TAPROOT BLOG: Psychoeducation for Clients and Providers
TAPROOT BLOG: Psychoeducation for Clients and Providers
Author: Luke Fox, Taproot Therapy Clinical Trainee
The pressures of being a parent are numerous. It seems that the tasks are endless, sleep can be unpredictable, and efforts often go unappreciated. And these things don’t exist in a vacuum, they are mixed in with various other daily stressors. In times of exhaustion or heightened stress, parents might find they are reacting to their children in a way that is not as attuned, understanding, and supportive as they’d like. This awareness can be followed by feelings of guilt and shame about not being the perfect parent. This is where the concept of rupture and repair can be helpful. Ruptures in relationships are inevitable and there is no such thing as a perfect parent.
In a study with infants and their parents, Tronick and Gianino found that the pairs were in sync about one third of the time.1 This results in mismatches that can be stressful for the child and parent. Both child and parent attempt to correct this mismatch and repair the communication. This attuned effort toward repair helps the child develop self-regulation and resilience. It can be helpful to remember that closeness and attunement are the key factors in fostering repair and growth. Shaming oneself for not being the perfect parent can have the opposite effect. Shame often decreases our self-worth and leads to isolation and distance from others. Understanding that parents make mistakes, and that efforts to repair the relationship are key, it might be possible to move away from shame toward self-compassion. And through repetition of this repair process, children learn that they are worth being understood, that conflict can be resolved, and that they can manage uncomfortable feelings.
From a place of self-compassion, it is easier to practice mentalization. Mentalization is the “human ability to interpret the meaning of others’ behavior by considering their underlying mental states and intentions, as well as the capacity to understand the impact of one’s own affects and behaviors on others”2. When we are stressed and not grounded, we tend to focus less on the intentions of others and more on their behaviors, especially the frustrating aspects. Being grounded increases our ability to see beyond behaviors and consider the world of thought and emotion that influences these behaviors. While we can never know what someone else is thinking, curious exploration tends to increase patience, attunement, and the child’s sense of being understood. And mentalization also means understanding what is driving our behaviors and how we are experienced by others. Acknowledging and accepting our own experience helps us to better understand ruptures and conflict cycles and move towards repair.
1Tronick, E., & Gianino, A. (1986). Interactive mismatch and repair: Challenges to the coping infant. Zero to Three, 6(3), 1–6.
2Fonagy, P., & Target, M. (1996b). Playing with reality: I. Theory of mind and the normal development of psychic reality. The international journal of Psychoanalysis
Self-soothing is a distress tolerance skill uses our senses to calm ourselves. We use our senses to soothe ourselves when we are feeling on edge, nervous, distracted, dissociative, or any other unpleasant feeling we might be experiencing. Our senses can ground us in the present, and help us regulate our emotions. When using this skill, try different methods to soothe using your senses. You might find some techniques are more effective than others.
Self-Soothing with Sight
Look at images that soothe you. Find phots of a beach, a mountain, someone you love, or an animal. If you are able to, go out into nature and look at your surroundings. Watch videos of waves rolling or fish swimming. Look at photos from a vacation you took.
Self-Soothing with Sound
Listen to soft music, or classical piano. Listen to nature sounds, such as rainfall or ocean waves. Open your window and notice all of the sounds you hear. Play an instrument you enjoy listening to.
Self-Soothing with Touch
Put on your favorite sweater, or your softest pajamas. Rub lotion on your skin. Take a bath or shower and notice how the water feels. Get cozy with clean bedsheets. Pet your dog or cat. Hug someone you love.
Self-Soothing with Taste
Cook something you enjoy eating, and then eat it (this also can use your sense of smell!). Eat your favorite piece of candy. Drink a cup of hot tea, coffee, or hot chocolate. Eat your favorite comfort foods.
Self-Soothing with Smell
Light a scented candle. Bake your favorite desserts and notice the smells. Use lavender oil in an oil diffuser, or use lavender scented lotion. Smell your fresh laundry as it comes out of the dryer. Smell flowers in your yard.
For more information on how to use Self-Soothing, listen to our latest episode, “”DBT Skill: Self-Soothing” on our podcast, Taproot Therapy: A Mindful Moment.
By Fiona Smith, Clinical Trainee
One major skill within Dialectical Behavior Therapy’s (DBT) Mindfulness Module is the idea of observing. Observing is the act of sensing or experiencing without labeling your experience. This can be challenging. It takes conscious effort to remind ourselves that we are allowed to be in the world and experience life without labeling, judging, or quantifying each moment. Over time, when we practice the art of simply observing, the mind grows quieter and our thoughts slow. It helps bring our awareness to things we may never before have noticed - like the fact that we have a talkative mind or tend to make quick judgments as we see or experience people or events.
