DBT Skills Training Concepts and Strategies

When a client states they are leaving therapy, a skill trainer may offer a referral and ensure the client has an avenue to continue their journey.

DBT trainers act as consultants to the client, not to other therapists or external parties involved in the client's care.

DBT assumes that clients have the ability to communicate and mediate between various therapists and health care providers within their support system.

In DBT, a skills trainer actively takes on a parental role or assumes clients lack communication skills.

When safety is paramount or a client is unable to effectively communicate with their support network, skills trainers may employ environmental intervention strategies instead of solely consulting with the client.

Irreverence, or a lack of seriousness, can be used effectively during individual skills training but requires caution in group settings due to potential unintended impact.

Skills trainers should monitor the immediate effects of irreverence and be prepared to address any negative reactions.

Skills trainers gain comfort using irreverence with clients as they become more familiar with their responses and dynamics.

If a client engages in self-injury during or after a group meeting, the skills trainer assesses the potential medical risk and ensures the client receives necessary medical treatment.

The skills trainer determines whether the client can seek medical help independently.

If the self-injury poses a medical emergency, the skills trainer calls emergency services immediately.

The skills trainer maintains contact with the client until help arrives to ensure their safety.

The skills trainer informs the client's individual therapist (if they have one) about the incident.

If the medical risk is low, the skills trainer instructs the client to seek medical attention if necessary and to contact their individual therapist.

Skills trainers should encourage group participation without overwhelming members.

Leaders should be mindful of reaching out to members who withdraw, but avoid creating dependency.

A group leader's withdrawal from a group member can lead to further withdrawal and potential dropout by the member.

Directly addressing issues in group sessions can be challenging and unhelpful as a first step, as it may feel threatening and not address the root cause.

A leader's inaction can be a sign of frustration and lack of motivation to keep a member in the group.

Having a second leader can help address issues, especially when one leader might be struggling with a certain group member.

Leaders should be mindful of their own judgments and avoid letting hostility impact their approach to the group.

Empathy and compassion are crucial in group leadership, especially when dealing with group members who may be withdrawn or struggling.

Sharing frustrations with the DBT team can provide valuable insights and support during challenging group dynamics.

Information gathered from individual therapy sessions can be invaluable in understanding the group's difficulties.

Relating a specific client issue to broader concerns that multiple people face, both within and outside the group, to help everyone feel seen and understood, and to promote generalization of skills.

A strategy in DBT that recognizes that clients may be initially unaware that a discussion applies to them but allows for them to gain insights later, avoiding direct confrontation.

The process of using strategies and techniques to address the identified problem through discussion and skill-building activities.

A specific DBT strategy that prompts clients to consider the underlying reasons or patterns causing their current difficulties.

Applying learned skills and insights from the group context to real-life situations beyond the group session.

When group members' interpersonal issues mirror their personal struggles outside therapy, skills trainers should address the similarities.

Clients with emotion dysregulation often face heightened sensitivity to criticism, leading to intense shame.

Clients with intense shame may struggle to regulate their emotions, especially when discussing difficult situations.

When a client's conflict with a loved one is the main focus, skills trainers should emphasize their own skill development, not changing the other person.

Clients may believe their efforts are insufficient or have blind spots about their own behavior when their loved ones' actions cause them distress.

Skills trainers should be persistent in reminding clients that the focus should be on developing their skills, even when clients try to shift attention to others.

When a client's personal struggles spill into the group therapy setting, skills trainers must be prepared to address them directly.

Actively plan for how skills learned in therapy will be applied in real-life situations.

Clients often experience initial resistance and discomfort during group training, particularly when participation is mandatory. This feeling is likened to navigating quicksand, requiring significant effort to make progress.

Conflict in DBT groups can arise from procedural issues, such as differing preferences for environment (e.g., window curtains). These conflicts can be addressed through group discussion mediated by a leader, similar to a parent managing children's squabbles.

A leader's role in managing conflict is to remain impartial, respecting the individual needs of each member without sacrificing one for the collective benefit.

The most challenging conflict in DBT group training can occur between the two leaders. A smooth working relationship between them is essential for the group's success.

Many pre-existing personal challenges can manifest in the DBT group setting, such as difficulties with authority figures, communication, or admitting progress.

Clients' personal issues, particularly those involving families, can resurface and become problematic in the group environment.

Clients may experience difficulties completing homework, admitting to progress or lack thereof, or utilizing skills effectively due to existing personal challenges.

The public nature of the group setting can intensify existing problems, making it crucial to maintain a supportive and non-judgmental environment.