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:
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.
Treatment will include a combination of the following:
Weekly individual psychotherapy (approx. 28 sessions) Individual DBT therapists will help the client to:
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:
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.
The primary goals of our DBT Graduate Groups are:
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)