Therapy is based on the following unalterable principles:

Mutual Trust

Clients need to trust that their therapist has made a commitment to work with them and will actually be available to them within the terms of their agreement.  Similarly therapists need to trust that clients will maintain their commitment to therapy. Each party is responsible for maintaining that trust.

Safety

Clients commit to the goal of safety towards self and others. If there are concerns this cannot happen, therapists will assist clients in creating a clear safety plan that specifies the steps they, or others, need to take to ensure safety. Active pursuit of harmful behaviors to self or others robs clients of the chance to remain committed to the current therapy goals and to learn more helpful ways of dealing with problems in life.  By agreeing to do their best to keep themselves and others safe, clients can have a better chance of applying the principles of DBT to their lives. All participants in DBT therapy are expected to act in a way that does not endanger their therapist, family, or others (e.g., through threats or acts of violence against people or property).  Such behavior may result in legal consequences or risk termination of therapy.

Skills Training

Skills training is a central part of DBT. During the period of therapy, clients will be expected to participate in learning DBT skills through individual therapy, skills group, and telephone coaching.  DBT Skills group meets for 24 weeks. An optional DBT Graduate Group is also available for those who have completed skills training and wish to deepen their skills. 

Role of Therapist or Other Providers

DBT makes a distinction between the roles of other providers and the DBT individual therapist. DBT individual therapists and DBT Skills Group facilitators will be seeking consultation on their work with clients through their consultation team.

The Ultimate Goal of Having a Life Worth Living

The ultimate goal of DBT is to no longer need therapy. Therefore, as clients become more competent with their skills, and strive toward a life worth living, this will result in a decrease in the need for and dependency on therapists. Although clients and therapists will have developed strong and positive therapeutic relationships, these are meant to be temporary and that is the goal. If this is not happening, there is something wrong, and consultation will be sought by the therapist.

Therapy is about learning skills that increase clients’ ability to have a life worth living.  Therapy is not about immediately “feeling better.” In fact, a good part of DBT is about learning to be better at feeling uncomfortable emotions in order to begin living a life worth living.

The target behaviors of DBT include:

Eliminating Behaviors that are Harmful to Self or Others

Clients will work towards solving problems in ways that do not include intentional harm to themselves or others.

Eliminating Therapy-Interfering Behaviors

Clients agree to work on any problems that interfere with the progress of therapy. Therapy is about working together and requires the participation of both the therapist and the client. Clients agree to give feedback to their therapists on how they are finding therapy, especially if they are concerned about anything that occurs in therapy. Similarly, therapists agree to provide feedback on how they are finding therapy.

Reducing Quality-of-Life Interfering Behaviors

Clients commit to actively engaging in the behaviors that are taught in the DBT training in order to improve their overall quality of life by increasing the following skills:

Core Mindfulness

Mindfulness is the ability to practice being aware and accepting one’s moment-to-moment experiences. Mindfulness teaches participants how to focus the mind, direct attention, and how to non-judgmentally observe and describe what they are feeling and thinking in the moment. These skills can help people develop a more stable sense of who they are and can help reduce reactivity to painful thoughts and emotions.

Distress Tolerance

Distress tolerance skills teach participants how to effectively distract and productively soothe themselves while in the midst of their distress. These skills typically replace problem behaviors such as missing school or work, self-inflicted cutting, physical fights, and alcohol or drug abuse.

Emotion Regulation

Emotion regulation skills address extreme emotional sensitivity, rapid mood changes, and other unregulated moods such as chronic depression, anxiety, or hostility. Examples of specific skills include learning to identify and label emotions, learning how to increase positive moods, and learning how to make yourself less vulnerable to negative moods.

Interpersonal Effectiveness

Interpersonal effectiveness skills address participants’ difficulties in maintaining consistent and rewarding relationships by teaching skills such as how to ask for what they want, how to maintain one’s sense of self-respect and independence in the face of external pressure. to say no in a gentle yet effective manner, and how to maintain one’s sense of self-respect and independence in the face of external pressure.

Our comprehensive DBT program includes the following modes of treatment:

Weekly Individual Therapy

Individual DBT therapists will help the client:

1. Identify and maintain focus on the primary problems to be addressed
2. Stay motivated to work hard in treatment and apply new behaviors in their daily lives
3. Coordinate and consolidate the different parts of treatment to make sure it is all tailored for the particular individual’s situation.

Individual therapy will proceed according to the following stages:

1. Targeting life-threatening behavior
2. Targeting self-harm behavior
3. Targeting therapy-interfering behavior (on the part of the therapist or the client)
4. Targeting quality of life issues (mood, relationship, work, self-defeating behaviors)
5. Targeting obstacles to full emotional experiencing
6. Reaching the goal of living a life that is meaningful and worthwhile

Individual sessions will be structured in the following manner:

1. Diary card review
2. Agenda setting for session starting with target behaviors
3. Behavior analysis of target behavior
4. Addressing other current issues including questions from skills group (if time allows)

Weekly Skills Training Group

The class meets for 90 minutes each week over a 24 week period of time and typically includes eight members. The sessions utilize lecture, discussion, and practice exercises in order to teach DBT skills. Individual sessions may also include skills training.  Most people learn the skills most effectively if they complete the full set of skill modules 2 to 3 times. An optional DBT graduate group is offered after skills training is completed for those clients who desire additional group support.

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 using DBT skills.  Phone coaching typically occurs in approximately a ten-minute time frame and focuses on how to utilize DBT skills. Clients are encouraged to call their primary therapist BEFORE engaging in ineffective behaviors. Calls made to the client’s primary therapist AFTER engaging in suicidal or self-harming behaviors will not be returned for 24 hours and will be addressed as the priority target behavior in the following session. Clients who are in crisis and are unable to reach their primary therapist may call 911 for immediate attention.

Weekly Therapist Consultation Team

The DBT treatment team of therapists meets weekly to assist each other in providing effective 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.