Welcome to Wise Mind: Your Hosts, DBT Basics & Dialectics Explained

Hello and welcome to Wise Mind, a DBT podcast with myself, Madeleine Robinson and Rachel Green, where you get your weekly dose of DBT to create a life worth living unskill at a time. If you are here for yourself, supporting someone else or just DBT curious, you are in the right place. Before we get into the skills, Wise Mind, a DBT podcast, would like to begin by acknowledging the dark and young people, the traditional custodians of the land on which we live and work. We pay our deepest respects to elders past, present and emerging. Always was, always will be aboriginal land. Okay, so let's introduce you to your DBT podcast team. I'm Rachel. I am an accredited mental health social worker, and I've lived and worked on the central coast of New South Wales for the past 30 years. And this November will be my 30th year of being a social worker. The vast majority of my clinical experience has been working in mental health services, mostly the public mental health system. So acute inpatient units, mental health acute crisis teams, community based teams for adults, older persons, mental health and child and adolescent mental health. I've moved around the system over many years. I've also done quite a bit of work in the private system as a DBT coordinator and delivering lots of DBT group therapy programs and DBT to individual clients. I left the public and private health systems just after COVID, and I did some really cool stuff. After that, I worked out in Uluru, Australia's cultural and spiritual centre in the Northern Territory, working with Indigenous clients, working with communities and working with the staff who live on that resort and my job was as the senior staff counsellor. So I did a lot of DBT out there. And also on Nauru, Australia's offshore detention centre, working with clients who are refugees, seeking asylum, who have significant histories of torture and trauma. So most recently, I've started my own private practice, Rachel Green counselling. And in that private practice, I specialised in the treatment of borderline personality disorder using dialectical behaviour therapy and complex post-traumatic stress disorder, mostly working with people who experienced trauma during childhood, what we would call as developmental trauma. That's me. Maddie, what about you? Yeah, so I have a little bit of a different background to you, Rachel. But God, 30 years as a social worker, I know I always say this and it makes you feel quite old, but I was, I was one when you became a social worker. But my background's a little bit diverse. I started in a Bachelor of Nutrition from University of Newcastle and worked in that realm doing psychoeducation and worked out that I wanted to work more in the field of the mental health and particularly was seeing quite a lot of eating disorders at that time. And so the mental health related to eating disorders, I went on to do a Masters in counselling from the University of Queensland and then completed a Masters of Social Work at Charles Darwin University, which is in Darwin, the Northern Territory. And throughout my career, I've worked extensively with adolescents and adults working mostly similar to you, Rachel, in that field of complex trauma, eating disorders, personality disorders, depression and anxiety. My experience includes working therapeutically with vulnerable people in out-of-care homes, in places like Headspace, which is quite big in Australia, which works with young people from the ages of 12 to 25, in high-risk suicide prevention programs, and in non-for-profit programs where clients can access free mental health support. And I continue to work in that now, including running and coordinating DBT groups and leading different clinical teams, which has been such a joy and a highlight for me and really fills my cup. I'm also a clinical supervisor, so I do a lot of work with clinicians in that supervision space and particularly drawing from trauma-informed DBT and how to work with clients with complex mental health issues and those diagnoses of what we call borderline personality disorder. And I was really drawn to that diagnosis because there was this group of people with borderline personality disorder that weren't getting the support that they were needing. And I really wanted to help them get the support so I'm registered with PACFA, for those that don't know, which is the Psychotherapy and Counseling Federation of Australia and Australian Association of Social Work as well. So that's a little bit about me and how I got into this realm, but maybe Rach kick us off a little bit with who this podcast is for and who we're aiming at. So we're really aware that getting treatment, getting DBT treatment, dialectical behaviour therapy is really, really challenging. It can be expensive and it can be hard to find the right clinician. So we've created this podcast as a way for people to learn the DBT skills, hear about the DBT skills to support them while they're going through DBT therapy or as a standalone service to learn and listen about DBT. So we see that this podcast could be really useful for clients, so people who have challenges with their mental health, whether that be borderline personality disorder, which is what DBT was originally created for, or complex post-traumatic stress disorder, depression, anxiety. If you're someone who wants to learn the DBT skills for yourself, then this is for you. The other group that we think this might be really helpful for is families and carers of people who are struggling with those issues. Families and carers need just as much information, support and advice as the people who need the support themselves. So we're hoping that this can be helpful for families and carers. And the last group we're really hoping this will be helpful for is clinicians or support workers or people who are working, helping professionals working directly with people who are struggling with mental health issues. So maybe you've just recently finished a DBT course and you want to know a little bit more. Maybe you're brand new to DBT and you want to hear and learn about the skills. No matter where you are in your DBT journey, this podcast is for you. So on that note, Rach, now that we've gone through who we are and who the podcast is for, let's actually dive into the official first episode and begin exploring our first DBT skill. But before that, what actually is DBT? How was it developed? And we'll introduce you to, of course, Marsha. And begin to explore how we can use it and how we can utilize this skill of dialectics and utilizing in our lives to build a life strategy. Let's go. So there are four DBT modules. First of all, let's talk about what DBT is. DBT is a psychological therapy that was developed by a doctor of psychology, Dr. Marsha Linnahan, who is based at Seattle University. Marsha. Marsha Marsha Marsha. We talk about it all the time. He is some people like Beyonce, some are Taylor Swift fans. Some are Bon Jovi. Some are Bon Jovi, some of us are Marsha Linnahan. So she's who we follow relentlessly and the fan club of her, absolutely. There's a Facebook page of people with borderline personality disorder who are all on this Facebook page and they share DBT skills and memes and things. And I think it's called Marsha Linnahan, you rock. I love that. I love that. I know my work group chat for our DBT team. It's a picture of Marsha holding a little shih tzu. And that's the group photo. So it shares how much we love her. And I would say, obviously, I'm very biased, but there isn't a day in my life where I don't talk or think about Marsha. Yeah, yeah. Marsha Marsha Marsha. Marsha Marsha Marsha. So Marsha Linnahan herself, while she was going through university, experienced significant mental health challenges. She had multiple suicide attempts, self harm. And she's written about this in her memoir, which is a great read. And she has a lot of psychiatric acute psychiatric admissions, right? And she was treated back then with cognitive behavioral therapy, which still to this day, there's a huge amount of evidence for cognitive behavioral therapy, particularly around the treatment of depression and anxiety disorders and other disorders. And I think I was trained in cognitive behavioral therapy, showed out a uni. It was it was the panacea for all ills, right? Even me, you know, you know, I obviously trained not as early as you, but I would say that's what I was trained in cognitive behavior therapy as the initial approach to all mental health challenges. Exactly. And look, there's plenty of evidence out there for CBT. We are not bagging CBT. And so this is the treatment Marsha had. And she very quickly found that unhelpful and invalidating. And this is what we hear from people with borderline personality disorder