Life on an Adolescent Intensive DBT Psych Unit

My bedroom was a tiny box of a single room. I had shuffled the furniture around so that my bed was tucked beneath the slanting of the ceiling at the far side of the room – so that I had a little safe cove I could hide in. Next to my bed was a stained wooden bedside drawer and a matching flimsy cupboard. I had not allowed for much legroom around the bed, after the furniture rearragement. The bed itself was low and the mattress paper thin. I always had two duvets because they were really thin also. They were these weird American duvets that go straight into the washing machine; they didn’t even need duvet covers, you just chuck the whole thing straight in.

Beyond the foot of the bed, nearer the bedroom door, was a desk which had all my writing equipment and books on it. (There was also a little glass angel my best friend had sent me in the post – which one night in a moment of desperation, I crushed so that I could use the shards to self-harm with.) On the floor I had laid down a yoga mat which I obsessively did puzzles on, because the floor itself was contaminated; everything seemed to stick to it no matter how often or obsessively I hoovered.

You would think that in an American hospital as expensive as that one, the rooms would be luxurious. Well, I assure you they were anything but. They were plain and old and in need or urgent renovation. When I moved in, it felt so dirty, dusty, old and damp – the kind of place you would not feel comfortable walking around bare foot. The kind of place that feels “hairy”, although I’m not sure exactly why that word came to mind. But by the time I left, the unit felt more like my home. I think I cleaned up well, making it as comfortable as I could for myself.

On one wall I had stuck tens of photos I had taken from home and cards and letters people had sent me, from half way across the world. Right by the door, where everyone could see, I stuck a large hand-crafted chart which I used to tally my behaviours and days free of self harm. (Until I ripped it down in anger and self-loathing after relapsing, that was).

Every weekday, we had a morning group which lasted 15 minutes, which was like a ‘check in’ session. I am sad because I cannot remember the exact name of this group. We would all write our goals on the stained whiteboard in creatively thought-out acronyms and varying colours of ink; most of us half asleep and with our moody teen attitude faces expressing how unenthusiastic we felt about starting a new day. I would grab muesli and yoghurt or fruit and take it with me in a plastic bowl to the lounge (where we did the check in), where I would subsequently be told off for eating outside the kitchen. Sometimes I would bring breakfast into the classroom instead, where even though I got told off, the ‘teachers’ (M and L) were too in love with my English accent and overall Britishness that they let me get away with these slight overhauls of the usual unit rules.

I would sit in the classroom with my hot water bottle and 5 or so other girls learning the DBT skills hour after hour, day after day. During our breaks I would go for a cigarette, if there were enough staff available, which often there were not. When the latter occured, I would inevitably throw up a hissy-fit, just because I could. Being on a psych ward allowed me to embrace my inner Hulk, you see. For once, it was safe for me to express my anger externally. I feel sorry for the staff, but it really helped my process.

If anything came up in class that was difficult, you could leave and go to the ‘nook’ at the other end of the hall, where a CRC (community residence counsellor) would be sitting for skills coaching availability. This was a regular occurrence – I don’t think any class went by without at least one girl having to leave for skills, whether we needed it or not! We worked our way through the massive DBT binder, compiled proudly by D (an old-timer CRC, who as yet had not been scared away), day after day after day. When we completed the binder, we started it all over again. Originally, I was not meant to be there for that long, but there was a slight delay in my transfer to ‘step-down’, due to how much I was still struggling on ‘intensive’.

Some groups and classes we had were in the ‘fishbowl’ – the room where the clinical meetings, handovers and assessments took place (not to mention the emergency ice-diving sessions). These groups included ‘relational dilemmas’ and ‘BA-CA-SA’ (behaviour-analysis, chain-analysis, solution-analysis – yes, what a mouthful). Lunch was from midday until 1pm. Overall meal times felt super early, and it was like being back in primary school. We had a shopping list for food we could add to on the fridge, and I ordered the same things every week. Animal crackers, sugar free hot chocolate, and a concoction of ingredients for my famous salad. Every day I made the same America-inspired salad – kale, feta, craisins, seeds, veg, raspberry dressing – and sometimes I made it for the members of staff, too. At lunchtimes, I always tried to get a seat at the table with the most clinicians – to ensure my daily dose of attention was attained. (We all ate together, informally, over 3 round tables, which often got full pretty quick).

