Skills Training Manual for Treating BPD – Chapter one discussion

di·a·lec·ti·cal/ˌdīəˈlektikəl/

Adjective:
  1. Relating to the logical discussion of ideas and opinions.
  2. Concerned with or acting through opposing forces.

So, I am going to start my journey with DBT from the very beginning. I want to understand it all, I want to understand the very basics so that is where I am going to start. I hope my following my journey, you will learn to help yourself too.

In the book (I am just going to refer to it as the book from now on as it’s easier) DBT is described as a cognitive – behavioural treatment which is used specifically for BPD, and is a combination of two things: individual psychotherapy and skills training.

*from now on I am going to refer to all of us BPD sufferers as ‘me’ or ‘myself’ – it’s a lot quicker!

The dialectic ‘view’ assumes three main things;

  • Everything is inter-related (emotions, behaviour etc)
  • Most behaviours and emotions are due to internal opposing forces (for example extremes of emotions), and within this there are three ‘polarities’ (internal extremes) which make it difficult for me to get by;

1) The need for me to accept myself as I am opposed to the need to change myself and become a ‘better’ person

2) The need for me to get the attention and support that I so desperately seek opposed to the fact I will lose that support an attention if I get better

3) The need for me to have my current emotions ‘validated’ (being made to feel like they are real) oppose to learning new skills to no longer feel my current emotions

  • The nature of life is change rather than stability – so therapy should be aimed at being able to cope with change, rather than maintaining a stable life environment

Marsha Linehan (the author of the book) describes the ‘Biosocial theory’ of BPD, which says that underneath everything, at the core of BPD is emotional dysregulation. This is an inability to regulate your emotions, and is caused jointly by a genetic/biological element (a disposition to being unable to regulate emotion), the surrounding environment and the relationship between those two aspects during development.

She goes on to explain that dysregulation is produced by an emotionally vulnerable person who has inadequate strategies in place to regulate emotion.

Are you still with me? I’m trying to put this is a context that is easy to understand as it’s a little heavy going reading the book!

The book then goes on to describe emotional vulnerability as someone who is:

  • highly sensitive to emotional stimuli
  • suffering from intense responses to emotional stimuli
  • suffering from a slow return to the emotional ‘norm’ after exposure to an emotional stimuli

(an emotional stimuli, I suppose, could be a trigger, or a difficult event.

Emotional modulation is another important term, and is described as the ability to:

  • stop yourself from carrying out innapropriate behaviour in response to strong emotions (for example, self harm)
  • organise yourself in such a way that you can still behave normally regardless of emotional stimuli
  • self-soothe (make yourself feel better after exposure to a negative emotional stimuli
  • re-focus attention in the presence of a strong emotion (for example, i’m assuming, during a panic attack?)

So, it makes sense to say that we as borderlines suffer from emotional vulnerability, without the ability to carry out emotional modulation – this then results in the behavioural symptoms we suffer, such as self harm and suicide attempts. Still with me? :D

The book then goes on to explain the impact an ‘invalidating environment’ has on the emotional growth of a child. It took a little time for me to understand exactly what an invalidating environment is, but I will do my best to explain it to you.

Imagine a child, who has a feeling, for example, ‘I’m hungry’. A parent that responds with ‘No, you’re not’ is providing an invalidating environment, because over time, the child will start to wonder, ‘Am I really hungry?’ – they will start to question their own feelings and emotions. This can apply to all sorts of feelings, emotions, and behaviours as a child is growing up, but can also continue into adulthood. An example in the workplace could be a boss who consistently makes an employee feel small, pointing out their mistakes or belittling their work.

One little note: invalidation is not the same as abuse. In essence, a loving parent can be invalidating by the way they disregard their childs thoughts and feelings. They may not even mean to do it, they may not even realise. It makes me very nervous about having my own children, but hopefully by the time I do, I will know enough about this to ensure I don’t do it.

Validation, the opposite, is the act of making a child feel as though their thoughts are fair and valid. Validation is not the same as praise, it can also be subtle, but it will result in much happier people. Validation is agreeing that someones feelings are real and valid, regardless of whether or not you agree with them.

