Managing Difficult Emotions: A-Side

“Emotions don’t kill you.” 

A discussion between Nadine and Oakland DBT therapist Jonny Cragg about how taking emotional inventories (in a therapeutic modality called DBT) tailor therapeutic skills to emotional intensity. High emotions need robust interventions, while moderate ones require cognitive strategies. Mindfulness in DBT helps manage emotions and communication. 

However, challenges include accurately observing emotions and applying strategies consistently. The approach is effective but needs practice and awareness, particularly for those with conditions like ADHD or borderline personality disorder. DBT focuses on present-moment regulation and techniques for immediate control, though deeper trauma may require additional treatments.

Transcript

JC NP 0

Speaker 1

So hello, everybody, and welcome to This Won't Fix You. We have Jonny Craig with us today and Jonny Craig lives in. Do you know what, Jonny? I don't even know where you live. I just know it's the States and it's on the West Coast. 

Speaker 2

[00.02.12]

 That's correct. I live in Oakland, California. It's. The 

Speaker 1

[00.02.16]

 Raiders are from, isn't it? 

Speaker 2

[00.02.17]

 Uh I think so. I'm not super up on American sports, but, um. Yeah. Uh, it's in the Bay area. And, um, it's it's what they call East Bay. So it's just east of San Francisco. Uh, it's just south of, uh, Napa, where they make all the wine. And it's just north of Cupertino, where they make all the computers or where they do all the technology and software around the computers. 

Speaker 1

[00.02.48]

 And where you live, they make all the therapists. 

Speaker 2

[00.02.51]

 Yeah, yeah. And graffiti artists are. 

Speaker 1

[00.02.56]

 And you are a therapist, is that right? 

Speaker 2

[00.02.58]

 Yeah. Do DBT and RODBT, which is radically open DBT. It's, um, a kind of variant of the standard model, um, which I can get into a bit in a, in a moment, but it's in a nutshell, DBT was developed for conditions and presentations of under control, you know, like, uh, addiction, emotionality, uh, borderline personality disorder primarily. And it got generalized to other diagnoses. And what they found down the line was that there were a lot of people with presentations of over control, uh, typified by, you know, obsessive compulsive disorders, anorexia nervosa, uh, you know, garden variety anxiety. The treatment didn't work for. So they kind of reimagined it for people that, uh, you know, people that need to relax a little bit, in other words. 

Speaker 1

[00.03.53]

 And so you do both. Both I do 

Speaker 2

[00.03.55]

 both. Yeah. Yeah, yeah. They called me the most under controlled RL therapist on the planet. So I guess the idea is that I model this, you know, all over the place sort of presentation to try and get people to, to sort of chill out a bit. 

Speaker 1

[00.04.14]

 And it works. 

Speaker 2

[00.04.16]

 You have success and you'd have to ask them. But yeah, I think it works. I think it's effective. Yeah. Yeah, I think it's a it's a great model. 

Speaker 1

[00.04.28]

 And we're talking about emotional inventories or user inventories. And maybe I'm saying it wrong even by British standards. Um, and does that fit in. Does it fit in both or one or either of the DBT or the ro DBT? 

Speaker 2

[00.04.41]

 It it fits in both, but I think it's more pertinent to standard DBT, namely that folks with presentations of over control tend to take a concept like emotional inventory very, very seriously. And they can be very planful and very exact about it. Uh, which is not necessarily what we're trying to kind of cultivate in the sessions or in their lives. Even. 

Speaker 1

[00.05.11]

 So, who's it for? Do you want to first of all, tell me what it is and then and then explain who who would really benefit from it from from taking emotional inventories. I think the idea of emotional inventory is primarily to understand that you would use a very different skill set. If you are, let's just say we've got a thermometer that goes up to 100, right. And if you're an 85 for anger, you would use a very different set of skills. To say if you were a 20 for jealousy. 

Speaker 2

[00.05.56]

 Do you understand what I mean? So I understand so far. Yeah. I thought you were going to say more. Sorry. Yeah. 

Speaker 1

[00.06.01]

 So I'm with you so far. 

Speaker 2

[00.06.03]

 So. Yeah. You know, if you if you're very, very emotional in a certain situation or context, you would probably need something more robust by way of a skill set than if you were moderately emotional. Um, you know, we might be looking at a distraction skill or, uh, a change of temperature or some intense bursts of physical exercise, whereas if you're, you know, in the lower lying, you know, if you're in the 15 or the 20s or the 25, so you might be looking at a more cognitive skill where your your brain is more on line. You haven't been hijacked by your emotions. Got it. So you're looking to do something a little bit more sophisticated. 

Speaker 1

[00.06.46]

 Okay, I understand so what you're trying to get people to do is to rate their responses rate. What's going on inside them? Yeah. 

Speaker 2

[00.06.53]

 It's you know, it's a pretty actionable model. It's quite collaborative. Um, so what would happen is we'd come up with what they call what Marsha Linehan would call a life worth living goal. And it's essentially a kind of mission statement for the therapeutic process, like, what do I want to do? Who do I want to be? What are achievable goals within this therapeutic relationship? So once you've got that and you understand collaboratively what that is, you go about recognizing the behaviors that are an affront to those goals. What's getting in the way? In other 

Speaker 1

[00.07.31]

 words, what's in the way. Yeah. Yeah. So exactly that same idea. What's in the way of it then? That's what you want to be. What's in the way. 

