My First, My Last, My DBT

Apologies in advance that this is a very negative post.  I know I should be giving things a fair chance, but sometimes a situation just sucks so much that it’s hard to set aside the frustration and try it again.  This morning I went to my first DBT group meeting.  I also may have gone to my last.

Going into the meeting, I was anxious.  It started hitting me about 45 minutes before the meeting time, when I was trying to figure out exactly what time to leave to be not-early and not-late.  I was anxious about figuring out how to pay – who to pay, what payment types would be accepted, and even whether or not I should pay, given that it will just be tacked onto my ever-growing bill if I don’t.  I was anxious about being in a group in general, and especially about joining a group of people who had all been attending for years and already knew each other.  I was anxious about which section of skills they might be working on, and how well that would line up with what I’d already done in individual therapy.  I was so anxious, in fact, that I drove right past the place and had to turn around in a parking lot to come back.

I did pay, in cash, to some confused receptionists who weren’t used to a client who doesn’t have Medicaid.  I entered the group meeting room and found two women sitting there.  When they introduced themselves, I thought they were the group leaders, but it turned out they were both just members with thick binders of all their accumulated handouts.  We were soon joined by two additional members (one of whom was male), and one of the two therapists who lead the group.  The other therapist and several members had called to say they could not attend today.

The meeting began with each of the other members describing which skills they had used during the previous week.  Two people did this in a succinct way, that avoided too much backstory.  Two others rambled on and on about all the situations they were in when using these skills, which I had been told in the orientation was not the appropriate way to use group time.  However, the therapist made no effort to reign them in.  To be honest, I was sitting there thinking that I don’t give a shit about these people or what they have to say.  It was mindnumbingly boring to listen to everyone whine about what all had gone wrong that week and then brag about how they handled it so well.

Then we moved on to actually discussing skills.  They had recently started the Interpersonal Effectiveness section, which is exactly where I hoped they wouldn’t be starting.  I’ve done Distress Tolerance and part of Mindfulness with my individual therapist, so starting with one of those, or even in the Emotion Regulation skills would have been fine.  The therapist went back to the first page of the handouts and reviewed, partially because people missed group so much over the holidays and partially, I think, to catch me up.  Yes, review of the previous week is built into each meeting, but we spent the entire second hour on review and never got to the point where they teach new skills.  In fact, the review didn’t exactly contain any skills either.

One member of the group would not stop running her mouth long enough for the therapist to get a whole sentence out, and also used a profanity for every third word she said.  The others could manage to wait their turn, but never seemed to be on the right track as far as what we were discussing.  I was asked at the end of the meeting whether I thought this was going to be helpful.  I said, “Not in the slightest.”  This earned me a lengthy speech from the member with diarrhea of the mouth, telling me all about how much DBT has helped her in the FIVE YEARS she has attended the group.  Five years.  You complete the whole set of skills in 6 months, so she has been through it all 10 times.  I cannot even remotely count that as helping, if she still feels the need to attend the group and be retaught these skills over and over again.

At the break in the middle of the meeting, the therapist went and made photocopies of the Interpersonal Effectiveness handouts and put them in a binder for me, along with a few copies of the weekly diary card.  I nearly left the binder on the table when I walked out.  I was already 95% sure I would not be returning next week, and 100% sure that I would not complete the entire program, so it’s hardly fair of me to come back and lead them on.  By the end of the meeting, I wasn’t anxious anymore.  I was just annoyed and frustrated, and felt that I had just wasted 2 hours and $12 on complete drivel.  I’m giving my therapist one chance to talk me into returning, at our appointment later this week.

What do I hate so much about it?  Well, aside from everything mentioned above, it’s repetitive.  The skills are just the same things said over and over in different ways.  I’m not an idiot who needs to hear things a hundred times in order to understand them.  In fact, I’m just plain not an idiot.  We went over a page about challenging myths about interpersonal effectiveness.  After just one of them, I said, “So in other words you just add a negative to the sentence.”  The therapist looked at me as though shocked that anyone would pick up on that on the first try.

I also hate that, in looking over the list of skills on the diary card, I once again find that the skills are not the same skills my therapist has been giving me.  The same happened with a DBT workbook I bought.  Oh sure, some of them are the same, and some of them are clearly just different wording.  But there are entire skills that are missing from this list.  How can DBT be some proven program if it’s not even the same skills when different people teach it?

I hate that the skills are not things I need to be taught.  We went over and over the idea that Interpersonal Effectiveness is about asking for help when you need it and being able to say no when you need to.  I don’t inherently have a problem with these things.  I have a problem with these things because I experience social anxiety, but I don’t need to be taught how to do them.  When my anxiety is under control, there’s no problem, and when it’s not, there’s no skill in the world that is going to help.

