New Employee Training in Dialectical Behavior Therapy Created by Shannon Olson Dialectical Behavior Therapy Specialist for The Larkin Center

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New Employee Training in Dialectical Behavior Therapy Created by Shannon Olson Dialectical Behavior Therapy Specialist for The Larkin Center Slide 2 July 13, 2007Created by Shannon Olson 847-695-5656 x269 A Life Worth Living This is the ultimate goal of Dialectical Behavior Therapy. It is the goal of every client and therapist(s) working together as a collaborative team and we are all therapists. To do this we must start with why Larkin chose DBT and the assumptions DBT makes about both the client and therapy. Then we will go through the Biosocial Theory and what that means for us. Review what dialectics are and how DBT uses them. Next we will review Levels of Disorder and what they are for. Finally we will go over each of the 4 skills that DBT teaches and why we teach them! Slide 3 July 13, 2007Created by Shannon Olson 847-695-5656 x269 Why are we all about DBT? Prior to Dialectical Behavior Therapy as a treatment approach, the majority of our clients had been behavior disordered and now the majority are mentally ill clients with behavioral problems and our B.D. approach was no longer working. Also, Larkin believes that the residential therapist is the lead for each of their 5 individual clients. However, therapists are trained differently and can direct the treatment team in a number of ways. This made life very confusing and frustrating for child care workers, activity therapists, case managers and even case workers. Not to mention the other clients on the unit! This confusion limited our ability to give treatment as a team, which led to a lack of unity and support. This led to staff burnout and we became less effective to meet the needs of our clients. DBT is a research proven model that gives us practical tools (the skills) to teach our clients and a universal way of interacting with them that reduces power struggles, treatment refusal, hospitalization and physical restraints. We as a treatment team have a common language and understanding as well as a plan of attack for providing clients with the best treatment. Slide 4 July 13, 2007Created by Shannon Olson 847-695-5656 x269 I Thought Assumptions Made An? DBT understands that every person has a personal set of values, beliefs and perspectives. When so many different people come from so many different places it can send clients scurrying for cover because no one can agree on anything! In DBT, assumptions are about ONE belief system or perspective from which we approach each client. It is from this foundation that all treatment must stem. Otherwise we fail and so does DBT and the one who loses is the client. Slide 5 July 13, 2007Created by Shannon Olson 847-695-5656 x269 DBT Assumptions about Clients Clients are doing the best they can in the moment. Clients want to improve. Clients must learn new behaviors in all relevant contexts. Clients cannot fail in DBT. Clients may not have caused all of their own problems, but they have to solve them anyway. Clients need to do better, try harder and/or be more motivated to change. The lives of clients are unbearable as they are currently being lived. Slide 6 July 13, 2007Created by Shannon Olson 847-695-5656 x269 DBT Assumptions about Therapy The most caring things a therapist can do is help the client in ways that bring them closer to their own ultimate goals. Clarity, precision, and compassion are of the utmost importance in the conduct of DBT. The therapeutic relationship is a real relationship between equals. Principles of behavior are universal, affecting therapists no less than clients. DBT therapists can fail. DBT can fail even when the therapists do not. Therapists treating clients need support. Slide 7 July 13, 2007Created by Shannon Olson 847-695-5656 x269 Biosocial Theory At its core Biosocial Theory takes each individuals environment and genetic make up, and puts them together to paint the full picture of each person in order for us to know where they are coming from, what skills they already have and which skills they still need to learn. Slide 8 July 13, 2007Created by Shannon Olson 847-695-5656 x269 The Biology Of Us Bio (of biosocial) is the nature part. The deficits we are born with. DBT says that there is a biological vulnerability to emotions: High sensitivity to emotions High reactivity to emotions Slow return to baseline, or normal As well as an inability to successfully regulate emotions This can be caused by a vast number of reasons, like: Fetal Alcohol Syndrome, mental retardation, genetic disorders and diseases, poor or no prenatal care, maternal addictions, history of family mental illness, birth defects, etc. The list is long for what could go wrong before we are even born! Slide 9 July 13, 2007Created by Shannon Olson 847-695-5656 x269 How we are loved can determine how we grow Nurture is all about the environment we grow up in. This is the social part of biosocial theory. Many times for our