Until the patient and the therapist agree on the course of treatment, methods and goals, the patient is not involved in DBT, but is in pre-treatment. Pre-treatment should generally not last more than three sessions, during which a typical assessment takes place, which is unlike any other form of psychotherapy. Agreements are reviewed and the therapist begins to implement engagement strategies to solidify the patient`s commitment to treatment. All patients begin pre-treatment. Next, the individual therapist discusses DBT agreements and assesses the motivation for the engagement. People involved in DBT must be voluntary. DBT expressly prohibits involuntary processing. Thus, in the event that treatment is not voluntary, the patient should have the opportunity to choose an alternative non-DBT treatment. So in DBT, there are patient agreements and therapist agreements. These can be oral, but are ideally written and returned if they are needed in the future. Absences affect the Group`s ability to work as a unit and we encourage clients to consider this group as a primary commitment. If a client is unable to attend, they must inform the moderators within 24 hours in advance, knowing that it is a courtesy for the moderators and participants to know who will be absent. Similarly, therapists will do their best to inform clients at least 24 hours in advance if it has become necessary to reschedule a session.

Clients who know in advance that they will miss a meeting should inform the group leaders at the previous meeting. The initial duration of treatment is usually one year. During this time, the client and therapist will check for progress, which can lead to refinement of goals and objectives. At the end of this period, the question of whether an additional therapeutic phase is necessary is discussed and can be implemented by mutual agreement. Customers agree to participate in scheduled individual and group sessions. It is unacceptable to miss sessions because a client finds them too unpleasant or aversive. is not in the mood for therapy; or is tired, wants to avoid certain topics or feels hopeless. Clients understand that it is important to attend each session, both for their own good and for the success of the professional training group.

Therefore, they undertake to attend each meeting unless they are prevented by circumstances beyond their control. We ask each member of the group to commit to attending all sessions of each module. The proposed material is built from one session to the next. Guests are expected to arrive on time, as late arrivals can be disruptive. If suicidal behavior or other self-destructive behavior is a problem for a particular client, reducing these behaviors is a primary treatment goal. Clients need to contract to reduce suicidal and self-injurious behaviour; work on behaviours that interfere with therapy; and participate weekly in professional training groups and individual therapies. Clients who participate in our program agree to highlight the resolution of issues that do not involve intentional self-harm or suicide. Clients agree to bring their own copy of the dbT Skills Training Handouts and Worksheets book and the final assignments to each individual and group session, as these will be an integral part of the session`s work.

In addition, customers agree to fill out the professional training card/journal on a daily basis. You commit to practicing the skills to the best of your ability and to participate verbally in group and individual sessions to the best of your ability. These are the conditions due to absences, in which clients cannot return to therapy before the end of the contractually agreed period, and then the return is a matter of negotiation (this also applies for reasons of prolonged hospitalization or illness). Clients understand that they have voluntarily withdrawn from the DBT program: the patient also agrees to attend weekly sessions and training. You agree to work to eliminate life-threatening behaviors, which include suicidal behaviors and self-destructive behaviors. You also agree to work on any behavior that interferes with therapy and is called behavior interfering with therapy. And when the payment is received by the therapist, he agrees to make the necessary payment. The patient accepts what we call a gentleman`s agreement.

It is therefore a one-year commitment to DBT as a whole. This is a renewable agreement so that the patient and therapist can return after the end of the year and review the progress made and determine if a new contract needs to be concluded. It`s a gentleman`s agreement because it`s not legally binding and there`s not necessarily a financial commitment that comes with it, but it`s like a handshake as you can agree today and change your mind tomorrow, but in the best case, it wouldn`t happen. The therapist undertakes to go beyond the usual ethical and confidentiality requirements of the profession, to make all so-called reasonable efforts to carry out the therapy in the most competent way possible and to participate in the meetings of the peer consultation team. The individual therapist also undertakes to establish appropriate intersessional contact in the form of telephone coaching. And they are committed to treating the patient with respect and working on their own behaviors interfering with therapy that might arise. Another engagement strategy is called Foot in the Door. And very similar to the foot in the door is what is called a door in the face. Thus, the foot in the door is when a therapist asks for a simple initial request that puts the foot in the door, which then expands the possibility of compliance and increases the likelihood that the patient will accept another request. The technique of the door on the face would be to ask for something bigger than expected, to be told no by the patient, and then to make it more likely that he will accept a less intense request. So if we consider homework, for example, if we use the door-to-face technique, we could ask for a new skill to be practiced every day, and that may be too much commitment for a new patient learning the skill, so we could step aside and ask for it three times a week. Thank you for choosing the Northland Counseling Center, Inc.

Dialectical Behavior Therapy (DBT) Program. Northland offers you certified DBT services! So engagement strategies are not something that is simply done at the very beginning of treatment. This is something a therapist would come back to again and again when engagement seems to fluctuate, when an episode of self-harm has occurred, when a patient`s suicidal drive has intensified, and when they may be considering stopping treatment. The way the therapist returns to it may vary depending on the style. You can remove written commitments or simply resort to the verbal commitment to work on behaviors that interfere with therapy or life-threatening behaviors by saying something like “but you promised at first that you wouldn`t stop treatment.” Once the therapist and patient have agreed on how the therapy will proceed, and the therapist determines that there is an appropriate commitment and that the treatment is voluntary, we can proceed to Step 1 of DBT. Please read, sign and date the form below. This form is an agreement between you and your therapist. This form explains what you accept when you participate in the DBT program.

If you have any questions, please contact your DBT therapist or group leader. In addition, a smooth transition to another engagement strategy that evaluates the pros and cons of dbT membership. It is important to sincerely point out the differences between DBT and other forms of therapy, including the disadvantages of entering treatment. DBT requires more time than CBT, taking into account weekly individual therapy, group training, and contact components between sessions. Instead of focusing on the week`s crisis, the therapist strives to manage and respond to problems according to the target hierarchies of DBT. So, instead of engaging in heart-to-heart or ventilation sessions, a therapist may repeatedly redirect a patient to discuss a potentially lethal behavior from the previous week. This can be aversive for some patients and so it is important to point out this as a potential disadvantage of treatment. Individual sessions are held weekly for 45 to 60 minutes, but from time to time a session may take place at different intervals, depending on the circumstances of both parties and by mutual agreement. DBT Competency Group sessions are held weekly and last 1.5 hours. Optional sessions of the DBT Graduate Group take place weekly and last 60 minutes. Some of the strategies are the devil`s advocacy technique, in which the therapist advocates that the site not engage in treatment.

This helps to strengthen the patient`s sense of choice and autonomy. What is said in the group remains in the group. Customers may want to discuss their own experiences in the group with others, but the names of other group members and their experiences should be safely protected. Confidentiality can only be violated if someone reports: danger to himself or to others or abuse of a minor or an elderly person. At both events, it will be the moderators, not the members, who will break confidentiality to report what has been said to the relevant authorities. While facilitators make every effort to emphasize the importance of confidentiality in the competency group, we cannot be held responsible for the individual actions of group members. Another particularly important engagement strategy in pre-treatment is to highlight the freedom of choice and lack of alternatives, i.e. the freedom to opt for dbT treatment, while pointing out that there seems to be a lack of alternatives that would be beneficial. .