So I actually just want to start off by letting you all know, in the interest of full disclosure, I am actually several weeks into my group already. So I’m already a few posts behind. The first several lessons or skills that I’ve learned so far will be posted relatively close together, until I can catch up to where I am in the group.
I also found out that the skills/lessons are actually not new every week for the full year, or fifty-two weeks. The first twenty-six weeks (or 6 months), each module is gone through in detail, or as much detail as time allows for, and then for the next twenty-six weeks (or 6 months), the modules are repeated. So the same skills/lessons are done a second time. At first I didn’t like this idea. I was disappointed. I didn’t want to repeat work I’d already done. I had signed on for fifty-two weeks of skills and lessons and you’re telling me I’m actually only getting twenty-six. Well that seems like a rip-off to me. But as I’m starting this group, and getting into the skills I can see why they are repeated.
First of all, it can be a lot of information, and NEW information at that. Some of the skills seem fairly easy or self-explanatory, but a great number of them I look at the Handouts or Worksheets and like it might as well be in a different language for all I’m understanding. Second, it takes time to implement the skills into your life, and more importantly it takes practice. And it’s hard to practice some of these skills when every single week for fifty-weeks is a new skill to learn. So the latter twenty-six weeks, or Round 2, is to allow for the skills to be refreshed and practiced further.
To give you a general outline of the program that I am currently in, you should probably know some of the details of the group.
Every week, for fifty-two weeks, I will attend one two-hour group session, and one one-hour individual session with one of the facilitators. There are two facilitators in my group, one of which I will see every week for individual therapy. My group currently has about 8 people in it although it will be shrinking down to about 6 in a few weeks when a couple of people will be graduating.
As per Marsha Linehan, the group is most effective when the group is kept relatively small. I can see why this is suggested because for the first hour the homework that was assigned in the previous week’s session is taken up, and everyone is expected to go over their homework. So if the group is too large then people would definitely be overlooked or missed, and that sort of defeats the purpose of not only the homework but the group itself as well. To be able to discuss the homework you completed is very instrumental in learning the skills because it’s at this time you would discuss what, if any, issues you had, or what difficulties you experienced.
Marsha Linehan has outlined in remarkable detail in the DBT Skills Training Manual how the DBT is to be implanted and taught. There are several factors that might change depending on what the purpose of the group is, or the disorder being addressed, and for how long the program will run for.
My DBT Group – Expectations & Guidelines
For my group though, this is the set-up:
- The group will be run by two facilitators at all times.
- The group will be held once a week for 52 consecutive weeks.
- The group will run for two hours.
- The group session will start with a short Mindfulness exercise led by the facilitators.
- The first hour of the group, after the Mindfulness exercise, the homework assigned in the previous week’s session will be taken up, with each participant contributing.
- After the first hour, there is to be a short break.
- The second hour will consist of teaching the next skill and the homework assignment.
- I will attend in addition to the group session, one one-hour individual session with one of the facilitators. The facilitator I am assigned will be my individual therapist/DBT coach for the duration of the 52 weeks.
- If I miss four consecutive group sessions or individual sessions then I am considered out of the program. And I will have to wait until the 52 weeks has ended to re-apply to the program again, and I am not guaranteed re-entry into the program, as I will be subject to the same pre-assessment and registration process as before.
- During working hours, I am expected to reach out and contact either or both facilitators for assistance should I feel unable to cope, if I need help in what skill to use, and how to use it, or if I have any questions or difficulty understanding or completing the homework.
- Should I reach out to the facilitator(s)/DBT coach, I am expected to make a genuine attempt to use the skill as discussed to cope with the situation before me. Should the skill be unsuccessful after a genuine effort is made I am expected to contact the facilitator(s)/DBT coach again for further assistance.
- I am also expected to refrain from self-harm behavior while I am a participant in the group. During work hours, I am expected to immediately contact the facilitator(s)/DBT coach for help, who will walk me through the skills to bring down the heightened emotion.*
*This one kind of shocked me when I asked what if it’s after work hours, or it’s the weekend, or a holiday, will I be kicked out of the group? And she said no. There is only one way out of the group, to miss four consecutive sessions. They would, of course, prefer that I not self-harm but if it happens then they will work with me to how I can manage the emotion the next time. At first this almost felt like a license to cut, all I had to say was it was at 1 o’clock in the morning, or it happened Saturday night, so what was I to do. I couldn’t call the facilitator(s)/DBT coach, so I cut. But then it occurred to me that in the end that would really defeat the purpose of why I was doing this program in the first place. Yeah I could lie but then I would only be hurting myself, literally and figuratively.
