Dialectical Behaviour Therapy (DBT) & Attachment Theory: The Meaning, The Impact and The Group

Can a statement have two truths?

Is everything black and white?

Can you repair a concerning attachment?

Najwa shares how DBT group therapy can support people struggling with impulsiveness, high-risk behaviours, mood swings, relationship and intimacy issues, suicidal thoughts and behaviours, identity confusion, as well as thoughts, behaviours and emotions causing distress and despair.

If you are interested in learning more please go to the Simply Counselling Website for more information or to register for the group.

SUMMARY KEYWORDS

group, dbt, skills, sessions, individual, learn, therapy, people, attachment, struggling, worked, emotions, individual counseling, person, parents, fantastic, calgary, important, share, started

SPEAKERS

Jenna Fortinski, Nicki Kirlin, Najwa

Nicki Kirlin  00:03

All right, thank you so much Najwa for joining us today on this episode. So the first question that we’re going to ask you is hopefully an easy one and one that we’ve asked to all of our guests in the past. So what we’re hoping is that you can tell us a little bit about yourself. So tell us now, maybe what you do for a living your hometown. And if you have a fun fact, if you want to share one with us.

Najwa  00:27

Thank you for having me here today. It’s a pleasure for me to be here with you and Jana. Oh, my background. Originally, I came from Lebanon. I was born in Lebanon and came to Canada in 1992. And the first time I learned about social work when I was in Ontario, and then I got interested in social work, and I want to know more about it. So in Forgive me, I came to Canada in 84. In two I came to Calgary Oh, there we go, okay. Yes. I worked in nonprofit organization. And from there, I started, started my education in social work on part time basis. Until I got my diploma. I finished my diploma and worked in Social Work field for a number of years did in home support, worked with families in schools and with their children. And from there, I worked at the shelter, Sheriff King home, I was working with battered woman’s and offered support there and decided to go back for further education. I went to USC and got my bachelor degree in social work. And after completing my degree, I joined children’s services. And I worked with children’s services for 10 years, and decided to go back and further my education. Wow. So I went back to USC and got my master’s degree in about nine months. I finished everything

Jenna Fortinski  02:23

nine months. Wow. Good for you.

Najwa  02:27

I did go back to children’s services for a short period of time until I found an opportunity with Alberta Health Services. At the time. The wildfire impact was a huge on residence in Fort McMurray. And I took the chance I went to Fort McMurray who worked for two years with families. I learned a lot. Yeah, that experience. I worked with young and old and seniors and it was a great experience. And from there I moved back to Calgary and since then I’ve been with Alberta Health Services at the south health campus. Wow.

Jenna Fortinski  03:14

Good for you. Najwa Oh my goodness.

Najwa  03:17

My goodness. Talk about my background. Yeah. And Fun fact. Yes, I will share this story. I am a busy person. I don’t like to sit. I love to keep moving and doing things. Yes. In 2004 I was renovating the house when I lived in northwest of Calgary. And I was going down the stairs. Normally I fell and broke my ankle. Oh no. And that was a nightmare for me. Yeah, sit. I have cast they had to do surgery. So I want to clean the house. I can sit right without cleaning. Yeah, yeah, of course. I have my crutches and go bring a co chair, put the chair in the middle of the room. I have the map and you know mop. And that’s how I manage that time being at home with a cast. Go out to the backyard. I cannot go into the flower beds. It’s summer I want to enjoy my flowers. I crawl into the flower bed on one knee and go and pull the weeds and water the plants and cut the dry leaves. And I managed and did it and I used to joke about it. I say to my co workers. I learned steps that a tap dancing so let’s try it. I want you to tap dance on stairs.

Najwa  05:08

Oh my goodness it was painful experience Oh my goodness. This is fun thing. Yeah,

Nicki Kirlin  05:21

you know it’s funny because in like in listening to your your story, your background and then listening to this fun fact that you just told us there’s one word that comes to my my head when I hear those things which is determined Yes, right? Such a determined person you Yeah, you know you you commit yourself to whatever it is that you’ve got your sights set on and you are going to make it

Najwa  05:43

right. Yes. And what helped me Really? I was setting small goals myself, just I have the big goal. Yep, far. And I set small steps to reach to that. Yeah. And that’s what helped me reach to where I am today.

