In this brief overview of Dialectical Behavioral Therapy (DBT), we are illustrating the efficacy of DBT for the treatment of patients with suicidal behavior, bipolar disorder, and borderline personality disorder. DBT has been shown to reduce severe dysfunctional behaviors in clients. DBT uses validation has a tool to the client accept unpleasant thoughts and feelings rather than react to them in a dysfunctional way. Simply put, dialectical means that two ideas can be true at the same time. Validation is the action of telling someone that what they see, feel, think or experience is real, logical and understandable. It’s important to remember that validation is non-judgmental and doesn’t mean you agree or even approve of the behavior you are validating.
Over the last year, Visions has effectively trained the staff to be DBT informed. We hold regular DBT skills groups at our residential and outpatient facilities. We have adopted and incorporated DBT skills into our day-to-day interactions with clients and are finding it to be incredibly beneficial.
I took some time to speak to Jesse Engdahl, MA, RRW, about his observations and experience with running the DBT skills group. He said, “We are happily surprised that it’s (DBT) become a community within a community. It’s set itself apart through the kids’ commitment to not only use the skills but in their support of each other. There is a high level of trust. We have kids coming into IOP who’ve felt marginalized and who hadn’t felt a broader amount of support, but find their place in DBT.”
The emphasis on validation in DBT is profound. Someone suffering from borderline personality disorder often has a movie playing in their heads and when the validity of that “movie” is denied, it can create a waterfall of dysregulation which can include anxiety, depression, anger, and fear. Taking a counter-intuitive stance and validating one’s reality is has been shown to be particularly efficacious. It deescalates the anxiety, and it teaches the client to self-regulate.
Joseph Rogers, MDiv-Candidate and DBT skills group facilitator and mindfulness teacher succinctly illustrates the value of our DBT groups, “Our DBT skills group gives our clients the confidence that they have the ability to meet their difficulties with skills that can be found within themselves and their capabilities. By utilizing daily skills diary cards and reporting on their results, clients are able to see where they are being effective and can acknowledge the positive outcomes they are responsible for through their actions. DBT has the ability to move clients out of their diagnosis toward a confidence in their personhood.”
We are really honored to be able to share another alumni post, this one talking about Alcoholics Anonymous through the lens of a young person. Having come to recovery as a young adult myself, her words resonate with me. It’s not easy walking in the rooms of Alcoholics Anonymous as a young person, but the beauty of young peoples’ meetings is the camaraderie and unspoken understanding amidst the community. No one wants to hang out in a smokey room, drinking bad coffee on a Saturday night…unless you have to be there. And these young people get that. They get that they have to be there and they show up, week after week, day after day, learning ways in which to show up for themselves and their recovery:
Walking into a room of Alcoholics Anonymous may be the most defining moment in an alcoholic’s life. I know it was pretty life changing for me. Not necessarily in the sense that my life was being threatened by my drug use (although my behavior was), but in the sense that if I hadn’t made it to rehab and to these rooms, I would not be where I am or who I am today.
I sat in the pre-meeting the other night, waiting for it to begin, when it struck me. “Where would I be if I hadn’t gone to rehab and been introduced to these rooms? What would my life look like?” Many people in the Young People’s rooms go through Treatment, many don’t. What matters is that whoever they are, if they are alcoholic, they make it to the rooms of AA.
My beliefs vary when it comes down to an alcoholic’s diagnosis. Sometimes I believe that an alcoholic is born an alcoholic, sometimes I believe they become one. When it comes to myself, I don’t exactly know. I still struggle with identifying, even at meetings, and especially when a speaker has a gnarly story.
I believe this is a common thread in the rooms of AA. Comparing ourselves to others is pretty standard among alcoholics, particularly in the rooms with young people. I used to think that the young people’s meetings were fake and ridiculous. I thought it was like a talent show. Everyone gets all dressed up just to call attention to themselves. That’s not what the principles state and its not what the program is about.
I know now that I was just uncomfortable and insecure, and I was projecting my feelings of dislike for myself into the room. One of my favorite counselors in rehab, who was a young person in the program and who I was very close to and respected very much, challenged my dislike and asked “Where else are we going to get all dressed up to go on a Saturday night?”
