dbt: behaviour chain analysis worksheet


working this one and finding it quite illuminating:

a worksheet from the 18 week peer led dbt workshop i am participating in

downloadable blank worksheet


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“What I perceive as the goal of DBT is to learn how to live a life that reflects and embraces all of the paradoxes inside me.” – innerlight


government-funded mental health care for BPD in bc, canada

When I saw my family doctor the other day, I told her that I was unclear and concerned about my care plan at my local mental health branch of the


British Columbia, Canada

Vancouver Island Health Authority (government funded mental health facility, referred to as VIHA). Her response and the discussion that ensued was one of the most useful conversations I have had with a medical professional here, despite the fact that it caused me to go into a dissociative state of depression, the subject of my recent post ‘authenticating my symptoms — dissociation & its ingredients. The state of dissociation from abandonment and invalidation has shifted to one of anger and activism that motivates me to write this article.

Although the stated mission of VIHA is “Serving and involving the people of the islands to maintain and improve health,” and although their website is rife with terms such as “Accountability”, “Quality of Care” and “Competence”; in my experience, which has now been confirmed by my family doctor in a generous and compassionate moment of candid honesty, treatment leading to recovery is not a realistic expectation of the services VIHA is currently able to provide.

The bottom line is that while psychotherapy and, in the case of BPD, DBT in its true and traditional format, have proven themselves to be the most effective in recovery from mental health issues and addiction; in BC, mental health patients pay for therapy themselves. Furthermore, professional therapists who are privately paid for, while being the most integral part of most recoveries, do not have the authority to sign government paperwork to qualify a person for (short-term orlong-term) disability support. So who does have this authority? The word “authority” in VIHA implies that VIHA does.

R. Sponsel's 'Tree of Psychotherapy'

R. Sponsel's 'Tree of Psychotherapy'

So, if VIHA is not offering the therapy that leads to recovery, what are they offering? The answer that my own personal experience of VIHA has provided so far, and which was emulated by the candid conclusions of my doctor, is that VIHA provides a monitoring and reporting service to the BC Ministry of Social Development’s program of Social and Disability Assistance.

This conclusion is not meant to dis-credit VIHA for the fact that it does provide immediate, critical care to people in crisis. Relative to the rest of the world, I don’t view it as any small grace that there is a crisis line, short-term emergency hospitalization and crisis counseling available to people in crisis. The area of care I am examining in this article is how a person with limited financial means who has been through a crisis, or experiences a cycle of crisis’ in their lives, finds long-term treatment and recovery for themselves. My point is that finding these services is not as straight forward as VIHA seems to imply; that actually, VIHA and related government services currently offer little in the goal of long-term recovery and sustainable well-being.

My doctor supported my conclusion that my contact with VIHA services serves one sole purpose that does not include the therapeutic experience of healing that I had been expecting and waiting for. The purpose of my sporatic and intermittent visits with the “case worker” every few weeks is to maintain my connection with the BC Ministry of Social Development, ensuring that there is an official representative who is able to speak on the most basic and generic level to my qualifications for financial support.

I acknowledge here that recovery is a very individual process, and that for some people, my local VIHA branch’s day program, based on Cognitive Behavioral Therapy, is a novel and useful experience in self-awareness that therefore has a positive effect on their mental health by initiating a new way of experiencing themselves and their lives. I celebrate this, and yet at the same time, I do not fit into this category of patients, as a person with BPD and as someone with a lifetime of experience in personal growth. I have been utilizing personal growth and awareness techniques and alternative health practices for most of my life, which is what allowed me to survive thus far in my life; but these things did not prevent me from attempting to end my life 6 months ago, ending up in the psych ward and being diagnosed with Borderline Personality Disorder and Generalized Anxiety Disorder. While it has been a genuine breakthrough and an integral piece of validation for me to receive these diagnosis’ in their inherent acknowledgement of deeply rooted patterns of self-sabotage, this is only the first step in recovering from these things; I have been proceeding since with the expectation that VIHA could offer the treatment of these “conditions”, and it is this expectation that I have now concluded to be unrealistic.

Fellow bloggers and the authors of all the BPD recovery books I have been reading (e.g. Rachel Reiland’s ‘Get Me Out of Here’, Kiera Van Gelder’s ‘The Buddha and the Borderline’, and Jerold J. Kreisman and Hal Straus’ ‘I Hate You, Don’t Leave Me’) — seem to have access somehow (through government-funded services or their own financial means) to group therapy programs at their local hospitals, and individual psycho-or Dialectical Behavior Therapy based therapy sessions several times per week, my reality is drastically different. The “free” services available to me are crisis management and intervention and intermittent therapy sessions with an assigned case worker who is supported by a professional psychiatrist and psychologist who serve as consultants for all the case workers at my local mental health branch. The realization that is key for me is that my case worker a) is not available with enough frequency and b) is not qualified to provide me with the intensive experience of DBT or transference that has healed so many fellow sufferers of BPD in other parts of the world.

