Plum Tree DBT Program

Dialectical Behavior Therapy (DBT) is a specialized approach to treating people who self-injure or attempt suicide. It is an evidence-based treatment, meaning its effectiveness has been examined and verified. To provide DBT, therapists undergo intensive training and are part of a DBT consultation team.

Qualifications for admission into the Plum Tree DBT Program include:

  • Age 13-21
  • Resides with guardians
  • History of suicidal behaviors and/or self-harming behaviors
  • Emotional instability
  • Discretion of Plum Tree DBT team
  • Plus, at least 2 of the following:
    • Interpersonal problems
    • Family dilemmas
    • Confusion about self
    • Impulsive behaviors
    • All-or-nothing thinking

DBT for adolescents includes three essential parts. (1) Individual Therapy, (2) Multi-Family Skills Group, and  (3) Coaching Calls. If even one of these 3 parts is missing, DBT treatment is no longer evidence-based or totally effective. Therefore, the Plum Tree DBT program requires participants to:

  • Commit to 20 weeks of treatment, with perfect attendance to all DBT sessions
  • Attend weekly, 60-minute, individual therapy with DBT Provider
  • Attend weekly, 60-minute, multi-family skills group with DBT Provider
  • Teens make appropriate use of phone calls to DBT Provider for help in using new skills
  • Parents make appropriate use of phone calls to DBT Provider for help using/reinforcing new skills

Information about Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a research-based mental health treatment developed by Dr. Marsha M. Linehan and her colleagues at the University of Washington. DBT combines principles and practices of Behaviorism, Cognitive-Behavioral Therapy (CBT), Eastern Mindfulness, Biosocial Theory, and Dialectics.

DBT was originally designed to treat borderline personality disorder (BPD) , which is characterized by symptoms of emotional dysregulation (extreme sensitivity), “black and white” thinking, chronic feelings of emptiness, thoughts or attempts of suicide or self-harm, inappropriate outbursts of anger, impulsivity, and a chronic instability in mood, behavior, sense of identity and relationships.

Over the past several years, the DBT model of therapy has been adapted to treat a broader range of mental health disorders, including: mood disorders (depression & bipolar), anxiety disorders (posttraumatic stress, generalized anxiety, panic disorder, and social anxiety disorder), eating disorders, substance abuse, self-harm in teens, and couples and relationship conflict.

How the DBT Model of Therapy Works  (read more)

DBT TREATMENT FOR ADOLESCENTS

Weekly Individual Therapy

In individual therapy sessions start by reviewing a weekly Diary Card, where the adolescent has monitored daily emotions, urges, treatment compliance, etc. This method of treatment clarifies the cause-and-effect role between thoughts, feelings, and behaviors. Alternatives to unsafe/ineffective behaviors are reviewed and practiced.

Weekly Multi-Family Skills Group

Multi-Family Skills Group is where each adolescent, plus at least one parent/guardian, attend a group session with a Ada Andrist, LCPC. This is where DBT skills are taught, reviewed, practiced, and reinforced. In adult DBT, families are not required to attend groups. But with adolescents, it is critical that a guardian learn, know, practice, and reinforce the adolescent’s new skills. There is much to learn on the family’s part. It is difficult for a teenager in a family to change behaviors, if everyone else stays the same. There are 5 modules (listed below) that are taught–one per month–over the course of the program.

1.) Mindfulness

Mindfulness helps people accept and tolerate powerful emotions. The concept of mindfulness and the meditative exercises used to teach it are derived from traditional Buddhist practice, though the version taught in DBT does not involve any religious or metaphysical concepts. Within DBT it is being able to pay attention—non-judgmentally—to the present moment. Mindfulness is living in the moment, experiencing one’s emotions and senses fully, yet with perspective.

2.) Emotion Regulation

Emotion Regulation is experiencing and expressing emotions without resorting to inappropriate, ineffective behavior. One way to increase emotion regulation is to reduce one’s vulnerability to intense emotions. Young people who have difficulty regulating emotions express themselves volatilely, such as screaming, lashing out verbally or physically, and acting aggressively toward themselves and others. These behaviors make it difficult for others to enjoy being around them, and then social problems get even worse. Emotionally dysregulated youngsters are more at risk of being excluded from social groups.

