“It is important to appreciate that once in hell, it is possible to climb out of it. -Marsha Linehan”

The authors describe their experience of using Dialectical Behavior Therapy (DBT) in the treatment of BPD. They offer their firsthand account of how DBT works with their emotional pain–acknowledging the time, effort, and practice needed for the skills to become effective in reducing their suffering.

At some point I realized that I could be in charge of my brain, that I could control where I put my attention. That by using DBT skills, I could get out of suffering and into the present moment, where there was usually nothing wrong. Even when everything was going wrong, and nothing was working, everything was perfectly fine. I spent a long time shifting from wise mind to emotion mind, going back and forth all day, every day. I was going deep inside myself, determined to examine all the beliefs that held me in suffering and blocked my freedom.

There are difficult days, there are times when I am vulnerable, and there are times when I lose sight of the dream. But no one can take my wise mind from me. No one can steal my peace. I am safe, and I am free. Author 12 (p. 90)

Even after a full year of DBT, I still struggled with suicidal ideation. The pain I experienced was so great, and I always felt like, eventually, even if I never had the guts to take my own life, I would just disintegrate into the earth. After all, I was already completely dead on the inside… But, as many months passed, there would be times when I no longer thought of dying all day. This was progress. I started to buy into the notion that the painful emotions were a result of my distorted thoughts. I started to pay more attention to my thoughts–what they sounded like, how loud they were, and how they made me feel. I had moderate success using certain DBT skills: mainly distract, opposite to emotion, a (rather novice) rendition of DEAR MAN, and the use of physical sensations. Author 12 (p. 88)

I found my way to DBT… My life skills were limited, and it was a brutal process to create them… I had to learn that I deserved to have my needs met and simultaneously get used to the idea that, even if I acted as skillfully as possible, they still might not be met. All of it was extremely difficult and painful. Author 6 (p. 48)

Living with chronic pain, like BPD, takes severe patience, discipline, and self-knowledge. It is absolutely exhausting on every level to have to be so constantly aware, to have to keep employing DBT skills over and over and over again, only to watch those skills break apart under pressure. Author 14 (p. 104)

I was diligent in using the DBT skills I understood. I certainly didn’t always use them effectively, but I never stopped trying. I got discouraged and wanted to give up several times a day, but there was something inside of me that said, “No! You are too close! Keep it moving! Layer by layer, peel by peel, I started discovering all the thoughts and beliefs that kept me miserable. It felt impossible, but it wasn’t. Author 12 (p. 89)

The next entry of this series on Pearls from Beyond Borderline will focus on the importance of the therapeutic relationship in DBT.

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