5 Ways To Be A Better Listener: Communication Through DBT Skills

DBT for Communication

by Megan Delp, MFT

The Dialectical Behavioral Therapy (or DBT) tenant called Interpersonal Effectiveness teaches us how to be a more effective communicator through learned to be a better listener.  We have always known that progress depends on the ability to communicate effectively.  The most effective communication does not begin with what a person says, but how well they hear the person they are communicating with. Only by listening effectively can you respond appropriately inany situation.

Throughout all forms of communication (reading, seeing, speaking, listening), we spend 40% of that time listening.  And yet, we get less training in listening than in any other kind of communication. All throughout childhood, we are taught how to speak, how to read, but very little time is spent on learning how to listen.  Learning to listen is difficult, but worth it.

For instance:

• You can not NOT communicate.  We're communicating verbally or nonverbally all the time.

• Whenever contact is made, some form of communication does occur.

• The true meaning of something is not in the words we use, it's in how people interpret the words.

• Yet the meanings cannot be transferred. We can't just put a computer file directly in someone's head. We can only send the words. So listening becomes a critical skill if we are going to fully understand the meaning someone is trying to send us.

We have the ability to listen in many different ways - it is important to be able to distinguish how we are approaching our communication so that we are prepared to handle it effectively.

The Five Listening Approaches are:

1. Appreciative:

People are more likely to listen if you feel inspired by what you are hearing or if you are enjoying yourself. You’re not necessarily interested in the details when you are using Appreciative Listening, rather you are more focused on the impression of the experience.

2. Empathic:

This style is often a sounding-board to others. A person would offer support to the person they are listening to.  They focus specifically on the feelings revealed by the person they are listening to. If you are often approached by people who need to confide or vent about something, you will know that's your typical approach to listening!  This style is much more focused on offering compassion.

3. Comprehensive:

A comprehensive listener can recognize key details between one message and another even when the speaker is less than organized. They can also recognize when someone doesn't understand what is being said and can re-explain clearly in their own words.

4. Discerning:

This approach of listening wants to get all the information and may take detailed notes.  Distractions can be very disturbing when using this listening approach. An example would be when other people are talking in class and you are trying to get all the notes.

5. Evaluative:

When listening with an evaluative approach, the listener will not automatically accept what is being said as true just because an expert says it. If they disagree, they will simply stop listening. They will also be more doubtful if the speaker is too passionate about their topic. This approach can be helpful when evaluating something and making a decision about it.

It can be highly useful to adapt your listening approach to the needs of the situation.  For example, if a close friend is sharing their difficulties with you, you would want to be empathic and not evaluative.  You have probably had the experience of someone giving you unsolicited advice when you really just wanted them to empathize with you!  The opposite can also be true. When you recognize the correct listening approach in any situation, and use the appropriate listening approach, you can build better relationships, make the correct decisions and use your interpersonal effectiveness skills.  It all starts with learning how to listen!

Megan Delp, MFTI

Megan is a pre-licensed Marriage and Family Therapist specializing in couples counseling and individual therapy for those struggling with depression, anxiety and relationship issues.  Megan practices with Spilove Psychotherapy in West Chester, Pennsylvania and on the Main Line of Philadelphia in Bryn Mawr.  For more information or to schedule a free 15 minute phone consultation, contact us here.

The Number 1 Trauma Treatment: EMDR Explained

Lucky us!  Scott Giacomucci, MSS, LSW, CTTS, CET III, trauma specialist, psychodramatist and all around amazing therapist has shared his insights and explained that complicated title: Eye-Movement Desensitization and Reprocessing, also known as EMDR.  The following is a handout Scott put together for his clients to help explain what EMDR is and how it's done:

EMDR: Eye-Movement Desensitization and Reprocessing

Often, when something traumatic happens, it seems to get locked in the nervous system with the original picture, sounds, thoughts, feelings, etc.  Since the experience is locked there, it continues to be triggered whenever a reminder comes up. It can be the basis for a lot of discomfort and sometimes a lot of negative emotions, such as fear and helplessness that we can’t seem to control. These are really the emotions connected with the old experience that are being triggered.