3.) Distress Tolerance

Life happens, including tough situations. Learning how to tolerate distressing emotions and events is important. Reacting with destructive emotions and behaviors only makes things worse down the road. Distress tolerance is managing unpleasant feelings and situations by using effective skills. It is often not possible to change circumstances of distressing events, but it is possible to bear pain skillfully.

4.) Interpersonal Effectiveness

Healthy relationships are equitable and balanced. Appropriate boundaries are important, including how to balance one’s priorities and demands with the other persons. Having effective relationships means having self-mastery, self-respect, and self-regard. It means knowing when and how to ask for help. It means knowing when to say “yes” to someone and when to say “no.”  It is about getting one’s needs met, but not at the expense of another person’s needs.

5.) Walking the Middle Path

Walking the Middle Path is about avoiding extremes. It is seeing the truth in both sides of the story. Two things that seem like opposites can both be true. For example, these polar statements are viewed as both true:  (A) The teenager is doing the best he/she can, and B) The teenager can do better. Parents can be firm AND gentle. Teenagers are independent AND dependent. Moving away from either/or thinking to both/and thinking improve the foundation from which parents and teens communicate. Walking the Middle Path is a module that is used only in DBT with adolescents.

Coaching Calls

The purpose of these calls is to coach participants—during stressful moments—to use DBT skills instead of resorting to ineffective behaviors. The calls are short—no more than 10-15 minutes. Teens are encouraged to call Dr. Weller, while parents are encouraged to call Ada Andrist, LCPC. Parents use the calls to plan in the moment about how to use and reinforce DBT skills when as a conflict occurs.

The Four Stages of Treatment

DBT therapy is organized into a hierarchy of four stages of treatment: (citation)

Stage I – Moving from Being Out of Control of One’s Behavior to Being in Control

Target 1: Reduce and then eliminate life-threatening behaviors (e.g., suicide attempts, suicidal thinking, intentional self-harm).

Target 2: Reduce and then eliminate behaviors that interfere with treatment (e.g., behavior that “burns out” people who try to help, sporadic completion of homework assignments, non-attendance of sessions, non-collaboration with therapists, etc.). This target includes reducing and then eliminating the use of hospitalization as a way to handle crises.

Target 3: Decreasing behaviors that destroy the quality of life (e.g., depression, phobias, eating disorders, non-attendance at school, neglect of medical problems, lack of friends, etc.) and increasing behaviors that make a life worth living (e.g., going to school, having friends, not feeling depressed and anxious all the time, etc.).

Target 4: Learn skills that help people do the following:

  • Control their attention, so they stop worrying about the future or obsessing about the past. Also, increase awareness of the “present moment” so they learn more and more about what makes them feel good or feel bad.
  • Start new relationships, improve current relationships, or end bad relationships.
  • Understand what emotions are, how they function, and how to experience them in a way that is not overwhelming.
  • Tolerate emotional pain without resorting to self-harm or self-destructive behaviors.

Stage II – Moving from Being Emotionally Shut Down to Experiencing Emotions Fully

The main target of this stage is to help clients experience feelings without having to shut down by dissociating, avoiding life, or having symptoms of post-traumatic stress disorder (PTSD). In DBT, we say that clients entering this stage are now in control of their behavior but are in “quiet desperation.” Teaching someone to suffer in silence is not the goal of treatment. In this stage, the therapist works with the client to treat PTSD and/or teaches the client to experience all of his or her emotions without shutting the emotions down and letting the emotions take the driver’s seat.

Stage III – Building an Ordinary Life, Solving Ordinary Life Problems

In Stage III, clients work on ordinary problems like family conflict, peer isolation, academic or vocational goals,  etc. Some clients choose to continue with the same therapist to accomplish these goals. Some take a long break from therapy and work on these goals without a therapist. Some decide to take a break and then work with a different therapist in a different type of therapy.

Stage IV – Moving from Incompleteness to Completeness/Connection

Most people may struggle with “existential” problems despite having completed therapy at the end of stage III. Even if they have the lives they wanted, they may feel somewhat empty or incomplete. Some people refer to this as “spiritual dryness” or “an empty feeling inside.