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DBT: Life Skills You Weren't Taught in School (Part 1) · RECOVERable: Mental Health and Addiction Experts Answer Your Questions

• 0:13
  SPEAKER_01: Insight can create change, but for a lot of people, it's not enough.
• 0:17
  SPEAKER_01: They can get stuck despite understanding everything and why everything is the way it is.
• 0:21
  SPEAKER_01: So DBT comes in and says, okay, you have all this knowledge now.
• 0:24
  SPEAKER_01: What do you do with it?
• 0:25
  SPEAKER_00: Dr.
• 0:26
  SPEAKER_01: Kiki Failing is a licensed psychologist, author, speaker, and expert in dialectical behavior therapy.
• 0:32
  SPEAKER_01: We evolve to feel emotions because they help us.
• 0:35
  SPEAKER_01: When we understand what we're feeling and why we're feeling it, it helps us make decisions.
• 0:39
  SPEAKER_01: It helps us change things we don't like and get more of what we want.
• 0:42
  SPEAKER_01: It helps us to connect with other people.
• 0:44
  SPEAKER_01: I understand how I got here.
• 0:45
  SPEAKER_01: I understand why I'm the way I am.
• 0:48
  SPEAKER_01: How do I change it?
• 0:49
  SPEAKER_01: What is happening in your life that you like and you don't like?
• 0:52
  SPEAKER_01: What are you doing that you wish you didn't do?
• 0:54
  SPEAKER_01: What are you not doing that you wish you would do?
• 0:56
  SPEAKER_01: Like when you think about your ideal life, what does that look like?
• 1:00
  SPEAKER_01: And what are you doing within it?
• 1:02
  SPEAKER_01: Wow.
• 1:03
  SPEAKER_00: Um what I I need a second.
• 1:05
  SPEAKER_00: Yeah.
• 1:09
  SPEAKER_00: Was there a specific moment or situation that you were studying DBT and thought, oh, I want to make this my life's work?
• 1:17
  SPEAKER_01: I had a number of people I worked with who had been in therapy previously for self-harm, for PTSD, for some very, very tricky mental health difficulties, and been in therapy multiple times and didn't see change until DBT.
• 1:33
  SPEAKER_01: And so I saw over and over how effective this therapy was and really believed in it.
• 1:38
  SPEAKER_01: But then when I was 29, I suffered a heart attack.
• 1:42
  SPEAKER_01: And it's hard to describe just exactly how grateful I was to have DBT's wisdom and coping skills under my belt because it was um just an incredibly difficult uh emotional recovery beyond the ways that DBT had already helped me like continue to work on and overcome my own depression and suicidal thoughts and just like mental health struggles in general.
• 2:05
  SPEAKER_01: I don't know how that emotional recovery would have gone without DBT.
• 2:08
  SPEAKER_00: So I was very all in once I saw it firsthand, how helpful it would be.
• 2:13
  SPEAKER_00: One of the goals of this podcast is that we're gonna ask the most searched and most asked questions on the internet about various topics.
• 2:19
  SPEAKER_00: Obviously, today's focus is DBT.
• 2:21
  SPEAKER_00: And big surprise, the very first one is what is DBT?
• 2:26
  SPEAKER_01: Yeah, I know.
• 2:27
  SPEAKER_01: So we've been talking all about this therapy, and I'm like, it's amazing.
• 2:30
  SPEAKER_01: Uh, what is it?
• 2:31
  SPEAKER_01: Okay, so DBT is, as I said, it's a pretty complex therapy.
• 2:36
  SPEAKER_01: Um, it is a form, a cognitive behavioral therapy that combines all of the very traditional behavioral components of what cognitive behavioral therapy normally involves, and then adds on acceptance and mindfulness-based practices as well, and then throws in a whole lot of coping skills.
• 2:58
  SPEAKER_01: At its core, it's a therapy designed to help people manage their emotions.
• 3:01
  SPEAKER_01: So learn how to understand, regulate, cope with, and work with their emotions when they're having troubles with them.
• 3:09
  SPEAKER_00: So when I look at the three words dialectical, behavior, therapy.
• 3:13
  SPEAKER_00: I'm all over behavior, I'm all over therapy.
• 3:15
  SPEAKER_00: Dialectal is not a word I use.
• 3:17
  SPEAKER_00: So can you explain what it is and why it's so key?
• 3:21
  SPEAKER_01: Yes.
• 3:21
  SPEAKER_01: So the D in DBT stands for dialectics.
• 3:25
  SPEAKER_01: And dialectics is a philosophy or worldview that recognizes that two seemingly opposite or contradictory things can be true at the same time.
• 3:35
  SPEAKER_01: So the reason D is so important is because when someone struggles with intense emotions, it's very easy to get caught in really extreme thinking as well.
• 3:44
  SPEAKER_01: Like, I love you, I hate you, I love myself, I hate myself, I love my life, I hate my life.
• 3:50
  SPEAKER_01: And often there's truth in the extremes, but not completely.
• 3:54
  SPEAKER_01: So I may love myself sometimes and hate myself sometimes, and it can be true that some things about myself I dislike, some things about myself I like.
• 4:03
  SPEAKER_01: And the D, the dialectics, is about finding the truth and validating what's true on both sides to come to a more accurate and nuanced understanding in the in-between that I'm a person with flaws and with strengths, or there's things about myself I like and I dislike.
• 4:20
  SPEAKER_01: So dialectics is about finding the nuance and the synthesis between opposites to help us come to like a more even keeled emotional space and accurate space.
