How DBT Skills Training Enhances Individual Counseling. Susan Marcus LCSW

Transcription

1 How DBT Skills Training Enhances Individual Counseling Susan Marcus LCSW

2 I Was in Hell I honestly didn t realize at the time that I was dealing with myself, Marsha Linehan said. But I suppose it s true that I developed a therapy that provides the things I needed for so many years and never got. Entered the Institute of Living on March 9, 1961, at age 17; Left May 31, 1963 Professor of Psychology and adjunct Professor of Psychiatry and Behavioral Sciences at the University of Washington Studied those who were suicidal Developer of Dialectical Behavior Therapy Effective in multiple trials in reducing suicidal behavior

3 DBT Skills - Group VS Individual Counseling Group Focus on behavioral skills training Focus on motivational issues Individual Manage crises Apply skills to life experiences Both Ongoing assessment and Data Collection on current behaviors

4 Who Can Benefit from DBT Those people identified as having: Borderline Personality Disorder Drug or Alcohol Addiction Eating Disorder Post Traumatic Stress Disorder Attention Deficit Hyperactivity Disorder

5 DBT BASICS 1st STRUCTURE 2nd Do BEHAVIOR THERAPY 3rd add VALIDATION 4th add DIALECTICS 5th add MINDFULNESS 5

6 EMOTIONALLY SENSITIVE PEOPLE PSYCHO EDUCATION NORMALIZE VALIDATE AGREEMENT TO LEARNING SKILLS TO CONTROL MALADAPTIVE BEHAVIOR STRUCTURE Decrease life threatening behaviors Decrease therapy interfering behaviors Increase skills

7 Basic Skills - Foundation of DBT Wise Mind - Combination of Reason, Emotion and Body Observe - Notice using 5 senses Describe - Put into words using only facts Non Judgmentally - Open minded without being good or bad Effectively - Doing what works Mindfulness - Being in the present moment Radical Acceptance - Accepting reality

8 VALIDATION Level One: Level Two: Level Three: Level Four: Level Five: Listening and Observing Accurate Reflection Reading Between the Lines Validation of Causes Validating as Reasonable in the Moment Level Six: Treating the Person as Valid

9 EMOTION REGULATION ABC Accumulate Positives Build Mastery Cope Ahead PLEASE Treat physical illness Balance eating Avoid mood altering drugs Balanced Sleep Get Exercise

10 Major Depressive Disorder Sally is a 30 year old mother of a 2 year old who lives with the child s father. She has a diagnosis of Major Depressive Disorder. Sally s parents divorced when she was 8 years old. Because her mother has been critical of her since childhood and currently criticizes her parenting skills, Sally copes by becoming defensive, inflicting self harm behaviors, like biting her lip until it bleeds, or becoming numb and unfeeling. Rather than listen to her and offer empathy or validation, her boyfriend offers suggestions on what she should say or do. Check the Facts Emotions that Fit the Facts Problem Solving Opposite Action Examples of Opposite Action for Emotions Anger and Sadness

11 Borderline Personality Disorder Sylvia is a 48 year old divorced woman who lives with her teenage daughter at a relative s home. Sylvia has been hospitalized several times after reporting she overdosed on her pills. Diagnosed with Borderline Personality Disorder because of her fears of abandonment, low self esteem, self harming behaviors and unstable interpersonal relationships, Sylvia shared a history of childhood sexual abuse along with spousal emotional and physical abuse. Myths Cognitive Distortion and Examining Facts Emotion Regulation Skills, like TIP and half smile Pros and Cons of actions Distraction activities

12 Substance Abuse Megan is a 38 year old single female who lives with her boyfriend. Diagnosed with Opioid Use Disorder, Megan has been in and out of rehabilitation to treat her addiction to prescription medication. Introduced to DBT Skills during her last rehabilitation treatment, Megan is highly motivated, has very good insight and has relapsed twice in the past six months. Megan shared a history of childhood sexual abuse and a rape years ago by someone at an NA Meeting. Currently, she attends AA, works full time and has a positive relationship with her parents. DBT Skills: Fact vs. Opinions Non judgmental DEAR MAN - interpersonal communication

13 DEAR MAN Describe Express Assert Reinforce (stay) Mindful Appear Confident Negotiate

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15 CHAIN ANALYSIS 1.What exactly was the problem behavior? 2.What event in the environment started the chain of events - PROMPTING EVENT 3.What were the vulnerabilities factors for that particular day? 4.What was the chain of events, link by link, that led from the PROMPTING EVENT to the PROBLEM BEHAVIOR? 5.What were the consequences of the behavior in the environment? 6.Look back and label those feelings, emotions, thoughts that were justified. 7.Look back and put a check by those thoughts which were effective.

16 Bibliography Aron, E The Highly Sensitive Person. New York: Kensington Publishing Corp. Chapman, A. Gratz, K The Borderline Personality Disorder Survival Guide. New York: The Guildford Press. Fruzzetti, A The High Conflict Couple. Oakland, CA: New Harbinger Publications. Koerner, K Doing Dialectical Behavior Therapy. First Edition. New York: The Guildford Press. Kreger, R The Essential Family Guide to Borderline Personality Disorder. Center City, MN: Hazelden Press. Kreger, R Stop Walking on Eggshells. Oakland, CA: New Harbinger Publications. Linehan, M DBT Skills Training, Handouts and Worksheets, Second Edition. New York: The Guildford Press. Linehan, M DBT Skills Training Manual, Second Edition. New York: The Guildford Press. Mazza, J. Dexter-Mazz, E. Miller, A DBT Skills in Schools. New York: The Guildford Press. McKay, M. Wood, J. Brantley, J The Dialectical Behavior Therapy Skills Workbook. California: New Harbinger Publications, Inc. Web Sites