Tuesday, February 21, 2012

More About DBT (Dialectical Behavior Therapy) and Ch-ch-changes

We are making choices for change in our household.  Some of those changes are forced upon us and we don’t like them.  They hurt.  Some of those changes are a result of getting ourselves into situations where we could hurt someone else, as well as be hurt.  Most of the changes have come from a sweet surrender, very connected to our faith, and our belief about the way God heals our family – how he refines gold.  If you’re just coming to the blog for the first time, this is an on-going theme for me these last several days.  The unexplainable JOY that has settled upon my soul in this full release cannot be explained in words.  There is relief, but it is not simply relief.  There is release, though it is not just release.  There is forgiveness from the One who matters most and there is unimaginable love for those who’ve harmed us, and continue to harm us, but those circumstances do not matter.  Again, it’s hard to explain.  Truth remains and some of that truth is uncomfortable.  Bitterness is gone in this household, at least.  The only word I have for it is “joy.”

As I wrote last time, Youngest Son has been doing very well these last several months.  Last year at this time, things were hard.  We were just getting into what would be a very difficult time of him going through a period of stealing, lying, shutting down, and being hateful.  At the time, a friend said some hard things to me, and I wasn’t ready to hear them.  Over time, God worked on my heart to understand the hurt that my son had endured and how it had changed his brain – for life.  No praying, pleading or begging to God was going to change that.  God had another plan.  It was not that He COULDN’T change it, but He doesn’t work that way, and I was slow to learn it.  The damage done to my son was not going to heal in the way I wanted it to heal.  Instead, God would lead us both to an acceptance of what is, what happened to him, and that he wasn’t the “same,” nor would he ever BE “the same” as my typical children.  Still, Youngest Son was his own unique, awesome, amazing kid.  He was a survivor.  He’s a smart kid and he’d learned to survive.  Since he was so smart, he could also learn to thrive.  He could heal THIS way – because God was in the business of refining gold!

We did more than two years of attachment therapy, and therapy that combined techniques from well-known adoption therapists such as Heather Forbes (Beyond Consequences, Logic, and Control), Daniel Hughes, Becky Bailey, and others.  We used what worked for us.  Not everything from every well-known clinician did work, but we used the things that helped us develop a connection.  Physical punishment never made a connection.  Time in (even if I was tired and didn’t want to do it), made the connection.  (That’s not to say that time outs did not have their place, too.  They still do.  I’m the one who needs them most often, so I don’t end up letting ALL my buttons get pushed and wind up doing something ineffective or harmful).  Validating my kids’ feelings worked.  Telling them to just “stop,” or just “obey,” or just “get over it,” only aggravated the situation.  They couldn’t JUST stop or obey, they had to have their feelings validated – even named for them because they could not name them alone.  They were too developmentally delayed emotionally to do so.  Natural consequences worked (still do).  Restitution worked, though it was hard.  Punishment only made matters worse.  It did not mean the same to my hurt children that it meant to my older, well-attached, biological children.  It felt like rejection.  Rejection meant using survival skills.  Survival skills were meant to build walls and stop more pain for the child, but they ended up causing more pain for all of us.  We still don’t have all this figured out or completely mastered, but after nearly four years in therapy, we’ve gotten a pretty good handle on a lot of it, most of the time.  I wish I’d had it more figured out at one year, or even two years home.  We could have been that much further along. – Ah, but I guess we’ve all learned at the rate we CAN learn.

After Youngest Son went through all those things, we decided it was time to be more directive with him in therapy and in our parenting.  Our therapist was using Dialectical Behavior Therapy (DBT) with teens and adults, and we decided to give it a go with Youngest Son, even though it would be flexible when/if his needs changed.  This therapy technique was originally developed by Dr. Marsha Linehan, Ph.D. (1993) and was initially used to help people with borderline personality disorder.  People with BPD usually struggle with other problems, not unlike the challenges our older adoptive kids face including complex trauma, anxiety, hyper-vigilance, depression, self-harm behaviors, out-of-control emotions (“big feelings” like rages), even substance abuse and suicide attempts.

When the brain is changed by trauma (read more about childhood trauma and the young brain HERE), it becomes hard-wired in a way that it processes emotions and events differently than the typical brain.  When something happens that triggers the brain back to that traumatic event, whether it is conscious or not in the person experiencing the trauma, the individual responds in reflex.  It is truly a reflex reaction.  DBT helps the person and his caregivers validate that reflex and those big feelings, and accept them.  When the person and his caregivers have learned to accept that past trauma, and that there is a profound difference in the way that person’s brain will always process triggers, then the healing can begin – the gold can be refined.  The older child can begin to use cognition of the triggers to gain control over behavior – even learning to be happy!

