Friday, April 11, 2014

How DBT Helped in Labor (TW)

This is a bit more of a personal post and has been an ongoing struggle to write.   Up until this month I felt like as a therapist it was unprofessional to write such an intimate blog post.  A student at DBT Path is also pregnant due in a few days and I felt like it would really helpful to share my birth experience with her.  The more I thought about it, started to write then stopped the more I realized it is not unprofessional to write a personal blog post, but rather professional and sincere to share what might be a post that is helpful to others.   Here we go- My Birth Story and how DBT Skills Kept Me Sane

TW- Although I do not get into medical detail, this can be uncomfortable to read for some.
Once I found out I was pregnant I was on what I called the “hippie mom bandwagon.”  I researched doulas in my area and had narrowed down my birthing options to two; home water birth and hospital water birth.  After talking it over with some “hippie mom,” friends I decided the latter provided some reassurance just in case something happened I wouldn't need to travel in the snow last minute in to the hospital.  Little by little my plan came together through talking to close friends, discussing it with my Midwife, endless blog posts, scientific articles and of course good ole’ Google.  I was to have a water birth as well as a four page birth plan I printed off a site that sold organic baby products.  I spent hours preparing for this event; creating a You Tube playlist of both calming mindfulness and upbeat songs for the big push.  I included You Tube videos of DBT skills I planned on using as I packed my hospital bag of herbal medication, lavender and healthy snacks in a cooler. I was prepared at 34 weeks with 6 weeks to spare. I spent the last few weeks on a yoga ball, practicing breathing, taking evening primrose, drinking Red Leaf Raspberry tea (with local honey of course!) and watching more You Tube videos of natural birth than I thought possible.

At my 38 week appointment I had been suffering from an ongoing headache and my blood pressure was elevated, they re-tested and it remained high.  I had some blood drawn to test for preeclampsia and told to call back at 3 for results.  It was unlikely, but I might be induced soon.  I went home and called back.  That was New Year’s Eve and was told to relax, lie on my side, deep breathe and take some Tylenol.  The headache would not go away and I continued to check my blood pressure at home and it remained very high.   I called back the next day and told Labor & Delivery at my hospital that my blood pressure had hit 174/129 and was told to come in for an induction.  I was immediately admitted and told I was suddenly “very high risk,” and might have a seizure at any moment. 

My dreams of a water birth surrounded by the scent of lavender and mindfulness exercises was thwarted when I was put in some heavy duty blood pressure medication and told I was not able to leave the bed, eat or drink until I gave birth and 24 hours after that to continue to prevent seizures.  I took their medical advice (I did try talking them out of how serious it was to not avail) and began a hefty regime of medication.  The cure for preeclampsia is delivery and the OBGYN (buh-bye Midwife) was trying to get my son out ASAP.  The next few hours were a blur or ongoing medical check-ins, a one-on-one nurse, hunger and medication that made me sick to my stomach.  I was admitted at around noon and that night was being told I was not allowed the “hippie haven,” I created.   I panicked and kept thinking suddenly things would be different and I would wake up in the birthing pool to deep breaths and the smell of fresh baby.  

At 10pm that night I had a breakdown- I felt hopeless and skill less.  I had not planned for this and had no clue what to do. I felt like I was losing my sense of control by going along with the process of medical intervention.  My husband slept in the couch next to me in the dark, fresh off of his dinner of a soda and a Snickers bar while I sat and waited and mourned.  I cried, a lot and asked him to hand me the iPad.  I had not updated anyone on what was happening and was unable to see straight because of the meds.  The first thing I did was play my business partner, Debbie Corso’s Conveyor Belt exercise video knowing I needed to begin separating the racetrack of thoughts coming my way.  I shut my eyes and listened, creating buckets including “medical concerns,” “worst case scenarios” and the biggest bucket of them all “the unknown.” I listed to that video twice.   From that I was able to notice that my major fear was the unknown ahead of me and was able to use the Function of The Emotion and identify it as survival and work on Fact Finding- noting I was safe and being well cared for. 

