Skills Training Manual for Treating BPD – Chapter two discussion

This chapter discusses the logistics on the DBT treatment and the positive and negatives of doing the treatment in different ways. First off, it explains that DBT is split into two sections – one is individual therapy and the other is skills training. These two things can’t be done together because it is too hard to try to discuss feelings and thoughts in a therapeutic environment at the same time as teaching someone how to learn new behavioural skills.

So, talking about skills training, Linehan explains the differences between individual and group skills training;

Individual Skills Training:

  • Hard to keep on a decent ‘track’ with regards to skills training because it is very easy to get sidetracked with current crises (this would not happen so readily in a group as there are more people there)
  • Easier to notice emotional state of patient (much harder to keep track of all members in a group – and this is vital because if traumatic ground has been covered they may leave the group in a ‘bad place’)
  • Inefficient – does not allow the therapist to watch and analyse person to person relationships (which is where these skills will eventually be applied)

Groups Skills Training:

  • Provide a validating environment (other people are suffering the same problems)
  • Provide peer support
  • New relationships formed encourage the patient to continue with therapy
  • A group can be ‘closed’ (no new members for a set period of time) – more trust built up between patients however may become resistant to change, or ‘open’ (members constantly coming and going) – allows patients to learn to accept change in a safe environment
  • Groups can be ‘homogeneous’ (all people of the same diagnosis) – this can provide a much more tailored and specific therapy group, however there are big risks with regards to patients being triggered by each other or copying each other (I know I personally am easily triggered, and if I am with someone who is suicidal I quickly become suicidal myself, this could also be worse in a group where the therapist may not notice your fragile emotional state as there are so many patients there)
  • They can also be ‘heterogeneous’ (different diagnoses) – this must be a more generalised therapy program
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