All Therapists are Jerks, and . . .

Jo and Ulland invite friend Kerrie Toole in a conversation reviewing some of the content presented at the annual DBT conference in Seattle.  If you are in Massachusetts and are looking for a therapist, consider Castlebrook Counseling Services, Inc. 

Jo and Ulland invite friend Kerrie Toole in a conversation reviewing some of the content presented at the annual DBT conference in Seattle.  If you are in Massachusetts and are looking for a therapist, consider Castlebrook Counseling Services, Inc. 

Ulland and Jo discuss how DBT is all about emotional processing while building capacity to live effectively regardless of emotional reactivity. 

Ulland and Jo discuss why apologies are often not helpful enough with conflict in relationships. They review what they mean by accountability and how it is different. Examples are given. Accountability has to do with looking for how we may contribute to how we may be perceived by important people in our life.

Ulland and Jo review the concept of fragilization.  They review how walking on eggshells with family members is generally not helpful, especially when both parties are walking on eggshells around each other.  Individuals in active passivity are more capable than we realize and need space to activate for themselves and build confidence.

Ulland and Jo review how parents can feel defensive in family work as though they are being blamed. They review how DBT is a no blame model and how family dynamics must be addressed. The biosocial theory suggests we learned from environments of origin and behaviors are maintained within current environments.   The idea of individual perception of past events may be more meaningful to relationships than focusing on the correct version "reality.” Individuals may see things differently. It is our individual perception of events, not necessarily the events themselves, that lead to our understanding of relationships and our lived history. 

Ulland and Jo address judgments towards DBT they have heard more than once regarding being “too easy” with clients. They discuss how those unfamiliar with acceptance strategies are more likely to misunderstand how acceptance is used to meet clients where they are so that meaningful change can happen.  They review some of the assumptions within DBT that make this possible. Please review the previous episode that reviews specific assumptions for further details. Ulland and Jo realized they had not previously covered ALL the assumptions.   

Ulland and Jo finally review the therapist and client assumptions within DBT. These assumptions help clinicians adhere to the principles of DBT. Knowing these leads to understanding interventions and the philosophy of treatment. They also discuss how there are some asymmetries that are protective of the client, as well as the therapist.

Ulland and Jo review common themes in demographics found within many DBT studies. They discuss that DBT studies often include many individuals who are not heterosexual or white for example. This would be consistent when considering the biosocial model and systemic invalidation as a common experience for many clients who benefit from DBT.  These studies were reviewed and shared at the 2022 ISITDBT conference in NYC.   Can minorities benefit from DBT? — All Therapists are Jerks (squarespace.com)

Ulland brings up ideas he sometimes presents in his group on the unit, albeit at a more reasonable pace than here.  Jo discusses what meaning is to her and how to find it. It can be overwhelming to be young and believe that one has to have already contributed to a society before completing high school. Earlier Episodes of the Podcast can be found at alltherapistsarejerks.libsyn.com

Ulland and Jo review ideas that came up after a Parent University this past week regarding dialects and parenting. They discuss how dialects are often seen as more contradictory rather than as acceptance and curiosity in communication. They provide several examples of “Yes and” thinking and also discuss some nuances.  Earlier Episodes of the Podcast can be found at alltherapistsarejerks.libsyn.com  

Ulland and Jo wonder how can we be certain about things? Also, how is it that Tyler Durden is writing about vaccinations and can he be trusted if he posts at 1010 PM on Friday the 13th?  And is it any wonder Mr. Durden supports vaccinations being dangerous? Please be aware that this episode and podcast has not been evaluated by the FDA and “is not intended to diagnose, treat, cure, or prevent any disease.”  Also, this episode has been in the can sooooo long it is not suitable for anyone's doomsday bunker.  Earlier Episodes of the Podcast can be found at alltherapistsarejerks.libsyn.com

