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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by Deneb on June 12, 2009, at 2:59:30
BirdSong suggested DBT. I'd like to look into that. Anyone want to do it with me?
Posted by seldomseen on June 12, 2009, at 7:09:40
In reply to I'd like to do some DBT, posted by Deneb on June 12, 2009, at 2:59:30
I would talk to your pdoc about it and see if she feels it would augment your treatment.
Actually, didn't you guys talk about this before? I can't remember her response though.
Seldom
Posted by Phillipa on June 12, 2009, at 12:10:58
In reply to Re: I'd like to do some DBT, posted by seldomseen on June 12, 2009, at 7:09:40
I thought a few of you were doing it a while back on psychology? No? Phillipa
Posted by Deneb on June 12, 2009, at 18:56:53
In reply to Re: I'd like to do some DBT, posted by seldomseen on June 12, 2009, at 7:09:40
> I would talk to your pdoc about it and see if she feels it would augment your treatment.
>
> Actually, didn't you guys talk about this before? I can't remember her response though.
>
> SeldomYeah, I asked her about joining a DBT group, but she said I was not ready for it. She didn't think it was a good idea.
My pdoc knows about DBT. I am not sure if she does it with me. I'm not too sure what DBT is about.
Posted by Deneb on June 12, 2009, at 18:58:16
In reply to Re: I'd like to do some DBT, posted by Phillipa on June 12, 2009, at 12:10:58
> I thought a few of you were doing it a while back on psychology? No? Phillipa
Yeah, it was a while ago. We kind of stopped doing it.
Posted by Phillipa on June 12, 2009, at 19:52:07
In reply to Re: I'd like to do some DBT » Phillipa, posted by Deneb on June 12, 2009, at 18:58:16
Any reason? Seemed hard work. Love Phillipa
Posted by BirdSong on June 12, 2009, at 20:43:47
In reply to Re: I'd like to do some DBT » Deneb, posted by Phillipa on June 12, 2009, at 19:52:07
While your pdoc may know of DBT, your pdoc is not doing DBT with you.
True DBT is a team approach and involves two components although "phone coaching" is sometimes considered a third component.
An important goal of DBT is to develop client's minds through the teaching of interpersonal skills, emotion regulation skills, mindfulness and acceptance skills, and distress tolerance skills.
The components of DBT are: (1) individual therapy and (2) group therapy where skills are learned
1. Individual Therapy.
Consists of teaching skills and adaptive behavior both within therapy sessions and between therapy sessions. Contact with therapist between session is highly encouraged and permitted. Therapy sessions occur weekly (sometimes bi-weekly) in which a particular problematic behavior or event from the past week is explored in detail, beginning with the chain of events leading up to it, going through alternative solutions that might have been used, and examining what kept the client from using more adaptive solutions to the problem. You do worksheets, keep diary cards, etc.The emphasis is on teaching clients to manage emotional issues rather than rescuing them out of crisis.
In addition, the therapist and client work towards improving the use of skills that are learned in weekly group. Often, skills group is discussed and obstacles to acting skillfully are addressed. The skills are practiced both in session and outside of session using frequent phone contact.
2. Group therapy.
Weekly 2-2.5 hour group therapy sessions in which interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught. The skills are taught and practiced. Most DBT groups use the DBT workbooks and exercises and follow the stages to a 't'.Both of these are required for DBT. It is very organized.
Posted by Deneb on June 12, 2009, at 21:03:12
In reply to Re: I'd like to do some DBT, posted by BirdSong on June 12, 2009, at 20:43:47
Is DBT expensive? I am out of a job right now and can't afford anything. I like my pdoc and have been seeing her for about 7 years now. I don't want to stop seeing her.
I've already improved a lot over these years. In the past I was ODing and making real suicidal threats. I even bought a rope to hang myself with once.
Now I am much better. I think therapy one weekly with pdoc helps.
Should I ask pdoc about group DBT work again? Last time I asked she said I wasn't ready for it.
Posted by Deneb on June 12, 2009, at 21:21:22
In reply to Re: I'd like to do some DBT » BirdSong, posted by Deneb on June 12, 2009, at 21:03:12
I googled DBT in Ottawa and got nothing. I got a page about DBT in women's prisons. I think they offer it in women's prisons.
I really don't think I am "bad" enough to need DBT right now and I think DBT is reserved for the most disordered. I wish I could practice some DBT though. Would anyone want to do it with me? I have Marsha Linehan's Skills Workbook.
