Addressing Potential Problems in DBT Skills Group Sessions

Stephanie-Vaughn

Psychē, PLLC Vanderbilt University

Key Points

  1. Group leaders need to know and practice the DBT skills in order to teach them.
  2. Problems in group can include suicidal/crisis behavior, self-harm, rules violations, and distractions.
  3. Responses to problems in group include ignoring, referring a member to his or her individual provider, prompting members to use skills, and consulting with the DBT peer consultation team.
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Addressing Potential Problems in DBT Skills Group Sessions

Addressing Potential Problems in DBT Skills Group Sessions

Minimizing problems in DBT group has a great deal to do with the skills group leader and co-leader. Both the leader and co-leader need to know and practice the DBT skills that they are teaching. It’s virtually impossible to teach the skills if you yourself don’t practice them. They need to be able to prioritize and stick to the targets within group which are different than the targets within individual therapy. Instead of getting off track and getting involved in individual member’s issues, they need to have a style about them that combines irreverence with a sense of humor and validation in a perfect blend, perhaps not perfect but in a skillful blend in order to juggle both the needs of the individual group members, the needs of the group as a whole and to be able to get the material out as quickly and effectively as possible.

Addressing Potential Problems in DBT Skills Group Sessions

They need to be able to stick to their own limits. And the limits of a DBT individual therapist, a group leader, a co-leader and members for that matter are going to differ from person to person. The only person who can observe limits is one’s self. So the leaders and co-leaders need to observe their own limits and communicate those. In communicating those and in teaching and in defining problems in group, the clinicians need to stick to behavioral language and avoid pejorative terminology as much as possible. This is a general DBT principle that is mentioned in another discussion. We want to as a DBT group leader continuously refer group members back to these skills. And if we’re considering problems which might arise in group, oftentimes problems can be addressed by simply using those as an opportunity to practice skills.For example, a group member recently in one of our groups indicated that she wanted to leave group because she was experiencing panic. The group leader referred back to a style in DBT which is referred to as making lemonade out of lemons and used this as an opportunity to practice skills. So the group leader said to the group member, oh great, not that it’s great that you’re experiencing panic but it’s great that this is an opportunity to be able to practice skills and then referred her back to the TIP skill which is mentioned in another discussion. So if we can continuously refer group members back to the skills that we’re actually teaching, we can look at interruptions not as being an interruption per se but as being an opportunity. So interruptions become opportunities to practice skills.

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