Dialectical behavior therapy groups By: Tawny Scollard
Developed by Dr. Marsha Linehan of the University of Washington EVIDENCE-BASED PRACTICE Now DBT Is being used with many different populations Substance abuse Juvenile and Adult offenders Psychiatric Facilities • Started with borderline personality disorder and suicidal individuals
Dialectics/Mindfulness The Foundation of DBT groups are built on Human 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 Emphasizes wholeness, interrelatedness and change as fundamental characteristics of reality. • Group treatment always entails balance of acceptance versus change and searching for what is left out • The goal of mindfulness practice is to fully participate in the present moment with complete awareness yet without judgment.
theory DEVELOPMENT THEORY Major Theory Systems Theory Psychodynamic Social Learning Conflict • Theories of moral reasoning (Kohlberg, Gilligan) • Theories of cognition (Piaget) • Transpersonal theories of human development
Psychodynamic Theory – 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.
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 Inability to modulate emotion Low threshold for emotional reaction Extreme reactions Dysregulation of cognitive process Slow return back to base line BIO-SOCIAL THEORY
Group Elements • Mindfulness activity • Review last weeks homework and pressing questions • Weekly Lesson on target skill • Activity to practice or apply lesson • Homework given that reinforces skilled learned
Roles of leadership in a democratic group Therapist/ Process Leader Teacher/Task Leader Coordination with Therapist and staff Summarizes/ Evaluator Elaborates Informational giver Recorder Standard setter Group Observer • 1st process in group; Release tensions by mindfulness activity • Accomplish goals • Harmonizer: Maintains interpersonal climate • Standard setter • Energizer
TRANSFORMATIONAL LEADERSHIP • 4 I’s • Idealized leadership • Inspirational motivation • Intellectual stimulation • Individual 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
Roles of leadership Challenges in Individual Roles B.I.S.S. Staff DBT Participants Informational seekers Opinion seeker & Givers Energizer Encouraging Followers Self-Confessor Aggressor Recognition seeker Disagreeable Joker • Gate Keepers • Encouraging • Compromiser • Standard setter • Mediators • Opinion seeker • Procedural technician • Energizer
Advantages of dbt group therapy Increased feedback • feedback from other people gives different perspectives and can be helpful in promoting growth and change. Modeling By 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 GOALS INCREASE DECREASE Suicidal and par suicidal behaviors Emotional reactivity Self-invalidation Crisis generating behaviors Negative thought process • Behavioral skills • Coping skills • Quality of life • self-respect • Emotion modulation • Self-validation • Realistic decision making
Relational activities Problem solving approaches • Discussion focused on peer relationships • Discussions on managing conflict • Integrate others ideas to another idea • Discussion about uncertainty in relationships
Activities that focus on general theme Topical focus activities 1. Mindfulness 2. Distress tolerance 3. Interpersonal Effectiveness 4. 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 group • Post-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 like • Sharing experiences, insights or feelings with group with is encouraged with positive open honest expression • Take 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 issues • Societal and cultural discourses can also be addressed and promote how members of the group can respond to the community in a different way • Culture that rewards anger and violence • Feeling socially unacceptable
Group 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.
references • Beebe, 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.