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DBT Skills

 

                                                             

 DBT Skill for June: Improve the Moment

Some of the ways we can Improve The Moment Are:

  • Imagery
  • Meaning
  • Prayer
  • Relaxation
  • One thing at a time
  • Vacation
  • Encouragement

When practicing this skill, we are not trying to CHANGE the external circumstance, but rather trying to improve the moment to make it more tolerable (or even more enjoyable) for just this moment.

Here are some examples of putting the skills into action:

  • Imagery: Imagine very relaxing scenes…Imagine everything going well. Imagine coping well…
  • Meaning: Find or create some purpose, meaning, or value in the pain [that’s what I do with this blog, by the way!]. Focus on whatever positive aspects of a painful situation you can find…
  • Prayer: Open your heart to a supreme being, greater wisdom, God, or your own wise mind. Ask for Strength to bear the pain in the moment…
  • Relaxation: Try muscle relaxing and tensing each large muscle group…take a hot bath…breathe deeply; half smile; change facial expression…
  • One thing in the Moment: Focus your entire attention on what you are doing right now. Keep yourself in the very moment you are in; put your mind in the present
  • Take a Brief Vacation: Rent a motel room at the beach or in the woods for a day or two. Ask your roommate to bring you coffee in bed or make you dinner (offer to reciprocate)…Get a  magazine or newspaper at the grocery store, get in bed with chocolates, and read it…
  • Encouragement: Cheerlead yourself. Repeat over and over: ‘I can stand it,’ ‘It won’t last forever.’ ‘I will make it out of this,’ ‘I am doing the best I can do.'”

 

Treating the Family System

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When an eating disorder strikes an individual, his or her entire family is affected. According to an article by Abigail Natenshon, MA, LCSW, GCFP, 87% of eating disorder patients are children and adolescents under the age of 20. As many in this age group still live at home, the eating disorder develops and plays out within the family dynamic. It often takes on a life of its own and can be the cause of many battles at meal times, family gatherings, holiday events, and can even affect extended family and school environments. Family therapy is an essential part of eating disorder treatment and is necessary to ensure everyone who is a part of the family system is cared for.

The Family System Theory

Developed by Dr. Murray Bowen, family systems theory posits that the family is a unit and the emotional connections fostered by thoughts, feelings, and actions create an interdependent environment. This interconnectedness helps the family to become cohesive and supportive of its members. If there is unrest and tension, emotional connections can become more stressful. If there is a member of the family who tends to take on the emotions of the other members and may take on an accommodating role, leading to overwhelm and isolation. This is the family member who may become more susceptible to addictions, depression, anxiety, eating disorders, and illness.

There are eight concepts to the family systems theory:

  • Triangles: A three-person relationship system
  • Differentiation of self: Variation in how people are susceptible to pressures to conform to the group
  • Nuclear family emotional system: Four basic relationship patterns (marital conflict, dysfunction in one spouse, impairment of children, emotional distance)
  • Family projection process: The way parents transmit their emotional issues to children
  • Multigenerational transmission: Differences in differentiation across generations
  • Emotional cutoff: Managing emotional issues by cutting off family members
  • Sibling position: Impact of sibling position on behavior and development
  • Societal emotional process: Emotional systems govern behavior on the societal level

Family systems theory can be used to help clinicians understand the dynamics of the family presenting to work through one member’s eating disorder.

Family Involvement in Eating Disorder Treatment

Comprehensive treatment plans at all levels of care will involve family therapy. Center for Discovery residential programs involve the family weekly in a therapeutic way, not only in family therapy but also at meal times by facilitating therapeutic family meals. The purpose of these activities is to observe family dynamics at meal times and in social situations in order to best prepare the family for realignment and a return to balanced interconnectedness.
Some clients benefit from a type of family therapy called Family Based Therapy (FBT, also known as Maudsley). This outpatient approach, which places the refeeding process in the hands of the parents and moves the family through phases of treatment as recovery develops, has proven to be very successful for adolescents with anorexia.

In outpatient settings, family therapy is usually recommended in conjunction with individual therapy, nutrition services, and group work. As the eating disordered member reintegrates back to the system after being away at treatment, therapy is needed to help the family adjust once again. An eating disorder has the potential to isolate family members from one another, create discord in the system, and indeed can be either sustained or eliminated depending on the dynamics of the family system. It is important for clinicians and parents to know that parents do not cause eating disorders. The entire system needs attention and support to thrive again.

