treatment implementation collaborative - bharp...dbt skills training manual: pp 416-450 dbt skills...
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Disseminating Evidence Based Practices Across the Continuum of Care
www.ticllc.org
Core Skills in DBT ©TIC 2017-18 Page 1 of 1
Treatment Implementation Collaborative
March 2, 2018 To: Registered Participants for Master Class: Core Skills in Dialectical Behavior Therapy©
16 weeks/hours with Annie McCall, MA, LMHC
From: Cindy Best ([email protected]) Thank you for registering for our Master Class: Core Skills in DBT©. This course is available through the TIC website (www.ticllc.org) until May 31, 2018. Part I: 12 hours available on demand Part II: 4 hours available on demand Access Instructions:
1. Visit the TIC website Registration page - https://www.ticllc.org/registration.html 2. Scroll down to the “Core Skills in DBT” section and click on the red “Login (paid registrants only”
button.
3. The Login button will take you to the list of recorded sessions in our WebEx account. Click on the
topic you want to watch or click view. You will be required to enter your name, email address and PASSWORD (SkillsAM18) prior to watching each session.
Please note that these are for our own personal use and should not be distributed or shared with others.
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
CORE SKILLS
of Dialectical Behavior Therapy©
12 Hours On Demand
with Annie McCall, MA, LMHC
Treatment Implementation Collaborative, LLC
www.ticllc.org
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 2
Week 1: Mindfulness 1
Intro to Mindfulness: Why Bother, States of Mind
DBT Skills Training Manual: pp 151-199
DBT Skills Training Handouts & Worksheets: pp 45-59 Both books by Marsha M. Linehan, Second Edition 2015
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 3
The Core Mindfulness Skills
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 4
Dialectics
Acceptance Change
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 5
Goals for Mindfulness Practice
Mindfulness is….
living life fully,
without self-consciousness
and with awareness
moment by moment.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 6
▪ Mindfulness
▪ Mindfulness Skills
▪ Mindfulness Practice
Explaining the Definitions
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 7
Mindfulness Practice v. Mindful Experiencing
Helping clients live a mindful life by presenting
them with ways to practice mindfulness
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 8
The goal of mindfulness practice is mindfulness practice.
Relaxation
Calming
Soothing
Just breathing
Religious experiencing
Mindfulness practice does not have a goal of:
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 9
▪ Feet on the floor
▪ “Open” position of hands
▪ Back straight but not rigid
▪ Head held slightly tilted
▪ Position that is not slumping but can
be held without moving
▪ Eyes open unless told otherwise
Mindfulness Posture
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 10
Opening the Mind
Focusing the Mind
Mindfulness
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 11
1. Orient/name the practice
2. Link the practice to a real life example using self
disclosure
3. Explain the practice. Make sure it does not have
multiple steps
4. Tell what to do if participants’ minds wander or
judgments arise
5. Ask if anyone has questions
6. Ring bell 3 times
7. Leader participates in mindfulness with participants
8. Ring bell once
9. Ask people to state what they observed (using describe
skills)
Leading Mindfulness Practice
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 12
From: Linehan, M. M. (1993). Skills Training Manual for Borderline Personality Disorder. New York: Guilford Press.
Three States of Mind (Cm 1)
WISEMIND
ReasonableMind
EmotionMind
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 13
Week 2: Mindfulness 2
Mindfulness What’s and How’s
DBT Skills Training Manual: pp 200-227
DBT Skills Training Handouts & Worksheets: pp 60-63
(worksheets pp 78-93)Both books by Marsha M. Linehan, Second Edition 2015
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 14
1. Pause, stop or slow down
2. Observe: notice without words
3. Describe: put labels on the experience without adding
4. Participate: fully engage without self-consciousness
These skills are linear with Participation as the goal.
The “What” Skills (CM 2)
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 15
1. Non-judgmentally: let go of evaluating
2. One-Mindfully: focus attention on the present moment,
doing one thing at a time
3. Effectively: focus on doing what needs to be done, despite
the principle or what you think is fair or unfair
These skills are designed to be used with all of the
mindfulness skills.