• 4:30
  SPEAKER_00: And I think of acceptance and change being the two key seemingly opposite but interconnected things.
• 4:38
  SPEAKER_00: How does that work in DBT?
• 4:41
  SPEAKER_01: Yeah, 100%.
• 4:42
  SPEAKER_01: That is like the biggest dialectical tension in DBT.
• 4:45
  SPEAKER_01: That's like it's all over the skills, it's all over the techniques.
• 4:49
  SPEAKER_01: How can I both accept what's here and work within what's here and just acknowledge what's true and change and make things different when I don't like it?
• 4:59
  SPEAKER_01: Right.
• 5:00
  SPEAKER_01: So that shows up in the skills, like I mentioned, of can I both feel my emotions, validate them, sit within them, and work to change them, work to feel differently, work to get over emotional cycles that are painful for me.
• 5:15
  SPEAKER_00: Is this the both and as opposed to either or that we hear about?
• 5:19
  SPEAKER_00: That's like a huge technique in DBT, yes.
• 5:22
  SPEAKER_00: So if the thing I have to accept is a situation I find wholly unacceptable, um, bad, let's say a bad relationship, a bad job, a bad whatever, whatever it is.
• 5:32
  SPEAKER_00: What do I have to accept?
• 5:34
  SPEAKER_00: And what is the value of accepting where I am right now?
• 5:37
  SPEAKER_00: Is it to know what I want to change?
• 5:40
  SPEAKER_00: Okay.
• 5:40
  SPEAKER_01: And to be able to change it more effectively.
• 5:43
  SPEAKER_01: So this is where dialectical tensions come in.
• 5:46
  SPEAKER_01: It's not that the point of acceptance is change, right?
• 5:50
  SPEAKER_01: The first step in change is acceptance, but acceptance is beautiful in and of itself.
• 5:55
  SPEAKER_01: So there's this thing that can happen that when you are not accepting something, I will make this live to my own experience.
• 6:03
  SPEAKER_01: So when I was in grad school, um, I was in a long-distance relationship.
• 6:07
  SPEAKER_01: And I was so frustrated about that.
• 6:13
  SPEAKER_01: And I desperately wanted to live with this person.
• 6:16
  SPEAKER_01: And I at the time, what I would say is I was non-accepting.
• 6:20
  SPEAKER_01: So I was refusing to accept that like I didn't live with him, that I lived separately from him.
• 6:25
  SPEAKER_01: And what that did is not only did that make me upset within the relationship with him, it made me not engage with social activities where I actually lived because I was waiting until I was going to move there.
• 6:36
  SPEAKER_02: Okay.
• 6:37
  SPEAKER_01: When I finally accepted, when I really worked on radical acceptance, not only did it release inherently this pressure or this added-on suffering, like, okay, this is fine.
• 6:46
  SPEAKER_01: Like I live in a place that I like and we will eventually live together.
• 6:50
  SPEAKER_01: It allowed me to then make more friends, spend more time, like invest in where I was.
• 6:56
  SPEAKER_01: It had me problem solve like the actual lived experience of living where I lived and change my situation to be more happy.
• 7:03
  SPEAKER_01: And it's hilarious.
• 7:04
  SPEAKER_01: But then, like right after I made that mental switch with my own therapist, he asked me to move.
• 7:11
  SPEAKER_01: So, like, that can happen where all of a sudden, when we let go and acknowledge and just accept what is real, change can happen, whether we're looking for it or not.
• 7:20
  SPEAKER_00: And in that example, it sounds like you might have been a happier and more whole and less critical and stressed person, which would make you a better partner, roommate, all of those things too.
• 7:33
  SPEAKER_01: 100%.
• 7:34
  SPEAKER_01: And for those who are listening and not watching, we're both using like this like tension when we're talking about the non-acceptance part.
• 7:40
  SPEAKER_01: And that's a like with our hand hands and tightening our muscles.
• 7:43
  SPEAKER_01: And that's a big part of non-acceptance.
• 7:45
  SPEAKER_01: There's often this like pushing against when there's this softening and opening up to actually just what's here, all of a sudden there's more movement available.
• 7:54
  SPEAKER_01: There's more options.
• 7:55
  SPEAKER_01: You see things more clearly because you're less emotional too.
• 7:58
  SPEAKER_01: Like you're just in the pain rather than the suffering.
• 8:00
  SPEAKER_00: So let's talk about in the mental health and substance use disorder and addiction realms.
• 8:05
  SPEAKER_00: Who can benefit from using DBT?
• 8:08
  SPEAKER_01: Yeah.
• 8:09
  SPEAKER_01: So DBT was originally developed to help folks with borderline personality disorder.
• 8:14
  SPEAKER_01: And this is a this is a diagnosis that is characterized by emotion dysregulation.
• 8:20
  SPEAKER_01: So, which is just a clinical term for having difficulties regulating your emotions.
• 8:25
  SPEAKER_01: So folks with uh BPD often not only experience intense emotional ups and downs, that leads to problems in their relationships, problems with impulsive behaviors, and problems with understanding themselves and how they feel about themselves.
• 8:39
  SPEAKER_01: So, since that original development of DBT for BPD, lots of research has been done to show that DBT can help not only BPD, but PTSD, anxiety, depression, substance use disorders, eating disorders, um, and other kind of generalized mental health difficulties.
