Dialectical Behavior Therapy

I had the privilege to attend a training session on the Dialectical Behavior Therapy (DBT) Model. This was a mandatory training for all the employees where I work at. It was presented by Sarah Jarvis, Psy,D.

I’m very glad I attended this session and I was very pleased to hear that all staff at my facility will get to attend this training too!

The training was based on the DBT model developed by Marsha Linehan, Ph.D. (University of Washington).

The DBT model is designed for treating people with severe, chronic, multi-diagnosis, and/ or people who are difficult to treat.

DBT assumes the following:
a.) Patient is doing best that they can.
b.) Patient wants to improve
c.) Patients need to do better, try harder and be motivated to change.
d.) Patient must learn new behaviors in all relevant contexts.
e.) Patient may not have caused all their problems, but they need to solve them anyways.
The lives of these individuals are unbearable as they are currently being lived.

The most caring thing we can do for our patients is to help them get closer to THEIR goals. Clarity and compassion is needed.

We need to help our patient learn how to regulate emotions. This is a balancing process that includes: change, acceptance, problem-solving, and validation.

Here are several types:

• High sensitivity: immediate reaction and low tolerance.


• High reactivity: extreme emotional/ behavior and disruption in cognitive process.


• Slow return to balance: requires extreme time to “calm down” and increased vulnerability to additional stimulus. This could re-start the cycle.
  

Here is an important key concept to remember:
Stress with our patients could lead to suicide, attempts, self-harmful behavior, substance abuse, social, occupational problems, clinical disorders/ syndromes, and continued maladaptive behavior.

For the service providers (therapists, counselors, rec. therapist) etc. it could create situations of chaos, distress, feeling fear, worry, or anger. There is tension within the system.

Here is another important key concept to remember:
Growth can’t occur in a stressed environment. People can’t learn in stress.

Introduction to Validation Therapy
This was first started with the geriatric population. Identify them as a person.
Here are some ways to offer comfort/ touch:
Acknowledge them, value them, re-assure, comfort, make them know they’re worthy, and worthy of being listened to, and that they’re important!

Here is a basic definition of validation:
Listening and observing, reflective statements, nonverbal signs of listening, being open and curious, and stating unspoken signs of emotions.

As a Rec. Therapist, I need to be mindful of what my body is communication.
Don’t ask “Why” questions because this puts a person on the defensive side. State, “I’m curious to know, could you explain to me.”

Here are some good tips:
Recognize past learning.
Focus on here and now (and not yesterday or previous problems)
Talk in a soft, calm tone of voice, have an open stance, use eye-contact, and even silence can be a type of validation. Be a good listener. Connect with the individual/ patient and try to be in the moment.

Invalidation often leads to power struggles and arguments.

Here are some things that invalidate a person:
Missing the point, using should/ ought, making it sound easy, assuming/ generalization.

Evidenced-based practice:

Validation creates a therapeutic environment for positive growth and change. It is a great tool for de-escalation, hope and healing. It assists in creating change and maintaining health.

Based on my personal experiences, I think “validating others” is a skill that comes natural to many people in the human-service/ helping field.

Recreational therapists may want to consider taking trainings: on mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance.

Here are two recommended resources:


And here is one more: