of DBT-based individual and group support, including phone support. Our support groups are offered for both females and males, adolescents and adults. Our comprehensive DBT outpatient program is designed to make immediate, measurable progress in reduction of symptoms and improvement in emotional functioning. Visit us at www.southlakecounseling.com to learn more.

Be Well,

Kimberly


Published on Monday May 10, 2010 in Borderline Personality Disorder. 0 Comments Tags: , , , , .