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Evaluation ViewAttendees 17

Mini Workshop

Treatment - Mindfulness & Acceptance

How did they agree to this?! A live demonstration of orientation and commitment in DBT-A

Mini Workshop 7 - How Did They Agree to This?! a Live Demonstration of Orientation and Commitment in DBT-A

Friday, November 15, 2024
12:30 PM – 2:00 PM EST
Location: Grand Ballroom C, Level 5, Downtown Marriott
Earn 1.5 Credit
Keywords: DBT (Dialectical Behavior Therapy), Adolescents, Therapeutic Alliance
Level of Familiarity: Basic
Recommended Readings: Fox, K. R., Bettis, A. H., Burke, T. A., Hart, E. A., & Wang, S. B. (2022). Exploring adolescent experiences with disclosing self-injurious thoughts and behaviors across settings. Research on child and adolescent psychopathology, 1-13.

,   McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., ... & Linehan, M. M. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA psychiatry, 75(8), 777-785.
Recommended Reading 3,   Coyle, T. N., Brill, C. D., Aunon, F. M., Peterson, A. P., Gasser, M. L., Kuehn, K. S., & Harned, M. S. (2019). Beginning to envision a life worth living: An introduction to pretreatment sessions in dialectical behavior therapy. Psychotherapy, 56(1), 21.

,   Bettis, A. H., Burke, T. A., Scott, S. R., Bedock, C., Ambriano, C., Parrish, J., ... & Fox, K. R. (2024). Disclosures of self‐injurious thoughts and behaviors to parents in the context of adolescent therapy: A qualitative investigation. Journal of Clinical Psychology, 80(3), 537-558.,  
For those of us who specialize in providing Dialectical Behavior Therapy to adolescents (DBT-A), a common refrain we hear from those who are DBT- and/or teen curious is “How on earth?!” This is especially true when it comes to establishing commitment to stick with DBT for a minimum of six months: an eternity to most teenagers! Although DBT is rarely easy, and teens are not always eager, we are proof that DBT-A is possible (and enjoyable!).

In previous mini workshops, we have demonstrated how to work on reducing self harm and emotion dysregulation with a teen who has already agreed to do DBT-A. But how do you get to that point? How do you demonstrate to a chronically dysregulated teen that you are the best person to help them reduce their suffering and build a life worth living?

One thing that differentiates DBT-A from other treatments is the orientation and commitment process: a pre-treatment stage that builds commitment and makes sure the teen knows what to expect from their time in DBT (Miller, Rathus, & Linehan, 2006). Orientation and commitment can feel intimidating to clinicians, and orientation and commitment with teens offers additional challenges over and above doing this work with adults: How do we respect the teen’s autonomy while acknowledging the therapy may not truly be their own independent choice?

This presentation will teach how to properly orient a teen to comprehensive DBT with a focus on the DBT commitment strategies. We will discuss common stuck points, including navigating confidentiality, identifying realistic and relevant treatment goals, and establishing trust. We will then do three live, unscripted role plays, covering the following topics:
How to elicit “life worth living goals” from a teen client and highlight the ways in which these do not align with self-harm or suicidal behaviors.
Getting commitment to “take suicide off the table” and actually do all the modes of DBT treatment.
How to effectively break confidentiality in order to keep the teen safe without rupturing the relationship with the teen.

These spontaneous role plays will be live coded for the audience, highlighting commitment strategies as well as DBT dialectical and stylistic strategies throughout in order to maximize the impact of our modeling. There will also be ample time for questions.

Outline:
● Overview of DBT orientation and commitment strategies
● Discussion of common stuck points, navigating confidentiality, and developing treatment goals
● Role play with live annotation on eliciting “life worth living” goals
● Role play with live annotation on “taking suicide off the table”
● Role play with live annotation on breaking confidentiality while maintaining rapport
● Audience question and answer

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Identify 4 DBT Commitment Strategies.
  2. Describe 3 common concerns about breaking confidentiality in DBT-A.
  3. Name 3 circumstances under which one would break confidentiality in DBT-A.
  4. Distinguish between “life worth living goals” and common treatment goals for teens.
  5. Long-term Goal: learn strategies to help translate non-specific therapy goals into behaviorally specific, measurable goals.
  6. Long-term Goal: better understand various behavioral strategies to increase client commitment to therapy, which can be applied transtheoretically, transdiagonstically and across the lifespan.