• 9:00
  SPEAKER_00: I'm gonna pick three specific ones that I think are very common, one the first being anxiety.
• 9:06
  SPEAKER_00: Tell me how DBT can be used to help somebody who is experiencing anxiety.
• 9:11
  SPEAKER_01: One of the biggest problems with anxiety is it causes you to avoid things that scare you and to get stuck in worry thoughts.
• 9:21
  SPEAKER_01: And so DBT offers ways to not only cope with worry and cope with the physiological symptoms of anxiety, like very specific skills that help with that, but then it sets up a system to help you start doing what's called exposure therapy or opposite action, which is a skill from DBT specifically, where we ask you to approach the things that are causing you fear and anxiety so hard.
• 9:45
  SPEAKER_01: And that's where the coping skills come into play, to start to take some control back and make your life what you want it to be versus continuing to get smaller and smaller because of the anxiety.
• 9:57
  SPEAKER_01: So DBT can help in that way, giving you the skills you need to do things even though they're scary, and across time learn that you are safe and can do those things.
• 10:07
  SPEAKER_01: And anxiety goes down across time.
• 10:09
  unknown: Whew.
• 10:10
  SPEAKER_01: That sounds so scary.
• 10:11
  SPEAKER_01: So scary.
• 10:12
  SPEAKER_01: It's so hard.
• 10:12
  SPEAKER_01: Yeah.
• 10:13
  SPEAKER_00: How can DBT help somebody with depression?
• 10:15
  SPEAKER_01: DVT approaches depression similarly to anxiety in the sense of we look at what does depression make us feel like doing.
• 10:23
  SPEAKER_01: It often makes us feel like isolating, like withdrawing, like making our world smaller and to disconnect from people.
• 10:29
  SPEAKER_01: And it asks you to reconnect, to try to reconnect with some of the positive things about life or to view things differently, change negative thoughts, if that's appropriate, and to start to just kind of get into the dialectics again and get more flexible and try to reconnect with what feels good about life and offers lots of coping skills again to help you do those hard things because, you know, even something like getting out of bed feels like climbing a mountain when you have depression.
• 10:59
  SPEAKER_01: So it's how can we flexibly meet you where you're at and help make change in a way that feels sustainable, attainable for you, and working towards what feels most important for you.
• 11:10
  SPEAKER_00: Switching to substance use disorder, how can DBT help somebody who's really struggling with that?
• 11:16
  SPEAKER_01: So so often, addiction and substance use is substance use disorders are caused by difficulties with emotions.
• 11:27
  SPEAKER_01: Not always, but often drugs and alcohol are used to cope with intense painful emotions.
• 11:32
  SPEAKER_01: So one of the really specific ways that DBT helps is giving more tools and wisdom to help someone understand what's going on for them and help them cope with their emotions without relying on the drugs.
• 11:43
  SPEAKER_01: It also offers once we figure out how to help you cope without the substances getting at the meat of the trauma or the emotional pain that's underneath, underneath the addiction.
• 11:56
  SPEAKER_01: So DBT comes at it from that way again.
• 11:59
  SPEAKER_00: When I was researching, I knew we'd be focusing on mental health and substance use disorder, but I read repeatedly things like DBT is for anyone who wants to learn how to manage big emotions, navigate difficult relationships, and build a more stable and fulfilling life.
• 12:15
  SPEAKER_00: And I'm like, isn't that everybody?
• 12:17
  SPEAKER_01: Isn't it?
• 12:17
  SPEAKER_01: Yeah.
• 12:18
  SPEAKER_01: Isn't it?
• 12:18
  SPEAKER_01: Uh yeah, I think that often when I'm teaching people what DBT skills are, I call them life skills.
• 12:24
  SPEAKER_01: I'm not alone with that.
• 12:25
  SPEAKER_01: I think that not everyone needs DBT, but everyone probably could benefit from DBT skills because yeah, it's just getting at how can I better understand myself and get more of what I want.
• 12:36
  SPEAKER_00: So why aren't we all being taught this?
• 12:39
  SPEAKER_00: Why isn't it part of school curriculum?
• 12:41
  SPEAKER_00: I mean, if just the word life skills.
• 12:44
  SPEAKER_00: Well, I I was not taught life skills, you know.
• 12:47
  SPEAKER_00: Now maybe it's a different generation, but I don't think uh people in general are learning them.
• 12:53
  SPEAKER_00: How different would life be?
• 12:55
  SPEAKER_00: I think of personal, I think of interpersonal, I think of societal.
• 13:00
  SPEAKER_00: It seems like a lot of problems could be, if not solved, mitigated with people having life skills.
• 13:10
  SPEAKER_01: Yeah, 100%.
• 13:11
  SPEAKER_01: Because I think about even like my nephew, who is five and in preschool and learning emotion words.
• 13:16
  SPEAKER_01: And I'm like, that's amazing.
• 13:18
  SPEAKER_01: Yeah.
• 13:18
  SPEAKER_01: Because emotions, we evolve to feel emotions because they help us.
• 13:22
  SPEAKER_01: When we understand what we're feeling and why we're feeling it, it helps us make decisions.
• 13:27
  SPEAKER_01: It helps us change things we don't like and get more of what we want.
• 13:30
  SPEAKER_01: It helps us to connect with other people.
• 13:32
  SPEAKER_01: And so they are paramount skills because everyone feels emotions.
• 13:37
  SPEAKER_01: So I think it's something that, yeah, I wish was in schools more, and but it's not.
