Blog

By: Katrin Steinert

Dialectical Behavior Therapy or DBT is an evidence-based treatment that was created by Marsha Linehan in the 1980s. DBT was originally created to treat highly acute borderline personality disorder. Linehan based DBT after having worked as a CBT therapist but realized that CBT was missing one key component; acceptance.

Dialect
The D in DBT stands for dialectical. The definition of a dialect is two seemingly opposite truths that exist at the same time. A good example of a dialect is I love you and I hate you. The world is full of dialects and DBT encourages the acceptance of living in the dialectic. 

Mindfulness
The cornerstone of DBT is mindfulness. According to Linehan, without the practice of mindfulness it would be nearly impossible to recognize and describe emotions that are coming up when high stress situations occur. Being mindful can be done in many ways including mindful walking, mindful driving or mindful eating. These are daily activities that most people engage in and by practicing them mindfully will create more insight into feelings and experiences that are coming up in the body.

If your family dinners are anything like mine, then you are probably used to individuals speaking over one another. You must fight to have your voice heard and there is no space to reflect before responding or else your voice will be lost. The result is that conversation is watered down and less meaningful than it could be if people slowed down, reflected, and took time to process how to respond. The following are different approaches you can use to respond in your next conversation. Make it meaningful, there is nothing wrong with a long pause as you process how to respond. As Buddha said, “If you propose to speak always ask yourself, is it true, is it necessary, is it kind.”  

Ways to Respond in Conversation
Advice (fix it)
Advice is when you give guidance on how someone should proceed in a situation or how you may proceed if you were in the same situation. You offer solutions to a problem by going into fix it mode. This is the probably the most common type of response that individuals offer in Western society. There is a time and place for advice, but often it is not the best way to build connection. There are more effective ways to show someone that you care about what they are saying.

Challenge (new perspective) –
When we listen to others speak, we often consider different perspectives that the speaker has not considered. This is when we challenge them to consider an alternative view. Challenging someone or being challenged by someone is how we grow and change. However, it is also not the most effective tool to build connection. Sometimes people want to be listened to and heard, and not challenged.  

Validate
Validation is when you demonstrate support for someone’s view or feeling. You say, “I understand what you are saying” or “It’s understandable that you feel that way.” It normalizes their experience and demonstrates that you are listening.

Empathize
Empathy is the strongest tool for emotional connection. Empathy is about putting yourself into someone else’s shoes and feeling the emotions they are feeling in that moment. Examples of empathic statements are “that sounds like it must have been very difficult for you” or “I don’t know what to say right now, but I am glad that you told me, and I am glad that we are talking about it.” Empathy is an advanced form of emotional connection and if you are not accustomed to using it, it will take some practice. A great prompt for empathizing is: “The part of your story that felt like it was happening to me was [Fill in a part of their story that was impactful to you, using their words, don’t talk about yourself].”

Ask the Speaker what they Need
Next time you have a conversation with someone, I encourage you to take a moment to slow down. Ask the speaker what type of response they need from you. Ask them if they are looking for advice, validation, empathy, or if they are looking for a new perspective (challenge). Many misunderstandings stem from the listener responding in way that the speaker was not looking for when they decided to share part of themselves with you. Ask them what they need and take a moment to reflect before you respond.   

By: Ranjita Rao

It is so easy to look back at the end of a day and be critical over the way you looked, the things you didn’t get accomplished, and things you wish you had done better. But how often do you look back and think about all the positive things, or give yourself a little pat on the back? My guess is not nearly as often. What if I told you that making some small changes every day could have a profound effect on not only your mental health, but your physical health as well?
 
Practicing self- gratitude can not only boost self-esteem and confidence levels, but can also improve symptoms of anxiety and depression, your relationships, and even your immune system. Let’s take a look at some easy changes to start implementing today so that you can start practicing self- gratitude and take advantage of these benefits!
 
Compliment yourself. Find a couple times a day where you can give yourself a compliment. If you’re in front of a mirror, tell yourself something that you like about your appearance. If you’ve just gotten out of a meeting, take a minute to recognize something you’ve done.
 
Practice self-care. It may be challenging to find the energy to compliment yourself when you don’t allow yourself the time to do what you love. Find time every day (even if it’s only twenty minutes) to do something for yourself!
 
Learn to take compliments. Ever felt uncomfortable when someone gives you a compliment? Accepting a compliment can be challenging in the beginning, but practice saying “thank you” and sitting with that compliment, and acknowledging the feeling that it brings – you may soon realize that you enjoy it!
 
Keep a Gratitude Journal/ Gratitude Jar. Take time every day, maybe at night before going to sleep, to write down some positive affirmations about yourself either in a journal or on some piece of paper that you can save and look at.  Linking behavior change to something tangible is the best way to hold yourself accountable and make it stick.  Lasting change will happen before you know it as you begin to experience the benefits of self-gratitude.

