Core DBT Training
“Building an Evidence-Based DBT Program”
Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment originally designed and developed by Marsha Linehan, PhD, as a treatment for chronically suicidal individuals, and first validated with suicidal women who met criteria for borderline personality disorder (BPD). Individuals with BPD make up 14-20% of inpatient and 8-11% outpatient admissions. They also consume a disparate amount of resources in the mental health community, often up to 40%. Effectively treating and addressing the needs of those who have BPD poses numerous challenges. They typically require treatment for multiple, complex and severe Axis I disorders (i.e. substance abuse, severe depression, trauma, panic, etc.), often in the same context of being suicidal. Often the amount of serious and life-threatening problems they present in therapy makes it difficult to establish and maintain a focus of treatment. Decisions made by the clinician are made yet more complicated due to the fact that clients with chronic suicidal behavior and intense emotional sensitivity/reactivity often act in ways that distress and burn out the clinician. Regardless of their training and experience, clinicians can often struggle with their own emotional reactions when a client is both begging for help and rejecting the help at the same time (and threatening to kill themselves at the clinician for not helping). Even when the clinician is right on track, progress with individuals with BPD is slow and tedious. All of these factors increase the probability of treatment errors, including making premature changes to the treatment plan, and may contribute to the fact that those with BPD have high rates of treatment failure (Perry & Cooper 1985; Tucker, Bauer, Wagner, Harlam, & Sher, 1987). Despite their best efforts, both the client who meets criteria for BPD and the clinician who treats them have historically been down this discouraging path of treatment failures. It was within this context that DBT was created and evolved over time.
DBT is known as a “third wave treatment”. The process of balancing change strategies found in traditional behavior therapy approaches with acceptance-based strategies found in Eastern Zen practice is what makes DBT unique. It’s within this dialectical process that clients learn how to fully (radically) accept themselves and the universe as it is in the current moment while at the same time working hard on changing what they can. DBT is a comprehensive multi-modal treatment, which consists of weekly individual therapy, weekly skills group, 24/7 telephonic skill coaching and weekly therapist consultation team meetings.
Currently, DBT is the treatment of choice for individuals who suffer from suicidal and non-suicidal self-injurious behavior. There is no other model of psychotherapy that produces greater efficacy to treat these conditions than DBT. Meta-analysis is the method of scientific assessment that provides support for the superiority of the evidence for any particular evidence-based practice over alternatives. DBT is the only BPD treatment to date that has sufficient outcome studies to enable a meta-analysis to be carried out. DBT has been validated by several authoritative organizations as meeting the highest ratings of evidence with other treatments having lower evidence ratings. DBT is currently the only therapy, apart from psychoeducational multifamily groups, listed as an evidence-based practice for BPD in the U.S. Substance Abuse and Mental Health Service Administration’s (SAMHSA) National Registry of Evidence-Based Programs and Practices report to the US Congress (SAMHSA, 2011). The SAMHSA report states, “DBT has a large empirical base compared with other treatments and is largely considered one of the best, if not the best, treatments for BPD” (SAMHSA, 2011). The American Psychological Association’s Society of Clinical Psychology considers DBT to be the only current treatment for BPD that has Level I (highest level) strong evidence for its use (APA Division 12, 2012).
In order to attend this 5-Day Core DBT Training, participants are required to have already successfully completed a 2-Day Introduction to DBT Training (or equivalent). This training will NOT be designed as a review of the theoretical underpinnings of DBT (i.e. Biosocial Theory of Borderline Personality Disorder, Dialectics, Modes and Functions of DBT and DBT Skills Training).
Due to the fact DBT is a comprehensive treatment, the core training ought to be comprehensive as well. This training is designed for staff that is directly responsible for delivering DBT. The trainer prides himself on his ability to teach concepts of DBT, model these concepts in forms of case examples, role-plays and taped real life sessions. To help with acquisition and generalization, participants will rehearse and engage in numerous discussions, role-plays and receive immediate feedback. It is expected that all participants will make a full commitment to attend mindfully and will participate fully in discussion, role-plays and complete daily homework and reading assignments. The following topics will be covered during this training:
Outline
- Stages and Targets of DBT
- Pre-Treatment
- Assessing appropriateness for DBT (Inclusion vs. Exclusion Criteria)
- Orienting clients to DBT (Contingency Clarification)
- Setting up Initial Treatment Plan (Negotiables vs. Non-Negotiables)
- Commitment Strategies (Eliciting a STRONG commitment to “building a life worth living”)
- Assessing appropriateness for DBT (Inclusion vs. Exclusion Criteria)
- Stage 1 Targets
- Eliminating Life Threatening Behavior
- Decreasing Therapy Interfering Behavior
- Decreasing Severe Quality of Life Interfering Behavior
- Increasing Behavioral Skills (DBT Skills)
- Eliminating Life Threatening Behavior
