Enhancing Therapists Capabilities and Motivation

The final function that is addressed in DBT is the enhancement of therapists' capabilities and motivation to treat multiply diagnosed clients. As stated earlier, Linehan saw the necessity of treating the therapists who are subjected to the intense emotional misery and out of control behaviours of a difficult to treat population. This is addressed through a weekly meeting of the therapists involved in all modes of the treatment. The therapist consultation team is not a standard treatment team. Therapists who treat high-risk clients need support from their peers in order to reduce burnout or falling out of the treatment - engaging in iatrogenic behaviours or not doing DBT. The therapist consultation team meets once weekly for one to two hours depending upon the setting. The team meeting is attended by anyone who is providing any mode of DBT. Only those therapists who are engaged in the treatment come to the meeting; there are no visitors. In a nutshell, the therapist consultation team meeting is the application of the therapy to the therapists. Each therapist has the opportunity to bring up problems with a client and ask for support, guidance, input, or whatever the therapist feels is needed. The team's role is to balance validating the difficulty of treating the patient while pointing out when the therapist is falling out of the treatment, being reinforced for providing ineffective treatment or being punished for providing effective treatment. Although supervision and consultation are often deemed ancillary in other treatments, in DBT the consultation team is a mandated mode of treatment regardless of whether DBT is being structured as a comprehensive or a component programme.

Comprehensive DBT can be modified for different settings. For example, an inpatient unit may decide to provide a comprehensive treatment, meeting all criteria through the different modes in the treatment. Capabilities can be enhanced on an inpatient unit through psychopharmacology, patient education and through skills training. Motivation on an inpatient unit is often improved by conjoint psychopharmocology and milieu treatment. Discharge planning with an emphasis on skills used for relapse prevention also supports the function of generalization as well as milieu, staff acting as skills coaches for clients on an inpatient or partial hospitalization unit. The environment in an inpatient unit is structured through the structuring of the administrative hierarchy as well as through family therapy and family education or accessing vocational/financial support through social work services. Finally, in an inpatient DBT programme, therapists' capabilities and motivation are usually enhanced through the DBT consultation team. In intensive outpatient programmes, partial hospitalization programmes and other acute programmes, skills training is streamlined to focus on the crisis skills and those skills needed to prevent relapse and recidivism. In forensic programmes telephone consultation is not a viable option for generalization to the natural environment, but staff on the unit or peers are often trained to be skills coaches.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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