Category: blog

Trick or Truth? How to Change Unwanted Emotions by Checking The Facts
Picture this: You’re alone in your home and hear a loud sound coming from the next room. Immediately you think, an intruder is in the house. Panic sets in and your heart starts racing. You’re terrified, of course, because you’re in danger. . .or are you?

Research shows that often it’s our interpretation of an event, rather than the event itself, that leads to unpleasant emotions and potentially ineffective responses. Take the above example: If you thought an intruder was in your home, perhaps you’d barricade yourself in your room and listen for hours until you felt sure it was safe to come out. Maybe you’d try shimmying down your fire escape to get to safety. Maybe you’d freeze in your tracks, paralyzed with fear. But let’s step back for a moment and think about what are some other possible reasons a person would hear a sound coming from the room next door when they thought they were home alone?

Maybe the heat turned on and the radiator is the culprit.

Maybe a pet knocked over something.

Maybe a family member came home early from school or work.

If you came up with any of those reasons or other benign possibilities, then you probably realized that scaling the firescape or building a barricade might not have been the most helpful move. Altering your interpretations and assumptions about a situation can help you change your emotional reactions to it and even respond more effectively to it. But how do you go about shifting those beliefs? In DBT, we use a skill called Check the facts.

Checking the facts helps us figure out whether our emotions, their intensity, and/or duration, are actually working for or against us in a given situation. It encourages us to ask ourselves, Am I responding to what’s directly in front of me right now, or to my own thoughts about it?

So how does one check the facts? Follow these six steps:

Step 1: Ask yourself, What is the emotion I want to change?
- I always say, “You gotta name it to tame it!” Labeling emotions is a powerful first step in being able to manage them. Take a moment to observe your thoughts, physical sensations, and urges. You can also rate the intensity of the emotion on a scale from 1-10 or 1-100. Rating your emotions before and after trying a skill can help you evaluate if it was an effective intervention.
Step 2: Ask yourself, What event sparked this emotion?
- Here you want to be sure to only describe the facts that you directly observed. Use your five senses to help you. What did you see? What did you hear? Oftentimes our descriptions of events are infused with assumptions, judgmental language, and extreme interpretations, which can spark intense unpleasant emotional reactions. Sticking to the facts of a situation can help us balance our emotions.
- Take a look at the two statements below and consider which one evokes a stronger or more unpleasant emotion:
Step 3: Ask, How am I interpreting this event? What assumptions am I making?
- In the texting example, the first statement contains a few different assumptions and interpretations of the facts. First, the narrator assumes they aren’t receiving a text back because the other person “hates” them and thinks they’re an “idiot.”
- Once you’ve labeled the judgments, assumptions, and extremes in thinking, come up with some other possible innocuous interpretations. Oftentimes, we have a negativity bias that keeps us from viewing all sides of a situation, so considering benign alternatives can help balance things out. Here are some examples:
Step 4: Ask yourself, Am I assuming a threat?
- Oftentimes unpleasant emotions are the byproduct of thinking that some type of feared outcome is on the horizon. You get a D on a test and figure you’ll fail the course. You wave to a friend who doesn’t wave back and assume he’s angry with you. You get passed over for a job opportunity and conclude that you’ll never rise up the ranks.
- Once you’ve labeled the threat you can ask yourself, How likely is it to occur? What are the chances that this horrible thing I’m imagining actually comes to fruition? Usually, once we step back and start asking critical questions, we see that the undesirable outcome isn’t as likely as we’d originally thought.
- Going back to the texting example, it’s possible that the narrator has concluded that not receiving a text back means the texter is angry with them for something they did, or maybe even that the relationship is over. It’s now up to the narrator to consider what are the odds of those threats coming true.
Step 5: Imagine yourself coping with the catastrophe
- Sometimes the threat really does happen, but spiraling out rarely helps the situation and frequently exacerbates it. Instead, DBT encourages folks to consider what coping with the situation would look like. So how would you deal with failing the course or losing a job? How would you handle it? What would your next move be?
- It can be helpful to actually visualize yourself coping well with the situation. Picture yourself handling it effectively, and jot down the steps you would take to do so.
- If the narrator in our example was broken up with, perhaps they’d start off by talking to a friend about how disappointed they are that the relationship is over. Maybe they’d spend some time doing fun activities they enjoy to bring some positive experiences back into the picture. Having an action plan and envisioning things going well can help lower the intensity or reduce the duration of an unpleasant emotion.
Step 6: Reflect on your emotions now
- Now that you’ve gone through the above steps, you can ask yourself, Does my emotion fit the actual facts of the situation? Remember, a lot of times our emotions are set off not by the events themselves, but by how we think about them.
- That said, there are totally times when your emotions will fit the facts. Every emotion, including fear, anger, sadness, jealousy, and more, has its place and makes sense in certain situations. Even if you find that your emotion was justified given the facts, I’d encourage you to check your emotional temperature. Is it as high as it was in step one? Sometimes walking through the above steps is enough to help modulate the intensity of an emotion or curb its extent.
Stay tuned for more ways to get unstuck from emotions in our next blog post!
November 1, 2022
Understanding Suicidality & DBT’s Approach

