Walk & Talk Therapy

Something magical happens from being in nature. Often times, even if it can’t be explained, it is most assuredly felt deep within. Being outside and at one with nature heals, restores, strengthens and rejuvenates with positivity. As ancient Greek physician Hippocrates wrote before his death in 375 BCE, “Nature itself is the best physician.”

It is consequently no wonder that over thousands of years, many cultures have encouraged connecting with nature. Even the Bible repeatedly describes the multitude of times that Jesus returned to the wilderness to pray and have his alone time (Luke 5:16, Mark 1:35, Matthew 14:23. Luke 9:28, just to name a few).

Research confirms the positive effect nature has on people. For instance, studies prove that some trees emit chemicals called phytoncides that have the potential to reduce stress hormones, lower blood pressure and improve immunity. Further, just living closer to green, open spaces can lower the heart rate and improve overall feelings of well-being. More recent research posits that a 90-minute walk in nature decreases negative rumination, which can thereby help alleviate anxiety and depression.

With such remarkable effects, therapists in the last several years have begun offering walk/talk sessions. What are walk/talk sessions? Well, they’re exactly as they sound. Instead of staying in an office environment and sitting in a therapy room, the therapist and client meet at a location previously agreed upon (or at the reception waiting room) and then hold a session while walking together outside on a predetermined course. The client leads the physical pace and topics of conversation.

Walk/talk therapy works well for anyone and all types of treatment. Specifically, people who love to be outdoors, exercise, or just keep their bodies moving tend to enjoy the unique sessions offered. It can be particularly effective for individuals who find traditional therapy to be stigmatizing, uncomfortable, or awkward. Movement propels people forward, both literally and figuratively. And, as therapist and client walk side by side, they are in sync, heading in the same direction while simultaneously forging a
strengthened connective bond. Creativity magically occurs and fosters in clients’ deeper ways of thinking that often facilitate breakthroughs. There is more clarity, insight, and connections that might not have been possible without the biochemical reaction from being active and outdoors.

In summary, walk/talk therapy improves emotion regulation and the ability to cope with life transitions or feeling stuck. It reduces anxiety, anger, stress, depression, and both ruminative and intrusive thoughts. A recent research study found that 71% of people who engage in a nature walk felt an almost immediate decrease in depressive-related symptoms and an increase in feeling relaxed and grounded in the moment. Clarity of thinking helps synthesize new pathways of thinking that stem from thought-stopping and a sense of centering. Author Mary Davis says it best, “A walk in nature walks the soul back home.”

— Jill Dagistino, Registered Mental Health Counselor Intern

Perception

According to Oxford Languages, perception is a way of regarding, understanding or interpreting something. Perception is like an impression. It is the ability to see, hear, or become aware of something through the senses, inevitably informing the way we think about or understand our surroundings.

Interestingly, perception flows two ways, meaning we take it in and give it out. In other words, it includes how we see something/someone and how someone sees us. Worthy of noting, there is no right or wrong perception. Perception comes from our own unique life experiences, and what we bring to the table. This means that no two people have the perfectly exact same experiences and consequential responses.

Here's a fun example of perception:

Read the following excerpt and then count the number of Fs you see.

FINISHED FILES ARE THE RESULT OF YEARS OF SCIENTIFIC STUDY COMBINED WITH THE EXPERIENCE OF YEARS...

How many do you see?  The correct answer is 6. Based on how your brain processes letters, you may initially come up with a different number. Go back and count again, slowing down to methodically absorb. Perception keeps us from processing the word “of.” Now do you see the 6? If so, you have a new and different perception.

Given the massive amounts of stimuli taken in by our senses, we only select a portion of the incoming information (just like the Fs) to organize and interpret based on our needs, interests, or expectations. We then organize and process that information into perceptions that inform our life direction and define our minds and opinions of ourselves, others, and the world surrounding us. Perceptions create emotions, which then, in turn, determine our behaviors, choices, and responses.

It is, therefore, critical to recognize the importance of being open-minded, objective, and willing to consider other points of view. When faced with challenging situations, taking a moment to examine the strengths and weaknesses of an issue is crucial to finding the best solutions and explanations. The most generally agreed-upon helpful response to disagreements, perhaps based on perception, is not to include shouting and screaming, because it will usually lead to nothing but additional problems. Sometimes, until we develop the ability to perceive broadly, it may take an objective person, one who can see different perceptions, to remind us to consider other views before finally reaching our own conclusions.

