Skills Training Manual for Treating BPD – Chapter three discussion

This chapter makes some observations on the format group training should take (or what seems to work for the author), and the importance of ground rules in the group, as well as suggesting the ones that seem to be most effective.

The author has a clinic, which runs sessions once per week, which last 2.5 hours, including a 15 minute break. The session consists of the following;

  • The beginning of the session where there is a brief discussion with anyone who has missed sessions, the reasons behind their absence are analysed and known as ‘therapy interfering behaviours’
  • Approximately an hour is spent reviewing ‘homework’ (the application of skills learnt at the last session throughout the past week). If someone did not practice, this must also be discussed as there will be reasons for their lack of motivation
  • A short break is good to have, to break up the session and to allow members of the group to interact in a structured manner and to re-fuel with food and drink
  • Approximately an hour is then spent going over new material, however it is important that the homework review is more important therefore if it needs longer than an hour, it should be given the extra time.
  • The session should be finished with a 15 minute ‘de-brief’ or ‘wind down’ to prevent people from leaving the group in a state of emotional turmoil. The book mentions two methods of ‘winding down’; the first is called process-observing whereby group members are asked to share (sometimes controversial) observations about how the session went). The second is using relaxation, meditation, visualisation and breathing exercises. Personally I prefer the second method, as it may be far too easy to make hurtful comments about other members and then damage their emotional state even further.

The book goes on to explain that it is very important to have ground rules within the group, and these should be explained in the first session, and to any new members who join the group (if it is an open group). It mentions the following;

1) Clients who drop out of therapy are out of therapy – The suggestion is that is someone does not attend four sessions, they are seen to have dropped out and cannot return to the group. This refers to ‘unexcused’ absences (absences with a valid excuse don’t count, such as hospitalisation).

2) Each client has to be in ongoing inividual therapy – As I mentioned before, it is important to have individual therapy alongside group skills training. Group training is for SKILLS, not the discussion of ongoing traumas in day-to-day life.

3) Clients must not come to the session under the influence of drugs or alcohol

4) Clients are not to discuss past (even if immediate) parasuicidal behaviours with other clients outside of sessions – I had to google ‘parasuicial’  but basically it means a suicide attempt or self harm which not result in death. This rule is mainly because when you hear about someones suicide attempt/self harm it creates a strong urge to copy their behaviour.

5) Clients who call one another for help when feeling suicidal must be willing to accept help from the person called – Basically if you phone someone, you must allow them to help you. You can’t tell them to keep it to themselves – if you are in trouble you must accept their help.

6) Information obtained during sessions, as well as the names of clients, must remain confidential

7) Clients who are going to be late or miss a session should call ahead of time – As well as being common courtesy, it also prevents other group members from worrying about you.

8) Clients may not form private relationships outside of training sessions – The emphasis here is on the word ‘private’, meaning a relationship that cannot be, or would be awkward to be, discussed in the group setting.

9) Sexual partners may not be in skills training together – This could be awkward for both parties and other group members

As always, if I have written something incorrect, please let me know, I am learning!

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3 comments

  1. mylifewithbpd · · Reply

    I wish all places doing dbt did it this way, most in my area is simply a one hour a week with a counselor, and no group stuff at all… 😦

    1. That’s pants. I bet that means you don’t get enough time to go through skills, and psychotherapy too.

  2. […] Session beginning strategies (Already discussed here) […]

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