Diabolical Behavior Therapy

Just kidding! It's actually called dialectical behavior therapy. My dad just called it that the first time he heard it and it's been a running gag between the two of us for years.

Dialectical behavior therapy was created by psychologist Marsha Linehan in the late 1980's to help people who have severe mental health problems, and hadn't had much success with other types of treatment. A wide range of problems can be helped with DBT- I've seen people with eating disorders, personality disorders, depression, anxiety, bipolar disorder, schizophrenia, and substance abuse problems all benefit from DBT. DBT teaches you to change your unhealthy patterns. For example, in a person who self-injures, DBT teaches how to find healthy self-soothing skills or healthy outlets for anger to replace the act of self-injury. DBT also helps with managing relationships, gaining and maintaining self-respect, self-advocacy, emotional regulation, mindfulness, etc. The awesome thing about DBT is that anyone, even people without a mental illness, can benefit and learn from the program.

I started self-injuring when I was in elementary school and first became suicidal while I was in middle school. By the time I turned fifteen, I had been away from home for over a year in hospitals and residential treatment. I'm turning twenty-three in a couple months and have been through twenty plus therapists, at least five psychiatrists, and several psychologists, not including all the other people I've worked with in my recovery. I'm not the trickiest mental illness patient there ever was, but I have certainly been a challenge to a lot of mental health professionals. They don't know what to do with me most of the time and I get frustrated because as badly as I want help, resources in the US are limited. One in four adults in the US has a mental illness, and in my area, there are waiting lists of three months for the first session of therapy. For people like me who need more than individual therapy twice a month and some Prozac, the situation can quickly become dire, especially since many of us are too mentally ill to handle the stress of finding help. Finding help feels like drawing straws. Only the very lucky people get what they need.

In June 2014, I started DBT again. DBT was part of the program I was in when I was in residential treatment, and while I loathed it, I also knew it worked. I decided to give it another shot when the suicidal thoughts got bad again and there was an opening for an intensive, three day a week group not far from where I live. I had been turned down by a hospital a few times between December 2013 to May 2014 when I checked in for suicidal ideation. My ER visits went something like this:

Me: I'm suicidal. I don't come in because I'm always suicidal but I don't trust myself tonight. I don't know what to do- the thoughts and urges are unbearable.

Doctor: Can you commit to safety?

Me: ... um... sure... I guess? Yeah.

Doctor: Okay, here are your discharge papers. Call a DBT group. We're not taking you unless you are in immediate danger to yourself or someone else.

I was- and am- upset the hospital would not admit me, but given the mental health crises in the country, I try not to be too upset with the doctor and hospital because I know someone else needed that bed just as badly as I did. I'm more upset with our society for causing this problem and our unwillingness to change. We have created a culture where we mourn Robin William's tragic death, but then turn around and laugh at Amanda Bynes when she has very real, very dangerous problems in full view of the public. As a whole, our society doesn't do much or care for those one in four Americans, and doesn't care about the fact that resources are not all that available. Of course that doctor had to make a call that was shitty to me. Someone else was suffering because our society failed them, too.

So a few days later, after having an adult-sized melt down on the side of a freeway because I was too overwhelmed and didn't know what to do, the DBT clinic called and I had intake scheduled later that week. Shortly after, I attended my first DBT session in six or so years. I became one of those very lucky people again, but not until I had overdosed several times and suffered a pretty major relapse in my self-injury.

There are four modules of DBT; it takes about six months to get through all four modules. It's recommended that you go through DBT two consecutive times because DBT has a language of its own, and it can be difficult to both learn the lingo and master DBT skills just going through it one time. In my group, we attend three nights a week for three hours apiece. We divide the session into 50 minute segments with ten minute breaks. In those three hours we have a DBT "class", track our mental health symptoms, and group therapy. We are expected to attend each session, and while exceptions to call out can be made for emergencies, we can't miss too many, or we run the risk of being discharged from the group. We are expected to participate in group discussion, and do our DBT homework. We are also expected to do our best.

Even though I've been through DBT before, I was a bit nervous to start again, since this time I have an IBD diagnosis. While the clinic does have to be strict about attendance to make sure clients don't bail and not take care of themselves, they've also been pretty understanding of emergencies and illness. My IBD has been pretty well managed, so I haven't needed to excuse myself from the group more than 3-4 times in a session outside of break times, but my group facilitators have never cared. They understand I need my bathroom access just like a person with another disability might need motility aids. I also found that a lot of the people in my group have a physical disability, chronic illness, or chronic pain in addition to mental health issues. While I wish I had a magical wand to wave away everyone's ailments, it was a relief to know that other people in the group understand chronic pain/illness. My group has been absolutely awesome. I was also concerned about the cost, but the clinic I go to had financial help available. If DBT is something you are interested in, make sure to get your financial help set up so you can worry about taking care of you and not worry about the cost of your care.

The first time I went through DBT in high school, I went from being a girl who could not go more than an hour without hurting herself to a girl who could go weeks or months before the urges would become too much. It's not a magic cure, and you only gain what you put into it. It is a very, very tough program. But if you need DBT and you want to be well, it works. I can acknowledge it might not be a fit for everyone as it is a huge time commitment and is very intense, but I strongly feel everyone could benefit from learning at least some of these skills since these are skills people use every day without even realizing they are part of DBT. Lets face it, none of us are perfect when it comes to effectively managing mental health. Not even people without a mental illness are perfect at taking care of themselves all the time. There is always room to improve on yourself, and become the best, healthiest person you can be.

I did go through DBT once, but life happened. I was diagnosed with a chronic illness. I went through some bad things in my personal life. My family has been battling it's demons and that's been hard on all of us. It's no wonder I needed to go back to DBT to brush up on my skills! The important thing is I recognized I needed intensive help, reached out to someone. Even if the hospital didn't admit me those couple times, I still had people rooting for me. Someone helped me schedule DBT intake. My aunt listened to my angry rants when I was in a bad place. My dad came over to and spent a few nights at my place when the hospital wouldn't admit me just so he could protect me in case I did harm myself. I know I might need DBT again in the future, and I know it doesn't mean I've failed in my recovery. It just means that life is hard, and I need help managing it when the going gets tough, like how I need extra help managing my IBD when I flare. There's nothing wrong with that.