Saturday, November 22, 2014

Dr Suzanne Robison speaks about DBT

The very knowledgeable Suzanne Robison, PsyD - see her impressive website here - has a practice in Lansdale, PA. We learned about her since she spoke at one of the NAMI meetings.

Psychiatry/psychology loves acronyms she said. DBT stands for dialectical behavior therapy, invented by Marsha Linehan. It's an effective treatment for borderline personality disorder - BPD - a term invented by Freud.

First, she defined symptoms of BPD. You must have 5 out of 9 in order to earn this most stigmatized condition. 

Here are a couple off the top of my head:

-Fear of abandonment
-Unstable relationships
-Self-harm, such as cutting
-Identity problems

I hadn't known about 'inappropriate expression of anger.' Read about it here. 

We had a good turnout. Many came in late. One woman, who asked many questions, found out about us from the Intelligencer. They need three weeks' notice and I always forget to do it, but obviously remembered. is always useless, but I'm always in a panic and post it on there anyway.

We've had several people in New Directions with BPD. Just looked up one individual, who would tell me over the phone she was dying, but she is still living with her husband in Staten Island.

Reminded me of a case Suzanne mentioned. The woman had BPD and the man had dependency issues. He controlled her and she allowed it. Suzanne is working with him to loosen the bonds and for her to become more independent.

Suzanne teaches her adolescent clients the meaning of BPD, but that's not going to change their behavior.

They work both in groups or in solo sessions.

The person with borderline feels absolutely horrible inside. To them, the world is a scary place with little safety. They are acting out on others what they feel inside. Their behavior, they think, makes them feel good, but it only exacerbates the situation, which has been described as living a soap opera, with crises every single day.

Life is frustrating for the people who love a person with borderline. And they rarely know how to talk to their loved one, thus upsetting them more.

"I didn't want to upset her b/c I was afraid she'd cut herself more."

The goal is to live a life worth living.

Dialectical means 'opposite.' Dialetical statements have opposing view points such as "I think you're a kind person, but sometimes you push people too far."

A statement like this can provoke the client. They can end up in the hospital from cutting. But then they must pay the consequences with Suzanne.

She was first a drug and alcohol counselor, and then received training in DBT.

Suzanne describes herself as direct and confrontational.

25 percent of her clientele have borderline.

DBT makes use of cognitive behavior therapy - CBT - which is probly the only psychotherapy whose results have been studied and found effective.

Mindfulness meditation is one component of dialectical behavior therapy. Stay in the present moment.

B/c the client's emotions are so sensitive, she must be taught 'distress tolerance.' Whereas a regular person might get angry and feel it for a few minutes, not so the borderline person. She or he might not cool off for hours or even days.

Interpersonal skills are also worked on. How do we relate to other human beings?

It's believed that MM had BPD.

There are dialectical dilemmas suffered by the borderline person, which shows their black and white thinking - all or nothing - no shades of gray

Active vs. passive

Unrelenting crisis vs inhibited grieving

Idealism vs invalidation

Is the disorder learned or innate?

It's believed there's a genetic component that is brought out by the environment, the way the child is raised. Usually there has been serious trauma or invalidation by parental figures.

Suzanne teaches parents how to validate their children. You learn how to talk. Avoid phrases like "Your thinking is ridiculous!"

Say, instead, "I can understand how you feel that way.

Also avoid speaking in absolutes and using words such as - everyone, always, never - these imply that the world is an orderly predictable place. Be openminded to being wrong b/c we're not always right.

We can change things or we can accept them. We may not like them, but we can accept them. This is Eastern philosophy, Buddhist, Zen.

Acceptance. These concepts are also used by Alcoholics Anonymous.


Look the person in the eye.

Keep facial expressions neutral, no rolling of the eyes or huffing while the client/loved one talks.


Staying up all night with the loved one to help calm their nerves or make sure they don't cut. You might say, "How about if I give you a hug?"

These are enmeshed relationships. Controlling relationships. Defending the individual if they do wrong. Dependent on one another, thinking about each other more frequently than the average person would think of family members. Bad boundaries. (I'm thinking now of Lee Harvey Oswald and his mother Marguerite.)