clients theres a poor fit between the person and the environment. DBT calls that poor fit the Invalidating Environment, which tells us that what is being felt, thought or done is inaccurate, inappropriate, or wrong. That environment often rejects, punishes and makes them feel less than- and then Our clients may begin to tell themselves the very same things! Slide 10 July 13, 2007Created by Shannon Olson 847-695-5656 x269 Go Slow and Be Kind So we take our time to get to know each client because we want to know them and their unique story. It is with this story that we will be able to figure out, with them, what they want and need. That will allow us to provide the best treatment possible. Slide 11 July 13, 2007Created by Shannon Olson 847-695-5656 x269 Dialectics in DBT Dialectics means 2 points-of-view that appear opposite AND can be true at the same time. Guiding Dialectic of DBT : Acceptance and Change Ex: A client is doing the best they can in the moment AND they need to do better. How can we accept the client where they are AND ask them to change? We understand, or validate, what they are doing based on who they are, what theyve been taught or what is in their history AND believe that they must be more skillful to have a better life. Details of Dialectics No absolute truths Always a chance we could be wrong Be open to the possibility Consider the and in every situation Slide 12 July 13, 2007Created by Shannon Olson 847-695-5656 x269 Emotion Vulnerability Verses Self-Invalidation Emotional Vulnerability is on the biological or nature side of Biosocial Theory. It is: Sensitivities that we are born with that make us more vulnerable to being controlled by our emotions Examples: genetic predispositions to mental illness, addictions, illnesses, Fetal Alcohol Syndrome, poor prenatal care, etc. Left, Cuba Gooding Jr. portrays Radio a mentally challenged young man who faces daily discrimination and humiliation at the hands of high school football players until their coach puts an end to it by asking Radio to join the team. Slide 13 July 13, 2007Created by Shannon Olson 847-695-5656 x269 Wouldnt it be nice if Im rubber, Youre glue actually worked? Self-Invalidation is the opposite of Emotion Vulnerability and is on the social or nurture side of the Biosocial Theory. It is: All the times our clients heard that they are stupid, their feelings are wrong or that theyll never amount to anything that build up to the times when they tell those things to themselves. Then it goes from what others tell them to things they tell themselves. Its like that sad saying goes, If you hear something enough you start to believe it. Negative self-talk is Self-Invalidation. Right, Michelle Pfeiffer plays Louanne Johnson in Dangerous Minds. Here she is trying to convince Emilio, her student, that he can change his life but he is convinced that his life is glued to the ghetto and getting out is not an option for him. Sadly, this becomes a self-fulfilling prophecy and he is killed. Slide 14 July 13, 2007Created by Shannon Olson 847-695-5656 x269 Unrelenting Crisis verses Inhibited Experiencing Unrelenting Crisis Life of chaos Difficult things happening one after the other after the other; no break; no rest; no peace. Difficulties may be big or small and all add up and leave them feeling exhausted. By living this way, many times, in order to survive they shut down emotionally and move to the opposite which is inhibited experiencing. Left, Steve Martin in Cheaper by the Dozen, has breakfast with his 12 children. One is trying to capture his runaway pet frog who jumps onto the table and chaos ensues. Slide 15 July 13, 2007Created by Shannon Olson 847-695-5656 x269 If I go numb no one can hurt me, but then I cant feel joy either. Inhibited Experiencing The grieving process that gets stuck before moving through acceptance. We get stuck in anger or depression and shut down emotionally. Without being able to move through acceptance we cant actually move forward. By shutting down one emotion we shut down all of our emotions which can deepen depression. Right, from Batman Begins Christian Bale as Bruce Wayne, revisits his parents graves. A tragedy that happened as a child that he carries with him into adulthood. His depression and pain are clear and his inability to enjoy love makes it certain that he is plagued by Inhibited Experiening. Slide 16 July 13, 2007Created by Shannon Olson 847-695-5656 x269 Active Passivity verses Apparent Competence Active Passivity This is when someone actively works on getting you to meet their needs instead of doing it themselves. The passivity comes into play when the persons needs are met by the actions of someone else instead of their own. Left, Bagger Vances (Will Smith) arrival into Rannulph Junnahs (Matt Damon) world completely alters the course of his life in The Legend of Baggar Vance. Junnah leaves behind his lady love and his amazing golf abilities to go to war. When he returns he completely checks out of his life and drinks himself into oblivion. Vanc

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