At the outset of treatment, children and their caregivers 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 child’s problems and treatment goals. To this end, we assess for the presence of the following 5 problem areas:
We have found that the use of special commitment strategies is very important in the pre-treatment assessment. That is, we ask children to commit to making certain behavioral changes even though they have not learned to master them. This is based on ample evidence suggesting that people are more likely to behave in a particular way if they agreed to do so beforehand. We also explain all aspects of treatment to the child and his or her parents, and anticipate and problem-solve any potential treatment barriers (e.g., not attending sessions, staying silent in sessions, feelings of hopelessness). We seek commitment not only from the child but also from the accompanying caregivers. The use of commitment strategies is crucial for children, given that many would not “choose” to be in therapy if given the option. It is for this reason that the individual DBT therapist spends time during the early phases of treatment using commitment strategies that aim to help the child understand the triggers of his/her behaviors, the consequences, both positive and negative, of their behaviors, and the implications for behavior change.
In weekly individual therapy, DBT therapists will help the client to:
In addition to individual therapy, the child and family participate in a weekly multi-family skills class. This class meets for 90 minutes in the evening for approximately 6 months and includes 3-5 children along with their caregiver(s). For the first half of the group session the children and caregivers will learn the DBT skills (described below) together. For the second half of the group session, the group will be divided into two smaller groups. The children will continue to practice the newly learned skills with one of the DBT skills trainers while parents learn specialized behavioral management strategies to effectively handle the children’s behavioral difficulties. The class 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 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.” In addition, parents are able to contact one of the skills trainers for coaching in how to apply skills with their children.
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 the child’s or their family’s quality of life.
Parents may also benefit from additional sessions with a parenting coach (who is typically one of the multi-family skills group leaders so the parents are already familiar with this person). The coach offers specialized parenting strategies to assist parents reaching their goals in a planful and proactive manner rather than relying on a reactive crisis-oriented approach.
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.
Please contact our Director of Intake Services at 212-595-9559 (ext.5) or 914-385-1150 (ext.1), or fill out the form above, with any questions regarding eligibility, for further information, or to make a referral. If you are a current patient at CBC, please speak to your individual therapist to see how this group may be of added benefit to you.