dialectical behavior therapy

Your Guide to Starting Therapy

by Abby Lombardo, LMFT

It’s daunting.

I get it.

Yes, I, too, have had to search for a therapist (therapists seeing therapists who see therapists, it’s a thing) and have just stared blankly at my screen hoping the right someone would fall into my inbox.

In this way, searching for a therapist is like dating: you’re basically courting someone to see if they are trustworthy and make you feel comfortable enough to tell all of your vulnerabilities and still feel accepted by them.

 Actually, it’s a lot like dating.

 It’s also like searching for an apartment or a place to live, you might not know it’s a good fit until you try it out, step into the space, spend some time there…to know if it is a good fit or not for what you’re needing.

That’s the important part: try to focus on what YOUR needs are at THIS time in your life and the kind of person/professional you’re looking to help support your journey.

 

To aid in this purpose, I’ve devised a “Searching for a Therapist Cheat Sheet” that outlines common words, phrases, acronyms, and questions to help guide your search. It can help to feel informed and oriented to the search process, so that you can focus more on what the professional has to offer YOU.

Ideally, this information is best used in a consult with a provider. A consult is usually a free 15-30 minute meeting (over the phone or virtual) to assess whether you’d like to work together and schedule your first appointment. If the provider’s website or profile page doesn’t advertise that they do consults, don’t be afraid to ask!

 

Let’s get started with common therapy words used in the search for a therapist, that might not be so intuitive or self-explanatory.

 

7 Common Therapy Search Words:

1.      Specialty: this is something a professional has added training, experience, and interest in. Usually this includes some kind of certificate, training, and additional letters after their name. It is also probably the clients they have seen and want to see. Pay attention to these, they can be a helpful way to filter through who you might want to work with on a certain issue or topic.

2.      Modality: this is a bit different than specialty in that it refers to the way a therapist conducts treatment, or, how they do therapy. Modalities are therapeutic frameworks, lenses, theories that often guide the professional’s way of doing things in session. See more in the Acronyms section for the names of several common modalities to know about.

*The cool thing? Research shows that it’s not necessarily the modality that brings success in therapy, but the relationship you have with your therapist! So, modality does not make or break unless it leads to you not vibing with your therapist!

3.      Intake: the term for the 1st session. Intake sessions are usually billed at a higher rate than normal sessions as they are used traditionally for assessment, onboarding, orientation, and paperwork. Intake sessions vary from therapist to therapist. Some have you, the client, talk about why you’re coming to therapy and what the issues are you’re experiencing. Some will ask for your family information to get more context. Some will go through a timeline with you of different experiences you had while growing up. Mostly though, they’ll all discuss confidentiality and privacy with you, as well as the exceptions and you will probably be asked about why you’re coming to therapy, what your goals are, and how the therapist can support you.

4.      Scope of practice: this is a lot like specialty and modality in that it is WHAT a professional provider can OFFER you in terms of services. For example, a marriage and family therapist (LMFT) cannot prescribe medications, it is legally and ethically outside of their scope of practice. Make sure you are looking for a provider who can offer you the services you are actually looking for.

5.      Somatic-focused: this term refers to anything body-related. Somatic techniques and modalities often help you learn to work with and regulate the systems of the body: the “flight, fight, freeze” system and the calm/rest/soothe system (for example). A somatic-focused therapist might ask you: “Where do you feel that in your body; can you describe it?” If this feels daunting, they are there to help you every step of the way. They see the body as a source of wisdom and connection. They also see the body as the #1 place that we store all of our emotion, trauma, energy, and pain. There’s a lot you can work with somatically that you might not be able to through talking.

6.      Attachment-based: this refers to a general modality/theory of therapy that examines and explores the way you relate to people and things. Attachment begins when we are infants, depending on caregivers to provide us with what we need to sustain life and be nourished. How we attach/ed to our caregivers can have a lot of sway over how we relate to significant others and even friends. This modality is incredibly informational and slightly Freudian, and most therapists have training in this, though some zoom in and use only an attachment-based lens as their main modality or get extra training in it.

7.      Mindfulness-based: this refers to a therapist who uses present-focused, attention-centering techniques in the therapy session or for the client’s homework to engage the client more mindfully with the here and now, whether that be with your breath or with the uncomfortable, restless feeling you are having. Mindfulness has many, many amazing benefits and can really help with anxiety, mood, and attention issues.

