By: Tawny Scollard

EVIDENCE- BASED PRACTICE Started with borderline personality disorder and suicidal individuals Now DBT Is being used with many different populations Substance abuse Juvenile and Adult offenders Psychiatric Facilities

DIALECTICS/MINDFULNESS Emphasizes wholeness, interrelatedness and change as fundamental characteristics of reality. Group treatment always entails balance of acceptance versus change and searching for what is left out The goal of mindfulness practice is to fully participate in the present moment with complete awareness yet without judgment. The Foundation of DBT groups are built on Human Communication Making sense of what we experience looking at patterns and structure Sharing sense of experience, thoughts and feelings Create meaning within your heart and mind

THEORY DEVELOPMENT THEORY  Theories of moral reasoning (Kohlberg, Gilligan)  Theories of cognition (Piaget)  Transpersonal theories of human development Major Theory  Systems Theory  Psychodynamic  Social Learning  Conflict

THEORY  Emotions have a central place in human behavior.  Unconscious, as well as conscious mental activity serves as the motivating force in human behavior.  Individuals may become overwhelmed by internal and/or external demands.  Individuals frequently use ego defense mechanisms to avoid becoming overwhelmed by internal and/or external demands. Psychodynamic Theory –

SOCIAL LEARNING THEORY  Social learning theory suggests that human behavior is learned as individuals interact with their environment.  Problem behavior is maintained by positive or negative reinforcement.  Cognitive- behavioral therapy looks at what role thoughts play in maintaining the problem. Emphasis is on changing dysfunctional thoughts which influence behavior.  Methods which stem from this theory are the gradual shaping of new behavior through positive and negative reinforcement, modeling, stress management: biofeedback, relaxation techniques, cognitive restructuring, imagery and systematic desensitization.

DBT

GROUP ELEMENTS Mindfulness activity Review last weeks homework and pressing questions Weekly Lesson on target skill Activity to practice or apply lesson Homework given that reinforces skilled learned

ROLES OF LEADERSHIP IN A DEMOCRATIC GROUP Therapist/ Process Leader 1 st process in group; Release tensions by mindfulness activity Accomplish goals Harmonizer: Maintains interpersonal climate Standard setter Energizer Teacher/Task Leader Coordination with Therapist and staff Summarizes/ Evaluator Elaborates Informational giver Recorder Standard setter Group Observer

TRANSFORMATIONAL LEADERSHIP 4 I’s Idealized leadership Inspirational motivation Intellectual stimulation Individual consideration DBT has evolved out of standard cognitive- behavioral treatments based on principles of learning, and blends behavioral change oriented strategies with concepts and techniques associated with acceptance and tolerance

ROLES OF LEADERSHIP B.I.S.S. Staff Gate Keepers Encouraging Compromiser Standard setter Mediators Opinion seeker Procedural technician Energizer DBT Participants Informational seekers Opinion seeker & Givers Energizer Encouraging Followers Self-Confessor Aggressor Recognition seeker Disagreeable Joker Challenges in Individual Roles

ADVANTAGES OF DBT GROUP THERAPY Increased feedback feedback from other people gives different perspectives and can be helpful in promoting growth and change. Modeling By seeing how others handle similar problems, the patient can rapidly add new coping methods to his or her behaviors. Improve social skills A group leader, and a therapist, help people to learn to communicate more clearly and effectively with one another in the group context. This is inevitably leads to people learning new social skills which they can generalize and use in all of their relationships with others. Less expensive By treating several patients simultaneously, the therapist can reduce the usual fee.

INCREASE Behavioral skills Coping skills Quality of life self-respect Emotion modulation Self-validation Realistic decision making DECREASE Suicidal and par suicidal behaviors Emotional reactivity Self-invalidation Crisis generating behaviors Negative thought process

PROBLEM SOLVING APPROACHES Discussion focused on peer relationships Discussions on managing conflict Integrate others ideas to another idea Discussion about uncertainty in relationships Relational activities

ACTIVITIES THAT FOCUS ON GENERAL THEME Topical focus activities 1. Mindfulness 2. Distress tolerance 3. Interpersonal Effectiveness 4. Emotion regulation

TASK-PROCESS ACTIVITIES Activities focus on problem Activities serve a function to keep discussions on task Activities bring solutions to problem

ETHICAL GUIDELINES IN GROUP Post-conventional – Ethics – Observing individual and group (societal) rights. Keeping the group small (no larger than 12) not so overwhelming to clients and therapist Treat others with the same respect you wish to be treated like Sharing experiences, insights or feelings with group with is encouraged with positive open honest expression Take this opportunity to grow and develop Be mindful, reflect, do your behaviors match your values Keep what shared in the room in the room (confidentiality)

CULTURAL ISSUES Societal and cultural discourses can also be addressed and promote how members of the group can respond to the community in a different way

Group therapy offers participants the opportunity to interact with others with similar issues in a safe, supportive environment. Participants can try out new behaviors, role play, and engage with others in not only receiving valuable feedback and insight from other group members, but also in giving it.

Q & A

REFERENCES Beebe, S. A., & Masterson, J. T. (2012). Communicating in small groups: principles and practices (10th ed.). Glenview, Ill.: Scott, Foresman. Dietz, L. (2012, March 13). What is DBT?. What is DBT?. Retrieved May 27, 2014, from Ph.D, M. H. (2014, January 1). » About Group Therapy - Psych Central. Psych Central.com. Retrieved May 27, 2014, from Services Alternatives, Inc., Training Institute. (2013). An Introduction to Dialectical Behavior Therapy. Service Alternatives. Everett, Washington, United States: Services Alternatives, Inc., Training Institute.  Johnannesen, R.I. (2002) Ethics in human communication (5 th ed.). Long Grove, IL: Waveland Press, Inc.