Insight-oriented therapy helps our students learn about themselves and have a deeper understanding ofwhat needs to change. Yet most people struggle to convert insight into action. DBT helps our students translate their insight into concrete skills to change behavior.
What is DBT? Dialectical Behavioral Therapy (DBT) provides a bridge between our clinical and residential programs at La Europa. DBT is both a philosophy to help view students' challenges from a functional, strength-based perspective and a structure that helps staff move students toward positive change.
The DBT philosophy is based on a dialectic frame of reference. A "dialectic" is a tension between two points of view that appear to be in opposition and in which there is no "right" answer. For example, in residential treatment, a dialectical dilemma occurs between providing enough structure for the students to help them "contain" their emotions and behavior but enough freedom for them to safely explore, grow and practice new skills. A dialectical approach to therapy means that the treating professionals are attempting to create a synthesis between the students' need to change and their need to accept themselves. This approach is important for helping the treatment team and the student not get stuck in a negative cycle of behavior but rather focusing attention on understanding behavior, recognizing incremental positive changes and moving forward.
Why is DBT helpful? The behavioral aspects of DBT help students learn to break behaviors down into\ smaller action steps and identify and practice effective skills to manage behavior and emotions. The structure of DBT increases the students' chances of effectively transitioning home by providing practical, in-the-moment understanding of how to use skillful behavior and translate insight gained in therapy into action!
How does La Europa Academy use DBT? The following DBT components are used at La Europa:
- DBT Skills Group: Students are taught and practice the four DBT skills of mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness. Staff are trained to coach students in skill use on a daily basis.
- Diary Cards: When students are on levels 1 through 4, they complete a daily diary card to help gain awareness about certain behaviors they are working to change and feelings they are learning to manage more skillfully. Diary cards are reviewed by residential staff and therapists each week and discussed with students.
- Mindfulness Group: Students attend a DBT mindfulness group in which they have an opportunity to practice mindfulness skills in a more concentrated format. Mindfulness is a core DBT skill because it fosters the awareness of thoughts, feelings and behavior necessary to make changes.
- Behavioral Chain Analysis: When a student is struggling to extinguish an ineffective behavior, a behavioral analysis is undertaken with the student's therapist to help the student identify triggers, thoughts and feelings perpetuating the behavior. This helps the student and therapist see where new skills may be applied or other changes made to provide the student with more options for engaging in effective behavior. Insights gleaned from Behavioral Analysis are shared with the residential team so that interventions can occur in conjunction with behavior in the moment. (we could put a picture of a typical chain analysis)
- DBT Coaching Group: This intervention is done when a student is experiencing difficulty extinguishing behaviors and moving forward in treatment. The student meets with the clinical director, their therapist and members of the residential team in order to receive additional support. During these meetings, the student establishes specific things she wants to work on and the team validates and supports the student in increased skill use.
- Staff Shift Reports: Residential staff complete an electronic questionnaire about each student after every shift. This questionnaire allows the staff to rate students' emotional dysregulation during shift, the students' use of skills, students' ineffective coping strategies and anything else that is a target of change for parents and therapist. This electronic shift report converts easily into graphs showing parents the students' progress from week to week.
- Therapeutic Interfering Behavior: Students and treatment team identify therapy interfering behaviors that are keeping the student from fully benefiting from therapy and focus on these behaviors. Students identify weekly targets to help them understand and extinguish therapy interfering behaviors.
- DBT Parent Support Group: We offer a DBT Parent Support Group that meets via webinar every other week for parents to learn about DBT and practice using DBT interventions while getting support from other parents.