#36: More Listener Questions
In this episode of The Skillful Podcast, we answer two listener questions. The first question is from a listener who wants advice about balancing conflicting values to build a life worth living. The second question is about how to maintain your DBT skills practice once treatment has ended. Marielle and Ed discuss the issues these questions bring up and offer creative ways to think about the dilemmas presented.
Show Highlights
- If your life doesn’t reflect what’s most important to you, you will be more prone to Emotion Mind
- Work on one value at a time to reduce overwhelm
- Getting started working on a value can give you more information about how to synthesize conflicting values
- Check in with Wise Mind over and over again
- Think dialectically, allowing more than one thing to be true at a time
- Values work gives you a sense of purpose and meaning in life
- Moving away from a sense of autopilot towards a more intentional life
- Ask yourself if you are living the life you want
- How do you maintain DBT skills practice without the structure and accountability of treatment and group?
- Leaving treatment is a transition time
- Cope Ahead can help you figure out what you want to have in place to support your ongoing skills practice
- DBT skills are rich and life-changing, and it takes time and practice to fully integrate them into your life
- Moving away from “There’s nothing I can do.” to “There is something I can do.”
DBT Skills Discussed
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#36: More Listener Questions Transcript
Marielle Berg
Hello and welcome to The Skillful Podcast where we explore DBT and RO-DBT skills to help you reduce emotional suffering, improve your relationships, and become more present in your life. I’m your host, Marielle Berg, a psychotherapist at the Bay Area DBT and Couples Counseling Center.
Marielle Berg
Today, we’re going to be answering a couple of listener questions. We really enjoy hearing from you. So if you’re a regular listener, and you have questions, you can reach out to us on the contact form of our website, which is BayAreaDBTCC.com. and submit your own question. We can’t promise we will get to them all. But we love reading them and thinking about them and talking about them.
Marielle Berg
So welcome back, Ed. And are you ready to dive into these questions?
Ed Fowler
Yes, I am very ready.
Marielle Berg
Okay, good. And just our standard disclaimer, the answers that we provide to these questions do not constitute a therapist patient relationship and are for educational and informational purposes only. And we hope folks who have the means and ability to pursue their own DBT therapy are able to do so.
Marielle Berg
So the first question we have is: How do you work through individual conflicting values? What advice would you give a client? This is a meaty one to start with. Again, how do you work through individual conflicting values?
Ed Fowler
kKnowing our own values, and paying attention to those values is a really core component of Emotion Regulation inDBT. This, this falls under our Emotion Regulation approach of knowing what our values are. So that can guide us, when we notice what emotions are coming up, as well as to make sure if we’re, you know, working on our goals and what’s important and trying to live out our values, our emotions tend to not be quite so overwhelming, there’s more balance.
Ed Fowler
So all of this would fall under the skill of Accumulating Positive Emotions. And in DBT, we divide that into Accumulating Positive Emotions in the Short Term, which is doing daily, really soothing and pleasurable things for ourselves. But Accumulating Positive Emotions in the Long Term is about identifying our values and making sure that we’re working on it. That’s what helps us create the life worth living that we’re going for.
Marielle Berg
And the reason why this skill is in the Emotion Regulation module. And why it’s so important is that if we are living a life that isn’t largely aligned with our values, we’re going to be much more susceptible to Emotion Mind and to feeling kind of those painful, negative emotions more often. And so the more we can work towards having our life reflect the things that are most important to us, the more likely we are to experience positive emotions – happiness, joy, contentment, connection – more often.
Ed Fowler
And I think definitely feel more grounded. Like I know what I’m working towards, and I’m working towards it. And that can give us a sense of just feeling secure in our lives, because we’re clear about what’s happening. Versus feeling like I don’t even know what’s important to me, and I’m not working on anything and and that will tend to make us a little bit more emotionally, up and down.
Marielle Berg
Yes, and so the the first step really of the skill around Accumulating Positive Emotions in the Long Term, which is a big part of the values and priorities work that we focus on, is avoiding avoiding. So they say avoid avoiding.
