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What is DBT? Do I have to meditate?

Dialectical Behaviour Therapy (DBT) was developed by Dr. Marsha Linehan beginning in the 1990s to help treat suicidal clients. Having struggled herself with self-harming behaviours and having been in an out of psychiatric facilities during her young adult life,(see her NYTimes interview dated June 2011) Marsha understood first-hand how desperate the client and the family is to find help. Through her research, Marsha found that chronically suicidal people have two unique experiences: An extremely sensitive emotional system combined with an invalidating environment. The invalidating environment varies for each individual but in general, in early life, the environment (family, school, peer group etc.) did not accommodate for the strong emotional experiences, anxieties and preferences of these individuals. Thus begins a lifetime pattern of emotional suffering.

Marsha’s own healing and stability began with a Zen Buddhist practice from which DBT is born. DBT teaches clients emotion regulation, distress tolerance and interpersonal effectiveness. At the foundation of each of each of these skills is mindfulness. Combining Eastern Buddhism with Western psychology has created this very useful psychological tool now referred to as mindfulness practice. To define it as simply as possible, it is paying attention to this moment, in a particular way, without judgement, without needing things to change or remain the same.

Everyone, it seems, has heard of this useful tool since it is a media buzzword and celebrity trend however the discipline required to sit in meditation practice is often daunting. It helps to start with very short daily meditation, even 1 minute(!) is enough to start. Paying attention to your breathing, noticing and letting go of thoughts and accepting the present moment is all that is required. Nothing else. As time goes on, you can add more minutes to your practice. You DO NOT need a special cushion, a Buddha statue or incense. Any chair, any location will work.

In my work with clients I find DBT skills are useful for treating clients with a variety of struggles. DBT is an evidence-based treatment that has expanded beyond treating suicidal individuals and has been proven effective to treat addictive disorders, anxiety, depression and eating disorders. DBT requires the therapist take specialized training, engage in on-going consultation and is dedicated to their own daily mindfulness practice. Like Marsha’s Lineman’s example, the best therapy is born of personal experience, trudging a similar track and finding healing.

I honestly didn’t realize at the time that I was dealing with myself. But I suppose it’s true that I developed a therapy that provides the things I needed for so many years and never got.
Marsha Linehan

Medical record

Quality & Actions of a Therapist

This is my first blog entry as I launch my new website for Own Mind Counselling.  I think it is fitting to discuss what good therapy is since it is important for both the client and the therapist to understand in order for therapy to effective.  I am committed to knowing what good therapy is and will do my very best to deliver it.  The following is a summary of an article I read recently and these are the attributes  and actions I embody and/or strive to achieve in my practice as a therapist.

First and foremost, therapy works if the therapist is effective! Research conducted by the American Psychological Association suggests that certain characteristics of the therapist are key to successful treatment.  Psychotherapy is proven to be as effective as psychotropic medications for various mental disorders including anxiety and depression and results  in lower relapse rates than medications alone. Studies indicate that the therapist is tremendously important to producing the benefits that therapy may bring.

The following 14 qualities and actions of a therapist are essential for a therapist to be effective:

1) Excellent interpersonal skills.  This includes verbal fluency, perceptiveness, expressiveness, warmth, acceptance and empathy.  The therapist is able to focus attention on the client and listens for nuanced communication.

2) Clients feel understood and trust the therapist will be helpful.  Clients are very perceptive and the first impression clients have of the therapist tells them whether the therapist can be trusted.  The therapist is able to communicate understanding both through both verbal and non-verbal communication. This is key to developing trust.

3) The therapist is able to form a working alliance with a broad range of clients.  A working alliance involves a collaborative, purposeful approach developed with the client’s goals being the guide to treatment. The therapist has knowledge of cultural, social, sexual, gender and socio-economic diversity.

4) Effective therapists provide an acceptable explanation for the client’s distress.  This includes an understanding of the client’s attitudes, values, culture and worldview.

5) The effective therapist provides a treatment plan that is consistent with the explanation she provided to the client.  The treatment plan will include healthy actions to be taken by the client.

6) The treatment plan provides realistic hope to the client and will benefit the client.

7) The therapist continually monitors the client’s progress in an authentic way and uses reliable instruments to measure change.  The Therapist is particularly attentive to evidence when the client is not improving.

8) Effective therapists are flexible and will adjust therapy if resistance to the treatment is apparent or the client is not making adequate progress.  The therapist is open to new information and is willing to be “wrong.”

9)  Effective therapists do not avoid difficult material in therapy and use this therapeutically.  Therapists are comfortable with strong emotional expression and client disclosure.

10) The therapist communicates realistic hope and optimism.  The therapist recognizes and communicates to the client her observed strengths and and mobilizes the client to solve his or her own problems in order to attain a sense of mastery.

11) The therapist works to coordinate the care of the client with other psychological, psychiatric, physical or social services when needed.

12) The therapist is aware of her own counter-transference and how this affects therapy. The therapist does not inject her own psychological processes into the sessions.

13) Effective therapy recognizes existing research and knows the most effective treatment approach for treating the client’s distress.  This includes biological, social and psychological bases of the disorder or problem experienced by the client.

14) The effective therapist always seeks to improve and develop new skills based on client feedback and new research findings.

Reference:

Wampold, B. (2014). Qualities and actions of Effective Therapists.  Continuing Education in Psychology.  American Psychological Association.