By: Eric Kruse

“Deciding whether or not to trust a person is like deciding whether or not to climb a tree, because you might get a wonderful view from the highest branch, or you might simply get covered in sap, and for this reason many people choose to spend their time alone and indoors, where it is harder to get a splinter.”        
Lemony Snicket

Lately I have heard many people talk about betrayal and how they are making the choice to never trust again. I understand where they are coming from. They have been hurt in the past and they are choosing self-preservation at the cost of cultivating deeper relationships. As the age old saying goes, fool me once… However, this is sad to me because I believe that those who choose not to trust are missing out on the opportunity to have something beautiful in their lives. The following are my thoughts about how to build trust.

Trust People to be Themselves
If you have been hurt in a relationship before, you probably are wary about opening yourself up again. You may be one of those individuals who says, “I tired building trust with others and then I got cheated on so…” or “trust isn’t worth giving to anyone honestly.” I would challenge these people to consider the ways they trust others in small ways in their life every day. For example, you trust your doctor/hair stylist/dentist/ will be in when you show up for your appointment. You trust that your parents will be annoying at thanksgiving. You trust that your teacher will administer an exam when its scheduled. You trust that your friend who forgets to shower may smell when you hang out. If you are starting to see a theme in the examples here, then you may begin to understand my point. People do as they do. There are patterns in their behavior that are consistent so you place faith in the probability that it will continue (with exceptions of course). Sometimes people try to change bad behaviors and if they fail at it, don’t take it personally. You can trust that quitting bad habits is a hard thing to do and that people falter at it along thee way.  

Surround Yourself with People who have Similar Values
Since people do as they do and you can trust them to do as they do, then pick someone with similar values to your own. For example, if you value honesty, integrity, and monogamy, then find someone who also values it. Talk about your values with this person and see if they also feel strongly about it. You may start to get a sense of whether you can place trust in this individual. If they live by their principals in the same way that you do, then you are less likely to get hurt. Unfortunately, there are deceptive people out there (The Betrayers) who can fool you. If you place your trust in someone and they betray you, then you have been “covered in sap” on your way up the tree in pursuit of the “wonderful view,” but that does not mean you should “spend your time alone and indoors, where it is harder to get a splinter” (see quote at the top). Furthermore, sometimes people who are trust worthy make a terrible mistake and it’s worth trying to rebuild that trust with them. This is where therapy can help.  

By: Katrin Steinert

Freud’s personality theory saw the psyche in three parts; the id, ego and superego, which develop during different stages of the life cycle. According to Freud, the id is the primitive and instinctual part of the mind. The id contains the sexual and aggressive drives and hidden memories. The superego operates as the moral conscience and the ego is the realistic part that mediates between the desires of the id and the superego. The three parts work together to create human behavior. Freud believed that in order to become a healthy person, the ego should be the strongest element. When the ego is the strongest out of the three, it can satisfy the need of the id, not upset the superego and still take into consideration the reality of every situation. 
 
3 ways to strengthen your ego:
 

• Acceptance: Start by accepting something small. It can either be accepting the rain, that person who cut you off in traffic or forgetting to take the trash out.
  
• Adjusting expectations: Every unrealistic expectation we create sets us up for disappointment. By adjusting what the expectations are regarding us and other people in our lives it lower our frustrations when expectations aren’t met.
  
• Consciously raising our frustrations and stress tolerance level: The strength of your self develops by framing things in empowering meanings. Positive framing and reframing allows us to take a new view of things, which then effects how we actually feel about things. In this way, framing and reframing things can enhance our ego-strength to face, cope with, and even master the challenges of life.
  

By: Ranjita Rao

Have you ever felt manipulated by someone repeatedly? Or maybe, you have a hard time saying “no” to someone in your life because of a fear of rejection and/or abandonment. If this sounds like you, you may struggle with setting healthy boundaries in your life. Boundaries are easier to envision when you think of them like fences around a house. A fence lets everyone know that everything inside of it is private property-- only accessible if invited inside. Personal boundaries can be a little trickier because most of the time, they are not tangible. Personal boundaries consist of both emotional and physical space, and help define which types of interactions, behaviors, and communication are acceptable for you.
Setting healthy boundaries can help build self-esteem, self- respect, and can develop assertive communication. This will not only empower you to make healthy decisions, but will also help you separate your feelings, thoughts and needs from those of others.
 
Here are some tips to help you get started in setting healthier boundaries in your life!
 
Be concise and firm. When setting a boundary, you do not need to justify yourself or apologize for that boundary. Instead, stay calm and be clear, while still holding firm and using as few words as possible to get your point across.
 
