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Rise Above: a podcast from Rogers Behavioral Health takes listeners on a journey of education and inspiration as we sit down with mental health and addiction experts and past patients who are changing how the world views mental health and addiction.
Residents become often a bit surprised in that they are pretty capable people, that they're safe going home and that they can do like ordinary teen stuff now. They may be an emotion sensitive person, but they can live their life.
Host - Andy:You're listening to Rise Above, a Rogers behavioral health podcast, where we sit down with Rogers experts who are changing the way the world views mental health and addiction. Hello, listeners, and welcome to another episode of Rise Above, a podcast from Rogers Behavioral Health. Today, I want to talk about emotional dysregulation. Now, it can be difficult to see and even harder to understand, and it doesn't always look like what someone would expect. Sometimes it's hidden beneath high achievement and perfectionism, or sometimes it shows up as crisis through self harm, overwhelming emotions, or patterns that feel impossible to break.
Host - Andy:So today on this episode of Rise Above, we're taking a closer look at what emotional dysregulation really is, how it impacts teens and families, and what effective evidence based treatment can look like. So joining me today is Doctor. Eric Ueland, Medical Director of the Nashota Center for DBT Adolescent Residential Care and DBT services at Rogers Behavioral Health. He's helped develop a highly specialized immersive program at Rogers focused on dialectical behavioral therapy or DBT. And together, we're gonna explore how DBT works, why relationships are central to recovery and how the right environment can help young people move from crisis and hopelessness toward capability, connection and long term resilience.
Host - Andy:And with that, Doctor. Yulen, thank you so much for joining me.
Dr. Ulland:You're welcome.
Host - Andy:So it's a long title and we'll get to pretty much everything in it. But to start off, can you tell listeners a little bit about who you are and what you do at Rogers?
Dr. Ulland:Yeah, I'm a child and adolescent psychiatrist that's been with Rogers for probably around eighteen years now. I used to be an inpatient medical director for a time before being able to start the initial program about twelve years ago with the hopes of doing high fidelity dialectal behavior therapy. We noticed a need on the inpatient unit with a lot of individuals who had histories of self harm or chronic suicidality or suicide attempts, many of whom were female and realized we didn't necessarily have a great residential space for them and inpatient isn't intense enough or done over a long enough period of time to really feel like you're making an impact in their lives.
Host - Andy:So when we talk about emotional dysregulation, is that what we're talking about, self harm? There's more to it, I assume.
Dr. Ulland:Yeah, so it's a very complex clinical picture and population to work with. But often one of the things you're going to see is like self injurious behavior or chronic suicidality or more immunomodulatory suicide attempt in patient hospitalizations.
Host - Andy:So when it shows up in someone's life, emotional dysregulation, what does it look like day to day for someone?
Dr. Ulland:It can actually look quite different. Generally, residents are typically likely emotionally sensitive when they were younger. Some of them have a presentation of being maybe perfectionistic or doing really well in school, having maybe an anxiety disorder, but then have maybe secretive self harming behaviors or have been inpatient for suicide attempts in the past. And sometimes they kind of rapidly reconstitute themselves and go home after inpatient, which is misleading because the patterns of behavior of this internal struggles are much greater than people around them realize. Other times you can see more of an externalized picture of behaviors with anger being expressed outwardly.
Dr. Ulland:Generally, patient population we're often working with, their anger is inward driven, so more self loathing, self hatred is going on. I think that parents still know that that's happening.
Host - Andy:Sure. And so as a parent, I mean, can you look for certain things? Like you just said that they don't know what's happening.
Dr. Ulland:Yeah, I think you're looking for, like I said before, like things like perfectionism, you may have self injurious behaviors that are difficult to treat. Sometimes it's a depression that doesn't really seem to go anywhere. Like it's severe enough, but doesn't seem to improve with medications or be kind of stuck for making progress for an outpatient or other levels of care. So it's a complex picture that can look very different. Sometimes it's very well hidden, but then there are these crises that happen that are very scary for parents.
Dr. Ulland:And sometimes it's a visible process that they've been struggling for a long period of time. But I think that self injury or self destructive behaviors tend to show you that that's someone who can't regulate through other means than self harm.
Host - Andy:And so at the Nashoda Center, DBT is a big part of your title, dialectical behavioral therapy. Can you explain what DBT is to someone like me?