Jenna Fortinski  06:02

That’s fantastic. Are you in ours was not even a cast can keep you down? That’s right, exactly. Right. She is determined, bound and determined. and resilient.

Najwa  06:14

That’s fantastic. resiliency has to do with the upbringing. Yes. What do you know, from your upbringing? When you have a solid, healthy relationship? That’s when you are resilient, and you fall but you get back up on your feet and continue? Yeah, nothing will stop you. That’s right,

Jenna Fortinski  06:33

that’s a really good point to lead or foot, you get back up on your foot? Or your feet? You can. You’ve proved that to us. We like that. Goodness. Okay,

Nicki Kirlin  06:50

so the topic of today’s episode is to dive a little bit deeper into a common, I guess intervention is what we can call it that is used in the counseling world and it’s called dialectical behavior therapy. So we would love for you now to share with us your insights and your experience in using this style of counseling. And giving us a little bit of Maybe, yeah, some insight into into how it’s used and why it’s used. So let’s start off with the big question, which is what is dialectical behavior therapy or it’s also known as DBT. So, can you share with us what what is it in a general sense

Najwa  07:34

that dialectical behavioral therapy originally started with individuals who have borderline personality diagnosis and that was expanded into all different types of mental health because of the the accuracy and the good results and the successes with that type of treatment, it is a huge and people are learning how to regulate their emotions therefore, that is why it is very successful and important to get into the dialectical behavioral therapy. What dialectical means dialectical means to statements are true. Okay, we can use one example. We have let’s take a chocolate, there is good and bad about chocolate. If we list the benefits of chocolate, we have a list of benefits. If we list the disadvantage of chocolate, we have a list of this advantage. And both statements are correct. Okay, so dialectical helps individual to learn how to be flexible, okay, and look at one situation from two different lenses. It’s not just a black and white, there is a gray area, and that is called the middle path. Okay, one person has a true statement is accurate and the other person has a true statement and it’s accurate. Each one is coming from different perspective, how we can move both into the middle and use both statements. So we come up with another statement. Okay, and that is very helpful in communication with any person, children, adult seniors, parents and their children, siblings. It’s a huge success with this type of therapy and teaching. Okay, our skills, being taught skills we don’t have definitely not everyone has these skills, but they are being taught and people will benefit from these skills.

Nicki Kirlin  09:55

Interesting, and so is DBT typically used In like individual counseling sessions, or is it seen in group therapy? Or how, where is it used most often?

Najwa  10:06

Well, this originally designed for individuals, okay, sorry for groups, okay, they started with adults, and then they created the version for teens. With a teens, they can have individual group sessions, and they can have the multifamily group sessions, okay. And that means that the parents and the team participate in this session. So parents and teens learn the same skills, okay, and practice the same skills with each other with other and with others. So they learn the skill and become successful in using the skill.

Nicki Kirlin  10:51

Oh, that’s fantastic. And so you had mentioned earlier that DBT was sort of designed for individuals who are have maybe been diagnosed with borderline personality concerns. So can you tell us a little bit more about that in terms of what would like, who would be eligible or who would be a good fit for receiving this kind of therapy?

Najwa  11:15

I mean, a person has a struggles, emotional struggles, communication struggles, have any type of mental health will benefit from the DBT group. Because they learn communication skills, they learn emotional regulation, they learn how to soothe themselves, and how to reduce their stress level. Okay.

Nicki Kirlin  11:46

Yeah. So I mean, all of us struggle with those issues. Right. So that’s, that’s fantastic that it kind of it offers those skills to any person, really. So that’s, that’s fantastic. So you had also mentioned earlier on that DBT, is, it’s known to be effective. So what is it about it that makes it effective? How do we know that it is, in fact effective and that it has been effective in the past?

Najwa  12:15

How do we know that it’s been effective? individuals who participated in the DBT groups, they report the changes they noticed in themselves, when they start applying the skills, especially around communication and self regulation, that’s a huge individual who has anger issues, and don’t know how to regulate their emotions. Either they burst out to tears or phrase or get into fight, they learn how to stop themselves before they reach to that explosion point.