Posted by Deneb on June 12, 2009, at 21:32:48
In reply to Re: I'd like to do some DBT, posted by Deneb on June 12, 2009, at 21:21:22
I have a lot of trouble coming to terms with having people accept me for who I am and changing myself for the better.
I really have improved a lot over the years and I felt really good about it, but recently people tell me it is not good enough.
Now I know I still have some problems and so there is always room to improve. It just makes me angry ya know?
I could have used DBT a lot more 5 years ago. These days I am a lot better.
I am very confused. On one hand I want to improve myself but on the other hand I am very angry and feel like acting out and doing DBT just to spite people. Does that make sense?
I am trying my best to not act out right now. I hope it is working.
Posted by BirdSong on June 12, 2009, at 22:47:53
In reply to Re: I'd like to do some DBT, posted by BirdSong on June 12, 2009, at 20:43:47
This is ridiculous.
DBT is not just for "bad" cases as you stated.
It is utilized for everyone with personality disorders or personality disordered tendencies. It is also utilized for people with substance abuse issues, dissociation issues, PTSD, and it is even utilized with teenagers. I work with teens who are in DBT and they are (1) not "bad" and (2) most have less PD behaviors than you display here....Compared with other therapy methods, in randomized controlled trials sponsored by the National Institutes of Health, DBT has shown to be significantly more successful in reducing self-harming and suicidal behaviors, improving emotional stability, and improving lives of clients with BPD or BPD tendencies.
It is a style of therapy that was created to deal with the exact things that you display in your posts: suicidal tendencies and threats, feelings of rejections that spiral into self-hate which then propels you to engage in punishment behaviors.
It's great that you have come "a long way" in 7 years with your pdoc. But print out your posts and read them. Look at the pattern. That pattern stops when you have appropriate therapy and learn skills.
You don't think your situation is "bad"....in just a month or so, you talked about jumping off the bridge in SF, you asked people to stop you and be responsible for you, you asked how many pills you could take so you don't OD, but still take alot, you have been told constantly to goto the hospital because you are threatening to harm yourself.......
That is what DBT is for.
Posted by Deneb on June 12, 2009, at 23:15:52
In reply to Re: I'd like to do some DBT, posted by BirdSong on June 12, 2009, at 22:47:53
Please respect my decision to make treatment choices for myself.
I think I feel pressured into DBT and that is why I am reacting in anger. Can we please let this issue drop? When and if I am ready for DBT I will look into it, but right now I am happy with my pdoc.
Please accept me the way I am. I am happy now.
Posted by gobbledygook on June 12, 2009, at 23:17:47
In reply to Re: I'd like to do some DBT, posted by BirdSong on June 12, 2009, at 22:47:53
"True DBT is a team approach and involves two components although "phone coaching" is sometimes considered
a third component." - Birdsong___________________________________________________________________________________________
Hi Birdsong,
I didn't realize that "phone coaching" is an optional component of Dialectical Behaviour Therapy. I wanted to ask
how important you think the telephone contact mode of treatment is as you seem to know a lot about DBT. I thought
it was an essential part of the treatment as it offers help and support "in real life" between sessions. Thanks.
Hi Deneb,In my city, the weekly fee for DBT is about $150 - $250 per week for individual and group sessions.
I actually have an appointment with one of Linehan's people in a month. It'll be interesting hear their analysis of me...
Ava
Posted by Deneb on June 12, 2009, at 23:25:47
In reply to Please respect my decision, posted by Deneb on June 12, 2009, at 23:15:52
I know this is childish of me, but the more someone pressures me into something, the more I don't want to do it.
I am very angry right now.
Please accept me for who I am. I am happy now!
Posted by gobbledygook on June 12, 2009, at 23:29:43
In reply to Re: Please respect my decision, posted by Deneb on June 12, 2009, at 23:25:47
"Please respect my decision to make treatment choices for myself.
I think I feel pressured into DBT and that is why I am reacting in anger. Can we please let this issue drop? When
and if I am ready for DBT I will look into it, but right now I am happy with my pdoc.Please accept me the way I am. I am happy now." - Deneb
___________________________________________________________________________________________Hi Deneb,
I didn't see this post when I posted earlier...
I wanted to clarify my earlier post...just in case. I completely respect any decision you make for yourself.
I only replied to answer your question about the cost of DBT...OK? I completely accept who you are, and I'm glad you're happy, Deneb.
