Session 41: What in the World is DBT?

Published Jan 24, 2018, 8:00 AM
This week's episode features Seida Hood, Licensed Clinical Social Worker. Seida and I discussed what DBT is, who can benefit from it, and how you can find a DBT group that might work for you.

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Welcome to the Therapy for Black Girls Podcast, where we discussed all things mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, Dr Joy Harden Bradford, a licensed psychologist in Atlanta, Georgia. To get more information and resources, visit the website at Therapy for Black Girls dot com. And while I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional. Hey, y'all, thanks so much for joining me for session fort one of the Therapy for Black Girls Podcast. For today's episode, I wanted to break down another set of alphabets you may have heard floating around DBT. DBT stands for dialectical behavioral therapy and is most commonly used with people who have been diagnosed with borderline personality disorder. To help us make sense of all of this, I chatted with licensed clinical social worker Cita Hood. Ceda is the clinical director of From the Heart Counseling, Incorporated in Saint Charles, Illinois, and specializes in working with angry and aggressive teens, people who have experienced trauma and millennial women looking to thrive in life. Cita and I discuss what DBT is, who can benefit from it, and how you can find a DBT group that might work for you. Here's our conversation. So thank you so much for joining us today, Cita, thank you for having me. I'm excited that you were able to join us because I like to bring on therapists to talk in more plain language, so to speak about a lot of the terms that we often you're thrown around in the field. So DBT is another big one that I think a lot of people here but don't quite know what is what is it used for? So can you tell us more about what DBT is? Absolutely, so, DBT is dialectical behavior therapy. So it's a form of cognitive behavioral therapy that's developed by Dr Marcia Lenahan. So if you're not a clinician, I know that makes no sense to you at all, right, So, just to put it plainly, DBT is essentially a combination of being able to regulate emotions, practice mindfulness, UM, the ability to tolerate intense levels of anxiety or distress, and UM. If you aren't familiar with cognitive behavioral therapy or CBT. What that does is just helped to modify emotions, behaviors, and thoughts. So DBT is just sort of like a portion of that um that I love using it because it's so simple and plain makes sense for people. So so tell us what is what you like so much about using it and like, how do you typically use it with your clients? Okay, Well, first and foremost, um, when I use it it, first of all, I tell people off top, I'm gonna get really petty with you. I'm gonna ask you questions about the incident that you might think is stupid. So if you come in and you tell me, oh, I was so upset. I worked with teens a lot. Oh I was so upset. My mom was being annoying, blah blah blah, my dad out on my nerves. So it's very practical for the teens. So if I say, all right, so digging deep into this situation, what was it that got you upset? Why did that upset you? What did you feel like when they said this or did this? What does that mean to you? So really just digging very deeply to discover, okay, what their beliefs are about the situation and how that could next to the actions that they then carried out after that. So it's really simple because it takes you down to the nitty gritty and the starting point of a conversation or an action, and it's it's easy for people to see as opposed to like some um far fetched thing of understanding like some other things might be. Does that make sense? Yeah, So what is the purpose of breaking it down into like all of these steps, like why do you have to get so petty so to speak, and kind of get all the details of an interaction to really use DBT Because we have to explore where your thought process is. Because what we believe is how we will act. Our actions are based on our belief system. So if we can combat those, the belief system then translates to a thought and then translates to actions. So if I was to put that very plainly, um, if my belief system is that just going off of an example, just a plain person or Jane Doe will say, if Jane Doe believes, Okay, my husband doesn't love me, then a thought that might come next is, oh, he left the garage up because he doesn't care about what I do he didn't. He wasn't concerned about me. He hopes that something happens to me when somebody walks into the house. And it sounds like it's really extreme, but I guarantee people think this way and then the action might be, well, I'm gonna get back at him by doing X, Y Z. So we have to go so deep so that we can understand where originated from versus having like, oh, if the husband were to come in, Oh, she's crazy. She just did this. She responded in this way, and all I did was forgot that the garage was up. Well, it sounds really simple off top, but if you actually go deeper with her and find out what she believes to be true, then that is the core of why she did what she did. So that is so important. Okay, So really it sounds like you're kind of boiling down all of these pieces and these steps so that you can see what influences a person's decision making so that maybe you can kind of change their thoughts that would then change their behavior. Absolutely, absolutely, that's exactly what it is. Got you. Okay, So I know that when we hear about DBT, you know, DBT often happens in groups, But of course you can also use it individually. But you often hear a lot about like all these skills and modules and UM, all of these different things that are a part of DBT. So can you break down what some of the skills are that are taught in DBT? Okay? So essentially it's again the ability to recognize your triggers to distress UM, identifying the emotions that are underneath those triggers, and the ability to withstand that distress. Practicing some mindfulness. So mindfulness is just being in the here and now of the situation. One thing that's really big with DBT is