Dialectical Behavior Therapy (DBT)

I have been intensively trained in DBT by Behavioral Tech, Inc. I am a member of Bi-State DBT Associates , a DBT Consultation Team based in the New York/New Jersey area. We meet regularly and are committed to the therapeutic practices developed by Dr. Marsha Linehan .

What is DBT?
DBT combines cognitive behavioral techniques designed to change behavior with mindfulness practice designed to promote focus and sense of self. Participants learn and practice skills to better identify and manage their emotions, control their impulses, handle difficult life events, improve their ability to interact effectively with others and gain greater ability to make positive rather than self-destructive choices in their lives. DBT has been proven effective in treating a variety of disorders characterized by problems in emotion. There are four skill areas that make up the DBT skills, which are the foundation of the treatment. Briefly, the skill areas are:

1) Mindfulness: Being in the present moment rather than dwelling on the past or worrying about the future. It is cultivating an awareness of thoughts, emotions and present-moment experiences and learning to see reality as it is, as opposed to our perception of reality.

2) Emotion Regulation: Understanding the function of emotions, learning to label emotions and learning ways to de-escalate or change painful emotions.

3) Interpersonal Effectiveness: Ways to get your needs met without damaging relationships.

4) Distress Tolerance: Ways to tolerate distressing emotions without making the situation worse.

Why do some people have more difficulty managing their emotions?
According to Dr. Marsha Linehan , who developed DBT, some people are born more emotionally sensitive than others. Not only do they feel emotions more quickly and intensely than other people, but it also takes them longer to “come down” from an emotion. That can work out fine if you learn skills for coping with strong emotions early in life within your family or elsewhere. This means that people around you "validate" you or acknowledge the reasonableness of your feelings. They also help you learn ways to soothe yourself, and/or show you what to do with strong emotions by demonstrating skillful behavior when they themselves have strong emotions. However, if you are raised without the opportunity to learn to cope skillfully with strong emotion, being emotionally sensitive can make life quite difficult.

I've been told DBT would be helpful for me. Does that mean I have Borderline Personality Disorder (BPD)?
It is true that DBT was originally developed to treat BPD and most books and articles regarding DBT are about treating BPD. But the truth is that DBT is helpful for people with many other problems too -- including eating disorders, depression, anxiety, and self-destructive and addictive behaviors. What all these disorders tend to have in common is that they stem from problems with emotion, or what DBT calls "emotional dysregulation." Emotional dysregulation means that emotions are intense, seem uncontrollable, and can lead to impulsive behaviors that may relieve the distress temporarily, but can make one's life worse in the long run. DBT can help people feel less emotionally dysregulated.

Who does DBT help?
DBT is appropriate for those who have difficulties with:

Mood Swings Anger Management
Anxiety/OCD ADHD
Impulse Control Social Difficulties
Eating Disorders Self-Destructive Behavior

For an article on DBT, go to: http://www.mfs.org/hh37.htm

What are the requirements for being in a skills training group?
1) You have to have an individual therapist and you have to be seeing them as often as they recommend. It doesn’t matter if that therapist isn’t doing DBT with you, but they must be willing to support your DBT work.

2) You have to meet with the DBT Skills Group leader once individually before joining a group. In that meeting, you’ll hear more about what DBT is and decide together whether it might be beneficial for you. If so, you’ll make a formal commitment to being a DBT group member. You’ll also set initial “target behaviors.” These are things that you do when you experience strong emotions that you’d like to stop doing.

What if I don’t like being in therapy groups? Is there some other way to do DBT?
If you’ve determined that you don’t like therapy groups based on past experience, you might be surprised at how different a DBT group is. Unlike traditional “process” groups, where members discuss their reactions to each other and work through their conflicts, DBT groups are more structured and "classroom-like." Skills learning is at the center of the groups and it may feel more like an interesting class than a traditional therapy group. While being in a group is the best way to learn DBT skills, individual skills training is available for those who are unable or unwilling to participate in a DBT group.

What does DBT treatment entail?
Full DBT treatment entails attending a 90-minute skills training group once a week and an individual DBT treatment session. However, many people who are already in individual therapy with a non-DBT therapist can benefit from coming just to the skills training group and sharing what they learn in DBT with their individual therapist.

What happens in the skills training group?
The agenda we usually follow is: 1) Brief check-in about how each member’s feeling; 2) Group mindfulness exercise; 3) Homework review; 4) New skill learning and discussion; 5) Homework/practice assignment for the week; and sometimes, 6) Another mindfulness exercise.

What about the group members? How many are there? What kinds of problem behaviors do they engage in?

The group size varies -- typically from 5 to 8 members. Members engage in a wide variety of problem behaviors, including self-destructive or addictive behaviors, isolating/avoiding behaviors, interpersonal aggression, and others. Problem behaviors differ but everyone in the group shares the same basic difficulty in managing their emotions. Sharing of problem behaviors is kept to a minimum. The group does not focus on discussing problem behaviors but on teaching skills.

Can I use my insurance?

If you have out-of-network mental health benefits, it is most likely that treatment will be covered in part or full by insurance. I offer my clients the service of submitting to insurance for them to make this process easier.

What if I have to miss a skills training group?
If it’s impossible to come to skills training group, you must call at least 24-hours in advance unless there is an illness or emergency. Otherwise, you will be charged for that group. DBT can be hard work and coming to group can feel burdensome sometimes. The cancellation policy is designed to support your commitment to coming and give you a reason not to act on an impulse to miss the group. If you’re getting reimbursed by insurance, you should be aware that they will not pay for sessions you have missed.

How do I get started?
Give me a call at 973 222-7863 to set up an individual appointment to discuss whether DBT makes sense for you and, if so, make a plan to get you started. I look forward to hearing from you.

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