San Francisco DBT Center

 
1702 Union Street; San Francisco, CA 94123  

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What is DBT?
Dialectical Behavior Therapy (DBT) is a well researched and comprehensive treatment approach designed to help people who have difficulty in regulating their emotions. This often results in a high degree of impulsive reactivity, self-destructive behaviors, and volatile relationships with others in their lives. DBT works by teaching participants to become more aware of their particular sensitivity to negative emotions such as anger and anxiety. At the same time, it provides the skills necessary to tolerate these feeling and then begin to regulate them. DBT also teaches assertiveness skills to enable participants to effectively begin asking for what they want from others and saying no to things they don't want.



Who can benefit from DBT?
Developed by Marsha Linehan, Ph.D. at the University of Washington in the early 1990's, DBT was originally designed as an innovative and integrative treatment for suicidal and actively self-harming patients with a history of multiple psychiatric hospitalizations who met criteria for Borderline Personality Disorder (BPD). Because of its success in treating this patient population, DBT has gained in popularity and has been used to treat a broader range patients who present with many of the characteristics listed below.
  • a tendency towards impulsivity and self-destructive behaviors
  • an unstable sense of self, including chronic feelings of emptiness
  • high emotional reactivity requiring a long time to calm down
  • a tendency to see others and the world in black and white terms
  • extremely sensitive and can lash out in anger over the slightest miscue
  • unstable relationships, especially those involving intimacy
  • a pronounced fear of being abandoned
  • rapid mood changes with mixed anxiety and depression


How does DBT work?
DBT separates skills training from individual psychotherapy, requiring participants to attend weekly skills training groups in addition to being in ongoing and weekly psychotherapy. As a unique and powerful way to further reinforce the skills taught in the skills groups, telephone coaching with a trained DBT therapist is available between group sessions. One of the key assumptions of DBT is that while we may not have caused all of our problems, we are the only ones capable and responsible for fixing them. This requires a continual willingness on the part of DBT participants to put in the hard work necessary for making the changes they want in order to create lives worth living. Because of the personal dedication, sacrifice and effort required to successfully complete our DBT program, applicants are required to complete a DBT Orientation and Commitment class before being eligible for admission into a DBT skills group.



DBT pre-treatment requirements:

Initial intake interview(s) to determine eligibility and readiness for DBT skills training.

  • Agreements with individual therapist and groups skills leaders, including insurance reimbursement and releases of information, reviewed and signed.

Skills Modules taught in DBT

  • Core Mindfulness - being present and non-judgmentally aware in the moment
  • Distress Tolerance - managing difficult feelings without acting impulsively
  • Emotion Regulation - learning to skillfully use or change emotions
  • Interpersonal Effectiveness –relating skillfully with others

DBT assumptions about participants:

  • People in DBT are doing the best they can.
  • People in DBT want to improve.
  • People in DBT need to do better, to work harder, and be motivated to change.
  • The lives of suicidal individuals are unbearable as they are currently being lived.
  • People in DBT must learn new behaviors in all areas of their lives.
  • People cannot fail in DBT.

DBT assumptions about therapists :

  • All therapists, no matter how well trained, are fallible.
  • We make every reasonable effort to conduct competent and effective therapy.
  • We obey standard ethical and professional guidelines.
  • We are available for weekly therapy sessions, phone consultations, and provide needed therapy back-up.
  • We respect the integrity and rights of the patient.
  • We maintain confidentiality.
  • We meet regularly to obtain consultation and support to be effective in the work we do.


Targets of DBT treatment:

(in order of priority)

  • Decreasing high-risk suicidal and self-harming behaviors
  • Decreasing therapy interfering behaviors by either therapist or patient
  • Decreasing quality of life interfering behaviors
  • Learning and mastering behavioral skills for mood-independent life choices
  • Decreasing symptoms related post-traumatic stress, other anxiety, and depression
  • Enhancing and sustaining self-respect
  • Additional goals set by patient to create a life worth living

Stages of DBT treatment:

Stage One
  • Decreasing or eliminating life-threatening behaviors (suicide attempts, suicidal thinking, self-injury, homicidal and aggressive behaviors)
  • Decreasing or eliminating therapy-interfering behaviors (missing sessions, not doing homework, behaving in a way that burns others out)
  • Reducing or eliminating hospitalization as a way of handling crisis
  • Decreasing behaviors that interfere with the quality of life (eating disorders, not going to work or school, addiction, chronic unemployment)
  • Increasing behaviors that will enable the person to have a life worth living
  • Increasing behavioral skills that help to build relationships, manage emotions and deal effectively with various life problems
Stage Two
  • Continuing and building on Stage One skills
  • Targeting and decreasing symptoms of Post Traumatic Stress Disorder (PTSD) and other Anxiety or Depression related symptoms
Stage Three
  • Increasing love and respect for self and others
  • Affirming individual life goals
  • Solving ordinary life problems
Stage Four
  • Developing the capacity for freedom and joy
  • Creating a life worth living!
 

2013
San Francisco DBT Center