Suicidality is a prevalent and complex problem in society today. As September is Suicide Awareness Month, it seems timely to revisit DBT’s approach to this global issue. In DBT, we try to understand what emotions are driving a client to suicide while also motivating clients to choose behaviors that fall in line with a life that is worth living. Oftentimes a client doesn’t necessarily want to die, rather they are in immense emotional pain and do not have the skills to ameliorate their intense emotions and pervasive thoughts. The model of comprehensive DBT, which will be detailed in this article, has been proven to effectively decrease the likelihood of ongoing behaviors. DBT’s approach focuses on preventing suicide while creating a “life worth living.” Thus, the objective is to enhance life instead of shielding the client from their pain, which is what suicidal behaviors aim to do.

The Biosocial Theory

It can be extremely difficult for loved ones to fathom how their friend/family member came to such a desperate place, and often loved ones do not know how to validate the pain they are experiencing for fear that this could lead to increased suicidal or self-harming behavior. It is crucial to understand DBT’s biosocial theory, the importance of validation, and how to invalidate the invalid. For instance, you might say, “it is completely understandable that you are feeling miserable in this situation and suicide is not the answer.” DBT’s biosocial theory posits that it is a transaction between innate emotional sensitivity and an invalidating environment that leads to emotion dysregulation and an inability to tolerate extreme distress, resulting in suicidal and self-injurious behaviors. Emotional sensitivity is characterized by high sensitivity, reactivity, and/or a slow return to baseline. Invalidation occurs when a person’s environment communicates, either directly or indirectly, that their private emotional experiences or expressions are “wrong.” While the term “invalidating environment” conjures up images of abuse and overt cruelty, this is often not the case. Many invalidating environments take the form of discouraging “negative” emotions or oversimplifying problem solving. For instance, if a child is crying, their caregiver might say something to the effect of “Why are you crying? There’s nothing to cry about” or “If you could finish your schoolwork on time, you wouldn’t be in this position.” These invalidating statements tend to affect people who have a high level of emotional sensitivity far more than those without a sensitive temperament. Thus, the emotionally vulnerable person becomes reactive, trying to prove that their emotions are in fact valid, which then escalates the invalidation from their environment and the transaction continues.

DBT’s View on Hospitalization

Many clinicians will choose to hospitalize their suicidal client as a means to keep the client safe. While this intervention may be effective in certain contexts, it is not always. DBT’s approach and stance on hospitalization is quite different from that of other therapeutic modalities. DBT routinely uses outpatient treatment in order to navigate suicidality and increase life satisfaction. While hospitals serve as good holding cells, preventing clients from harming themselves, there is no evidence that hospitalization decreases chronic suicidality any more than outpatient treatment does. In fact, there is some evidence to support the theory that hospitalization may actually have iatrogenic effects on suicidality. Data shows that not only is suicide the leading cause of death on inpatient psychiatric units, but that clients are at highest risk for completing suicide in the week to year following release from an inpatient facility. Additionally, DBT clinicians believe that hospitalization inadvertently reinforces suicidal behaviors, as clients learn that they will be contained and nurtured following a suicide attempt or self-injurious behavior, in essence, validating the behavior. While there are some exceptions, it is for these reasons that DBT therapists steer clear of hospitalization whenever possible.

A Life Worth Living Program

The primary focus of DBT is to help the client create a life for themselves that they feel is worth staying alive for. The individual clinician assists their client in creating a “life worth living” by first looking at their values in order to determine goals for their lives. Once the client has set some short and long-term goals, the clinician guides them through the process of breaking down goals into action steps which are specific, measurable, achievable, relevant, and time-bound (otherwise known as SMART goals- see fig. below). As the client progresses in their recovery and they begin to achieve their set goals, they become more motivated to continue their lives in a way that feels meaningful to them.

