Dbt: not just for our clients Alison Franklin, LCSW Utica College ahfrankl@utica.edu www.alisonfranklinlcsw.org

Objectives Gain a better understanding of the DBT model Learn how to implement skills into your own  practice/personal life in order to help avoid burnout Be connected to additional resources for further information  

"I directly model what I would like them to do in a therapy session," Beck says. "You are giving them experience of what structure and collaboration are like." Beck outlined this cognitive therapy supervision approach in a chapter in "Handbook of Psychotherapy Supervision" (John Wiley & Sons, 1997). http://www.apa.org/monitor/mar06/supervision.aspx

BURNOUT “Natural emotional exhaustion that results from spending forty hours or more per week giving to others and forgetting to take care of ourselves” Sleep disturbances or insomnia. Irritability or depressed mood. Lack of patience. Lack of enthusiasm for things you once enjoyed. Estrangement from others. Increased startle response. Fear and anxiety. http://www.communitycare.co.uk/2015/07/14/social-workers-on-the-edge-of-burnout-but-still-achieving-positive-changes/ Fatigue. Difficulty separating work and personal time. Preoccupation with work. Lack of compassion toward others. Feelings of resentment.

UB MSW self care https://socialwork. buffalo

What is DBT? Dialectical behavior therapy (DBT) was developed by Marsha Linehan, Ph.D., ABPP, in the 1970s. It is a comprehensive cognitive-behavioral treatment (CBT) that was originally developed to treat chronically suicidal individuals suffering from borderline personality disorder (BPD). DBT has been found especially effective for those with suicidal and other multiply occurring severely dysfunctional behaviors. Research has shown DBT to be effective in reducing suicidal behavior, psychiatric hospitalization, treatment dropout, substance abuse, anger, and interpersonal difficulties. Combines cognitive and behavioral therapy, incorporating methodologies from various practices including eastern mindfulness techniques. Http://behavioraltech.Org/resources/whatisdbt.Cfm THE GOAL: To learn and refine skills in changing behavior, emotional, and thinking patterns associated with problems in living that cause misery and distress. Developed to help people who: Live chaotic, painful lives Feel suicidal most of the time Hurt themselves deliberately to change the way they feel Are anxious much of the time Have spells of disassociation, forgetfulness or blackouts Feel painful & empty Fee out of control of their behavior Having trouble staying sober Hear voices Eat and/or sleep too much or too little

4 components of DBT Skills group Individual DBT sessions Weekly classes that teach you skills for coping with very painful experiences to improve your relationships, to help you better focus on the things that are important to you and to help you to manage your emotional ups and downs more effectively. Individual DBT sessions This is where you will learn to apply the skills that you learn in skills group to your very individual and unique issues. Skills coaching This additional service is offered after hours for you to be able to contact your individual DBT therapist at times where you are feeling unsafe. Consultation team This work is difficult for both you and your therapist. Your individual therapist and skills group facilitators will meet weekly in order to maintain the most effective treatment for you.

Empathy https://youtu.be/1Evwgu369Jw

Reducing vulnerabilities PHAULT Pain Hunger Anger Upset Lonely Tired

Moving on to the skills..

Mindfulness https://youtu.be/w6T02g5hnT4 An “intentional process of observing, describing, and participating in reality nonjudgmentally, in the moment, and with effectiveness” (Linehan, 2015). Being aware of thoughts and emotions as they occur, before they lead to problem behaviors Being present in the moment Not being consumed by thinking about the past and/or future https://youtu.be/w6T02g5hnT4

Mindful activities Write your name with your non-dominant hand or backwards Take a walk Color Deep breathing Fold laundry

Grounding “That you are present in your body and connected with the earth, allowing you to feel centered and balanced no matter what's going on around you” www.mindbodygreen.com

Emotion regulation Develop a better understanding of emotions so we can better identify and describe them Learn how to change unwanted emotions Identify vulnerabilities Learn how to manage extreme emotions Anger Disgust Envy Fear Happy Jealous Love Sad Shame Guilt

Learn how to change unwanted emotions…

Distress tolerance “to experience one’s current emotional state without attempting to change it; and to observe one’s own thoughts and action patterns without attempting to stop or control them” (Linehan, 2015). Learning how to better tolerate the stress Sitting with the feeling instead of fighting it Validating, acknowledge and not trying to push away or block

Interpersonal effectiveness Learning how to express your feelings, needs, and wants without being judgmental State the facts “I” statements State clearly what you want Remain calm and focused

Resources Print Online Practice Ground DBT Self Help Skills Training Manual For Treating Borderline Personality Disorder; DBT Skills Training Handouts And Worksheets (2nd Edition Skills Manual) Linehan The Relaxation & Stress Reduction Workbook Davis, Eshelman, Mckay Grieving Mindfully Kumar Mind And Emotions, A Universal Treatment For Emotional Disorders Mckay, Fanning, Zurita Practice Ground http://www.practiceground.org/ DBT Self Help http://www.dbtselfhelp.Com/ Portland DBT Institute https://www.pdbti.org/ The Linehan Institute, Behavioral Tech http://behavioraltech.org/index.cfm