DBT Handout

Today I made my way back to where I was hospitalised over a month ago, the Psychiatry Department of the general hospital. They don’t exactly make it easy to find. Must be something to do with hiding away the crazy people and all… Yes, I was an inpatient there, but going in I was wheeled from the Emergency Department to the psych ward in the middle of the night, and the darkness combined with my fear didn’t make for a good sense of where I was. Walking out of the psych ward upon discharge, I wasn’t exactly looking to find out how to make my way back in again.

I had an appointment scheduled with one of the social workers from the counselling service for those who present to the ED with self harm and/or thoughts of suicide. I had spoken to R on the phone once, but had yet to meet him in person. My anxiety levels were raised when I learnt he was a man who looked to be in his 50s…he turned out to be a nice enough chap, but even so, I don’t really feel as though middle aged men can relate well to nineteen year old females like me.

We established that I was still seeing Dr T and had been referred to a DBT program, as had been discussed during our telephone conversation. Told him I was starting OT at Uni this year, which he said they had mentioned. By ‘they,’ I assume he was referring to the doctors I spoke with whilst an inpatient. He also enquired as to how things were at home, as he was aware things aren’t great with my father. Bearing in mind I had never met him before and only had a five minute phone conversation prior to the appointment, I was a little disconcerted that he knew all this about me already. I assume it’s through my notes being passed around, which makes me rather uncomfortable.

He informed me that the reason I was here today meeting with him is so that they could help me stop self harming. Right. As long as I’m not engaging in cutting behaviours, it means I’m cured.

He thought it a good idea for me to be introduced to some DBT skills as I am being referred for the very program, and so he handed me a sheet entitled ‘Distress Tolerance Handout 1’, an excerpt from the book Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan.

We went through the handout, the three sections being DISTRACT with “Wise Mind ACCEPTS“, SELF SOOTHE the FIVE SENSES and IMPROVE THE MOMENT. Unfortunately it was not even halfway down the first page that I decided it was a patronising pile of crap. It was this suggestion for distracting oneself that did it,

With Comparisons:

[…] Compare yourself to those less fortunate than you. Watch soap operas; read about disasters, others’ suffering.

R suggested thinking of those Australians recently hit by the natural disasters and being grateful not to be amongst those affected. I do feel awful for them, but really. Being mindful of the fact that there are others less fortunate than I is not going to divert from my own crisis and thoughts of self harm and suicide.

Similar cheery suggestions for distress tolerance are given throughout the handout. My favourite include; ‘call 800 or other information numbers to hear a human voice’, ‘half smile; change facial expression’, ‘go sit in the lobby of a beautiful old hotel’ and… ‘sex’.

The DBT program I am being referred to runs for a year. A. Whole. Year. If I am eventually accepted into it, how am I going to tolerate going through this useless drivel for an entire year? Maybe it is a blessing that the DBT Co-ordinator hasn’t contacted me after all…

I know I should keep an open mind and not display such terrible attitude. But… I guess I’m just way too cynical for my own good…

In any case, I don’t think I’m willing, nor do I even want to let go of self harming just yet. Which suggests if I embark on the DBT program it would be rather pointless.

At the close of the appointment, R told me he’d give me a call next week to see how I get on with these Distress Tolerance techniques and whether another appointment should be made or not. I’m thinking not.

33 thoughts on “DBT Handout

  1. Oh dear me. the DBT course that my doctor keeps suggesting to me lasts for an entire year as well. I keep smiling and saying lol no.

    I can only speak for myself, but I think comparing myself to others is a shit idea. Reading about disasters isn’t going to make me feel better. I once went completely loopy and obsessive about the Rwandan genocide, I wouldn’t fucking recommend reading about it in order to ~feel better~. And way to use other people’s suffering to feel good about ourselves.

    Go and sit in the lobby of a beautiful old hotel? Yeah, and get kicked out for loitering.

  2. Compare yourself to those less fortunate than you…?

    Yeah, I agree with you. Reading about other peoples problems makes me feel worse, more guilty and more of a failure. If they have all these problems, why can’t I deal with mine?

    I don’t know, I’ve never had DBT. But I hope if you do get accepted it’s helpful.

