“DBT immediately gave me hope.”

The Linehan Institute has collected many DBT success stories via our website. These stories spread hope and inspiration to DBT clients, their family and supporters, and DBT providers. This week, we’d like to introduce you to Nina in Washington, USA.

My trauma therapist recommended DBT after 3 years of treatment. I was able to start individual therapy right away…and started [a skills] group a month later.

DBT immediately gave me hope. Where I previously thought “there’s something wrong with me, I’ll be like this forever,” I now think nobody taught me these skills growing up because I was more emotionally sensitive than the rest of my family…and now that I have learned about these skills I have hope that if I keep practicing and doing the work, I will live the life I want! The skills have been so helpful in navigating painful emotions. I lost my father to suicide in my 8th month of DBT and I am fairly certain that I would not have been able to handle the last 7 months of my life as effectively as I have if it weren’t for DBT. I have been able to improve my relationships with others, experience emotions with the knowledge that I can use distress tolerance skills if needed. I am making changes to make my life more meaningful and challenging myself to become more confident. I am not sure there are enough ways to say just how much I trust that DBT has changed and saved my life.

I have had several friends and family members tell me that they can notice the impact that DBT has had on me, and they are so proud!

Mental Illness and Stigma

In honor of Mental Illness Awareness Week earlier this month, Behavioral Tech trainer and consultant Randy Wolbert, LMSW, CAADC, shared his perspectives on the stigma surrounding mental illness and what he has observed throughout his career.

Randy

I have been fortunate to be involved in the delivery of mental health services since 1978, and much has changed over the years.  Back in the day parents were often seen as the cause of mental illness, and mental health care was seen as palliative in nature.  The pharmacological options were few and most psychotherapy was utilized on the “worried well”. 

Now a days, there is  better recognition of the neurobiological component of mental illness.  The number of pharmacotherapy options has exponentially increased, and there is an emphasis on empirically-supported psychotherapies.  Also, there is a growing recognition that recovery is not only possible, but is more the expectation than the exception.   The influential rise of consumers (individuals) and families has pushed the system both professionally and legislatively towards recognition of the problem and resources towards solutions.  The consumer movement has led former service recipients into the role of service providers working as peer support specialists. 

I have been privileged over the years to have been personally involved with empirically-supported psychotherapies, including Assertive Community Treatment (ACT) and Dialectical Behavior Therapy (DBT).  Both of these programs have a particular emphasis on building lives in the community, seeing the person beyond the illness, and acknowledging the wisdom of their goals and working towards them.

While it would be tempting to congratulate ourselves for progress made, we still have a long ways to go.  Mental health parity is not yet fully realized; twenty-one states have failed to expand Medicaid leaving the poor and most vulnerable individuals with mental illness with no coverage for physical or behavioral health.  The number of mentally ill in jails and prisons remains a national disgrace and the suicide rate is increasing.

Finally, there is the problem of stigma. Mental illness is still seen as a sign of weakness and that behaviors associated with the illness are intentional and could be stopped if only the individual desired to do so.  As a trainer of DBT, I am still struck during workshops by participants using descriptors such as:  “feeding into the drama; playing games; self-sabotage; attention seeking; upping the ante; and being manipulative.”  Recipients of service are often referred to by the diagnosis (e.g., the schizophrenic, the borderline; the bi-pole; the addict) rather than as a person first who has the same desires and goals in life as everyone else.   These descriptors have the effect of blaming the victim for their illness.

We all have an obligation to work on eliminating stigma.  An excellent starting point would be embracing DBT assumptions and consultation agreements (Linehan, M.M. 1993, Cognitive Behavioral Treatment for Borderline Personality Disorder, New York: Guilford Press), which include the assumption that individuals are doing the best they can and want to improve, that the therapeutic relationship is a real relationship among equals, and also that the most caring thing a treatment provider can do is help people change in ways that bring them closer to their own ultimate goals.  Finally, let’s all embrace the DBT consultation agreement that all other things being equal, we should all search for non-pejorative or phenomenologically empathic interpretations of the individual’s behavior; in other words, we agree to view one another’s behaviors through an empathic lens and not assume negative or ulterior motives.

Let us all strive to eliminate stigma-enhancing stereotypes regarding mental illness and continue to push for dissemination and implementation of evidence-based treatments.  So, congratulations on our progress made, and know that there is still a lot of mountain to climb.

Randy’s next Behavioral Tech training will be at the Dialectical Behavior Therapy Foundational Training™ in Apple Valley, MN (http://behavioraltech.org/training/details.cfm?eid=4743.)

