• DBT.

    •  IN DISTRESS 

      •  THERE IS CONNECTION 

    • DBT.

      •  IN CONFUSION 

        •  THERE IS ANSWERS 

      • DBT.

        • IN ANGER

          • THERE IS PEACE 

        • DBT.

          •  IN LOATHING 

            •  THERE IS COMFORT

          • DBT.

            •  IN GROWTH 

              •  THERE IS FEAR 

            • DBT.

              •  IN LONELINESS 

                •  THERE IS FREEDOM

              • DBT.

                •  IN ACCEPTANCE 

                  •  THERE IS CHANGE 

                • DBT.

                  •  IN PAIN 

                    •  THERE IS RELIEF 

                  our amazing team 

                  Who We Are

                  Ivor Barnard

                  Clinical Psychologist

                  Ivor has co-developed and co-facilitated the outpatient DBT day program at Mosman Private Hospital.

                  Read More

                  Ilana Karpin

                  Clinical Psychologist

                  Ilana has advanced training in DBT, run the group with Tony, and is a highly skilled DBT trainer

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                  Tony Merritt

                  Clinical Pschologist

                  Tony has advanced training in DBT and runs the DBT group programme at Sydney DBT with Ilana.

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                  Meg Houtzaager

                  Clinical Psychologist

                  Meg has undertaken advanced training in DBT and ran the outpatient program at Wesley Private Hospital.

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                  Danielle McHugh

                  Clinical Psychologist

                  Danielle has extensive experience work in the fields of drug and alcohol, childhood trauma, and personality issues.

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                  Dr Viktoria Sundakov

                  Psychiatrist

                  Dr Sundakov has worked as an adult psychiatrist since 2005 in both the private and public sector.

                  Read More

                  For You

                  If you’ve arrived here it’s likely that you or someone you know is experiencing ongoing difficulties managing their emotions. Our wish is that we can be a source of hope and information.

                  Often people find Dialectical Behaviour Therapy after struggling to cope for quite some time. This struggle can have many personal costs. These can include using self-harm, alcohol, drugs, or chronic avoidance to cope, damaged relationships or experiencing life as a series of letdowns. Understandably life may feel unliveable as it is. If you identify with these types of problems then DBT may be able to help you.

                  This website is about real hope, not false hope. Through DBT many people have learned to make sense of their feelings, manage them more effectively, and live fuller, richer lives.  There is extensive research supporting the use of DBT with a wide range of problems that often are not usually helped with other forms of therapy.

                  DBT is not a quick fix, and DBT therapists will not treat you like there is. If there was a quick fix you wouldn’t be here reading this now. DBT appreciates the complexity of ongoing emotional problems, that change can be difficult work, feel risky, and challenging, and also that through the right type of support and therapy lasting change is possible.

                  Through this website you can start to look at whether you might be interested in DBT for yourself, and how you can use DBT to help support someone you are close to. You will get to know the ideas behind DBT, how they work and what DBT might involve if you commit to it. For people looking to help someone else, the website will introduce you to how you can use the principles of DBT effectively, as well as understanding how DBT can help the person you care for.

                  What is DBT?

                  Dialectical Behaviour Therapy was developed by Dr Marsha Linehan. She was interested in finding a treatment that worked for people with ongoing problems of self harm, suicidal thoughts, and suicidal behaviour.

                  Dr Linehan had direct personal experience of these problems as well as professional training and experience in well-researched behavioural therapies (see link re: Linehan’s personal history with this).  When she found that traditional behavioural treatments did not seem to work for certain clients she started incorporating Eastern psychological theory and practices into her treatment. Through feedback from clients and observers about what worked in the treatment she developed DBT.  The resulting treatment was shown to be highly effective in reducing hospitalisations, helping people stay in treatment (preventing drop out) and reducing suicidal and self harm behaviours.