• 13:43
  SPEAKER_01: And so a lot of people have to learn this as adults, and that's okay.
• 13:46
  SPEAKER_01: Just like any other skill, you have to learn it.
• 13:49
  SPEAKER_01: And if you're not taught it, then you can't know it.
• 13:51
  SPEAKER_01: And you just have to do your best to try to learn it now.
• 13:53
  SPEAKER_00: And when you talk about black and white thinking, I think emotions were very that way with, right?
• 13:58
  SPEAKER_00: There are good emotions and there are bad emotions, which is everything that doesn't feel really good.
• 14:04
  SPEAKER_00: And I don't even know that most of us can name what we're feeling at any given time.
• 14:09
  SPEAKER_01: Yeah.
• 14:10
  SPEAKER_01: And that's something I talk about with my clients a lot.
• 14:12
  SPEAKER_01: Like there are some people that find happiness very uncomfortable, actually.
• 14:18
  SPEAKER_01: So even something like pleasure feels inaccessible because, for example, they might be worried that the other shoe is like, when is the other shoe gonna drop?
• 14:25
  SPEAKER_01: Right.
• 14:25
  SPEAKER_01: So this idea of like good and bad emotions is what in DBT we'd call a judgment.
• 14:31
  SPEAKER_01: It's an added-on story.
• 14:33
  SPEAKER_01: So I think it's more useful to talk about what feels painful and what feels pleasant and what feels helpful and what feels unhelpful.
• 14:40
  SPEAKER_01: And when we get more emotional language to understand and describe our emotions, we can actually make that differentiation and decide between and decide how to use our emotions and move forward.
• 14:52
  SPEAKER_01: It's not easy.
• 14:54
  SPEAKER_00: Hearing you say helpful makes me think that that how different that is than good, because it might be very helpful to experience fear.
• 15:03
  SPEAKER_01: Yes.
• 15:03
  SPEAKER_00: You know, exactly negative emotion.
• 15:06
  SPEAKER_01: Yes.
• 15:06
  SPEAKER_01: And even anger, another big one that people are very uncomfortable with.
• 15:10
  SPEAKER_01: Anger makes us defend ourselves.
• 15:12
  SPEAKER_01: So if we are actually, if our well-being is actually being threatened, anger is probably going to help us assert our boundaries, defend ourselves, defend loved ones.
• 15:20
  SPEAKER_01: And fear, if we are physically in danger, the fight or flight response helps us run away, helps us to escape, helps help us to problem solve and prevent things dangerous from happening.
• 15:31
  SPEAKER_01: So 100%, when an emotion is justified by reality, when there is something dangerous threatening our well-being, any other kind of trigger of an emotion that's real and true, emotions then help us act and change things in a way that keep us safe and protect us and help us be happier in the long run.
• 15:49
  SPEAKER_00: When I think of therapies and correct me if I'm wrong, but I think talk therapy is probably the one most people are familiar with, might also be the one people are most resistant to because I hear I'm not crazy, I don't need therapy, I'm not going to tell some stranger, how would telling some stranger, you know, help?
• 16:05
  SPEAKER_00: What's the difference between a skill-based therapy and a familiar therapy like talk therapy?
• 16:15
  SPEAKER_01: I do think when most people think of talk therapy, they think more of how does that make you feel?
• 16:20
  SPEAKER_01: Or the psychoanalyst sitting on the couch in the corner, not saying anything.
• 16:24
  SPEAKER_01: Um, and that is a type of therapy.
• 16:26
  SPEAKER_01: DBT is a different type of therapy that is talk therapy, but it's much more active.
• 16:31
  SPEAKER_01: So in DBT, there it's very um, it's a team effort between the client and the therapist.
• 16:39
  SPEAKER_01: When I work with clients, I often say, okay, I am an expert in DBT, but you are an expert in you.
• 16:45
  SPEAKER_01: I don't know where you want to go in your life.
• 16:47
  SPEAKER_01: I don't know what gives you pleasure, I don't know what gives you fulfillment unless you tell me.
• 16:51
  SPEAKER_01: Like we have to figure this out together.
• 16:52
  SPEAKER_01: So you bring in what's important to you, and I give you my knowledge and my wisdom and my skills to try to help you get more of what you want and build a life.
• 17:01
  SPEAKER_01: So in that process, DBT brings in a lot of behavioral techniques.
• 17:06
  SPEAKER_01: That's where the B comes from, where there's tracking, there's monitoring of like how are you feeling each day?
• 17:11
  SPEAKER_01: What how do you practice skills?
• 17:14
  SPEAKER_01: Uh, what impulsive behaviors are you doing or not doing?
• 17:17
  SPEAKER_01: All that depends on what your goals are for the therapy.
• 17:20
  SPEAKER_01: But we track that and then address it in pretty specific, concrete ways to make sure that you're seeing change in these things in these uh behaviors that you want to change.
• 17:29
  SPEAKER_01: So it's much more directive.
• 17:31
  SPEAKER_01: As a DBT therapist, I am often giving advice.
• 17:34
  SPEAKER_01: I'm often involved, asking lots of questions, giving my opinion as a part of this like collaboration to help us figure out how do we move moving you forward.
• 17:43
  SPEAKER_00: As someone who's been in therapy on and off for decades, I'm not sure how often I actually get the have you figured that out yet?
• 17:52
  SPEAKER_00: Have you gotten better at blank?
• 17:54
  SPEAKER_00: Yeah.