The Treatment

The comprehensive model of DBT includes five components (see fig. below). The components of DBT are as follows: Individual psychotherapy, skills training, phone coaching, clinician consultation team, and case management (as needed). Each component serves a function that helps to relieve chronic suicidality and increase the possibility of creating a valued life. Weekly individual therapy aids to increase clients’ motivation and decrease maladaptive behaviors. Skills training, usually executed in a group format, addresses clients’ skills deficits and enhances capabilities in the areas of mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Phone coaching, in which DBT clients are able to contact their individual therapist for skill strengthening and generalization, ensures that the skills learned during group are generalized to all contexts of the client’s life. Case management, when needed, functions to psycho-educate and to structure the client’s often chaotic environment. Finally, the DBT consultation team is a weekly meeting in which individual clinicians enhance their own motivation and capabilities in order to best serve their clients.

If you or a loved one is experiencing suicidal behaviors and/or non-suicidal self-injury, there is a solution. DBT is an evidence-based treatment to address these very behaviors. DBT clinicians strive to be non-judgmental in their approach while balancing acceptance and change-based strategies. They teach this balance to their clients, encouraging them to find a middle path between accepting the reality of their lives and their pain while pushing themselves to change what they can control in order to make their lives worth living.

October 3, 2022
How to Live in Accordance With What Matters: A Crash Course on Acceptance and Commitment Therapy (ACT)
What the heck is ACT? If you find yourself thinking, “another type of behavioral therapy? Another acronym?!” I would get it. It’s true, as a therapist, I geek out on this stuff. But I wouldn’t write a blog post about it if I didn’t think it was really worth your time.

So what is it? ACT is all about accepting what is out of your personal control and committing to action that enriches your life. What do you want to stand for in your life? What truly matters to you? Once you clarify your core values you can use them as guides to motivate and inspire behavioral change.
- Accept your thoughts and feelings, and be present
- Choose a valued direction
- Take action
How is this different from other types of therapy? We are often being sent messages about the need to control our emotional states. Think about the self-help section in a bookstore: You see titles like “How to Feel Less Stress” or “5 Ways To Find Happiness.” At some point, all of us probably received feedback about getting over an unpleasant emotional state. It’s what I like to call the wipe off your knees and keep going mentality. When we buy into this, we tell ourselves we’re not doing a good enough job– if we feel too much stress, anxiety, fear, shame, guilt, and not enough happiness or joy. When we internalize these messages we try to control our thoughts and feelings. In ACT, we believe that thoughts and feelings themselves are not pathological. We don’t need to chase them down and change them. Rather, the focus is on relating to them in a different way by accepting their presence, fully and without defense, and choosing what you will or won’t do based on your personal values. It sounds nice, but how do we actually put that into practice? In ACT, there are six core processes that can help guide you: defusion, self-as-context, presence, acceptance, values, and committed action. Each of these processes comes with a number of different skills. For this blog post, I will explain each step and scatter into some exercises.

Defusion:

We get caught up in our thoughts; we take them as capital “T” truth and often see the world through the lens of a painful thought we have about ourselves, others, or the world. Defusion is about stepping back and detaching from inner thoughts or images. Instead of getting caught up in our thoughts, we let them come and go. We see thoughts for what they are– nothing more or less than words or pictures. We hold them lightly instead of clutching to them tightly.

Exercise: Take a painful thought such as, “I’m unlovable” and get a bit of space from it by inserting one of the clauses below:
- “I’m having the thought that [“I’m unlovable]”
- “When I experience the emotion [shame], my mind tends to tell me [“I’m unlovable”]
- “The story I tell myself is [“I’m unlovable”]
The Observing Self (also known as Self-as-context):

There are two elements of the mind: The thinking self and the observing self. The thinking self is the part of us that is always thinking– generating judgments, fantasies, beliefs, and so on. The observing self is less talked about in our culture. This is the part of us that is aware of whatever we’re thinking, feeling, sensing, or doing in any moment. Throughout life your body, thoughts, roles, and feelings all change but the “you” that’s able to notice or observe all those things never changes.

Contact the present moment

Our judgmental, problem-solving minds constantly pull our attention away from the present. Why? We want to avoid suffering and we yearn for orientation– to know where we are in our life journey. But instead of orienting ourselves, we end up ruminating about what’s happened in the past or worry about what will happen in the future. Both of these “thinking self” processes are associated with depression and anxiety. Contacting the present moment is about mindfulness, defined as “paying attention in a particular way, on purpose, in the present moment, and non-judgmentally” (Jon Kabat-Zinn).

Exercise: Try this simple 6-minute meditation

Acceptance:

When we try to avoid uncomfortable thoughts and feelings, we demonize natural human experiences. Our efforts, energy, and attention are spent trying to control unwanted inner experiences and we feel even worse when they show up. Avoidance is not workable as a long-term solution. As we say in ACT:

If you don’t want it, you’ve already got it.

