Dialectical Behavior Therapy (DBT) offers a set of skills to help with many different emotional and relational difficulties. The four pillars of DBT are Mindfulness, Emotion Regulation, Interpersonal Effectiveness and Distress Tolerance. Each of these pillars offers a number of skills to practice in that area. I have selected three DBT skills that I believe can make a significant difference for those managing depression.
Depression is an experience that includes a slow-down or freeze response in the nervous system. People managing depression may feel numb, detached, hopeless and sad. These internal experiences may cause them to isolate from relationships, get stuck in their difficult emotions, struggle to complete normal activities. Often, those managing depression feel misunderstood by the people in their life, especially when they are encouraged to “think positively” and “just get over it.” In fact, people managing depression are often expending enormous effort to engage in their life in the most simple ways. The following set of DBT skills can be used together or individually to improve depression symptoms and help catalyze healing and forward movement.

1.Emotion Regulation Skill: Opposite Action
When we are using Emotional Regulation skills, we are paying attention to whether or not our emotions fit the situation we are in. Opposite Action is a skill that we reach for when we have determined that our emotions DO NOT fit the facts of the situation. This is often the case with depression. Depression is like a lens that makes life look harder and sadder than it actually is.
All emotions have an action urge, an instinctual action that the emotion makes us want to do. When our emotions DO NOT fit the situation, we benefit from acting opposite to the action urge. Here are some common emotions experienced in depression and suggestions for opposite action.

• Hopelessness --> Action Urge: give up -->Opposite Action: stay engaged, keep trying
• Sadness --> Action Urge: isolate, wallow, freeze --> Opposite Action: share, express, move
• Numb --> Action Urge: disengage, stop moving --> Opposite Action: gentle movement, embodiment

 
2.Interpersonal Effectiveness Skill: Making Requests
Making Requests is a relationship skill that is very closely related to making boundaries. Requests highlight what we need from another person. While they can be vulnerable to make, they are also vital to communicating our needs with others. Loved ones are not mind-readers and need invitations and instructions to know how to care for those managing depression.
People experiencing depression are almost always misunderstood by the people who care for them most. Unless they have experienced depression themselves, loved ones will likely minimize the depressed experience. From the outside, it may appear that it would only take a few simple steps to recover from depression. If only that were true.
In order to stay connected with loved ones and to receive the care they absolutely need, those managing depression need to lean into this skill of making requests. They need to speak about how they are feeling and the effort they are expending to engage with their lives. They need to ask their loved ones to be patient with them, to use encouraging language, to offer comfort and presence rather than solutions.
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3.Distress Tolerance Skill: Radical Acceptance
We reach for distress tolerance skills when we are going through circumstances that are too big and/or too hard for us to change. Depression often comes on the tails of a big and hard life event, such as the loss of a loved one, a difficult transition, a painful event or unmovable circumstances. When there is truly nothing we can do to change our circumstances, we need to shift our focus toward acceptance.
We are using radical acceptance skills when we work to create openness and willingness toward our difficult circumstances. Willingness is a powerful mindset shift and means that we will stop fighting against what is inevitable. Endlessly fighting against unfavorable circumstances is a recipe for suffering. Pain is inevitable in our lives, but suffering is a choice. We can still live meaningful lives in the midst of painful circumstances. When we give up the fight, we are more able to find acceptance. . . and peace. 

Losing someone we love is always a heartbreaking and emotionally difficult experience. Grief is the word we use to describe the set of emotions we have and the emotional process we experience related to that important loss. Grief can feel gentle and straightforward or it can feel extremely difficult and consuming, or any variety of this. Grief is often a very natural process of healing from a loss. Sometimes, though, we can get stuck in the healing process and need support to move forward. It might be helpful to understand the different circumstances that might cause us to get stuck.

