I came across a blog post alleging that many survivors of childhood sexual abuse have been further traumatized by therapists applying DBT to them.
Basically, they are told to stuff their feelings related to the abuse, because it’s in the past. No connection allowed to that past self and his or her experiences, even though those experiences are hanging in limbo and can never be metabolized without revisiting them. It’s yet another authoritative voice saying “Shhh! Don’t tell, or you’ll get in trouble.”
Part of the trouble seems to be in the wrong application of the various skills, as if any of them were always universally applicable.
The skill of distraction is overapplied, as if it’s appropriate for all situations, and as if dissociation were not a danger. The skill of temporarily storing overwhelming emotions is likewise misapplied, as if the therapist were conveniently forgetting the “temporarily” part and the need to revisit those feelings at a more safe time and place. The skill of not catastrophising is applied as if there’s no such thing as a catastrophe, instead of only when the distress is NOT a catastrophe. The skill of acting opposite to feelings is misapplied, as if the idea is to hide one’s yucky self or deny one’s yucky feelings, instead of mere impulse control: being able to have one’s feelings, own them, but act according to wisdom instead of impulse. In fact, I remember DBT focusing on emotions being value-less — that even the so-called “negative” emotions are important and have something to say to us. They shouldn’t be pushed aside any more than they should be deliberately sought after.
Some of these skills seem to me clearly intended for distresses that are mild to moderate, not severe. They’re for distresses that recur after you’ve already dealt with the root issue — distresses that you KNOW are based on lies.
Take the half-smile, for example. Of course it’s ridiculous to think that simply smiling will solve all of your sadnesses. But I don’t think that’s the point of the skill. It’s just one small tool. For occasional no-good-reason blues, it’s a great physiological feedback tool. For deep sadnesses, it can be a very small comfort, again purely physiologically, not as if you’re pretending not to be sad. There’s no “should” or “must” about it, and it’s not about denial or stuffing.
Then there’s apparently an idea that using the skills is a matter of instant perfection, and not practice. The blogger writes about people being chewed out for mentioning their distress in group. Yikes! How can you learn distress tolerance if you can’t even mention distress? And again, distress tolerance isn’t the same thing as distress denial or not being bothered by distress at all. It’s about letting each distress be its own true self, neither making it more of a catastrophe than it is, nor minimizing it less than it is. It’s about trusting that the true self can survive, can get through, will not be destroyed by the distress.
It sounds to me like part of the issue is a matter of language and connotations. When a therapist says something like “acknowledge without attaching,” it might mean something very different to their client. Maybe the therapist means “Stay in the present, but allow yourself to feel the feelings that are coming.” Maybe the client hears “The person that experienced those feelings is not, and never was, you.”
Suppose you’re the client and you’re experiencing distress because of something from your past. I think there are at least three possible approaches.
1) You might get sucked into the past moment as if you’re time traveling, reliving it exactly as you did in the past. In this case, there’s no sense of the present moment at all. There’s not enough separation from the past moment to observe it, listen to it, evaluate it, and respond to it. There is only reliving and reacting. I don’t think this approach can solve anything, and it seems clear that it could cause problems in the present.
2) You might push away, deny, or ignore the past moment as if nothing from the past matters anymore. This approach is even less helpful, even though it might preserve a semblance of functioning in the present. The present self grew out of the past self, and so the past DOES matter. Past experiences — especially those that haven’t been fully metabolized — will continue to exert pressure on the present self, causing all sorts of present problems.
3) What seems to me the best approach, in line with how I understand DBT and what I learned in other therapy as well, is to be present while the past moment is speaking. Don’t time travel, and don’t shut your ears. Feel the feelings, experience the experience, mindfully, neither pushing away nor clinging. Listen with compassion. Listen with your present self’s wisdom. See what the past self is saying, what the past self needs from the present self. The only way to metabolize that past moment’s feelings is to feel them — in the present.
You can’t change what happened in the past, but that doesn’t mean it’s safe to ignore the past. Ignoring the past and time-traveling into it are both ways of fighting against reality. Mindfulness is NOT saying reality is wonderful and peachy-keen, but it is accepting that reality is what it is — including the realities that this is the present, and that the past really happened and really matters.