Marielle Berg
Because oftentimes, there can be a sense of overwhelm or confusion for folks like I don’t even know where to start. What are my values? What actually matters to me versus what I was maybe raised to think should matter or what the, you know, my particular community that surrounds me says, should matter, but maybe that isn’t actually aligned with what I believe and what I want. So it, it can bring up a lot. And I know that we’re veering off into talking about kind of this skill or the whole idea around values and why it’s important in DBT, I want to just bring us back a little bit to the question, which was around how does one work through individual conflicting values, because this is actually quite common.
Marielle Berg
That when we begin to really focus on values work, that there are conflicts. We might value independence, but also really value connection. You know we might really value a lot of novelty and excitement and doing new and sort of potentially risky things or the excitement value and the variety that this can bring to our lives, but we might also really value security and stability. So what do we what do we do with that? Because we, as I said, this is, this is not uncommon.
Ed Fowler
And so the way we approach identifying our values as part of this Accumulating Positive Emotions in the Long Term, like you said, Marielle, first, avoid avoiding. So notice, oh, I’m not really focusing on my values, don’t just push it to the side and put it off and say, I’ll get to that someday. But take some time to look at what values are important to me.
Ed Fowler
And then the next step after we avoid avoiding is to identify values important to us. And so we do some reflection, our DBT Skills Handouts and Worksheets book gives like a long list of possible values to go through to identify which values stand out to me. And then this is where the conflicts can come is when we sit down and say what’s important to me, what values do I want to be focusing on in my life, we may find some of these conflicts.
Ed Fowler
And so for me, what I think is helpful is to number one, just name all the things that are important. So I can say, yes, I want novelty, and I want security, I want independence. And I want to very much be a part of a group, so that we can name it all. But where I think that this can be helpful is in our approach to looking at our values and working on our values, we just pick one to focus on first.
Ed Fowler
I think that’s where if we’re having conflicting values, rather than sitting in spending a lot of time trying to figure out how do I resolve this conflict, we’ll just pick one value that seems the most important right now the one that has the most energy to work on it, or the one that like makes sense to start with, like, I want to make more money, and I have this opportunity to go to school to get a degree that will help me to do that.
Ed Fowler
So I got to focus on getting into school or whatever it might be just picking one value and focusing on that, and doing a little bit of legwork on that one value gets us moving gets us started. Other values may get integrated in a way that really makes sense that we’re not going to know, unless we’re starting to work on one value.
Marielle Berg
Yes, in the beginning, work on one value might start to make things clearer, in terms of the other values that feel like they’re in conflict, it might become clear that perhaps both these values can be integrated into your life. And I think when we can get when we get a little bit stuck, and of course, we don’t know more about what this listener is struggling with exactly in terms of conflicting values, I think that a thing that can happen is we can get a little bit black and white in our thinking or move away from dialectical thinking.
Marielle Berg
Like, either I have security or I have excitement. And I think there’s lots of shades of grey, and that both can potentially be integrated into your life. And so as you begin to make progress or make movement towards integrating the first value you choose to work on, that things might change, you might make new connections, you might see like, oh, I can, I can actually have this other value that feels so diametrically opposed, I can integrate it in one way or another.
Ed Fowler
And so I think so often what we find is that when we are feeling a sense of conflict and having some things that are hard to integrate, just start working on it and see what happens. That can often bring, help us, again, to get more concrete information about how to synthesize conflicting values, because we’re already starting to work on it.
Ed Fowler
And it’s, we recognize, oh, this is a part of it, that I didn’t recognize, and that helps resolve this other conflict. And now I can integrate them. So get started, maybe the first thing to do.
Marielle Berg
Yeah. And if someone is having difficulty in choosing, and this might be the reason why this person wrote, like, you know, these two values feel equally important, and I don’t even know where to begin or where to begin to, you know, take a step towards making either of these values that feel in conflict, you know, a reality in my life.