                  Initially the treatment was researched as an effective treatment for Borderline Personality Disorder. Over time, however, DBT has been shown to be effective for other groups, such as adolescents with complex, multiple problem behaviours, binge eating, substance abuse and gambling. In general DBT tends to be applied when the core problem seems to be emotion regulation.  In DBT ongoing life threatening and quality of life threatening behaviours are viewed as a person’s best attempt in the moment to solve the problem of painful emotions.

                  At present researchers are trying to work out which bits of DBT make it work and who is it most effective for. In Australia and around the world there are both comprehensive DBT programs and programs that have incorporated some of the principles of DBT into their treatment. Similarly there are clinicians who have extensive, formal training in DBT, and those who incorporate some ideas from DBT in their work.

                  Dialectics

                  One of the important principles in DBT is Dialectics. This is the idea that there can be truth in experiences that appear contradictory and that there is a natural tension between these two seemingly opposing things.

                  So, an experience can be both helpful and unhelpful, or two different points of view can both have elements of “truth”.  So for example, self harm can be both helpful in that it brings a person immediate relief and is a way of coping with pain, and it can also be unhelpful in that it brings with it a variety of undesired consequences, including increased scrutiny, a sense of being unable to cope, shame and scars.  Another aspect of dialectics is that experiences, situations, thoughts and feelings are interconnected and often only make sense when looked at within the context of the experiences around them.

                  One of the goals of DBT is to help people identify the dialectical tensions that occur both in their life and their therapy and to find a balance between seemingly contradictory experiences of thoughts, emotions and behaviours.   This can lead to a new way of looking at and responding to experiences.

                  DBT emphasises a number of ‘core dialectics’ including:

                  That both change and acceptance are important for dealing with emotional problems.

                  That people’s thoughts, feelings and behaviours usually makes sense even when they may be unhelpful.

                  That a person is doing the best they can do in that moment and at the same time they may want and need to do something different.

                   

                  The Biosocial Model

                  The Biosocial Theory

                  Linehan’s research and other research on the brain shows that some people tend to experience things more intensely and as a result are more reactive to events than the general population.  This can be something that is part of the person’s genetics or the product of early life experiences that have shaped how the brain responds. Either way, the person has a higher degree of sensitivity to emotions, so that arousal occurs more easily, is heightened and is slower to come back down once activated.

                  It is important to note that it is not just the person reacting more intensely. It is that their experience is more intense for both pleasant and unpleasant events. Linehan (1983) refers to this as lacking an emotional skin, and likens it to a burns victim who experiences pain at the slightest touch.

                  Emotional sensitivity is not a problem per se, it can have the benefits of increased intensity of love, passion, empathy and connection.  However, when a person does not know how to take care of their sensitivity they may learn to dull the pain through escaping or avoiding emotions, and this can lead to extreme measures that have their own consequences as well the by-product of maintaining the belief that the person cannot tolerate and cope with intense emotions. (See more on the Biosocial Model)

                  The Role of Invalidation and Validation

                  When a person experiences emotions that are more intense than those around them they often feel disconnected or alienated from others.  They may receive a range of messages from those around them that are about toning down their emotions, such as being  told they are ”too emotional”, or “too sensitive”.  They may then experience a sense of being rejected, not understood or punished for their level of emotional intensity.  Over time the person starts to believe the messages that “there emotions should not be as they are”, or that “they are over reacting”. They may then learn to distrust their own emotional experience and start to reject or punish themselves for their emotional experience.  Linehan (1983) says that you cannot ride and have control of a horse without being on the horse, so if you reject your emotional experience it is hard to learn how to manage it. This brings us to the dialectic in DBT that in order to manage or change our response to our emotions we must first accept that this is the experience we are having.

                   

                  Skills

                  Part of the solution in managing ongoing intense emotional distress.

                  What does DBT suggest is the solution to ongoing intense emotional experiences.  The experience of having intense emotional experiences has been likened to being equipped with a Formula One race car motor when everyone around you is driving a standard car (Hollander, 2008). Most people learn how to drive in an ordinary car and so the advice most people get about driving relates to this. However, to drive a Formula One car you need more specialised skills otherwise you are going to careen around, feeing out of control and crashing.  Similarly, most people can get on a horse, do a few laps around the paddock, or even a trail ride, without too much trouble. However, it takes specialist skills to ride a thoroughbred racehorse. What’s more, and this is very important, to learn how to drive a Formula One car or ride a thoroughbred, it takes time and practice. Similarly, learning to manage an emotional system that is more sensitive to the outside world requires learning and practising different skills.

