Please explain DBT

[Depression = 72% of members]

I believe that my husband has BPD - high functioning.  He is "normal" and reasonable a lot of the time but when he "dysregulates," he becomes the opposite and I am the one he punishes and blames.  I have read that DBT can help someone with BPD and my husband has read about it too and agreed that it might be useful.  He has seen three therapists in the last few years and each time he has come back with the same behavior towards while claiming that he is "working on it." He waited months to get an appointment with a therapist who supposedly specializes in DBT. He has finally started seeing the therapist but the outcome seems to be the same as with the others.  He seems to be doing more of the same "talk therapy" where the therapist comforts him for things that give him anxiety about work, etc., while continuing to use the same old behavior with me.  I asked if they had discussed any strategies he could use when he gets worked up and he said they had not addressed that.  That was the specific reason why he went there.  He is once again seems to be losing focus on why he went to therapy and it feels like Ground Hog Day for me.  I am losing hope.  Can someone please explain how DBT therapy works?  Perhaps if I understand it better, I can get some sense of whether there is any of that being applied to his therapy and perhaps how long it will take before anything will change.

Please don't reply that I need to seek help myself and that I should focus on changing myself and not him. I understand that.  He has recognized time and time again that he needs help.  We have three little kids (5, 3, and 1), and he now starting to take things out on them too.  I can't protect them from that by simply focusing on my behavior. 

Thank you for any explanations of DBT and how it works with BPD.

[Evalon]

I believe that my husband has BPD - high functioning.  He is "normal" and reasonable a lot of the time but when he "dysregulates," he becomes the opposite and I am the one he punishes and blames.  I have read that DBT can help someone with BPD and my husband has read about it too and agreed that it might be useful.  He has seen three therapists in the last few years and each time he has come back with the same behavior towards while claiming that he is "working on it." He waited months to get an appointment with a therapist who supposedly specializes in DBT. He has finally started seeing the therapist but the outcome seems to be the same as with the others.  He seems to be doing more of the same "talk therapy" where the therapist comforts him for things that give him anxiety about work, etc., while continuing to use the same old behavior with me.  I asked if they had discussed any strategies he could use when he gets worked up and he said they had not addressed that.  That was the specific reason why he went there.  He is once again seems to be losing focus on why he went to therapy and it feels like Ground Hog Day for me.  I am losing hope.  Can someone please explain how DBT therapy works?  Perhaps if I understand it better, I can get some sense of whether there is any of that being applied to his therapy and perhaps how long it will take before anything will change.

Please don't reply that I need to seek help myself and that I should focus on changing myself and not him. I understand that.  He has recognized time and time again that he needs help.  We have three little kids (5, 3, and 1), and he now starting to take things out on them too.  I can't protect them from that by simply focusing on my behavior. 

Thank you for any explanations of DBT and how it works with BPD.

[PLEASE - NO RUN MESSAGES]

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[jp254958]

First, I'm not a therapist.  And I have no personal experience with DBT.

I'm only guessing why the new T is “talking" to your spouse. I've read that a lot of the early relationship with a T and a BPD patient is about building some trust.  People with BPD often devalue their T's and quit therapy, so therapists try to create an early atmosphere where the patient feels some trust and calmness around them.  Later on, they will probably go into the “mindfulness" side of the therapy, which includes meditation practice and guidance on how to improve in the moment mindfulness of emotions so patients can choose how to react to emotions instead of just immediately reacting to them.  DBT helps minimize impulsive emotional reactions.

On some level, it may be less “threatening" to a BPD patient when a therapist questions their beliefs, which can lead to devaluation. DBT and schema based therapy are those most clinically effective treatments for BPD.

DBT is especially interesting because meditation can actually INCREASE brain matter, and really can help regulate emotions. It helps minimize stress too, which is a very big positive because stress can induce BPD emotional outbursts.

[jp254958]

See the link below about meditation's effect on grey matter in the amygdala, which is a key part of the brain regulating emotions, as well as the hippocampus. Other studies (results available on Internet) showed that people with BPD have a smaller amygdala and hippocamlus vs “normal" people, which is a key reason for their emotional instability.  


www.sciencedaily.com/releases/2011/01/110121144007.htm

[united for now]

The first area DBT focus on is preventing suicidal behavior and any behavior that could disrupt T. Building skills and practicing mindfulness are next, followed by learning to improve relationships. Relationships are later, since they have to first keep them alive and in therapy forchanges

to occur.

DBT is very effective - and - it takes time to see improvements. Remember,  in many senses they are having to completely rewire his brain

I know how frustrating it can seem when you aren't seeing improvements and still feel like a target. This is when our wishes and hopes for change meets the reality of time constraints.