Marielle Berg
And I would say check in with Wise Mind. And you might have to keep checking in the answer may not be so apparent, it may not be so clear, but getting quiet and really, you know, going inside and checking out what your Wise Mind has to say, seeing where it might guide you.
Ed Fowler
And another aspect is that you, by yourself, may not be able to get clarity. And so you might talk to someone about conflicting values. So, friends, therapist, mentors, whoever it might be that makes sense. Talk to somebody about here are the values that seem really important. I’m not sure how to pursue these. This is the conflict I’m feeling. That might get you some new information that you bring back to your own Wise Mind to figure out a way forward.
Marielle Berg
I’m glad you mentioned that, that I think we might think we need to do values work in isolation. And I think that this skill in particular can really come to life when we talk it through with trusted others. And someone else’s perspective might help us see like, oh, these, both these things can exist in my life, they don’t have to be sort of in a tug of war with each other. Either I’m connected, or I’m independent. Either I have a life of, you know, pleasure and satisfaction, or I’m working on self development, like maybe it’s not so diametrically opposed.
Ed Fowler
I do think that when we find ourselves having those kinds of conflicts of I have competing values, or competing interests, or competing ideas, or whatever it might be taking a step back, accessing our Wise Mind, trying to think dialectically, allowing more than one thing to be true at the same time, or real, or important.
Ed Fowler
And then sometimes checking it out and doing that process with others. All of that can get us moving with, you know, the guide being: do I feel like I’m moving in the direction I want to go? And if not, go back, revisit figure out, Okay, do I need more Wise Mind? Do I need more dialectical thinking? Do I need to talk to somebody else? What might it be, and we keep moving towards the sense of purpose. And that’s the primary thing about values work, I have a sense of purpose, I know what’s important to me, and I am doing things to work towards that.
Marielle Berg
And it related to a sense of purpose is, I think, a sense of identity, which many people who come to DBT, and who struggle with emotion regulation have a hard time with, or that like sort of their inner compass of who am I, what matters to me can feel a bit off at times. And so there’s many things that go into our sense of self, our sense of identity, but becoming clear on what what matters to us, is one important piece of this puzzle.
Ed Fowler
Take the time to reflect on this stuff. And again, this kind of values work tends to be a little bit later in the process, because first we want to have a really solid Distress Tolerance, so we’re not like overwhelmed by our emotions at any given moment, we want to have a really solid Emotion Regulation so that we can pay attention, all of which gets us into our ability to practice Wise Mind. To notice, what’s the balance here for me, and then reflect on this deeper stuff, building our sense of self, our sense of identity, our sense of what’s important, our sense of, of movement in life.
Marielle Berg
And I always think when we we teach this skill in our group, we do it for one week, and then we move on. And I feel like, I always think, this is huge, this is, and I tell we tell this to people in our groups, and the folks we work with like this, we’re covering this one week. And if you stay and you repeat the skill several times, which a lot of you know, many people do and we encourage them to do, maybe you’re gonna get it three times a skill, you know, we’ll kind of dive into it and work on it for a week.
Marielle Berg
And then then we move on, because there’s so much to cover in DBT. And this is a skill in particular that I encourage people, you know, bring this to therapy, talk about it with other people, as we said a moment ago, this is not a one and done. I think values work is lifelong work is something that we want to keep revisiting over and over. Because our values can change as we change as our life experiences change, as we age as we go through different stages of life, different things can become important. And doing this work takes courage.
Marielle Berg
I think for many people we don’t, we don’t take time, or we don’t think we have a right to sit and ask ourselves, what matters to me? And how can I have my life reflect what matters to me, because we’re in survival mode. Just trying to get through the day, perhaps healing from trauma. Just trying to make it through day to day. And so to be able to sit and reflect on these larger themes is is a privilege and I think can be can be a bit frightening.
Ed Fowler
Again, because I think it can feel so big. And I think so many of us can spend time avoiding this deeper work on what’s important to me, and am I living that out. And so that’s where just taking the time to notice and to pick one thing and do one thing to get started can make it less overwhelming.
