The DBT offers an Intensive Outpatient Program consisting of nine hours of therapy per week. Our programs are seven hours of skills training and two hours of individual therapy.

PATHWAYS TO HEALTHY LIVING

ADULT INTENSIVE OUTPATIENT PROGRAM FOR MOOD DYSREGULATION and BORDERLINE PERSONALITY DISORDER

PROGRAM DESCRIPTION

Referrals

Appropriate referrals include individuals with a diagnosis of Borderline Personality Disorder or features of Borderline Personality Disorder, Post Traumatic Stress Disorder, and mood disorders that seriously impair the individual’s functioning, such as Major Depression, Generalized Anxiety Disorder or Bipolar Disorder.. Individuals who are primarily manic are not appropriate for this program. We work with treatment resistance depression. Ages 16 and up will be considered. The program is a voluntary program and will not accept patients who, after the initial evaluation, are not making a commitment to the program. Referrals can be made at any time. Medication evaluation or follow up is not included in the program. Psychiatrists typically follow the patients they refer or a referral is made to a psychiatrist for psychiatric evaluation.

To refer please contact

DBT Center
713-973-2800

Initial Evaluation

The initial evaluation will consist of two parts: The first part will include completion of a structured history. The second part may include one or more of the following:

SCL-90 (Symptom Checklist 90)
Personality Diagnostic Questionnaire-IV
Beck Depression Inventory
MMPI
Millon (MCMI-III)
The second part of the initial evaluation will be a clinical interview. This interview will be conducted using motivational interviewing techniques (Miller, Rollnick and Conforti 2002). Goals will be outlined and a contract for safety (including self mutilation), attendance, and adherence to medications as prescribed will be made. The patient will be given an overview of the program and the ground rules. A written contract will be reviewed and signed.

Five Functions of Comprehensive Treatment

Pathways to Healthy Living is committed to the five functions of comprehensive treatment as developed by Marsha Linehan, Ph.D. The five functions are: To enhance the capabilities of the patients, improve the motivation of the patient, to assure generalization from the treatment program to the patient’s environment, to structure the patient’s environment to help with recovery, and to motivate the therapists working with the patient to use effective treatment strategies. These functions are addressed by our program in the following ways, outlined originally by Dr. Linehan:

Enhance Patients’ Capabilities to Recover
Skills Training
Psychoeducation
Handouts Readings
Pharmacotherapy

Improve Patients’ Motivation to Recover
Contingent Reinforcement
Extinction
Exposure/response prevention
Cognitive modification

Assure Generalization to the Patients’ Natural Environments
After hours/crisis phone coaching
E-mail consultation
Review of session tapes
Homework/practice

Enhance Therapist Capabilities and Motivation to Treat Effectively
Supervision
DBT Consultation Team
Continuing Education
Treatment manuals
Staff incentives

Structure the Patients’ Environment
Contingency management within the treatment program as a whole
Contingency management within the community (family, marital interventions)


Treatment Modalities

Individual DBT
Bibliotherapy
Coaching
Skills Groups
Family and Friends Group


Description of Groups

Skills Training Group

The Skills Training is offered seven hours each week to help the patient learn how to manage a crisis without making it worse and how to manage their emotions so they do not feel overwhelmed by them. The following areas are covered: Mindfulness, Interpersonal Effectiveness, Distress Tolerance, Goal Setting, Chain Analysis, and Emotion Regulation.


Mindfulness Group

Mindfulness is at the core of all the skills learned and therefore is given a strong emphasis in the program. In this group patients learn what mindfulness is, the ways in which many people are not mindful and do not see or accept the world as it is, and ways to being to see reality in a more accurate way. Many Cognitive Behavior Therapy techniques will be discussed here as ways to not cognitively distort what you experience. Mindfulness will address grounding techniques, living in the present, and learning self validation as well.

Interpersonal Effectiveness Group

Often much of the stress for patients comes from relationships with other people or the lack of relationships with others. In this group, issues important to being effective interpersonally will be explored and discussed. Resolving conflicts, setting relationship priorities, learning to say no, learning to ask for what you need, and learning to maintain relationships will be included in the topics.


Behavior Chain Analysis/Self Management Group

Learning how events affect emotions and behavior and how to understand these reactions is one of the goals of this group. In addition the concepts of reinforcement, shaping, extinction, exposure, aversive consequences, modeling, classical conditioning and contingency management will be discussed. The basic problem solving skills of DBT will be the focus of this group.

Goal Setting Group

In this group you how to set goals, monitor goal progress, reviewing and reassessing goals in terms of what works versus failure is addressed. Setting goals for the coming week will be done in this group. These goals become the patient’s personal plan for recovery, one step at a time. You will also review your goals from last week to see what progress you made.

DBT for Family and Friends

One evening each week there is a meeting led by a therapist for family members and friends who support you. When they understand the skills you are learning as well as your illness they can be more supportive of you and the work you are doing.


Individual Sessions

You will meet with your individual therapist twice weekly. In these sessions, you will learn about the Biosocial Theory, address any self harm urges, therapy interfering behavior, and quality of life interfering behavior. Your diary card will be reviewed and areas of concern addressed according to the problem solving options you are learning. In your individual sessions you will have the opportunity to apply the skills you are learning in group to your unique situation and learn and apply problem solving options (skills, behavior analysis, insight or pattern highlighting, solution analysis, cognitive modification, contingency management, exposure therapy or opposite action) to help you improve your ability to manage your life stresses.


Skills Coaching

Skills Coaching is provided by your individual therapist to help you think about and use the skills that you are learning. You will work out how to get skills coaching with your individual therapist. Phone contact and email (for nonemergency situations) between sessions will be made available on an as needed basis and will be determined between the individual therapist and the patient.


Program Length

The anticipated length of treatment is 8 to 12 weeks.

Generalization of Skills

Phone and/or email contact between sessions will be made available to the patient and discussed between the patient and the individual therapist. The goal of the phone contact is to help the patient apply the coping skills being learned outside of the therapy sessions. This interaction is handled according to the guidelines set forth by Linehan (1993) in order to focus on increasing independent, not dependent, functioning on the part of the patient.

Homework (practicing the skill being learned) will be emphasized. Homework diary cards will be collected each week. Homework will be reviewed by both the group and the individual therapist. Practice of the skills being learned is believed to be a major criterion of who benefits from the program and is thus emphasized repeatedly.

Tapes and/or Videotapes of the Skills Training Modules will be made available to the patients for review between sessions. Handouts concerning all the skills will be given during the group sessions and a patient handbook concerning the DBT skills will be given to each patient. Reference materials and books will be made available as well.


Aftercare
An aftercare group will be available. Aftercare is seen as transition to once weekly psychotherapy. Tapes, videos and books will continue to be used. Part of the program includes developing more social support in the community and assisting the patient with being willing to seek and utilize community opportunities as available and appropriate.

If the patient is from out of town, efforts will be made to seek resources in the hometown prior to discharge. In addition, email and phone consultation will still be made available during the transition.