• 17:55
  SPEAKER_00: And that sounds so uh so helpful to actually be learning skills and implementing implementing them and trying them in different situations and saying, yeah, this isn't working, and I'm still feeling this way, and maybe even knowing what that feeling is for a change.
• 18:13
  SPEAKER_01: Yes.
• 18:13
  SPEAKER_01: So that is one of the big differences between CBT and DBT and some of the older uh therapies.
• 18:19
  SPEAKER_01: So DBT is third wave, as I said, and CBT is second wave.
• 18:23
  SPEAKER_01: These are both like behavioral and action-based.
• 18:25
  SPEAKER_01: And the first one is more psychoanalytic, psychodynamic, this generalized talk therapy we're talking about.
• 18:30
  SPEAKER_01: And those are often called like insight-oriented therapies, where the goal is to help you understand things.
• 18:38
  SPEAKER_01: And the idea is that that insight can make change happen.
• 18:43
  SPEAKER_01: And 100% insight can create change.
• 18:46
  SPEAKER_01: But for a lot of people, it's not enough.
• 18:48
  SPEAKER_01: Like they can get stuck despite understanding everything and why everything is the way it is.
• 18:53
  SPEAKER_01: Still all here.
• 18:54
  SPEAKER_01: Yes.
• 18:54
  SPEAKER_01: So DBT comes in and says, okay, you have all this knowledge now.
• 18:58
  SPEAKER_01: What do you do with it?
• 18:59
  SPEAKER_01: And how do we help you do something with it?
• 19:02
  SPEAKER_00: Tell me.
• 19:03
  SPEAKER_00: I've got it all here.
• 19:04
  SPEAKER_00: I've been talk therapy for years.
• 19:06
  SPEAKER_00: Then how does that happen if somebody who has comes in and sits down with you?
• 19:10
  SPEAKER_00: Uh, are they on a couch?
• 19:12
  SPEAKER_00: I don't know.
• 19:12
  SPEAKER_00: And says, like, okay, I I understand how I got here.
• 19:16
  SPEAKER_00: I understand why I'm the way I am.
• 19:18
  SPEAKER_00: Um, I fear what I fear, I whatever.
• 19:21
  SPEAKER_00: Well, how do I change it?
• 19:23
  SPEAKER_01: So one thing is we're very present-oriented.
• 19:26
  SPEAKER_01: So we talk, okay, right now, what are you feeling?
• 19:28
  SPEAKER_01: Like on a daily basis, what's going on for you?
• 19:30
  SPEAKER_01: But when I have a new client come in with me for TBT, one of the very first things we do is what I mentioned before of what is happening in your life that you like and you don't like?
• 19:41
  SPEAKER_01: What specifically behavior.
• 19:42
  SPEAKER_01: So, what are you doing that you wish you didn't do?
• 19:46
  SPEAKER_01: What are you not doing that you wish you would do?
• 19:48
  SPEAKER_01: Like when you think about your ideal life, what does that look like?
• 19:52
  SPEAKER_01: And what are you doing within it?
• 19:54
  SPEAKER_00: And you're saying, what are you doing and wanting to do, not what are other people doing that's bothering you so much?
• 20:00
  SPEAKER_00: 100%.
• 20:01
  SPEAKER_01: That's a big one for a lot of folks who struggle with emotions.
• 20:04
  SPEAKER_01: So like relationships are difficult, first of all.
• 20:06
  SPEAKER_01: But so often we feel a lot of um like judgment and expectation from others for not being enough, for being too much.
• 20:12
  SPEAKER_01: So in DBT, we we do we're fine if you care about what other people think about you, of course.
• 20:18
  SPEAKER_01: And we care what what do you want, what would feel best for you.
• 20:21
  SPEAKER_01: And so we dive in to talking about that and get really specific about that.
• 20:26
  SPEAKER_01: What do you want to increase?
• 20:27
  SPEAKER_01: What do you want to decrease?
• 20:28
  SPEAKER_01: We decide where we want to start, and then we start working on that one or two specific things.
• 20:33
  SPEAKER_00: Do most people know the answers?
• 20:36
  SPEAKER_01: Most, yes.
• 20:37
  SPEAKER_01: But it's a conversation.
• 20:39
  SPEAKER_01: So this is also where a DBT therapist has a lot of wisdom and experience of like, okay, I can hear you're talking about this and can ask questions to help the person find what it is they don't actually like.
• 20:52
  SPEAKER_01: Because yeah, not everyone has that skill of like, I just know I feel bad.
• 20:56
  SPEAKER_01: Right.
• 20:56
  SPEAKER_01: Right.
• 20:57
  SPEAKER_01: So um, not everyone.
• 20:58
  SPEAKER_01: Sometimes it takes a number of sessions, but that is how we start the therapy, helping you figure that out.
• 21:04
  SPEAKER_01: And then what?
• 21:05
  SPEAKER_01: Often a thing we're working on in DBT, for example, is self-harm or other types of impulsive behaviors.
• 21:10
  SPEAKER_01: And so if someone comes in and they have self-harmed or they have had a drink or they have uh done binge eating or something like that that they don't want to do anymore, um, we will spend the entire session like breaking down what was that, what happened there?
• 21:27
  SPEAKER_01: What emotions caused you to feel like doing that?
• 21:29
  SPEAKER_01: What urges did you have?
• 21:31
  SPEAKER_01: What in a personal situation happened that made you feel that way, that led to the urges, that led to the behavior?
