DBT: Live with Claire Whetter MS, LPC IT, NCC

Is DBT therapy for you? Today Claire with be sharing information on DBT. What is it? Who can benefit from it? What can DBT help with? Why she utilizes DBT in her practice?

Laurie: Hi! My name's Laurie Groh. I'm co-owner at Shoreside Therapies today. Today we're here again with Claire Whetter and we're going to be talking about DBT today and welcome Claire.

Claire: Thanks! Hi, Laurie.

Laurie: How is it going?

Claire: Good! How are you today?

Laurie: Good, good, it's beautiful out, so pretty good now!

Claire: Yeah, absolutely, I'll have to go outside after this.

Laurie: Yeah! So let's get started. I want to hear a little bit about DBT. I don't actually use that all that much in my practice, so I'm very, very interested in hearing how you use it. I think we should start out with just describing what it is and go from there.

Claire: Yeah, absolutely so DBT stands for dialectical behavior therapy and that dialectical piece is the biggest part of it. So that's asking us to think dialectically, which means looking at that grey area. So a lot of times when we might feel depressed or we have anxiety, we're thinking in black and white. So this is right and this is wrong. This is good and this is bad and the dialectic part of DBT asks us to look at, well, is there anything good in this bad thing going on or anything positive in this negative situation? So it's kind of learning to live in that grey area which a lot of times can make things feel a little bit better and we have a better world. So that's kind of an overview of the dialectic and what it stands for. There are also four modules within that teach different skills. So throughout my practice I don't necessarily like go through each module in any certain order, just kind of adding in skills that help the client in that moment. So I always start, though, with mindfulness. So how can I just be present in the current moment, so enjoying what I'm doing, really engaging with it, not thinking about the past or the future, not ruminating about problems that I might have going on. I'm just enjoying life or engaging in the activity that I'm doing and then...

Laurie: Just being present, right? Being present, being awake in the moment, and taking it in.

Claire: Right. A lot of times, I'm asking clients like: did you actually enjoy that? Do you remember how that was? Did you feel happy? Did you feel sad? And a lot of times they're like no, I don't even know, because I was thinking about how much anxiety I had the whole time.

Laurie: Right, right, so that's the first part.

Claire: Yep! So then I kind of move into the stress tolerance skills, which are going to help us get through those moments of anxiety. So maybe I'm out with friends and I have a lot of social anxiety so I can use those skills to help me get through that moment. So there are short-term skills that are going to help me get through distress or just essentially a crisis moment, so an anxiety attack or something like that.

Laurie: So working on that distress tolerance, would you say, or finding coping skills on how to deal with it?

Claire: Yeah, so like it says, distress tolerance, so it's also kind of teaching our brain that it's okay to feel uncomfortable and I can get through this. It doesn't have to be a catastrophe that I have anxiety when I go to the grocery store or when I do something like that, so I can get through this and the skills will help make it a little bit more comfortable.

Laurie: Sounds great.

Claire: Yeah, so then I will move into emotion regulation, which is more long-term. So those skills are going to help us, like we say in DBT, create that life worth living. So how do I deal more long-term with my anxiety or figure out why I have this anxiety and kind of like reframe some of those things? We talk about checking the facts. So is this level of anxiety justified for the situation and just in general, how do I regulate myself? Have emotions, not let them take over and enjoy my life or get my life back from my mental health issues?

Laurie: Well, that I mean that does sound really amazing. Right. Being able to just enjoy your life and having the skills for not just the short-term moment then, so more of how do we see this moving on, how do we see this in our future, and how do we continue down that?

Claire: Right, yeah, it could be detrimental if we only use those just distress tolerance skills, because then we would be kind on this, like up and down, up and down. I feel okay now I'm not so emotion regulation skills are important, and then the last model is interpersonal effectiveness, which is one of my favorites. So how do I communicate with others around me, have positive relationships and how do I have a positive relationship with myself? So being honest with myself about how I feel and being fair to myself, and that it's okay to have these emotions, and that doesn't mean that I'm a failure or that I can't deal with these things. Everyone has emotions, so we have to learn how to deal with them essentially.