• UNEMBARKED GRIEF
  • Unembarked grief is an emotional journey that hasn’t been initiated yet. This person has yet to enter the wilderness of  processing through the emotions they have related to the loss of their loved one. There are a number of reasons one might avoid entering the grieving process, and this person may need a skilled grief companion to help them overcome the barriers that exist for them to enter their personal grief journey.
• IMPASSE GRIEF
  • Someone experiencing a grief impasse has come up against a significant barrier in processing their emotions related to their loss. Their grief journey has become obstructed; stuck at a certain point. This may present as a prolonged experience of anger, anxiety, sadness, guilt or panic, and this person may need skilled help to feel safe enough to experience their grief emotions and move forward through them.
• CARRIED GRIEF
  • A person with carried grief has an accumulation of grief from prior losses that have not been mourned completely. This experience may look like difficulty with trust/intimacy, depression, negative outlook, anxiety, panic, emotional numbing, addictions, irritability, physical problems, etc. Additionally, when this person experiences another loss, they are flooded with emotions from all of their losses.
• OFF-TRAIL GRIEF
  • Off—trail grief happens when avoidance patterns replace the work of grief or mourning. These avoidance patterns may look like overworking, overeating, overthinking, addictive behaviors, shopping, travelling, displacing, somaticizing. These may offer temporary relief, but the reality is that they create more personal suffering because the grief does not go away and they have maladaptive patterns that also need to be addressed.
• ENCAMPED GRIEF
  • When someone has encamped grief, they have stopped moving on the journey of grief, they set up permanent residence in their grief. They avoid moving through their emotions related to their loss and become entrenched in their grief experience. This person is choosing their grief experience over nurturing relationships with living family/friends. This may look like unending, unchanging distress, depression and it has a function in their life that will need to be addressed for them to move forward and heal.

Each person’s grief story is completely unique to that person and to the relationship that is lost. Even though we have noticed specific patterns related to complicated grief, there are no consistent reasons why any one person may have these experiences. It is helpful to understand the factors that may be complicating their emotional process:

1. SOCIETAL CONTRIBUTORS
   • How is death incorporated in society?
   • Western societies tend to dodge grief altogether
2. CIRCUMSTANCES OF THE DEATH
   • Are there traumatic elements that make grieving that much harder?
   • Sudden, unexpected, tragic, before-time, out-of-order, means of death, physical distance from death, self-blame for death
3. THE GRIEVER’S UNIQUE PERSONALITY
   • How do they handle emotions, expressing difficult emotions, doing inner work?
4. MENTAL HEALTH
   • Any existing mental health challenges will magnify the grief experience
5. THE GREIVER’S RELATIONSHIP WITH THE PERSON WHO DIED
   • Strong attachments will cause painful grief journeys
   • Complex, complicated or abusive relationships complicate grief process
6. THE GRIEVER’S LOSS HISTORY
   • Each new grief experience is built on all former grief experiences
   • A person’s loss history is as important as their medical history to their doctor
7. THE GRIEVER’S ACCESS TO AND USE OF SUPPORT
   • Does the griever have close family and friends who are offering consistent and ongoing support?
   • Is the person willing to accept support?
8. OTHER CONCURRENT STRESSORS IN THE GRIEVER’S LIFE
   • Grief is made more complicated if it was already a difficult time in life
   • Other stressors might include health, education, aging, relationships, children, parents, finances, etc.
9. THE GRIEVER’S RELIGIOUS/SPIRITUAL/PHILOSOPICAL BACKGROUND
   • Faith systems may help or hinder grief process
   • May provide comfort if grief is embraced; may cause complications if it is not
10. THE GRIEVER’S FAMILY SYSTEM
    • Families have unwritten rules about values, behaviors, social norms, emotionality
    • Some families have the belief that death, grief, emotions are inappropriate to discuss
11. THE GRIEVER’S PARTICIPATION IN MEANINGFUL CEREMONIES
    • Generally speaking, ceremonies help move grief forward. Complicated ceremonies may complicate the grief process.
    • Honoring the loss and remembering the person are crucial to grief journey!
12. THE GRIEVER’S GRIEF COUNSELING EXPERIENCE TO DATE
    • Previous grief counseling may have been positive/negative
    • Beliefs or difficulties experienced before will impact their grief journey now

Now that we may have helped you identify why your grief has become complicated, we want to offer you hope. All of these experiences can be improved! Our skilled therapists know how to meet each person in their grief journey, offering support to get unstuck or to overcome significant barriers. If you are stuck and want to move forward, please reach out to our team! We would love to provide skilled and sensitive grief therapy to make the journey more approachable for you!