The world may often be presented as two-sided — black and white, right and wrong — with little room for objective thinking. In reality, few things are so clean-cut. Unfortunately, many people lack the initiative to recognize this so they can embrace all the possibilities that are available. Examining facts and options in a calm and objective manner is the primary way to broaden perspective and make educated choices, a useful concept for forming strong relationships, business partnerships, and sound decisions overall. The idea of understanding and acknowledging perception as a permanent priority is key to developing open-minded and well-rounded individuals.

In closing, now that you’re probably thinking about perception, what animal or animals do you see in this image? 

Do you think your experiences have shaped the image(s) you see? When you look more closely and intently, you more than likely will see both animals. Which did you see first? Hmmm…

— Jill Dagistino, Registered Mental Health Intern

The Importance of the Therapeutic Relationship

I often hear people say they’ve tried therapy before and got nothing out of it. They complain that they didn’t like their therapist, their therapist rubbed them the wrong way, or worse yet, their therapist was emotionless or even fell asleep. Clearly, they developed a bad taste for therapy. When that happens, it’s highly unfortunate because the individual then shoves their pain, discomfort, or suffering aside with the belief that therapy is useless.

Irvin D. Yalom, in his book “The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients,” says friendship between therapist and patient (at SRCC, we prefer “client”) is a necessary condition of closeness that promotes a means to an end. In other words, relationship is
essential to achieving progression and, ultimately, success. If a client doesn’t feel connected, it becomes difficult to trust and feel safe enough to open up. Revealing one’s innermost thoughts and feelings does not come easily. One wants to feel seen, heard, and understood, all the while sensing compassion,
care, and kindness. Experts say that therapy has nothing to do with the skills or techniques a
therapist uses. It has everything to do with a level of intimacy that endorses relation and collaboration. Think of the therapeutic relationship as one of the closest experienced because, let’s face it, it is. Your therapist may know your innermost secrets and/or what makes you tick. Research proves
therapy outcomes are predominantly based on the therapeutic alliance rather than the length or type of treatment.

How does one know if the therapist they’ve seen or are seeing is “the right fit”? Consider the same criteria you’d use when assessing a new romantic interest or potential best friend:

• Does this person listen attentively? Does he ask open-ended questions to motivate me to express myself?

• Does she present alternative options, ideas, approaches, interpretations, or perspectives?

• Does this person help me navigate versus take control of the wheel by promoting collaboration?

• Is she responsive and participative?

• Is he respectful?

• Is there genuineness? Empathy? Encouragement? Validation? Cooperation?

• Does your therapist set you with mutually agreeable goals or plans?

• Does he instill hope?

• Does she provide explanations and lay out expectations?

• Is there negotiation or flexibility present?

• Is he or she confident yet still honest, warm, and friendly?

• Does this person support unconditionally? (That doesn’t mean they
agree)

True, many of these qualities will not be present in the first couple of sessions. Therapy is a process that begins with the first contact between the two parties and continues through the last contact. Interactions are important, and so are first impressions. Often times a client will know right away about fit based on a gut feeling. Experts say that if, by the 5th session, there is still no connection, the fit may not be conducive to successful outcomes. A client is looking for a meeting the hearts (bond) and meeting of minds (goals and tasks) (“Highly Effective Therapy,” Len Sperry). Taking these points into consideration, if you have had a less than positive experience with therapy, will you be willing to try again with another therapist? You may just find the “right” one. Yalom says therapist and client are like fellow travelers who set out on a long and winding journey until their destination is completed. Wouldn’t it be comforting to have a beneficial sidekick and companion while taking that voyage?

— Jill Dagistino

Should We Use the Word Should?

American psychologist and founder of Rational Emotive Behavior Therapy (REBT) Albert Ellis wisely and humorously said, “Stop shoulding on yourself.” Logically, one can deduct then, based on Dr. Ellis’ remark, that the use of should is something to consider removing from our vocabulary. Doing so, however, is a tall order, as it has become ingrained in our comments to one another and ourselves:

• “You know what you should do?”

• “You should…”

• “Aw man, you should have…”

• “When I look back now, I probably should have…”

Well…you get the idea.

