Dialectical Behavioral Therapy (DBT) is an evidence-based outpatient treatment designed to help people with problems managing emotions, relationships and behaviors that interfere with being successful or happy. These behaviors can range in intensity from mild to severe, and include such problems as anger and other emotion management, relationship issues, substance abuse, eating disorders, self harm or suicidal gestures and ideation and more.
The treatment consists of clients initially contracting for 7-8 months to attend 1 session of individual therapy per week and 1 session of a 2-hr DBT Skills Group per week:
Individual therapy is one session for 45-60 min per week. DBT individual therapy takes a client through 4 stages of treatment; however, clients must first complete the pretreatment/commitment and orientation phase of individual therapy before starting any of the 4 stages. The pretreatment/commitment phase typically lasts between 4-6 weeks and the goal is to orient the client to the treatment and obtain the commitment to the therapy goals that are developed between the client and therapist. Following pretreatment, Stage 1 of DBT individual therapy focuses on life-threatening, risky, and therapy-interfering behaviors. Stage 2 dives into the deep emotional experiences of a client, including trauma experiences, while keeping behaviors tackled within Stage 1 stabilized. After Stage 1, other evidence-based treatment modalities might be used for PTSD treatments like DBT-Prolonged Exposure (DBT-PE), Cognitive Processing Therapy (CPT), and Trauma Focused CBT for teens (TFCBT). Other therapies in Stage 2 and beyond would include Behavioral Activation for Depression, Emotional Exposure, Cognitive Restructuring and others. Stage 3 centers around helping clients apply their skills to cope with day-to-day life situations or conflicts. Stage 4 focuses on helping clients apply their skills in order to accomplish their life goals (ex: starting a business, starting a family, traveling, etc.). It is important to note that, at TBC for CBT, some clients might meet the criteria for “DBT Informed’ therapy, which is a less-intensive form of standard DBT–this can look like switching to biweekly individual therapy without a Skills Group, or Skills Group only, or any other form of non-standard DBT that may be recommended by the client’s individual therapist. There is no set length of treatment. All treatment plans and criteria for discharge are individually developed by the therapist and client (and family). Family therapy will be provided as needed, determined by the client and therapist. We also provide a Family Education & Support Group (FESP) for Family members who want to learn skills and get support on how to best support the recovery of their loved one who is in treatment, whether that person is in treatment with us or not.
The DBT Skills Group. (Virtual or In-Person for 2-hours) For adults, the maximum number of clients is 8-9. For adolescents, it is a Multi-family Skills Group which requires participation by the teen and one parent/guardian. The maximum number of participants in the group is 10. In these groups we teach 5 sets of skills that all participants will be learning and practicing. The skills modules are; “Mindfulness”, “Walking the Middle Path” (skills to address family issues), “Interpersonal Effectiveness” (skills to improve relationships with others), “Distress Tolerance” (how to manage a crisis or impulsive, intense urges to act in ways that get you in trouble), and “Emotion Regulation” (how to more skillfully manage emotions). In our DBT groups, Mindfulness and Walking the Middle Path are combined within the same module, sectioning our groups into 4 modules of 6 weeks each module, totaling 24 weeks. There is homework assigned each week, and each session starts with a review of the practice homework and a mindfulness practice, then learning a new skill and ends with practice homework assignment of what was learned in group that day. Clients interested in completing a Skills Group Only are permitted to do so if the client has an outside mental health provider and if the client is deemed appropriate for the group after group orientation.
Note: We get a lot of referrals from clients, family members or therapists for people who are currently in treatment with a therapist but are not making progress they would like to see despite there being a strong supportive therapeutic relationship. While in full comprehensive DBT, the client needs to agree to stop other psychotherapy elsewhere so there is only one individual therapist at a time. DBT also requires a solid team between client and the therapist, much like the relationship between an athlete and their primary coach. More than one primary coach can lead to confusion and difficulty with not only forming the therapeutic relationship but with doing the difficult work of putting DBT concepts and skills into action. The research supports this requirement of having only one individual therapist. Once you have completed DBT, you are free to return to a previous therapy/therapist if you choose so. Clients in DBT continue to see other treatment providers like psychiatrists and other medical practitioners. Some clients also take part in other supportive services, such as Twelve-Step, and these types of services are not usually considered a conflict with DBT therapy.