comprehensive dbt for adolescents & families

comprehensive dbt for adolescents & families: faq

1. Dialectical Behaviour Therapy (DBT) has been recommended for my teen. What is DBT?

Dialectical Behaviour Therapy, or DBT, is an evidence-based treatment for people suffering from a range of difficulties. Some of the difficulties DBT is designed to treat include impulsive behaviour, difficult to control emotions, difficulties in relationships, and in some cases, self-harm, and suicide attempts. 

DBT is comprised of four modes or components: 

1. DBT Based Individual Therapy (distinct from typical individual therapy)

2. Group Skills Training

3. Out of Office Telephone Coaching

4. DBT Therapist Consultation Team. 

DBT also includes a 4-6 week long Pre-Treatment Phase during which a clinician assesses the client’s appropriateness for DBT, orients the client to what DBT is, and the client and clinician collaboratively solve any commitment challenges before beginning treatment. 

After this Pre-Treatment Phase, DBT includes a commitment to 25 weeks of treatment. In some cases, at the conclusion of this 25 weeks of treatment, there is sometimes the possibility of extending treatment if space allows in the clinician's schedule, and if the client and clinician both feel that would be helpful for the client. 

This video is a helpful introduction to DBT for teens and families. Much of the programming described in this video is consistent with the teen and family programming at Broadleaf Health. 

2. Is DBT for teens different from standard DBT? How are families included?

DBT for teens can in some ways be thought of as DBT for the family. Responding to the needs of the teen necessarily involves responding to the needs of the family. 

Several unique treatment components are:

1. Teens meet their Individual DBT Therapists once per week.

2. Teens attend a weekly 2-hour DBT Skills Group with other teens. This group is held in person at our Guelph location on Wednesdays from 6pm to 8pm.  

3. Parents join a weekly online DBT Skills Group for Parents on Mondays from 6pm to 8pm. 

4. Parents also participate in DBT based Individual Parent Skills Coaching approximately once every 2-4 weeks.

3. What is different about DBT at Broadleaf Health?

Broadleaf Health is committed to providing effective treatment. While we cannot guarantee that any client will benefit from DBT in exactly the way they want or expect, Broadleaf Health is committed to providing therapy that has been independently established as beneficial for clients. 

One tangible example of our commitment to providing effective care is our Certification through the Dialectical Behaviour Therapy Linehan Board of Certification (DBT-LBC). DBT-LBC is the only certification body established by the treatment developer, Dr. Marsha Linehan. DBT-LBC provides separate processes for individual DBT therapist certification and DBT program certification. 

Multiple DBT-LBC certified individual clinicians work at Broadleaf Health. Broadleaf Health is also one of only three DBT-LBC certified programs in Canada, and the only DBT-LBC certified program in Ontario. 

The DBT-LBC certification process is a thorough and comprehensive process that typically lasts 6-12 months for successful programs. 

Certification by DBT-LBC is highly rigorous and includes:

1. Providing hundreds of pages of clinic policies and program descriptions.

2. Interviews with clinicians during which their knowledge, skills, and abilities are tested by established experts.

3. Observation of DBT Skills Groups.

4. Observation of DBT Consultation Team Meetings.

5. Interviews with clients who gave consent to describe their experiences receiving DBT at Broadleaf Health. 

Our staff chose to participate in this intensive process as a kind of gift to our clients and ourselves. The gift to our clients is that they can know they are getting DBT provided by therapists at a program that meets the highest possible standards. The gift to ourselves is having the opportunity to gain feedback on our programming, make changes where changes might improve our programming, and receive validation from leading experts that our DBT programming meets the highest possible standards. 

While some “DBT-informed” programs/ therapists may provide helpful care, there is some concern amongst clients and treatment providers that there is increasing confusion about what DBT is, what the most essential elements of it are, and how to make sure it is as helpful as possible. 

For example, there is no research that suggests that DBT for teens that does not include significant and structured parent programming is effective. Research indicates that comprehensive DBT, which includes all 4 modes described in Question 1 above, is significantly more effective than DBT-informed interventions that do not include all four modes. 

We believe clients should receive the treatment they are being told they are receiving. We believe that clients should receive the very best version of that treatment possible. 

Broadleaf Health was granted DBT-LBC certification in 2022 and this process as well as interviews with clinicians and clients has ended. 

4. What can my teen expect from Individual DBT Appointments?

It is difficult to describe the many uniquenesses of Individual DBT Appointments compared to other kinds of psychotherapy. On a basic level, DBT operates from the assumption that client’s difficulties result from difficult to control emotions. DBT is also based on the belief that clients need to learn skills to build the better life of their choosing, and that learning includes both exposure to skills and also a supportive, validating, and accountable atmosphere that facilitates the skill use that is necessary to build a life worth living. 

Individual DBT appointments provide both validation and a focus on goals the teen has set during their Pre-Treatment Phase. 

Conversations between teens and clinicians remain confidential. 

