DBT Phase I
We offer treatment adherent to the model developed and extensively researched by Marsha Linehan, PhD at the University of Washington. This includes weekly 50 minute individual therapy and weekly two hour group therapy. Our groups are psycho-educational format, which means it is more like a class than a therapy group where people come to vent or get support. Our groups are 24 weeks long. For clients with complex, multi-diagnostic, difficult to treat concerns, taking the Phase I group twice is recommended.
In Phase I, there are one week sessions of mindfulness and orientation offered every six weeks, where new clients can join the group. The 5 week long modules are Distress Tolerance, also known as crisis survival skills; Emotion Regulation; Interpersonal Effectiveness; and Problem Solving, also known as how to be your own therapist.
Twenty four hour phone coaching is available to clients through their individual therapist.
An underlying premise in DBT is that painful emotions drive clients to use ineffective “target behaviors” that make the situation worse in the long run. Specialty programs such as DBT PME (for eating disorders) and DBT SUD (for substance abuse) have been developed to address the unique problems that may occur with these conditions.
Medication management is available through psychiatric nurse practitioners who are on-site and part of the PDBTI team. They take part in weekly consultation and are available to DBT clinicians for maximum coordination of care.
Drawing from the work of Dr. Linehan, and further refined by Alec Miller, PhD and his colleagues at Montefiore Medical Center/Albert Einstein School of Medicine, we offer a 16 week program adjusted to the developmental needs of teens. The teen years are even more difficult for those vulnerable to emotion dysregulation, with increased risk of self-harm and/or suicidality. Teens in this program attend a weekly 90-minute skills training groups, weekly individual therapy sessions, and have access to twenty-four hour phone coaching. Parents attend a weekly Parent Skills group as well, in order to treat the comprehensive needs of the family.
Our program designed for young adults (18 to 25 year olds) recognizes an increased need for independence is sometimes accompanied by a lack of skills to effectively make the transition. This is a 24 week program, with a weekly two hour skills group, and includes individual therapy and as needed phone coaching. A Young Adult Parent group helps parents provide effective support while encouraging mutual use of skills.
Based on research-supported DBT modifications by Dr. Christine Telch at Stanford University and Dr. Lucene Wisniewski of the Cleveland Center for Eating Disorders, this is a 24 week program with two hour groups. An essential part of the group program is the therapeutic meal, where clients eat together. Individual therapy and as needed phone coaching is provided by clinicians trained in DBT and eating disorder treatment.
Nutrition Therapy: The American Psychiatric Association and the American Dietetic Association both recommend nutrition counseling in the treatment of eating disorders. In the DBT-PME Program, a registered dietitian, on site, works closely with other members of the team. Goals can include weight restoration, adequate food and fluid intake, meal planning, developing appropriate exercise habits, and overcoming challenges around food, body weight and shape concerns.
DBT-SUD (“Path to Clear Mind”) is a modification of standard DBT developed by Dr. Linda Dimeff while at the Behavioral Technology Transfer Group. Dr. Dimeff is now the clinical director at Portland DBTI.
DBT-SUD is for those who have co-occurring mental health and chemical dependency concerns. Among the goals of DBT-SUD are to: become more aware of urges to drink or use and tolerate or reduce them; increase motivation to stop abusing alcohol or drugs; manage aversive emotions such as anxiety, depression, and anger without alcohol or drugs; and structure the environment to support substance-free living. Individual therapy and as needed phone coaching is provided by clinicians trained in DBT and substance use treatment. Many are credentialed with both a mental health license and certification as addictions counselors (CADC). Participants strive for dialectical abstinence, being 100 percent clean and sober, but participation is tempered by a harm reduction model. Urinalysis is available as a treatment option if clinically indicated.
Portland DBTI’s Trauma Recovery Program is for individuals who have experienced traumatic events, often during childhood and usually in the context of relationships. Treatment targets the reliving and avoidance cycle commonly experienced by trauma survivors.
Trauma Skills and Processing Group: This 10 week, 90 minute group provides information about PTSD and complex trauma, common reactions to trauma, and the impact of traumatic events on the brain and body. Specific trauma grounding skills are practiced in session and assigned as homework. The group blends what people have learned in DBT with Cognitive Processing Therapy (CPT) the treatment developed for rape survivors and now endorsed by the federal government for helping veterans.
After group, individuals may choose to do exposure therapy, the evidence-based treatment recognized as most effective for treating trauma. With an individual therapist, at the client’s own pace, clients review trauma-related material with the goals of decreasing avoidance, psychologically “digesting” traumatic memories, and reducing emotional distress.
Peer Exposure Group: This group, for individuals who have good coping and communication skills, is both supportive and corrective. In a safe environment, corrective peer experiences help clients to identify problematic interpersonal behaviors and replace them with more effective ways of relating.
Medication Management Services
Clients can integrate medications into their overall DBT treatment plan. Our psychiatric nurse practitioners emphasize educating clients in understanding how medications work, the benefits and possible side effects, and targets for improvement. Medications are part of the biosocial approach that addresses the individual and their interaction with the environment. Being on-site and trained in DBT allows greater coordination of care, balancing psychological with physiological concerns.
Medication management services include:
- Initial medication evaluation
- On-going medication management
- Consultation with primary care provider
- Facilitation of related care such as laboratory testing
- Assessment of need for higher level of care for issues like potentially dangerous withdrawal from drugs or life threateningly low body weight.
Services to Family and Friends
Friends and Family Workshop: This three hour workshop provides basic information regarding Dialectical Behavior Therapy (DBT), Borderline Personality Disorder, and services available through the Portland DBT Institute. It is offered on a Saturday morning four times per year.
Parents’ Group: This 16-week group is designed to help parents facilitate the progress of their son/daughter in the program. The goals of the group are to:
- Explain the biosocial model of development and maintenance of clients’ issues and problems;
- Teach some of the basic DBT ideas and skills that clients are learning in the program;
- Explore ways to provide an environment for clients that balances validation (where the focus is on acceptance) and problem-solving (where the focus is on change)
- Facilitate mutual support and problem-solving between group members as their family member advances through the program.
Couples Group: Drawn from the work of Alan Fruzzetti, PhD, and John Gottman, PhD, this 8-week group teaches emotion regulation, validation, effective communication, and problem solving skills to help couples resolve conflict and achieve greater understanding and closeness.
DBT-Informed Family Therapy and Couples Therapy: An individually tailored treatment plan is developed based on your family’s specific needs. Common areas of intervention include reducing patterns of harmful conflict and polarization, as well as strengthening relationship-enhancing behaviors such as accurate expression and validation.
Family Consultation Services: Individual consultation sessions are available for family members to share concerns about their loved one, gain a better understanding of their current situation, and to discuss treatment options.