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4-Part Series: Using DBT Principles and Skills in Clinical Practice – Ella Brent

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Buy the whole series or just choose which one hour, pre-recorded module suits your requirements!

CPD / CE / NBCC Hours: 1 for every module

 

This 4 module course introduces participants to the Dialectical Behaviour Therapy approach developed by Marsha Linehan (1991) in a way that can be effectively used in psychotherapy practice across a variety of clinical settings.

The DBT treatment approach was initially developed for patients suffering from cycles of suicidality, self-harm and other impulsive behaviours, inter-personal conflict, shame and self-hatred. This clinical group, diagnosed variously as having Complex Post-Traumatic Stress Disorder, Emotion Dysregulation Disorder, or Borderline Personality Disorder, can be difficult for clinicians to treat, on both a level of technique and personal emotional strain.

This course will provide clinicians with a clear and yet in-depth understanding of the client’s presenting problem, and provide a clinical approach that is applicable across psychotherapeutic approaches. The presenter will make these clinical skills relevant across a wide range of presenting difficulties, from a severe personality disorder presentation to more integrated patients’ struggles with impulsivity and mood disturbances. Read More

TRAINING information

This 4 module course introduces participants to the Dialectical Behaviour Therapy approach developed by Marsha Linehan (1991) in a way that can be effectively used in psychotherapy practice across a variety of clinical settings.

The DBT treatment approach was initially developed for patients suffering from cycles of suicidality, self-harm and other impulsive behaviours, inter-personal conflict, shame and self-hatred. This clinical group, diagnosed variously as having Complex Post-Traumatic Stress Disorder, Emotion Dysregulation Disorder, or Borderline Personality Disorder, can be difficult for clinicians to treat, on both a level of technique and personal emotional strain.

This course will provide clinicians with a clear and yet in-depth understanding of the client’s presenting problem, and provide a clinical approach that is applicable across psychotherapeutic approaches. The presenter will make these clinical skills relevant across a wide range of presenting difficulties, from a severe personality disorder presentation to more integrated patients’ struggles with impulsivity and mood disturbances. Read More

Module 1

Module One: A Clinical Framework

This Module introduces Marsha Linehan’s development of DBT as a distinct approach to treating clients’ impulsivity and suicidal behaviour. It provides an insight into the limitations of non-dialectical approaches for this population and illustrates the core dialectic between Acceptance and Change.

Clients presenting with emotion dysregulation, impulsive behaviour, and recurrent life crises often feel overwhelmed by the apparent unpredictable and chaotic nature of their daily lives. They can feel like the world happens at them and are left feeling out of control, and with a profound sense of being bad.

As clinicians we may have some diagnostic lists that provide a tool for assessment, but which do not account for an integrated meaning of the behaviours that we see. In terms of a diagnosis of Borderline Personality Disorder the DSM V gives a checklist of observable symptoms which identify the disorder, but which do not provide an account of why and how these features fit together. The Distress Cycle presented in this module provides an inclusive understanding of the key features of emotion dysregulation including BPD, and how they are maintained.

It has been a profound experience for clients to be offered a deeply meaningful over view of how their “problems” and behaviours make sense, even when they don’t work. It demonstrates how their problems are interconnected, and that there is a realistic way out of the vicious cycle of distress, ie “A way out of hell” (Linehan 1991).

Learning Objectives

  1.  Introduce the dilemmas of working with clients who present with impulsive behaviour and suicidal intent.
  2. Clarify the limits with this population of approaches that emphasise validation, and those that focus on change. This is the paradox that validation can maintain current behaviours, while a focus on change can be invalidating.
  3. Illustrate that this contradiction between positions can be resolved by a synthesis of both; the validation of the current situation with an invitation to change.
  4. Demonstrate a practical way to explain to clients that their current behaviours make sense using the Distress Cycle.
  5. Demonstrate a practical way to illustrate to clients how their current behaviours are not working to achieve a life worth living.
  6. Demonstrate that DBT skills can assist in interrupting the distress cycle in order to establish a life worth living.

Module 2

Module 2: Core Dialectics

The core dialectic in DBT of Acceptance and Change was introduced in Module 1. In this module the concept of synthesis will be expanded to include other core dialectics of the DBT approach.

It is the tendency in dysregulation states to “do feelings” that results in clients’ impulsivity. Their feelings are valid and make sense in the context of their experiences in life. At the same time, “doing feelings” on impulse often results in consequences that obstruct developing rewarding lives. Therefore, teaching clients the difference between the validity of their “Inside experience,” alongside the skillfulness of their “outside action” is necessary to achieve a life worth living.

A central tenet of DBT is the awareness of the opposition between the Emotion Mind and the Rational Mind. The Emotion Mind is when the client is flooded with intense emotions, to the exclusion of being able to reflect on their experience. In contrast, the Rational Mind is when the mind is filled with logic to the exclusion of felt experience. For emotionally dysregulated clients this swing between being flooded with feeling to a disconnection (or even dissociation) from their feelings is a maintain factor in the Distress Cycle.

This module illustrates these concepts and introduce the idea that the first step in disrupting the cycle of distress is to become aware of and distinguish between these states of mind. The Emotion Mind is a valuable resource in providing emotional connection, self-validation, and motivation in our lives. However, emotion without thought results in an urge to impulsively “do feelings” as a form of action. The Rational Mind is a valuable resource in providing the ability to plan and problem solve. However, rationality without connection to feelings, tends to be meaningless and empty. The dialectical approach provides a meaningful way to synthesize these two oppositions in the form of the Wise Mind which offers the possibility to think about feelings and feel emotionally connected to our planning and organizing skills.

