Good morning DBT adventurers. Ok, here is the first bit of the DBT story...

What is DBT?

DBT is SUPPOSED to be a very comprehensive therapy involving group skills training (which is the bit we are playing with here in Forum Land), individual therapy, telephone coaching and a therapist consultation team (i.e. therapists are supposed to have the support of other therapists who are collectively supporting the client). However, I know I have expressed my frustration more than once in Forum Land over the fact that in my experience, most therapists who SAY they do DBT actually only do the skills component. I think the skills are extremely valuable (hence this thread) and indeed, there is a bit of research floating around that indicates the skills alone can super help some client populations. However, it still seems quite clear that for people with very complex muddles (like mine and like that of many other Forumites), the skills alone are never going to actually FIX the muddle. Thus it seems to me that because a lot of therapist reduce DBT to only the skills component, a lot of people with complex muddles are condemned to only ever "cope" rather than "get better." This is a reality that I find crushing and that I still super struggle with.

The dialectical world view and basic assumptions.

At the start of a DBT adventure, it kind-of makes sense to clarify what is meant by "dialectics." Ok, I'm going to TRY and summarize what Linehan (2015) says in this section. Now is probably a good time to mention that summarizing isn't one of my strengths - EVERYTHING seems superly duperly important to me. But I will try...

According to Linehan, there are three key characteristics of dialectical perspectives on the nature of reality and human behaviour:

First, dialectics stresses the fundamental interrelatedness or wholeness of reality. In other words, the whole is greater than the sum of its parts. So in DBT, we super focus on individual thoughts, feelings and behaviours, but at the same time, these are contextualised within the whole framework of the person and their environment. I like this bit that Linehan says; Learning behavioural skills is particularly hard when a person's immediate environment or larger culture do not support such learning (p. 4). To me that validates the reality of so many people; that often the environment is not conducive to healing. However, this isn't an entirely pessimistic story because one of the modules of DBT is "interpersonal effectiveness" which is all about learning skills to shape one's environment to make it more conducive to healing.

Second, reality isn't viewed as static, but rather, it is viewed as being made up of opposing forces which are constantly pushing against each other and thus shaping a new reality moment by moment. According to Linehan, dichotomous and extreme thinking, behaviour, and emotions are viewed as dialectical failures. I'm not entirely convinced on this point. I think it can SOMETIMES be true, but my personal view is that in a lot of instances things really are much more black and white than is allowed for in our post-modern society. I've spent my entire life being told that I'm "too black and white." I don't actually think I am...but then I'm diagnosed with both BPD and ASD, and black and white thinking is a core feature of both of these diagnoses, so what the heck would I know. Secretly though, these days when people tell me I'm being too black and white, I think to myself, "yeah...or maybe you are just seeing a whole lot of grey that isn't really there."

Having said all of that, Linehan identifies three areas in which black and white thinking can make DBT skills training difficult: a) The need for the client to totally accept themselves as they are right now, while also recognising a need to change, b) The need for the client to work towards becoming competent, while recognising that once they are competent, the support they get from the therapist will end, c) It is likely that as the client gets better at using the DBT skills, they will feel validated that their struggles had been due to a lack of skill and not because they had been trying to be manipulative or hurtful to others (which is what other people may have told them). On the other hand, people in the client's environment are likely to use the client's improvement to validate their own view that the client was "the problem" all along.

I find this stuff tricky. For example, it is super hard for me to understand the concept that I'm ok just as I am...but I need to change. That doesn't make sense to me at all. I would be super interested in hearing what others think about this.

The third key characteristic of dialectical perspectives that Linehan identifies is that the fundamental nature of reality is change and process rather than content or structure (p. 5). That is, she thinks change is a good thing. Yeah...I'm not a fan of change. Linehan says, therapy does not focus on maintaining a stable, consistent environment, but rather aims to help the client become comfortable with change. I would SUPER love to find a therapist who could help me become comfortable with change!!!! Reading this caused me to reflect on whether the autistic experience of struggling with change is quantitatively different or whether it is qualitatively different to the neurotypical experience of struggling with change. That is, does it differ only in strength, or is it a fundamentally different experience? I don't know the answer to that and I would super like to find someone who could help me unpack that puzzle.

Wow, that was really long and kind-of intense wasn't it. Don't worry, there are only 499 pages left to go in the manual. If it helps, there are only 13 pages left in the introduction, and then we get onto the actual doing bit...unless @CheerBear super busting can't wait and just dives in right now with what she has been playing with in the manual...and that would be a bazillion percent ok.