On this page
About DBT + Narrative Therapy
About my Adaptation of DBT
“A Week in the Life” of Therapy
getting started / orientation
in every session
wrapping up a block of sessions
saying Goodbye, when the time comes
My Adapted Individual DBT Skills-Training Program
in-session skills lessons
at-home skills lessons
DBT Diary Cards
DBT Phone Coaching
How This Might Benefit You
ABOUT DBT + Narrative Therapy
Dialectical behaviour therapy (DBT) and narrative therapy are both systemic therapies, which means that they view your life as a “system of systems:” Everything is a web of interacting factors. Every family or community is a system of relationships. Every land is a system of peoples, resources, values, rules and history. DBT would say that each link within each system has the potential -- in fact the necessity-- to change. Narrative therapy would say that each unique outcome within each system offers stories that can inspire change.
DBT was created by Marsha Linehan and based in Zen Buddhism, the philosophy of dialectics and learning theory. Dialectics means to hold two seemingly opposite things together as true at the same time. The main dialectic about me as your therapist is that I will wholly and absolutely accept you, just as you are; and I will push for you to change and grow. DBT is emotion-focused: Every emotion is what Linehan calls a “full-system response,” made up of bodily sensations, thoughts, values, motor functions and actions. So DBT explores how the full system of each emotion shapes and is shaped by all of life's other systems. This insight helps us to build the emotional mastery we need to feel in control, to “feel our feelings” without overwhelm, to feel calm whether we’re content or discontent, and to know joy.
Narrative therapy was created by Michael White, David Epston and Cheryl White. It says that the stories we tell about our lives create our identities. Compounding traumas (e.g., microagressions, multiple oppressions, repeated abuse) and even survival (e.g., the evolution of our fight-or-flight response) have conditioned us to tell stories of fear, shame and loss. These dominant stories hold truth and are important: They tell us to hide ourselves from danger, often because the danger is real; they tell us to despair, often because real horrors and injustices have occurred that we need to mourn. But dominant stories can also distort truth in ways that tell us our identities are the problem, are shameful, are hopeless or powerless. Narrative therapy is preference-focused: We all have certain values, accomplishments, hopes and commitments that we hold as more precious than others. So narrative therapy explores the stories that “thicken” these preferred parts of our identities, and this storying helps us to build up our preferred selves.
I love DBT because it can bring us right into our bodies and emotions when it's safe enough to go there, and because it can help us just as much to notice at times when going there is not safe enough. The more we fine-tune these forms of emotional mastery, the more insight we gain into how we can both love and shape our reality.
I love narrative therapy because it takes us into our imaginations, values, preferred memories and hopes. These adventures can help us to connect with what we hold most precious. In these connections, we start to weave our preferred stories into our actual identities in the here-and-now.
You'll notice that I'm speaking about DBT and narrative therapy together, rather than giving each their own separte section. That's because I use these two models together, at once. I believe that they balance each other out: embodiment versus imagination, and reality versus ideals. DBT would call this pairing a dialectic: a greater synthesis of two polarities. Narrative therapy would call this pairing multi-storied: a thick description of experience. In my experience (and I admit that not everyone agrees with me), DBT and narrative therapy make a lot of room for one another and bring out each other's best.
You may also wish to check out my blog post DBT 101: It's So Much More Than Just the Skills!
ABOUT My Adaptation of DBT
The DBT that I use is classified as “adapted” because there are three ways that I don’t follow the rules of standard DBT:
(1) While DBT is my main model, I also use a lot of other psychotherapy models that don’t always follow the rules of standard DBT. Here’s one example. In standard DBT, the therapist decides based on their professional experience what behaviours of yours are adaptive versus maladaptive; but the “narrative therapy” part of me is like, Nope! You’re the teller of your own stories, and so you’re the one who decides based on your lived experience what things in your life are problems versus preferences.
(2) In my clinical consultation meetings (i.e., where professionals who practice psychotherapy get together and talk about how to grow in our work), I meet with colleagues who work from all kinds of different psychotherapy models besides DBT. This doesn’t meet standard DBT’s requirement of DBT therapists to go to weekly meetings made up of DBT therapists-only who are using DBT-only (rather than other models) to guide their meeting. There are pros and cons to everything, and there are definitely some big “pros” to the standard DBT approach, which I can tell you more about if you like. But in the end, for my work, I choose the “pro” of learning from psychotherapists with all kinds of different styles, which I get from attending “mixed bag” consultation meetings rather than standard DBT meetings. I think this keeps my work balanced and wise.
(3) My practice doesn’t offer any DBT skills-training groups, which are a major part of DBT. I’ll refer you whenever I can to free or affordable DBT skills-training groups in the community, but reality is that these aren’t always accessible to you financially, location-wise or schedule-wise. To make up for the lack of DBT skills-training groups in my practice, I include individual DBT skills-training as part of our work together (see “about my individual skills-training program,” later on).Even with these adaptations, I believe that my approach and skills in DBT are in-depth. In addition to ongoing reading, study and training in DBT, I also keep the following DBT-informed practices throughout my professional and personal life:
All that said, if you are looking for pure DBT rather than my adapted approach, I have some excellent colleagues to whom I can happily refer you.
“A Week* in the Life” of therapy
*Note that this looks slightly different for my biweekly clients (i.e., I do not offer phone coaching to my biweekly clients).
Every week in therapy with me, there will be:
a 1-hour face-to-face session,
an individual DBT skills-training lesson during the first 5-10 minutes of the above session,
at-home DBT skills-training lessons for you to do,
a daily DBT Diary Card to do and
DBT phone coaching.
