Tips for Clinicians Using Dialectical Behavior Therapy

TIPS FOR CLINICIANS USING DBT

Be clear with patients and their families about what type of "DBT treatment" is being offered

■ Comprehensive DBT always involves multifamily skills group, weekly individual psychotherapy based on DBT principles, diary cards, between session coaching calls, and a DBT consultation team for the therapist

■ If all elements are not being offered, clarify this and label the treatment as "modified DBT" or another caveat of your choice (if patients and families don't understand the difference, they may think that DBT "doesn't work when, in fact, they've never had comprehensive DBT as it was created)

Many clinicians hesitate to use coaching calls; however, when patients are well-trained in how to use calls effectively, and parameters are set in advance, the use of coaching calls can actually decrease the clinician's workload

■ Keep the call short (5 to 15 minutes)

■ Train the patient (through repeated discussion, role-play, rehearsal, validation, shaping, and other behavioral techniques) to call only when he or she is committed to stopping or preventing the problem behavior

■ Encourage "good news" calls; this helps reinforce positive coping, keeps the alliance strong, and keeps both adolescent and clinician motivated

■ During the call, patients should clearly identify the problem and be open to using collaboratively identified skills   

An adolescent patient must voluntarily agree to treatment. However, the clinician and family use environmental contingencies to motivate the patient to agree to DBT commitments (eg, choice within limits, absence of alternatives, pros and cons, and devil's advocate)

■ Take your time to obtain full commitment from the adolescent and family and fully elaborate the adolescent's "life worth living" plan and current targets of treatment. Many problems that arise in the treatment can be traced to an incomplete commitment-setting phase

For more on this topic, please see "Treating Adolescent Depression With Psychotherapy: The Three Ts," from which this Tipsheet was adapted.

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