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Suicide is a traumatic experience for an entire community. As there is a diverse range of signs, symptoms, and causes, understanding the many signs can help you reach out to a loved one. If you are concerned that someone you know may be having suicidal thoughts, learn to spot common warning signs and how adult DBT can help them deal with their thoughts, feelings, and actions.
Changes in Mood
While no single sign can completely predict attempted suicide, many individuals who are considering show mood changes:
Anxiety
Shame/humiliation
Depression
Irritability
Anger/agitation
Sudden calmness
While a sense of calmness may initially come as a relief, many individuals experience an appearance of calmness as their mood changes from depression to suicidal thoughts. Not everyone processes emotions the same. Debilitating sadness could lead some to suicidal thinking, while extreme shame could be the cause for others. Few individuals will express all of these mood changes, so look for individual ones that are unusually intense or long-lasting.
Unusual Behaviors
While behavioral changes can vary dramatically, one or more of these changes can be signs that a person is experiencing suicidal thoughts:
Increased alcohol or drug use
Withdrawal or isolation
Saying goodbye to friends and family
Unusual sleep habits
Increased aggression or fatigue
Do not wait to ask a loved one about these actions. Whether these actions change as a result of a sudden life event or not, they can be signs that a person is considering suicide as an option for dealing with their pain. Alcohol and self-medication can be signs that a person is dealing with intense emotions, even if they may not be expressing any unusual emotions.
Suicidal or Depressed Talk
Communication is perhaps the most straightforward way a person considering suicide may give hints or show warning signs. Remember that while not everyone presents all warning signs, many of these signs are connected with particular moods or actions. Any or all of these communication changes should not be ignored:
Discussing ways to kill oneself
Talk of hopelessness or purposelessness
Communicating unbearable pain
Lack of communication
Sudden and extreme mood swings
Direct talk of suicide
Discussing suicide should not be seen as a cry for attention. Instead, it is often a sign that the individual needs immediate help. Many individuals who attempt suicide have communicated with at least one loved one before the attempt. Treat any discussion about suicide seriously, and contact a local health care professional if you suspect any suicidal thinking.
How DBT Can Help
If you or a loved one is experiencing any of these signs or symptoms of suicidal thinking, DBT can help. From mindfulness training to emotional regulation, you will gain access to the skills necessary to combat debilitative suicidal thinking. Whether the depressive thoughts are suicidal or not, DBT can assist in emotional regulation for any individual who is struggling with extreme emotional turmoil.
Contact MHS Today
Find out more about DBT, suicide warning signs, and assistance with suicidal or depressive thoughts by scheduling an appointment today. At MHS, we serve Minnesotans and provide DBT at both our Edina and Woodbury locations. Find the help and hope you need to assist a loved one who is struggling with suicidal thoughts.
Challenging behavior is a frequently experienced part of raising a child, and it’s not unusual for a child to act out as a response to everyday stressors, changes in their routine, and other typical factors. However, if you’re concerned that your child is struggling to overcome significant behavioral issues and/or emotional difficulties, it may be time to seek out professional help and resources.
What is Causing this Behavior?
It’s not unusual for parents to be confused by a child’s challenging behavior, especially when it’s difficult to pinpoint the reasons behind it. It can be difficult not to feel like you are at fault, or to experience feelings of guilt for wondering if you simply have a “bad” child. However, a child’s negative behavior can often be attributed to one key factor: on some level, their basic needs are not being met. For some children, that may be something as simple as an inconsistent sleep schedule, the stress of dealing with a new school, or complex feelings about the birth of a new sibling.
But for other children, there is a major obstacle that prevents their basic needs from being met: severe emotional difficulties that require professional therapy.
DBT Therapy: A Way to Help Your Child Overcome Emotional Difficulties
Making the decision to seek professional help for your child is the first step, and it’s important to consider the full range of options available. One of the effective treatment options for juveniles is called DBT therapy, a type of therapy that provides successful aid for patients with varying needs.
What is DBT Therapy?
Dialectical Behavior Therapy (DBT) is a type of cognitive behavioral therapy that combines the acceptance of a patient’s emotions and behaviors with a focus on working toward change. Essentially, children learn to tolerate and function through emotional distress while learning concrete skills to respond in more productive ways. Parents are often involved in the process as well, enabling them to support the development of their child’s emotional regulation, self-esteem, and positive behavior.
