Dialectical Behavior Therapy (DBT) is a type of cognitive behavioral therapy that focuses on helping people manage emotions, improve relationships, and decrease problem behaviors that interfere with creating satisfying lives.
DBT is very effective at treating out-of-control problems, including self-harm (e.g., cutting or burning), chaotic relationships, suicide attempts, and other impulsive and high-risk behaviors related to emotion dysregulation. In addition, DBT is effective at reducing anger, depression, shame, PTSD, and other painful emotional issues.
DBT therapy can be provided in standard outpatient, intensive outpatient, residential treatment, or other program settings.
How can you tell if a DBT program or provider is the right one for your child or adolescent? According to David Briggs, LCSW, Director of Clinical Services at Willow Springs Center, there are two key elements to look for: 1) Have the therapists/DBT program clinicians been comprehensively trained in the current gold-standard DBT model as originally designed by Marsha Linehan, Ph.D. of the University of Washington? And 2) Does the program offer full/ comprehensive DBT services?
Being comprehensively trained means having completed at least 80 hours of DBT training, along with self-study and considerable practice. Some therapists and programs feature DBT-informed clinical work. This means they may have had some training but not comprehensive training.
Once you have determined that the therapist and treatment team at the psychiatric program you are considering have received comprehensive DBT training, you can assess whether they offer comprehensive DBT, or only partial DBT, services. Comprehensive DBT includes five core components that must be present and that confirm this is the “real deal.”
The following are the five components that must be followed for therapists and for programs to call themselves DBT, and how Willow Springs provides these services:
1. Skills Training
Five modules of skills are taught in DBT: mindfulness, interpersonal effectiveness, distress tolerance, self-validation, and emotion regulation. These are usually conducted in a group format with role-plays and didactic presentations. The skills are taught to enhance the ability to live better lives.
At Willow Springs, DBT patients get at least four skills training groups per week.
2. Improving Motivation
DBT has clear treatment targets and uses unique diary cards and behavior chain analyses to monitor progress and determine areas needing improvement. Clients and therapists then collaborate on developing and implementing solutions to problems, based on DBT skills learned in skills training. The goals are to make accurate assessments as to what is happening to help clients remain focused in session, and to enhance motivation both for continued treatment and on-going implementation of skills.
At Willow Springs, patients get weekly individual therapy where diary cards and behavior chains are utilized on a regular basis, with clear solutions generated and practiced. Sessions also are randomly recorded and reviewed to ensure meeting comprehensive DBT standards of care.
3. Generalizing to the Natural Environment
DBT is most useful when the skills can be generalized to natural, often difficult, situations in life, and to other environments, such as at home, work, and school. In an outpatient setting, this would occur when the patient calls his or her therapist when a life experience outside of therapy is triggering thoughts of self-harm or related behaviors, and the patient needs assistance to follow through on his or her skills plan. Through phone coaching and crisis calls, the patient and his/her therapist determine what happened (the behavior chain) and what skills can be used to manage the situation skillfully and avert a return to self-destructive behaviors.
In the residential setting at Willow Springs, the front-line staff is trained in skills coaching and provides this 24/7. When a patient has achieved progress in the program and is assessed to be safe, he/she may earn a pass to go outside of the facility where he/she can work on generalizing skills to the real world environment.
4. Enhancing Therapist Capabilities and Motivation
All comprehensively trained and practicing DBT clinicians participate in consultation team meetings. This may be in person or remotely via phone or video teleconference. This is the time when DBT therapists discuss clinical challenges, strategize interventions, stay true to DBT principles and concepts, and practice self-care to keep motivation high and decrease risk of burnout.
At Willow Springs, weekly consultation team meetings are held under the supervision of Alan Fruzzetti, Ph.D., our internationally known DBT program consultant and Dr. Marsha Linehan colleague.
5. Structuring the Social Environment to Allow or Facilitate Progress
This component focuses on family therapy and family skills training because success is less likely if only the patient, but not the family, learns DBT skills and techniques. Being on the same page helps ensure better outcomes post-discharge. On an outpatient basis, this may occur on a different day or time than the patient’s individual session with the therapist.
At Willow Springs, family therapy occurs weekly (in person, via phone or video teleconference). Plus, family skills retreats are offered regularly at Willow Springs (16 hours over a Saturday and Sunday), allowing each patient’s parent(s) to attend the family skills weekend at least once during the 60+ day DBT program.
If all five conditions are met, you can rest assured you have found a therapist or a program that complies with comprehensive DBT standards for training, treatment, and reliability.
One more distinguishing feature: If you are looking at one or two residential DBT programs that meet the above criteria, find out if the patients are in their own distinct program or if they are integrated with other patients. At Willow Springs, the DBT program is separate and distinct in its own section of the building. This helps focus treatment and provides a 24/7 “All DBT, all the time” environment.