Cultural Perspectives on Mental Health

foto-pablo                   Vinicius

Pablo Gagliesi, MD                   Vinicíus Dornelles, Psicólogo Me.

In 2014, Behavioral Tech joined with Fundacíon Foro in Argentina to welcome 130 people from across Central and South America to the Dialectical Behavior Therapy Intensive™ in Buenos Aires.  This training was spearheaded by Fundacíon Foro director Pablo Gagliesi, MD, who is a driving force for expanding DBT in Latin America.  Along with another dedicated psychologist, Vinicíus Dornelles, Psicólogo Me., we are honored to offer another DBT Intensive Training in the region. Later this month, Behavioral Tech Trainer Dr. Tony DuBose will travel to Vinicíus’s hometown of Porto Alegre, Brazil, to lead the training.

In honor of Mental Illness Awareness Week 2015, we reached out to both Pablo and Vinicíus and asked them about the status of mental health in their respective countries and how stigma affects those suffering with mental illness.

Pablo: In Argentina, the changes in relation to human rights and the fight against discrimination in the last 10 years are amazing. Much remains to be done.

The social problems of verbal abuse are still rife. While there is universal access to health and social protection, we have problems for people accessing [these] right[s]. The right to have the most efficient treatment – based on evidence, is one of the central problems. Access to work, something that dignifies people, is still a [problem].

Vinicíus: There’s a great stigma towards people with mental illness in Brazil. I believe this is due to a lack of information about mental illness and a long history of discrimination and exclusion [of] people [who are] suffer[ing].

There is neglect from mental health professionals in studying and properly educating their patients about mental illness. This happens because of the belief that the patient’s knowledge about his psychopathology would turn their identity into the psychopathology. Besides, there is a group of professionals that talk about mental illness in a pejorative way, saying that the identity of the patients is the mental illness.  Another thing that contributes [to stigma] is the patients’ fear of seeking treatment, receiving a diagnostic, and becoming a “crazy person.”  And finally, in our society it’s very difficult for a person to assume his mental illness and still be accepted in the [employment] field.

Brazil needs two specific things in this situation: A government program to stop this stigma and a review of the formation of professionals of mental health for a more valid model of professional formation.

Use #MIAW2015 and #IAmStigmaFree on Facebook and Twitter to join in the discussion surrounding Mental Illness Awareness Week.

“Expertise at the ultimate level!”

Yesterday concluded a four-day training titled Summer in Seattle with Marsha & Friends: Advanced Topics in DBT. This new training  from Behavioral Tech, a Linehan Institute company, offered participants the opportunity to learn from six noted DBT experts, each teaching from their area of DBT expertise and sharing new research developments in the field.

In the post-training evaluation, one participant wrote, “I got so many helpful, specific ‘tidbits’ that built onto what I already knew and will enhance my effectiveness.  You hit on so many key topics that clinicians who have been practicing for a while really need!”

The training covered specialized content frequently requested form our customers, including using exposure in DBT, challenges in working with suicidal clients, the DBT consultation team, implementing DBT to fidelity, getting to the heart of clients’ problems, and new mindfulness skills.

“[It’s] always helpful to hear Marsha in person – she is irreplaceable – [I] always learn more from her!  [I’m] very grateful to hear the range of speakers on the various topics and delighted with depth of expertise I heard in clinical practice,” said one participant.

The advanced training in Seattle, WA, drew an international group of participants, with attendees from the United States, Canada, Argentina, Chile, Colombia, Australia, and New Zealand. It is very exciting for Behavioral Tech to see a diverse demographic like this; it gives us the opportunity to disseminate DBT worldwide by developing the skills and expertise of clinicians from around the world – these individuals can return to their homes and advocate and lead the adoption of DBT treatment in their communities.

Many thanks to our passionate trainers who led this training: Tony DuBose, PsyD, Melanie Harned, PhD, ABPP, Elizabeth Dexter-Mazza, PsyD, Jennifer Sayrs, PhD, ABPP, Marsha Linehan, PhD, ABPP, and André Ivanoff, PhD. According to one of our participants, you offered “very well structured material [and] expertise at the ultimate level!”

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“A rare and unique opportunity”

Last year, Behavioral Tech formed a collaboration with Columbia University’s School of Social Work. The goal of this collaboration was to bring an innovative approach to training advanced students and licensed mental health professionals through a combined DBT Intensive training. We’re very excited to be offering this training for a second year and asked former student participant Jenna Williamson, MSW, to give us her impressions of what she believes is a “rare and unique opportunity.”

Jenna Profile Pic
Jenna Williamson, MSW

What did you gain from having a mixture of both clinicians and students in the room?

