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8/14/2019 Program Presentation Team Telemark
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Program presentationTeam Telemark
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General description
Location: Telemark county, Norway Aprox. 170.000 inhibitants
Educational setting leading to certificationTelephone supervision from USATherapists from two cooperating clinicsAdult outpatient setting6 therapists in the team6-8 clients in the first group
Each therapist has got 1-2 clients in individualtreatment
Planned 2 complete rounds, total duration of 60weeks
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Organizational map
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Narrative description of our DBT-program
Outpatient setting.In the first round we have chosen to only take in
female patients with BPD (SCID II) and self-harm
to tissueWe are 6 therapists from different clinical divisionsand geographical locations.
The therapists will circulate as leader/co-leader ofthe skills training group
We offer a full comprehensive DBT program
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Our DBT-program
Individual therapy Each patient will have aprimary therapist to develop and monitor thetreatment plan. The primary therapist is a
member of our DBT team. Skills training modules- All four skills training
modules are taught during weekly classes over a30-weeks cycle. The clients are encouraged to
participate in two complete cycles. Modulescover Interpersonal Effectiveness, CoreMindfulness, Emotion Regulation, and DistressTolerance skills. New members may join a group
during any of the Core Mindfulness modules.
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Our DBT-program, cont
Phone consultations The therapists are available 24/7for skills coaching on the phone. There may be someindividual modifications. This helps to assure thatindividuals have the skills they need to manage
situations effectively. DBT Consultation Team Meetings- To ensure that thestructure of each persons treatment is maintained, theconsultation team meets weekly for case review,ongoing training and supervision.
Complementary/Environmental Support ServicesThese services include psychiatric consultation toreview medication issues and referral for inpatientservices, when needed. It may also include involvement
of community services, couples therapy, cooperationwith GP, etc.
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Functions and modes
- Five functions
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Enhancing capabilities
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Improving motivation
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Ensuring generalization to naturalenvironment
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Structuring the environment
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Enhancing therapist capabilities &motivation
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Therapists
From two cooperating clinicsFour therapists from Sykehuset Telemark, SkienTwo therapists from DPS Notodden/SeljordTwo therapists are psychologistsTwo therapists are medical doctorsTwo therapists are nursesFive therapists work in an inpatient settingOne therapist work in an outpatient setting
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Clients in the first group
Six clients, can be expanded to eightRecruited from our two clinicsRecruited from a wider geographical areaAge 19 to 32Five of six have had several admissions to hospitalVariable coping skillsVariable ways of copingSome clients well known to the therapist, some
new to the therapist
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Criteria for inclusion/exclusion
Inclusion F 60.3 Borderline
diagnosis (SCIDII)
Emotionaldysregulation
Impulsivebehaviour
Women Self-harming (to
tissue) Suicidal/parasuicida
l ideations Probable ability to
adhere to the
treatment Geo ra hical
Exclusion Psychosis (MINI) Drug
dependence, notnecessarily drugabuse
Bipolar disorder(MINI)
Low IQ (
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Pre-inclusion psychiatricevaluation
SCID IIMINI (General psychiatric screening)SIMS (Self Injury Motivation Scale)
HAD (Hospitality Anxiety and Depression Scale)SCL-90 R (Symptom Check List)GAF
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DBT-presentation to the Clients
Biosocial theoryElements of the treatment, rationaleThe working model
Presentation of mutual rights and dutiesTreatment contract
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Therapists Agreement
Adherence to the treatment modelContinuing educationAccepting external supervisionParticipation in the Consultation TeamRotating participation in the Skills Training GroupMutual obligation with the clients
Individual treatmentTelephone consultationsBackup case management
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Clients agreement
Commitment to the treatment targetsCommitment to the treatment program
Participate in the Skills Training GroupAdherence to the individual treatment
Adherence to the rules for telephone consultationsAccept confidentialityEstablish and work towards individual goals
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Protocol: Individual therapy
Recognize current emotional state If necessary: Repair relationships If necessary: Follow-up phone consultations Mindfulness training
Review progress (diary cards, priority: suicidality) Targets as way of organizing sessions:
Suicidality, self-harmingTherapy interference
Quality of life Attend to relevant stage Progress in other modes Closure:
Homework, summarize session
Cheerleading, reassuring, troubleshooting
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Protocol: Telephone Consultation
Be available during crisis, attend to the contract Two conditions:
Skills management
Relational repair Focus on the current problem 24-hour rule Keep available the crisis protocols
Consider scheduling phone calls Consider therapist initiated phone calls No psychotherapy on the phone No pejorative interpretations
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Protocol: Skills training group
Welcome and agenda Mindfulness exercise Examine diary cards
Examine homework from last session Questions about new material last session Presentation of new material Homework assignments for next session
Minor modification from standard DBT:Sessions of 4 x 30 minutes, with three breaks lasting
10-15 minutes each
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Protocol: Crisis Intervention
Assess suicide risk, eventually self-harm risk (If necessary: move to the suicidal crisis protocol)
Give priority to affect over content Focus on the situation here and now Explore the immediate problem Start problem solving:
Advice and direct suggestionsSuggest use of behavioural skills (DBT-skills)
Discuss consequences of actions, confrontingbelieves
Reinforce productive actions
Focus on affect tolerance
Obtain a commitment to a plan
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Protocol: Suicidal behaviour
Assess the risk of suicide Try to remove lethal items Emphatically instruct the client not to commit
suicide or to stop parasuicidal activities While validating pain, maintain that suicide is not a
good solution. Generate hopeful statements and solutions
Reinforce non-suicidal responses When suicidal risk is imminent and high: Keep
contact, else adhere to the treatment plan. Get a commitment to a non-suicidal behavioural
plan
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Protocol: Suicidal behaviour (cont.)
When the situation is unstable in spite of theintervention, with no real commitments, and therisk of suicide is continued high and imminent:
Consider emergency services
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Evaluation procedures
Inpatient daysBefore, during and after the DBT program
Psychometrics before, during and at termination
SCL-90, GAF, HADS AttendanceSkills-training group, individual therapy
Homework accomplishment Monitoring clients self-reported behaviour and
thoughts from diaries:Suicidal behaviour and thoughts, self-harming
episodes, use of alcohol and drugs, reportedsuffering
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Coordination: Clients impression
The clients are informed that behind the treatmentthere is a consultation team, coordinating theDBT program.
Each client have met, and have been presented to,all the members of the consultation team Skills trainers are recruited from the consultation
team, so that the leaders of the group rotates
amongst all the individual therapists In the case that the primary therapist for somereason is not available, another therapist from theconsultation team will step in.
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Coordination: Team aspects
Increasing coordination
Therapists get to know each
other better
Therapists get a betterunderstanding of the conceptof DBT
Therapists spend time togetherbeyond the consultation team
meetings The consultation team has a
steadily focus on coordinationof the program
Decreasing coordination
Therapists have other duties,
interfering with the DBT
program Therapists come from two
different clinics, with differenttasks and priorities
Therapists work in different
clinical and geographicalsettings
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DBT Blog
http://dbtnorge.posterous.com/
If you are interested, please contact us:
[email protected] [email protected]
http://dbtnorge.posterous.com/mailto:[email protected]:[email protected]://dbtnorge.posterous.com/