  3. I encountered the same patronising shite with DBT, and had the same appalled reaction. It’s a complete crock of shit in my view.

    It’s invalidating and client-blaming. Also, I agree with you on the self-harm point. OK, there’s research that ‘proves’ that it reduces self-harm and suicide attempts, but I’ve yet to see a study that demonstrates that it reduces/eliminates depression, anxiety, dissociation, suicidal ideation (as opposed to actions), and all the other things that go with BPD for which it was originally developed.

    I’m sorry to be so negative, especially when you’re still due to go on a course of this therapy. For what it’s worth, I had a friend who felt the same utter disgust for DBT, but when she started the actual programme, she felt much better about it, and even found it pretty helpful.

    • It’s good to hear that the actual DBT program is somewhat better than the book… it can’t get any more patronising and ridiculous than what’s written on this handout…

  4. I’ve heard good stuff about DBT from the two people I know who’ve done it. Its strength seems to come from giving people the chance to build a relationship with everyone else in the treatment group. That’s something you can’t get from the book (which does sound shite, I’ll agree).

    When I was quite early on in recovery I got given “Overcoming Intensive Emotions and Self-Destructive Behaviours” by Lorraine Bell. I really really recommend that book. It’s written mainly for people with BPD, but it can be used by people with other MH problems. It’s very practical and I liked the respectful tone she uses. There’s never any suggestion that people with BPD are bringing it on themselves or that ending the behaviours is the same as ending the problems.

    • Yeah, that’s true that the actual group could be quite different from just reading these DBT concepts from a book.

      Glad to hear not all books on this subject are filled with patronising, client blaming nonsense.

  5. Your right. A crock of shit. Thinking of others less fortunate? That just makes me more depressed.
    You just know that this was written by someone who has never experienced any of our issues. They are so ‘normal’ themselves that they will never be able to relate to us or what we go through. Its patronizing to even think they know what we deal with. I tell them,… Go save a whale instead cuz your not doing anyone here any good,….

  6. I wouldn’t exactly feel better comparing myself to those less fortunate than me, either. That would only make me sadder and more likely to SI. The other suggestions you list sound rather weird, too.

  7. I understand that whole “distract-yourself” mentality, but I think that really can only serve as a temporary solution as you work on the reasons why you’re self harming in the first place.

    It’s like telling an obese person to lose weight by simply getting their mind off food. How about some suggestions on how to eat healthier but incorporating foods they already like? How about making small changes and finding how they’ve got to be where they are.

    There is no ‘one-step’ solution for anything. Idiots.

    • I agree there needs to be therapy that actually allows the client to explore why they turned to self harm in the first place and to work on resolving the deeper issues behind it.

  8. OMG that sounds like a pile of patronising crap. I don’t have a diagnosis of BPD but my shrink has threatened one…I’m dubious that BPD exists…but the problems are real, and yes agree completely with the comment that whoever wrote that pile of crap has obviously never had a mental health issue. I mean, ‘think of others who are less fortunate’…ugh…yeah, I was crying after reading an article about eating disorders and generally thinking about how no-one with MH issues gets the treatment they need and it’s so unfair that anyone has to suffer…so that really helped. Oh and various times I decided to ‘help others’ by volunteering, I overcommitted and ended up just letting them down, which doesn’t help them and makes me feel guilty. What stupid nonsense advice that is.

    • ‘Threatened BPD’…yep, BPD is not a diagnosis that is favoured by many it seems!
      Ugh yes, it is stupid advice…I don’t see how it helps people get out of a crisis…

  9. I’ve seen the sheet that you are talking about and to be honest cannot see how giving someone that on it’s own can ask for any other response. It gets that kind of response in group from a lot of people. Don’t be put off trying DBT. I’m not going to rage about it but i will say that it has been helpful. I have recieved a lot of support from attending the group. I’m not sure how it will work with yourself but in addition to attending a group situation once a week i have also seen a psychologist once a week also. She has been the driving force behind my care, kicking those that were/are supposed to be helping into doing their jobs. There is a lot about DBT that feels very tongue in cheek and patronising and if you go, wait til you actually see the videos with marsha. I would say that i personally have probably gained rather than lost from being in a DBT programme. Good luck with what you decide.