• 21:36
  SPEAKER_01: And how can we intervene earlier and earlier in that chain to keep that from happening?
• 21:43
  SPEAKER_01: Or how could we just maybe it all comes down to you were really sleep deprived.
• 21:47
  SPEAKER_01: So we figure that out together, and then all of a sudden we're focused on how do we give you better sleep hygiene?
• 21:51
  SPEAKER_01: And then we fix that or work on that to help you prevent the behavior and the like ever happening in the first place.
• 21:57
  SPEAKER_01: So each person's gonna be really unique, but each, and so each session is again, you come in as the client, say, this happened, this didn't happen.
• 22:06
  SPEAKER_01: And we've already agreed that's the focus for our therapy.
• 22:09
  SPEAKER_01: And we talk about, okay, so this session we're gonna talk about this together.
• 22:12
  SPEAKER_01: Sound good?
• 22:13
  SPEAKER_01: It sounds good.
• 22:14
  SPEAKER_01: And then we go for it.
• 22:16
  SPEAKER_00: The conversations you're describing sound like the client coming in has a pretty high level of self-awareness.
• 22:23
  SPEAKER_00: Because if you ask me why do you think these things are happening in your life, or what are you feeling when they begin or end or whatever it is, I don't know that I could answer.
• 22:35
  SPEAKER_01: Nope.
• 22:35
  SPEAKER_01: And that's so some people can, some people can't.
• 22:39
  SPEAKER_01: And that's where, like the as a DBT therapist, I have lots of techniques in mind to help you figure that out, help us figure that out.
• 22:49
  SPEAKER_01: So even for example, again, like if you come in saying, Yes, I had a drink this past week, we go into that chain analysis of examining what happened when you had that drink.
• 22:59
  SPEAKER_01: We might spend the entire 45 minutes of the session talking about like a five-minute period, just trying to help you figure out what was going on.
• 23:10
  SPEAKER_01: And I know that sounds tedious.
• 23:11
  SPEAKER_01: So, and it can be very difficult, but it we help you get that insight.
• 23:16
  SPEAKER_01: We help you gain the emotional knowledge, the self-awareness, the understanding of what are my passions, what are my values, what are the things that impact me, how am I interconnected to other people?
• 23:27
  SPEAKER_01: How do they impact me back?
• 23:29
  SPEAKER_01: How do I impact them?
• 23:31
  SPEAKER_01: So we give you the language and the skill set to have that awareness and self-understanding that is a part of the therapy.
• 23:38
  SPEAKER_00: The visual that's coming to mind is the string of holiday lights.
• 23:42
  SPEAKER_00: And if one goes out, nothing after it lights, but you have to check each one to figure, because they're all out, you know, which one to figure out, where is it shorting?
• 23:52
  SPEAKER_01: I love that.
• 23:53
  SPEAKER_01: That's a great metaphor.
• 23:54
  SPEAKER_01: And I think that's a really apt description of what especially early DBT can feel like when we're still trying to figure this out together.
• 24:03
  SPEAKER_00: I I just I'm fascinated.
• 24:05
  SPEAKER_00: Like I just want to be your client because I'm thinking about that five minutes maybe in in your day or your week that really affected everything.
• 24:14
  SPEAKER_00: Because at that point, you decided to do something or not do something that changed the course of that time period.
• 24:21
  SPEAKER_00: Yes.
• 24:22
  SPEAKER_00: And it will continue to do that unless you figure out which light's not lighting.
• 24:28
  SPEAKER_01: Yeah.
• 24:28
  SPEAKER_01: And that's so it's again another dialectical tension of like this one moment is what we're looking at, recognizing that all the moments around it have impacted it and will continue to impact each other.
• 24:38
  SPEAKER_01: Um, one thing I want to throw out because I'm even wondering to some people who might be listening, this could sound very like intellectual and heady and like lots of talking and figuring out rather than just feeling.
• 24:51
  SPEAKER_01: And I do think DBT tends towards that more.
• 24:55
  SPEAKER_01: And what can happen as an example is if you find out that as we're doing the chain together, if we discover together that, oh my gosh, that drink happened because I like dissociated almost from like something happened with my roommate and it upset me.
• 25:10
  SPEAKER_01: And then I kind of can't remember anything until I was at the bar, right?
• 25:15
  SPEAKER_01: Like it just was like a rush to get there or something like that.
• 25:19
  SPEAKER_01: In session, we might decide, oh, we need to bring your awareness to your body more.
• 25:23
  SPEAKER_01: And in session, we might stop that chain and together practice mindfulness or help you learn emotion words, or help you be here now in your body without no longer talking about the chain.
• 25:34
  SPEAKER_01: So there's this constant back and forth of how do we again, right?
• 25:37
  SPEAKER_01: Like work towards change while also helping you live and hear what's now.
• 25:42
  SPEAKER_00: So using that example, I had an interaction, or maybe they weren't there at all, and that was part of the problem with a roommate and then ended up in a bar when I'm trying not to drink.
• 25:57
  SPEAKER_00: What would the conversation be like to get from I had this feeling, I was angry, I was whatever, to I'll be damned if it didn't happen again.
• 26:08
  SPEAKER_01: Well, first step is figuring out did you know if you were angry?
• 26:12
  SPEAKER_01: Did you know you were hurt?
• 26:13
  SPEAKER_01: So making sure we understand that on the chain.
• 26:15
  SPEAKER_01: So important is figuring out the emotions in particular.