Dr. Ulland:Yeah, DBT originated to work with a population of patients that typically other psychotherapies weren't really benefiting. So these are initially was built for individuals who are highly suicidal and that's the individual, the creator Marshall Linehan wanted to work with suicidal individuals having been suicidal herself in the past. And so her idea was, you know, I can go into hell to bring people back with me because I've been there, like I know the road. So part of that deciding to work with people who have chronic or suicidal have chronic emotion dysregulation. And so that's basically the population of Luke with our work with are people who don't regulate emotion very well.
Dr. Ulland:So DBT then uses a lot of change strategies from cognitive behavioral therapy or those other aspects that are known to work quite well. However, for patients who do well with DBT is they're generally too emotionally sensitive or lack the skill to regulate emotion. So the typical strategies used in cognitive therapy don't work. And so DBT brings with it a lot of acceptance based strategies that at the time CBT didn't have as much of, and a lot of principles and philosophies that are beneficial for this patient population because there's a lot of interpersonal conflict because it can affect personality. So patients who need DBT often can do things unintentionally that negatively impact the therapeutic relationship or interfere with their own treatment.
Dr. Ulland:And so if you're aware of that and what to look for, then you help them not to do that. So it's a long explanation of history, more in a nutshell, Dialectical Behavioral Therapy has a lot to do with Behaviorism, like capital B Behaviorism. So we use a lot of behavioral strategies, but they're also used within the context of a relationship. So how I'm impacted by a resident or how I impact a resident or a client, those things do matter. Our relationships matter greatly because a lot of the illness shows up in the context of relationships.
Dr. Ulland:So you have to use that with treatment. The dialectal component is realizing that, you know, aren't typically always all good or bad. There are gray areas to life or areas where, both sides of an issue can both have truth to them. How do you find that? Which is important because if you want to validate someone's perspective that you don't understand, you can still validate it without saying that you accept what's going on, but at the same time, you can see from their perspective.
Dr. Ulland:So there's a lot of perspective taking, a lot of principles and philosophies that patients tend to learn over time, misalearning skills, which help somebody live more effectively over time.
Host - Andy:So what would like one therapy session implementing DBT look like then?
Dr. Ulland:Well, you would definitely have a diary card. So as a client of DBT, you would have to have a diary card where you are tracking emotions throughout each day, throughout the week. You'd also be tracking target behaviors, which often in DBT would be things like self injury, but it could be substance use. It could be yelling at a spouse, but these are behaviors that either are directly initially related to safety or survival, or treatment interfering behaviors that cause problems in relationships, or maybe like not doing your homework for a DBT, for example, or not doing the diary card would be treatment interfering. So you're looking at target behaviors that are linked to those things, but then also towards skills acquisition.
Dr. Ulland:So you're following those, you're hopefully tracking mindfulness and then tracking skills. So how often and how regularly are you using skills? You'll review that diary card at the beginning of any DBT session. So that's the expectation. So with your individual therapist, you'll review the diary card and that sets the agenda.
Dr. Ulland:So the therapist then knows like, here's what we're going to address today. And the hierarchy would be if there are safety interfering behaviors, that's number one has to be addressed immediately. Next would be treatment interfering. If those things aren't happening or they've been sufficiently addressed, then you move on to quality of life interfering behaviors and then down to working on skills acquisition where people can use skills in multiple contexts. And that's what DBT looks like in stage one, which is mostly what we're doing a lot on the unit, where you have self destructive behaviors.
Dr. Ulland:As people graduate from that and become more skillful, then DBT might start looking more like other forms of therapy in a sense. But when you think of DBT at its most DBT esque, it's when individuals are presenting with more dangerous behaviors. So you mentioned the unit, the Nishota program.
Host - Andy:For listeners who aren't familiar with it, you wanna give us an overview of the Nishota program as it is?
Dr. Ulland:Yeah, it's an adherent program with high fidelity and then it's immersive. So we do use the adult skills manual, which we decided to do from the beginning because we wanted to make sure that was an intense program. We had a goal at that time of working with residents who are of at least average intelligence with the idea that if you have kids who have a lot of potential, but their ability to regulate gets in the way of that potential, if you could teach them skills how to regulate, that it kind of unlocks their future. Where the risk is you have kids with a good amount of potential for life, but they're at risk to die from suicide or at risk to continue to get into unhealthy relationships or not go as far in their academic studies or work or those types of things. We really wanted to have impact long term, not just help someone be less depressed, but actually be more capable of living life.
