DBT
Marsha Linehan.
I had the privilege of studying under Marsha Linehan in Seattle, Washington at the University of Washington. She is a brilliant behaviorist and also an unashamed Buddhist. And I am an unashamed evangelical Christian. Our world and life views clash, especially when it comes to absolute truth. Linehan holds that truth is always changing. It consists of a thesis, an antithesis and then a synthesis. Philosophically, Linehan and I differ as far as the Bible being absolute truth; but I have been able to understand certain dialectics that exist in the treatment of Borderline Personality Disorder such as:
Emotional Vulnerability v. Self-evaluation
Active Passivity v. Apparent Competence
Unrelenting Crisis v. Inhibited Grieving
Linehan, Dr.Marsha; Cognitve Behavioral Treatment of Borderline Personality Disorder, (New York, London: Guilford Press, 1993) p. 67 figure 3:1.
Her skills training manual is outstanding.When I teach mindfulness to my borderline clients who are Christians, I concentrate on the reflective wisdom books, especially the Psalms.
The God of the Bible is a Loving, Holy God who makes Himself known to those who receive Jesus Christ as Savior (John 1:11, 12).
In the Old Testament He is known as El-Shaddai, Jehovah and One who is a Strong Refuge for those who know Him and seek His help. In the New Testament He is the Father of Mercies and the God of all Comfort (2 Corinthians 1) who comforts His children in all their troubles, afflictions and in their darkest hours.I believe that the God of the Bible, as made known through His Son, Jesus, by the Holy Spirit is far superior to any religion; having said that when I do DBT therapy and teach skills training I constantly use the DBT approach
What about Dialectical Behavior Therapy (DBT)?
Steve is a certified DBT therapist; actually, he was personally instructed in DBT by Dr. Marsha Linehan. He and a coworker were the first in the area to set up and run a DBT group. It was very successful for a number of years.Steve also has done personal therapy with scores of those who suffer Borderline Personality Disorder. He subsitutes some of the Budist principles which are inherent in DBT with Christian priniciples of biblical meditation and contemplation.
At this point, Steve is considering opening a DBT group in which would be on line using Google Earth.He also has success in doing DBT phone therapy.
Please call me at 616.427.0775 or email me at camimovement@yahoo,com
Borderline Personality Disorder
The main tenet of the bio-social theory is that the core disorder in Borderline Personality Disorder is emotion dysregulation. Emotional dysregulation is viewed as a joint outcome of biological disposition, environmental context, and the transaction between the two during development.
The theory asserts that borderline individuals have difficulties in regulating several, if not all, emotions. The systemic dysregulation is produced by emotional vulnerability and by maladaptive and inadequate emotion modulation strategies. (Linehan, Marsha, Skills Training Manual for Treating Borderline Personality Disorder. (1993) New York, London, Guilford Press}, p.2
What about Dialectical Behavior Therapy (DBT)?
Steve is a certified DBT therapist; actually, he was personally instructed in DBT by Dr. Marsha Linehan. He and a coworker were the first in the area to setup and run a DBT group. It was very successful for a number of years.Steve also has done personal therapy with scores of those with Borderline PersonalityDisorder. He substitutes some of the Buddhist principles which are inherent
in DBT with Christian principles of biblical meditation and contemplation.At this point, Steve is considering opening a DBT Group in Palm Beach County, FL. He also has success in doing DBT phone therapy.
Pretreatment targets orientation to treatment and agreement on goals.
First stage targets
1. Decreasing suicidal behaviors
2. Decreasing therapy-interfering behaviors
3. Decreasing quality-of-life-interfering behaviors
4. Increasing behaviors skills
A. Core mindfulness skills
B. Interpersonal effectiveness skills
C. Emotion regulation skills
D. Distress tolerance skills
E. Self management skills
Second stage targets
5. decreasing post-traumatic symptoms
Third stage targets
6. Increasing respect for self
Table 5.2 Linehan Behaviors that Interfere with Quality of Life
1. Substance abuse (examples “alcohol drinking; abuse of illicit or prescription drugs).
2. High risk or unprotected sexual behavior (examples: unsafe sex practices; abusing others sexually; excessively promiscuous sex; sex with inappropriate persons).
3. Extreme financial difficulties (example: overwhelming unpaid bills, difficulties in budgeting; excessive spending or gambling; inability to manage public assistance agencies).