What Can DBT Be Used to Treat?
The early forms of DBT were created solely for the treatment of borderline personality disorder. Today, DBT has been successfully used to help patients dealing with a range of concerns including eating disorders, depression, post-traumatic stress disorder, substance addiction, and suicidal thoughts.
Early adolescent DBT provides professional assistance to children, helping them deal with the challenges arising from one or more of the following difficulties:
Behavioral challenges at home, school, or other environments
Isolation
Anxiety
Depression
Self-harming
Aggression
Who Benefits from DBT Therapy?
Although DBT was initially created as a treatment option for borderline personality disorder (BPD), mental health professionals have adopted the therapy for effective use with a wide range of patients. Early adolescent DBT therapy is specifically designed for targeted use with children and young teens.
Partner with a Professional in Your Child’s Wellbeing
Helping a child with emotional difficulties is challenging for any parent or caregiver, but you don’t have to do it alone. MHS is a professional provider of comprehensive treatment programs, specializing in DBT therapy and behavioral health, including programs specifically created for young patients.
Our Early Adolescent DBT Program is expertly designed to help children and young teens build the skills they need to successfully manage emotional difficulties and implement positive behavioral changes. A combination of ongoing therapy, consistent skill-building, and regular assessment allows the MHS team to take a personalized approach to your child the help they need.
Learn more about DBT therapy and how it may help your child by contacting MHS today.
Mental illness is not a light matter. It takes a toll on everyone involved. If you or a loved one are experiencing signs of mental illness, it’s important to explain them to your doctor. As mental illness becomes more understood, there are a lot of treatments available to help individuals carry on a normal, healthy life. One solution is dialectical behavior therapy, which is a specific version of cognitive behavioral therapy. The word “dialectical” comes into play because, during therapy, opposite forces such as acceptance and change are brought into balance.
How Does It Work?
During DBT, patients are reassured through acceptance of their experience. They are also taught how to work on changing negative behaviors. Many patients who need this type of therapy simply don’t feel accurately accepted or in control of negative emotions. They may exhibit avoidance, depression, anxiety, suicidal behaviors, irregular emotions, anger control issues, eating disorders and non-suicidal self-injury.
When a patient begins therapy, they can expect to participate in a four-part system, though this may change from person to person. The four parts include:
Individual Therapy – The patient works one-on-one with a DBT therapist, who addresses all needs as related by the patient or observed by the professional. During these sessions, the therapist motivates the patient and helps them to apply daily skills.
Group Skills Training – A group skills training session gives patients an opportunity to be accountable to someone other than a family member or individual therapist. During these sessions, individuals are encouraged to share personal experiences and then to practice skills. They are given assignments to work on during the week.
Consultation – If required or suggested by the therapist, a consultation keeps healthcare providers in the know so they can continue to provide the best care for the patient.
Phone Coaching – Because emergencies arise and crises can happen without warning, phone coaching is available for patients between individual and group therapy sessions.
Who Is DBT For?
There’s a wide array of individuals who can be helped by DBT. Patients of all ages can participate in therapy appropriate for their age group. Programs serve patients dealing with:
Difficulty regulating emotions
Anxiety, panic disorder, depression, PTSD and other personality disorders
Out of control family relationships
Suicidal behaviors
Difficulty functioning during daily activities at work, home, school or other social settings
Non-suicidal self-injury
Overuse of mental health services, including hospitalization
Self-destructive behaviors
Studies show that even pre-adolescents can benefit from dialectical behavior therapy. It is effective across the board, benefiting all genders and ages. It is currently being used in over 25 countries with similar positive results for a wide variety of individuals. Programs at MHS include Early Adolescent for ages 12-14, Adolescents for ages 14-18, Horizons for the developmentally-disabled/mentally-ill, Adult, Integrated Dual Disorder and Individual therapy.
Receive Help Today
Patients dealing with mental illness do not have to suffer in silence. With so many options available to improve lives, individuals can receive the help they need to experience mindfulness, implement distress tolerance, regulate emotions, and allow interpersonal effectiveness.