is so cognitive behavior therapy, one of the core strategies is reef cognitive reframing, changing the way you think about specific issues and challenges in your life. And for people with borderline personality disorder, BPD, that can be really invalidated because the message they get is what you think is wrong. What you feel is wrong. The way you're acting, your behavior, it's wrong. Stop it. They've heard that their whole lives. And here's a therapy that's saying, stop that. Yeah. You know, and I can imagine how distressing that is when it's like, I have no control over my thoughts, but they're wrong and stop having them. Exactly. Which is even for me, I think in this moment right now, God, I have a million thoughts going through my head. And some of them are absolutely wild. And some are not. And it's like, that must be really uncomfortable. Exactly. So she said, this therapy isn't going to help me. And what an incredible woman. She turned around and created her own therapy, it's a dialectical behavior therapy. However, her original textbook is called cognitive behavior therapy for the treatment of borderline personality disorder. Everyone always so shocked by that when I tell them, so shocked by that. And when you look at the DBT skills, which we're going to do in this podcast in great detail, there's only a few that are cognitively, one we're talking about today, dialectical thinking, really is the CBT equivalent of black and white, working with black and white people, right? Yeah. But in a very different context and in a very different way. So Marsha created this therapy and rolled it out around the world to help probably millions, I would say, over time. And continues to, right? Yeah, and that beautiful story. Do you want to share that? Because I know you love that story and it gives you chills every time you hear it and every time you tell it about how Marsha created this. I've done so many groups now and I swear every time I tell this story, I still have the same like physical body sensation response. So like you said, Marsha really struggled throughout her adolescence and early twenties, you know, with her mental health in and out of psychiatric hospitals, often, you know, sectioned in them against her will and really struggled. She's actually initially diagnosed with psychosis, right? And how many times do we hear that from people with BPD? The original diagnosis is psychosis. Even in the last weekend, I've had a couple of referrals and it says psychosis and it's just like once you sit in front of the room with that client, it's like, I am not getting that vibe at all. And there is very limited evidence on this. I'm not even sure. And we'll talk about how, you know, and why psychosis can often be seen on referrals in a moment or in future episodes. But yeah, Marsha really, really struggled. She got this diagnosis of psychosis. She got this diagnosis of psychosis. God, that sounded funny to say then. And she ended up having kind of a final inpatient stay. Hated it, struggled. I'm not, I'm not bloody going back there. There's no way in hell. No way in hell. So she went on to get well again. She built up skills herself and got well, went on to study. And obviously she's quite clever and developed DBT and went on and said, I'm never going back there. And I developed a bit DBT and said, I'm going back into the fire. I'm going back down into that pit of hell. That's what she called it wasn't living with BPD in that acute unwellness was like living in hell. She describes it beautifully. I'm climbing back down that ladder and I'm giving them DBT and DBT, I guess all that pit of hell was the birthplace of DBT. I guess that's how it developed. That's how she developed it from her own lived experience. And the way she described it is, it is like climbing on this ladder that is on fire and burning the hell out of you and it's painful and it's suffering. But my option is to let go of this ladder and I stay in hell or I climb it. And that's how she describes BPD and kind of getting yourself out of hell and getting yourself out of suffering. What we know now is that Marsha was diagnosed in a running life before the Lyme personality disorder and used the skills to recover. And she shared that with the world. So we want to recognise her work and we stand on her shoulder. What's the say, Marsha walked so we could run? Yeah, I don't feel like I can run anymore. So we could do a quick walk so that we could walk briskly. A brisk walk. So we are brisk walking. Absolutely. So and a lot of people don't know that Marsha based a lot of DBT on Buddhism, right? Like part of her healing journey was to go down that Buddhist path. However, the Buddhism taught in DBT has the religion sucked out of it. And I think that's important for people to know because not everyone's comfortable with religion. You're not going to be sitting in a corner in a robe with your prayer beads, you know? Unless you want to, feel free. Yeah, you're welcome to do that if you choose to. If you choose to, that is skillful and effective for you. Go for it. If you sit in your robe, that is fine with your beads. That's right. But it's Buddha, it's that, you know, there's a whole module on mindfulness. They can stray out of Buddhism and in particular the Zen School of Buddhism. So there's and a lot of people find that quite attractive, you know, the belief there is a belief that Buddhism is, you know, full of wisdom. But DBT is an evidence based treatment. So there's a well, we won't bore you, but if you want to go down the rabbit hole of clinical randomized control trials, looking at the effectiveness of BPD, you'll be there for a while. Absolutely. Originally created as a gold standard treatment for borderline personality disorder. So for people who experienced exactly what Marsha was experiencing, however, has since gone on to shown to be really effective with a halt. Like I use DBT with people with eating disorders, depressed people with depression, anxiety, any type of trauma. What about you, Maddie? What are you? No, I couldn't agree more that I use it with such a range of different clients. And I think, again, like the evidence is growing in DBT with these different presentations. But definitely in, you know, when I do have clients with any type of emotional dysregulation, and when I have clients that present with anxiety, depression, distress, distress, eating disorders, I've had a client even where I've used it with dissociative identity disorder. So quite a complex mental health condition. And it's been really effective in that safety and stabilization in supporting them. Exactly. So such a range of different presentations we can use this with. Yeah. And the outcomes with it, I've seen it. I just, obviously this is where we just start to hear our passion, but the outcomes I've seen and how it has saved people's lives are genuinely, like genuinely incredible. Yeah, absolutely. So there are, what is DBT? It's a psychological therapy, but it's not sitting around in a circle talking about the trauma terrible things that have happened to us. It is one of trauma treatment. As I said, what is phase one safety and stabilization? What does that mean? So four modules. So let's have a, we're going to talk about all the skills in great detail. So just sort of take it over to you. So module one, mindfulness. Very Buddhist, right? A lot of Buddhist philosophy and module in this idea, mindfulness. What is mindfulness? Paying attention on purpose to the present moment. Why is that important for people with mental health challenges? Well, people with mental health challenges spend a lot of time living in the past. Yeah. Shame, depression. Why did I, why should have? Oh my God, I'll never, you know, put up. Yeah. Yeah. All of that. They also spend a lot of time living in the future. Oh my God, what will happen? It'll go wrong. Not only will it will go wrong, it'll be a catastrophe. What ifs? What? Oh my God, if something terrible is going to happen and I won't be able to manage it, they spend very little time living in the present, which is the only thing we have. And the only thing that exists, the past doesn't exist. It's over. It's done. The future doesn't exist. It hasn't happened yet. So mindfulness is a really important set of skills for anybody when learning someone with people. I think everybody on the planet could benefit from learning how to be more mindful. Absolutely. And I was just going to add to that, you know, being in the present is the only place for solution. Yeah. So trying to solve your problems in the past or the future. It's black. You have no power there. Just got no power there. And so this style of mindfulness is really effective in bringing you into the here and now so we can actually be really effective with that. Rachel, I don't know about you and I know