- Individual Session Beginning Strategies
- Stage 1 Targeting Strategies
- Using the Client’s Diary Card and In-Session Behavior to Target Behaviors to Treat
- Problem Assessment Strategies
- Behavioral Chain Analysis (Functional Analysis)
- Secondary Targets (Identifying controlling variables i.e. the problems that need to be solved)
- Behavioral Chain Analysis (Functional Analysis)
- Solution Analysis Strategies
- Setting up and getting clients to practice new behavior (skills)
- Session Ending Strategies
- Validation Strategies
- Levels of Validation (Staying Awake to Radical Genuineness)
- Validating the Client’s Emotions, Behaviors and Cognitions
- Levels of Validation (Staying Awake to Radical Genuineness)
- Crisis Behavior Strategies
- Strategies to use with clients in crisis after-hours and in-session
- Suicide Behavior Protocol
- Long-Term and Short-Term Risk Assessment
- Data on hospitalizing suicidal clients
- DBT Arbitrary Rules when treating suicidal clients
- Individual Therapist Protocol for clients at imminent risk of suicide or serious self-harm
- Team Member Protocol when treating clients who are at imminent risk of suicide or serious self-harm
- Protocol for treating clients who are engaging in on-going suicidal and non-suicidal self-injurious behavior
- Long-Term and Short-Term Risk Assessment
- Case-Management Strategies
- Consultation-to-the-Client Strategies (when to coach the client up on how to be their own spokesperson and advocate)
- Consultation-to-the-Environment Strategies (when to step into the client’s environment and intervene on their behalf)
- Consultation-to-the-Client Strategies (when to coach the client up on how to be their own spokesperson and advocate)
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Fee
- Early Bird (30 days before) $1,250
- Standard $1,500
- Group Rate* $ 999
*Rate per person when four or more individuals from the same agency register at the same time.
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Daily Agenda
- 8:30am – 9:00am – Registration and Coffee
- 9:00am – 12:00pm – Morning Session
- 12:00pm – 1:00pm – Lunch Break, provided
- 1:00pm – 4:00pm – Afternoon Session with snack provided
- 4:00pm – Adjourn
Required Text
All participants will be required to bring a copy of “Cognitive Behavioral Treatment of Borderline Personality Disorder” (Guilford Press) by Marsha Linehan, PhD. -
Target Audience and Practice Level
This training is specifically targeted to Beginner (new graduates or individuals who have recently changed fields of practice) and Intermediate (individuals with a year or more experience in mental health treatment) level social workers, counselors, psychologists, marriage and family therapists, psychiatrists, case managers and
nurses. PLEASE NOTE: You must have completed an Introduction to DBT Training before attending this 5-Day Core DBT Training. -
Objectives
1. Identify inclusion and exclusion criteria in DBT.2. Explain how many Pre-Treatment sessions are allowed in DBT.3. Explain the function of Pre-Treatment in DBT.4. Distinguish between “negotiables” and “non-negotiables”.5. Translate Stage 1 Target behaviors onto a diary card.6. Identify what behaviors are targeted as Life Threatening Behavior.7. Identify what behaviors are targeted as Therapy Interfering Behavior.8. Identify what behaviors are targeted as Quality of Life interfering Behavior.9. Demonstrate the use of 3 commitment strategies used in DBT.10. Define what validation means and why it is used in DBT.11. Identify the 6 levels of validation.12. Explain what “radical genuineness” means.13. Identify what is needed in the first four sessions in pre-treatment.14. Implement session beginning strategies in an individual therapy session.15. Implement the 5 steps to conducting a behavioral chain analysis.16. Explain the reasons behind using a behavioral chain analysis.17. Identify behaviors that would be targeted as “active passivity”.18. Identify behaviors that would be targeted as “apparent competence”.19. Identify behaviors that would be targeted as “unrelenting crisis”.20. Identify behaviors that would be targeted as “inhibited grieving”.21. Identify behaviors that would be targeted as “emotional vulnerability”.22. Identify behaviors that would be targeted as “self-invalidation”.23. Identify 3 DBT skills that would treat “active passivity”.24. Identify 3 DBT skills that would treat “apparent competence”.25. Identify 3 DBT skills that would treat “unrelenting crisis”.26. Identify 3 DBT skills that would treat “inhibited grieving”.27. Identify 3 DBT skills that would treat “emotional vulnerability”.28. Identify 3 DBT skills that would treat “self-invalidation”.29. Identify the 3 arbitrary rules of treating suicidal clients in DBT.30. List at least 5 known short-term risk factors for suicide.31. Explain the roles of the individual therapist and team members with clients who are in crisis.32. Differentiate between consultation-to-the-patient strategies vsconsultation-to-the-environment strategies.
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Lodging Options
These hotels are the closest to our headquarters, the intersection has a variety of hotels to choose from:
- Comfort Inn Okemos
- Courtyard Marriott Okemos
- Hampton Inn Okemos
- Holiday Inn Express & Suites Okemos-University Area
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Additional Info
This training has been approved for continuing education credits by the Association of Social Work Boards (ASWB), 400 South Ridge Parkway, Suite B, Culpeper, VA 22701. www.aswb.org. Social Workers will earn 30 CEUs for the successful completion of this course. No partial credits will be awarded. To earn the allotted CEUs, Social Workers will need to be in full attendance. For all other professions, please check with your individual board to seek approval for CEUs regarding this event.