To learn more about dialectical behavior therapy or to request an appointment with a therapist, contact MHS today. Better health is just within reach.
Randall Webb: So we’ll go ahead and get started. My name is Randall Webb. I work for TARCSYS Corporation. We are a Southern-based IT company. I come from the great metropolis of Nashville, Tennessee. We focus on IT security. What the point of this is, is I really want to change your paradigm and change your mindset about what IT security is. Okay? All of us either are parents or we work with IT in our lives, and we know people that we may want to implement some of these things for, and so that’s what the goal is. The title of this is Household Incorporated, and we will explain what that is and why. It’s a roadmap for IT security in our homes.
Randall Webb: The overview for tonight is first, we want to define what the IT security problem is. Secondly, we want to actually create Household Incorporated. Thirdly, we want to begin implementing and sustaining a plan. So not just creating a plan, but creating one that can be sustainable because we work. We have jobs. We have lives, and adding this to our lives, it takes time, and it takes energy. You don’t want to invest time, and energy, and effort in trying to create something that is impossible to maintain. When that happens, many parents and many people, you just give up. If you’re trying to deal with IT security from the perspective of I’m going to keep up with the stuff — right — you’re setting yourself up for failure. Okay?
Randall Webb:When we think of security for our homes, it can’t just be solely about children because that is a very limited and very narrow view of what IT is in our homes. Okay? Number one, this may be hard to see, true, IT security is about more than apps and smartphones. Okay? The task that we have is we have to change our paradigm of IT security that is more universal across technology. Okay? If your idea of IT security is tech-specific, then you’re going to have to invoke a gazillion different rules and standards if it’s about each individual pc of technology. Our paradigm needs to shift away from the individual technical things and needs to be more broad and more universal.
Randall Webb:When you really get right down to it, IT is about the exchange of information. Period. That’s all that it is. We have sophisticated ways of doing it, but at the end of the day information technology, or IT, when you boil it down, it’s just about information. There’s some IT security you can do without being technical at all because it’s about information. Okay? In the IT world, if this phone, this is my phone, if it can’t turn on, and if it can’t do anything, we call this a brick because that’s essentially all that it’s worth. It’s just a thing that you can stack stuff on or throw. It’s brick. It has no value, and it’s the same thing with a cell phone or any other technical device. A device that can’t share information, it’s a brick, no matter how great it is.
Randall Webb:We will see that regardless of whether it’s an iPhone, it’s a droid, it’s a computer, it’s a laptop, it’s a tablet, it’s a video game, there are some rules, and policies, and restrictions that we can implement that aren’t technical whatsoever, and they’re effective. We mention here, someone being able to listen in on your phone conversation. Aren’t there ways that we could technically do the same thing? One way is, you go to your child, or you go to whoever’s in your house … I have a list of all the apps on this phone. I want passwords to every single one, and at random I can ask you for it, and I’m going to log into every single one and look at it. That is, we didn’t install anything. We didn’t do any type of sophisticated add-ons of technology. That’s just a simple, good old-fashioned adaptation of something that could’ve been done with the telephone, and that’s the reason why I brought it up, you’re on the phone and your parents listening to your conversation.
Randall Webb: Smartphones, tablets, video game consoles, they’re all computers so let’s cut out all that difficulty. I’ve got to have security for this, and I’ve got to have security for that. No, you’re having security for computers. Period. They’re all computers. I just brought some simple facts to drive home the fact that all of this tech, they’re computers, number one. They have processors, they have memory, and they have storage. A processor is, you may have heard of it as a CPU, but whether it’s your phone, or whether it’s your computer, or whether it’s your laptop, or whether it’s your tablet, they all have a processor. They all have memory, and they can all store stuff. They all have an operating system, whether it’s Windows, whether it’s Linux. If it’s a tablet, it’s going to use Android or IOS. They all, if they have any value, can get on the internet. Right? They all run some type of software. They all run some type of software, some type of application, and they all cost a lot.
Randall Webb: It drives me nuts how cheap people are when it comes to IT. I see people get really, really cheap when it comes to security. They get really cheap. In May, I did this presentation for someone and recommended a product, and they wouldn’t do it. This product will, it will allow you to monitor seven accounts, $70 a year. That’s too expensive.