    • Marsha Linehan videos? That sounds thrilling…

      Still, I’m glad to hear the actual DBT program is better than just receiving the sheets and that it has been helpful.

  10. When I read the content of the handout, I threw up all over your blog. I really am so terribly sorry. Fear not! I made myself feel better about my actions by reflecting on those less fortunate than myself. I’ve done my best to clean up the puke – I hope you can forgive me. Lots of love. LittleFeet

    • No worries, another suggestion on the handout is to do something nice for someone else- if I forgive you for vomiting on my blog, does that count? 😉 In any case I feel better now that I’ve read about you throwing up because I can feel grateful that I’m not feeling physically sick and therefore am more fortunate than someone else!

  11. Oh the helpfulness of the handouts really does depend on who is explaining them hahaha. The DBT handout is really just a “toolbox” of things to try – some may be useful to you, others may seem ridiculous. The suggestion to think of those less fortunate can be helpful to some (it can help put things in perspective), but for most people it is just morbid. They try to give as many suggestions as possible to help you think up your own ideas. Just chuck anything that seems naff. The “activities”, and “thoughts” are my favourites, but “pushing away” doesn’t work for me (I just think about it more of course, duh). The concepts are used everywhere too, not just for BPD.

    But it really is a fantastic program, IF it is run by the right kind of facilitator who has done the DBT training. The person who runs the group cannot be dry and boring, and has to help you find what works for you – don’t take them as gospel or follow step by step. If the facilitator is rude and invalidating, find another group (same with therapists). I know of people who have gone through some truly awful things in their life who have come out of the program so much better. Yes, it is long, but think of how many years of bad experiences and unhelpful thinking a person must have gone through to get to the point of attending the group. It took years to build a way of thinking, so it’s gonna take a while to consciously try to change it.

    I hope that helps a little!

    P.S. I sat in on a couple of DBT sessions for women with BPD at a place where the clients attend over TWO years. In the second year, they repeat the program to make sure they learn the concepts. The women actually love the 2nd year because they see how far they have come and they love sharing and helping the first timers. It was so incredible hearing how their lives had improved – there were several who had abusive partners when they started, but they were able to stand up for themselves and be stronger people towards the end.

    • Thank you, that is helpful to know there is more to the DBT program than just what is written on those handouts, and that if it is run well it is beneficial.

      The DBT program I am being referred to, you repeat the modules again too. Except it only goes for a year, so in the second half of the year, you repeat what you learnt in the first half.

      I notice on your profile you are from Perth, which is where I am. If you don’t mind me asking, where are the DBT programs you talk about?

      • Ahh I had never come across your blog before, and only read your profile details after I made my comment! When I realised you were from Australia, I started to get the sneaking suspicion you were from Perth too hahaha.

        I’ll send you a private email 😀

  12. I just came outof an intensive residential DBT program and can honestly say it saved my life. Yeah the Marsha Lineham stuff is sometimes ridiculous, we had a lot of fun while I was there laughing over her ‘book a motel room in the woods, wear a fluffy dressing gown and eat lots of chocolates rubbish’ and also a particularly irritating story about daffodils, but the general premis is great I think, and Distress Tolerance was my favourite module actually. Don’t knock it based on a hand out, as I say, a lot of her stuff is crap, but DBT really did work for me and I stopped self harming quite early on in the course. I don’t know how good it would be as outpatient treatment though. I think it possibly wouldn’t be as effective if you weren’t full-time inpatient (and that’s pretty hard to come by in any country!)

  13. I am among the minority, I am 99.5 % sure I have BPD, infact i’ve told a few practitioners and they freak out because I am self-aware and the very fact that I think I have BPD means I couldn’t possibly have it apparently. I’ve had a few reluctantly investigate me and say I seem to have it, but can’t get over the fact that I knew before them, or something. Anyway I have been trying to get into a DBT course for years, and no one will listen to me. No other forms of therapy have helped in the slightest (all made me worse) I am tired of pissing around and trying to convince people I need it. Any suggestions anyone? (Perth) Send a private email if you like.

