Have your friends or loved ones suggested for you to chill out or relax? If our first podcast episode with Hope Arnold, about excessive self-control, leaves you wondering how to help with this biologically-based personality trait, then keep listening!  Join Debbie for another engaging discussion with Hope Arnold, senior clinician and trainer in Radically Open Dialectical Behavioral Therapy (RO DBT), for evidence-based strategies on how to work with “over controlling” biology in the service of loosening up a bit, more fulfilling relationships, and gaining the capacity to just chill!

Listen and Learn:

  • Why eyebrows are important and too much Botox might be a problem.

  • The benefits of being “ordinary,” being wrong, and seeing what hard experiences can teach us about ourselves.

  • How our threat and safety systems play into overcontrol and treatment

  • The importance of “social signaling”

  • How “Radical Openness” differs from “Radical Acceptance”

RESOURCES:

ABOUT HOPE ARNOLD: Hope Arnold, LCSW, MA is a Senior Clinician and one-day Trainer in Radically Open DBT (RO DBT). She began her RO DBT training with Dr. Tom Lynch, treatment developer, in 2016. Hope writes a blog for PsychCentral on RO DBT topics called Radical Hope. In her clinical work, Hope is the founder of RO DBT Denver in Denver, Colorado, a center dedicated to evidence-based care and treating disorders of overcontrol. She specializes in personality disorders (Obsessive Compulsive PD, Paranoid PD, Dependent PD, Avoidant PD), eating disorders, autism spectrum disorders (special interest in female autism), and treatment-resistant disorders (depression and anxiety). Prior to opening RO DBT Denver, Hope was in private practice at the DBT Center of Houston and was the RO DBT Lead Clinician. Hope graduated from Loyola University in New Orleans with a BBA in marketing. She worked for two of the largest private financial and consulting firms in the world before transitioning to clinical work. She has master’s degrees in social work from the University of Houston and psychology from Saybrook University with a concentration in Jungian studies. Hope has presented at the local, national, and international level on topics related to Dialectical Behavioral Therapy, Radically Open DBT, and Jungian Analysis and Theory. She is licensed as a LCSW in the states of Colorado, Texas, and Virginia. For fun, Hope enjoys hiking, traveling, visiting with friends and family, and creating art.

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Transcript of EpisodE

Hope Arnold: [00:00:00] it’s going to a place and having a Passion to go to a place that might be distressing for you in order to learn and grow and then also to be wrong. Cultivating a willingness to be wrong. I can I always tell my clients. I have been more wrong in the last three or four years that I’ve been practicing radical openness than I have in my whole life and it’s a blessing and I can also say I’m a lot happier as a human being because it is a something that affects your whole being and your whole life. It’s wonderful.

Debbie Sorensen: [00:00:33] That was Hope Arnold on Psychologists Off the Clock.

Diana Hill: [00:00:37] We are three clinical psychologist committed to cutting edge, integrative, and evidence-based strategies for living well.

Yael Schonbrun: [00:00:52] On this podcast, we bring you ideas from psychology that can help you flourish in your work parenting relationships and health.

Diana Hill: [00:00:59] I am [00:01:00] Dr. Diana Hill practicing in Seaside Santa Barbara, California.

Debbie Sorensen: [00:01:03] I’m Dr. Debbie Sorensen practicing in Mile High Denver, Colorado.

Yael Schonbrun: [00:01:06] And from coast to coast, I’m Dr. Yael Schonbrun, a Boston-based clinical psychologist and assistant professor at Brown University.

Debbie Sorensen: [00:01:13] We hope this podcast offers you ideas for how to live a full and meaningful life.

Diana Hill: Thank you for listening to Psychologists Off the Clock.

Debbie Sorensen: So now we’ve had an episode with Hope Arnold on Overcontrol and what it’s like to have too much self-control and how that can be, you know, kind of good and bad but there are some downsides. So the question is what do we do about it? How do we help people when that’s the case or if you’re someone who’s over controlled? What can you do?

Diana Hill: [00:01:52] Yes, and I think actually a lot of our culture leans in the unhelpful side of things because so much of our [00:02:00] childhood is about increasing control. I mean everything from the moment we get into the classroom. We’re taught to sit down and how to chew and do our homework after school and all those things are reinforced. And if you struggle with Overcontrol, it may be that you’ve been environments that have actually made it worse or really rewarded you for it.

Debbie Sorensen: [00:02:19] I think that’s true. We train our children to follow the rules and there’s reinforced for being rule-followers. And we you know, we give them a lot of Praise when they break the rules they get in trouble. And so we kind of learned this rule bound to be rule Bound and over controlled

Diana Hill: [00:02:36] and some of those kids end up having things like anxiety disorders because temperaments for their temperament that type of reinforcement actually makes things worse.