Speaker 2

[00.07.37]

 So, you know, once you've got that you can say, well, I can have a thought and the thought can generate an emotion and. There's nothing wrong with that. We're all emotional beings. Emotions are in our bodies to give us information, right? Um. Except when the behavior that it translates into capsizes, you know, a relationship or a job or something like that. 

Speaker 1

[00.08.05]

 So you talk about a narrative, a kind of an interpretation, then that people have, 

Speaker 2

[00.08.10]

 uh, it's part of the journey, uh, from the, you know, the translation of an emotional response into a behavior. Because you can have a thought. I mean, you can have thousands of thoughts, right? Every day we have thousands of thoughts. It's all about what what you pay attention to, you know, so you could have a thought that your partner doesn't love you anymore. You could have a thought that you can't do your job. You can have a thought that you want to kick your grandma down a flight of stairs. It doesn't mean to say you have to act on it, you know? It just means to say that it's a thought, right? So the glue that holds DBT together, this is what Marcia came up with in the 80s and 90s because she was a cognitive behavioral therapist. And somewhere along the line she got disillusioned and she figured she she took some time out, essentially, and studied mindfulness. She went and traveled and and she was diagnosed with borderline personality disorder. She would describe herself as the sickest person in the room. And in many ways, the cognitive behavioral model was falling short for her. So she infused her model with mindfulness. So mindfulness informs all the skills. So it's essentially a a mash up of, you know, a straight up cognitive behavioral evidence based practice and Zen Buddhism, if you like. Huh. 

Speaker 1

[00.09.36]

 That's intriguing. What's the what's the Zen Buddhism element of it? Well, 

Speaker 2

[00.09.40]

 that's the, you know, the she's drawn from Zen Buddhism, those basic tenets of mindfulness, like the what and the how of mindfulness. Like what you do is you observe Mhm. You describe without judgment and you participate fully. And then how you do it is you do what you do effectively, you do it non-judgmental and you do it one mindfully. And that suffuses everything in DBT. So it's the sort of glue that holds it all together, if you like. 

Speaker 1

[00.10.16]

 Can you give me give us an example of of. Um, and I appreciate you can't use actual people case studies, but perhaps you can, I don't know, kind of cobbled together a sort of a fictional scenario in your head that isn't necessarily, you know, somebody's experience. And tell us. Tell us how that would present. 

Speaker 2

[00.10.36]

 Sure. Okay, so I could say, uh, let's just say you have a couple in a, in a domestic partnership. Let's just say, uh, one of the partners came into my consultation room and says, you'll never guess what. Uh, I had this horrible fight with my partner. Oh, really? What happened? Tell me about what happened, and they'll proceed to tell me about what happens. And I said, well, look, do you mind if we. We do a chain analysis. Chain and solution analysis is a key tool in DBT. And what we're looking at is the the antecedents, the behavior itself and the consequences. So and to just to zoom in on that for a minute, you're looking at what is the behavior that you want to change. Right. So let's go back to the couple. They had this big file. And the person that's in my consultation room threw a pan at their partner and hit their partner, and they had to go to the hospital. You're like, okay, well that's that's unfortunate. So let's, let's, let's zoom back to what actually happened. And let's take a little bit of a inventory of what happened immediately before it. And they might say, well, you know, I went out the night before and I had a few drinks with my friends, and I was pretty hungover when I woke up the next morning and I, I took the day off work, my partner went into work as normal, and, uh, I skipped breakfast because I just had this raging hangover and I just couldn't sleep. My headache was so bad I couldn't sleep. And then they they came home at 4:00 in the afternoon, and, uh, you know, they got angry with me because I hadn't tidied up the front room because we'd been in the in the room partying the night before. So we got into this fight and I threw the pan at my partner. I'll be like, oh, no, that's that's awful. Um, but let's let's just take a closer look at what happened. So what we know already is that sleep and food are pretty critical to that chain analysis. That person has not slept adequately. That person has a hangover. That person has not eaten breakfast. So by the time the partner comes home, we know that there's there's a lot of vulnerabilities in the chain. Then you zoom in further and you say, well, what did they say to you? Well, they said this thing about, you know, they made a personal comment and that was it. I flipped out and I grabbed the pen and I threw it at them. Okay. So we've we've now identified the prompting event. The prompting event was the comment, right. So what? So let's zoom in closer to the actual moment that you picked up the pan and you threw it at your partner. Well, um, what could you have done differently? You know what do you know already about DBT? What do you know about your physiology? What do you know about what's happened in the last 12 hours that's contributes to this situation? You know that you're malnourished. You know that you're dehydrated. You know that you haven't slept properly, and you know that you're kind of feeling like you're under attack from your partner. So is there an intervention in that moment that you can take? So one of the things we talk about in DBT is the stop skill. It's a great example of, uh, an interface of, you know, what is needed in the moment and using mindfulness. So stop stands for stop. Take a step back, observe the situation and proceed mindfully. Right. And there's a lot of echoes of this in with other therapists. And I've heard other people talking about inventory. Um, Tara Brandt talks about inventory in she uses the Rain acronym, which is recognize, acknowledge, investigate and nurture. You know so it's a similar concept, which is if you just stop in that moment. You can observe not only what's going on in the room. Okay, so what's going on in the room is, is you're being attacked, your partner is verbally attacking you, but there's also an untidy front room. There's also an unmade bed. Um, the other very important thing is to observe what's going on internally, what's what's happening in this moment right now. Where is your emotion? What is your emotion? How do you know what your emotion is? So let's talk about the emotion of anger. So very similar physiological events take place in your body when you're angry or say when you're excited, right? So it's the same with anxiety like anxiety and excitement. They show up very similarly physiologically. So it's all about just just taking that inventory of saying, well, how do you know you're mad? How do you know you're jealous? How do you know that you're in love? What does love feel like? You know, describe the color blue. Like it's difficult, right. And it takes a minute. So sometimes with clients it might take six months just to, to build that muscle of understanding that inventory. Right. So so I work with men a lot. And this is really important work for men because men are growing up to to ignore their emotions and as such, ignore the physiological things that tell them that they're having that emotion. If you then take that concept and you think of it as a thermometer or an inventory or a scale, you can then get into the fine tuning of which skills to use in which situation. Mhm. 