The “How” Skills (CM 3)
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 16
▪ Spiritual Practices—Wise Mind from a spiritual perspective
(CM 7, p.68)
▪ Loving Kindness (CM 8, p. 70)
▪ Doing Mind v. Being Mind (CM 9, p. 71)
▪ Walking the Middle Path (CM 10, p.74)
Supplemental CM Skills:
Other Perspectives on Mindfulness
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 17
Week 3: Distress Tolerance 1
Changing the Body: TIPP, Self-Soothe
DBT Skills Training Manual: pp 416-450
DBT Skills Training Handouts & Worksheets: pp 328-329, 334
(worksheets pp 374-376, 382, 386)Both books by Marsha M. Linehan, Second Edition 2015
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 18
Dialectics
Acceptance Change
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 19
Two Types of Distress Tolerance Skills
Crisis Survival Skills
• Short term pain
• Urges
• Impulses
Acceptance Skills
• Long term pain
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 20
Change your physiological response to a situation/emotion through
TIP. This skill works best when you do the steps in order.
TIP Skills (DT 6, p. 329)
• TemperatureT
• Intense ExerciseI
• Paced Breathing/Paired Muscle RelaxationP
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 21
Self-Soothing:
Using your senses to calm your body and your mind
Self-Soothing (DT 8, p. 334)
VISION HEARING SMELL
TASTE TOUCH
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 22
Week 4: Distress Tolerance 2
Changing the Mind: Pros/Cons, ACCEPTS,
IMPROVE
DBT Skills Training Manual: pp 416-450
DBT Skills Training Handouts & Worksheets: pp 333, 336
(worksheets pp 379-381)Both books by Marsha M. Linehan, Second Edition 2015
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 23
Dialectics
Acceptance Change
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 24
Making wise mind decisions about responses to high
emotion, high urge situations
Pros and Cons (DT5, p. 328)
Pros Cons
ToleratingThe Distress
Not Tolerating the distress
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 25
Distracting (putting your attention on something else)
with Wise Mind ACCEPTS
Distracting (DT 7, p.333)
• ActivitiesA
• ContributingC
• ComparisonsC
• Emotions (that are different from the ones you are experiencing)E
• Pushing AwayP
• ThoughtsT
• Sensations S
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 26
Replacing negative events with more positive ones using IMPROVE
Improving the Moment (DT 9, p. 336)
• ImageryI
• MeaningM
• PrayerP
• RelaxationR
• One thing at a timeO
• VacationV
• Encouragement E
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 27
Week 5: Distress Tolerance 3
Reality Acceptance
DBT Skills Training Manual: pp 450-476
DBT Skills Training Handouts & Worksheets: pp 342, 345-353
(worksheets pp 391-400)Both books by Marsha M. Linehan, Second Edition 2015
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 28
Dialectics
Acceptance Change
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 29
Reality Acceptance
Radical Acceptance, (DT 11, p. 342)
Turning the mind(DT 12, p. 345)
Willingness vs. willfulness(DT 13, p, 346)
Half Smiling & Willing Hands (DT 14, p. 347)
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 30
Change your posture and breathing to make you more accepting
Distress Tolerance: Acceptance Skills (DT 14)
Breathing skills
Awareness
Half-smile
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 31
▪ Observe thoughts
▪ Don’t suppress or magnify thoughts
▪ Allow thoughts to come and go
▪ Play with your thoughts
Mindfulness of Current Thoughts (DT 15, p. 350)
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 32
Week 6: Distress Tolerance 4
Addiction Skills
DBT Skills Training Manual: pp 477-490
DBT Skills Training Handouts & Worksheets: pp 357-363
(worksheets pp 403-410)Both books by Marsha M. Linehan, Second Edition 2015
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 33
▪ Dialectical Abstinence (DT 17, p. 357)
▪ Clear Mind (DT 18, p. 359)
▪ Community Reinforcement (DT 19, p. 361)
▪ Burning Bridges and Building New Ones (DT 20, p. 362)
▪ Alternate Rebellion (DT 21, p. 363)
▪ Adaptive Denial (DT 21, p. 363)
Skills for Addictions
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 34
Week 7: Interpersonal Effectiveness I
DEAR MAN
DBT Skills Training Manual: pp 231-270
DBT Skills Training Handouts & Worksheets: pp 123-126
(worksheets pp 174)Both books by Marsha M. Linehan, Second Edition 2015
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 35
Dialectics
