Vol 3 • Issue 3 • June-2012

Employing Dialectical Behavior Therapy to Manage Emotional Trauma

Grafton Integrated Health Network’s Intensive Outpatient Program (IOP) supports adolescents aged 14 through eighteen who are in need of treatment due to a psychiatric condition that is making it difficult for them to function successfully within the community.

IOP services are provided for adolescents with:

• Chronic behavioral health conditions or those recovering from severe behavioral health conditions and/or;
• Confirmed or suspected alcohol or drug abuse conditions in addition to behavioral health conditions

The program employs dialectical behavioral therapy (DBT), a cognitive-behavioral approach that emphasizes the psychosocial aspects of treatment.

Characteristics of DBT:

• Support-oriented: Helps the individual identify their strengths, and builds on them so that the person can feel better about him/herself;
• Cognitive-based: Helps the individual identify thoughts, beliefs and assumptions that make life harder, i.e. “I have to be perfect”, “If I get angry, I am a terrible person”; Helps the individual learn different ways of thinking and focus on healthier thoughts, beliefs and assumptions such as, “I don’t have to be perfect for people to care about me”. Vera, a client served in the program, who you will meet later in this newsletter, has made considerable progress in modifying previous self-defeating thoughts to improve her self-concept as well as her relationships with others.
• Collaborative: Requires regular and collaborative feedback from the therapist regarding relationships with others.

Integrating mindfulness, interpersonal effectiveness, distress tolerance and emotional regulation are all components of DBT that lead to the success of those served in the IOP program. Other activities offered for clients include yoga, art therapy and music therapy. Recently, weekly parent support groups were added to help parents struggling with similar issues in supporting their children.

A unique characteristic about the intensive outpatient program is that is promotes learning and growth from other participants within the program. In fact, a peer volunteer component of the program was initiated recently to pair clients who had graduated from the program with those currently in treatment. Peer volunteers are IOP alumni who play an essential role in supporting clients. Peer volunteers receive training and debriefings within the program. Vera, the client featured in this edition, served as the first peer volunteer in the program. One client paired with Vera had this to say, “Vera really saved my life. If it had not been for her, I don’t know what I would have done.”

For more information on the Intensive Outpatient Program, please contact (703) 777-3485 ext 1379.

Success Story

Vera’s Story

CLINICAL PRESENTATION:

Vera* is a sixteen year old young lady referred initially to the intensive outpatient program due to severe problems with depression, suicidal ideation, self-injurious behavior, eating disorder symptoms, anxiety, trichtillomania (compulsive hair pulling), cannabis abuse and declining school performance.

As a result of negative social interactions during pre-adolescence, Vera experiences an unhealthy view of her body image and of herself. She struggles with cognitive distortions and she truly is her own worst critic. Vera defends herself against strong feelings by means of repression and “stuffing” her feelings inside, withdrawal and isolating herself and retroflection or turning her pain inwards. Historically, Vera has struggled with relationships and typically has had unhealthy boundaries and has put the needs of others above her own.

TREATMENT INTERVENTIONS:

Vera has many, many gifts including a great sense of humor and a fun loving personality. She is articulate, intelligent and motivated. Her family is committed to her success and to one another. In addition, the family acknowledges problems beyond what led Vera to seek treatment.

Within the intensive outpatient program, Vera received group therapy that has a combination of dialectical behavior therapy, cognitive behavioral approaches and expressive therapy. She also received individual therapy and family therapy within the program. Dialectical behavior therapy is a powerful treatment modality that has helped Vera build skills in mindfulness, emotional regulation, interpersonal effectiveness and distress tolerance. These skills were reinforced within the program through role playing and modeling effective communication. Vera’s treatment focused on checking and rechecking distorted thinking patterns that would in turn lead to negative feelings and at times, self-destructive behaviors. Vera presented with a number of cognitive distortions. Therapy sessions focused on helping her develop more balanced thinking and modifying distortions in thought patterns. Vera’s self report on the Subjective Units of Distress Scale (SUDs) was a convenient way of communicating to others how much distress she was experiencing at any given time. Scores ranged from zero which signified extreme distress to “10” which translated to no distress. Vera’s scores fluctuated on a day to day basis during treatment. In the beginning her numbers ranged from 1-4 out of 10. Towards the end of treatment her numbers ranged from 5-7 out of 10.

Over time, Vera became more and more receptive to feedback presented to her. A critical component to Vera’s progress was a strong and supportive family network. Like Vera, her family demonstrated a willingness and motivation to “adapt and adopt” new strategies and new ways of thinking. A weekly parent support group, multi-family group and family therapy were offered to engage and support families. The multi-family group included all clients, parents and family members at the same time. Innovative and creative interventions like “Family Sculpture” were introduced to families to relay that families struggled with common issues. During Family Sculpture, family members are asked to visually portray another family member through gestures, postures and facial expressions. The activity, facilitated by a clinician, frequently leads to lively and interesting discussion between clients and helps to increase awareness amongst family members by expressing how they are presenting themselves.

PROGRESS:

As a result of her progress and her commitment to the program, Vera successfully completed the intensive outpatient program at the end of January. She now serves as a peer volunteer where she helps other teens in the intensive outpatient program. As a matter of fact, Vera was the first peer volunteer within the program. As a peer volunteer, she plays an essential role in helping other kids who are experiencing a wide variety of mental health issues by instilling hope.

“I remember feeling hopeless, depressed and directionless when I first came here. IOP taught me to communicate my feelings and use coping skills when I found myself feeling anxious or sad. I felt understood and one of the coolest things is that I am able as a peer volunteer help other kids in the program.”

Overall, Vera has made significant improvement. Although, she will always need to remain focused on her treatment, she has a much more optimistic outlook on life. It is rewarding to see Vera go from apathetic and hopeless to using her experience to help others. Vera continues to work on her treatment goals in weekly therapy at Grafton on an outpatient basis. Vera has remained self-harm free for approximately 5 months now and counting.

Vera’s mother shares, “Vera’s therapist had a true partnership with us and was professional, persistent, thoughtful and genuinely cared about my daughter. It was comforting to have Vera’s needs placed in good hands and the continuum of care available at Grafton Integrated Health Network provided a safe and therapeutic place for us. Grafton’s intensive outpatient program is a rare gem in our community.”

*Client’s name has been changed to protect her privacy

• Kim Sanders, Executive Vice President and Chief Outcomes Officer and Christopher Feltner, Training Support Manager conducted training on Extraordinary Blocking at Sunshine, Inc. in Maumee, Ohio on May 4th. Extraordinary Blocking is a revolutionary technique developed at Grafton Integrated Health Network as an alternative to restraint and seclusion.
• Grafton Integrated Health Network employees and clients participated in the Autism Society of Central Virginia 5K Run/Walk for Autism scheduled in Richmond on May 26th.
• Jason Craig, Director, ABA services and Kim Sanders presented, “Trauma Informed Applied Behavior Analysis” at the ABAI annual conference on May 28th in Seattle, Washington.

• Grafton will serve as the golden sponsor for the 11th annual Virginia Central Region CSA Training and Resource Day scheduled on September 24, 2012 in Richmond, Virginia.