Ava
Posted by BirdSong on June 13, 2009, at 0:09:57
In reply to Re: I'd like to do some DBT » BirdSong, posted by gobbledygook on June 12, 2009, at 23:17:47
Hi gobbledygook,
Actually the phone component is very important. I think I confused you when I wrote "True DBT is a team approach and involves two components although "phone coaching" is sometimes considered a third component."
It is actually just semantics.
DBT can be seen as two ways:1) Individual and Group AND the phone is part of individual (as designed)
or
2) Individual, Phone, and Group because the phone is such a "special" part of this whole therapy (ie. the majority of other therapy methods do not encourage as much phone contact)So some people semantically split it into 3 components....
Sorry.Most DBT therapists are available 24 hours for help with dealing with the behavioral cycle and for practicing skills.
However, there are boundaries set around phone contact.In my work....a teen can call me before smoking pot at the skate park and we can work through the skills and choices available and their thoughts and even the feelings leading to their decisions and behaviors...but if the teen calls me stoned, I tell them that they must wait to our next appointment to talk about the event, because they already acted the behavioral pattern.
Now, teen could call me again for another issue before their session, and we could work that issue over the phone.
The phone contact is not stopped because they choose the least favorable path in another situation...
Every situation is new and an opportunity to work on stopping the cycle.The point of the phone contact is to prevent the escalation of emotion and prevent crisis by connecting with someone who helps work through skills and thoughts.
Also, as the client works and learns more skills and gets better at "talking themselves down," phone contact may lessen. In the beginning, there is lots of contact.
It is a very effective form of therapy if it is done correctly and a client is willing to put the effort in and learn. Many people with personality disorders are very successful after 1 year and go on to either no more therapy or being able to do a more insightful form of therapy (psychodynamic, humanistic, etc) because they can self-regulate better.
Posted by BirdSong on June 13, 2009, at 0:22:51
In reply to Please respect my decision, posted by Deneb on June 12, 2009, at 23:15:52
Whether you do DBT is your choice.
But stating that it is for "bad" cases is completely (a) misinformed and (b) not insightful into your own actions.Personally, I just find it frightening when someone threatens suicide multiple times and is allowed to do so on a public forum. Obviously these other people know you and feel comfortable just "supporting and telling you to goto the hospital."
There may come a time that someone calls the police because of posts like that. It has been done on other forums and results in police at your home once they track the IP address.
We as readers don't know whether your talk of suicide is serious, manipulation, or an attempt to communicate your needs. But it is frightening and it is sad that it is supported here.
Posted by Deneb on June 13, 2009, at 0:37:20
In reply to Re: Please respect my decision, posted by BirdSong on June 13, 2009, at 0:22:51
In no way have I threatened to commit suicide here, not in a long time. I have written that I DO NOT want to jump off the bridge. I am AFRAID of jumping off. Does that sound like a threat??
I also wrote I am thinking about, but WILL NOT OD. Again does that seem like a threat?
In the past I have threatened. When I threaten I will say, I am going to hang myself on Mon with the rope I bought today at Walmart. THAT is threatening.
I am also not trying to be manipulative. At times I am scared for myself and I am communicating my FEAR of harming myself.
Right now I do not want to die, so if I ever truly threaten I will be serious. The fact is, I do scare myself. I have OD'd seriously enough to end up in hospital. Other times I just did not go to the hospital. I don't lie on Babble. If I write I took 10 pills, I really DID take 10 pills. If I write that I am OK, it really means I am OK.
I am feeling angry and unheard.
Posted by BirdSong on June 13, 2009, at 1:52:44
In reply to I'd like to do some DBT, posted by Deneb on June 12, 2009, at 2:59:30
I am not responding anymore to you after this.
Several of your posts you talked about your potential for committing suicide.
http://www.dr-bob.org/babble/social/20090331/msgs/888415.html
http://www.dr-bob.org/babble/social/20090331/msgs/889124.html
http://www.dr-bob.org/babble/social/20090331/msgs/889136.html
http://www.dr-bob.org/babble/psycho/20090328/msgs/890914.html
http://www.dr-bob.org/babble/psycho/20090328/msgs/891062.html
http://www.dr-bob.org/babble/social/20090604/msgs/900068.html
These are all show thoughts of suicide with plans from April to June. And I don't have the time to copy more.While you waiver back and forth, a plan where you say how you are going to do it, communicates more intention. And when you get the response you want from babblers saying goto the hospital, your ok, etc; you stop communicating your plan until the next cycle starts again.