J: As a second-year graduate student attending the [Dialectical Behavior Therapy] Intensive Training™, it was an invaluable experience to have a mixture of both students and clinicians in the training room. I felt truly lucky to go through this experience with clinicians who were already practicing in the field, as they offered a different perspective of clinical work that you do not have when you are just starting your clinical career. Since most of the Columbia School of Social Work (CSSW) [student] team had only completed one clinical internship prior to the Intensive, we definitely benefitted from hearing the questions raised and examples provided from the other clinicians in the room.

What most surprised you about the DBT Intensive Training?

J: What surprised me the most about the Intensive was how much closer my teammates and I grew during Part 2. Towards the end of Part 2, [the trainers], Randy [Wolbert, LMSW, CAADC, CCS] and Gwen [Abney-Cunningham, LMSW], had all the teams meet to discuss their “professional dialectical dilemmas,” and I really pinpoint this as the moment we all became more energized to strengthen our CSSW consultation team. I think this exercise in particular helped us learn how to better work together as a team and enabled us to keep each other accountable in a non-judgmental way. I know I’ll take what I learned from my team with me to wherever I end up next, and I really couldn’t have asked for a better team!

Do you think that this experience was useful in transitioning into an internship?

J: The Intensive Training was very useful in helping me transition into my DBT internship. Since a large portion of the consultation team at my internship were trainees who had not completed the Intensive Training yet, I was able to offer more insight into the underlying theory and principles of DBT. Even though I did not have as much clinical experience as most of my team, having the Intensive training to fall back on when I encountered difficult cases was extremely helpful. My supervisor was also integral in helping me learn how to put the theory into practice in real world settings—if there’s one thing I learned this year, it’s how incredibly important it is to have quality supervision from someone who really knows the treatment when you are first learning how to do DBT.

Has your experience at the Intensive been useful in terms of moving forward in a career in social work?

J: Having the opportunity to receive specialized training like this is a rare and unique opportunity for a social work graduate student, as many social work graduates do not typically get this amount of clinical training during a 2-year graduate program. Both the Intensive and my DBT internship provided me with a clinical skill set that will hopefully allow me to continue working with difficult populations who struggle with a wide range of emotional and behavioral issues.

Would you tell other people in your position to apply for an Intensive Training?

J: Yes—especially if they can get it through a similar DBT graduate training program. There is a LOT of work required between Part 1 and Part 2 (in addition to DBT being a complex treatment to learn in general), so having many of these assignments infused within a school curriculum was really helpful to stay on track. If you’re lucky, you’ll also get a DBT professor who is both extremely knowledgeable about DBT, AND is dedicated to keeping your team motivated when burnout inevitably increases under the stress of an intense DBT internship and a graduate school workload!

In terms of the format of an Intensive, was there anything that you found particularly helpful in your learning process?

J: The client/consultation team videos and trainer role-plays were absolutely essential to learning DBT. It’s one thing to read about what irreverence is, and it’s another thing entirely to actually correctly execute an irreverent statement without sounding sarcastic or judgmental. So much of the value of these videos and role-plays rests in seeing how to use the various dialectical strategies, in addition to getting a better sense of the “movement, speed, and flow” of DBT. This in and of itself made the Intensive completely worth it.

If you are part of a DBT Consultation Team and would like more information on this training, click here.

Dialectical Behavior Therapy (DBT) in Latin America

Behavioral Tech celebrated its very first training in Latin America last October. With a great deal of hard work and collaboration, we joined co-host Fundación Foro in welcoming 130 people to the Dialectical Behavior Therapy Intensive Training™ in Buenos Aires, Argentina. This training was spearheaded by Fundación Foro director Pablo Gagliesi, MD, whose enthusiasm for bringing DBT to Argentina went on to be a driving force for the creation of another DBT training in Latin America. Along with dedicated psychologist Vinicíus Dornelles, Psicólogo Me., Behavioral Tech looks forward to welcoming the next group in late 2015 in Puerto Alegre, Brazil.

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Pablo Gagliesi, MD (Argentina)
Director, Fundación Foro

Vinicius
Vinicíus Dornelles, Psicólogo Me. (Brazil)
Coordinator, Grupo de Estudos e Pesquisa em Personalidade (GEP)

Dr. Gagliesi and Dr. Dornelles shared their experiences in bringing DBT to their respective countries and their hopes for their communities are nothing short of inspirational. We share their vision for better access to care in Latin America.

When and how did you learn about DBT?