Our son has worked this year on being mindful of the things that trigger him.  He is working on interpersonal effectiveness by learning to respectfully and properly ask for the things he wants, accept when the answer is no (without TOO much begging and bargaining – he is, after all, still 16), and even accept correction when his behavior warrants it!  For example, yesterday after church, the kids were in the back seat of the car, bickering and just being plain nasty to one another.  Exasperated, I said, “Can’t you guys take ONE 10 minute car ride and THINK about treating the other person they way you’d like to be treated?  Can’t you TRY to be kind?”  Youngest son said, “Yes Ma’am.  Sorry.”  (I nearly had a heart attack.)  The Princess said, “But he started it!”  (Yeah, we’ll keep working with her.)  This example shows that Youngest Son has made great strides in regulating his emotions so that a trigger does not turn into a full-blown shut down (or rage).  By being more aware of the triggers, and accepting of an awareness of who he is, he is increasing his tolerance of the things that stress him.

In DBT therapy, the therapist is “in charge.”  It is more directive.  It is not so open-ended. 

The three fundamentals of DBT are 1) Cognitive Behavioral Therapy where the teen learns NEW behaviors – behaviors that show him that life is WORTH living; 2) Validation (Acceptance) where the teen is taught by the therapist to accept their differences, to use cognitive behavioral strategies and also to accept and validate new skills and behaviors learned.  [Note: this is a VERY simplified explanation.  For more detail, see the links posted below.]; and 3) Dialectics which teaches us that everything is connected to everything else (everyone is connected to everyone else), change is constant and inevitable, and with work, we can take even opposite thoughts, feelings, and perceptions and form a closer approximation to what is true and move forward.

A big challenge for hurt kids is getting “unstuck” from the age, stage, and developmental process the child was in when the trauma occurred.  When triggered, a child will revert to that age and stage and be unaware he’s done so.  This is why our kids will behave much younger than their chronological age when they are triggered.  DBT helps get them “unstuck” from those rigid ways of thinking, because it accepts those rigid thoughts, and allows for another arrow to shoot off into a more healthy direction.  It is accepting that life gave you lemons and trading those lemons for limes to make limeade.

The goals of DBT are to instill a closely-held belief that life is worth living, and that a good life now is not dependent upon having had a good life all along.  To do this, DBT organizes treatment into four stages:

1.      Gaining control of one’s behavior by reducing and then eliminating life-threatening thoughts and behaviors, and by eliminating behaviors that interfere with treatment.  (For Youngest Son, this was “controlled” by him with shutting down and refusing to participate in treatment.  When we because very firm and directive with him, he complied.)

2.      Moving from being shut down to being able to experience and express emotions.  By shutting down, they may think they have control, but they are taught instead that their traumatized brain has them in a state of “quiet desperation.”  Here the therapist and his caregivers become very directive so that the client experiences all of his emotions and is able to label them without shutting down.  This is the hard part.  In letting the emotion out, the client also then needs to learn to not allow those emotions to take over.

3.      Making it through ordinary life – working on ordinary life problems, rehearsing how to behave, what to say, how to do it.  THIS is what enabled my son to say, “Yes, Ma’am” on Sunday.  He had to be taught – firmly – how to do that.  Eventually, just yesterday, he was able to do it on his own.

4.      Moving from feeling incomplete and like something is missing to connection and completeness is something we are still in process for with Youngest Son.  For him, that connection began last summer when he made a real commitment to a Christian faith.  For other teens, it may be something different.  I happen to believe God makes the biggest difference in a refined gold healing.

Just as therapists are directive in DBT, parents must be keenly involved.  As parents, we must experience this therapy for ourselves.  As our kids go through these stages, we can, too – if we’re willing – if we’re not afraid to let go. 

Personally, I’ve equated it to being like Jonah.  I was called to Ninevah, but went running my own way and ended up in the belly of a stinky ol’ fish.  I’ve been spit out.  We’re heading to Ninevah where we belonged in the first place.  Our gold is being refined.  (Okay, so that’s not a mixed metaphor, but is there such thing as a mixed “biblephor?”  Eh, it works, don’t you think?)


Annie said...

What a great post! I want to read it again, and send it to our therapist. I do not think Anastasia is ready for this yet, however, this is very similar to what "worked" with Maxim, though I just stumbled on it/intuited how to go about it.

Honestly, I also think maturing helps quite a bit.

Trauma Mama T said...

Yes - and I think the tweak in his therapy helped him mature as well. He's come a long way. If you remember this time last year, I wondered if he'd be in jail by now. Not so worried anymore. I just keep praying he continues to do well.

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Mama T said...

Thank you so much. I appreciate your comment.