Posted by Deneb on June 13, 2009, at 2:42:02
In reply to Re: I'd like to do some DBT, posted by BirdSong on June 13, 2009, at 1:52:44
Thank-you for not posting to me. I think we are just triggering each other. Perhaps we should agree to just not read each other's posts.
Posted by SLS on June 13, 2009, at 7:20:21
In reply to Thank-you for not posting to me » BirdSong, posted by Deneb on June 13, 2009, at 2:42:02
Hi Deneb.
I am pretty sure that there is no one here who would want to "push" you into doing anything. I do think that there are some people with strong personalities who would like to see you reach your goals. Please don't confuse a firmness in offering suggestions with a lack of empathy.
This is just my personal opinion, which is based upon my background in the field as an observer and having done some reading. I find BirdSong, a person whom you would rather not have any further communication with at this juncture, to be very well educated in the field of understanding and treating people with borderline personality disorder (BPD). I don't presume at this point to know you well enough to know what diagnostic categories apply to you. I just haven't visited these boards frequently enough to know your story. Anyway, I find BirdSong's contributions so far to be enriching of my own understanding of BPD.
I really doubt that anyone on this website carries around with them an archaic stigmatic attitude towards people who have BPD. I think the worst that can be said is that some people have more patience than others when dealing with certain people, just as in real life. Deneb, you have found a gold mine of extraordinary patience on Psycho-Babble. There is more patience and empathy here for BPD than there was on the part of the professional staff at a mental health clinic I attended.
- Scott
Posted by seldomseen on June 13, 2009, at 8:29:09
In reply to Please respect my decision, posted by Deneb on June 12, 2009, at 23:15:52
YOU are the major participant in your recovery/therapy in conjunction with your pdoc.
Deneb, you go girl!
S
Posted by Deneb on June 13, 2009, at 17:28:49
In reply to Re: Thank-you for not posting to me » Deneb, posted by SLS on June 13, 2009, at 7:20:21
I know I was reacting in anger. I know there is still plenty of room to improve. I still feel very bad at times.
BirdSong probably wants me to feel better and not control me. I think there are some misunderstandings. It is likely that BirdSong's method of communication with me is triggering me. BirdSong's method of communication is backfiring with me, instead of making me want to do DBT, it is pushing me away from it. I feel very unheard.
When I read what DBT is about, I am genuinely interested in it. I think it can probably help me, but then when I feel like others are pushing it on me, I resist. I have to balance wanting others to accept me for who I am and changing for the better.
I like the idea of 24 hour phone contact. My pdoc doesn't give me that.
Posted by fayeroe on June 13, 2009, at 18:12:18
In reply to I like the idea of 24 hour phone contact, posted by Deneb on June 13, 2009, at 17:28:49
Deneb, I don't think that anyone here is pressuring you to do anything.
I believe that at times you throw something out and if someone responds to you in a way that you dislike, you react in an annoyed manner.
Please go back and read the posts in your thread.
Pat
Posted by Larry Hoover on June 13, 2009, at 20:24:56
In reply to I'd like to do some DBT, posted by Deneb on June 12, 2009, at 2:59:30
When I looked at the wiki page for DBT, I liked what I saw. It sounds like an excellent tool for anyone to possess. In fact, this description could apply to the focussed therapy I've received to help me to cope with my intense neuropathic pain from CRPS.
"DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of mindful awareness, distress tolerance, and acceptance largely derived from Buddhist meditative practice....
The key elements of DBT are conventional behavioral therapy and cognitive therapy, along with its signature concepts of dialectics and mindfulness. Dialectical thinking, similar to its role in philosophy, is introduced as an alternative to intense, polarized emotions. Rather than reacting to events as either perfect or unbearable, patients are encouraged to recognize multiple viewpoints and bring them "into dialogue." Mindfulness is taught as a method for becoming aware of one's actual, realistic experience in the moment, and separating it from fears about the future or rumination about the past."
The mindfulness aspect encourages almost a third-party observer stance of the self, and permits an interpretive and self-soothing dialogue. As I say, it is a tool that anyone could benefit from. It's certainly not only a tool for borderline individuals, although some specific treatment goals and practises may well be shaped around that model. That's nothing more than an individual focus of any therapy, to shape the supports to the person seeking help with coping.
Lar
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