If you aren’t willing to be anxious, you will feel even more anxious.

If you aren’t willing to feel pain, you will feel even more pain.

If you keep doing what you’re doing, you’ll keep getting what you’re getting.

The goal of acceptance is a willingness to make room for uncomfortable feelings, sensations, urges, and emotions. Instead of struggling against them, we open up to them and let them be. This does not mean you have to like it or want it (anxiety IS uncomfortable), but it’s about allowing yourself to have it. In fact, the wisdom of pain is that it tells us what matters most. For example, I might feel pain if a friend is upset with me or I might feel anxiety after a social interaction. What those uncomfortable emotions tell me is that I don’t want to hurt my friends or that I care about how I’m perceived in social situations because connection matters to me. Values and vulnerabilities are two sides of the same coin; the more we pursue our values the more vulnerable we will feel.

Exercise: Say “Yes”

Consider a painful thought or memory that you often struggle with or avoid altogether. Put a 1-minute timer on. Close your eyes and adopt a “no” stance towards that thought or memory as in: “No, that’s not good. That needs to change; that is unacceptable.” Allow yourself to struggle against it as you normally do. When the timer goes off, note any observations of what that experience was like: What emotion did you feel? How did you hold your body (tense, relaxed)? What happened in your mind (did your thoughts speed up? Slow down?) Next, put the timer on again for 1 minute. This time, take that same thought or memory but instead adopt a “yes” stance towards it as in: “yes, I am willing to allow that to be there, just as it is. I do not need to change it.” Afterward, observe or describe how these experiences were different.

Values

In ACT, we define values as qualities of being. For example: Being a loving, caring, attentive, curious, and supportive partner.

Values are not goals. Goals can be met, checked off a list, or completed. Values are what we live by and we continuously commit and recommit to them. I can meet my goal of getting married but I’m never done being a loving partner. Love is ongoing. It matters before and after you get a partner.

The more in touch we are with what truly matters, the easier it is to take a step in the right direction.

Exercise: Attend your own funeral

Close your eyes and take a few deep breaths to calm your mind. Picture witnessing your own funeral. Think about where it would be and visualize a clear picture of your funeral service in your mind. Imagine that a loved one is saying a few words about what you stood for in your life; about what you cared about. Write out what you would want to hear in your eulogy about how you lived your life. Notice if certain thoughts or judgments come up. Defuse from them. This is not a prediction of your life but rather a reflection on the meaning you would most like to create; the purpose you would most like to reveal about the time you spent on this planet.

Committed Action

Take effective action towards upholding your values. Value-guided action gives rise to a wide range of thoughts and feelings– both pleasurable and painful. Committed action means doing what it takes even if it brings on pain and discomfort. Maybe I’m terrified to open up fully in a relationship; to be vulnerable. I could choose to avoid that feeling by saying no to dates, being hypercritical of someone I meet, or closing myself off from someone emotionally, but that won’t help me get to where I want to go (having a close, connected, intimate relationship). Instead, what do I do? Committed action often encompasses all other act processes: Download the dating app (action), defuse from self-critical thoughts, accept the anxiety you feel, observe fear and shift towards curiosity and openness (values), show up fully present, with the intention of getting to know someone.

Putting it all together:

One quick way to put it all together yourself. If you find that you’re in a situation and struggling with your inner world, ask yourself these questions:
1. What is the story I am telling myself in this moment? (e.g. the story of no one likes me)
2. How do I react when I buy into that story? (e.g. get quiet, retreat, internally criticize everything I do)
3. Who or what is important to me right now? (e.g. getting to know someone, connecting, being present)
4. What are some actionable steps towards that? (e.g. find someone approachable, sit and ask them questions, listen intently)
Now you try!
September 1, 2022
3 Skills for Responding to Invalidating Environments
Invalidation is one of the most corrosive factors in any given relationship. After all, chronic invalidation resides at the heart of DBT’s Biosocial Theory, which expounds upon why one may struggle to control one’s own emotions and actions. Invalidation, at its core, “tells you your emotions are invalid, weird, wrong, or bad” (Linehan, 2015). It can take many different forms, and while the intention may not be harmful, the impact very well might be. Whether at home, at work, in school, or at a social gathering with friends, it is possible that invalidation will arise.

