Frequently Asked Questions About the Adult DBT Program

Q. Do I need to have hope to be in DBT?
A. No. Many people who come to DBT have very little, if any, hope that their suffering can be lessened. We know that it is only with time that your experiences with DBT will help to increase hope. We ask that clients "act opposite" to their limited hope by showing up regularly to sessions, practicing their skills, and allowing the treatment to work!

Q. Is DBT a suicide prevention treatment?
A. No. While the majority of clients who come to DBT have chronic thoughts about committing suicide and may have attempted suicide on multiple occasions, the goal of DBT is not to prevent suicide. The goal is to help clients "build a life worth living" by learning skills, accepting who they are, and changing what they can so that they will no longer want to kill themselves.

Q. Is DBT a trauma treatment?
A. No. The majority of clients who come to DBT have single or multiple traumas. However, in DBT, we believe that if clients do not have the skills to deal effectively in their daily lives, they surely do not have the skills necessary to work through traumaeffectively. As a result, trauma treatment is recommended and conducted only after clients complete skills training and are no longer showing self-harm and suicidal behaviors.

Q. Is DBT only for people with Borderline Personality Disorder?
A. No. While DBT was originally created for individuals with BPD who were chronically suicidal and self-harming, it is now used to treat individuals with multiple diagnoses who have difficulties with emotional dysregulation, distress tolerance, interpersonal relationships and impulsivity.

Q. Will I be encouraged to talk about my past/childhood in DBT?
A. It depends. While early childhood experiences are helpful in the beginning of therapy to fully understand how the biosocial theory applies to you (e.g., invalidating/ineffective environment, biological irregularities), DBT primarily focuses on the present and future.

Q. Can DBT work for me even if nothing else has worked?
A. Definitely! Many clients who come to DBT have had limited success in other therapies. This is usually because the other therapies did not effectively treat the skills deficits that lead to their difficulties. DBT believes that gaining "insight" into the reasons for difficulties/behaviors does not solve the issue. Instead it may be the first step to changing the behaviors. However, insight is not necessarily required to make changes.

Q. I have had family, friends and even therapists tell me that I do not want to get better and/or that I am "lazy." Will I hear those things in DBT?
A. Absolutely not! In DBT we have the following beliefs/assumptions about clients:

• Clients are doing the best they can
• Clients want to improve
• Clients need to do better, try harder, and be more motivated to change
• Clients may not have caused all of their own problems but they have to solve them anyway
• The lives of suicidal, borderline individuals are unbearable as they are currently being lived
• Clients must learn new behaviors in all relevant contexts
• Clients cannot fail in therapy

Q. How fast does DBT work?
A. DBT is a marathon, not a sprint. Changing behaviors takes time and patience. In some ways, we are "re-wiring" the connections in the brain by teaching people to act and think in different ways which then leads to different outcomes. As DBT therapists, we do not expect to see major, if any, changes during the first six months. It is usually right after the first six months of continuous treatment that clients start to see some changes. Most adult DBT research suggests that it is not until an individual has completed the curriculum two times that the real changes take place. The research we have done in our program suggests that clients need 18 months in DBT to experience the most significant change.

Q. Are there rules in DBT?
A. Only one. The only real "rule" in DBT is that if you miss four consecutive individual sessions or four consecutive DBT skills group sessions, you are discharged from the program. This is based on the idea that DBT can only work if a person is coming to treatment. There are other "guidelines" for DBT treatment and for the Trinitas DBT program; however, these are more flexible and violations of them are seen as learning opportunities.

Q. I've been "kicked out" of a lot of programs because of my difficulties. Will you kick me out?
A. The only real way to be "kicked out" is to absence out. Any other issues that come up (e.g., violations of guidelines, suicidal behavior, self-harm behavior, treatment interfering behaviors, etc.) will be worked on with your therapist with the goal of helping you not absence out. Behaviors that occur in group that are destructive or make the environment unsafe for other clients or the leaders may result in your not being allowed back in group until a plan has been created to prevent the behaviors from recurring. As long as that plan is in place without your missing four groups in a row, you will not be discharged.