It increases perfectionism or it makes them really worried all the time that. They’re not getting their homework done perfectly and you can see how actually our approach needs to be different for People based on their style and temperament [00:03:00] and for the someone that’s overcontrolled, an approach that’s more laxed, humor-oriented, teaching them how to use more animation and facial expressions could be helpful as opposed to someone that’s under control. That would be a totally different approach. So, Hope talks about these two different approaches. The one the one that acronym that people may be familiar with is DBT, which a lot of therapists are familiar with it’s an approach that’s been used for more over- undercontrolled individuals and her approach is called Radically Open DBT, which is quite different.

Debbie Sorensen: [00:03:35] It’s quite different. It’s in some ways. It’s almost the opposite in some ways. They’re philosophically aligned but they’re different and I think this is a unique way of looking at it because it really specifically addresses this issue, which is very unusual for therapies for therapy approaches.

Diana Hill: [00:03:54] So when you said that to me Debbie, you know what you did

Debbie Sorensen: [00:03:56] What?

Diana Hill: [00:03:57] You did an eyebrow wag

Debbie Sorensen: [00:03:58] I did?

[00:04:00] Diana Hill: [00:03:59] Raised your eyebrows and she talks about the eyebrow wag in this episode of how our facial expression and the animation on our face is part of the way that we connect with each other and it was it was interesting because a lot of clients and actually a lot of women in Santa Barbara are doing a lot of Botox.

Which prevents you from raising your eyebrows and I’ve been thinking about after listening that I wonder what the consequences are for them in their relationships but also for them with their kids because their kids aren’t getting that feedback of how to animate their faces quite as big.

Debbie Sorensen: [00:04:35] Yeah, actually, I didn’t talk to Hope about this in this episode.

But I’ve talked to her before about how when people have a lot of Botox they lose some of that expressiveness on their face and that is very hard for people to interpret and I remember seeing  I saw this on the news one time there was a study about Botox and how sometimes that does make people a little bit less.

Socially likable if they have a lot of [00:05:00] Botox because when you’re looking at someone and their face is very still it’s really hard to interpret what they’re saying and thinking and feeling.

Diana Hill: [00:05:10] So if you’re getting Botox, maybe tell your tell your dermatologist. Let me still be able to wag a little.

Debbie Sorensen: [00:05:16] Yeah, ease up a little

Diana Hill: [00:05:17] ease up a little yeah, but that aside I think I think this episode is a great one for both therapists who maybe want to do some of these strategies with their clients, but also for yourself if you struggle with Overcontrol how to loosen up a bit and yeah feel more flexible.

Debbie Sorensen: [00:05:39] We’re continuing the conversation now with hope Arnold who is a senior clinician and trainer in Radically Open Dialectical Behavior Therapy. Hope now we’re going to talk about RO DBT and it’s the gold standard treatment for disorders related to Overcontrol, which we talked about last time. I [00:06:00] think we could start with the story of why Thomas Lynch developed RODBT because it’s a fascinating one. How and why did he come up with this treatment?

Hope Arnold: [00:06:09] That’s a it’s a wonderful thing to talk about  Dr. Lynch was working with the DBT treatment team and Marsha Linnehan and he  started to get clients that just weren’t getting better with traditional DBT.

He started to go what is going on here what is not working? And so he started to notice this dynamic of they weren’t really expressing a ton on the outside, but they felt a lot on the inside sometimes and they were sort of maybe a little bit difficult to treat and they weren’t looking like a normal quote-unquote borderline personality disorder patient of something else that was going on.

And so he started to do some research and found. People like Luna Clark and a couple of other researchers had started [00:07:00] to understand about over and under control and many thought. Oh, well, there’s got to be a way to treat Over Control the opposite spectrum of what DBT was treating so it started to develop Radically Open DBT and started to do trials and  this giant randomized control trial RO DBT effect efficacy, and it was published and the data is just outstanding.

I believe that the number is 1.03 percent Effectiveness, which is like the next closest thing to treat chronic depression. I believe is like .5 3 I want to say I’ll see if I can give you the numbers and we can put them up. So that the effectiveness RO DBT is astronomical and what he started to notice is that this Overcontrol, we don’t need to do things like mind read people and validation really isn’t that important for over control people. We actually need to learn to get them to [00:08:00] chill out. Be less rigid less rule-governed deal with the threat sensitivity that they have and actually learned how to get them to connect and stop being so lonely.

And so that’s kind of how it started to develop is him noticing that people weren’t actually getting better.

Debbie Sorensen: [00:08:16] And I think what’s interesting about it. Is that traditional DBT in some ways does the opposite right? So it’s worked on things like distress tolerance and sort of being a little bit more.

Controlled in your emotions. Yeah, and you could imagine that for some people that’s the opposite of what they need,

Hope Arnold: [00:08:34] Right, if you put a overcontrolled-leaning person in a traditional DBT group, they’re going to learn skills that they either already know and I do really well, right. They don’t really need to learn to regulate their emotions. They need to learn to do with opposite which is to acknowledge distress to actually express it and then to be open about it and maybe deal with the problem solving in a different way. Yeah.