we will do full episodes on mindfulness, but you know, clients can have some real strong beliefs when you say it. Oh, they hate it. Today we're going to do some mindfulness and they're like, oh, I had a client once that just, it was our first session. She said, I'm open to everything. But if you introduce me to mindfulness one more time and say mindfulness, if one more commission tells me to breathe, I swear to God, I'm getting up and leaving. And I just burst out laughing. She was laughing too. But people can have some strong beliefs around it, right? Absolutely. And when we do those mindfulness skills, we'll talk about clients often come in hating mindfulness and not wanting to do it. And you really have to, and I get it. Why should I do this? You have to be able to answer that question. What's in it for me to learn mindfulness? Well, there's a hell of a lot in it for you. And I think the other thing is people think I can't do mindfulness because I get distracted and I lose my tear. That's part, all part of mindfulness training. So module one, mindfulness. Then we have distress tolerance. What is the distress tolerance module? The distress tolerance module is people with BPD and other mental health issues can experience overwhelming distress that is beyond their capacity to cope or manage. This is where we get into crisis, suicidal thoughts, suicidal behaviors, self harm, using drugs and alcohol to manage so we can get in really difficult, tricky situations and just overwhelmed and I cannot cope. The distress tolerance module is that module where we're looking at what are the skills where we can help you learn to manage and tolerate, increase your ability to tolerate distress and then to regulate your yourself back down where you can then use other more complex skills. So the distress tolerance skills, people are often surprised. They're pretty simple. Yeah. There's not a lot of language. There's not a lot of talking going on those skills because the prefrontal cortex, which will talk about the neurobiology of trauma in great detail. I think we're doing that episode two. Yeah, episode two is the neurobiology of trauma and what actually is the brain doing? Exactly. So you don't have access to your prefrontal cortex when you are highly distressed and therefore things can go off the rails pretty quickly when you haven't got that thinking part of your brain. So it's an important module. I was just going to add, I like to kind of introduce these to clients as your fire putting out. So it's like there is a fire. Put it out. You need a skill to put it out. Yeah. This isn't prevention work in the sense of it isn't preventing dysregulation. It's you've got a big fire. Don't try and put the fire alarms in. Yeah. Actually get the water bucket and put it out. Yeah. And so these are skills to help clients yeah put out the crisis in their life. It's crisis skills. In the moment. Yeah. High distress, 10 out of 10. Can't think of anything else. Panic, distress, need to put it out. Exactly. Then we have our emotion regulation module. This is all and we are going to do an episode looking at well what are the traits of borderline personality disorder and emotional dysregulation is a huge component. It's not the only component. It's probably the one that people talk about the most but plenty of people experience emotional dysregulation who don't have BPD. People with depression, people with anxiety, people with drug and out like new night. Absolutely. People with no diagnoses. People like us, right? Like we name up, God, there's times in my life I've been so emotionally dysregulated. Yeah. Hence why we use the skills. Exactly. And again, I call these ones the fire alarm skills. So these are the preventative ones, right? These are ones. Can you start to see or notice or smell the smoke? Can you start to see the smoke? Can you hear an alarm going off? How do you put the alarm on the system in your house? So these are your fire prevention skills. How do I stop the fire? Yep. We all like learning to emotionally regulate starts in childhood, right? Most kids by the age of five to seven are starting to be able to regulate on your own. If you had a caring caregiver, whether that's a parent, a grandparent, whoever, whoever your main caregiver, caregiver's had to teach you. We learn how to emotionally regulate in childhood. Now if trauma interrupted that or unfortunately you didn't have a caregiver who knew how to regulate themselves or, you know, had their own traumas, if there was abuse, neglect, you didn't learn that through no fault of your own. You did not learn those emotion regulation skills. So the great news is with neuroplasticity, which means changing our brains, we can learn those skills as an adult, no problem. Absolutely, absolutely. So just as, you know, we learn ways of or patterns of dysregulation. We also can learn patterns of regulation and regulating our nervous system, right? That's therapy. That's DBT, which is pretty incredible work that you can do. Absolutely. And then the last module is my favorite personally. What's your favorite module? I really like Distress Tolerance because I like really being able to give that knowledge of why am I doing what I'm doing? Like what is the brain doing? But then look, I do like interpersonal effectiveness second best because I use it so much in my personal life. Yeah. So God, I want to say all of them. I've got these urge to be like, and mindfulness and this. Yeah, I would say just stress tolerance, definitely. All right, gun to your head. Who's your favorite child? Mindfulness? Yeah. So interpersonal effectiveness is all about how do I have effective relationships? And when we look at the traits of BPD, one of them is a history of unstable relationships. And you and I both see this ad nauseam. Unfortunately, people with BPD can blow up their lives, blow up their relationships, push people away. Yeah. Often old, they have what we would call a disorganized attachment style. So it can become here. I love you. I need you. You're my favorite person. I can't live without you. And then I hate you. Go away. You're the worst thing that ever happened to me. That's a really difficult relationship to be. Yeah. Right. I'm smiling because, right, how often do we even see this as therapists? Come, go, come, go. You're the best therapist I ever had. You're the shittiest worst therapist I've ever seen. I hate you. I'm never coming back. Then you get a phone call. I'm so sorry. Can I come back? See you next week. It's all just part, it's all part of the illness, right? It is what it is. Yeah. But it's also about asking for what I need effectively. Yeah. Yeah. And assertiveness. Yeah. And ending toxic, destructive relationships. Yeah. Relationships that aren't working. Yeah. Absolutely. Making friends is one that we work on quite a lot. Yeah. Making healthy. What is, what is the, a lot of our clients who come to DVT skills groups, when I say, what does a healthy relationship look like? They wouldn't have a clue. No. They've never, like, they've never experienced a healthy relationship. And I'm talking about the first relationships we ever have, which is the relationships with our primary care kids. Absolutely. Absolutely. I'm also thinking things that are coming to mind, setting boundaries, right? What even are boundaries? So many clients, I start to have the boundary talk and I'm like, hold on, do we, have you heard the word about, like, do you know what a boundary is? And it's, oh, actually, no. Yeah. I grew up with no boundaries. No boundaries. So even, how do we set them? What are they? Only important work to do, right? So DVT is skills training. It's not, as I said, sitting around in a circle talking about, oh, this terrible thing happened to me, my sexual assault, my this, that, the other. And when we do our pregroup assessment with clients who are coming into a DVT skills group, and I should say, DVT can be done on an individual basis or in a group, right? It doesn't have to be either or. The beautiful thing about DVT is you don't have to download and talk about your trauma. And a lot of clients find that as a great relief. Absolutely. You know, and I think specifically in group, a lot, anyone on one's clients, like, I'm so fearful of unpacking, talking about it. And it's like, great, because we're not going there. We're not going there. We're not going there. But we are going to support you in building skills to manage the distress that that incident has caused or the ongoing incidences of trauma. Yeah, the many experiences. The many experiences, what we call those ongoing little tea traumas. And the big tea traumas, we're not going to ask you details about it. We're just going to support you in managing this distress. Exactly. Like, giving you the skills that you haven't learned. Tea is not trauma