Dialectical Behavior Therapy
DBT is a form of Cognitive Behavioral Therapy (CBT) that has been shown to be effective for people with therapy-resistant anxiety, major depression (MDD), bipolar depression (BPD), personality disorders, Borderline Personality Disorder (BPD), mild autism spectrum disorders, Post Traumatic Stress Disorder (PTSD), Eating Disorders, and/or addictions (SUD). DBT has been particularly helpful for clients who have not succeeded at other treatments, who find it difficult to maintain healthy life changes, or who have difficulty remaining safe.
DBT focuses on helping a person learn to recognize, change, and control their own emotional states. DBT teaches a set of skills including Mindfulness, Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness. By learning these skills and applying them in individual sessions with DBT-trained therapists, clients can learn to manage emotions better, feel better, and have more control over their mental health and impulse control.
DBT was originally created by Professor Marsha Linehan at University of Washington in Seattle. It is gaining momentum to treat a wide variety of disorders across the US and internationally. Here is a FAQ page about DBT from the founder of DBT.
Types of Treatment
Informed Mental Health Treatment
Clients attending our DBT Informed Treatment Program have a mental health disorder and have not been successful at making changes in previous treatment. We offer DBT informed mental health treatment programs for adolescents, ages 11 to 18, and adults.
Informed Addictions Treatment
Clients attending our DBT Informed Addictions Treatment Program may have an Addictions/Substance Use Disorder (SUD) or a dual diagnosis of SUD and a Mental Health Disorder. They might also be people who have struggled to achieve or maintain sobriety through standard SUD treatment models. We offer DBT informed addictions treatment programs for adolescents, ages 11 to 18, and adults.
How are we different from other Programs?
We are a Dialectical Behavior Therapy (DBT)-informed treatment program offering services for individuals who have not found success in decreasing emotion dysregulation, impulse control, and self-harm behaviors with other modes of treatment. We draw from the work of Dr. Marsha Linehan and Dr. Lane Peterson, and offer the components of a DBT “program”. Many others offer groups that teach DBT skills, but are not fully encompassing programs. Much of the learning, practice, and application is lost with just a group or class. We work hard to help our clients incorporate new skills and new ways of living into their lives; even individual and family therapy is done differently in a DBT Program. We help our clients and their families to understand the concepts while incorporating or modifying those concepts to work for their specific needs. This is not a one-size-fits-all program: we modify every aspect of DBT to work for you.
Features of our program important to making change, learning, and using DBT include:
- DBT skills classes twice per week
- Individual therapy with a DBT-informed clinician up to twice per week
- A parent or spouse/significant other group once per week where they learn the skills that the clients are taught
- Access to the 24-hour, seven-days-per-week on-call phone
- Case management/wrap-around services
- Weekly staff clinical supervision and consultation meetings; we constantly re-direct treatment based on what our clients need
- Homework given to each client to reinforce the skills taught in groups and in individual therapy
- Most insurances accepted for a portion of the program
Our DBT-informed Program incorporates aspects of other treatment modalities, including cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), Adlerian Therapy, etc., while holding true to the core DBT principles and skills. The program at Integrative Counseling and Congruent Counseling is one of the only programs around that can incorporate our full DBT-informed program and addiction treatment programs. This has been very effective for clients who cannot maintain clean time or who have dual diagnoses who have not been able to maintain a healthy lifestyle.
Each of these components of our program is what makes us stand out from other groups, which may offer only one group per week or just individual therapy. We tailor the program to each client’s needs; hence the four levels of treatment as described. We are also different because the individual and family therapy portion of the program can be covered in-network with most commercial insurance companies. No other program in the area offers this.
Four Levels of Care
Level I-Intensive/ Comprehensive
Individuals who have difficulties between sessions and difficulty resolving issues or calming down on their own.
You can manage in between sessions and are making good use of individual treatment and skills classes. This level of care is less intense with only once a week individual or family treatment.
Level III-Classes only
For most clients this will mean that their individual/family treatment is being handled outside of the DBT team, however, they want to continue to attend or need skills classes. This level gets access to all the classes and once-a-month coordination with DBT Team member. This does not include on-call or in between crisis management.
Level IV-Individual sessions only
This level is there for those clients who no longer need skills classes or who choose to work the skills independently. This level is available to those people who want to continue to receive DBT therapy by a team member and who no longer have any of the high-risk behaviors that would require more intense treatment. This therapy is provided under Integrative Counseling and is not billed through insurance.
Why is DBT so difficult to get covered by insurance?
DBT treatment has many components of treatment that are not paid for by any health insurance at this time, including but not limited to skills training classes, phone sessions, parent coaching, crisis intervention, and case coordination with schools and psychiatrists. At this time, no insurance is covering these services. Most DBT programs require out of pocket payment and do not bill insurance because of this challenge. We have been able to get the cost down by billing insurance for the individual and family counseling through Congruent Counseling.
Why do I get charged by two different companies every month?
In order to get as much covered by insurance as we can, our DBT program straddles two companies. Congruent Counseling Services bills the insurance for the in-person office individual, Intensive Outpatient Program (IOP), or family therapy. Integrative Counseling holds no insurance contracts and manages the monthly subscription and services not covered by insurance.
Why are initial consultations not covered by insurance?
During the initial consultation we meet to discover whether you or your family member are appropriate for the program and allow time for discussion and questions. The consult is a longer discussion period and not a formal assessment or intake as required by insurance companies. Because DBT is an involved and time intensive program, we want to spend the time with you and your family so you can fully understand and agree to commit to treatment.
Expectations for families of teens and adults
For Teens, expect parent participation in most sessions. Teens should not be coming by themselves. Most individual sessions will require a parent for at least a few minutes. Teens have an expectation of privacy for therapy; however, until they are safe and without episodes of suicidality or other risky behaviors the safety planning and treatment may occur with the adult in the room.
For adults living at home with parents, parents are also encouraged to participate in weekly sessions and in scheduled family sessions. For adults living on their own, we encourage participation by spouses, significant others, or family members. Often mental health or substance use disorders cause strain and tension in relationships. Parents, spouses, or significant others may also do things that contribute to the problem or may simply need support themselves. We work to change the system so that everyone is healthier and happier. This not only helps our client get healthy, but also helps families stay together and learn to be healthy as a group.