    • Hi Jay,
      Personality disorders are quite a tricky thing to diagnose, and it is possible you may share a lot of the traits but don’t actually have them in sufficient strength or number to meet the full criteria. Yes, it would be unusual to have someone be so sure that they have a personality disorder, but I would think such strong insight and a desire to improve would be a good thing! Here is a recent newsletter (pdf document) I just found (looking for someone’s email :P) that runs through myths of BPD which you might find interesting: http://www.fhhs.health.wa.gov.au/Utilities/BinaryDownload.aspx?BinaryField=DocumentBinary&BinaryTable=TBLEDCMSDOCUMENTS&BinaryID=DOCUMENTID&BinaryIDValue=32659
      Lots of other info there about personality disorders for Perth health professionals.

      But regardless of whether you meet the diagnosis or now, it seems you are keen to do DBT and believe it would help you. It seems a lot of the DBT groups in Perth require a diagnosis to attend, but I assume they would make exceptions if you seemed to need it. Otherwise, you may be able to see a private clinical psych for the DBT therapy on an individual basis (if you do the group, individual therapy is a requirement anyway).

      In the meantime, look at the skills in the “Skills Training Manual for Treating Borderline Personality Disorder” (Marsha Linehan). The groups are run from this book (so it is targeted to therapists running a group for BPD) and it has all the exercises. I also flicked through “The Dialectical Behavior Therapy Skills Workbook” (McKay, Wood, Brantley) at Borders and it seemed like quite a good self-help text for anyone wanting the skills for themselves (it was also a much better price!). It was newer and more approachable.

      Hope that helps 🙂

  14. Jeeeez. What a load of shit. Yes, induuuulge in watching depressing media material while already low. And while ur at it, beat urself up for being so upset and fucked up when YOU haven’t even been in a tsunami…. Really!? Ooh and phone random numbers just to hear a human voice? Because THAT won’t add to the desperate, lonely, pathetic I-have-no-one feeling you wiah to alleviate. Sometimes btf, I wonder if we are the sane ones. Xxx

  15. Comparisons…..

    The point about this DBT skill is that most Borderlines think in black and white terms. They engage in making comparisons all the time… mainly negatively focused on themselves. If this is the case, why not learn how to do it differently! Turn it around, you are good at making comparisons so use the skill you already have to make yourself feel better.

    As a DBT practitioner I’ve used all the skills I teach – they really work. If you approach skills training in a non-judgemental way (mindfully), then you will get the very best out of your therapy.


  16. Marsha Linehan apparently had BPD and got cured. But since BPD was entirely incurable before DBT, which Marsha invented, I am confused how. Maybe Psychoanalyzes in her time?, they were the only ones willing to deal with a known case of BPD at the time, because they were the only ones conceited enough to think their clever insight alone could cure a severe, usually trauma based disorder. Psychoanalysts keep intensive records of sessions, I would love to read Linehan’s in that case.

    But of course she was never actually cured. You ever watched a video of Marsha?. One of the most clinical, icy people one ever saw, though she does seem to enjoy making a joke on BPD sufferers. My favorite was a speech in front of a large audience. She explained how if someone dropped out of the program, nothing at all about them or what in the therapy caused it, it was always easy to find another suicidal borderline. She laughed, the audience laughed. I swear she simply turned BPD self loathing meta. Instead of hating herself, she blames the disorder in a rigorous way, and thus hates anyone with it, which caused her to create a therapy which is literally as irritating and invalidating for those with BPD as possible.

    Every time she feels like cutting, she can write another article about how a therapist should use paradoxical intervention, that is mind games, or how zen Buddhist mindfulness is required. knowing her therapy is almost always used in non Buddhist countries, because everyone loves having a particular culturally foreign spiritual tradition pushed on them, or radical genuineness, that is the therapist can say anything no matter how shitty, or punishment and aversives by the therapist, which needs no explanation.

    I get her self loathing. The idea that cutting is a decision, that good or bad without getting to the root of the problem, cutting is a less than ideal method of distress tolerance an adult is deciding to do, is not even entertained. But hurting the rest of us is not needed if you do not want to cut Marsha. I drink, its more socially acceptable, I know how important that is for her, and can be fun.

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