Parenting Parallels to Therapy

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As a parent I have noticed there are a number of different camps in parenthood literature: ones that espouse behavioural modification shaping (i.e. cry it out in terms of sleep) and others who espouse attachment/ child-led philosophies that tend to emphasize the child’s innate ability to know what they need and face natural consequences. As a parents I have found wisdom in both of these camps.

Similarly in working as a therapist I have found competing theories in working with clients with what psychiatrists often call “behavioural issues”, or “personality disorders”.

These are clients who for whatever reason (often poor attachment growing up, but not always) employ coping mechanisms that keep them stuck in a negative emotional state over the long-haul and often involve intensive contact with the psychiatric system. Some approaches demand a very rigorous and structured approach, and others espouse a focus on the creation of re-creating an attachment relationship over many years in therapy.

In working with these clients, you are often presented with dilemmas familiar to being a parent to a child who has temper tantrums, misbehaves at school, or directs anger inwards at themselves. How do I respond to problematic behaviour and strong emotions in a way that shows love and respect ? How do I respond so that I do not inadvertently make the problem worse rather than better ?

However, unlike parents, I do not have the same amount of time, nor even trust with such clients; I might see my client one hour per week, rather than working with them 24 hours a day. In addition, the clinical situations I face require decisions that force me to balance the risks between encouraging positive change in the long-term, and short-term safety risks (i.e. suicide). I am usually the most recent therapist of a long list of helpers and caregivers that have tried to help them and have given up, left for other reasons, or passed them on to another care provider.

I am by no means an expert in helping these complex clients, but I do care about them and would aim to work therapeutically for their benefit and recovery.In my effort to try and be a contributing force for good in the my work I hope to actively process reflections from various books on this blog, beginning with “Doing Dialectical Therapy” by Kelly Koerner (2012).

Never Insight Alone: DBT Therapy

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In Doing Dialectical Behavior Therapy, Koerner (2012) asserts states that “You’d never consider insight alone to be enough to change your golf swing or paint with oils.  Yet we often think that insight alone is somehow enough to change the complicated, highly habitual maladaptive behaviors of regulating emotion.”  

 What this means essentially is that understanding that what you’re doing is not working is not enough to change what your doing; you need to be taught and practice a lot. 

Similarly, telling someone what to do without actively assisting them to act out new skills can set someone up for failure.  However, even the act of learning a new skill needs to be handled with care to provide validation for their efforts and inherent value, especially when techniques to handle emotional pain aren’t performed perfectly the first swing. To do this you not only need to have the right information but deliver it in a wise way, like an excellent coach. 

Growing up, many of you played team sports; more often than not the coach would be a parent volunteer.  However as most of us know, there were good coaches, there were bad coaches and there were excellent coaches.

I had an excellent soccer coach throughout my childhood.  A tall lanky British born man with a distinct accent; he had nicknames for all of us.  He was no softy, but always explained his rationale “If I’m yelling at you on the field, it’s not because I don’t like you or am mad, it’s that I need to you to hear and respond quickly”.  This explanation helped poor sensitive spirits like myself.  He had a way of honing on your particular talents and garnering enough encouragement to keep trying at something that you’d failed at 100 times. For example, he knew I had a knack for heading the ball, and always stationed me near the net at corner kicks, despite playing left defence.  It was because of his coaching I eventually did score that way in a provincial championship game.   I can’t say that I didn’t shed quite a few tears on the soccer field trying to learn how to punt, but I kept persevering.  He had high expectations and outlined what it would take to improve, but never used high-handed verbal threats.  I thrived under his excellent coaching which was solution-based corrective feedback , with firm constant validation. 

This is what our clients need to move forward; excellent coaches, trained in their craft, knowledgeable about how they can move forward, providing corrective feedback in a validating way.  Looking back, I think the key to the success of my childhood coach was that he knew everybody as a person, our nicknames signified our value and belonging.  His connecting with each person, not just the stars made the biggest difference.

I’ve found similarly with some of my clients, I work as a coach, sIowly working out alternate strategies that work for them, without the use of deeper emotional processing therapy. For example I worked with a client who engaged in self-ham activity and suicidal urges, which was always precipitated by binge-drinking.  I went through this creative problem solving and testing out with him until he eventually felt confident in his chosen strategy and even if he relapsed into old ways was able to provide self-talk to himself realizing it was just a “slip” and continue on.  Yet throughout this process, I always encouraged him to see that he did have choices in how to deal with the problem, but they held different consequences.  This process has taken almost a year, long slow work with setbacks and small steps forward. Important work in the playing field of life.