Some examples of invalidation might look like being ignored, receiving unequal treatment, or being told any iteration of the following:
- “Stop being such a drama queen!”
- “You have to move on from this. Normal people don’t care this much about _____.”
- “It’s not that bad.”
- “You’re seriously overreacting.”
- “Just get back on the horse.”
People in your life who invalidate you are typically doing the best they can in the given moment. Perhaps they aren’t sure what or how to validate you, or they’re experiencing distress watching your distress, and are seeking to ameliorate it as quickly as possible. For example, I distinctly recall driving to prom with my very well-intentioned mother when I was 18 years old. I was feeling insecure and uncomfortable in my own body, and when I shared this, my mother said: ‘You look great! Don’t worry about it!’ My distress was so discomforting to her that, rather than validating my emotions, she proffered a different form of invalidating feedback. This makes sense, in so many ways. Who wants to witness their own child in pain? And, this wasn’t what I needed in that moment, and only furthered my sense of distress.

Oftentimes, people who invalidate others grew up in invalidating households or social environments. This behavior was learned, over time, and it’s not uncommon that the individuals invalidating you may also be persistently invalidating themselves. This consideration can be a useful tool for building compassion in the face of invalidation, and for removing the inclination to judge and blame — which only contributes to further suffering. Whatever the cause, we have collated three of our favorite skills for responding to an invalidating environment.

Skill 1: Self-Soothe

While it may be difficult to self-soothe in the presence of the individual who has invalidated you, take some time in the wake of the invalidation to practice self-soothe. You are feeling pain, and that make sense! Practice self-soothing with the six senses (sight, touch, smell, taste, sound, and movement) to re-regulate, and move forward effectively. Sometimes this requires planning ahead with some self-soothe objects or materials. As a starting point, take a look at these ideas for each sense:
- Sight: Watch a funny YouTube clip from your favorite television show. Go outside and catch the sunset. Pull up a picture of a time that made you feel safe and content.
- Touch: Purchase some silly putty or a fidget spinner. Pet your cat or dog. Take a nice, long bath or shower.
- Smell: Brew some fresh coffee or light a candle that you love. Put some hand lotion on and notice the smell.
- Taste: Mindfully eat a favorite food or drink a healthful beverage that you enjoy.
- Sound: Listen to your favorite playlist, or pull up a recording of a stream, rainstorm, or bird calls.
- Movement: Go for a walk outside or try a minute of jumping jacks or burpees. Dance in your bedroom!
Skill 2: Self-Validate

While we may be skilled at validating others, it’s often the case that we forget to or struggle to validate ourselves. Use the Six Levels of Validation on yourself, just as you would with a loved one.

Skill 3: Radical Acceptance

Radical Acceptance is a key component on the path towards minimizing suffering. While pain is a fact of life, suffering is a choice. Acknowledge and validate the pain of the invalidation you’ve experienced, and then practice exercises like turning the mind, willing hands, or half-smiling to bolster your pursuit of relief from pain. It may be useful to imagine the invalidating person in your mind’s eye while practicing willing hands or a half-smile, for example.

Remember, some skills work for some people some of the time, so practice makes progress with all of the above!
July 28, 2022
How to Talk about Consent With Your Children

Sex. It’s a topic parents often cringe at when thinking about how to broach the subject. And while teaching children about the birds and the bees is an important step toward sexual health and safety, allow me to make another suggestion: talk to your kids about consent too.

A recent study demonstrated that receiving consent education before college was a protective factor against sexual assault and with unwanted sexual contact occurring every 68 seconds in America, the importance of talking to kids early and often cannot be understated. In addition to preventing harassment, teaching toddlers, tweens, and teens about consent helps them develop a healthy relationship with themselves and others throughout the lifespan.

Talking to Children

Although often linked to sex, consent is all about giving permission—a concept that can be applied to many childhood experiences, such as sharing and hugging. Here are some tips for talking to children about consent:

Let children set their boundaries.

For young children, conversations about consent can start with bodily autonomy. For example, if your child doesn’t want to hug or kiss a family member, let them know it’s okay. Try saying, “It’s alright if you don’t want to give hugs. Do you want to wave or say a silly hello instead?”

Or, if you and your child are having a tickle fight and your child says, “Stop!” pause the play and say, “I heard you say stop so I’m going to stop. Let me know if you’d like to keep playing or do something else.”

Model how to respect the boundaries of others.

Children often learn through play. If your child is upset that a friend of theirs doesn’t want to play the same game, use this opportunity to tell them, “Games are only fun if both friends want to play” or “Sounds like your friend didn’t want to play that. I wonder if you can find a game you both want to play?” Teach your child to say, “Okay, thanks for telling me” when someone says no.

Instead of telling your child, “Give your sibling a hug,” switch the script to, “Ask your sibling if they’d like a hug” to model how they can practice asking for consent.