 

9 Common Therapy Acronyms (in alphabetical order!):

1.      ACT: Acceptance and Commitment Therapy – teaches mindfulness-based coping tools for unwanted/negative thoughts and emotions, while focusing on identifying client’s values and moving towards goals based in the client’s values.

2.      CBT: Cognitive-Behavioral Therapy - probably the most common therapy acronym used these days; explores the connections of the 3 parts of the CBT Triangle: thoughts, emotions, behaviors and how they all interact with each other to build negative cycles and habits. Offers ways to interrupt negative/unwanted thought, emotion, or behavior sequences through practical changes and reframing. Most mental health professionals are trained in this type of therapy.

3.      CPT: Cognitive Processing Therapy – a common therapy for treating PTSD

4.      DBT: Dialectical Behavioral Therapy – a skills-based therapy that offers tools for many things including: self efficacy/assertion, emotion regulation, distress tolerance, receiving feedback, making a decision, etc. Great for someone who benefits from structured therapies.

5.      EFT: Emotionally-Focused Therapy – often for couples, this process-oriented therapy strives to find the vulnerable, intimate spots that we often try to protect out of fear or hurt and uses it to reconnect partners who are struggling.

6.      EMDR: Eye-Movement Desensitization and Reprocessing – this therapy is very cool. It is a somatic-based, trauma therapy that uses your body’s way of processing information to help you work through issues, sometimes without talking about them with the therapist. They teach a lot of coping strategies so that you feel ready for what comes up, too. Essentially, they use what you naturally do in REM sleep in session and utilize bilateral stimulation (sensation happening on 2 different sides of your body at different intervals). This is a therapy that I recommend for people who want to have tools and process their trauma without having to re-hash a timeline or go detail by detail with a therapist – or for someone who talk therapy just hasn’t helped much.

7.      IFS: Internal Family Systems – a family systems therapy that is also used with individuals in therapy to look at the different “parts” we all have within us that make us who we are and influence our behavior. For example, most clients have a “part of them” that wants change and a “part of them” that resists or is scared of change. IFS therapists work with these different parts in different ways to work towards client’s goals and self-integration.

8.      RO-DBT: Radically-Open Dialectical Behavior Therapy - this is a specialized therapy, that is derived from traditional DBT but geared more towards those that are over-controlled, think: perfectionist, Type-A people. This has been used successfully with those with eating disorders as well. RO-DBT is also a skills-based, structured therapy that teaches skills about emotional expression, social signaling, self-inquiry, personal effectiveness, boundaries, how to receive feedback, how to challenge rigidity in order to be more flexible, etc.

9.      SFBT: Solution-focused Brief Therapy – a strengths-based, post-modern approach that believes the client is the expert in the therapy room and the therapist is the guide to the client’s own wisdom about what has worked for them and what they want instead of the issues/problems they are experiencing now. Together, they build moments of “exceptions” to the problem and identify what success and solutions looks like for the client, sometimes without diving too deeply into the problem. “Brief” refers to length of treatment common for this type of therapy (~ less than 10 sessions, but not all SFBT providers limit their sessions to be this brief).

10.  TF-CBT: Trauma-focused Cognitive-Behavioral Therapy - this framework is therapy that guides the clinician and the client through trauma processing. Usually the therapy involves desensitizing oneself to one’s trauma story by sharing it with the clinician and reframing and reprocessing where necessary to work through an “old trauma story” and hopefully find a new story that helps the client integrate the events into their life while decreasing triggers and PTSD symptoms.

 

Questions to Ask Them (at first contact/consult):

1.      Do you take insurance/how much will this cost?

2.      What would a session with you look like?

3.      What experience do you have working with these issues/topics?

4.      How frequently will we meet/What determines the frequency of sessions?

5.      What are your specialties?

6.      What modalities do you use?

7.      What client do you work with best?

 

Questions to Ask Yourself (after first contact/consult):

1.      Did I feel comfortable talking to this person?

2.      Do I feel hopeful about working together?

3.      Did I feel heard and understood?

4.      Does it feel like a good fit for what I’m needing/wanting right now?

5.      Am I looking forward to my next session?

 

I hope you can use this cheat sheet to feel empowered in your search to find the a provider who is a good fit for what you are needing.

