What is DBT?By Kerrie Toole, LICSW, Executive Director “I tried DBT before and it didn’t help.”
If I had a nickel for every time I’ve heard this statement from a client during an initial meeting… Typically after hearing this from a prospective client, my next line of questioning includes asking what they did in their DBT sessions: What Target Behaviors were on their Diary Cards? What patterns were identified through Chain Analyses? How often did they utilize Phone Coaching with their therapist? How long did they participate in Skills Groups? Most of the time, I’m met with blank stares and confusion. There is a sizable amount of misinformation in the therapy world about what Dialectical Behavior Therapy (DBT) is, and many therapists are even attending trainings where they are led to believe that they are doing DBT treatment when they actually are not. This is why the developer of DBT, Marsha M. Linehan, Ph.D., ABPP created the Dialectical Behavior Therapy - Linehan Board of Certification credentialing process to demonstrate to the public those therapists who are providing DBT with full fidelity to the treatment as it was designed. In this post, I will review the core components of DBT so you can ensure that you are receiving the best form of treatment for your needs. DBT was initially developed by psychologist Dr. Marsha M. Linehan to address self-harming behaviors and emotion dysregulation commonly associated with borderline personality disorder (BPD). However, DBT has since proven to be beneficial for individuals dealing with a range of mental health concerns, including depression, anxiety, bipolar disorder, and eating disorders. Dialectical Behavior Therapy (DBT) consists of four core modalities that work together to provide a comprehensive and integrated approach to therapy. These four modalities are:
Adolescent DBT: Modifications in the treatment protocol for adolescent clients and their families include an additional Module in DBT Skills Groups called Walking the Middle Path, which focuses on building the balance between validation and change within families and within oneself. Family therapy is also a signature component of Adolescent DBT, and Castlebrook also requires that parents or caregivers attend a 12-Session DBT for Parents group to educate parents about ways to recognize patterns in their teens, regulate themselves, and offer support in constructive and compassionate ways. If you read this far, you can see that DBT is a highly structured, intensive treatment protocol. What is described above just scratches the surface of what DBT treatment looks like. Now one might ask, does following the full DBT Protocol to a “T” mean that this is the ONLY way that DBT can be effective? The research says no, not necessarily. Recent studies on DBT have been focusing on the dosage of treatment, and how to match up a person’s individual symptoms with the most effective component of DBT. This may mean that someone could benefit from participating in the DBT Skills Groups as an adjunct to traditional therapy. Conversely, it may mean that the full protocol is the recommended dosage, and to provide less than that would be doing a disservice to the client. The dosage of DBT is often assessed by the therapist and the client during the initial assessment process.
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Clinician Spotlight: An Interview with David Polidi, LICSWWelcome to the third installment of Clinician Spotlight, a series where I sit down with some of our wonderful therapists for a cozy conversation about work, mental health, and many life tidbits in between. This month, I had the opportunity to speak with David Polidi, LICSW. David specializes in trauma, EMDR, and runs a popular couples’ workshop at Castlebrook. David discussed his journey towards trauma-focused practice, the importance of deep conversation, and interestingly, his previous life as a street magician.
Lauren: Hi David! Thank you for sitting down with me to chat. Can you tell me a little bit about your career journey thus far? David: Sure! My career in the field began in the Massachusetts public school system as a guidance counselor where I was for about six years. Then, I went back to school and started working at nonprofit agencies where I focused on community mental health. During this time, I was trained in the ARC model (Attachment, Regulation, Competency) which I applied to working with families that had experienced trauma, especially children. With the pandemic, I pivoted and started working at Castlebrook which allowed me to continue focusing my training on trauma-specific approaches. I had some prior interest in trauma, but I went deep into the trauma world here. Lauren: Is there anything specific that was a catalyst for you to step into that world? David: I believe that I came into this field for a reason. I read this article a long time ago called “Wounded Healers” by Carl Jung about how we’re all kind of wounded and are able to offer support from our own journeys. I definitely wanted to be there for others and to study different evidenced based approaches that aligned with trauma work. I’ve always been interested in the mind though. I grew up in NYC and I was a magician [laughs]. I love magic and I actually did magic on the streets of New York to save for college. Magic is connected to different things, part of it being psychological. You can do amazing things with your hands, but the magic happens in people’s minds. In addition to magic, there is this piece of hypnosis which I’ve always been fascinated with too. All of this culminated in an interest in psychology, but for trauma, I’ve had my own journey with my own experiences and I wanted to learn more about it. I’ve actually had EMDR (Eye Movement Desensitization and Reprocessing) done on myself, too! Lauren: Do you feel like experiencing EMDR yourself has informed your ability to practice it and feel comfortable? David: It has definitely helped me to understand what it’s like to be a client. It’s scary and it’s hard work. For me personally, I love to talk through things and be in my head so EMDR gets you to a place where you can take all of the wonderful stuff in your head and see if you can step aside a little bit to get in touch with it. That’s been a meaningful journey for me. Lauren: EMDR seems to have certainly caught your attention! What other modalities have you explored? David: Internal Family Systems, or IFS. EMDR led me to IFS which, to me, feels like EMDR on steroids. The IFS model kind of creates a map for beginning to dive into your mind with EMDR. You can work with a client to start mapping out the different parts of the self and help the client prepare and feel safe to explore deeper trauma work. Lauren: I know a magician never reveals their tricks, but what would you say has been one of your most successful EMDR interventions that you do with your clients? David: Definitely resourcing. While some approaches boast that everything you need to heal is inside of you, other approaches, such as EMDR, acknowledge that