As Marsha Linehan writes in the DBT manual: “Observing your thoughts can sometimes be very difficult. This is because your thoughts about events may often seem to you like facts instead of thoughts. Many people have never really tried to just sit back and watch their thoughts. When you observe your own mind, you will see that your thoughts (and also your emotions and bodily sensations) never stop following one another. From morning till night, there is an uninterrupted flow of events inside your mind. As you watch, these will come and go like clouds in the sky. This is what thoughts and feelings do inside the mind when just observed—they come and go.”
Observing is not dissociating. It is coming back to yourself and grounding through your feet into the earth to nonjudgmentally let experiences unfold. One of the parts that I appreciate most about this DBT skill is that I find it helps me understand my reactions to situations, things, and people more closely. With plain observation, I can hear what my gut reactions really are. This provides insight into how I’m seeing the world and opens up the option to see certain events from a different perspective. This skill goes hand in hand with the “how” skill of non-judgement.
Author: Fiona Smith, Taproot Therapy Clinical Trainee
Dialectical Behavior Therapy (DBT) is a skills based therapy founded by Dr. Marsha Linehan that is oriented around the idea of dialectics: the existence of opposites. We can accept where we are, while also acknowledging that we need to change certain things. The dialectical aspect of DBT addresses the integration or synthesis of two opposing points.
One core component of DBT is its effort to educate the participant. DBT believes that participants show greater levels of improvement when they comprehend the mechanisms behind their actions, thoughts, and feelings. The education aspect of DBT puts the power in the participants’ hands and provides a reason for why we are focusing on certain skills. DBT investigates the underlying reality of a situation through a compassionate lens and an understanding that life is complex and ever evolving. It helps us to recognize negative patterns of thinking and unproductive behaviors.
DBT is effective in treating a wide range of life’s stressors. The skills taught within a DBT group or DBT-informed therapy can be applied to various circumstances and help us to deal with overwhelming emotions, unexpected life events, difficult relationships, anxiety, depression, and rocky transitions, and more. Though there is no “one size fits all” method of therapy that works in every scenario, DBT skills are useful to have in our back pockets as we navigate life.
Pulling from ancient spiritual traditions, these techniques help to focus us in the present moment and ground through the body. These skills encourage us to slow down and use our “wise mind.”
These set of skills teach productive and healthy coping mechanisms and self soothing techniques for when we are feeling upset or any intensity of emotion. Crisis survival skills are a key element in this module, as are reality acceptance skills.
This module offers ideas for reducing the intensity of strong emotions and learning to ride the wave instead of reacting or acting out. It helps us to better understand and navigate our feelings.
These skills address relationships and effective ways of ensuring our needs are met. Key elements in this module include self respect and respect of others, effective listening and communication techniques, learning how to deal with challenging individuals, knowing when to say no, and repairing relationships.
Author: Fiona Smith, Taproot Therapy Clinical Trainee
A central pillar of Dialectical Behavior Therapy (DBT) is the concept of Radical Acceptance. This DBT skill is featured in the distress tolerance module and encourages the complete and unrestrained being at peace with unwanted events, problems, or emotions. Instead of resisting, we are encouraged to accept that the unwanted situation is occurring. Depending on the scenario, total acceptance can be enormously difficult to achieve.
DBT posits that pain - emotional or physical - is a sign that something is off. It’s your body’s natural way of alerting you to this. Accepting a painful event or emotion does not mean you condone it, like it, or approve of it. Rather, the acceptance of it in your mind, body and soul - that it did happen or is present in your environment - eliminates the mental struggle against it. It frees up your energy to move forward skillfully. Radical Acceptance is built on the idea that changing one’s reality first requires acknowledgement of what that reality truly is. Rejection of reality morphs pain into suffering and thus, prolongs that uncomfortable sensation.
An important facet of Radical Acceptance is that practicing of this skill does not mean we tolerate or stand for any unhealthy or abusive behavior. Rather, it is a framework for acknowledging the reality in which we find ourselves.
The first step is to simply observe. Ask: am I telling myself “it shouldn’t be this way.” “Am I denying the fact that things turned out differently from how I wanted them to?” Am I ruminating: “If only it had turned out differently.”
Practicing Radical Acceptance in daily life can feel like embracing the flow of each day as it comes. Let’s say you missed your train to work and now you’re going to be late because they only stop at your station every thirty minutes. Rather than resisting the reality of this scenario (that you will not be on time), Radical Acceptance instructs us to release any resistance to how things are and seek an alternate solution. In this case, one next step might consist of consulting the train schedule and planning ahead by texting your boss or colleagues that you will arrive later than expected. There is no problem too small or too large for this skill.