Taking things personally.

Enabling by allowing use of drugs in the home.

Instead of cutting, do something pleasant for your body, such as Take a warm bath or light scented candles or talk to someone.


A slow process. Before DBT, no good treatments. Patients had chronic suicidality. They had gotten progressively worse. Wrong behavior was reinforced. Meds are not very helpful.

Suzanne tells her clients she is very bad with email, so don't email her.

Suzanne, dressed for the cold weather, left with our gifts

Further reading: 

I Hate You, Don't Leave Me by Kreisman and Straus

Stop Walking on Eggshells by Mason and Kreger.

Great Turnout at Coffeeshop Writers - My poem: December

Because we met late - 3:30 pm - after the New Directions' program on Dialectical Behavior Therapy - we were the proud recipients of a box of of goodies given to us by Cathy of the Beautiful Nails behind the counter. Likely, she loved our nails too and that's why she gave us

Each one of them a delicious sugary treat. Allan requested the Figure Eight. I would have chosen the one in the upper left. Or, no, gimme the one in the lower right. Wait a minute how about the ....

It was great seeing everyone since I was in NOLA last week. Really?

Today I debuted the painting of my Dr Scholl's shoes. Had to paint em cuz they remind me of my mother's orthopedic shoes

My granddaughter Grace, four, saw them at the Giant. She bent down and touched them.

"They're dry, Bubby," she said.

Beatriz's fascinating essay "Food Web in the Milkweed Patch" told how the plant protects itself by emitting several different poisons and playing 'cat and mouse' with those that would prey on it.

A particular kind of wasp spends its entire life cycle inside an oleander aphid, killing it and using it as food for its wasp babies. The aphid is turned into a "mummy."

Said Allan about the essay, "It imparts so much information w/o being pedantic." Yes, that's one of B's great gifts.

B/c she's from Argentina, I told her about an Argentine-made film I saw on Friday at the Huntingdon Valley Library:  The German Doctor - a true story about Josef Mengele who experimented on victims at Auschwitz. Read about this inhumane racist here. Born in 1911, he escaped from Nazi Germany before the end of the war and lived in South America until his death in 1979.

Allan presented an exciting flash fiction called "Silhouette" about homeless individuals in downtown Philadelphia. The narrator, an educated but not a very nice person, cannot stand these unfortunate individuals. "Get out of the way, you lousy panhandler!"

"Very entertaining," pronounced Floyd, "and I like the way you dropped hints" of who the narrator is. He is, of course, homeless himself, and kicked a man off a grate, so he could have it for himself.

Selfish man!

He wrote it a week ago.

Then, in a surprise, Allan read us his obituary and the epitaph on his tombstone. Also very enjoyable. People found it sad. I sure didn't. These are imaginary works of art.

Beatriz questioned the title "Silhouette." Allan said the homeless are shadows of their former selves, silhouettes.

We discussed the great oldies' song "Silhouettes." Carly was not familiar with it. I said I thought it was by The Diamonds. Let us see.

Here are The Rays - a doo-wop band - performing Silhouettes on the Shade.

But wait a minute! The Diamonds also performed it in a faster version, according to Wiki. Ach! I'm so proud of this ancient brain of mine.

Carly brought in "Do We Need More Automobiles?"

"At that magical age after blowing out the candles on the cake," the kid is ready to drive! From southern California, Carly learned to drive the freeways. Floyd added that people think nothing of driving 70 or 80 mph and tailgaiting. We'd all be terrified today!

Carly and Charlie's new SUV, the Chrysler Pacifica.

The two of them will spend Thanksgiving in NYC watching the Macy's Thanksgving Day Parade. In person and not on television.

Donna had a very emotional week and turned her feelings into a cathartic poem. Those of us who know her know who the source of her misery always is. And it is not her BF.

"The Mangled Mess," replete with assonance and alliteration - the former is vowels - the latter consonants (thanks for your help, Allan) tells of a woman

Matter that resembles seaweed is multiplying in my brain

She had great similes in the poem - a dumbwaiter cranking down. 