                  The DBT Skills

                  Mindfulness

                  Mindfulness skills work to increase awareness, focus and acceptance. These are the skills to be more present in each moment, learning how to attend to the range of details (both emotional and factual) in a situation and therefore to make wise choices, rather than ones that are dictated by or deny emotion.

                  Distress Tolerance

                  Distress Tolerance skills are those that allow you to work through and survive moments of situational and emotional crisis without making the situation or your suffering worse. These skills provide options and alternative ways of responding to distress that enhance your sense of being able to cope and manage pain, emotions and difficult situations.

                  Emotion Regulation

                  Emotion Regulation involves learning how to identify emotions, recognise them before they escalate, understanding the function of emotions and the factors that increase vulnerability to emotions. It includes learning to tolerate unpleasant emotions and problem solving factors that prompt patterns of emotional suffering.  It also involves identifying and practising ways to generate pleasant emotions.  Overall this module increases awareness of emotions, the skills needed to take care of and live effectively with them.

                  Interpersonal Effectiveness

                  The interpersonal effectiveness skills focus on learning how to maximise the chances of getting your needs met in a way that maintains relationships and self respect.  Being interpersonally effective includes learning to identify priorities within interpersonal situations and factors that get in the way of being effective, as well as how to “ask”, “say no” and communicate in a way that reflects your own values and opinions.

                  Validation

                  Another important part of DBT is understanding the role of validation and invalidation. When we are invalidated (communications that send a message that our experience doesn’t make sense) our arousal goes up and this adds to our distress and the difficulty of managing emotions. Conversely validation soothes our arousal system. As such, it is important to learn how to validate our emotional experience as a part of learning how to manage it.  (see DBT self help links: tips on how to validate and validation examples).

                  Resources for You

                  DBT skills

                  Aguirre, B. & Galen, G. (2013). Mindfulness for borderline personality disorder: relieve your suffering using the core skill of Dialectical Behavior therapy. New Harbinger Publications. CA

                  Hoekstra, R. (2013). The Emotional Extremist’s Guide to Handling Cartoon Elephants: How to Solve Elephantine Emotional Problems Without Getting Run Over, Chased, Flattened. Hoekstra

                  Linehan, M.M. (2015) DBT Skills Training Handouts and Worksheets 2nd Edition . The Guilford Press, N.Y.

                  Spradlin, S. (2003). Don’t Let Your Emotions Run Your Life: How Dialectical Behavior Therapy Can Put You in Control. Oakland: New Harbinger

                  Van Dijk, S. (2011). Don’t Let Your Emotions Run Your Life for Teens: Dialectical Behavior Therapy Skills for Helping You Manage Mood. Oakland. New Harbinger Publications

                   

                  Websites

                  http://www.bpdresources.net/

                  http://www.dbtselfhelp.com

                  http://www.myborderlinelife.co.uk/

                  http://www.bpdcentral.com/

                  http://www.tara4bpd.org

                  http://www.buddhaandborderline.com/

                  http://www.mydialecticallife.com

                  http://www.behavioraltech.com/

                  http://www.borderlinepersonalitydisorder.com

                  http://www.my-borderline-personality-disorder.com

                   

                  Books for those experiencing BPD

                  Chapman, A. L., & Gratz, K. L. (2007). The borderline personality disorder survival guide: Everything you need to know about living with BPD. New Harbinger Publications

                  Chapman, A. L., & Gratz, K. L. (2013). Borderline Personality Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications

                  Kreisman, Jerold; and Straus, Hal. (2004). Sometimes I Act Crazy: Living with Borderline Personality Disorder.  New York: Wiley