 

The Dialectics of God’s Love and Radical Acceptance (DBT musings part 3)

Dialectical Behavioral Therapy has the aim of teaching people to both accept themselves as they are and at the same time realize their need for change.  It works on shifting a person’s assessment of themselves (and the world) from one of dialectical thinking (either all good or all bad) to one of non-judgement, and acceptance.

In the previous post, commenter Sean challenged the view that Christians can be non-judgemental in all circumstances and clearly differentiated circumstances which warranted  refraining from judgement (being judgemental) and those that warranted judgement (i.e. to identify sin.).  This is a dialectic in itself and merges well with DBT’s aim to encourage its participants to both accept themselves and realize their need for change.

This dialectic of acceptance and change is one that is inherent in the Gospel.  We learn through Jesus that God loves the world so deeply that he gave his only son (John 3:16).  However, God’s love requires reciprocation, action, and relationship as the rest of the verse says “whoever believes in him will not perish but have everlasting life.

Time and time again in the New Testament Jesus demonstrates God’s extravagant love to those considered the most outcast, hated (not loved) and rejected including the Samaritan woman at the well (John 4), the woman who lavished him with perfume (Luke 7), the tax collector (Luke 19), etc.  He was accused by the religious of frequenting with “sinners and tax-collectors”.  This likely aggravated the religious folk because they feared that he was accepting of sin, as it seems contradictory that you could both accept and reject at the same time.  Indeed it can be.

The key to handling this dialectic is forgiveness.  God’s amazing ability and offer to forgive to all who seek it provides a true and radical acceptance a bridge between being who we are and changing to becoming more like God/Christ.

When Jesus teachers his disciples to pray he teaches this practice of continually coming to God in for forgiveness, realizing that at the same time we are his beloved Children, we are also deeply fallen and sinful creatures who need God’s love.  Many people get stuck in this process.  They find it hard to let go and believe that God could truly love them and forgive the things in the past that were truly sinful.  Another problem we have is blindness to our own sinful nature- especially as people who have been trying to follow God for a little longer- we haven’t committed some of the “big” sins and so we figure we are “Ok” and fail to look more deeply at the nature of our selves and have come to accept too much of our desires and yearnings that are in fact more worldly (“Me” centred) rather than Godly (God-centred).  So we both need acceptance and forgiveness to engage in the radical acceptance and transformation that God offers through Jesus.

You may wonder how this differs from the “Radical Acceptance” espoused in current psychological treatments.   Radical Acceptance in DBT is based on Buddhist principles that we will endure pain but we have a choice to suffer- radical acceptance may entail accepting a situation or a person as they are rather than striving to change it, or bemoan it.   To stop dwelling on things that we may or may not have control.

There are passages in the bible and whole books (Job) which talk about suffering.  Paul regards suffering as purposeful,cleansing us from selfishness, as a place of joy (Colossians 1:24) and connecting us to Christ’s suffering (2 Cor. 1:5-7). Jesus also admonishes us that those who follow Him will be persecuted for righteousness. In this way Radical acceptance may at times be advisable to Christians.  In addition the reasons or results of enduring pain, for the Christian, may be different from those espoused by Radical Acceptance in DBT.

Enduring pain seems justified for those who suffer apart from their actions, but can Christians advocate radical acceptance when suffering is self-inflicted?

That’s a very good question.

What do you think?

Jesus and Judgement (DBT musings part II)

Today I was in the DBT group that I observe as a student therapist and found scripture coming to mind as we covered mindfulness basics.

Nonjudgement is a key aspect of of Dialectical Behavioral Therapy. In DBT Mindfulness participants are encouraged to refrain from judgmnt and instead to observe, describe, then fully participate.  Many people who come to the group are plagued with judgement of themselves. 

Jesus says “Do not judge or you too will be judged. For in the same way you judge others, you will be judged, and with the measure you use, it will be measured to you.” (Matthew 7 1-2)

It is interesting that Jesus makes this link.  I previously interpreted this verse to mean that God will judge me as I have judged others.  However, I see now that it is also possible to interpret this scripture in the present tense- the more judgement I pass on others, the more I will also pass on myself. 

However, as in the parable about the log and speck (Matthew 7) just as we judge others incorrectly we also judge ourselves (I’m no good, I’m unloveable) inaccurately, often overjudge, and miss the parts of ourselves that hurt others (pride, arrogance). 

Throughout the Bible we are told that the only true judge is God alone- he is the ultimate judge- then why do we so often take on that role? 