Randall Webb: But again, but everyone’s different. Again, resources, companies realize that they need to allocate resources to this effort, whether that’s personnel, whether that’s time and money. You can’t say you want a secure environment if you’re not willing to allocate time, effort, money, energy to this. Okay? We need to focus less on the aspects and more on the rules, policies, and guidelines. Let’s focus less on the tech and more on rules, more on policies, and more on guidelines. Number one, we need to know what we want to accomplish. Okay? We know that what we want to accomplish is far more valuable than figuring out how to get it done.
Randall Webb: I can’t stress that enough. Knowing in your mind what you want to do is far more important than trying to be the one to do it because you can find technical people to build it, but you have to tell them what you want to build. There’s nothing you are come up with that there is not a technical solution for it, but you have to know what it is that you want. Don’t spend the majority of your time trying to get something and accomplish something that is way out in left field. It’s not productive. Find an IT consultant or a company with the skillset to set up and implement the security. Again, this is going to be simple for them. It’s going to be easy. You’re small. You’re simple. They’ll love it. They’ll love it.
Randall Webb: I mean it’s easy. Okay? Some of this may include using hardware that you’re not going to get at Best Buy, and it may be a little more sophisticated, but it’s going to enable you to implement and carry out the things that you want to come up with. Again, it’s just like insurance. When it comes to insurance, give the heavy stuff to the insurance company, but the smaller things that you can handle, handle that yourself. There’s only one person who can come up with what needs to happen in your home, and that’s you. Okay? A less technical approach within the family is more geared on the what and the why, rather than the how. Okay? What are we trying to do? Why are we trying to do it? You can get the how with help.
Randall Webb: You’ve got to sit down and really think about for my family, or for my household, or for a business, for an organization, you really have to think about what is it that all of our effort of us being together, what is our goal. What drives those things that you’re talking about, and it’s true, I know this almost seems simplistic, but the reason why I’m going way high is because as we start peeling these things, and we start coming with things that branch off of that, that’s where you can start becoming more specific about the material, and the content, and the who, and so on, and so forth.
Randall Webb: There’s software out there that you can install on their phones where … There’s one I really like called Qustodio. It will show you every app that’s installed and you can lock it down to where they can use certain apps for a certain amount of time. You can block it, and this works across phones, tablets, PCs. Again, people get stuck, “I don’t know what to install. I don’t know what to install.” There’s plenty of things that you can install, and they all do a lot of great and wonderful stuff, but if you know what it is that you want to do, that will help you be able to pick what it is that you want to get.
Randall Webb: Again, it’s funny, but again when you really need to think about who owns this stuff. On a business perspective, it’s the executives who own it. Period. Not only do they own it, they own everything that’s done on it, and they own all the intellectual property that goes along with it. They own it all. Whether it’s one parent, or two parents, or however, it needs to be clearly known and stated that in our household or in our business, we own all this stuff. It’s all ours and we can get it, or take it, or do anything we want with it. By the way, legally if something were to happen, they’re not coming to the kids. They’re coming to you. I mean legally. They legally cannot own anything. Again, the only way you’re going to move forward is you have to start.
Randall Webb: You have to start. For the things that, you know what, I could’ve done this better. I probably should’ve looked at this differently. You know what? It’s all water under the bridge. Again, if you’re a company, if you say, “This quarter we lost money.” No, I’m serious. This is the reason why I use this as the paradigm. “We lost money this quarter, but this next quarter, we’re going to try to …” Again, it takes you out of trying to get so emotionally invested and wrapped up in it and to think more logically. Again, if you weren’t as disciplined as you would have liked to have been, so what?
Randall Webb: Companies do it all the time. If you install a program that has higher administrative privileges, then your users, they can’t get rid of it. They can’t take it off. These programs actually go in and make changes to the registry and other things in the computer they cannot change. What Qustodio does, again, when you first install it, they’re going to be pissed because their usage is going to drop. But what it does, it goes out and it finds every single app installed. It shows you every single one. You start, “I’m good with this one, I’m good with this one, I’m good with this one. I know how to monitor this, and so … ” Again, text messages, it’ll allow you to see their text messages, and who, but your number one, primary goal is to protect them from themselves. Period. If you err too much in that, that’s actually better than introducing a level of risk that you, and again, this is your decision, that you are not comfortable with. It’s not them. It’s you.
