1. Facilitator and Patient Reflections
Implementation of the new DBT Skills Manual in a Medium Secure Services
Facilitator and Patient Reflections
Presented by:
Zoe Otter (Forensic Psychologist)
Kristy Summers (Forensic Psychologist in Training)
Partnerships in Care Midlands

2. Outline DBT in PiC Midlands Who are we
Introducing & implementing the new skills manual
Outcome measures
Preliminary findings
Reflections from group members
Reflections from facilitators
Future directions

3. DBT programme PiC Midlands
Group Skills
Individual Sessions
Weekly Consultation Team Meeting
Telephone consultation: Replaced by Staff awareness training
Established in 2005
2 groups currently running over 2 sites (MSU & LSU)
Regular training opportunities for new therapists
Implementation of the new skills manual in December 2014 at Calverton Hill (MSU)

4. Who are we?
Currently 5 DBT Therapists working within the Female Medium Secure Service with a range of experience
2 Trained in 2008/2009
1 Trained in 2013/2014
2 Trained in 2016
Group delivered on a rota basis
All have individual DBT patients

5. “New” Skills Manual Preparation
Previous lead attended Marsha’s Linehan’s new skills training in Ireland
Discussed in consultation team meetings
Number of consultation meetings were spent reviewing the new material to become familiar with it
New manuals purchased
Consultation meetings – discussed concerns, acceptance, updated for a reason
New manual – time spent reviewing the material

6. “New” Skills Manual Implementation
Discussed new manual with existing group members
Re-evaluated outcome measures
Discussed and prepared to introduce orientation module
Continuous review of Group members feedback

7. Outcome Measures Assessment Measures
Borderline Symptoms List -23 (BSL-23)
BPD Symptoms
DBT Ways of Coping (DBT-WCCL)
Current Skill Level
Beck Suicide Scale (BSS)
Suicidal Ideation
STAXI-II
Anger
Dissociative Experiences Scale
Dissociation
Beck Hopelessness Scale (BHS)
Hopelessness (relates to emptiness)
Beck Depression Inventory (BDI-II)
Depression (relates to emptiness)
Barratt’s Impulsiveness Scale (BIS-11)
Impulsiveness
Pre-Post Programme AND Pre-Post Module
Freiburg Mindfulness Questionnaire
Mindfulness
Difficulties in Emotion Regulation Scale (DERS)
Emotional Response
Distress Tolerance Scale (DTS)
Current level of distress tolerance
Inventory of Altered Self-Capacities
Interpersonal skills
Goal Attainment Scale*
Overall use of skills
The measures aim to assess change throughout the completion of the programme and also measure change following each module. The measures chosen map onto the criteria of BPD to assess change in BPD symptomology.
All information will be recorded anonymously on the DBT assessment database.
Outcomes will be reviewed after each module and after each individual cycle of DBT skills training.

8. Orientation & Mindfulness Interpersonal Effectiveness
Programme Outline
Rolling Programme
Pre Therapy for 4-6 weeks before joining the group
New intakes at Orientation & Mindfulness
Orientation & Mindfulness  
Distress Tolerance
Interpersonal Effectiveness
Emotion Regulation
Assessments take place in pre therapy
Orientation & mindfulness – 6 weeks
DT – 10 weeks
IE – 10 weeks
ER – 12 weeks
Once on the group 50 week skills training programme – 3 weeks break plus 2 over xmas

9. Preliminary Findings – Mindfulness (1)

10. Preliminary Findings – Mindfulness (1)

11. Preliminary Findings – Emotion Regulation

12. Preliminary Findings – Emotion Regulation

13. Preliminary Findings – Mindfulness (2)

14. Preliminary Findings – Distress Tolerance
Distress Tolerance Scale (DTS) Measures current level of distress tolerance
Goal Attainment Scale
Interpersonal Effectiveness
Inventory of Altered Self-Capacities – measures Interpersonal skills
To complete:

15. Group Member Reflections
The course was well presented and the facilitators were very knowledgeable in the subject
Paper work – too much
Not having paperwork clipped together was confusing
Some sessions were a bit rushed because there was so much to get through
The more they [facilitators] have done it the more they have got out of it too
Sharing experiences of BPD has helped me to not feel alone in the difficulties I experience
It was quite long. It took a while to get into.
Length and content of the session – feedback was that there was too much material to get through in the sessions and it was feeling rushed. The group was extended by half an hour, received positively.
The patients have reflected that the more familiar the facilitators are becoming with the new manual the better it has become
Paperwork – some have found the new materials difficult to get their head around – Initially patients were given out the hand out for each session as we went along. Following the feedback patients were given all of the module paperwork all together. Further feedback resulted in us finding a way to secure the hand out into two separate packs for work sheets and hand outs.
Length of the modules – the modules have felt to long for the patients with this first cycle of the new manual, now that we are familiar with the manual it is clearer how to get through the modules in a more timely manor.
Patients have valued sharing experiences of BPD and the biosocial model, this has increased group cohesion.

16. Group Member Reflections
Thank you for my certificate
I can’t wait to do it again!
It made me more aware of myself and how to facilitate what I want or need
It has given me even more skills to use and practice to change my former unhelpful and destructive behaviour
I hope I may be able to do mindfulness again when I have finished my DBT course because it is the one I really use every day
It provided me with lots of new exercises that I can apply daily
Received positively by patients, they have continued to be motivated to attend
Certificates have reinforced the progress they are making
They value to modules
Programme helps changing behaviour

17. Our Reflections Inclusion of the Group members in the process
Introduction of orientation module received positively
Good additions to the manual – radical acceptance example
Highlights DBT assumptions – does not treat individuals as fragile
Extended time of the sessions
Out of session work, links well to the structure of the session
Could have been better
Discussed changes with current group members
Orientation module – sharing experiences of BPD and identifying with biosocial model very powerful, helped group cohesion
Uses powerful examples
Does not treat patients as fragile when exploring their own behavioural difficulties and reasons for this
Found that extending the session has allowed for a smoother running of the programme

18. Our Reflections Preparation – JUST DO IT!
Hand outs and work sheets – juggling act
Currently have a low referral rate – high turn over on admission ward
Nature of patients – many suited for an adapted version/too unwell
Long!
Preparation – reading of the manual could have been better – we went with JUST DO IT!
Hand outs and work sheets can be difficult to navigate through for patients – introduction of sticky notes and tabs appears to have helped with this
Number of admission who have quickly moved on back to home areas
Number of MI patients admitted and acute admissions who are not yet ready
First run through of the manual we ensured that we tried to deliver all of it to be familiar with the manual – we have now started to reduce this to get through the manual

19. Future Directions Increase out coming Presenting findings
Continue to send others of full DBT training
Develop a new staff awareness package

20. Questions?