Getting Started / Orientation
Our first four face-to-face sessions will jump around between exploring the following things:
your values, commitments, joys and strengths that could help us work through whatever problems brought you to therapy;
your wishes, hopes and dreams;
the problems that you’ve come to therapy for help with;
some goals for us to work on for our next block of sessions;
why these goals might (or might not) be things we’re each motivated enough to bother committing to work on together;
whether our commitment is strong enough, and whether our relationship feels like a good enough fit, to keep going into session #5 and beyond;
how many sessions our next block will be after session #4 (usually 20 sessions in a block, but we might decide on a different number).
In Every Session
From session #5 onward, we’ll:
(1) review your DBT Diary Card (see “About Doing DBT Diary Cards”);
(2) spend 5-10 minutes on individual DBT skills-training (see “About my Individual Skills-Training Program”);
(3) make a to-do list of things to cover in the rest of the session, which we’ll rank in this order of priority:
protecting your life.
protecting our therapy relationship and work together.
promoting your quality-of-life.
(4) go through our to-do list, focusing on:
things that help you to feel joyful, safe, strong or connected; or things that help you to act in sync with your goals and values;
things that increase the risk of you feeling miserable, overwhelmed, unsafe, or isolated; or things that go against your values or goals;
the “links” between the above things and what you might want to monitor, savour or change about those links.
(5) debrief about how our session went, and we’ll decide on your and my to-do’s before next session.
Wrapping Up a Block of Sessions
About five sessions from the end of our block, we’ll decide whether our work together will be over at the end of our block, or whether we’ll keep going together for another-block of sessions after that. This will be based on whether you and I both feel like there’s more we can work through together. If we decide to continue on for another block of sessions, we’ll still “wrap up” the one we’re in, by celebrating what you’ve accomplished, pointing out what’s left that you might want to keep working on, and any new hopes for the next block.
Saying Goodbye, When the Time Comes
Saying Goodbye can be really hard (at least for me!). So once we decide that we’re in our last block of sessions, we’ll start talking about what it’s like to be saying goodbye soon, what you’ve accomplished, and what we might want to set you up with to keep working on after we part. For our last session or second-last session, we’ll decide on some kind of Goodbye ritual: This might be exchanging cards or something like that. And we’ll decide whether or not to stay in touch by writing letters once a year or so, which will be totally up to you.
My Adapted Individual DBT Skills-Training Program
I’ve made an adapted individual DBT skills-training program, which uses standard DBT handouts and worksheets by Linehan and by Rathus and Miller, and which also uses the Headspace mindfulness app. You’ll be doing DBT skills-training in two ways:
(a) in-session lessons with me and
(b) at-home lessons with standard DBT handouts and worksheets and the Headspace app.
In-Session Skills Lessons
We’ll do individual skills-training lessons during the first 5-10 minutes of each face-to-face session. First we’ll take up your homework, then we’ll cover new material.
At-Home Skills Lessons
Like I’ve said, standard DBT teaches skills-training in groups because it can be a much more engaging way to learn. How do we make up for not having a group? That’s where the Headspace app comes in. Along with helpful guided meditations, it has tons of smart and fun animated videos that are waaaay more interesting than listening to me talk! So each week, you’ll be assigned five at-home lessons that will have info from me, and will send you to the Headspace app and the standard DBT handouts and worksheets.
DBT Diary Cards
DBT diary cards are a way to quick-and-mindfully journal each day. I’ll show you how to fill one out. Doing this has two important benefits:
(a) it can help you to grow your awareness of your daily experiences and patterns, which studies have linked with desired change even when you’re not doing therapy;
(b) it gives me a super-detailed update about your week in all of about two minutes, instead of taking up 40 minutes of the session!
We go over your daily DBT diary card right at the beginning of each face-to-face session, which helps us to make our session to-do list.
DBT Phone Coaching*
*For weekly clients only.
I offer DBT phone coaching between sessions to weekly clients because your day-to-day stuff often looks different than your therapy session. So I’m there on the phone to coach you in how to transfer what you’re learning in therapy to the rest of your life.
Each phone coaching call is about five minutes. We can talk by phone a max of once a day, four days per week (as in, not on my “weekend,” which is Sun-Mon, and not on your therapy day).
How this might benefit you
Psychotherapy can help you to grow different kinds of emotional mastery or wellbeing. For example:
feeling-your-feelings, without overwhelm;
being able to grieve painful things when you need to, without shutting down or falling apart;
becoming in some ways angrier and more “awake” to the harm done to you and others while also becoming more aware and appreciative of the love you do encounter in the world;
trust in yourself, and in others who have earned your trust;
respect for yourself and for others;
kindness and compassion, for yourself and others;
having more of an emotional filter;
having more choice about when, where and how you show vulnerability or “fall apart;”
calm, in the face of both contentment and discontentment;
deeper connections, with people and the world;
interdependence with others;
becoming more assertive, confident and unapologetic while also becoming more gentle, easygoing and humble;
friendship between your mind, body and emotions;
living more in harmony with your values;
These are just words and metaphors that some people like. If none of them resonate with you, that’s totally ok. We can talk about what your hopes are for psychotherapy in the words that matter to you; odds are, we can find a way for our work to honour those hopes and values.
To set up a free phone consultation, please contact me at **email@example.com. Alternately, you can text or phone me at 647 968 7628**. I’ll respond within 24 hours if you contact me Tuesday-Saturday, and within 60 hours if you contact me Sunday-Monday.
Alejandra Lindan, MMT, RP (she/her)
Registered Psychotherapist #001976