Speaker 1

[00.16.24]

 Mhm. It's really empowering the person to, to take control isn't it. To, to notice what's going on inside themselves. 

Speaker 2

[00.16.32]

 Exactly. So it's saying look it's not, there's nothing wrong with being um apoplectic rageful towards your partner. That's, that's, that's information. That's important information. You should be you should be listening to that. And it does not have to translate into a violent action. Mhm. Because that's going to interfere with your relationship goals. That's going to be a director front that's going to land you in jail. Mhm. Right. So no one wants that. Of course. 

Speaker 1

[00.17.05]

 That's beautifully illustrated. Thank you so much for that And you're absolutely right. There is all sorts of overlap. And I'm really glad that you put in the time scale that this this can take months and months and months to kind of practice. Yeah. Looking inward and trusting then trusting what you get let you say without judgement, without shame that what we get is, is that is just what we are. It's data. I use the word data. You're saying it's information exactly the same process. 

Speaker 2

[00.17.31]

 And it's very interesting how deficits in mindfulness reflects different mental health diagnoses. So for example you know I have ADHD. So observing is very difficult for me. It's like oh where's the 98% uploaded button. It might take me five minutes to find that button. Right. Another person could see it straight away. And that's my ADHD, right. Um, a person with borderline personality disorder might struggle to describe with integrity. Right. So 

Speaker 1

[00.18.10]

 what does that mean? Help me understand that? Well, when I say 

Speaker 2

[00.18.12]

 describe with integrity, I mean describe things just as they are through the senses, right. So for the podcast listeners, we're looking at each other on a screen right now. But, uh, Nadine can see that there's a picture behind me now. There'll be numerous ways that you could describe that picture. There would be numerous ways you could describe a piece of music. You know, describe Taylor Swift. Right. Um, you might be. Tempted to use judgmental words in describing a piece of music that you either really like or really don't like. So what we're trying to do is to say, well, it's a it's an artist, a female artist. And, and I can hear that there's a bass guitar and there's a keyboard, and the tempo is maybe about 98 beats per minute. And, and there's a sample that happens in the bridge, you know, that that would be describing with integrity. But obviously there's there's a number of ways you can you can go about that. You can fall into the rabbit hole, especially if you have a borderline personality diagnosis of getting very hooked on the judgments. Right? Very, um, compelled by skewing the information to support whatever narrative you have, you think about the participate part of mindfulness, right? And participate fully in what you're doing. Right. Just get into it. Just get up and dance. Everybody dance right now. Right. That's very, very, very difficult for a highly anxious over control person. Right. So the mindfulness components of DBT tend to indirectly those diagnoses uh respectively. 

Speaker 1

[00.20.02]

 They tend to what. I don't understand what you mean sorry. They tend to. 

Speaker 2

[00.20.05]

 Well you can have you can have an observed say I talked about the stop skill. Right. Stop stop everything that you're doing. Like observe the situation that that might be a struggle for someone like me, right. That might be a struggle to notice, to just slow everything down and notice what's going on. Right. We have another skill. This is a skill for getting what you want, right? Let's just say, um, let's just say I'm your brother and I don't have a car, and I need to get a ride to the airport. There's a way to ask for that, right? It's called the demand. It's a very popular skill in DBT. All the teenagers love it because they all use it to get their phones back from their parents and stuff like that. So it's a great skill. And and the root of it is in, uh, assertiveness training from the 60s, essentially. Um, funny story when I was in a band. We had a therapist for the group, and we had various beefs with each other, and she gave us these sheets where we would all talk to each other. And it was essentially when you did this, I felt, and therefore would you write so demands a more sophisticated version of that. It's essentially saying describe the situation. And when I say describe, I mean just the facts. And when I say just the facts, I mean just what you can see here, touch and taste everything else is a thought or an idea. 