interpersonal effectiveness. So how you relate to people? Are you assertive? If you know you are assertive? Are you too assertive? You need to tone it down a little bit. Can you effectively problem solved without UM maybe causing some major damage to the relationship. How well can you regulate your emotions? Can you recognize when you're feeling anxious or stressed in the moment um? And I use these skills, I go over it. I actually run a group called reconnect UM in my practice, and it's for teams that are struggling with UM self harm, self harming behaviors, who have had UH suicide ideation or previous suicide attempts, And so when we're in the group, we'll go back to like practical ways that we practice this. So as a part of the group, everybody has an opportunity to check in, and the check in process is so essential to running the group because yes they're learning new skills, but they really value the check in process. This is them sharing how they're week went, identifying triggers, UM figuring out if they recognize those triggers in the moment, how the situation was resolved with whatever they may have brought up, Is there a way that they could have handled it maybe more positively. So exploring these questions gives a lot of insight into UM different situations and they might practice role plan a different response, so ways they could have avoided the situation altogether. And I think here's the best part about the group. When I described this process to people, you know, most people think that like, I'm the one asking questions, and sometimes it is me, but the majority of the time is group members that are supporting one another, and it's so beautiful just to witness and um they help one another and as they help each other, they themselves receive what they need. So they may give the feedback on the check in and practice those skills and push one another, and then when it's their turn, they're like, Okay, I know I should have done exactly what I just told you to do. So really it's pretty practical and easy for them to pick up and understand. It doesn't take long at all for me to stop being the one to ask the questions before they are holding one another accountable. I know that was kind of a long answer. No, No, that's a good information. But I do want to go back to you on one of the skills that I think can probably be really helpful whether you are participating in DBT or not, UM the skills around interpersonal effectiveness. So can you talk more about that and like maybe some exercises are different kinds of strategies you might use to help someone become more interpersonally effective. Wow, well that's a big one, first, yew Or. I think it's a big one because so many people, so part of a huge part of like DBT is acceptance and then working towards change. So you have to um number one, except that certain situations are gonna be frustrating. For example, if I'm a teenager and my mom has to wake me up for school every day, that's probably gonna be a frustrating situation. That's just part of life. Um. But then recognizing that how I am handling this situation plays a much bigger role in how easily or not so easily it's resolved. So a lot of things that we work on when we are in the group, I tell them, you know, or even if I'm talking to somebody personally, if you are asking me to hold you accountable for something, I'm gonna push you outside of your comfort zone. I'm gonna ask you why did you do that? You know, what do you think the motive was for this? Because our first instinct as humans, and we all do it is to say, well, because they did blah blah blah. Well that might be the case, But did I handle that situation effectively? What am I wanting out of this situation? Am I properly communicating that? Because sometimes we think that we are communicating those things and we're actually not being as clear as we think we are. So I pretty much work with people on Like I started talking a little bit earlier about the assertiveness, So UM, knowing when and where to be assertive? What what does that look like? Can you gauge a situation to be able to say, Okay, this is the time to bring this up. UM, this is my my tone of voice and my setting boundaries. Is this, according to UM, something that's comfortable for me? Or am I stepping outside of what I'm comfortable with to make this other person happy and then getting upset about it and not really communicate adding that effectively. So really just looking at a lot of internal things and then how that relates to the other person that I'm dealing with or people around me, my relationships. It looks like a lot of it is really related to taking responsibility for your actions and also looking at were you effective in initiating a conversation and not putting so much focus on what someone else did exactly. And another another big thing that I a skill that I practice with anybody, UM, and this could be like even if I'm talking to a friend. Just very practically UM is called using eye messages, and I know therapists are familiar with this, but essentially the way that this format goes is when you blank, I feel blank, please, so an example might be when you yell at me, I feel sad or maybe like you're upset with me, would you speak to me in a softer tone. So it does several things. It Number one names the issue that you have. Number two names the feeling that you have, and then number three offers a solution. And that kind of opens up the door for dialogue there because if we use that, you know, oftentimes the other person is going to respond and say, yes, I could stop doing that, but this is what I need from you as well. And so it's important, you know, to be able to verbalize as well as to receive what other people have to say. So something that UM you said just made me think about, you know, like if if I am participating in DVT and then I learned all these skills about maybe how to talk more effectively to my partner or my friends, UM, and then I'm doing all of this work, but then they are not, of course, engage in the therapy, maybe right, And so I wonder how that plays out when someone has developed this new skill of like maybe asking a partner using the model that you just