processing. That's phase two, right? So DVT is all about phase one. Peopleise the person enough. And I have, I reckon it's 50/50 for my clients. I don't know about you. Like, some of my, about 50% of my clients will come in, they'll have DVT and they will feel stable, often for the first time in their life. And they will say, that's me done. It's enough for me now. I don't actually feel any need or desire to go into phase two and process my traumatic memory, my traumatic experiences. I still get triggered by those memories and those and bodies. But now I know how to manage it and I feel in control and that's me done. Yeah, great. Absolutely. And then there's this other group of clients say, now I'm stable and I still have this traumatic memory or I still have these traumatic post traumatic symptoms. I'm now ready for processing. And so then we can go into therapies like EMDR, cognitive reprocess, written exposure, whatever. There's a range of trauma processing therapies, but DVT is great for phase one. Absolutely. And I think a lot of the research lines at the moment as well is that beginning the process of supporting clients in regulating, building skills in managing distress actually in itself starts to do some of the processing. And again, not all of the processing, but doing those skills, bringing your frontal cortex back online, understanding the whys and hows of what I'm doing, why I am like I am in itself begins the process of processing trauma and brain plasticity, right? Creating new neural pathways in the brain for new ways of behaving, being, doing and thinking. Yeah, I'm so glad you said that because I'm even thinking of a client at the moment came in with a really horrific trauma history. And you know, as a therapist sometimes it's like, gosh, there's a lot of work here to do. And after we moved through that 12-week group that they had, sorry, they did 24-week group, ongoing one-on-one sessions, they were like, I feel like I'm in a place where I'm okay not to go further with the processing. I'm stable. Exactly. And that's all I need. So I think it really speaks to the therapy and the skills here, but also the resilience that we have in our clients to do this work. Exactly. And let's talk about trauma-informed DBT. Because DBT has been, and I think it's a fair criticism that DBT has been criticised for not being trauma-informed because there's this focus on behaviour, change your behaviour. And trauma-informed DBT, yes, clients need to change their behaviour. Of course they do. That's why they're coming to therapy. There's no trauma-informed DBT. What we're saying is you're currently engaging in behaviours that are ineffective and are blowing up your life. However, there was a point in time, often in childhood, where the behaviours started and they were absolutely adaptive, effective and completely and 100% functional. What do I mean by that? That those behaviours that were developed, let's take a behaviour, for example, people pleasing. The first one that pops into my brain. If you're growing up in a family where you're living with a perpetrator of domestic violence and there's a lot of yelling and screaming and fighting and you're a little person and you have no control over any of that and that is frightening and scary, you have to somehow figure out how am I going to survive this. Absolutely. If I'm a people pleaser, if I please the perpetrator, if I do everything right, if I look after them, if I care for them, if I meet their needs, if I say yes to every request that they make, it's just absolutely ridiculous. Exactly. What a protective behaviour. Then maybe I'll be safe. Maybe if I do everything right, the perpetrator will like a little animal in the wild. The perpetrator will not see me and pass me by or being incredibly withdrawn and isolated. Well, when I was a child living with that perpetrator, I couldn't be seen. I couldn't allow, I had to be quiet. I had to be hidden. I had to make no noise and I just had to make myself very small. Now, that's an incredibly adaptive response to surviving your childhood, right? I think it's resilience and it's incredible, right? These are the things, these are behaviours that have often saved their lives. Yeah, but what happens when you're adult and you're still making yourself small and you're still hiding away and you still don't want to be seeing? Yeah. You become depressed and isolated and incredibly lonely. Absolutely. And then people say, well, you need to change your behaviour. But I've been doing these behaviours to survive. Yeah. I won't be safe without these behaviours. I won't be safe without these and that's exact. So it's about understanding where these behaviours come from. Not judging them as bad. Like, how often do we hear people with BPD, you say, you've got to change your behaviour. It's your behaviour. You're too much. You're too difficult. Your manipulative. Something's wrong with you. Exactly. It's like, instead of looking at that person going, wow, you developed all these behaviours at the time were highly functional. Not so functional now. Maybe not so effective now. But at one point, they kept your life. Absolutely. And I think, again, we really work from a trauma-informed DBT perspective of really acknowledging, you know, there's a reason for this to develop. Let's understand and also then give you the opportunity to decide, do I want to continue doing this? Yeah. Or do I want to change my life? That's because it's unfortunate part of it. The skills that kept you alive as a child are the skills that are blowing it up as an adult. Yeah. Absolutely. Right. Like we always say, all behaviour is functional. Let's just work out the function. Yeah. What is this behaviour trying to achieve? How can we achieve that same result by using skills in an effective way? Absolutely. So let's have a little look now about what the options are for people who are coming in with complex problems, complex challenges, you know, the clients that we're working with, they've had a rough life and they've had and they've got a lot of challenges, you know, economic challenges, interpersonal challenges, challenges with emotional regulation, housing stability, the loss, all of that. Right. So DBT, what is the DBT sort of philosophy around this? And so it says, well, in DBT, people have a range of options that they have for solving problems that are in front of them. And so we'll just have a little look at these. So the first option, when faced with a problem, you can solve the problem. Right. Option one. Sounds easy enough. Let's just solve it. Right. If it's within your control, you're able to influence it, you can manage it, go ahead and solve. Go wild. Go what? Go ahead and solve the problem. Yeah. Yeah. Or leave the problem. You know, if it's a bad relationship, get out of it and leave it and get out of the situation. However, not every problem is solvable. Right. We would almost say most problems are not solvable. And ideally, we'd love to solve them and it's like, oh, that happened in the past. I can't quite help you with that. Right. Right. So DBT teaches and we'll go through some of these skills, problem solving skills. Right. So that's option one that DBT presents. Is this problem solvable? Is it if it is? Let's teach you a range of problem solving skills. Option two is if the problem can't be changed, which we just often now clients come in with problems that can't be changed. Can we change the way we feel about the problem? Can we feel better about the problem than we actually do? What does this mean? Can we change or regulate our emotional response to the problem? I would almost say clients struggle the most with this one. It's like this belief of like, what do you mean I can change my emotions? Yeah. What do you mean that's like, once I feel an emotion, like I don't just have to feel like I can actually change it. It's mind blowing. Yeah. And so DBT teaches skills to tolerate emotional experiences. Do more than tolerate. Sit with emotional experiences and really appreciate them is where I like to move to. Every emotion is important. Yeah. So or to shift out of that emotion and move into an emotion that is more effective for that given situation. So that's option two. Option three, accept and tolerate the problem because the problem is that this is our distress tolerance skills. Yeah. Right now this problem can't be changed. So what skills can I use to just be able to tolerate like that crisis? Put out the for now. How can I manage right now? How can I put out the fire that's happening and prevent myself from blowing up the situation more? Exactly. Right. How can I not throw the grenade now and just deal with what I'm experiencing? That's right. And option four, which is a legitimate option and an option that I have taken myself on many occasions. Yes. Very valid is to