Saving Lives by Changing Minds



   Tara* was drowning.

   Diagnosed with myriad mental health disorders, including bipolar disorder, post-traumatic stress disorder and attention deficit disorder, she had been fighting the demons of her mental illness for as long as she could remember.

   Having turned to self-harm at an early age, Tara quickly spiraled out of control until, as an adult (and a wife and mother of three), she became a regular patient at many KC metro psychiatric hospitals, trying to take her own life every chance she got.

   Skeptical, cynical and hopeless, Tara, upon referral, turned to Kansas City’s Lilac Center for help. That’s where she met Amy Tibbitts. Little did Tara know that meeting and working with Tibbitts would change her life.

   Shortly after beginning her therapy sessions with Tibbitts, a licensed specialized clinical social worker, Tara was diagnosed with Borderline Personality Disorder (BPD), a mental illness characterized by instability in moods, thought patterns, interpersonal relationships, self-image and behavior.

   Astonishingly, 80 percent of all people diagnosed with BPD have a history of at least one serious suicide attempt.

   “Clients whom I see live in a realm darkened by the fears of inadequacy,” Tibbitts says. “They are continually tormented by self-doubt.”

   Since its inception in the early 1990s by psychology researcher Marsha Linehan at the University of Washington, the most effective form of therapy for those individuals who suffer from BPD is Dialectical Behavior Therapy (DBT).

   The Lilac Center, which is housed in a historic home in Kansas City’s Quality Hill district, specializes in DBT, a groundbreaking type of skills-based therapy. It teaches problem-solving techniques, emotion regulation and mindfulness skills designed to bring a healthy balance to thoughts, feelings and actions.

   Tibbitts, a Kansas City native, opened the Lilac Center in 2001 after completing her post-graduate work in Wyandotte County. She recognized an acute need for a specialized BPD therapy center in the area.

   “When I went to college, I looked around and saw people truly happy,” says Tibbitts. “I became fascinated in how to create a happy, fulfilling life for myself. I grew up in a very chaotic home and knew I wanted something different.”

   Tibbitts, determined to change her destiny, found her happiness in helping others do the same.

   “I became a therapist because I am talented at identifying how people carry hurt forward,” Tibbitts says. “I can help others reevaluate and radically accept pain and sorrow, change their harmful reactions and move forward in life with more freedom.”

   To that end, Tibbitts opened the Lilac Center, and it has steadily grown through the years as more and more people have discovered the benefits of DBT. Today, the Lilac Center employs 12 therapists and one psychiatrist and sees more than 200 clients on a weekly basis who range in age from 8 to 80.

   While DBT does fall under the umbrella of traditional cognitive behavioral therapy, it differs in its scope. While traditional therapy works on unraveling why individuals behave and respond in maladaptive ways, DBT takes it a step further and provides skills that create change through mindful living.

   Through DBT, therapists such as Tibbitts form healthy alliances with their clients. Accordingly, therapists aim to accept and validate the client’s feelings. The goal is to equip them with tools to overcome circumstances and emotions and function effectively in society without turning to self-harm.

   DBT is made up of three main components: individual therapy, group therapy and crisis intervention.

   In individual sessions, the therapist and client discuss and evaluate issues that have interfered with the patient’s life and ability to function in the week leading up to the session. The main focus of individual sessions is on honing DBT skills to minimize crisis, control impulse behavior and improve relationships.

   “We look for the details around events that happened throughout the week which prompted the destructive behavior,” Tibbitts says. “Then we work on skills to reduce the problem behaviors or to eliminate the trigger.”

   Secondary to gaining control of para-suicidal behaviors, Tibbitts works with her clients on altering behaviors that inhibit relationships and connection to others.

   An equally important branch of DBT, group sessions are held once a week for approximately two hours. During group sessions, clients of the Lilac Center work from the workbook Tibbitts penned herself entitled “You, Untangled.”

   Perhaps what sets the Lilac Center apart from other DBT centers is its Web presence.

   Tibbitts has created an online membership group called mydbtgroup.com, which allows members to access online resources such as skills videos at any time. Clients of the Lilac Center and individuals who purchase "You, Untangled" gain free access to these online resources. The site is particularly helpful to individuals with mental health issues who don’t have access to DBT counseling due to geography or other circumstances.

   But Tibbitts doesn’t want to stop there. In the near future, the Lilac Center plans to offer live crisis intervention from licensed therapists available on a membership site for clients across the country seeking immediate support.

   For now, Tibbitts and her staff of therapists at the Lilac Center make themselves available 24/7 for crisis intervention. For instance, if a client’s situation triggers intense feelings heading toward self-harm, the therapist is always available to help the client remember and utilize DBT skills through a coaching phone call.

