![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 29 to 53 of 88. Go back in thread:
Posted by gardenergirl on July 1, 2006, at 12:23:55
In reply to Ideas about content and structure, posted by gardenergirl on July 1, 2006, at 12:16:17
I also think we need to agree on some rules/guidelines for the group. Some for us to consider include:
· No one has to post or participate at any time if they don’t wish to.
· Maybe a statement or some other “consent” that this is a self-help process, agreeing that it is not therapy, not therapist or otherwise professionally led, it’s voluntary, etc. Do we need to talk about possible risks?
· Our interactions should be non-judgmental, supportive, constructive, etc. And how do we handle any incidences of incivility as a group (assuming Dr. Bob or non-participating deputies might intervene?…I would not feel comfortable acting as a deputy for these posts if I’m so involved. I suppose unless there’s something grossly inappropriate.)I’ve also thought of the following potential concerns that may or may not actually happen and may or may not need addressing either in advance or as they might occur. What concerns do others have?
· Anything we post about our skills practice or events going on will be archived in Babble. Will this present a problem/concern? I suppose we could form a closed yahoo (or some other) group instead of doing this here if it’s a strong concern.
· Others who are not participating will be able to read our threads as they develop. Some might choose to post comments or questions. Will this be an interruption or trigger? How should we handle these? A couple of thoughts I had about this: we could politely ask the person with the comment or question to begin a new thread, and anyone who wishes to participate in that dialog may do so. Or…(I cringe to even suggest this), maybe this would be a good trial for a small, closed board? (ducking…just an idea).
· If we rotate leaders, and more than one person volunteers to lead a module or even a week, how do we decide?
· How to handle any conflicts which might come up.
· How to handle triggers, and what constitutes a trigger (a big topic).
· How to handle disclosures: i.e. no one can share these with those outside of Babble? No one has to disclose. No pressing for details if the person does not wish to give details?
· Can people join at any time? Only at the start of a new module? If someone drops out, can they drop back in?What do you think? Any other concerns or suggestions? Anyone want to volunteer to write up the rules as a post when we agree to them?
gg
Posted by Dinah on July 1, 2006, at 12:46:54
In reply to Ideas about content and structure, posted by gardenergirl on July 1, 2006, at 12:16:17
> Potential content:
> There are four modules: core mindfulness skills , interpersonal effectiveness skills, emotion regulation skills, and distress tolerance skills. According to the manual, the latter three can be covered in eight weeks each, although I think we might do better to allow two weeks between “assignments”, so likely we will need to go longer. The book also says to allow 2-3 sessions for the mindfulness skills. These skills are infused throughout the rest of the program, allowing us a chance to refine them and apply them fairly regularly.
>
> In each module there are “lessons” and activities that would be done in the group session, and then homework assignments. The homework is reviewed in the next “session”. So one way we could do this is to have someone (the current leader?) start a discussion about the current lesson/topic and describing the skills. We could take a week or some other amount of time to discuss it in a thread, and then take a week or two to do the homework and then post about it? Maybe Day 1 of topic: Start discussion thread. Day 5 (or 7): Assign/explain homework. Day 10 (or 14) start posting homework experiences. Going forward continue any discussion as needed about this, but at the same time (Day 14?) the leader introduces the next lesson? Or do we need to have a period of time to end discussion of current homework before moving on?I think it's fine to move on. But one advantage to having separate threads for separate lessons is to have it be possible for people to go back to a lesson or catch up on lessons without confusing the current lesson. I think you suggested linking the threads on a central thread? I think I'd vote for that.
>
> I also thought that maybe we could have a standard way of making subject lines that identify which module/activity it refers to. I think that would be easier for me, at least. And if someone gets behind, we could easily see what their posts refer to. For example, a subject line about the first Mindfulness lesson could include at the beginning: “M1” and then discussion. Or M1 homework. Or M1 question? Or M1 (specific issue/topic), etc. I don’t think we need to make this mandatory, but I think it would help.That does sound good, and also separate threads would help.
>
> Also, should these be all in one gigantic thread, or a new thread for each module? New thread for each lesson? Separate discussion and homework threads? Hmm, if this could be a large sticky thread (linked at the top) that could be helpful.My vote would be a new thread for each lesson linked from a central thread.
