Practice What You Preach


I’m very excited to be working with a new team!  There is enthusiasm with all of us for this fresh start.  One of our main goals is to get Dialectical Behaviour Therapy (DBT) up and running efficiently.  In preparation for this there is a self-study portion of our training, which includes reading Dr. Marsha Linehan’s book Cognitive-Behavioural Treatment of Borderline Personality Disorder (1993) as well as reading the 1993 Dialectical Behaviour Therapy Skills Training Manual.  As I mentioned almost one year ago, I was thrilled that Dr. Linehan was releasing a new and improved Skills Training Manual (2015).

I suggested to the team that, in addition to reading the suggested material, we actually go through the new skills training manual ourselves to truly “get it” from the client’s perspective.  This is in part due to a response to my post last year when a dear friend who has participated in DBT treatment said, “It must be more fun for the therapist than the client. Lol.”  Good Point!!!  It is a lot of hard work, so it is important for the therapist to clearly have an understanding of what is being asked of the client.  We get to practice what we preach.  As well, the skills benefit everyone who uses them and is not restricted to those with mental health diagnoses!!!  Regularly practicing the skills will help us as therapists with good self-care.  This is something we don’t always do so well as we are so focused on the well-being of others, and we don’t always prioritize ourselves.  Working through the skills as a team will help with accountability, and will help brainstorm ways to present the information to our clients.

There are four modules.  Mindfulness,in essence, helps you live in the present moment with clarity and wisdom.  Emotion Regulation assists with identifying and managing the various emotions we experience throughout our lives.  Interpersonal Effectiveness helps us maintain healthy relationships and end those that are unhealthy.  Finally, Distress Tolerance teaches skills to help reduce suffering.

I will keep you posted as to our progress!

Readiness For Action


For the past several months I have been wanting to get back into writing again.  However, as you can see, I haven’t been able to follow through with this desire.  Recently a reader commented on my blog asking if I had stopped writing.  That was a great prompt for me to see this morning to get me going, so thank you.  And a great focus for today!  Readiness for action.  There are several components to taking action and desire alone does not quite cut it.

I actually had that conversation this week with a client after telling them it would be our final session until they were more fully engaged in treatment.  Their response was “But I want to get help”.  My response, wanting alone does not necessarily mean readiness for change.  The lack of commitment was evident due to not attending, or being late for sessions, and not putting into action skills covered in session.  The same was true for myself because I was not writing.  The commitment to take action was not there.  The door is always open to that person; remaining in therapy at this point is actually counter-therapeutic and when they are ready for change then true therapy can begin.

Lack of commitment does not necessarily mean lack of interest.  Competing priorities is a common downfall, making it difficult to stay focused on or put your desire into action.  These competing priorities can be positive or negative. For example, housecleaning on the weekend doesn’t always get done the way I would like it to because I want to explore and take in the beauty of our amazing province. On the other hand, heavy demands of life can inhibit taking action; such as, job loss, relationship breakdown, financial strain, and sometimes all of those things at once.

I actually have started several pieces for writing over the past six months only to discard them.  They either didn’t feel right, or good enough to post.  Yes, perhaps a bit of perfectionism sneaks in.  I was able to get the outline of what I wanted to say, but the creative flare was not there.  It seemed flat.  So, I walked away, and “gave up” and went on to do something else.

Fear is something that prevents us from change. We stay in our comfort zone out of fear of the unknown.  Hence the saying; “The devil you know is better than the devil you don’t”.  Paradoxically, when we let go and step out of the comfort zone, the dark clouds that have been hovering over us part and the sun begins to shine.  Staying in the comfort zone out of fear prevents us from vitality and living life to the fullest!

My recommendation is to really examine what the barriers are for you.  There are many more beyond what I have covered.  Maybe the thing that you have been beating yourself up about is not a priority anymore and you can let it go.  Take it off your “to do” list and feel the weight lift off your shoulders.  Or you may identify that your desired goal is really is something you want so you need to clear away some of the barriers.  If you don’t have insight into what is going on then you cannot make the necessary changes.  Whatever it is, you need to pause and take stock of your situation for the best course of action.

Balancing Wants and Shoulds

Where has the time gone?  The end of 2014 is rapidly approaching, likely in part due to the increased activity that occurs during the month of December for those celebrating Christmas and other holiday traditions.  I enjoyed reading Brene Brown’s recent post dated December 3, 2014 “The show must go on. But at what cost?” She is referencing the chaos that occurs at Christmas and sometimes we are the ringmasters of the Circus that ensues this time of year.

One of the Dialectical Behaviour Therapy (DBT) concepts that can be useful to manage the “circus” is “Balancing Wants and Shoulds”.  Dialectic essentially means the art of investigating seemingly opposites to achieve the best outcome.  “Wants and Shoulds” at times appear to be at opposite ends of the spectrum.  I want to stay home and rest, but I should go to the Christmas party.  I want to buy people I love gifts, but I should be paying down my debts.  I want to eat all the delicious food, but I should be sticking to healthy eating.  I want to go out and visit friends, but I should get housework completed.