stay miserable or even make it worse. Oh, absolutely. Since so throw the grenades. You know, I mean, blow it up the situation. I've even had clients that, you know, come in and we do a session and I'm like, this is going really well. And they're like, oh yeah, I'll probably do it anyway. You know, whatever. I've already made it up. Yeah. Exactly. I don't want my life. I'll do it anyway. And it's like, yeah, that's, that's fine. It's a choice. You're allowed to do that. That's, that's valid. Yep. Being unskillful is a choice not to use any skills. And that's okay too. So that's sort of the, the DBT approach to problem to the problems that people are coming in. Yeah. And people come in with all sorts of goals for skills, you know, and we'll have a look at that. Like why, like in your opinion, what's the main reason people come to DBT for you? And they say, these are my goals. There's just what I'm hoping to achieve. Oh my God. There's such a range of reasons that people come in to DBT groups. I think again, like to speak broadly, the reasons they come is they're doing something that's no longer working for them that's blowing up their life. To give examples of that, avoidance. Yeah. I'm not leaving their house and scrolling all day on my phone. So, you know, I'm not going out and meeting new people or I have no friends and I'm isolated. I am drinking alcohol and doing drugs. And so, you know, I'm feeling so much discomfort. I drink and do or do the drugs and all of a sudden I feel better, but that's also blowing up my life. I feel horribly sick. I've got no money and my wife's about to leave me. Relationship breakdown is a big trigger for people to come in, right? I've been rejected and abandoned yet again. Rejected, abandoned or I'm blowing up my relationship and I don't want to blow up the relationship because there's so much conflict in it right now because I'm terrified of them leaving. Yeah. And I think probably the biggest reason people come in is they're still aside, all right? Yeah. Their life is not, as Marsha said, they're experiencing their life as not worth living. Absolutely. So, most people come in and say, "I don't have a life worth living and I want to die." It would be the big trigger or I'm self-harming. Or I'm self-harming. Yes, absolutely. Self-harm would be one of the, would be so common in, especially my grips at the moment. I would say 90%. Yep. There you go. Right. So, that's our little bit of a brief intro into DBT. We are going to take a big deep dive into all of this that we've just talked about in upcoming episodes, but that's just a bird's eye kind of overview. So, shall we move on to our skill for today, which is the first skill we're looking at and that is understanding dialectics and under and what is dialectical thinking and this skill of dialectical thinking and what it is and how it can be helpful. Okay. So, what is this word dialectic, dialectical? It's a pretty tricky word, right? Because not a lot of people have heard it. Yeah, when I talk to clients, they have, when I say, "Have you ever heard of dialectics?" They go, "Nope, I've heard of dialectical behavior therapy and I've been told by psychiatrists." They've told I need it. I've been told I need it. Exactly. I have no clue. Yeah. And so, it's the first time they're hearing this word, right? Yeah. You know, I usually start sessions with going, "Have you heard this word dialectic? What do you think it means?" And a lot of people say, "Oh, like language, like a different language." And I go, "Yeah, probably. Digit is a bit of a different language at times, so I feel you." But I guess overall, I think what might be helpful is breaking it down a little bit into, you know, where it comes from to kind of understand why it's really prevalent now. Yeah. So, I guess the word like all psychology words kind of comes from Greek philosophy. "Dia" meaning through or across and "Lectic" meaning to speak or to talk. So, it's really interesting. Overall, that translation means talking through things. Therapy. Who would have thought? Those pesky Greeks in there. Pesky Greeks. And so, what we see this, we sort of saw this really early on in Greek philosophy through Plato and Socrates' work and they describe using dialectics as a method of arriving through and to a question rather to a solution, which I thought was really interesting, right? So, their philosophy was on, "Hey, let's actually solve this problem through the right question versus finding an answer through a statement." Have you heard of that before? Not until I'd done DBTI, I have. But, you know, if you even like cognitive behavior therapy is based on, you know, the Socratic method, for example. It's ancient philosophy that it's a lot of people saying, "Oh, there's nothing new here. This is all thinking that we've had before." Yeah, they're right. Just repackaged in a different way. Absolutely. I just think it's so interesting to go back and understand the history of some of these words, right? But I guess today dialectics and especially in DBTI, in dialectical behavior therapy, is the process of finding the balance between two opposing forces. So, holding a belief that can be both true and likely with its extremist opposite end belief, right? And it can be true at the same time. So, you'll often hear us say, you know, two things can be true or holding two extremes at the same time. And I guess one of the, and I'll give some examples, which might be really helpful to understand this word dialectic and what it looks like and sounds like. But one of the biggest ones that we start to see is this belief of acceptance and change. Absolutely. That happen at the same time. And that sounds weird. How can accepting myself exactly how I am and this isn't working. I need to change. How can they sound like complete opposites, right? How can those two things be true at the same time? And it's clients are like, what the hell are you talking about? You like actually stop it. But you're right. It's this, I am going to completely and utterly accept myself for who I am in this moment and the challenges I'm facing with full open acceptance. You can't see me at the moment, but I've got my arms wide open and not but not but but at the same time, recognize I need to change to live this life worth living. And these things are happening at the same time. So, a dialectic really focuses on this idea of and and not but right. And you'll hear us say and because and really shows us these two things happening at the same time. It's not instead of it is as well as that's right. And so, yeah, one of the biggest we will talk about is acceptance and change happening at the same time, the same time for clients. Some other ones, you know, that, you know, we can use as example is I'm doing the best I can. We all are. Yep. And I can do better. We'll definitely explore that in the bio social model in future episodes. But, you know, our parents doing the best they can and it wasn't good enough. I think one of my favorites is this idea of freedom versus responsibility. I'm going to do whatever I want. I'm going to drink. I'm going to take drugs. I'm going to self harm. I'm going to I'm just going to do all these things like the freedom to do whatever I want to do. And then at the other end is this idea of responsibility of and I'm the only one that can change my life. You know, my therapist, my counselor can can, you know, give me tools and kind of show me the way. But the responsibility is on me to change my life. Now, that sounds like two opposing things. But both of these things can be true. I can want the freedom to do what I want. And I also need to take responsibility for myself and my behavior. Absolutely. And again, we're not saying these are easy things to accept and understand or neither extremes right here, sometimes pleasant, but yet they're true at the same time. You know, I think examples that we might often see just day to day is I think of this when my partner doesn't do the dishes. I'm really angry with you right now. I'm really pissed off and I still care for you and love you and I'm going to treat you with respect anyway. That often existing at the same time. I want to be close to you, but I need space right now. I'm completely heartbroken that this relationship has ended and I'm really grateful for the time we had together. And so we're going to start to see these a lot more and we see them a lot in sessions with clients, these two extreme views and helping our clients really understand it. Hold on. These are both true. Neither are wrong. And that's what dialectical thinking is. Dialectical thinking is the ability to look at the extreme ends. One end will be extreme. The other end of thinking will be extreme. And in the middle is the walking what Marsha and Buddhism would refer to as the middle path. So let's look at