DBT FAQs: Development, Structure, and Focus
Marsha M. Linehan
American Psychologist, Founder of DBT
There are four stages of DBT, as follows:
Pretreatment
Stage 1
Stage 2
Stage 3
Stage 4
DBT Treatment Components
1
Individual Therapy
50 minute sessions
2
Skills Training Group
2 hour sessions
3
Between-Session Phone Coaching
brief phone call
4
Therapist Consultation Team
held weekly
between therapists
DBT Treatment Components
1
Individual Therapy
50 minute sessions
2
Skills Training Group
2 hour sessions
3
Between-Session Phone Coaching
brief phone call
4
Therapist Consultation Team
held weekly between therapists
DBT Treatment Priorities, or Treatment Hierarchy, followed during individual therapy sessions
- Decrease Suicidal and/or Self-Injurious Behaviors
- Decrease Therapy-Interfering Behaviors
- Address Quality-of-Life Behaviors
- Skills Acquisition
The 5 areas of instability that clients may experience in daily life*
- Emotional Dysregulation
- Cognitive Instability
- Interpersonal Instability
- Behavior Instability
- Self Instability
*Cognitive-Behavioral Treatment of Borderline Personality Disorder, Marsha M. Linehan, 1993; p. 60
DBT Skills Groups
Skills Trainings Modules include: Core Mindfulness (first 3 weeks of each group), Emotion Regulation (14 weeks), Interpersonal Effectiveness (10 weeks) and Distress Tolerance (10 weeks)
Skills training is delivered in a group format that meets one time per week for approximately 2 hours. Skills training is organized in two segments – review of homework practice from the preceding week and teaching of skills. The DBT skills group is not a processing group – meaning it is not a group where clients discuss and process individual challenges. It is a group that is led by a therapist and co-therapist, and is structured to teach clients behavioral skills to:
- Enhance an individual’s capability by increasing skillful behavior
- Improve and maintain a client’s motivation to change and be engaged with treatment
- Ensure generalization of change occurring through treatment
- Enhance the motivation of therapists to deliver effective treatment
- Assist the individual in restructuring or changing their environment such that it supports and maintains progress and advancement towards goals
Between-Session Phone Coaching
- An opportunity to combine therapist feedback with instruction
- In-the-moment coaching on using skills to effectively cope with situations that arise in everyday life
- Help to avert crisis behaviors prior to engaging in them (including self-injurious/suicidal behaviors)
- Reports of “good” news to therapist when a client has success in skills use
- Repairing any misunderstandings or behaviors that may interfere in the therapist/client relationship
- Contact with the therapist is brief, focused, and target-oriented
- These coaching sessions are not a time for complaining and venting problems, it is for help in using DBT skills
Information About Diagnoses:
- Borderline Personality Disorder (BPD)
https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml - Dissociative Disorders and Dissociative Identity Disorder (DID)
https://www.nami.org/Learn-More/Mental-Health-Conditions/Dissociative-Disorders - Social Anxiety
https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml - Generalized Anxiety
https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml
https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803 - Persistent Depressive Disorder
https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929 - Major Depressive Disorder
https://www.nimh.nih.gov/health/topics/depression/index.shtml - Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
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