DBT Metaphors and Stories

Understanding the Skills That Make Life Worth Living

James J. Esmail

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000339833
• Edition: 1
• Topic: Psicología
• Subtopic: Terapia cognitiva conductual (TCC)

DBT Metaphors and Stories gives therapists and DBT skills trainers the skills they need to make effective use of dialectical behavior therapy and to help clients more deeply understand complex realities.

Each page is devoted to explaining a specific DBT skill. The book is structured so that it can be used in several ways, including as a reference tool to look up specific skills the reader is struggling to understand or (for skills trainers) to teach. The book can also be read cover to cover, both for understanding the broad array of skills and as a source of motivation to devote one's self to regular practice of skills. It's a vital guide for trainers, therapists, and their clients interested in fully harnessing DBT's power to change lives.

Why Engage in Skills Training?

Chapter 1

Why Engage in Skills Training?

Metaphor—Batman

I grew up in the 1960s. In 1966, when I was in the second grade, a TV show came on that rocked my world and the world of my classmates—Batman (starring Adam West and Burt Ward; Dozier, 1966).

Each episode, a villain would put Batman and Robin in some dangerous situation, but Batman would reach into his “utility belt” for the perfect weapon or defense to counter what the villain had done. I remember one episode in which Batman and Robin were stung by scorpions, but Batman was able to reach into his utility belt for his “Bat-anti-scorpion-venom antidote.”

Your life has been wrought with heartache, emotional pain, relationship failures, and self-destructive behaviors. Your life has been this difficult, in large part, because nobody has given you the complete array of skills needed to cope with life’s demands and difficulties. In essence, you are like Batman without a utility belt.

DBT skills training is the answer to this dilemma. You will fill your utility belt with Emotion Regulation, Interpersonal Effectiveness, and Distress Tolerance skills that will enable you to (in the words of Marsha Linehan) build a life worth living. Mindfulness skills (Linehan, 2015, p. 49) will be the foundation upon which you build the other skills.

It is important to remember that Batman not only had a utility belt filled with tools, but he had honed a great deal of skill in using them by repeated practice. For example he had a boomerang (shaped like a bat) which he attached to the “bat-rope”: Batman could throw the “Bat-o-rang” with great skill and use it to climb a building or catch a criminal. Just having the “bat-o-rang” was not enough: similarly, you need not only to know about the skills, but acquire skill by practicing them

Dr Linehan recommends that a person engage in a skills training group for at least one year. In my practice, I have noticed that the longer people are in skills training, the more effective they become in using what is in their utility belts. Don’t become discouraged if you don’t notice a huge difference in your life the first several weeks; stocking your utility belt will take some time. Once it is filled, you will wonder how you made it through life without these tools.

Practicing Skills—The Importance of Practice

Some people look at psychotherapy as if it were a modern car wash. You drive up, put your car in neutral, and let the car wash pull your vehicle through—the car wash itself does all the work. You emerge on the other side of the psychotherapy process fully cleansed of your problems. All you must do is pay for the car wash.

DBT is very different than a car wash. One gets the maximum benefit of DBT by doing the homework every week and practicing the skills daily.

Here is one of my early experiences with practice. When I was in fifth grade, I decided to join my school band. The other students all got shiny new instruments, whereas I had to wait a couple weeks to borrow a tarnished old trombone from my cousin Mark. In hindsight, I realize my band teacher felt sorry for me with the tarnished old instrument, and he lavished a lot of encouragement upon me. As such, I practiced regularly and dutifully, and within several months became the best instrumentalist in the whole band. About this time, my parents did buy me a shiny new trombone. The band director began to focus his encouragement and teaching on other students who were struggling to make progress. Without his attention and encouragement, I quit practicing regularly. By the end of the year I diminished to being an average player. Within a couple years, I became one of the worst players in the band, all because I was no longer practicing.

