A DBT ‘Pros and Cons’ Example

Off the back of this post here, and the continual angst it has been causing me, I decided to call the substitute skills coach for her advice. She does not know me as well as my therapist, and I did not want to delve into it with her. But I gave her the facts and the pros and cons discussed in the previous post, and we decided together that it would be best for me to not go to the research team meeting.

She then asked me to use the DBT skill of writing a Pros and Cons list to inform our next steps – weighing up whether I express my needs to my supervisor transparently or not.

Here it is:

Pros of being transparent with supervisor:
• Acting opposite to shame will give my brain the message that shame isn’t justified (even if I don’t believe that that’s true)
• She is very knowledgeable and non-judgmental about this stuff – it’s her field of expertise – she, more than anyone, will understand
• She may appreciate my being transparent with her
• It may help her consider the unspoken needs of other service users/ people with similar struggles who she works with and inform her future practice
• Me stating my needs may foster self-respect and feel empowering
• If she responds in a supportive way it will show me that there genuinely is no current threat – and the emotions attached may become easier to manage
• Being something that I do not ever talk about or expose, expressing it could show me that it is actually acceptable to do so (with a safe person, like her) and that nothing bad has to happen as a result

Cons of being transparent
• Insurmountable shame and self-disgust etc
• I am paranoid/ hyper-vigilant about how she sees me already and it is so hard keeping up this façade – this will get even harder
• Physical consequences (panic, red, sweaty, dissociation, dizzy, flustered, shaky, etc) depending on the context of the conversation
• She may try and talk about it with me or want to discuss it further
• Once she knows, she knows – there will be no going back
• Will be challenging to look her in the eye and have the same “pure” relationship with her… the relationship will feel “contaminated”
• My constant worry thoughts regarding her perception of me if she “knows the truth”
• “Borderline me” who cannot cope with life will have won over “functional competent me” and the façade of the former version of me will be blown
• I may be perceived as weak, unprofessional, not far along enough in my recovery, etc…
• … She therefore may feel less inclined to put me on sensitive projects in the future
• She may feel guilty for not considering this actuality/ my needs earlier/ of her own accord
• She may “walk on eggshells” around me more or treat me differently having been exposed to my vulnerability

Pros of not being transparent
• It is easier
• Sometimes saying no is enough – why should I have to justify myself?
• Can avoid the excruciating shame of her knowing
• No risk of “shame attacks” and other physical reactions that I hate
• Will be easier to face her if she doesn’t know
• There are other more appropriate times to expose information such as this, especially having barely even started this work in therapy
• I can hardly talk to my therapist about it, I do not think I need to push myself to start with talking to my supervisor about it, in any capacity
• Feels safer to not expose this – it is important to feel as safe as possible with regards to this regardless of if it is avoidance or not

Cons of not being transparent
• Going with shame and fear will give my brain the message that these emotions are justified
• Avoidance behaviours will keep me stuck in avoidance – perpetuating a mindset of “I have to avoid this stuff in order to survive it”
• Giving my past power over my present, letting it dictate and control me feels like… shit. Opposite of self-mastery.
• Will deny myself the opportunity of doing things differently
• May feel like I am hiding something from her and that she is aware, leading to paranoia…
• … This interpersonal paranoia could strain our relationship
• She may push for further information to understand the situation more clearly, which would be challenging

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