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Dialectical Behaviour Therapy DBT Skills Group

Historically speaking. Clinical lore often leads us to believe that psychotherapy for people with intellectual disabilities and mental health concerns (Dual Diagnosis) is limited to behaviour modification. The facts. There is a growing appreciation that people with an intellectual disability suff

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Dialectical Behaviour Therapy DBT Skills Group

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    1. Dialectical Behaviour Therapy (DBT) Skills Group Anne Coombe Community Consultant Regional Support Associates

    2. Historically speaking Clinical lore often leads us to believe that psychotherapy for people with intellectual disabilities and mental health concerns (Dual Diagnosis) is limited to behaviour modification

    3. The facts There is a growing appreciation that people with an intellectual disability suffer from the same difficulties in life that persons of average intelligence do, such as anxiety, mood disorders, substance abuse and a range of other mental health concerns (Charlton, 2002; Butz, Bowling and Bliss, 2000; Nezu and Nezu, 1994)

    4. More facts Persons with intellectual disabilities obtain significant benefits from participation in psychotherapy to address their mental health needs, provided the psychotherapy is presented to them in a manner that is accessible to them (Szymanski et al., 1994)

    5. Dialectical Behaviour Therapy (DBT) Originally developed by Marsha Linehan to treat people diagnosed with Personality Disorders Evidence-based treatment approach addressing skills deficits in emotion regulation, distress tolerance and interpersonal relationships

    6. My interest Over the years much of my work has focused around behavioural challenges I became interested in DBT when it became apparent that standard behavioural approaches were not effective for some of our most challenging clients

    7. DBT Beginning in 2006, I began to attend as many workshops as I could in order to better understand DBT had discussions with Keith and Evelina at HBBS, and Patricia Patterson-Wybrow Attended training in Rochester in 2008 Had a number of very challenging clients who I thought would benefit from DBT they were suffering!! tried to access DBT groups in London area with no success London Health Sciences and St. Leonards ran small groups lengthy wait lists

    8. The process began Began to occur to me that maybe I could put together a group to help some of our most challenging clients learn some of these skills, to help them lead a healthier, balanced, calmer life, which would ultimately build self confidence and improve long term outcomes.

    9. How would we do this True DBT model of therapy, individual sessions with a therapist available 24/7 to talk that we couldnt do So I began to think what if we could educate support staff in some of these skills and then they could provide support on a as-needed basis, as well use these skills to help support other folks that they worked with

    10. Planning continues So now I was envisioning a DBT Skills group with clients and support staff attending Started planning with Patricia and Dr. Bob Carey at RSA for an 8 week group therapy session began to consider some of our most challenging clients- my colleagues Val and Peggy were very generous of time and information around group-work they had done in the past

    11. And then I met Margaret Dr. Margaret Charlton, Clinical Psychologist NADD in April sat in on a presentation that Margaret was presenting on Dual Diagnosis and Trauma Aurora Mental Health Centre in Denver, Colorado Mutual interest in DBT She had developed an extensive draft curriculum called DBT Skills Training Adapted for Special Populations, along with her partner Eric J. Dykstra, Psy.D.

    12. Margaret cont Margaret agreed to send me her complete 131 page curriculum 25 weeks to fully address Not feasible for us I had 8 weeks, 1 hour and a half per session Dilemma how would I pare it down when this whole process was completely new to me

    13. The Curriculum 8 weeks 1st week would focus on getting to know each other, practicing mindfulness exercises and setting the ground rules for the group DISTRESS TOLERANCE Weeks 2 and 3 EMOTION REGULATION Weeks 4 and 5 RELATIONSHIP EFFECTIVENESSWeeks 6 and 7 Complete review Week 8

    14. Curriculum cont Each of our sessions begins and ends with a mindfulness practice Review of homework - each week to complete independently and with support staff Learn new skills for the week practice, practice, practice Take home gift to solidify skill learned that week

    15. Outcomes Both clients and support staff report they are continuing to successfully use the skills learned One client reports This has helped me so much Another client who attended the group has given a presentation on the skills she learned to the management team of the agency that supports her

    16. Where do we go from here Pre and Post tests to measure outcomes around retention of skills, effective use of skills and measurements around mental health status Follow up sessions for initial group planned to review skills Planning now for next group in late October Review with RSA management around efficiency/effectiveness of the model

    17. Thank you for your time

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