Wendy Douglas, LCSW, PhD


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May-June 2020

March Membership Meeting Write-Up — Madeline Taylor, LMFT

Dialectical Behavior Therapy

Presented by Wendy Douglas, LCSW, PhD

This was our first online meeting due to the coronavirus pandemic. Wendy Douglas, an experienced LCSW trained at UCLA, presented us with a lively and engaging discussion of Marsha Linehan’s Dialectical Behavior Therapy. This cognitive/behavioral modality was developed in the 1980s specifically to work with patients in borderline states of mind whose emotional needs were intensely conflicted. However, it is presently being used to treat patients with a variety of symptoms and DSM diagnoses.

As I understand it, the therapeutic stance is to help the patient manage painful feelings and decrease conflict in interpersonal relationships. The long-term goal is to minimize black and white thinking and to promote a gentler, more self-accepting “both/and” perspective on emotional experience. Hence the term, “dialectic,” the balancing of opposites.

To illustrate, Wendy used a simple graphic of two circles overlapping. The left circle is the Rational Mind, the right circle is the Emotional Mind, and in the center where the circles overlap, is the Wise Mind. This is one way of conceptualizing the goal of integrating feelings and thoughts which are often deeply conflicted in our patients, and of illustrating the experience of mental and emotional integration.

Dialectical Behavior Therapy adheres to a strict treatment regimen of individual therapy sessions, DBT skills groups, and daily coaching sessions. Treatment lasts approximately 12-14 months; individual therapy and skills groups occur once a week each, and patient and therapist engage in daily coaching sessions on the phone. The therapist has to be part of a consultation team, especially when working with patients who are suicidal or in borderline states.

The focus of treatment can be said to center on the development of four skills or capacities: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Patients are trained in mindful attention to thoughts, urges, bodily sensations, emotions, and surroundings . . . TUBES. Developing these capacities assists the patient’s ability to modulate the intensity of painful feeling states and offers them a way of self-soothing. When they are in particularly reactivating or re-traumatizing circumstances, especially in relation to important people in their lives, they are encouraged to utilize mindfulness practices and interpersonal effectiveness skills in order to modulate and manage intense affect.

I found it interesting when Wendy suggested that at some point in the development of DBT, Marsha Linehan found it necessary to understand the subjective experience of her patients. If I understood Wendy correctly, Linehan’s therapeutic stance shifted then from primarily trying to change the patient, to one of helping illuminate all aspects of the patient’s conflicted needs and feelings. While any given therapist, and even the patient him/herself, might want thoughts, feelings, and behaviors to change, what seems to potentiate that kind of development is, paradoxically, the therapist’s understanding and acceptance of the patient’s lived experience in any given moment, especially one of heightened affect.

So the dialectic, the integration of seeming opposites, at the heart of DBT is acceptance and change. One doesn’t happen without the other.

 



Madeline Taylor, PhD, LMFT, has been in practice for 40 years. She is associated with the Institute of Contemporary Psychoanalysis and has taught attachment theory, self-psychology, and intersubjectivity theory for 30 years. She has offices in Santa Monica and Calabasas, seeing adolescents, adults, and couples. “Nothing is as powerful as human understanding.” (George Atwood)






San Fernando Valley Chapter – California Marriage and Family Therapists