- The last part of my group is to fill out the DBT Diary Card, that is tailored to my specific issues on a daily basis, and I have to bring it to my individual session every week to go over with my DBT coach.
All of the above are a part of the agreement I signed at the beginning of this program. It seems daunting at times, and like I said with #7, I am tempted to sometimes lie, in group, in individual, on my Diary Card, but then if all I’m going to do is lie then why bother doing the program? The skills and the facilitators/DBT coach are there for a reason, the Diary Card is used for a reason, and if I’m just going to crap all over them I might as well leave the group and let someone who is willing to give it genuine effort a chance.
The DBT Diary Card
For those of you unfamiliar with the DBT Diary Card, it is used to track what urges you’ve had, where your emotions were at, and what actions, if any, you took, and what skills were used, if any, over the course of the week. The Diary Card will often be tailored to whatever your issues are so that it can properly reflect where your urges, emotions, and actions are.
The Diary Card is a particularly weak spot for me because as I see all the things for me to check off, the Urges I’ve had to cut, or die, or binge, the emotions and where they were at, were they high or low, was I in a position of vulnerability, and then what actions did I take? Did I use any skills? Did I even consider the skills? Could I be honest with this? Did I want to see how often I wanted to die, or self-harm? If I saw it there every week, did that mean I was beyond hope or help? If my emotions showed high across the board was I a lost cause? If I did binge, or purge, or both, or I did cut myself, was I screwed? As it turns out, no. it was safe for me to be honest because my mistakes, or my slip-ups, were not cause for me to leave the program, and they were certainly not cause for me to be beyond help or hope. In fact it was quite the opposite. What happened there, she will ask me? What was going on? You felt overwhelmed? Do you know why? Do you want to talk about it? Do you want to figure out what happened that led you to cut, or binge, or purge? Wait a second…you mean you’re not going to reprimand me? You’re not going to kick my ass out the door? You’re going to…help me? Oh my. Okay. This is new. Yes I would like to talk about it. I would like to try and figure this out.
One of the worst feelings I hate to experience is that not only am I in this personal hell but I am there all by myself with no hope of getting out. For the first time, it feels like maybe life doesn’t have to be hell.
Onto DBT Assumptions
There are “DBT Assumptions” that are applied to every group, every participant, and every program, no matter how long the program is, that are to be adhered to. The assumptions are typically covered in orientation but are also covered again whenever there is a new member to the group. The “Assumptions” are just that, assumptions. They are expected to be adhered to by everyone, and in essence they reflect what is at the core of DBT.
- People are doing the best they can.
- The idea here is that all people at any given point in time are doing the best they can, given the causes of behavior that have occurred up to this moment.
- People want to improve.
- The common characteristic of all people is that they want to improve their lives.
- *People need to do better, try harder, and be more motivated to change.
- The fact that someone is doing the best he or she can and wants to do even better does not mean that this is enough to solve the problem.
- …when progress is steady and occurring at a realistic rate, doing better…trying harder…is not needed.
- People may not have caused all of their own problems, but they have to solve them anyway.
- People have to change their own behavioral responses and alter their environment for their lives to change.
- New behavior has to be learned in all relevant contexts.
- New behavioral skills have to be practiced in the situations where the skills are needed, not just in the situation where the skills are first learned.
- All behaviours (actions, thoughts, emotions) are caused.
- There is always a cause or set of causes for actions, thoughts, and emotions, even if people do not know what the causes are.
- Figuring out and changing the causes of behavior is a more effective way to change than judging and blaming
- Judging and blaming are easier, but anyone who wants to create change in the world has to change the chains of events that cause unwanted behavior and events.
I actually like these assumptions because they allow for me to personally, and dialectically I might add, hold myself accountable, and it also allows for me to recognize that there are some things that I can’t control, and that’s okay. It also shows me that I need to be more understanding and patient with others and what they are accountable for, and what they are unable to control, since those assumptions applied to them too.
So there it is, the framework of my DBT program. And now onto the skills…
Next post: Week One
Skills, Assumptions and DBT Diary Card are from DBT Skills Training Manual, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.