Laurie: How to accept them right? I mean, I think that's the number one thing that happens with clients I'm working with is that same thing is: I'm feeling this way and now I'm feeling bad or guilty because of this feeling, instead of maybe moving towards the reality, which is that we all have different emotions and they can be really negative at times, and we might wish that they were different. I wish I didn't feel this way, but ultimately we feel that way, and accepting it, now what do we do with it right?

Claire: Right, yeah, how do I tell someone that I'm feeling this way or that something they did really bothered me in a way that's not going to damage our relationship as well.

Laurie: Right, more thoughtful, more relational thinking about that other person. How are they going to take the information, how are they going to receive it and moving from that? So that's really great. I like that module myself. I work a lot with relationships and how people can change how they say things, how they navigate relationships and how to think about the other person when communicating. That's really hopeful.

Claire: Yeah, absolutely.

Laurie: So that was a great breakdown of DBT and the four modules and how you work with clients, and so you kind of jump around it sounds like it's not just hey, day one we're going to do this, day two we're going to do this, it's meaning that client where they're at.

Claire: Right. So if I was going to run a group which kind of stay tuned for that, I would probably have a certain order of the things that I would do, and if I'm doing individual sessions, I'd definitely meet the client where they're at. So if you're having an interpersonal issue, let's work on some of those skills. If you're really struggling with high anxiety, you can't leave the house, things are feeling difficult. Let's work on those distress tolerant skills. So really just meeting the person where they're at, like you said.

Laurie: Yeah, that sounds awesome, so it sounds to me like it could benefit anyone. But who would you say DBT is really meant for? Who can benefit from it?

Claire: Yeah, so for a long time, DBT got this reputation of only being for people with borderline personality disorder and over the last few years we've really been able to use it with a lot more population. So I've used it for people who are trying to get ready to do trauma work. They want some skills to be able to deal with that a little bit easier as they process. It can also be really helpful for anxiety like we've been talking about, depression. I've also worked with some patients with OCD and things like that. So really there's a wide range of people that can benefit from it and it can help with a lot of issues. And again we don't always use each module or all of the concepts. We can take small pieces of it and it can be helpful.

Laurie: Right, picking what might work for that person too. Some people might relate more to the relational aspect of it and wanting to communicate better versus maybe less on the distress tolerance. So you can move it around a little bit, which sounds really cool.

Claire: Yeah, absolutely!

Laurie: So what specifically, can DBT help with?

Claire: Yeah, so I think in general it can really help you kind of get back to like enjoying life like we've been talking about. So maybe my depressions really been getting in the way, or I'm just really kind of feeling too much anxiety to engage with other people to do the things that I used to like to do, and it's going to give you some skills that are going to help you get back to those things. Like I've been saying a little bit, it kind of gives you back the control from your emotions. A lot of times when our emotions are really intense, it feels like we're out of control and DBT is going to help us kind of real that in, so that we still experience our emotions while feeling confident in our ability to handle them and not have them ruin our entire day or ruin a moment with someone that we care about.

Laurie: Right, right, and it does seem like the mindfulness aspect can help a lot with that. Kind of taking that almost like just a smidge of a step back and observing what that feeling is in order to then know what to do with it. So that makes a lot of sense.

Claire: Yes. Mindfulness is at the core of everything within it and I think sometimes people hear mindfulness and I'm like, oh, I don't like meditating, I don't want to just sit there and do nothing, and that is absolutely not what it's about. You can do that but it's really just about enjoying and being in the moment.

Laurie: Yeah, yeah, being present, instead of thinking about what's going to happen or what could happen or what did happen, it puts us right in the place we need to be, which is right now. And you know it's not just that, though. It sounds like that's part of it, but you still have to somewhat have some plan for the future, like you said, otherwise you're moving up and down and just kind of going with whatever comes next, which in the moment maybe makes sense, but not for the long term. So I like how that integrates all of those aspects.