Randall Webb:Now, again, if you get to a point where you want to give them more privilege, then again that’s something that you sit down, you think about, you articulate, but again, come up with it, write it down, and make it concrete, and be very specific about privileges, expectations, and consequences. So you could, so here’s the thing, so-
Randall Webb: … the way Qustodio works is you can install it on anything, but Qustodio is going to go out to your account and it’s going to see, well, what are the profiles that are there. Then I’m going to base my restrictions on those profiles. Does that make sense? You can install it on as many phones, as many tablets, and as a matter of fact, Qustodio has a free version that will allow you to just block basic porn and stuff that you can try it out. Without getting technical, we were really talking about is if I write a program to create a new way to share data, no one can really know what that is.
Randall Webb: It’s kind of like if someone creates a new virus and it, no one has the time to build protection against it because it’s new, so if someone builds something or writes a program where data is shared in some proprietary way, then unless you go out and buy something for it, you’re not going to be able to see what’s in it. Again, this why I stress, again, going back to it, set up certain apps that are used for certain communication, allow the ones that you control. Otherwise, you’ll be always trying to play catch-up. Allow the ones that you control allow the ones that you feel comfortable with. I can’t do anything. Well, you know, well you just can’t.
Randall Webb: But that’s your responsibility. Again, I want to … I really see a lot of parents, you just feel so beat down. You feel so beat down. You feel sad. You feel like you’re being irresponsible, that you’re being a tyrant, and none of that’s true. It’s absolutely not true. Whether you’re a therapist, or if you’re a parent, your number one responsibility is to create a safe, productive environment where they can thrive. That is always paramount to anything else.
Dr. Lane P.: Hi, I’m Dr. Lane Pederson. One of the most common questions I get from participants in my seminars is, How do I get clients to do homework? In this short video, I’m going to share with you eight tips that I find to be very effective.
Dr. Lane P.: Now, the first one is simply changing the name. I often times say the word “homework” when I talk to other therapists, but I rarely use that word when I’m working with clients. Instead, I might say, “Let’s do a task.” or “Let’s do an experiment.” Sounds kind of fun. Or I might simply say, “Let’s do our skill practice.” Sometimes, just changing the name can make all the difference. I’ve met so many clients who are just simply allergic to the word “homework”.
Dr. Lane P.: The second tip is really important. At the beginning of therapy, I always want to orient and educate my client about why homework is important to them. Why do they need to practice these skills, or why do they need to practice what we learned in session between sessions? An analogy I like to use is: To not practice between session is a lot like going to a personal trainer and talking about exercising but not actually exercising between those sessions. You’re just not going to reach your goals. It really is about plugging into what’s important to clients. Where do they want to be in life? What does recovery look like? What do they want to accomplish? You explicitly make that connection between skill practice and what it is that they desire, what they want.
Dr. Lane P.: The next idea is to always include clients in coming up with ideas for skills practice or tasks, or experiments. A lot of times, we therapists think that we need to generate all of the ideas, but our ideas for what might be helpful in terms of homework might not resonate with some of our clients. So, instead of doing homework to clients, I like to think about doing homework with clients and spending some time with having them come up with what they think would be helpful to do between sessions.
Dr. Lane P.: Which leads us to the next tip, which is: if you want clients to do homework or tasks or experiments between sessions, it’s good to initiate that skills practice in session. So for example, if I want a client to practice guided imagery, we’re going to practice guided imagery in session. If it’s important for a client to fill out an application before the next session, I might have the client just start to fill out the first parts of the application in the session with me. There’s something about breaking the ice in session with homework that gets clients motivated to complete and to finish it between sessions outside of our time together.
Dr. Lane P.: The next idea is to take one problem or opportunity and play it off of another. So for example, let’s say that you have a client who would like to walk to get some self care exercise in and the client also would like to socialize more to decrease isolation. You can set it up so if you don’t do one, you need to definitely commit to doing the other, so in this case, if the client didn’t go for the walk, he or she would definitely need to call a friend or to get out and socialize in one way or another. It’s a strategy that works really well.