Acceptance Change
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 36
Getting your objective with DEAR
Guidelines for Getting What You Want (IE 5, p. 125)
• Describe the facts of the situation (when needed)D
• Express your feelings and opinions about the situationE
• Assert what you want/say noA
• Reinforce the person ahead of time R
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 37
Guidelines for Getting Your Objectives (continued)
• (stay) MindfulM
• Appear confidentA
• NegotiateN
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 38
▪ Suggestions for Interpersonal Effectiveness Practice
▪ In session practice
▪ Round robin
▪ Directed role plays (demonstration with rehearsal)
▪ Role play with leader
▪ Role play with each other
▪ “Clash of the Titans”
Getting People to Practice
Interpersonal Effectiveness Skills
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 39
Week 8: Interpersonal Effectiveness 2
GIVE, FAST
DBT Skills Training Manual: pp 270-285
DBT Skills Training Handouts & Worksheets: pp 128-133
(worksheets pp 175-177)Both books by Marsha M. Linehan, Second Edition 2015
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 40
Dialectics
Acceptance Change
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 41
Guidelines for Relationship Effectiveness:
Keeping the Relationship (IE 6, p. 128)
• (be) GentleG
• (act) InterestedI
• ValidateV
• (use an) Easy MannerE
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 42
Guidelines for Self-Respect Effectiveness:
Keeping Respect for Yourself (IE 7, p. 130)
•(be) FairF
•(no) ApologiesA
•Stick to valuesS
•(be) TruthfulT
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 43
Options—use wise mind to determine intensity
If not, use factors to determine intensity
(the dime game)
Options for Intensity of Asking/Saying No (IE8, p. 131)
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 44
▪ Finding and getting people to
like you (IE 11, p. 140)
▪ Mindfulness of Others
(IE 12, p. 143)
▪ Ending Relationships
(IE 13, p. 145)
Supplemental IE Skills:
Building Relationships and Ending Destructive Ones
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 45
Week 9: Interpersonal Effectiveness 3
Dialectics and Behaviorism
DBT Skills Training Manual: pp 285-316
DBT Skills Training Handouts & Worksheets: pp 149-151, 161-163
(worksheets pp 189-191, 194-195)Both books by Marsha M. Linehan, Second Edition 2015
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 46
Dialectics
Acceptance Change
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 47
▪ Dialectics (IE 15, p. 150)
▪ Validation (IE 17, p. 155)
▪ Recovering from invalidation (IE 18, p. 158)
▪ Increasing the Probability of Behaviors You Want (IE 20, p. 161)
Supplemental IE Skills: Walking the Middle Path
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 48
Week 10: Emotion Regulation 1
Model of Emotion, Checking the Facts
DBT Skills Training Manual: pp 318-359
DBT Skills Training Handouts & Worksheets: pp 205, 213, 228
(worksheets pp 281-282, 285-286)Both books by Marsha M. Linehan, Second Edition 2015
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 49
Dialectics
Acceptance Change
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 50
1. Understand and name emotions
2. Decrease the frequency of
unwanted emotions
3. Decrease emotional vulnerability
4. Decrease emotional suffering
Goals of Emotion Regulation (ER1, p. 205)
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 51
Model of Emotions (ER 5, p. 213)
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 52
▪ Check the Facts (ER 8, p. 228)
▪ Opposite Action and Problem Solving: Deciding Which to Use
(ER 9, p.230)
▪ Opposite Action (ER 10, p. 231)
▪ Problem Solving (ER 12, p. 241)
Changing Emotional Responses
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 53
Week 11: Emotion Regulation 2
Opposite Action & Problem-solving
DBT Skills Training Manual: pp 359-381
DBT Skills Training Handouts & Worksheets: pp 230-231, 241
(worksheets pp 288-289)Both books by Marsha M. Linehan, Second Edition 2015
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 54
Dialectics
Acceptance Change
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 55
▪ Check the Facts (ER 8, p. 228)
▪ Opposite Action and Problem Solving: Deciding Which to Use
(ER 9, p.230)
▪ Opposite Action (ER 10, p. 231)
▪ Problem Solving (ER 12, p. 241)
Changing Emotional Responses
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 56
Know the emotion. Know the action urge.