Be responsible only for communicating your boundary appropriately. You are only responsible for making sure that your boundary is communicated appropriately. You are not responsible for the other person’s reaction. If you apologize for setting a boundary, you risk sending mixed messages to the other person.
 
Don’t let fear, anxiety, or guilt stand in your way. Many people avoid setting boundaries because of the fear of rejection, abandonment and confrontation. Healthy boundaries not only build your self-esteem and self-respect, but also can reduce your anxiety and empower you to make healthier decisions for yourself.
 
Learn to get in tune with your feelings. If you are feeling angry, frustrated, or resentful, learn how to check in with yourself to figure out why you are feeling that way and what you can do about it. Listen to what you might need, and do it assertively.
 
Distinguish between those who can and cannot respect your boundaries. Not everyone can respect boundaries. While setting healthy boundaries, you learn who will continue to respect them, and who cannot. Eliminate toxic people in your life, especially those who manipulate and abuse your relationship.

By: Eric Kruse

In espionage jargon, a mole (also called a “penetration agent”, “deep cover agent”, or “sleeper agent”) is a spy who is recruited to penetrate and sabotage an organization from the inside.  When one is addicted to drugs or alcohol, it’s as if they have a mole in their mind who is feeding them with false information. If you have tried a quit a bad habit, then you are probably familiar with the shift in your thoughts. One moment you know you need to stop, and you feel ready to take the necessary steps, and the next moment you find yourself rationalizing those thoughts away. This is the mole at work providing you with bad intelligence. The mole tells you that you don’t need to stop, and its appetite insatiable.
              Addicts cannot trust their own thoughts because their thoughts have been penetrated. They must share their thoughts with others who are capable of uncovering the mole. This could be a mental health professional, drug and alcohol abuse counselor, sober companion, or member of a recovery meeting with a significant amount of sobriety time. 12-step meetings ask members to turn themselves over to a higher power. Many people who are not religious get stuck on this concept. What they do not realize is that their higher power can be the power of the group. The group can help them identify which thoughts are coming from the mole and which thoughts are their own.
Examples of Mole Thoughts

• “I can smoke weed sometimes. My problem was alcohol.”
• “I don’t need to stop drinking. I just need to stay away from hard liquor.”
• “I will quit smoking cigarettes after I finish this pack.”
• “I am young, and I am just trying to have a good time. I have plenty of time to stop using when I get older.”
• “I am different than the people at these recovery meetings. I don’t need to be here.”
• “I am in control of my behavior. I just don’t want to stop right now. I will stop tomorrow.”

Examples of Self-Thoughts that should be listened to

• I am scared.
• I think I need help.
• I don’t want to do this anymore.
• I feel ashamed.

Do addicts have a choice?
Many would argue that addicts have no control over their own behavior. This is a controversial topic because to those who have never been addicted, it looks as if the addict is choosing to be self-destructive. I mean, who is administering the drug? They are! Right?
However, addicts are being manipulated by the mole in their mind and they don’t know the mole is there. The mole is providing false information and it is influencing their choices. Thus, they are not choosing to administer themselves with poison. They are choosing to administer comfort and pleasure because the mole is telling them it will make them feel better. Addicts do have a choice though, but it is an incredibly difficult choice. They have the choice to seek help, but making that choice is like trying to listen to a whisper in a room full of loud voices. It starts with walking into a recovery meeting or asking someone to take you to one.

By: Ranjita Rao

Do the holidays stress you out?  Do you feel like you have too many obligations?  Are you anxious and overwhelmed this time of year? You are not alone. 
The holidays can be an overwhelming time for many people, especially those who suffer from symptoms of anxiety and depression. While it’s true that the holidays are a time for joy and happiness, for many, they are chalked full of stressors-- financial, personal, relationship, and family issues are often exacerbated during the holidays. Though the holidays are a great time to do for others, it is important to be aware of your own needs and to take care of yourself as well. The best gift you can give to yourself this holiday season is to learn how to manage your stress and anxiety before it strikes. 
Below are some helpful tips to set yourself up for success.
 

1. Learn to be realistic.Be realistic about expectations of others, but most importantly, for yourself.  Take the pressure off of yourself by not taking on too much.  If you have a problematic relationship with your parents, don’t expect to solve it all over a weekend – instead, just aim to make progress, and celebrate the small wins. 
2. Learn to say no.It is perfectly fine to say no. No one expects you to be able to do everything, and if you already feel that you are committing too much of yourself, there is nothing wrong with saying no. 
3. Make a budget. Take away that post-holiday stress by creating a budget early on and sticking to it. Remember that you cannot buy happiness, and that the thought behind a gift goes much further than the gift itself.  You’ll definitely thank yourself for doing so in the new year!
4. Don’t abandon self-care practices. Even if you are extremely busy, there is always time to practice self-care. Remember that if you let yourself become depleted, you will have far less to give others. Make sure that you stick to a routine-- practice your meditation, go to a yoga class, draw a bath for yourself every night, or do something else that you love to assure that you are creating and maintaining a healthy mindset.
5. Reach out. Be kind to yourself and know when you need some extra help. Reach out to family or friends if you’ve got too much going on and need some support. It’s also important to recognize when you may need to reach out to a mental health professional. Sometimes, despite our best efforts, we cannot do it all. Reaching out to a doctor or mental health professional is a great way to get extra support, learn coping strategies, and expand your support network. 