>
>
>
> Another aspect of DBT skills training as it’s written is the use of diary cards. These are used to track specific behaviors and feelings, as well as track practice and use of the skills. I think that tracking is a useful thing, as our “impressions” of how we are doing are not always accurate. So I think there are two questions about diary cards. One, do we want to use them? And then if we do, do we want to share them either generally or specifically? There are also different versions of the diary card available. I found the following at: http://home.everestkc.net/vics/Diary%20Cards/diary_cards.htm
> A few examples below.
> Original card: http://home.everestkc.net/vics/Diary%20Cards/original%20diary%20card.pdf
> Newer version: http://home.everestkc.net/vics/Diary%20Cards/DBT%20style%20mood%20chart%204-17-5.doc
>Maybe people could share as they feel comfortable? Different people seem to have different comfort levels on what they feel comfortable disclosing.
> This one does not have a place to mark skills used, but it’s otherwise pretty good. The others are options as well. There may also be other versions out there, but I just clicked on the first google link. So if anyone finds something else, we can look at that as well. Links to the handouts and the book below:
>
> http://www.borderlinepersonality.ca/dbt.htm
> http://www.amazon.com/exec/obidos/ASIN/0898620341/drbobsvirte00-20
>
> Other ideas? Reactions? Suggestions for when to start?
>As soon as possible? I'm looking forward to it.
Posted by Dinah on July 1, 2006, at 13:07:56
In reply to Potential concerns, ideas for rules, posted by gardenergirl on July 1, 2006, at 12:23:55
> I also think we need to agree on some rules/guidelines for the group. Some for us to consider include:
> · No one has to post or participate at any time if they don’t wish to.
> · Maybe a statement or some other “consent” that this is a self-help process, agreeing that it is not therapy, not therapist or otherwise professionally led, it’s voluntary, etc. Do we need to talk about possible risks?
> · Our interactions should be non-judgmental, supportive, constructive, etc. And how do we handle any incidences of incivility as a group (assuming Dr. Bob or non-participating deputies might intervene?…I would not feel comfortable acting as a deputy for these posts if I’m so involved. I suppose unless there’s something grossly inappropriate.)I think those are good rules. And I'm sure incivilities would be handled under ordinary Babble guidelines. I'm with you about preferring not to deputize when I'm involved, unless it is a gross violation of the civility rules.
>
> I’ve also thought of the following potential concerns that may or may not actually happen and may or may not need addressing either in advance or as they might occur. What concerns do others have?
>
> · Anything we post about our skills practice or events going on will be archived in Babble. Will this present a problem/concern? I suppose we could form a closed yahoo (or some other) group instead of doing this here if it’s a strong concern.
> · Others who are not participating will be able to read our threads as they develop. Some might choose to post comments or questions. Will this be an interruption or trigger? How should we handle these? A couple of thoughts I had about this: we could politely ask the person with the comment or question to begin a new thread, and anyone who wishes to participate in that dialog may do so. Or…(I cringe to even suggest this), maybe this would be a good trial for a small, closed board? (ducking…just an idea).I guess there'd be the same advantages or disadvantages as always to an open and archived forum like this. People should use their customary judgement about disclosure. You would miss some of the advantages of a IRL closed group but would gain the advantages of someone becoming interested and deciding to join in in whole or in part.
> · If we rotate leaders, and more than one person volunteers to lead a module or even a week, how do we decide?
First post offering gets the job? And those who have led before wait until there is no leader forthcoming with time run out to volunteer again?
> · How to handle any conflicts which might come up.
With our customary tact and grace? And Dr. Bob to fall back on? I've never been involved in DBT. Is there a greater than ordinary chance for conflict?
> · How to handle triggers, and what constitutes a trigger (a big topic).
Given the topics covered in DBT, triggers are probably a definite issue. We request that people follow the trigger warning customs that appear to be in the process of becoming formalized on Babble? If anyone has any specific triggers, others try to be polite by pointing them out in the subject line?
> · How to handle disclosures: i.e. no one can share these with those outside of Babble? No one has to disclose. No pressing for details if the person does not wish to give details?
