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Regulating Emotion the DBT Way
Regulating Emotion the DBT Way is a practical guide to the DBT skill
of ‘Opposite Action’, which helps clients develop the skill of up- or
down-regulating their emotions when necessary. It is the skill that
fosters emotional literacy in clients who have learned to fear or avoid
painful feelings.
Part A of the text introduces emotion theory, describes how to
validate emotions, and explains how Linehan’s ‘Opposite Action’ skill
is used to regulate problematic responses. There are examples and
analogies that can be shared with clients, and clinical examples to
demonstrate the key points. There is a description of how DBT
therapists contextualise emotion using chain analysis. Part B
dedicates a chapter to each of the basic emotions and describes its
signature features. A session scenario is included allowing the
reader to see how the therapist coaches the skill of opposite action,
elicits behavioural rehearsal, and gives corrective feedback. There
are some tips on handling common issues specific to that emotion,
based on the author’s extensive experience.
This book will be of interest to any therapist who wants to learn
more about a behavioural approach to emotion such as
psychologists, nurses, social workers, psychiatrists, counsellors,
cognitive therapists, prison staff, and occupational therapists. It is an
accessible explanation of emotion regulation for people who have
already undertaken DBT training.
Christine Dunkley, DClinP, is a consultant trainer with the British
Isles DBT training team, and a fellow of the Society for DBT in the
UK and Ireland. She has 20 years of working experience with self-
harming patients in the NHS.
Regulating Emotion the DBT Way
A Therapist’s Guide to Opposite Action
Christine Dunkley
First published 2021
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
52 Vanderbilt Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2021 Christine Dunkley
The right of Christine Dunkley to be identified as author of this work has been
asserted by her in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in writing from the
publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record has been requested for this book
ISBN: 978-0-367-25920-4 (hbk)
ISBN: 978-0-367-25921-1 (pbk)
ISBN: 978-0-429-29053-4 (ebk)
Typeset in Optima
by codeMantra
To John Dunkley, Laura Dunkley, Lucy Darby, Matt Darby
and Silver Kate Darby
Contents
Acknowledgements
Introduction
Index
Acknowledgements
Deep gratitude to the clients with whom I have worked over the
years, who taught me so much. Also to Marsha Linehan for her
inspirational career and therapeutic genius.
Thank you to my beloved gurus Michaela Swales and Heidi Heard
for their clinical excellence, and for setting by example their standard
for the British Isles DBT (BI-DBT) Training team. Special gratitude to
Amy Gaglia who is my personal sounding board, longstanding friend
and stalwart confidante, who helped clarify a number of complex
points. Appreciation to Janet Feigenbaum, my DBT twin in our
trainer careers. Thank you also to Becky Wallace for helping get this
book into print. and to all my colleagues at BI-DBT: Richard, Carolyn,
Jim, Maggie, Stephanie, Dan, Ceri, Brandon, Roo, Barbara, Angie,
and Michelle.
Acknowledgements to my co-volunteers in the Society for DBT,
especially my best friends Pamela Henderson and Emily Fox, who
along with Amy make all our DBT adventures enjoyable. To Stephen
Palmer, thank you for your consistent encouragement and sage
advice. To all those who uphold the work at the Linehan Institute,
thank you for your regular welcome at the trainers meeting. Personal
thanks for exceptional kindness to Jennifer Sayrs, Tony Du Bose,
and Sara Schmidt.
Introduction
We all recognise that this was a bad idea. Yet it is the perfect
metaphor for the actions of clients who suffer intense painful
emotions. They no longer want to understand what the feeling is
trying to tell them, they just want to snip the wire. For these clients
we have some bad news and some good news.
The bad news is that emotion regulation is time-consuming and
complicated to learn. It will involve staying with some unpleasant
bodily experiences slightly longer than they really want, and trying to
decipher what each one signifies. It will mean actively keeping
around some unpleasant sensations like anger or sadness
sometimes because, well, that’s what is needed in the moment.
The good news is that at the end of the DBT programme it is
possible that each new emotion coming into their body will be a
welcome guest, bringing with it a valuable source of information,
acting as a useful guide. They can have confidence that if an
emotion is too intense they can reduce it without resorting to drastic
means. They will no longer feel as though an emotion just settles in
for the week. They will be able to increase some emotions when they
are necessary, and then let them go when they have served their
usefulness. In short, Linehan says they can learn to love their
emotions.
Taking a dialectical approach
The skill of Opposite Action is a method of working out what level of
emotion is justified by a given situation, and then either increasing
the amount that is needed, or decreasing it, according to how much
emotion fits the facts. There are other skills in the emotion regulation
module in DBT, but this particular one is what I think of as the jewel
in the crown, because it is the most dialectical of them all. But what
do we mean by ‘dialectical?’ For anyone not familiar with dialectics a
pithy definition is, ‘It depends’. A dialectical stance is the exact
opposite of black-and-white thinking.