Sharing your questions here can be a great way to figure out what its realistic while also gaining support and understanding... .

[almost789]

Hi Evalon,

Congratulations! to you and your husband for him recognizing his problem and seeking help. Don't lose hope and don't give up. You are already far ahead of most of us since your has accepted he needs help.

About DBT. DBT is a special type of congnitive behavioral therapy (CBT) which focuses on mindfulness, emotional regulation, distress tolerance. There are specific skills to be practiced. If you want to know more about what type of skills and excercises DBT encompases, there is lots of information about DBT on the web and in books. There are DBT workbooks and a DBT self help website. There is even DBT software and DBT mobile apps. Your husband could also just ask the therapist, have we done any DBT stuff yet? and if not ask why. DBT focuses on chaning the way we think and react to emotions. DBT therapy is a long slow process and takes years to change a pwBPD and not all are cured or put into remission. DBT can help anyone, not just pwBPD. It can help non's with reactions to difficult emotional situations and can also help a person with anxiety and depression issues. 

There is also Schema Therapy for pwBPD. Schema Therapy deals with both CBT and the attachment issues which stem from childhood which are root cause of BPD. Studies for Schema Therapy show high cure rates with less than one year of therapy and very low drop out rates. Currently, it's alot harder to find a therapist who is experienced with Schema Therapy.

Finding the right therapist is one of the most difficult things. The more you and he know about BPD and the treatment options the better for him and you to find the right one. If you find this isnt the right one, look for another.

[Evalon]

Thank you for your supportive replies.  They are very helpful to me.

[almost789]

You are welcome. Please keep us updated on how things go. Your husband seems to be of a rare breed, one who is trying to help himself by getting to therapy and not in denial. Good for him.

[Evalon]

Update:  This week, my husband had his first therapy session since his last "episode" which was on Christmas.  Apparently, the therapist, who supposedly specializes in DBT, told him that he did not think DBT was what he needed.  Instead, he told him that if he gets worked up and starts to blame me, he should just remove himself from the situation and try to consider what I am saying.  This was the advice he gave him, apparently.  It didn't make sense even to my husband because he knows that he needs to learn skills and techniques to handle his emotions and treatment of me in those situations, and that if he was able to do as the therapist suggested he would not need help.

I am wondering whether my husband has not been honest with the therapist.  One of the above responses mentioned that my husband was rare in the sense that he admitted that he needed help.  The usual pattern with the therapy, however (and what seems to be happening this time too) is that he recognizes he needs help, he actively seeks help, and then once he starts seeing the therapist, he manages to turn things around and somehow I am the one who needs help, he is largely fine, and so the cycle goes. 

I believe that my husband is high functioning.  He is very successful professionally and has a very high paying job.  Outside of our home he is generally perceived as a nice, reasonable, and likable guy.  I am the only one who sees the Mr. Hyde side (and, sadly, our kids too, now that they are getting old enough to understand).

I just don't know how to keep going in circles like this. I was so hopeful that this therapist would be able to help, but instead it is turning out to be just another round of the same game we have been playing for 17 years.

[MaybeSo]

He may have some narcisstic features; In any event, it is unusual that he's willing to seek help and progress takes a long time. You don't want to hear this, but, are you doing any of your own therapy? I ask because,  Usually both Partners have some issues that when combined together, over time, exacerbates each persons greater or lesser individual issues and combined together creates a never ending interactive feedback loop;  the combo together helps keep the whole dynamic dysfunctional. It's almost never enough for one person to get better or change, both have to really work at their own part. Regardless of whose part is perceptually or demonstrably worse. Steph's husband over time recovered with DBT. But, Steph eventually had to do her own work to address her codependence before they got healthy as a couple.   Doing your own work won't lessen your ability to protect the kids, and in the long run it offers you the best all around chance for a healthier situation.

[Cloudy Days]

Hello, I just wanted to say that my husband has been in DBT for 7 months and he is just now starting to show signs of trying to rethink what he is doing. When he first started it I went in with him and explained to the therapist some of our problems and his problems. He had just had 5 teeth pulled and couldn't talk well. He was willing to go and it took awhile to get him in so I wasn't going to let him waste it. I know that the first few sessions they talk about his life and the problems he is having. The focus on trying to keep him in therapy and self harming behaviors. Anyways, I think what helps my husband the most with his therapy is that he can pretty much contanct his therapist whenever he needs to. She will either call him as soon as she can or they can text back and forth. She tells him things to try and I have truly seen a differnce in him. I can't say that he is anywhere close to being better but he's trying. I also know that he isn't 100% truthful with her either and he also doesn't understand some things. I have been reading some of the skills they use and it is very similar to some of the things on this site. He was telling me what he learned that day and they way he explained it didn't make much sense, once I looked it up I could see how he took it that way but he didn't really get it. It takes years to really get it for them but he's getting there! Yay!