4. Criminal behaviors that if not changed may lead to jail (examples: shoplifting; setting fires).
5. Serious dysfunctional interpersonal behaviors (examples: choosing or staying with physically, sexually, and/or emotionally abusive partners; excessive contact with abuse relatives; ending relationships prematurely; making other people feel so uncomfortable that few friends are possible; incapacitating shyness or fear of social disapproval).
6. Employment or school related dysfunctional behaviors (examples: quitting jobs or school prematurely; inability to look for or find a job; fear of going to school or school related work; inappropriate career choices; getting fired or failing in school excessively.
7. Illness-related dysfunctional behaviors (examples: inability to get proper medical care; not taking necessary medications; overtaking medication; fear of physicians; refusal to treat illness.
8. Housing related dysfunctional behaviors (examples; living in shelters, in cars, or in overcrowded housing; living with abusive or incompatible people; not finding stable housing engaging in behaviors that cause evictions or rejections from housing possibilities)
9. Mental Health-related dysfunctional behaviors (examples: going into psychiatric hospitals; shopping; not finding ancillary treatments.)
10. Mental-disorder-related dysfunctional behaviors (examples: behavior patterns that meet criteria for other severe or debilitating Axis I or Axis II behaviors in the DSM IV manual.
If you are interested in DBT counseling from a certified DBT therapist please go to the link below
I am sorry the link on my web site is
ReplyDeletehttp://heartfeltcounselingministries.com/counseling.aspx
Having being diagnosed with personality disoder there are some behaviours I recognise in me from the list but lots I don't. The problem I have is if it is to do with personality how much is disorder and how much is sin that needs to be dealt with rather then new behaviours learnt. Please could you give an example of how you teach mindfulness using scripture.
ReplyDeleteHi Heather,
ReplyDeletePeople who have a personality disorder meet a certain number of criteria for each type. No one really knows why this is so but it seems to be universal. There are some personality disorders such as schizotypal or schizoid which in the future may become classified as a type of mental illness and listed as an Axis I, not Axis II of the DSM IV. On the contrast there is now a personality disorder called ODD which stands for Oppositional Defiant Disorder which seems to present as adolescent and preadolescent rebellion.
Borderline Personality Disorder was so named because they did not know if these behaviors were a result of neurosis, (a term of Freudian origin) or a psychosis which means they would lose touch with reality. Persons who fell between these disorders were classified as having Borderline Personality Disorder.
Christians believe that God exists in three Persons and their source of truth is different than Linehan’s because we believe the 66 books of the Bible are considered to be God-breathed through the men who wrote them onto the page. This is known as "inspiration."
If you have a personality disorder, one of the results is that you cut on yourself to cope with psychic pain, which, biblically speaking, would be a sin. Psychologically, there are reasons why a person would do so and certain actions must be taken by the therapist to not reinforce this behavior. Linehan would call “cutting” a maladaptive coping mechanism, not a sin, because she does not believe in sin against a Holy Triune God.
Well, I do tend to be a little long in my explanations but please bear with me. DBT talks about “wise mind.” This is to help the borderline slow down and think reasonably. Emotional Dysregualtion is a core belief of Linehan in regards to what is wrong with those who have Borderline Personality Disorder; Mindfulness has Buddhist origins. It has met with considerable success in helping the borderline patient.
If I am practicing a form of DBT, I would tailor the Scripture according to the Bible. For example, if you are lonely and feel like cutting, then you could be encouraged to read a Psalm which talks about “God being a refuge, a very present help in the time of trouble.” If your mind is racing (in a borderline way not bipolar), you might be encouraged to "Cease striving and know that I am God.” You also would be taught to "pour out your heart to God and trust in Him at all times."
The LORD God of the Bible is a real Person. We agree with Linehan about using Distress Tolerance Skills to cope with emotional pain and the Bible gives all kinds of incentives, commands and reasons for why we would see distress as something meaningful, as having to be endured. Romans 5 would be a great example on the assurances that come from being justified by faith.
Please forgive the lack of extensive editing on this page and also for not putting Scripture references next to them.
So do you encounter Christians with mental illness, and specifically BPd, whose recovery is complicated by the patient's past experience of the inability of 'The Church' to diagnose or recognize mental illness and have further damaged the patient's ability to get well due to the negative effects that 'The Church's' judgments, discipline, and ex-communication (not due to any sin i.e., sexual, behavioral, scriptural) but their abject inability to understand and help the church member and instead resorted to those other tactics rather than recognizing mental illness and the need for treatment?
