Common Questions about DBT

  • I have been diagnosed with BPD, what does that mean?

    I have been diagnosed with BPD, what does that mean?

    Most people who have borderline personality disorder (BPD) suffer from problems with regulating emotions and thoughts, impulsive decision making or behavior, and unstable relationships with other people. Though not necessary for the diagnosis, most people with BPD have a history of suicidal thoughts or suicide attempts. People diagnosed with BPD may also have a history of self-injury.

    BPD can make getting through daily life very difficult. Fortunately, Dialectical Behavior Therapy has been shown to be very effective in treating BPD. A diagnosis of BPD is an important first step to getting necessary treatment for this disorder.

  • What is DBT?

    What is DBT?

    Dialectical Behavior Therapy (DBT) is an evidence-based type of cognitive behavioral treatment for individuals who have significant difficulty regulating emotions and behaviors. Developed by Marsha Linehan, Ph.D., DBT was first introduced in 1991 as a treatment for suicidal and self-injurious individuals diagnosed with Borderline Personality Disorder (BPD). DBT has also been modified so that it can be used with other psychological problems such as eating disorders, substance use, and anger management, as well as other age groups like children and adolescents.

    DBT targets the issues that cause distress and teaches clients new skills to deal with these problems in a new way; without self-harm or thinking of suicide. DBT strategically blends behavior therapy (change orientation) with validation (acceptance orientation).

    Being a participant in DBT involves:

    1. Several sessions of assesment and “pre-treatment” where both the therapist and person receiving treatment agree on the goals and targets of treatment and agree to do DBT together.
    2. Weekly individual therapy
    3. Weekly group skills training which teaches:
      • mindfulness skills,
      • emotion regulation skills
      • interpersonal effectiveness skills
      • tolerating emotional distress skills
    4. In-between session skills coaching to help participants learn to use their skills in the situations where they need them most, not just in the office.
    5. In addition, DBT therapists meet weekly to discuss cases, and to provide the supervision, training, and support required to be effective therapists.

    Currently, our programs in Beverly Hills, Long Beach, and Orange County are accepting adults for DBT treatment. We are also excited to announce availability in our adolescent program in Orange County.

    For further information about DBT, visit www.behavioraltech.org for more information about DBT.

  • What does DBT Treat?

    What does DBT Treat?

    DBT is a targeted, yet flexible, treatment that first addresses a client’s suicidal thoughts or behaviors, or intentional self-injury. Once these behaviors are reduced or eliminated, other distress, emotional pain, depression, anxiety, interpersonal difficulties, and behavioral problems such as over-eating, under-eating, or using substances are targeted. Treatment goals are tailored to each client and agreed on in advance by the client and DBT therapist.

  • What is the evidence to support DBT’s efficacy?

    What is the evidence to support DBT's efficacy?

    Dialectical Behavior Therapy (DBT) is proven in clinical research to help people with the following problems:

    • Borderline Personality Disorder
    • Suicidal behavior in adolescents
    • Substance use disorders
    • Impulsive behaviors (i.e. shoplifting, high risk sex, etc.)
    • Suicidal behavior/Self-injurious behavior
    • Intense emotions (i.e. anger, sadness, fear)
    • Difficulty building and maintaining healthy relationships
    • Chronic feelings of emptiness
    • Depression among older adults

    DBT also is better than standard treatments for BPD at keeping people out of the emergency room and the hospital. In fact, DBT is the most well-established psychological treatment for problems related to BPD. Both the American Psychological Association and the American Psychiatric Association currently consider DBT to be a first-line treatment for BPD.

  • Trauma Treatment or DBT?

    Trauma Treatment or DBT?

    Individuals diagnosed with BPD frequently (though not always) have experienced trauma in their past. We recommend DBT first for clients diagnosed with BPD who have suicidal thoughts or are currently engaging in self-harm. Before beginning trauma treatment, empirical studies support clients learning new skills to handle strong emotions without self-harm or suicidal behavior. When clients have acquired and become proficient at these new skills, and client and therapist agree, trauma treatment may begin. However, these options should be discussed fully with a clinician before deciding on a treatment plan.

  • How do I choose a good DBT program?

    How do I choose a good DBT program?

    Choosing a DBT program can be especially difficult. Not only do you want someone caring and compassionate, you also want a program that provides the most effective treatment available. Nationally recognized DBT experts have prepared a checklist to aid in this process. It can be located here. DBT California meets or exceeds the recommendations on the checklist. The answers are below.

     

    1. Is your team intensively trained by experts?

    We are intensively trained DBT experts ourselves, who are entrusted by universities including UCLA, USC and UCI to train other clinicians how to do DBT. Our staff has published papers on DBT and have trained and presented research on DBT internationally. Please see our presentations and publications here.

     

    2. Are you on a DBT Consultation Team? If yes, what percentage of your DBT team has
    been intensively/comprehensively trained by a recognized DBT expert?

    Yes, our consultation team meets weekly. 100% of our team has been intensively/comprehensively trained by DBT experts.

