What happens when I add hashtags

So my last post was about food, and it had a couple eating disorder tags. I ended up getting some spam accounts liking my post – spam accounts pushing weight loss.


It gave me an idea – how many spam likes could I get if I had a post that was primarily tags? Let’s find out!



Grits shouldn’t have sugar in them

Nor should cornbread. And not everything needs cheese. Examples of two things that do not need cheese: cornbread and grits. Cornbread and grits do not need sugar and/or cheese. Blasphemy.

Food is tied in with identity, as is the case of my insistence that grits and cornbread needn’t have sugar in them. My husband begs to differ on the grits and made me try grits with sugar in them the other day. He made the argument that was how it was done when he was stationed in Georgia many years ago, which was to counter the argument that I spent my summers with family in Tennessee when I was growing up and was not taught to add sugar to grits. We have had this disagreement for several years. I finally agreed to try them. They tasted like a five year old crushed up stale kettle corn in a bowl of water and squished it all together with tiny fingers. To each their own, I guess.

A lot of rules about food come from broader culture, faith traditions, and family norms. Food keeps us alive, food keeps us connected. Food is ritualistic and communal – wedding cakes, barbecues, Thanksgiving dinners, and potlucks. Rules for a particular food can vary by region, like sugar and grits (Which admittedly is no less Southern as grits without sugar, it just happens to be gross). Food has a funny way of bringing people together.

Except people who more or less don’t feel togetherness don’t often bond over food. Food-prominent events are at best awkward and at worst prompting events for self-destructive behavior. There is no quick advice for these people that hasn’t already been heard a million times over. Cope ahead, positive/rational self-talk, just eat anyway and don’t hate yourself for it, stay in the moment, etc. etc. Not bad advice, just won’t fix anything in the long-term.

Autism, Empathy, and Something About Accountants

I finally watched The Accountant. To summarize, it’s a thriller movie with a bunch of the usual thriller tropes, except the anti-hero is an attempt at portraying diversity but instead ends up an amalgamation of clichés about people on the spectrum. Pro Tip: If you’re making a film with an autistic character, consider spending more time consulting with autistic people than time with neurotypical people.

Anyway, the film got me thinking about empathy. Especially the way in which people who do not appear to have much empathy are filed in with abusive spouses, serial killers, and those who maim kittens. While abusive spouses, serial killers, and those who maim kittens are often low on empathy, it does not mean that all who are low on empathy are any of those things nor does it mean that abusing, killing, and maiming requires low empathy. Empathy is not the same thing as compassion or sympathy or pity or loving-kindness or being moral or whatever other nice-sounding quality you think is associated with empathy.

Empathy is, per Merriam-Webster, “the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner; also :  the capacity for this”

Empathy can be broken down into cognitive (being able to take the perspective of real and fictional people), affective (being able to respond to someone else’s emotional state), and somatic (having a physical reaction). Deficits in these types of empathy are found in yes, autism, as well as anorexia, all personality disorders, psychotic disorders, OCD and a few of the related disorders – a significant number of people, the majority caring and welcome in society.

Deficits in empathy makes violence and cruelty easier, no doubt. What often happens, though, is that people with a lower ability to be empathic feel disconnected from others, lonely, and depressed. It is harder to communicate effectively with empathy is lower. People are punished for being being different, and those punished withdraw from others.



You’re Not In DBT, part 2

In You’re Not in DBT, part 1, I gave a brief definition of Dialectical Behavior Therapy (DBT) and suggested your therapist may be engaging in dishonesty behavior if claiming to provide DBT services when they are not providing all modes of DBT service delivery.

Today we’ll talk about what to expect from DBT and how to find a provider.

