What is DBT?

DBT means Dialectical Behavior Therapy, which could also be referred to as becoming more open minded. A dialectic is a dialogue between opposites. Dialectical therapy seeks the ability to tolerate opposites and to see truth in more than one perspective. DBT is an offshoot of CBT, or Cognitive Behavioral Therapy. This branch of psychology is aimed at helping you understand your thinking and behavior choices so they are more effective for your life and happiness.

Mindfulness is balancing emotion mind and wise mind.Distress Tolerance is when you have a problem you cannot solve, but you don't want to make it worse.Emotion Regulation is having less negative emotions and vulnerability, and more positive emotional experiences.Interpersonal Effectiveness is asking for what you want and saying no effectively.

Saturday, August 11, 2012

Mindful Parenting


Life Skills Parenting

Post image for Life Skills Parenting
A mindful post by Fred Ingham.  You can read more by Fred here and here

There is a new way of looking at parenting that is being developed at the University of Washington.  It’s so new, there isn’t even a book you can buy.  There’s no cottage industry of trainers and web-experts.  The parenting ideas are still being fleshed out by professors, graduate students and like-minded mental health practitioners who have found a compelling, evidence based approach to creating happier, healthier kids and families.
The approach doesn’t even have a catchy name, though on March 17th at Kane Hall on the UW campus, 4 researchers and practitioners gave presentations at a symposium called “Life Skills Parenting”.  The approach builds on the ground-breaking work of UW Professor Dr. Marsha Linehan, creator of Dialectical Behavioral Therapy (DBT).  DBT, an outgrowth of Cognitive Behavioral Therapy, was developed by Dr. Linehan when she realized that certain classes of patients (she was focused on those at high risk for suicide), did not respond well to Cognitive Behavioral approaches.  In particular, those patients resented and resisted her attempts to “fix” them.  At the same time, when she tried to simply be empathetic and accepting, the patients grew frustrated that she wasn’t doing anything to help them.  The word “dialectical” in DBT represents how her approach synthesizes “radical acceptance” of the patient as he or she is with the presentation of practical skills to help him or her be more effective and happier.
So what does a mental health treatment protocol developed for suicidally depressed people have to do with parenting?  Quite a bit, it turns out.  Dr. Linehan explained that one of the key ideas behind DBT is that patients are usually suffering a skills deficit (perhaps in addition to issues with brain chemistry and other environmental conditions).  By teaching the patients certain life skills, the patients’ outcomes were greatly improved.  The key skills that Linehan identified are: emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness.
In families, we often struggle with these same issues.  Do family members stay calm when things aren’t going their way?  Do we purposefully respond to situations, or instinctively react?  Do our emotions spin out of control, damaging relationships and undermining our effectiveness?  Practicing the four DBT life skills can help.
One important idea presented at the symposium was that the ability of an individual to regulate their own emotions seems to have some genetic basis.  Research indicates that some of us come to the world with better emotional balance than others.  It isn’t necessarily anyone’s “fault” that an individual, whether parent or child, is emotionally sensitive and prone to experiencing emotional extremes.  However, untreated, these emotionally sensitive people may create a lot of stress for themselves and their loved ones.
The good news is that everyone can improve their emotional regulation and other life skills with effective practice.  In addition, the improvements are beneficial no matter who in the family is doing the work.  If any member of the family becomes better at the skills, their changes will likely have a positive influence on other family members.  In the best case, everyone is practicing to improve.
So what do “Life Skills” have to do with parenting?
At the seminar, three other speakers were featured in addition to Dr. Linehan: Dr. Liliana Lengua, director of the UW’s Center for Child and Family Well-Being; Dr. Laura Kastner, Associate Professor at the UW, and author of several book on the adolescent years; and Tony DuBose, Psy.D., president of Evidence Based Treatment Centers in Seattle, who has focused on the use of DBT with adolescents.  It is beyond the scope of this article to review everything they covered in the seminar, but there are a few key ideas that I took away from the sessions.
The first take-away for me is that DBT is a set of “meta-skills” when it comes to parenting.  The fours skills, in and of themselves, don’t contain any prescriptions about particular parenting dilemmas.  Whether we choose to pursue a “love and logic” approach, or “attachment parenting”, or “positive discipline”, or “emotion coaching”, or any other particular blend of strategies, DBT will be helpful because it will improve the likelihood that we’ll be able to execute those strategies in any given moment.  Everyone knows it’s easy to stay calm and be attentive and foster positive emotions when everything is going well.  But what about when we’re tired and stressed, and our kids are willfully breaking rules, and company is coming in 10 minutes?  DBT, with its emphasis on mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness will help keep us on track with our intentions in all types of situations.