there are external things that can help people. For instance, one resource I help people build up is called a safe space, or if somebody doesn’t like that word, we can use “safe enough” space. You envision a sacred, beautiful space, imagined or not, and really try to feel yourself there. You allow yourself to experience what your nervous system feels like in this safe space and build upon that resource with more positive images or ideals. Another example of this is parents–who would have been a really great mother or father? What would having that person in different stages of your life have felt like? The more you practice, the more you’re able to get into those calm states. So when you’re eventually going into the trauma spaces and feeling activated, you can bring in some of the positive resources to help the nervous system regulate itself before getting back into the deeper level of work. The person-centered approach, human connection, and wisdom of the trauma field is very interesting to me. Lauren: Speaking of human connection, what are some things in your life that are important to you outside of work? David: Well, I think it’s important to mention my favorite artist–my daughter! She’s really good. I live with my wonderful, inspiring wife, my artistically talented daughter, and two furry creatures; a dog named Nala and a cat named Fozzy. They’re very therapeutic. Lauren: What’s been exciting you about your work recently? David: I have my couples workshop that I’ve been running called Deepening the Conversation. I’m all about conversation in any shape or form. While I work with both individuals and couples, I actually find the work to be quite similar. There are parallels between listening to the parts inside yourself and having a didactic conversation with another person. There are certain things that help move a conversation along whether it’s with yourself or with each other; you need to make room for different perspectives, listen, and develop a deep level of understanding of the different parts (or people) involved. For future directions, I’m interested in learning more about dissociation and its connection to trauma. Lauren: That’s great! Before we end, can you demonstrate a magic trick? **David goes on to blow Lauren’s mind with a card trick related to his IFS work** David: In my heart, I am so many things, but one of the things I admire about people is being able to be a storyteller. If I can use my magic tricks to tell a good story and help people remember the imagery of what I’m telling, it can be something really special that they can take with them. It’s another way to externalize the work and make it tangible for people; I’m excited to start using more of it in my practice. How to Tell Your Therapist That Sessions Have Gone Stale By Lauren Chapin, LICSW
Whether you’ve been in therapy for a few months or a few years, there may come a time when sessions feel less helpful than they once did. Maybe over time, discussions have felt more casual than focused, or perhaps you’ve found yourself giving a monotonous play-by-play of your week during each meeting. No matter what has made your sessions grow stale, addressing this with your therapist is the best way to change course. But how? Go Back to the Beginning One way to get things moving and grooving again is to revisit your original goals for therapy. Often, when someone embarks on the therapy journey, one of the first questions they’re asked is, “What brings you here today?” Do you remember your answer? Perhaps you realize that your goals were never actually solidified. That’s okay! This is a great opportunity to let your therapist know that you’d like help working on your goals for treatment in a more concrete way. On the other hand, you may find that you’ve made substantial progress with your original goals and can spend time reviewing your progress and identify fresh areas for growth. Remember, your treatment plan is like a living, breathing document. It’s something to return to with your therapist whenever you feel off track as a reminder of your original goals. But Goals Are Hard It’s easy enough to say, “Identify some goals!” but harder to actually put that into practice. If you’d like a headstart on this before bringing the issue to your therapist, it might be helpful to do a personal inventory. Think about some of the different domains in your life such as health, relationships, career, education, leisure, or spirituality. For each category you identify, rate your personal satisfaction with that area on a scale of one to five with one being “This area needs major damage control” and five being “I am thriving.” Once you’ve set your ratings, prioritize one or two areas of your life that could use the most attention and care. Sometimes, it may feel like problems are crawling out of the woodwork from all areas. That may be true, but spreading your focus too thin may impede progress. Think of this like building a house. The roof will eventually need to be built too, but right now you’re still pouring the concrete. Change in Frequency How often are you finding yourself in the therapy chair? If you have been seeing your therapist weekly for quite some time, this could be an opportunity to scale back sessions to biweekly and test out all of your new coping skills in between. On the other hand, maybe you’ve been seeing your therapist biweekly or monthly already and this is disrupting continuity for you. Towards the end of each session, many therapists will ask when you would like to come back. This would be the perfect time to discuss any questions or concerns you may have about switching up the frequency of your visits and receive feedback. Can I Have Homework? Did you ever think you’d be the one requesting a homework assignment? Probably not. Homework allows you to solidify what you have learned. Whether that’s by practicing a new skill, reflecting on an idea or question, or following through on a weekly goal, homework helps to keep the work going in between sessions. It also gives you a ready-made topic to discuss during your next meeting–the work will be less stale in no time. Together with your therapist, come up with something you’d like to focus on before you see them again. Communicate Lastly, and perhaps most importantly, practice communicating your needs to your therapist. This can feel scary and confrontational, so it may be easier to review old goals and identify new ones, switch up session frequency, or ask for homework without ever saying why this is important to you. However, take this as an opportunity to advocate for yourself in a safe space. A lot of therapy is what you make of it and if your therapist doesn’t know that you’re feeling stagnant, you may not see timely improvement. |
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Castlebrook Counseling Services, Inc. is a group of private practice clinicians with a shared goal of strengthening our community by providing therapy and clinical support designed for children, adults, and families to successfully meet life’s challenges.