     

    3. Do your patients complete diary cards?

    All patients enrolled in the DBT program complete weekly Diary Cards.

     

    4. Have your DBT cases been supervised by a recognized DBT expert? If yes, has your
    supervisor listened to audio/video recordings of your sessions?

    Yes, all clinicians have been trained, supervised and had sessions evaluated by experts.
    5. Have you completed any of the BTECH DBT online courses (www.behavioraltech.org) or
    participated in the DBT Track of PracticeGround (www.practiceground.org)?

    Our clinicians routinely subscribe to trainings on Btech and Practice Ground. Additionally, many of our team attend the ISITDBT conference every year from updates on research and clinical workshops. Drs McFarr, Graling and Schneider, Benson, and Wendy Morgan all serve on the Program Committee for ISITDBT.
    6. Do you routinely audio/video record your DBT individual therapy sessions and does your
    DBT Team listen to and critique each other’s sessions to make sure you are doing
    adherent therapy?

    Yes. Our team routinely tapes sessions, particularly for clinicians still under supervision. Tapes are discussed in supervision and consult team.
    7. Are you a DBT Certified Clinician through the DBT-Linehan Board of Certification? (see
    http://www.dbt-lbc.org/). If no, do you intend to apply? When?

    Dr. McFarr serves on one of the DBT Certification committees. The certification process is relatively new so very few clinicians have been certified yet.  DBTC clinicians will pursue certification once the process is well established.

     

    8. Do you offer all of the following elements of comprehensive DBT?

    a. DBT individual therapy
    b. DBT skills training class
    c. DBT Consultation Team and
    d. Phone Consultation

     

    We do! Please feel free to contact us here with any questions.

  • How long does treatment last?

    A large aspect of DBT treatment is making and keeping commitments. Joining the DBT program is a serious commitment, both in time, energy, and resources. Treatment generally lasts a year. Both providers and patients make an initial six month commitment and if treatment is progressing, recommit for the second six months. DBT California also offers several post-DBT programs after graduation.

  • How does payment work?

    DBT is an intensive outpatient treatment that has four components; individual therapy, group skills training class, in-between session coaching and a therapist team meeting. Treatment generally lasts a year. Both providers and patients make an initial six month commitment and if treatment is progressing, recommit for the second six months. Individual therapy is paid at the time of session, and the tuition for group skills class is paid per module (8 weeks) in advance. Like tuition for most courses, there are no refunds for skills class. The patient is offered two 10 min or less coaching calls a week. If this is exceeded, coaching calls will be billed at the prorated session rate. Credit Card billing agreements are signed once per treatment cycle. We do not accept insurance as payment although we are happy to provide monthly statements to submit to insurance and health care spending accounts upon request.

  • Do you take insurance?

    We are an out-of-network provider for insurance which means that we do not accept insurance as payment. However, many of our clients do get reimbursed by their insurance providers (please check with your company for information regarding rates and reimbursement). Upon request, we are happy to provide monthly statements to submit to insurance, as well as health care spending accounts. We have a range of fees and several reduced fee slots for patients in financial need.

  • My family member/spouse is learning all these new DBT skills and I want to understand what he/she is working on. What can I do?

    Our Friends and Family Group is a great place to start. Like many mental health issues, coping with anxiety, depression, emotion regulation problems, and interpersonal chaos are not just one individual’s problem. Emotional sensitivity and associated behaviors greatly impact friends, family, girlfriends, boyfriends, spouses, co-workers. We encourage those individuals to become educated to better understand and cope with these issues. Along with seeking out information from online sources, (www.bpddemystified.com ) and books, (see “Borderline Personality Disorder Demystified” by Dr. Robert O. Friedel and Perry D. Hoffman or “Loving Someone with Borderline Personality Disorder” by Shari Manning, Ph.D.) we encourage anyone impacted by these issues to also join our skills-based Friends and Family group. Friend and Family groups meet weekly to learn and practice new DBT skills that can help those impacted effectively understand and cope with issues as they arise. You can also visit www.dbtselfhelp.com for an excellent, user friendly overview of the DBT skills.

  • What if there is a crisis? Who should I call? Are you a 24 hour service?

    If you or your loved one are experiencing a life-threatening emergency, do not wait to speak to us, call 911 immediately. Although we want to be available to our patients for coaching, we are not a 24 hour service, nor do we supply formal emergency services. Again, if this is a life threatening emergency, CALL 911. Otherwise, it is best if you encourage your loved one to call for coaching themselves. It may also be advisable to contact your loved one’s psychiatrist, if s/he has one.

  • What about missed sessions?

    We have a 48 hour cancellation policy for individual sessions. Missed sessions are not eligible for reimbursement by insurance companies and will be reflected as a missed session on billing statements. If a patient misses four individual sessions in a row or four group sessions in a row, s/he will no longer be in the DBT program and is considered to have dropped out. Patients who drop out are not eligible to return to treatment with us for three months.

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