Weekly sessions are prioritized to address 3 things (safety, therapy interfering behaviors, and quality of life). These are prioritized in this order. When safety is the focus, everything else takes a back seat until safety is achieved. Therapy interfering behaviors include missing or arriving late to sessions or skills group, not tracking on the diary card, or engaging in behaviors that can affect the alliance with the therapist. Quality of life covers everything else (relationships, school, activities, etc). Expect that goals in this area will not be addressed if there is still work needed on the first 2 priorities. Priorities are assessed week to week.
DBT utilizes a goal behavior, emotions, and skills tracker that allows the client to both increase awareness of and work deliberately on their treatment goals and skills use. It is expected to be completed daily, though therapists understand this is a difficult skill to master so work with clients to increase compliance over time. Inconsistent use of the diary card is addressed as a treatment interfering behavior and is used to prioritize the weekly session. The diary card is to be used between the client and individual therapist and not reviewed or managed by the parent.
Skills Training Group
Separate 1.5 hour weekly skills training groups for both the client and the parent. For parents of adolescents, attendance by one parent at a time for each module is mandatory. If the client repeats a second cycle of skills group and there is a second parent in the adolescent’s life, that other parent is required to attend the next cycle of parent group (see attendance policy). For young adults over 18 who live at home with parents we highly encourage a parent to commit to attending parent skills group. Each group includes a short mindfulness practice activity, review of the homework (these are short assignments designed to reinforce the skill taught each week), and teaching 2-3 new skills. Each member will be provided with a binder and all the materials needed for participation. Group members share experiences in group that demonstrate skills practice. Summary notes from group sessions will be emailed weekly to the client, the parents and any treatment providers requested.
DBT recognizes that it is difficult to generalize the demonstration of skills learned in group to real life situations. Phone coaching is offered and encouraged so when clients feel challenged by emotions, thoughts, or urges, they can seek support from their individual therapist/skills coach in a difficult moment. Coaching calls or texts are designed to be brief and focus on targeting skills use. This in vivo work is critical for skills integration. Parents are also encouraged to contact the parent skills group leader for parent skills coaching.
DBT Consultation Team
The individual DBT therapists as well as the parent skills leader meet weekly to collaborate on delivering thoughtful treatment. The purpose of the consult team is to help the therapists stay adherent to the DBT model, explore their own thoughts or feelings that may become treatment interfering with clients, and coordinate so families feel they have a team that is working in concert to help clients achieve their goals. As a result, confidential information is shared amongst the team and stays in the team. There may be times that treatment recommendations for your care come from “the team.” The DBT team is a peer collaboration of self-employed clinicians. The individual DBT therapist functions as the “case manager” in coordinating services for their client and is the point of contact for any and all concerns regarding treatment of your child. Julie Baron is the point of contact for any programmatic or billing concerns unless she is also the individual therapist. Otherwise “the team” together consults to assist each clinician in making DBT treatment compliant recommendations.
Due to the intense nature of the concerns that bring clients to DBT, we encourage individual therapists to focus on treating the behaviors and goals for their adolescent or young adult clients. They are available to parents for parent communication, feedback and coordination, regarding situational concerns and to assess progress toward goals. When parents need guidance on parenting approaches and behavior plans, such as ways to structure the home environment or develop and implement effective contingencies, or if they are struggling with their own ability to understand or accept the philosophy or skills of DBT, it is helpful for them to seek parent phone coaching and/or have some extra sessions with the parent skills coach for parent guidance work.