Ed Fowler
But like you said, Marielle I think it takes courage to look at what’s important and reflect on that and try to actually build the life that we want instead of having just a sense of life happens to me and I don’t have any influence on it, which many of us have had that repeated over and over to us and need to think more broadly than that. And so it can be challenging.
Ed Fowler
I will say for myself, this kind of reflection on what’s important to me noticing conflicts, and what’s important, sorting out what am I going to be focusing on at this stage in my life, this has been extremely energizing for me. I really gain so much when I take the time to think about, am I living the life I want? Am I doing what’s important to me?
Ed Fowler
I’ve got lots of things that I want to be involved in, I can’t possibly be involved in all of them. How do I prioritize? And how do I take steps to do it, versus just saying, Oh, I’d love to be involved in that, but actually act on it, I get so much energy from that. And it’s kind of an amazing thing. And so this is a good reminder for me to be reflecting on this for myself. And if I notice conflicts between my values, trying to do things around Wise Mind or dialectics to try to figure out what’s the way forward?
Marielle Berg
Yes, I love that you mentioned that it can be energizing. Once you make some movement on it, it can feel very enlivening. Like, oh, I have a say in how my life looks, this value is important to me, I want it, I want to have it show up in my life in one way or another. And I know for myself that there are certain values that I say I value, or, you know, that I say are important to me. And there’s a, I put them off and think oh, look later when I’m, when I get older, when I get older, you know, if I should be so lucky. I’m hoping that that happens. And then that, you know, when I come back to values work that makes me question like, maybe this actually isn’t that important because I’m choosing other things, and how can I be conscious about my choices?
Ed Fowler
Right. Right. And again, all of this is the foundation for feeling secure and stable, balanced in our lives, is I have a sense of what’s important to me, and how I’m working towards it. And that can have a lot of benefit overall, in lots of different ways.
Marielle Berg
Yes. And so should we move on to our next question?
Ed Fowler
Yeah, let’s go for it. So I will read this one, which is a little bit longer question than the first.
Ed Fowler
Hello, and thank you so much for your podcasts. I would like to ask for your points of view on how to manage the DBT skills once the therapy ends. I’m coming to the end of a one year skills therapy group, and I’m feeling anxious about how I will remember the skills and when to use them. I don’t know if I can do it on my own. I’m afraid that I won’t be able to keep up the practice of DBT, and that things will go back to the way they were before. Do you have any tips for people like me who will soon not be in therapy?
Ed Fowler
I think this is a question that we get pretty regularly as people are coming to the end of DBT skills group or DBT treatment, how do I maintain my practice, have the skills to keep this progress going when I don’t have the structure of a skills group? Which is a huge benefit of participating in a DBT treatment, is you have this structure with other people to keep us accountable and working and focused on what we’re working on in skills practice. How do I do this when I don’t have that same structure?
Ed Fowler
And I think that the first thing I want to note, as I was reading through the question is that fear that if, the all or nothing, basically. If I’m not in skills group, I might not practice the skills, and then my life will go back to exactly the way it was before. When the reality is in the middle.
Ed Fowler
Where if you’ve been in DBT, if you’ve been practicing skills, your life has probably changed for the better. And that doesn’t just disappear. If you stop practicing skills, as consistently, we have an opportunity to notice, okay, am I practicing skills in a way that continues to support me? And if not, how do I build that in? And it does take some effort to figure out how to do that without the context of a structured group. And it definitely, people do it all the time.
Ed Fowler
So I think that the fear that I’m just going to go back to where I was may be unhelpful and can deenergize us of like, oh, that’s a lot of pressure. But really, it’s more like okay, how do I transition into this new phase of skills practice where I am figuring out some structures to support my skills practice, as opposed to having the external structure of a skills group or therapy.