Debbie Sorensen: [00:08:58] And. For me, I trained [00:09:00] in dialectical behavior therapy DBT years ago. When I first heard about RO DBT, I just had this assumption that like, oh, I probably pretty much know what that is because I know something about DBT. In fact, I was completely wrong. It’s really not at all, but

Hope Arnold: [00:09:16] it’s pretty much the opposite

Debbie Sorensen: [00:09:20] opposite, but what’s interesting is that there are some philosophical underpinnings of both that are are actually not that different even though the. Form of it looks very different. There’s some similarities. Can you talk a little bit about the philosophy underlying Ro DBT?

Hope Arnold: [00:09:36] So I so there is we do definitely dialectical stances, you know, which would be like I want a relationship and also I’m afraid of one that’s definitely part of the treatment so that could be one thing we do. We also work on skills building as well for, not emotional regulation, but actually to [00:10:00] learn different kinds of skills, and it’s based in Malamati Sufism. And Malamati Sufism is the idea of there’s a there’s a practice called self-enquiry in RO DBT and it’s based on this idea of like called The Path of Blame which is hey what’s going on here? Before I blame externally or a for I want other people to change. Let me just look inward and really understand a little bit more about what’s going on for me. So that I can be a little bit more aware of some of my own biases, even though we can’t fully be aware of our biases. And maybe interact in a different way than I have before. So that’s what that practices teaching and contrast to something like traditional DBT which is based in Zen Buddhism. And there’s a lot more of like acceptance of things. We’re actually not getting people in Ro DBT to accept anything. We’re getting [00:11:00] a lot of challenges and actually saying like, you know, I wonder if there’s something to learn here from any given situation rather than just trying to accept.

Debbie Sorensen: [00:11:11] I love that idea of looking within because I can’t tell you how many clients I’ve seen where they come into the room and they all the problems are sort of about other people or situations in their life. Sometimes. It feels really hard to get them to maybe take a look at the. Common denominator, which is themselves, right?

Hope Arnold: [00:11:32] Absolutely. And so not only is that a practice of looking in but then actually it’s a practice of speaking outwardly. So if I do the practice and I actually, you know, maybe maybe you know your Debbie and I since we’re buddies, we you know, maybe we getting some argument about something I don’t like something that you did and I do my self enquiry I practice radically openness about it and I start to think about you know, what’s my part in this and what is here for me to learn, and you know, what’s that it [00:12:00] all that energy about? And then I actually maybe find something out and I might go and tell you them if I want a closer relationship with you, so I’d actually say like hey. Now I noticed this about myself and I’m kind of aware of imagining something about how you feel about it.

And then I just kind of wanted to let you know and I’m not expecting you to do anything or change, but I’m telling you because I want a closer relationship with you. That’s really the practice of radical openness.

Debbie Sorensen: [00:12:29] That’s interesting. And I think that that radical openness is sometimes confused with radical acceptance, but that’s a different thing.

Hope Arnold: [00:12:36] Yeah. So if you want we can talk a little bit about the difference.

Debbie Sorensen: [00:12:39] Yeah. What’s the difference?

Hope Arnold: [00:12:40] Yeah. So radical openness is challenging our perception of reality. So we don’t see things as they are. We see things as we are so I can only know what I know and I can only see what I see radical acceptance is, in traditional DBT, is letting go of [00:13:00] fighting reality. It’s the idea of being free from way to turn suffering into toleration of pain that can be tolerated a bit and we don’t really. In radical openness, it’s more like.  it’s more than mindful awareness. It’s going to a place and having a Passion to go to a place that might be distressing for you in order to learn and grow and then also to be wrong. Cultivating a willingness to be wrong. I can I always tell my clients. I have been more wrong in the last three or four years that I’ve been practicing radical openness than I have in my whole life and it’s a blessing and I can also say I’m a lot happier as a human being because it is a something that affects your whole being in your whole life. It’s wonderful.

Debbie Sorensen: [00:13:54] So you’re a self-confessed Over Control.

Hope Arnold: [00:13:57] I am yeah

Debbie Sorensen: [00:13:58] You’ve found this treatment helpful for [00:14:00] the your own life.

Hope Arnold: [00:14:01] Yeah, I think one of the important things if there’s clinicians that are listening to understand is that in order to do RO DBT treatment well, we actually require that you practice it as well because it’s kind of like saying like do I really know this skills and my really flexing flexible and open a my receptive to feedback.  Am I practicing what I preach a lot of therapies don’t require that but we really do because we think it’s important

Debbie Sorensen: [00:14:29] cool. Yeah.  Well one other piece about the Sufism philosophy that I liked was something about it’s okay to be ordinary. Am I getting that right?

Hope Arnold: [00:14:40] So part of the idea this idea of the path of blame. It’s the idea with okay that ordinariness is okay and ordinary doesn’t necessarily mean that we don’t strive for goals or try to do our best, but it’s more like.  Do I have to be special?  What’s so important about [00:15:00] being special here? What is being ordinary mean to me?  You know, if you and I were to enter into a dialogue about it, you know, do we have energy about being ordinary now what’s wrong with that? And if I’m ordinary, is there anything good about that?

