[rainbow8]

I called two DBT programs in my area. The one who called me back is run by a hospital that's in my insurance network. It's a short form program, not what I expected, and goes every day, for about 5 hours a day, for 4 to 6 weeks. I don't know if that's a good idea or not, and I have to call insurance but they will probably cover it. You have to see their p-doc while you're taking it, but I can easily do without my T for that time period. It's kind of intense if it's daily, isn't it?

It's an excellent hospital but I don't know about their mental health department.

I didn't call them yet. I'm supposed to say it's the partial hospitalization program. That sounded scary and I said I didn't want to be in the hospital. He said that's just its name.

Has anyone been in a program that's only 4-6 weeks? The man who took my call told me that people are generally happy with the program.

The other program is with an agency that my T knows about and says its good. They didn't call back yet.

I've read the handouts about DBT. It seems kind of cut and dry. Do programs vary that much, do you think, or know? Thanks.

[Chopin99]

I was lucky enough to have a T that did DBT with me in session. She encouraged me to find a group, but decided due to my hesitance to go ahead and do it one on one. It is quite cut and dry, but actually putting what you learn into practice is harder. It probably took me 3 years past that round of therapy to actually "get it" and fully integrate it into my life without having to think about it.

[kiki86]

i think 4-6 weeks isn't really long enough. i think people need long term support to make long term changes.

BUT it can't hurt can it? i mean if it even has a small impact that's worth it isn't it? i just wouldn't expect it to be a cure, six weeks done and dusted if you know what i mean?

[rainbow8]

Thanks, kiki. I know, but then I think of the courses my T has taken, like 4 days to learn about EMDR or sensory experiencing. My former T learned to be a mediator in a week. I wondered about that.

If the price is right, I think it's better than nothing. It's a start, and can't hurt, like you said. I'll see what the other program offers, and then ask my T's opinion.

I DO know DBT is supposed to be 6 months to a year, but maybe that's once a week?

[scorpiosis37]

Originally Posted by rainbow8

Thanks, kiki. I know, but then I think of the courses my T has taken, like 4 days to learn about EMDR or sensory experiencing. My former T learned to be a mediator in a week. I wondered about that.

Well that's scary! I don't think anyone can reliably learn those skills in 4 days or a week. Any program that "certifies" someone in those skills (or others) in such a short period of time should be viewed rather skeptically. And any professional who thinks they are qualified to practice those skills independently after such a short period of time, should be viewed skeptically as well. It reminds me of my uncle, who is a surgeon, telling me horror stories about for-profit medical seminars that "certify" a doctor in a particular technique during a weekend course, and then allow the doctor to go back home and begin practicing that skill in his own practice. The doctor may have done very well that weekend, under the supervision of the expert, but going home after 3 or 4 days and practicing that technique by himself on patients? Yikes. My uncle hates those kinds of certification programs. He calls them money scams, for doctors with egos, that end up hurting patients. Clearly, with mediation or something like that, the consequences aren't as dire-- but still. If there is any skill involved in something, it takes time, direction, practice, supervision, correction, and more practice to learn it correctly.

Rainbow, I can't add much to your discussion about DBT specifically-- don't know much about it myself-- but from what I've read others post about it, it does sound as though it would be helpful for you. So, I hope you try one of the two programs your T recommended-- whichever one you think sounds better for you.

[LoneWolfie]

Even though it only goes for 4 or 6 weeks it will be intensive if they are full days. I am waiting to get into a 15 week DBT program that is three full days a week in the fall.

Right now I am taking a 6 week one hour and a half a week in distress tolerance, honestly I am sort of lost. I did a 6 week program called Keeping it simple and that was twice a week for an hour and a half per session. We only touched on one thing each week and it wasn't enough, I don't remember a thing from that program 6 months after the fact.

Why would you stop going to your T if you are in a program? Is it because your insurance will not pay for both?

