Saturday, November 22, 2014

Dr Suzanne Robison speaks about DBT

The very knowledgeable Suzanne Robison, PsyD - see her impressive website here - has a practice in Lansdale, PA. We learned about her since she spoke at one of the NAMI meetings.

Psychiatry/psychology loves acronyms she said. DBT stands for dialectical behavior therapy, invented by Marsha Linehan. It's an effective treatment for borderline personality disorder - BPD - a term invented by Freud.

First, she defined symptoms of BPD. You must have 5 out of 9 in order to earn this most stigmatized condition. 

Here are a couple off the top of my head:

-Fear of abandonment
-Unstable relationships
-Self-harm, such as cutting
-Identity problems

I hadn't known about 'inappropriate expression of anger.' Read about it here. 

We had a good turnout. Many came in late. One woman, who asked many questions, found out about us from the Intelligencer. They need three weeks' notice and I always forget to do it, but obviously remembered. is always useless, but I'm always in a panic and post it on there anyway.

We've had several people in New Directions with BPD. Just looked up one individual, who would tell me over the phone she was dying, but she is still living with her husband in Staten Island.

Reminded me of a case Suzanne mentioned. The woman had BPD and the man had dependency issues. He controlled her and she allowed it. Suzanne is working with him to loosen the bonds and for her to become more independent.

Suzanne teaches her adolescent clients the meaning of BPD, but that's not going to change their behavior.

They work both in groups or in solo sessions.

The person with borderline feels absolutely horrible inside. To them, the world is a scary place with little safety. They are acting out on others what they feel inside. Their behavior, they think, makes them feel good, but it only exacerbates the situation, which has been described as living a soap opera, with crises every single day.

Life is frustrating for the people who love a person with borderline. And they rarely know how to talk to their loved one, thus upsetting them more.

"I didn't want to upset her b/c I was afraid she'd cut herself more."

The goal is to live a life worth living.

Dialectical means 'opposite.' Dialetical statements have opposing view points such as "I think you're a kind person, but sometimes you push people too far."

A statement like this can provoke the client. They can end up in the hospital from cutting. But then they must pay the consequences with Suzanne.

She was first a drug and alcohol counselor, and then received training in DBT.

Suzanne describes herself as direct and confrontational.

25 percent of her clientele have borderline.

DBT makes use of cognitive behavior therapy - CBT - which is probly the only psychotherapy whose results have been studied and found effective.

Mindfulness meditation is one component of dialectical behavior therapy. Stay in the present moment.

B/c the client's emotions are so sensitive, she must be taught 'distress tolerance.' Whereas a regular person might get angry and feel it for a few minutes, not so the borderline person. She or he might not cool off for hours or even days.

Interpersonal skills are also worked on. How do we relate to other human beings?

It's believed that MM had BPD.

There are dialectical dilemmas suffered by the borderline person, which shows their black and white thinking - all or nothing - no shades of gray

Active vs. passive

Unrelenting crisis vs inhibited grieving

Idealism vs invalidation

Is the disorder learned or innate?

It's believed there's a genetic component that is brought out by the environment, the way the child is raised. Usually there has been serious trauma or invalidation by parental figures.

Suzanne teaches parents how to validate their children. You learn how to talk. Avoid phrases like "Your thinking is ridiculous!"

Say, instead, "I can understand how you feel that way.

Also avoid speaking in absolutes and using words such as - everyone, always, never - these imply that the world is an orderly predictable place. Be openminded to being wrong b/c we're not always right.

We can change things or we can accept them. We may not like them, but we can accept them. This is Eastern philosophy, Buddhist, Zen.

Acceptance. These concepts are also used by Alcoholics Anonymous.


Look the person in the eye.

Keep facial expressions neutral, no rolling of the eyes or huffing while the client/loved one talks.


Staying up all night with the loved one to help calm their nerves or make sure they don't cut. You might say, "How about if I give you a hug?"

These are enmeshed relationships. Controlling relationships. Defending the individual if they do wrong. Dependent on one another, thinking about each other more frequently than the average person would think of family members. Bad boundaries. (I'm thinking now of Lee Harvey Oswald and his mother Marguerite.)

Taking things personally.

Enabling by allowing use of drugs in the home.

Instead of cutting, do something pleasant for your body, such as Take a warm bath or light scented candles or talk to someone.


A slow process. Before DBT, no good treatments. Patients had chronic suicidality. They had gotten progressively worse. Wrong behavior was reinforced. Meds are not very helpful.

Suzanne tells her clients she is very bad with email, so don't email her.

Suzanne, dressed for the cold weather, left with our gifts

Further reading: 

I Hate You, Don't Leave Me by Kreisman and Straus

Stop Walking on Eggshells by Mason and Kreger.

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