Could it come out of you know this different sort of place of being like  okay, with who we are. Yeah,

Debbie Sorensen: [00:15:25] I like that so you don’t have to be perfect. You can be human and that’s okay. I actually think I work sometimes on that with my kids. I think a lot of times we convened as pressure like my kid has to be this amazing person and I want them to have everything all the opportunities like or that we could just let them be themselves and that’s fine.

Hope Arnold: [00:15:44] Yeah, and we don’t have to be the best at everything. We don’t have to even be our best selves all of this time, but it’s like what would ordinary mean to us?  And if we were to live that would we be happier? Yeah, how would we treat people [00:16:00] that would be differently would I be more socially connected or less if I was ordinary?

Debbie Sorensen: [00:16:05] So we talked about why DBT doesn’t really work well with disorders of Overcontrol what about traditional CBT cognitive behavioral therapy?

Hope Arnold: [00:16:15] Yeah, so that’s a great question. I actually have a lot of clients that have come to me from traditional CBT and they’re like it’s not working and this the thing about it because Overcontrol is a biological predisposition and you can’t change your biology. You know, we’re for your born. Y’all can’t see Debbie has blue eyes or brown eyes. We’re not going to be able to change our eye color just because we snap our fingers. We can’t really change our biology that way. So one of the things that we notice in RO DBT because you can’t change your biology.

You actually have to work with it rather than against it and so in this kind of case is someone comes and they’re over controlled and their threat sensitive. What we’re trying to teach them to [00:17:00] do is actually turn on their safety systems. Which is based in polyvagal theory. So that’s turning on their ventral vagal complex and by doing that and turning off the threat system a bit that they can actually feel safe relaxed and the urge when you’re in your safety system is to socialize versus your threat system is irritation anxiety and the urge to fight or flight mostly flight. Like a void and so what we’re trying to do is actually get people to work with their biology to then change their social signaling not to change their thinking. Yeah, we’re going to have some thoughts and we’re going to have some distressing emotions because we’re all human beings and it’s like part of the deal but it’s okay, you know, it’s kind of like welcome to the human race and then the other part that CBT doesn’t really account for is the biology but it’s kind of like language doesn’t come on for about 200 [00:18:00] milliseconds and we’re getting all of this sensory input super quickly at around 4 to 7 milliseconds. So you have this sensory awareness that’s happening. And if you’re really threat sensitive before you can even talk you feel the threat.  And so that’s why activating safety is so important and how you can’t actually think your way out of that you actually have to change your biology to then act differently.

Debbie Sorensen: [00:18:28] That’s right. That’s like Joseph LaDoux’s work about how we the emotional parts of our brain sort of get activated before our frontal lobe can catch up and figure out what’s happening and understand it intellectually.

Hope Arnold: [00:18:41] Well cool I should check that out. I actually am not familiar with him

Debbie Sorensen: [00:18:43] The Emotional Brain. Check it out. It’s interesting. Yeah, it takes a second to get into the higher level processing but there’s a lot more that happens before that.

Hope Arnold: [00:18:52] Okay. Yeah. Yeah, so it’s. This actually might be a good way for us to talk about [00:19:00] mirror neurons if that’s cool.

Debbie Sorensen: [00:19:01] Oh yeah, this is fascinating and I attended one of Hope’s trainings. Tell us about that.

Hope Arnold: [00:19:06] Yeah. Yeah. So because people that lean Overcontrol are threat sensitive. What happens is that they are receiving this stimuli and this input and one of the things that Tom Lynch noticed as he was doing this is one of his clients, you know, if you think about a normal therapist face. I just step back here for a second and start the story over you’re thinking about a normal therapist face. They tend to actually look kind of like and obviously you’d have to see me to do this, but I’ll describe it as well. They kind of furrow their eyebrows and they shake their head slowly maybe to the side. They look very concerned about what’s going on and they’re not really giving you a lot of facial expressions.

Debbie Sorensen: [00:19:49] We can post a video of us doing that. If you want to check it out on our web page.

Hope Arnold: [00:19:54] Great. And one of the things than feedback that Tom got was his client [00:20:00] said to him. You know, Tom if,  you know, am I doing something wrong is with the client said and Tom is, like what he said if I’m not doing anything wrong.

