What To Expect
DBT Skills Groups
DBT skills groups are more like classes than therapy groups, and there is a maximum of eight clients in each group. The primary goal of skills group is to learn skills. Groups are led by two clinicians, a leader and a co-leader. These roles generally switch each week. The leader reviews homework and diary cards, teaches skills, and makes sure that the group runs smoothly. The co-leader observes, supports and validates the clients' experiences in group, helps provide coaching outside of the group when necessary, and helps to explain the teachings if clients get confused. Skills groups do not allow for discussion or even mention of topics that might be upsetting for other group members. These include, but are not limited to, self-harm, suicidality, substance use, violence, trauma, and eating disordered behaviors. In addition, interpersonal conflicts between group members and reasons for current emotional upset are generally not discussed in skills groups. Instead, clients are encouraged to wait until their next individual therapy session, get coaching from the co-leader, or reach out for phone coaching from their individual therapist.
DBT Individual Therapy
Individual DBT therapy sessions are cooperative sessions between client and therapist. An instrument called a "Diary Card" (a form filled out daily by the client about emotions, urges, behaviors, and skills used) provides the road map to the session. The therapist "drives" the session based on information reported on the diary card in the following order of priority:
1. Life-threatening behaviors
2. Therapy-interfering behaviors
3. Quality-of-life interfering behaviors
Everybody needs help and encouragement when learning new behaviors to replace old habits. In order to learn how to use skills in real-life situations outside of therapy, the Trinitas DBT programs offer phone coaching as an essential part of treatment. Here are some examples of when coaching can be helpful:
> When your emotions are very high, and it feels impossible to use skills that you have learned in group
> When you have not yet thought of what skills to use in a specific situation
> When you need to use a skill that you have not yet learned
> When urges overpower your brain and you cannot seem to remember the skills you already know
We want you to call for help at these times so that you can use skills rather than make your situation worse. People that use coaching notice it helps them think more clearly, and helps them know what to do the next time a difficult situation comes up.
Currently, Trinitas phone coaching is available Monday through Friday, 9am to 5pm.
While you may, at times, feel frustrated that you cannot "talk about what you want to talk about, when you want to talk about it," it is important to remember that part of the effectiveness of DBT is based on following this structure. The therapist is careful to balance both validation of your experiences with problem-solving and will help you to practice some of your skills in session whenever possible.
Helping DBT Work for You
DBT is a treatment that requires hard work, time, and energy. The most successful clients make sure to do the following:
> Come to every individual session and DBT skills group
> Practice skills outside of sessions
> Complete homework assignments
> Fill out the diary card regularly
> Follow the guidelines of the program
> Are honest with their therapists
> Are willing to listen to feedback from their therapists
> Are willing to make mistakes
> Are active members in DBT skills group (e.g. asking questions, sharing thoughts, etc.)
> Remind themselves that changing behavior is difficult and requires patience