DBT
A Christian Overview and Practical Taste of Dialectical Behavioral
Therapy for Your Clinical Practice
Heidi Vermeer-Quist, Psy.D.Licensed Clinical PsychologistPine Rest Christian Mental Health Services
Serenity Prayer (for today)God, grant me the Serenity (tranquility, composure and peace)
to ACCEPT (gratefully receive) the things I cannot change (Others, Outcomes and Old stuff),
COURAGE to change the things I can (myself in this moment, managing my Feelings, Attitudes, and Behaviors),
and WISDOM (understanding) to know the difference…LIVING One Day at a time…ENJOYING One MOMENT at a time(mindfully observing, describing and participating in the precious
present)ACCEPTING HARDSHIP as a pathway to PEACE…
TAKING, as Jesus did, this sinful (evil, corrupt and broken) world as it IS,
not as I would have it…TRUSTING that You are making all things right as I SURRENDER (give
in)to YOUR will…
So that I am reasonably (sensibly and quite) HAPPY in this life and SUPREMELY HAPPY with You forever in the next.
AMEN (So be it!) —Adapted from Reinhold Niebuhr’s original by Heidi Vermeer-Quist
Introduction
Resources For You: This PPT @ www.vqconsult.comGrounding Book Info
2012 AACC Article
A Christian Overview and Practical Taste of Dialectical Behavior
Therapy (DBT)Heidi Vermeer-Quist, Psy.D.
Published in Christian Counseling Connection (2012), Volume 18, Issue 4 (A Publication of the American Association of Christian Counselors)
Introduction
Developed by Dr. Marsha Linehan – 1993; Second Edition released in 2014
One of the most effective treatment methods for patients, especially those with Borderline Personality Disorder (Olenchek, 2008)
Goal Today: provide an overview of DBT, a Christian integrative approach, and some practical skills you can use with your clients.
Overview of DBT
Cognitive-Behavioral Intervention designed to target maladaptive coping
Dialectic – the idea that two things can be true at the same time
Central Dialectic: Acceptance versus Change
Developed to treat Borderline Personality Disorder (self harm/suicidal behavior), but now expanded to treat many disorders that involve Emotion Dysregulation and Interpersonal Disruption
Overview of DBT
Four Skills Training Modules1.Core Mindfulness2.Interpersonal Effectiveness3.Emotion Regulation4.Distress Tolerance
Overview of DBT
Core MindfulnessMindfulness is the CORE skill
reinforced throughout DBT. Take hold of your mind, using your
whole mind as fully as possible.Turning your mind to fully
participating in the present moment.
First Module
Core Mindfulness
Engage both our “reasonable mind” and “emotional mind,” increasing the likelihood of better decisions. We come to a place of “wise mind” when we consider both our reasonable and emotional mental processes.
Reasonable Mind
Emotional Mind
WISE Mind
First Module
Christian Integration of Core MindfulnessWe acknowledge that relying on God’s presence and His Word are enormously helpful:
First Module
God’sPresence
Reasonable Mind
Emotional Mind
WISE Mind
Christian Integration of Core MindfulnessWise mind – produced by reasonable mind and emotional minds working together through dependent dialogue with God…
First Module
God’sPresence
Reasonable Mind
Emotional Mind
WISE Mind
Christian Integration of Core MindfulnessBenefits of Prayer: Feel less alone – aware of being
with God Look at a bigger picture Discern meaning and purpose in
the midst of suffering
First Module
Christian Integration of Core MindfulnessBlessed is the man who trusts in the Lord, whose confidence is in him. He will be like a tree planted by the water that sends out its roots by the stream. It does not fear when heat comes, its leaves are always green. It has no worries in a year of drought and never fails to bear fruit. (Jeremiah 17:7-8, NIV)
First Module
Core Mindfulness SkillsWHAT Skills:1.Observe – observe the moment you are in.
Turn your mind to WHATEVER is in this present moment. External and internal mindfulness…
2.Describe – describe what you are observing. Attach words to what you are experiencing…
3. Participate – participate in the moment. Be involved in whatever you are doing…
First Module
Core Mindfulness SkillsHOW skills: Non-Judgmentally – Assume non-judgmental stance
and accept the moment just as it is. Notice what is helpful and harmful but try not to judge.
One-Mindfully – Be mindful of each activity, doing one thing at a time. Let go of distractions – use “Teflon mind” – letting unhelpful thoughts slide off your mental frying pan and then return to the present moment.
Effectively – Focus on what works effectively for the moment. Use the principles, morals and values you know and trust. Use effective tools: journaling, prayer and social support. Consider your options – what is most effective (not perfect) for the situation.
First Module
Mindfulness Exercise External Mindfulness – focus on the
breath and guide your clients through observing, describing and participating in their five senses.
Internal Mindfulness – focus on breath and guide your clients through observing, describing and letting go of thoughts. Notice, name and move on to the next thought.
