Young Adult DBT Program

What to expect in the Young Adult DBT Program

Assessment

At the outset of treatment, clients have a 90-minute consultation with a DBT therapist. Depending on the age of the individual. 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 clarity about goals/values, and how one feels and thinks);
• Impulsive Behavior;
• Emotion Dysregulation; and
• Interpersonal Difficulties.

(1-2 sessions)

Pre-treatment

We have found that the use of special commitment strategies is very important in the pre-treatment assessment. 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).

It is often helpful for young adults to involve their parents for a portion of this pre-treatment phase to provide any additional family history, as well as to inform parents of the treatment structure and CBC’s policies involving attendance and missed appointments.

(1-6 sessions)

Treatment

Treatment will include a combination of the following:

Weekly individual psychotherapy (approx. 28 sessions) Individual 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 behaviors in their daily lives; and
• coordinate and consolidate the different parts of treatment and make sure it is all tailored for the particular individual’s situation.

Weekly skills training class (28 sessions) 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 non-judgmentally 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. Other reality 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, learning how to increase positive moods, and learning how to make yourself less vulnerable to negative moods.
• Interpersonal Effectiveness: addresses 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.
• Walking the Middle Path: targets extreme, rigid, or non-balanced thinking and behaviors among young adults and their roommates and/or family members. These skills involve learning about common areas of conflict and polarization in relationships, and reducing the conflict by learning methods of behavior change as well as methods of validation and acceptance.

Telephone coaching with the therapist. Phone coaching 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.”

Parents of Young Adult Skills Group (14 weeks) Parents of young adults often feel confused and at a loss as to how to best help their young adult “children” meet their goals. This may include living more independently, finding gainful employment, improving communication, reducing conflicts, and validating their life challenges, as well as clarifying wants, needs, and expectations. This group is co-led by two DBT therapists who teach parents some of the same skills their young adult children are learning (e.g., mindfulness, validation, distress tolerance, and interpersonal effectiveness) in the context of a supportive atmosphere.

Family therapy. 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.

(Weekly therapist-only consultation team). The two-hour consultation meeting is for DBT practitioners at CBC. 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.

Graduate Group

The primary goals of our DBT Graduate Groups are:

• to learn more advanced DBT skills;
• to prevent relapse by reinforcing the progress made in Phase I of DBT; and
• to 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 individual homework assignments tailored to assist them in reaching their longer term goals. 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.

(16 weeks, with opportunity to extend)