This skill is not an easy one. It requires persistence in order to fully incorporate it into your reflexive mindset, but once mastered, it is a comforting and freeing perspective through which to view life.
Have you practiced dialectics in your daily life? What has or hasn’t worked for you? What have you found challenging? What has come naturally to you?
Author: Alyssa Pammer, Taproot Therapy Clinical Trainee
Pros and Cons can function as a beneficial distress tolerance skill in DBT. As with other distress
tolerance skills, Pros and Cons are often used in crisis situations. It can aid in helping us avoid
acting impulsively while weighing the pros and cons of the impulsive decision at hand. Instead
of acting impulsively, making the pros and cons list can help us act skillfully. It shows us that
better results pan out by making a skillful decision with our pain, rather than an impulsive
decision with our pain. It’s most common to use pros and cons when we have to participate in
something that we really don’t want to do.
The most common way to use the pros and cons skill is to make a pros and cons list. Most
people, at one point in their life, have made a pros and cons list about a decision. In DBT, we can
make a pros and cons list of our impulsive decisions and maladaptive behaviors.
In order to make this list, we can pick a maladaptive or impulsive behavior that we typically
engage in. First, we would make a pros and cons list of specifically engaging in the behavior. We
may ask ourselves, what good can come out of engaging in the behavior, and what negative
consequences can result as a part of engaging in the behavior? Then, we would make an
additional pros and cons list. This list will be for the same behavior, but we would evaluate the
pros and cons of not participating in the impulsive behavior.
While making the list, we can also consider both the short and long-term consequences of
engaging vs. not engaging in impulsive behavior. A way to do this on this list would be to signify
“ST” for short term, and “LT” for long term next to specific statements on the list. This shows us
that our behaviors can provide short-term relief, but may cause long-term conflict. By labeling
behaviors as short-term or long-term, we can also identify maladaptive patterns within our
behaviors, and learn to challenge them. Once we identify these patterns, we can skillfully find
ways to integrate new coping strategies in replacement of maladaptive and impulsive behaviors.
Pros and cons lists are often created before a behavior occurs, likely in therapy with a DBT
therapist. The list can then be used in a moment of distress, when there is an impulsive urge to
act upon a behavior. We can refer to the list that we made in a time of clear-minded thinking,
instead of using an emotional mind to make a decision.
Emotions come in waves. There are times when feelings can be overwhelming. During a stressful day, when you are feeling elevated, utilize the DBT skill STOP. Stopping involves taking a step back, observing what is happening, and choosing to proceed mindfully. It is easier said than done, stepping back involves taking a break from what you are doing, or pausing.
When you hit pause, take the time to observe. Observing involves sitting with our emotions and understanding the sensations in our body. In a way when we observe, we think of ourselves as a fly on the wall. Instead of passing a judgment about what is going on, the goal is to see the situation clearly and look at the facts. Observing also includes steering away from subjective assessment. It involves taking the facts of a situation and bearing your emotions in mind.
The last step is proceeding mindfully. Proceeding mindfully involves taking what is observed, keeping your goals in mind and bridging the gap between your rational mind and emotional mind, in other words it is activating your wise mind. When your wise mind is activated, think about what you would like to get from the situation at hand and whether the emotions that you feel fit the circumstances. When you utilize the STOP skill, think about the outcome of your actions and your goals. You can ask yourself, what would I like to get from this situation? What are my goals? What can I do that could make this situation better or worse?
In other words, proceeding mindfully involves emotional regulation, staying calm and collected when you have gathered all the information internally and externally about how it can impact your goals.
Guest Writer: Revna Ozdamar
Accumulating positives is a DBT skill that reduces vulnerability to difficult emotions and creates a barrier between you and feeling overwhelmed. Increase your pleasant experiences by building positives. Building positives refers to increasing positive emotions.
Do one pleasant event per day. Positive events can be anything of your choice examples include reading, gardening, taking a bubble bath. Create a list of things that bring you joy and practice these activities for 25-30 days. While accumulating positives, be present, and immerse yourself fully in a chosen activity. If you get distracted and worry starts to take over your experience refocus.
Refocus your attention on pleasant events and participate fully. Be present with what you are doing. Be unmindful of worrying; do not destroy positive experiences by thinking about when they will end? Acknowledge and release these thoughts.
Another way to accumulate positives is to focus on something good that happens every day. Be mindful of your positive experiences. Journaling and keeping a gratitude journal is a great practice. Accumulating positives, in the long run, requires a different skill set.
Accumulating Positives: Long-Term
Avoid-avoiding. There is a natural tendency to procrastinate on tasks that do not spark joy. Avoiding problems builds up stress and activates your emotional mind. Practice makes perfect, the more you flex your mindfulness skills and address agenda items the better you will feel. Another way to build positives in the long-term is to live a life in alignment with your values, goals, and aspirations.