So, what is so “bad” about using should? Well, firstly, it implies a sense of judgment. If I tell myself I should do something, then I’m laying out the expectation of it actually being done, and if I don’t do it, then I’m falling short in some way. Eventually, with repeated use, we slowly eat away at our sense of esteem, especially if we fail to deliver on the “should.” It’s almost as if we begin to believe we can’t do anything right with our current knowledge. We consistently arm-chair quarterback or backseat drive. Neither is helpful.

When it comes to our interactions with others, using should give the impression that we are the experts on the other person’s life. That couldn’t be further from the truth. In all honesty, are we really even sure we’re the experts on our own lives? (After all, we’re second-guessing and undermining ourselves with our own shoulds, as was just explained). What gives us the idea that we know what’s best for someone else? And, just as should do to each of us individually, using should with others creates a sense that we’re superior and they’re inferior.

Looking back on a situation or a specific behavior and saying we should have done “this” instead of “that” also hints at disappointment or regret. Of course, it’s easy to look back with our current knowledge of knowing how things turned out. At the time of decision-making, we weren’t privy to the information learned along the way. We made choices in the past based on the facts staring directly at us. Hindsight is 20/20. Even though we more than likely set out to do our very best, it doesn’t always work out as we expected. That’s when we boldly state what should have been done, again implying failure and/or stupidity.

If using should is not appropriate or helpful, then what can take its place? Here are some replacement suggestions:

• Instead of remarking, “You know what you should do?”, try “Have you considered…”

• In place of “You should…”, say “It might be helpful if…”

• Substitute “Aw man, you should have…” with “It may have been more beneficial if…”

• Change “When I look back now, I probably should have…” to “Looking back, I may have found ____ to be more useful.”

Now that should’s meaning has been identified and highlighted, what should you do (pun intended) about using it? Even better yet, what would be more helpful? What would best benefit you or someone else? Use or replace it? Dr. Albert Ellis would repeat himself, “Stop shoulding on yourself”(and others) and set yourself free.

— Jill Dagistino, Registered Mental Health Counselor Intern

The Alarming Statistics on Mental Health

On June 17th of this year, the World Health Organization (WHO) released its most extensive review of the world’s mental health since the turn of the century. Here is what the report found:

• In 2019, nearly a billion people, including 14% of teens, were living with a mental disorder

• Suicide accounted for more than 1 in 100 deaths

• 58% of suicides occurred before the age of 50

• Mental disorders are the leading cause of disability, causing 1 in 6 years lived with a disability

• People with severe mental health conditions die on average 10 to 20 years earlier than the general population, primarily due to preventable physical diseases that stem from psychological symptoms

• Childhood sexual abuse and bullying victimization are significant causes of depression

• Social and economic inequalities, public health emergencies, war, and the climate crisis are among the global, structural threats to mental health

• Depression and anxiety went up by more than 25% in the first year of the pandemic alone

Additional reports from December 2020 to January 2021 found the following percentages of individuals reporting suffering from anxiety and/or depressive disorders:

• Anxiety 35.8%

• Depression 28.4%

• Both anxiety and depressive disorders 41.1%

Broken down by age group, the U.S. Census Bureau/Kaiser Family Foundation discovered the percentages of those affirming depressive disorders to be as follows:

• 18-24 years of age 56.2%

• 25-49 48.9%

• 50-64 39.1%

• 65+ 29.3%

For 2022 to date, national statistics show that Florida ranks smack dab in the middle of U.S. states, sandwiched between New Jersey at #1 and Colorado at #50 with the prevalence of mental illness and rates of access to care. That means that NJ has the lowest prevalence of mental health and the highest rate of access to care for adults. Conversely, CO has the highest prevalence of mental health and the lowest rates of access to care. This statistic is for adults. For youth, Florida comes in at #30, with Pennsylvania in the #1 spot and Nevada last.

The W.H.O. hones in on U.S. statistics for adults, highlighting the following:

• 19.86% of adults are experiencing a mental illness. Equivalent to nearly 50 million Americans

• 4.91% are experiencing a severe mental illness

• The percentage of adults reporting serious thoughts of suicide is 4.58%. The estimated number of adults with serious suicidal thoughts is over 11.4 million - an increase of 664,000 people from last year's data set

• The national rate of adults experiencing suicidal ideation has increased every year since 2011-2012.

For youth (ages 12-17), the following data was discovered for 2022:

• 15.08% of youth (age 12-17) report suffering from at least one major depressive episode (MDE) in the past year

• Childhood depression is more likely to persist into adulthood if gone untreated

• The number of youths experiencing depression increased by 306,000 (1.24%) from last year's data set.