Dr. Lane P.: Related to this strategy is another one which is simply making it a game. So, if you have a dichotomous choice like doing a fun activity versus taking care of a task at home, more of a responsibility, you can simply flip a coin. Heads you do one, tales you do the other. Or if you and the client have brainstormed lots of ideas, simply draw a cards. So, one skills practice might be associated with hearts, another one with clubs, another one with spades, and so on.
Dr. Lane P.: The seventh tip that I have is using the Premack principle. The Premack principle means that you make performing a high probability behavior contingent on performing the low probability behavior first. We sometimes call this grandma’s rule. Grandma’s rule is this. When you eat your vegetables, then you can go out and play. So with the Premack principle, let’s say I have a client who turns on the television every night. He or she really loves to watch evening television. I might say, “I want you to do your skills practice and then you can turn on the television.” Of course, many of us naturally do this Premack principle. You know, I need to return my emails and then I can surf the internet. It’s such a great strategy because the reinforcement is built-in.
Dr. Lane P.: And now, for the very last tip … and this one I think is the heaviest hitter. It is so important to simply schedule it. A lot of clients don’t complete their homework simply because they haven’t thought about where and when they’re going to complete it.
Dr. Lane P.: There was a study that happened many years ago and in this study, there was one group of people who agreed to do a task. They were committed to doing it. The second group of people were also committed, but that group also determined when and where they were going to complete the task. They completed it 80% more of the time. Hey, think about you or me. A lot of us don’t complete what would be important to do in life simply because we don’t write it down, we don’t commit to it in the schedule. So, taking a little bit of time to schedule homework is going to make all of the difference for your clients.
Dr. Lane P.: I hope these eight tips help you out a lot and, more importantly, help out your clients.
Lane Pederson: Hi, I’m Dr. Lane Pederson, co-owner of Mental Health Systems and I’m here with Dr. Eboni Webb for an interview on her upcoming training on attachment and trauma.
Eboni, tell us a little bit about your background, that really got you interested in becoming an expert in attachment and trauma.
Eboni Webb: Well, once I moved to the South and started doing private practice, I started working with a lot of families that had adopted and really had not been educated that adoption inherently has trauma to it. That really expanded my need to be more educated, help parents be educated and even their children understanding why they’re experiencing the difficulties that they’re experiencing.
Lane Pederson: Sure. So, when you talk about adoption having trauma inherent in it, what are some of the traumatic situations that you see these children coming from?
Eboni Webb: Oh, well, many of them come from orphanages where there were not enough care providers to even take care of the children that are there, so there’s a lot of neglect. Poor resources, maybe even inadequate food, but then also the circumstances that necessitated being put into an orphanage often have trauma, abuse, neglect as a part of their story.
Lane Pederson: So, naturally, you’re seeing trauma starting in early childhood and really starting to go across the lifespan. At least early lifespan, with some of the clients you’re working with.
Eboni Webb: Absolutely. There are what we would call single incident traumas; accidents, major natural disasters. But then also developmental trauma. Developmental trauma will go across the lifespan and has to be addressed at every stage of development then.
Lane Pederson: For many people, even if it’s one event, in terms of how it’s experienced, it really is much greater than that event. It really sort of affects their whole course of life, so to speak.
Eboni Webb: Mm-hmm (affirmative). Yeah. Because trauma is self-perceived and it’s driven by the individual’s experiences of it, what they were able to do, what they weren’t able to do, and what other environmental resources were available to them. So, it will vary.
Lane Pederson: So there’s a lot of variants with that. One thing that I wanted to ask you about was what are some of the misconceptions that therapists have about people with trauma and misconceptions about how to treat it?
Eboni Webb: One of the big presentations that we’ll see with the client, is that they may be very activated in a session, which makes it very difficult to connect with them. Or they may be very checked out, which a therapist may initially perceive as a person who’s not interested or not invested in the work. And that is a common misperception until you understand that they’re often defending and that their traumatic response has just permeated their life.
Lane Pederson: Right. So, as a therapist, how do you overcome those type of barriers?
Eboni Webb: I think one, educating the client about what’s happening to them. They may not be conscious of it because trauma based defenses are no conscious by very design, right? So, we have to educate and then to be able to help them normalize and feel safe in the therapeutic environment to let those defenses down.