Dr. Ulland:So from that, I think our unit then looks unique from other units in that there aren't a lot of residential units for adolescents with DBT that are highly adherent. Our units are all female program, so biological female, which is helpful. Women often recover with their motion dysregulation, recover better amongst other women. Having men present tends to impacts their ability to recover. Also, our length of stay is relatively long compared to most other programs in the country.
Dr. Ulland:And learning skills and learning how to regulate for people who are chronically hopeless and suicidal does take time. And also, want people to be pretty solid with their skills useful in these so that they're autonomously regulating. The unit's very unique in that we have a lot of limits for behavior or the things that residents can talk about. You're trying to build a culture of recovery, which is not easy to do if residents aren't willing to follow limits. So limits would be that we're not talking about previous treatments, what medications we're on, talking about self injury, substance abuse, either things like politics or religion.
Dr. Ulland:We're setting those limits because these are areas where we don't want people identifying with their illness by talking as if they're mental health patients or sharing that information. We want them to be able to move away from that and then also try to reduce the risk of conflict on the unit. So certain subject matters leads to conflict or arguing. And if you have a lot of tension or invalidation on the unit, that prevents people from feeling comfortable enough to try new behaviors. And that's an important part of the unit.
Dr. Ulland:Acting sort of like a sandbox where people can try new things they haven't tried before. Many residents, for instance, are not assertive. They often won't speak their mind or ask for their needs to be met, especially around people who are maybe rejecting or invalidating. Far less likely to do it. And that's a skill that they need to have just to live life, but also be safe in relationships.
Dr. Ulland:So I think these are things that the unit's different with. I think also we do a lot of research. So we have a lot of outcomes we're following on the unit to look at ways we can improve things or maybe move treatment faster, which is difficult. But we're also looking at physiological markers for regulation. We're looking at how medications impact regulation.
Dr. Ulland:Possibly doing studies with EEGs as well, because this patient population tends to have a difference with their arrest in EEG than other populations. So there's a lot of things we want to understand about dysregulation. And so we are actually doing a lot of research as well as providing good care.
Host - Andy:So you mentioned a little bit about things that people don't talk about in the program and how it's an all female population, but how important are relationships in the program, whether it's with the staff or their peers? Like does that benefit in the treatment?
Dr. Ulland:Yeah, it's extraordinarily important that when Marsha Linehan wanted where tubular chronically suicidal, she was working with patients who had something called borderline personality disorder, which basically part of the illness is that it totally impacts relationships in very negative ways. And so that patterns develop within relationships that actually make the illness worse or continue the patterns of the illness. So actually that's why therapy becomes important is that it is like an interpersonal therapy. So even though it's very behavioral therapy, it's not just like teaching how to do exposures or just teaching skills. It's like, I would share openly, if I'm emotionally impacted by a resident, may share that, like, I may have a perception that of a resident that they may need to hear because they may also, other people in life may have the same perception of them, whether it's like a positive or negative.
Dr. Ulland:So we would share that within the context of relationships so that they know how they're impacting their relationships. And I think a large portion of people who need to give it to you or do well with it are very compassionate and highly sensitive. And so that tends to be important. So the level of connection in the relationship often can drive the recovery pretty well. And the other, that's all the positive stuff.
Dr. Ulland:The negative stuff is that we, well, to stay regulated, you have to have a source of validation. So either you are able to validate yourself so that, you know, your mind, if something difficult happens that like, I get why this happened. I know I'm having these feelings. It's okay that I feel this way. And I know that I can still act within my values.
Dr. Ulland:Or I can meet the demands of my environment, even though I'm experiencing a tense eruption. But I have to be able to validate myself. Residents typically don't have that skill, so they require their validation coming from the environment. So the environment has to communicate to them that it makes sense that you feel the way that you do, and it's okay that you feel that way. But many of them don't have that experience coming in.
Dr. Ulland:And then if the milieu is not providing that, if there's a lot of rejection or the relationships are unsafe or unhealthy, then it's hard to regulate. Because you can use a lot of skills, but if you're not able to validate yourself or be validated, then people will come dysregulated pretty quickly. So kind of come back to your question, how important are relationships? And extraordinarily important. The patterns don't exist on a discer island, so to speak.
Dr. Ulland:These patterns of behavior exist in the context of relationships almost always. Invalidation or rejection you know, or judgment from other people can dysregulate someone into eventually doing dangerous behaviors potentially.