gave, when you do such and such, I feel such and such, can you please um? Do you have any tips or is there a part of DVT that also talks about like how to train the other people in your life to maybe do some of this. Well, what I usually say like that's the way that we practice the skill in therapy. But I always tell people you make it your own. So if it sounds like to rehearsed there, you make own. And then even when you're talking to because most often, of course, like parents know their their their kid is engaged in therapy, so they're working on a therapeutic skill. Even if you know maybe one parents not on board or the other one you know, maybe they both are. But a lot of times, like like you said, with partners, how do you bring them on board? And I think I would just simply have the conversation you know what, um, And I've given this a lot um. I have to think of specific situations for people I say, UM, So if I were you and I were in this relationship, I would say, initially, you know what, honey, I really appreciate how well you've been supporting me. I know, you know, maybe I've always not been the best at X y Z. I've made a couple of mistakes, so I've been working lately to try harder to understand you and to try and get you to understand me, and I know that sometimes that process is a little bit frustrating, so um, I'm just trying to work on communicating with you more. And if you kind of set the tone in that way to where you are highlighting what the person is doing positively, it makes them more receptive because a lot of times we are it's a matter of us getting frustrated over something that someone else is doing, and most often that person perceives that they're trying to help you or support you. So you just want to be supported in a different way because it's not working for you the way they're doing it. So if you have that conversation off top, building upon the positive things that they already do, I believe that they will be in a much safer space to want to hear from you. Which again is not to say that the conversations will go perfectly all the time, because sometimes you're gonna say that and it's gonna start an argument, and sometimes you're gonna say it, and sometimes the other person is going to be receptive of it. But again it goes back to how do you handle that so when that conflict does come up, what will be your response? If you instantly, you know, lash out and you know, get aggressive verbally, then you just kind of took away some of the progress that maybe you were making in that relationship. So it's really about um being intentional and again mindful about how you are approaching the situations and laying the foundation or the safe space for the conversations. So let's go with the mindful piece that you just mentioned, because of course that is another big component of DBT. So what does mindfulness look like? I know some people often get confused when we talk about like mindfulness and what does that mean? And oh, I can't see quiet for that long? So can you talk about like mindfulness and why it's important and maybe some like strategies to become more mindful? And I think you've just hit the nail on the head with a common misconception about mindfulness. People think that mindfulness has to look one way, when that's actually not true. It can look several ways depending on what context we're talking about. So mindfulness could be sitting still and meditating on a thought or something like that, or clear in your head. It could be something like that. But mindfulness could also be I know UM with clients who struggle with eating disorders. There are a lot of therapists who use mindfulness to UM teach them a different way to re engage with food UM. And so in that same sense, when I work on mindfulness with my clients, then we are looking at truly being aware of everything that's happening in the situation in that moment, being aware of how I'm feeling. Why is this situation upsetting me right now? Or why am I reacting like this? Am I upset? Or am I am I sad? Do I feel anxious in this moment? What is going to be helpful to me in this moment? So really looking at UM those specific things like being in the here and now. If I am upset, is this the best place to express it? If we are at home and it's just you know, the two of us, or me and my parents, maybe this is a good time to express it. If we are at home and my parents are super stressed right now because they have something going on, maybe not the best time to express it. If we're out at a dinner that's honoring you know, my spouse, is that the best place to express how I'm feeling, so really honing in on what it is you're feeling, why you're feeling that what you're trying to communicate. Is this the best time to communicate it? Is it the best way to communicate it? Um? So, I think mindfulness can look a lot of different ways. But I know that when I work with clients, that is essentially what I am getting them to focus on in those moments. And then there could be sometimes where you know, if I'm working with a client who has anxiety throughout the day, severe anxiety, then we may work on, Okay, how can I sit still in the moment and just simply enjoy sitting right now, sitting in the grass, the wind blowing in my hair, decompressing my mind from all of the things that are stressful right now. So it can look a lot of different ways, and it just really depends on what you're working on um or what you're experiencing as the person. So the other thing that you mentioned that DBT is really helpful for is helping people to tolerate distress. So people who often feel overwhelmed by their emotions, I feel like things just kind of spin out. A can troll to get out of control. What are UM, some of the distress tolerance techniques that you might use with a client. Well, I think those techniques start off baby steps. So I have several clients that UM may feel extremely anxious about or feeling like they're in distress about maybe leaving the house or when someone talks to them a certain way, or UM, let's just go with the one UM leaving the house. Let's go with that example. So the the fear there, well, there are a ton of fears that are attached to it, just