Q. What is your policy on substance use when in the program?
A. We require that clients be willing to work on reducing and ultimately stopping the use of illegal substances in order to be in the program. At the same time, depending on the presenting problems, substance use may not be the top priority in the beginning of therapy unless it somehow causes and/or relates to behaviors like suicide and self-harm. When clients complete their first year of treatment and are still using substances, they will be required to agree to work on stopping the substance use if they are to continue in our program. This is because in the second year of treatment, clients will need to be more active in finding their own "wise mind" and regulating their emotions, something that is nearly impossible when under the influence of substances.

Q. I am not willing to stop my self-harm or suicidal behaviors. Should I come to DBT?
A. Probably not. DBT sees both suicidal and self-harm behaviors as problem solving strategies, that, while potentially effective in the moment to deal with distress, will not help you in the long-term. The behaviors also have many consequences that lead you to suffer more and feel worse. If you are not willing to work on replacing these strategies with more effective long-term strategies, all DBT sessions would be filled with endless battles because of differing goals. Both you and the therapist would quickly get burnt out and therapy would not be able to continue.

Q. My family members want me to go to DBT but I don't want to. Should I come to DBT?
A. Unless you want to be in DBT treatment, it is unlikely to work. Just showing up is not enough. You will be asked to practice skills and do homework outside of sessions, and if you do not have at least a little bit of motivation and/or interest in doing the work, changes are unlikely to occur.

Q. Am I going to have to be in DBT treatment forever?
A. No! DBT is a recovery based model. This means that we will try our hardest to work with you on building a life that doesn't require you to be in DBT or any other treatment. Most clients who graduate from our program go on to live very meaningful lives with much reduced suffering.

Q. What constitutes an absence in DBT?
A. Not showing up to session, cancelling a session, or coming more than 15 minutes late to session.

Q. I've heard that DBT has strict attendance guidelines. What are they?
A. In DBT, if you miss four consecutive individual sessions or four consecutive DBT skills group sessions, you are discharged from the program. This is based on the idea that DBT can only work if a person is coming to treatment. There are no "excused" absences for things like being in the hospital, going on vacation, or being sick. Ultimately, if a client misses a full month of treatment for any reason, it is clear that the timing just isn't right for them to be in DBT. In addition to the four-miss rule of standard DBT treatment, Trinitas also has a guideline stating that any more than six misses in six months will likely lead to discharge. Coming late to sessions does not count as one of these misses because we want clients to try and come to sessions even if they are running late.

Q. How can I be excused for an absence?
A. While there are understandable, justified, and valid reasons for missing a session, there are no excused absences in DBT.

Q. Can I make friends with other clients in your DBT program?
A. Yes. Clients who join DBT often feel relieved by how much they have in common with others in the program. Connecting with others in DBT can help you practice your skills and feel supported. However, DBT does not allow "private relationships" with other clients, meaning that secretkeeping is not allowed and that interactions can be discussed in individual sessions. Clients are not permitted to talk about suicide, self-harm, or substance use with each other, either in group or outside of the program.

Q. What if I do not like the individual therapist that is assigned to me?
A. You will be assigned a therapist based upon who has an opening for a new client. All members of the DBT team receive supervision and consultation, and are capable of providing you the best DBT services. Even if you do not feel like the assigned therapist is the "best fit" for you, we believe that the therapist can still help you learn, practice, and generalize skills because we all work in accordance with the same treatment model.

What if I don't like members of my skills group?
A. Usually clients find at least one person in their skills group who they either do not like or to whom they feel they cannot relate. We see this as a great opportunity for you to learn how to, not only tolerate being around people who you do not like, but also practice observing your own limits and have effective interpersonal interactions.