We can always expect something surprising from Martha.

GOD was the title of her short poem which traced the history of the word 'God.' In the Book of Genesis, the word was unknown. It was first used in the Germanic for "Good One."

When Moses asked The Burning Bush, it answered "I am what I am." The word for God was invented one to two thousand years ago. The Old Testament was written in the third century, BC.

The poem featured other names for gods such as Juno, Ares, Artemis, and my favorite Coyolxauhqui, a goddess, whose picture has been recorded 

This stele has been colorized - Ted Turner?

Martha ended the poem with Namaste, a Sanskrit word meaning, "I salute the god in you."

We noticed how dark it was outside. Carly, Donna and I stayed and chatted with one another for quite a while. Donna will be spending Thanksgiving with her son and his family, including grandkids John Dylan and Brittany. The baby-on-the-way will be called Brianna, also the name of Marf's granddaughter.

Donna usually reads a piece of hers at Thanksgiving. We laffed hysterically when she suggested she read "The Mangled Mess."

Oh, I read the start of my short story which I newly titled The House on Lincoln Avenue. I passed around the photo of the real house, which my sister Donna was interested in purchasing.

  Told the group that one of the seven books - egads! - I'm reading now is With Hemingway - about a young man who knocks on the door of EH's house in Key West and ends up being his best buddy.

EH, as Arnold Samuelson refers to him in the book, gave him a lot of advice about writing. They were all out on EH's yacht, for he had gotten rich from writing and having his books turned into films.

Poetry is easy, he said, referring to poet laureate Archie MacLeish, who was violently seasick on the boat and stayed inside his cabin. I can't remember a single MacLeish poem, so will look em up later. Maybe in ten years or so.

The best kind of fiction, he told Arnold Samuelson, who hailed from N Dakota - of Norwegian descent, is to not know what comes after the sentence you've just written.

Well, that's certainly me, with my new work. Since I'll probly stay home on Thanksgiving, weeping softly by the window, I can work on my story. I'm still coming off the 'high' of having "More Decaf Please" published.

Reason I wrote "December" is b/c I have a November I'm very pleased with. This, however, I am not pleased with. Que pense-tu?


Birth month
why must you be
so cruel?

Darkness come early
as when He lay
on the Cross

His rebellious
sobbing inside
the way all mankind
at that one clear moment
the truth

When will my time come?
Shall it be on a travel bus
toppling over, hearing screams,
smelling blood, as I pass from
here to there

The sun breaks through
the clouds and joy
reigns again
Gone are the nasty thoughts
I see my turquoise birthstone – huge -
on the ring of a man I admire

Did Jesus foresee the decimation
of his people of the buffalo
or those of The Rhineland?

Are we a despicable species?

Why they say God is good and just
is as opaque as a stone inside my shoe
Let me close my eyes to sleep
nearly certain I’ve got one more day
to celebrate the shimmer of life
and watch the red-headed woodpecker
who knows nothing of death
hammer on the bark of my
last remaining maple tree.  


"More Decaf Please" is finally published - A Night at the Fresh Ground Coffee House

Read it here.

It's such a relief when my stories finally get published. Like sending your kindergartner out by himself to the bus and you see him safely step aboard.

At the Willow Grove Bible Church "Fresh Ground Coffee" event tonite, I had an in-depth discussion with Burt, a physician and a missionary. Told him about getting the story published and how I deal with rejection.

I have a ritual. Two huge documents are on my upstairs computer. "Submissions Many" contains dozens upon dozens of lit mags where I've submitted stories and poetry. Bc "Decaf" was just accepted, I type it into the Mad Swirl category - that's the name of the publication, after a Jack Kerouac quote - and note that I submitted it June 26 and it was accepted November 21. Long wait.

Then I go to "All Short Stories" and look up More Decaf. It's been rejected - quickly - by Haunted Waters Press (which published my Mail Order Couch poem) and Caketrain.

I told Burt that this lessens the sting of the rejection. He is a great listener.