Remember, consent isn’t limited to physical touch. If we teach children that getting consent means getting permission, then we create more opportunities for children to get comfortable saying no and respecting no. For example, parents can model asking their children, “Can I have a bite of your mac and cheese?” rather than reaching over and helping themselves.

Talking to Adolescents

As kids get older, conversations around consent should be much more direct.

Discuss what consent means for them.

Oftentimes, consent is confused with a simple “Yes.” In reality, it’s often much less clear. Use the FRIES acronym to teach your teen about what true consent means.

● Freely Given: consent is always given without pressure or coercion.

● Reversible: people can change their minds and decide to stop at any point — even if they’re in the middle of sexual activity.

● Informed: everyone involved needs to know exactly what they are consenting to, every single time.

● Enthusiastic: if the “yes” isn’t excited, or if the person is disengaged, it’s a “no.”

● Specific: consent is specific to what is being asked in the moment; it is not a green light for future requests.

Encourage them to reflect on their personal values.

We want adolescents to feel confident in their sexual decision making. By asking them to consider their reasons for wanting to have sex, what types of intimacy they are comfortable with, and how they intend to be safe during sexual activity, we open up a space for them to reflect on their feelings and their personal readiness level. Parents should also encourage teens to not only think about their own boundaries, but to have open conversations with their partner regularly. Remind teens that sex is never owed regardless of how long they have been with their partner or what other people are doing in their relationships.

Talk about substance use and consent.

We want to make it clear that consent cannot be given if someone is intoxicated, asleep, or incapacitated in some way. Any sexual behaviors with a person who can’t consent is assault. Ask your teens to reflect on how they will be safe at parties and collaborate on a safety plan, whether that means having a trusted friend by their side throughout the night or calling you to pick them up if they feel uncomfortable at any point.

Keep the conversation going.

Be proactive in talking to your kids about consent. One conversation is not enough. By regularly discussing consent with children and adolescents not only are you modeling that it should be an ongoing conversation to have with their peers and partners, you’re also empowering them with the knowledge and language to do so.

June 30, 2022
Pop Quiz: What is the difference between pain and suffering?

There are certain circumstances in life which we cannot fix, we cannot problem solve, and we cannot change. To name a few: how others react, our past experiences, our genetic disposition, death, natural disasters, etc. One might ask: are we just meant to suffer?

Make a fist with your right hand. This is pain. Pain might be sadness, disappointment, anger, grief, boredom, or anxiety. This pain in our lives is inevitable. Now take your left hand and cup it over your right fist. The pain has now doubled in size and has now morphed into what we call suffering. This left hand represents the rejection of our inevitable pain. We reject pain because it is—well—painful. We do this in many ways by denying, panicking, avoiding, suppressing, or fighting this pain. The goal is to let the left hand go—in other words to accept the pain, thus releasing our suffering.

In Dialectical Behavior Therapy (DBT) we say suffering = pain + non-acceptance.

How do we accept? Radical acceptance is acknowledging what is with our mind, body, and soul. Accepting our reality does not mean we approve of our reality, make light of our reality, or are passive. However, if we can gently acknowledge what is instead of what we wish it could be then we stop fighting our reality. It is the fighting of our own reality that leads to suffering. If my life is a book, I can hate chapter three but I need to accept that chapter three happened in order to move forward. Chapter three exists whether I like it or not. Change cannot begin to occur until we have accepted the past and the present moment.

Pain is inevitable. To love is to experience pain. To live is to experience pain. Suffering; however, is a choice.

When you find yourself saying “Why me?” or “This is so unfair” you are probably stuck in a state of suffering (non-acceptance). Rejecting our reality does not change our reality so why would we choose to suffer?

A father has a son who is an alcoholic. He has always fantasized a future where he and his son sit on the back porch drinking beers and shooting the shit. Much to his dismay, his son grows up and struggles with addiction. The father has a difficult time accepting this reality. He ignores instances of destructive behavior and attributes it to an issue of will power or immaturity. When others mention concern he unintentionally invalidates their fears. He talks about when his son will “be able” to drink again.

Why might he reject the reality that his son is an alcoholic? To avoid the pain of acceptance. With acceptance comes relief as well as a deep sadness (pain). This avoidance keeps people stuck in their suffering. Not only does Dad have to acknowledge the pain associated with his son’s health but he also has to mourn the loss of an idea he’s been holding onto for years. He has to accept that his relationship with his son will be different than what he once imagined.

Let go of suffering. You will feel the pain, but eventually, you will also feel great relief, which tells you that you have entered a place of acceptance. The pain will bring you to peace.