Q. Can I have family/couples sessions?
A. Family and couples sessions are not generally a part of adult DBT treatment. However, if the individual therapist believes any of the following is happening, a family/couples session may eventually be conducted:

• You ask for the session because you want to discuss something with your family member/significant other 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 you and the therapist are targeting and the therapist believes that you have not yet learned the necessary skills to manage the situation on your own
• There is imminent risk to safety and you have asked for your family/significant other to be contacted

Q. I work/go to school. Can you accommodate my schedule?
A. We have four DBT skills groups for clients to choose to attend. Two are in the evenings, one is in the morning, and one is in the mid-afternoon. Once you choose a group that fits your schedule, you will attend that group weekly for the length of the program. Our individual therapists can usually accommodate your schedule, Monday through Friday, with appointments scheduled until 7pm on several days.

Q. How much work do I have to put in outside of my sessions?
A. Each week you will be expected to complete a homework assignment for the DBT skills group. This homework usually involves practicing a skill and filling out a short worksheet. You will also complete a daily diary card that you bring to both DBT skills group and individual sessions. At times, homework may also be assigned by your individual therapist if you or he/she believes it will be helpful in reaching your goals. While not required, clients who review what was taught in skills group during the week tend to have more success in DBT.

Q. Can I still see my outside therapist when I join DBT?
A. Unfortunately not. There are several reasons why clients who join DBT at Trinitas must take a break from any other therapists:

• DBT follows a specific structure and theory. Having an outside therapist who has a different perspective would be confusing for the client because he/she may get very mixed messages and suggestions
• To know if a particular treatment is helpful, it is best to give the treatment a chance in its most "pure" version. This is similar to a medical doctor whowill start with one research supported medication and add another only when it is clear that the first one is not enough on its own
• Part of what makes DBT effective for clients is that there is frequent collaboration between skills trainers and individual therapists. The level of necessary collaboration would not be possible with a therapist who was not part of our team
• Your current therapist may be amazing at helping you with certain issues and you may choose to go back to them after completing the program. However, if you were experiencing the success you were hoping with your current therapist, you probably would not be looking for a comprehensive DBT program.

Q. Can I still see my outside psychiatrist when I join DBT?
A. Yes. Because any medication treatment is considered "ancillary" treatment to DBT, you may keep seeing your outside psychiatrist. However, there are a few things to consider when doing so:

• DBT uses a method called "consultation to the client" which means that you will be in charge of discussing any issues that come up with your psychiatrist. Your individual therapist will not be talking to the psychiatrist on your behalf under most circumstances
• If you do any form of "talk therapy" with your psychiatrist, it will need to stop when you join our DBT program. Appointments with your psychiatrist are to focus only on issues related to medication and medical conditions
• If, at any point, your individual therapist or the team feel that your psychiatrist is somehow getting in the way of your reaching your goals (much like if a family member, significant other, or friend is believed to be getting in the way), you will be asked to problem solve this issue using your skills so that your progress towards your goals can stay on track

Q. Do you take insurance?
A. At the current time we take most insurances, Medicare and Medicaid.

Q. Are there other services that I can be part of while I wait for my DBT screening?
A. You may join any of the services on the Adult Outpatient Unit while you wait for your screening. There are medication management services, group therapy, and short-term individual therapy. You will need to go through an intake to participate in these services. Feel free to let the intake clinician know that you are on the wait-list for DBT. The central access number is 908-994-7556 or 908-994-7557.

Q. Is your program co-ed?
A. Yes. We have both male and female clients and male and female therapists in our program.

Q. What happens after I complete the full length of stay?
A. When you complete the 2 1/2 years or have decided with your individual therapist that you have reached your DBT goals, you will graduate from our DBT program. Many clients continue to seek individual therapy from providers outside the program, join peer-run support groups, or join other therapeutic groups on the Adult Outpatient Unit at Trinitas. Others do not continue with any formal therapy and get support from their environment only.

Balance is the key!
"Life is a balance of holding on, and letting go, and knowing when to do which of the two." Anonymous