Dialectical behavior therapy groups

Dialectical behavior therapy groupsBy: Tawny Scollard

Developed by Dr. Marsha Linehan of the University of Washington

EVIDENCE-BASED PRACTICEStarted with borderline personality disorder and suicidal individuals

Now DBT Is being used with many different populations

Substance abuse

Juvenile and Adult offenders

Psychiatric FacilitiesDialectics/MindfulnessEmphasizes wholeness, interrelatedness and change as fundamental characteristics of reality.Group treatment always entails balance of acceptance versus change and searching for what is left outThe goal of mindfulness practice is to fully participate in the present moment with complete awareness yet without judgment.

The Foundation of DBT groups are built onHuman Communication

Making sense of what we experience looking at patterns and structure

Sharing sense of experience, thoughts and feelings

Create meaning within your heart and mind

theoryDEVELOPMENT THEORY Theories of moral reasoning (Kohlberg, Gilligan) Theories of cognition (Piaget) Transpersonal theories of human development

Major Theory

Systems Theory Psychodynamic Social Learning Conflict

theory Emotions have a central place in human behavior. Unconscious, as well as conscious mental activity serves as the motivating force in human behavior. Individuals may become overwhelmed by internal and/or external demands. Individuals frequently use ego defense mechanisms to avoid becoming overwhelmed by internal and/or external demands.

Psychodynamic Theory

Social learning theory Social learning theory suggests that human behavior is learned as individuals interact with their environment. Problem behavior is maintained by positive or negative reinforcement. Cognitive- behavioral therapy looks at what role thoughts play in maintaining the problem. Emphasis is on changing dysfunctional thoughts which influence behavior. Methods which stem from this theory are the gradual shaping of new behavior through positive and negative reinforcement, modeling, stress management: biofeedback, relaxation techniques, cognitive restructuring, imagery and systematic desensitization.

DBT BIO-SOCIAL THEORYInability to modulate emotionLow threshold for emotional reactionExtreme reactionsDysregulation of cognitive processSlow return back to base lineEnvironment, experiences, cognitive ability7Group ElementsMindfulness activityReview last weeks homework and pressing questionsWeekly Lesson on target skillActivity to practice or apply lessonHomework given that reinforces skilled learned

http://youtu.be/WNq2mFBS9K8Roles of leadership in a democratic group Therapist/ Process Leader1st process in group; Release tensions by mindfulness activityAccomplish goalsHarmonizer: Maintains interpersonal climateStandard setterEnergizer

Teacher/Task Leader

Coordination with Therapist and staffSummarizes/ EvaluatorElaboratesInformational giverRecorderStandard setterGroup Observer

Social worker, psychiatric all coordinates with therapist and teacher as a team outside of group// green is task roles, blue maintenance

10TRANSFORMATIONAL LEADERSHIP4 IsIdealized leadershipInspirational motivationIntellectual stimulationIndividual consideration

DBT has evolved out of standard cognitive-behavioral treatments based on principles of learning, and blends behavioral change oriented strategies with concepts and techniques associated with acceptance and tolerance

CHALLENGE IN LEADERSHIP: RELIGN EXISTING NON-SOCIAL NORMS OF VARIATIONS TO RESTRUCTURE POSITIVE pro-social NORMS THROUGH SHARED VISION/ MULTUALITY OF CONCERN,CHALLENGING MENTAL MODELS, ENGAGE IN SYSTEM THINKING 11Roles of leadershipB.I.S.S. Staff

Gate KeepersEncouragingCompromiserStandard setterMediatorsOpinion seekerProcedural technicianEnergizerDBT Participants

Informational seekersOpinion seeker & GiversEnergizerEncouragingFollowersSelf-Confessor

AggressorRecognition seekerDisagreeableJoker

Challenges in Individual Roles Reward Tickets, seating arrangements, discuss with girls to open them up. Green task, blue maintenance12Advantages of dbt group therapyIncreased feedbackfeedback from other people gives different perspectives and can be helpful in promoting growth and change. ModelingBy seeing how others handle similar problems, the patient can rapidly add new coping methods to his or her behaviors.

Improve social skills A group leader, and a therapist, help people to learn to communicate more clearly and effectively with one another in the group context. This is inevitably leads to people learning new social skills which they can generalize and use in all of their relationships with others. Less expensiveBy treating several patients simultaneously, the therapist can reduce the usual fee.

Purpose of DBT GOALSINCREASEBehavioral skillsCoping skills Quality of life self-respectEmotion modulation Self-validationRealistic decision makingDECREASESuicidal and par suicidal behaviorsEmotional reactivitySelf-invalidationCrisis generating behaviorsNegative thought process

Problem solving approachesDiscussion focused on peer relationshipsDiscussions on managing conflictIntegrate others ideas to another ideaDiscussion about uncertainty in relationshipsRelational activitiesMulti-sequence model; Relational communication that can build or damage group climate15Activities that focus on general theme

Topical focus activities1. Mindfulness2. Distress tolerance3. Interpersonal Effectiveness4. Emotion regulation

Task-process activities

Activities focus on problem

Activities serve a function to keep discussions on task

Activities bring solutions to problem

Ethical guidelines in groupPost-conventional Ethics Observing individual and group (societal) rights.Keeping the group small (no larger than 12) not so overwhelming to clients and therapist Treat others with the same respect you wish to be treated likeSharing experiences, insights or feelings with group with is encouraged with positive open honest expressionTake this opportunity to grow and develop Be mindful, reflect, do your behaviors match your values Keep what shared in the room in the room (confidentiality)

Cultural issuesSocietal and cultural discourses can also be addressed and promote how members of the group can respond to the community in a different wayCulture that rewards anger and violence

Feeling socially unacceptableGroup therapy offers participants the opportunity to interact with others with similar issues in a safe, supportive environment. Participants can try out new behaviors, role play, and engage with others in not only receiving valuable feedback and insight from other group members, but also in giving it.Q & a

referencesBeebe, S. A., & Masterson, J. T. (2012). Communicating in small groups: principles and practices (10th ed.). Glenview, Ill.: Scott, Foresman.

Dietz, L. (2012, March 13). What is DBT?. What is DBT?. Retrieved May 27, 2014, from http://www.dbtselfhelp.com/html/what_is_dbt_.html

Ph.D, M. H. (2014, January 1). About Group Therapy - Psych Central. Psych Central.com. Retrieved May 27, 2014, from http://psychcentral.com/lib/about-group-therapy/000677

Services Alternatives, Inc., Training Institute. (2013). An Introduction to Dialectical Behavior Therapy. Service Alternatives. Everett, Washington, United States: Services Alternatives, Inc., Training Institute.

Johnannesen, R.I. (2002) Ethics in human communication (5th ed.).

Long Grove, IL: Waveland Press, Inc.