Fully engage in the opposite of the action
Change Your Emotion: Opposite Action (ER 10)
•do what is prompting the emotionFear
•engage in meaningful activity, behaviorally activateSadness
•engage in the behavior over and over (don’t apologize)Guilt
•disclose what you are hiding Shame
•approach, pick up, make contact with cue Disgust
•count your blessingsEnvy
•wish the bestJealousy
•stop driving by, calling, texting, etc.Love
• compassion, empathy, do something kind, gently avoidAnger
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 57
Week 12: Emotion Regulation 3
Coping Ahead &The Wave
DBT Skills Training Manual: pp 381-410
DBT Skills Training Handouts & Worksheets: pp 256, 264
(worksheets pp 301, 311)Both books by Marsha M. Linehan, Second Edition 2015
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 58
Dialectics
Acceptance Change
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 59
▪ Accumulating Positive Emotions: Short Term (ER 15, p. 248)
▪ Accumulating Positive Emotions: Long Term (ER 17, p. 252)
▪ Values and Priorities List (ER 18, p. 253)
▪ Build Mastery and Cope Ahead (ER 19, p. 256)
▪ PLEASE (ER 20, p. 257)
Reducing Vulnerability to Emotion Mind –
Building a Life Worth Living
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 60
Accept Your Emotion: Mindfulness to Current Emotion
(ER 22)
”THE WAVE”
▪ Experience your emotion as a wave
without avoiding or
amplifying
▪ Pay attention to your physical
sensations
Master Class: Core Skills in DBT Annie McCall, MA, LMHC
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
Core Skills of DBT with Annie McCall, MA, LMHC
www.ticllc.org :: © TIC 2011-2017 :: Slide 61
www.ticllc.org
TIC as a Resource
Helen Best, M.Ed.
President, TIC
(206)251-5134
Shari Manning, Ph.D.
Chief Executive Officer, TIC
DBT-Linehan Board Certified Clinician
(803)479-4545
Cindy Best
Chief Operating Officer, TIC
Annie McCall, MA, LMHC
Trainer & Advisor, TIC
DBT-Linehan Board Certified Clinician
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
MASTER CLASS: Core Skills in DBT
Part II: How to Structure and
Run Skills Training Groups©
Dates: June 7 and 14, 2017
Presented by: Annie McCall, MA, LMHC
Treatment Implementation Collaborative, LLC
www.ticllc.org :: © TIC 2011-17 :: Slide 2
Enhancing Capability: DBT Skills Group
www.ticllc.org :: © TIC 2011-17 :: Slide 3
▪ Lack of skill; not knowing what to do or how to do it
▪ High emotion
▪ Thoughts: “I can’t do this.” “Nothing will change.” “This isn’t
my fault--I shouldn’t have to do this.”
▪ Failure to generalize across contexts (ex. more skillful at work
than at home)
▪ Willfulness
▪ Contingencies: old, problematic behavior works better than
new, more effective behavior at solving problems (reducing
emotion, getting help, distracting the mind)
Things that Interfere with Capability
Page 1 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 4
▪ Addresses capability problems: Clients do not have behaviors
in their behavioral repertoire (Skills Acquisition)
▪ Model new behaviors
▪ Teach new behaviors
▪ Increase learning of skills (Skills Strengthening)
▪ Rehearse new skills in group
▪ Reinforce new skills when they occur
▪ Give feedback on skills use (don’t reinforce incorrect practice)
▪ Make sure skills are used outside of group (Skills
Generalization)
▪ Homework assignments
▪ Homework review
The Purpose of Skills Training
www.ticllc.org :: © TIC 2011-17 :: Slide 5
Therapy Destroying Behaviors (Examples)
Behavioral Skills (Core Mindfulness, Emotion Regulation,
Distress Tolerance, Interpersonal Effectiveness)
Therapy Interfering Behaviors
Skills Training Targets
www.ticllc.org :: © TIC 2011-17 :: Slide 6
Interlocking Core Paradigms
DialecticsAcceptance Change
Your current behavior
is understandable and
inevitable.
Your behavior needs to
change in order to meet
your goals.
Page 2 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 7
Using the Skills Training
Manual(s)
www.ticllc.org :: © TIC 2011-17 :: Slide 8
▪ Determine your population
▪ Determine the length of your skills training program
▪ Review the schedules in the DBT Skills Training Manual (pgs.