First Module
Mindfulness Exercise
Give Thanks as you and your clients practice mindfulness!
Pray without ceasing. In every thing give thanks, for this is the will of God in Christ Jesus concerning you. Quench not the Spirit. (1 Thessalonians 5:17-19, KJ21)
First Module
Interpersonal Effectiveness
self-respect
respect for others
respect of their relationships
Second Module
DEAR MANA helpful tool to facilitate truthful and loving conversations
Speaking the truth in love, we will grow to become in every respect the mature body of him who is the head, that is, Christ (Ephesians 4:15, NIV)
Second Module
DEAR (WHAT to say) Describe the situation.Express what you are
feeling/experiencing.Assert what you want or don’t
want.Reinforce how getting what you
want will help you and the relationship.
Second Module
MAN (HOW to say it) Mindful: Remain focused and mindful of the
objective or subject at hand. Repeat your objective if the other person is going down another track.
Appear Confident: You don’t need to feel confident, but maintain good eye contact, remain calm and speak confidently.
Negotiate: Respect their “no,” but also explore if you can negotiate a third option to satisfy you both. Also consider his/her perspective. If necessary, take time to think of other options and come back together at a later date.
Second Module
Emotion Management…Whoa, Nelly!
Third Module
Emotion Management…Whoa, Nelly!
Third Module
The horse – emotional mind – needs the rider
The rider – reasonable mind – needs the horse (with all of its strength and ability)
Designed by God to work together to produce “wise mind” realities, especially as we pay attention to God, our Ultimate Horse Whisperer!
Emotion Management
Third Module
Observe Your Emotion – just name it. Experience Your Emotion – as a wave
coming and going. Remember You Are Not Your Emotion –
emotions only last 8-15 seconds. The more we accept what we feel and distract our thoughts to neutral or positive experiences, the less we feed the distress and suffering of our emotions.
Practice Loving Your Emotion – don’t judge it… practice accepting it.
Emotion Management
Prayer Journaling through Emotions Dear God, • What am I feeling?• What am I reacting to?
o the current situation:o my interpretation (subjective):o the truth (objective):
• How did I (or how am I now) respond(ing) to my interpretation of the situation? What is my typical knee jerk response?
• What other options do I have? (Really listen to yourself, God, what others have taught you….)
• What do I choose to do?
Emotion Management
PLEASE MASTER
• Treat PhysicaL illness • Balance Eating • Avoid mood-Altering drugs• Balance Sleep• Get Exercise• Build MASTERy – do simple
activities that make you feel competent and in control
Distress ToleranceWise Mind ACCEPTS
A – ActivitiesC – ContributingC – ComparisonsE – Opposite EmotionP – Push AwayT – Other ThoughtsS – Five Senses
Fourth Module
Distress TolerancePROVE HIM
PrayRecreationOpposite EmotionVacationEat
HealthImagineMeditate
Fourth Module
Serenity PrayerRadical Acceptance
It is what it is. There are just things outside of ourselves we cannot control – “O” zone of Others, Outcomes and Old Stuff.
“Accepting what we cannot change” “Taking this sinful world as it as it is, not
as I would have it” “Trusting that You are at work…”
GYL version – integration of skills with this classic prayer by Reinhold Niebuhr
Distress Tolerance
Grounding, Grieving & Growing in the hands of our Master Gardener
John 15 – Abiding in the Vine
Gardening Your Life
Mental health is a lot like gardening…
Book One: Grounding – Available! AACC Special Today Only: $20 Cash/Check only (regular price $24.95, plus S&H) Book Two: Grieving (pruning) Coming Fall of 2016 Book Three: Growing (new growth in grateful community) Coming Spring of 2017
Gardening Your Life
Personal Growth Series (for groups or individuals):
Closing
A Christian Overview and Practical Taste
of Dialectical Behavioral Therapy
for Your Clinical Practice
Q & A
Serenity Prayer (for today)God, grant me the Serenity (tranquility, composure and peace)
to ACCEPT (gratefully receive) the things I cannot change (Others, Outcomes and Old stuff),
COURAGE to change the things I can (myself in this moment, managing my Feelings, Attitudes, and Behaviors),
and WISDOM (understanding) to know the difference…LIVING One Day at a time…ENJOYING One MOMENT at a time(mindfully observing, describing and participating in the precious
present)ACCEPTING HARDSHIP as a pathway to PEACE…
TAKING, as Jesus did, this sinful (evil, corrupt and broken) world as it IS,
not as I would have it…TRUSTING that You are making all things right as I SURRENDER (give
in)to YOUR will…
So that I am reasonably (sensibly and quite) HAPPY in this life and SUPREMELY HAPPY with You forever in the next.
AMEN (So be it!) —Adapted from Reinhold Niebuhr’s Original by Heidi Vermeer-Quist
Closing