Host - Andy:And we will be right back. Real quick, wanted to take a moment to talk to you about W. S. The initiative for stigma elimination. It unites people across the nation to support those touched by mental illness and addiction.
Host - Andy:The compassionate approach champions personal stories and powerful connections, fostering healing by reducing stigma through evidence based practices. Rogers Behavioral Health supports the work of WISE through their Community Learning and Engagement department. WISE collaborates with a diverse network of organizations and individuals united in the fight against stigma. You can learn more about WISE, explore their four key programs, connect with them by visiting the website www.eliminatestigma.org. And now back to the interview.
Host - Andy:So when someone is learning to regulate their emotions, what are some, I guess, like, small wins that you notice? Maybe they don't even notice them.
Dr. Ulland:Yeah. You you'll tend to see, like them being a little bit more calm in their body overall. You end up connecting better emotionally. So often individuals aren't regulated well or experience high shame or anxiety. They're hard to connect with because they're suffering so much.
Dr. Ulland:So you start seeing them becoming more of like a genuine person. Like you kind there's a flavor of who they are, I think. But then as they're regulating better, you start feeling the connection is more authentic. A lot of, what we see with coming up in families that we don't often appreciate is that a lot of times most dysregulation's present early childhood and parents don't know it. Many clients are very good at hiding the dysregulation because they often feel like a burden but don't want to be a burden to their parents or their loved ones.
Dr. Ulland:They all get good at pretending like everything's fine, but it's not. So a lot of times you'll hear that, oh, you're doing well fine, but internally they're not really fine, but they're trying to present what they're They're fine. And then things will end up in crisis later, typically during adolescence where that just doesn't work anymore. Relationships are super complex for young women. After the puberty things get much more complicated, emotions are much more intense from the ages of like 12 to 22.
Dr. Ulland:Life happens quite loudly for most people. And so it feels like the wheels are coming off for parents, think, where they don't realize that this is much deeper and more pervasive than they realize. And that's part of where treatment takes so long. And there were like some things you see in this population is that they're often confused about how they feel or they're highly avoidant of how they feel. So that's part of the I'm fine, but I'm not really fine, but I'll tell you I'm fine.
Dr. Ulland:And then what happens over time is you pretend you're okay, you're avoiding your emotion a lot, you actually won't develop really good skills at problem solving in the context of relationships or for emotions. So that people are very good at school, getting great grades, but they don't manage well emotionally nor in relationships. Also, they don't develop the kind of success in life from missing those skills. I am seeing within the context of relationships and suffering is they begin to get more hopeless over time because they don't know how to change how they feel or change the patterns that keep happening to them. So then over time, they've tried everything, they've done things, but nothing seems to work.
Dr. Ulland:They tend to be perfectionistic and set high expectations they can't meet. And then over time, that leads them to develop more and more shame, more hopelessness. So we get them at a time in the unit where they're quite hopeless that anything could work. And then often, the hopelessness is felt within the family. So families can be quite hopeless about change and don't know how to go about getting change to happen.
Dr. Ulland:And then there can be crisis in connection, where everything seems hidden until we fall into crisis, and then parents and loved ones are now aware that we're in dire straits, and so they're putting a lot of time and attention into helping them get through this crisis. The issue is that the person's so dysregulated and not really learning from that, So the pattern is likely to happen again. But also, we have all of a focus on them, so there's a lot of connection and things like that that happened at the time of crisis. So crisis can be reinforced through connection in these family systems. And so it's hard to not reinforce the illness that you're trying to get rid of or trying to improve.
Host - Andy:So you mentioned shame. How does the treatment help with the way the people see themselves?
Dr. Ulland:Yeah, that's a difficult one because you feel like you kind of, with treatment, have learned to do it in layers or things happen in sequences or stages. And I think shame is probably, we're addressing it a lot. And there are specific skills, mindfulness, a lot of mindfulness practices that have compassion as part of it. And just in general, if you have a good mindfulness practice yourself, you tend to become more compassionate towards self and others anyways. But there are specific things like loving kindness they can do, or there's other self compassion mindfulness they can do.
Dr. Ulland:There's like checking the facts on shame. Residents have very high, high levels of shame and self loathing that are not really primary emotions. You get stuck in secondary emotions or emotions about emotions, which aren't helpful. So you have to be able to sort that out through skills use. And then what is also helpful, think too, is that you, because of the acceptance strategy in DBT is that when you're experiencing high levels of shame, you don't have a team that's judging you.