Definitely no pressing. On an open internet board like this, I'm afraid confidentiality will of necessity be limited.
> · Can people join at any time? Only at the start of a new module? If someone drops out, can they drop back in?
Because of the nature of this place, maybe the ordinary rules of DBT groups could be waived? Apart from all else there may be lurkers following who are moved to join in at any given point. Babble hospitality would indicate they be welcomed. Suggestions on reading the modules could be given as necessary, if it's clear someone has no idea what we're doing. I know it's not how DBT is usually done, but this isn't the usual forum either.
>
> What do you think? Any other concerns or suggestions? Anyone want to volunteer to write up the rules as a post when we agree to them?
>
> gg
>That seems reasonable. At the beginning or as things come up, after discussion someone could write up the conclusion we've come to, and post it somewhere along with other conclusions.
I'm wondering if Dr. Bob would let us enforce nonBabble rules?
Posted by gardenergirl on July 1, 2006, at 22:05:10
In reply to Re: Potential concerns, ideas for rules, posted by Dinah on July 1, 2006, at 13:07:56
Posted by Dr. Bob on July 2, 2006, at 4:48:06
In reply to Re: Potential concerns, ideas for rules, posted by Dinah on July 1, 2006, at 13:07:56
> > · Maybe a statement or some other “consent” that this is a self-help process, agreeing that it is not therapy, not therapist or otherwise professionally led, it’s voluntary, etc.
>
> I've never been involved in DBT. Is there a greater than ordinary chance for conflict?
>
> Given the topics covered in DBT, triggers are probably a definite issue.
>
> Because of the nature of this place, maybe the ordinary rules of DBT groups could be waived?Would this *be* DBT? Or just discussing it?
> I'm wondering if Dr. Bob would let us enforce nonBabble rules?
It's something we could discuss...
Bob
Posted by gardenergirl on July 2, 2006, at 4:56:33
In reply to Re: Potential concerns, ideas for rules, posted by Dr. Bob on July 2, 2006, at 4:48:06
> Would this *be* DBT? Or just discussing it?It would not *be* DBT, as that involves much more than just the skills training. It also would not be DBT skills *training* as it occurs in individual or group psychotherapy. Instead, I am viewing this as a group of individuals with a common interest in developing these skills via a self-help approach. Instead of each of working through the workbook on our own, we agree to do it together in order to stay on track, give and receive feedback, and have support.
> > I'm wondering if Dr. Bob would let us enforce nonBabble rules?
>
> It's something we could discuss...When I suggested we might need "rules" or guidelines, I was thinking these would be things that the group would work to resolve together. I do think the babble rules still need to apply. If there were to be a major conflict, civility rules still apply, but I'd like to see us as a group try to deal with the conflict, as well. It would be a good opportunity to practice new skills! :)
Thanks for weighing in on this, Dr. Bob. I know that this could have implications for you if we are not clear about what this is and what this isn't.
Posted by Dinah on July 2, 2006, at 9:24:28
In reply to Re: Potential concerns, ideas for rules, posted by Dr. Bob on July 2, 2006, at 4:48:06
We've been talking about this for a while, Dr. Bob. A lot of us want to practice DBT skills, but find the motivation is hard to come by in a solitary setting. So we're just practicing together. Clearly it's not a skills group per se. There's no overall leader, although we'll take turns starting up discussion in each individual chapter. It's not terribly unlike the thread that mainly Midnight Blue and I are doing on Health about weight (although others are certainly welcome to join in). If there are ways you would prefer we structure it, please let us know.
Posted by Dinah on July 2, 2006, at 9:25:21
In reply to Should we start Monday July 10? (nm), posted by gardenergirl on July 1, 2006, at 22:05:10
Sounds great. Anything we should do before then? Download diary cards or handouts? Read anything from the skills manual if we have it?
Posted by canadagirl on July 2, 2006, at 14:39:14
In reply to Re: Potential concerns, ideas for rules » Dr. Bob, posted by gardenergirl on July 2, 2006, at 4:56:33
I like the idea of having headers for the threads depending on the heading of the section being discussed. I know I would get lost in a big thread, (um... and I don't know what a "sticky" thread is...)
