Tag Archive for 'Dialectical Behavioral Therapy (DBT)'

Page 3 of 5

Your Say Yes to Life Monday Motivator: Turning Holiday Woes into Holiday Wonders

No Gravatar

Oh boy. The holidays are here.

Again.

You are not sure whether you have been anticipating this moment all year, or dreading it.

Or maybe a bit of both.

Nevertheless, here they are again – upon us for yet another season, and once again before we are ready for them to come. So now the question becomes not “where can I hide?” but rather “what am I going to do differently this year?”

That is what we are going to discuss in this month’s blog series “Turning Holiday Woes into Holiday Wonders.”

For our series, you have been my inspiration, because each one of the woes I have selected is one I have heard you share with me in private session year after year, right around this time.

For instance, you have shared with me how hard you find it to carve out time for self-care while feeling called to take extra special good care of others as well.

You have told me that sometimes it feels simply impossible to locate the fine line between treating yourself to holiday goodies and maintaining your physical health and nutrition.

And you have confided that you sometimes – often – find it incredibly difficult to release a whole past year’s worth of errors and triumphs only to discover an entirely new, sparkling fresh year sweeping down on you before you have had any time to prepare for its arrival.

So this month, we will examine strategies to turn each of these woes into wonders, one week at a time. To do this, we will revisit one of my favorite therapeutic approaches for recovery and life – Dialectical Behavioral Therapy, or DBT for short.

DBT is a wonderful pathway to effective daily living authored by Dr. Marsha Linehan. The focus and goal of DBT work is to stay centered, present, open, and willing to do our best in every moment.

The teaching tools that DBT uses include mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Each tool builds upon and integrates with the others, and when used together can produce a centered, balanced, present-focused approach to daily life during the holidays and at every moment of the year.

So before we begin our “woes to wonders” adventure together, let’s just take a quick review of each of the four key DBT tools we will be using:

  • Mindfulness training equips us to take back control over our mind’s thoughts and our reactions to those thoughts
  • Emotion Regulation teaches us to name and experience our emotions without allowing them to overtake us
  • Distress Tolerance cultivates our ability to stay present and focused for each moment of our lives regardless of what the day may bring
  • Interpersonal Effectiveness helps us to develop assertiveness skills to ask for what we want and need in safe, healthy, and affirming ways

It is easy to see how each of these tools becomes particularly essential during the heightened energy and emotion the holiday season ushers in. During the next few weeks, we will look at how to apply each of these skills to transform a traditional holiday woe into a true source of delight and wonder.

If you are finding that you are struggling this holiday season to find the wonder in the midst of the woes, Southlake Counseling can help. Our compassionate and skilled staff has more than two decades of experience with guiding individuals in how to effectively use the DBT principles of mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Learn more by visiting us at www.southlakecounseling.com.

Be Well – and happy holidays!

Kimberly

You’re Talking, But Am I Really Listening?

No Gravatar

You’re talking, but am I really listening?  

Too often couples are seen in therapy due to communication problems. Phrases like, “he/she just doesn’t understand me,” or “I just don’t feel like he/she is listening to me,” are all too common phrases.

Many times when we are in heated discussions with a loved one, we are thinking about what we are going to say next, or trying to jump in to get our point across. Subsequently, we are not being “mindful” of what the other person is saying. Being “mindful” is being fully present in the moment you are in just as it is unfolding in front of you.  If while your loved one is speaking, you are thinking about what you are going to say, you are already in the future and not in the moment.

Mindfulness is a skill that is the core of Dialectical Behavior Therapy (DBT). It’s a skill that requires practice because our society tends to promote being “mindless” by encouraging multi-tasking. One way to get started in becoming more “mindful,” or more fully present in the moment when having a neutral or pleasant discussion, (for both parties) with your loved one is to focus on what they’re saying, pay attention to their tone, and focus on understanding. If you feel the urge to “jump in” to assert your view, just notice that urge, but bring your attention back to what your loved one is saying. Feeling understood and listened to are powerful tools in strengthening relationships.    

Shannon T. Brewer, M.A., L.P.A.

Love and Support in Action

No Gravatar

On a recent weekend I had the great fortune of being at the Susan G. Komen Race for the Cure in Charlotte. Every year I’m amazed at the wonderful outpouring of support and love that I see at that event. I believe that 16,000 people participated and 1.6 million dollars were raised, of which 75% stays in the Charlotte area. As I was surrounded by all the love and support generated by all those people walking and running for their mothers, sisters, aunts, nieces, and friends, I thought about what a great way to ”cope” with a sometimes devastating illness.

In Dialectical Behavior Therapy (DBT) Skills Training, the module on Distress Tolerance teaches various skills used to cope with painful situations and/or emotions. DBT operates on the principle that pain is inevitable, but suffering is optional. One of the skills featured in DBT is ACCEPTS. ACCEPTS is an acronynm standing for Activities, Comparisons, Contributing, Emotions, Pushing Away, Thoughts and Sensations.

Fundraising, walking and/or running for a cause such as the Susan G. Komen is an excellent example of something that involves Activities, Contributing and Comparisons, which is why an event like this and others like it are such a huge draw for so many, on so many levels. If you would like to learn more about DBT and the skills training group contact Southlake Counseling for more information.

In good health,

Shannon

Shannon T. Brewer, M.A., L.P.A.


Acceptance and My Dear Friend

No Gravatar

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

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

No Gravatar

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