Even Jesus’ disciples were notorious judgers- how many times did Jesus’ disciples want to turn away people because they innacurately judged Jesus’ love and desire to meet them?  For example, the little children (Matthew 19:13-15), and the Caananite woman (Matthew 15: 21-27). 

Is part of faith in Jesus refraining from judgement?  Not only to others, but to ourselves, and in judging what God can do and how He loves the world?

At first when I heard about non-judgement  I thought that th idea was ridiculous and not Christian as we want God to change our lives and free us from sin.  Isn’t judging the way we recognize sin in our lives?

Maybe, maybe not.

First of all we ask God to identify sin in our lives (Psalm 139: 22-24). 

Secondly we can examine ourselves with compassion and kindness- without judgement as God affirms us that he has saved us through his son and there is no condemnation (Romans 8: 1).  Why would we condemn ourselves when God has freed us?

How then do we identify sin in our lives?  We can examine our lives and observe the times and ways in which we have been far and near from God.  This can take the from of the daily examen – an ancient practice develop by St. Ignatius of Loyola.  Through observation of ourselves the discrepency between what is Godly and good, and what are the desires of flesh we can understand our actions, and seek forgiveness, repent, and recieve new life.

Many who have been saved by God continue to condemn and judge themselves.  Especially people we see in our neighborhood who have mental illness and drug addiction, are estranged from their family, and see their life as a string of failure. 

“It doesn’t make sense why God would love a person like me…”

“It’s hard to see anything but sin and regret in my life…”

Can Jesus free us from self-judgement? Yes, he must.  But he also fills us with the Holy Spirit which groans within us to rebuke us kindly and gently and as we experience the father’s love he slowly shows us our sin as we’re ready in a gentle way through scripture and his spirit.

In that way observing and describing and refrain judgeing can be a good start to accepting the love of Christ, rather than pushing it away or reinforcing the lies of the world (that we are unloveable, no good, constantly failing…). 

What do you think?  Comments?? Ideas?

Dialectical Behavioral Therapy (DBT) Musings Part One

Dialectical Behavioral Therapy was created by Marsha Linehan, a psychologist based in Washington. It combines cognitive behavioral therapy and mindfulness principles in a highly structured program to treat individuals with emotional regulation problems, most notably those with Borderline Personality Disorders.

It has undergone a lot of scientific review and now is considered one of the most successful therapies for this diagnosis, as Borderline personality disorder (BPD) is not treatable by pharmaceuticals (although medication can be used to address symptoms of depression, anxiety, and sleep issues).

I was eager to receive training in DBT at my practicum and jumped at the chance as I knew it was one of those therapies that is very valuable to have under your belt as an up and coming therapist. However, I was wary of how much I would be comfortable with it as it relies heavily on Zen Buddhist principles, and I am a Christian.

I have never myself gotten into practicing meditation. In an Anglican church I was part of I tried to engage in centring prayer but did not persist in it nor did attend any training.  I have done meditation on verses or words in the Bible, as there are verses in the Bible that tell us to meditate on God’s nature, his creation, and his word.  However, I was wary of meditation that aims to empty the mind or to be rid of all thoughts.

Why is that, you may ask? I wondered the purpose of emptying the mind, and what you fill it with after it is empty? I experiences of meditation alone form one’s basis for who they are then I would object, because I think we discover that in discovering God’s love for us, not in entering a state of nothingness.  However, it is true that emptying our mind can be good for getting rid of anxious, depressing, or disturbing thoughts which most people struggle with, especially those with Borderline Personality Disorder.

A scripture came to mind when I was thinking of the idea of emptying the mind: Luke 11: 24-36

24 “When an impure spirit comes out of a person, it goes through arid places seeking rest and does not find it. Then it says, ‘I will return to the house I left.’ 25 When it arrives, it finds the house swept clean and put in order. 26 Then it goes and takes seven other spirits more wicked than itself, and they go in and live there. And the final condition of that person is worse than the first.”

So the message I get from this verse is to be mindful that after you cleanse or heal the soul/mind that you do not leave it unoccupied, which can be the case with meditation.  But this verse is not primarily directed at those whose lives are cleansed by God but then do not fill it with anything from God afterward.

Needless to say I had my reservations about whether I could teach this therapy given that I have not previously practiced meditation and I wondered if my faith would be in conflict.

What I have discovered to date (within the context of the DBT group that I have been observing) have been very useful concepts, many for which I can see a clear biblical basis which I will outline in my next post.