Natenshon, A. Family Treatment is Cornerstone of Effective Care for Eating Disordered Children. Treating Eating Disorders, www.abigailnatenshon.com

The Bowen Center for the Study of the Family. www.thebowencenter.org

S / M / D / W – What’s your status?

 

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S / M / D / W – What’s your status?

In the age of internet dating and saturation of picture perfect images, it is easy to get swept away in a search for love. We tweeze, pluck, lift, slather, sweat, scrub, dress, and obsess all in a preparatory hope to meet The One. Perhaps we go on blind dates, fill out online inventories, suffer through coffee with the nice boy/girl our granny knows from church, or hit the bar/club scene when all we want to do is crash on the couch with a bottle of wine after a long week.  Amidst the ads for eHarmony, Match.com, etc. and the wedding planning industry, I can’t help but think about what all the buzz is about. Why is finding love (or at least the appearance of it) so important to us and to society? What are we really looking for; who are we looking for; how are we defining love; and where are we looking for it?

The way I see it, love takes many forms and that’s a wonderful thing, because it means we have access to a variety of loving sources that can feed our souls and comfort our hearts. One of the reasons I think the focus on our romantic status has become increasingly important is that we are searching for an external solution to an internal problem. In this search for love, we are often looking for validation, support, and acceptance from someone else. I’ll be the first to admit, this feels really, really, really good, it’s nice, really nice to hear that someone you care about values your opinion and cares.

The unfortunate reality is that sometimes this search for external validation, compounded by external pressures to meet The One or “make it work” we lose our power in the process. Maybe, we try to make the one we are with fit into the space we have created for the one, which feels about as good as a dress that’s two sizes too small. We’re cramming all our needs and expectations into a source that’s not built for it. When the search for the one takes too long or when we’ve kissed one too many frogs, we start to question ourselves. It’s disheartening. In searching for connection for the external validation, we can lose connection with ourselves. What am I doing wrong?! What’s wrong with me?! Why don’t they like me? I’ll never find love. We all know what that looks and feels like, when we sit on the couch with our bottle of wine and get so deep in our thoughts we could drown ourselves in a cup of water. Or maybe we are in a relationship, or recently lost one, and feeling hopeless and deflated. We forget the most important source of love, self-love. We forget that we can feed our own souls and comfort our own hearts. Often, instead of believing that we are enough, we self-damn and self-criticize and reinforce this society preference for a deficit based approach.

What if we turned that on its head? What if, instead of wallowing or questioning or assuming there is something wrong with us, we took that time to really get grounded in who we are and what we like. What if we started to pull from all the sources of love around us, and let that be enough? I am a true believer that like energy attracts like. If you are in a good place mentally, physically, spiritually then you are going to be well positioned to draw and attract that same kind of love from a partner (the residual benefit being that other relationships in our lives start to shift for the better). It’s less about what am I doing wrong and more about what am I doing to serve myself and the people I love. Where am I not taking care of myself the way I want someone else to take care of me?

If we listen to all the expectations of society, our family, friends, and that vision we had for what life was supposed to look like, then we end up missing out on living and loving the life we have. The relationship with ourselves is and will always be the most important relationship we have. Staying connected to our true self helps guide us to the path where we will be primed to love and be loved. The take away here is regardless of your status, start with your relationship with yourself.

Be Kind to Yourself. Be kind to Others. Keep it Moving.

When Perfection is Imperfect

perfection-pursuit

What is perfection? Current society would have us believe that it is the Stepford Standard, that anything less than keeping up with the Joneses makes us substandard, less relevant, not good enough, or just plain not enough. Webster’s defines perfection as “having all the required or desirable elements, qualities, or characteristics” and “completely free from faults or defects”. Maybe it’s just me but I feel like these definitions are in conflict.  Why can’t I have all the required or desirable elements, qualities and characteristics, AND still have faults? Why can’t I be perfectly imperfect? Perfection can be found in the faults, in the quirks that make us who we are and the experiences that we grow from that have been less than perfect.

Is it even possible for anyone or anything to be truly perfect (i.e., without flaws)? Rationally, I think most would agree that it’s not. Rationally, we know that it is part of the human experience to be flawed, to make mistakes, to rise from the proverbial ashes. But how can we rise if we’ve never been burned? Rather, in perfectionism we are consumed by the flames, the need for this unattainable perfect. Why is accepting imperfection so hard? Brene Brown has done an amazing job of addressing this question, in fact much of her work focuses this very topic.