walking out of the house and different things that they may experience in that moment. So you know, I know that therapists have a lot of different theories in a lot of different ways that they approach things. Um, I'm really relationship based. I really think that the therapeutic relationship is one of the most essential components to how well the client progressed us. So if that means that for me, you know, you being afraid to step outside of your house, then we might work towards baby steps towards that. So maybe the first day, you know, we just talk about moving towards the door, moving towards getting outside of the house. The next time we may talk about okay, go take a shower, put on some clothes as if you're leaving the house, and then the next time it may be something as me coming to your door to come with you outside of the house, or us going and having lunch somewhere. So it's baby steps and when you work up to those things slowly but surely, so that they're able to tolerate it and it's okay if you know maybe on that day that you were supposed to open the door and look outside just for five minutes, that you couldn't do it, we'll talk about that, we'll process through that, but slow levels of UM essentially exposure to what it is and building up those grounding techniques and those grounding skills to help them really focus on okay, I can do this, affirmations, I'm capable of doing this, you know nothing bad is gonna happen, and just really using those coping skills so I know, Cita that we hear a lot about DBT, and of course actor Lenahan Um developed DBT related to working with people who have been diagnosed with borderline personality disorder. But are there other concerns? Are other people struggling with other things? That you think DBT could be really useful for absolutely UM. So DBT is also used with people who struggle with post traumatic stress disorder UM, obsessive compulsive disorder, and like we talked about anxiety and depression and different things like that. UM. I really do think that clinically everybody could benefit from, you know, mindfulness and better distress tolerance and different things like that. UM. It is widely known for borderline personality disorder, though you and are there some concerns where DBT might not be appropriate at all, So again I think everybody could benefit from some skills there. However, if you are attempting to UM use DBT or you're interested in it, I would highly suggest training because again, the techniques and different things are simple, you know when you look at it or when you read about it. But you never want to be in a position where you open someone up emotionally so to speak to where they are completely vulnerable UM, only to not have the therapeutic skill set to leave them in a safe space. So that is a very dangerous position to be in. Again, people can benefit from DBC, but if you're not trained and you have some on you know, bearing their soul I always tell people therapy is a place to express those dark, ugly thoughts that maybe you don't tell anyone, and you can't just walk away with those on the table without you know, having the skill to be able to bring the person back to grounding, like a level of safety where they're like, Okay, I'm fine, I can continue through my day. This was a very difficult session, but I'm ready to progress. So those would be UM, I think personally, just some concerns that I would have about UM using DVT and other situations. So it sounds like, UM, if somebody is listening to the podcast and you know, they kind of like, Okay, I like what she's saying. I feel like some of these seals might be helpful for me. If they're looking for like a DVT group in their area, it sounds like you are saying that they definitely want to make sure that UM, whoever they're going to do a group with has had appropriate training in DBT. Absolutely absolutely. And you know, not only that, but I think if you are looking for a DVT group and it sounds like something that you're interested in, you want to also look for a network of supporters, like people who can be helpful outside of the group. I know, you know, some people's programs, like I know a lot of times hospitals don't necessarily encourage sharing UM personal contact information and different things like that. But UM, I have found in the group that I lead that it is very helpful for the teams to be in contact with each other throughout the week. And I know I get a lot of UM anxious parents and people who are like the way, if they're all struggling with the same thing, how can they help each other well? Because they are also all committed to getting better. So if one person is struggling in that moment, they are extremely supportive of one another and they are super good about like holding each other accountable. So I would really look for UM a place where you feel comfortable and again that the facilitator is relationship oriented, relationship oriented with not only UM you know each other, like encouraging members to have relationships and talk to one another, but also how the facilitator's relationship is with each group member, because that's that's key, it's essential UM, and that there are no quick fixes. You know, you might go to a DBT group and it might suck the first two times, like that's reality. I tell people, when you start therapy, it's gonna get worse before it gets better. So you know, maybe don't run away scared if it doesn't work the first time, but figure out again why didn't it work? Is it because I'm just not comfortable here? Or is it because of something that I'm not addressing or I'm running away from? Know? What are some of your favorite resources for anybody who might want to learn more about DBT? And I'm not talking about therapists, more like clients who might be interested in DBT or there any like client friendly resources you found? Yes, okay, so this is like I think therapists would feel some type of way with me mentioning this. But there's actually a YouTube channel from her doctor hand and she gives a lot of um videos on practical ways to use DBT. And then like for parents who think, you know, when my kid is struggling with this specific disorder, I love the