Structuring the Environment

The fourth function of a comprehensive DBT is to structure the environment, which in standard outpatient DBT is the precise structuring of the clinic to ensure that the behaviours that are targeted for increase through the treatment are reinforced and the behaviours that the treatment is attempting to extinguish are not being reinforced. The role of the administrator in a DBT clinic is to ensure that the clinic itself does not punish target-relevant behaviour and reinforce maladaptive behaviour (for example the clinic might provide extra attention for ongoing suicidal crises and withdraw attention upon improvement).

Case-management issues are also addressed through structuring the environment. DBT favors teaching the client to intervene in his/her own behalf (consultation-to-the-patient strategies) over intervening for them whenever possible. Unless the outcome of the intervention is more important than the client's loss of learning, the therapist will coach and practice with the client how to talk with others. Dialectical behaviour therapists do not provide information to others, including other professionals. Clients are encouraged to speak for themselves whenever they are capable of doing so. Therefore, DBT therapists coach clients on how to interact with their environments whenever possible. For example, the DBT therapist does not contact a client's physician and make suggestions for medications or medical interventions. Instead, the DBT coaches clients on how to ask the physician for whatever it is that they want. Of course, there are times when environmental intervention is necessitated. These times are generally when the outcome is more important that the learning of skilful behaviour by the client or if there is an imminent risk to the client or someone else.

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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