Lane Pederson: Sure. So, a part of it is just orienting the client to what the therapy is about and what their sort of natural, if you will, response will be and educating them about that and that helps set up more therapeutic success.
Eboni Webb: That’s right. Mm-hmm (affirmative).
Lane Pederson: Okay. Along with misconceptions, what are some of the mistakes that people sometimes make? By people, I mean therapists. What are some of the mistakes that therapists make when they’re working with trauma?
Eboni Webb: I think even one of the primary problems that a therapist can do in terms of the therapeutic space, is assume that this space is aesthetically pleasing, the client will feel comfortable in it. But with trauma as a factor, proximity matters. So, even the spacing of seats can be a problem or it can keep them feeling safe and secure. Tone of voice, inflection. Also, I think therapists often personalize how the client is presenting and making sure that they’re mindful constantly that this is how they are defending and that they really cannot help it. And just as I’ve said before, their brain cannot discern between real and perceived threat. So, a therapist may be doing something unintentionally that is perceived as threatening, and that can create a disconnect in the relationship.
Lane Pederson: Sure. So, really I’m hearing a few things there. One is that therapists sometimes are not aware enough of their clients and how their clients are presenting. And at the same time, therapists can sometimes take how their clients are presenting as being very personal, which of course is … We’ll use the word countertransference. Having countertransference get in the way, rather than be useful in the therapy. And then just kind of those environmental things; how the office is set up, use of space, what’s a safe or comfortable environment for one client versus another.
Eboni Webb: Mm-hmm (affirmative). Yeah. And when I think about doing trauma treatment, I pull into those three concepts of basically healthy parenting, right? So, proximity maintenance, and the safe haven, and the secure base. Those are issues that have to be negotiated between therapist and client because those are the areas that have been affected by trauma.
Lane Pederson: Sure, sure. Now, when you think about working with people, what are some of the tools or strategies you think are must have to maximize the chances for a successful outcome?
Eboni Webb: I think absolutely you have to have a very solid psychoeducational base. Helping the client understand how the brain works when it comes to trauma and a language in a way that they really can take it in. I think that is an essential tool, to have something even visually for them to understand. I think also, to be successful, when there is a breakdown in the session, what resources even do you have in your room to bring them back online, and to be able to kind of move forward. So, it’s really critical to have that psychoeducation, but also in the moment resources for when the process kind of goes astray.
Lane Pederson: So, a lot of it is back to that setting the foundation. Does the client actually have an understanding, a real understanding of what happened, how that’s affecting them now, even in this moment, and how that informs what you’re doing as a therapist.
Eboni Webb: Yes.
Lane Pederson: And then of course, it can be at times, really unsettling and sometimes clients can become dysregulated as you’re doing the work. And as a therapist, you need to have the skills to be able to manage those situations when they come up, so the client can leave put together, rather than …
Eboni Webb: Mm-hmm (affirmative). And you have to be very patient because it is a slow process depending on the nature of the trauma. Especially if it’s developmental, it is going to be a slow course.
Lane Pederson: Right.
Eboni Webb: Very, very slow course. So, yeah.
Lane Pederson: Yeah. When you’re thinking about that, the course of treatment, of course there have been times when I’ve thought therapists jump in too soon, too fast with trauma. How as a therapist do you gauge what is an appropriate course of treatment for an individual client?
Eboni Webb: In terms of course of treatment, it’s really determined by the severity of the trauma and the frequency. So, single incident trauma can be cleared pretty quickly and you can go straight to that. But with developmental trauma, you’re going to have to take some time. You really have to work with the client alone, just to be able to tolerate our relationship, right? The relationship between the client and the therapist. And to make sure that they are safe in this moment. So, it can take time to go back to actually the core event. And it’s often not necessary because the brain doesn’t need the original players per se, to be able to work through the trauma.
Lane Pederson: Sure, sure. Well, I know that we’ve really just scratched the surface of what’s going to be covered in the training. I can tell you I’m really looking forward to it. Having worked with people with a lot of trauma in their history for a long time, I know that there’s going to be a lot of new stuff that I’m going to get from this, too. So, thank you for taking a few minutes to talk with me about this.
