Creating a Life Worth Living

Shortly before 2 p.m. on a Thursday afternoon, Erica Silverman* left school to go attend a consultation at the Ann Arbor DBT Center. She had been on the waiting list for quite a while and was finally contacted to set up an appointment with her new therapist.

“Honestly [I was] kind of happy,” Silverman said. “Because I knew this would help me get better.” However, she also felt her stomach in a knot, knowing that this would consume a lot of her free time.

She climbed to the fifth floor, the main office, past an old metal drinking fountain. The soft buzz of a sound machine filled the otherwise quiet air. A sign asked for silence in the waiting room, so not to disturb the current appointments.

This appointment was due to the fact that Silverman had recently admitted to her mother that she was having suicidal thoughts and tendencies. Her mother, alarmed, signed her daughter up for a local center downtown. Called the Ann Arbor DBT Center, the facility is dedicated to treating people in danger of taking their own life and working toward the goal of creating ‘a life worth living’.

This practice is called Dialectical Behavioral Therapy (DBT) and is a possible tool for many Ann Arbor teens who struggle with coping with their emotions.

These appointments ended up occupying a large part of Silverman’s life for the next two and a half years. Each week she would meet with her individual therapist, along with attending group therapy for two hours a week. Parents attend group therapy with their adolescents, with the intention of helping the parents to be educated and involved in their child’s self-improvement. DBT tends to be adamant on assigning daily and weekly homework, adding another factor to consume Silverman’s life outside of school.

“[I was] kind of frustrated because I knew would be a really big time commitment, honestly,” Silverman said. She found herself occasionally overwhelmed, especially after being in the program for a while.

DBT was developed as a type of Cognitive Behavior Therapy by Marsha Linehan, Ph.D., ABPP. The main idea is thinking more dialectically, with a central idea around avoiding ‘black and white thinking’. This is the idea that two opposing things can be true at once, the grey area between black and white.

DBT consists of four modules for teens: distress tolerance, ‘walking the middle path’ (relationship skills), emotion regulation, interpersonal effectiveness, with two mindfulness weeks between each module. 

Though it was originally designed for treatment of borderline personality disorder, research shows that dialectical behavioral therapy can be very successful in the treatment of individuals with depression, bulimia, binge-eating, bipolar disorder, post-traumatic stress disorder, and substance abuse. DBT therapists often ask clients to fill out a diary card each day. On this sheet, they rate their mood, along with urges for substance use or self-harm.

In addition to developing interpersonal skills, DBT is believed to help individuals better communicate with friends, family, and others in their community. Mental illnesses, like depression and anxiety, can affect people’s social lives, and there are DBT skills developed to help them.

For example, a skill like DEARMAN (Describe, Express, Assert, Reinforce, (stay) Mindful, Appear confident, and Negotiate) is designed to be an easy, memorable acronym that clients can use to ask for something they want or need. When teens are having trouble asking for things, even as simple as a curfew extension, this skill can be very useful. It helps the adolescent appear confident and mature, often resulting in them getting what they were asking for.

Natalie Burns, L.M.S.W., M.A., is a senior licensed clinical social worker at the University of Michigan. Burns started to learn about DBT during her post-graduate fellowship program, where she observed her supervisor, who was trained in the subject.  “I believe these skills are so integrated into who I am as a person.”

“I thought it was really interesting and I was drawn to all the evidence behind the intervention,” Burns said, “But it wasn’t really until my fellowship that I started to see how effective DBT was.” After her fellowship, Burns proceeded to become certified as a DBT therapist.

Silverman continued in this program for about two and a half years, before her family agreed that she was ready to move on. Adolescents typically have a type of ‘graduation’ on their last day of group therapy. It is almost ceremonial, where each member of the group writes an anonymous letter or affirmation to the graduating teen and parent.

“Everyone in the group had to write something they liked about me, and it was awkward,” Silverman said. “But I don’t know, it wasn’t terrible.” She attended this final meeting with her father, as her mom couldn’t make it. She had been doing well for a while before her graduation, and her parents agreed that she had gotten as much as she could from the program.

Silverman said goodbye and wished her friends well, ready to enter the real world. She still applies DBT to her life, after graduating from the program. The therapy is designed to teach easy skills that can be used in any situation, especially in an emergency.

“I’d say the biggest one that I use every day in my life is mindfulness,” Silverman said, “My mom [thinks] everyone should go through this because it’s just part of life skills. I don’t know, not even people who are just emotionally dysregulated need this, because it’s just things to help you be a sufficient human.”

Learning these skills are not only beneficial for the adolescents, but often for all parties involved. It’s not uncommon for parents, like Silverman’s mother, to find a lot of use in applying these skills in their lives.

“I believe these skills are so integrated into who I am as a person,” Burns said, “I so often think in wise mind and what the right decision or choice for me is.”

Dialectical behavioral therapy is designed to make a difference in people’s lives, to help them create a life worth living.

“[I] was amazed how the combination of individual and group therapy was life-changing for individuals,” Burns said, “It’s incredible the difference it can make in individual clients lives.” Silverman, being one of these individuals, agrees that this form of therapy made an impact on her life and overall mental health.

“I was really unhealthy mentally before going into the program, but I think also a lot of things changed,” Silverman said, “I actually started caring about myself and practicing what they taught me.

*Name has been changed for confidentiality