• 26:19
  SPEAKER_01: Um, and so we will walk through literally, okay, you found out your roommate wasn't there.
• 26:26
  SPEAKER_01: Then what did you do?
• 26:28
  SPEAKER_01: Then what happened?
• 26:29
  SPEAKER_01: Then what happened?
• 26:30
  SPEAKER_01: Then what happened?
• 26:31
  SPEAKER_01: Every single step you take between there and the bar is a chance to do something different.
• 26:37
  SPEAKER_02: Yeah.
• 26:38
  SPEAKER_01: And so together with this like chain technique, we figure out not only what's the best place we could have intervened, like the sleep hygiene example, or the communication with your partner, or that emotion of anger, how can you cope with it, or how can you knock it in the car when you have the urge, or how can you knock it in the bar when you get there?
• 26:56
  SPEAKER_01: Every single one of those, DBT has dozens of skills to throw at you and help you do something different.
• 27:02
  SPEAKER_01: So we break it down so minutely to help you realize that there's so many more options that you have choice, that you have power if we can slow you, slow it down and help you see it.
• 27:14
  SPEAKER_01: Because so often we do these things because we don't feel like we have power.
• 27:17
  SPEAKER_01: So it tries to give you that back.
• 27:20
  SPEAKER_00: So if somebody is interested in DBT, what do they do and and what's it gonna be like?
• 27:26
  SPEAKER_00: Is this a you come in once a month and you know we give you homework, or or what kind of a scenario would somebody be entering if they began DBT program?
• 27:36
  SPEAKER_00: It's a great question.
• 27:38
  SPEAKER_01: Uh so DBT is very complex therapy.
• 27:42
  SPEAKER_01: If you're in full DBT as it's traditionally developed, you're gonna be in weekly individual therapy and then also weekly skills group where you meet so twice a week.
• 27:54
  SPEAKER_01: Wow.
• 27:55
  SPEAKER_01: Yes, twice a week.
• 27:56
  SPEAKER_01: And where so that skills group is you're gonna be meeting, depending on the group, often 90 minutes to two hours, learning and practicing and talking about the skills.
• 28:05
  SPEAKER_01: In the individual session, you're doing those chains, you're learning how to apply the skills to your specific life.
• 28:11
  SPEAKER_01: And then between all of those sessions, you have something called phone coaching, where your therapist will be available to you 24-7 to call in your real life about like, I am in a situation with my roommate, they didn't show up, help.
• 28:26
  SPEAKER_01: And right there, I'm there almost like a coach on the sidelines telling you, like, okay, remember that skill we talked about?
• 28:32
  SPEAKER_01: Practice it now.
• 28:33
  SPEAKER_01: Let me walk it through with you.
• 28:35
  SPEAKER_01: So you get this real life feedback about how to create change in your life.
• 28:40
  SPEAKER_01: So, in addition to those three things, uh, individual, group, and phone coaching, your DBT therapist will be in a team meeting with other DBT therapists talking about their cases and making sure they're providing the best therapy to you.
• 28:54
  SPEAKER_01: I mentioned this because it is really important.
• 28:57
  SPEAKER_01: Full DBT, your therapist will be in like their own therapy, essentially, with team consultation.
• 29:03
  SPEAKER_01: And then you'll that weekly structure, you'll usually be in it for six months at least.
• 29:11
  SPEAKER_01: That's a hell of a commitment.
• 29:12
  SPEAKER_01: It's a hell of a commitment.
• 29:13
  SPEAKER_01: Yeah.
• 29:13
  SPEAKER_01: It also is one of the things that make DBT less accessible because even therapists don't always want to do the phone coaching and things like that, unfortunately, because it's so effective and helpful.
• 29:23
  SPEAKER_01: But it's six months because that's how long it takes to go through one round of skills group, if it's uh the traditional model, at least.
• 29:34
  SPEAKER_01: A lot of folks, especially if they struggle with self-harm or substances or um PTSD, like kind of more intense impulsive behaviors or more difficulties with emotions, will be in for 12 months or six or 18 months.
• 29:52
  SPEAKER_01: Yeah, it's up to the person and obviously their means in terms of access accessing and paying for DBT because you know, therapy is not cheap, unfortunately.
• 30:02
  SPEAKER_00: I don't even know what to say because I'm thinking it's a lot.
• 30:05
  SPEAKER_00: Six months, 12 months, 18 months.
• 30:07
  SPEAKER_00: Even that sounds like a lot, even though you know some therapies go on that long, but they're not that kind of a time commitment or or economic commitment.
• 30:15
  SPEAKER_00: Yes.
• 30:15
  SPEAKER_00: So wow.
• 30:17
  SPEAKER_00: Um what I I need a second.
• 30:20
  SPEAKER_00: Yeah.
• 30:20
  SPEAKER_01: One of the things I can say is not everyone needs full DBT.
• 30:23
  SPEAKER_01: Okay.
• 30:24
  SPEAKER_01: I would most humans alive do not need full DBT.
• 30:26
  SPEAKER_01: Okay.
• 30:27
  SPEAKER_01: So this applies for folks who, as I said, like have BPD, maybe have um more intense difficulties with emotions and impulsive behaviors.
• 30:35
  SPEAKER_01: And I make that distinction because often these are people who've been in and out in therapy for years already.
• 30:41
  SPEAKER_01: Right.
• 30:42
  SPEAKER_01: DBT is actually designed to be almost like short and efficient, and it's often not short, it's all relative, right?