Why do you look so concerned? Hmm and. If you think about that if someone is a very threat sensitive person and they’re reading very therapists like furrowed eyebrows and concerned face is a problem. They’re actually not going to do that well in therapy. The idea in RO DBT is to therapist to chill out so the patient can chill out also. So what you’ll see therapists do in RO is we kind of lean back and we have our little glass of water and we’re like, you know kind of chatting with a friend. It’s like kind of woo relax and it’s really actually fun. One of the things that I’ve noticed and as a RO practitioner is that I have way more fun in therapy now than I ever did doing the other kind of therapy because I feel good which then allows someone else to feel good. Human beings are excellent, excellent social [00:21:00] safety detectors meaning that if I feel safe you tend to feel safe because you can see that it’s genuine. It’s from

Debbie Sorensen: [00:21:07] Even just noticing watching you on the video this versus the concerned therapist, you know the kind of yeah, it does, it feels different like it, hey, let’s yeah,

Hope Arnold: [00:21:16] let’s talk about that. That’s cool. Yeah good. And so the other thing that we this this works because there’s something called the mirror neuron system. And I kind of let me just do a little bit of explanation about what that is because it’s kind of complicated but it’s worth mentioning  so a mirror neuron fires when a person acts or when a person observes an action performed by another person. So if you’ve ever had the experience of walking down the street and you see a person on the opposite side of the street grimace in pain and you kind of go with them and you kind of Grimace as well and you sort of make that face that is your mirror neuron [00:22:00] system. And so you actually micro mimicry their pain and this is why we actually think we have empathy is because this mirror neuron system is on and this is happening in milliseconds. This is so so fast. So this activates the same brain structures and physiological arousal and experience as the grimacing person. So you actually your brain is going oh my gosh. I’m in pain just like that other person than I see. And so this is why we think that people feel empathy and why we think that this sort of super Cooperative idea and super, there’s actually research that so we have a super Cooperative Gene allows us to then go and help people that we might not even know sometimes because we actually don’t want them to be in distress and we want to help them which is kind of cool. So another way to think about this in therapy. And is so is we do all these wonderful facial expressions. One of [00:23:00] them is a called an eyebrow wag and an eyebrow wag is basically and moving your eyebrows up and down and one of the things I tend to look for in someone that’s coming in to be assessed for Overcontrol is their face moving. The face isn’t moving. They might be overcontrolled. So if my eyebrows are going up and down.

One of the things that I might know is that so I just did it to Deb right now. And and how did you feel when I was doing it when you’re watching me do it.

Debbie Sorensen: [00:23:31] It’s like kind of like we’re about to do something fun. All right.

Hope Arnold: [00:23:34] I know I we’re gonna have a great time

Debbie Sorensen: [00:23:35] you lean and it’s like what’s coming next.

Hope Arnold: [00:23:38] Yeah. So an eyebrow wag is a universal expression of openness. And and it also lets me know. I’m not really, you know on your case and kind of chilled. I want to be open and talk with you. I feel really good about it. And when I wag at someone eyebrow wag, move  my eyebrows up and down actually I’m kind of [00:24:00] like yeah, this is friendly and engaged.

It also activates my ventral vagal complex, my safety system, and it feels like relaxing. And so it’s part of a skill that we teach called the big three plus one. But if you go around and kind of wag at people every once in awhile, and that doesn’t mean hold your eyebrows up for a long period of time that looks weird and it doesn’t mean you know, you do it incessantly, but if you just do it to yourself a couple of times you might actually see a physiological change in yourself, which is really fun.

Debbie Sorensen: [00:24:30] Interesting. And it activates that sort of calm and connected state of being which is the opposite of the threat system.

Hope Arnold: [00:24:37] Yeah fact being safety, which means I want to socialize with you when I get closer to you. I want to share myself with you, which is cool.

Debbie Sorensen: [00:24:45] So what are some of the main treatment targets in RO DBT? What are you working on in there?

Hope Arnold: [00:24:52] Yeah, so. Well, let me actually step back and talk about you know, the focus of the therapy the focus of the [00:25:00] therapy is social signaling. So am I expressing myself in a way that’s getting my value getting me closer to my value goals. So for example, a lot of clients come in and say something like I would like to have more friends. I’d like to develop more friendships which seems like a wonderful goal to have and to be able to work towards and so one of the ways that. That we might do that is to work on their social signaling. So for example, if you ever been walking down a street and you see someone pass you by and they don’t acknowledge you. It’s a good way not to make a friend, you know, because these are like no acknowledgement that you’re even there. It’s kind of like what the heck or you don’t shake hands or you don’t, you know sort of like nod at someone or all of these like little sort of polite signals that we do our social signals and the idea is that you don’t have to feel well just [00:26:00] signal well and I’ll give you an example about this. So I sometimes have bad days at work like everybody does and maybe I’ve had a bad day and my nieces who I love more than anybody in the whole world call me and I don’t answer the phone like “hey, what do you want, why are you calling me today?” I go. “Hey, babe, what’s happening?” Because it’s my value goal to Signal well to them to show them that I love them. And that doesn’t necessarily mean anything other than me living my values and my truth. So I want to signal in a certain way. So if I want to have friends, I probably am going to have to start with a polite smile or ahead not every once in a while because why would someone want to talk to me if I’m not doing this like small things that kind of make us all connected and human.

Debbie Sorensen: [00:26:46] Yeah, that’s you know, I take more  of an ACT approach to therapy. It just seems like a way of living your values.