Was talking about my recent trip to NOLA and I said I blogged about it. "I had to," I said. "There's no way I couldn't have written about it," I said.

"You were compelled to write," he added.

"Yes, that's a good way to express it." And asked if he were compelled to do something.

"Pray," he said. "I've been praying all my life."

He told me some fascinating spiritual stories, one about his getting anointed by God. These people are believers. Many, like Pastor Ken, came to God and Jesus after rejecting them.

They are ultra-radical on the right. The Bible is the word of God. Every word is the truth. The world did not evolve. The Lord created it.

What's the purpose of life? I asked Burt.

"To love and be loved by God," he said. 

Fresh Ground Round created a new tradition..... a Prayer Room where you enter and Pastor Ken and one of the women will pray with you, if you wish.

I must try it, I thought and was happy to see that Joni, Burt's wife was the woman.

Pastor Ken has a beautiful speaking voice. Powerfully male, with a gentle quality and a musical quality. And a firm handshake.

Joni is an incredibly warm woman with intense listening powers like her husband Burt.

I asked Pastor Ken his view on homosexuals. Bc of the sound of his voice, I was certain he would accept them.

I was wrong.

Homosexuality is a sin, he stated confidently. My heart was crushed, but I did not let on, nor did I say a mumbling word. Just nodded. And could not wait to get out of there into the fresh cold air of freedom.

Will work on my short story, unnamed as yet, that begins, "You'll laugh when you see where I live."

Click here and you'll see where she lives.

"Copy image" is not available to bring it to you.

I'm fading fast, despite four cups of delicious hot decaf at the church. I'll give myself till 1 am and then fall into bed.

Thursday, November 20, 2014

Ingrid Waldron's talk on communication at Warminster Hospital, Warminster, PA - Poem: The Night of Your 302

Ingrid Waldron, PhD, is a research biologist who teaches at University of Pennsylvania. She's also president of NAMI Main Line and gives talks on how to communicate with a mentally ill loved one.

I'm also a researcher and just figured out why I left my red notebook in the kitchen instead of bringing it out into the living room to use for this blog post.

It's called 'the law of two.' I went into the kitchen to retrieve my red notebook

and also to fill a bowl with almonds.

Apparently, at my age, late sixties, I can't remember two things at a time. Sadly, true.

Ingrid is also a lay counselor. Here's a website that shows her publications.

I was happy to see Raighne there. He's on the board of NAMI Bucks County, which hosted the event.

I can't show my photo of director Debbie Moritz - the greatest! - bc she's chatting with one of the 25 or more attendees.

Reighne is an assistant teacher - English and Special Ed - at an excellent high school in Bucks County. Can't remember the name - Central Bucks perhaps.

When he saw me, he said, "Too cold to go to Lake Galena."

Told Reighne - and this is the first time I'm spelling his name correctly - that I sent in a photo of myself to a lit journal, while paddle-boating with his mom on that great glassy man-made lake.

This book - third edition - is the bible of communicating with a mentally ill loved one. Ingrid noted that it can be used to communicate with anyone.

Except if you're President Obama trying to talk to contrary Republicans. While we were at Warminster Hospital, he was addressing the nation with his immigration reform plan.

Can't wait to read about it.

NY Times photo. I spose I'll listen to the pundits on Charlie Rose at midnight.

COMMUNICATION, said Ingrid, is a two-way process. Listening is crucial. You must really listen to your mentally ill loved one and pick up clues about what matters to them.

Doing so will contribute to greater compliance with treatment. Do 'reflective listening' with curiosity.

"I hear that you're very upset about...."

Perhaps the individual believes that the CIA are tapping the phones.

"That must be really scary," you say, empathizing with them.

If an individual is delusional, you can't argue with them. There's no way they can respond to logic. Ingrid said it reminds her of her 4-yo granddaughter who is so stubborn she won't change her mind.

Hmmm, that sounds like my 4-yo Grace Catherine, PhD of Stubbornness. 

