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