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"What's your distress level?" my therapist asked.
"Six," I replied. Rating my level of distress was still a difficult thing for me. I felt like I was assigning some arbitrary number with no criteria to back it up.
The other group members answered the question, and the official discussion began. First, each of us had an opportunity to present a scenario from the past week which had provided us an opportunity to practice skills we had learned so far during our time as participants in the group. When one of us presented a scenario, the others provided feedback regarding the scenario as it occurred and skills which could have been used to address it.
During the second half of the session, we discussed new skills which we would aim to practice during the upcoming week. This part of the session was often difficult for me. I learned many things about myself and often thought of how the topic of discussion could have related to an event in my past. But I could not judge myself..... I could only keep the lesson in mind for a future time when it might be needed.
This is dialectical behavior therapy (DBT). I first heard about it when I was reading about different types of therapy on the Internet. I was interested primarily because I was a psychology student and curious about what therapies were available and what differences existed between them. However, I was also a mental health consumer, and the more I read the more I became convinced that DBT was the one therapy which might enable me to resolve some of the issues which I had not been able to resolve in ten years of talk therapy.
Dialectical behavior therapy addresses four areas of mental health which are most problematic for people: mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. It includes two components: a regular group session which usually lasts for 90 minutes and regularly scheduled individual therapy sessions. The group setting is designed to provide an accepting environment where consumers learn effective strategies for coping with situations and practice these skills using situations they have experienced personally. The skills are further reinforced during individual therapy. Individual therapy also provides the avenue for working with issues specific to each group member's needs so that the group session does not lose its focus.
I did not find a DBT group for several years. In fact, I moved 1,000 miles before I found a therapist who had even heard of DBT. I mentioned my desire to participate in a group to her in early 1999. Several months later, she started a group, and I was finally able to dive in and try this therapy.
I was not disappointed. The work was long and draining, but it was also rewarding. I found that as I became more accustomed to using the new skills I was learning, I began to discard my old (and ineffective) ways of responding to situations which had upset me in the past. I also found that I gained a deeper respect and trust for my therapist, and I felt that my individual sessions were more productive. I was able to identify and address specific areas of my life which were problematic instead of spending each session rambling about the events of the week.
DBT has not addressed all of my needs, but it has addressed a great number of them and enabled me to feel that staying in therapy is worthwhile and to feel free to explore other resources for information about techniques which can be used as complements to address other issues.