What is EMDR?

 Eye Movement Desensitization and Reprocessing, is a late-stage, trauma resolution method.  Developed in the late 1980's, EMDR currently has more scientific research as a treatment for trauma than any other non-pharmaceutical intervention. Based on empirical evidence as well as thousands of client and clinician testimonials, EMDR has proven an efficacious and rapid method of reprocessing traumatic material.

EMDR appears to assist in processing of traumatic information, resulting in enhanced integration - and a more adaptive perspective of the traumatic material. The utilization of EMDR has been shown to be effective with a variety of conditions including generalized and specific anxieties, panic attacks, PTSD symptoms (such as intrusive thoughts, nightmares, and flashbacks), dissociative disorders, mood disorders and other traumatic experiences. Theoretically, EMDR is about integration - bilateral hemispheric (right/left brain) integration; triune brain (brain stem, limbic system and cerebral cortex) integration; and mind/body integration, but practically, it’s about convincing the mind and body that the traumatic event is, indeed over. EMDR helps to put the past in the past, where it belongs, instead of staying stuck in it (feeling like it is happened all over again in the present-with the same thoughts, emotions and body sensations- that accompanied the event in the past).

The eye movements (or other bilateral stimulation) we use in EMDR seem to unlock the nervous system and allow your brain to process the experience. That may be what is happening in REM, or dream, sleep: The eye movements may be involved in processing the unconscious material. The important thing to remember is that it is your own brain that will be doing the healing and you are the one in charge.

How is EMDR Done?  (Parnell, 2006)

• Establishment of Safety and Resources - Safety within the therapeutic relationship and safety within each individual EMDR session. During each EMDR session, your therapist will begin by activating your own internal resources. (S)he will guide you in an imaginal, multisensory imagery exercise designed to activate images, emotions and body sensations of safety, protection, nurture and comfort. Once these images have been activated, the actual trauma reprocessing will begin.
• Activating the Traumatic Memory Network - The therapist will ask a series of questions regarding the traumatic memory. The purpose of these questions (or script) is to activate the entire traumatic memory network.
• Adding Alternating Bilateral Stimulation - Once the entire traumatic memory is activated, the therapist will add alternating bilateral stimulation using:

a) buzzing in your hands by turning on the Theratapper

b) alternating auditory tones via headphones or ear buds

c) moving his/her hands back and forth, so you may visually track the movement

• Reestablishment of Safety - regardless of whether the traumatic material was completely processed or not, the session will end at a pre-set time. Before you leave, you will be stable, embodied, oriented and calm. Depending on you and your therapist’s preferences, this may be accomplished in a variety of ways including, but not limited to re-activating your own internal resources, breathing exercises, prolonged muscle relaxation, etc.

Looking to continue EMDR therapy?

-You might begin by asking your IOP/PHP counselor for a recommended outpatient counselor who is skilled in EMDR.

-At the EMDR International Association website (EMDRIA.org) you can navigate to the “Find a Therapist” tab and search for a certified EMDR therapist in your community.

 The current treatment guidelines of the American Psychiatric Association and the International Society for Traumatic Stress Studies designate EMDR as an effective treatment for post traumatic stress. EMDR was also found effective by the U.S. Department of Veterans Affairs and Department of Defense, the United Kingdom Department of Health, the Israeli National Council for Mental Health, and many other international health and governmental agencies.

