What is a Fully Adherent DBT Program and Why Should You Care?

Dialectical Behavior Therapy (DBT) is a therapeutic model for treating mental health issues. Since its development approximately 30 years ago1, DBT has become a recognized therapeutic approach for helping individuals learn how to regulate their emotions, develop healthy coping skills, and heal from trauma. However, not all DBT practitioners are the same. There is a difference between programs that incorporate Dialectical Behavior Therapy into their practice by offering periodic DBT groups, for instance, and a program that has fully integrated DBT into every aspect of treatment, providing the opportunity to practice DBT skills in everyday life on an ongoing basis. This is an especially critical distinction when treating adolescents, who benefit most from being able to draw upon life-changing (and life-saving) skills to create a healthy future for themselves.

A fully adherent DBT program integrates DBT into all aspects of treatment and daily life. The program follows the DBT model and includes the four pillars of DBT treatment. At Sunrise, all our clinicians and residential directors are at least foundationally trained.  Our teachers use and incorporate mindfulness into the classroom.  All our staff, from the cook to the residential managers, receive regular training in DBT and participate regularly in DBT skills group. This training allows the treatment center to have a common, evidence-based modality and language to operate from.

Our goal is to not only teach your daughter and your family to utilize these skills, but to help you incorporate and live these skills to create a life worth living.

Four Pillars of DBT Treatment

There are four pillars that a DBT treatment center must follow in order to be considered fully adherent. Each pillar is necessary to provide the complete DBT experience. Skills are, of course, incredibly helpful and important. However, in order for true healing to occur and skills to ultimately be useful in your daughter’s life, much more needs to happen during the treatment process. The four pillars ensure that your daughter receives well-rounded care while she is at Sunrise.

What-Does-it-Mean-to-Be-a-Fully-Integrated-DBT-center-4-Pillars

Skills

The dialectical behavior therapy skills are the first of the four pillars. All skills, not just a few, are taught and integrated. At a fully adherent DBT program, each employee is trained in DBT. Skills are practiced at all times, by all students and employees on campus.

Consultation

Therapists need support, too. The consultation pillar is meant to be "therapy for therapists"2 to ensure each therapist is feeling supported. Additionally, therapists will discuss their case load with peers for ideas on how to best serve the family or student. As in any profession, feedback and support from peers can help us think of solutions we may not have thought of ourselves. At Sunrise, consultation occurs in a weekly meeting generally referred to as treatment team.

Phone coaching

Sunrise uses the "phone coaching" pillar in two different ways. Every week, a Sunrise therapist hosts a webinar about DBT skills for current and alumni families. Participants are able to submit questions they would like the therapist to address ahead of time, or live during the webinar. Additionally, Sunrise requires current parents to participate in an hour of family therapy through a video conference each week. During this time, the therapist will guide the family towards a healthier and happier family life. The family work done at Sunrise will be among the most influential pieces of your daughter’s healing journey.

Individual Therapy

Students at Sunrise will participate in an hour of individual therapy each week. While skills are incorporated into therapy, this is also a time for a student to address and process through concerns from all areas of her life. Our therapists are trained to treat a milieu of treatment issues, including post-traumatic stress disorder (PTSD), borderline personality disorder, eating disorders, depression, anxiety, and other mental health issues.

How Are Fully Adherent DBT Programs Different?

At a fully adherent program, every employee is trained in and is modeling and living the DBT skills.

Generally, when a program claims they provide DBT it means that they are teaching DBT skills and may be providing a DBT skills group. They may have had some formal DBT training, or may simply know skills well enough to teach them.

In order to fully integrate the DBT skills into a student’s life, they must be fully integrated into the program.