Claire: Right, I think it's important to figure out, so why am I having so much anxiety around this situation? Maybe I know how to deal with the anxiety and how can I long term, maybe not experience it as intensely or not experienced it at all. So I think that aspect of it is really important as well to get that long-term effect of my anxiety feels a lot better or my depression is feeling a lot better. It's not just this like, oh, I feel better today, not tomorrow.

Laurie: Right right! I do like the multifaceted approach, where it kind of works at all different angles but works together really nicely. So why do you utilize DBT in your practice? Tell me a little bit about the 'why'.

Claire: Yeah, so I have found that a lot of clients are looking for, I guess not a quick fix. However, they want something that's going to work pretty quickly right. So if you're looking for a really solution based way of doing therapy, these skills can be implemented pretty quickly. You can learn the skills and start applying them to your life. You can come back and say: well, I tried that and it didn't really work. We can work on trouble shooting it and then you can continue to practice and try them again. So I found that a lot of clients really like that they leave their session feeling like okay. I have some really tangible things that I can do versus feeling like, oh, I just kind of like sat there and we talked for a while and that's nice and I don't really know what to do now. So that's something I really like about it.

Laurie: Right, it gives a direction versus what sometimes can happen in therapy, which is someone comes in, they tell you what's going on, what the problem is. They might vent, feels good in the moment and then leaves and then goes immediately back to square one. Or you know, maybe that same problem just comes up again later that day or the next day, without really going into what would actually help me. What would actually help, so that the next day's better and the next day is even better than that. So that is really great.

Claire: Right, and I think in a lot of ways, DBT skills are essentially life skills. So how do I talk with someone and validate their feelings? How do I validate my own feelings? Again, how do I just enjoy life, do those things that are hard for me and make me feel uncomfortable and feel good about that. So while it sounds kind of complicated, not in a lot of times people already know these skills and maybe they've lost track of them or they just don't use them regularly. So I think it's nice to kind of get people back to some of the things that they have maybe already been doing and just happened lately.

Laurie: Right, I do feel like that could happen so easily. We can get off track of what was working, we're doing better, we're feeling great and then all of a sudden, oh now we're not, and a lot of times it's because the skills either kind of drop away or you might not even need them anymore. Like if your anxiety goes away or you're not having panic attacks, your skills aren't going to be at that level where you think okay, I need to do this and I need to do that and so then it can fade away. So it's a great thing to have even just a check-in even if you've seen Claire before, or saw another therapist before, and just feeling like you're off track, it's a good thing to just come back and even if it's a session or two, just to see, you know what might help, what can get you back on track and refreshing some of those skills you already have.

Claire: Yeah, absolutely!

Laurie: So, Claire, I don't mean to put you on the spot, but you talked a little bit about a group. So, is there a group in the works?

Claire: Yeah, so I really want to bring more of a like casual outpatient level DBT group to the Milwaukee area, because I have found in my practice that when I'm looking for some kind of like stepdown group there really aren't very many. There are a few and I think most of them are pretty full. So my hope is to have either a six or eight weeks group for those looking to either refresh their DBT skills or to learn more about it. So I'm working on that and I'm hoping to have some information in the next few weeks about that.

Laurie: That sounds really great and I think groups are just so great for practicing, just practicing skills. It might not feel so comfortable maybe telling your friend how you're feeling right away, but your practice on one member in the group or you work it out through the group and it makes it a lot easier. That is really cool.

Claire: Yeah, I think it opens up an environment where you can hear different examples of how other people use the skills. Like you said, you can practice with other people and just feel more comfortable that like, if I mess this up, no one's judging me because we're all learning here. So I really like that aspect of groups as well.

Laurie: Yeah, I'm very excited. I'm very, very excited for that group. All right, Claire, so thank you so much for meeting with me again and I look forward to hearing more about the group. And so what will happen is, I'll send out some information for those of you interested in the group, so you'll know all of that information. You can contact Claire through www.shoresidetherapies.com, and all of our information is there, and a bio, so if you want more information, check that out and thanks again for being here.

Claire: Thanks Laurie!

Laurie: All right, take care, Claire.

Claire: Bye!