If we are only following through with our “wants” there are several consequences that may happen using the above examples.  We may miss a great event if we stay home, we may cause ourselves financial strain, we may gain weight, and our chores get neglected.  Alternatively, if we just focus on “shoulds” we may miss out on some much needed rest, we may feel bad we didn’t buy our loved one a gift, we may miss the pleasure of a food we enjoy, and we may miss the opportunity to connect with friends.

As you can see some consequences are seemingly good and some bad.  There is no right or wrong.  Every individual has different needs, so the consequences will alternate depending on the person.  Each of these scenarios represents a dialectical dilemma.  Take the opportunity to practice dialectics to contemplate situations that arise for you to find your inner truth; the right balance of wants and should for you.

The results for some will be a clear decision that falls one way or another.  You will either go to the party or you will stay home.  For others, you will make an appearance at the party and then go home early.  Some will strictly keep to their budget or diet, and others will spend or eat in varying degrees of moderation.

Remember there is no right or wrong.  The key is to explore what the right balance is for you.  Pause to seek your inner truth, contemplating both “wants” and “shoulds”.

The Power of Gratitude

GratitudeOne of the anecdotes for anxiety and depression is gratitude.  As humans we have a variety of life experiences; joys and hurts.  We chase the dream (illusion) of being happy 100% of the time; especially since we live in a world where marketing experts create the impression that we will obtain happiness in their product.  Instead, the reality of many is the experience of anxiety and depression (inherently, in part, a result of those same marketing schemes).

Gratitude does not take away the experience of hardship, however, it allows us to have a more holistic, integrated perspective as opposed to being trapped in a “negative filter” – a world view of only considering what is wrong.  When we are consumed by these negative images and thoughts, we suffer.

Don’t get me wrong, being oblivious to a concern that we need to attend to can also cause suffering.  For example, consider someone who has the experience of chronic pain.  When the body signals pain, the intention is to get our attention.  Perhaps we need to slow down, discontinue repetitive movements, or go and see our health care provider to investigate the problem.  Completely ignoring the pain signal may result in further injury to our body worsening our situation.

Being overly focused can be damaging in a different way.  A hypersensitivity to pain can cause us to immobilize and shut down.  The focus becomes what we cannot do; self-worth and confidence can decline due to interpretations: “I am not contributing enough”, “I’m broken”, “I have no value”, “I am a failure”.  A solution is to acknowledge the pain, and then shift your focus to capabilities rather than limitations.  “Even though I have this pain, I am able to enjoy spending time with my family.”

Rather than remain stuck in whatever your problem area is (chronic pain, money, relationship, work, loss, ________) consider something that provides gratitude.  The mental shift that occurs is profound.  When you fill the space with gratitude there is less room for sorrow or anxiety.  Acknowledge the problem area and then orient to gratitude.  “Even though ___________, I am grateful for family, our home, living in Nova Scotia, my ability to make choices, a career I love, caring friends, learning, experiences that allow personal growth.”

Global gratitude is helpful; such as, “I am thankful for my home”.  However, contemplating the seemingly smaller things in life provides us the details that matter, because these are the things that really do matter!  “I am grateful for my cup of coffee in the morning, the warm embrace of my daughter, the kiss from my husband, watching the eagle fly by, having an engaging conversation with a friend, the look of realization/insight/relief on a client’s face, the warmth of my comforter as I crawl into bed.”

To make room for contentment and peace of mind, I encourage daily practice of gratitude – both routine and random moments of gratitude!

Falling in Love All Over Again…with DBT


Last night a package arrived at the post office with my new books: DBT Skills Training Manual and DBT Skills Training Handouts and Worksheets.  Yipppeee!!!!  I was so excited to start flipping through the pages to see what revisions have been done.  However, I had to delay that gratification because my husband gently reminded me that it was time to get out of work mode for the night.

I have to confess that I’ve had a love affair with DBT since I was first introduced to it in 1997 when a wonderful mentor, psychologist Dr. Donna McDonagh, worked tirelessly to bring DBT to Correctional Services of Canada to help rehabilitate women inmates.  That is a whole other topic though.  When it came time to train trainers (to ensure treatment integrity) Donna set the bar at psychologist’s being the trainers.  Her bar also was set at PhD level psychologists.  Because of my passion for DBT, and a vote of confidence from another colleague, Donna hesitantly agreed to allow me to be trained as a trainer.  Something I am forever grateful for!

