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DBT offers acceptance, provides continuity of care for OSH patients


For many, change is difficult. We are creatures of habit who tend to fall back on past behaviors, whether they've proven to be effective or not. This can be especially true for people suffering with mental illness; however, staff from Oregon State Hospital-Portland (POSH) are using a relatively new approach to treatment known as Dialectical Behavioral Therapy (DBT) in which acceptance is the catalyst for positive change.

Patient discusses DBT program with psychologist
Psychologist Catherine Marshall listens as patient Kim Applegarth talks about the progress she's made participating in the hospital's DBT program. DBT is a multi-faceted behavioral intervention based on the idea that patients can be more successful in therapy if they feel accepted, are encouraged to set their own goals and when there is a systematic support structure in place to help them achieve those goals.


Unlike other types of behavioral treatments that focus solely on identifying and changing a patient's maladaptive behaviors, the philosophy of DBT is to accept patients for who they are and where they currently are in their life. This approach helps a patient to see his or her therapist as an ally rather than an adversary. With this new perspective, patients are often more open to working with their therapist and listening to his or her suggestions.


After establishing a partnership, the next step is to empower patients by letting them determine their own goals, and then ensuring there is a systematic support structure in place to help them stay on track and reach their goals.


"I think it works because it is explicitly welcoming of people's challenges," explained psychologist Jennifer Hill, Ph.D. "DBT offers real relationships between real people — both clients and clinicians bring all of who they are to the treatment, so it's less stilted than some other treatments."


Designed in the early 1980s, DBT is a behavioral treatment that was originally used to treat suicidal patients who were typically disengaged in their therapy. In the past decade the use of DBT has been expanded, and it is now recognized as an effective treatment for a range of dysregulated behaviors, such as substance addiction, self-harm, anger issues and obsessive compulsive disorder.


Hill said that while psychologists at POSH have been using DBT in some form for nearly eight years, the program really took off six months ago when administrators made the decision to make DBT an integral and visible part of treatment in OSH's Adult Treatment Services program.


"We saw an opportunity to take what we were already doing and grow our program, and it's been really effective," said Hill, who is part of the hospital's interdisciplinary DBT consultation team.


Patients can participate in the DBT program through a self-referral or a referral from their treatment teams. They begin with an introductory group to learn about the program and decide if it is something they think will benefit them.


If they choose to use DBT, patients set concrete goals and commit to participate in group therapy twice a week, individual therapy once a week, and interact with the "skills coaches" on their unit on a daily basis.


Whatever goals patients choose to work toward — to stop harming themselves, to build better relationships with staff or to improve their communication skills so they can one day have a job — they work on them within all the hospital's different treatment environments. So whether it's treatment mall, individual therapy or back on their unit during off hours, patients are consistently working toward the same self-identified goals.


"The program is multi-faceted and requires all of these different pieces to work," Hill said. "You really have to have a team of people committed to applying DBT 24/7 for it to be effective."


This has led members of the DBT consultation team to spend much of their time in recent months offering training to as many POSH staff as possible — everyone from direct-care to housekeeping and security. The goal is that within the next few months, the DBT team will have provided the initial two-hour training to all of the hospital's staff.


"If you work here, we want you to know something about DBT and be able to speak the language of the treatment," Hill said.


In addition, more than 40 nurses have already received an additional four hours of training to learn practical applications of DBT and become skills coaches for their units. Skills coaches work with patients outside of formal treatment to help them stay on track to meet their goals. This can be anything from a gentle reminder to helping them with their coping skills to just lending an ear.


"The nursing staff has really warmed to the idea of DBT," Director of Nursing Services Artyce Robison said. "It has given us a connection to our patients' actual therapy, and provides them with wonderful continuity of care throughout their treatment."