The program I am waiting to get into I will continue to see my psychiatrist every week. The program only offers group therapy and does not med support or anything else. I continue as it is now, I have an ACT team worker and my Pdoc.

You would think there would be more resources it seems that everyone is waiting to get into a DBT program and the length seems to vary on all of them.

LoneWolfie

[unaluna]

wow that sounds interesting. I can see how - being given a list of 100 soothing activities, and instead of coming back in a WEEK and saying (like I did) I didn't do any, I was too depressed - you might be more likely to do at least ONE that first week, if you saw the people every day, all day. if you can make the time commitment, like you have no grandkids or H commitments? I would do it. we (I!) spend that much time on the computer or tv or reading anyway!

[rainbow8]

Originally Posted by LoneWolfie

Why would you stop going to your T if you are in a program? Is it because your insurance will not pay for both?

The program I am waiting to get into I will continue to see my psychiatrist every week. The program only offers group therapy and does not med support or anything else. I continue as it is now, I have an ACT team worker and my Pdoc.

You would think there would be more resources it seems that everyone is waiting to get into a DBT program and the length seems to vary on all of them.

LoneWolfie

The program REQUIRES that I don't see my own T for half of the DBT sessions. I've heard programs don't let you see your T for the entire time. Didn't that happen to you, Kacey? They have their own Ts in the program.

[sunrise]

Rainbow, if you have a choice of programs, I would encourage you to do one that meets less frequently for a longer period of time, say once or twice weekly for 6-12 months. I think there is value in spreading it out over a longer period and having a longer period of time between sessions to work on coping skills on one's own. You can get a week between meetings to practice your distress tolerance in not contacting the therapist. And if you are unable to make it through the week, you can call the therapist and they talk you through your DBT skills to help you cope. At least that is my understanding of one aspect of DBT. It sounds like that part might be really valuable for you, since you often email your therapist between sessions when the impulse hits you. If you were going to a DBT program that met every day, there might not be the same benefit of having to make it through a whole week. It might be very easy to just wait until the next day, and so would not match up as well to that particular need.

I work at a psych hospital and we have partial hospitalization programs there. At our hospital, the partial patients come 5 days a week and join with the hospitalized patients for the therapeutic program 6 hours a day. So there is a mixture of inpatient and outpatient (partials) in the groups. The inpatient folks are more acute, often actively suicidal. The partials are often people who have been inpatient at the hospital recently and then will do the partial program as a "step-down" to being on their own. So the partials often have a lot of familiarity with the hospital since they are former patients. Sometimes we get partials who were not previous inpatients, but this is the minority. Also, when the partials are in the hospital with the inpatients, they have the same restrictions as the inpatients, i.e., they can't come and go as they please (they would need to get staff to unlock the doors for them to leave). There are a lot of rules! I don't know if the partial hospitalization program you are looking into would share any features with what I've described for my hospital, but it might raise some questions for you that you could get answers to before you make a commitment.

Originally Posted by rainbow8

It's kind of intense if it's daily, isn't it?

My experience has been that it's super hard to have that level of intensity for 6 hours straight, so the program in hospital is actually less intense because it is so many hours in a row. It is easier to do 6 hours of intensity if you do 1 hour a week, 6 weeks in a row, than 6 sequential hours in one day. Does that make sense? So it ends up the 6 hours in a row has pauses and breaks and lighter, less intense times. I'm not saying the hospital DBT program you're looking into would be like this, but it might raise questions for you to ask about.

I hope you hear back from the other DBT group too. Do you know if it is also a short program at a hospital?

[LoneWolfie]

Originally Posted by rainbow8

The program REQUIRES that I don't see my own T for half of the DBT sessions. I've heard programs don't let you see your T for the entire time. Didn't that happen to you, Kacey? They have their own Ts in the program.

Thanks for clarifying that about why you will not be seeing your T.