110-122, Linehan, 2015)
▪ Choose a curriculum that matches your program
▪ Either give clients a copy of the DBT Skills Training Handouts
and Worksheets (Linehan, 2015) or make copies
Choosing a Schedule
www.ticllc.org :: © TIC 2011-17 :: Slide 9
▪ The Handouts with stars are the core skills
▪ Divided into main handouts and
supplementary handouts
▪ Multiple Worksheets for each skill
The Skills Training Handouts and Worksheets
Page 3 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 10
▪ To address a specific problem (11 week Emotion Regulation)
▪ With a less out of control (Stage 3) population
▪ With non-DBT individual therapy
▪ With intensive, structured case management
REMEMBER: Skills alone is NOT recommended for clients with
repeated or chronic life threatening (suicidal, self-harm, assaultive
and homicidal) behaviors or people too dysregulated to tolerate
group without 1:1 DBT therapy
When Might You Do Skills Alone?
www.ticllc.org :: © TIC 2011-17 :: Slide 11
▪ Who manages crises? Who creates and maintains the crisis
plan?
▪ Who has clinical responsibility?
▪ Who treats therapy-interfering behavior related to group (ex.
not attending, not doing homework, conflict with other
members)
▪ Who manages contingencies related to group attendance?
▪ Who helps clients generalize skills from the skills training
room to real life?
Issues to Consider in Offering Skills Alone
www.ticllc.org :: © TIC 2011-17 :: Slide 12
Leadership in Skills Training Group:
Each group requires a leader and a co-leader
Page 4 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 13
In order to be an effective
skills trainer you must
believe in the power of
skills to change lives.
The best way to do that is
to learn and use skills in
your own life.
www.ticllc.org :: © TIC 2011-17 :: Slide 14
▪ Participate in a skills training course
▪ Co-lead or observe a skills class where you work and do the
homework
▪ Read and practice from the manual
▪ Teach your team and others skills
▪ Keep a skills diary card for yourself
How to Learn the Skills Yourself
www.ticllc.org :: © TIC 2011-17 :: Slide 15
The Leader:
▪ Plans lessons (w co-leader)
▪ Leads mindfulness
▪ Leads homework review
▪ Teaches new skills
▪ Provides coaching and
feedback
▪ Rotates no more often than
1x per module
Leader and Co-leader
The Co-Leader:
▪ Helps with time management
▪ Manages TIB w/ proximity
and facial expression
▪ Adds questions, examples
based on observing members
▪ Coaches clients who leave
▪ Calls missing members
▪ Observes behavioral shaping
Page 5 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 16
Setting Up Your Skills Training Group
www.ticllc.org :: © TIC 2011-17 :: Slide 17
Getting the Right People in the Room:
Orientation and Commitment in DBT
www.ticllc.org :: © TIC 2011-17 :: Slide 18
DBT is a voluntary treatment.
Page 6 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 19
▪ Use DBT commitment strategies
▪ Uncover goals and link DBT skills to achieving them
▪ Orient to roles (skills trainers v. individual therapists/case
managers)
▪ Skills v. process therapy
▪ Homework/practice/diary card
▪ Throwing yourself in and participating (no ”tourists”)
▪ Schedule and attendance, including 4-miss rule
Core DBT Strategies: Orientation and Commitment
www.ticllc.org :: © TIC 2011-17 :: Slide 20
▪ Clients have dropped out of therapy if they miss 4 of any
MODE of treatment in a row, e.g. 4 individual sessions OR 4
group sessions in a row
▪ No “excused” or “unexcused” absences
▪ If clients drop out, they may not request to return until after
the end of their current contracted period of treatment and
then they must start over with assessment, intake, etc.
▪ Even in skills alone, consider the 4-miss rule with the non-
DBT therapist as a contingency to keep people in skills group.
The Four Miss Rule in DBT
www.ticllc.org :: © TIC 2011-17 :: Slide 21
▪ Classroom setting
▪ Tables vs. comfy chairs
▪ Whiteboard/flip chart
▪ Classroom supplies: pens, extra paper, extra copies of all materials
▪ Each client gets a notebook with all materials in it, including a
syllabus with page numbers
▪ Mindfully shape norms for your group that promote practicing
vs. processing
Creating a Learning Environment
Page 7 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 22
▪ Greeting
▪ Mindfulness Practice (5-10 minutes)
▪ Homework Review (45 minutes -1 hour)
▪ Break (5-10 minutes)
▪ Teaching new lesson (45-50 minutes)
▪ Homework assignment (5 minutes)
▪ Closing mindfulness practice (usually an observe and describe)
Standard Skills Training Format: 2-2.5 hours
www.ticllc.org :: © TIC 2011-17 :: Slide 23
▪ Read the teaching notes
▪ Think about how to “sell” clients on the skill. Why do THESE
people need THIS skill right NOW?