Nicki Kirlin  12:56

Right. Okay. And I think like, that’s so important. We were chatting before we started recording just about having that awareness of emotions and how critical that skill really is, and how some of us take it for granted. And others don’t even know that it’s that it’s something that they should be aware of. Right. So that’s so fantastic that this group can give, you know, can give that opportunity to learn about that skill.

Najwa  13:24

Definitely, especially when individual don’t have the skill, they didn’t learn it growing up. It will help them for a lifetime, and help them to connect with the most difficult people when they learn the skills.

Nicki Kirlin  13:43

Okay, awesome. So what do you think? Why would Why is DBT effective in that group

Najwa  13:51

setting what makes what makes the group setting especially important for it, the group setting it’s important, number one, for parents and children to be on the same page, learn the same skills, its children will see their parents that yes, the parents also they need the skills. It’s not just the children. And when there is a number of families. These families and individuals, they learned that they are not alone. They are not the only family. They are facing challenges. When they hear other people’s perspectives and experiences. They will look at their issue that it’s less intense. And they will realize that there is number of people who are struggling with similar issues. Awesome.

Nicki Kirlin  14:43

And so I guess then, what what would you say is and we’ve touched on a few of these pieces already, but thinking in a more general sense. Why is group therapy potentially sometimes more effective than individual accounts?

Najwa  15:01

group therapy because there is more discussion more dialogue going on than individual sessions. Okay, individual sessions are really good to talk on a personnel issues. For example, drama, or depression. Meanwhile, a group, it addresses the emotions, it addresses the behaviors. And this is needed in everyday living, communicating with others and struggling at some point how to de escalate the tension are how do you reduce your stress level when you are in a stressful situation. And that’s why they are more effective, it is a more effective because number of people are learning and talking about it. So in group, they aren’t learning more than just having one to one session. therapists then individual, they take the work with them home, and they might not look at the paperwork that they have. Meanwhile, in a group, they have to practice what they learned. And when they come back the following session, they will share with the group my their experience with using the skills and how did they benefit from using this skills when they experience stressful situation? Interesting. Okay.

Nicki Kirlin  16:33

Jenna, anything you want to add on that? Yeah, I’d

Jenna Fortinski  16:35

like I want to echo what Najwa said. And I think that what I’ve noticed in my career in in running groups is just as a general, like looking at group therapy as a whole is the beauty of having those conversations of what’s working, what’s not working and learning from the other families, right, I really love the learning opportunity that the group setting gives. And, and then the next piece that I wanted to comment on is this past year, this past year has been such a year and a half, I should say, a year and a half now, right? Of the isolation. And the the feeling of that we’re alone. And you know, if you’re a family that’s struggling, or, you know, you, as parents, you’re struggling or as a teen you’re struggling, like more than ever, there’s this theme of isolation. And I think that’s why this group is such a great opportunity for families to come together to really get a sense that, you know, there’s a lot of people out there that are struggling. And a lot of times we are struggling with the same things in different ways. And you know, to hear those stories and and to learn from each other is such a good opportunity. And like Najwa said, individual counseling is great, and it’s got its places. But group group therapy just gives it that little bit of an extra nudge of the learning opportunity from learning from each other. And, and also to see how how things can be structured in a way that mimic everyday life, and being around other people and understanding how to interact with people and communicate with people in that group setting. And especially like I said, given the last year and a half, we are kind of you know, I think there’s a lot of people out there that are lacking skills, and people are nervous about being in group settings again. So this is a great way to nudge your way back into that and to understand how you can build your skill set and and to get back to healthy ways of being in a group setting. So those are my couple extra thoughts.

Nicki Kirlin  18:33

No, and I think Yeah, and I think that’s it’s really important that you’ve touched on all of those pieces that are so relevant for today and for the situation that we’re in today. So okay, so then for folks that might be listening to this episode, maybe they’ve never participated in group therapy before and they’re wondering about it. What, how can we like what advice can you share to those listeners that are maybe considering joining? And to let them know like, how can they get the most out of participating in group therapy? How can they ensure their own sort of success out of out of participating? What what would what advice would you give them?

