Our success with DBT specifically shows:

• 92% Increase in probation youth family reunifications
• 93% client attendance at Drug/Alcohol treatment groups
• 20% reduction in youth to youth violence
• 51% reduction in youth conflict with staff
• 27% reduction in AWOL
• 40% reduction in police involvement
• 45% reduction in property destruction

DBT was originally developed by Marsha Linehan, PhD at the University of Washington to treat severe, suicidal borderline personality disordered clients. It is now demonstrating success with other difficult to treat populations including adolescents and substance abusers. The model is especially effective for those who have highly reactive emotions that lead to impulsive, destructive behaviors and chaotic relationships.

Dr. Linehan recognized that clients who are vulnerable to criticism and have behaviors that are primarily driven by emotion have had some difficulty in effectively utilizing standard Cognitive Behavior Therapy (CBT). DBT adds the components of Acceptance and Validation to the excellent Change strategies found in behavior therapy. These clients often hold tight to learned problem behaviors. The addition of acceptance and validation strategies provides clients with the tools to accept themselves and change their behaviors.

The basic dialectic in DBT is Acceptance & Change – this continuum reminds both staff and residents to accept that a youth has very good reasons for choosing the behaviors that he has chosen in the past and that those behaviors need to change in order for him to be effective in meeting his goals to leave placement and function successfully at home, in school and in the community. Acceptance strategies are used to help residents tolerate things that they can not change, like being in a group home, following rules they are not used to and loss of significant others in their lives. Change strategies are used to teach new problem solving skills and ways to regulate their emotions without getting into further trouble or making their situation worse.

While there is no guarantee that every adolescent entering our program will be successful, our outcomes to date provide positive evidence of the exceptional benefits of this model. This model is increasing stability and safety in placement while providing the youth with skills to take back out into the community.

DBT is skills based and teaches the clients how to make more effective behavioral choices by identifying and addressing the triggers that have in the past lead to impulsive or aggressive behaviors. The group homes provide structured daily practice of these new skills and ready the residents for return to the community.

The five (5) functions of the Dialectical Behavior Treatment Model are to:

Pre-Treatment Tasks and Goals include:

Stage 1 Treatment Targets

• Decreasing Therapy Interfering Behaviors - both those of the client and of the therapist or other mental health provider. This is one of the unique and most powerful facets of this model. Once life threatening behaviors have been significantly reduced or eliminated, the focus moves to what would traditionally be identified as “treatment failure, resistance, lack of motivation, etc.”. The treatment targets the very behaviors that prevent treatment from taking place or behaviors by both the client and the treatment providers that interfere with the client’s benefiting from the treatment that is offered.
  • Examples of Therapy Interfering behaviors seen in our population include, but are not limited to:
    • AWOL
    • Refusing to see the therapist;
    • Walking out of groups;
    • Vocal disrespect toward the therapist or to the treatment provider;
    • Crossing over personal limits and boundaries;
    • Refusal to participate; non-attention; sleeping during sessions;
    • Disrupting groups or rehabilitation activities;
    • Crossing over staff boundaries;
    • Threatening staff;
    • Non-collaborative behaviors “Yea But” syndrome;
    • Refusal to do treatment assignments;
    • Behaviors that interfere with other clients;
    • Behaviors that burn out staff.
  • Therapy interfering behaviors from the treatment providers side are also addressed both as part of the treatment with the client and in the treatment team consultation. For our treatment staff working with this difficult population, examples may include, but are not limited to,
    • burning out on the client;
    • not respecting the client;
    • avoiding sessions with a client because he is difficult;
    • starting groups late;
    • canceling appointments;
    • acting upon feelings of intimidation by the client, etc.;
    • avoiding clients who are unpleasant or insulting to staff.

Stage 2 Treatment Targets include, but are not limited to:

This approach has also been successfully used when working with addictions. The focus in Stage 1 of treatment is to eliminate the use of substances and THEN to address the underlying issues related to the substance usage in Stage 2. The skills learned in eliminating substance use then become a resource to the client while dealing with the difficult and painful issues of secondary recovery (underlying issues and trauma).

• Treatment strategies during Stage 2 include the use a variety of proven therapeutic methods to reduce the trauma, abandonment, related cues, etc. Techniques are drawn from family systems. cognitive-behavior, interpersonal, narrative, and other therapies to address underlying issues related to the behaviors and symptoms targeted in Stage 1.
• Stage 3 works on daily living problems as the child learns to function successfully in the community in a non-restricted family environment. This stage is often continued in out-patient therapy following discharge from residential care.