DIALECTICAL BEHAVIOR THERAPY (DBT)
Dialectical Behavioral Therapy (DBT) is a unique and specialized form of cognitive behavioral therapy used to help people manage impulsive behaviors, emotional responses, and self-destructive urges. DBT focuses on changing problematic patterns and teaching helpful skills in a multi-stage process. Empirical research has shown that DBT can help address a variety of concerns including suicidal and self-harm behaviors, eating disorders, anxiety disorders, and mood disorders. DBT skills can help you manage stress and live a healthier, more meaningful life.
A dialectical approach aims to find a middle ground when faced with opposite extremes of emotions, events, and positions. A core "dialectical dilemma" in DBT is the need to combine acceptance and change.
Nashville Child and Family Wellness Center offers Comprehensive Dialectical Behavior Therapy (DBT) and DBT Skills Groups for Adolescents and for Adults with a family-based approach to care. We follow the evidence-based DBT protocol developed by Marsha Linehan, PhD, ABPP for adults and, with adolescents, the protocol adapted by Alec Miller, PsyD and Jill Rathus, PhD. Our DBT therapists are trained by Behavioral Tech, the non-profit training company founded by the treatment developer, Dr. Marsha Linehan.
Your Path to a Life Worth Living
NCFWC offers a comprehensive DBT program that is implemented with fidelity to the model articulated by the treatment developer, Dr. Marsha Linehan. A comprehensive DBT program includes four elements: individual therapy (weekly), group skills training (weekly), phone coaching (as needed), and consultation team (for therapists only). A fifth element of parent, school, or other case management is sometimes added for adolescents. Clients must be in individual therapy with an intensively trained DBT therapist to be eligible for this program.
NCFWC offer DBT for Young Adults and specializes in providing DBT for Adolescents (DBT-A). The four standard DBT sets of skills that are taught are: Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. The adolescent curriculum includes a fifth set of skills in a module called Walking the Middle Path, in which adolescents and their caregivers learn about validation, behaviorism, and common family dilemmas that occur with teens.
DBT SKILLS GROUPS
Building Your Toobox
NCFWC offers DBT Skills Groups for Adults using the Adult Skills Manual to teach Emotion Regulation, Distress Tolerance, Interpersonal Effectiveness and Mindfulness skills. We also offer DBT Skills Groups for Adolescents (DBT-A) in a multi-family format also known as “Family DBT” meaning one or both parents or caregivers attend group alongside the adolescent learning the same skills sometimes in the same room and sometimes in separate parent and teen subgroups. The DBT-A Skills Groups teaches the additional Walking the Middle Path Module.
DBT Skills Groups aim to increase client capabilities by teaching techniques and reviewing assigned practice homework to reinforce learning. At NCFWC, we offer DBT Skills Groups for those enrolled in Comprehensive DBT as well as for those seeking only DBT Skills who are not enrolled in our Comprehensive DBT Program. The latter are typically those wanting to learn the skills as part of another type of treatment plan, typically for less severe difficulties.
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FREQUENTLY ASKED QUESTIONS
DBT related questions and information, answered and explained for you.
HOW DO I KNOW IF I SHOULD BE IN COMPREHENSIVE DBT OR JUST ENROLL IN A DBT SKILLS GROUP?
The DBT Intake Session allows NCFWC to fully understand your experiences, symptoms, and therapy goals in order to best match you with both the evidenced-based treatment modality and the clinician that best fits your needs. After completing a DBT Intake Session, the intake provider, along with input from any other providers you see, will determine which DBT program would be a good fit for you and, if applicable, which group would fit. If you are not an existing client at NCFW, you may be asked to complete an additional Initial Intake Session so that a complete assessment can be conducted. An intake session with an intake provider is not an agreement to treatment and your intake provider may not be your therapy provider.
If your intake provider feels that you are not a match for the services we provide, they will provide you with treatment referrals in the area that better fit your needs. If your intake provider feels that we offer services that best fit your needs, they will schedule you with one of our individual therapy providers, which will be determined by a goodness of fit with clinician expertise as well as availability. If you have a preference for the type of therapy or a specific provider you would like to see, please let your intake provider know of these preferences and we will do our best to match you in this way.