Studies indicate that up to 50% of individuals diagnosed with chronic pain will also meet the DSM-IV-TR diagnostic criteria for anxiety. This is because many individuals who experience chronic pain describe anxiety and pain distress as a circular fashion: pain contributing to stress, which leads to muscle tension, which leads to more pain. It is important to practice relaxation strategies to cope with anxiety which will release tension in the body. You will find one example of a relaxation script below. In addition, use your mindfulness skills to pay attention to your body’s needs and shift the relaxation script as needed.
Breathing and Body Relaxation Script:
Begin by resting your body in a comfortable position. You may close your eyes, or if you are more comfortable keeping them open, stare at a fixed focal point in the room. Start grounding your awareness into your body. Feel your feet firmly meeting the floor, your back supporting you in your chair.
Once you have physically grounded yourself, slowly bring your attention to your breath. Notice the patterns of your breathing- the inhalation, pause, and exhalation.
Observe the rise and fall of your belly as you are breathing. If you notice that you are breathing from the chest, work to slow your breathing down, with slower and deeper breaths from your diaphragm. Allow for a few more rotations of this breath, going deeper and deeper into your core.
The goal of this breathing exercise is target a slower breath, a soothing breath. Perhaps counting allows you to pace your breathing. Try this experience, perhaps starting with intervals of 4 seconds.
It is natural for distractions to pop up in your mind. If you observe a distraction, identify it as just a thought and redirect your attention to your breathing.
Inhale, 2, 3, 4. Pause, 2, 3, 4. Exhale, 2, 3, 4.
Continue this breathing until you have found a natural rhythm of inhalations and exhalations that work for your body today.
Continuing to move with this rhythm, consider the idea of releasing tension with your exhalation as we expand into meditation with the breath. Feel yourself working to inhale calming energy, and exhaling muscle tension.
Inhale calm, 2, 3, 4. Pause, 2, 3, 4. Exhale tension, 2, 3, 4. Inhale calm, 2, 3, 4. Pause, 2, 3, 4. Exhale tension, 2, 3, 4. Imagine your body slowly releasing all of the built up tension.
As you work through your muscle groups, observe the experience of feeling lighter in your muscles are you work to cleanse your body of the tension.
Continue this process for as long as you find meaningful for you. When you are ready, you may begin the process of orienting yourself back to your surroundings. Feel your back against the chair, your legs against the chair, your feet resting on the ground. When you are ready, you may start to shift your body and prepare to move on to the next part of your day. Remember that you can return to this place, to ground yourself and release tension in your body, at any time you choose.
All clients recovering from addiction face setbacks. While demoralizing, these lapses provide important lessons that inform sustained recovery in the future. To help clients apply these lessons, use this FREE Handout and Worksheet from Dr. Lane Pederson’s book DBT in Integrated Dual Disorder Treatment Settings.
It can be challenging for individuals with chronic conditions to find the balance when asking for help. Many people have experienced barriers with everyday household activities and responsibilities as well as occasions of cancelling plans due to pain. It is common for individuals to feel like they will upset their support system by asking for help. This leads many people to keep their needs to themselves. It can be easy to think that other people will automatically know what you need, and frustrations can result when they don’t get it.
Even though it may feel this way, keep in mind that we don’t know what other people are thinking. Other people cannot read your mind to know what you need. It is appropriate to ask for help, and doing so builds self-respect. Use this idea as motivation to prepare and reach out
Start by identifying your different support needs. This includes emotional and physical needs.
The clearer and more specific you are, the better.
Communicate with your supports ahead of time. Ask them what kind of help they are willing to offer. For some, it may be help with chores like carrying laundry. For others, it may be help with getting to appointments or providing emotional support during challenging times.
Make sure to reinforce others for jumping in.
It may feel challenging in the moment to follow up and ask for help. Remember that your supports have shared with you what they feel comfortable with, and to trust their word and intention with what they offered. Use mindfulness to work on balancing the acceptance of help from others with the things you can do independently to enhance your quality of life.
It can be challenging to identify and manage what triggers addictive behaviors. Understanding what sets off these behaviors and knowing which strategies and solutions for change are effective are essential in one’s recovery.
