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Restoration Beyond the Couch
The Beyond the Couch with Dr. Lee Long podcast is intended solely for general informational purposes and does not represent the practice of medicine, therapeutic and psychiatric services, nursing, or other professional health care services. It also does not constitute the provision of medical, therapeutic or psychiatric advice, and no doctor/patient relationship is established. The information on this podcast and any materials linked from it are used at the user's own risk. The content provided through this podcast should not be considered a replacement for professional medical, therapeutic, or psychiatric advice, diagnosis, or treatment. It is important that users do not ignore or postpone seeking medical, therapeutic, or psychiatric advice for any health or mental health condition they might have, and should always consult with their health care professionals regarding such conditions.
Restoration Beyond the Couch
Finding Restoration With Dialectical Behavior Therapy- DBT
Embark on a transformative journey with Dr. Lee Long as he and Brandon Stewart, a revered DBT coordinator at Restoration Counseling, unravel the profound impacts of Dialectical Behavior Therapy on emotional regulation and relationships. Picture a life where balance is not just a concept but a practiced reality, where the art of mindfulness walks hand in hand with the necessity for change. In the heart of our discussion, we delve into the foundational principles of DBT—mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness—and how mastering these can pave the way to a life worth living. With Brandon's expert guidance, we dissect the intricate dance of acceptance and change, providing you with the strategies to navigate life's complexities with poise and resilience.
Imagine standing at a crossroads with your adult child, searching for the right path forward. This episode shines a light on the nuanced approach to supporting adult children through DBT. We touch on the structure of DBT sessions, the critical role of diary cards in targeting behaviors, and the depth of parental involvement required for truly effective outcomes. The conversation reveals the subtle yet significant dynamics of therapy interfering behaviors and the paramount importance of being both physically and emotionally available to navigate the therapy process successfully. Let us guide you and your loved ones toward positive change and mutual understanding.
Finally, we share a compass for your emotional landscape with practical DBT techniques to manage intense emotions and maintain focus on personal goals. Learn about the immediate relief provided by the 'TIPP' method and the simple, yet transformative strategy of naming emotions to better manage them. These tools, part of the DBT toolkit, are designed to guide you toward a more fulfilling and liberated existence. Join us for a session filled with heartfelt insights and strategies, all aimed at guiding you one step closer to a balanced and enriched life.
Welcome to episode 2 of Restoration Beyond the Couch presented by Restoration Counseling. Today, we're excited to host Brandon Stewart, an expert in dialectical behavior therapy, alongside Dr Lee Long, esteemed author and CEO of Restoration Counseling. Together, they'll dive into the transformative power of DBT, sharing its core principles and the impactful ways it can enhance emotional regulation and interpersonal relationships. This discussion will offer practical insights and strategies enriching your understanding of DBT and its application in daily life. Your path to mental wellness starts here.
Speaker 2:Hello and welcome back to Restoration Beyond the Couch podcast. I'm your host, dr Lee Long, and I'm thrilled to have you join us for our second episode. Today we're delving into a topic that is especially meaningful the transformative power of mindfulness in your everyday lives. Whether you're a returning listener or joining us for the first time, a warm welcome to you. This podcast is a sanctuary for exploring the many facets of mental health and well-being and the journey towards a more balanced and fulfilling life. This episode, we're fortunate to be joined by a very special guest, brandon Stewart.
Speaker 2:Brandon is not only the DBT coordinator at Restoration Counseling, but also a compassionate therapist and a depth neurofeedback practitioner, a DBT skills group leader and an individual skills trainer At Restoration. His approach is unique. He walks alongside individuals with grace and love, staying completely present. He brings a blend of encouragement and humor, while also challenging and guiding in specific areas. Brandon's goal is to foster change and hope, helping people embark on a journey toward a life worth living. So, as we unfold the layers of mindfulness and its impact, I'm excited to welcome Brandon to our conversation. Brandon, it's an honor to have you here with us. Welcome to Restoration Beyond the Couch. Hey, brandon, how are you doing. Hey, lee, I'm doing good, good. So we're going to talk about DBT today Dialectical Behavioral Therapy. So could you give us a brief introduction about what we know about DBT so that our listeners can be up to speed with us?
