Dialectical Behaviour Therapy
Context
Deliberate self-harm tends to be a secretive behaviour which is usually only disclosed when considerable trust has developed. The need for specific treatment will not always be established at the first stages. Only a limited number of interventions, namely Dialectical Behavioural Therapy, currently hold evidence as an effective treatment for such difficulties.
Reliable and trusting relationships with the team are essential to creating a sense of security and continuity for the young person. The underlying personality of the young person will be an important target to the intervention.
A Full Dialectical Behavioural Therapy programme (DBT) is available at the Bear Project YPT. The programme is led by Heli Sarin-Yates who is an experienced DBT therapist.
The therapy consists of three parts: weekly individual therapy/skills session (60 minutes), the frequency of these sessions can vary in agreement with the young person, and telephone coaching when this has been actioned.
During the individual therapy session a diary card is used to analyse the week and any negative behaviours that there may have been. There is an expectation that the diary card is filled in on a daily basis. The diary card should indicate any negative behaviours or urges that there may have been, and these actions or action urges are analysed, trying to find patterns and triggers that lead to negative behaviours. We also practice skills learnt in the skills group.
Who can be helped by DBT
DBT has a range of indications including deliberate self harm, however it is also indicated in individuals with very deregulated emotions namely when these lead to problematic behaviours, posing either a harm to themself or to others. Such problem behaviours include substance misuse behaviours particularly when these represent a maladaptive behaviour compensating for an underlying emotional predicament.
The aim of the intervention is to help young people managing difficult emotional dilemmas, express these in a safe and effective way without using negative coping methods. Underlying negative emotions can include anger, episodic depression, irritability and anxiety, chaotic relationship patterns, impulsivity or stress...
Structure of therapy
The skills work is based on four different modules: Mindfulness, Interpersonal effectiveness, Distress tolerance and Emotion regulation.
• Mindfulness teaches how to focus mind and attention to be able to live in the moment. We talk about different states of mind (this module is for 2 weeks).
• Distress tolerance helps to fight the crises and accept the current situation and to tolerate difficult moments without acting on them. We teach strategies and coping skills to distract the mind in crisis.
• Emotion regulation includes learning and labelling emotions, reducing emotional reactivity, increasing positive emotions and how to change emotions.
• Interpersonal Effectiveness teaches people skills; how to build and maintain relationships, how to cope with interpersonal conflicts, how to ask what you need and how to say no.
Telephone coaching is live coaching in a situation where there are attempts made to use skills however the situation is difficult to manage. The therapist can help by suggesting skills, by suggesting how to use the skills differently, and by developing strategies, together with the young person, in how to cope without using negative behaviours. Telephone coaching can only be accessed when there are efforts are being made to cope, and no identified negative behaviours such as self-harm or drug abuse have been used.
We introduce new skills every week and homework is given to be completed for the next session. The goal is for the young person to learn new skills and to be able to cope with any challenges that life may bring.