ReplyDeleteYes, Anon, I believe that you put it well. Heartfelt Ministries
ReplyDeleteis dedicated to have the church be compassionate towards those who have mental illness and to make provisions that will help the mentally ill people feel welcome, loved and help at the church they attend.
Dear Steve, I am at a loss of words to express my appreciation of this blog (and your other blogs esp. VOM. that I've been looking at as a result of finding this blog) God is faithful. I am praying that you are still practicing. I am an evangelical Christian. I am in DBT currently. From the moment I began the 'classes' (aka- therapy) I had an uneasy feeling in my heart. I can explain more off-line. I've been struggling with DBT. I come home and turn to the Scripture for wisdom. I'm in Scripture daily, and weekly I continue to feel uneasy as class goes on. I've been on Google all night, researching CBT and DBT and the Christian. I then came upon an article/interview with Marsha. I'd like to talk more about that offline as well, but it prompted me to keep on Googlin'. And then I found your blog. I felt peace when I read it. I thank Jesus and I Radically Accept that I was led here by Him. Please advise, if you are still practicing remotely, Skype, phone, etc. Thank you for your faithfulness.
ReplyDeleteHello Anonymous,
ReplyDeleteThank you for your appreciation of our ministry. I am very glad that you joined my blog. I am still practicing. Robyn and I have started a Christians Afflicted with Mental Illness group (CAMI) in our local church, Boca Glades Baptist, Boca Raton, Florida. We also have a CAMI group in Byron Center Michigan which is a suburb of Grand Rapids. I continue to counsel those who have borderline personality disorder, in person and by phone. I also do other types of counseling. Are you aware that we have written a book, Broken Minds Hope for Healing When You Feel Like You're Losing It which is published by Kregel of Grand Rapids, MI?
Here is a link to our web site. http://www.heartfeltmin.org/#!contact/cito. You can request a brochure and we will send it to you Heartfelt Counseling Ministries phone number is 561-909-9109
Thanks, Serving Christ, Steve Bloem
Hi Steve:
ReplyDeleteI am a believer, or am I?? I feel that those who are close to me and are also believers continue to tell me to "Give it to God, let it go, have Faith that God will take this from you, this disorder is not of God, etc.........", if I my heart were completely with God, then why do I still suffer from the debilitating systoms of BPD, Anxiety/Panic Disorder?? I have attended DBT classes for two years and although I have gotten understanding of my emotional dysregulation, which helps, I feel strongly that I haven't gotten nor understand the prolonged Exosure Therapy that might help to heal from the anxiety/panic that enprisons me today and has for the last 40 plus years. Please reply.
Marina
Hello Anon,
DeleteI am sorry it took me a while to get back to you. I have been praying for you. First of all, you seem to be shaken regarding your assurance of salvation because of other Christians urging you to give over your disorders, to "let go and let God." There are times that a Christian does, "Stand by and see the salvation of the Lord." But we must remind ourselves that we are in a battle against evil spiritual beings and Scripture tells us in Ephesians 6; Finally, be strong in the Lord and in the strength of His might. Put on the full armor of God, so that you will be able to stand firm against the schemes of the devil. For our struggle is not against flesh and blood, but against the rulers, against the powers, against the world forces of this darkness, against the spiritual forces of wickedness in the heavenly places." Each piece of the armor must be put on by us.
Trusting isn't God does not magically take things away from us. DBT has its limitations. Exposure Therapy does not always work. But I am wondering in regards to your anxiety and panic, are you on an antidepressant?
Many times people with Borderline Personality Disorder have what we call a co-morbid disease and the general treatment by psychiatrists for panic is to put you on an SSRI such as Zoloft, Paxil, Celexa and others.
Also remember, I John 2 tells us; “My dear children, I write this to you so that you will not sin. But if anybody does sin, we have one who speaks to the Father in our defense--Jesus Christ, the Righteous One. He is the atoning sacrifice for our sins, and not only for ours but also for the sins of the whole world.” Our aim not to sin but we also have a Savior, who pleads our case before the Savior. Here is a link to another one of my blogs. http://sbloemreflections.blogspot.com/2011/06/christ-our-advocate-intercessor-and.html
Have you read our book, Broken Minds Hope for Healing When You Feel Like You're Losing It? Our new web site is http://www.heartfeltmin.org/#!contact/cito