What is Comprehensive DBT?
One of the many strengths of Dialectical Behavior Therapy (DBT) is that it is an evidence-based practice. This means that the treatment plan integrates clinical expertise with external scientific evidence. Many providers will claim that they provide DBT when it is not in fact comprehensive. Be sure to ask your provider which components of DBT are offered as a part of your treatment program. Once the treatment plan is adapted, it is no longer considered to be an evidence-based practice. This is what we call DBT “informed” practice whereas Comprehensive DBT includes all of the following:
- Weekly individual therapy
- Weekly skills training (usually in a group)
- Contact through your individual therapist outside of session (usually by phone)
- Weekly consultation for the therapists
Weekly Individual Therapy
Clients are required to have an individual session with their DBT therapist weekly. The main objectives of this session are to review the diary card, discuss target behaviors, and troubleshoot what may be getting in the way of creating a life worth living. The diary card is used as a way to track behaviors that the client and therapist have targeted as well as a way to monitor what skills are being used outside of therapy.
Weekly Skills Training
Skills training is typically offered once a week for two and a half hours. The group begins with a mindfulness practice followed by homework review, and finally, a new skill is taught. Clients are taught material from all four modules of the treatment manual including Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness (including Walking the Middle Path), and Mindfulness. The length of the DBT program is structured to allow two rotations through the DBT Skills. While this is not always possible, we do the best we can to encourage this.
Comprehensive DBT is often conducted in an outpatient treatment setting so that clients can learn the necessary skills while living in their own environment. This allows them to face difficult situations that may arise in their day-to-day lives with the help of their individual therapist to coach them through the experience-highlighting one of the many benefits that phone coaching provides clients. Each mode of therapy is an integral part of the treatment, and phone coaching is no exception!
If outpatient treatment is not the appropriate level of care, fear not! Comprehensive DBT can also be implemented in residential treatment settings. The only difference is that phone coaching is replaced with milieu coaching on the unit. Staff is trained in DBT and available for coaching 24/7 when needed.
In DBT it is just as important that the therapists receive therapy as it is the clients. Therapists gather once a week to consult and discuss what is getting in the way of doing their best work. This is beneficial to both the therapist and client to manage burnout and enhance the therapeutic relationship. Therapists work together to provide validation and problem solving as needed.
Now you have it! For more information visit: behavioraltech.org.