One point made my the book, not applicable to me, but I will mention it as it hopefully may help some of you guys. It says that one of the main invalidating experiences someone can go through is sexual abuse. It also says that although not all BPD sufferers have been sexually abused, most people who have been sexually abused do show some BPD traits later on in life.

Carrying on, it says that behaviour linked to BPD can be explained using this theory. Impulsive behaviour (such as self harm and suicide attempts) are typical emotional regulation strategies. Using the same example as the book, an overdose leads to a long period of sleep (which is normally very healing for the emotions), and a suicide attempt can also cause a welcome distraction and intervention from the surrounding environment (help, support and attention).

This inability to regulate emotions will also affect the development of a ‘sense of self’ (sounding familiar?). I really struggle with this. I seem to pick up ideas from people around me and copy them, rather than having my own style. I flit from one style to another – with my clothes, hair, even my lifestyle. Sometimes I think I’m a vegetarian, a vegan, a buddhist, an athiest, a hippy, a glam chic, a townie, a jitter, a goth, sporty, surfer chick – the list goes on, and it changes on a daily basis. I never understood why I felt the need to consistently re-invent myself but I believe I am starting to find the root of the problem.

According to the book, in order to develop your own identity, your emotions must be stable. If what I have just discussed is to be believed, then it stands to reason that we have no sense of self. Another note – if we are consistently invalidated, it will lead to an overdependance on the opinions and validation of others to tell us we are doing the ‘right’ thing by the way we are living our lives.

This unstable sense of self also leads to unstable relationships – chaotic even – and it’s understandable – how can a person who doesn’t even know who they are, and cannot regulate their emotions – hold down a stable relationship?

If you’ve got this far, well done! (We’re nearly done for the first chapter!)

According to the book, DBT emphasizes the ongoing assessment of the behaviour of the patient, a clear and transparent discussion of therapy targets, and the most important, is a good, honest and healthy relationship between the patient and the therapist.

Quoted from the book, “The whole of treatment emphasizes building and maintaining a positive, interpersonal, collaborative relationship between client and therapist. A major characteristic of the therapeutic relationship is that the primary role of the therapist is as consultant to the client, not consultant to other individuals.”

The difficulties that we suffer, as BPD diagnosed, can be categorised into five groups, and there are four different ‘skills’ trained through DBT that address each of these groups;

  • Emotional Dysregulation (Treated through emotional regulation skills)
  • Interpersonal (Chaotic relationships) Dysregulation (Treated through interpersonal effectiveness skills)
  • Behavioural Dysregulation (Impulsive behaviours) (Treated through distress tolerance skills)
  • Dysregulation of sense of self (Treated through mindfullness skills)
  • Non-psychotic cognitive disturbances (such as dissasociation) (Treated through minfullness skills)

I hope you enjoyed this discussion on the first chapter. I hope I have been clear and easy to understand, by writing in out like this it not only helps me to understand more, but hopefully will help many more people to understand themselves and how to heal.

If I have written anything wrong, or incorrect, please let me know, as I am new to all of this!!

Take Care and get in touch if you have any comments!

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5 comments

  1. I have this book myself… although I’ve never gotten round to reading it as it is VERY heavy going… and i thought I’d have to be in DBT to be able to understand it. But perhaps that’s just my ignorance. But thank you for sharing your insight into the first chapter. It’s compelled me to dig my copy out and to try and get my head round it myself. :) xx

  2. Yeah it’s pretty hard going. I take it paragraph by paragraph – read it and think – do I understand this? If so, I then move on. I think it’s the only way to do it otherwise you get overloaded with information!

  3. [...] to the therapy); 2) Presenting the bio-social theory of BPD which I have previously discussed here; 3) Giving the client an overview of skills training and its rationale – what is expecting of [...]

  4. mazinmets9 · · Reply

    i just began DBT on the dbtclass as well. just did lesson 22 as my first assignment. (opposite emotion). i truly hope this is the answer to my disordered emotions. i wish i could say that i will be a mother once i am well on my road to health, but i cant. i have 3 children, all of which are teens and all of which have dealt with crazy me.

    1. I hope DBT helps you and I am sure it will – it sorted my life out for me. x

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