Published in the Westchester Guardian, March 2012
Of all the fields of science, psychotherapy is relatively new and the least understood when one considers the lack of understanding via the preponderance of theories and therapies. There are no blood tests clarifying a mental illness. Even a proper diagnosis along with cause-effect relationships can be elusive. Due to the complexity of human relationships and the dynamics of the individual’s personality, it may take years to properly reach the core issues of a person’s suffering. Take it as truth from someone who had been misdiagnosed and on the wrong medications for years.
Considering the above how does both patient and doctor (and therapist) create/obtain a safe mindset of thought patterns, activities and beliefs? How can one have healing when the real cause is unknown? What is true healing and can it ever be achieved? What therefore are the goals to be obtained when confronting disease? Usually it is to maintain or create a reasonable quality of life acceptable to both patient and doctor/therapist, even when core issues may not have been resolved. To achieve acceptable standards, a rethinking process or a retraining/retooling of the brain must occur, where the patient can come to an understanding of the cause and effect of these thoughts and behaviors, leading to a constructive internal dialogue between mind and brain.
Now that is has taken me two paragraphs to explain what has to be done to create a proper an inner discourse, I can try to explain the concept developed by Marsha Linehan, Ph.D. called Dialectical Behavior Therapy (DBT). Originally developed for patients with Borderline Personality Disorder – those having erratic behavior, stormy, hostile relationships, and suicidal thoughts and attempts – DBT is being applied to treat a broader range of those with mental illness. Fortunately, it is being utilized where I receive treatment. Unfortunately, these skills are not being used by the general population.
Through her personal bout with mental illness and her research in treating others, Dr. Linehan has broken down DBT into four modules, each with its own set of skills and exercises. The process is difficult, at times painful, may take years to fully implement, but works. Slowly, the brain and the mind see circumstances differently, as the individual applies skills to relationships and trials in their lives, as the inner discourse or conversation changes for the positive. This brief column can never really state how valuable these building blocks are to improving lives.
These four modules – mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance – enables us to (re)connect with a norm. I am now more acceptable and aware of the world I interact with, slowly creating an inner dialogue between mind and brain, action and re-action. I’m putting less pressure upon myself and slowly finding ways to manage and enjoy life while building up self-confidence and acceptance. Developing these proper survival skills is a necessity for those under this terrible umbrella of diseases.
With our eyes and ears are constantly plugged into mediums such as twitter, I-pads and Droids, the mindfulness module teaches us to focus on the concept of being in the moment. A social concept lost on our individualistic society which is constantly in motion as we channel-surf through life. It is about what we pay attention to. It is about developing a more spiritual and/or Zen-like qualities to life. My mind, busy with numerous thoughts and images, is able to slow down a little and focus in this now. (See also my column “Mindfulness and Being in the Moment”, October 13, 2011)
Interpersonal effectiveness focuses on improving all relationships from the supermarket line to the dinner table. It helps us acquire and develop goals and priorities. I have difficulties in saying no, in stating my wants and needs but that has tapered while my self-confidence has increased and insecurities lessened. We try to learn, observe and establish limits. Slowly, confidence grows as do our relationships or at least our understanding of them. Self-respect grows as one learns about fairness, sticking to values and truthfulness. It takes work, some role playing, and some give and take.
Emotions are certainly not a friend of us who suffer. When first asked to describe emotions, the terms I presented were usually negatives, fearful ones until someone brings to light the positive affirmations so easily forgotten. Not only might I harp on these unconstructive terms, letting go of these feelings is a struggle onto itself. There are many ways defined in this module to help master and overcome negative tendencies and build the positive confirmations to sustain us daily.
With its hellish manifestations, the anguish and pain of distress is unfortunately, all too common. Distress tolerance teaches one how to avoid this inner terror. At times, the agony becomes so intolerable the only supposed relief is to have ones blood slowly ooze from self-made incisions – cutting. Or worse. I dread this distress tolerance module for the imaginary scenarios my brain creates. Images pass and the dark impressions of an untold future cloud my mind. Hearing the suffering of others may only reinforce my own, but we are learning, building ourselves up toward a better future and a stronger self.
Learning these and other skills is basic training for life. A personal, growing spirituality is important and certainly helps. Applying these skills while not a cure, will lead to productive, contributing lives and improved long-lasting relationships. The dynamics DBT has brought to the field of psychiatry continues to grow. It is painful. It is a struggle. It helps, it works. It enables me to see I “see” a better life in this imperfect, self-involved world.
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Glenn Slaby Blog