Started DBT

Now that I’ve had both my first individual and group DBT session, I’m still rather apprehensive about it all. During individual therapy while D was giving me more information about the DBT program, as much as I didn’t want them to, tears started rolling down my face. D asked me about the tears, and I told her that I was overwhelmed with fear and anxiety about how full on the program seemed, and that I was thinking that it’s all too hard. I acknowledge that wanting to run away from it because of fear about how hard it is is my problem, but from what I’ve been told by D and the documents I’ve been given, there are certain aspects of the DBT program itself that I have an issue with too. A few of them are;

  • I dislike how regimented it is and I find some of the rules and boundaries presumptuous and condescending.
  • It seems to run on a system of punishments. For example, the 24 hour rule: If you’ve self harmed, the therapist will not have unscheduled contact with you for 24 hours. I don’t see how your therapist not talking to you because you’ve self harmed can seem anything but punitive. 
  • Based on the number of rules there are and contracts I’ve had to sign prior to starting, I feel like I’m being boxed into the assumption that I’m difficult, I cross boundaries, am overly needy and time intensive. I’ve never been someone who’s crossed boundaries in therapy, tried to obtain extra therapy outside of scheduled sessions or been demanding of a therapist, and frankly I’m insulted by documents I’ve received that hint I am. 
  • There’s a big emphasis on not missing either group or individual sessions, especially not “just because you don’t feel like coming”.  If you don’t attend a certain number of groups, you’re banned for the rest of the term, and if you miss a certain number of individual therapy sessions, you’re also banned from group for a certain period. Again, I’ve never not turned up or cancelled appointments just because “I didn’t feel like it,” and I’m irritated this point had been reiterated to me even though it’s a non-issue. As for not missing sessions, I try not to, but you know, I have a life. I study occupational therapy at uni, we have fieldwork to attend, and on top of that I volunteer/work in four different mental health groups/organisations. 
  • I still get the impression that DBT is all about using skills to stop the self harming and suicidal behaviours without actually addressing the actual issues behind it and the hopelessness, fear of rejection and abandonment, not knowing who you are, past trauma, depression etc.

I have however barely begun this year long program so I can’t say yet whether it is helpful or not. Despite all my objections, I do want to be open to it and give it a go. In group a couple of the members who are now in their eighth month of DBT spoke about how at first they didn’t get it and it seemed stupid, but it then clicked and they do use DBT skills in their everyday life, and another group member who I spoke to before group told me about how DBT has been life changing, and she can now cope with things she wasn’t able to before. So who knows, maybe if I use my wise mind, take a non judgemental stance and act opposite to my emotion by fully engaging with DBT, I will be singing a completely different tune about it this time next year.  

12 thoughts on “Started DBT

  1. Give it a chance. They just make those rules because they want to know that you are really dedicated to it because you have to or else it won’t work. I’ve done DBT and it is life-changing. They are not trying to punish you. They are trying to help you. They want you to develop skills and not be as dependent on them or anyone else. You will learn how to manage your emotions and stand on your own two feet. I still try to practice my skills every day. You will learn other ways of coping with distress rather than self-harming and you won’t need to do it anymore. You may not even have the urge to as much. Again, stick with it. It will change your life for the better.

  2. I wish you the VERY BEST with the DBT. I totally see why you are apprehensive and for all of those reasons you listed, I agree with them! But I can’t deny (and now you have seen already), how people say that they didn’t like things and get things at the beginning of the DBT and I don’t think I’ve ever seen anyone that was really OK with it to start with… But also once again, these people have told you how good it is and that in some cases, even really life changing. It really does seem to help people.

    Go for it (I know you will anyway!) and good luck!

  3. Excellent article – Although I do not suffer from BPD I think this is a very concise and relevant summary. It seems to me, like a lot of what goes on in NHS outpatient (and inpatient) mental health “recovery” settings, the agenda is geared towards “reprogramming” rather than valuing and validating individuals and their struggles. Making people feel like a nuisance because they are “personality disordered” often enforces the stigma that exists that those who struggle with a contant torrent of challenging emotions are not worthy of true validation. All the best to you with your journey, however.

  4. I agree with what you posted. I tried to get into DBT group therapy and it didn’t work out, but even before that when the lady was telling me the rules I was shocked – specifically the self harm one. I mean what if it was escalating to suicidal thoughrs? That whole concept seems ridiculous to me. I found schema therapy and CBT helped me and suspect it did just as much as DBT would have if I did it. Best of luck in it though bc I know that most people swear by it

  5. I completed the 12 month dbt and graduated a few months ago. Its the best thing I have ever done in my life despite having a love hate relationship with the group lol. I can’t seem to find the words I wish to share with you. But its worth the time, energy, and everything in between. I wish you nothing but the best with it :):):)

  6. How long did you wait for your DBT to start? I am on a waiting list and simply can not wait! Currently dipping in and out of tools I’ve found online. They seem really useful!

    I hope you are able to stick with the treatment and eventually find it less scary. You can do this, it is worth doing!

    • It was three years between being first referred for DBT and actually starting the DBT program, however I think my case is unusual and usually the wait isn’t that long. Hopefully it won’t be too much of a wait!

  7. Imagine the following situation: A patient with cancer goes to see an oncologist. The oncologist demands that the patient not exhibit symptoms of cancer, or else the doctor will cut off contact for 24 hours. That makes no sense, right? The doctor would be scoffed at, have no patients, probably lose his/her job. It’s obvious the doctor is not treating the cancer.

    But in DBT patients who have mental disorders like bipolar/depression are told not to exhibit any symptoms of their disorders or else their therapist will cut off contact for 24 hours. Somehow this is referred to as “therapy” even though the therapist is not helping the patient in any way and actually demeaning the person for asking for help.

    Someone please explain to me why the mental health industry is allowed to profit from this disgusting behavior.

  8. Sounds like you’ve got a good head on your shoulders about everything. I know it’s scary and learning new things is often hard and freightening, but I know you/we can do it. Also, just a wordage thing I like to use. Some people use the word punishment, some use the word consequences. I personally like consequences. Because it isn’t about being “in trouble” or doing something “wrong” it’s about there being a react to every action that we make. And to things that we say and do. I’m sure that just sounds like a platitiude, and maybe it is. But I have found in more than one experience that the words we use to define our circumstances and surroundings often carry great weight in the way that we process information and the way that our minds work. Great post!!

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