(Giacomucci 2017)(References: EMDRIA; Linda Curran; Laurel Parnell)

Scott Giacomucci, MSS, LSW, CTTS, CET III is a certified trauma treatment specialist and licensed social worker in Pennsylvania. He is a graduate of Bryn Mawr College where he received his Masters in Social Service (MSS) with a concentration in clinical social work. He facilitates trauma treatment services at Mirmont Treatment Center serving a variety of populations including young adults and emergency responders (veterans, police, fire, etc..) in both individual therapy and group sessions. Scott has a gentle, non-judgmental treatment approach that honors the inherent worth of each individual. He utilizes a blend of treatment modalities including both traditional talk therapy and experiential therapy which have been research-proven as the treatment of choice for treating trauma. 

To learn more about Scott Giacomucci and the work he does, you can visit his website at: http://sgiacomucci.com/

Any comments or questions?  We'd love to hear from you!  Please comment below.  For confidential questions, email TiffanySpilove@yahoo.com.  If you need help finding an EMDR therapist, please call 610-314-8402, I'd be happy to help.

Dining Out ... With an Eating Disorder

I know, I know, it sounds TERRIFYING!  Yes, I'm serious - you will not die from eating food in a restaurant ... I PROMISE!  It might FEEL like you'll die, it might seem like you'll gain a hundred pounds just from eating the food that is cooked for you back in that kitchen you can't see.  

As my friend and colleague, Natalie says, "there aren't calorie ninja's back in the kitchen adding calories to your food"!  I understand the fear - I get that allowing somebody else to prepare your food is giving up control in a way that might not feel safe for you just yet.  Here's the rub, though - even though it might be hard to admit, I KNOW you want to be able to participate in experiences that involve food.  You WANT to be social.  You want to hang with your friends while they get frozen yogurt or try the food at the new cafe.  You want to live your life again... it's just that ED forbids it.  Here are some helpful tips for you to get more comfortable with dining out:

Practice

When you find yourself feeling fear about eating in a restaurant, it's sort of like a phobia - a very heightened anxiety around something specific.  The way to deal with and cure this type of phobia is through exposure - WITHOUT - re-traumatizing yourself.  So you don't want to push yourself to take it all on without practicing and getting comfortable with various aspects of it first.  

Use affirmations - they are wonderfully helpful ways to rewire your brain!

You might want to enlist the help of your therapist, friend or family member.  Tell them some food options that you consider safe.  Start small.  

It's better to have success with something less challenging than to get overwhelmed with something scarier.  

Your support team member could either get you food from a restaurant or give you food that they made without you present.  Or if you need to start even smaller, you could watch them make your meal so you know it's safe.  Eat with them.  Notice your feelings.  Use anxiety reduction and grounding techniques.  Keep breathing and do your best.  Keep practicing this step until your anxiety stays below a 7 on a 0-10 scale with 10 being the worst anxiety you've felt and 0 being no anxiety at all. 

Increase the challenge slowly

Once you get comfortable with eating meals made by others, up the ante.  If you're still not ready for restaurant dining, try getting take-out or try eating foods you didn't see being prepared.  Use an affirmation like "This food is safe and nourishing; I am safe and I can eat this food".  Make sure you start off each experience with some breathing and relaxing techniques so that you don't associate fear with the experience.

Dining Out

If noise bothers you, choose a restaurant that's quieter or a time of day that's less intense like lunch.  See if you can get a table that's against a wall, in a corner or in a quieter area of the restaurant.  This reduces over-stimulation and feelings of vulnerability.  

Have a plan

In earlier recovery, it's helpful to have a plan.  If you know which restaurant you'll be going to, look up their menu online.  Work with your therapist or dietician to determine which menu item you'll be selecting.  Most restaurants have portions that are significantly larger than the exchanges on your meal plan.  If this is the case, you could anticipate eating half the meal.  One tip is to ask for a to-go box at the beginning of the meal so that you can put half away for later and just focus on what's on your plate.  

Go with someone supportive

This experience is hard enough, don't add to it by going with someone who doesn't "get it" or tries to sabotage your recovery.  Some therapists or dietitians will conduct sessions at the restaurant with you so that you can talk through it as it's happening.  If that's not an option, or you're ready for the next step, choose a member of your support group who understands your recovery.  Let them know the plan beforehand and maybe come up with a code word in case you need to abandon the mission.