▪ Choose worksheets (or other means of recording practice)
▪ Determine which mindfulness practice to begin group
▪ Which WHAT skill and HOW skills will it focus on? Why?
▪ Plan personal stories, metaphors, analogies, etc. to make the
skill vivid and appealing
▪ Plan live practices
Lesson-planning for Your DBT Skills Group
www.ticllc.org :: © TIC 2011-17 :: Slide 24
▪ Stand up (at least periodically)
▪ Manage the room with your presence
▪ Write on the whiteboard
▪ Light touch
▪ Humor (irreverence will keep people coming)
▪ Self-disclosure
Teaching Tips
Page 8 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 25
▪ Identify a WHAT and at least one HOW skill that needs
practice
▪ Possibly link the practice to the module you’re on (e.g.
Mindfulness of Others, a “brain teaser” to model the “T” in
ACCEPTS, listen to evocative music to cue sensation for a
”wave” practice)
▪ Talk as little as possible once the practice starts
▪ Over time, balance active participation practices with quiet
observation practices
The Opening Mindfulness Practice
www.ticllc.org :: © TIC 2011-17 :: Slide 26
1. Orient/name the practice
2. Link the practice to a real life example using self
disclosure
3. Explain the practice. Make sure it does not have
multiple steps
4. Tell what to do if participants’ minds wander or
judgments arise
5. Ask if anyone has questions
6. Ring bell 3 times
7. Leader participates in mindfulness with participants
8. Ring bell once
9. Ask people to state what they observed (using describe
skills)
Leading Mindfulness Practice
www.ticllc.org :: © TIC 2011-17 :: Slide 27
▪ Begin with what people know. Ask a question that draws on
their experience and starts a discussion.
▪ Does your mind ever get stuck on something and you can’t let it go?
▪ Anybody ever stay mad even when they don’t want to be mad
anymore?
▪ Introduce the lesson. Link to last week’s learning.
▪ Build a case for how they (perhaps all people) have a problem,
and the skill is a solution
▪ Don’t read the handout word-for-word.
▪ Explain HOW to do the skill (i.e. what to DO with their body
and/or their thoughts)
Tips for Teaching the New Skill
Page 9 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 28
Generalizing Skills to the Natural Environment
www.ticllc.org :: © TIC 2011-17 :: Slide 29
▪ The end of each group—don’t rush
▪ Write it on the board and show the sheet
▪ No more than two practices
▪ Make sure participants understand (ask if there are questions)
▪ Get a verbal commitment from each member
▪ If anyone says “no,” assess, validate, clarify and re-sell, try again
for commitment.
Assigning Homework
www.ticllc.org :: © TIC 2011-17 :: Slide 30
▪ Half of group time is mindfulness and homework review; the other half is
new teaching and live practice.
▪ Divide time evenly across attendees.
▪ Get help from your co-leader or a timer if necessary.
▪ Ask group to remind you what the assignment was
▪ No passes (except in extreme cases)
▪ Ask questions that shape discussion of SKILL use, not the story or failures
▪ Make corrections. Give productive feedback
▪ Reinforce any practice, even if it was wrong
▪ Watch for dysregulation and move in with validation
Reviewing Homework
Page 10 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 31
▪ Very quick, round robin review where everyone says
something
▪ Pick a random person from each family
▪ Divide adolescents and adults and everyone does review
Reviewing Homework
in Multi-Family Skills Training Groups: Options
www.ticllc.org :: © TIC 2011-17 :: Slide 32
▪ With very few exceptions, NO ONE passes
▪ Make sure that the client gets as much time as everyone else
▪ Do Missing Links Analysis
▪ Whenever possible, get them to do the skill in the moment:
▪ DEAR MAN you to move to the next person
▪ Non-judgmentally describe how they didn’t do the homework
▪ Imaginal practice/cope ahead to practice this week. Get
commitment and troubleshoot.
“I didn’t do the homework.”
www.ticllc.org :: © TIC 2011-17 :: Slide 33
▪ Are you sure you didn’t do it? Practicing vs. writing it down
▪ Did you understand the skill and/or the assignment? Did you
intend to do it when you said “yes?”
▪ Did you remember that you were supposed to practice?
▪ What got in the way of doing the homework?
▪ Emotion: Hopelessness? Fear? Shame?