When you walk into the rooms of a young peoples’ meeting, a thick smog of E-cig vapor coats the room. It’s so clouded that if the lighting is right and you are sitting far back enough, sometimes you can’t even see the speaker clearly. Everyone is uncomfortable and many people are new to the program. There are a handful of people that are “chronic relapsers,” but they keep coming back. That’s what’s so special about this program.
Altogether, there are many years of sobriety in the room. These meetings are popular; even a few from the older crowd shuffle in. We are all for having a good time, yet most people take the meeting very seriously; it’s life and death for many people. That’s what’s so special about these meetings.
Some of us are very judgmental, its honestly because we are insecure about ourselves. Many of us have been through the wringer, and we are sick and tired of being sick and tired. We are the only people who truly get one another. That’s what’s so special about people in recovery.
It’s that time: New Year’s Eve celebrations are upon us! For many, it’s the time of year often met with party plans and resolutions. Parties and resolutions together sound like a juxtaposition and affect some legitimate irony, but nevertheless, they go together for most people every 31st of December. However, if you are in recovery, have clearer eyes and hopefully a wiser mind, things might look a bit different during this time of year.
There are several articles offering tips and guidelines for setting up the “perfect” New Year resolutions, 0r embarking on a New Year cleanse, or signing up for a New Year workout plan. The one thing all of these have in common is the idea that you can and will actually commit to changing a bevy of major things just because it’s the New Year. Sadly, many fail or abandon those impassioned resolutions after a few weeks. One article in particular stuck out to me. This article suggests creating a theme for the New Year rather than a resolution. A New Year’s Theme! That is right in line with the New Year Intentions I have suggested in the past. Both of these, a theme or an intention, are something that can easily be created, worked with and maintained throughout the year. Rather than seeking perfection, or a grand, finite accomplishment, a theme or intention allows one to slowly change behaviors and invite the possibility of more long-term, sustainable changes.
What might your New Year’s Theme or Intention be for 2014?
Kindness: The wonderful quality of being friendly, generous, and considerate. You can choose to practice random and not so random acts of kindness throughout the year. Make it a year of being kind when you might otherwise be gruff. Invite some personal curiosity and investigation about what it might be like to respond to difficulty with kindness instead of anger or fear. It’s an interesting one to work with, but everyone can be kind and deserves kindness in return.
Mindfulness: Also looked at as keen “awareness,” mindfulness is an astute awareness of reality and the present moment. It is an acknowledgement that things are just as they are in that moment. If you make mindfulness your New Year theme, perhaps you will begin by investigating the contemplative practices of meditation and yoga. Or perhaps it might mean choosing not to use your cell phone when you are walking around and instead bringing your awareness to your surroundings and becoming more present. It might mean driving without the radio on, or not always having your cell phone nearby. It might mean eating dinner without the television on so you can be more present with your family. Remember, it is not about perfection; this is a practice.
Wellness: If you are desirous of changing your health or the way you eat or the amount of activity you engage in, this is a wonderful theme. You might do this by ruling out meat for one day a week, or by eating more greens. You may choose to limit your caffeine, or cut down on your cigarettes or vape pens: eventually you may even quit! You can increase your wellness, that healthy balance of mind, body and spirit, even if you start small. In fact, small changes over a long period of time have a longer lasting effect.
Movement: Increase your physicality in 2014. You can start with walking more or riding your bike. If you usually drive to the corner store or to a meeting that’s only a mile away, try riding a bike once a week! The more you do ride your bike or walk, the more it might become a habit. Honestly, there’s no concrete rule about how long habits take to form or break. Instead, look at this as small opportunities for personal change.
Service: Make 2014 your year of being of service! Take a commitment at a meeting and keep it for a year. Volunteer to feed the homeless. Volunteer at an animal shelter once a week. Find a cause you believe in and get involved in raising awareness about it. Being of service is the fulcrum of recovery; “We can’t keep it unless we give it away” is one of the most-often repeated sayings relating to being of service. Write it on something you can always see to remind you to get out of yourself and into action.
No matter your theme or plan, the New Year is a time of reflection and growth. It is an opportunity to reflect on the past year so we can grow into the new one. May you ring this New Year in with self-care, compassion, kindness, and great joy. We wish you a wonderful New Year celebration and look forward to celebrating and growing with you in 2014.