Remember to breathe

Keep taking those deep belly breaths and know that this is just one meal.  One meal won't make you fat.  If you notice yourself starting to get overwhelmed or anxious, just come back to your breath.  While you're eating, try to focus the conversation on something else like the weather, the new movie just out or anything fun.  Take a sip of water, feel your feet.  You got this!!

Do's and Don'ts:

Do:

• Keep the conversation light
• Have some topics in mind to talk about while you're eating
• Get the food down
• Chew thoroughly
• Focus on the conversation, the beautiful setting or anything but the food and body
• Wear comfortable clothes
• Stay at the table for the entirety of the meal
• Set your pace to about 30 minutes to complete your meal

Don't:

• Count the calories
• Compare your dish to anyone else's
• Body check while you're at the table
• Talk about food, weight, exercise or anything triggering while you're at the table

Keep your eye on the prize!

This experience is not just about today or next week.  You are engaging in this exercise so that you can enjoy your life - so that you can HAVE a life!  Spending all your time in isolation, feeling lonely, not participating in social events is no way to live.  Remember that you are doing this so that you can be happy and free of your eating disorder.  

One day at a time

One meal at a time

One bite at a time

You CAN recover!!  Recovery from an eating disorder is not a linear process.  It goes all over the place, it's messy at times and sometimes you need to take 5 steps backward so that you can get good 2 steps forwards.  Even one success is worth celebrating, so give yourself credit for EVERYTHING you do right.  

If you're still feeling anxious about dining out and you'd like some support, I'd be happy to schedule a time to help you reach your goals.  Contact me now at 610.314.8402 to learn more about how to dine out with an eating disorder.  Please feel free to share this post with anyone who is looking for help with eating and body issues.

Good luck and enjoy!!

If you have any questions or need support, please feel free to call me at 610.314.8402 for a free 15 minute phone consultation.

Please comment below and tell us your story!

Hats off to a Better Christmas: 8 FREE Tips for Eating Disorder Support

Holidays may be happy and exciting for some of us and for some, they are also very stressful.  Food is definitely a big deal during the holiday season for most people.  Gym memberships go up afterward, people are often found dieting or “cheating” on their diets.  Some binge, some restrict, some over-eat and some fall apart.  I’d like to help you find a bit of peace from my corner of the world during this time when Christmas is fast approaching.  If you haven’t already read them, check out some free tips on normal eating, getting grounded, reducing anxiety, navigating the grocery store… They should prove useful for you as well. 

Here are some tips specific to Christmas:

1.     Create an intention for this holiday

Remember that Christmas can be about celebrating spirituality.  It can be about enjoying family or giving.  It can be about service, love, bundling up on a cold day or anything you want it to be! 

What would you LIKE your intention to be for Christmas this year? 

Find a purpose and go for it.  If your purpose is about service, think about how you’d like to be of service.  It could be as simple as helping to set up or clean up the party.  You could help the less fortunate through a soup kitchen or donating gifts to children who need them.  If you’d like your purpose to be about reading a great book and drinking tea, then go for it!  Any intention you’d like for Christmas is yours to have!

2.    Get Grounded:

BEFORE you leave your house.  Think about what grounds you?  Do something that feels very grounding for you and set an intention to keep checking in with yourself during the day.  One of my favorite ways to get grounded is to ask myself

“Where are your feet?”

– then look down at them; wiggle my toes, feel my feet on the floor or in my shoes.  When I do that, I can rest assured that right here, in this moment, I am safe.  In this moment, where my feet are, I am okay.  Here are some other examples of grounding activities:

• Prayer and meditation
• Aromatherapy: earthy smells like cedar, bergamot, and pine can be particularly grounding
• Yoga
• Coloring mandala’s or other coloring
• Going for a walk
• Make a list: of anxieties, gratitude’s or plans, etc.
• Have a bit of a plan for the day – perhaps write it down in the morning.
• Journaling

3.  Create Foods You Love

Try a new recipe you've been thinking about.  Bring safe foods for you to the event you go to so that you have at least one option while you're there.  