I then decided I needed to Radically Accept the situation- it was beyond my control and the more I tried to fight it or continued to hope that I would wake up in a lavender tub it was not happening.  I cried some more, mourning this lose.  The OBGYN came in to check on me and asked what I wanted to keep in my birth plan- I was shocked.  My black or white thinking lead me to believe I had to give it all up.  I noticed using Wise Mind that I was thinking and acting very emotionally and not being skillful.  I re-drafted my 3 page plan into three important bullet points including having immediate skin to skin contact with my son.  This made me feel more in control of the situation even if I had not moved from the bed in 12 hours.   

I also noticed I was being less than kind to the nursing and other medical staff, partly due to side effects from the medication and a larger part was me being willful and grumpy.  The nurses had done nothing wrong and since I had one-to-one care they were actually being very kind and gentle.  When the nurse returned that morning I used GIVE to ask if I could have some ice since I was so parched and not allowed even water.  She checked with the doctor and I received two cups of joy.   With staff I also utilized Opposite Action and remembered to be kind to others even if I was not feeling well.  I knew I had a long day ahead of me since I was assured I would probably deliver my son next day and knowing I was unable to focus for very long on the iPad screen I googled mindfulness music and listened with my eyes closed until I fell asleep.   I utilized PLEASE skills as best I could and was able to get a few hours of sleep.  I also utilized Building Positive Experiences by trying my hardest to notice the positives; I was healthy and being well cared for, the staff was friendly and knowledgeable and most of all I was going to meet my son soon.    

For the next few hours I focused on Mindfulness and Distress Tolerance skills.  I self-soothed by holding the lavender in my hands and breathing it in as well as listening to some of my favorite songs.  I used the ice in the cup to remain focused, I utilized Mindfulness What skills to observe, describe and participate by releasing the pain with my breathes.  I utilized IMPROVE and took a vacation thinking of the summer’s I spent with my family as a child while it was snowing 6” outside, as well as encouragement by telling myself I can do this.  I utilized DEAR MAN with my husband by telling him to encourage me and even though he is squeamish he was able to help me cheerlead and validate my feelings.  I utilized Half Smile with staff in order to be in a place where I could get my needs meet and be kind to others.   Using Ride the Wave allowed me to handle the physical pain a bit better as well as some of the sudden changed in my treatment that had to be made for the safety of myself and my son.  Lastly I focused on an object in the final moments of labor, which the nurse initiated by telling me to look at her while I pushed.

At 10:17am my son, Javier was born to a set of parents who were able to make the best out of a less than pleasant experience.

Friday, February 21, 2014

How to Find a (Good) DBT Therapist

One of the most common e-mails I receive at DBT Path is asking for a referral for DBT counselors in their areas.  It can find like a needle in a haystack to even find a DBT counselor let alone one you connect with.  Don’t fret there are options out there and some don’t involve leaving the house.

The Good:  This list is of those formally trained though Behavioral Tech.
The Bad: Many DBT Therapists are not trained through Behavioral Tech (myself included) and it includes mostly DBT Clinics over individual counselors.

2.  Google
The Good: It’s simple and it might bring up therapists who willing to do sliding scale or starting a practice than those who pay to be on search sites.
The Bad: It’s google, so anything with “DBT+ Phoenix” will come up, including a band called Drive By Truckers.

The Good: Easy to use search engine just for therapists.  You can search for DBT-specific therapists and see short bios and pictures.
The Bad: Same as with other search engines for therapists, they pay for the advertisements so small practices might not advertise.

The Good: This is the top site for searching- more listings and more detail in profiles.
The Bad:  Same as good therapy regarding therapists paying for their listing.

The Good: It’s online, via e-mail or make a phone appointment so stay in your PJs also some therapists profiles say “live now,” which means if you want to talk to someone at 3am they might be someone there (it’s not crisis counseling.)  Therapists do not pay to be listed and they have reviews.
The Bad: Many people like face-to-face therapy and the prices are a bit steep if you are looking for ongoing help.  There are also less than 10 DBT Therapists listed right now.

