At The DBT Center of Michigan, we pride ourselves on providing full, comprehensive, evidence-based DBT treatment.  We provide all modes of DBT for both adults and adolescents.  Our mission is the delivery of competent and effective DBT treatment to consumers throughout the State of Michigan.  We are working to "raise the bar" or standard of care in our region and to set an example for other treatment providers. All of the clinicians at The DBT Center of Michigan have been extensively trained in DBT. 

DBT is known as a comprehensive treatment.  In other words, individuals who receive DBT treatment at the Center receive individual therapy and skills training as well as skills coaching from their individual therapist over the telephone.

Individual Therapy
The main function of individual therapy is to “enhance the client’s motivation to change”.  Throughout the course of treatment, the individual therapist will help the client progress through 4 Stages of Treatment.

In the Pre-Treatment Stage, the individual therapist and the client will begin to build the framework of the treatment.  This will include collaborative assessment and formulation of the treatment plan.  The therapist will review DBT and the expectations of treatment in detail with the client.  Agreements of both the therapist and client will be discussed and a mutual commitment will be made before the actual treatment begins.

Once a commitment is obtained to take part in the treatment, the individual therapist will help the client complete Stage 1 of treatment.  During Stage 1, the client can expect to decrease and eliminate all life-threatening behavior (suicidal behaviors, severe thoughts of suicide, self-injury, etc.), therapy-interfering behaviors (behaviors that might interfere with the progress of therapy), and quality-of-life interfering behaviors (depression, anxiety, substance abuse, eating disorders, etc.).  For the client to benefit from this treatment, the client must stay alive and receive the treatment so we can address and decrease the behaviors that are interfering with the client’s quality of life.

After Stage 1 is complete, the client can expect to enter the second stage of treatment.  Stage 2 will help the client decrease emotions and behaviors that are related to traumatic experiences they may undergone in the past.  This includes helping clients live their daily lives to the fullest without experiencing post-traumatic responses.  Some of our therapists are trained in Eye Movement Desensitization Reprocessing (EMDR).  This approach has been scientifically proven to be a valid and effective treatment for Post-Traumatic Stress Disorder.  

Upon completion of Stage 2, the therapist will address Stage 3 behaviors. The goals in this stage are to increase self-respect (being able to say no to unwanted requests and sticking to this no, learning how to be assertive, etc.), to set and work toward certain individual goals the consumer has such as obtaining and keeping a job, and to teach the client how to solve ordinary life problems (budget money, pay bills, etc.).  The completion of Stage 3 will eventually lead to the termination of treatment.

Group Skills Training
During Stage 1 of treatment, the client can expect to take part in DBT Skills Training.  The function of DBT Skills Training is to “enhance the client’s capabilities to change”.  In order to help the client change they will learn Core Mindfulness, Distress Tolerance, Interpersonal Effectiveness and Emotion Regulation skills.  The skills training mode of DBT is usually done in a group format. However, it can be done on a one-on-one basis although separate from individual therapy.  Skills groups are done in a psychoeducational format.  In other words, clients who attend group will be expected to LEARN skills that the DBT skills trainer will TEACH through lecture, discussion, handouts, and role-plays.

Each client who participates in DBT will be expected to fill out a Diary Card on a daily basis.  This Diary Card serves as a very important daily self-monitoring tool for both the client and the therapist to use in the course of treatment.  The clients will rate daily urges, emotions, drugs and actions as well as keep track of what skills they use everyday.  They will bring the Diary Cards to both their individual therapy and skills training sessions.  When clients come to group, they will use the Diary Card to present to the group what specific skills they used throughout the week and give brief explanations on how they used them.  After the client presents the Diary Card to the group, the group will give feedback to strengthen and reinforce the skill usage.

The Core Mindfulness Skills are the “core” skills in DBT.  They consist of the “what” skills (Observe, Describe, and Participate) and “how” skills (Non-Judgmental Stance, One-Mindful, and Effectiveness) clients will use in order to operate with a Wise Mind.  These skills will help teach clients to become less judgmental of themselves and others, participate fully in life, gain control over emotions and attention, and increase impulse control.  The Core Mindfulness Skills will be taught through lecture and mindfulness exercises.

The Distress Tolerance Skills are designed to help clients tolerate distress and survive crisis without making it worse than it already is.  Many people tend to add to the crisis by making impulsive decisions.  Before one knows it, the crisis, the behaviors, and the emotions spiral out of control.  DBT teaches individuals ways to distract from the crisis in order to handle the situation more effectively or even improve the situation with imagery, meaning, prayer, relaxation, self-soothing, etc.  DBT will also help individuals learn how to radically accept the crisis as it is in the moment while teaching them how to manage it.

Interpersonal Effectiveness Skills are are very similar to assertiveness training.  The word “interpersonal” means interaction with others.  DBT stresses being “effective” with others while working towards getting what you want or need from them.  These skills will teach individuals how to assert their needs and desires to others while at the same time maintaining and increasing self-respect.  These skills are also designed to help clients attend to, maintain, and even improve important relationships they have with others.

Due to the fact that many people who receive DBT have difficulties regulating emotions, DBT teaches Emotion Regulation Skills.  These skills will help individuals decrease their vulnerability to intense emotions, increase emotional hardiness, increase pleasurable and decrease negative emotions, build confidence and competence in themselves, and learn how to control or change emotions by acting in a manner that is opposite to what the emotion is urging (or in other words, doing the “opposite action” to the emotion).

On average, it takes approximately 6 months to complete one rotation of DBT Skills Training.  It is highly recommended that individuals commit to going through the rotation twice in order to gain confidence in and mastery of the skills.

Telephone Consultation
In order to assist clients in using the DBT skills in their everyday lives, your individual therapist also acts as a Skills Coach. The group facilitator, if different from the individual therapist, will serve as a back-up Skills Coach.  Skills coaching is used outside of therapy sessions "to ensure skills generalization in the environment".  A typical skills coaching session takes place over the phone and typically lasts approximately ten to fifteen minutes.  When a client calls for a skills coaching session, the Skills Coach will:

• Assess the situation.
• Have the client discuss what skills (if any) have already been used.
• Brainstorm what skills the client thinks he/she can use now and how they can use them.
• Offer skills suggestions the Coach thinks the client can use in the moment. 

After this discussion, the Skills Coach will direct the client to go back into the environment with a new plan of action.

*This information was summarized/paraphrased from:

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. The Guilford Press: New York.
Lihenan, M. M. (1993). Skills training manual for treating borderline personality disorder. The Guilford Press: New York.