4.  Don't Push Yourself

This is not the time for major challenge meals.  While I encourage you to taste some of every food you're interested in, if you know that a certain food will completely set you off, just avoid it for now.  Challenge meals are best done with the support of a therapist or a support community.  You can practice eating challenge meals until they're no longer as challenging.  Once you've accomplished taking the power out of the challenging foods, THEN you can incorporate them into your holiday festivities.  In this instance, it might be better to be safe than sorry - don't push yourself so hard that you find yourself wanting to act out in a binge-purge cycle.  Support yourself in enjoying Christmas as much as possible rather than pushing yourself into discomfort.

5.  Contain the food

Do your best to eat meals at the normal times you usually eat them.  So instead of skipping breakfast and going to Christmas hungry, eat your normal breakfast. 

When you get to your event, check into your hunger cues.

On a scale of 0-10, with zero being extremely starving, 5 is having a light sense of satisfaction – being neither hungry nor full and ten being the most stuffed you’ve ever experienced.  How hungry are you?  Aim for letting yourself empty out to a 2-3 before eating a meal.  See if you can stop eating at a 5-7. 

Once you are hungry, rather than grazing on all the different foods, make a plate. 

Allow yourself to put at least a little bit of each food you love on the plate or foods you’d like to try. 

Skip the foods that don’t interest you much.  Sit down and really savor the foods you chose.  Check in with your hunger and satiety signals a few times while you eat your plate.  Once you are satisfied, tell yourself that you can have more when you are hungry again and follow through.  Making a practice of using hunger and satiety cues is extremely helpful in finding balance with food.

6.  Keep Your Boundaries

People tend to project their OWN food and body issues onto others’.  So if you notice yourself engaged in a conversation with someone who’s trying to talk you in or out of eating or commenting on your body, take a step back. 

Check in with yourself and see what YOU NEED, rather than what this person is trying to get you to do. 

Saying you need to use the bathroom is always an easy out to give yourself some time and space to check back in with yourself and get grounded.  Take some deep breaths, splash some water on your face and ask yourself what you need in that moment to take care of yourself before you leave the bathroom.  Here are some examples of things you can say to people who are pushing you:

• “No, thank you”
• “I’m okay right now”
• “Yes, I’m going to enjoy this food right now”
• “I’m not hungry”
• “I’ll let you know when I’m ready for ...”
• “I’d rather not discuss my body with you”

Practice saying these boundaries out loud BEFORE the holiday, so that when you’re in the moment, they flow easily and effortlessly.

7.  Ask for Help

Enlist a member of your support group to be ‘Holiday Buddies’ to practice what I call ‘Book Ending’:  Have a few agreed upon times you with check-in with one another throughout the day – perhaps before, during and after.  You could plan to call or text one another to report how things are going.  If you don’t hear from your buddy, shoot them a text to see what’s going on.  In this way, you have another person who has your best interest in mind to be accountable to.  This practice is also helpful in getting your mind off yourself and your own difficulties.

8.  Breathe

Remember that Christmas is only one day out of the year.  Breathe into the gifts you receive whether they are material or spiritual, gratitude or emotions - breathe into this experience of life and know that you can get through this.  You don't need to be perfect and neither does your holiday.  When you feel yourself getting overwhelmed, focus on your breath.  Remember you can start your day over at any time.

I hope you've found these Christmas tips helpful.  If you're still feeling overwhelmed, please feel free to give me a call at 610.314.8402 - I'd be happy to help.

Merry Christmas from Tiffany Spilove Psychotherapy in West Chester, Pa!

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