Pablo: Towards the end of the 1990s, I was working in a [leading] programme based on emergency home visits, and at the same time, I was practising as a psychiatrist and psychotherapist for an agency.  We had many challenges with patients “chronically attached to emergency.”  I was also supervising together with colleagues who belonged to a generation motivated to see a change in the way we did things in my country, and [it] was then that a psychiatrist shared with me a paper by Dr. Linehan.

At that time, it was not easy to get hold of the papers, and I had to run to a special place to photocopy them and return them immediately.  I still recall, sitting outside in the street reading until it was late, a theory that made a lot of sense to me. 

A few weeks later, the agency sent a few of us to the American Psychiatric Association Congress, a luxury for us that faded quickly after a major crisis in my country in 2001.  It was during that congress that I bought a book and saw Dr. Linehan.

I read the book between flights and travels, and when I returned to Buenos Aires, I started together with a colleague a study group.  I also offered the book to someone close to me; she followed the criteria of BPD and had followed all possible treatments available.  She started reading the book, and it is still today that she says to me, “The best ever treatment was a book.”  She is an excellent professional and successful human being.

Vinicíus: During my Psychology graduation, I had a Psychopathology class in which I was enchanted by the work done with borderline personality disorder patients, and right there I started to deepen my studies in the treatment approaches for that population.  I wondered if one day I would be capable of putting a DBT team together to work with borderline patients.

I continue to direct my career to the work with borderline patients, so I’ve done my master’s dissertation [on] this subject. I developed a neuropsychological evaluation of borderline personality disorder (BPD) patients. After it, I continued studying BPD and the different treatment approaches. Although I had a great interest in DBT, I still lacked the basis to assemble a team and initiate DBT’s clinical practice as a whole.  It was only in 2012 (exactly three years ago) that my contact with DBT started to become reality.

During a Latin American Congress about cognitive behavior therapy (CBT), I saw that there was another person, an Argentinian man, Pablo Gagliesi, who would talk about DBT.  At the end of it, I introduced myself to him; he promptly asked me if I was Vinicius and gave me two DBT books and said, “You have to assemble a team in Brazil.”  It was with this kindness that … our deepened, DBT training started.

What part of the DBT Intensive Training did you find to be the most valuable to your personal and professional life?

Pablo:  It was not until I participated in the Intensive Programme [sic] that everything began to make sense –.  It has truly been a life-changing experience for me.  I [first] took the Intensive training in Minneapolis, MN, and the teamwork was to me very enriching, not to mention the role-plays, which are still in my memory.

Vinicíus:  The first one was the case consultations, because it helped us to improve technically as DBT therapists, and it gave us a broader view of the consultation team. Besides that, we were granted the opportunity to know about other great work that is being done by our Latin American fellows. The second part that was very important to me was the specific work done by the team and consultation meeting. It was a great moment when our team could train a lot and talk about all the things we thought about the team in a validating way. That moment was very touching and of great personal growth for my team and me. Besides that, this moment was useful so we could have the real notion of our roles in a consultation team and the real importance of it.

Is there anything that surprised you about the Intensive Training?

Pablo: It has to be the role-playing for sure; it transformed my life.  I remember on the first day, I arrived late and the trainers did a Chain Analysis [with me]. I recall exactly what happened; it was the first time that we did such a thing on ourselves.  I understood then that DBT was something we had to apply among us. 

Vinicíus:  First, the affective and close approach of the trainers was very surprising and positive.  Besides that, I believed that what also caused me surprise during the training was the work [and how much] all the teams have been developing.  It was an amazing experience to live through the growing intimacy among the teams because of this work.

Have you seen the same enthusiasm from others who attended the training?

Pablo:  For sure, I know that many others enjoyed and experienced a lot of value from this programme.

Vinicíus:  There’s great enthusiasm with the arrival of DBT in Latin America. This was clearly noticeable in the people taking the training and in the conversations we held during breaks.  We’re talking about a treatment approach that incorporates many of our great cultural values and that has a solid evidence base about its effectiveness. So, it’s only natural that there’s great excitement with the coming of DBT here.

Even though many Latin American countries are currently going through an intense political and economic crisis, as is the case in Brazil, we [have] never before had such a political and economic importance in the global scene as we have today. This translates to a significant increase in training opportunities, work, and promotion of new jobs in the most diverse scenarios and fields.  We can glimpse a plan in [the] medium and long term of the arrival of DBT, not only in private health treatment [options], but also in public health, allowing many improvements in the quality of life of our patients.

What changes do you hope to see in treating clients as a result of the Intensive?

Pablo: The changes happened to us.  And I believe that translated into the clinical practice.  I know that [as a result of training], we were convinced that when the treatment is done well, it works.

