What worked or didn't work for you in a DBT Skills Group?
August 24, 2016 6:45 PM   Subscribe

I am in training to facilitate DBT Skills Groups. Could anyone with any experience (leading or participating) share anything you found particularly helpful or particularly frustrating? Or share any tips or insight that might help a new leader?

From what I understand of the full DBT protocol, it involves these Skills Groups (with handouts and trainings and worksheets) plus individual therapy and phone consults. We'll just be doing the Skills Groups, though some of our clients are also in individual therapy with a DBT-trained (but not DBT-certified or exclusively DBT) therapist, and all have access to our (not at all DBT) 24hr crisis line. (I would love to be able to offer the full DBT protocol, but it's not in the cards right now.)

I'm new to DBT, and I'm really open to any advice, insight, feedback, suggestions, or anything else anyone might be able to share, in order to better help my clients and better anticipate their needs.
posted by lazuli to Health & Fitness (12 answers total) 7 users marked this as a favorite
I've gone to a counsellor for DBT in the past, it was helpful, but it has limits. I can't speak as an authority, but here's what I've learned:

DBT is very focused on in-moment coping, but does not provide any help towards creating longterm change. This should be something everyone is aware of, and this is also why DBT is not exactly suitable for people in abusive or otherwise unsafe situations. DBT is very good for helping cope when there is an issue that can't be changed, or that will be changed very slowly. DBT skills are in my opinion best paired with practical life advice and empowerment for the participants to make changes in their life. For me DBT was helpful when I needed to just hold on through a tough patch, and weather the storm.

Also, watch for what your handouts look like, and how they read. I found that a lot of DBT handouts looked like they were aimed at children(even if the content therein was mature-oriented). If you're treating adults, don't do this, it'll just make them feel condescended to. Clear, precise information is much better than something with a bunch of clipart or childish fonts.
posted by InkDrinker at 7:25 PM on August 24, 2016 [2 favorites]

I was in DBT five years ago and it was incredibly useful and helpful. For the skills groups, I think what really made them so useful, compared to standard group therapy was that there were strict rules on not disclosing personal information or talking much about personal experiences, particularly with regard to self-harm or self-destructive behaviors. I feel like group therapy can be really triggering for people who have self-destructive habits, which is most people in DBT. I really liked that the groups were structured like classes. They weren't about unburdening your soul, they were about learning particular skills. And putting the self-destructive habits in such calm and clinical terms made them seem far less overwhelming and far less related to your identity as a person.

I agree that DBT is best for a crisis situation. The handouts are a little overly simplified and could be perceived as condescending. However, I think that can be helpful for someone experiencing overwhelming emotions.
posted by armadillo1224 at 7:32 PM on August 24, 2016 [2 favorites]

The biggest advice I would have given the leaders of my DBT group(s) was:

We can tell this is the first time you've read this material out loud. This is uncomfortable and distracting. Please practice reading the little intros and discussion prompts.

In fact, it would be very nice of you were comfortable enough with this material that you could just...talk about it in a natural way.

(I really enjoy public speaking, I know that for many people this is a difficult task. But still. Please seem comfortable with the material. Your discomfort with public speaking just reads as discomfor with the actual words, or discomfort with the group, or an incomplete understanding of the material.)
posted by bilabial at 7:55 PM on August 24, 2016 [5 favorites]

I hate DBT and think it is victim-blaming and gross. Please, please please make sure that the people in your group actually like DBT and aren't just being dumped there because DBT is pushed on everyone. Read "do I need to rethink my feelings on DBT" (not my blog, but it gives a good explanation) for more info.

If you are new to DBT, I don't think it's a good idea for you to be leading a group, sorry.
posted by Violet Hour at 9:12 PM on August 24, 2016 [1 favorite]

I participated in a DBT group. I liked the leaders. They set clear rules, kept the group on schedule, but were also warm and curious. I felt they showed the participants respect, as if we were taking any other skill building class.

Content-wise, I was underwhelmed by DBT . It did have some good tools but my sense is it's been a bit oversold, so I guess setting realistic expectations would be good.
posted by latkes at 10:06 PM on August 24, 2016 [1 favorite]

I'm not a DBT client so I hope it's ok if I weigh in. I am a therapist who practices loose DBT (I am not strictly adherent to all aspects of the model). The best(s) of DBT are the practical skills for managing crises and the overall structure for people whose lives feel out of control. DBT's limits are its assumptions that behavioral change addresses the totality of a person's problems and that random concepts (i.e. radical acceptance) are more relevant than context and/or practicality. Happy to talk more about this, feel free to send me a message.
posted by rglass at 10:19 PM on August 24, 2016 [2 favorites]

I don't know if this will be helpful, as I have only taught DBT skills in the context of individual therapy, and have usually only taught the Emotion Regulation Module and some basic mindfulness skills. What I would say is that clients tend to either love it or hate it, so you'll probably get a mixed bag of responses. Not everyone is going to be happy, and it won't be about you. I myself have mixed feelings about the material itself. I don't know how much flexibility you will have in how you can present the material. I really don't like how jargon-y the standard presentation of DBT is. I tend to talk about it through the lens of inner child work, and that the goal of what we are doing is learning how to provide care, attention, and self-love for the scared and hurting little one inside when he/she comes up. I find that this framework helps people to feel less crazy, make sense of, and have more compassion for these extreme emotional states, which are usually some kind of traumatic flashback to childhood, but YMMV in this.
posted by amileighs at 10:40 PM on August 24, 2016 [2 favorites]