As a therapist, I do not take these statistics lightly. In fact, I interpret them — as I would imagine all of my peers would — as motivation to do our jobs as professionally, thoroughly, compassionately, and intently as possible to reach more people. Unfortunately, over half (56%) of adults with a mental illness receive no treatment, which translates to over 27 million individuals going untreated. Of youth, 60.3% with major depression do not receive any mental health treatment. Even among the states with the greatest access for youth, 1 in 3 youth are still not receiving the mental health services they need.

How this translates for us as Floridians is alarming. Florida is tied with Georgia in the 49th and 50th positions, ranking only behind Hawaii, with 63.5% of adults not getting help. This is 7.6% worse than the national average. For youth, Florida comes in at #45 with 67.3% of youth not receiving any treatment. 

Clearly, there is room for improvement. W.H.O. recently redefined its mental health awareness goals to include clear-cut strategies to reach more youth and adults. They include increasing the number of counselors, therapists, and clinicians and preserving access to telehealth services that proved their usefulness and effectiveness during the pandemic. 

The Spanish River Counseling Center has an entire staff of therapists, male and female, ranging in age and specialty, with a variety of scheduling options. Telehealth services (phone or video cam) are also provided to add convenience and flexibility. Therapist profiles are available on the center’s website, which can be accessed via www.spanishrivercounseling.com or by going to the church website and clicking on the “care and support” tab, where you’ll see the link for the center’s home page. New client forms can be submitted via the website or by speaking with one of our caring and supportive team members. If you or someone you know needs help, there is a high likelihood of finding the “right” fit to create a therapeutic relationship that will facilitate connection and positive change. Let us help. It would be our honor.

— Jill Dagistino

Refined in the Fires

Some of the many questions I get when working with individuals who have gone through challenging times in life are, “Why is this happening to me?”, “What did I do wrong to deserve this?” Or, “Why is God punishing me?” Of course, it is natural to think these things. Who hasn’t been through a troubling experience and pondered the very same questions, all while feeling anger, sadness, disappointment, confusion, frustration, and perhaps even chaos? 

The natural inclination is to shrug shoulders and pass it off as “just one of those things we deal with.” That doesn’t lend itself to providing legitimate answers or validating emotional pain. So, we search for meaning.

In his book “Bait of Satan”, John Bevere beautifully tackles this very subject matter, providing an effective metaphor that pairs the technical process of refining gold to the metamorphosis that takes place in people. First, solid gold is pliable, malleable, and shapeable. Only when it is mixed with other metal alloys does it become hard as a rock. To return it to its natural desired consistency so it can be molded to any desired shape, the gold is intensely heated to the point that the impurities begin to float to the surface. The craftsman then carefully removes the unfavorable metals with great intentionality and patience, tossing them to the side because they are no longer needed and get in his way of creating his masterpiece. Once pure, he can then form the gold into any shape he wants. The end result could be a sparkling piece of jewelry, a shiny-plated set of utensils, a glistening sculpture, or perhaps a radiant set of scrollwork on a building. The gold, through extreme stress, moves from one consistency to another oftentimes without anyone even knowing what it went through to do so. It may have appeared to be okay before being exposed to the fire, but after, it became something beyond just okay. The artist transformed it into exceptionally remarkable.

People go through a similar metamorphosis. They could be going through life just fine and then BOOM, just like that, something happens that knocks them down to their very core where they are left feeling broken. It is during these difficult times that strength of character is rebuilt in more powerful and meaningful ways. The old character traits that no longer serve a beneficial purpose get filtered out and replaced by more effective skills, behaviors, or tendencies. It’s often hard to see the “good” through the “bad” while it’s happening. That’s when the deep questioning sets in, and we wander back to the questions asked in the opening of this blog. Naturally, we slide down the slippery slope of self-doubt that erodes our confidence. Thankfully, it is temporary. Only once through the heat, just like the gold, are we able to see our positive transformations. We realize how we’ve grown into better versions of ourselves because we’ve filtered out the characteristics of people that may have been keeping our hearts hard. The intense difficulties filtered out the flaws, making way for the strengths. 

This refining is not by accident. For those who have faith in Christ, these challenging periods, by design, occur to draw us closer to the Father. He heats things up to strengthen our relationship with Him, so He can guide us with love and patience towards what He has envisioned for us. While it’s happening, it sometimes makes no sense and admittedly, it’s easy to lash out with negativity. Yet, by faith, we miraculously dedicate ourselves to staying connected, and, in the end, all is well.