a clinical example here. So you might have someone with, I don't know, an eating disorder. Now, on one end of the dialectic, they're bingeing. They're overeating. They're eating their feelings as I like to say. Making themselves sick. Making themselves sick. And then the next day often they flip to the other end of the dialectic, which is in guilt and shame after what, how much I ate yesterday often. Now I have to restrict. Now I must need a single calorie. Now I have to exercise all day long and they're on the other end of the dialectic. And then so it's about helping clients identify your behavior, your emotions, the way you're thinking, maybe falling at the extreme end of the dialectic. What's in the middle? What's walking the middle path? Well, the middle path might be eating until I'm full. Yeah. Regularly building regular eating patterns into my daily routine. Having a half an hour walk every day. You know, this is the middle path. And often people with BPD and trauma are unable to find that middle path and they often live on the one extreme. And then they flip, but they swing between one extreme to the other. And in CBT, we would call this, I guess, the black and white thinking. Absolutely. And I guess the aim of, and we'll get into that maybe a little bit here, is the aim is to build, the purpose of a dialectic, sorry, is to build that psychological flexibility. Exactly. And prevent that rigid thinking, which we also hear through the lens of black and white thinking, right? Yeah. What is rigid thinking? Will we see it in these extremist words? Yeah. What are the words you hear when a client, when you go, oh, this client's got really rigid thinking. What are the types of words that you're hearing? Oh, I hear clients like, hey, I must build this, or I should have, I never can, I always. I have to. Have to. It's always like this. It's never like this. Nothing works. Yeah. It's all or nothing. And we can get, we, you can get stuck there, right? In that, this is the way I think about every aspect of my life. Whereas flexible thinking is around on this day, with this person, in this situation, I will react this way. And tomorrow, in a different situation with a different person, it will, I can be flexible and I can adapt my thinking, my emotional response, my behaviors to flexibly respond to a situation. Whereas sometimes when we're living on the extremes of our thinking, or the extremes of our behavior, or the extreme emotional responses, we get stuck at the, at the extreme end of the dialectic, right? Absolutely. You know, and getting stuck in those extreme ends where there's no flexibility, where it's inflexible thinking doesn't allow for any movement, any consideration of others' perspectives, even possibilities. And that becomes, can be really an effective right. Because life and the life we live is often in that gray space. Yep. Like we often live a life in those gray areas. Because nothing really is black or white, yet at the same time, they both are true and existing at the same time. You know, I guess maybe some examples of how we might hear clients say this, you know, I'm even thinking at the moment, I had a client this morning that kind of said, "Oh, you know, Maddie, I made a mistake, so I'm just going to give up. I'm not going to do what I failed." Exactly. And it's like, hold on, like... That's one end of the dialectic, right? Failure. Yeah. So I made a mistake, therefore, I'm a failure. It's like, can we exist somewhere in the middle? What does that middle part look like? So what's, if failure is down one end of the dialectic, what's at the other end of that dialectic? What's the opposite? This is the two opposites can be. It's perfection, right? Perfection. Absolutely. If I can do it perfectly, I must, I should always do it perfectly, because that's a protective, adaptive response. If I can do it perfectly, maybe then I won't get criticised. Maybe then you'll love me. Maybe then I'll be good enough. Where do we learn to be perfectionists in childhood, right? In childhood, it's a learned behaviour. It's a learned behaviour. All behaviour is functional. And so I guess overall, dialectical thinking is the opposite to rigid thinking. Yes. It allows for multiple truths to exist in the same moment and encourages us to be flexible with our responses. That's it. So we've got failure. I'm a failure down one end. I'm perfect at the other end. And in the middle, where we're wanting to move to on this day, on this occasion, this situation, good enough. Good enough. And we say that a lot, right? Yeah. Good enough therapists, good enough mothers, good enough friends, good enough sisters. And that's all we kind of need to be. Exactly. Yeah. So look, we've got a couple of case scenarios we can work through here. I love it when you bring a good example in case scenario. And this is what we do in group, right? So when we're teaching clients dialectical thinking, we'll do that introduction. And we often do it on the whiteboard, where we put up, so we often start off with some really simple dialectics. Like if I say hot, Maddie, that's one end of the dialectic. What's at the other end? Cold. Yeah, maybe even freezing cold. Freezing cold cannot move. What's in the middle? We're warm. Yep. Okay. If I say, what's another really, if I say night? Day. Day. Okay. What's in the middle? Afternoon, mid-morning, lunchtime. So we can, the way to introduce this with clients is just some really simple, simple dialectics. And then you can bring in some more complex dialectics. I'm just looking, I've got a dialectical poster on the wall here. So on one end, I feel strong and capable. That's one in the dialectic. I'm full of confidence. And we all have those days, right? And then what's at the other end of the dialectic, Maddie? Yeah, I can be vulnerable. Right? I can express how I'm feeling. I can cry. Yeah. I feel underconfident. I feel unsure. Absolutely. And what's in the middle? It could be a range of things of, I'm feeling somewhat confident, but I have some doubts. I know I'm taking a risk here, but I know I have the strength and the skills to move. I can be both vulnerable and confident at the same time. At the same time. Absolutely. Like you said, I think starting with those scenarios of hot and cold and day and night are a really good place to get clients to start to think in this way. Yeah. And then start to go in maybe some of their own experiences of, yeah, dialectical thinking that might be present for them. Yeah. Like another classic one is, I'm using, I'm drinking, I'm using drugs, I'm using every day. I'm in the throes of using mind, we would call it. Yeah, absolutely. What's at the other end of that dialectic? You know, completely clean and abstinence. Yeah, abstinence. With abstinence. Sober, sobriety. Sober, sobriety. I'll never touch it again. And we see clients swing between those two things. You know, I'm using, I party, I had a great weekend. I used everything under the sun. Yeah. Got real smashed, had a great time. Come Monday, I'm sober. Yeah. And I must stay sober. I should stay sober. You know, all that. And then the relapse happens. And where do they go? Back to the other end of the dialectic. Absolutely. So what's in the middle? Harm minimization. Harm minimization. Absolutely. Yeah. So these are examples. So let's, let's look at the, and so then in group, so we would do that as a whiteboard exercise, introduce this idea of dialectical thinking and discuss it, making sure people understand what dialectical thinking is. And then we would often do some case scenarios. Well, this is the way I like to do it in group. So these are some realized, so we break people in the larger group, you've usually got 10 people in a group, or if you can do this, absolutely one-on-one with clients and give them a case scenario and get them to, to talk it through. So let's have a look at the, the first one. So I've got here, Katie is moving house and she asked six of her best friends to come and help her. Three of her friends can't help due to other commitments. Katie feels angry and abandoned by the three friends who can't help and is now refusing to speak to them. Yep. Typical kind of interpersonal blow-up interaction that we see our clients experience. Absolutely. Absolutely. I would say this is a really common one. You know, the, the nose of friendship can hit hard, almost that hit of abandonment. Absolutely. I'm triggered. I'm feeling abandoned and rejected. The extreme thinking. Yeah. I want them out of my life. They're dead to me. Well, that's, yeah, that's one end, right? They're dead to me. They don't like me. I have no friends, stuff them. I can't trust anyone. Exactly. So that's one. What else might be here at that? You know, I've asked my friends to come. Nobody loves me. Nobody cares. No one's there for me. They should help