June 2, 2022

10 Tips to Support Your TGNB (Transgender/Nonbinary) Loved One

Considering the recent increase in anti-trans legislation across the U.S., I wanted to write this post to show our direct support of transgender, nonbinary and gender-diverse people, who make up a large portion of our clients at BPS. The impact of these bills can be understood as an example of traumatic invalidation, which ie extreme or repetitive invalidation of an individual’s significant private experiences or characteristics, resulting in damage to their self-construct and pervasive insecurity (Harned, 2022). Sources of traumatic invalidation can be macro (institutional, systemic) or micro (among important relationships, especially parents and family of origin).

When Possible, Choose Joy over Grief

Many parents experience a period of grief, sadness, or shock when adjusting to their child’s gender disclosure. This may be related to hopes or expectations that parents formed about who their child would be; which may extend beyond their gender. Similarly, we often expect our children to participate in specific activities, achieve certain grades, or pursue a particular career. While these emotional reactions are common, they can be effectively processed alone, with one’s co-parent or partner, with one’s therapist, friends or other sources of social support, and not their transgender nonbinary (TGNB) child. These reactions can be emotionally burdensome to children who may internalize negative reactions from their parents as evidence of their own failures or rejections of their identities. Research indicates familial support, more than any other source of support, as the number one protective factor against suicidal ideation and attempts (Travers et al, 2012; Matsuno & Israel, 2018).

Once the grief is less pressing, you may have more emotional capacity to join in on the joy. How many new moments of connection might you enjoy with your child once you can celebrate their gender? How many might you miss during a period of non-acceptance?

In the spirit of dialectics, I believe we are all doing the best we can to support our TGNB friends and relatives, and we all need to try harder, do better and show up more for our TGNB loved ones. These include the people in your life that might not even be out to you as TGNB. (There are at least 1.4 million of us in the U.S. alone) (Flores, Herman, Gates & Brown, 2016; Wilson & Meyer, 2021). The tips below are here to help you show up in a validating way.

10 Tips for How to Show Up for Your Transgender / Nonbinary (TGNB) Family Member

1. Use their pronouns and chosen name. There are many ways to “transition:” medically, legally, and socially. Not everyone has the option or interest in transitioning medically, so correctly acknowledging social aspects of people’s gender may be even more important as a means of communicating your support.

2. Get them a gift with their chosen name or initials on it (a cup, a key chain) and tell them you love the name they chose. These are great ways to celebrate this step with them.

3. If you’re not sure what pronouns to use for someone, ask! “What pronouns should I use for you?” is not an offensive question. However, refusing to use someone’s pronouns communicates that their gender is not valid or you don’t perceive them as they experience themselves. Misinterpreting and ignoring are forms of traumatic invalidation (Harned, 2022).

■ Challenge question: Can you remember the last time someone misunderstood or ignored something about you that is fundamental to your self-concept? How did this affect your subsequent interactions? 4. Practice, practice, practice! Practice pronouns with this free (and addicting!) online game. Practice using they/them pronouns with your pets, your friends, yourself, or practice when you are talking about the TGNB person when they are not in the room.

5. Don’t give up. What happens when I mess up? It’s ok! And, keep trying to do better. Forgive yourself internally, acknowledge the mistake briefly, and move on with the conversation. Mistakes happen, especially when we’re learning something new. Dwelling on this moment by apologizing multiple times or trying to explain how it happened is generally more overwhelming to the person who has been misgendered.

○ “She, I mean he, loves skateboarding. My bad. Where should we go for lunch?”

6. Get outside support. Tap your community, including online support threads (linked below) for advice and resources. It’s okay to be struggling, and it’s best to process your challenging emotions away from your trans or nonbinary child.

7. Familiarize yourself with trans culture, media, and narratives. Who does your child look up to and why? Celebrate their role model’s successes and keep an eye out for potential mentors to hire for additional support.

8. Diversify your sources of information. Direct your questions and research to trans-led organizations and doctors who are trans and/or have extensive experience working with TGNB individuals.

9. Practice radical acceptance. In order to avoid intentional or inadvertent rejection of their gender-diverse children, parents can practice the DBT skill of radical acceptance of both their emotional reactions and their child’s gender.

10. Be intentional about your observations, comments, and questions. The following is a table of common TGNB microaggressions. A microaggression is a seemingly inconsequential comment or action that is invalidating or hurtful. These are usually accidental and have a significant negative impact, especially cumulatively and over time. The negative impact on the person receiving the comment is often unknown to the person who committed the microaggression (Sue & Spanierman, 2020).

