our amazing team
Who We Are
Training Stephanie completed her undergraduate psychology degree at UNSW and her post graduate studies, including a Masters ofRead More
Training Cassandra completed her undergraduate and honours degrees at Macquarie University, and a combined Doctor of Clinical PsychologyRead More
Training Adam completed his undergraduate studies at the Australian National University and post-graduate training at the University ofRead More
Ivor has co-developed and co-facilitated the outpatient DBT day program at Mosman Private Hospital.Read More
Ilana has advanced training in DBT, run the group with Tony, and is a highly skilled DBT trainerRead More
Tony has advanced training in DBT and runs the DBT group programme at Sydney DBT with Ilana.Read More
Dr Sundakov has worked as an adult psychiatrist since 2005 in both the private and public sector.Read More
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, and that it may feel risky and challenging. However, DBT appreciates 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. 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 DBT and how you can use the principles of DBT effectively to 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 more complex problems who often did not benefit from more traditional therapies.
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 observations 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, and helping with problems such as depression, anxiety, drug and alcohol use issues, and many other problems.
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 many problems, such as ongoing life threatening or self-harming behaviours are viewed as a person’s attempt in the moment to solve the problem of painful emotions. These and other behaviours develop in response to feeling overwhelmed, confused, or lost in emotions, or alternatively being cut off from them. The person learns ways of managing these emotions that may be effective in the short term, drugs for example, but cause more problems in the long term.
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 programmes and programmes 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. The research indicates that therapists with extensive formal training in DBT achieve better outcomes for their clients, and that people who engage in one-on-one DBT therapy while also attending a DBT group get better outcomes. Furthermore, it appears that when family members and significant others attend a DBT group as well, outcomes are further improved.
The concept of dialectics means that 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. This also means that a family member may want someone to stop self harming because it is not good for them, and the person may want to continue because they find it helps. Both of these things can be true.
Sounds confusing? Well It can be! Especially if the two people are in a discussion and both are trying to establish who is right. It can lead to conflict, things could get heated, and one or the other person may end up feeling unheard, invalidated, angry, dejected and so on. What if the people agreed, however, that they were both right and both wrong, and worked to find a common place that allowed for difference and at the same time allowed them to move forward effectively? That sounds like a good thing. That would be a dialectical solution.
Where it gets really interesting and indeed helpful is when people apply these ideas to themselves. How often do people try to work out whether they are right wrong, good or bad, smart of dumb, and so on. Applying a dialectical approach means letting go of this kind of stuff, accepting there may be truth in both views, letting go of the struggles these types of dilemmas cause, and trying to find a view that allows you to be effective in finding a way forward. It may sound easy but taking this view is very challenging at fist as it involves finding a whole new way of doing things. However, with practice it is a skill that anyone can develop.
The DBT Skills
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 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 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.
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.
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
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
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
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
DBT Group Programmes
DBT Treatment Skills Group
DBT was designed to be a comprehensive treatment programme for people with more complex problems. The two core treatment aspects of DBT are the skills group and one-on-one therapy. At Sydney DBT we offer both skills groups and individual therapy, along with phone coaching, consult group, and programmes for families, friends and carers. In this way Sydney DBT offers one of the very few fully comprehensive, integrated DBT programmes in Australia.
The DBT skills group is aimed at helping people learn the core DBT coping skills that will allow them to manage their emotions, actions and thoughts effectively.
People who attend the skills group participate in an active process that helps them acquire new skills. This is quite different from most ‘psychotherapy’ groups, which focus in in-depth exploration and analysis of the person’s personality and past history. In DBT group we work on what is happening how, and how to develop ways of responding differently and effectively.
Over the twenty weeks participants learn four different sets of skills, these are Distress Tolerance, Emotional Regulation, Mindfulness, and Interpersonal Effectiveness.
Distress tolerance skills help people to withstand and overcome strong emotions and urges. They are central to managing problems such as drug and alcohol use, self-harm, suicidal urges and so on.
Emotional regulation skills help the person develop a more effective and liveable emotional world. The skills build emotional awareness and resilience, and help reduce vulnerability to problematic emotions.
Mindfulness is a common component of mots psychological therapies now days. However, it has been a part of DBT for many years. Mindfulness helps people to be more aware of, and engage more effectively with, their inner world. Through mindfulness people learn to step back and not get so caught up in unhelpful thoughts and feelings.
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.
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; that things might change for the worse afterwards; that loved ones will get angry; or that other people may be told or get involved. 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. As such, learning how to validate is crucial.
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:
- How to Help a Loved One with Borderline Personality Disorder – Part 1 | Part 2
- Families on the Line Using Dialectical Behavioral Therapy
Family and Friends Group Programme
The families, friends, partners and carers play a number of very important roles the lives of people with psychological problems. First and foremost, they can play an important role in supporting and helping their loved one cope with their problems and develop more effective coping skills.
Anyone who has been in a relationship of some sort with someone with a more severe or complex problem will know that interactions can at times be challenging. Even people with the very best intentions may do or say things that make things worse at that time. Frustrations can boil over into anger, harsh things are said, then there is guilt, regret and so on. Sometimes these interactions develop into long term patterns, while at other times that may result in the relationship falling apart.
People who attend the skills group participate in an active process that helps them acquire new skills. This is quite different from most ‘psychotherapy’ groups, which focus on in-depth exploration and analysis of the person’s personality and past history. In DBT group we work on what is happening how, and how to develop ways of responding differently and effectively.
There is also the problem of carer burden. Families, friends, partners, carers and so on can often develop their own problems as a result of their role. Depression, anxiety, problems with alcohol or drugs, can all be a consequence of carer burden. Often people feel guilty that they have a problem and will try to hide it, or they may not seek help even if they need it.
The DBT Family and Friends programme is aimed at these and other issues. Through the programme participants learn how to help their loved one more effectively and how to also help themselves.
The programme helps participants to:
- Understand complex and severe psychological problems from a DBT perspective
- Use the DBT perspective to develop an understanding of their loved one’s problems
- Understand what his going on in treatment for their loved one
- Develop skills that complement DBT therapy
- Apply DBT skills to their own emotions
- Model the skills taught in DBT in their relationship with their loved one
- Cope with their own feelings of guilt, anger, blame, regret and so on
- Develop their own self-care skills, including setting and maintaining boundaries
The programme runs once a week in the evening for twelve weeks. It involves a group of approximately fifteen people who are in some way involved with someone with the type of problem usually helped by DBT. The groups involve discussions, teaching, skills development, and homework. The groups are very supportive and focused on developing long lasting change.
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 such as BPD Family, and there are national organisations dedicated to supporting people and carers, such as the Mental Health Carers Association, ARAFMI or NEABPD. NEABPD is the Australian arm of an international organisation set up to support family and friends of people with severe emotional problems.
Our organisation and others provides group and one-on-one support to family and 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 attending a group based programme for family and friends can make a huge difference.
Resources for Family and Friends
VIDEOS FOR FAMILY
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
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