me. They're supposed to be my friends. They're supposed to be there for me. You know, no one's here to support me. No one ever supports me. If they were really my friend, really were my friends, they must be here. You know, you hear that the must should have to. I would never do this. I would never do this to them. Right. Okay. That's one end of that. So a client can come in saying this extreme end of the dialectic, you know, and we hear it. And oftentimes our first step is to jump in and empathize. That sounds terrible. That's, and of course we need to validate, right? We validate, we validate, we validate. We're going to talk about the role of validation a lot. However, that doesn't necessarily help. It might help the client feel hurt and understood, but it doesn't necessarily help them with this challenge. So if we would go to the other extreme of the dialectic, what might Katie be thinking on the opposite end? So it might be things like, oh, yes, my, my poor friends, they're so busy. They've got so much to do. I can't expect them to, it was, I shouldn't have asked. I shouldn't have asked. I'm not asked again, you know. Yeah. I feel guilty. I feel guilty. I don't want to put them out. You know, I've upset them for asking. They said, no, I don't want to talk to me again. Yeah. So we can go to that other end of the dialectic of the people pleasing, the caretaking. Yeah. I'm not allowed to have needs. I'm not allowed to ask for help. I shouldn't have asked. Now I feel shame and guilt for asking in the first place. You know, I need to make it up for them for asking and do more for them. I've got to pay them back. All of that. And that's just as extreme. Absolutely. And what's in the middle? How might we think about this if we were walking the middle ground of the Buddha, so to speak? Yeah. And, you know, again, client, this is where we see clients really kind of go quite, well, I noticed, let's go really quiet that they're like, I actually have no idea. I've never thought of it this way. Exactly. You know, and what we might start to kind of urge them is, okay, what about the friends that have helped you? Let's explore that. Three out of the 50%, which is a pretty good strike rate for moving house, right? Because moving house sucks. Oh my God. It sucks dogs balls. Nobody wants to help you move house. It really sucks. Absolutely. Couldn't have said that better myself. It sucks dogs balls. I own cats. I don't know why it's their dogs. But it sucks. You're right. Yeah. But I've got two friends that are willing to help me. I reckon that, you know, someone loves you, really, really loves you in two social situations. One is they help you move house. Yeah. And the other one is the airport pickup, right? Absolutely. That also sucks to do sucks dogs balls. Absolutely. Absolutely. Absolutely. So she has a 50% strike rate. 50% of three of her friends are coming to help her. I almost even want to jump in to go, I wonder if there's times in Katie's life where she hasn't been able to support her friends because it's like, I've got something else booked or, you know, I'm not in the city this weekend, but I really want to help you. Yeah. Could they have something gone? Could they be struggling themselves with moving house? Like who really knows, right? Yeah. How much notice did I get? I only told them. I only asked them yesterday and it's on Saturday. Well, it's reasonable to expect. Not everyone's going to be able to make it. As if someone is unable to help you move, does that mean they're rejecting and abandoning you? Is that what they're saying? Does that mean the relationship's over? And I think, again, that's what we're trying to indicate, right? The answer is no. The answer is no. Yeah. Because, again, extreme thinking here, what's the middle ground? Yeah. Maybe the middle ground is I'm disappointed. Yeah. My friends. I validate my own experience. Can't help me. I'm disappointed, but I know they love me. It's a shame they can't help me, but that's life. It is what it is. It is that classic. And we're going to talk about that a lot when we look at the skill of radical acceptance as one of my favourite skills. Absolutely. So because this, you're seeing the extreme behaviour is she's refusing to speak to them now, right? So what happens to those relationships? She blows them up. She blows them up, never speaks to them again, and then all of a sudden she's isolated. Back to doing those same behaviours that were really functional, kept her safe when she was in childhood. Yeah. No longer effective. Exactly. And it's almost creating the rejection and abandonment. And we're going to talk a lot about that in episode two, I think. All right, let's do another one. So let's go with Frazier. I chose Frazier because I'm a fan of Below. My guilty pleasure is watching Below Deck and there's a character on there called Frazier. So funny. Anyway, so Frazier's been working for the same company for the past 10 years. He's been passed over for a promotion for a less experienced staff member. He's angry. He's resentful. And this is causing poor performance at work to the point where his boss is like, time to come in for a chat. And wants to talk about his performance. These are all real life problems that clients have brought to therapy sessions, by the way. So they're real life examples. So let's help Frazier think about this dialectically. Let's take, you take one end of the dialectic. I'll take the other. Which one do you go on with? I'm jumping to the end of stuff work, the fuck it's stuff it's I'm not doing this stuff work. They've hurt me. I'm done. I'm, you know, protesting. I'm not working. I'm out. I'm not going to do my work. They've rejected me. You know, I'm out done stuff it fuck them. Yep. Okay. And what do you think the consequences for Frazier are going to be thinking at that extreme end of the dialectic? Oh God, I could imagine. I'm thinking of my own. If I did the fuck it, then I think I've seen you do the fuck it. Oh yeah. Sometimes I'm really ineffective and I do the fuck it, fuck it, fuck everyone, fuck them. Yeah, me too. But what would the consequences of that be? Right? Okay. Well, maybe I'm really need this job, a reference for this job for future jobs. Okay. Maybe I'm going to lose this job. Maybe I'm going to lose this job. And I'm actually, you know, living week to week because cause he lives cost the living and I need the money each week. Yeah. So I can't afford to lose my job. Yeah. Maybe the person I hired had a skill set that I don't have and I could actually learn something can actually increase my skills. Well, that's middle ground thinking, right? That's middle ground. Oh, where did I jump to then? Well, so this is you and your years of doing dialect. You go straight to the middle ground. Straight to the middle ground. But again, if I was in that extreme thinking, well, I wouldn't be thinking that middle ground. But I would, there's some of the impacts, right? Yeah. Might not get a future job reference. Might lose my job, which might impact me financially. Yeah. Might turn away from being someone who is perceived as a high performer to a low performer because of the way I'm responding to a disappointment. Yeah. Yeah. Absolutely. So if I take the other end of the dialectic, I might plunge into depression. Oh, I didn't get the job because I'm useless. I'm hopeless. This person younger, they're smarter, better looking, faster than me. And I've got all this experience and even they are better than me. I didn't get it because I'm useless and pathetic and I should never go for a promotion ever again. Often the consequences of that is, you know, depression, lapse, give up, hopelessness that we see. My performance goes down the tube anyway. Work performance goes down at either end, right? Okay. So what's in the middle of those two extremes? What might be there? So like I said before, maybe I could start to see that the person that was hired for this job opportunity has some skills that I haven't yet mastered or got any of. Maybe I could learn. Yeah. Okay. Maybe I could explore some feedback. Can I have some feedback on what I need to work out to get a job promotion? Yeah. Maybe I just, how many times have we seen this people, highly skilled individuals who do their job great, but they suck at interviews. Absolutely. So many amazing clinicians not get jobs, not because they weren't fantastic clinicians, but they just sucked it in. Interviewing is a skill. Maybe Fraser needs to brush up on his interview skills. Absolutely, absolutely. Again, there's opportunity for development here and that could really be missed and prevent him from future opportunities that could be, you know, getting more money than that job promotion, you know. Exactly. Maybe this is an opportunity for me to learn how to sit with and get comfortable with