In case you are wondering, DBT stands for Dialectical Behaviour Therapy.  DBT was developed in the early 1990’s by Dr. Marsha Linehan to help those with chronic suicidal behaviours with a diagnosis of Borderline Personality Disorder. Simplistically the goal was to help them with emotion regulation and improve relationship functioning.  Her first manual was published in 1993 and over twenty years later research shows that a variety of individuals can benefit from the various DBT skills.  In fact, all of us can benefit from some (or all) of the skills in the manual.  I regularly incorporate skills in my practice for a variety of concerns ranging from situational stressors to severe disorders, and I regularly try to practice what I preach!

My initial assessment from flipping through the pages –  the manual and handout companion are amazing!  Revisions are extensive because of widespread application of DBT that research has empirically validated, as well as feedback from users of DBT.  There is expanded information including specific targets for addictions.

I feel like I am falling in love with DBT all over again and cannot wait to further “get to know” the additions and changes and incorporate them into my practice.

Desiderata poem – so beautiful and full of meaning!



Every time I go one of my friend’s house I admire a wall hanging that he has of the full Desiderata’s poem written by Max Ehrmann.  There is a lot of value in these words and I think they speak for themselves.  I encourage you to read the poem when you have a moment to reflect fully on each sentence.  Enjoy!

“Go placidly amid the noise and haste, and remember what peace there may be in silence. As far as possible without surrender be on good terms with all persons.

Speak your truth quietly and clearly; and listen to others, even the dull and the ignorant; they too have their story.

Avoid loud and aggressive persons, they are vexations to the spirit. If you compare yourself with others, you may become vain and bitter; for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs; for the world is full of trickery. But let this not blind you to what virtue there is; many persons strive for high ideals; and everywhere life is full of heroism.

Be yourself. Especially, do not feign affection. Neither be cynical about love; for in the face of all aridity and disenchantment it is as perennial as the grass.

Take kindly the counsel of the years, gracefully surrendering the things of youth.

Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness.

Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe, no less than the trees and the stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should.

Therefore be at peace with God, whatever you conceive Him to be, and whatever your labors and aspirations, in the noisy confusion of life keep peace with your soul. With all its sham, drudgery, and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy.”


Part 2: What Gets in the Way of Living Your Truth?


Once you orient to your truth, which encompasses goals, relationships, self-respect (values), there may be some barriers to living your truth.  Barriers include Circumstances, Absence of Skills, Perfectionism/Fear of Vulnerability, People Pleasing, Avoidance, Cognitive Distortions, Expectations, Habits, Pathology (self or others), or Attachment Disruptions/Traumas.

Circumstances can include relational losses, financial difficulties, lack of resources, and environmental restrictions.  Solution: Work within your limitations rather than completely give up. 

Absence of Skills is such things as not having knowledge as it relates to regulating emotions, setting goals, ingredients to healthy relationships, assertiveness skills.  Solution: Opening yourself up, and finding opportunities, for learning.

Perfectionism/Fear of Vulnerability Perfectionism is different from healthy striving.  We are driven to do more – and be more – for fear of being judged (by self and others).  The result is we are driven to overachieve, or paralysis and we do nothing.  Solution: Develop a plan and build mastery/confidence one step at a time.

People Pleasing is when we put other’s needs ahead of own to avoid judgement or conflict. Solution: Dr  Brené Brown’s mantra “Chose discomfort over resentment”.  Be true to yourself so you aren’t resentful and do it in a way (if possible) that minimizes damage to the relationship.

Avoidance is when we are numbing out, escaping, or simply avoiding because making changes is too difficult.  Solution: Behaviour Activation to face what you are avoiding by simply doing what you know you are supposed to be doing.  I know, easier said than done, but it works!

Cognitive Distortions includes “all or nothing thinking”, “jumping to conclusions”, “emotional reasoning”, “catastrophizing” –basically our thinking has run amuck.  Solution: Cognitive restructuring to create realistic awareness and self-talk from a “Wise Mind” perspective.

Expectations versus reality is as it sounds and the greater the gap, the more distressed and out of balance we become.  Solution: Change expectations, or reality, or both

Habits are something that we repetitively do without awareness.  What we continue to practice is what we manifest.  Solution: Create new healthy habits, which will initially require effort but after a period of time will become second nature.

Pathology is when we, or someone in our life, have a non-treated mental illness, addiction or personality disorder then intrapsychic and interpersonal chaos is guaranteed to exist.  Solution: Insight into the disorder, diagnosis, boundary setting, and treatment.

Attachment Disruptions and other Traumas create emotional injuries (stuck points/hot spots) we carry with us because the trauma changes our world view, belief systems, brain wiring, and the trauma settles into our body.  Solution: Psychological treatment is proven to help change brain neuroplasticity through insights, and encouraging environmental and behavioural changes.  Therapy also helps clear the trauma from your body reducing anxiety and depressive symptoms.

Fill in Your Blank _____________ Because we are all unique beings, we each have our own barriers to living our truth.  What is yours?