[Evalon]

Thank you for your responses. 

MaybeSo, I appreciate your advice and I agree.  I know there are things I can do better myself and that there is work I can do to make things better.

CloudyDays, I'm glad to hear of your husband moving in the right direction.  How did you guys find the therapist?  The therapist my husband is seeing now is the head of a Center that supposedly specializes in DBT.  I was hopeful that he would be the answer.  However, apparently, he told my husband that he does not think he needs DBT.  Really, my husband is like two different people and from what I have read this is common for the high functioning type of BPD.  He comes off as rational, compassionate, etc.  He is kind and understanding to me much of the time.  However, when he gets dysregulated, it is like his evil twin has appeared and his personality completely changes.  There is literally a physical switch I can see when he turns and it is most often only at home and with me.  His eyes change, his facial expressions change, he becomes irrational, and acts with the emotional maturity of a two year old child.  I don't know how a therapist would ever understand this because, of course, this is not the guy who shows up to the therapy appointment.

[iluminati]

First, let's talk about the mechanics of DBT.  In order for something to be DBT, there has to be a group portion and an individual portion.  The group portion is generally a small group (roughly less than 10) where they learn the various skills that they need to function, such as emotional regulation, distress tolerance, mindfulness and interpersonal effectiveness.  The individual portion is common referred to as "coaching", and this is where they are taught how to apply the skills they've learned in day-to-day life.  I've personally witnessed an individual session my wife had at her request, and the general tenor is that of a parent talking to a child about how to deal with their day, except it's a more structured environment. 

Say that someone with BPD is getting dysregulated at work, for example.  They'll mention that they can understand while they felt they need to cope that way, but they should use skills A, B and C in the future.  Also, there is a regular phone coaching aspect that is added on, but they must call BEFORE engaging in any trigger behaviors.  If they do so after engaging in such behaviors, they are not allowed to speak for 24 hours, save for any previously scheduled appointments.  The leader of the group therapy and the individual therapists regularly meet to compare notes on the patients served by the team, and every one of the therapists is going through therapy themselves to deal with the challenges this unique population presents.

It has been said by Dr. Marsha Linehan, better know as the professor at the University of Washington who birthed this whole field, that if you do not have all of the aspects involved, you are NOT having DBT.  I repeat, you need all of the pieces to be considered going through DBT therapy.

The reason I say that is because it doesn't look like your husband is going through the full DBT experience.  Now, there are groups that offer just the group portion, and there are therapists who do regularly therapy as well as DBT.  There are even therapists who say they offer DBT if they took a one day seminar about it.  However, in order to be certified as a DBT therapist, you need to take a 2 month course offered by the good people at Behavior Tech on top of your normal psychological qualifications.

That's the story of DBT.  So now what are you doing to take care of yourself?

[Steph]

 Actual DBT consists of a classroom setting once a week... .  a couple of hours, and then another appointment with a DBT skills therapist to discuss what you are learning and to integrate into your life.

DBT takes at least a year to complete and most people go another year to reinforce what you have learned. In my Hs case, he went for 2 years, then another year for advanced skills training.


During those years, behaviors were up and down. Some of the worst acting out came right before integration. We also separated during some of that time. I went to therapy, he was in DBT and we also went to MC. It took alot.

It has been almost 5 years now since he completed,  and there is zero BPD behavior, and has not been.

Doesnt sound like your H is in actual DBT, but with a T who has some training.

Steph

[Cloudy Days]

I typed in DBT therapy on my computer and just started looking through places. I stumbled on a place that specializes in treating Borderlines only. The only treatments they offer are treatments that are for Borderlines, DBT and EMDR therapys. They have sevral therapists and Phycologists that work there. It's a really neat place, and they know what they are doing. It's a bit of a drive for my husband but I was tierd of getting people that didn't know how to treat him. He had been to county run places and they didn't help him at all. They just wanted to medicate him and that's not what he needed. The quality of care he gets at this place is insane compared to the past places he has been treated at. It's all about finding someone who knows what they are doing. One of my first questions when looking for a therapist was have you ever treated someone with Borderline Personality Disorder and have you ever seen them get better. This place obviously has said yes to both.

[Evalon]

These descriptions of DBT are illuminating and very very helpful. Thank you! They reinforce for me that this is exactly what would benefit my husband.  I know that in his calm moments he himself would read these descriptions and agree that this is what he has been looking for.  It is clear to me after reading the responses that what my husband is currently doing is not DBT.  It's more the run of the mill, patient-vents-therapist-comforts-type therapy... .