Speaker 1

[00.21.45]

 Yeah. Or a 

Speaker 2

[00.21.46]

 judgment or an interpretation. Right. So if you if you can agree on the facts, you've got the template for agreement. You've got you've got a conduit for an arrangement. Okay. You know that if you can't agree on the facts, you're not likely to have a successful Dearman. Right? And for a client with borderline personality disorder, describing the situation with integrity is incredibly challenging, right? So, for example, let's go back to the example of okay, I'm your brother and you've got the car. I've got borderline personality disorder, right. And I've had a series of unsuccessful jobs and relationships. And I don't have a car. And it's like you're always doing this. You never lend me the car, you know? It's like, I'm sick of this. You never think about me. I've got to get to the airport for this important meeting. And, you know, that's that's the emotionality piece capsizing and hijacking the described skill, and that's mindfulness. And as you work through the gears of the skill, you then get an opportunity to express yourself. But it starts with the facts. It starts with describing with integrity exactly what's going on. Right. So it might be something like, um. I have a flight to go to Paris on Saturday. Uh, the flight to Paris is for an important meeting with the potential for a job. I don't have a car. I know that you don't work on Saturdays. And I'm wondering if you could give me a ride Can you give me a ride? You know, so the way you do that is, is just to sort of delineate just what is factual rather than getting into the narrative, you express yourself. With a little bit of the emotionality, just a little bit. You assert what you actually need in a very direct way. You're working through the acronym, aren't you at the moment. Yeah. That's the yeah, okay. That's the end. The R is to reinforce. So reinforcement. You know, this is behaviorism 101. This is this is Skinner and Pavlov and all all those crinkly old white guys. They they talk about reinforcement, like the schedules of reinforcement. How do I make this attractive to Nadine? How can I how can I sweeten the deal? Maybe I could buy you breakfast. Maybe I could put some gas in your car. You know, just saying thank you. Alone. Yeah. Serves as some sort of reinforcement you've got to give to get right. There's got to be some transactional piece to this conversation. I mean, something, 

Speaker 1

[00.24.43]

 or at least I want an acknowledgement. At the very least, I want an acknowledgement 

Speaker 2

[00.24.46]

 of absolutely what this 

Speaker 1

[00.24.47]

 is costing me. Not necessarily financially, but 

Speaker 2

[00.24.49]

 and it might be something like, hey, I recognize that you've given me a ride a few times in the past. Right. I understand that that I've asked you a few times now and I'm aware of it. And I got you. You know, it might not be anything concrete. It might just be an acknowledgement. That's the reinforce. And the aim is to remain mindful. So let's just say you push back, you say, you know what? I've got football practice on Saturday morning. I don't think I can do it. And besides, you know, I'm kind of getting a bit sick of you asking me for a ride all the time. That's where that's the point at which the conversation could get emotional. Right? That's the point at which you, you know, you the at me, the asker could lose control. It could be a case of like, oh, well, that's not cool. Well, if you, you know, like I'm out of here. So the idea of remaining mindful is to keep your eye on the objective. And it's the one mindful piece of the how skill of mindfulness. Sorry this is a lot I know this is a lot of dense. No, 

Speaker 1

[00.26.01]

 no, I'm I'm holding on to the dear Man acronym I'm working through. I've got it. Brilliant, 

Speaker 2

[00.26.06]

 brilliant. Thank you. Um, so I 

Speaker 1

[00.26.08]

 think I think the listeners are also pretty, you know, we're on episode 15 by now or something like that. So, yeah, people are, I think I think this is grand. Well, good. Wicked. Um, sorry if I'm, if I'm being too dense, but anyway, mindful is just. Taking inventory. Staying. Staying focused on the objective. And using the broken record technique. So the broken record technique is essentially. Hey, Nadine, I can see this is probably not a good time to ask. It seems like you're a little irritated right now. Maybe you're a little preoccupied. Would you mind if we tabled this conversation for tomorrow? Okay, sure. We'll talk about it tomorrow. Okay. Bye. And the broken record is just giving you that opportunity to to reopen the conversation at a later date. Mhm. 

Speaker 2

[00.27.02]

 Appear confident. Pretty self-explanatory. That's the a endearment and negotiate similar to reinforce is what do you got. You know do you have a budget for breakfast. Do you have a way to give your sister a ride when you get a car, you know, is there something that you can do to sweeten the deal? And that's it. That's the deal now and again. And so mindfulness is at the helm of the skill. 

Speaker 1

[00.27.31]

 Because it's thinking about the other person as well as yourself and the things that you're being drawn into, but also about the other person and the and their perspectives and where they're coming 

Speaker 2

[00.27.40]

 from. Exactly. And it's it's being able to describe with integrity what is happening without going to the narratives and the hyperbole. Right? 