I am typically disorganised, and when I came back, I was sure that it was a behavioural problem I had to resolve.  So I did, and we aligned with protocols and process guides and agendas.  Being structured while keeping the magic of creativity.

Vinicíus:  The main result I expect is to become more effective at helping my patients to build lives that are worth living.  Besides that, I would like to develop each time more [the skill of] listening to my patients [in an] emphatic [sic] and humane [way].  I expect being much more effective with my team, in the means of building our teamwork and feeling that I can, together with everybody’s work, increase each time more our motivation to work and continuous training.

What change do you hope to see in your community as a result of these trainings?

Pablo:  Argentina is one of the countries with [the most] psychologists per inhabitant in the world.  Most are psychoanalysts from different schools.  We have always been different by practising Cognitive Therapy and DBT; we were far away from what the rest were doing.

It was most likely for that reason that our team has grown enormously in the last 10 years.  We get invited to conferences by universities and agencies to talk about our project, and we have won a respectful place in the world of mental health.  The difference was a gain.

Vinicíus:  I expect the training in Brazil [will] allow us to develop teams in different regions of the country.  After that, I would really like to create a communication channel between these teams, so that we can learn about each other’s work and maintain a continuous training of these teams in Brazil.  I have a great hope that DBT ends up entering Brazilian public healthcare proposals, so that independent of financial conditions, all patients that need treatment can have access to it.  There’s always a first step for everything, and I’m honestly very happy and honored that my team, Grupo de Estudos e Pesquisa em Personalidade  GEP, is starting this process.

What resources are needed to reach more people who seek treatment?

Pablo: We need to find the opportunity to convince politicians and those in charge of our public health system that DBT saves lives and is financially doable.  We know how to do it, but sometimes we don´t have the chance to do it.

Vinicíus: I believe that having more access to materials in the Portuguese language is fundamental to increasing the reach of DBT in our context.  Another factor that would be decisive is the construction of effectiveness studies of DBT in the Brazilian population; that could improve greatly the adoption of this model of treatment by the clinicians in Brazil.  Moreover, the development of partnerships with government health organizations would [stimulate] a lot of training of professionals and treatment for patients who can’t afford it in the private care.

I believe that more important than the delivery of resources, we would be writing DBT history in Brazil together.  Giving to DBT, as we popularly say around here, “the face of Brazil.” 

“I want to help people to be able to see the same light I see now…”

May is Mental Health Month in the United States. Many organizations, including NAMI and Mental Health America, run awareness campaigns to reduce stigma, share hope, and spread the word that mental health is something everyone should care about. To support that effort, The Linehan Institute will be sharing stories from both national and international DBT clients and therapists throughout the month.

The Linehan Institute has collected many DBT success stories via our website. These stories spread hope and inspiration to DBT clients, their family and supporters, and DBT providers. This week, we’d like to introduce you to Natalia (18) in Scotland, who shared with us her struggle to find treatment and the incredible changes she has seen in her life once she was able to access care.

What was your experience in seeking and finding the help you needed?
N: I live in the UK, and access to DBT was difficult.  There were only two trained DBT therapists in a nearby city, but when I found one, I clicked with my therapist straight away.

When did you receive treatment?
N: I am currently receiving DBT.  Having the DBT Skills Training Handouts and Worksheets helps a lot in my DBT homework!  I have the DBT Skills Training Manual as well.  Yes, it’s for professionals, but sometimes I like to learn from it.

What changes have you observed in your life as a result of receiving DBT?
N: My cutting and risky and suicidal behaviors have been reduced greatly.  They happen from time-to-time, but I am no longer cutting every single day like I used to.  I am currently learning Radical Acceptance [a DBT Distress Tolerance Skill], and Willing Hands [another Distress Tolerance skill] has helped me to accept that sometimes I need to be willing to accept a certain emotion instead of fighting it and constantly trying to get away from it.

With skills coaching, I managed to apply the skills to my life.  I did used to feel that they weren’t effective at the time of crisis, but looking back, I see that they did help me to resist urges, despite what I told myself at the time.

Crisis survival skills have been extremely valuable.  The “cold water” trick is extremely effective in calming me down, ice cubes too.  All of the crisis survival skills have been helpful in resisting urges.

Because of DBT, I no longer think that my life is not worth living.  I want to help people to be able to see the same light that I see now, and I want to help those who are in that same dark place I was digging myself out of.  I am determined to stay alive and determined to keep going.

To find out more about the books that Natalia found helpful, visit the Behavioral Tech website.