• Dialectical Behavior Therapy

    DBT IOP

    Structure and Design

    1. The DBT IOP is located at our Macklind office where each two hour group DBT IOP session occurs four times a week; from 4PM – 6PM on Mondays – Thursdays
    2. Each client meets with their primary therapist weekly
    3. Sessions with a psychiatrist are available through the Institute; these are not included in the DBT IOP and must be scheduled and billed through insurance separately
    4. Family sessions may also be recommended
    5. All professional appointments need to be scheduled outside of the DBT IOP program hours; in order to avoid missing group.

    DBT Intensive Outpatient Program Group Schedule

    Monday 4-6 PMTuesday 4-6 PMWednesday 4-6PMThursday 4-6PM
    Check In

    Mindfulness

    Assumptions

    Goal Setting

    Homework Review

    Break

    Interpersonal Effectiveness skills teaching

    Homework assignment

    Check In

    Mindfulness

    Homework Review

    Break

    Distress Tolerance skills teaching

    Homework assignment

    Check In

    Mindfulness

    Homework Review

    Break

    Emotion Regulation skills teaching

    Homework assignment

    Check In

    Mindfulness

    Weekend Planning

    Break

    Schema Therapy

    Other Topics

    *  Resilience

    *  Relapse Prevention

    * Cognitive Restructuring  

    DBT IOP Skills Training Schedule

    WeekInterpersonal EffectivenessDistress Tolerance  Emotion Regulation
    1Introduction

    Factors that Interfere

    Myths

    Obtaining Objectives

    Clarifying Goals

    Introduction

    STOP

    Pros/Cons

    TIP

    Introduction

    What Emotions Do

    What Makes It Hard To Regulate

    2DEAR MAN

    GIVE

    Distracting

    Self-Soothing

    Model for Describing Emotions

    Myths About Emotions

    Ways To Describe Emotions

    3FAST

    How to Ask or Say No

    Factors to Consider

    Improve the MomentCheck the Facts
    4Troubleshooting

    People to Like You

    Mindfulness of Others

    Radical Acceptance

    Turn the Mind

    Opposite Action

    Problem Solving

    5Ending Relationships

    Walking the Middle Path

     

    Willingness,

    Half Smile

    Willing Hands

    Accumulate Positives

    Values

    6Validation

    Recovering From Invalidation

    Increasing/Decreasing Behaviors

     

    Mindfulness of Current ThoughtsBuild Mastery

    Cope Ahead

    PLEASE

    Sleep Hygiene

    Managing Really Difficult Emotions

    Optional Topics   Paired Muscle Relaxation, Body Scan Mediation, Sensory Awareness, Dialectic Abstinence, Clear Mind, Burn Bridges, Alternate Rebellion, Adaptive DenialMindfulness of Emotions

    Troubleshooting & Review

    Individual Psychotherapy

    DBT IOP clients use individual therapy sessions to apply the skills learned in group to the individual’s life challenges.

    While participating in the DBT IOP program, clients are expected to work with a DBT IOP therapist at least once a week.  Clients are responsible for scheduling these appointments.  With the client’s permission, we will provide treatment updates to outpatient clinicians and collaborate on discharge planning.  We can also assist clients in selecting a DBT therapist to work with after discharge.

    Individual DBT therapy follows a hierarchical approach to problems; this may feel different than types of therapy that encourage clients to speak about ‘whatever is on your mind’.  Session time, in DBT, is used to address problems in the following order:

    Tier 1:  Life-threatening problems such as suicide ideation, life-threatening behaviors, etc.  Also, self-injurious behavior.

    Tier 2:  Therapy-interfering behaviors on the client’s part or the client’s therapist’s part, including urges to quit therapy, willfulness about completing homework assignments, missing session, not feeling understood by the therapist, etc.

    Tier 3:  Quality of life-interfering behaviors or conditions, like mood disorders, substance abuse, eating disorders, anxiety disorders, serious interpersonal conflict, etc.

    Tier 4:  Increasing behavioral skills.

    Tier 5:  Creating a life worth living.

    The hierarchy serves to guide treatment, prioritize the most pressing problems, and ensure that one problem is focused on long enough to make progress (versus discussing a different crisis each session).  Thus, the therapist may conclude that discussing a recent episode of self-injury, for example, is a more pressing use of therapy time than discussing a fight with a significant other, even though the latter may be more distressing to the client.

    Diary Cards

    A required component of treatment is filling out a diary card daily.  This is a form of self-monitoring; helps clients become more mindful of thoughts, emotions, and behaviors which is necessary to change them.  Clients are asked to fill out a double-sided diary card on which they track both the emotions and problem behaviors they are trying to change, as well as the skills they are using daily.  Diary cards are a way of tracking progress and identifying issues to be addressed in therapy.

    After Discharge

    Upon completing the DBT IOP, an aftercare plan will be developed with your DBT IOP primary therapist. Nearly always, additional outpatient treatment is recommended in order to further develop coping skills and progress further to live the life you really want to be living.

    Outpatient DBT skills groups are available at the Institute. It is impossible to fully understand and apply the skills taught after being introduced to them once. Repeated exposure and practice using them is necessary to maximize their effectiveness in their lives.

    Individual psychotherapy of some kind is usually recommended. If you have been working with a therapist prior to entering the DBT IOP, we would encourage you to return to them. The Institute has many highly qualified clinicians from a variety of disciplines available work with after discharge.