DBT and CBT Therapy Interview
Me: Hi, so today's episode will be an interview from Christina Cummings. She is a DBT therapist from New Jersey and she will describe what that is in the episode, and this will be the first part of her interview. There will be several parts to her interview, and I hope you enjoy learning about her therapy. And comparing it to CBT therapy as well, which is Cognitive Behavioral Therapy. DBT stands for Dialectical Behavioral Therapy and we will be comparing those two throughout the interviews with her at me episodes that talk about that interview and also, Describing what DBT is and how it's different from CBT and I hope you learn some new things about how DBT helps people with NLD and how it's different from CBT and that this information will be helpful to you or to somebody that you know. So please enjoy this interview. Thank you. All right, so I am here today with Christina Cumming and she will begin by introducing herself.
Christina: Hi, I'm Christina. I am a DBT therapist in New Jersey and I work with a few niches. Populations and one of them is individuals with NVLD.
Me: Thank you, Christina. So I am really glad that you wanted to do this interview and that you work with NVLD people as that's one of the populations that I know needs help. And so I wanted to ask you how long you've been in DBT therapy and kind of what. Got you into it.
Christina: I have been in the mental health field for 11 years, and along the way I found DBT. I was not looking for it. but it landed in my lap and that started about five years ago. I. Always had a little bit of a grudge, for lack of a better term, against DBT because it's very intensive training.
Me: Mm-hmm.
Christina: And it really turns me off, the work turns me off because as a therapist you have to go through so much school and so much training to think of getting done. All of that to go back into training, really turned me off for a long time. And, I'm kind of jumping ahead a little bit, but I worked for an amazing nonprofit a few years back and I had the opportunity to go through a very rigorous training and had that be incorporated into, my working hours, which all of a sudden really lowered my defenses towards it and thought, well, if I'm working, I'm getting paid. I can do this additional training because it's within my 40 hour work week, and I fell in love. I really wasn't expecting to, but I found a lot of use out of it. And in some of the clients that I was working with that weren't making any progress, I was able to bring these techniques and skills to them and all of a sudden, There was change, there was movement forward where there was stagnation for so long.
And of course it's when you see something that works, you wanna continue doing it and I fell more and more in love with it as I went through and found more success. Yeah. That makes sense to me. That actually kind of makes me think of my podcast. Starting it and not realizing that I would really like doing the research and love helping the people that have reached out to me as a result of it, like you and any others who gave me feedback on it.
And he has told me how it's helping people that they know and being able to realize that this is a new passion of mine. So yes, it's like that unexpected positive feedback loop.
Me: Mm-hmm.
Christina: You didn't go into it thinking that it would be there. And yet it's there. And so it motivates you forward. And that is exactly what happened here with me.
Me: Yeah, I would agree with you on that. So the next question I was gonna ask you about was just, Briefly, if you want to explain what DBT is for people who don't know about it.
Christina: Yeah, so DBT dialectical Behavior Therapy is a very specific style of therapy that combines the need for validation of how difficult life can be, how hard things are in this moment, and pushing the clients in this therapy towards change. So, And that is a constant balancing act that the therapist is always doing. How much to validate versus how much to change or push towards change, because that's really what we want. We want people to change. We want people to take control of their behavior, to change their lives in order to meet the goals that are most important to them. But we can't just always be in change mode. Sometimes we have to be in. This sucks mode and just validating that and being with that. so dialectic, that idea, that word is.
When two things that seem opposite can be true at the same time. The fact that, uh, I might need to validate someone quite a bit and just be with them where they are, and that will actually promote more change in the future. There's lots of dialectical understanding in life. And some of it's really simple, like, seeing the sunshine even though it just rained a couple minutes ago. So seeing the sunshine on a rainy day or being mad at someone but loving them and we're trying to harness that. There's always, there's always balancing points in life. DBT has a pretty structured therapy session and you use a diary card, whether it's virtual, an app, or an actual piece of paper or journal.
You use this tool to go over how you felt throughout the week.
Me: Mm-hmm.