Marielle Berg
And you can think about using the Cope Ahead skill, exactly for this situation. Anticipating that without the regular structure of DBT therapy, that it’s going to be hard to keep up the practice, so what can I put into place? And that’s what the Cope Ahead skill is about anticipating that this might be a roadblock, and what what can I do? Do I want to take out my book? Do I want to listen to podcasts like this? Is there a way I can have some check in or some kind of therapy, even if it isn’t regular therapy, whatever the program was before, that you were in, some kind of regular support, to help me be consistent in my practice.
Ed Fowler
I think one thing that helps in in DBT, when people are in DBT therapy, we encourage people to use what we call a diary card to track their use of skills. So the basic format is just a list of the skills, the DBT skills that we teach in skills group, and people can check each day. Which of these did I use?
Ed Fowler
Some people use that on a paper diary card or an online thing, or using an app to track their skills use. And so continuing that, and checking in on a regular basis every day, or whenever, some sort of regular schedule of checking to look at the list of skills to see which ones am I using? Which ones am I not using, that might be helpful to me? To think about, oh, I probably could have used Opposite Action today, and I forgot about that I’m going to keep that in mind for tomorrow. Just reviewing the list of skills can be so helpful to remind us that we have these options. And to reflect just a little bit on when am I practicing them, when might I want to practice them?
Marielle Berg
Yes, and I know for our groups, we really hope that when people end that the skills have been pretty integrated. And I know that’s not possible for everyone everywhere to be able to stay in DBT therapy therapy long enough for that to really happen.
Marielle Berg
But the reason why I’m bringing it up is that we know that learning these skills and having a deeper understanding of them where you have kind of skill dexterity, which means that at a moment’s notice, you can pull out a DEAR MAN, that takes time to learn that and to build that. Just as if we were learning a new language or a new instrument. So I just really want to normalize that the skills are dense, they’re very rich, they can be life changing, and it does take time to really get them kind of in our bones.
Ed Fowler
And the thing that I think about is accepting that we will all go through periods where we’re really actively and consciously engaged in skill practice. And other times where we’re just not, we’re not paying close attention, and the skills are not as well integrated. For me, because I definitely go through the back and forth of that. What reminds me to go back to skills practice is when I start not feeling so great. When my emotions feel a little bit more overwhelming, when I’m having more frustration than I want. That’s a natural reminder, oh, what skills might I use? Oh, I haven’t been using skills at all.
Ed Fowler
Maybe I could start with something. And so I never worry for myself or for others that we will totally forget about the skills and totally lose them. Because if we’re paying attention, when we’re feeling off, we know oh, skills are available, what skills might I use? And that’s a great chance to review and see oh, what might help me right now at this point in my life in this day? If we’re mindfully paying attention to what’s going on, we’re going to notice I feel off. Maybe I could go back and try some skills, which ones will I focus on?
Ed Fowler
And I think that, like Marielle said, DBT skills are like so rich and meaningful. There are so many variety of ways that we can practice them to help ourselves to keep our lives effective. And it does take time and practice, and we always have those opportunities. So I think for me, the most important thing is to just keep noticing what’s going on right now, what do I need? If I’m if I’m stuck, and I’m not sure, take a look at the skills and see which ones I might try? See how that goes? If it helps, great. If it doesn’t, what else could I try?
Ed Fowler
Trying to, you know, for me DBT skills, give a sense of power instead of powerlessness. There’s nothing I can do. Well, I could try a skill, it might not exactly meet my need, but it’ll be doing something. And if that doesn’t work, I can try another skill. And there’s such a long list. I’m not I’m gonna figure something out before I get to the end of skills to try. And so we just keep doing that. And, again, I think it’s natural to go through phases in and out. And the skills are there and available. And anytime we need them, we can reach for them.
Marielle Berg
All right. Thank you, Ed.
Ed Fowler
Thank you.
Marielle Berg
And thank you listeners for your great questions. We look forward to answering more on subsequent episodes.
Marielle Berg
Thanks for listening to today’s episode. To learn more or if you’re in In the Bay Area and want to get started with therapy you can find us online at bayareadbtcc.com. That’s BayArea DBTCC.com.