Adult DBT Information For Families

A Family’s Support Can Make a Huge Difference

As a family member or loved one of a client in DBT you may notice some big differences from other therapies:

• DBT therapists will generally not be speaking with you about the client. This is not only because of confidentiality, but also because of a concept called "consultation to the client," in which clients are encouraged to speak for themselves, be active in solving problems/dealing with conflicts, and become independently functioning individuals. You may start hearing clients use terminology with which you are unfamiliar (e.g., validation/invalidation, emotion mind, radical acceptance, DEAR MAN, etc.)
• You may notice the client start trying some new interpersonal techniques with you (perhaps not so skillfully at the beginning)
• The client may not want to share with you what goes on in his/her sessions
• The client may show a worsening of some behaviors or symptoms during the first 6 months of therapy
• The client may leave certain sessions feeling worse than when his/her session began
• A family/couples session in adult DBT is held only if the individual therapist believes any of the following is happening:
• The client asks for the session because he/she wants to discuss something with you and would like the individual therapist there as a coach
• There is a crisis erupting in the family that is getting in the way of progress
• A family member/significant other is doing something that is reinforcing a behavior that the client and therapist are targeting, and the therapist believes that the client has not yet learned the necessary skills to manage the situation on his/her own
• There is an imminent risk to safety and the client has asked for the family member/significant other to be contacted

How Can You Help?

The best way to help a client who is in DBT is to let the therapy be conducted in accordance with the model. This may mean stepping back from intervening on the client's behalf and allowing the client to experience the natural consequences of his/her actions:

• If you see the client trying to use skills or a different method of interacting with you, give him/her clear, specific, and factual feedback about how what he/she is doing/saying is working or not working
• Attend the free monthly Family Education Nights so that you can learn about DBT, BPD, and the skills that the clients learn
• Try to be consistent when interacting with the client, especially at the beginning of treatment. It is much easier for the therapist to help the client effectively interact with you if he/she knows what to expect
• If the client is doing something you like, tell him/her! Reinforcement goes a long way in helping behaviors change
• Similarly, if the client is doing something you don't like, tell him/her! While punishment, like yelling or insulting, definitely does not change behavior in the long term, providing clear information to the client does help change behavior. Share things like, "When you do XXX, it does not make me want to be around you."