Speaker 3:Yeah, I get that question a lot of. What does DBT mean? What does it stand for? It's got some fancy words within it dialectical behavior therapy. In short, how I describe it to people is that it's a focused, structured therapy that is skills focused. So, as compared to maybe some other therapies that kind of go where they're going to go and you just kind of follow a flow and see where it takes you DBT-faced, focused, structured and skills focused as well.
Speaker 2:Which staying structured and focused. That's a benefit to the people that are coming in looking for relief from the things that bring them right to us.
Speaker 3:Yeah, yeah, absolutely Many people who come in for DBT or maybe referred from other counselors to DBT, referred by residential treatment centers or hospitals. They are struggling at life and so to get some direction and skills, given that they want that, they need that, it's appreciated. To be a little bit more technical too on DBT, everyone asks you know what is dialectical In the initials, dialectical means essentially two things that seem opposed to one another can actually exist at the same time and the theme that runs through DBT as far as the two dialectics are acceptance and change. So I'm accepting the client where they're at, who they are, what's going on. I accept that and we are also working towards change and so that balance of acceptance and change.
Speaker 2:Which is such a beautiful concept is that someone could come in and feel like they've made all these mistakes or they live with a certain amount of shame, and yet they can be accepted right where they are. Knowing us, knowing them, knowing. It's not just accepting where they are and saying, making accommodations for that per se. It's saying I accept you and I want to help you move to where you want to be. Yeah, absolutely.
Speaker 3:A couple of the assumptions within DBT that they talk about are people are doing the best they can and they need to do better, Right? You know there's some tension there. I'm accepting and we're moving towards change.
Speaker 2:Yeah, which, at its core, is a really powerful piece for these folks coming in, is that we recognize that You're valuable, yeah, and your behavior is something that we want to help you walk through differently.
Speaker 3:Yeah, exactly, I like that Exactly.
Speaker 2:So what are the core principles of DBT? How would you tell our listeners what the core principles are and how do they help address the concerns that people come to us for DBT?
Speaker 3:Yeah, how I think of the core principles, what one of the main core principles with DBT is that a person has a skill Deficit and that the reason right now they're suffering in life and struggling at life is they have a skill deficit, and so we're which.
Speaker 2:Sorry to interrupt, but the beauty of the skill deficit is the acceptance part of what we just talked about in the dialectic right. It's that we accept you and you have a skill deficit. So let's shore you up on the skills.
Speaker 3:Exactly Okay, exactly so again, with DBT being very structured and and focused. It's you have some skill deficits and we're going to help you build up those skills and the four broad skills that we're helping people develop our mindfulness of motion, regulation, distress tolerance and interpersonal effectiveness. So they are struggling in those four core areas. Or we're going to teach skills specific to those that they can then apply in their lives and start to develop a life worth living.
Speaker 2:Yeah, that sounds, sounds helpful, right, yeah, and the people that end up in this program, in the DBT program, the idea of mindfulness, how do the four tenants from? As you see them? How could we help our listeners understand? How do those four tenants weave into acceptance and change? I know that there's a certain aspect of acceptance in those skills and there's a certain aspect of change in those skills. How would you lay that out for them?
Speaker 3:Yeah, they. They say mindfulness and distress tolerance are more acceptance. Focused motion regulation and interpersonal effectiveness are more change oriented. So mindfulness that they part about. Mindfulness is accepting the way things are and and just observing and noticing that. So mindfulness of an emotion could be. I'm accepting that. Okay, I'm anxious right now. I'm gonna step back. I'm gonna be curious about that anxiety, see where I feel it in my body, where maybe is this coming from? But ultimately I'm not trying to wrestle it and pin it down and make it go away. I'm going to gently just notice and watch and in that acceptance that actually paradoxically kind of helps around judging it and Oftentimes judgment can put lighter fluid on things. Right. So mindfulness I'm accepting of my emotions. They're gonna come and they're gonna go. Distress tolerance it has a lot to do with one of the big skills within distress tolerance is radical acceptance. So how do I accept my current situation, the facts of my life, and come to terms with that? So distress tolerance, mindfulness, more about acceptance.
