Adult DBT Program

What to expect in the Adult DBT Program

Assessment

At the outset of treatment, clients have a 90-minute consultation with a DBT therapist. An important initial part of treatment is evaluating the “goodness of fit” between DBT and the client’s problems and treatment goals. To this end, we assess for the presence of the following problem areas:

• Confusion about Self (including one’s goals and values and also how one feels and thinks)
• Impulsive Behaviors
• Emotion Dysregulation
• Interpersonal Difficulties

Pre-Treatment

We have found that the use of special commitment strategies is very important in the pre-treatment phase of DBT therapy. That is, we ask clients to commit to making certain behavioral changes even though they have not yet learned how to make such changes. We do this because of the ample evidence suggesting that people are more likely to behave in a particular way if they agreed to do so beforehand. Clients are asked to agree to all aspects of treatment as described below, and his/her individual therapist will help to anticipate and problem-solve any potential treatment barriers (e.g., missing sessions due to transportation problems, staying silent in sessions, feelings of hopelessness).

Treatment

In weekly individual therapy, DBT therapists will help the client to:

• Identify and maintain focus on the primary problems to be addressed
• Stay motivated to work hard in treatment and apply new skills in their daily lives
• Coordinate and consolidate the different parts of treatment and make sure it is all tailored for the particular individual’s situation

Clients are also required to attend a weekly skills training class. The class meets for two hours each week over a seven-month period of time, and typically includes 5-9 members. It is led by two skills trainers who combine lecture, discussion, and practice exercises in order to teach the following skill modules:

• Core mindfulness: teaches participants how to focus the mind, direct attention, and how to nonjudgmentally observe and describe what they are feeling and thinking in the moment. These skills can help adults develop a more stable sense of who they are, and can help reduce reactivity to painful thoughts and emotions.
• Distress tolerance: targets impulsivity by teaching adults how to effectively distract and soothe themselves while considering pros and cons of their actions. These skills typically replace problem behaviors such as cutting classes, self-inflicted cutting, physical fights, and using alcohol or drugs. Acceptance skills help adults learn how to radically accept and cope with painful life events that cannot be altered (e.g., divorce, death of a loved one, a diagnosis of a chronic medical illness).
• Emotion regulation: addresses extreme emotional sensitivity, rapid mood changes, and other unregulated moods such as chronic depression, anxiety, anger and shame. Examples of specific skills include learning to identify and label emotions, increase positive moods, and make yourself less vulnerable to negative moods.
• Interpersonal Effectiveness: targets difficulties in maintaining consistent and rewarding relationships by teaching skills such as how to ask for what you want, how to say no in a gentle yet effective manner, and how to maintain your sense of self-respect and independence in the face of external pressure.

Telephone coaching with the therapist is designed to promote skills use where it matters most–in the real world. When clients feel “stuck” and unsure what to do, they are encouraged to contact their individual therapist for help in applying their newly learned DBT skills in “real time.”

Family therapy occurs on an as-needed basis to increase behavioral skill use within the family system, improve communication between family members, and to reduce family interactions that interfere with either the adult’s or their family’s quality of life.

Graduate Group

Once clients have completed the weekly skills training class, they can “graduate” to a DBT Graduate Group. The graduate group is a 90-minute group that occurs once weekly for 16 weeks, with the opportunity to re-contract for additional time if there are clear treatment goals identified. The primary goals of our Graduate Groups are to:

• learn more advanced DBT skills
• prevent relapse by reinforcing the progress made
• help strengthen and generalize behavioral skills to various settings and relationships

To achieve these goals, the group leaders encourage participants to employ all of their newly learned DBT skills, with extra attention being paid to the use of validation and problem-solving skills with each other. Each week, participants are required to identify home practice assignments tailored to assist them in reaching their longer term goals.

All DBT therapists at CBC participate in a weekly, two-hour consultation meeting. The DBT treatment team meets weekly to assist each other in providing effective, efficient, and compassionate treatment. We spend time problem-solving difficulties that interfere with client progress in treatment and help keep each other practicing within a dialectical framework.