Connections I have made with others in my position have revealed that recovery from mental illness here in BC is one of synergistic, miraculous connections with “the right” counselor who may not be qualified to sign the government forms for social assistance, but who is able to make a difference in the long-term stability and well-being (recovery) of the patient. The other day, I heard a story of a renowned psychologist who offered his services free-of-charge to an acquaintance of mine who has been in recovery for over a decade, seeing addictions and mental health case workers and counselors while being unable to work.

'Angel of Universal Love' by Tome & Renee West

'Angel of Universal Love' by Tome & Renee West

So where would we be, as a community of borderline and ptsd patients here in BC without the spontaneous kindness of such doctors and the seemingly miraculous connections we make with peers and alternative healing techniques? This is a question that VIHA may want to ponder and acknowledge in their presentation of services. In my current position, VIHA is my connection to government financial assistance; but the real healing will take place through what I have come to believe as the grace of a higher power and the resulting synergy of the connections I am able to make with others on authentic paths of recovery that cannot be served by the current health care system.

I think it is a rare case that healing comes easily to anyone, anywhere in the world. This is not something that you can google, get the information and take the pill for; it is not offered as a 2 for 1 special at Wal-Mart, and there is no representative icon to click on, on any website. Regardless of available resources of knowledge, finances and personnel, no external force can be our guiding light; no one system can truly meet the needs of individual well-being, and that is perhaps the most difficult and integral part of any person’s recovery — becoming authentically aware of the resources within ourselves and the people we encounter when we begin to live authentically. In this world of instant gratification that seems to disregard and attempt to control the underlying mystery force that truly governs our existence, we must embark on the underground journey to find the universal well of compassion and support that is available to all of us in our search for fulfillment, happiness and well-being.


diary card experiment — posting #1

Note: Since this posting, I have posted an diary card experiment — posting #2.

a Diary Card is something used in DBT. To view and/or download a typical diary card, click here.

i haven’t done DBT, but I’ve been reading up on it, and after a conversation with one of my recovery buddies, I was inspired to create one for myself. It is extremely personalized to me and my symptoms, so that when I am feeling confused, I have a way to identify how I am really doing, get myself out of confusion, and take action if necessary to return to balance. Here’s my template. Tell me what you think — what is your diary card?

my personalized diary card


(10 is extreme presence of symptom)

Impulsivity   __ / 10

Compulsivity   __ / 10

Escape    __ / 10

Procrastination   __ / 10

Scattered  __ / 10

Neglecting Self-Care   __ / 10

Isolation & avoidance  __ / 10

Confusion  __ / 10

Anxiety  __ / 10

Total Symptom Rating:  __ / 90


Sense of balance and well-being:  __ / 3


(things I am grateful for / what I learned today)


dialectical vs. cognitive behavior therapy

These excerpts speak about the experience I had with cbt, and seem to illustrate well what is different about dbt from cbt. click on the headings to view the sources. Continue reading

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core beliefs: making sense of the chaos

Parts of my story are revealing themselves. Not the physical who’s and what’s but the internal experience of the events in my life, while looking at Core Beliefs and how they were formed in me.

The situation that caused me to remove myself this spring was a “damned-if-you-do, damned-if-you-don’t”. It was a gradual build-up that crescendo’d, as everything in my life became unbearable and my authentic self seemed to be demanding I:

change.         everything.            leave.             everything.

my marriage, my job, my career identity, my home, my geographical location and a $50,000 national scholarship award for leadership.

leaving all these things at once was unbearable, and felt impossible with the level of cumulative stress and exhaustion i was feeling. who in their right mind would leave all these things at once? and yet, not leaving them was also unbearable.

I’ve spent my whole life with one foot on the ledge of validating the dysfunction in my present life, and one foot on the ledge of needing to have it validated for me. All the common affirmations of “seeing things in a more positive light”, “not focusing too much or dwelling on the negative” and “not being too hard on myself” are what have kept me straddled between the two realities.

By the time of my crescendo, I had lived in one place for long enough that I felt enough people were “on” to the negative core beliefs I was hiding / over-compensating for / resisting through positive thinking, for me to feel humiliated and isolated; yet no one would tell this to my face. Once again, I didn’t know what to believe. The crevice between the two worlds — 1) There’s nothing wrong with me; it’s how I’m choosing to see myself and 2) There IS something wrong with me and I need to get honest with myself and others and stop over-compensating — this crevice opened up wide, and I fell down the middle because I couldn’t decide.

Looking back on my childhood tonight, I wrote:

I was repeatedly, and then traumatically, invalidated and abandoned. The foundation of my ability to perceive reality was neglected, bombed and then left to rot. Inside me there is this chronic landscape of the aftermath; rubble, chaotic and desolate disarray.

I think this might be my own personal description of bdp. another one floating around in my brain lately is that I am awake during the operation of living — the anaesthetic didn’t work, but no one knows. i wish i could stop pretending to be asleep.

what’s your definition?