Another Perspective

The Other Side of the Couch: Another Perspective on DBT and PTSD

by Dr. Laura Burlingame

Now, here's the thing learning the DBT skills does not take two years, but it does take practice and commitment. The actual skills you learn for the most part make a lot of sense - things like distracting yourself when you feel like you can't stand the symptoms anymore, or self-soothing. However, there are a few that take explanation and some processing - like opposite action or half-smile - the skills training groups come in handy here. Learning mindfulness - and compassionate detachment is also hugely important - is so important that some groups will use it to start each of the three main coping skills sections (Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance). Mindfulness is also a set of skills in its own right.

One of the really important things you'll get out of attending a DBT skills training group is the support. You'll be around people who are learning to cope with similar symptoms regardless of the diagnosis. The therapists that run the groups are also supportive - we're trained to use humor (appropriately), empathy and compassionate but firm challenges to help you get the most out of the group.

Another important thing about DBT skills training, though, is that the group leaders are NOT going to be your therapists - they are there to lead the group, help you with the homework (practicing the skills), and teach. This is another reason why it's important to have an individual therapist while learning DBT skills - your individual therapist can provide support designed for YOU and you alone while you're learning these skills, and will also help you in processing and healing from your trauma.

Remember - DBT skills are about coping with symptoms, not necessarily the main avenue for healing (although they certainly can help!). When combined with individual therapy, DBT is a powerful system and set of tools that can help you feel better and cope with the situations that trigger, hurt or re-traumatize you. If you're interested in finding a therapist trained in DBT and/or a skills training group, you can find more information from Dr. Linehan's web site. You can also call your local mental or behavioral health hospital for information - they are likely to keep track of therapists and therapy groups in the area.

After you've completed the skills training classes, you're still likely to continue in your individual therapy. One thing to keep in mind that is that the things that happened and the PTSD symptoms have probably been going on for quite a while, and they are not likely to be healed overnight. Skills training groups are time-limited - they are not usually and ongoing process for most people. So, what happens when you're done with the skills training? Well, as I mentioned you'll probably want to keep working with your individual therapist for a variety of reasons, one of which is that you'll still want to practice and get feedback on using the skills you've just learned.

Another option in the DBT system that follows the skills training groups is to join a Supportive Process Group. These groups are ongoing and also require participation in individual therapy during the time in which you're in the group. However, these groups are not always around or may not be part of the system in your area - this is another reason why continuing in individual therapy is important. The supportive process groups support what you learned in skills training and also support you in using the skills. The group here is more like a traditional therapy group. One thing to keep in mind though is that these groups are optional - you can do just fine with your individual therapy and skills training.

If you're interested in learning about or looking at the DBT skill sets, I have a few resources for you.

First, I have done
a five-part series on my blog explaining the skills training and situations where they might be used. Marsha Linehan's training group, Behavioral Tech also has a good website with materials. There is also a DBT therapist directory on her site if you are interested in pursuing DBT further. Finally, I'm happy to be a resource for you as well. You can check out my blog, The Other Side of the Couch, or email me at:

Laura Burlingame-Lee, Ph.D. is a recent graduate who obtained her doctoral degree in counseling psychology from Colorado State University. She is currently pursuing licensure in this field, and is available to answer questions concerning DBT and a variety of other topics. Laura has had personal and professional experience in dealing with PTSD, Depression, and Anxiety, in addition to extensive clinical training and experience in treating Borderline Personality Disorder and other chronic and severe emotional issues. She completed her internship at the Colorado Mental Health Institute at Ft. Logan in Denver, Colorado and is looking forward to beginning her practice as DBT-trained therapist. She generally works with CBT and DBT, but also brings in mindfulness and spirituality as well as other aspects in order to work holistically with her clients.

Laura lives in Loveland, CO with her husband, three children and two uppity cats who deign to allow her to serve them.

(Photos: Laura Burlingame-Lee, Eyes of the World Media)

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