Ulland and Jo review a formulation Ulland finds helpful as a framework for understanding which interventions might work by understanding how eating disorders develop and maintain themselves. The formulation is largely influenced by the works of Garner and Garfield, and Fairburn. Earlier Episodes of the Podcast can be found at alltherapistsarejerks.libsyn.com

Shamefully, Ulland and Jo make good on a more than a year-old request. A fellow traveler posted a comment to discuss suicide, and to approach from the perspective of an educator.  The Linehan Risk Assessment and Management Protocol (LRAMP) for suicide is reviewed as a framework to understand suicidal risk in an organized way. Earlier Episodes of the Podcast can be found at alltherapistsarejerks.libsyn.com

Ulland and Jo review several common problems that Marsha Linehan. PhD had to solve after deciding to work with suicidal patients, ranging from a need to validate suffering while knowing that life was unbearable as it was being lived. 

Ulland and Jo continue a discussion regarding anger. Ulland reviews the ruminative anger cycle and Jo provides more discussion of how to use skills to avoid ineffective angry responses.

Ulland and Jo review anger at the request of a listener.  Ulland goes on a tangent in culture and expression of anger. Culture and expectation can lead to angry reactions. Suggestions for skills use are provided.  

Ulland and Jo realize how long this has taken, unfortunately, but it is the end of the series. Are emotionally reactive people empaths, or are empaths emotionally reactive? Ulland and Jo end with more concerning questions, regarding adolescents who may have difficulties who are trying to help peers with similar issues/ behaviors.  They remind listeners of active passivity and that there are difficult behavioral patterns such as the secondary targets which can lead to confusion in the relationship and burnout in loved ones.

Ulland and Jo review what they believe to be some of the biggest misconceptions about seeking therapy. Ulland challenges the duality of “biological” versus “environmental” depression.  They also review a question wondering about in which instances Dialectical Behavior Therapy might out-perform Cognitive Behavioral Therapy for patients. They end with reviewing the importance of the philosophical outlook within DBT that can be powerful to prevent relapse and continue to work towards building a life well-lived.

Ulland answers a question regarding medications for emotional reactivity and discusses how he often prescribes for clients he assesses.  Ulland reviews some differences between how ADHD may present in males vs. females. Ulland and Jo discuss how each of them would consider building a residential program for males, compared to how their female unit operates. Ulland is likely to take population differences into account for gender traits, aware that populations don't represent any specific individual in the program. 

The series continues with “frequently asked questions” from a high school psychology class. The questions they are tasked to answer are: What's the hardest case or behaviors they have worked on?  Have they had more cooperative or uncooperative parents? What is the hardest or most stressful part about their job?

The crew continues with explaining the origins of the program.  Ulland describes reasons of need and efficiency, while Jo discusses the prevention of suffering for the future, including, hopefully next generation effects.  They briefly describe some differences between CBT and DBT. 

Psych 101.1. How and why did you come to do this?  Ulland and Jo answer questions written by local high school students after presenting for a couple psychology classes.  This episode reviews why each of them decided to work in mental health in their different roles.  Ulland had to get a haircut and get a real job.

Burning Bridges and Building New Ones.  Ulland and Jo reviews these concepts while giving examples that these skills are not only applied to relationships but may be applied to behaviors that are ineffective or behaviors needed to replace maladaptive behaviors. Because, let's face it, “Just Say No!” failed miserably.  Jo brings up the idea of exposure and tolerance of suffering.  Ulland responds by bringing up hypothermia and appendectomies. Somehow it should fit, and maybe it doesn't.  Supposedly everything's connected.

100th uploaded episode.  Ulland and Jo discuss the origins and some of the difficulties with keeping the dream alive. They offer thanks to listeners, with some posts from around the world that have been shared. Ulland gives a breakdown of the top countries following the podcast.

Episode 93.  Holidays 2021.  By special request from a friend and through gratitude from a recent pre-holiday Parent University, Jo decides it's time for a holiday episode. A spur of the moment, feel the holiday spirit in your bones kind of episode.  Ulland, as usual, is game for the ride. Childhood secrets are revealed and suggestions to deal with holiday stressors are offered that are more about mindset and approach rather than specific skills.