So, the next time you’re questioning why you’ve been put through the fire, try to remember to ride it out. Instead of trying to completely douse the flames, let them unfold around you. Seek counsel from someone you trust to help lower the heat a few degrees so it’s more tolerable and patiently wait for the new and improved you to emerge, shiny as gold. 

— Jill Dagistino

Anxiety Can Be a Blessing

Most of us see anxiety as something unpleasant, that must be shoved aside, is not allowed, and certainly not helpful. It gets in the way of having a calm, peaceful life. It wreaks havoc on our schedules, not to mention our relationships. In some cases, anxiety makes us think we are unworthy of joy. It can rob us of hope, leading us down a dark path. 

The possibility exists, however, that we can reframe anxiety and see it in a whole new light. Our body creates anxiety to get us to hit the pause button, pull out the magnifying glass, and zoom in to see what our bodies are trying to tell us. Specifically, what needs addressing? What needs confronting? What needs are we neglecting? Our lives would benefit from naming it so we can begin taming it.

When I’m driving in my car and my tire pressure gauge signal lights up on my dash, my first inclination is to groan and moan, probably making a comment like “Great, just what I need right now!” True. It is an unwelcome inconvenience. With that being said, the alert warns me to fill my tire in order to stay safe. I could decide to ignore it and keep driving. That option may expose me to a potentially dangerous situation like a blowout, damage to my rim, loss of maneuverability, or even an accident. The ripple effect of such possibilities trickles into affecting everyone around me, especially if I get hurt or worse. The alternative is to take the time to stop, heed the warning and fill the tire. Maybe I would benefit from seeing the warning light as helpful.

Almost everyone deals with some type of anxiety — even Jesus. When Jesus was on the Mount of Olives with the disciples, he pulled himself away to pray to God three separate times, uttering the words, “Father, if you are willing, remove this cup from me. Nevertheless, not my will, but yours be done. (Luke 22:42) Scripture describes him as “being in agony” about his impending crucifixion to the point that he was actually sweating drops of blood (a rare medical condition called hematidrosis), and example of the highest form of anxiety possible. He, being human, related to our fear and anxiety. And, he did what we do. We pray for relief and reach out to our loved ones and friends for help and to voice our innermost feelings. Matthew 26:37 tells us that he went to Peter, James, and John in great distress and trouble to confess, “My soul is exceedingly sorrowful, even to death. Stay here and watch with me.” Clearly, he was upset and didn’t want to be alone. We know how his story ends. 

Could we, therefore, look at our anxiety as a blessing, something to be thankful for? It’s a warning that allows us to begin discerning how to identify what changes to make in our lives.  We can use the anxiety to unveil past wounds and highlight the pain that would benefit from being healed. This process is not exactly welcome, just like the tire pressure warning light, but it does perhaps give us the opportunity to save ourselves from additional heartache and pave the way to more positive feelings and emotions.

So, try not to see anxiety as simply 100% negative. The emotions associated with it ultimately raise awareness and give us the wisdom to make the appropriate change. Instead of shoving body sensations and thoughts aside, move into them and pay attention. Instead of crying out in prayer for God to “fix it”, ask what it is God’s trying to teach. And finally, reframe the negative connotations, seeing them as helpful. It may just help strengthen enough to move through and out of discomfort. 

— Jill Dagistino, Registered Mental Health Counselor Intern (Level 2 DBT trained)

“But” and It’s Implied Meaning

“But” is a word most of us get into the habit of using quite often when engaging in dialogue. It sort of slips out as a way to link two separate phrases or defend our own beliefs or opinions. For example, “You know I love you, but…” or “I want to go to the gym, but…” or “You did a great job, but…” Well, you get the idea. What happens when you read these examples? Our response becomes emotional and we rationally ignore everything that was uttered before “but” and focus on the words that follow. From a grammatical perspective, “but” is a conjunction used specifically to imply contrast when the second idea or statement is different from the first, negating the first statement as if it is not true. The phrase attached after “but” is the defining, last impression, the one that sticks. 