Hope Arnold: [00:26:54] Yeah,

Debbie Sorensen: [00:26:54] and and bring you closer to your values, even if your emotions aren’t congruent with that. So like [00:27:00] if I had a bad day and I’m grumpy, I’m not, it’s not really consistent with my values to walk in the door and just be a jerk to everybody in the house.

Hope Arnold: [00:27:07] That’s right.

Debbie Sorensen: [00:27:08] But sometimes I have to kind of override some of my emotions.

Hope Arnold: [00:27:12] Yeah. And that’s what we actually work on with our Overcontrol-leaning clients is because they have superior capacities to inhibit so they don’t actually need to necessarily emotionally regulate in order to Signal well, and so they’re able to do this quite effectively. However, a lot of times they don’t know how to actually signal what they want to.

Debbie Sorensen: [00:27:36] that’s a good point. It’s actually kind of the opposite like they’re what they need to learn how to do is to actually let a little. Emotion in maybe

Hope Arnold: [00:27:43] yeah, so an example of this might be something like a client who’s overly has overly pro-social signaling. So a lot of head nodding wagging or high-pitched voice or something that’s going on and. What they like to Signal his interest in [00:28:00] someone but they might be like he yes, I’m gonna see her so happy

and has wonderful. Thought I was really

you know, and it sounds a little cuckoo, you know, and I mean that in a nice way, but it’s kind of like do you want to go have a coffee with that person that sounds like that or would you like to actually like maybe get them to Signal more genuinely, so that they can have that relationship

Debbie Sorensen: [00:28:24] more authentic. and more vulnerable maybe even sometimes sure.

Hope Arnold: [00:28:28] Yeah. Absolutely. Yeah.

Debbie Sorensen: [00:28:31] Okay any other treatment targets?

Hope Arnold: [00:28:34] Yes, we definitely work on obviously social signaling as this the major thing, but we do want to make sure that our clients are alive and safe and so many overcontrol leaning clients are highly suicidal or have self harmed in the past. That’s not just clients that have borderline personality disorder many Over Control clients also do that. So we do work on [00:29:00] self-harm and over suicidality and we also work on making sure that people are communicating directly and feeling understood. In therapy because a lot of times we get clients to say, you know, I’ve never I don’t get anything out of therapy. I just go in there and talk and nothing actually ever happens. And this is a very active treatment where people have homework and they’re doing different kinds of skills and their learning different ways to behave and so it’s actually very. Dynamic treatment I think not and you know, there’s a lot of like psychoeducation that goes along as well as behavioral changes as well.

Debbie Sorensen: [00:29:39] And a big part of that is the group treatment. Why is the group treatment important and what kinds of things are you doing in these groups?

Hope Arnold: [00:29:47] Yeah, so our skills classes are teaching 30 lessons and the lessons that we teach are not skills that people generally teach in therapy. We’re working on things like envy, [00:30:00] bitterness, forgiveness, how to not be fixed minded or rigid about something, how to not give up. Sometimes we’re also working on things like maybe not correcting someone if you see a mistake, learning to question our perceptual biases, learning how to activate that safety system. Like we’re talking about, actually doing it practicing quite a bit and then learning how to signal what we hope is signaling the biggest thing is to teach intention and signal. The more that we can get them to match the more likely we are to have fulfilling relationships. Yeah.

Debbie Sorensen: [00:30:43] Do you use a lot of humor in those groups or what…

Hope Arnold: [00:30:49] Oh, yeah, absolutely. So that’s the other fun thing about RO DBT and being an RO DBT therapist in particular is you know, it’s fun like there’s a lot [00:31:00] of. Playful teasing it’s not mean teasing. It’s playful teasing. It’s kind of like noticing that there’s something sort of odd going on in a particular moment and you actually tease someone like you would tease a friend and it’s and then you get your client teasing you back and it’s like a great time and yeah, everybody’s sort of is changing and growing because what we start to know is that people that don’t take themselves too seriously are actually generally speaking more psychologically healthy and so giving ourselves the gift of humor can be a really wonderful powerful thing and hey, guess what now? We tend to like people that are funny. Like I don’t know that I’ve ever really met a person that’s like, you know, I don’t like any but I don’t like humor at all.  Like the right never have….  I mean, I’m sure there’s someone out there but generally speaking people like to laugh and have a good time.

Debbie Sorensen: [00:31:52] I mean humor bonds us with each other. I think it makes it fun and it brings. Builds connection.

Hope Arnold: [00:31:58] Yeah. Yeah

Debbie Sorensen: [00:31:59] And it lightens [00:32:00] up the therapy I think because therapy can be such serious business.

Hope Arnold: [00:32:04] Oh, yeah.  And why, why does it have to be? It doesn’t, right?

Debbie Sorensen: [00:32:08] Yeah, and there’s that irreverence. I think that’s another similarity with traditional DBT because irreverence is used very intentionally  in DBT, yeah, and it shakes things up with people because I think people get in a certain way of being and sometimes it’s irreverent humor can just sort of shake them out of it.