6.  Look for a non-DBT Therapist.  : I know this seems weird, but hear me out on this.
     The Good:  Many counselors who are not DBT Therapists are still great counselors.  If you are looking for help      with trauma and sharing diary card/homework accountability, a non-DBT Counselor might be a great fit.  Yes,      you won’t talk DBT the whole time, but you might get great non-DBT coping skills.  This opens up the number      of local Mental Health Professionals exponentially.
     The Bad: It’s not DBT-oriented.

So now you have some names and numbers of DBT Therapists so where to start?  There are many articles on how to find a “good” therapist.  This site has a great list of what to ask so I am going to focus on what to ask a “DBT Therapist.” 

I put “DBT Therapist” in quotes for a reason.  There are many great therapists that have some training on DBT and list DBT in their profiles, but then don’t have much knowledge of it.  Many of the search sites have check boxes and I think many therapists get “click happy.”  I am not saying these are not great therapists, but if you are looking to talk DBT, review diary cards and talk skills these counselors might not be a good fit.  Here’s a list of what to as a “DBT Therapist to ensure they are DBT Counselors:

·         Give them a ring, not an e-mail.  Sounds sneaky but try to catch them a bit off guard so their answers are not prepared even if they end up calling you back.
·         Take the free meet-and-greet.  If you are searching someone in person, most offer an initial consultation on person or on the phone- take them up on it and be prepared with questions.  Consider this a job interview and you are the boss!
·         What training do you have specific to DBT?
·         How many clients who have (your diagnosis or primary issue) have you used DBT skills with?
·         Have you ever facilitated a DBT group?
·         Are you familiar with DBT Diary Cards?  Emotion Regulation 1a worksheets?
·         How familiar are you with specific skill?  Heck name a few major skills (i.e. Wise Mind and Opposite Action) and see if they can keep up.

You are the consumer and deserve the best- be assertive!  Ask for exactly what you want to work on.  If you are struggling with relationship issues and past trauma issue start the conversation with, “I am working on relationship issues and handling past trauma that is interfering with my life.  I am looking for more accountability and skill building one-on-one.  I have found wise mind, radical acceptance and mindfulness most effective and could use more depth in my learning of these skills.”  A good therapist who isn't well versed in DBT will re-direct you to someone else.

No matter which way you go, if you need help be EFFECTIVE and find it!

Sunday, September 22, 2013

Family and Loved Ones with Emotional Regulation Issue Seminar

A week from today Sunday 9/29 from 4-5:30PST Debbie Corso from Healing from BPD, myself and guest Dr. Perry Hoffman from NEA BPD (National Education Alliance for Borderline Personality Disorder) will be facilitating an global seminar for family and loved ones of those with Emotional Regulation Issues.  We will be talking about how loved ones can help, what resources are available to both clients and their families and have an open Q&A session.  

There are 2 days left to get the discounted price.

If you have any questions e-mail

Friday, April 5, 2013

Ask Any DBT or BPD Questions This Weekend!

Hi All,

Quick note.  This weekend I will do a Q&A on twitter.  Feel free to ask me any questions about DBT or BPD.  Tweet them @apazma, DM me to be anonymous, e-mail or leave them in the comments below.  I will re-post all questions (minus names) here after I am done.

Great way to get some professional information!

Thursday, March 21, 2013

My Job: Dual Diagnosis Counselor at a Womens' Prison

Today's post is a little off topic, but today was the inmates graduation and being the emcee I posted about my nerves on Facebook and told my friends with an interesting response.  I have been working there for 8 months and it always seems to be an interesting topic to talk about with friends, family even strangers.  The reactions are mixed, but people have the same few questions so here goes.  If I seem vague it's because well it's a prison and although some information is open, certain some things are not.

