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The idea of peer-monitored post-DBT follow up groups got started from conversations with other DBT graduates. We noticed that there was not a format for long-term, ongoing DBT. It wasn't so much that we felt the need to learn more skills, but to discuss the skills we had learned and foster an environment of support and accountability for our everyday lives. We wanted it to be similar to AA groups except that all participants had to be DBT graduates.
When we first presented this idea to Marsha Linehan, she told us right away that it wouldn't work because of the nature of BPD (or people with similar types of diagnosis'). People with BPD have trouble with boundary confusion as well as inappropriate behaviors when triggered by stories similar to their own and have the tendency to be addicted to crisis. We balked at this response, certain that we could make it work anyway if all the participants were focused on a goal.
But Marsha was correct. The boundaries required for leadership were outside the skill set of group members. Triggering behavior often required professional intervention. Plus, when feelings were hurt or when someone felt panic, we were unable to provide the kind of validation offered by professionals. In a peer-led situation without training it was unrealistic to ask our leaders to rise above their own lives and issues in order to exert control of the group. We even tried creating a set of rules and circumstances and guidelines that groups would have to follow. But truly, the nature of the diagnosis is ill-suited to a peer-led environment.
However, there has been one situation in which there has been some success in Toronto and Boston. In this situation, if a group of DBT graduates (attending classes in phase one and two of DBT training) continued an ongoing group with the very same people in the same setting (the medical institution as opposed to someone's home) with access to professionals and where professionals regularly came to "check up" on the group, there was a degree of success. The difficulty of widespread recreating this sort of group was the involvement of professionals & using their physical space required either donated help or regular payment by the clients. Furthermore, insurance liability compromised any professional willing to take it on. It was, for the most part, too difficult to obtain unless a DBT organization built it into their curriculum.
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(continued)
Although not technically an “ongoing follow-up group,” I once received an email from someone who said she had been participating in 12-step groups before DBT. After learning DBT, she brought the skills to the attention of the 12-step group and they decided to incorporate them as part of their practice. However, she was the only DBT graduate in the group. After I heard this, I have wondered whether this limited venue might work for others because many DBT participants are already attending 12-step groups.
So, the best methods we have found for people who would like to maintain ongoing support is to continue with a DBT therapist or with a therapist that has some DBT training; to have occasional social gatherings with previous group members; to participate in online groups and discussions; to continue independent reading and practicing, even teaching the basics of DBT to friends and family to help with accountability; and to find a way to become active in some aspect of DBT or mental health.
A few examples of being involved in some aspect of DBT are Kiera van Gelder who became very involved with NAMI (originally as a volunteer). I work on this website and others write their stories with the specific idea of showing how DBT helped them. Some people publish these stories in paper form, on a website or on their blogs. There are innumerable possibilities for involvement and volunteering. You could strike up a conversation with the leaders at your DBT center and ask them if they have any ideas on how to help you continue training - or staying up to date. At the very least, if you volunteer your services to do whatever you are capable of doing in order to help the organization and yourself at the same time, well, free help is always hard for folks to turn down.
I would say that the fact that a person has the desire to continue to get help with DBT is, in itself, a good sign. I encourage those people to hang on to that desire and don't allow yourself to lose hope. Your desire is healthy and shows that you have had some success with DBT. Use your creativity to find a way to make it happen for you.
Lisa
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