DIALECTICAL BEHAVIORAL THERAPY (DBT) SERVICES

The Program

The Dialectical Behavioral Therapy (DBT) Program is designed to serve persons with Borderline Personality Disorder (BPD). To be admitted to our program, a person shall meet diagnostic criteria for Borderline Personality Disorder (person can also meet criteria for other disorders, but BPD is primary) and be committed to long-term treatment including frequency and duration of treatment activities, significant participation in and adherence to in-session and out-of-session treatment tasks and strategies. Full admission to the program shall be determined after and based on an initial comprehensive assessment. The initial assessment includes: thorough diagnostic evaluation; background history of psychiatric and medical disorders and treatment; cognitive and personality testing; and assessment of treatment expectancy, commitment and motivation. Treatment shall be intensive, and delivered in individual and group modalities by clinical professionals with experience and training in DBT and BPD.

What is Borderline Personality Disorder

Borderline Personality Disorder is a severe and chronic debilitating disorder. Symptoms of Borderline Personality Disorder are: unstable affect or mood, unstable interpersonal relations, impulsivity and self-damaging behavior, suicidal and or self-injurious behavior, problems with anger, efforts to avoid abandonment, unstable identity, and paranoia or dissociation in response to major stressors. A pattern of symptoms typically begin in adolescences or early adulthood and become pervasive and enduring. Functioning in major life domains (educational, social, and occupational) deteriorates significantly. Not all clients with Borderline Personality Disorder will have all the symptoms listed.

Clients with Borderline Personality Disorder are often high utilizers of crisis and hospital based services. And about 97% of all persons with Borderline Personality Disorder also meet diagnostic criteria for another psychiatric disorder; the most common co-occurring disorders are depression, substance use disorder, posttraumatic stress disorder, other anxiety disorders, and eating disorders. Treatment shall be intensive and comprehensive, and of adequate duration. Therefore, this treatment, in order to maximize efficacy, requires a sincere, long-term commitment from both persons being treated and clinical-professional staff.

Understanding the cognitive process of Borderline Personality Disorder beginning with a triggering event or cue.

What is Dialectical Behavioral Therapy?

Dialectical Behavioral Therapy is an evidence-based comprehensive, structured protocol of treatment strategies and procedures developed by Marsha Linehan, Ph.D. (Linehan, 1993, Linehan 2014). Dialectical Behavioral Therapy has been well researched and proven effective across multiple studies. Main targets of treatment are: decrease suicidal behaviors, decrease treatment interfering behaviors, decrease behaviors that interfere with quality of life, increase behavioral skills, decrease behaviors related to posttraumatic distress, and increase respect for self. Secondary targets of treatment are: increase emotional modulation, decrease self-invalidation, increase realistic decision-making and judgment, decrease crisis-generating behavior, increase emotional experiencing, decrease inhibited grieving, increase active problem-solving, decrease active-passivity behaviors, increase accurate communication of emotions and competencies, and decrease mood dependence on behavior.

Dialectical Behavioral Therapy treatment strategies and procedures are group into categories: dialectical, validation, problem-solving, contingency procedures, skills training, exposure, cognitive modification, balancing communication, interacting with the community, and strategies for specific tasks (treatment structure, special treatment strategies). These strategies are discussed with persons being treated, beginning with a basic overview, and then as needed for clarification.

Modes of Treatment

Individual Psychotherapy

Each client works with a psychotherapist in individual therapy. This therapist is the primary clinician-professional for that client on the treatment team. Individual therapy is treatment activity, including cognitive and behavioral strategies, designed to reduce maladaptive borderline behaviors, to maximize behavioral self-control, skillful responses, and emotional regulation and adjustment, thus enabling improved functioning in major life domains and more appropriate interpersonal and social relationships. Individual therapy is typically conducted once weekly (but can be more frequent), lasting from 50-60 minutes to 90-120 minutes depending on the therapy tasks to be accomplished.

Skills Training

Group skills training is conducted in an instructive or psycho-educational format. Skills training treatment activities are highly structured and focused on specific skills development including mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance. All clients attend skills training during the first year of treatment. Sessions are weekly and generally last for 1 to 2 hours. After completing the skills training, clients can attend optional supportive process group therapy.

Telephone/Electronic Communication Consultation

Clients will have access to the primary individual therapist via phone consultation. Phone consultation strategies provide additional therapy time between sessions; these strategies are designed to encourage application of skills learned in therapy to situations that arise in everyday life, and well as crisis management and learning how to effectively and appropriately request help when in need. Guidelines for use of phone consultation, including frequency and duration of calls, when and who to call, are discussed between the client and primary therapy.

Case Consultation Meetings

The consultation (or treatment) team includes individuals committed to the ongoing study, learning and applying of DBT. The team consists of a team leader, the primary therapist, and other clinical staff and para-professionals. Client cases are discussed, with input from all team members. The main goals of the consultation meeting are: managing life threatening behaviors of clients; assisting therapist in providing ethical treatment, maintaining adherence to treatment strategies, and addressing motivation or “burnout”; and increasing professional skills of the therapists involved. Case consultation meetings are held weekly. The consultation team is a community of therapists treating a community of clients.

Ancillary Treatments

These treatment modalities include pharmacotherapy (medication), family therapy, vocational counseling, case management, and more.

Measurement of Success

To ensure clinical professionals follow treatment guidelines and that our program produces effective results, we employ fidelity measures and outcome measures. Fidelity measures are used to assess how closely clinical staff follow the program and treatment guidelines. Fidelity measures were developed by our trained clinical staff and include DBT treatment strategy checklists, DBT structure and program checklists, and treatment utilization checklists. Outcome measures are tools used to assess how well a person does in treatment – typically beginning with an initial assessment and every 3 months thereafter. Outcome measures include: Structured Clinical Interview for DSM-V Axis I (SCID), Structured Clinical Interview for DSM-V Axis II Personality Disorders (SCID-II), Millon Clinical Multiaxial Inventory – Third Edition (MCMI-IV), and Brief Borderline Personality Disorder Treatment Outcome Assessment.