Learning Objectives:

  1. Present the distinction between Inside Experience and Outside Action in a clinically accessible form.
  2.  Illustrate the synthesis between acceptance and change, showing how to validate feeling and change behaviour.
  3.  Illustrate the meaning of the Emotion Mind, Rational Mind, and Wise Mind in DBT with reference to video material.
  4.  Explain the value of all 3 States of Mind for clients.

Module 3

Module 3: Mindfulness: The What and How Skills

The Core Dialectics highlighted the difficulties associated with non-dialectical approaches, and the usefulness of a synthesis between opposing positions. It is however one thing to understand the value of a dialectical approach, and quite another to be able to implement it. Many clinicians might suggest to their clients the benefits of “sitting with feelings,” yet clients need more direct assistance in learning what this means, how to do this, and what the benefits could be.

The Mindfulness Skills develop the capacity to guide the focus of one’s attention. It is more of an active capacity to attend, integrate, and inhibit action, than to aspire to rest or relaxation. Mindfulness Skills are like the reigns we put around the wild horse of our emotions to guide the forceful nature of the beast safely in useful directions.

In all forms of acceptance and change an awareness of both the current reality, and the focus of attention to learn and apply new skills are required. Therefore the Mindfulness Skills are the first skills taught in DBT, and are also reviewed and repeated between all new skills sets.

Marsha Linehan recognised that traditional forms of Mindfulness that focus on achieving stillness by traditional meditation can often be an aversive experience for both dysregulated and traumatised clients. She developed a more practical and tolerable set of goals. These are the “What to Do”, and “How to Do it “ Skills as presented in this Module.

In addition to the attentional control offered by these Mindful Skills, they also offer ways to “plug back in” as an antidote to disconnection and emptiness. While many of the skills focus on the downregulation of an agitated and over-aroused Emotion Mind, the Mindfulness Skills are needed for the capacity to move from an overly Rational Mind into a more empathically connected Wise Mind.

Learning Objectives

  1. Demonstrate what is meant by Mindfulness in the context of DBT
  2. Demonstrate why the Mindfulness Skills are useful for dysregulated clients
  3. Present the What and How Skills
  4. Teach how to support clients to implement these skills in their everyday lives

Module 4

Module 4: Distress Tolerance

A useful understanding of impulsive behaviour is the tendency for clients to “do” their feelings as actions in the outside world. This means that their impulsive behaviours are discharged emotions rather than actions that are able to address or communicate thoughts and feelings. This is the result of problems in regulating the intensity of feelings, and also the ability to experience them as an inside experience. In combination this means that clients have more intense emotional experiences combined with less ability to tolerate them.

In order to reduce impulsive behaviour, clients would need to be able to tolerate intense and distressing feelings without acting on urges. This is because acting impulsively tends to have consequences that in turn make the situation even more distressing and difficult for clients to tolerate. Therefore, once in the Emotion Mind the priority becomes to resist the urge to act impulsively, in order to prevent difficult situations becoming even more difficult to face.

The Distress Tolerance Skills are those skills that prevent distressing situations becoming worse. It is often the consequences of impulsive behaviour, such as using substances, self-harm, reckless driving, and so on, that make life more unbearable for clients than caused by their initial emotional distress. If clients are able to experience the distressing feelings without acting on urges, the distress is able to ebb and flow without long term damage being done, to the self, relationships, and work.

Distress Tolerance can be divided into the skills needed to survive acute crises where no immediate solution is possible, and acceptance skills needed to tolerate profoundly difficult life situations that can result in long term suffering.

Learning Objectives

  1. Illustrate the link between emotional intensity and behavioural dysregulation
  2. Introduce Crisis Survival Skills that draw on body chemistry
  3. Demonstrate ways Distraction Skills offer emotional regulation
  4. Present the importance of Radical Acceptance in reducing suffering

About Ella

Dr Ella Brent acquired a Doctorate in Clinical Psychology from University College London in 1999. Between 2000 and 2002 she worked in Public Health in the UK in NHS Child and Family Services. From 2002 until 2008 she worked at Tara Psychiatric Hospital Johannesburg South Africa, across a variety of inpatient and outpatient services, culminating in her heading the Tara Hospital Psychology Department. Since leaving Tara Hospital, she has worked in private practice, offering individual adult psychotherapy and clinical supervision.

In 2015 Ella joined with colleagues in conceptualising and establishing The Day Clinic in Johannesburg. The Day Clinic is an innovative Day Hospital facility offering a DBT informed intensive stabilisation treatment programme. The Day Clinic offers adult and adolescent services to interrupt clients’ cycles of emotion dysregulation, impulsive behaviour and mood disturbances.

Ella has a special interest in the meaningful application of Dialectical Behaviour Therapy (DBT) and Mentalising Based Therapies (MBT) to address long-standing relationship difficulties, mood disorders and impulsive behaviour. She is also passionate about locating these treatments within existing theoretical models for the professional community.

CPD / CE

CPD / CE / NBCC credits: 1 for each module

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4-Part Series: Using DBT Principles and Skills in Clinical Practice – Ella Brent

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