Dr. Ulland:So that's really hard. So when we feel shame, we want to hide. And therapy, we'll even hide from our therapists and not talk about the things we probably need to talk about. But on a unit is having the exposure to it where residents are hopefully able to share the shame that they feel, even if it's not their primary emotion, they also need to know that, be able to look at us and know that we're not judging them like by our facial expression, that this is just part of what we're working on and they're not a bad person. And then truth, within DBT, truth and meaning evolve over time.
Dr. Ulland:So part of recovery is that we always have a narrative of who we are and what our journey in life is, and that's free to change. Like you could think we've done a bad job or we could later in life view ourselves as the underdog that overcame some difficulties. And then that narrative matters for choices we make in the current moment, but that is can change over time. It's not like an absolute, like I'm a horrible person or a bad person. That idea can't change, that needs to change.
Host - Andy:You say that oftentimes there are parts of the treatment that surprise people that are in the program?
Dr. Ulland:It's hard to say what surprises. They can be very different for everybody. Like for a lot of reasons, I'll ask is they're leaving, what were the most helpful things? And I guess it's interesting what answers you'll get. So I'll say in a very vain way that like, you mean skills or people?
Dr. Ulland:I'm like, anything. Like it doesn't matter. It could be someone held a coke for you at what I was reading one day or anything really. So it's interesting to hear how varied the responses are. I think that residents become often a bit surprised by their autonomy in that they are pretty capable people.
Dr. Ulland:I think they realize how skillful they can be. So to go from a point of hopelessness to where they have experienced themselves regulating very difficult things in family therapy or other things, I think that's a surprise to them. For them to realize that they're safe going home and that they can do like ordinary teen stuff now. They may be an emotionally sensitive person, but they can live their life. So I think that's fun to watch their autonomy, that they can be in relationships, but then also they could also be on their own at regular experience relatively well.
Dr. Ulland:And parents sometimes I think are surprised by that as well because they're usually dropping off a client at a time where you're in crisis and they don't know if they're ever going get to a point of safety again. And so when their child comes home, they may want to set limits that are too strict, assuming how things were when they got here, but their child hasn't been living with them in the last couple of months. So it's hard for them to maybe appreciate that change, the surprise of how well they're doing when they get home sometimes surprised parents, I think, pleasantly surprised.
Host - Andy:Well, and that was what I was gonna ask about next is, so for these people that are going home to their parents or loved ones, how should parents and loved ones, I mean, do things need to change at home usually?
Dr. Ulland:Yeah, I think yes. Part of DBT is a bio social theory, which in short means that individuals come from environments, right? So we learn lessons from environments. So individuals impact environments and environments impact individuals. And because this is such an interpersonal process, that means that the family has definitely been contributing in some way.
Dr. Ulland:Like they hold their end of the pattern, so to speak. And it's not, most times, it's not intentional. Parents aren't doing things with ill intent ever. It's just there's a miscommunication between them and a sensitive child, and this mismatch leads to miscommunication. So we wanna work in therapy ideally with parents to recognize like where the miscommunication is.
Dr. Ulland:Because like, I know what your intent was for your child to feel shame when you did this. I know that's not your intent. The issue is that from their perspective, that's how they're gonna view it or see it. And can't it make sense to a parent that like, well, of course they see it that way. So kind of looking for of course ness, which is something I like in DBT, which is when things happen or behaviors happen, we have to find the of course ness of it.
Dr. Ulland:Like, of course it makes sense. Like, how could it be any other way? Is it a certain level of mindfulness where it's nonjudgmental and it's like, this is just the way it is. It couldn't be any other way. It doesn't always have to be this way moving forward, but you find the of course and stuff like, oh, I get it.
Dr. Ulland:Like from your perspective, when I do this thing, this is how you would experience it. And it's unlikely that person would just experience it differently because you talked about it. What it probably means is there's pressure on me. Like if I had a resident who was upset by things I did and they had the courage to tell me, I would hold my response to be like, Oh yeah, from your lived experience or from where you're from, I can see why this comes across pretty poorly. Or like, You feel shame or you're frustrated with me because of this thing.
Dr. Ulland:And then I would seek to change that thing for them. Because like, I can't tell them not to feel the way they feel based on my behavior. But if I care enough about the relationship, I will try to be mindful and not do it the same way in the future. So that's a lot of what family work is, is trying to line up fragile intent with what is experienced by the child because with Emotional sense that people don't always see things the same way or experience things the same way. And so it's helpful for families to know that and understand that.