Christina: And, any specific targets, behavioral targets. So if someone is trying to. Reduce thoughts of really being disappointed in themselves, then you would hone right in on those thoughts and get right to the stuff that matters. And, in addition to the diary card and the therapy session, there are skills sessions where people learn the DBT skills. This is another really Awesome reason why it seems to click so well with people with NVLD because there's solid and specific skills to use and try. It's not like maybe I'll just kind of wing this or try this concept. It's very like step one, step two, step three, and people love that. And then finally on the backend, something that's very important that makes DBT is, the therapist having a consultation team.
So that means that as a DBT therapist, I meet with a team of other DBT therapists every week, like with the exception of holidays and things like that, but, We are very committed. We meet every week and we support each other in supporting our clients. Okay. That, that makes sense. When you were talking about the detailed process, that actually made me think of NVLD mind and how they like very detailed things.
Me: So I can see how it works well with a NVLD person and, when you were talking about the diary, made me think of my own therapy where my therapist, she has me do, basically think of homeworks for the next week. And, I guess that's a little similar to a diary where you would be thinking of homework that you would wanna work on.
And that's been helpful because I try to pick something to work on while. In between sessions basically. And yeah, it's kind of fun sometimes. Like one of the examples or one, one of the homework assignments was, trying to pick up on emotions more in an emphasis of tone conversation.
So I listened to a YouTube clip of Disney clips and, it was, I did Cinderella, so that was kind of cool. And it was fun because I'm very good with my audio memory and so I can recite really well with it. but it was like, okay, I'm not reciting just with the words I have to pick up on the emotion, the tones.
Christina: Yeah. That's a great homework assignment by the way. Like, kudos to your therapist. That's a really good one. I like filing that one away and I'm going to use it. Yeah. There's, there's a lot. There's often homework in DBT, especially in skills, so mm-hmm. How that looks just a little bit more, Someone will generally go to two sessions a week in order to learn all the skills and start therapy for some period of time.
Me: Mm-hmm.
Christina: Sometimes skills are taught individually, often they're taught in the group session. People with NVLD, it's like a mixed bag. And I ask that, folks. Reflect on what's worked best for them. Sometimes group skills or group teaching environments have not been really beneficial in the past, so we would go towards individual teaching sessions for those skills.
And usually people are coming into this knowing exactly how many weeks they're going to make that bigger commitment of doing twice a week appointments. To learn all those skills. Something like 12 or 16 weeks.
Me: Hmm. Yeah, that does make sense because I know, before I was with the therapist and I have now, I used to do group therapy and individual therapy, and so that was, I think that was, it was either, it might have been twice a week or I did both on the same day.
I forget. Yeah. Cause that was a while ago, but that felt like a bigger commitment because I had both, but it was, it was nice because I got to know the other girls that were in the group and got to see the different stories of them and got to appreciate the differences between mine and theirs. So it does help knowing, okay, which one's gonna help be a better group or individual. And, sometimes it depends on the kind of therapy, you know, whether it's talk therapy or something like psychodrama. I've done a lot of that too. but I know one thing I wanna ask you. I know DBT can help NLD, but what else can it help?
Christina: It was designed to help. Highly suicidal people. When it was first created, it was designed to help people with borderline personality disorder or features, strong features of that disorder. So people who have, self-harm behaviors, chronic suicidal ideations, and as time's gone on, it's been. Studied in more and more settings, more, mental settings, so other diagnostic criteria that people would meet aside from those very, extreme, very severe cases.
And there's one common factor in the people that it really helps for those that it really helps. Talking about something and gaining insight into it doesn't lead to feeling better. Mm-hmm. You can, for some people just talking about something, getting it out, getting it off your chest, that leads to gaining insight and course adjusting.
Some people have a really hard time adjusting even when they know exactly what's going on. So that person that says, I know exactly what I wanna stop doing, or I wanna start doing, and I've tried and tried and tried and I can't do it, that's the person that I would recommend trying DBT.
Me: That makes sense. Cause, it sounds like they probably would need to do a different behavior or something. You got it. Yep. That's, you hit the nail on the head. It's like trying new things. Mm-hmm. Even though you're pretty sure they might not work. Even though you don't actually wanna do them. So you learn the new skills and then you try the new skills, even though it's a huge pain and it's all a gamble, all in effort for achieving those goals, that you really wanna be moving towards. But something is standing in your way. Something about your behavior, your current behavior is stamping in your way.