Speaker 2:One of the things it is so, I think, powerful about mindfulness and distress tolerance is if you don't know when you are, how do you know where you're trying to go? Yeah, and so with mindfulness, it's a, it's an. It's the idea that we are trying to help you find you, yeah, in your struggles, so that we can then help you move toward.
Speaker 3:Yeah, the change. So the change part is a motion regulation, interpersonal effectiveness in short. With the motion regulation, it, you are then taught skills of how can I change the way I feel or how can I turn down the volume on this Emotion in interpersonal effectiveness of oftentimes, how can I change my environment, how you know if this Pattern is happening in my relationship or this constant conflict is happening, how can I talk to them, how can I make this request, how can I say no, that Changes things for me. So, with the dialectic, as hopefully people are seeing, there is tension, mm-hmm, I'm gonna accept my emotion and you want me to change it. So right, it's a fine line, but it really helps calm down some pressure.
Speaker 2:Yeah sometimes people feel Of the pressure that they're you're describing is such that they think that they're supposed to grab a bull by the horns, yeah, and make the bull go at 180 degrees different direction, and really it's more about accepting that this is the, this is the path this is taking. Yes, we want to turn the bull and move the bull in a different direction. Yeah, but it doesn't all have to happen overnight with one thing. That's it's so. It's a process that you have to learn how to do for the rest of your life.
Speaker 3:Yeah, yeah, and it's not just gonna take group force, right, right, yeah, that's.
Speaker 2:That's really powerful. Who can benefit? How could we explain to our to our listeners who would benefit from DBT?
Speaker 3:Yeah, I would say DBT, first and foremost, is helpful for people who are under control, who do not have enough control in their life when it comes to Managing emotions, thoughts, behaviors. So they struggle regulating their emotions. It's too much, and so oftentimes the skills are helping Bring things in.
Speaker 2:I always look at it from the perspective of if we drew a box, yeah, and we were to color that box, we would a person that is living in a dysregulated state would be coloring outside all of those lines, while we have the flip for some people who are over-regulated. They may feel high senses of emotion, but they are so over-regulated that they don't color even near the lines. Yeah, they keep it all inside. And so your, our thought is is that dbt is more for those people who have emotions, that color way outside the line, yeah, and, and it's kind of like For another person on the outside.
Speaker 3:They don't have to guess too much of how they're feeling or how they're doing. Yeah, they kind of it's like a big splash, yeah, you know. More specifically, issues or disorders that do benefit from dbt are One or darling personality disorder. That's where the original research started. People struggling with self-harm, suicidality, depression, bipolar anger, binge eating disorder, externalizing type behaviors yeah, with, with my anger, I'm not holding it all within and people don't know I'm angry, it's I'm getting into Maybe a yelling match with my partner co-worker at work. These disorders are usually Externalizing outside. Again, the slasher.
Speaker 2:Yeah, and it seems like substance addiction and, yes, that's those types of things that, like you said, pull us outside of of where we are aiming, if you will. Yeah, yeah, and it's. It's interesting a little background is that this dbt began for people struggling with suicidality and self-harm and then the grant was awarded was for borderline yeah, and that would be the struggle that a person would live most outside of the lines Right is is characterized as borderline personality, and then it's utilized for the depression, the anxiety, the bipolar, the Eating disorders, those right, binge eating disorders, not anorexia, because that would be more of the over control. Right, right, is there an age group that we need to, that we need to point our listeners to? That works best from this, from what you've seen.
Speaker 3:So what dbt has found based on their researches. They say ages seven and up can benefit from dbt, researching dbt all over the nation. As you know, at our office we're applying dbt for ten and up, so plenty of adults who are in our dbt program, plenty of teenagers in our dbt program and now even doing a dbt skills group for 10 to 12 year olds where the kids are learning the skills and then also parents are learning skills and joining together in a group together which I'm glad you brought that up, because the kids learning these skills are, frankly, anybody learning these skills.
Speaker 2:It's a different approach to life and the family or the community or the partner, depending on the age, may benefit. We have seen benefit from learning the skills as well, and so, again, I'm glad you pointed that out. About the 10 to 12 year olds, we also do offer for the teenagers up to age 18 and, honestly, a parenting Class or a parenting skills class. Right, that benefits them. We've also had parents of adult children go through, yeah, that parenting skills class too. You want to say anything about that Like?
