Committing to Treatment in Dialectical Behavior Therapy

Committing to Treatment in Dialectical Behavior Therapy

I sat across from my therapist, avoiding her eyes. She was asking a lot from me. A few weeks ago I resorted back to my old, destructive behaviors and continued to believe they would work. Self-injury makes the pain go away, I justified. In a weird, paradoxical way, giving in to the urge not only makes the urge disappear but also keeps suicide at bay.

“Listen, Amanda,” my therapist said, “if we’re going to work together and get through this, you’re going to have to commit to me that you’ll be safe. You can’t say you’ll do this treatment, go through the motions, and in the back of your head, have this plan to kill yourself. You’ve got to commit to me all the way, to a life worth living, Amanda.”

There it was — the life worth living card. It was the ultimate goal of dialectical behavior therapy. In its best form, DBT goes beyond survival and posits that a life worth living is possible. It was an idea that I tried to believe in for the past  seven years. Now, however, as I looked at the floor, squirming in my seat, I was angry. I put my faith in this treatment and it got me here, closer than ever to death. I tried it your way and it failed. I can’t do it again. I don’t have the strength to do it all again.

“I need you to commit to me,” my therapist said, “that you’ll do everything you can in order to live, Amanda. I’m not expecting all your thoughts about suicide will magically go away once you commit. I am asking that you’ll be willing to choose life over and over again when those feelings do arise. That you’ll reach out for coaching. That you’ll go to the emergency room if it’s too much.

“I know this is hard and it will take a lot of work. I know I’m asking a lot from you and you’ll probably get mad at me because of it, but I’m only asking because I know you can do it. You’ve done it before and you have it in you to do it again.”

My therapist wanted me to take a leap of faith, an entire shift in thinking, in my belief system. Despite all signs telling me that my life is not worth it — that I shouldn’t exist — she was asking me to believe that it was. She wanted me to fight for my life, but who was she to tell me what I was able to do? Did she know what it was like to listen to all those voices inside pulling you closer and closer towards death? Did she know how difficult it was to wrestle with your demons and go beyond what your body is telling you to do?

I needed her to know how difficult it was to commit to this. I needed her to know I didn’t have the strength to live for myself. I needed her to know how much I needed her by my side, carrying my belief when I couldn’t believe on my own.

“I need a sign,” I said to my therapist, “a symbol from you that we’re in this together, that it’s not just me trying to keep myself alive for the sake of keeping me alive. I’ll make that commitment, I’ll fight to live, to make something out of my life, but you need to believe in me because I can’t do it for myself just yet. When the anguish is too much and I don’t have the strength to carry on, I need to know you’ll be there.”

She looked around her office, searching for something to give me. It could have been a paper clip for all I cared, just as long as it was something — a sign of our commitment together.

“I wish I had something here with more thought to it, but for now, will this do?” she asked.

She held out her hand and gave me a blue squishy stress ball with a happy face on it. It captured her personality quite nicely, a woman who had a cheerful demeanor, always greeting me with a smile.

“This is perfect.” I said.

It was all the reassurance I needed to take that leap forward. I closed the door on suicide as a possible solution to my pain. I was ready to begin the hard work of fighting for my life all over again. And somehow I believe it will all be worth it.

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