One thing that sets DBT apart from other therapies is a pre-treatment period. It’s like an orientation, allowing the therapist and client to build rapport, trust, collaboration and a foundational alliance that makes DBT effective.
Comprehensive DBT can be challenging, and we want to set realistic expectations for what’s involved. So one purpose of pre-treatment is to determine if DBT is the best fit for you right now. Another is to give you (and perhaps your family) enough understanding of what’s involved to evaluate if you’re prepared for the commitment required.
Throughout pre-treatment, the therapist provides psychoeducation about what DBT is, and learns more about you to see if DBT will help you with your presenting concerns.
Pre-treatment usually takes about 4 sessions with your DBT therapist and covers these topics:
- Goals for a life worth living
- Biosocial theory
- Modes and stages of DBT
- Areas of dysregulation and target hierarchy
- Orientation to skills group and phone coaching
- Behavioral chain analysis
- Client and therapist agreements
- Caregiver involvement (if applicable)
The whole process tends to increase clients’ sense of control and motivation to engage in DBT.
Pre-treatment may feel frustrating at times; most people seek out DBT practitioners because they’ve decided to get help and want to hit the ground running. However, the work done during pre-treatment is part of what makes DBT effective. While your therapist is bringing information about DBT to the session, you are bringing your goals to the session. DBT needs both to help you build a life worth living!
If you have any concerns about pre-treatment, share them with your therapist so you can problem-solve together. For adolescents and others with caregivers, pre-treatment typically includes at least one session with caregivers to prepare them for DBT and the Multifamily Skills Group.
Lastly, if you, your family, or the therapist decides that DBT is not the right fit, that’s OK; we’ll use that understanding to discuss other treatment options that may suit you better.
Pre-treatment sets the foundation for DBT and creates better outcomes. We look forward to starting DBT Pre-treatment with you.
APR
About the Author:
Hannah Heffner, LPCC, ATR-BC, DBT-LBC, is intensively trained in Dialectical Behavior Therapy, and is a DBT-LBC Certified Clinician. She has extensive history working with adolescents, young adults and their families who have presenting concerns such as depression, suicidality/self-harm, anxiety, autism, low self-esteem and trauma.