Speaker 3:you said. We've had several parents who their adult child is in dbt. They're they're 25, they're 35 or they're 40. They want to learn what their adult child is learning. They want to help support their adult child in the skills that they are learning and even for themselves. I want to know how to use those skills for me too, to help me know how to Not necessarily parent, because they're an adult now, but how do I support them? And sometimes I need to be regulated to to help support them. So that's always a neat thing we get to do.
Speaker 2:If that it is a powerful thing. We one of the things that I don't know, that we always One of the things that I don't know that humanity always gives space for is the fact that if you're living with somebody or living in community with somebody close community that is, living outside of the lines what kind of an effect that that has on you. Right, and Knowing that, oh, I may need to sort through mindfulness of my own emotions. I may it may have caused an opposite response in you of being really drawn in word, but it is that bringing that attention to it. Thanks for bringing that up. Could you walk us through what happens in a typical dbt session here at restoration?
Speaker 3:Yes, absolutely going back to what I was saying earlier, dbt is structured. They do have a pretty structured setup for a session. So, in short, how I would say and then I'll explain a little bit more is a Person brings in their diary card I'll talk about that a second but they bring in their diary card. Therapist looks over the diary card. Looking over that diary card, then an agenda is set for the session. What needs to be targeted is then targeted, if you will, and usually that is, there's something called a chain analysis. Skills are discovered and applied for where they need it to be, and Then homework is given and a new diary card is given. So what that actually means for our listeners, this diary card that I mentioned. On the diary card there's a, there's a front in the back. On the front are what we call targets and With the therapist's help, a client chooses Target behaviors that they want to work on while they're in dbt. So that helps us stay focused and clear of why is this person coming to counseling? What do they want to?
Speaker 2:work on. This also describes the bee in dbt. This is the behavioral part. Right is Targeting. Behaviors that are causing that are the pain point, which I find to be Wonderfully unique in the sense that we're not just talking around the room right about in. Feelings are important and we do need to talk about feeling yeah, and we have behaviors that are those results that we are Targeting and saying, okay, these are the pain points that we want to work on.
Speaker 3:Yeah, that keeps us like an anchor point of. We need to keep coming back to this, because this is this is the most support. This is what brought you here. Yeah, right, and when it comes to the targets, dbt Divided up into three levels. So level one is anything safety related, which really is Suicidality, a suicidal thought and so far. So if that applies for a person's situation, that's going to be on the diary card, and if they had urges for those behaviors, or if they acted on those behaviors, then that sets the agenda. Okay, that's level one. Ie that is the most important. So that's what we're gonna spend our time on today.
Speaker 2:Right, because if you don't have a life, yeah, then we're not really going to be doing a lot of work.
Speaker 3:Then level two is what they call therapy interfering behavior. So that's any sort of behavior that's coming from the client or the counselor that is getting in the way of delivering therapy. So it sounds obvious, and not to some crafts, but it's. They have to be alive for therapy to be working and Therapy has to be happening for it to be right, and so anything that's getting in the way of therapy has to be addressed. And that can be something like they're not showing up to the counseling sessions, they're not showing up to the skills group, they're not filling out their diary card, they're not doing their homework, they're Silent in therapy, or they're yelling at the therapist of therapy. Any of those types of situation Make it hard to do therapy. So that's addressed. Which?
Speaker 2:is such a neat component because, again, like you said, you have to be alive, so we need you to show up, and then we also need you to show up Emotionally. Yeah, we're level two, the therapy, interfering behaviors. There has to be therapy occurring. Yeah, right, because that's what you're here for. Yeah, yeah, right.
Speaker 3:It's gonna be effective right then, so that keeps it effective. And then, lastly, level three is almost a catch-all for everything else, but they call it a quality of life. So that might be on the diary card tracking panic attacks. It could be tracking isolating at home. It could be Calling in to work, not showing up. It could be yelling at your spouse. It kind of runs the gambit. But it's about quality of life and we help the client and the client helps us figure out what are those big issues that are not making my life as enjoyable as it could be right.