Stress can be really high at this time of the year. Family reunions aren’t always easy, money can be tight, and if you are newly in recovery, the temptation to imbibe is high. The reality is, stress if everywhere no matter the time of year; it’s how we manage it that makes the most difference. Developing quality coping skills is an essential piece to managing stress. Here are 8 tools to help you manage your stress and have fun while doing it!
1: Create some healthy rituals: take a bath before bed, do yoga or meditation in the morning before you start your day or before you retire at night.
2: Get outside: take walks, go on hikes, do whatever you need to do to get some sunshine (even in December) and absorb some of that healthy Vitamin D. If going outside isn’t an option (say, you are in Maine and there’s an ice storm!), adding plants to your home or workspace can elicit a similar sense of calm and reduce stress.
3: Do something that is relaxing and which allows to turn off your head: do a puzzle, knit or crochet, read a book, draw, go surfing or skiing. Essentially, do something that focuses doing something with your hands or body.
4: Use positive imagery or meditation to ground (stay connected):
A: Check in with your mind and body and visualize a safe space where you are rooted to the earth, and connected to your breath and body. Find an image that is soothing for you and breathe into that heart space.
B: Place one hand on your belly and one hand on your heart: breathe into your hands for a minimum of 3 cycles of 10 breaths.
5: Exercise: go for a run, walk, or hike. Take a spin class, or go to yoga. Get your endorphins going. You’ll be amazing at the stress relief you find!
6: Breathe. Take long, deep breaths. The longer your exhale, the more efficient you are at activating the parasympathetic nervous system.
Try this: breathe in for the count of 4, breathe out for the count of 5.
Do this several times. In layman’s terms, the parasympathetic nervious system is what calms you down. It is essentially the emergency medical technician of your nervous system. The best thing about the breath: It’s portable, you do it all the time, and it’s easy to use.
7: Have a dance party. Put on some silly tunes and rock out in your kitchen, or living room, or wherever the mood strikes you. The goofier, the better.
8: Say “No.” You don’t have to always say “Yes” to someone’s request. If your plate is too full, say “No”! Creating those boundaries will lesson your stress. You can only do so much.
Be kind to yourself this holiday season and beyond and Kick Stress to the Curb. As the Buddha said, “You yourself, as much as anybody in the entire universe, deserve your love and affection”
Every day is a day for practicing kindness, compassion, and generosity. In fact, these qualities and practices shouldn’t be relegated to once a year around the holidays. However, that’s often the time when we hear about it the most. Around Thanksgiving, there’s a flood of people who commit to feeding the homeless. Ironically, that’s the one time of year that the homeless aren’t actually seeking food. The shelters, the food banks, the plethora of good Samaritans are all providing that one hot, nourishing meal. The day after Thanksgiving, however, many of us move on with our lives…until next year, when we commit to feeding the homeless of helping the helpless.
What happens if we consciously choose to practice kindness and compassion in this way every day? What if we decide to be of service, and practice kindness, compassion, and generosity as a way of living our lives? Would we be happier? Would we be less stressed? Would our mental health improve or at least be less overwhelming? I would garner a resounding yes to these questions.
Consciously choose to be kind, compassionate, and generous…every day:
By doing so, we have the opportunity to get out of ourselves and realize that we are not, in fact, the center of the universe. In the AA big book, alcoholics (and I am going to include addicts as well) are referred to as “selfish and self-seeking” or as the “actor, director, and producer” of their own show. By choosing to be kind, compassionate and generous in our daily lives, we have a chance to overcome this state of mind. Being of service is key.
Happiness is contagious. If you can find one joyful thing to focus on or go back to during your day, your day will be brighter. Surround yourself with joyful people, have random dance parties, revel in the little things that bring you joy. I giggle every time I hear my dog snore, or when little kids laugh, or when my son cracks a joke. Joy is everywhere, even when things feel dark.
Pay attention to the little things and find gratitude in that: the way the light hits a flower, the fact that you got a parking spot…right in front, waking up at home with family, seeing your kids, a shared smile with a stranger, or a shared joke with a coworker. The list can go on. Essentially, begin looking at the seemingly banal and find some gratitude there.
