Thursday, March 18, 2010

Marsha Marsha Marsha

So Therapy Thursday was a doozy today. Basically, my private therapist (D) has been informed by Public Mental Health peeps that they think that the psychodynamic therapy is not the right thing for me at the moment, and that I should be doing DBT. I guess the basic concern is the increased suicidality. She couldn't tell me much as the letter she recieved was confidential (WTF? It's about ME!), but she needed to check in with me to ensure that continuing therapy with her was a) what I wanted and b) in my best interests. DBT has been brought up to me before through public mental health, and I have always rejected it. Firstly, I have developed (much to my dismay and disgust at times) a rapport with (D) and would need to stop seeing her, in order to do it. Secondly, my treatment before has been very CBT-ish with hints of the ol DBT mindfulness, and whilst it can be helpful in symptom reduction, it doesn't solve the problem. I don't want to live a managed life. I want a life. With ups and downs like everyone else, yes, but without the intrusiveness of these PTSD gremlins ruling my thoughts. It just takes so much energy. I knew going into psychotherapy that it was going to get a lot worse, before it got better.

I don't know. My head is very muddled. Voices are screaming inside my head. But my gut is telling me, that (D) is that path I need to take.......

(D) reiterated that she would be there and support whatever choice I make, treatment wise. I worry about whether it will be the same with PMH? If I choose not to undertake DBT will that be seen as non-compliance? I guess I'll have to cross that bridge when I come to it.

Mostly there is just this anger that this is not being dealt with directly with me. As I mentioned DBT has been brought up and I declined. But if they feel strongly enough to write a letter to my private therapist, should they not bring the matter up with me again, and emphasise why they feel so strongly about it. Give me more of a voice. I guess its probably professional curtesy.. I don't know.

In an attempt to make a more educated decision I have been reading some more about DBT. I can't put my finger on it, but something about the whole thing just sets my teeth on edge. The whole process is supposed to be about validation.... but I walked away from the reading feeling invalidated and pretty damned patronised.

Experiences anyone? DBT, good, bad or ugly?

P.S. I start changing to Venaflaxine today....we shall see....


  1. I have to admit that I didn't do it in any detail - but that's because I was horrified by the very idea of it. It is typical of cognitive behavioural approches in my view; it focuses on symptoms only, not causes and, worst of all for me, it is wholly patronising.

    Having said that, the concept of dialectics has an ancient and fairly sensible philosophical background (I wrote a post on this - 'To Hell With Today and the Philosophy of DBT'). I'm just not sure Linehan's take on that really works. It has empirical backing in a way, but even in those circumstances where it does produce results, as far as I can see the overwhelming majority of results is only re: external symptoms - suicidality, self-harm etc. It doesn't seem to mean you feel any better.

    I do have one friend (who blogs at who found DBT helpful, just so you get a balanced view. But yeah, personally I hated it.

    Good luck whatever way you proceed. Take care of yourself. xxx

  2. I completely agree with you that the goal should not be to live a managed life, but to live a (normal) life. I was doubtful about DBT until I attended a couple of workshops on it run by Marsha Linehan herself, and those experiences just made it clear to me how right I was to be doubtful. Also, I agree with Pandora about the importance of identifying causes and really feeling better (two things that are central to CBT when it's properly done).

    Psychodynamic approaches generally tend to focus on relationship and rapport to the exclusion of causes and recovery, which is why they have a bad reputation, and your writings here do not seem to indicate that D is any different. I would guess that that is the thing PMH are concerned about. Can't you contact PMH directly to find out what's going on?

  3. You know what really sucks? That fact that we have to live this way! And you guys know what I'm talking about. I mean in highschool, you pass by people, not one person but many. And they stare at you as if you have something coming out of your nose. They stop and ask "Are you ok?" This only pisses you off more and you try and explain " I have depression and anxiety disorders, it takes over my life." Slowly they say, "Oh depression thats no big deal just think positive." And your world is crused at the fact that no one understands.

  4. I have done DBT in public mental health in brissy. I found it hard at first as I did it in group and they did an intake every so often when there was enough space. I had to go once a week for a year but I was never told to not see my therapist. I also had a case manager type person who was connect with the DBT who I had to see once a week too. I found the skills of it all not great, however, I am not doing DBT for a second time one on one with my psychologist and I can NOW understand completely how it works. I guess I don't do group. I found that other people's issues would always piss me off. I also was at my lowest weight then and nearly considered anorexic, so I couldn't think and I was self harming then too. DBT does work, it really does. You just have to figure out the best way to do it. If you want any more info you can email me on and I will answer as many questions as I can for you. I really really don't mind if you email me :-)