I think DBT can be really beneficial to certain people, but not tailoring the material to the needs of individual clients due to the nature of the group setting can be damaging in my experience. I touched on this very briefly a few days ago on the green, but some of the DBT skills just reinforced some extremely maladaptive coping strategies I'd already adopted in response to my education about borderline personality disorder. For instance, in the distress tolerance module you are encouraged to do ACCEPTS--activities, contributing, comparing, emotion, push away, thoughts, and sensations. Sounds great, right? For me, not so much. My entire maladaptive coping strategy involves obsessive immersion in distracting activities, complete avoidance of strong emotion through isolation and distance, lowering my self-esteem by comparing myself to others negatively, etc. None of this ACCEPTS stuff, except for the portion about giving to others, is healthy for me at all. Now you could validly argue that I've perverted ACCEPTS, but in a group setting where participants are actively discouraged from personal sharing the two coordinators had no idea that I was doing that and couldn't really course correct me or help me adopt healthier alternatives. It was up to me to figure out that I was already doing some of this stuff way too much and it was actively harmful to me.
posted by xyzzy at 3:32 AM on August 25, 2016 [6 favorites]

Newish DBT skills trainer here, so feel free to disagree & correct :-)

Our setup: Maximum eight participants, two trainers, full DBT.
I have no experience with partial DBT, but I'd imagine that you'd have to lower your ambitions somewhat.
Personally I would not endeavor to do DBT without team consultation.

Although I'm kind of in love with the concept at the moment, I can certainly relate to xyzzy's comment about every skill not fitting everyone or certain skills being maladaptive for some people.
When I teach I stress two things: What's the point of the skill, the rationale, and the fact that DBT skills are a scattergun approach: Some skills work for some people some of the time. So if a skill does the opposite of what it's supposed to, stop and try out another. Do what's effective.
So if you're on a diet, then perhaps don't try to improve the moment by eating something nice. And so on.

Random thoughts, no order:

Read Marsha Linehan's books. Really.

Don't skimp on the mindfulness.

I usually give some example either made-up or -usually- from my own life, to illustrate the skill or the concept being taught. The examples from my own life go down better. Nothing beats real.

Validate, validate, validate.

We tend to share quite a lot, both during the homework review, where we frequently do a chain analysis on the white-board, if it's relevant, and - to a lesser degree - when we assign homework, where we seek to pinpoint how the skill can be tried out in the person's life. But the skill is in focus.

If you can get the group to try the skill in session it's best.

The advice above about having read the material beforehand is spot on. I'd go a bit further: You can't teach what you don't know. So get to know the skills and try them out. Share your blunders. It defuses tension.

Also: Have fun! Teaching is fun!
Consider: 10 people in a room, discussing how to effectively deal with the most painful stuff in life. That calls for some serious warmth and also some, well, lightness, I suppose. Like: A problem! Yeah! Let's get technical on this!

Sorry if I kludged the lingo, fellow DBT-guys, I'm not a native ;-)
posted by Thug at 8:09 AM on August 25, 2016 [3 favorites]

As a group participant in a DBT-lite program, I found it helpful when the facilitators pulled from other resources in addition to Marsha Linehan. I like to hear multiple perspectives. Some of the resources I learned from and found helpful were: Brene Brown (self compassion, shame, and vulnerability), Tara Brach (Radical Acceptance), Kristen Neff (Self Compassion), Jon Cabot Zinn (Mindfulness), and the "tiny habits" guy whose name I forget (I googled it: BJ Fogg). Watching Ted Talks and reading the writings of these people (and others whose names I don't remember) sort of helped me put the DBT skills into context. I think the two biggest things I learned from my DBT informed group were: Self Compassion is a real thing and it isn't being selfish or coddling yourself, and Mindfulness actually works to make you feel better and it teaches you that there really is a calm place inside yourself no matter what's going on on the surface. I might not always be able to reach the calm place but it's nice to know it's there and have some real experience of it.

I also found it helpful when we actually took the time to fill out the worksheets in group. It's easy to look over the worksheets as remedial busy work until you actually do them and then when you dive in you realize that while the questions are simple, the answers are anything but.

One last thing: I really disliked it when the group would get weighed down in processing one individuals' experience. I think DBT works better when it's really focused on the skill work and the individual processing is held in balance. That's probably easier said than done, I can imagine that finding the right balance with that takes practice and experience.
posted by dchrssyr at 1:28 PM on August 25, 2016 [5 favorites]

Yeah, I didn't think about it before, but:
Full/standard DBT skills training lasts about a year and teaches each skills module two times, with -usually - mindfulness in between modules. The idea is that the skills are interwoven and really requires each other, so you can't really do relationship skills without distress tolerance skills and vice-versa. And so on.
Also, you can't change what you don't notice, therefore lots of mindfulness.
Thus if you try to compress the training, you have to go light on the process and up the facts, if that makes sense.
posted by Thug at 2:06 PM on August 25, 2016

Thanks, everyone. I'm definitely of the opinion that DBT offers some really useful skills but it's certainly not a panacea, so I won't be presenting it as The One and Only Way (which is true of any and all interventions I teach/do). And xyzzy, that's something I definitely will keep in mind (and have been thinking about anyway, because I've been noticing that our clients tend to use distraction almost exclusively to deal with negative emotions, which is great sometimes but, as you mention, not great if it's the only thing you're doing).

From what I understand, we will have consultation, though I'm not sure how long that will be the case. And my co-facilitators have been participants in DBT groups, which I am assuming and hoping will be helpful. And not much choice about whether I'm doing groups -- my workplace is insisting we have DBT Skills groups, and those of us who attended the agency-sponsored training are being required to start groups.

I will certainly pay attention to the handouts. I'm actually worried they're going to be a bit too complicated for our client population (many of whom haven't finished high school), but maybe I'm underestimating the clients. I plan on using the standard DBT-issued handouts (no clipart!), at least to start, and we'll see how it goes.

Thanks again. This was a lot of helpful info.
posted by lazuli at 8:24 PM on August 25, 2016

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