[rainbow8]

Originally Posted by sunrise

Rainbow, if you have a choice of programs, I would encourage you to do one that meets less frequently for a longer period of time, say once or twice weekly for 6-12 months. I think there is value in spreading it out over a longer period and having a longer period of time between sessions to work on coping skills on one's own. You can get a week between meetings to practice your distress tolerance in not contacting the therapist. And if you are unable to make it through the week, you can call the therapist and they talk you through your DBT skills to help you cope. At least that is my understanding of one aspect of DBT. It sounds like that part might be really valuable for you, since you often email your therapist between sessions when the impulse hits you. If you were going to a DBT program that met every day, there might not be the same benefit of having to make it through a whole week. It might be very easy to just wait until the next day, and so would not match up as well to that particular need.

I work at a psych hospital and we have partial hospitalization programs there. At our hospital, the partial patients come 5 days a week and join with the hospitalized patients for the therapeutic program 6 hours a day. So there is a mixture of inpatient and outpatient (partials) in the groups. The inpatient folks are more acute, often actively suicidal. The partials are often people who have been inpatient at the hospital recently and then will do the partial program as a "step-down" to being on their own. So the partials often have a lot of familiarity with the hospital since they are former patients. Sometimes we get partials who were not previous inpatients, but this is the minority. Also, when the partials are in the hospital with the inpatients, they have the same restrictions as the inpatients, i.e., they can't come and go as they please (they would need to get staff to unlock the doors for them to leave). There are a lot of rules! I don't know if the partial hospitalization program you are looking into would share any features with what I've described for my hospital, but it might raise some questions for you that you could get answers to before you make a commitment.

My experience has been that it's super hard to have that level of intensity for 6 hours straight, so the program in hospital is actually less intense because it is so many hours in a row. It is easier to do 6 hours of intensity if you do 1 hour a week, 6 weeks in a row, than 6 sequential hours in one day. Does that make sense? So it ends up the 6 hours in a row has pauses and breaks and lighter, less intense times. I'm not saying the hospital DBT program you're looking into would be like this, but it might raise questions for you to ask about.

I hope you hear back from the other DBT group too. Do you know if it is also a short program at a hospital?

Thanks, sunrise. I agree with you and I appreciate your input. I haven't heard from the other program yet. It's almost 24 hours since I left my message and I'm home, so I'm not sure why they haven't called yet. No, this one is not through a hospital.

I certainly do not want to be with inpatients are those who have been recently hospitalized. I think there should be a separate group for them. I will call back and ask about that after I call my insurance about the coverage for the program. I'd better clarify what I said above. Not that I wouldn't want to be with them, but I think it would be more beneficial to me to be in a group with people who are going about their daily life and are not so seriously ill.

[Perna]

Here's the "other" kind of partial hospitalization program in behavioral health, what you could be hoping for (from Akron Hospital, presumably Akron, Ohio?):

http://www.akrongeneral.org/portal/p...IATRY_services

[minneymouse]

Hi rainbow

I agree with sunrise that it would be much better to do a weekly skills group instead. That way you would be supported over a longer period of time- it takes *time* to embed skills in your daily life- plus with partial hospitalization you'd be removed from your daily life, so you'd have fewer opportunities to try out the skills in situ. What we know about learning new skills is that they don't automatically generalise across contexts, so if you learn them in a therapy room, that doesn't mean you can use them in real life. That's what the phone coaching in DBT is for.

I'd also totally agree with your concerns about being with people who are much more poorly than you. Many of my most destructive behaviours were 'learnt' in a hospital, as they are highly contagious, and unless the contingencies are managed very very well, the whole set up can quickly become so that those in unrelenting crisis get the most support and attention which reinforces... unrelenting crisis (surprise surprise- though incredibly, many inpatient units still seem to be clueless about this)!