Things that have gone wrong or which present difficulty for us is also something to be grateful for: These are often our greatest teaching moments.
Thanksgiving may have passed, but your ability to engage in compassionate acts, kindness, and gratitude are alive and well. These practices contribute to better mental health, a fuller life, and a higher level of optimism. Being present and honoring what’s happening right now is a gift and an opportunity to open your heart. When you show someone kindness, they are more apt to show someone else kindness. It’s a wonderfully positive domino effect!
It’s hard not to get excited about Visions when you talk to Amanda Shumow. She is passionate, dedicated and inspired by the Visions’ staff, the clients, and the work as a whole. Amanda Shumow is the co-founder of Visions Adolescent Treatment Centers. She holds a Master’s Degree in psychology, a CDAAC, and she is currently working toward her Doctorate in Psychology (PsyD). Her dedication to furthering her own education is matched with her encouragement of others to do the same. Everything Amanda does is in the best interest of helping teens.
Amanda initially worked with adults in treatment at Promises, but she quickly realized she wanted to direct her energies toward working with kids. It became clear to her that what she had to offer adults was much different than what she could offer kids. Amanda said, “When I was a teen, if someone had asked me ‘Do you have a problem with drugs,’ I would have said, ‘yes.’ I wish there was something like Visions when I was young.” It was this realization and awareness that drew her to work with teens and start building Visions Adolescent Treatment Centers with her husband, Chris Shumow.
She is the mother of four amazing children, wife to Chris Shumow, and deeply involved with all aspects of what makes Visions tick. When I asked Amanda about the Visions culture, she said, “We are humble about a lot of things we do, but we are not humble about the staff. We have the best team. The Visions culture is like nothing else. If people love what they do, they do whatever it takes to make things work. Everyone here has deep dedication.”
When I interviewed Amanda for this piece, the conversation we had was rich with passion and love for what everyone on this team does. She said, “We provide a high level of mental health care: for example, we’ve recently integrated DBT training for all staff. Don’t underestimate someone’s magic.” She’s right. Yes, we encourage fun, and revel in team building activities, but we are deeply serious about the level of care we provide our clients. We understand the need for jocularity, because nothing opens the heart like a healthy belly laugh, but our foundation is built on recognizing the intrinsic value and need for deep work.
I asked Amanda to name some of the things she really loves about the Visions culture and the team she’s help build. She said, “Having things like Glamping – that’s bonding. I have found a place where people fall in love with the work they do. It’s also where the ‘least likely to succeed’ come back to work, and that’s inspiring!” She shared this quote from a client, and frankly, I think it sums up the magic that Visions holds, “This is the first group of people who loved me because they want to, not because they have to.” Amanda, you are the matriarch of a magnificent program, providing a gift of hope, healing, and love.
Read on for some quotes for the staff.
“It’s hard to be in a bad mood around Amanda. Her energy is contagious in every way. She’s one of the most inspiring people I’ve ever met, I can only hope to a little bit like her. She’s taught me so much about working in this industry and more importantly how to maintain a sense of humor and not lose yourself. She’s our fearless leader and we wouldn’t change it for anything!” – Ashley Harris
“There are so many great things to say about Amanda but I guess to keep it short and sweet and not go on and on and on I would have to go with this…. From what I have been blessed to experience with Amanda is that she is a very kind and generous soul. Always willing to help out and do what she can for others even with a full plate of her own. She is truly the best boss I have had the pleasure of working for. She’s always there to support all the staff in crises mode or silly mode. She keeps the work environment safe but most importantly fun!! She is an inspiration and a role model.” Jennifer Garrett
“Amanda is a rockstar!! She has such a wonderful personality that draws you in. She knows how to talk to the residents in a relaxed manner while still holding boundaries and keeping them in line. She has been a wonderful and understanding employer and to me that is so important!! How she balances running Visions and raising her 4 children I will never know.” Amy Lawhorn
“I think Amanda’s greatest gift to Visions families and staff is her realness. She has the unique ability to turn a serious work related question into a “your mom” joke, and it never gets old.” Patrick Schettler
“I love this woman for so many different reasons. She is a genius to start. Her brilliant ideas start out as giant dreams that come true because of who she is a human being. Amanda’s core beliefs in hard work, family and fun are just a few building blocks she has implemented into Visions’ moral code. As a woman who gets to work for a spectacular woman I am grateful for her leadership inside and outside the office. Her passion for impromptu dance parties reminds me of the meaning of life. Amanda is all business with a gigantic heart that will never grow up!” Christina Howard
Amanda may be the most intelligent person I know. Being around her quick wit, incredible memory, sincerity, fun and compassion makes everyone want to be the best they can. A constant reminder that there are authentic, good people in the world. – Mie Kaneda
It has been my pleasure to have worked with Amanda for almost twelve years. She is always an abundance of energy and highly unpredictable but consistently keeps the best interest of our kids in mind. – Bill Hoban
1: Roller skates or blades?