                  Kreisman, Jerold; and Straus, Hal. (2010). I Hate You – Don’t Leave Me: Understanding the Borderline Personality. New York: Wiley

                   

                  Personal Stories

                  S.R. Blauner, S.R. (2003). How I stayed alive when my brain was trying to kill me: one person’s guide to suicide prevention. William Morrow Paperbacks

                  Johnson, M.L. (2010). Girl in need of a tourniquet: memoir of a borderline personality. Seal Press, California

                  Pershall, S. (2012). Loud in the House of Myself: Memoir of a Strange Girl. WW Norton & Company

                  Reiland, Rachel. (2004). Get Me Out of Here : My Recovery from Borderline Personality Disorder.  Hazelden City Center, Minn: Hazelden

                  Van Gelder, K. (2010). The Buddha & The  Borderline: My Recovery from Borderline Personality Disorder through Dialectical Behavior Therapy, Buddhism & Online Dating. Oakland: New Harbinger

                   

                   

                   

                   

                   

                   

                  For Family and Friends

                  People struggling with emotional difficulties need the help of their family, friends, partners, spouses, etc.

                  Sometimes this just involves just a little understanding and support while the person works through their problems. You may just need to give them time to talk or space to work on things. However, when things are more complex support needs get more complex. You may feel that whatever you do isn’t good enough, or that you try to help but it seems to make things worse. Maybe you’ve even given up trying.

                  DBT has long understood that a person’s broader environment matters. Family, friends, work, school, all play crucial roles in complex emotional problems. The biosocial model explains how a person’s environment can interact/transact with their emotional sensitivity in a way that shapes and reinforces particular patterns of responding to emotions. It’s very important here to say that this is not about blame. In our experience people with the kind of emotional problems that DBT is designed for can come from a range of different family backgrounds from very loving, supportive and caring families, as well as families that are rejecting, harsh or where there is high levels of conflict.

                  So DBT is not just for people struggling with emotional difficulties. DBT is also for anyone who interacts with the person and wants to learn to help in more effective ways. The good news is that there are many resources around, including our forthcoming family and friends programme.

                  Support and carers people can also experience emotional difficulties themselves. They tend to experience higher levels of anxiety, depression and  sleep problems. This can then impact on the support person’s work, family life, leisure activities, which then feeds anxiety etc. This makes complete sense of course, and yet support people and carers often do not get help themselves. They may not feel they have the time; they may feel that they should be focusing on the person they are trying to help; they may feel guilty about focusing on their needs or think they are not as important. However, it is very important to understand that you will be more effective if you get help and support, and in the end being effective in providing help and support is what really matters.

                  How You Can Help

                  There are many, many ways you can help, but from a DBT perspective there are perhaps four.

                  There are many, many ways you can help, but from a DBT perspective there are perhaps four. The first is to understand the difficulties your loved one is experiencing from a scientifically validated approach, such as DBT. The theory behind DBT is solidly founded in scientifically based principles. The theory behind DBT is called the biosocial theory and you can read about it elsewhere on this website. This theory will give you a great understanding into what is happening for your loved one.

                  This second is to learn effective validation skills. In brief , validation is communicating that the person’s experience makes sense and is understandable in some way. The biosocial model explains why this is helpful. Validation is a core skill in DBT and central to helping people who come to DBT for treatment. Effective validation is a skill that can be learnt with practice, and in our experience major changes can come about when significant other develops the skills taught in DBT.

                  If you look in chat rooms, on YouTube, at blogs and other social media you will find people discussing whether to involve family members by disclosing difficulties. One common discussion is about whether to tell parents about self-harm or other problem behaviours. You find lots of advice from people to not tell parents or loved ones. This advice is driven by bad experiences or fears that: parents can’t be trusted, things might change for the worse afterwards, loved ones will get angry, they’ll tell my teachers/work and so on. These fears all centre around invalidation. The person fears that telling someone will be an invalidating experience. Invalidation and the fear of being invalidated can increase a person’s distress and make it harder to accept support. So learning how to validate, is crucial.