   Therapist accessibility and an amplified degree of trust are hallmarks of the center’s DBT program.

   “Many times (clients) are emotional, upset and bordering on needing hospitalization,” Tibbitts says. “They need skills to help them understand how to handle these situations without self-destruction.”

   That sentiment rings especially true for Tara.

   The low point for Tara came when she was in for one of her many hospital stays related to her BPD. Though she had been in therapy with Tibbitts for some time, she hadn’t fully committed to her therapy and still spiraled often into self-harming behavior.

   “It was my anniversary and my husband came up to tell me he wanted a divorce,” Tara recalls. “I couldn't blame him. I couldn't drive myself. I couldn't take care of my family. I struggled every day.”

   From that low point, Tara committed wholeheartedly to DBT and the Lilac Center. The first thing Tibbitts presented to Tara was a “commit to life contract” — a vital piece of DBT therapy and Tibbitts’ approach.

   “My number one goal is to keep my clients alive,” Tibbitts says. “This ‘pact’ is a way to get them to commit to life, go through the program, to learn and practice the skills. It is a promise. The first path of self-destruction for many is simply the lack of commitment to be alive.”

   In addition, Tibbitts recognizes the acute need for BPD clients to live in a healthy environment free from as many triggers as possible. To that end, Tibbitts involved Tara’s entire family in her therapy and helped them to walk alongside her on the road to health.

   Tibbitts says that almost without fail, clients see symptoms decrease over time using the three components of DBT, especially reduction of para-suicidal behaviors and increased willingness to comply with treatment.

   In addition, Tibbitts has seen extraordinary healing and progress with her many clients who suffer from eating disorders alongside BPD.

Because Tibbitts’ clients gain practical coping skills through DBT, many see drastic improvements in self-care, a reduction in substance abuse and marked improvement in relationships. In many cases, clients are able to decrease medications significantly using DBT.

   Throughout the past decade, Tibbitts has partnered with various managed care companies to provide a comprehensive model of DBT therapy. Tibbitts has proven time and time again that DBT paves a pathway for significant transformations in the lives of her clients.

   In fact, of the 30 members monitored jointly by Tibbitts and the managed care company, DBT therapy reduced the cumulative number of acute in-patient hospital days from 281 to only five.

   As a result of such astonishing results and the corresponding cost-effectiveness, DBT is accepted by almost all insurance companies.

   But for Tibbitts, the results of DBT therapy are useful for much more than reducing the dollar amounts paid out for claims. The value of DBT lies in seeing her clients learn to work though life’s challenging circumstances and watching them thrive in their self-acceptance and in their relationships.

   For Tara, specifically, Tibbitts’ DBT shed hope on a once hopeless existence. One day at a time, Tara has used skills honed in DBT to rebuild her life, recently earning an associate degree in graphic design and graduating at the top of her class — a feat that she credits Tibbitts with helping her to achieve.

   “I was ready to end my life for so long that I never thought about my future,” Tara says. “Amy never gave up on me. DBT is a lifestyle change. It is reprogramming everything you thought you knew and replacing your thoughts with a healthy proactive skill.”

    “These are skills that can be used in almost any relationship,” Tibbitts says. “If you are living a happy life, you are using these skills automatically. DBT skills are equivalent to following a diabetic diet. The diet is ideal for everyone to follow, but if you are diabetic, it is essential. With a mental illness, DBT skills are essential to a healthy, connected, fulfilled life.”

    Tara continues to see Tibbitts twice each week to check in. Her marriage and family are intact, and she credits her DBT skills for the happiness she has created.

    “Amy has been successful with her clients because she balances compassionate support with a level of personal accountability within the realms of therapy,” says her husband, Tony Tibbitts. “She empowers her patients to sort through intense emotional situations and take accountability for their actions, but she does it with a smile on her face, always reassuring her clients that she is there for them, no matter what.”

   And for Tara, that has made all the difference.

 

*The patient’s name in this article has been changed to comply with HIPAA guidelines.

 

What is Borderline Personality Disorder?

For individuals who struggle with BPD, there is an internal struggle to try to control their emotions. That leads them to invalidate those feelings and try to get rid of the emotions through an impulsive response such as:

  • self-harm
  • eating disordered behavior
  • substance abuse
  • gambling
  • impulsive spending
  • hair pulling
  • sexual promiscuity

Over time, such impulsive behaviors become an addiction that returns every time the individual experiences an intense emotion.

 

May is Borderline Personality Disorder Awareness Month. For more information on BPD or Dialectical Behavior Therapy, visit lilaccenter.org.