DBT in Pennsylvania

 Members of PA's DBT Team seated left to right: Nabila Murshed, LPC; Antoinette Lyle,M.A.; Kelly Earl, LCSW; Standing left to right: Arlene Schofield, MEd CAC and Dannetta Purnell, LCSW

By: Arlene Schofield, Director of Outpatient Services, FHR Pennsylvania

A comprehensive Dialectical Behavior Therapy (DBT) treatment program is unfolding within Pennsylvania’s Outpatient Services. DBT, developed by Marsha Linehan, a psychology researcher at the University of Washington, is a systematic treatment approach utilizing cognitive and behavioral therapies, along with Eastern spiritual principles, to treat clients diagnosed with Borderline Personality Disorder. Research also suggests that clients with chronic mood disorders and suicide/self-injurious behaviors also benefit from DBT (Linehan et al, 2006). DBT treatment is an evidence-based practice focusing on treating clients typically seen as difficult to treat and keep in therapy. In addition, these individuals may be highly demanding/draining on the emotional resources of the therapist, as well as non-responsive to classical therapeutic interventions; e.g., cognitive, behavioral or psychodynamic approaches. DBT was developed as a means to treat the client in an encouraging and promising manner, while minimizing the risk of therapist burnout through team support and consultation. In other words - the client receives DBT from the therapist and the therapist receives DBT from the team.

The year-long training process started in March 2012, with a two- day leadership planning meeting with PA’s major funders (Chester County & CCBH), trainers from the University of Washington, and key FHR administrators. The purpose of this initial meeting was to assess FHR’s commitment, resources, and administrative support to implement such an intensive treatment program. Following this agency assessment, several clinicians and case managers participated in a two-day training session, which provided an overview of DBT treatment. The DBT orientation training subsequently led to the selection of four clinicians to join forces with the Clinical Director to create FHR PA’s DBT team. The DBT team consists of a team leader, skills group leader and co-leader, observer, and note taker. All team members are DBT primary therapists as well. All five staff collectively agreed to commit to future trainings, implement DBT treatment by June 2012, and support one another’s professional well-being.

DBT consists of four primary methods of treatment:

  1. Individual therapy.
  2. Group Skills training.
  3. Client telephone contact in between sessions for skills coaching by therapist.
  4. Weekly therapist consultation meetings.

Major strategies used in DBT treatment are validation, problem-solving, and contingency management. There are four stages of DBT Treatment. The first stage is Pre-treatment. Pre-treatment focuses on client assessment, commitment, and orientation to DBT therapy. Clients are asked to make a one-year commitment to treatment. Stage 1 focuses on suicidal behaviors, therapy interfering behaviors, and behaviors that interfere with quality of life and skills acquisition. In skills group training, clients are taught mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills. Stage 2 concentrates on the individual’s learning to fully experience emotion, while remaining in control. Stage 2 also deals with post-traumatic stress related problems. Stage 3 explores methods for successfully dealing with everyday life. Individuals learn to achieve “ordinary” happiness and unhappiness and to reduce ongoing disorders and problems in living. In addition, Stage 3 focuses on self-esteem and individual treatment goals. Stage 3 DBT Therapy will help the individual to resolve a sense of incompleteness and achieve joy (Linehan, et al 2001).

The DBT skills group began meeting weekly for two hours in June 2012. Clients are expected to come to class prepared with diary cards and homework assignments completed. The clients also receive weekly individual therapy, and medication management services monthly. Many of the clients also receive case management services and participate in our Psych Rehab program. Since one of DBT’s main goals is to decrease suicidal/parasuicidal behaviors by teaching skills, case managers are expected to contact DBT clinicians before possible ER visits and inpatient hospitalizations so that coaching by DBT therapists can be provided to the clients.

The DBT team meets weekly for a mandatory consultation/support meeting. The team also meets for one hour of monthly supervision with Dr. Karyn Hall, founder and President of The DBT Center in Houston, Texas. The team’s training program will be completed in December 2012, but supervision will continue for one year.

PA is excited about this innovative and intensive treatment program. The DBT team is to be applauded for their dedication and commitment to providing effective treatment to clients with BPD and other serious & persistent mental illnesses. The DBT Team, along with all FHR staff, believe that quality services and treatment, coupled with the belief that people can change, want to change and have the right to change, are essential foundations for recovery.