Episode 92. Community Reinforcement. Ulland and Jo review aspects of how to reinforce abstinence with the environment and how to replace addictive behaviors by accumulating positives. Even though it has been mentioned before, abstinence sampling is explained and reviewed. Ulland is excited by new tech--all too easy.

Episode 91. Clear Mind. Ulland and Jo review clean mind and addict mind, and the overlap where clear mind exists. This is a similar synthesis to reasonable, emotion and wise mind. They review characteristics of clean and clear mind, many of which are provided by the DBT skills manual authored by Marsha Linehan, PhD.

Episode 90. Dialectical Abstinence.  Man, this one has a rough start.  Ulland has a head cold, and probably presents as though he has viral meningitis.  Ulland and Jo review Dialectical Abstinence, what it is and provide several examples from the skills manual written by Marsha Linehan, PhD.  The examples provided are for planning for abstinence and harm reduction.

Episode 89. When the Crisis is Addiction. Ulland and Jo begin reviewing which DBT skills are often used for addictions with this brief overview defining addictions, the kinds of behaviors that can be addictive and the skills to use when the crisis is addiction.  

Episode 82. AODA 7:  Special Strategies to Cope. Ulland and Jo review special strategies and skills that are necessary for working with substance use disorders.  They do not review the skills in depth although some skills may be reviewed during later episodes more specifically.

Episode 87. Interview with Raina 4. Raina shares how her treatment has translated into her life over the past two years. She discusses some lapses she had that were short lived, due to an understanding of dialectical abstinence. As she has done more work with trauma, she appreciates how important the work she has put into experiencing body sensations has been. She shares, “It would have been a fire” if she would not have been able to regulate her body sensations.  She shares how she continues to use skills from DBT now as a way to live and not just because they worked to prevent NSSIB in the past.

Episode 86. Raina 3.  Raina shares how treatment was like for her and her family.  She discusses how limits on the unit were difficult and helpful, since she was more able to see how rescuing behaviors could lead to reinforcement of suicidality.  She reviews how some patterns within relationships inadvertently worsened her suffering. She shares how it was for her to effectively resolve a conflict with an adult and what that meant for her recovery.

Episode 85. Interview with Raina 2. Caution: This episode briefly mentions sexual abuse and suicide. Raina discusses what things were like right before treatment with conversion disorder symptoms, and dissociative episodes. She reviews a history of sexual trauma that led to her first suicide attempt and hospitalization that likely made things worse. She shares that her wish for suicide was not necessarily to die, but to escape her suffering, “I didn't know how to live [my life].”

Episode 84. Interview with Raina 1. While on a visit to see family, Raina stops by to visit about life and how things changed after residential DBT treatment. This first episode reviews a history of multiple inpatient hospitalizations and suicide attempts leading to her readiness to commit to change in an intense, highly adherent program. She discusses the complexity of her symptoms and diagnosis prior to arriving. This interview is broken into 4 parts, and this is the beginning. 

Episode 83. AODA 6 : Special Attachment Strategies. In this episode Ulland and Jo review some of the special strategies for how to foster attachment with clients who are in Dialectical Behavior Therapy for alcohol or other drugs of abuse.  They review the unique challenges in attachment due to competition with powerful reinforcers for ongoing substance use in their daily lives which have often formed around substance use for an extended period of time. 

Episode 82. AODA 5: Treatment Hierarchy.  Ulland and Jo break down the early stages of DBT for AODA as compared to standard DBT. They review pre commitment through Stage I targets such as life interfering, treatment interfering, and quality of life interfering behaviors. 

Episode 81. Ulland and Jo come back.  They have been keeping busy, probably like everyone.  Life changes, manuals, Magic the Gathering, etc. And the You Tube announcement. Please catch the earlier podcasts with some visuals on the site. Same name, different place. 