I think the "rules" could have suggestions similar to terms of reference in a working group (is Dr Bob is concerned about the word "rules?") e.g., an understanding that we are not engaging in "therapy", that the members of the group are communicating information, the the group will review and comment on the sections, there will be a respectful environment,etc.
Anyway just a suggestion. I'm on vacation until July 9 so the 10th works for me; someone suggested that date?
I think this is a great idea by the way.
Posted by Jost on July 2, 2006, at 20:43:29
In reply to Should we start Monday July 10? (nm), posted by gardenergirl on July 1, 2006, at 22:05:10
Posted by fallsfall on July 2, 2006, at 20:43:43
In reply to Re: Potential concerns, ideas for rules ? gardenergirl, posted by canadagirl on July 2, 2006, at 14:39:14
I don't have the time to join you guys formally, but I've done DBT, so I may comment now and then.
There was a question about diary cards. They serve two functions in DBT, in my opinion. The first is to give the patient a way to track their moods and what things in their lives impact their moods. The second is to make sure that everything is discussed with the therapist. I think that the first could be helpful for Babblers. It can be helpful to see things that happen in a day and the impact they have.
So I would recommend that people do the diary cards for themselves.
Posted by rubenstein on July 3, 2006, at 12:04:47
In reply to Going through DBT skills training book together, posted by gardenergirl on June 29, 2006, at 9:39:55
> I have the book and I would be interested.
rachel
Anyone still interested? I'd like to go ahead and at least go through it myself, but I'd love to have others join me.
>
> I'm not sure exactly how best to do it, but we could set a rough time frame for different modules and the lessons in them. I would recommend starting with the Mindfulness module, and then we could either follow the book in order or vote on what module we wanted to do next.
>
> Many of the lesson handouts are available online at www.dbtselfhelp.com , so those who don't have the book and can't get it from a library can still follow along with the exercises.
>
> We could take turns facilitating the discussion for different sections so that one person isn't seen as the leader.
>
> Any other ideas?
>
>
> gg
Posted by Dr. Bob on July 5, 2006, at 23:27:46
In reply to Re: Potential concerns, ideas for rules » Dr. Bob, posted by gardenergirl on July 2, 2006, at 4:56:33
> It would not *be* DBT, as that involves much more than just the skills training. It also would not be DBT skills *training* as it occurs in individual or group psychotherapy. Instead, I am viewing this as a group of individuals with a common interest in developing these skills via a self-help approach. Instead of each of working through the workbook on our own, we agree to do it together in order to stay on track, give and receive feedback, and have support.
>
> When I suggested we might need "rules" or guidelines, I was thinking these would be things that the group would work to resolve together. ... I'd like to see us as a group try to deal with the conflict, as well. It would be a good opportunity to practice new skills! :)OK, sounds good!
Bob
Posted by gardenergirl on July 6, 2006, at 9:01:05
In reply to Re: Potential concerns, ideas for rules, posted by Dr. Bob on July 5, 2006, at 23:27:46
1. Obtain a copy of the book "Skills Training Manual for Treating Borderline Personality Disorder" if possible.
2. Read pages 59-61 (and any of the beginning that interests you). The first "session" as described in the book begins on page 59 and is an orientation. Not all of what's there will apply to this format, but it describes different types of behavioral patterns and how the different skills can help. As an introduction, it might be helpful for each of us to say a few words about what you hope to get out of this process, if there are any specific problems or issues you want to pay special attention to, or any other comments or feedback. I think we could cover that with allowing just a few days, and move to beginning the core mindfulness skills module right away.
3. Select a diary card format (if you choose) and begin filling it out. If you do the diary cards, you will do one each week. I think I'd prefer to do this on my own, and to share aspects of it when I wish versus posting it anywhere. What do others think?
4. Start reading Chapter 7, Core mindfulness skills (pages 63-69). I'll make a post to introduce this topic (for those who don't have the book) and start a discussion about it. There are no homework assignments for the module, but there are activities to try, and we can do these and post our reactions.
5. Download or view from book the three mindfulness handouts. http://www.borderlinepersonality.ca/mindfulness.pdf Post any questions or comments you have about them in the discussion thread (coming soon).