Identify your goals, aspirations, and values and build a life around them. Examples include improving relationships, ending destructive ones, and spending time working on your goals and dreams.
Accumulating positives takes time and practice. Building a life worth living is a journey and experiencing positive events daily is a component of it. Baby steps pave the way for greater self-awareness and self-discovery. Creating a working list of positive activities takes time and patience. I invite anyone who is embarking on this journey to also practice gentleness. It takes time to build a life that matches your values.
Guest Writer: Molly Zimetbaum
An important Interpersonal Effectiveness DBT skill involves learning how to balance goals and priorities when we are dealing with a conflict. This skill teaches us to be mindful about our relationships and the conflicts within them, and subsequently decide how to make effective, gratifying compromises.
Generally, within an interpersonal conflict, there are three factors we must decide how to prioritize and balance: our desire to get what we want, our desire to maintain a good relationship with the other person, and our desire to maintain our own self-respect.
Let’s discuss these factors in greater detail:
The objective: this refers to our goal, or what we want to get out of the conflict. We might want to request something effectively, to deny a request effectively, to stand up for ourselves, or for our opinion or viewpoint to be taken seriously.
(It’s important to note that, no matter how skilled we are at interpersonal communication, sometimes we simply cannot attain our objective. That’s when radical acceptance and distress tolerance come into the mix.)
The relationship: this refers to the importance of preserving the relationship despite the conflict within it. We might preserve the relationship by balancing our immediate goals with the good of the long-term relationship, or by choosing a way to communicate that does not erode respect and trust within the relationship.
Our self-respect: this refers to the importance of maintaining our positive feelings towards ourselves, and our adherence to our beliefs and values while dealing with a conflict. We might preserve our self-respect by remaining true to our morals, or by acting in a way that makes us feel competent, as opposed to lying, manipulating, or giving in for the sake of approval.
These three factors will be prioritized differently depending on the particular situation.
For example, let’s say your boss assigns you work that is far outside the purview of your job description and does not offer compensation. You don’t want to do the work, it is not fair that you have to do the work, but you are concerned with maintaining a good relationship with your boss. Ultimately, you might choose to ask for what you want, prioritizing getting what you want while communicating skillfully.
But let’s say your significant other asks you to stay home with him instead of attending a party you wanted to go to, because he had a difficult day. You might consider your own goal—to attend the party—and your sense of self-respect, which entails independence. But ultimately, you would likely choose to prioritize the relationship here.
Now, let’s say your friend asks you to help him cheat on a test. In this situation, you may be concerned about preserving the relationship, but you would ultimately prioritize self-respect and adhere to your morals, and deny the request using skilled communication.
Of course, these examples are simplified, and real life conflicts are often more complicated and involve more context. Nonetheless, remembering these factors can help us organize our priorities and make better decisions in moments of conflict with others.
Radical Acceptance is a distress tolerance skill in Dialectical Behavior Therapy (DBT). It teaches us to accept things as they are, completely and fully. It means not resisting, or not attempting to change. Rather it means seeing things as they are.
This can be a challenging skill in DBT! It can be hard to look at our problems and say “I accept it for exactly what it is.” We want to change things that are unfair, painful, or problematic. But radical acceptance forces us to look at something and say, “it is what it is.”
It’s important to clarify with this skill that it doesn’t necessarily mean that we are approving of something. Acceptance does not mean approval. It does not mean we have to like something. It simply means we recognize the facts of the situations.
Acceptance also doesn’t mean agreeing. I can accept that something is happening without agreeing with it. For example, let’s say you’ve asked your boss for a raise, and your boss says no. Despite the fact that you’ve worked late, taken on extra projects, and have definitely earned your raise. You might completely disagree with this decision, and you can still radically accept that this is the final decision.
Radical Acceptance does not mean that we tolerate abusive behavior. Radical Acceptance does allow us to recognize abusive behavior, however, and help us decide how to respond to it. Once I recognize that something is happening, once I radically accept it, I can then decide how to respond to it. Moreover, by accepting our pain, we reduce our suffering. As the famous saying goes, “Pain is inevitable. Suffering is optional.” Radical Acceptance helps us reduce suffering.
As with all of our DBT skills, Radical Acceptance takes a lot of practice. It is not easy to accept things as they are. To practice, start first by practicing small things. If it’s raining out and you were hoping to go on a hike, radically accept the weather. If you wanted to pick up a bottle of olive oil and the grocery store is already closed, radically accept that you’ll go to the store the next day. As you feel comfortable practicing these smaller instances, you’ll be able to start practicing radical acceptance with bigger issues that come up for you.