 

Trust yourself.

And if it turns out to not be such a good fit, you have the right to terminate treatment at any time! Remember, research shows it is the quality of the therapeutic relationship that determines overall therapeutic success.

 

Good luck out there! I’m cheering for you!

If you’re interested in scheduling a free consultation with one of Riverbank’s therapists, fill out the contact form here.

3 Crucial Communication Skills

The holidays are often full of strained communication. We’re spending more time with family and friends, and things can get…awkward and uncomfortable and tense.

Is your goal a specific objective? Do you want your uncle to change his mind about impeachment? Do you want your mom to change how many questions she asks you about when you’re getting married? Do you want your friend to show up on time for Friendsgiving? These are examples of objectives as the primary goal of the interaction. Get clear on what those objectives are and stay connected to those goals throughout the conversation so you don’t get sidetracked by other things.

Is your goal to maintain your own self-respect? How do you want to think and feel about yourself after this conversation? Do you want to make sure you spoke your truth honestly, clearly and kindly? Do you want to be an advocate for what you believe in? Do you want to feel grounded and proud of how you composed yourself? These are examples of self-respect objectives. If this is your first priority, get clear on how you want to look back on yourself in this interaction.

 

Is your goal to maintain the health of the relationship? Do you want the other person to perceive you as well-informed and calm? Do you want the conversation to remain peaceful because you know fights lead to months of silence? Do you want to be seen as kind and thoughtful, even in disagreement? These might show that the relationship is your first priority. Spend some time getting clear on how you want the relationship to be after this interaction. Yes, you only have control over half of this, but it can help you make sure you are showing up in the way you want to.

These are all skills from DBT (dialectical behavior therapy) focusing on interpersonal effectiveness. They’re super helpful to revisit this time of year for some reason…


So, your goal might be to achieve an objective, to maintain your own self-respect, or to maintain the relationship. (It might also be, and often is, all three). DBT has some great acronyms (Dialectical Behavior Therapy; they love their acronyms!) to help you have more effective conversation.

-

For objectives effectiveness, DEAR MAN

Describe the situation objectively and clearly, using only the facts. Imagine you're a fly on the wall or an impartial observer, and use *that* to describe. Not "you're being an asshole", but rather, "you haven't been home for a week and when you get here you work instead of spending time with me."

Express how you feel with an “I statement”. Be honest about how you are feeling, and make sure to speak from yourself using actual feeling words. Not "I feel like you're ignoring me", rather, "I feel lonely and angry."

Assert your need/request clearly and unequivocally, don’t sugarcoat or beat around the bush. Clarity will really help you here, to be sure the other person understands exactly what you're asking for. "I would like you not to work when you're home and spend time with me."

Reinforce the person meeting your request by explaining why they should. Give them a reason to meet your need, rather than pushing them away. "I really think we would both enjoy spending more time together, and you would probably be less stressed."

Mindful of what you’re going for, don’t get distracted by other things. If they bring up a different topic, or if you feel drawn to bring up another issue, stick to this single topic. "I don't want to get off track, let's talk about that other thing tomorrow."

Appear confident, even if you’re not, make eye contact, don’t mumble, stand up straight, speak clearly and calmly. Breathe.

Negotiate if needed. You may not get exactly what you are asking for, remember to compromise if appropriate to find something that works for both of you.

For relationship effectiveness, GIVE:

Gentle in your approach

Interested in what the other person has to say and what they feel, practice listening to them as much as you are talking.

Validate the other person, let them know you understand how they feel (even if you don’t agree).

Easy Manner--don’t approach with too much intensity, let the conversation be light, possibly bring in some humor.

 

For self-respect effectiveness, FAST:

Fair--be fair to both yourself and the person you’re talking to. Consider the other person and incorporate that into the conversation.

(no) Apologies--you are allowed to ask for this or to set this boundary. Don’t apologize for how you feel or what you’re requesting. It’s okay to have needs and express them, and it’s okay to disagree.

Stick to your values. Don’t compromise what you value to please the other person or avoid conflict. Stand by what you believe in and what is important to you, while keeping these other practices in mind.

Truthfulness. Don’t lie, exaggerate, or judge harshly. Stick to the facts and be honest about what you need and how you feel.


What are your thoughts? Let us know in the comments!