Hope Arnold: [00:32:25] Yeah. And teasing actually is a wonderful way to give someone feedback without really being on their case. You know, right? It’s too kind of like say hey, this is like, you know that it’s like if you were an art were doing something and you were being extremely directive to me and I would be like, okay your highness, you know, it’s kind of like a silly thing and your kind of like, oop. You know you sort of know what I’m saying, but I didn’t actually come out and say hey Deb Debbie. Stop being so directive towards me. Yeah. Yeah. It’s kind of like [00:33:00] letting it be soft and letting it be kind and also the feedback is very clear like stop being so uptight about whatever we’re doing

Debbie Sorensen: [00:33:08] and that feedback piece again, you do the self enquiry where people open up to feedback. they take a look at things from a different point of view, they sort of think, what can I learn from this situation  Do you do that in the in the the skills group as well or is it more in individual?

Hope Arnold: [00:33:23] We do that in both. So there’s the skill that’s you’re just mentioning is called the DEF skill, it’s number one and the skills manual and it’s flexible mind definitely.

So it’s noticing distress, engaging in self enquiry, and then flexibly responding according to our values because a lot of times what happens is that people that are overcontrol-leaning get very ruminative about something or habitually respond in an Overcontrolled coping kind of way and what we really want them to do is learn that every situation doesn’t have to be the same. It can actually be a flexible response in any any given situation and [00:34:00] rather than trying to immediately problem-solve or fix something. We’re just like, hey, let’s step back and look at this and see if it’s actually working. Hmm. Maybe we could change something. Is this keeping me stuck, depressed or sad, lonely, anxious. Yeah,

Debbie Sorensen: [00:34:14] So if it’s not working. there’s where the change part comes in. Like let’s do what we can do to change it and build the life. That is working.

Hope Arnold: [00:34:21] Yeah. Yeah, absolutely and a connected life  in particular.

Debbie Sorensen: [00:34:25] Connection, social connection. That’s kind of the heart of the matter.

Hope Arnold: [00:34:28] Absolutely.

 So I took the Styles of Coping Word Pair Questionnaire that you gave me, Hope, which I think helps identify if you’re OC leaning or under control leaning.

Yep

Debbie Sorensen: [00:34:40] But is that how you actually decide that a client you’re seeing is overcontrolled or are there other ways that you get that information?

Hope Arnold: [00:34:49] Well one times we do give them that word choice pair, but that’s really not pathology leaning. We are looking for maladaptive Overcontrol. So we also give [00:35:00] them three other things: the Personal Need for Structure Scale or Test and that’s talking about order and structure and how does someone need to adhere to things in their life in order to feel safe and comfortable. The AAQ-2 and I’m going to actually ask you to help me with the that wording that stands for what

Debbie Sorensen: [00:35:23] The Acceptance and Action Questionnaire.

Hope Arnold: [00:35:26] Thank you very much. Yeah, so it’s based in ACT in that, you know higher levels on that scale are about experiential avoidance, and how much do you not want to feel your emotions? So we’re looking for avoidance in that one. And then there’s one that’s in the text book that’s called the Overcontrol Global Prototype Rating Scale and that is specifically designed for over control maladaptation and it’s looking for these very specific things that are in over control that would be problems and sort of themes that we look for as [00:36:00] well.

Debbie Sorensen: [00:36:00] Okay. So those are some of the formal assessment measures are there particular things you’re looking for just conversationally or when you observe people in that very first session that might point toward Over Control.

Hope Arnold: [00:36:12] Absolutely. One of the things I tend to look for is whether or not someone is moving or moving their face moving their body. How rigid are they behaviorally when they first come in? And if they’re not moving very much then I’m they might lean OC, you know, that’s not always the rule but I might look for that I also might look for qualifiers. How much are they using things like “it depends” or “maybe” or “well, sometimes” that might be an over controlled leaning person and then in general are they saying things that talk a little bit about structure, order, rigidity rule-governed behavior, things that might get in the way of them making a friend or being lonely.

Debbie Sorensen: [00:36:59] Okay. [00:37:00] So if you see some of that rigidity that kind of thing would imply maybe yeah

Hope Arnold: [00:37:05] and since most most of my clients are pretty aware that they’re doing these behaviors. And anyway, so once you start bringing it up there like oh, yeah, that’s me. Yeah. Yeah, that’s that’s what I do.

Debbie Sorensen: [00:37:15] And you mentioned that there’s a really low dropout rate how in this treatment? How do you explain that? So very very ….it’s not a therapy that people, like, hate and they flee from because painful

Hope Arnold: [00:37:29] well the thing about when you start talking to a high Overcontrol client  who’s overcontrolled and they have been through a lot of therapy or maybe just new to therapy and they start to really go, oh my gosh, that’s me. And they identify as overcontrol and they go I actually am this and I think this is that big cause of my issues then what will happen is.  Because you sort of said okay, I’m OC and if OC is the primary [00:38:00] problem and it’s maladaptive for me and I want to change this is the therapy. Now if that’s not the problem, go do another therapy. There’s plenty of other wonderful therapies out there. But if Overcontrol maladaptation is the problem, this is the one for you. So that’s the first part and the second part is some is kind of like, you know, hey, it’s going to be tough. I’m not always going, you know, we’re not always going to be talking about puppies and kitties in here. We’re gonna be talking about some challenging things. Yeah, and it’s it’s it’s work. It’s work and it’s also fulfilling work. And so we we ask our clients to commit to the the full treatment 30 lessons and we teach them skills to actually change their life in the way that they choose to change it.

