This month, we’re talking with systemic psychotherapist Deirdre Hayes about her work at MyMind, borderline personality disorder and dialectical behaviour therapy.
This the second instalment of this interview in which we will talk about dialectical behaviour therapy and its accessibility in Ireland. Read about Deirdre’s work at MyMind and her knowledge of BPD in the first instalment of this interview here.
Could you tell me about Dialectical Behaviour Therapy (DBT)?
DBT is, at its most simple description, an advanced form of cognitive behavioural therapy (CBT). Its founder is Marsha Linehan, a psychologist who suffered from severe depression and, indeed, in her youth, attempted suicide multiple times. She was hospitalised, but never got the right treatment. She felt that there were aspects of CBT which were useful, but that it was based too much on thoughts and not enough attention was being paid to people’s emotions. She added on some very important components. Linehan’s two key points are that people need to be validated and practise mindfulness.
By validation, she means that people need someone to acknowledge that their feelings are real and that it makes sense for them to have those feelings. The therapist needs to convey deep-down acceptance of the person they’re talking to. A good DBT therapist will spend quite a lot of time talking to somebody on a one-to-one basis to really pay attention to their feelings.
The other really important component of DBT is mindfulness. Even though we have been wired to think in certain ways throughout our life from life experiences, we have some element of control over how we want our mind to work from now on. Mindfulness brings us back to the present moment. This helps people to develop some level of stability in their life and they can then calm themselves down, regulate their breathing and tackle what is happening to them.
DBT really came as a lifesaver in terms of a really formulated, structured programme of treatment that people attended for a year or two. There are methods of helping people through coaching, group work and individual work.
Linehan did a lot of research and she discovered that there are four levels of people who can benefit from DBT. The first level of people is very severe – they are in and out of hospital due to very severe self-injurious behaviours. The second level of people have post-traumatic stress disorder – people who have had severe adverse events happen to them in their life. The third level includes people with everyday life problems – people who can’t hold down a job very well, fight with other people in their family a lot, or who just really are having difficulty with their relationships. The fourth level consists of people like you and me. I use DBT in my life – I try to practise mindfulness regularly to keep myself centred. Is that DBT? Yes, very much so.
It can be hard to find DBT in Ireland. Will it be something we will see more of in the future?
There are lots of therapists who are interested in learning about different components of DBT and who are upskilling themselves in those areas. All of the therapists in MyMind were invited to the DBT mental health services in Cork – about 20 of us went and we had an introduction to DBT from Daniel Flynn, who is the head psychologist there. I had already trained in DBT and I’ve been teaching DBT to therapists for a couple of years. I believe that DBT is beginning to take off in Ireland.
You’ve mentioned that DBT is mostly accessible through the HSE – What if someone was unable to wait for public health care but unable to afford private health care? Would MyMind be accessible for DBT or would you recommend alternative therapies?
Feeling accepted and validated are major components of DBT. A lot of therapists naturally practise acceptance and validation and I think to feel heard and understood is something that is very important for people.
I would encourage people to come to any of the MyMind therapists because feeling accepted and validated are core parts of DBT and are actually also core parts of any good therapy training. This means that any of the MyMind therapists could help those looking for DBT.