                  The third way you can help is to learn about change from a DBT perspective. Change is important for anyone wanting to overcome emotional problems. DBT has many changes strategies and teaches skills such as mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. If your loved one is in DBT you can really help by learning about the skills they are trying to build. You can learn how to encourage the use of these skills, and to reinforce them when the person puts them to use. It is also important to know how to balance supporting and encouraging change with validation when helping someone

                  The final way you can help is to look after yourself effectively. Caring for anyone with a psychological problem can be tough, and it becomes more demanding the more complex the problems. If you experience sleep problems for just a few nights it could negatively impact on your ability to be an effective support. Longer-term impacts can include depression, anxiety, problems with alcohol, and so on, all of which will definitely make it harder to be more effective. In the end you may develop burn out or compassion fatigue, and that will really make things tough.

                  Information for families on how to help:

                   

                  Some Family Patterns

                  Katie grew up in a small beachside suburb in far north Queensland. Her parents and sisters rose early to surf everyday and loved the beach life. Summer was full of hanging out at the beach and evening barbeques. Her mum ran a local shop and her dad was a carpenter. Both were very involved in the community and surf-lifesaving. The family was well known and well liked and everyone called them easygoing people. Katie was pale-skinned, never liked the beach, and preferred to sleep in. She just didn’t seem to enjoy the same things as her family. She felt that she didn’t fit in no matter how much her family tried to include her. At school she didn’t identify with the surf culture and preferred to develop an alternative image. People didn’t describe Katie as easygoing. She seemed uninterested in everyone and unhappy as a teenager. Her parents tried to cheer her up but that pushed her further into being withdrawn and negative. She spent more time in her room alone longing to leave home. Katie started to self-harm to cope with her feelings of despair. She also binged on alcohol. At 15 she was hospitalised after she cut herself . Soon after she left home in Sydney. In Sydney she got a job but struggled to meet people. She continued to feel out of place and coped with self-harm and alcohol. Her family told her she was always welcome at home and asked her to come back. This made her more distressed.

                  Li’s mum and dad worked hard throughout their life and dad was often working during Li’s childhood. Her mum was always busy with housework and looking after the family. Dad was often tired and short-tempered. When Li was eight she was sexually assaulted by a neighbour. She was afraid of what her parents might say so told no one. She became withdrawn and cautious of people. The family thought it was ‘just Li’ and didn’t take much notice of the changes. As a teenager she experienced emotions very strongly, particularly fear of new people. She developed problems with trust and tended to get angry when people tried to get close to her. This led her to be bullied and to occasionally bully others at school. She had one close relationship with a friend at school but they fell out over a boyfriend, and her other friendships were not that supportive. At 15 Li became quite promiscuous. Her parents found out and were angry at her. They felt they had worked hard to bring her up the right way. There was a lot of conflict at home and Li started to self-harm. She wanted to punish herself when she felt she did things wrong as the guilt was overwhelming.

                  Sonja’s parents were hard working who built a very successful business. They had all the signs of success; a big house, cars etc. Sonja went to a private school and her parents had high expectations for her. They felt they had worked hard to get her a good education and that she should not waste it. They made her work hard and study. She did well at school but never felt it was enough. Her parents would punish her for not working hard enough but rarely praised her successes. They thought that hard work was the norm and that their daughter didn’t need to be praised for it. At 14 Sonja developed an eating disorder but her parents didn’t notice. They thought that she looked good and was being careful with her appearance. Soon after she started to self harm whenever her emotions became too greatintense felt “too strong”?. Her parents did not know she self-harmed and were in denial about her eating disorder. By the time she was sixteen Sonja was suffering from depression and had regular panic attacks.

                  Support Resources and Ideas

                  The good news is that there are many resources out there that can help you to develop your understanding and knowledge. Many are listed in our site.

                  Consider joining a support group such as Borderline Support. There are online communities (LINK) or groups you can attend (LINK), and there are national organisations dedicated to supporting people and carers, such as the Mental Health Carers Association, ARAFMI. In the USA there are a number of DBT centred family originations. Some have chat rooms you can join, and blogs you can follow. These organisations include BPD Family.

