Dialectical Behavior Therapy (DBT)
Self-Management of Dissociative Disorders
Too Much To Manage
Dialectical Behavior Therapy (DBT)
Skills for Living Effectively
Skills training is an essential part of Dialectical Behavior Therapy (DBT). This treatment was developed by Marsha Linehan, Ph.D. as a treatment for borderline personality disorder. It has been demonstrated to be effective for this as well as other related disorders. Treatment outcome research has shown that subjects participating in DBT skill-oriented group therapy, in combination with DBT individual psychotherapy, evidenced improved mood stability, behavioral stability, and psychosocial functioning.
Persons who experience unstable and extreme emotions, impulsiveness, confusion about their identity and have unstable relationships with others will benefit from this group.
What is Dialectical Behavior Therapy?
Originated by Marsha Linehan, Ph.D., of the University of Washington, Dialectical Behavior Therapy (DBT) is the only research-based treatment protocol for individuals with Borderline Personality Disorder.
Grounded in bio-social developmental theory, the DBT approach is based upon the premise that emotional dysregulation is the core dysfunction for Borderline Personality Disorder. DBT applies an array of cognitive and behavioral therapy strategies to problems most commonly experienced by individuals with Borderline Personality Disorder, especially those related to motivation and interpersonal interactions.
Why a Group Approach?
Designed to support and supplement the work of individual psychotherapy, focus of the Dialectical Behavior Therapy group is upon:
Increasing interpersonal effectiveness
Decreasing crisis inpatient admissions
Teaching skills for managing distress and impulsiveness
Group is divided into four areas:
Emotion Regulation Skills: Clients often experience difficulties with anger expression, anxiety, and inappropriate inhibition of affect or being emotionally "shut down." Skills taught in this module include accurate recognition of emotions and effective and appropriate ways of expressing emotions.
Interpersonal Effectiveness Skills: Because individuals with Borderline Personality Disorder and related conditions often experience relationships that are chaotic, intense, and marked with difficulties, this module teaches skills for maintaining balanced interpersonal relationships.
Distress Tolerance Skills: Impulsive behavior, including self-injury and suicidal acts are viewed by many traditional therapies as manipulative. DBT approaches impulsiveness as a sign of the individual's difficulty in tolerating stress.
Mindfulness Skills: Feelings of emptiness, no sense of self and dissociation caused by stressful situations are problems that clients frequently encounter. "Mindfulness" skills - skills targeted toward increasing reliance upon accurate perceptions, are learned in this module.
What This Group Is Not
The Dialectical Behavior Therapy group treatment approach is not a substitute for individual psychotherapy. Rather, its highly structured, skill-focused process has shown to be effective for clients who are currently involved in individual treatment.
Combining DBT group therapy with ongoing individual psychotherapy has shown to be effective in decreasing episodes of self-mutilation, suicide gestures and attempts, need for hospitalization, and other common outpatient treatment crises.
Who May Participate
Designed to serve as an adjunct to individual psychotherapy, participation in this group is contingent upon simultaneous involvement in individual psychotherapy. Referral from the client's primary mental health care provider or inpatient treatment program is required. Persons interested in beginning this group may contact Psychotherapy Associates to arrange a screening interview to see if this treatment is indicated.
LauraLee Clinchard, MALaurie Patton, MAMark Hankla, MA
Trained in DBT, LauraLee, Laurie and Mark each have extensive experience in providing treatment to individuals with complex personality and post-trauma disorders.
This time-limited group meets weekly for 90 minute sessions and repeats biannually. Held in the Psychotherapy Associates offices, group meeting time will be discussed at the screening interview. Fees for group are $50 per session. This treatment protocol has been covered by most health insurance and other third party payment plans.
Referral, in writing or by telephone, should be directed to the attention of Bill Bonacker at 402-475-5069, fax 402-475-2350, or e-mail firstname.lastname@example.org. Clients who have been referred are asked to contact the Psychotherapy Associates office to schedule an individual screening and assessment interview prior to acceptance into the group.
Self-Management of Dissociative Disorders
Focus Upon Stabilization
The standard of care for Dissociative Identity Disorder and Ego State Disorder/DDNOS requires that the foundation stage of treatment focus upon stabilization of psychosocial functioning (Internal Society for the Study of Dissociation, 2005).
Before further treatment can be effective, dissociative patients must be prepared with extensive knowledge regarding the nature and function of these difficult-to-understand conditions. Psychological tools needed to manage suicidal and self mutilating impulses, amnesias and fugues, flashback panics, and "out of control" switching among states of consciousness must be provided.
Balancing Treatment Needs
While essential to a positive prognosis, teaching procedures for increasing individual awareness and understanding of the dissociative process is time consuming and demanding. In individual psychotherapy, demonstration and coaching for mastery of non-dissociative coping skills is often interrupted by the requirements of emerging crises.
Maintaining a balance among psychological skill development, resolution of traumatic associations, and crisis intervention is a significant challenge in psychotherapy of the dissociative disorders, accounting for frequent use of inpatient care, partial hospitalization, and intensive outpatient treatment.
Why a Group Approach?