▪ Thoughts: What’s the point? Skills don’t work?
▪ Contingencies: More reinforcing to watch tv, other people interfered
▪ Willfulness
Missing Links Analysis
Page 11 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 34
▪ Says skills don’t work
▪ Passes or refuses to talk
▪ Tells long stories
▪ Consistently shows up after
homework review
▪ Did the skill wrong
▪ Talks exclusively their about skillful
behavior in one context
Provide Coaching and Feedback when the Client…
www.ticllc.org :: © TIC 2011-17 :: Slide 35
▪ Did s/he do the effective skill?
▪ Did s/he do it accurately?
▪ Did s/he do it sufficiently?
▪ Did s/he do it mindfully?
▪ Did judgments, hopelessness or other cognitions or emotions
interfere?
When the Skills “Don’t Work”
www.ticllc.org :: © TIC 2011-17 :: Slide 36
▪ I’m seeing what looks like shame to me, and I wonder if it’s shown
up because you didn’t do the homework perfectly.
▪ Shame is only effective when it protects us from being rejected.
▪ Your shame isn’t effective in skills group because we don’t want you
to go away because you didn’t do the homework.
▪ Your shame will come down if you drop your shoulders, get your
chin up, and look at me, and look around the room.
▪ What’s happening in your body while you do that? You’re doing
great!
Coaching Opposite Action for Shame
Page 12 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 37
▪ Would YOU attend your group? Is it engaging, interesting, and
fun? Is it a good interpersonal experience?
▪ Link skills to LWGs: Why do THESE people need THIS skill
right NOW?
▪ Live practice in every session
▪ Tailor homework practices to be relevant to LWLGs
Remember: SKILLS themselves are not reinforcing until they
work; in the short term, SKILLS GROUP must be reinforcing.
Improving Homework Completion and Attendance
www.ticllc.org :: © TIC 2011-17 :: Slide 38
Dealing with Behaviors
that Interfere with Learning
www.ticllc.org :: © TIC 2011-17 :: Slide 39
Remember the Skills Training Targets
Page 13 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 40
Therapy Destroying Behaviors (Examples)
Behavioral Skills
(Core Mindfulness, Emotion Regulation,
Distress Tolerance, Interpersonal Effectiveness)
Therapy Interfering Behaviors
Skills Training Targets
www.ticllc.org :: © TIC 2011-17 :: Slide 41
Therapy Destroying Behaviors
▪ Clients will quit coming to
group
▪ Therapists will quit coming to
group
▪ Presence of threat
▪ Group can’t be conducted
▪ DBT will get discontinued
Determining Therapy Destroying v.
Therapy Interfering Behaviors
Therapy Interfering Behaviors
▪ Annoying
▪ Distracting
▪ Interfere more with personal
learning than the learning of
others (e.g. sleeping)
▪ If not addressed, could escalate
into TDB over time
www.ticllc.org :: © TIC 2011-17 :: Slide 42
▪ Criticizing, making fun of other members
▪ Bringing a knife
▪ Interrupting repeatedly
▪ Crying
▪ Sleeping
▪ Picking at scabs
▪ Threatening another group member
▪ Leaving the room
Which are Therapy Interfering and
Which are Therapy Destroying?
Page 14 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 43
Reciprocal/Vulnerable Irreverent/Confrontational
TIB TDB
Ignore Face/Body Request Demand EBPlanguage Coaching happens here
Managing Group TIB vs. TDB
www.ticllc.org :: © TIC 2011-17 :: Slide 44
▪ Non-judgmentally describe the behavior to the client
▪ Quickly validate the behavior, the emotion behind it, or the
urge to do the behavior
▪ Instruct and coach the client in the behavior you want
▪ Reinforce when they do the new behavior
▪ Avoid power struggles and a scolding, “teacherly” tone (“You
need to… “I need you to...”)
▪ Work VERY HARDto keep people in the room vs. asking or
allowing them to leave
Managing Therapy-Interfering Behavior in Skills Group
www.ticllc.org :: © TIC 2011-17 :: Slide 45
▪ Genuinely understanding the individual’s thoughts, feelings,
behaviors, etc. in a nonjudgmental way
▪ Conveying that understanding to the individual so he or she
feels understood
▪ Validation is essential to coaching and maintaining
relationships.
▪ Individuals are more likely to use skills and accept coaching IF
they think the the coach “gets” them.