  • My job is Dual Diagnosis therapist, although not all my clients are what the program considers DD.  To them DD is MH medication+therapist+diagnosis of MH & Addiction.  The medication they can receive is not the same medication they often have Rx with their regular MH doctor.
  • The programs main focus is substance abuse and they attend 16+ hours of group a week including cognitive skills, seeking safety, and process.  They learn a lot of skills for their recovery and must attend 2-12 step meetings a week.  
  • We have a wait list of over one year most times, some of them are parole-board recommended- which translates that they need to complete the program.  
  • The program is 6 months long.  There are reviews of their progress every 30 days- it's very time consuming.
  • My caseload is about 20 people, although not all people graduate due to various reasons most are due to lying, manipulating and confidentiality.
  • The "program" is all housed together- the rooms hold from 2-6 people, most are "2-man cells."
  • We utilize a peer-support program which includes 10 "lifers," all which are murderers some of which have been incarcerated for 25 years.
  • We are contracted by the state.
  • A vast majority of these women have been the victim of horrific abuse as a child (often sexual,) abusive relationships, raped, started using substances around age 13 and have or in the process of losing their kids permanently.  Most would meet the criteria for PTSD.
Now to the questions people have most often:
  • I always feel safe- the rare time I don't is when I am with general population and someone s cursing or yelling at someone else.  There are physical fights- but rarely .  There has been 1 in the 8 months I have been there, and I don't think there was more than one prior.
  • The "lifers" and inmates in general are not scary or mean.  Part of it is because they in some way need the program to parole or stay out of another more-strict.more dangerous unit (or they have an extra 2 years+ typically.)
  • Some do recovery- this is probably the #1 question.  Some come back.  We don't know statistics on how many, but I would assume half of them relapse on substances with in first 2-3 years.  If they relapse they often go to a different program, rather than repeating this one although we have had a few come back 5 years later.
  • Half of my co-workers are in recovery, my boss has 33 years and my co-worker has 13 years clean! We had a counselor pass this year and she has 13 as well, she died due to complications from her Hep C she contracted at age 17 using heroin.
  • It's very, very stressful- these women have been through so much and get "caught up" in what we call "prison bullshit," relationships, manipulation and lying to staff.  A lot of my time is spend in crisis mode, especially in the beginning of the 6 months.  
  • I cry, I try not to and most of the time I am fine.  They write an autobiography about halfway through and share it with the group- it's all triggering.  Some stories don't affect me so much and then there are a few that keep me up at night, make me cry or change the way I look at the inmate.  These women have such strength and perseverance and their stories are so tragic.  
  • We can't hug!  Nope, no touching on shoulder, no embracing at all.  This is a strict rule and could lead to termination.  It is difficult and un-natural at times, especially when someone comes to be on-on-one and tells me their child died in the streets selling dope or there mom has terminal cancer.  Life goes on while they are in jail and they often feel and are powerless.I am called by my last name only
  • Yes, they eat crap.  Carb and calorie heavy food is the norm around here. They are allowed to work out at times and watch videos during the day.  There really isn't healthy options and most gain weight while incarcerated. Food is a commodity and is traded like cash.
  • There are drugs in the prison.  Seems strange, but like all institutions there are drugs.  Most often it's Rx drugs that another inmate "cheeks" and sells, but there is also narcotics.
  • 3" toothbrushes, and other strange things (to me) are used as if it's normal.  They are allowed to purchase (or someone purchases it for them) certain products these mostly include non-name brand lotions and such.  They are not allowed make-up (they use paint,) nail polish, headbands, etc.  Many still have them though.  A "full size" toothbrush that is easily 15 years old can go for $25.
That's all I can think of off-hand, I am open to answering any questions as I often think people think I work in one of those "reality" TV shows that fill prime-time TV now.  Here's a secret- the inmates in one of those shows is told to yell obscenities and appear aggressive for the cameras...I know I have 3 people in my group that were on it!

**Trigger Warning: There is a movie Sin By Silence (trailer here) which is a documentary about abused women who kill their husbands.  It's very sad, and triggering but very empowering as they work to change California laws and get out**