Frequently Asked Questions
What is Dialectical Behavior Therapy?
Dialectical Behavior Therapy (DBT) is a treatment designed specifically for individuals with emotional regulation difficulties, self-harm behaviors, such as self-cutting, suicide thoughts, urges to suicide, and suicide attempts. Many clients with these behaviors meet criteria for a disorder called borderline personality (BPD) or the traits of BPD. It is not unusual for individuals diagnosed with BPD to also struggle with other problems — depression, bipolar disorder, post-traumatic stress disorder (PTSD), anxiety, eating disorders, or alcohol and drug problems.
DBT is a modification of cognitive behavioral therapy (CBT). In developing DBT, Marsha Linehan, Ph.D. first tried applying standard CBT to people who engaged in self-injury, made suicide attempts, and struggled with out-of-control emotions. When CBT did not work as well as she thought it would, Dr. Linehan and her research team added other types of techniques until they developed a treatment that worked better. It’s important to note that DBT is an “empirically-supported treatment.” That means it has been researched in clinical trials, just as new medications should be researched to determine whether or not they work better than a placebo (sugar pill). While the research on DBT was conducted initially with women who were diagnosed with BPD, DBT is now being used for women who binge-eat, teenagers who are depressed and suicidal, and older clients who become depressed again and again.
What is the role of the parents when a child is in DBT therapy?
We at Compass Behavioral Health have found that the kids and teens we treat heal more quickly and show greater success in their therapy process when their immediate family members also undertake to adjust the environment in which the child lives and the people with whom he/she interacts with. Therefore, Compass offers a very dynamic class for siblings and parents of our clients called The Family Connections Class***. This in-demand class meets once a week for twelve weeks and is two-hours long. This is a time for parents and siblings to become educated about the skills their family member is learning and to meet with other families who also have a child in treatment. Read about Family Connections here.
Compass also offers family therapy, multi-family groups and a family support group for more intensive work. Please check with your child’s therapist for more details about these services.
***Because there is always a waiting list to join this class, please contact our office immediately to be placed on the waitlist. (888) 399-0138 or email firstname.lastname@example.org
Family Therapy – Oftentimes, the children we serve experience conflicts with their parents and siblings. In order to minimize those conflicts and reduce the suffering of the family unit, we often ask the parents and sometimes the siblings of our clients to attend family therapy. In this setting, real-time coaching and education can be given to reduce the high-conflict experiences a family may be encountering. Click here to read more.
How long is Therapy going to last?
Most of our clients experience a reduction in symptoms in the first 6-12 months, however, longer standing issues such as building a new sense of self around positive coping skills and developing core values usually takes longer. In our experience, most kids we see have been struggling with anxiety and depression anywhere from 2-4 years. It makes sense that it would take some time to undo those thoughts, behaviors and habits.
Can I do therapy and not skills coaching?
Yes. Each child’s case is different. As a team, Compass will evaluate and decide what each patient needs and develop a treatment plan accordingly.
Can I do skills coaching and not be in individual therapy?
In order to take advantage of Compass’ skills coaching (which has no out of pocket costs to families) kids must be enrolled in individual therapy with their own DBT therapist or one of our therapists. Kids enrolled in skills group only may also attend the free homework hour where skills are coached and practiced and homework is completed prior to every group (between 5-6 pm) on group nights.
How often is therapy? Can I come every other week or once per month?
Compass’ quality assurance policy requires kids with active suicidal thoughts or self-harm to be seen at least twice weekly. In addition, If the child is stepping down from inpatient, boarding school, residential, partial hospitalization or IOP it is highly recommended to start at a twice a week frequency to assist with the transition and to prevent destabilization.
Am I going to get progress reports on my child? (I know therapy is confidential but I want to know what my child says)
In the State of California minors (age 17 and younger) have the right to confidentiality. Parents, however, have the right to know how their child is progressing in treatment. But this does not include a detailed description of every session. It has been our experience that a teen needs a safe place to talk about scary things such as suicidal thoughts and self-harm. And a lack of confidentiality could promote the withholding of important therapeutic information between the child and the therapist.
However, a therapist, by law, has to break confidentiality if their patient is at imminent risk for acting on their suicidal thoughts. If your child is in treatment with us for suicidal thoughts your therapist will collaborate with the entire family to create a safety plan and to give you updates.
Why does it cost so much to work with an Intern?
Our interns have completed a minimum of six years of higher education and approximately 3,000 hours of clinical training. In addition, at Compass, both the intern’s medical records and videotaped sessions are reviewed by a team of professionals including our consultants which results in many clinical hours being invested in your child’s care.
Is my child going to learn “bad behaviors” if he or she is in a group?
This is a great question. Contagion behaviors are a part of any adolescent program, however, at Compass we go to extraordinary lengths to not romanticize depression and other self-destructive behaviors. Compass kids are well-trained to use the words “target behaviors” to describe any urges that they are struggling with rather than talking in graphic details. Compass also creates a culture of positive-peer pressure where being like our older, recovery skills coaches in advanced DBT are what is considered “cool” and “desirable.”
Is the group a “process” group or a “class-type” setting?
DBT skills training group is NOT a process type group where members sit around and just discuss their problems. In fact, process type groups are discouraged for teens with self-destructive type behaviors. Skills group at Compass are run similar to a classroom in that a lesson is taught and a skill is behaviorally rehearsed and coaching, feedback and homework are given.
Why do you use a “team approach”?