We already know that a rigid or extreme approach, and the
inability to see other perspectives, is associated with poor mental
health (Morris and Mansell 2018). Flexibility and openness to a wide
range of views enable us to maximise our resources and coping
strategies. Dialectics encapsulates that ability to move fluidly to
another solution if the one we are using is not working, or to switch
perspectives. An example of a dialectical approach is ‘if you pull on
the door-handle and the door doesn’t open, try pushing’. Or ‘If you
look left and there is no way out, look right, in fact look up and down
too’. The ability to adapt to incremental changes in a situation is
another dialectical skill, unlike the toad that if placed in a pan of cool
water will simply sit there till it boils. Dialectics would say – while the
water is cool stay in, and when it gets hot, jump out. Adopting a
dialectical philosophy means being willing to swerve, reverse,
advance, hold firm, settle, sink, or soar as needed. There is no ‘one-
size-fits-all’.
Dialectics goes further than suggesting we just widen our
viewpoint. It espouses the idea that whilst two views might appear to
be polar opposites, it is possible for them to co-exist. For example,
consider these statements; ‘I love my job’ and ‘I hate my job’. I am
sure that most of us have wavered between these two positions
about the same job, maybe even flowing back and forth in the same
day. It’s not as if when you love your job all the reasons for hating it
go away, or when you hate it, there is nothing to like at all. It’s
complicated. The position you take in any given moment is likely to
be influenced by the context – whether a client just told you that your
intervention saved their life, or whether you’re expected to do eight
tasks with only the time and resources to do three. So nothing stays
the same, and everything is subjected to influence.
As DBT therapists, we might say that we are ‘influence analysers’.
Rather than reject one position as bad and the other as good, we
establish which factors strengthen either end of that polarity. We are
interested in how we stack the deck to make, in this case, ‘liking your
job’ come out on top, and ‘hating your job’ recede to the bottom. A
dialectician is looking for controlling variables, to see how to tweak
them to get the best out of any situation.
If we look at the dialectic of loving your job. Perhaps you have a
better day at work if the person you share your office with appears
cheerful. She, in turn, finds her mood is lifted if her partner is happy.
Let’s say he is a green-grocer and supplies local restaurants with
fresh produce. He gets stressed if he cannot meet his orders. Your
satisfaction at work may now depend on the availability of avocados.
So another law of dialectics is that everything is in relationship,
everything is connected. Turn one cog, and a number of them also
turn, ad infinitum. Nothing stays the same, everything happens in a
swirling net of interconnected systems.
Once we understand this we can see the futility of saying, ‘if you
get angry do X or do Y’. It depends on the trigger for the anger, the
situation in which it occurs, the intensity of it, the duration of it, and
how it might function to help you. Each emotion can only be seen as
regulated or dysregulated by exploring the context.
We are always trying to establish whether the emotional intensity
is appropriate using the skill called, ‘Check the Facts’ (Linehan
2015b pg 285). It is important to state here that the CBT skill of the
same name is about collecting evidence for or against a cognition.
Linehan’s skill might be better named, ‘Match the Facts’ because of
its focus on regulating an emotional response to the facts of the
situation.
The following teaching scenario can be used to teach this concept
to your clients:
Draw a column on the flipchart, representing a scale showing
100% at the top, and zero at the bottom.
It is not unusual for the client to say that if they feel guilty about
anything at all, it will shoot straight up to 100%. Then I might ask,
‘Ok, if being late for coffee is 100%, what if you’d run over her dog in
your car?’ The most common answer is, ‘Then I would feel 200%’.
Which of course is against the rules! If you use up all your guilt for a
late coffee date, you have nothing in reserve for things that are even
worse. If you only have one level of guilt for everything it becomes
meaningless. So when we regulate an emotion, we are not trying to
get it down to zero, we are trying to get it up or down to roughly the
right amount in this moment. Which is why DBT is a mindfulness-
based therapy.
The effect we are looking for at this stage is that when a client
notices an emotion they stop and think, hang on a minute, how much
of this emotion am I feeling, and how much might fit the facts? This
act of pausing to assess the intensity of feeling is an early step in
emotion regulation. Others will be added in later chapters.
