I credit my former psychiatrist, Dr. Lev, and the work we did together using the specialized therapy she practiced, TFP or Transference-Focused Psychotherapy, for saving my life and giving a life worth living. But, she once said something to me, which I will never forget.
What is TFP?
First, TFP is a psychodynamic treatment also developed to treat borderline personality disorder. As its name suggests, TFP is based on the transference or relationship that develops between therapist and client. The premise is that this relationship reflects the client’s relationship patterns outside of the therapy practice. By gaining insight into behaviors that occur during therapy, the client can begin to change destructive patterns in other relationships.
DBT as foundation
TFP can be extremely intense when Dr. Lev and I have been digging into painful topics and memories. She said my DBT skills laid the foundation for my ability to tolerate the intense emotions that arose over the 11 years we worked together. Although there were times when I felt like self-harming, I was able to use the Distress Tolerance Module skills to temper my urges. My favorite is self-soothing with the five senses. I have Shelby, my rescue dog to touch and play, and a weighted blanket, which is great when Shelby wants to be left alone. I have a scented candle and my favorite painting, passed down from my grandmother. I have a playlist on my phone full of the music I grew up with in the 70s and 80s and some newer songs that I enjoy. When it comes to taste, I like frozen yogurt bars, which come in a variety of flavors.
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I had the good fortune to learn DBT in a long-term hospitalization unit where I stayed for 10 months from 1990 to 1991. It was really an intensive environment. We have lived, eaten and breathed DBT. We had individual DBT therapy sessions, group skills sessions and coaching sessions, we had to fill out journal cards each evening for homework and then there was informal coaching by the staff all day and all evening.
After I was released from the long-term unit, the same hospital opened a DBT day program, so I went there for 18 months. We arrived at 9am and left at 3pm. It was pretty much the same structure except we didn’t sleep there. Even though it was a long time ago, I engaged in a lot of intensive DBT.
As some of you may know from reading my blog over the past few years, in 2014 I attempted suicide. This attempt was triggered by the death of my father the previous year. He and I had an adversarial relationship and after his death I imploded with resentment and rage. The emotions associated with his death felt like a charging rhinoceros and I doubt any DBT skill, no matter how well practiced, could have stopped this 3000 pound animal in me.
Some DBT skills I use frequently and ones I tend to teach my clients include Radical Acceptance. I think this skill is particularly useful in dealing with painful situations that arise in our lives, which for one reason or another linger in our memory. Mindfulness is a basic skill that helps me keep my feet on the ground. If I’m away from home and need to recharge, I use deep breathing. It’s free, portable, accessible and discreet. Who could ask for more? Wise Mind is another favorite. First, I try to figure out if I’m in the emotional mind or the logical mind, or what’s the difference between the two. If I am strongly into one against the other, I try to understand why and what I am avoiding in order to regain balance or as close as possible.
Today, DBT has been extended for use beyond borderline personality disorder. It has been shown to be effective in people diagnosed with substance use disorder and eating disorders, for example.
An article published in the New York Times on August 27, 2022, titled “The Best Tool We Have” for suicidal and self-destructive teens, states that “studies indicate that dialectical behavior therapy offers greater benefits than more widespread, but treatment is intensive and costly.
Pay for the treatment
My DBT treatment was obtained before the era of managed care. Long-term units still exist – they are now called a residential level of care, but insurance rarely covers them. Most people have to pay out of pocket, which is out of reach for those in the middle and lower income range.
My TFP treatment was fully paid out of my pocket as Dr. Lev did not accept insurance. I contributed what I could and my brother was generous as he also helped me. Dr. Lev also generously lowered her usual fees so that I could work with her twice a week, which TFP requests and sometimes she let me carry a balance which I paid back.
I realize that I was very lucky to have access to DBT and TFP treatment, it was a major contributing factor to my recovery. I realize that most people don’t have the ability to access this type of intensive treatment.
I remain grateful.
Thanks for the reading. Andrea
Source: © Andrea Rosenhaft