So we’re always going back to, what does the client want, not what’s the therapist want, what does the client want? Is this in line with their value goals? What skills do they need to learn to be able to do that? And then we [00:39:00] ask them to let us know if something’s not working to come and talk about it and have a pretty candid, open conversation rather than just, you know, disappearing or ghosting. So that’s what really keeps people in just because it is an open dialogue and that that is very different than a lot of therapies where you know the traditional talk therapy where people are just kind of been talking or a more directive therapy where people are saying do this, do this, do this, do this. We’re sort of letting the client saying these are my issues and we’re working on psychological health, not, you know, kind of…. We’re working on what is what is psychologically healthy for everybody not just what is psychologically healthy for that client, you know, that’s what the therapist is doing.

And then the client has their own goals that they’re working on as well.

Debbie Sorensen: [00:39:53] So the motivation is high because it really helps people and once they see that this is their issue they can, [00:40:00] have some buy-in. Yeah, this is going to help me. Yeah, absolutely.

Hope Arnold: [00:40:05] Yeah, and you know if the buy-in is not there then there are other therapies. You know, we’re not saying that this is the only treatment or this is the treatment for everybody. But if it is the problem then people are kind of like oh thank God I’m here. I was like this actually might work. I saw a gentleman that had been in therapy for many many years and was just saying, you know.

No one’s ever talked to me about this kind of stuff before no one’s talked to me about my social signaling. No one’s talked to me about how Over Control might be a problem and I saw another client who said why where was this when I was 16. I wish that it was here because people that are over control sort of know that this is the problem.

They just don’t have words for again.

Debbie Sorensen: [00:40:50] Well as a therapist I can think back through some of the patients. I’ve seen in the past and think this is what I should have been doing. Yeah, because whatever I [00:41:00] was doing probably wasn’t going to really help with Over Control in this way.

Hope Arnold: [00:41:05] Yeah, and thank you to Dr. Lynch for going through all of the pain that he did to figure this out, you know, I mean I can tell him thank you. Uh-huh.

Debbie Sorensen: [00:41:13] And now I know for myself I need to learn more so and I’m imagining some listeners, maybe some therapists, maybe even some clients who want to learn more, what where do people turn who want training in this or who want to find a therapist?

Hope Arnold: [00:41:25] So the very first place I’d send you to is radically open dotnet that is the international website for radically open DBT. It has training information on it has therapist directory. It has a wonderful video by dr. Lynch That’s explaining a little bit more about over control for clients. And then it has a wonderful blog on that. I’ve written some articles on there. And it has links to all kinds of wonderful things, research, the book if you’d like to read it. If you know [00:42:00] because there aren’t a ton of radically open DBT therapists in the country. Yet, yeah, it’s but hopefully we’re building we’re building right? What is is happening as a we get requests all of the time from different states and we try to connect people and you know, you can reach out on the website if there isn’t a therapist in your area, but hopefully what will happen is even more therapists get interested and there’s intensive trainings, which are too week trainings that do the therapy very in-depth and you per have a six month break. Can you practice between Week 1 and week 2. And that’s really wonderful for them.

There’s also people like me that train people in either one hour programs or six our programs like all full day about radically open DBT and just to give them an intro and frankly, you know, now the books are out. So everybody can go read about it. There’s a skills manual and also a textbook as well which is on new Harbinger, or you can buy it on Amazon also.

Debbie Sorensen: [00:42:58] We’ll link to [00:43:00] this on our website for today’s episode. We’ll link to the website and also to the books and the Articles you mentioned today so that people can find those easily. We’ll post a couple videos of Hope’s fabulous social signaling examples because there’re so fun. You just you can’t capture it on audio.

Hope Arnold: [00:43:18] Okay, I love that. That would be wonderful. Thank you so much

Debbie Sorensen: [00:43:22] Well, thank you for coming on, Hope, we really enjoyed I enjoyed the conversation very much.

Hope Arnold: [00:43:27] Yeah, absolutely. Thank you so much for having me.

 Diana Hill: Thank you for listening to Psychologists Off the Clock.

Yael Schonbrun: You can find us on iTunes Facebook and Twitter.

Debbie Sorensen: This podcast is for informational and entertainment purposes only and is not meant to be a substitute for mental health treatment. If you are having a mental health emergency, please dial nine-one-one if you’re looking for mental health treatment.

Please visit the resources on our web page. Our website is [00:43:00] www.offtheclockpsych.com. That’s www.off the clock P-S-Y-C-H.com.

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