Does this work for everyone? Feedback welcome. I'm not sure what issues might still be up in the air, except maybe how to link threads and such. But I'll check back in and do a bit more later.
I'm excited about this! :)
gg
Posted by Dinah on July 6, 2006, at 9:38:29
In reply to Okay, things to do before July 10, posted by gardenergirl on July 6, 2006, at 9:01:05
I'm excited too!!
I've got my books out already, and I've been updating my therapist on Linehan.
I've printed out this post as well as bookmarked it. Hopefully I'll be able to check things off before Monday.
Posted by puravida on July 6, 2006, at 19:47:32
In reply to Okay, things to do before July 10, posted by gardenergirl on July 6, 2006, at 9:01:05
I'd like to join you guys. My T recommended this to me but the time away from work is too much.
BTW, I have been diagnosed w/depression, not borderline - so???? I guess either it is being used for more than borderline or I she thinks I am borderline and hasn't said it...
Either way, can't hurt, right?
Posted by Dinah on July 6, 2006, at 20:54:43
In reply to Re: Okay, things to do before July 10, posted by puravida on July 6, 2006, at 19:47:32
Love to have you!
Originally, her research and treatment were for suicidal and self injury behaviors and thoughts. It later got expanded to borderline, but I think it's good practice for just about everyone. Maybe should be taught in elementary school.
It's good sensible stuff.
Posted by Jost on July 7, 2006, at 19:35:01
In reply to Re: Okay, things to do before July 10 » puravida, posted by Dinah on July 6, 2006, at 20:54:43
Got the book day before yesterday. Looks to me like anyone could benefit from it-- definitely anyone who suffers from "emotional dysregulation" (or, is emotionally intense, whichever you prefer)--
I'm interested to read and possibly discuss some or all of the first 50+ pages, and have read the first chapter--
but I'm glad we're skipping to the workbook--
I have a couple of concrete goals in mind-- around which I might orient my thoughts-- and I'm very much looking forward to this.
Jost
Posted by gardenergirl on July 8, 2006, at 17:44:21
In reply to Re: Okay, things to do before July 10 » gardenergirl, posted by Dinah on July 6, 2006, at 9:38:29
Yeah! It's okay if you're not ready with every last thing on Monday. Heck, I might not be. :) But we'll have fun and learn stuff and it will go how it goes.
:)
gg
Posted by gardenergirl on July 8, 2006, at 17:47:44
In reply to Re: Okay, things to do before July 10, posted by puravida on July 6, 2006, at 19:47:32
Hmmm, I could swear I made a post in reply to you, but maybe I just imagined that. :)
Welcome! I'm glad you're joining us, and I hope you enjoy it. As Dinah said, the skills are not just for BPD anymore. There are studies using them with depresion and eating disorders. I'm sure that different therapists use some version of them with clients with other diagnoses, too.
gg
Posted by gardenergirl on July 8, 2006, at 17:52:24
In reply to Re: Okay, things to do before July 10, posted by Jost on July 7, 2006, at 19:35:01
That's great! Sounds like you're leading the pack with getting started. I've got to think about some concrete goals for myself. And review the reading, since it's been awhile for me.
:D
Posted by Jost on July 10, 2006, at 19:21:41
In reply to Diary cards, posted by fallsfall on July 2, 2006, at 20:43:43
Does anyone know where there's a fuller description in the Skills Training Manual for the diary card shown on page 32 (and mentioned briefly on page 31)?
The front of the card has areas for alcohol, OTC medications, prescriptions, misery, etc. I'm not sure how to fill it in (if I were to) and what these refer to--is it just using these things? or using them in a way that you shouldn't?
There are what look like acronyms (DEAR MAN, GIVE, FAST, etc).
Also there are some blank colums on the right and I'm not sure what they're for.
Is there an online explanation somewhere?
This therapeutic approach seems down-to-earth, a really useful, practical guide to living.
Jost
Posted by fallsfall on July 10, 2006, at 22:08:26
In reply to Re: Diary cards, posted by Jost on July 10, 2006, at 19:21:41
Those areas in the diary card are so you can keep track of things you did or did not do.