Speaker 1

[00.27.51]

 Yeah. Because it's that that then gets emotionally emotionally heated. That's the part where people start disagreeing and shouting at each other. Because exactly. That's when the that's when the, the, the productivity of the conversation breaks down. And that's when the thermometer starts going up. And that's when you lose control. Because when as, as most of us, I'm sure know, we call, you know, let's just talk about anger for a minute. When you get angry, we say, oh, the blinkers have gone up. And it's a very good analogy for what happens when you get angry, as is your your nervous system gets hijacked and all you can really focus on is being right in that moment or the moral outrage that you're experiencing. You can't really solve anything when you're in a boat. We call it emotion mind. 

Speaker 2

[00.28.41]

 In DBT. I'm an emotion mind. I got to step off. I'm out. 

Speaker 1

[00.28.46]

 And again recognizing when that's when that's happening. And there's a negotiation there as well isn't it. Because if my partner keeps keeps wanting to disappear at key heated moments, then I'm going to be frustrated. And so there's a negotiation then between the in the partnership or the relationship. If it's not a partnership, because if somebody's saying I need time out, I'm going to I want to reregulate myself and then I'm going to come and have a conversation. I might not want to do that. And so then there's a negotiation over time. Again, that good point. I need to be involved. Yeah. 

Speaker 2

[00.29.20]

 And the caveat is, is if you're the one leaving, you have to give some reassurance that you're going to come back, say, hey, I'm out. Let's come back to this in 30 minutes. I'm going to go for a walk. I'm going to take a cold shower. I'm going to do some breathing. I'm going to do some yoga. I'm going to do something to to get back in my body so that I can actually have a productive conversation. I get it. Tell me. You're talking a lot about the strength, and it's absolutely apparent how this would help people navigate challenging situations. High, high emotional conflict situations. What are the limitations of it? When when does it when does it doesn't work. When does it not work? When does it when when do people kind of 

Speaker 1

[00.30.07]

 stumble, I suppose. 

Speaker 2

[00.30.10]

 Hmm. Yeah. That's, uh, that's a pretty general question. I'm trying to figure out how I can answer it. Um, you mean for the patient? For the client? You know, when does it not work? 

Speaker 1

[00.30.24]

 I suppose I was I was maybe angling for more, um, if there were certain areas where this is the bit that people find difficult. This is where the the real challenge is. And and this is where in the six months where we're dealing with this particular issue, this is where they're stumbling a lot or is there not is it just unique to each individual person that they'll all completely depends on the person. Right. And and again mindfulness is often the barometer, which is to say if you have um. Let's just say you have someone with anorexia. Uh, participating is is a very difficult skill in the mindfulness triumvirate of of what? Skills to pull off, which is to say, can you participate fully in a meal? Let's just say let's go for some Moroccan food, right. Let's let's go to this place. Can you fully participate in that without looking at what's in the food like trying to analyze the calories, trying to sort of, um, calibrate a portion, trying to look around the place and see what everybody else is eating, you know, trying to figure out where the nearest bathroom is if you if you want to expel the food. Right. So that's the plan fullness. That's the hyper detail focus that happens with that kind of diagnosis. And that's why the participate skill is so important. So when I do the classes and this is our ODBC right. It's different from DBT when I do the classes in row. It's all about participating. It's like doing crazy things like, I'll get them to do mad stuff for like, 30s and then say, oh, well done, everybody. You know, they all look at me, do what I do and then they'll do it. And it's all about training the nervous system to understand that those situations are not threatening. They're actually, um, a potential for for union, a potential for for cohesion with the group. Yeah. 

Speaker 2

[00.32.37]

 So that to answer your question, the, the, the the deficits and the struggles that really depend on the client and what they're bringing into the room. 

Speaker 1

[00.32.47]

 Sure. And I can totally see that. And I'm now thinking as well about what happens to what happens to the past trauma that is arguably and I mean that literally, arguably creating um, a more volatile internal system. What happens to the trauma like, because you're working very much with regulation in the present tense, you're trying to sort of regulate the present tense, to make the present and arguably the future a little bit better. So there are there potentially are traumas that sit that make somebody's nervous system more volatile. Would you agree? 

Speaker 2

[00.33.21]

 Absolutely. Yeah, absolutely. 100%. This is not a trauma informed, uh, modality. Uh, I definitely refer out for someone that has PTSD or PTSD. Uh, and DBT can be very helpful to manage those, you know, in the moment symptoms. So I would say to someone that has PTSD, um, the distress tolerance component of DTS, super, super helpful, I think all of it's super helpful. And I would probably, you know. Divert them to an eMDR therapist for the appropriate treatment 

Speaker 1

[00.34.04]

 so your eye can see. I can totally see how it's hugely effective as that sort of firefighting first line of defense. Like we've just got to change your behavior in the in the immediate term. We've got to. Yeah. Give you some control over your yeah. Your ability to regulate. Yeah. And see how it's it's imperative that people have these skills. 

Speaker 2

[00.34.23]

 There is a prolonged exposure DBT model but I'm not trained in it. 

Speaker 1

[00.34.28]

 Oh um there's a reason why you're not trained. You don't want to do it. It's 

Speaker 2

[00.34.33]

 there's only so many hours in the day. 

