USING DBT TO INCREASE COUNSELOR SELF-EFFICACY
WENDY S. BRUTON, PH.D, LPC, ACS
STUDY TITLE The Impact of a DBT Training on the
Counselor Self-Efficacy of Pre-service Counselors Working with Borderline Personality Disordered Clients
LITERATURE REVIEW
A literature review on three main themes was conducted.Borderline Personality DisorderDialectical Behavior TherapyPre-ervice Counselor Self-Efficacy
BORDERLINE PERSONALITY DISORDER (BPD)
Symptomology Emotional dis-regulation &Impulsivity Increased self-harm risk Chronically suicidal Lack of sense of self
Serious Mental Health Concern Vast majority have made at least one suicide
attempt Treatment Concerns
20% clients in community mental heath agencies meet criteria for BPD
Counselor’s Experience with BPD Clients Overwhelmed & Underprepared BPD clients do not respond to TAU
THERAPEUTIC ALLIANCE &IMPACT ON CLINICIANS
Counselors are continually assessing… creating hyper-vigilance Individuals with BPD are 16 time more likely to engage in
suicidal behavior than people with Major Depressive Disorder (Kelly, Soloff, Lynch, Haas, & Mann, 2001).
Clients are “all in” or “all out” of therapeutic alliance Therapy is a “way of life”
97% receive outpatient treatment over a life time with an average of 6 therapists (Lieb, et al., 2004)
Impulsivity and Psychotic Reactivity create nervousness and confusion for counselors.
“They latch on to you and it’s like suck suck suck suck……I feel that we’re like in this kind of quicksand, and I might be on the edge, but they’re in there, and I’m holding their hands, but I feel… urghhh (gestures)… pulled in, no firm foothold.” (Rizq, 2012, p. 40)
Countertransference is almost always present.
DIALECTICAL BEHAVIOR THERAPY (DBT)
HistoryDeveloped by Marsha Linehan
in late 1980s Effectiveness
First method of therapy to be shown in clinical trials to be effective with BPD clients
Significant drop in parasuicidal actions
Decreased dropout rate in counseling
GENERALIZABILITY OF DBT DBT covers most presenting problems that
counselors face. The inability to handle difficult emotions (ie:
sadness, fear, anger) The inability to change emotions when needed (ie:
stop being angry, stop being sad… etc. ) Difficulty staying in the “here and now” Unable to be effective in relationships.
INTRODUCTION TO DBT Dialectics~ (holding two things in
balance that are in conflict or contrary) Sustaining Balance
Four ModulesCore MindfulnessDistress ToleranceEmotional Regulation Interpersonal Effectiveness
SkillsEach module has specific skills that require
practice.
IMPACT OF DBT ON THE CLINICIAN Empowerment with tools Professional application
Dialectics Mindfulness
Personal application Dialectics Emotional Regulation Mindfulness
Normalizing Attention to internal
experience with clients Counselor’s reaction is
diagnostic criteria Skills increase CSE
COUNSELOR SELF-EFFICACY(CSE)
Defining CSE “One’s beliefs or judgments about his or
her capabilities to effectively counsel a client in the near future.” (Larson, 1998, p. 180)
Importance of CSE With higher CSE counselors are able to:
Use more skills Handle difficult situations more effectively Accept feedback from instructors and supervisors
CSE as a Predictor of Career Choice As CSE increases so does the likelihood that
they will accept and maintain the therapeutic relationship (Larson, 1992)
RESEARCH QUESTION
The “hole” in the research:
What is the impact of DBT training on the counselor self-efficacy of counselors with regards to their work with BPD clients?
This study examined changes in counselor self-efficacy (CSE) with regards to counselor’s work with BPD clients, following a DBT training.
PURPOSE OF THE STUDY
The inclusion criteria for this study:All participants were enrolled in the final semester of
their clinical internship experience.All participants were in their final semester of study
and enrolled in a clinical internship supervision class. All participants were recruited by the researcher
during a regularly scheduled class time. The participants were divided by class
room into treatment and comparison groups.
PARTICIPANTS
Demographic Questionnaire Counselor Self-Estimate
Inventory (COSE) Self-assessment measurement of
counseling effectivenessSub-scales: micro-skills, counseling
process, difficult clients, cultural competence, and awareness of values
INSTRUMENT: QUESTIONNAIRE/COSE
DESIGN
Quasi-Experimental, Nonequivalent Group,
Pretest~Posttest Design
The study demonstrated that training pre-service counselors in DBT can positively impact their counselor self-efficacy.
Gives insight into changes that need to be made:Willingness of counselors to work with BPD
Population Increase in training on personality
disorders… specifically BPD… and other high needs clients.
RESULTS
Your experience with BPD? Your use or non-use of the four DBT
Modules:MindfulnessDistress ToleranceEmotional RegulationInterpersonal Effectiveness
Where do you use these skills in daily life... Work, personal time, etc?
Where can you find support in using these skills more effectively?
DISCUSSION
DBT TRAINING Oak Springs Wellness Centre, LLC
Salem, OR ~ 503-983-1559www.oakspringswellness.com
January 23-24, 2015Friday & Saturday: 9:00am-4:00pmCost: $300: Price includes a one hour
individual coaching session($50 off if you came to this session)
QUESTIONS?
~Thank you~
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