instant help books for teens. They have a ton of them, um but specifically dealing with DBT. And you know, it says for teens, but it could actually practically be used for adults as well. Um, just some of the stories are based like in high school, but the skills are still there. Um. It's called Don't Let Emotions Run Your Life um um. And again it's an instant help book for teens. You can find it on Amazon. So those books like that, and even if you look up um DVT Skill Workbook on Amazon, there are just a ton of resources there. But I would say if you're really interested, before you want to purchase anything, you should look up that YouTube channel because she has literally a ton of videos there with a lot of information. Okay, and of course all this information will be included in the show notes for people to find very easily. So can you talk more about, um, what happens in your practice? So it sounds like you have a very like strong teen DBT group. But are there any other exciting projects that you're working on? Are things you're gonna be offering in your practice? Yes, I'm so excited. UM. So we just did in November, um our first Ladies Night, and essentially Ladies Night was filled with these wonderful women from the community, um, who are small business owners, not not therapist. Actually I was the only therapist there, but women who were ready to help other women in the community come out and relax and enjoy themselves. So we had massages going, we had painting, we had wine, UM, we had a lip since Lady lu LaRue, just a ton of stuff. UM. And so I'm looking forward to bringing that back because even that night, people were like, yes, please, let's do this more than one time a year. And then, UM, I'm a person who loves to do giveaways on my website and everything, or you know, if you're subscribed to my email list, I love to do giveaways. And so last February we did this UM challenge where we focused on self love, and so I'm gonna bring that challenge back and I haven't told subscribers yet, but this time, if you share pictures and things like that during the challenge, you'll get entered into a Apple to win a fifty dollar visa gift card. So I have some pretty exciting things coming up, even you know, dance movement workshop for stress relief, all of these different things. UM. We have an intern who's offering pro bono intake assessments and then UM reduced rate therapy. So just a lot of fun, exciting things that I you know, I want people to take advantage of because some of the offerings will be free, and then some of them won't be free, they'll be paid, but you will get more bang for your buck. I feel like plains. Yeah, it sounds like you're doing a lot of really cool things to kind of introduce people to more kind of mental health constructs that don't involve just therapy. Yeah, because you know what, ultimately, that's what it's about. It's about establishing those positive support systems that are maybe outside of the norm, outside of just going to work and coming home, but really um, thriving in life and discovering what you love and living out those passions. Nice. So where can people find you? You mentioned your email subscribing this, so I want to hear more about that. But can you also give us, like your website information in any social media handles that you'd like to share. Yes, So if you Google from the Heart Counseling, Inc. You um will see my website. UM. My website is f T and then the word heart spelled out and the word counseling spelled out dot com and then um on social media on Instagram and Twitter, I am Sita f T h C. So if you don't know how to spell my name, s E I d A F T h C. So that is my Twitter and my Instagram, and then we're just on Facebook as UM From the Heart Counseling. And then I also have a try a group. It's called the Tribe lound Um. It's a Facebook group and it's just for people all over that want to be a part of From the Heart Counseling that aren't local, they can join. We do challenges throughout the year, so that's where we did the February Self Love Challenge last year. We do UM challenges and sometimes you know, if I have products that I release or something like that, the Lounge members get discounts and different things, early access and a lot of fun things like that. Nice and of course again all that will be including the show notes, so people can find all of that easily. Well. Thank you so much for joining us seated and sharing your expertise with us today. I really appreciate it. Thank you so much for having me. I love therapy for Black girls. I'm so happy about the things that you're doing on your website. Thank you, thank you. I'm very thankful that Cetera was able to drop in and share her expertise with us and encourage you If you'd like to learn more about DBT are the things she's offering in her practice. To check got the books and stuff she mentioned by going to Therapy for Black Girls dot com slash Session forty one. If you've learned something new from this episode or have had experiences with DBT yourself, we'd love to hear all about it. Please share your thoughts with us on social media and use the hashtag TBG in session. Remember that if you're looking for a therapist in your area, check out the therapist directory at Therapy for Black Girls dot com slash directory. And if you want to join us in the thrive tribe, where we continue the conversations from the podcast and talk about all kinds of other stuff, head on over to Therapy for Black Girls dot com slash tribe and join us to keep up with important updates and important mental health information. Make sure you're following us all across social media. You can find us on Twitter at Therapy for the Number four b Girls, and you can find us on Instagram and Facebook at Therapy for Black Girls. And please make sure that you're continuing to share the podcast with your new friends. You can do that by texting them tweeting them, or sharing the info about the podcast in your Insta stories. I really appreciate that. Thank y'all again for joining me this week, and I'm looking forward to continue in this conversation with you all real soon. Take it care a hotter Fi Hoctor

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