Common Microaggression	Example & Affirming Replacement	Rationale
Misgendering	“Charlie was born as a girl and now is a boy.” → “Charlie is a boy.” If you must reference someone’s assigned sex at birth and you have their consent to share this information: → “Charlie was assigned female at birth.”	Comments about who a person “used to” be can be invalidating because people are often aware of their gender before coming out to others about it – the fear of rejection might have kept them from disclosing widely. It’s best practice to retroactively refer to people with the pronouns and gender they currently identify with.
Unwanted body commentary	“You used to have such nice (body-related comment)” “But you’re such an attractive/beautiful/handsome girl/boy!” → “I love who you are becoming.” → “Let’s go shopping for some new clothes!” → “What words would you like me to use to refer to you? (handsome, beautiful, intelligent…)”	Comments about someone’s physical appearance, body, or attractiveness in regards to their assigned gender can be really hurtful to TGNB people. When uncertain, always frame compliments or observations in the context of their present sense of gender.
Dismissing / controlling transition-related goals	“I’m scared that you’re going to want surgery/hormones.” “I’ll support you as long as you don’t medically transition.” → “If you feel open to sharing, what are your goals for transition? → “How can I support you?” → “What do you like to receive affirmation about?” → “What gives you gender euphoria?”	Not everybody wants to medically transition, and people’s gender related goals are personal and change over time. It’s important to ask questions about medical transition with sensitivity and an openness to not receive an answer. They might not be ready to share details about their body, goals for transition or current gender affirmation processes. Depending on your relationship (sibling, parent, etc.) certain questions may be more or less appropriate.
Projecting fears	“I feel sad/worried for you” “You must feel trapped in your body.” “I’m scared of how people will treat you.” → “I’m so proud of you.” → “I’m going to be right by your side through this process.” → “I have some questions, and I’m going to do research on my own.”	While there are higher risks of distress and negative psychosocial outcomes associated with being TGNB, these risks come from social stigma, invalidation, and barriers to resources, not from one’s gender identity! Instead of sharing your concern for their anticipated difficulties, decide to be an ally and ask how you can support them.
Ageism	“You’re too young – you won’t know what’s real or best for you until you’re older.” “You’re too old – if this were real, you would have known about it since you were a child.” → “I’m honored you decided to share this with me. It’s never too late/too early to come out as trans.” → “I believe you, let’s get more information together about potential options for affirming your gender.” → “Thank you for telling me, that was really brave. I’m excited to get to know more about you and who you’re becoming.	TGNB people are told they are either “too young” or “too old” to be trans quite often. This shows that ageism exists across the spectrum of transness. There is no “right” age when we “truly know” what our gender is. At the same time, our readiness to make decisions about which gender affirming steps to take may shift depending on a number of factors, including our age. Regardless of these decisions and readiness factors, validation and support are necessary every step of the way.

Additional Resources

APA: Singular “They” Is Grammatically Correct

Practice pronouns with this free online game

How parents can support a child who comes out as trans – by conquering their own fears, following their child’s lead and tolerating ambiguity

Free and low-cost letters of support from therapists for clients seeking gender-affirming medical care

Gender-affirming tele-health care Counseling groups for TGNB youth/parents

Sylvia Rivera Project & Lambda Legal – Trans legal collective and legislative support

References

Flores, A.R., Herman, J.L., Gates, G.J., & Brown, T.N.T. (2016). How many adults identify as transgender in the United States? Los Angeles, CA: The Williams Institute

Harned, M. S. (2022). Treating trauma in dialectical behavioral therapy: The DBT prolonged exposure protocol. The Guilford Press.

Matsuno, E. & Israel, T. (2018). Psychological interventions promoting resilience among transgender individuals: Transgender resilience intervention model (TRIM). The Counseling Psychologist, 46(5), 632-655.

Olson, K.R., Durwood, L., DeMeules, M. & McLaughlin, K.A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3), 1-8.

Sue, D. W., & Spanierman, L. B. (2020). (2nd ed.). John Wiley & Sons, Inc.

Travers, R., Bauer, G., Pyne, J., Bradley, K., Gale, L., & Papadimitriou, M. (2012). Impacts of strong parental support for trans youth: A report prepared for Children’s Aid Society of Toronto and Delisle Youth Services. Retrieved from http://transpulseproject.ca/wp-content/uploads/2012/10/Impacts-of-Strong- Parental-Support-for-Trans-Youth-vFINAL.pdf

Wilson, B. D. M. & Meyer, I. H. (2021). Nonbinary LGBTQ adults in the United States. Los Angeles: The Williams Institute.

May 6, 2022

Category: blog

Skill 1: Self-Soothe

Skill 2: Self-Validate

Skill 3: Radical Acceptance