Language: English
NEW YORK
DODD, MEAD AND COMPANY
1897
CONTENTS
Page
Prologue. The Pavilion of the Island 1
Chapter
I. Christine the Child 11
II. The Quest of the Woman 16
III. Andrea Finds Christine 23
IV. The Word is Spoken 42
V. A Wedding Journey 50
VI. In the Hut of Orio 62
VII. Christine Awakes 74
VIII. A Man of the Mountains 82
IX. The White Room 88
X. Count Paul at Home 104
XI. Andrea Bears Witness 114
XII. Andrea Puts the Question 125
XIII. “If the Man Lives” 130
XIV. The Whirling Fire 138
XV. The Apparition in the Cloisters 147
XVI. The Second Coming of Ugo Klun 166
XVII. Andrea Leaves Jézero 187
XVIII. “Le Monde est le Livre des Femmes” 200
XIX. Andrea goes an Errand 210
XX. La Prova 216
XXI. “Zol” 232
XXII. The Morning of the Day 238
XXIII. The Beginning of the Night 254
XXIV. “Joseph” 263
XXV. The End of the Story 278
CHRISTINE OF THE HILLS
PROLOGUE
THE PAVILION OF THE ISLAND
We had been sailing for some hours with no word between us, but
Barbarossa woke up as the yacht went about under the lee of the
promontory, and with a lordly sweep of his brown-burnt arms he
indicated the place.
“Olà, excellency,” said he, “yonder is the pavilion of little Christine.”
I had called him Barbarossa, though heaven knows he was neither
Suabian nor renegade Greek of Mitylene, but an old sinner of
Sebenico who chanced to have a yacht to let and a week to idle
through.
“Shew your excellency the islands?” cried he, when I had made him
the offer. “Madonna mia, there is no man in all the city that knows
them so well! From Trieste to Cattaro I shall lead you with a
handkerchief upon my eyes. Hills and woods and cities—they are my
children; the Adriatic—she is my daughter. Hasten to step in,
excellency. God has been good to you in sending you to me.”
It was all very well for him thus to appropriate the special
dispensations of Providence; but, as the fact went, he proved almost
an ideal boatman. Silent when he saw that silence was my mood;
gay when he read laughter in my voice; well-informed to the point of
learning—this sage of Sebenico was a treasure. For days together I
let him lead me through the silent islands and the infinitely blue
channels of the “spouseless sea;” for days together we pitched our
tent in some haven which the foot of man never seemed to tread. No
bay or bight was there of which he had not the history; no island
people whose story he could not write for you. Now rising in finely
chosen heroics to the dead splendours of Venice, now cackling upon
the trickeries of some village maiden, the resources of this guide of
guides were infinite, beyond praise, above all experience. And I
admitted the spell of mastership quickly, and avowed that
Barbarossa was a miracle in a land where miracles were rare and to
be prized.
“Yonder is the pavilion of little Christine.”
It was early in the afternoon of the seventh day when the words were
spoken. We were cruising upon the eastern side of an island whose
name I did not then know. When the little yacht was put about she
came suddenly into a bay, beautiful beyond any of the bays to which
the sage had yet conducted me. Here the water was in colour like
the deepest indigo; the hills, rising from a sweep of golden sand,
were decked out with vines and orange-trees and rare shrubs, and
beyond those, again, with shade-giving woods of chestnuts and of
oaks. So powerful was the sunshine, though the month was
September, that all the splendid foliage was mirrored in the waters;
and looking down from the ship’s deck you could see phantom
thickets and flowery dells and dark woods wherein the nereids might
have loved to play. Yet I turned my eyes rather to the shore, for
thereon was the house I had come to see, and there, if luck willed it,
was the woman in whom my guide had interested me so deeply.
We had held a slow course for many minutes in this haven of woods
and flowers before Barbarossa was moved to a second outburst.
Until that came I had observed little of the pavilion which he had
spoken of, though its shape was plain, standing out white and
prominent in a clearing of the woods. I saw at once that it was a new
building, for the flowering creepers had scarce climbed above its
lower windows, and gardeners were even then engaged in laying out
formal terraces and in setting up fountains. But the house was no
way remarkable, either for size or beauty, resembling nothing so
much as the bungalows now common upon the banks of the
Thames; and my first impression was one of disappointment, as the
excellent Barbarossa did not fail to observe.
“Diamine,” said he; “it is necessary to wait. To-day they build; to-
morrow we praise. There will be no finer house in Dalmatia when the
sirocco comes again. God grant that she is not alone then!”
He was stroking his fine beard as he spoke, and there was a
troubled look upon his face; but at the very moment when it was on
my lips to protest against his riddles he gripped me by the arm and
pointed quickly to the shore.
“Accidente!” cried he; “there is little Christine herself.”
At the word, we had come quite close into the woods upon the
northern side of the bay. Here was a great tangle of flowering bush
and generous creeper rising up above a bank which sloped steeply
to the water’s edge. Through the tracery of tree and thicket I could
see the glades of the island, unsurpassably green, and rich in the
finest grasses. Countless roses gave colour to the dark places of the
woods, rare orchids, blossoms ripe in the deepest tones of violet and
of purple, contrived the perfection of that natural garden. And
conspicuous in it, nay—first to be observed—was the girl who had
called the exclamation from Barbarossa.