Najwa  19:11

Well, their advice is to be present, be consistent, not to escape sessions and practice, practice the skills that they learn in group therapy.

Nicki Kirlin  19:25

So is there homework in going there?

Najwa  19:28

Yes, yeah, definitely. worth it. It’s not too much what we discussed in session, that will be the homework, for example, we teach them a skill, how to reduce their stress level, there is a few of them and they can choose one of the skills that they learn, and they can practice that when they are in a stressful situation. Awesome.

Nicki Kirlin  19:54

So it’s pieces that they can take and sort of immediately implement into their everyday Life will hopefully bring some sense of relief and, and helpfulness to what they’re doing. Yeah. Okay, well, go ahead. Yeah,

Jenna Fortinski  20:08

I wanted to add Yes. That my, my tagline has always been, you know, like to join the group and, and to challenge yourself just a little bit, just step, you know, take a tiny step outside that comfort zone and whether it’s, you know, you know, just nodding along or, you know, offering a little bit, you know, sharing a little bit about yourself, you know, the intention is to try and challenge yourself a little bit and, and to get outside of your comfort zone. And I think that’s when you see people really bloom in group and to really get the most benefit out of it is that they’ve challenged themselves just a little bit.

Najwa  20:45

I have examples to share. I had a teen in my group recently, who she joined after she was admitted to the hospital. And at first she wasn’t engaging, wasn’t interested in the group totally ignoring any question comes to her direction, and shrugged her shoulders and say, I don’t know. Shortly before she completed the 24 weeks, she came to me in front of everyone and said, I have something to tell you. And she apologized from me for her behaviors and how ignorant she was and wasn’t engaging. Wow. impressive to see the changes in hair coming into the group has nothing to say. And towards the end of the group. She was the leader in the group, she starts the conversation, she shares her experience, she learned how to express her feelings and her emotions with her parents and with her others. And she managed how to regulate her emotions instead of harming herself. She learned how to de escalate stressful situations and distract yourself or just to avoid self harming. And when she graduated from the program, she was very grateful and thankful even her parents were very thankful for learning skills. They didn’t have to add themselves. Wow, incredible. Oh, my

Jenna Fortinski  22:27

goodness. So if you have any doubt about Yeah, joining

Nicki Kirlin  22:32

joining the group or if you’re wondering about the effectiveness, it’s I mean, that, in a nutshell, is a fantastic example to share to show the potential for success. If you’re considering enrolling, what do you think it was that switched for her that made her have that realization,

Najwa  22:52

I didn’t back down I was persistent in my communication and my engagement, when she realized that I am available to support her and to help her to have a voice with her family, then that was the time where she switched and realized that she is there for a reason. And she needs to learn these skills. Wow.

Nicki Kirlin  23:18

That’s incredible. It sounds to me like that, you know, the connection that we often talk about that happens in individual counseling between a therapist and a client is so critical. And I’m hearing that it’s also important in this in the group therapy setting as well, right? Because you were that person for her. And that’s that’s so fantastic that she was able to succeed, you know,

Najwa  23:40

definitely and throughout the group, also family members and participants. They do have about half hour coaching session that’s included in the price for therapy. So if they have a question have concern or they feel stuck, they have us therapists who they can reach out for us and we will support them in problem solving and finding solution for their issues.

Jenna Fortinski  24:12

What a great resource. Amazing, right.

Nicki Kirlin  24:15

Oh, that’s fantastic. Thank you so much for sharing that example. Hopefully people will find that helpful. Do Yes, yeah. So I guess and maybe the example that you just shared might answer part of this question, but I guess I want to hear from both your personal and your professional perspective. Why do you offer group therapy? What What do you enjoy about it?

Najwa  24:41

What do I enjoy about the group therapy? I am teaching skills that most of us we didn’t acquire growing up skills but our parents didn’t have. I believe every family they have some skills. They didn’t have they You didn’t learn due to many reasons. And that doesn’t mean that they can’t learn these skills, they will learn the skills, they will apply them to have a better life.