Speaker 1

[00.34.35]

 Got it. No, it's done that. Yeah. And the outcome, the thing that you're working towards. Sorry. Go on, I interrupted you. Go ahead. Sorry. No, 

Speaker 2

[00.34.42]

 that's that's quite all right. You know, the the, uh, for me, my personal, um, arc of learning is, um, I think eMDR is something that I'm super interested in and would like to learn more about. Um, as a kind of addendum to the work that I already do. Because it's true. I mean, a lot of people come in and they have trauma and they're trying to process that, and there's only so far you can take them with DBT. Um, 

Speaker 1

[00.35.09]

 and so the outcome you're looking for then is. Well, you tell me, why am I putting words in your mouth? The outcome that you'd be looking for with people is not. It's just not to go there. That's not. That's not on your agenda to go back to. And pointing back over there to to a past trauma. What you're trying to deal with is to mix somebodies behavior in the in the immediate relationship dynamic. You're trying to make that 

Speaker 2

[00.35.36]

 better. Yes. And I think that, you know, there's a certain degree to which you can, you know, you can interrupt, um, you know, say, for example, recurring nightmares, you know, like recurring, you know, there's a thing called the, the nightmare protocol where it's like, write down the dream. Um, come up with a new narrative, make it comedic, make it empowering, make it surreal, make it silly, make it whatever you want to make it. But but take control of the narrative and learn it and stay, um, conversant with that. Alternate narrative. And it actually works. I was a little skeptical about it, and I tried it with a few clients, and they came back and they were like, oh yeah, it worked, you know? Um, so that's one intervention. It stopped short of being a, uh, a comprehensive PTSD. Mm. Therapy. You know, 

Speaker 1

[00.36.33]

 nice horses for courses, isn't it? People are looking for different things. But what you're doing is you're changing people's relationships in the short, immediate term. Yeah. It's 

Speaker 2

[00.36.41]

 powerful. Yeah. 

Speaker 1

[00.36.43]

 Mm. And what about you did allude earlier to there are people who have where you work more subtly with people where they do have a greater degree of emotional regulation on that thermometer. You're talking about we're talking about the sort of lower end where they're not as explosive, they're not as volatile, they're nowhere near throwing pans. And and the. Tell me about working with, with with those kind of presenting, um, temperatures on the thermometer. 

Speaker 2

[00.37.10]

 Yeah. I'm trying to think about an example of somebody with a more moderate presentation. 

Speaker 1

[00.37.18]

 We take your time because I can cut out any, you know, long pauses or anything. Yeah. 

Speaker 2

[00.37.22]

 Um. Okay. Let me think Um, yeah. You could talk about, say, procrastination. You know, it's a very common hallmark of modern life. You know, everyone's working from home. Everybody's got ample opportunities to like screen, screen addiction, screen use, doomscrolling, you know, that kind of thing. How do you use a concept like opposite action to, um, counter procrastination? And again, it's it's it could be part of a more complex ADHD symptomology. But, uh, opposite action is essentially if the emotion or the behavior doesn't, if the emotion doesn't fit the facts or the behavior is not in line with your goals, could you go opposite to that? Right. So if you're like, say for example, and this is a mid-range, we call it an emotion regulation skill. So it's somewhere in the middle of the thermometer. Say you're at a 40 or a 50. Um, let's just say you have a fear of taking exams or a fear of getting on an airplane, for example. Does the emotion fit the facts? Well, maybe not right. It might feel really big to the individual and you want to validate that. And ultimately it's getting in the way of their goals. So let's take exams If you take the exam and you fail, uh, you're not going to die. You'll fail the exam, and it'll be inconvenient, and it will be bothersome. And nothing really bad is going to happen. So how do we go opposite to that? How do you prepare for the exam? Because the only thing we know is that if you don't take the exam because you're too scared, you'll definitely fail. Right. So how do you kind of engage a person who's really, really, really, really scared of going into that exam room and get them to fully engage in opposite action? Right. So it's, um, well, I don't have a I don't have a quick answer, but it's all about can you cope ahead for that situation. So another DBT skill Copperhead. Copperhead for a difficult situation. What materials do you need? What things are going to help you? How do you self-soothe through the senses to put yourself in the best possible place? What could you do the night before? How much sleep do you need right? How do you completely commit to this activity to give it your best shot, right? And so sometimes we'll meticulously plan a Copperhead, um, ratio of things that they're going to do in the 24 hours before the exam and the week before the exam. And, um, and then we'll do some basic, um. You know, some breathing exercises, a guided meditation. Um, you know, I'll have people, like, download the calm app. It's like lots and lots of different tools to create the conditions, to walk in that exam room and take the exam. I can't help them pass, but I can help them get in the room. Yeah, 

Speaker 1

[00.40.49]

 and there's a massive amount of compassion in that Cobra head strategy, isn't there? Because there's yeah, there's a huge acknowledgement of this is impossible for me. It feels impossible. It's not impossible. It feels impossible. All right. Where where am I struggling? And what can I do to help myself? It's kind of calling on the adult inside the individual, isn't it, to kind of nurture the. Yeah, child through. 