Here is another personal story with a better ending. Unlike probably any other author you have read, I held a part-time job for 30 years at a major shipping company loading trucks. I did this all during college and graduate school, as well as in my early years as a psychologist to supplement my income. I will not tell you which company it was, but I will say our trucks were painted brown. After 28 years of loading, I needed a knee operation. My surgeon explained before the operation the type of exercises he wanted me to do to post-operatively to rehab my knee. I realized my 30-year pension was hanging in the balance, and I did the exercises religiously. I saw the surgeon two weeks after the operation, and he was amazed at my knee’s strength and flexibility. He had never seen someone progress so rapidly and completely. Then he told me about the knee exercises again as if I had never heard of them. I said, “oh no, I’ve been doing this all along.” The surgeon expressed amazement that I paid attention to what he said before the operation, and that I actually practiced the exercises. Please note this disclaimer: my diligence in practicing the exercises was not due to my personal virtue, but rather the realization that my 30-year pension (a lot of money) was hanging in the balance. Regular practice makes a huge difference.

How much do you want to get out of your DBT skills group? Invest in your practice accordingly.

Why Study Skills—The Karate Kid

The Karate Kid (Louis & Avildsen, 1984) is a movie about a teenager, Daniel, played by Ralph Macchio, who is bullied by a gang of other teenage boys who are being trained in a renegade form of karate called Cobra Kai. Cobra Kai was considered unethical and vicious by other karate practitioners. When Daniel is being bullied and beaten by five Cobra Kai teens, the maintenance man from his apartment complex, an old man from Okinawa, Mr. Miyagi, intervenes, fighting and beating the five Cobra Kai thugs.

Eventually Mr. Miyagi agrees to teach Daniel karate, but first puts him to work waxing his vintage automobiles. Miyagi teaches Daniel to “wax on” with one arm and “wax off” with the other in a circular motion. After a long period of this, Daniel feels that he is being exploited and angrily protests. At this point, his teacher throws several punches at Daniel, and Daniel blocks these with ease using the same circular motion, thus discovering that what he really was doing was practicing defensive blocks, committing them to muscle memory by repeating the “wax on-wax off” motions. He does not have to think to use the blocks, rather he does them instantly and automatically, without thought.

A hallmark of DBT is practice, practice, practice. You may get tired of doing the homework every week. You may be tempted to not practice the skills on a regular basis. Life can be a very difficult battle, and if you learn the skills to the point that they become second nature, you will be masterful in the ability to defend yourself in the face of life’s challenges.

Don’t let the repetition of skills practice deter you. The only way to become a master in athletics, playing a musical instrument, or using DBT skills is by repeated practice.

Why Learn Skills—Parable of Two Lumberjacks

Imagine two lumberjacks living side-by-side. Their boss approaches them one morning, telling them that he needs ten oak trees cut down immediately, and so he is going to give a bonus of $100 to the one who first cuts down ten oaks. Once they finish with the ten trees, they can take the rest of the day off with pay. Remember, oak trees are very hard, and very difficult to cut.

Both lumberjacks are very motivated by this prize, but they approach the challenge very differently. The first lumberjack races out into the woods and begins chopping vigorously at these very hard trees. The second does not go immediately into the woods, in fact there is a half hour delay before he takes his first swing. The second lumberjack spends approximately 30 minutes sharpening his ax. As a result, he soon passes the first lumberjack, who is still vigorously chopping, but with less results.

I have no doubt that you have worked very hard to construct a good life for yourself. Even though you have chopped to the point of blood, sweat, and tears, doing your best, you have not reaped the reward you have sought. Your Wise Mind has told you there has to be a more effective way; hence you have pursued learning DBT skills, including reading this book. Learning the skills that Marsha Linehan has brought together in dialectical behavior therapy is like sharpening your ax. Like the oak trees, life is hard. Learning DBT will not make life easy, but it will make life much easier in the long run. Compared to chopping away with the dull ax, using the sharp ax of DBT will be easier.

Bravo to you for having the wisdom to sharpen your ax!