Most importantly, I hate that I’m not doing this because I want to do it, or think it will help me.  I’m doing it because it’s what my therapist wants me to be doing, and I feel that if I tell her I’ve had enough of the DBT and that I’m not going to the group or letting her teach me the skills anymore, then even if she can work with that there will always be a tension between us.

I don’t even really believe my BPD diagnosis is correct.  I don’t have most of the stereotypical symptoms, and the ones I do have can be easily attributed to bipolar.  I don’t always use self-injury to cope or think about suicide, only when I’m depressed.  I don’t always drive too fast or overspend, only when manic.  If the diagnosis is wrong, and the therapy is not what I need either way, then why the hell am I doing it?

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11 thoughts on “My First, My Last, My DBT

  1. I feel you on this so much. My previous therapy wanted me to do this program that was supposedly going to help with my agoraphobia, but I told him I wasn’t ready… I know myself and I knew that this form of “therapy” wasn’t going to work with me. He fought me, told me that it was just the agoraphobia speaking, and I went once and never went back again. It was so frustrating and painful and I felt so disappointed and just… bleh.

    If you feel like the diagnosis you got isn’t correct, you should definitely challenge it with your healthcare professionals. I was diagnosed with PMDD initially, and I knew in my gut that wasn’t quite it, so I challenged it and got some real answers.

    Wishing you all the best!

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    • I don’t even know why I tried the group. I knew from the orientation that it sounded awful, but I tried to convince myself I was just anxious about it and that once I got there it would be fine. I think in a way I thought it would be at least close to what my therapist and I were doing, if taught somewhat differently, and that as a result she would back off on teaching me the skills so we could actually make some kind of progress. Now I suspect we’ll spend just as much time on DBT, only it will be talking about what I learned in group instead.

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    • My dilemma here is that I don’t know how much of this feeling is because I think it’s an inaccurate diagnosis, and how much is because I have ulterior motives for not wanting that diagnosis. How much is because I’m ashamed? How much is because I hate DBT with a fiery passion and would do anything to convince my therapist to drop it?

      I think both (or all three?) things are true at the same time, I just don’t know the ratio between them. Every time I’ve mentioned BPD to friends they’ve all said, “That doesn’t sound like you.” The response on bipolar was totally different – everyone saying that it explained a lot. Granted these friends are not mental health professionals, but they are well-educated friends who have the advantage of having known me for decades.

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      • Well, you sound like an intelligent, articulate, thoughtful person to me regardless of the accurate diagnosis. At the risk of sounding like I am engaging in shameless self-promotion, you might find it helpful to read the first two Chapters (not posts…Chapters) of our blog. It is the true story of Robin, a former patient of mine. Many people thought she had BPD, since she did manifest many of the symptoms of this diagnosis when she was in the midst of a bipolar mixed episode. Since she has now been accurately diagnosed with Bipolar Disorder and appropriately treated for this issue, she no longer shows any resemblance to someone with BPD. Reading her story and my commentary during the telling of the story may be informative to you in terms of sorting through your dilemma. Regardless, I wish you the best!

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        • I finally got around to reading your blog. I made it through the first two chapters, then kept on reading. It was a difficult read, emotionally, and really made me consider what my therapist must go through every time she questions my safety.

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          • I am sorry it was a difficult read, but I hope you keep on reading because Robin’s story gets better soon. We are about ready to start writing the last Chapter in Part One….Achieving Stability. Then Part Two of the book will be Robin telling her own story about what happened after that year, and how much better she is now. There is so much more to tell about how she got to a MUCH better place. If reading our blog was thought provoking for you about your own therapy in a helpful way, then I am glad. That is the goal. I really appreciate you reading, and commenting.

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  2. I feel you i do. Ive completed dbt in nz we do the program twice so complete a full year. Imo the first 3 months are to settle in. The next 6 is where you learn the most and the last 3 are to brush up on anything youve missed and to help other group members with you experience. Personally i wanted to quit once a month. But stuck it out. Ive recently been through a rough patch and am pulling my dbt info out to refresh. Also by choice (im signed out of the system) ill be doing my diary cards again. Dbt will only work if you let it. I wish you well

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    • I honestly don’t think I can let it. It’s been almost a year since Deputy Wayne took me to the ER for a psych evaluation, almost a year since this whole adventure started. I thought by now I’d be accepting of my new reality, but I’m not. Intellectually I know that my life now consists of multiple types of therapy, handfuls of pills every day, and struggling to find a new job that works with my symptoms and side effects. Emotionally, I want to tell everyone to screw off and stop inflicting this useless therapy on me. I want to flush the meds down the toilet. The only real reason I see for staying alive is to prove that I’m well and don’t need these people.

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      • I fully understand where your coming from. Feeling of no control of your own life. But you do. If you want to check out my posts on my experiences your welcome to. Im out the other side after a few years and strangely miss the therapy etc. Its a hard road but imo its well worth it.

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  3. Pingback: DBTwo | Stuff That Needs Saying

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