I was originally meant to be doing the full year of DBT, but due to me passing all my units at uni (yay!) and going on fieldwork next year, I ended up only doing the six months. Which meant I still completed all four modules; mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance, I just won’t be repeating it for the second time round.
I had my last individual DBT therapy session with my psychologist yesterday. When I think about twice when I’ve overdosed/self harmed and ended up in hospital when I had to stop seeing a psychologist, the same when I just thought a psychiatrist was going to stop seeing me, and the rest of the time when I didn’t even properly end with a psychologist, it’s weird not to feel that sense of loss, dread, abandonment and feeling of being ripped apart that I usually feel in ending with a clinician. I guess I just didn’t really feel that sense of connection with her. And it got pretty repetitive and monotonous go go through the same thing every session: diary card, chain analysis, looking at where I could’ve used those DBT skills.
I think I’d feel a much bigger sense of dread and loss when it comes time to be discharged from the mental health clinic and stop seeing my community MH nurse. I was resistant to the idea of seeing a community nurse at the time when I was relapsing with my eating disorder last year, but now that I’ve been seeing her for over a year I’ve come to appreciate being able to just talk to her about whatever’s been going on in my life.
So now that I’ve finished DBT how did I find it? Well perhaps I’m not quite as scathing as I was before starting it. I can see where some of the DBT skills can be helpful when trying to get through a crisis or when trying to deal effectively with other people. At the same time though, I still feel like it doesn’t help me understand myself better on a deeper level and why I feel a certain way then react how I do, and learning the DBT skills doesn’t address if I’m motivated or not to use them in the first place. It’s also quite scary for me that because DBT seems to be regarded as the best damn thing since sliced bread for those who have BPD, now that I’ve completed it, it’s kinda like “Well what now?” So many times when I’ve been in the ED or psych ward, I’ve been told that doing DBT is the solution. Now I’m left wondering “What’s your solution for me now?”
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.