Episode 80: Is this what it’s coming to?  Ulland discusses some ideas and shares some emotion about his experience this past weekend with social media and the polarization of posting. Jo brings her insights to social dialects and poses some DBT skills solutions, including dialectical thinking. She informs Ulland of what Cancel Culture is, since, as typical, he has no idea what’s going on “in the real world.” [Why’d we hire this guy again?] 

Episode 79. AODA 4: How AODA DBT differs from standard DBT.  Ulland and Jo review some key differences in how DBT is adapted to work for individuals with predominant substance use issues. A key difference is how dialectical abstinence is applied to decrease risk and severity of relapses should they occur. It is a middle path between absolute abstinence and harm reduction models.

Episode 78. Horror Stories from the Ward. Ulland admits outright to Jo that the title of this episode is clear click-bait. The content of the episode discusses how some things have not changed with stigma in mental health and with some discussion of systemic invalidation. They review the idea of DBT being misunderstood and at times judged as “elitist”. They pose ideas as to why this might be. Sometimes one provider sees things another providers might miss, and judging others for not knowing what they don’t know isn’t fair.

Episode 77. AODA 3: Similarities and Differences for 12 step and DBT.  Ulland and Jo take the time to review similarities and differences between the types of treatment. As always, examples are provided.

Episode 76. AODA 2: Evidence for DBT in SUDs.  Ulland and Jo discuss some evidence for DBT for treating substance use disorders as being promising, especially if clients have lower functioning or worse emotion dysregulation at the start of treatment. It is more likely that other programs are likely to be helpful for less severe pathology, whereas DBT might be more helpful for high comorbidity in clients.  

Episode 75. Listener Feedback for AODA Episodes.  Ulland and Jo consider the helpfulness of feedback provided via a listener who cautions against being to disparaging towards the twelve step model.  It is fitting and necessary feedback as the 12 step model is ubiquitous and helpful for so many individuals at various phases of recovery. 

Episode 74 . We’re Baaaack!  Welcome Back and Welcome 2021. Ulland and Jo come back after a period of quarantines and the craziness that has been 2020.  No resolutions for New Year’s here.  And 2021 seems no less crazy than 2020 thus far for Americans.

Episode 73. AODA 1: Why? Ulland and Jo discuss the reason. They point out that they are not experts in addictions treatment. So, please, listen to the episode with grain, no . . . say a pound of salt.

Episode 72. Val 7: Accumulating Positives in the Long Term. Finally Jo tries her hardest to teach Ulland a skill. It is strenuous and treacherous, but valuable work, Jo says.

Episode 71. Ramblings of a Quarantined Mind. Apologies to the Listener. You may have been expecting accumulating positives in the long term, and that is not what this is about. Ulland and Jo discuss trying to get back in the saddle of recording when COVID hits close to home, and it ends up being about ‘Merica, the world, and trying to vote from a wise mind place. It may feel like they are asking the impossible in today’s world.

Episode 70. Val 6.2 Death. Life after death. Kidding. In this episode Ulland and Jo wrap up the death talk. Ulland tries to monetize the Podcast with Tacos. Ulland talks about his liver… like who approaches living this way?! Jo comments to Ulland “You did a major cliff hanger from that episode to this episode—I almost forgot.” Some cliffhanger, Ulland, some cliffhanger.

Episode 69. Val 6.1: Death 1. Ulland and Jo review Immortality Projects and how they are related to values. Ulland provides the only initial conditions for which he might chose to extinguish his flame—he’s desperately hoping to never become a vampire, because, let’s be honest, life is mostly routine and boring. He makes yet another mistake: the title of the Raymond Carver’s last book of poetry is “A New Path to the Waterfall.” Worth a read if poetry and brutal, honest self-reflection are your thing.

Episode 68. Val 5.2: Rejection. Ulland starts by inadvertently blaming Jo for difficulty starting to record due to generalized shenanigans.   What a dum dum. The partnership continues a dialogue about rejection and limits and how they pertain to relationships and codependency. This episode addresses more relational aspects of rejection.