Dr. Ulland:And if we're building a culture on the unit where recovery occurs, it makes a lot of logical sense that if someone then leaves this culture into a similar enough culture, they'll continue to progress. So families are making some changes too that match more of what happens, like how we talk about emotions on the unit, recovery will be stronger, it'll be less stressful as a resident. But there's a pressure. If you learn how to operate really well and regulate well in an environment that helps reinforce that, it's harder to regulate an environment that's doing things against that or not positively reinforced. So it puts more pressure on the resident to work harder to stay regulated in relationships that are somewhat invalid.
Host - Andy:And we will be right back. We don't talk enough about mental health later in life. Big changes like retirement, health issues, grief, or caregiving can really take a toll. And a lot of people feel like they're supposed to just push through it. LifeWell at Rogers Behavioral Health is an inpatient mental health program created specifically for adults 55 and older.
Host - Andy:The care is age specific, compassionate, and focused on helping people feel stable again, surrounded by peers who are in a similar stage of life. If you or someone you care about needs support right now, help is available. You can learn more or request a free screening at rogersbh.org/lifewell or call (833) 308-5887. And now back to the interview. You mentioned the length of the program a few times.
Host - Andy:You said a couple of months. I mean, long are people typically in the program?
Dr. Ulland:It's somewhat varied. Think I view it as a sixty to ninety day program. And the reason I deal with that way is because generally, if people leave before sixty days, I don't know if we've appreciably decreased risk for future hospitalization. I have some data from a survey a couple of years ago that would suggest that if you leave a horse sixty days, probably hasn't really substantially changed things. But if you look at the the group of residents who have been here sixty days or longer and look at their outcome data, they're definitely different with regards to risk for continued self harm or hospitalization.
Dr. Ulland:It's dropped drastically after sixty days, which makes sense because it takes about a month to get to the manual once. And then at past sixty days, the residents have been through the manual twice. So they're learning a ton of skills, we're really at that point working hard towards generalization in the third month and then doing more exposure protocols, assertiveness training, and things like that. So then you're actively putting them in difficult situations that they then have to be skillful, but also regulate that experience, which is a good practice for you going home. So I think that promotes recovery really well.
Dr. Ulland:I think a lot of, at one point, average length of stay covered by insurance for something like eighty eight days at one point. But that was a while ago. But I can see that probably over time after COVID, we've recognized and maybe built and hopefully enough trust with insurance that they realize that the value is there, that the bit of the extra time past the sixty day mark actually is time well spent recovery. So a lot of the residents aren't going back to higher levels of care after they leave, and they can be managed safely and do well, typically at a low, like outpatient DBT practice would be fine. And this is good because the average resident in The US already had three suicide attempts, has self harm behaviors.
Dr. Ulland:So we're talking about teens that aren't like difficult or like sensitive or however people judge that, but more basically like they're high risk individuals. The whole unit is high risk residents who aren't high risk when they leave.
Host - Andy:So is it okay if we talk about you for a second?
Dr. Ulland:Sure.
Host - Andy:What makes you so passionate about this?
Dr. Ulland:I think it's interesting because I think learning drives a lot of what I like. So if I have a challenge or I'm learning a lot, I find value in that. And I think it comes back a little bit. I know it sounds odd because I sound very logical, but I think I generally am. But also like efficiency, the idea that how much bang from the buck can I get?
Dr. Ulland:So the idea of DBT is like, you can take someone really far. If you're gonna spend effort helping someone, I wanna see it. I wanna see it take off and I wanna see it pay itself forward. So I'm always interested in strength based things. Like you can get someone to feel better, but that feels like a very temporary thing to do.
Dr. Ulland:Sort of like the parable of give a man a fish to eat for a day, but teach him how to fish eat for a life. And so I think with DBT, a highly educational model and I love learning and your teaching skills. Maybe someone doesn't feel super great when they leave or anything like that, but that's not what's important to me. It's like, are you more competent and capable when you leave? That's where And generally, if you're more competent, your mood is gonna be better.
