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Dialectical Behavioral Therapy


Dialectical Behaviour Therapy (DBT) is the application of behavioural and cognitive strategies to managing emotional dysregulation. It emphasises current behaviour patterns using evidence based procedures of problem solving, exposure techniques, skills training, contingency management and cognitive modification. The approach integrates Western and Eastern approaches, and as such places an emphasis on acceptance and change. This is where the name comes from as there is a tension or "dialectic" between accepting clients as they are but trying to teach them how to change.

The primary treatment strategies covered in DBT are: Emotion regulation, interpersonal effectiveness, distress tolerance, mindfulness and self-management skills.

The skills modules

Emotion Regulation

Emotion Regulation is about learning how to identify emotions particularly before they escalate, understanding the function of emotions and the factors that increase vulnerability to emotions, learning to tolerate unpleasant emotions and identifying ways to generate pleasant emotions. Overall this module increases awareness of emotions, the skills needed to take care of them and live effectively with them.

Distress Tolerance

The ability to cope in a crisis (situational or emotional), how to get through the crisis without escalating it or resorting to "problem behaviours". This module teaches the skills for increasing the options to effectively manage and/or accept the difficult situations which are a normal part of life and growth.

Mindfulness

Mindfulness skills work to increase awareness, focus and acceptance. These are the skills to be more present in each moment, learning how to attend to the range of details (both emotional and factual) in a situation and therefore to make wise choices, rather than ones that are dictated by or deny emotion.

Interpersonal Effectiveness

Being effective in relationships means being able to maximise your chances of getting your needs met in a way that maintains relationships and maintains self-respect. An important step in this is learning to identify priorities in interpersonal interactions and to identify and manage the barriers to interpersonal effectiveness.

Treatment Format

DBT treatment can be delivered either individually or through one of our DBT workshops. We have also created an online program for adolescents based on the workshop content.

Workshops

DBT workshops are 1 hour in length, cover the DBT skills broken down into 3 modules: Mindfulness + Emotion regulation, Mindfulness + Distress Tolerance and Mindfulness + Interpersonal Effectiveness. We run adult groups during school terms on Thursday evenings from 7-8pm.

As the workshops are 1 hour in length, we do not revise diary cards during the workshop nor discuss the implementation of the skills from the last week. To ensure that the skills are being applied and generalised, each member of the group is required to attend individual sessions on a fortnightly or weekly basis for the duration of the group. It is anticipated that the individual sessions will be within a DBT frame and cover the following: diary cards, chain analyses, revision of any skills that have been learnt, behavioural and cognitive strategies in session to reinforce learning.

If you are not currently under the treatment of a DBT trained psychologist / psychiatrist then we ask that you call the practice so that we can ask for some history and conduct a brief triage to allocate you to an appropriate clinician. A DBT trained therapist will conduct the assessment with you and discuss the options for treatments, including attending the workshops if appropriate.

We also accept referrals from clinicians in a couple of ways. If you are a DBT clinician and will be working with your client in a DBT frame, meeting weekly or fortnightly, checking their diary cards each session and reinforcing the skills discussed in the workshop, then we are happy to complete a 1 hour assessment prior to the group and have them attend the workshop, alongside your individual work with them.

If you are wishing to refer them into the program and will not be doing DBT with them, we will assess them for the workshop, the assessing clinician will arrange weekly or fortnightly sessions for the duration of the workshop to conduct the individual work with them. Research suggests that it is not beneficial for clients to receive DBT and another therapy at the same time. So we would recommend that they only see the DBT clinician during the workshops, rather than continuing with the individual therapy in a different frame.

At the conclusion of the group, in consultation with you and your client, you can decide whether to have the client recommence therapy with you or to continue with the individual therapist within this service.

Given the importance of the therapeutic relationship in our work with clients who benefit from DBT, we are very supportive of clients maintaining their ongoing relationship with the referring clinician, particularly when there has been a long term history with that clinician. We aim to support the work that you are doing with them and to practice in a way that has been shown to assist clients to be most effective in their uptake and application of the DBT skills.