Me: Mm-hmm.
Christina: So, one of the mottoes in DBT is that our minds no longer control us. We control our minds and therefore we control our behavior. I like that. Yeah. It's powerful.
Me: Mm-hmm. Yeah. I was thinking about when you were trying new things because I think NVLD has pushed me to do that many times since I've been diagnosed when I was in college. Because whenever I need to tackle a challenge, I need to be able to look at it and be like, okay, I may need to get at this in different ways that I haven't before. Or do something that I've done before but slightly different. Be able to make it easier for me. Yeah, yeah. And that constant course adjusting, like I had mentioned earlier, the constant course adjusting, like I, it's very difficult.
A lot of people find difficulty with this and have some support in coming at it. From a different perspective, from that skills perspective in trying something that is not where your mind would've automatically gone, trying something that is, you know, out of the creator of DBT, her name is Marsha Lenahan. Trying something from Marsha Linehan's perspective instead of from our own perspective, can. Really help us to get out of those, those funks that we're in when we are trying to figure out like what's, how is this going to work out best? How am I gonna make this easier? Maybe not really easy, but easier for myself.
Yeah, and I don't know if this happens with any of your NVLD clients, but I know sometimes for me, I can be, and this is something I'm still working on, I can be dismissive of trying something in a different way because I don't always think it's gonna work and I go to being the literal part of NLD being black and white with the extreme of it.
No, it's not gonna work when I should just be open up. Maybe it won't. You know, it's something that I see in my NVLD clients and it's something that I see in my non NVLD clients. Like I think that it is part of the human condition to be like, okay, I know this is going to take effort. And do I really believe that there's going to be an equal outcome?
Me: Mm-hmm.
Christina: And we can sometimes logic ourselves into saying, no, there's not gonna be an outcome there when we don't really know, but our logic is telling us that. And it might make a lot of sense and still, DBT skill is called being willing. It's just simply doing what works, which means trying new things to figure out what works and what doesn't work is one of the hardest skills.
Me: Mm-hmm.
Christina: Because it's so easy to see at times to say to yourself at times, oh, that's not gonna work. I'm not going there. It's not gonna be worth the effort. Yeah, that does make sense because I can, I can think of times where I've been trying to get a challenge. Like, driving is probably one of the hardest ones for me where I try to visualize spatially, I try to focus on my surroundings, but also not run into anything.
Me: And, It's a little nerve wracking. I know that I'm not the only one that gets nervous when I drive, so Yeah, like there is that mix of looking far enough out. Mm-hmm. So that you are really like, In the big picture of driving, but also having to know if there is a pedestrian just to your left.
Yes. And the skills to do that are it, it's a juggle, right? Yeah. You're right. Yeah. The big picture and the little picture.
Mm-hmm. Yeah so also a question I wanna ask you was, how does DBT differ from CBT?
Christina: Cognitive behavioral therapy is really based in the mental restructuring of our thoughts, how you speak to yourself, that running dialogue that a lot of us don't even realize that we have.
Me: Mm-hmm.
Christina: There is for so many people, an almost constant running. Not dialogue, but monologue of what you're saying to yourself. Mm-hmm. And while thoughts are very important with DBT, we view them as another behavior. And DBT has a huge focus on behavior, which is a big difference from CBT, where it's mostly about those thoughts, those cognitions. So with the greater focus on all behaviors, including thoughts like getting up and going to work, even if you're having thoughts of you don't feel like it in CBT, you might focus on changing those thoughts. And in DBT we might eventually get there, but it would be about in that moment getting up acting opposite to those thoughts and going to work anyway.
And that's the true target. The true win is getting up and going to work anyway. That makes sense. Cause I know I've worked with creating some better self-talk for myself as well and making more positive words and, Trying to make myself think better about myself and love myself more over the years of therapy, which isn't always easy, depending on how you think about yourself.
It can be really difficult. You know, I don't wanna get too tangential here, but when you are living in a neurotypical world, which we all are, you're kind of getting. The invalidation that something is wrong, something is off. Your brain's not working like others. You are not quite like everyone else are you?