Speaker 2

[00.41.12]

 And it's the same thing as you take that emotional inventory. Like, what am I feeling right now? I'm feeling jealousy. I'm feeling like this person who's talking to my partner is going to take away my partner. Right. So what is the opposite of jealousy What's the opposite Behavior to jealousy. Well, what do you do when you're jealous? When you're jealous, you just want to hold on to someone. When you're jealous, you fear that another third party is going to take away something that you feel belongs to you in parentheses. And the behavior, it doesn't work. It actually reinforces the displacement of the relationship. So would not the opposite be true in that case, could you behaviorally take the opposite approach in order to cultivate the relationship? So say yeah, go and hang out with your friend. Right. Okay. It might it might bite you in the ass. But more likely than not it's going to enhance the relationship. And the partner is going to be like, oh yeah, my partner is really cool. You know, like they, they, they give me lots of freedom to do these things A, B and C and that's, that's why I love them so much. Opposite action to jealousy. Opposite action to love. Right. Let's say you had a breakup, right? You have a messy breakup. What do you do? You're following this person on Instagram. Oh my God. They've got a new partner right there smooching with their partner on stories on Instagram. Oh my God, it's the end of my world, right? You know, I'm going to walk past my ex partner's house on the way to work every morning, even if I have to walk out of my way to get to go past it. And guess what? I saw someone else's car in their driveway. Right? What is opposite action to love? Opposite action to love is to retreat, right? It's to unfollow them on Instagram. It's to take a different route to work. Right? Opposite action to anger is to is to back the hell up. You know, just don't approach when you're angry. You want to approach what happens to the emotional fallout of that. Because I'll be hit. We can we can arguably make ourselves behave in a different way by, for instance, walk in a different way to work So we're not passing the house and seeing the car in the drive and. 

Speaker 1

[00.43.35]

 But what are we doing with the feelings then, that remain? Because there must be kind of this byproduct then that that remains, even though I'm behaving more dignified, arguably I'm still. Great 

Speaker 2

[00.43.46]

 question. Great. 

Speaker 1

[00.43.48]

 Carrying that emotional byproduct. 

Speaker 2

[00.43.50]

 Well, that's the mindfulness of current emotion, which is to say, right. Yeah. Emotions don't kill you. Um, they never kill you. They might feel unbearable in the moment, but the denial of the of the emotion, the repression of the emotion is the very self-same thing that propagates the emotion. Right. So it's all about are you going to rip the Band-Aid off or not? Right. You have to rip the Band-Aid off. And it's so hard. It is. It's the hardest piece in DBT, actually. And it's this idea of if you're familiar with the term radical acceptance, which is I've got to radically accept that my partner has left me for another partner and that that person's car is in my partner's driveway right now. Except, you know, I can radically accept it. I don't have to look at it every morning on the way to work. Right. And it's the extinction burst that happens when. When you just remove the stimulus. Right. Because if you're walking past that person's house every morning, it it just it fires all the neurons that take you back to that pain place where if you unfollow them on Instagram, there's no more emotional cues. So you're essentially you're doing two things is you're you're acknowledging the intensity of that emotional event, which is the breakup. And you're saying to yourself, I can accept this. I don't have to like it. I can accept it, and I can choose not to look at it. Mhm. 

Speaker 1

[00.45.30]

 It's what Tara Brach uses in the A of rain, which you mentioned earlier, isn't it, that that acceptance is very much like. Yeah I don't have to like it. But what I'm doing is I'm giving myself time away. I'm giving myself time to heal time. I do not need that kind of. It's like it's basically putting pins in your eyes, isn't it? But I'm just going to put the pins down. If 

Speaker 2

[00.45.49]

 only I knew that when I was in college. 

Speaker 1

[00.45.53]

 Have you been there, Johnny? Have you been there? I've been 

Speaker 2

[00.45.55]

 there. Yeah, I've walked past the house. Yeah, yeah, I've had that hot dog. I've read the book. Yeah, I did, I mean, I was that guy. I mean, I was, I was the guy that was putting pins in my eyes, you know, taking years to recover from breakups that could have taken months, you know. It's just it. And it's sort of rooted in non-acceptance. I can't accept that this has happened. It's not fair. Why me? How dare they? You know, these are these are all like, uh, statements of non-acceptance. Right. When you when you accept a difficult situation, you you get to the you get through the gears of recovery much more quickly. And it's like grief. Right? So grief is different every time. You know, the loss of a a parent from natural causes is is very different to the loss of, say, a child or a brother or a sister in an accident. You know, that's a so that's where radical acceptance becomes particularly challenging. It's like, you know, someone dies, age 90 of, you know, it's sad, but it's like I think acceptance comes pretty quickly. But, you know, in other scenarios it's much, much more difficult to to model. Something. I mean, it's like when you're dealing with those massive, massive grief events and it's like, oh, have you tried radical acceptance? It's like it's it's not easy. It's a concept that needs to be kind of introduced very, very gently. And, you know, because there's a lot of pushback to to the idea of radical acceptance, because people come into the consultation room and they're they're in pain, you know. 