Designed to support and supplement the work of individual psychotherapy, focus of the Self-Management group is upon:
Increasing psychosocial stability
Decreasing crisis inpatient admissions, and
Accelerating the process of individual psychotherapy
Group is divided into three areas:
Awareness and Understanding: Minimization, rationalization, and avoidance are common treatment-interfering responses of individuals with dissociative disorders. Skills taught in this module include discrimination of normal from pathological dissociative experience and awareness of how once-helpful dissociation can become counterproductive.
Consciousness Skills: Dissociative clients often experience a sense of unreality, behavior inconsistent with conscious intent, and amnesia to recent events. In this segment, skills for enhancing perception and memory across states of consciousness are taught.
Affect Management: Individuals who have long used dissociative defenses to deal with current-day emotional distress and recall of past traumatic events, are ill prepared to deal with the intensity of emotion-laden stimuli. Skills for affect containment, modulation, and appropriate expression are presented and practiced in this module.
What This Group is Not
The Self-Management therapy group is not a substitute for individual therapy. Rather, it is a structured, skill-focused group designed to increase individual psychotherapy time- and cost-effectiveness.
The Self-Management group is not a forum for exploration of past traumatic experience or identity components. Consistent with the standard of care, clients are encouraged to limit the tasks of reviewing and resolving traumatic memories to the security of the individual therapeutic relationship.
Participating clients may be assured that all aspects of the self (alters,ego states) are welcomed to the group. At the same time, clients will be encouraged and assisted to participate within states of consciousness most suited to a learning environment.
Who May Participate
Participation in group is contingent upon simultaneous involvement in individual therapy. Referral from the client's primary mental health care provider or inpatient treatment program is required.
Sheralyn Cox, Ph.D
Sherry has received advanced training in treatment of the dissociative disorders. She is a member of the International Society for the Study of Dissociation, the International Society for Traumatic Stress Studies and the American Society for Clinical Hypnosis and has done extensive teaching and consultation in this area.
This time-limited group meets weekly for 90 minute sessions and repeats quarterly. Held in the Psychotherapy Associates offices, group meeting time will be negotiated among participants. Fees for group are $50 per session. This treatment protocol has been covered by most health insurance and other third party payment plans, including Medicare and the Nebraska Medical Assistance Program (Medicaid).
Too Much to Manage
A Skills-Based Therapy Group for Individuals Overwhelmed with Compulsive Acquiring, Saving, and Hoarding
How do I know if this group is right for me?
Save broken items or things that other people see as useless;
Often buy more of an item than you can use;
Feel anxiety or panic at the thought of losing any of your belongings;
Are embarrassed to invite friends or family into your home because of it’s crowded or messy condition;
Rescue more animals than you can keep up with, care for, or afford;
Have difficulty discarding anything because of a fear of accidentally throwing out something important;
Save large amounts of certain items for possible use by others or for future recycling;
Sometimes feel as though your surroundings are controlling you rather than the other way around
…this group is for you!
What if I don’t think I’m a hoarder?
Come anyway. If acquiring, sorting, organizing, managing, or saving are problems in your life, you are welcome in this group.
This therapy group is divided into four specific skills training modules:
Self-Understanding: We’ll work together to figure out why hoarding is a problem for you, to identify your specific patterns of acquiring and saving, and to identify what roles fear or anxiety play.
Thinking Patterns: Common thoughts and beliefs of individuals who have difficulty with acquiring and saving will be examined. We’ll help you identify any of your own thoughts that interfere with your ability to manage your home as you want. Belief-testing, decision-making, and problem-solving skills will be taught and practiced in a friendly setting.
“Hands-On” Practice: We’ll use a variety of group exercises and homework assignments to help you improve task organization, priority setting, sorting, and “letting go” skills.
Preventing Future Problems: Using discussion and planning, in-group exercises and practice, and homework assignments, we’ll help you develop strategies for resisting acquisition urges.
Sharon Knaub, M.S.EdMark Hankla, MA
Group meets weekly for 90 minute sessions. Skill training modules are repeated every six months and new clients may join the group during the first three sessions of each cycle.
Meeting in the Psychotherapy Associates offices at 1919 So. 40th Street, Suite 312, group size is limited to no more than eight members.
Meeting dates and times will be arranged to meet the needs of group members. Prospective participants are encouraged to contact Psychotherapy Associates for more information.
Fees for group treatment are $50 per session. Similar treatment protocols have been covered by most health insurance and other third payment plans, including Medicare, Magellan Behavioral Health, and the Nebraska Medical Assistance Program (Medicaid).
Who may participate and how do I go about it?
Designed to serve as an adjunct to individual psychotherapy, participation in the group is contingent upon simultaneous involvement in individual therapy. Referral from the client’s primary mental health care provider is required.
If you do not currently have an individual therapist, but are ready to address problems related to acquiring and saving, we’ll be happy to help you find a therapist with expertise in these issues.
Referrals should be directed to the attention of Sharon Knaub or Mark Hankla.
Clients who have been referred are asked to contact the Psychotherapy Associates office to schedule an individual screening and assessment interview prior to acceptance into the group.
In psychotherapy, you and your therapist work out strategies for handling problems of daily living. Examples of problems which can be effectively addressed include depression, anxiety and panic, "flashbacks," guilt, low self-esteem, eating disorders, alcohol and drug abuse, couple and family difficulties, and general interpersonal difficulties. Additionally, psychotherapy can lead to personal growth through clarification of your thoughts and feelings about yourself, others, and events in your life.