2: In three words, describe your passion for kids:
Love, laughter, hope
3: If you were in the circus, what would your specialty be?
4: Favorite song…ever.
Could not even begin to list them, I have one for every genre in every decade…seriously.
5: What do you do for self-care?
Watch really, really bad reality TV and go to Vegas as much as possible.
6: What is your greatest accomplishment thus far?
My family and my relationship with my husband.
7: What makes your heart sing?
My kids, slot machines.
8: If you could have dinner with anyone, alive or dead, who would it be?
9: What makes you laugh?
My kids, and everyone at work. I have a pretty adolescent sense of humor and so does everyone we work with, so it gets loud and crazy sometimes.
10: How does Visions Inspire you?
Everyday in every way. From kids to staff, we have daily moments that connect us and drive me to do better and do more. Almost every decision we (I) have made in the past 11 years has been inspired by Visions!
The ideology behind therapeutic tools like DBT is to facilitate and encourage an emotional and psychological paradigm shift towards a more sustainable relationship to one’s mental health challenges. The foundational tenant of DBT (Dialectical Behavioral Therapy) is mindfulness training. By using core mindfulness skills, one becomes personally active in redefining their relationship to their suffering. Using these tools, one can learn to be non-reactive to their discomfort while staying emotionally present. In a nutshell, they are taking what is a learned response to stress and dismantling it. DBT teaches you how to put it back together in a healthier, more sustainable and manageable way.
Are we programmed to fix things? Is being present with “what is” simply too much? For many, the answer to these questions is a wholehearted “Yes!” We come to recovery in deep suffering, and often times, this suffering is precluded by failed attempts at “fixing” what was “wrong” with us. Substance abuse, sex, shopping, self-harming, video games, the Internet, and gambling are used as ways to mollify our pain; these things are temporary and eventually, they cease to work. What we are left with are the frayed shadows of unaddressed traumas, hurt, loss, shame, sadness, depression, anxiety, et cetera.
Redefining the way we approach our difficulties takes patience. It takes effort. It takes acceptance. It requires us to sit with our discomfort without trying to fix it or change it in any way. Imagine someone clutching something with all of their might, because letting go would be unfathomable. But their grip is so tight, what they are holding onto is crushed, creating sheer devastation and heartbreak. What if we look at our difficulties the same way: if we hold onto them so tightly, we create heartbreak and devastation. Instead, we can hold them gently, giving those same difficulties room to breathe and change.
There is no magic bullet. There is work to be done, and it takes effort and patience and support. With tremendous tools like DBT elicited by skilled clinicians, it’s clear the temperature of mental health recovery is changing; it’s more inclusive and collaborative.
The overwhelming sense of unworthiness that permeates someone’s mind when they begin their recovery can be astonishing. So often, we begin the path to recovery with this sense of not being worth anything: love, affection, respect, you name it. We show the world our feelings of unworthiness in our actions and our interactions. This is an interesting phenomenon to behold, and a challenging one to unwind and rewire. From the perspective of one who holds the position of sponsor or mentor, the way to help someone rewire often comes by way of being an example; planting seeds and watering them with knowledge, love, and support, and waiting for them to root. They eventually do, but not always in my time, or your time. They root during the natural progression of the person’s readiness to recover and do the necessary work.
