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Therapists at The Resource Group in Towson have been in a year-long training process in Dialectical Behavioral Therapy. We believe this technique will be particularly well-suited to our clients with chemical dependency and other severe and seemingly intractable problems. We are really excited about how this program energizes us and our clients.

Dialectical behavioral therapy was first developed by Marcia Linehan to treat suicidal and parasuicidal patients. She discovered that, by combining the techniques of cognitive-behavioral therapy (using shaping, exposure therapy, cognitive restructuring and the like) with mindfulness meditation practices, she could help even severely traumatized patients drastically reduce self-harming behaviors. Further, these techniques, when utilized in a formal program of treatment, helped borderline patients particularly well, and reduced therapist “burn out” from working with these severely depressed people.

As time went on, Dr. Linehan and her colleagues at the University of Washington noted that DBT was helpful with nearly any client who had problems with emotional dysregulation, interpersonal dysregulation, self-dysregulation, and behavioral or cognitive dysregulation. Most people who have such difficulties started out as emotionally vulnerable children who then experienced an invalidating environment. As we all know, the four deficits above also interfere with the therapy intended to reduce them! The job of the DBT therapist is to simultaneously offer a validating environment to the client, while outfitting him/her with the skills to manage his emotions and distress. In this fashion we might actually keep the client in therapy long enough to improve his/her life.

This is not new to most social workers, who are trained to be “warm, empathic, and genuine” while persistently demanding change, in order to empower our clients. However, Dr. Linehan and her colleagues at BehavioralTech offer a research-based program to deliver these skills in an organized, coherent fashion.

The organizing principles of any DBT program are the following assumptions about patients and about the treating therapists:

About Patients

• Patients are doing the best they can AND patients want to improve
• Patients must learn new behaviors in all relevant contexts
• Patients cannot fail in DBT AND patients need to do better, try harder, and/or be more motivated to change
• Patients may not have caused all of their problems, BUT they have to be the ones to solve them, anyway
• The lives of our patients are unbearable as they are currently being lived.

About Therapy and Therapists

• The most caring thing a therapist can do is to help a patient change in ways that bring the patient closer to his/her own ultimate goals
• Clarity, precision, and compassion are crucial in the conduct of DBT
• The therapeutic relationship is a real relationship between equals
• Principles of behavior are universal, affecting therapists no less than patients
• DBT therapists can fail
• DBT can fail even when therapists do not
• Therapists treating multi-problem, emotionally deregulated patients need support.

This last assumption requires the creation and continuation of a DBT treatment consultation team. At The Resource Group, our team meets for 90 minutes every week, and any individual therapists are welcome to join the group. The team troubleshoots individual cases and assists therapists in “maintaining a dialectical stance”.

Our new DBT program includes weekly individual therapy on the DBT model (balancing validation with demand for change) and a weekly 90 minute Skillful Living Group (class). In the 12-week class, participants learn and practice these skills: mindfulness practices, emotional regulation, distress tolerance, and interpersonal effectiveness. Weekly homework review holds clients accountable for generalizing their new knowledge out in the real world.

Several of the clients in the Skillful Living Group also attend one of our Addiction Education or Early Recovery groups. We are finding that using a dialectical behavioral approach in individual therapy, coupled with the skills training group, results in more functional behavior and improved self-concept and mood for those afflicted with chemical dependency, eating disorders, chronic depression or bipolar illness, “codependent” and chaotic relationship patterns, and compulsive gambling.

Anyone interested in learning more about this “rationally eclectic” treatment approach can contact Betsy Amey or Katharine Blakeslee at The Resource Group, 410-337-7772 or ameyrg@verizon.net, or Dr. Linehan’s company, BehavioralTech, at www.behavioraltech.org.

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