Why Practice Skills—Batting Practice

If you go to a Major League Baseball game, you will have the opportunity to enter the ballpark early, perhaps as early as two hours before the first inning. Teams allow fans to do this to watch batting practice, with each player taking maybe ten minutes of pitches, practicing their timing, stroke, and body mechanics in preparation for the game.

If you should live close enough to a Major League team to do this, realize what you’re looking at. These are not little league players, nor high school athletes. These are not collegiate players or persons in Single A, Double A, or Triple A baseball. Even at the Little League level, you will see a fair amount of skill. In high school and college baseball you will see a lot of skill. When you enter the minor leagues, the skill level is extraordinary, probably everybody on the field was the best player at of about 1000+.

When you watch Major League Baseball, you’re watching the best of the best of the best. And yet two hours before game, what are these guys doing? They are taking batting practice.

Getting DBT skills to attain tangible benefits in your life does not come by wishing, but by practicing. I don’t know about you, but I sure as heck am NOT going to skip batting practice.

Why Practice Skills—The Parable of the Sloppy Guitarist

I play in a rock and roll band, and we had a very successful gig three nights ago. The other three instrumentalists and our two lead singers sounded really great; people were up dancing and singing along with the songs that we covered.

I, however, did not play so well. I hit some wrong notes, and my timing was not “spot on.” I am fortunate that the other five were playing so well that they carried the day.

Why was my guitar playing so sub-par? For the last three to four months I have been working very hard to complete this book (a lifelong ambition). To find time for it, I sacrificed in other areas, and perhaps the area for which I “robbed Peter to pay Paul” was sacrificing guitar practice to write the book. By not practicing, not only was I not getting better, but my skills started to diminish. I remember having a conversation with my long-time guitar teacher, Craig Wilson about this. Both of us agreed that if we did not practice, our skills and execution would begin to erode within days.

The same is true of DBT skills. It is not enough to learn them. We must keep them sharp by practicing on an ongoing basis. Rather than seeing this is some sort of burden, I see it as similar to practicing the guitar. Sometimes there are frustrating exercises that are not easy to implement or rehearse, but most of the time I enjoy practicing, and the benefit manifests itself in a short period of time.

How much will DBT skills pay off in your effort to build a life worth living? Depends on how much you practice.

References

Dozier, W (Executive Producer). (1966) Batman [Television Series]. United States: 20th Century Fox Television and Greenway Productions.

Linehan, M M. (2015) DBT skills training: Handouts and worksheets. New York: Guilford.

Louis, R J (Executive Producer) & Avildsen, J G (Director). (1984). The Karate Kid [Motion Picture]. United States: Columbia Pictures Corporation and Delphi II Productions.

Mindfulness

Chapter 2

Mindfulness Definition—What’s Going On—Album by Marvin Gaye

When I explain what Mindfulness is, I often think of the title of Marvin Gaye’s classic album, What’s Going On (Cleveland, Benson, Gaye, 1971). Gaye wrote the album from the vantage point of a solder returning from Viet Nam, observing what and how American was different since his return. Mindfulness is “what’s going on.” Mindfulness is paying attention to what is going on in your external and internal environments.

Notice what the title is not: it is not “What Went On” or “What Will Go On.” Mindfulness is in the present. This does not mean we never think about the past, but when we do, we recognize we are experiencing a memory, not a present reality.

We as humans have the unique ability to think about the past and the future. This ability also poses a potential trap for suffering. Do you ever worry about the future to the point that you feel tortured? Realize that neither a dog, horse, nor giraffe has this same kind of suffering. Hypothesizing about the future can be a useful tool, but it can also be a tyrannical master. Mindfulness practice is about gently bringing our awareness and focus back to the present, to “what’s going on” in this very moment.

We will discuss this deliberate steering of our attention to the here-and-now under the Participate skill.

By the way, in its list of the 500 Greatest Albums of All Time, Rolling Stone ranked What’s Going On as the sixth greatest album of all time. I hope being present with what’s going on will be one of the greatest skills you acquire from DBT.

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