                  Our organisation and others provides one-on-one support to carers from DBT perspective. You can learn about complex emotional problems from a DBT perspective, and learn about validation and DBT skills. In our experience a few sessions can make a considerable amount of difference. We will soon be running a group for people wanting to support their significant others. It is available to people irrespective of whether their loved one is in DBT. Information on the group can be found in the section on our Family and Friends programme.

                  Resources for Family and Friends

                  VIDEOS FOR FAMILY


                   

                  BPD from a client perspective

                  Tom – http://www.youtube.com/watch?v=gWU6vSYM4dU

                  Advice for mums and dads – http://www.youtube.com/watch?v=_b_QDENOOw8

                  Lets talk self harm – if can handle disruption in adds many good points, also put up sequel to friends of self harm, a bit focused on body image, however great points – http://www.youtube.com/watch?v=QrNXpV9-HPY

                  Interesting video about the effects of bullying – http://www.youtube.com/watch?v=Cx27wL7E6So

                   

                  DVD


                   

                  If Only We Had Known: A Family Guide to Borderline Personality

                  The five videos in the series are available in two formats. One is via streaming video which can be obtained at the website. http://www.bpdvideo.com. Each video can be viewed several times over the course of a month and cannot be saved. The cost is $14.99 per video.

                  The programs are also available on DVD via Amazon. The cost is $99.99 per DVD or $449.99 for the five part set.

                  Instructions for accessing the instant streaming videos and the DVD are located on the website.

                  NEABPD has a distance family psycho-education program called Tele-connections. It’s an offshoot of their location based Family Connections program. You can learn more about this from the NEABPD website http://borderlinepersonalitydisorder.com.

                   

                  BOOKS FOR FAMILIES


                  Aguirre, B.A. (2007) Borderline Personality Disorder in Adolescents: A complete guide to understanding and coping when your adolescent has BPD. Fair Winds Press. 

                  Harvey, P., Penzo, J.A. (2009). Parenting a Child Who Has Intense Emotions; Diaectical Behavior Therapy Skills to Help Your Child regulate emotional Outburts & Aggressive Behaviors. New Harbinger Publications. CA

                  Hollander, M (2008). Helping teens who cut, understanding and ending self-injury. The Guiford Press. NewYork

                  Fruzzetti, A.E (2006). The high conflict couple; A Dialectical Behavior Therapy Guide to Finding Peace, Intimacy & Validation. New Harbinger Publications. CA

                  Manning, S. (2011). Loving Someone with Borderine Personality Disorder. How to Keep Out-of-Control Emotions from Destroying Your Relationship. The Guilford Press. NewYork

                  Porr, V. (2010). Overcoming Borderline Personality Disorder; A Family Guide for Healing and Change. New York, Oxford University Press

                  Brief written overview of the experience of emotional sensitivity:

                  Finding a DBT therapist-brief overview of DBT and questions to ask to find a therapist:

                   

                  BORDERLINE PERSONALITY DISORDER


                  An open letter – http://www.youtube.com/watch?v=KGXdxtZZisE

                  The quiet Borderline – http://www.youtube.com/watch?v=9CoASG8VseQ&list=PLKw8iI-cO80UjDQaKa8RwesDl_6GEO7pj

                  Compassionate documentary – http://www.youtube.com/watch?v=Ikl4GjQHPz4&list=PLKw8iI-cO80UjDQaKa8RwesDl_6GEO7pj&index=3

                  Back from the Edge, doco-with lots of supportive info for families and clients – https://www.youtube.com/watch?v=967Ckat7f98

                   

                  WEBSITES


                  BPD family:

                  http://bpdfamily.com/index.html

                  http://www.borderlinepersonalitydisorder.com

                  http://www.tara4bpd.org/dyn/index.php

                  get in touch

                  Contact

                  Suite 211, RPA Medical Centre
                  100 Carillon Avenue
                  Newtown, NSW 2042
                  ph (02) 9517 1764 fx (02) 9517 1832