Somehow along the way, we adapted its usage and applied “but” as we would the word “and”. We use it to add rhythm and flow to verbal sentence structure. And, let’s face it, we use it to interrupt someone else who’s speaking. “But” signals “I have something to say that matters more than what you’re saying.” It evokes judgment, condemnation, and an elevated sense of self. Think of a small child who whines, “But I don’t want to!” “But” can push our buttons and provoke us to feel negativity. Think this may seem like a bit of a stretch? Consider how this one little word and the attitude that goes with it is ingrained in our culture. It’s become common.

Of course, there is nothing wrong with using “but”, as long as there is an awareness of how it influences other people’s thinking. That means using it when it becomes important to acknowledge something negative while emphasizing a positive alternative. For example, “This test didn’t show your best effort, ‘but’ I know you’ll do better next time” or “This sets us back a bit, ‘but’ we’ve gotten through it before and we’ll do it again.”

The reason for highlighting the use of “but” is to motivate us to hit the pause button, replace it with the word “and”, or add a period and make 2 distinct sentences. Doing so gives equality and validity to both opposing phrases.

Habits are hard to change, and we can do it. “But” may be part of your daily vocabulary, and it doesn’t have to remain active. (Did you catch those statements as examples?) Many department heads or managers erode the potential benefits of motivating speeches by using “but”.  Parents lose their children’s attention or interest by contradicting themselves. And, spouses create doubt about love with careless uses of “but”. Several years ago, I attended a seminar on this very subject. Every time someone said “but” we were encouraged to jump out of our seats, point our fingers, and scream, “You said but!” Not exactly the nicest way to break a habit, “BUT” it is effective. 

Now that “but” has been given the spotlight, you won’t be able to unhear it when used around you. You’ll notice also how frequently it enters conversation and presentations. It may be to you like nails on a chalkboard, something irritating. You may even catch yourself internally chanting “He said but. She said but”. Try making a change and see how others respond. 

— Jill Dagistino, Registered Mental Health Counselor Intern

What is DBT (Dialectical Behavior Therapy)?

Dialectical Behavior Therapy, a form of cognitive-behavioral therapy, incorporates the use of skills or strategies that, when put to use, create a life worth living. Developed in the 1970s by its founder, Dr. Marsha Linehan, it has proven to be effective as an evidence-based practice for a number of mental health issues including anxiety, depression, post-traumatic stress disorder (PTSD), eating disorders, borderline personality disorder, suicidal and self-harm behaviors, substance abuse, and anyone desiring tools for tackling life. DBT operates on the platform of dialectics, meaning there exists at the same time acceptance and the desire for change. It is neither one nor the other and is instead both simultaneously. The overall goal of DBT is to help individuals change behavioral, emotional, thinking, and interpersonal patterns associated with problems in living. The key to success is the client/therapist relationship.

DBT originally operated on a platform set out to tackle 4 main targeted modules: Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. Just recently a 5th, “Middle Path”, was added to help families and teens manage the relevant issues within their relationship. These modules are further divided into sections and then even further into a series of separate skills that are usually taught in sequence but can be pulled out individually so clients do not feel overwhelmed. An explanation of each module is as follows:

Mindfulness Skills

Mindfulness Skills are considered core skills in individual DBT therapy because they help develop an ability to control attention, a skill that is needed before one can learn to regulate emotions. In this DBT skills module, the primary goal is to help clients learn to participate fully in life while being non-judgmental and staying one-mindful. It helps with emotional suffering, worry, and depression by keeping clients in the moment versus in the past (where regret, shame, and grief can live) or the future (where worry and fear live). 

Interpersonal Effectiveness Skills 

Interpersonal Effectiveness Skills are taught to learn the nuances of effective communication in a range of relationships from work to family to friendships and romantic relationships.  Approaching relationships from a different perspective, the skills help balance the ability to be assertive by asking for what one wants and balancing how to say no while maintaining relationships and increasing self-respect. The goal is to decrease interpersonal conflict, improve active interpersonal problem-solving, and build positive social support in individual DBT therapy. 

Emotion Regulation Skills 

Emotional Regulation Skills help individuals in DBT therapy appreciate the purpose of emotions when encountering different problems and situations. Clients learn to accurately identify and label emotions, change emotional responses to situations, reduce vulnerability to negative emotions, and learn to manage extreme emotions. This helps instill the feeling of being in some degree of control over emotions, rather than feeling that emotions are in control of you. For most clients, the development of emotion regulation DBT skills includes the process of learning an emotion vocabulary that increases the recognition and communication of emotional needs to others.

