![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Dinah on August 16, 2003, at 16:40:08
I found someplace that offers online DBT skills training in ten week courses for each module. They assign homework and assess your diary cards, etc.
Does anyone have any thoughts on the subject?
Posted by judy1 on August 16, 2003, at 19:57:58
In reply to What do you think of online DBT?, posted by Dinah on August 16, 2003, at 16:40:08
Hi Dinah,
Haven't you dealt with an on-line therapist before? If so, how did it go? I've done DBT with my therapist (actually it's probably the core of what we do), but I guess it's difficult for me to consider not having her there to read her body cues and probably her read mine. While it sounds like DBT doesn't need the actual presence of a therapist because of all the 'homework', I still think having a therapist interact 'live' is important (this is totally my opinion). I know your therapist doesn't use this method which is a shame because it really is effective, so maybe because you are so motivated you will get some benefit. I hope it isn't terribly expensive. If you decide to do it, I'll be really interested in how it works for you. best of luck- judy
Posted by Dinah on August 16, 2003, at 21:51:16
In reply to Re: What do you think of online DBT? » Dinah, posted by judy1 on August 16, 2003, at 19:57:58
I did do an online therapy session, but it was more of a consultation thing. "Here's what's going on with me. Are we on the right track do you think." It worked out fine, and both validated our assumptions and gave a few new insights. I didn't do anything else with the online therapist though, and still actually have an hour prepaid that I don't know how to use.
There just isn't anyone around here who does skills training. I've thought of trying to see if my therapist would let me train him enough to coach me, but honestly I don't know if he would, and I don't know if I'd want him to. I don't want to lose my comforting therapist/mommy to an authoritarian therapist/father checking my diary cards and ragging on me. I've already got a nagging authoritarian husband/father and a yelling authoritarian father/father. While I'm the rebellious and sulky child. I don't want to recreate that dynamic yet again.
Perhaps I'll try to use the skills manual on my own and just ask my therapist to help me out with my specific areas that need work. For example, identifying "myths" that I have, or suggesting homework assignments. But not having him check the diary cards. That might just be too disruptive to the therapeutic alliance. I just don't take criticism well (even when it's called something other than criticism).
Posted by fallsfall on August 16, 2003, at 23:33:50
In reply to Re: What do you think of online DBT? » judy1, posted by Dinah on August 16, 2003, at 21:51:16
The diary cards don't necessarily generate a conflict. I found that they were a good way to record what was going on (so I wouldn't forget it). My therapist always looked at it from a standpoint of either "Wow that was good", or "Why was this hard and how can we make it easier for the next time.
I had enough trouble understanding the skills with the presentation in a group and immediate feedback from the therapists. If the online DBT is all text, I think it would be hard. If there is video then it might be better.
I think that you would need to go over the homework with your therapist to be sure you were understanding it. Would you want him to also make sure you did the homework?
I guess DBT is 3 things:
1. Review diary cards to see if there are problem areas
2. Review homework to make sure you did it/understood it.
3. Presentation of new material and demonstration of how the homework should be done.I'm impressed that you found DBT online! How can he say that you are lazy??????
Posted by Dinah on August 17, 2003, at 0:59:10
In reply to Re: What do you think of online DBT? » Dinah, posted by fallsfall on August 16, 2003, at 23:33:50
>
> I'm impressed that you found DBT online! How can he say that you are lazy??????Because I did it when I should have been working? (grin)
I think for the moment, I'll try using the skills manual without the online skills trainer. The trouble is that my therapist isn't trained in it, so I probably know as much as he does.
If he's willing, I think it would be a good idea to have him help me interpret the skills and think of ways to apply them. Maybe even to assess my abilities at different things. But not to routinely check the diary card or to ask how I'm doing in a routine way. I think that would make him too much one of the father/husband/boss people in my life. He already tread over that line this week. I don't take it well. And heaven help him if he suggests distress tolerance skills when he's the one who's upset me. No, way too much conflict of interest going if he gets too involved with the DBT. He'd only be able to do it from the didactic side, and stay out of the evaluation side.
I'm trying to figure out if it's good or not that I can guess my reactions with reasonable accuracy. I think it must be bad, because it means I'm not willing to change them. Hmmmm.....
Posted by Dinah on August 17, 2003, at 1:01:24
In reply to Re: What do you think of online DBT?, posted by Dinah on August 17, 2003, at 0:59:10
I'm not supposed to say good or bad. That's judging. I'm supposed to word it in terms of the consequences.
I'm not sure if being able to predict my reaction will cause me to avoid unneccessary pain. Or if it's a covert statement of being unwilling to change my reaction.
Posted by fallsfall on August 17, 2003, at 6:45:08
In reply to Re: What do you think of online DBT?, posted by Dinah on August 17, 2003, at 0:59:10
> >
> > I'm impressed that you found DBT online! How can he say that you are lazy??????