• References: Wolfelt, A.D. (2016) Counseling Skills for Companioning the Mourner. Ft. Collins, CO: Companion Press.

Grief is often a completely confusing, disorienting, painful and lonely experience. There are many elements of our modern society and culture that make this experience that much more difficult and lonely. Bereavement, grief and mourning are very natural and necessary experiences, and they have the potential to be traumatic and/or transformative. One of the greatest gifts the bereaved can receive is the presence of a compassionate companion. Let’s take a closer look at what it means to offer this meaningful and healing companionship to someone who is grieving.

The most effective way to mourn after a loss is to share your thoughts and feelings (grief) with a compassionate listener (grief companion). The Grief Companion HOLDS SPACE for those who are grieving by providing a safe and empathetic presence in which the mourner can begin to explore the terrain of their inner world. HOLDING SPACE for the mourner is your contribution to their care. The grief companion does not guide the mourner, instead allows the mourner to choose the path. True expertise of grief lies with (and only with) the unique person who is grieving.

More specifically, Grief Companionship is being present to another person’s pain. The Grief Companion is willing to go into the wilderness of the soul with the bereaved. This is a spiritual journey, not only an intellectual journey. The Grief Companion is committed to bear witness to the struggles of the bereaved without judgement, direction, or quick fixes. They allow the disorder and confusion that so often afflicts the bereaved. They trust that the bereaved will find their way through the jungle of emotion and joins their journey with compassionate curiosity.

Central to the role of Grief Companion is the art of honoring stories.

In telling the story of their love and loss, mourners:

• Find wholeness among their fractured parts,
• Identify how loving and losing has affected their life,
• Build comfort with the emotional and spiritual realms of life,
• Create awareness and connections they previously haven’t made,
• Discover their truth in the present moment,
• Explore their changing identity and ways in which they have been transformed.

The art of Grief Companionship involves slowing down, becoming acquainted with the mourner’s inner world, and to really listen as the mourner embraces the reality of their loss, their pain, important memories and search for meaning. Each of our Benediction therapists are equipped as compassionate Grief Companions and we would be honored to journey with you in your grief.

• References: Wolfelt, A.D. (2016) Counseling Skills for Companioning the Mourner. Ft. Collins, CO: Companion Press.

Have you have lost a significant person (or pet or relationship or opportunity) in your life? These significant losses can be terribly painful and disorienting. You know there is an emotional process to help you recover from that loss. This process can feel elusive, consuming or anything in-between! We have heard about grief before, and may even be familiar with the common emotions involved in grieving. But what are we actually doing when we grieve? Let’s clear up this grief thing!
Bereavement and Mourning and Grief are all words related to processing a significant loss. Bereavement is what happens to us—we lost someone important. Bereavement literally means “to be torn apart” and “to have special needs.” Aren’t those statements relatable? Grief is what we think and feel internally after a significant loss. This is a very natural process of integrating the loss and learning to move forward after the loss. Mourning is what we can do to externalize what we are thinking and feeling. Mourning is how we heal in our grief.
The grief process is so unique to each person and to each specific loss. Each of us manage our emotions differently. Some internalize emotion and others externalize emotion. Regardless of what we are feeling, different personalities land on different emotions more regularly—emotions like shame, anger or fear. We all have a different relationship with sadness, depending on our exposure to sadness and how sadness was modeled for us throughout our life. The emotions we feel about a particular loss are completely intertwined with the emotions we hold about the relationship with that person. If there was deep love and respect in our relationship with the person lost, then these feelings are going to be very present in the grief process. If there was tension or hurt or unspoken conversations, then those complicated feelings are going to be very present through the grieving process.
Now that we know we need to externalize our grief emotions through the process of mourning in order to heal, what does that even look like? This can take the form of journaling, artwork, listening to music or finding movement to express those internal thoughts and emotions. Mourning can be embraced and enhanced through conversations with caring people. Sharing about our loved one can be the most beneficial way to externalize our grief feelings, remembering our loved one and integrating their loss. We like to call this grief companioning. Each of our therapists are trained in this special way of being with those who are grieving, to soften their healing journey and to honor the person they have lost.