Dr. Marsha Linehan, the developer of Dialectical Behavior Therapy (DBT), has a section in her recent memoir titled, “DBT Skills are Life Skills.” She describes, “…in all these skills, the emphasis is on being effective in one’s life, in the social and practical realms.” Dr. Linehan speaks not only from her professional training, but also her personal experience as a teen having spent years in a higher level of care facility for suicidality and severe depression. “Creating a life worth living,” is a very important aspect of Comprehensive DBT.
Dr. Linehan published her official development of DBT in an academic paper in 1991. Since then, dozens of studies have demonstrated the efficacy of this model in treating highly persistent suicidal or self-harming clients, as well as Borderline Personality Disorder. Treatment using DBT has also been shown effective for the following:
- Emotional/behavioral dysregulation
- Major depression or anxiety
- Family or relationship conflict
- Impulsive or destructive behaviors
- Anger management issues
- Alcohol and/or substance abuse
- Impulse control problems, and
- Eating disorders
In this blog, I introduce some basics about DBT, highlight some of the unique assumptions of DBT, the core elements of Comprehensive DBT versus a DBT-Informed therapy, and how you can get the help you need.
What is DBT?
DBT uses the dialectic framework; namely, that two allegedly opposing things can co-exist, both can be true. Its primary dialectic balances the factors of acceptance and those of change. This occurs by creating a synthesis of the opposing statements using ‘both/and’ instead of ‘either/or’ thinking. For instance, if the opposing beliefs are:
- Emotions should be felt & experienced (acceptance), or
- Emotions should be managed & contained (change)
The dialectic is: It is true that emotions can be both felt and managed.
Another example could look like this:
- I don’t like taking exams, or
- I want to take exams to get good grades
The dialectic is: It is true that I can both not like exams and it’s important I take them if I want good grades.
DBT seeks to reduce the following:
- Poor self-awareness
- Impulsivity/Risk-taking behaviors
- Emotion Dysregulation
- Interpersonal Problems
- Teen/Family Challenges
And improve them with the following skills:
- Distress Tolerance
- Walking the Middle Path
- Emotion Regulation
- Interpersonal Effectiveness
Assumptions of DBT
DBT holds the position that problematic behaviors evolve as a way to cope with a situation, in other words, they are or were an attempt to solve a problem. While these behaviors might provide temporary relief, they often do not prove effective in the long-term. Here are some other assumptions foundational to DBT:
- People are doing the best they can, want to improve, and need to do better, try harder and be more motivated to change.
- People need to learn new behaviors in all relevant areas of their life.
- People cannot fail in DBT (all experiences are information, and clients/therapists can adapt).
- People may not have caused all of their problems, and they have to solve them anyway.
- The lives of people who are suicidal are unbearable as they are currently being lived.
What does “DBT-Informed” mean?
To be a DBT-Informed therapist simply means you understand some of the skills from some of the modules, and you may use those skills in specific, symptom-related situations with your clients. You may use them very frequently, in fact. As this is a continuum, some DBT-Informed therapists might have even taken one-, two-, or three-day trainings by various certified clinicians.
Remember those good ol’ analogies on your SAT/ACT exams? Well here’s one for you in real life:
“DBT-informed” is to “Comprehensive DBT” is to “Trauma-informed” is to “Trauma-trained.”
Being “informed” simply means you:
- Know about the topic in question
- Are aware of the impact this topic could have on clients in treatment
- Do what you can to mitigate any possible negative impacts or triggers present
Being trained, on the other hand, involves all the above, and:
- Having structured, time-limited instruction by one already proficient
- Learning specific tools, procedures, principles and protocols
- Practice applying those tools, procedures, principles and protocols to help improve the life of others
- Are open to oversight & supervision within this area
- Obtain a certification or license acknowledging the standardized training
What is “Comprehensive DBT?”
Comprehensive DBT is vastly different from DBT-Informed treatment. As you will see, it provides more structure, teaching/skills-training, real-time coaching support, weekly therapeutic support and a weekly, therapist-attended consultation meeting.
The role of the individual therapist is to manage primary treatment decisions, reinforce the skills learned in Skills Training Class, manage any crises that arise, and support the client’s motivation to change and engage in treatment. For adolescents, it can also include combined adolescent & family therapy sessions.
Skills Training Class
The skills training facilitators (there are always two in Skills Training Class) are responsible for holding weekly 1.5 hours of training classes for 24 weeks. This is not group therapy but an instructional setting where both parent and adolescent learn the 5 Skills Modules. At Connections, for adult clients, their supports/caregivers can attend a Friends & Family Skills Training class. The skills are systematically taught from a planned curriculum, homework is assigned & reviewed, and obstacles regarding any non-compliance are addressed. The goal of skills training is to replace ineffective behaviors with effective ones.
Phone Coaching Support
This is designed to provide support from any member of the consultation team in order that the client strengthens and generalizes the learned skills into their real environment. This is a client-initiated, structured 10-15 minute call for the client to receive support, guidance or reminders about what skills might be effective.
The purpose of the consultation team is to meet weekly in order to improve the therapists’ motivation and maintain their skills. It’s commonly referred to as “therapy for the therapist.” The client/client family benefits from the collective support and experience of highly trained clinicians, working together, to provide the most effective care.
As you can now see, this is far more therapeutic support and intervention than one hour/weekly sessions with standard outpatient therapy, even with a DBT-Informed therapist.
Who is the Ideal Client for Comprehensive DBT?
This comprehensive, skills-based support is ideal for the following:
- Clients who experience chronic suicidal thoughts, or non-suicidal self-injury behaviors, or have attempted suicide in the past.
- Clients who struggle using effective skills when ‘big emotions’ or situation hit, and as a result, may also experience unstable relationships.
- Clients who have not progressed in standard therapy for approximately 3-4 months and appear to be escalating their ineffective or unhealthy behaviors such as school/work avoidance, risk-taking behaviors, high levels of conflict or avoidance, etc.
- Clients who want to avoid higher levels of care (HLOC) such as residential, partial-hospitalization programs or intensive outpatient programs where they will have to withdraw from school.
- Clients who have already experienced HLOC and require ongoing structure and skills support after completing these programs.
How to Get Help
If you are interested in learning more about the Comprehensive DBT program at Connections Child & Family Center, please click here. If you are interested in speaking with someone about this program, don’t hesitate to contact us here for more information, stating you are interested in DBT and we will get back to you within 24-48 hours.
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