A fully adherent and fully integrated Dialectical Behavior Therapy program also offers DBT groups for clients, and then goes above and beyond. In order to fully integrate the DBT skills into a student’s life, they must be fully integrated into the program. Instead of walking out of DBT group expected to practice a DBT skill, she will leave group expected to live the DBT skill. Dialectical Behavior Therapy is integrated into activities, academics, therapy sessions, and relationships. Sunrise is one of the only fully adherent and fully integrated DBT residential treatment centers for teen girls.

girls-in-a-therapy-session-dbt-

Training Employees In DBT

Being trained to work for a fully adherent DBT treatment center is not an easy task. At Sunrise, our employees — that means all of them — are required to be trained in DBT.  We always have at least one intensively trained therapist with all other clinicians and residential directors being foundationally trained in DBT by Behavioral Tech.  These certified clinicians and directors then hold regular training sessions and skills groups with the rest of our employees.  This means the teachers, residential staff, and even our cooks are equipped to incorporate DBT into every aspect of treatment.  This training also gives employees a common language to support and strengthen one another and equips them to strengthen students and families.

Primary Targets of DBT Treatment

Being a fully adherent DBT program means we go beyond just training our employees and adhere to the DBT treatment model.   This model is backed by solid research and is the gold standard for treating all kinds of mental health issues.  There are four primary targets of DBT treatment that each student will meet before her transition back home. These targets are addressed in order, as the lower target won’t be useful if the higher target hasn’t been met.

1 Life Threatening Behaviors (Decrease)

Safety is our first priority at Sunrise. After a student’s admission, she will be with a staff at all times until she demonstrates that she can keep herself and others safe. If at any time during programming we have reason to believe her safety is at risk, we will take appropriate precautions to keep her safe.

2 Therapy-Interfering Behaviors (Decrease)

Once the student is physically safe, it’s time to start working therapeutically. Therapy-interfering behaviors include refusal to go to therapy (whether individual, family, or group), or refusal to work in therapy. Taking the leap into vulnerability can sometimes be the scariest part of treatment! Sunrise’s residential staff and therapists will help your daughter feel comfortable and safe as she begins to build relationships with them. Her peers in the program will also encourage her to begin working therapeutically.

3 Quality of Life-Interfering Behaviors (Decrease)

Once your daughter is attending and willing to work in therapy, she will begin changing behaviors that negatively affect her quality of life. An example of this is ending relationships with her peer group at home who encourage her use of drugs and alcohol.

4 Skills Acquisition (Increase)

Once your daughter's self-destructive behaviors are under control, she will be able to "learn new skillful behaviors to replace ineffective behaviors"2. By learning, applying, and internalizing DBT skills, she will build healthier relationships with herself, her family, and her friends. Skills acquisition is about creating a life worth living.

Applying, Not Just Learning DBT

A fully adherent DBT treatment center offers your daughter and your family full therapeutic healing in an environment that is constantly coaching in DBT. Sunrise is focused on helping you and your daughter internalize and practice DBT skills in all aspect of life both while your daughter is enrolled at Sunrise and long after graduation.

A fully adherent DBT treatment center offers your daughter and your family full therapeutic healing in an environment that is constantly coaching in DBT.

To accomplish this, your daughter will receive in-the-moment coaching in her interactions throughout the day. You and your family will receive this same coaching during therapy sessions and weekly webinars. Therapists work with each student to identify what skills she will need to succeed at home, and also works with your family to identify the skills needed within the family system. Over time, application of the skills will feel more normal and become second nature for your daughter. Before she returns home, she will be able to apply the DBT skills without coaching.  DBT will become a natural part of her everyday life.

Students-With-The-DBT-Trained-Chef-Cooking-A-Meal

Skills are great, but they’re not everything. A fully adherent DBT treatment center offers your daughter and your family full therapeutic healing in an environment that constantly coaches in DBT skills. When dialectical behavior therapy is a part of her everyday life, your daughter will be better able to triumph over the challenges she will face. By involving the family, your daughter’s chance of success is even greater. Sunrise is one of the only fully adherent DBT centers for teen girls, and we are confident that your daughter will return home as a healthy and independent young woman.

Download what does it mean to be a fully adherent DBT program.

We invite you to call 888.317.3961 to learn more about how our fully adherent DBT program can help your family.

By Craig Simpson, Executive Clinical Director at Sunrise Residential Treatment Center

References
1 "Dialectical Behavior Therapy." Wikipedia. Wikimedia Foundation, 13 June 2017. Web. 15 June 2017.
2 "What Is DBT?" What Is DBT? | Behavioral Tech. Web. 19 June 2017.

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