WHY SHOULD I DO A DBT SKILLS GROUP THIS IF I ALREADY DO INDIVIDUAL THERAPY?
Sometimes individual therapy may not be enough, especially when your emotions get to a really intense level. This group offers actual skills and strategies to try to get closer to feeling better and back in control. Learning skills in group saves time in your individual therapy sessions to talk about the stuff that is most central to you. DBT is an evidence-based therapy, which means that these skills have been proven to work for teens! Learning the skills will not be enough, you will have to practice them which your individual therapist can help you do.
I DON’T THINK I FEEL COMFORTABLE SHARING ALL MY PERSONAL INFO WITH A RANDOM GROUP. DO I HAVE TO SHARE?
That’s a fair concern. The thing about the group is that we often don’t have too much time to get deep into individual symptoms. We do go through a lot of content. While group leaders might ask you to share what your experience was like trying the homework, that doesn’t mean you have to share your deepest worries! The other benefit to group is that you get to talk to other people going through similar stressors. It’s a chance to feel like someone else really gets it, in a way that friends and family sometimes can’t.
WHY IS MY PARENT THERE?!
If you are in a DBT Skills Group for Adolescents, at least one of your parents must attend. The rule that a parent must also attend group takes a lot of teens by surprise. But as you would find in the group, your parent is not there to talk about you, what you did, what you didn’t do, etc. The goal is to have your parent there to actually learn the skills and apply them in their own lives, not just in relation to you. The parent is held just as accountable as the teen and has the same homework and tasks to complete! We have often had teens complain that their parent throw therapy words in their face without really knowing what they mean and it ends up making things feel worse. This group helps your parent actually learn the skills. This makes it way more likely that they will be able to help and respond effectively in a moment of crisis.
BUT MY EMOTIONS JUST GET TOO STRONG, NOTHING HAS HELPED! WHY MIGHT THIS?
This is where that term “evidence-based treatment” comes into play. DBT was created specifically to help with the most intense emotions. The strategies we teach in DBT even get into crisis survival skills that have been shown to reduce intense emotions quickly. If there is anything out there that can help with intense emotions, DBT skills can.
WHY DO I HAVE TO ATTEND? IT'S MY TEEN THAT EXPLODES, NOT ME!
This group requires a parent or caregiver to be present and participate in the group. Yes, you read that right. You, the parent, are in the group! There are a number of reasons for this.
1. Reduce the interaction effect
If you are reading this, it is very likely that your teen becomes easily dysregulated, perhaps even more so than your typical teenage “mood swing”. If this occurs often in your household, it likely impacts the whole household. You may find that you feel as though you are walking on eggshells. You might feel a sense of loss, hopelessness, and frustration. You may even find yourself losing control of your emotions and behaviors. The Family DBT Skills group is created to help you learn skills to respond more effectively to your teen when they are emotionally dysregulated, as well as skills to help you manage your own reactions to your teen, thus reducing the chances of perpetuating a negative interaction effect.
2. Feel Connected
While individual therapy can be very helpful for teenagers, parents can often feel left-out or very disconnected from the process. The group puts you right in the thick of things. Learning the same skills and strategies and completing the same homework as your teen. Our experience as well as that of other DBT providers is that parent-teen communication and relationships improve as a result of participating together.
3. Be “In The Know”
Sometimes parents get snippets of therapy terms and goals. They then try to use them to help their teen, with varying degrees of success. Being in the group, you have the opportunity to fully understand the function and purpose behind each skill. In addition, you have an incredible opportunity to model appropriate and effective behavior. Ever heard of the phrase “actions speak louder than words?” The group helps you talk the talk AND walk the walk.
4. DBT Skills are Universally Effective
No one is calm and in control all the time. Our emotions tend to get the better of us, in some shape or form. The great thing about DBT skills is that they can be universally applied: with your teen, with your partner, or with a colleague at work. They are concrete strategies that can help you be more effective in your communication, increase the chances of getting what you want, all while working towards staying in control of your mind so that you can build a life worth living (a classic DBT goal!).