>
> Because I did it when I should have been working? (grin)This is a fine line. I might call that unfocused rather than lazy.
>
> I think for the moment, I'll try using the skills manual without the online skills trainer. The trouble is that my therapist isn't trained in it, so I probably know as much as he does.
>
He should be familiar with all of the material in the skills training, and should be able to explain it easily after a quick review of the section (to be sure that what he is teaching is what is in the section). He wouldn't necessarily be familiar with the DBT Therapist guidelines (i.e. how to prioritize issues, guidelines on types of communication (i.e. irreverent?), theory of why we are the way we are), but that shouldn't impact his ability to teach the skills.> If he's willing, I think it would be a good idea to have him help me interpret the skills and think of ways to apply them. Maybe even to assess my abilities at different things. But not to routinely check the diary card or to ask how I'm doing in a routine way. I think that would make him too much one of the father/husband/boss people in my life. He already tread over that line this week. I don't take it well. And heaven help him if he suggests distress tolerance skills when he's the one who's upset me. No, way too much conflict of interest going if he gets too involved with the DBT. He'd only be able to do it from the didactic side, and stay out of the evaluation side.
You are very, very defensive about these diary cards, and I really don't quite understand why. When you go to see him, do you tell him in general how things have been since the last time you saw him? "I've had a terrible couple of days, I just wanted to stay in bed and cry. I had to go to a Cub Scout meeting with my son and I couldn't talk to anyone and kept leaving to go to the bathroom." Or "Life's been wonderful! I cleaned off my desk, finished the big project for work, and went out for a romantic dinner with my husband". That's really all a diary card says. It gives a little more detail about how you are feeling and functioning. It has a place to indicate if you are hurting yourself or feeling suicidal. Is that what you are worried about? Don't you think he should know those things anyway? He won't be there to judge you any more than he is now (which I hope is never). The diary cards just are a more complete picture, and you don't have to worry about forgetting what went on on Wednesday. I always thought that the more information she had, the better off I was because then she could make better decisions on how to help me.
I understand that you are feeling a bit like he is ordering you around. I'm sure that you will talk to him about that. Either it was a mistake on his part, or he is trying to accomplish something - you need to find out which. But I think that your hesitence with DBT/Diary cards pre-dates that (am I remembering correctly?). I guess I'm still not clear what your concern is.
>
> I'm trying to figure out if it's good or not that I can guess my reactions with reasonable accuracy. I think it must be bad, because it means I'm not willing to change them. Hmmmm.....I think it is good that you can predict your reactions. That means that you are understanding yourself. It also means that you have some advance notice in case a less desirable reaction is coming - maybe that will give you enough time to change something and make things better.
Posted by Dinah on August 17, 2003, at 16:42:44
In reply to Re: What do you think of online DBT? » Dinah, posted by fallsfall on August 17, 2003, at 6:45:08
Yeah, I re-read the skills manual and a lot of what's in it is stuff he does in his CBT mode anyway. He'd probably be saying I told you so all the time. Of course, he usually annoys me in his CBT mode, and has to slip it in without my noticing it.
About the diary cards.... I am inordinately sensitive to the idea of transforming the one place I feel safe and nurtured into yet another place where I feel criticized and more than I feel I can do is expected of me. (family, extended family, work, health) If I have one more demand placed on me, even if it's something that will benefit me, I'll just blow a gasket. So any work has to be initiated and sustained by me, with only requested input from him.
I'm sure I'm more sensitive about the idea than I need to be, but I'm terrified of changing the nature of my safe person and being left with nothing that gives and renews rather than demands and depletes.
Posted by judy1 on August 17, 2003, at 16:44:03
In reply to Re: What do you think of online DBT? » Dinah, posted by fallsfall on August 17, 2003, at 6:45:08
Dinah,
I tend to agree with fallsfall- the cards are really just a way to facilitate in reporting what's going on in your life (which is why I guess I think the actual presence of a therapist is important). There were times when I did find myself more honest during 'homework' then during therapy hour, but that could be an organizational problem. Anyway, it sounds like you're thinking a lot about the dynamic between you and your therp, do you know what precipitated that (or is it ongoing?)
take care, judy
Posted by Dinah on August 17, 2003, at 16:59:12
In reply to Re: What do you think of online DBT?, posted by judy1 on August 17, 2003, at 16:44:03
Oh it's ongoing. I jealously guard the relationship we've built against any potential threats. The safety I feel with him is too important to my mental stability to jeopardize it for any DBT gains that may or may not arise.
I have no real problem being honest about what happens during the week with him, but if I don't feel like relating what happened to DBT skills or practicing what I could have done instead, I don't want him to feel like it's his place to push. It would just change everything, and I'd hate that to the point of being totally.... Well, I'm not always the most reasonable person in the world.
