Saturday, September 7, 2013

Willingness vs. Willfulness

One concept of DBT is that of Willingness vs Willfulness. Willfulness is stubbornness, it is cutting off your nose to spite your face. It is doing what doesn't work. Willingness is openness. Willingness it engagement. Willingness is doing what works, even when you would rather be doing something else.

The first time I encountered DBT, I did not have a good experience with it. I think there were really 3 reasons. First, and perhaps most importantly, I was not in the right place for it- I was too deeply depressed, I was too suicidal- I wasn't sure I wanted to live. My questions were existential- did I want to live? And here DBT was trying to teach me how to get through the moment. I didn't know if I wanted to get through the moment.

Secondly, I think the program wasn't very good, and wasn't explained very well to me. The second time around, 12 years later, it was a very good program. These people lived and breathed DBT! And it made a lot more sense to me.

But thirdly, the second time I was willing, and the first time I was willful. I can only say that in hindsight, because I didn't know those terms at the time. But I had a different attitude. My first time with the program, I did the exercises expecting them not to help, almost to prove to myself that they wouldn't help. 

After my latest hospitalization, I was referred to an IOP program that was DBT based. I had very low expectations, because the groups in the hospital were so terrible. I told myself that I would give it a couple of weeks- and if the groups were equally terrible, I would quit. But I would try it. And if they were good, I would stay the whole 6 weeks. And just that willingness to be open, to give it that 2 weeks, and to really work it- that was enough.

I was in a different place that second time. I had decided that, at least for the moment, I wasn't going to kill myself. I had a job to go back to. I was not feeling as desperate. 

DBT was designed for people with borderline personality disorder, although now it is being used for a lot of other things. It is designed for handling mood swings. I think that it can fall short for dealing with severe, prolonged, depression. But maybe I am just not doing it right.

As time passes since I was in the program, I think I am using some of the concrete skills less and less- but some of the big concepts just as much. Mindfulness. Radical Acceptance. Wise Mind. Willingness vs. Willfulness. And appreciating the dialectics in life.

The skill I continue to practice is Opposite to Emotion Action. Part of me says, well, of course. If you have spent much of your life depressed, you have spent much of your life doing opposite to emotion action if you have any kind of life. But the difference is to do it more mindfully, and with an acknowledgement of the emotions that you are experiencing, so that it does not feel like such a denial of self to carry on.

1 comment:

Just Me said...

Thank you. That makes a lot of sense and it makes sense why it didn't seem to be right for me at the time; I was too depressed to sit through NAMI's Peer to Peer class without a great deal of weekly encouragement. And even that I sometimes wonder if it would have been better to wait. I left Peer to Peer and went to a small group for a little bit but the drive was so long and the group kept doing fun things that cost money I didn't have so I quit. When I took Peer to Peer I needed somewhere to go and other people to interact but I was so sick that I didn't make friends or participate much.

I wish I could do IOP at Cleveland Clinic. They have a 6 week program that addresses a lot of things that everyone agrees would help me but I can't drive 5 hours daily for 6 weeks. The IOP that is closer didn't want me to see my therapist or my psychiatrist and since I've had a bad experience with their psychiatrist and my lithium level was very touchy at the time I wasn't about to agree. They also didn't separate partial hospitalization from IOP and couldn't tell me what I was going to learn through IOP that was different than going to have a safe place every day for a little bit.

Perhaps someday. There is probably an IOP about an hour from here so maybe the next time I need it (assuming that happens) I'll be more able to do it.

I'm glad you had a good experience this time. I did a level I fieldwork in a community mental health program that used DBT as one of their main tools to promote community living for people who were really ill. The clubhouse places had a lot of DBT related activities and I think most patients had been through a class at some point. That was a city with a notorious old psych hospital and the community put a lot of money into keeping the people who were de-institutionalized at home. I didn't appreciate that until I worked in what were basically "we don't know what to do with you" institutions.