Distress Tolerance Skills

Distress Tolerance Skills are taught so that clients can learn to cope with periods of intense emotions and stress without behaving in a way that would make the situation or problems worse. These DBT skills provide clients with a more effective way of managing crisis situations by means of distraction, improving the moment, and self-soothing. Distress tolerance skills for chronic problems and stressors help individuals accept reality by practicing the skills of radical acceptance, willingness and turning the mind. A key driver is to make decisions once calmer in “wise mind” (learned in the interpersonal effectiveness module).

Middle Path Skills

Middle Path skills help clients balance acceptance and change so they are able to see that there is more than one way to view a situation or solve a problem. A primary goal of this module is for clients to work on changing painful or difficult thoughts, feelings, or situations while also accepting themselves, others, and current problems.

Since DBT is constructed as a modular intervention, therapists and clients together as a team have the inherent flexibility to zero in on components to meet specific needs. Ultimately, comprehensive treatment strives to 1.) strengthen capability by increasing skillful behavior, 2.) improve and maintain motivation to change and engage with treatment, 3.) ensure that generalization of change occurs through treatment, 4.) enhance therapist motivation to deliver effective treatment, and 5.) assist restructuring or changing the environment to support and maintain progress and advancement towards goals. To accomplish these functions effectively, treatment is spread among a variety of modes that include individual treatment, group or individual skills training, between-session skills coaching, and a therapist consultation team. 

DBT is purposefully set up to not be a quick-fix type of therapy. In fact, it takes 24 weeks (6 months of weekly individual sessions and skills training classes) to complete the entire DBT skills training because it goes at a pace to ensure skills are learned, understood and applied to real-life situations. There is an array of new skills that cannot be rushed. Oftentimes, some clients end up repeating the process once completed, finding it to be so beneficial in finding fulfillment in all aspects of their lives. Those who commit fully make the most progress. 

If traditional “talk” therapy is something you’ve tried before and didn’t get the results you wanted, or if DBT sounds like something you may be interested in, please give us a call. We’d be happy and honored to answer any questions.

— Jill Dagistino, Registered Mental Health Counselor Intern (Level 2 DBT trained)

Compassion, Kindness, and Grace

The other day while putting dishes away, I dropped a ceramic serving platter onto the hard-tiled kitchen floor shattering it into what looked like a gazillion tiny pieces. There was no chance of trying to piece it delicately back together with several bottles of super glue. It was a goner. What a shame, right? One would think I would have simply swept up the remnants, tossed them into the trash, and planned on a way to replace the dish.  Nope. Instead, I went on a couple-minute-long bash about my clumsiness and stupidity for being so incompetent. I really let myself have it. Then, I heard my rational brain kick in and tell me to lay off the verbal attack. Yes, it was a silly mistake. Things happen. I could forgive myself and move on. It was, after all, just a serving dish. No need to berate myself any longer. 

As I moved out of this irrational state, I found myself chuckling at the ridiculousness of my self-inflicted bashing. I tell my clients to practice self-compassion and kindness and fully expect them to do so. Here I am not practicing what I preach. One of those moments of proof that we are all human and beautifully imperfect. Point is well-made and taken. 

What this incident did was re-instill in me the importance of self-acceptance, compassion, and kindness. The world will inherently beat us up. We don’t need to do it to ourselves. The Bible tells us to follow the Golden Rule: “So whatever you wish that others would do to you, do also to them, for this is the Law and the Prophets.” (Matthew 7:12). This applies as well to our treatment of ourselves. What do we say to a friend, loved one, or co-worker who comes to us with a particular challenge or dilemma they’re in the midst of handling? They confess they’ve made a mistake. Do we call them stupid? Do we tell them things will never get better? Not even close. Instead, we lift them up. We encourage them with words such as “It’s okay,” “It’s going to get better,” “You’ve got this,” “You’re strong and smart,” and “I believe in you.” We try our best to improve their state of mind. If we agreed with them and joined the bash fest, the relationship most definitely would be strained, if not damaged. No one wants to be around people that treat them poorly. So, why do we do it ourselves? Clearly, we would benefit from speaking kinder to ourselves with more empathy, love, and, yes, humor, which in turn work together to open the door for more acceptance of our perfect imperfections. 