The point of this post is not to delve into imperfection, but rather how we know when our need to be perfect, to be “completely free from faults or defects” is getting in the way of this thing called life. Society tells us that if we aren’t the highest performers, if our parties aren’t the biggest, the best, the ultimate event that has Gatsby in envy, then we aren’t doing it right.

How does this happen? How do we miss the point of the very thing we are trying to achieve? It’s simple, we forget to think about the intent of the goal itself. And, when we forget about the intent (the desired end state or outcome) we go into the perfectionistic planning mode. If you are prone to this mentality then you know how time consuming and crazed the planning gets around a desired goal. The flaw here is that the obsessive planning, the extensive preparation and painstaking compulsion to think about everything that should happen, everything that might happen, the need to think (aka obsess) about all of the knowns and unknowns, gets in the way of the goal. Not to mention it makes the process of reaching the goal exhausting. Essentially we run ourselves into the fire of worry about the “what if’s”, all the while missing the point of the event.

Take this for example, say you want to get friends together for a game night. The idea being that you would get folks together, maybe have some food, maybe some drinks, and everyone has a night full of commercial worthy fun. The perfectionist dives immediately into the planning and organizing of the “perfect” game night. Sending out the fancy semi-formal electronic invitations with the “perfect” play on words that “perfectly” captures the theme of the night. Then to the food, drinks, and venue prep. The perfectionist struggles with letting everyone bring a dish (what if two people bring the same thing, or some other catastrophe happens?!), people can bring a side but no matter what the “perfect” host needs to have the “perfect” culinary item that could make Martha Stewart green with envy. Everything must be organized, “perfectly”… heaven forbid the drink cooler not match the centerpiece. The games, must be selected with care, to facilitate the most fun of course. And then amidst all the planning and preparation for the “perfect” party, the home must be spotless. Above all cost’s this house must not look lived in!!! In the perfectionist frenzy, you stop thinking about the intent of game night, and start obsessing on the need for “perfect”, the rave reviews; you’re looking for the 5 star yelp review for what started as a means to connect with your friends/families.

Rather than connecting, you’re disconnecting. There’s no room for fun and friends when there’s a “perfect” party on the horizon. If you think your friends can’t feel the anxiety of your perfection obsession aura puts off, let me tell you, in no uncertain terms, they can. Your “perfect” planning is imperfect. It’s driven by an unattainable need to be “perfect”. Did you ever stop to wonder what perfect was?… in this case it’s not the best party favors, or the game selection, or the food, or the drinks. What makes game night perfect is the intent. You are creating a space for people that you know and love to come together and have fun (that’s the intent, that’s the desired outcome). It doesn’t matter if people love the food, or find a speck of dust under the coffee table, or if no body plays games at all on game night. What matters is that you brought people together for an evening of levity.

Some of the common cognitive distortions associated with perfectionism are:

  • Black-and-white thinking – “If this is not perfect, I am a failure.” Or “Only lazy people ask for help.”
  • Catastrophic thinking – “Everyone is watching me, if I make a mistake they will think I am stupid.” Or “If my presentation isn’t flawless, I will lose my job”
  • Probability overestimation – “Even if I study a lot, I still won’t do well on my exam.”

What happens in the above statements is that there is no room for life; because perfect isn’t defined and the intent hasn’t been identified, there is no way to determine success. There are always things we can do differently or do better in the future, that’s part of the learning curve of all life’s situations. Perfectionists have a hard time thinking about what success looks like ahead of time, instead they look retrospectively and judge themselves harshly for the things they “should” have known, never accounting for the fact that these things could not have been known at that time.

Here are some questions to ask yourself to make sure you aren’t going into a perfection obsession.

  • What is the intent? (really think about it)
  • Are the thoughts and actions you are engaging contributing to or detracting from the intent?
  • Are you enjoying it? (If the answer is no, ask yourself 1. Why am I doing this (i.e. is it aligned with my intent or my need to be perfect)? 2. What about this am I not enjoying? 3. Could I approach this differently to feel better about this?
  • Am I being competitive? (With myself? With someone else?)
  • Am I willing to ask for help? (perfectionists tend not to ask for help and/or have trouble truly delegating, also known as micromanaging)

 

Be kind to yourself, be kind to others, and keep it moving.

 

Ashley Steelman, MSW