DBT SKILLS GROUPS

1.The primary goal of the DBT Skills Groups is to learn new skills and to support the generalization of these skills to participants’ lives outside of group. This is to help participants to become more effective in reaching their long-term personal goals.

2.This is primarily an educational/support group and not a process group.

a.Participants are here primarily for themselves and should not have to feel like they have to take care of others.

b.We encourage “I statements.”

c.We discourage direct advice giving.

e.We discourage “private relationships.”

In order to maximize the group’s effectiveness and each individual’s skill acquisition, we agree to pursue the following goals:
  1. If a participant is not a consistent group member, they will miss out on learning skills. Therefore it is important that participants agree to make every effort to attend all skills groups. Because the groups begin with a mindfulness meditation, it is important that members show up on time, in order not to miss this essential component of group. Participants also agree to attempt to apply distress tolerance skills in order to stay in the room as long as possible and not leave the room unless absolutely necessary.
  1. Often group brings up issues that a member might want to avoid by mentally checking out. However, it is important that group members agree to try to stay mentally in the room as much as possible. In particular, group members agree to try to reduce dissociation over time, as well as use skills to shorten times when they may become emotionally overwhelmed in group. Use of prescription or over the counter drugs that result in a participant’s being mentally “out of it” during group can make learning skills difficult. If this is a consistent problem, it is important to trouble shoot this with the participant’s prescribing MD.
  1. Skills can often be a struggle to learn, especially during emotionally hard times. However, a willing attitude to try something new is an important goal to strive for in order to support successful skill acquisition. In particular, it is important that participants agree to be willing to use skills, even when under distress. This is when skill acquisition is most difficult but also most rewarding, because if you can use a skill when in distress, then you have a powerful tool to help you reach your long-term goals. In addition, participants need to be willing to do the homework as assigned, weekly skills cards, and weekly chain analysis. These are the group’s main tools for skill acquisition.

Another important aspect of a willing attitude is to realize that being constantly stuck in “I can’t,” or “I won’t’” or “It’s too hard” can be part of a long-term problem in making life changes. While we all get stuck in these places occasionally, participants agree to target such moments as opportunities for using skills, in order to attempt to shift to a more useful and often less painful stance of willingness.

Also a part of an overall willing attitude is to agree to be generally supportive of others in the group and DBT. Lastly, it is important to realize that group leaders are human too and that alienation of group leaders can reduce their willingness to be of help and reduce group effectiveness.

In any particular group, members and leaders are trying to balance…

Mindfulness Principles – ACCEPTANCE

1.Entire class is a mindfulness practice.

2.Whatever happens in group presents an opportunity to grow and practice mindfulness skills.

Behavioral Principles - CHANGE

Reinforce adaptive behavior

1.Reinforce skills acquisition and generalization.

2.Support using skills in group to increase coping behavior in the here and now.

3.Reinforce individual behavior that will lead to skill acquisition.

4.Reinforce group behavior that will lead to skill acquisition.

Extinguish and do not reinforce maladaptive behaviors

1.Behaviors that inhibit individual skill acquisition.

2.Behaviors that inhibit or hinder the group’s ability to learn skills.

Behaviors that get in the way of attaining participants’ goals…

Therapy Interfering Behaviors (behaviors that affect only the individual)

1.Not showing up on time.

2.Not doing homework, etc.

3.Not being mentally present.

4.Not being willing to learn or participate.

Protocol for Therapy Interfering Behaviors

Therapy interfering behaviors are usually dealt with by targeting the behaviors and performing chain analyses on the behaviors either in group or in individual therapy.

Group Interfering Behaviors(individual behaviors that affect the group)

1.Physically threatening or abusive behavior to others.

2.Verbally threatening or abusive behavior to others.

3.Generally disruptive behavior.

a.Constantly interrupting, talking over, multiple conversations, etc.

b.Being overly distracting during group (excessive and disruptive noise, movement, etc.)

c.Overly monopolizing group time.

d.Self-harm behavior.

Protocol for Group Interfering Behaviors

1.There is a zero tolerance policy for physically threatening behaviors. A threatening participant will be asked to leave the group immediately. Readmission to group will depend upon obtaining permission from group leaders.

2.There is a zero tolerance policy for verbally threatening behavior. A threatening participant will be asked to leave the group immediately. Readmission to group will depend upon obtaining permission from group leaders.

3.If a participant’s behavior is excessively disruptive to the group, the individual will be asked to attempt to use skills to stop the behavior. If the participant cannot stop the behavior, they will be asked to leave the group for that day. A chain analysis must be done on the behavior and reviewed with their individual therapist.

4.If a participant self harms during the group and this is brought to the group’s attention, the participant will be asked to leave the group for that day. One of the group leaders will screen the participant outside the group to see if there needs to be an immediate hospitalization. This will be an extremely short interview that focuses on that one issue only. If the participant is not hospitalized, the participant will need to conduct a chain analysis on the self-harm behavior and discuss it with their individual therapist before returning to the group.

Skills Group Leader Availability Outside of Group

1.Skills group leaders will be available for a brief meeting before or after group, by appointment, to discuss any problems regarding group.

2.Skills group leaders are available by phone in order to clarify any skills questions or to give out homework assignments in case of a missed group. Leaders will attempt to return any calls within 24 hours.

DBT GROUP RULES

1. The communications in group are confidential. Do not tell others outside of group what group members have discussed or disclose the names of group members.

  1. The exceptions to confidentiality for group therapists include:
  1. You are suicidal or homicidal.
  2. You discuss child or elder abuse currently or in the past.
  3. You discuss substance use that poses a health or medical risk.
  4. We are issued a court order.
  5. You discuss eating disorder behaviors that pose a health or medical risk.
  1. Do not attend group under the influence of substances.
  1. Avoid discussions (war stories) that glamorize dangerous or risky behaviors that encourage violence or substance use, or that support harm to oneself or others.
  1. Refrain from sexist, racist, and homophobic language.
  1. Please call (925) 680-1844 or (925) 314-6354 if you are unable to attend group.

9. Client who call one another for help when feeling suicidal must be willing to accept help from the persons called.