At the outset of treatment, teens 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 teen’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 teens 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 teen 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 teen but also from the accompanying caregivers. The use of commitment strategies is crucial for teens, 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 teen 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 teen and family participate in a weekly multi-family skills class. This class meets for two hours in the evening for approximately 6 months and includes 3-5 teens along with their caregiver(s). Each family learns skills and receives support from each other within a DBT framework. Parents also learn to understand and respond to certain adolescent behaviors and to encourage use of the skills at home. The class lasts for approximately six months and 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.
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:
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.