DBT is a decent therapy for borderline personality disorder and it can teach us a lot about regulation. It is also not meant to be used for trauma or dissociative disorders. That is why we will run into problems, when we try to use DBT skills here. The concept of dissociation in DBT is one where dissociation is a rare and disruptive symptom that needs to be stopped. There is no further plan to work with dissociation, including structural dissociation. That is why DBT will fail.
Here is how we can kind fo make it work:
When we notice that we left our window of tolerance, we need to find out who inside is freaking out. Sometimes we can sense someone else in the system going into hyperarousal or hypoarousal.
If we use DBT Skills now we might be able to keep our head clear while we are using them, but the hyper/hypoarousal will be back the moment we stop. We were regulating ourself through distraction without helping that part of us to return to their window of tolerance.
[If you are a T and you see a pattern in your patient, where as soon as they stop using Skills the dissociation/ urges to self-harm are back, please change tactics. They can use Skills til they drop (been there!) and it won’t solve anything.]
As soon as we know who is in trouble, we need to ask: is this part connected to the body? If not, using Skills for the body won’t make a difference. We are making a fool of ourself, without results. This cannot work. The part who is in trouble needs to use the Skills. That means the part either has to front, which can be difficult to control, or we need to get them involved with the outside world first.
We can try to help them to connect with the body by drawing their attention to our senses. Have them look out of our eyes. Aim for co-consciousness.Then we can carefully start using Skills while we keep the connection inside. When we lose them, we stop and bring them back. We need to share the experience to make it work.
Skills for the mind or movement works best for this. If we start with aversive stimulation they might let the connection drop again to avoid discomfort.
Communicate. Find out what is going on and what triggered it. Most of the time Inner conversations can replace DBT Skills completely. Use relational regulation on yourselves.
Sometimes when we are flooded by pictures and sensations from the past, the source is not our own flashback, but a part stuck in a flashback. We cannot just use containment for everything that comes up. We need to help that part of ourselves to get out of their flashback! It will stop our flooding experience too.
Don’t ever use DBT Skills to support your avoidance of the inner experience. You cannot „skill“ your parts away. Avoiding connection and communication makes everyone get stuck in a bad situation. Skills cannot and should not replace our work with our inner team.
DBT skills are not ideal for regulating dissociative parts. It needs special effort to even make it work a little bit. Every approach that includes actual parts work will be better. Janina Fisher offers detailed instructions for that.
If you insist on using DBT skills, please be careful. There is a great potential that the interventions will be seen as abusive. Strong aversive stimulation can be a direct trigger. I would highly recommend you use the abundance of grounding tools and inner communication instead. Almost everything works better than skills. DBT is not the right tool to solve this. It was never meant for this specific problem.
Things went wrong and you want to learn from it? Try the DID-adapted behavior chain analysis!
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