Speaker 1

[00.47.51]

 Yeah. And if you're talking about those mass grief events or an out of sequence grief event, it's it's utterly contradicting my narrative of how the world should work, isn't it? It's it's absolutely gone against the order of things. And it's and so then we're railing against randomness, which is a fact of life, isn't it? But yeah. Impossible. 

Speaker 2

[00.48.12]

 Yeah. 

Speaker 1

[00.48.13]

 Take me to one last thing then, about how you know when to stop. Who? Who how do things conclude in your work What's interesting? You play the role that the client plays. How how did you how do you know that those behaviors have been, um, arrived at the outcomes? 

Speaker 2

[00.48.32]

 Well, a lot of it's in the treatment plan, and I, I'm pretty transparent about my treatment plans or of of grown to be transparent. Maybe not at first. But, um, I try to share it with my clients every 3 to 6 months and I'll be like, hey, have we met our targets? Do we need new targets? Are there some things that you want to work on that are different from what we discussed? Uh, and then there's clients that are pretty reliant on weekly counseling. So, for example, I'm, I'm transitioning from one practice to another right now because I moved recently from Washington to California and, uh, you know, for various contractual reasons. And I'm sort of sunsetting some of my Washington clients. And, uh, it really depends on what's clinically appropriate for the client. And in the case, to answer your question of the client that's met their goals is, you know, it's a collaborative conversation. And I think with DBT, I try to make it time limited. I try to be pretty clear at the beginning to say, well, look, I think we could probably. Do what we need to do in a year. Maybe. Maybe we only need six months. You know, if the client is doing a, like a group. Like a psychoeducation group, I would ask that they do it for a year, um, so that they really understand the skills and how they apply to them. Um, so obviously it depends on the client, but I try and I try and get them out the door if I can, you know, um, as far as possible. Um, 

Speaker 1

[00.50.20]

 and so people that's something that you manage, that's something you carry. That kind of determination is something that is largely in your hands. It's not something they kind of come to you with. 

Speaker 2

[00.50.30]

 Uh, it has to come from the client. I wouldn't I wouldn't discharge a client against their will. No. 

Speaker 1

[00.50.37]

 Sure, I understand that. 

Speaker 2

[00.50.38]

 Uh, and it's it's a conversation I'm quite happy to have, you know, 

Speaker 1

[00.50.46]

 so you kind of bring it in. Oh, yeah. Introduces 

Speaker 2

[00.50.49]

 it. Yeah, definitely. Yeah. I mean, I see people who are doing great and I'll be like, what are we doing here? We. 

Speaker 1

[00.50.56]

 Yeah. We don't want to be reliant, do we? I 

Speaker 2

[00.50.58]

 don't think you need to see me anymore you know. Mhm. Yeah, yeah, 

Speaker 1

[00.51.02]

 I find it when people I can be quieter and quieter and quieter, and people have sort of internalized the things that we've talked about, and they start talking about the difference between who they were and how who they are now. And yeah, and like, okay, you're you're telling me everything. Everything's done here. That's that's what you're telling me, is it? Are we, like you said, do we need to readdress? But what my my job is, is finite. And my job is to make myself redundant. You know, I want you out there and surviving in your own life, and 

Speaker 2

[00.51.31]

 for sure, that's that's a that's the sign of you having done a great job. And. Yeah. Because it's, it's yeah, I mean, you know, what happens when, when it, it drags on and it's not effective and it's, it's, it's expensive for the client. 

Speaker 1

[00.51.48]

 Of course it is. Yeah. Real world problem. Yeah. 

Speaker 2

[00.51.51]

 It doesn't need to be, you know, unnecessary expense. 

Speaker 1

[00.51.59]

 Johnny I'm about to wrap us up. Unless you've got anything else you want to say. 

Speaker 2

[00.52.03]

 No, I think I've talked enough. Yeah. 

Speaker 1

[00.52.07]

 Before. Before you do, go tell me where people can find you if, uh, if we've got any. Because I do have some folks stateside who I've seen on my stats. So where can people find you? I'm 

Speaker 2

[00.52.19]

 licensed to work with clients in the states of Washington and California. And you can find me at guidepost dbt.com. That's guidepost.com. Our center is in Madera in Marin County just north of the Bay bridge, not the Bay bridge. The Golden Gate Bridge. Um, but we see clients remotely, uh, all over the state and in my case, Washington to. 

Speaker 1

[00.52.50]

 So you get licensed to individual states? I didn't know that. 

Speaker 2

[00.52.53]

 Yes. It's, um, it's quite a thing here, huh? Yeah. It's like you think of it like different countries. You know, you have to. I had to, you know, go back to school basically to to study for my California licensure, which was a lot. Yeah. But 

Speaker 1

[00.53.11]

 yeah, because you already been doing it in Washington. 

Speaker 2

[00.53.13]

 Oh yeah. For five years I've been working. Yeah. Wow. Huh. 

Speaker 1

[00.53.19]

 Jonny, thank you so much for joining me. This has been thank you. 

Speaker 2

[00.53.22]

 Thank you. Nadine, it's wonderful to talk to you. And, uh. Yeah. Good luck with the 

Speaker 1

[00.53.27]

 podcast. Thank you.