Dialectical behavior therapy group information

The Wayne State Psychology Clinic currently offers a dialectical behavior therapy (DBT) skills group for individuals experiencing extensive problems with emotion dysregulation. The DBT group focuses on learning specific adaptive skills and is modeled after Marsha Linehan’s successful intervention. This group should not be considered an alternative to individual therapy; rather the group serves as a structured adjunct treatment.

DBT skills group is divided into three modules: interpersonal effectiveness, emotion regulation and distress tolerance. Each module focuses on learning new skills, as well as building on the skills learned in previous modules. The beginning of each module focuses on core mindfulness skills followed by the respective module theme. Modules are aimed at decreasing emotion dysregulation and increase coping with emotionally challenging situations. Group sessions last two hours and include time spent reviewing members’ homework, providing feedback and learning new skills.

Weekly groups are offered on Tuesdays and Thursdays from 5:45 to 7:45 p.m.

The groups typically contain six to eight members, with three doctoral students serving as a leader, co-leader and assistant. The group leaders are clinical psychology doctoral students who are supervised by Dr. Marla Bartoi. All of the leaders have received training in DBT.

New members join at the beginning of each module. On average, it takes six to eight months to complete all three modules. Since this is an adjunct to individual treatment, all members are required to have an individual therapist that they meet with on at least a biweekly basis throughout their term in the skills group. When an opening in a group is expected, potential group members will be contacted to begin their preferred group.

What is dialectical behavior therapy?

Dialectic refers to holding two opposite thoughts in your mind at the same time, such as change and acceptance. The purpose of DBT is to learn new (healthy) coping skills to manage problematic behaviors and to decrease the frequency and duration of such behaviors and symptoms. Examples of problematic behaviors and symptoms include relationship chaos, labile emotions, impulsiveness and confusing thoughts and self/others.

There are four DBT themes covered three modules:

• Mindfulness: How to be present, in the moment, and attuned to the thoughts and feelings you are experiencing.
• Distress tolerance: How to tolerate crisis situations without making it worse.
• Emotion regulation: Learning how to regulate/stabilize emotions without under or overreacting.
• Interpersonal effectiveness: Learning how to meet your objectives in relationships without compromising your or others’ self-respect.

• Guidelines for DBT skills group
  • Attendance
    • Clients who drop out of skills group are out of the skills group for that module. They may be eligible to enroll in future modules if deemed appropriate by clinic staff.
    • If a client misses three sessions within a module, they're ineligible to complete that module (i.e., they may not attend further sessions in the module). They may be eligible to enroll in future modules if deemed appropriate by clinic staff. Missing 45 to 90 minutes will count as a half absence. Missing more than 90 minutes of a session will count as a full absence.
    • Clients may attend a maximum of two sets of modules (for a total of six modules), which typically takes a little over one year. Following the completion of two sets of modules, clients may only enroll in additional modules if deemed appropriate by clinic staff.
  • All clients must be in ongoing individual therapy and see their therapist at least twice per month (required minimum). Our group is skill-focused and is therefore unable to address crises or explore important personal topics. As such, it's important to have an individual therapist who can speak to such issues.
  • Clients are not to come under the influence of drugs or alcohol.
  • Clients are not to discuss past self-injury with other clients outside of sessions. During skills group, no details of past trauma and self-injury should be shared.
  • Clients who call one another for help when feeling suicidal must be willing to accept help from the person called.
  • Information obtained during sessions, as well as the names of clients, must remain confidential. There are two exceptions to this rule: (1) feel free to discuss the group with your individual therapist (although please use first names only), and (2) if you're worried about another group member’s safety, it's appropriate to seek help and professional assistance.
  • Please arrive to the group on time. Clients who are going to be late or miss a session should call ahead of time. A client who is 45 minutes late to group will have a ½ session-recorded absence. A client who is more than 90 minutes late will have a full recorded absence.
  • Clients may not form private relationships with other group members outside of skills group. “Private” reflects activities that clients would not be comfortable sharing with the rest of the group. This also includes refraining from seeking outside information (online or otherwise) about other group members or group leaders.
  • Sexual partners may not be in skills training together.
  • Please be respectful of others and keep phones put away during group. Please make every effort to watch language and to be sensitive to one another’s diversity.
  • Please ask permission before touching others.
  • If the group leaders receive four calls from members unable to attend group because of road/weather conditions, you'll receive a call that group is canceled. Additionally, the group will not be held if Wayne State University closes. Please check the wayne.edu for closures.
  • From time to time, the group marks an occasion by sharing snacks together (e.g., goodbyes for group members, leaders). Should you wish to contribute, please do not spend more than $5 on whatever you bring.
  • Payment for the group is expected in full at the first session. We understand that this may be a hardship for some clients, however, an outstanding balance by the end of the module will preclude the client’s eligibility to return for the next module.
  • Sessions held by Zoom will not be recorded by the clinicians. All group members are prohibited from recording group sessions, taking screen captures, etc.
  • In order to participate in DBT sessions via Zoom, you must be able to call in from a private location that ensures nothing discussed in group will be seen or overheard by non-members. We strongly encourage the use of headphones for individuals not living alone.
  • During Zoom sessions, if a client feels that they are having trouble coping or feel that they crucially need to communicate something privately to one of the clinicians, they can use the private “chat” function.
• Some thoughts on “homework”
  • Please do it! Homework is your means to learn and grow, and it will help you use these skills in your daily life. In addition, the group benefits from your experience with the homework. You can offer insights into what you learned from the homework and provide better feedback to other group members.
  • If you did not do the homework, please do not attempt to complete it during group. We will help you to create an example so that you can practice using the homework skill in group. You're welcome to turn in the homework the following week for comments from the group leaders.
  • Please use the homework and feedback time as an opportunity to focus your attention and practice mindfulness skills. It’s an excellent opportunity to tune in, listen, and be one-mindful of others’ experiences. In addition, listening attentively is respectful to the person who is speaking and will help you to provide better feedback. As a side note, please refrain from engaging in distracting behaviors during homework and feedback time.
• Giving feedback
  • Think about feedback you have received that you found valuable.
  • Be descriptive rather than deciding something is just good or bad.
    • For example: It seems that whenever your sister says something critical to you, you first want to hurt yourself but then you practice wise mind and distraction and can keep yourself safe.
    • Try using your observing and describing skills from the mindfulness module.
  • Be specific rather than general (like above).
  • Think lean and precise when giving feedback!
  • Be constructive and directed toward changeable behavior.
    • Example: ideas about skills to try; hints on how to implement the skill; a pat on the back “Good job. I think it was great that you…”; something you liked about how they used a skill; a respectful challenge… one that motivates the member in the use of the skill.”
  • Relate feedback to skills we are learning or have learned.
  • Be balanced in feedback. It is important to offer comments on what is working well as well as what needs further work.
• Getting feedback

  It's critical that you learn how to receive feedback so you can grow and learn.

  Tips:

  • Breathe.
  • Say “thank you” if you feel you can.
  • Ask for clarification if you need it.
  • Avoid explaining and defending (e.g., "yes…but…").
  • Even if what the person says is in some ways inaccurate or off the mark, try to look for the “grain of truth” in what they said
  • Group is an opportunity to learn about how others see you. Members may be willing to tell you things that others would not. Think of feedback as a resource.
• Hammer metaphor

  Receiving feedback is like getting a hammer. When you're given a hammer, you have a choice of what you can do with it. You can:

  • Beat yourself up with it.
  • Beat up the person who gave it to you.
  • Throw it away.
  • Put it in a drawer to use later when you might need it.
  • Use it now to build yourself as a person.