By: Katrin Steinert 

​Group therapy may be a great adjunctive resource if you would like more support outside of individual therapy or seeking a like-minded community. Group therapy is a small group of people that meet to discuss their problems together under the supervision of a therapist or co-therapists. There are a variety type of groups including grief groups, recovery groups and support groups. In his book The Theory and Practice of Group Psychotherapy, Irvin D. Yalom discusses key principles that create a successful group therapy experience. Here are a few: 
 

1. The instillation of hope: Seeing others process and recover during their treatment gives hope to group members who are in different stages of their treatment. 
2. Universality: Connecting with others who have a shared experience helps group members realize they are not alone in their struggle. 
3. Imparting Information: Helping other group members by sharing and reflecting on their own experiences. 
4. Altruism: Helping group members recognize their own confidence by helping others realize their strengths. 
5. Catharsis: By sharing pain, experiences and feelings with the group will help relieve guilt or stress. 

 
Group therapy has many benefits including creating a community, gaining coping skills, finding and becoming a role model, having a safe haven and is cost effective. Group therapy can be the right choice for you if you feel alone in your struggle and want to connect with others. 

By Rachel Thomasian
​
For over a decade, I have been helping children overcome worry, anxiety and fears. When my son developed his own fear of “a green guy in his room at night” I knew I had to arm him with the arsenal I had created over the years.
 
The first thing I want parents to know about bedtime anxiety in preschool-aged children is that some degree of it is completely normal and, in fact, developmentally appropriate. At this age, children’s imaginations are running wild. We encourage this behavior by asking them to play pretend and reading them fairytales because we’re working to foster their creative, cognitive, problem-solving and social skills. When we couple that with the development of an increased sense of danger around this age, children naturally start thinking about the possibility of bad guys and monsters. Additionally, at this age, children are taking greater leaps away from their parents. As they enter preschool or naturally engage in more independent activities, they may start to realize how big and scary the world might be and how vulnerable the world is. All of this can combine into the perfect storm of bedtime worry.
 
As a mom, I can understand the need to protect our children and the discomfort we feel when our children experience any kind of discomfort or pain. As a therapist, I know the importance of adversity and the growth and strength that come from working through a problem. So this issue of bedtime worry often becomes one of the first encounters of a problem a child has that their parents cannot simply solve for them, but instead can help the child learn ways to cope with the problem.  We can’t make the monsters go away, we have to teach our children ways to protect themselves from the monsters.
 
I’m going to start with what not to do: Don’t tell your child that they’re big brave kid who shouldn’t be worried. All this does is give them another thing to worry about, the fact that they are not as brave as you think they are.
 
The second thing you should not say is: “Monsters aren’t real”. The same strong imagination that allows your kid to believe in Santa or Mickey Mouse as a real entity is the same mechanism in play that makes monsters very real to your child. You have to get on their level if you’re going to start to help. By validating their fears “I know that must feel so scary” you can make a connection that will help your child feel less alone and more able to trust that you can help.
 
So now we start with what is helpful to a child in this developmental stage, and that is the same thing that created the problem in the first place: their imagination. I like to help kids imagine a superhero that will protect them from the green guy, we’ll draw it and talk about their super powers, and now the superhero becomes just as powerful as the monster in their world view. Another protective tactic is to line up stuffed animals as a line of defense. I always arm these children with “no monster spray” (a spray bottle with some magic water). We talk about how spraying this magic potion while we say “go away monster” makes it impossible for a monster to enter our room.
 
I like to share some of my favorite books about the topic with kids experiencing night time worry. These are a combination of stories to help a child feel not alone in their experience as well as books that teach simple yet effective coping skills. Links to some of my favorites are below. 
​
 
Typically, it takes a few nights to a few weeks of practicing these rituals to create such a sense of safety that a child will no longer be bothered by their bedtime fears, so much so that not only do they no longer need the ritual but they forget about the fear altogether. When this anxiety persists or consumes a lot of your child’s day, a great child therapist can be really helpful in working through this problem in a safe and efficient way through play therapy, usually on a short term basis.  

Please note these are affiliate links and PVC will receive a small commission from your purchase at no additional cost to you.