Why is it we sometimes say the nastiest things to the person we love the most? How is it that seemingly simple negotiations sometimes end up with partners screaming at each other? How do we end up snapping and acting in ways we swore we would never do again? What makes people who love each other sometimes get really anxious when approaching each other, or leads us to avoid talking about important matters? And more importantly, how can we learn to stop long-standing patterns of destructive conflict, develop the skills to manage our negative emotions and destructive urges, and learn how to talk and listen in ways that lead to understanding, validation, negotiation and closeness?
I spend my days teaching clients how to use skills … to reduce tough symptoms of depression. One day, one of those same clients taught me a valuable lesson — it’s not about the individual skills, it’s about what they can do in combination.
A mighty oak will not fall in one swing of the ax; a formidable foe will not fall after a single punch; a powerful army will not raise the white flag after one shot fired; and a chess master will not resign after the very first move. In that same regard, depression will not be quelled following a single application of a therapeutic intervention – not a fact I like very much, but a fact nonetheless.
As a therapist who specializes in treating intense and unrelenting depression and anxiety often associated with chronic mental illness and personality disorders, I spend my days teaching clients how to use skills like deep breathing, distraction, positive activity scheduling, thought restructuring, and mindfulness to reduce tough symptoms of depression. One day, one of those same clients taught me a valuable lesson — it’s not about the individual skills, it’s about what they can do in combination.
Mary and John have had the same predictable fight week after week for almost five years. They have it down to who says what when. They both could benefit from DBT.
Imagine — Mary and her husband, John, have the same predictable fight week after week. John cheated on Mary five years ago and she can’t let it go. When John is late getting home from work, which happens frequently, she obsesses he’s having another affair and is going to leave her. By the time he gets home, she is so worked up she accuses him of cheating and threatens suicide if he leaves. He dreads walking in the door because he knows what’s coming. By the time he pulls in the driveway, he’s just as worked up as she is. According to script, he rages while she cries and begs and throws things. He starts drinking and she goes to the bathroom to cut away the pain with a razor blade. The next morning, she apologizes and he goes about his business silent and hung over. She calls him six times over the course of the day to apologize. He refuses her calls. In between calls, she beats herself up for what happened. She can’t let go of the thought that he is going to leave and it will be her fault.
I have started explaining mindfulness and meditation to some clients in the context of their own spiritual tradition, when appropriate. The key words here are “some clients” and “when appropriate.” Careful assessment is needed ….
As therapists, whether we are using DBT, MBSR, ACT, MBCT, MBRE or another mindfulness-based approach, most often we tell clients mindfulness evolved out of Eastern spiritual traditions when we introduce it. We take care to explain that the benefits of mindfulness are documented with hard science[i] and mindfulness will be presented based on the science stripped of its spiritual roots.
Our therapists all use evidence-based approaches. This means what we do in therapy is based on extensive research showing the approach achieves its goals with most individuals.
Finding the “right” therapist to help you achieve your therapy goals can be tough. You deserve a therapist who fits your needs, someone competent with whom you feel comfortable.
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To be sure, she had been through a lot of pain in her life. At the same time, however, she suffered more because of the irrational “lessons” she had learned from the pain.
Clients with borderline personality disorder often assume the worst. No one is ever trustworthy. If the kids go on a canoe trip, they are going to drown. If a stranger strikes up a conversation in the grocery store, she just knows the person has an agenda and it isn’t good. If a supervisor says something about her work, she knows she is going to get fired any minute. There always has to be someone else to blame. Nothing happens by accident; someone has to have caused her suffering. At the same time, she constantly criticizes herself. She never measures up to her own expectations. The rare times she notices something good in her life, she quickly dismisseds it, telling herself it couldn’t be true or surely it wouldn’t last. She is isolated and miserable.
When people identify what’s not working for them and change the underlying behaviors, their lives get better. When their lives get better, their thinking about the past and future changes. The future looks brighter and the past is just that, past.
It is always a bittersweet moment when a client “graduates.” I am happy to see their hard work pay off yet sad to see them go. But, of course, the goal of therapy is healing and that means letting go when the time comes.
From the first session, my goal is to help clients heal to the point of graduation. Some people come at a turning point and want a course correction; others want a major overhaul. Their lives are out of control and they are feeling hopelessly caught in a downward spiral.