Even something as simple as him asking to see the diary card, or commenting if I didn't fill it out, or asking what distress tolerance skills I could have applied. Even if he did it non-judgementally. If he did those things on a consistent basis, I would feel like he was pushing me. And I'd dig in my heels, act very badly indeed, and blow up continuously. Probably storm out of sessions. And lose my safety.
On the other hand, it would make it really really easy to cut down on the number of times I'd want to see him.
Ok, you CBT types. I know I'm fortunetelling here. But I prefer to call it evaluating past experience and applying it to future possibilities.
I'll discuss it with him on Tuesday. But in the past, whenever I've gotten on a CBT kick and asked him to help me stay on task and evaluate my progress, he has quite wisely declined. I'm sure he knows as well as I do the pitfalls involved and we can probably work out an acceptable arrangement.
Posted by fallsfall on August 17, 2003, at 21:18:26
In reply to Re: What do you think of online DBT? » fallsfall, posted by Dinah on August 17, 2003, at 16:42:44
I certainly understand your desire to keep your "safety". I wish it was 6 months from now and I had a safe place.
I do not think that you should jeopardize that.
I guess that I see my therapist more like a teacher or coach or fitness trainer. I figure that he has some knowledge that I could use. I also think that he can see things more objectively than I can. He's working for what is best for me (and he is literally working *for* me). If I don't like what he's doing I can tell him, but I really should listen carefully to what he says because I may know more about me, but he knows more about the rest of the world.
I see us as a team.
Sometimes I think a therapist can push too hard. But I think that sometimes when we think they are pushing too hard, they are really doing it in our best interests. Reminds me of convincing my kids to get their shots - it *does* hurt, but the benefits are worth the pain.
I'll stop talking now. If I've been too pushy please chalk it up to vacation fever.
Posted by Dinah on August 17, 2003, at 21:39:19
In reply to Re: What do you think of online DBT? » Dinah, posted by fallsfall on August 17, 2003, at 21:18:26
Certainly not too pushy. :) Looks like you were over here worried about offending me, while I was on social worried about offending you.
Posted by judy1 on August 18, 2003, at 1:43:02
In reply to Re: What do you think of online DBT? » fallsfall, posted by Dinah on August 17, 2003, at 21:39:19
It sounds like you really need to keep the status quo with your therp, and the DBT diversion is something you want to approach on your own- duh:-)
I do understand that need for safety and it's very apparent that you have it with him (which is wonderful). I don't think I would want to jeopardize that either- not that I think you would jeopardize it by bringing up something different with him, but if it makes you uncomfortable that means your perception changes which is what is most important here. good luck with your decision- judy
Posted by Dinah on August 22, 2003, at 13:28:17
In reply to ok, I think I finally get it:-) » Dinah, posted by judy1 on August 18, 2003, at 1:43:02
And he is in agreement with my ideas about how he should be involved. So today we discussed ideas of how to best customize the diary card to fit my own issues. And how to quantify those 0-5 scales, because I am generally at a loss with those subjective scales. He had some good ideas, and I'm going to work on it while he's gone.
Oh, and his itinerary was in error. He'll be back Friday, so it'll only be one week. And he apologized for his poor choice of words last week. He says that he was thinking aloud, and that he sometimes forgets that when he starts with the beginning of a thought with the intent of working all the way through it, that I get scared that the end result will be something that I don't like. So he said he'd try to keep that in mind.
And I reminded him of the results of flaming amygdala attacks. That he needs to say all the good stuff *first*, then the bad stuff. Because once he says the bad stuff, the chemical reactions start happening and it's hard to get back to normal quickly.
Altogether a nice session.
Posted by fallsfall on August 22, 2003, at 13:37:04
In reply to Re: We started working together on it, posted by Dinah on August 22, 2003, at 13:28:17
I'm so glad it was a good session. And you'll only miss one session for his vacation. I'm happy for you.
Posted by noa on September 1, 2003, at 9:49:06
In reply to Re: We started working together on it, posted by Dinah on August 22, 2003, at 13:28:17
>
> And I reminded him of the results of flaming amygdala attacks. That he needs to say all the good stuff *first*, then the bad stuff. Because once he says the bad stuff, the chemical reactions start happening and it's hard to get back to normal quickly.And I'm sure at that point, you can't even really hear the good stuff!
I loved reading this--I love seeing how you use the flaming amygdala phrase to name what is happening!!! And, now you are educating your therapist about what is going on inside you, and asking for what you need in therapy! YAY!
>
Posted by Dinah on September 1, 2003, at 10:24:22
In reply to Re: We started working together on it, posted by noa on September 1, 2003, at 9:49:06
This is the end of the thread.
Psycho-Babble Psychology | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.