We all want to refute untrue ideas from our loved ones. Allow their criticism of us to flow over us. Pretend you're in a movie and don't react. I did hear on the Charlie Rose Show, that Obama is supremely confident and doesn't care about the opinions of others. That's because, he said, Obama is not a politician in the traditional sense. 

   Sadly, the director, Mike Nichols, died yesterday of a heart attack in his Manhattan apartment. Diane Sawyer was his wife.

Ingrid said that when your loved one talks to you, you must be relatively calm. You must take care of yourself b/c this will be a lifetime challenge.

Change or transition is exceedingly difficult for people with mental illness. Our group consisted of parents or siblings of folks with schizophrenia, bipolar disorder, and borderline personality disorder. At group's end I mentioned our upcoming program on DBT this Saturday at the Giant. Nothing worse than an empty room.

To take c/o yourself Ingrid suggested people attend NAMI groups or call someone on the phone to vent. Vent b/c of all the things you could not tell your loved one b/c it would loosen the bonds of trust. So tell someone who knows what's it like.

You must find out what works for YOU. Every situation is different.

To communicate, use I sentences and choose your battles.

"I need you to take out the trash."

People in the audience shared their concerns. One woman said she had to watch her ill son "give up his dreams."

This was a tough one: The elderly mother died. The ill son had lived with her his entire life.

He will not hear of moving elsewhere. Does not respond to conversation.

Ingrid said it will take a while before he's ready to hear about it. Keep planting the seed.

SET LIMITS. I'm just not open for business at all hours, said Ingrid. There's too much distress she listens to.

Find a time when you're calm and can talk to your loved one.

Speak in brief, concise sentences. Be specific.

"Please finish loading the dishwasher."

Don't use expressions like 'always' or 'never.' The loved one will take them literally.

When speaking, stick with one thing. Be willing to negotiate.

"Change" is a long process, whether it's smoking cessation, getting more exercise, or eating almonds every night before bed.

In the book, Xavier Amador, who was born in Cuba, and has a brother with schizophrenia, advocates for the LEAP system. Amador doesn't have a Wiki page, but you can read this interesting piece about him. I sure will after I finish this post.

LISTEN. Reflect back
AGREE, finding areas of agreement. Maybe the two of us like the NY Yankees.
PARTNERING - we can achieve goals, little by little.

Below is one of a dozen poems I've written about mental illness.

3 0 2

The following poem was written when I worked as a psychotherapist at Bristol-Bensalem Human Services in Bristol, PA. “302” is a nickname meaning “involuntary hospitalization.”

I watched
through the glass doors
of our mental health clinic
for the person to be 302d,
he would walk through
the outer doors,
a man who’d lost the
finer workings of his mind,
and would be delivered up
for safekeeping by the cops,
escorted into a tiny room that locked
and was filled with windows
that can’t be broken.

They were wild sometimes,
crying out in broken words,
fighting to escape their captors,
believing until the end
deliverance was at hand.

From my perch at the door
the doctor joins me.
She is eating an apple and
talking about going out for
Chinese food after.
302-ing makes you hungry.

I tell her that once
I had ridden
in the back of a police car.
My senses gone,
radiating to the
staccato points of night
and the babble of the police radio,
I leaned forward in my backseat nest
like caged Hansel in the gingerbread forest
and stuck my little finger
through the iron grates that contained me.
It was all I had of freedom.

“Were you scared?” the doctor asked.
“Why, not at all,” I said.
“I thought they were taking me to a live
performance of the Nutcracker Suite.”

Thinking I was kidding
she crumpled up with merriment.

We watched as a police car
pulled in sideways.
Black letters like ribbons scrolled
across the door.

I watched as
a man stepped from the car,
steady, unafraid,
handsome as a game show host
striding on stage
to marvelous applause.
his hair uncombed with
great prodigal waves falling upon
his brow,
his face had a pulled-down look
I hadn’t expected to see.
He’d played his chips and lost.

Chin up, I whispered.
This is your hour,
for now --
for all time.
Use it well.
Don’t get hurt,
run a comb through your hair,
And, for God’s sakes, pay attention
with whatever’s left inside you,
for this is the night of your 302.