Speaker 2:You know, I think sometimes therapy gets a bad rap because a person may say I need to go deal with some issues, but their willingness may be low. There may be a level one, meaning a self-harming, suicidal ideation issue, or a level two, a relationship or therapy interfering behavior. And it seems so ominous because a lot of times I don't know that other Therapies always address these matters before they try to go to the quality of life issues. Yeah, therefore it puts us behind the eight ball twice in trying to get something accomplished, but we're not ready to do therapy yet. We need to prepare you, and it seems like level one, the suicidal and self-harming behaviors, our safety, and level two, the therapy interfering is really prepping someone for deep therapy.
Speaker 3:Exactly, exactly.
Speaker 2:Yeah, it's not putting the cart in front of the horse, Right? It's like how painters prep to paint. We had our house painted some time ago and I was amazed at how long it took the painters to prep to paint. It was almost a week. And then they came in and the painting actually went pretty quickly because they prepped in advance. And it's like we as the painters are prepping the individual to receive the paint, so to speak. And it's do you find it in your own practice to be more effective when you can get these level one and level two, the self harm and the therapy interfering behaviors to subside?
Speaker 3:Oh yeah, absolutely. When those have been dealt with, it just things go a lot smoother. Yeah.
Speaker 2:So I'm thinking, okay, how do we know or how does a therapist ensure that the principles of DBT are effectively communicated in practice during the session? But you've pointed out such an effective tool as to the diary cart. Yeah, that's one of the tools. Do you have any other thoughts that you wanted to weave in there for the listener?
Speaker 3:So you've got the targets, the client is tracking the targets and then let's say there's no level one that needs to be addressed, there's no level two that needs to be addressed. Now we're looking at level three. So, for example, this person is yelling at their spouse and that did happen, let's say on a Tuesday. What then happens is the chain analysis and, in short, simply put a chain analysis. Almost let's get obnoxiously detailed about what happened. Right, you know, it's okay. What led up to this? How are you feeling? What were you doing before it happened? What happened then? What happened then? What happened? How are we feeling Then? How are we feeling? What are you thinking Now? What are you thinking? What was your urge Then? What did you do Then? What happened?
Speaker 3:Yeah, it seems pretty granular. It's very granular and that's written out on a board. We can see it visually, and so we see these chain links, links on a chain. Right, you start seeing it visually and then doing that session over and over and over again. A person starts to see some patterns In that chain. One, there's acceptance, we validate through that process and we look at change of what could have been done differently, what skills could be used. We're working together and again, this is not like a broken record. It stays focused and it's structured so that one helps us ensure that we're doing DVT wells Right. Stick to the diary guard, stick to the targets, make sure you have good, well-defined targets. And the other big part about DVT that helps us stay home and at focus is what they call the DVT consultation.
Speaker 2:Which is a very unique piece to DVT, because I don't know of any other therapy that forces that issue of the therapist staying connected to other therapists and really pressing that community.
Speaker 3:Yeah, so, as you know, we talk about our DVT cases and we're giving info where info is needed. We're asking for help. We're asking for help where help is needed. We're encouraging one another. We're encouraging that is needed.
Speaker 2:So I may be getting personal help, but when someone else is getting help, I'm, of course, learning too and, as we know, that's very special, very important and has been extremely helpful for the team Right, because it keeps us sharp and that we're constantly thinking with our community through what is the best thing we can do for these amazing human beings that are showing up in our office, that we are desiring to offer acceptance to and, at the same time, walking with them toward change in their life and behaviors.
Speaker 3:Yeah, I mean, I kind of think of it as like if you're going on a hike, and a hike that you've never been on before, you're not as familiar with it, you've got a compass, sometimes we can start to drift or start to. You know if you're to the left, you're to the right, or we should be going north but we're going northwest. The consultation meeting keeps everybody focused. Things can get complicated, as we all know, and this helps us kind of keep reorienting back to, okay, what's true north, where do I mean to be?