Remember to Validate!
Used with permission from Jennifer Eaton, M.S.
Page 15 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 46
▪ Leader asks client to stop behavior, gently or irreverently
▪ Leader uses the relationship as a contingency (e.g. “Help me
out and...”)
▪ Leader or co-leader uses proximity and facial expression to
manage behavior (i.e. The Teacher Face)
▪ Leader uses moment for a practice: “let’s do a mindfulness
skill here to make sure we are doing one thing in the
moment.”
Therapy Interfering Behavior
www.ticllc.org :: © TIC 2011-17 :: Slide 47
▪ Done by the co-leader
▪ The goal is to get them back in the room; it is NOT therapy in
the hallway
▪ Get a brief explanation of the problem
▪ Genuinely validate what has sent them from the room
▪ Coach skillful behavior that will help them to get regulated
enough to participate and learn in group
▪ Reinforce participating in coaching and coming back
▪ If the person does not collaborate, go back to group
Coaching a Client Who Has Left Group
www.ticllc.org :: © TIC 2011-17 :: Slide 48
▪ When there is conflict, distress, too much talking, or
generalized low affect
▪ Use mindfulness as an irreverent/unexpected intervention
▪ Choose practices strategically to quiet or activate a group
▪ Choose practices to build connection and decrease
“outsiderness”
▪ Consider a group mindfulness practice if you yourself become
dysregulated in group
Using Mindfulness to Address Whole-group TIB
Page 16 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 49
▪ Often done in consultation-to-client approach (i.e. client tells
leaders what to look for and how to respond
▪ Leaders loudly get client’s attention and coach them to:
▪ Get up and move around the room
▪ Do wall sits, stand on a balance board, stand on one foot
▪ Hold ice
▪ Throw themselves into group-–take notes, ask questions, interact with
other members
TIB of Dissociation
www.ticllc.org :: © TIC 2011-17 :: Slide 50
Using mindfulness to treat group TIB
Up-regulating
GroupIndividual
Down-regulating
www.ticllc.org :: © TIC 2011-17 :: Slide 51
▪ Leader-directed observing
▪ Shoe mindfulness
▪ Build-a-body
▪ “Twist and Shout”
▪ Sound ball
▪ Non-dominant writing of “Everything is perfect as it is.”
▪ Mindful walking
Mindfulness Practice Examples
Page 17 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 52
▪ If you want one behavior to STOP, you must identify what
behavior you want to START in its place.
▪ e.g. What is the behavior of “waiting your turn” or “not interrupting”?
▪ Make sure you reinforce the new, functional behavior
Remember…
www.ticllc.org :: © TIC 2011-17 :: Slide 53
▪ Stop them in the moment
▪ Use language of skills
▪ Discuss behavior with client outside of group
▪ Attend to group members’ reactions if
necessary
▪ Individual therapist (if available) targets in
therapy
▪ Egregious Behavior Protocol
Therapy Destroying Behaviors
www.ticllc.org :: © TIC 2011-17 :: Slide 54
▪ An aversive contingency designed to STOP therapy destroying
behaviors
▪ Client cannot return to group until the plan is approved
▪ Client determines harm that was done by behavior (to other
clients, staff, facilities, etc.)
▪ Client determines how to repair/correct harm
▪ Client determines how to over-repair/correct harm
▪ Client implements the plan
The Egregious Behavior Protocol
Page 18 of 19
MASTER CLASS: Core Skills in DBTPart Two: How to Structure and Run Skills Training Groups©
Presented by: Annie McCall, MA, LMHC
Dates: June 7 and 14, 2017
© 2017 Treatment Implementation Collaborative, LLC :: www.ticllc.orgDo not copy/use without permission.
www.ticllc.org :: © TIC 2011-17 :: Slide 55
Punishment, e.g. egregious behavior protocol,
only works while you are doing it, therefore you
want to REINFORCE any new functional
behavior no matter how small it is.
Remember Principles of Reinforcement
www.ticllc.org :: © TIC 2011-17 :: Slide 56
www.ticllc.org
TIC as a Resource
Helen Best, M.Ed.
President, TIC
(206)251-5134
Shari Manning, Ph.D.
Chief Executive Officer, TIC
DBT-Linehan Board Certified Clinician
(803)479-4545
Cindy Best
Chief Operating Officer, TIC
Annie McCall, MA, LMHC
Page 19 of 19