Classes continued in the afternoon until 3pm, which was homework hour. I think I was the only one who actually did every single piece of homework, being the keen-bean that I am. Twice a week we also had the infamous ‘community meeting’, where everyone came together in the lounge to work through a structured outline. This included a mindfulness activity, rewarding people for effective behaviour, community issues, introducing new people and saying goodbye to leavers, etc. I managed to avoid leading ‘community meeting’ until many weeks had past, when my therapist decided it would be a grand idea to expose me to anxiety and shame – and my fear of my face going red. 

At 4pm, we had exercise hour, which was more like ‘exercise 15 mins’. We would much rather take our 3rd naps of the day, or eavesdrop on the ‘handovers’ going on between staff in the ‘fishbowl’. There were options for the exercise we could undertake: ‘tunnel walks’, or boring outside walks, or yoga when certain members of the team were available to facilitate it. When it snowed I wanted to be outside the whole time, building snowmen and singing Frozen with my friend T, much to everyone else’s annoyance. (We were the only two who had never experienced snow to the extent they had it in New England that year, being from abroad).

Tunnel walks were pretty cool too; replaying scenes from Girl, Interrupted, singing and shouting down hallways, hiding around corners, running into a wall with a poster that read ‘Unit 9 3/4’ – getting together to make the unbearable somewhat more bearable again. On Fridays for one group we were taken to the main canteen where we were allowed to buy anything up to $5, before sitting together and having ‘Cope Ahead’ group in the empty seating area, overlooking further empty seats. On occasion, one of the girls would try and run away. Usually, I just asked to go to the bathroom, so that I could sneakily take advantage of the wifi and use my phone (which had somehow gone missing from the office in the unit, having safely found a hiding place in my bra.)

On Thursday nights we had ice cream outings, which were everyone’s favourite. (Except for the time that one girl ran away, and the police had to arrest her. Poor girl in her PJs carrying her teddy bear, who we never saw again, as she was shipped somewhere more secure).

On weekends it was quiet – fewer staff and fewer patients. We went on outings (Americans apparently do not say ‘trips’, people) such as ice skating, cinema, walks, museums, pottery painting at MadeByMe, shopping, Build a Bear, bowling, you name it. If you got through without having a panic attack, it was on occasion actually enjoyable. (Unless someone else had a panic attack, which was not so much fun either, especially in the middle of shopping ‘mall’ (as they say), or during a ‘U’ rated movie (such as Big Hero 6… don’t even ask).)

My favourite outing I remember was an adventure to a local common, when I witnessed a pond that had totally frozen over for the first time in my life. I pretended I was going to walk on it, just to freak out the staff, who were essentially responsible for my life. (Then I found a lollipop on the floor and gave it to K, because she sucked sweets 24/7 when trying to quit smoking. Goodness knows how or why I remember that, out of everything.) I remember being happy that day, and people always mentioned thereafter how much they had loved seeing me like that. Especially because of the simplicity of it all, the fact that my glee was all because of a frozen pond.

Back at the unit, I had therapy twice a week with W, and family therapy over the phone once per. I also saw my psych S twice a week, although this was usually doubled because of the complications with my meds at the time, or halved because she forgot (bless her) or was busy. I usually was my own boss anyway, constantly making my own ‘appointments’ to speak to many members of the team whenever I needed a dose of attention. I also played many games of Scrabble with the head psychiatrist and read many chapters of my book in the clinical director’s office whilst she did her paperwork, curled up like a cat on her sofa (begging for cuddles).

On my last day I read out a speech I had written that was 4 pages long. I thanked everyone for all they had done for me, not that words could do it justice. I recounted memories, the good and the bad. I laughed, I cried. I put on my best British accent, and then my best American one. I joked and referenced multiple members of staff, some of whom starting crying too. My ‘hugging ban’ was lifted, and I left to the airport having felt more held (both physically and emotionally) than I ever had in my life.


8 thoughts on “Life on an Adolescent Intensive DBT Psych Unit

  1. It’s very interesting to read of your experiences. I have not been in that kind of a DBT program. I have been in the psychiatric unit of the hospital five times though (two in the adolescent unit which no longer exists) and three in the adult unit which is always a little unnerving. Didn’t realize an inpatient unit for DBT existed. That would have to be pretty intense. I find weekly therapy sessions and skills group on an outpatient basis intense enough, daily inpatient had to have been more so. Thank you for writing about your experiences.

    And no, sadly, hospitals are never luxurious. And if they are, they usually save those luxuries for the birthing suites, NOT psych units. I was horrified the last time I was there to see they had changed things and there were no longer regular doors for the bathrooms but more like saloon type doors and the fixtures were all stainless steel like those you would find in a prison. Of course now, the unit has been shut for the moment due to lack of psychiatric doctors. If you’re in need of emergency mental health, you’ll have to go to another hospital.


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