Monday, October 15, 2007

Dialectical Behavior Therapy: Interview with Sabrina Heller, LSW

[Episode 26] In today’s podcast, I speak with Sabrina Heller, a social worker in Pittsburgh, Pennsylvania who has used Dialectical Behavior Therapy, (DBT) in a variety of clinical settings, including an inpatient eating disorders clinic and an outpatient substance abuse treatment program. In today's interview we spoke about the goal of DBT, clinical techniques, the role of the client and clinician, the skills training workshop, the three mind states: reasonable mind, emotion mind, and wise mind, and how Sabrina incorporates DBT into her work with clients.
Download MP3 [52:12]




Transcript

Introduction

In today’s podcast, I speak with Sabrina Heller, a social worker in Pittsburgh, Pennsylvania who has used Dialectical Behavior Therapy, (DBT) in a variety of clinical settings, including an inpatient eating disorders clinic and an outpatient substance abuse treatment program. In today's interview we spoke about the goal of DBT, clinical techniques, the role of the client and clinician, the skills training workshop, the three mind states: reasonable mind, emotion mind, and wise mind, and how Sabrina incorporates DBT into her work with clients.

DBT is an evidence-based cognitive-behavioral therapy developed by Marsha Linehan and her colleagues at the University of Washington in Seattle for suicidal clients who meet criteria for BPD. When I say it is an evidence-based treatment, I mean that as of 2007, DBT has more randomized trials demonstrating efficacy in the treatment of BPD and suicidal behaviors than any other approach, including psychodynamic or even other cognitive-behavioral treatments.

I saw Dr. Linehan speak at the American Association of Suicidology conference in Seattle, WA in June of 2006. During her presentation she said that if the name “CBT” had not already been taken, she would have called her approach CBT. She also said that, although DBT is an evidence-based approach for treating people with BPD, she initially sought to develop a more effective treatment for people with suicidal behaviors. During her research, she noticed that many of her clients met criteria for BPD. Because funding for research tends to favor projects that are tied to a diagnosis such as BPD rather than a set of behaviors such as suicide attempts, Linehan found that she could only get funding if she discussed her treatment in relation to the diagnosis, not the behaviors. So, even though DBT has become identified as a treatment for BPD, it was originally developed to treat people with self-harm behaviors, such as self-cutting, suicide thoughts, and suicide attempts.

There are five functions that are addressed by standard DBT: (1) increasing behavioral capabilities, (2) improving motivation for skillful behavior (through contingency management and reduction of interfering emotions and cognitions), (3) assuring generalization of gains to the natural environment, (4) structuring the treatment environment so that it reinforces functional rather than dysfunctional behaviors, and (5) enhancing therapist capabilities and motivation to treat patients effectively. These functions are divided among the following 4 modes of service delivery: (1) weekly individual psychotherapy (1 h/wk), (2) group skills training (2½ h/wk), (3) telephone consultation (as needed within the therapist’s limits to ensure generalization), and (4) weekly therapist consultation team meetings (to enhance therapist motivation and skills and to provide therapy for the therapists). (Linehan et al, 2006, p.759)

Since Linehan published her treatment manual in 1993, DBT has become one of the most empirically-validated approaches to treating BPD and self-harm behaviors. A 2006 study compared DBT to expert therapies and found that participants who received DBT had better outcomes. Linehan reported that subjects “were half as likely to make a suicide attempt (hazard ratio, 2.66; p=.005), required less hospitalization for suicide ideation (F1,92=7.3; p =.004), and had lower medical risk (F1,50=3.2; P=.04) across all suicide attempts and self-injurious acts combined. Subjects receiving DBT were less likely to drop out of treatment (hazard ratio, 3.2; p <.001) and had fewer psychiatric hospitalizations (F1,92=6.0; p =.007) and psychiatric emergency department visits (F1,92=2.9; P=.04)” (Linehan et al, 2006, p. 757).

And now, without further ado, on to episode 26 of the Social Work Podcast. Dialectical behavior therapy: Interview with Sabrina Heller, LSW.

References



APA (6th ed) citation for this podcast:

Singer, J. B. (Producer). (2007, October 15). Dialectical Behavior Therapy: Interview with Sabrina Heller, LSW. [Episode 26]. Social Work Podcast. Podcast retrieved from http://socialworkpodcast.com/2007/10/dialectical-behavior-therapy-interview.html

5 comments:

t said...

Behavioral Treatments help patients engage in the treatment process, modify their attitudes and behaviors related to alcohol abuse, and increase healthy life skills. The ultimate goal of alcohol addiction treatment is to enable an individual to achieve lasting abstinence.
http://www.drugrehabscenters.com/terms/Behaviour-and-Motivation-Therapy/index.html

suomanona said...

This is extremely helpful, thank you for posting it.
I'm diagnosed bipolar and very isolated by it so I was thrilled to find this podcast and plan to relisten to it several times and to pass it on.

Noelita said...

Thank you so much for The Social Work Podcast! I first listened to the podcast during my first field placement -to supplement lessons on therapeutic interventions. Now, I'm listening again to brush up before the LMSW exam. ...And, I was looking for information on DBT, and hoping that there would be a DBT podcast and whaddya' know The Social Work Podcast did an episode on DBT!

drug said...

The motivational therapy is the combination of the humanistic treatment with high ethics and the cognitive behavioral strategies. In the motivational therapy it is very much essential that the students. Patients should be influenced with the educators, professional counselors and the expert trainers that offer the behavioral and motivation therapies. They provide the individual as well as the group therapies for their development. Te troubled teens as well as drug and alcohol addictors are unable to maintain the good relations with the families and society.
http://www.edrugrehabs.com/

diamond said...

hi sabrina my name is shakea sease and i have a daughter who steals every single day. she steals food, electronics, money etc... one day my aunt sent her to the store buy some things on the list. the owner of the store caught her stealing cookies and told her to leave the store. my daughter didnt even buy the things on the list. somebody outside of the store who knows my aunt took the list and money from my daughter and bought the stuff for her. my daugheter has been in therapy for over five years, has been on meds for the same amount of years. she has been stealing for almost five years. punishment does not work for her, she still gets up three or four oclock in the morning to steal food. she gets fed everyday at home. i think something is wrong with my daughters function of the brain can you please help me with this situation.