It has been a very long time since I have done a focus exercise. I made the first mistake when I switched exercises several times. The purpose of the focus exercise is to be able to use it anywhere at any time to clear your mind. When I finally did start the focus exercise, I found my mind wandering to many things (where’s the dog, will my web page go up o.k., etc.). During a focus exercise, your mind is to focus only on the thing being presented (in this case, the song Silver Cloud). If you have a thought, you notice it (do not get involved in it, just notice that is there, then let it go, like a balloon.) I am sorry to say that I only stayed focused for a few moments. On the positive light (since I am attempting to not put myself down) is that I did not get cause in judging the song, i.e., is it pleasant sounding, the type of music, etc.

POINT TO REMEMBER: When practicing a focus exercise. You choose a sense, i.e. something to hear, touch, or taste. You focus on the sensation only. Any other thought you notice then let go. Do not judge the activity, i.e., I like the touch of this, this tastes sour, just stay in the moment and activity.

THE FIRST PART OF DBT, WHICH MOST OF US NEVER SEE IS THE EVALUATION. ARE YOU FIT FOR DBT. MARSHA LINEHAN (I WILL BE REFERRING TO HER BOOK AS LINEHAN (WB) FOR CITES FROM NOW ON REFERS TO RULES OF DBT. I WOULD LIKE TO START WITH THE WHY YOU WANT TO DO DBT.

This really does not matter. Research has shown that DBT skills are effective for a wide variety of people. However, for the sake of this site, I will list the DSM criteria for Borderline Personality Disorder:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. frantic efforts to avoid real or imagined abandonment.
   Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5
2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
   identity disturbance: markedly and persistently unstable self-image or sense of self
   
3. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
   
   
   Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
   
   
4. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
   
5. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
   
6. chronic feelings of emptiness
   
7. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
   
8. transient, stress-related paranoid ideation or severe dissociative symptoms

To officially considered borderline, you must be diagnosised with five of the eight above criteria.  There are different degrees of borderline.  Unfortunately, I am considered to have complex borderline personality disorder.  I easily fall into all eight of the criteria above.

Three years ago, I took a "medical leave" and was placed in a traditional day treatment program. While in the program I was fired mostly due to my cutting problems, misunderstanding of BPD, and betrayal of people I thought were friends. Nevertheless, the day treatment program was not helping. I then moved a couple of states, lived in a hotel, so I could attend a treatment program created by the lovely Dr. Paul Holmes, UIC, TRINITY SERVICES, EAP program. Basically, it was a day treatment program focused on the teachings of Linehan. After four months of the program, I moved on to a job and a start to rebuild my life. For a while, I used DBT skills and enjoyed a rather peaceful existence. However, I eventually became lazy and stopped using DBT. I went through several therapists who considered themselves DBT therapists. However, none of them even came close (please take the Linehan referrals before you sign up for someone who calls themselves a DBT therapist, I wasted time, emotions, and lots of money to find that therapist did not have a clue what DBT was except they heard it was great). I finally gave up and have been in individual therapy for almost a year with a survivor minded therapist, who admits she does not practice DBT. She, however, has encouraged me to use DBT. I have tried to get into a group and when I finally found a suitable one, I found that I simply could not afford it. Alas, I decided that I would try on my own (I know the skills, I just have not been using them) and run a self DBT group each week. I know DBT works for me. I just need to use it.

Linehan suggests nine rules for a DBT group. How will I commit myself to them, since basically, I am running a individual online DBT criteria.

I dedicate myself to DBT. I know that I need it. I have created a site to make sure I keep to it.

This is important to me both for DBT and medication.

Not an issue for me.

I am modifying this for myself to include that I will focus these sessions on learning skills. If I have had an episode during the week, I will include this in my diary card and if discussions come up. But I dedicate myself for the one and half hours each week to reviewing and posting skills.

I am changing this for myself to mean if I call anyone for help I will accept their help.

Unfortunately, there is nothing I can do about this except to hope that any users of this site will respect that I am putting this all online to hope to help my peers and will respect my privacy and that of other users of the site.

For this, my rule is if I’m going to miss a posting by Saturday before bed, I must post a reason why on the message board.

For me, this rule will now me that I will not meet, e-mail, etc. outside of the site on a personal basis. One of my goals, which I will outline below is to live in the "real" world.

Not applicable to this situation.

© Marsha Linehan, WB, p. 108, General Handout 2

O.k., these are how I will put the guidelines in place for myself. If you are following along.

Think about your dedications to DBT and this online group will be.

Linehan sees that starting at the top of the period, DBT must be dealt with by addressing certain problems in this level:

For me this would be in order (suicdial acts [walking in front of buses, etc], cutting, hitting, and finally, suicidal thoughts.

For me this includes (not creating crises to evade the underlying factors, not focusing on therapy)

For me this includes decreasing anger outbursts so as not to lose positions and increasing "good" communications with BF.

For me this includes increasing my interpersonal skills so I can have more than one friend.

For me, this means being able to have good sleep, accept compliments, and engage in parties and social outtings

Where are you on the pyrmiad? Are you still on the top with me? Or have your progressed? What are your goals?

© Thank you also to Anita Mandley, Center for Contextual Change, for the handout "The Hierachy of Primary Targets in DBT" for a little more in depth pyramid.

© Marsha Linehan, WB, General Handout 1

O.K., Let’s get started with DBT

© Marsha Linehan, WB, Mindfullness Handout 1

Linehan describes two types of general states of mind that we are used to being in: Emotional Mind and Reasonable Mind. What we are striving for is the intersection of the two, the wise mind.

Lets start with Reasonable Mind

Linehan states Reasonable Mind is "your rational, thinking, logical mind. It is that part of you that plans and evaluates things logically. It is your cool part."

© Marsha Linehan, WB, p. 65

For most of use, reasonable mind is what we struggle to get into. It what’s lets us gets tasks done. BUT, be careful. Your reasonable mind is not your wise mind. For example,

I tend to be too much in my reasonable mind at work. People think that I am cold towards them. In reality, I am just in my reasonable mind, trying to think things through logically. Of course, whenever you are working with people you must always show some empathy, some emotion for their situation if you are really doing your job. I struggle with this constantly.

Linehan states Emotional Mind: "You are in emotion mind when your emotions are in control-when they influence and control your thinking and behavior."

Emotion mind helps you to empathize with people. It allows us to love and to have beliefs. However, emotion mind becomes a problem when we let our emotions rule our actions.

I have a lot of problems with emotion mind. Lately, it has come out in anger. For example, I had a client insult me this week. I let my anger take over and slammed a chair and stormed out of the room.

The Key is to use wise mind. A combination of both. To realize the client may have hurt you, but at the same time reasonably remember that the clients have problems of their owns they are dealing with which may cause them not to be using their wise mind.

We will start next week with Wise Mind.

HOMEWORK:

Next week, we will start with your focus activity, move to a short diary card review, a homework review, then pick up with wise mind. Thank you for anyone following along and enjoy a skillful week.

END WEEK ONE