She was standing, as then I saw her, in a gap of the bank, in a tiny
creek where the sea lapped gently and the bushes bent down their
heads to the cool of the water. She had red stockings upon her feet,
and a short skirt of dark blue stuff shewed her shapely limbs in all
their perfection. I observed that the sun had burnt her naked arms to
a tint of the deepest brown, and that the dress she wore hung upon
her loosely and without affording protection even to her shoulders.
Nor was there any token elsewhere in her attire of that state and
condition to which rumour had elevated her. A tawdry Greek cap,
such as skilled impostors sell to tourists for a gulden, scarce hid
anything of the beauty of her gold-brown hair. Her hands, small to
the point of absurdity, were without rings; her wrists without
bracelets. She might have been a little vagrant of the hills, run out of
school to let the waves lap about her feet, to gather roses from the
banks above the sea.
This, I say, she might have been; yet I knew well that she was not.
Though I had led Barbarossa to believe me profoundly ignorant even
of the existence of his “little Christine,” I had seen her once before—
at Vienna, in the first week of the January of that year. She was
driving a sleigh in the Prater then, and all the city pointed the finger
and cried: “That is she.” I remember the look of girlish triumph upon
her face as she drove through the throngs which were so eager to
anticipate a victory for her; I could recollect even the splendour of
her furs and the excellence of her horses; the muttered exclamations
to which her coming gave birth. Yet here she was, become the
peasant again, on the island of Zlarin.
We had come upon the girl suddenly, as I have written, and the drift
of our boat towards the shore was without wash of water, so that
minutes passed and she did not see us. So close, for a truth, did the
stream carry us to the bank that I could have put out my hand and
clutched the roses as we passed. From this near point of view the
child’s face was very plain to me. In many ways it was the face of the
Mademoiselle Zlarin I had seen in Vienna; yet it lacked the feverish
colour which then had been the subject of my remark, and there
were lines now where no lines had been eight months before.
Whatever had been her story, the fact that she had suffered much
was plain to all the world. Yet suffering had but deepened that
indescribable charm of feature and of expression which set Vienna
running wild after her in the January of the year. She was of an age
when a face loses nothing by repose. Her youth dominated all. She
could yet reap of the years, and glean beauty from their harvest.
Neither dress nor jewels were needed to round off that picture. I said
to myself that she was the prettier a hundred times for her tawdry
Greek cap and her skirt of common stuff. I declared that the rôle of
peasant girl became her beyond any part that she had played in the
life of the city. And with this thought there came the engrossing
question—how was it that she, who had disappeared like a ray of
sunlight from her haunts and her triumphs in the capital, should be
here upon an island of the Adriatic, the mistress of a home which
made the people about her raise their hands in wonder, the subject
of a story of which no man was able to tell more than a chapter? And
this was the question I now set myself to answer.
All this passed through my mind quickly as our felucca lay flapping
her sails in the wind, and we drifted slowly under the shadow of the
bushes. I was still speculating upon it when the girl saw us, and
awoke, as it were, from a reverie, to spring back and hide herself
behind the bushes. But Barbarossa called out loudly at the action,
and when she heard his voice she returned again to the water’s
edge and kissed her hand to him most prettily. Then she ran away
swiftly towards her house, and was instantly hidden from our sight by
the foliage.
“Barbarossa,” said I, when she was gone, “does your wife permit you
often to come to these islands?”
The old rogue feigned astonishment for a moment, but pluming
himself upon the compliment, he leered presently like some old man
of the sea, and his body danced with his laughter.
“Ho, ho, that is very good. Does my wife permit? Per Baccho, that I
should have a woman at my heels—I, who am the father of the city
and can kiss where I please! Ho, ho, excellency, what a fine wit you
have!”
“But,” said I, with some indignation, “the lady had the bad taste to
mean that salute for you and not for me.”
He became grave instantly, stroking his long beard and carrying his
mind back in thought.
“Securo!” cried he, after a pause; “it was meant for me, and why not?
Have I not been a father to her? Was it not to me that she came for
bread when all the world cried out upon her for a vagrant and
worthless? Did I not shelter her from her brother’s blows and the
curses of the priest? Nay, she is my daughter—the little Christine
that I love.”
I heard him out, silent in astonishment.
“You know the story of her life, then?” I exclaimed.
“Santa Maria! The story of her life! Who should know it if I do not?”
“Then you shall tell it to me to-night, when we have dined, my friend.”
He nodded his head gravely at the words, repeating them after me.
“To-night, when we have dined, the story of Christine. Benissimo!
There are few that have my tongue, excellency. God was good to
you in sending you to me.”
CHAPTER I
CHRISTINE THE CHILD