If you drink alcohol, then you put it on the card. Later, you may see a pattern that shows you that when you drink alcohol bad things happen, or you are extra depressed the next day, or that you usually drink alcohol after something particular happens.
Prescription drugs - write down if you took your meds on time. This can help you to remember to take them, or can make you aware that you have forgotten them. I find that if I start forgetting to take my meds that it is a red flag that something is bothering me. You can also record if you take any PRN meds that day.
For misery, rank your misery on a 1 - 10 scale. Then you can chart your misery, and figure out if things are getting better or worse, or see if you have patterns to when you feel the worst.
The purpose of the cards is to make you aware of what is going on in your day, and also to give you a record so that you can see patterns in your life (like "every time I talk to my mother on the phone I drink", or "when I forget to take my meds in the morning, I feel really lousy", or "if I get 7 or more hours of sleep I have a good day"). These patterns are often very simple, but you don't notice them unless you keep track of certain things.
As you go through the DBT program, you will learn the acronyms. You can ignore those sections until you come to them.
You can use the blank columns for whatever is important to you to keep track of. For instance, how many times you SI, or what time you get out of bed, or how many people you talk to, or if you took a shower, or how many hours of sleep you got.
Good luck!
Posted by gardenergirl on July 10, 2006, at 22:30:32
In reply to Re: Diary cards, posted by Jost on July 10, 2006, at 19:21:41
Heck's Becks. I didn't get to this today. My T was a half hour late for our session today (I really think he forgot that it was scheduled an hour earlier than usual!), and this afternoon was spent trying to calm myself and the dog from the chirping smoke alarm. Every 39 seconds for 3 hours!!!!!!!!! Aagghh~
Jost, thanks for posting today. I appreciate the reminder in my inbox.
I apologize for not being prepared today. I will get on this first thing tomorrow. After my rescheduled T appt., that is. Bah.
About diary cards.... the acronyms like DEAR MAN and PLEASE MASTER refer to specific skills. As we get to them we should start logging on the diary card if we practiced them or used them in a situation. But for now, if it doesn't apply or we haven't gotten to it, we can skip those sections.
The diary cards are explained in Chap. 6 of the main book versus this manual, which is kind of annoying. The original card was designed to track mainly self-harm behaviors. So for example, the first column, alcohol, is where you would write how many drinks and what kind you may have had that day. The next few are pretty much the same. When you get to suicidal ideation and misery, you rank them from one to five. Zero is the absence of a behavior, urge, or feeling. Five represents the most intense or worst behavior, urge, or feeling according to the column header. The last column, "Used skills" has a key at the bottom of the card (1-7). The two empty columns are for customizing the card. You can add anything you want to track there.
I'm not planning to use the original version of the card, since a lot of it doesn't seem to meet to my needs.
I thought I had more versions or links to versions in a file on my hard drive. I do have one that I modified that is specific to eating disorders, so if anyone is interested in that one, email me and I'll email the file to you.
I'll keep looking about other versions. In the meantime, I think I'll use this one, although I wish it was a one-week version versus a one-month.
http://home.everestkc.net/vics/Diary%20Cards/DBT%20style%20mood%20chart%204-17-5.docMore later,
gg
Posted by gardenergirl on July 10, 2006, at 22:59:07
In reply to Re: Diary cards, posted by gardenergirl on July 10, 2006, at 22:30:32
Thanks for posting that, Falls! :)
Here are some links about diary cards that look useful (the site map for the www.dbtselfhelp.com site lists "traditional diary card" as one choice, but it pulls up the alternate version from what I can tell.
Explanation: http://www.dbtselfhelp.com/html/diary_card_explanation.html
A rather complicated version supposedly in Microsoft Excel (but I'm not sure how you make it work): http://www.dbtselfhelp.com/html/diary_card_4.html
Another link (Do these look wonky to anybody else?): http://www.dbtselfhelp.com/html/diary_card_3.html
What they call the "traditional card":
http://www.dbtselfhelp.com/html/diary_card_1.html
Another alternate version:
http://www.dbtselfhelp.com/html/diary_card_2.html
Example of a completed card:
http://www.behavioraltech.com/downloads/diarycrdexamples.pdf
Okay, I'll stop now. :)gg
Go forward in 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.