From every direction, from the media, from school, from peers, and I'm sure there's just so many realms of living that I'm leaving out here and. All of that goes. It works surprisingly well. I wish it didn't work so well at creating negative self-talk for people with NVLD so many of my clients struggle with, I'm a freak. I'm such a loser. I wish my brain was different. Why was I born like this? Mm-hmm all of these things that are just like it's heartbreaking, honestly, when you hear these people that have amazing things to contribute to the world, but because their brains worked a little differently. They just got these messages over and over and over again that their differences were not okay and were inconvenient or, you know, just different from the norm.
This self-talk is really severely affected. And so in DBT we view that as a behavior and try to actively change that. And we would call that type of self-talk a myth. So that is a myth that you are saying to yourself, a myth being something that is not true. Just because you have NVLD doesn't make you a freak.
It doesn't make you useless. It's a really common theme I see among the people I work with. And it kind of, I don't know if you can tell, but it gets me a little revved up because it's, it really is, it's, it's like stealing from all that they could potentially be contributing to the world.
Me: Mm-hmm. Yeah, I can relate with that because, I'm sure it's true with not just people with NLD, but any learning challenge as I like to call it, because, or like you were saying, nonverbal learning differences of disability. Yeah, and I like that because it is really, you think differently than a neurotypical, and that is true with somebody with autism or, Asperger's or I. Other ones as well, and ADHD also. And that, they, you know, I know for me, I've had some of those words in my mind too, where, oh, I'm, you know, I don't know if I've thought of freak, but maybe outcast, and.
You know, like I know sometimes I've thought where this, made me laugh cuz I was thinking of something I said in previous broadcast episode where I was talking about emotions and emojis and how sometimes I don't know what an emoji means and I'm afraid to ask some of my neurotypical friends that may not know about NLD. So, And I'm like, they may, I'm thinking their response would be like, she doesn't know what that emoji means, like is she not in? Or something like that. And so like that's kind of something like I'm a freak because like you would think, oh, you would know that. So usually I, if they don't know I have an ld, I Google it to divorce that.
Christina: Yeah. It's something that's like, well, is this supposed to come naturally? Other people get it naturally, why don't I? Yeah, yeah. Right. Yeah, and it's interesting because there's emojis that I don't know, and I don't get, and. And, I occasionally have to ask like, what, what does that mean? I remember, oh, I won't go into a story, but I mean, I, yeah, and it, here's the difference though.
I haven't been getting all my life, like what you, you're not picking up on that. You can't read that facial expression. You don't know what they're trying to say to you. Even though they said those words. That's not really what, so on and so forth. I haven't been getting those messages all my life. So my anxiety surrounding asking about an emoji is really, really low because there's no fear there about having a deficit in that area or being different in that area, and. I think that's what creates the fear in asking for people, and not just emojis, but like the, can you repeat those instructions again?
Me: Mm-hmm. Or is there any way that you could write that out for me? or so on and so forth in asking any question because they, people with NLD have gotten those messages for a long time about how, it is abnormal to have to ask as much as they're asking. Yeah, I agree with you, with those sorts of questions. Or like if somebody says to you, why do you have that face? And you're like, what face? Like, I don't know, that's often what I would say. Like, I don't know what my face looks like. Like I'm not looking in a mirror. And even if I was, I would probably, I. Be changing it because I would, I mean, I, that's just probably what somebody would do.
Christina: Mm-hmm.
Me: And, like I know when I was taking a test, or trying to be diagnosed with NLD they had me looking at facial expressions and trying to say what they were without any labels on. The pictures of them and I was like, I'm not sure where they are. Like I was clearly guessing, so that I can relate to that too. And as I wrap up, there are some things I would like to share with you. My audience. Please know that just because I have a podcast doesn't mean that I'm perfect in every way and don't make mistakes. I make them every day and try to learn from them. I hope that this podcast helps you feel included. Not alone inspired, safe and encouraged to make your life a little easier for you every day for a chance. I hope you enjoyed today's episode and I will talk to you next Friday. Bye.