A team approach is used at Compass because research on the team DBT model of care has proven that this approach is the most effective. When there is an entire team treating your child there are multiple “eyes” on a complex case including: An individual DBT therapist, a group therapist, a skills coach and possibly a family therapist along with expert consultants and the rest of the team all collaborating to create a comprehensive treatment team approach to your child’s care.
Do you take insurance?
Compass is an out of network provider, meaning we do not contract with insurance carriers. However, we will be happy to bill your insurance as an out of network provider, to help you meet your deductible. Our office is able to obtain Authorizations or Single Case Agreements for many of our families from their insurance companies, based on our unique specialty and the lack of in-network DBT providers in Orange County.
These authorizations allow the claims to be processed just like an in Network provider, thus lowering the family’s total cost. To help determine if your insurance plan will consider a Single Case Agreement, please contact your Insurance company Behavioral Health Authorization department.
Some good questions you can ask your insurance company are:
* What are my mental health benefits, including deductibles and out of pocket maximums?
* How much does my insurance pay for an out of network provider and for an in network provider?
*Is any approval required before I can see an out of network provider?
* Can I request a Single Case Agreement for this specific provider? If yes, what is the process?
For further assistance with your insurance needs, please contact Melody@mycompassnow.com and she will address your needs.
How can I get to know more about Compass Behavioral Health?
What will my child’s experience in DBT therapy be like?
During the intake meeting with our Compass staff, first you and then your child will be asked to meet one-on-one with a therapist – the beginning of therapy. Initially, the therapist will want to get to know you and then your child or teenager. From that point your child will meet with his/her therapist and sessions will be structured around the DBT hierarchy of treatment which you can read more about here. Your child may also be enrolled in one of our group skills class
Our groups include peers in a close age-range to your child. These groups meet once a week. You can read more about them here. Your child will also be expected to interact with their therapist during the week as he/she puts her new skills into practice. These interactions can happen by talking over the phone or via text messaging. Finally, there will be a bit of homework most weeks for your child to complete. However, this homework will likely not interrupt your child’s profess in school as it is mostly centered on recording, observing and noticing self and others.
Why do people engage in self-destructive or “Scary Behaviors”?
A key assumption in DBT is that self-destructive behaviors are learned coping techniques for unbearably intense and negative emotions. Negative emotions like shame, guilt, sadness, fear, and anger are a normal part of life. However, it seems that some people are particularly inclined to have very intense and frequent negative emotions. Sometimes, the human brain is simply “hard-wired” to experience stronger emotions, just like an expensive stereo is “hard-wired” to produce very complex sounds. Or, it could be that severe emotional or physical trauma causes changes in the brain to make it more vulnerable to intense feeling states. Additionally, sometimes clients have mood disorders – Major Depression or Generalized Anxiety — that are not controlled by standard medications and thus lead to emotional suffering. Any one of these factors, or any combination of them, can lead to a problem called emotional vulnerability.
A person who is emotionally vulnerable tends to have quick, intense, and difficult-to-control emotional reactions that make his or her life seem like a rollercoaster. Extreme emotional vulnerability is rarely the sole cause of psychological problems. An invalidating environment is also a major contributing factor.
What is an invalidating environment?
When considering the term “invalidating environment,” the environment, in this case, is usually other people in relationship with the client. This may include parents, siblings, teachers, coaches, leaders and extended family. “Invalidating” refers to the failure to treat a person in a manner that conveys attention, respect, and understanding. Examples of an invalidating environment can range from mismatched personalities of children and parents (e.g., a shy child growing up in a family of extraverts who tease her about her shyness); to extremes of physical or emotional abuse.
In DBT, we think that borderline personality disorder arises from the transaction between emotional vulnerability and the invalidating environment. Back to the example of a shy child: If a shy child is teased by his siblings or forced to go into social situations he wants to avoid, he may learn to have tantrums to let others realize that he’s scared. If his shyness is only taken seriously when he has an outburst, he learns (without being conscious of it) that tantrums work. He has not been “validated.” In this case, forms of validation could have included telling the person that being shy is normal for some people, teaching him that shy people have to work harder to overcome social anxiety, or helping him learn skills for managing shyness so it does not interfere with his life.
This is a relatively benign example. Some individuals, however, grow up in situations where they are abused or neglected. They may learn more extreme ways of getting other people to take them seriously. Further, because they are in painful circumstances, they may learn to cope with emotional pain by thinking about or attempting suicide, cutting themselves, restricting their food intake, using drugs and alcohol or other behaviors that hurt them and scare those around them – which is why we call these “Scary behaviors.” (Read more here)
A vicious cycle can get started: The person is really sad and scared, she has no one who listens to her, she is afraid to ask for help or knows no help is available, and so she tries to kill herself. Then, when her pain is treated seriously at the hospital, she learns (without being conscious of it) that when she’s suicidal, other people understand how badly she feels. Repeated self-injury can result if it is seen as the only means for getting better or achieving understanding from other people.
What kind of therapy do clients receive in DBT?
Clients in standard DBT receive three main modes of treatment – individual therapy, skills group, and phone coaching. In individual therapy, clients receive once weekly individual sessions that are typically an hour to an hour-and-a half in length. Clients also must attend a two-hour weekly skills group.
Unlike with regular group psychotherapy, these skills groups emerge as classes during which clients learn four sets of important skills – Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. Clients are also asked to call their individual therapists for skills coaching prior to hurting themselves. The therapist then walks them through alternatives to self-harm or suicidal behaviors.