Nicki Kirlin  25:11

What and so what could be more fulfilling than that? That’s awesome. So one of the pieces that sort of core to DBT is there’s a discussion about mindfulness. And I think, in sort of our society as it is, right now, it’s a bit of a buzzword. So do you want to share with our listeners why, thinking about practicing learning about mindfulness is so important and effective? Yes.

Najwa  25:44

We live in a busy world, we learned how to multitask and not be focusing on one task at the time. And that takes away the enjoyment and the effectiveness of the tasks that we are doing. Therefore, when we apply mindfulness, we refocus on the tasks or at the present moment, to be more accurate and successful in what we are doing. And many research many studies shows that when you are multitasking, you are not putting 100% into the task you’re working on. Therefore, that will is helpful to ground people, to bring them back to the moment and to focus on what they are doing. At the same time, it will reduce their stress level and the tension they are experiencing.

Nicki Kirlin  26:40

Awesome. Janet, anything that you want to add to that?

Jenna Fortinski  26:44

No, I think Najwa captured it beautifully. And I think that the biggest thing is, how busy we are today. And how and I and again, I’m gonna go back to the last year and a half, I think the last year and a half kind of gave everybody a slap in the face or maybe a slap on the wrist for how busy Our lives have been. Because everything came to a halt. And I think that’s why a lot of people are struggling right now as society is is you know, slowly reopening. If you’re if you’re in an area where it’s reopening is now it’s how could I ever go back to the way it used to be? Because it was it was you know, everybody’s always running on the so called hamster wheel. And it’s nonstop and, and so you know, this last year and a half was little bit of a gift in that sense for people to realize that it’s not necessary to be that busy, and to live that way. And so I think like when we think of mindfulness for those of us that are wondering about it, that’s a really good snippet. To understand what mindfulness is about is that, you know, like that halt that we went through, of Okay, now everything stops. And now you’re focused, you’re you’re forced to focus on what’s happening right now here in the moment. And we’re we’re only worried about what’s happening today. That’s a really good example of what mindfulness is about and and to see that, okay, well, that’s all I have to focus on. And I can just be in this moment and just figure out, you know, how I’m going to get through today. Right. And so I think that it’s, it’s a good little snippet, and I think everybody has experienced with it now, given the past year and a half. So obviously, in in a therapeutic setting, it will look a little bit different, but that helps you to understand what it what a little bit it is about, I guess. Yeah,

Nicki Kirlin  28:31

I think that’s a fantastic, practical example that everybody can relate to that. Yeah, that’s, that’s, that’s really good. So thank you for sharing that. So knowledge was something that I know is important to you, in your, from your professional perspective is an understanding of what’s called attachment theory. So can you explain for our listeners, what is attachment theory all about? In like 30 seconds. I’m just kidding.

Najwa  29:05

Attachment starts from day one, from the minute the baby or the individual is born. And they need a sense of belonging, they need to feel that they are loved and cared for and they are their emotions are being nurtured. So that’s what attachment is and when we are not receiving such attention as having healthy attachment with caregivers with people around us, then that will cause a lots of emotional stress. People feel especially at younger age, they lose trust in adults and their parents and their and their caregivers. That they are not present for them emotionally. They try to stomp All across ways of learning what they need, how they can meet their emotional needs, and it could be a negative skill they learn to meet their emotional needs. So that’s in a nutshell, what attachment is.

Nicki Kirlin  30:19

So then draw that line for me of how does that then connect into DBT?

Najwa  30:25

How that connects into DBT. When you learn skills, learn how to validate the other person’s emotions made their emotional needs, then the individuals, they get what they are looking for that attention, that attachment, the belonging, that they are being acknowledged, if they are happy, if they are upset, they are receiving that validation. And that’s the important piece when we are validated, that our emotions go down, we are calm, we feel that we are being here. And our emotions, emotional needs are being met. We have example in the circle of security, where they say that we are constantly needing to fill up our emotional cup. And by coming back around receiving the nurturing from the person is close to us a parent a partner efront. Okay, awesome.