Unworthiness is a state of mind, a feeling that tends to hover over those who are feeling down and out. It can be a temporary state or it can linger and lead to depression. It is not something to shrug off and ignore or to be held lightly.
In order to combat this, it’s vital we do the deep excavating work that’s required for the healing process of recovery to take effect. This work is not an opportunity to beat ourselves up but instead, a time to learn to take steps toward self-care and freedom. Unfortunately, the tendency toward self-deprecation is far too high and can often hinder one’s willingness to move forward.
How do we overcome this sense of being unworthy so we can develop feelings of being valuable or worthwhile?
1: Be of service: It can be as small as doing your dishes, or picking up the phone and calling someone to see how they are. Smiling at strangers is a nice way to bring some light to your day.
Going through this process of recovery can be dark. We have to find ways in which to bring some light. Gratitude lists, being of service, and asking for help, developing a meditation practice, and practicing acts of kindness to others and ourselves: those are all flickers of light. We can and will recover, one step, one tear, and one laugh at a time. Those feelings of unworthiness will eventually fade and we will soon realize our feelings aren’t facts.
*editors note: Kevin Breel’s speech was not an actual TEDx Teen talk as previously stated. I have made the appropriate edits to the blog and in the tags.
Real depression crosses our threshold every day at Visions. We see it, treat it, and experience it firsthand. When I saw Kevin Breel’s speech where he openly speaks about his depression, I was deeply moved. He bravely talks about the alienating stigma of mental illness. He talks about the societal push to empathize with what is comfortable (broken bones, sprained ankles), and the deep seeded fear of mental illness. This 19-year-old names the pain, and he sheds light on the darkness that haunts him.
In his speech, Keven Breel says, “Unfortunately we live in a world where when you break your arm, everyone runs over to sign your cast. But if you tell people you’re depressed, everyone runs the other way. That’s the stigma. We are so so so accepting of any body part breaking down, other than our brains.” He goes on to say, “Depression is one of the best documented problems we have in the world, yet it’s one of the least discussed.” In his speech, Breel recognizes that his hurt allows him to hope; his darkness allows him to recognize light.
I’ll leave you with one of my favorite quotes from this speech:
“The world I believe in is where where embracing your light doesn’t mean ignoring your dark. The world I believe in is one where we are measured by our ability to overcome adversities not avoid them.” Amen to that. Watch the whole thing. It’s only 11 minutes and well-worth your time.
Mental health is not something to be meddled with. It’s not something that can be fixed by prayer or meditation or going to yoga or by thinking positively. It requires legitimate clinically supported psychological care. For some that may require a long-term in-patient program, for some, that may require an intensive outpatient program, and for some that may require weekly meetings with a therapist. The spiritual practices of prayer, meditation and yoga can and ought to be integrated into any therapeutic work but they are not the end all be all.
Stepping onto the path of recovery is about change. It’s about shifting one’s perspective and learning how to redefine and shift old paradigms so we can create new ones. We must first begin with our old thought patterns and old ideals, which are heavily ingrained in us. The older we are, the deeper the planting, and often the more difficult the change, though not impossible.
It is imperative that we seek help for our mental health needs when we need it. If we are confronted with clinical depression, anxiety, OCD, panic disorders, or PTSD, this is where a skilled psychologist or therapist or possibly a psychiatrist should come in. Bypassing it is dangerous and causes us more harm than it does good. Often times, we seek that magic bullet that will make everything just go away, but it doesn’t. We have to walk through it, or stumble through it, whatever the case may be.
I am reminded of my newcomer years: I was a mess. And when I say mess, I mean, a real mess. I was angry, resistant, but I was full of fire. I was ultimately convinced that I was going to be killed by my feelings (clearly, that didn’t happen!), and I would wax poetic dramatically that it was so. If it weren’t for people pulling me out of myself and into reality, I wouldn’t be where I am today. Part of that process was also learning to walk through my issues not around them, because wherever I went, they were right there with me, like a trusted companion, ready and willing to make my life miserable.
You don’t have to do this alone. In fact, you can’t. There is a network of mental health care that avails you and a network of support groups at the ready. One step at a time, one breath at time, one minute at time, recovery is possible. Mental health care is possible but one thing is for sure, the only way out is through.