The Initial Session
The initial session, which may require two or three sessions,
will consist of two parts: The first part will include completion
of a structured history.
The second part of the initial evaluation will be a clinical
interview. This interview offers an opportunity for the clinician
to determine if the patient is likely to benefit from the program
and gives the patient an opportunity to determine if he or she
thinks the program will help meet his/her goals. If a decision
is made to proceed then goals, as defined by the patient, 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 for Skills Training
Group will be reviewed and signed. A determination about the
level of intensity of the program will be made.
Intensity Levels
Level I
The first level provides one individual per week, in addition
to the Skills Training Group. The individual appointment will
range from 50 minutes to 90 minutes. The Skills Training Group
will be 90 to 120 minutes in duration. The length of the Skills
Training Group will depend on the number of participants.
Level 2
The second level of intensity is that of two individual sessions
per week plus Skills Training Group. If more than one Skills
Training Group is being held and it is believed to be clinically
advisable, then a patient may attend more than one Skills Training
Group on either Level I or Level II. Patients at Level 2 will
be moved to Level 2 when it is considered clinically advisable
to do so.
Coaching (Both Level I and Level II)
Phone contact between sessions will be made available to the
patient on an as needed basis and will be determined between
the individual therapist and the patient. Email contact for
nonemergency matters will also be made available as determined
to be clinically appropriate.
Family Contact
When the patient has family members who are closely involved in his/her life,
then a meeting is held with the family members to provide an overview of DBT.
Basic behavior modification principles are discussed (reinforcement of desired
behaviors, etc.) and a reading list is provided.
Program Length
Six months is the time period allotted for this program. Each
patient will be given an opportunity to continue in group as is clinically indicated. Individual therapy will continue after completion
of the 6 months program.
If a patient misses 4 appointments in a row (either Skills Training
Group or individual) then the patient is considered to have terminated
from the program. The patient may request to be readmitted after
one year.
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.
Emergencies are not to be reported through email.
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.
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