disappointment. Yeah. Maybe I need to learn how to tolerate that. Maybe I need to learn the skills to sit with a bit of distress and a bit of discomfort. Exactly. So dialectical thinking is really helping your client go identify where are they on the dialectic, which end, figure out where they are. Then remember, two things can be true at the same time. What is the opposite? And if you were to think the exact opposite, what would be there, where are you on the dialectic today right now? And what do you need to do? What is the middle ground and what do you need to do to get there? I love it. Great question. So what is the middle ground? But actually on top of that, how do I need to get to the middle ground? What skills do I need to use? What do I need to think about in changing my thinking, changing my behaviour, changing my emotions? What do I need to do to make that shift? Yeah. And again, we will build the skills in managing this because one of the skills that's really important here, right, is that mindfulness skill of can I observe what I'm thinking and can I observe that this is extreme thinking? Yes. And can I observe what other perspectives there could be? Exactly. So clients can have, on the dialectic, they can have extremes in thinking. And this is where CBT, you know, there can be extreme, behavioural extreme. Yeah. And there can be emotional extreme, so high levels of emotional intensity or completely hypo aroused, not feeling anything at all. You've got some beautiful resources on actually how to practice this in session. They'll be in the show notes, won't they? Yeah. Absolutely. So this is dialectical thinking. It takes clients, in my experience, I don't know about yours, but quite a while to get this. Absolutely. And I would say it even takes time, you know, often re-defining and giving the definition of what a dialectic is. Often we have it hashing it. But also, I think as a clinician, if you're a clinician listening, often using the language of that's a dialectic, is really, really important to help clients kind of climatize to this word of dialectic and dialectical thinking. I would say, you know, to be completely transparent, even as a therapist, I think for at least my first three years of doing dialectical baby therapy, I was like, I don't really know what a dialectic is, do you? Your continuum would be another word. Continuum is another word, absolutely. So it takes a bit of time to wrap your head around for us as clinicians, but for our clients as well. So use the language. And when you are noticing it, really kind of pull it out while you're noticing that's an extreme and that's a dialectic. Exactly. What's the opposite end? Exactly. So for clients, I'll be saying as you go away this week, I want you to just to start. Step one, just notice when you are having extreme thinking. Just notice, don't try and change. Remember, there's the dialectic of change versus acceptance. We always start with acceptance where you are right now. We don't need to change things straightaway. It's perfectly okay to accept this is the way I think I have this extreme in thinking. We get our heads around that and validate that. Then we only then are people ready to move towards and now I'm willing to change this. Absolutely. Absolutely. This is, I think, so interesting. I think the biggest error I see because I do a lot of clinical supervision mistake that clinicians make is they pushed clients to change way too quickly, way before they're ready. Clients need to hear that they're people need to hear that they're understood, that they're heard to understand the end of the dialectic where they actually are and have that validated, validated and never underestimate how much validation people need because this is a group of people who have had very little validation in their lives. Chronic invalidation. You're so right. One of the things that I learned so early on and I'm so thankful for learning it, but I continue to drill into the clinicians I do supervise is if the behavior is ramping up, it means or there's a willfulness. Talk about this word of willfulness later on. It probably means you've moved too quickly from validation and the client is not feeling understood. Yep. They're not ready for change. You've moved too fast. So sitting in acceptance for as long as the person needs you to sit there, don't rush them. You'll get signals when they're ready and you'll start to move toward change and then they'll move back and it's like that's okay. That's okay. We go back to accept we continue to validate when they're ready. Then we move towards change. We are moving up and down the dialect because the person needs us to. Yeah, beautiful. And if you are a client or someone that thinks that this is really helpful to have this conversation and what are my next steps, we'd really encourage you to start to, I guess, we use that word homework, but the skill that you could practice is starting to work out in your life. What are the extreme styles of thinking or behaviours that I'm engaging in at the moment? What put them both down on a bit of paper and start to work out what does the middle ground look like? Yep. What does it sound like and start to explore it, you know, in your own time to start to do this and practice this skill. Yeah. Yep. Absolutely. So that's week one, done and dusted, introduction to DBT, introduction to this word dialectic and dialectical thinking. How you feeling, Matt? Good. I'm excited. I can't wait for the future episodes. And we have finally completed episode one, which is so wonderful for us. I guess we're moving into now kind of signing off on today. Well, maybe we need to, what's next week? So next week is Mirobiology in episode two and three. That question of why am I like I am. Yeah. And that's a big question that clients kind of come in of going like, why am I like this? Exactly. And they really help us to explain, okay, this is what is happening from a biological anatomy perspective to your brain and the connection with environment. Yeah. Next week is going to be a good one. Don't miss it. Don't miss it. And we obviously want to do a really special shout out. We've got a very special intro song. Oh, we do. Please give us the goss on it. Yeah. So our intro and outro, I don't know if that's a word, song is a song called A Note to Daisy by my beautiful son Micah, who's a very talented musician who gave us a special permission to use it for this podcast. He gave us the master file. He did. So I trust, he put that in my hands, which I felt very nervous about, but it's such an awesome song every time I hear it play. I'm just bopping along. So download it on Spotify and help a kid out, right? Absolutely. Before we mindfully sign off though, I just want to thank you for joining us and listening. Follow us if you have found this helpful and share to your teams, if you're a clinician or to other friends and family that, you know, you think this could be helpful for. If you have thoughts or feedback or questions for us as well, we want to hear from you. So email us anytime on [email protected], because we really do want to hear from you. We really value feedback. We're learning, right? This is our first podcast. We didn't go to podcast school. But yeah, we're fresh in the podcast. So we want to hear feedback, just like we do in our groups at the end of every group, feedback for us and clinicians as well, right? So feedback questions are really important. The other thing, if you want to work with us, right? We are clinicians and we've got a wealth of experience in this space. So we offer, you know, a range of different intensive group trainings for organizations and staff and supporting you in setting up actually a DBT group in your organization or supporting you with building skills. And that could be anything from a one and a half hour online training session to a full four day immersive DBT training program or DBT consultation sessions, which is what we call clinical supervision in DBT. Yeah. And yeah, like you said, one on one or group supervision is also something we can support with. And if you're interested in that, that's wonderful. All the resources and recommendations that we've talked about today are going to be in the show notes. And that includes if you're a clinician and wanting that resource example for dialectics, that'll be in the show notes. That is a beautiful self made one by Rachel. And if you are someone or you know someone that is in immediate danger or crisis, please seek your local emergency contact services. We are in Australia food. So for us, that's triple O, but we'll also put some crisis services in the show notes. So on that note, I would like to say we are mindfully signing off. So keep showing up, keep practicing the skills, keep your boys mind within reach, mindfully signing off. Stay next time.