• 30:49
  SPEAKER_01: But it's it's so powerful that all of a sudden, if you look at it that way compared to the type of experiences people have often had in mental health previous to joining DBT, it's so worth it.
• 31:00
  SPEAKER_01: So that's again, not everyone.
• 31:02
  SPEAKER_01: But then if you don't need comprehensive DBT, then you might not need to be in therapy for that long.
• 31:09
  SPEAKER_01: A huge part of the therapy, especially at the start, will be me working with the client of like, is this a good fit?
• 31:16
  SPEAKER_01: Do you need comprehensive DBT?
• 31:18
  SPEAKER_01: I don't want you to do this thing if it's not going to help you and it's gonna make your life difficult.
• 31:22
  SPEAKER_01: And then even if you, and if you do need it, but it'll be difficult.
• 31:25
  SPEAKER_01: DBT has so many things to come up with creative problem solving for how can we help you make this work in your life?
• 31:32
  SPEAKER_01: How can we help you stay committed?
• 31:34
  SPEAKER_01: How can we help you problem solve logistical problems?
• 31:37
  SPEAKER_01: How can we help you get through whatever is difficult about this commitment?
• 31:42
  SPEAKER_01: Like we are in this together.
• 31:43
  SPEAKER_01: So that's another thing that often makes it easier.
• 31:46
  SPEAKER_01: It's like very much a relationship, and we're both committing to that time frame.
• 31:51
  SPEAKER_00: So between full, is that the right adjective DBT?
• 31:55
  SPEAKER_00: Yeah, comprehensive.
• 31:56
  SPEAKER_00: Comprehensive.
• 31:57
  SPEAKER_00: Between comprehensive DBT and I think I'm gonna read a book about this and try it on my own.
• 32:04
  SPEAKER_00: What's in the middle?
• 32:05
  SPEAKER_01: I would say DBT informed.
• 32:07
  SPEAKER_01: Okay.
• 32:07
  SPEAKER_01: So there are some DBT therapists who will work with people outside of that like comprehensive structure and just meet weekly, individually, like kind of typical psychotherapy cadence, meet one-on-one and teach DBT skills one-on-one.
• 32:23
  SPEAKER_01: Um, but it's often going to depend on the person and what they're hoping to get out of it.
• 32:27
  SPEAKER_01: That won't be enough for some people.
• 32:29
  SPEAKER_01: That'll be perfectly fine for some people.
• 32:31
  SPEAKER_01: So that's another in-between, like DBT informed.
• 32:34
  SPEAKER_01: And that's not an official definition, but that's often what we call it.
• 32:39
  SPEAKER_00: And how much benefit can someone get if they don't have access, time, money, all the reasons they may not have access to the full program.
• 32:48
  SPEAKER_00: How much benefit can somebody get from talking to a therapist, perhaps um joining some online and online group, and or, you know, using books like the one you've written and cards, you know, that can help them learn some of the skills and implement them in their lives?
• 33:05
  SPEAKER_01: I'm so glad you asked that and mentioned the online groups because there are some online DBT groups available.
• 33:10
  SPEAKER_01: Um, like there's some really great DBT therapists putting their brains together to figure out how do we get DBT skills out here.
• 33:16
  SPEAKER_01: But the answer is, you know, on a research standpoint, we're not really sure who needs how much DBT to get the like exactly what they need.
• 33:27
  SPEAKER_01: Um, but what we do know from research, and then what I've seen personally, is just learning DBT skills, even just being in a DBT skills group, at least, for even less than six months.
• 33:40
  SPEAKER_01: There's some research showing like 12 weeks, sometimes even less, can help people with those things like depression and anxiety, anger difficulties, emotion regulation difficulties.
• 33:53
  SPEAKER_01: So if someone is getting DBT in a way that works for them, that feels good to them, that they're understanding, then most people can get an impact, at least a little bit from just learning the skills.
• 34:06
  SPEAKER_01: And then often folks, as I said, like with BPD, with PTSD, or substance use disorders will probably benefit more from the full model.
• 34:16
  SPEAKER_00: So the full model would be most effective, really, for anyone who needs it.
• 34:21
  SPEAKER_00: Right.
• 34:21
  SPEAKER_00: Um, a DBT-informed is going to be a nice midpoint.
• 34:26
  SPEAKER_00: Trying to do it on your own, you'll at least learn some skills that can help you.
• 34:31
  SPEAKER_00: Is that a safe?
• 34:32
  SPEAKER_01: Absolutely.
• 34:33
  SPEAKER_01: Even for folks, like even for someone who has BPD, for example, because therapy in general, let alone DBT, is very hard to find and access, depending on where you live in the country, depending on what your financial situation is.
• 34:44
  SPEAKER_01: So, yes, there is some research that suggests that even just learning skills could help anybody and at least can like offer some relief while you're on a wait list or while you keep looking, just to give you some options while you're trying to figure it out.
• 34:59
  SPEAKER_00: Well, I'm glad we're we've been talking around the skills.
• 35:02
  SPEAKER_00: And the reason is because they're so important.
• 35:05
  SPEAKER_00: We want to make sure that whatever level of care somebody's able to access, that they will hear in some detail about these skills.
• 35:12
  SPEAKER_00: And so we've set aside an entire another episode of this podcast where you're gonna dive into those and tell us how you use them in your life, how you see your clients using them, and we'll step through them.
• 35:22
  SPEAKER_00: Yeah, I can't wait.
• 35:24
  SPEAKER_00: Thank you.