What to Expect (Briefly)

  1. Providing a commitment not to kill yourself or engage in self-harm – and keeping that commitment.
  2. Avoiding psychiatric hospitalization like the plague.
  3. One hour of individual therapy and one to two hours of skills training per week, with homework.
  4. It’s behavioral, so you change your behavior – yes, that’s easier said than done, but the plus side is you get guidance on change.
  5. And there is a big emphasis on acceptance – you are where you are.
  6. Getting comfy with what seem like contradictions – dialectics.
  7. Tracking emotions, symptoms, and skills used on a diary card on a daily basis.
  8. Acronyms upon acronyms.
  9. Structure – all sessions have an agenda, starting with keeping you alive followed by sticking with therapy and ending with everything else. You don’t get much time to ramble.
  10. Being viewed as capable – which means you’re held accountable for your actions.
  11. Many, many “Assumptions,” a noteworthy one being the relationship between the therapist and client as a relationship between equal people. Yep, your therapist is a human, not unlike you.

Where do I find a DBT therapist?

Check the Behavioral Tech “Find a Therapist” directory

Also check the DBT-Linehan Board of Certification website

You can also ask your psychiatrist or get a referral from an inpatient program, if applicable. Chances are pretty good they’ll suggest it before you ask if there is a program close to you, and your risk of committing suicide is high.

Next in the series will feature alternatives to DBT, for those who find DBT ineffective, don’t have access to it, or just don’t plain care for it.

You’re Not in DBT, part 1

Today I am going to talk about DBT, or Dialectical Behavior Therapy. I’m a therapist on two DBT teams, and I have noticed a major problem in the therapy community is that clinicians are advertising DBT services when they are not providing them. A lot of folks with “over control” disorders are referred to DBT programs, particularly those with restrictive-type anorexia, so it’s a topic worth discussing.

DBT is a cognitive behavior therapy-related treatment for Borderline Personality Disorder (BPD). It assumes that people with BPD have a biological predisposition to high emotional sensitivity and slow return to baseline emotional state, coupled with a history of an invalidating social environment. This is called the biosocial theory.

DBT addresses the sequelae of these factors, which can include life-threatening behavior, problems with impulse control, cognitive rigidity, emotion dysregulation and ability to tolerate distress, and interpersonal difficulties. It is a mindfulness-based therapy, drawing from the work of Jon Kabat-Zinn as well as the Zen school of thought.

DBT programs are made up of “modes” of treatment, which are:

  • Weekly individual therapy, with a therapist who has training in DBT (via internship/residency, on-the-job supervised by a trained DBT therapist, and/or formal training events)
  • Weekly skills training – individual, group, or family (as a separate appointment, and also with a trained healthcare provider)
  • Access to phone skills coaching in between appointments
  • Therapists and other DBT providers are members of a consultation team with weekly meetings – “therapy for therapists”

If your therapist is not offering these services to you, there is a chance that you are not in DBT.

There are some exceptions. Hospitals, residential programs, and research settings may provide variations on service delivery. You could also be waiting for a therapist or skills trainer but may still have access to other services.

DBT is different from some types of therapy in that it is not an all-encompassing theory with treatments for a large number of disorders. For example, Psychodynamic theory focuses on the impact of early life on conscious and unconscious psychological processes. Another example is Cognitive Behavior Therapy, which is a problem-solving approach and examines the role of present thinking and behaviors on mood state with the intent to change thoughts and behaviors.

DBT is not a theory in itself. It is a specific treatment with protocols within it aimed primarily at BPD and BPD traits (though may work for other disorders).

There is absolutely nothing wrong with therapists using elements of DBT, such as:

  • Using worksheets from the skills training manual in session or as homework because they find them useful.
  • Assuming and teaching the biosocial theory when working with individuals with BPD.
  • Teaching DBT terms to clients.
  • Using a DBT-like session structure.
  • Teaching mindfulness – mindfulness is not exclusive to therapy.

But advertising DBT services when not providing them is not okay.

Worse, many insurance companies will not verify whether or not a clinician is providing DBT services before listing them as DBT providers on clinician directories.

The next post will focus on how to find a DBT therapist, what to expect, and alternatives to DBT.