So, how do we do that? Kristen Neff and Christopher Germer, in their book entitled “The Mindful Self-Compassion Workbook,” challenge us to offer ourselves unconditional warmth and acceptance. Acknowledge the suffering. Sit with it long enough to respond with care and kindness. It’s easy to get caught up in immediate problem-solving to make the uncomfortableness go away. However, pain is part of the human experiences we share, and it is one way to connect with others. Moreover, that uneasiness is where true change and growth ignite. 

So, rather than shoving it aside or erasing the pain, actively look for ways to soothe and comfort the soul. Find a posture that works for you-maybe it’s wrapping your arms around yourself like a giant hug, or putting your hand on your heart, or curling up into a fetal position. I find placing my hands on my cheeks and sort of leaning forward to be particularly calming. And, naturally, turn to a loved one for support, building upon the commonality of the shared emotion. You’ll more than likely feel grounded in unity and bonding. Most importantly, look also to Jesus. Scripture reminds us repeatedly that Jesus is there for us, ready to comfort and embrace us. He unconditionally and entirely accepts us for who we are right here in the moment. 

I’m reminded of that popular phrase “What Would Jesus Do? “(WWJD) that was proudly displayed on wrists across the world several years ago. If I ask myself about his response to my platter-smashing mishap, it most certainly wouldn’t have been to berate me with name-calling. We can rest assured he’d offer up loving kindness and support. Wouldn’t it be beneficial for us to follow his example and show ourselves some true forgiveness and self-compassion? From serving dishes to more serious matters, Jesus is the ideal role model, showing grace and love. He gives both freely, “For by grace you have been saved through faith. And this is not your own doing; it is the gift of God.” (Ephesians 2:8). Let’s follow his lead. 

— Jill Dagistino, Registered Mental Health Counselor Intern

It’s All in the Tone. Do You Sound the Way You’d Like or Intend?

There’s a long-standing joke in our family about my husband’s former use of tone. If you ask him, he’ll agree with what I’m about to share and will be quick to add that he has changed. I’m proud to say that with the concerted effort he has indeed.  Just to be upfront, I completely have his blessing to let you in on the humor associated with his old communication style. We all agree that he had (still does) wonderfully poignant things to say, thought-provoking and intellectually stimulating. His advice was (and is) legit. However, and it’s a big however, in the past, we used to not get beyond a few sentences without tuning him out, sort of reminiscent of how Charlie Brown and his classmates hear their teacher (blah, blah, blah, blah, blah). Why? His delivery was less than desirable. What was it in particular that caused us to lose interest? His negative, almost attack-ish, and overly intelligent-sounding blah-ish tone. Maybe you know someone who speaks in a similar way. Maybe it’s you? Oftentimes, there only needs to be a newly-created awareness to stimulate a dramatic change.

Let’s take a look back into our childhoods for proof that tone is really what stands out in being an effective communicator. When we were rocked to sleep, or perhaps when we lulled our little ones off into Neverland, “Rock-a-Bye Baby” delightfully induced an overwhelming sense of peace. Hum the tune. I’m sure it’s one that is very familiar. Now, take away the sing-song, delightful melody and read the lyric just as you would a passage from a novel:

“Rock-a-bye baby, in the tree top.

When the wind blows, the cradle will rock.

When the bough breaks, the cradle will fall,

And down will come baby, cradle and all.”

What? Did that sweet little infant just go smashing into the ground with broken tree bark, shattered cradle wood, and tattered leaves? Although the origin of this famous lullaby remains unproven, many believe it was written by a Mayflower pilgrim who was inspired by the way Native American women rocked their babies in birch-bark cradles suspended from high tree branches with the wind providing a natural, soothing motion. Whoever composed the music and lyrics, the intent was meant to be positive and provide a relaxing way for caregivers to get their little ones to sleep. It’s worked successfully for generations due to one factor--the tone we use to sing it.

Tone means the world when communicating. Experts say the comprehension of the message we deliver to others is contingent mostly not on our words, but on the way, we say those words. In fact, according to “Psychology Today,” as much as 90% of communication is nonverbal. Specifically, 55% percent is body language, 38% is the tone of voice, only 7% is the actual words. With these figures in mind, we see how imperative it is to employ a positive and encouraging tone, even when discussing serious topics. 

So, the next time you find yourself about to engage in a conversation where you are trying to accomplish a particular task, stop and pay attention to your tone. Listen to yourself. Practice by recording and playing back the audio. Do you sound the way you’d like or intend? What adjustments can be beneficial to help you achieve your desired results? 

— Jill Dagistino, Registered Mental Health Counselor Intern