Speaker 2:Yeah, I love that and I hope that everybody listening hears the heart behind that compass is the true acceptance of those acceptance and I want to say love for the image of the person who's walking through those doors is that our desire is to see you, to be with you and to help you, and that's where we gain that sense of true north is. It's really out of a care and compassion for you and where you're trying to go. We want to champion that with you, Because one thing at Restoration that we say in our DBT program you have to have a life worth living. But our mantra is we want to celebrate restored freedom and it's like we want to get to a place where we celebrate that restored freedom but we got to help you find that life that's worth living first. What about transitioning to the practical side here for our listeners? What is there? A DBT technique that listeners can safely practice at home that you want to impart to them?
Speaker 3:Yeah, yeah, there are a few. One is from the Distress Tolerance module. It's one that I like. It's called TIPP it's an acronym and they teach TIPP as a skill to be used when emotions are high and I need something quickly to calm me down. And so they found that these four skills the T, the I, and then there's two P's P and the other P these four skills affect the nervous system and get us into a part of the nervous system that slows our body down.
Speaker 3:So the one that I have found to be helpful is TIPP your temperature. And the most formal way of doing this is getting a bowl of cold ice water and disclaimer they say if you have a heart condition, don't do this one. So you did ask if you can do this safely. Yes, yes, and I chose the one that may be sketchy. So if you have a heart condition, don't do this one. But to your temperature. You take a bowl of cold ice water and then you dip your head in that bowl of cold ice water and you get your temples, your forehead and kind of the top of your head in the water, hold your breath, hold it, then come out, take a few deep breaths and then you do it again, hold your breath, then come out, take a few deep breaths and you do it several times and what they say is that that hits something called your dive reflex All mammals have that and it engages something called the parasympathetic nervous system and it comes to sound. So that one's pretty cool, and I know a lot of clients have used that and they've used it where they've got really anxious, panicky or really mad and they immediately feel the volume turned down. And if you don't have the ability to get a bowl of cold ice water, what you can do is also just splash some cold water on your face or take an ice pack, put it over your eyes and you're going to get somewhat of a similar effect.
Speaker 3:The other one I would say is coming from the Emotion Regulation module, and this one's simple but powerful and I have found in therapy and in DVT it's a really important one. So for Emotion Regulation, it's just simply naming your emotion, identifying your emotion. One psychiatrist, dan Siebel, he says name it to tame it, and I like that. Yeah, it's a good one. And when we name our emotion, something about that helps, something about that again calms the nervous system down because we've identified how we're feeling. I challenge people not just to say I'm mad or I'm sad, but get kind of particular with it. There's emotion wheels out there. Maybe it's sad or more specific, is that you're feeling helpless, are you feeling tired, are you feeling scared, helpless, defeated. When you get the more exact emotion that's powerful and helpful and then takes you to that next step of change, I'm getting closer to the problem. Now I maybe know how to solve it or what I need to do about it.
Speaker 2:I love the fact that you're illuminating. We need to continuously understand where we are. Talking about a compass. If I don't know where I am, I north doesn't mean much to me. If I don't know where I'm trying to go, south doesn't mean much to me. And so I love this skill that you're giving our listeners of the naming of the emotion, because it is so important again for us to be aware of who we are and where we are and what we are feeling. Yeah, yeah and that's it.
Speaker 2:Well, thanks, brandon, for being here today and, of course, for taking us through the acceptance piece of DBT, which is so critical. It's such a foundational block that bumps right up against the whole idea of change. So acceptance and change and how those two go together in the dialectical piece and the behavioral part of DBT, the diary card and the target behaviors and looking for those things that we want to alter and change, and the tea part is the therapy part, right, and the therapy part I guess we could see as being woven all the way through the dialectical piece of acceptance and change and the four amazing modules of mindfulness, distress, tolerance, emotional regulation and interpersonal effectiveness, and all the beauty that DBT brings about for the folks that have gone through it. So thank you, thanks for having me Absolutely Enjoy it.
Speaker 4:If you found value in our discussion and wish to uncover more about the fascinating world of mental wellness, don't forget to subscribe to the podcast. Stay tuned for our upcoming episodes, where Dr Long will continue to delve into empowering therapies and strategies for mental wellness. Your journey to understanding and embracing mental health is just beginning and we're excited to have you with us every step of the way. Until next time, keep exploring, keep growing and remember to celebrate restored freedom as you uncover it.
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