Dr. Ulland:You're gonna become better anyways. So I love the idea of the competence within DBT. It's a challenge to do, and it's more time consuming to learn and a little bit more time consuming to do, but the payoffs are so great. And then I think also there's those, like for me, logical or like cognitive examples, but the emotional part of knowing that when you walk onto a unit that it's working a lot for a lot of people much of the time, and then seeing their growth after Emotional is great because we have a resident now who's in medical school. I have a couple in PhD programs for psychology as at least a couple who are now becoming GBT therapists on outpatient because they love psychotherapy.
Dr. Ulland:So you see the success of you've had residents where families thought they weren't going to make it out of their teenage years. Or I've had at least two fathers who were sadly pricing out options for funerals because they only believed that was what was going to happen and that was their responsibility as the income provider of the family. They had to see all eventualities and the shame they felt for having to do that, but that's how hopeless the families were. So you see families sometimes coming in at the worst, but then you know that they're gonna be so much better in the future if they're committed and they work hard and work hard with them. I So guess the emotional part is you are just making somebody feel better, you might be setting them back on track to live a really good life.
Dr. Ulland:And that's the hope with any of the residents that we're working with.
Host - Andy:So if someone's listening to this, there may be a parent and they feel like, you know, maybe their their daughter is experiencing what you've been talking about. Like, what should they do?
Dr. Ulland:Well, I think like learning more. So we have a podcast for the unit that we use for parent university, which I think is helpful learning more about it. So we talk a lot about the biosocial theory in detail. So some of the things that we're teaching within the program are done in the podcast so that parents can follow that along. So there's that.
Dr. Ulland:There are books written on self injury. So a lot of good resources to learn more about, dysregulation and then self injury. So I don't know if you have time for those resources, but I think that they're helpful to start learning, but also getting an evaluation for the child. Also, if you've been inpatient more than once and it doesn't seem to be working or we're missing something, then you may want to consider a residential referral. Because if it's not inpatient, sometimes people are in crisis and they go inpatient, they come home fine and that's good.
Dr. Ulland:But if a lot of dysregulation is there, that's probably a pattern you're going be familiar with until someone treats the dysregulation adequately. DBT does also work very well. It was built at an outpatient level of care for dangerous patients, so we know that it does work on outpatient as well. It's just difficult sometimes finding a good program that's also inherent in high fidelity. But we're good for working with residents where maybe they don't have access to that in their local community or maybe they're security sign up for during a DBT program, but they can't move the needle without having to do it more intensely like on a residential unit.
Host - Andy:I guess finally, when you walk through the doors every day, what brings you hope?
Dr. Ulland:Think it's the, knowing what we do matters, like for the residents. And I think just as an evidence based person, like you'll, the evidence for DVT work on patient populations is really high in research studies. And then I'm watching it happen clinically every day or every batch of residents. So I just know that it works. I know the work is hard and I know that residents are suffering, but I also know that they are working hard and like together, like we're going to do it and you see it over and over.
Dr. Ulland:You get challenged, like you'll have cases where things are stuck or things aren't moving and eventually start moving again. You've just seen it happen like enough. So I think that the work is hard, but it's meaningful work and it does work. So you have the outcomes to show it. So I think like, I just, I know that.
Dr. Ulland:And I think for me as a skeptical person, I don't want to ever, for me, it's like the nightmare would be like, think I'm doing really good at helping people and find out later I really wasn't. Like, I just don't want to be in that position where I'm spending time with a team. I don't want to waste other people's time on a model. Maybe that doesn't work as well. I don't want to be fooled to think I'm doing a good job or maybe we aren't.
Dr. Ulland:So that's part of the reason we have so many outcomes and things that we're doing or assessments that we look at is to make sure like are we hitting the market as well as we can so that we're not wasting the time of people who are suffering greatly? I think they need every opportunity that this is going to work. That's the hopeless they are. And so we have to do our best to try to provide that. So that's how the hope is.
Dr. Ulland:I know we all work hard and I just, I see it working.
Host - Andy:Doctor. Uhlen, thank you so much for taking some time out of your day to join me.
Dr. Ulland:Yes, absolutely.
Host - Andy:I appreciate it. Thanks.
Dr. Ulland:Thank you.
Host - Andy:Well, listener, as you heard today, emotional dysregulation is complex, but it's also treatable. With the right support, structure, and skills, change is not only possible, it's sustainable. And DBT focuses not only on helping someone feel better in the moment, but on helping them become more capable over time, learning how to navigate intense emotions, build healthier relationships, and how to move forward with confidence. At Rogers and the Shota Center, that work is intentional and immersive, creating an