One line we heard repeatedly at the seminar was “You may be right, but are you effective?”  This means that it’s not enough for us to be “in the right” to get our kids to change their behavior.  Being “right” is also not a license to be verbally or physically abusive or psychologically controlling.  These approaches may be expedient, but they’re also destructive.  Instead, when faced with a challenging situation, we can use our DBT skills to cool down, assess the situation, and make a plan that is more likely to be effective in the short and long run.
Pay attention to attention
The idea of paying attention to our attention also popped up in numerous contexts.  At it’s most basic, “mindfulness” can be defined as “non-judgmental awareness”.  It means simply paying attention to what is before us without labeling and evaluating.  By being fully present to what is really happening, instead of getting caught up in our thoughts and feelings about it, we are more free to respond effectively.  This is one of the core skills of DBT.
However, our attention is also a powerful influence on our kids.  They need our attention, and we get to decide whether to give it to them in situations that are likely to foster positive emotions, or whether we end up having our kids demand our attention in ways that are less pleasant (such as night waking, defiance, whining, dawdling, and worse).  One simple idea from Dr. Lengua was to institute regular “child-led” activities.  This is when the parent engages in the child’s play without distractions (PUT DOWN THAT IPHONE!) and without coaching or correcting or directing.  We just get down on our hands and knees, observe and participate.  By making daily time for child-led play, we can build trust and rapport with our kids, while potentially heading off disruptive attention seeking.  For parents who believe that they don’t have time to do child-led play, the obvious counter-question is to ask how much time they have for coping with negative attention-seeking behavior?  If 15 minutes of child-led play can head-off one attention-seeking disruption, everyone comes out ahead.
The other thing that was said about attention is that it is ALWAYS reinforcing.  So, when we pay attention to things our kids are doing that we don’t like, we’re actually subtly reinforcing that behavior.  So how does one provide discipline when presented with this paradox?  The recommendation was to ignore negative behavior as much as possible (which may require us parents to practice our distress tolerance skills!), while praising and giving attention to positive behavior.  With regard to consequences, the recommended strategy was to rely on “natural consequences” when practical. In situations where natural consequences aren’t appropriate, we need to take some time to ensure that parentally-imposed consequences are carefully constructed to logically reflect and respond to the specific nature of the infraction.  Finally, discipline works best in the context of a positive relationship.  If the parent-child relationship is stressed by external factors or a difficult history, it will be harder for that parent to discipline effectively.  This last fact is another reason to make sure we’re building in lots of time with our kids where we’re fully attentive and supportive and building trust.  From that relationship foundation, displine will be easier and more effective.
Radical acceptance
Another major idea that ran through presentations by different speakers was the idea of “radical” acceptance.  This means not only mindfully observing a situation, but actually embracing the idea that things really couldn’t be otherwise at this moment.  The speakers emphasized that acceptance is not the same thing as approval.  Acceptance is simply a more effective mental state for us to be in when considering a response to our child’s behavior than a state of condemnation, judgment or resistence.
Behind the idea of radical acceptance is the notion that all thoughts, feelings and behaviors are outgrowths of an individual doing the best they can to meet the needs that are important to them in that particular moment.  A child’s temper tantrum, for example, is often an attempt to motivate an adult to change something the child doesn’t like.  The fact that there might be more effective strategies (“Use your words!”), or that things just aren’t going to change (“The zoo is closed, sweetie, we have to go!”) doesn’t matter when the child is flooded with emotion and when the temper tantrum may have worked in past situations.  Radical acceptance sees the temper tantrum not as misbehavior, with the child in the “wrong”, but simply as the way things are, with the child doing the best they can given the tools and experience they have.
By practicing radical acceptance, parents can let go of the need to punish or judge their kids and focus instead on what might be underneath the behavior – the legitimate needs that are being expressed (so that we can respond with that in mind), and also what age appropriate skill deficiencies the child might have with regard to their difficult behaviors.  By accepting the child as he or she is, we can leave shame and blame out of the relationship, which helps maintain the connection that the child needs to thrive, and also allows us to teach them from a position of respect and authority, as opposed to using shame or coercion.
Radical acceptance also extends to ourselves, as parents.  Nobody does parenting “perfectly”.  In acceptance, we can let go of both defensiveness AND self-criticism.  The opportunity we have is to reflect on where we are, accept that we’re doing the best we know how, and then consider whether we’re as effective as we could be and how we might do better.  By practicing and improving our own skills of mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness (especially with the support of like-minded peers), we can keep moving toward becoming the kind of parent (and person) we want to be.

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