Nicki Kirlin  31:31

And, and what I’m hearing in here, and you sharing those pieces is, I get a sense of hope, that like, you know, if you’re a person who’s really struggling, and things are just not going your way, and you just you know, you’re you’re fighting your way through every day, what I’m hearing from you is that there is hope, because there’s ways to tackle whatever issues are in front of you, because maybe it does come from a place of struggling with understanding your own emotions. And so the skills that are provided in this group are key to maybe finding your way out of those struggles, right?

Najwa  32:08

Yeah, the hope is there, and every person look for attention for love. When you show that unconditional love your magic, not judging the person not giving them love based on their status or their performance, that unconditional love, brings peace into people, and they feel that they belong.

Nicki Kirlin  32:38

It’s amazing. Jenna, anything that you want to add, before we close this out,

Jenna Fortinski  32:43

I think it’s a good time to touch on the resiliency of human beings. And, you know, like, as human beings, we are very resilient. So, if you are a family that’s struggling, and you know, if you have somebody in your family that’s struggling with difficult behaviors, and as parents you’re struggling with how to manage it, or if you are that person that is struggling yourself with the difficult behaviors is that we are resilient. So there is always that opportunity to rebuild that attachment. And and to create new and to help people function better and to understand each other better, and to feel safe and to feel secure and to feel like you’re attached. So there is always always always that opportunity. So if you hear one thing today, that’s what you need to hear is that there’s always that opportunity to rebuild, and and to build that sense of safety and security and attachment and unconditional love. So I really need to echo that.

Nicki Kirlin  33:41

Yes, yes. Okay, so last question then is about there is a DBT group being offered through simply counseling services. So I want you to give me the details on it. So who can attend? When will it be happening? And how long are the sessions? So give me all the details on it.

Najwa  34:04

Okay, we are hoping were aiming to start

Jenna Fortinski  34:09

in the fall. So the Yeah, so the first session, so we’re looking to start at the beginning of October. And we’ll be running it on Saturdays so that it makes it easy for families to attend. And they will be approximately two hour sessions. Correct. And so we’re going to hopefully make it and it’ll be located here at simply counseling services in northwest Calgary at our North location. Najwa who can attend

Najwa  34:36

any family member, any family basically can attend individuals who are struggling emotionally struggling with their communication, having issues with the school attendance with learning any person any family can attend.

Jenna Fortinski  34:56

Excellent and it’s so it’s for 24 weeks. We didn’t talk about that. So it’s 24 weeks,

Najwa  35:02

yes, 24 weeks, and it is DBT. It is set up into four modules, each module six sessions, okay? These sessions built on each other, because these skills we’ll learn as we go. And that being said that for each module people can start a new people can start at the first session of the Met module. A new families can join the group. Okay, so it’s not just the closed 24 weeks,

Nicki Kirlin  35:38

perfect. So if you want to join in and it’s already been running for six weeks, you can hop in right at that next module and start right. Okay, fantastic. So how do people join? How do they sign up? Yeah, so

Jenna Fortinski  35:53

on our website, we have a link under group therapy, where you can register and and then we’ll connect with you and we’ll get you started and get you signed up and, and do a quick conversation to make sure that you’re a good fit for the group and that it’ll make sense for you and for the family. And we’ll, we’ll get you sorted and get you in. So yeah, sounds good. Okay,

Nicki Kirlin  36:15

any last thoughts, Najwa, that you want to share with us before we end the episode, anything else that you any advice? Maybe you want to leave with our listeners? Give them some of your good energy?

Najwa  36:30

Well, what I would like to say that, from my experience and from statistics, so far, no family member or individual took the DBT training and regretted it.

Jenna Fortinski  36:49

Perfect, that’s really good. That’s a good statement. No,

36:54

nothing else needs to be said. Yeah.

Jenna Fortinski  36:58

Thank you so much. Najwa. You You’re brilliant. And my pleasure, more so honored at simply counseling to have you do this for us. Yeah.

Nicki Kirlin  37:07

Thank you very much. And thank you so much for sharing your story and your insight and your wisdom. In this episode. We learned a lot. So thank you.

Najwa  37:16

Thank you. And I learned a lot from both of you. And it was an honor for me to be here. Thank you.