The teen’s clinician will not typically provide direct updates, check-ins, or directions to parents. 

In order to ensure the teen’s clinician has all relevant information about family life, parents can share information with their child’s clinician via email once per week. The content of the email may be shared with the teen. 

5. What can I expect from Parent Coaching?

Parent Coaching is an opportunity for caregivers to receive the validation and skills they need to become more effective. Parent coaching occurs less frequently than the teen’s weekly appointments. Parent coaching appointments occur approximately once every 2-4 weeks and focus on helping parents practice DBT skills themselves in order to improve the overall health of their family.

6. What can my teen and I expect from DBT Skills Group?

Teens sometimes begin treatment reluctant to participate in the DBT Skills Group, and then oftentimes end up absolutely loving this mode of the treatment. Teens attend a 25-week DBT Skills Group. Parents attend a separate group which covers the same skills from a care-giver perspective. In this way, teens and caregivers have an opportunity to build a supportive community of peers in their respective groups. 

DBT Skills Groups focus on learning skills to better regulate emotions, thoughts, and behaviour, tolerate distress, and improve relationships. 

All DBT Skills Group participants are expected to learn, practice, and share their home practice with the group each week. We often tell our clients that participating in therapy is just as important as attending therapy.

7. Are caregivers required to be involved?

Yes, at least one caregiver must participate in both Parent DBT Skills Group and Parent Coaching as improvements in family functioning are crucial for better improvements in teen health. 

8. Can my teen participate in only one aspect of the treatment, like individual therapy or skills group?

Comprehensive DBT (Individual DBT Therapy, DBT Skills Groups, Out of Office Telephone Coaching, and a DBT Based Therapist Consultation Team) is the only known intervention for teens and families that is considered an evidence based practice. Meaning, this is the only treatment format that has been established as effective in helping teens and families. We provide comprehensive DBT and adhere to its model because it is the model that is mostly likely to create consistent outcomes for teens and families.

9. My teen was recommended DBT, and we believe it's the right choice. Can they skip some of the assessment sessions and start treatment right away?

DBT incorporates a crucial Pre-Treatment Phase, which serves multiple purposes. This phase is not only about gathering information but also about building rapport and establishing a strong working relationship. Individuals are often referred to DBT by well-intentioned care providers who recognize its effectiveness but may not fully understand the treatment process.

It is essential that all family members have the opportunity to be heard and that they also understand the commitment involved, as it may differ from previous therapy experiences. Pre-Treatment forms the necessary foundation for successful treatment as it allows time to develop rapport, set treatment related goals, and develop a shared understanding of what treatment will entail for the teen client and care-providers. Skipping this phase can compromise the overall effectiveness of the treatment and is not allowed in our programming. 

10. Can you accommodate complex needs?

DBT was designed to address complex needs. At the same time, some individual accommodations are limited. 

In some cases, we may be unable to meet unique needs related to intellectual disabilities, Autism Spectrum Disorder, or other challenges that may hinder treatment effectiveness. 

Suitability for treatment will be evaluated during the Pre-Treatment Phase and as needed during treatment. 

Just as medication for high blood pressure may not be a suitable treatment for diabetes, families deserve to not have a treatment that is effective for some difficulties be offered for difficulties it was not designed to treat. 

In rare cases, Pre-Treatment or Treatment may be suspended or ended if Broadleaf Health staff believe they are unable to meet your child’s needs. 

11. We are interested. What are the next steps?

​​Once you contact our office, we'll send you a prospective client form. Once we receive your completed form, you'll be added to our waitlist. Please note that appointment availability is limited due to the nature of the program. If you're offered an appointment that doesn't align with your schedule you can decline, but be aware that the wait for another appointment may be significant.

The DBT Pre-Treatment Phase typically includes 4-6 assessment/orientation and commitment sessions. The first 1-2 sessions are 1-on-1 between the clinician and your teen. The second or third appointment involves both you and your teen’s clinician. The final 1-2 sessions are between the clinician and your teen.

Once your teen and clinician decide to pursue DBT, and a commitment is made, your teen will receive a treatment contract to review with your family. 

After your family signs the contract, your teen will then be participating in the Treatment Phase of DBT. At that time the focus of the appointments will shift from Assessment, Orientation, and Commitment to a focus on validating the difficulties that have led the teen to seek treatment and focusing on goals and skill practice to start building the better life of their choosing. The start date for the group will be communicated when the contract is signed. The administrative team will also contact caregivers to set up a DBT Parent Coaching, schedule a start date for the DBT Parent Skills Group, and address any remaining questions or concerns.

12. What if I have more questions?

If you're considering DBT for your teen or want more information, please reach out via our contact page (https://www.broadleafhealth.ca/contact), phone (519) 265-7734, or email our admin (admin@broadleafhealth.ca). We can add you to our waitlist or schedule a brief, no fee, phone call with one of our clinicians to address any questions not covered in this FAQ.