If you are going to do individual DBT therapy alongside the skills training, I think it would be helpful to have a think about what behaviours you would target. Individual DBT is focused on eradicating problem behaviours in a hierarchy. Most important are life-threatening (suicide and self harm behaviours), then 'therapy interfering', then 'quality of life interfering'. Each session is based around an occasion in the last week where you engaged in a target behaviour. You do a behaviour chain looking at how the behaviour came about, and identifying where you could have used skills instead. I guess I'm just not sure what your target behaviours would be?

[minneymouse]

Just wanted to add that there is a fab free online DBT class via a yahoo group. They email out the homework on Saturdays and you post your homework, then a moderator replies to it. I think the DBT skills are tricky to grasp, and it'd be difficult to use only the group unless you were exceptionally well motivated, but it's great to do alongside group skills training, and while you're waiting. We learn any new skill best through practice practice practice

[sunrise]

Originally Posted by Perna

Here's the "other" kind of partial hospitalization program in behavioral health, what you could be hoping for (from Akron Hospital, presumably Akron, Ohio?):

http://www.akrongeneral.org/portal/p...IATRY_services

I looked at that and they mention both an Intensive Outpatient Program (IOP) and a Partial Hospitalization Program (PHP). I am familiar with IOPs too. They are indeed different from PHPs. Rainbow, I do think an IOP would be a better fit than a PHP, but I think the weekly program would be even better. There are lots of models of service delivery, aren't there?

[rainbow8]

Originally Posted by minneymouse

Hi rainbow

I agree with sunrise that it would be much better to do a weekly skills group instead. That way you would be supported over a longer period of time- it takes *time* to embed skills in your daily life- plus with partial hospitalization you'd be removed from your daily life, so you'd have fewer opportunities to try out the skills in situ. What we know about learning new skills is that they don't automatically generalise across contexts, so if you learn them in a therapy room, that doesn't mean you can use them in real life. That's what the phone coaching in DBT is for.

I'd also totally agree with your concerns about being with people who are much more poorly than you. Many of my most destructive behaviours were 'learnt' in a hospital, as they are highly contagious, and unless the contingencies are managed very very well, the whole set up can quickly become so that those in unrelenting crisis get the most support and attention which reinforces... unrelenting crisis (surprise surprise- though incredibly, many inpatient units still seem to be clueless about this)!

If you are going to do individual DBT therapy alongside the skills training, I think it would be helpful to have a think about what behaviours you would target. Individual DBT is focused on eradicating problem behaviours in a hierarchy. Most important are life-threatening (suicide and self harm behaviours), then 'therapy interfering', then 'quality of life interfering'. Each session is based around an occasion in the last week where you engaged in a target behaviour. You do a behaviour chain looking at how the behaviour came about, and identifying where you could have used skills instead. I guess I'm just not sure what your target behaviours would be?

thanks, minney. I don't know if I would do individual DBT T along with the skills training. I thought programs have their own requirements about that.

Originally Posted by minneymouse

Just wanted to add that there is a fab free online DBT class via a yahoo group. They email out the homework on Saturdays and you post your homework, then a moderator replies to it. I think the DBT skills are tricky to grasp, and it'd be difficult to use only the group unless you were exceptionally well motivated, but it's great to do alongside group skills training, and while you're waiting. We learn any new skill best through practice practice practice

I used to be in that online class, if it's the same one. I printed out all the handouts. Can you post it, or PM me about it? I remember I had trouble doing the assignments so I kind of gave up and later on thought it was discontinued.

Originally Posted by sunrise

I looked at that and they mention both an Intensive Outpatient Program (IOP) and a Partial Hospitalization Program (PHP). I am familiar with IOPs too. They are indeed different from PHPs. Rainbow, I do think an IOP would be a better fit than a PHP, but I think the weekly program would be even better. There are lots of models of service delivery, aren't there?

Thanks to your advice, I called back the hospital program because I saw online that there WAS a separate IOP listed. But the man told me they were altogether, one group! I don't understand that. When I asked if most of the people in the groups have recently been hospitalized, he said that was private information and he couldn't tell me. He said maybe this wasn't the right group for me. I asked if there was any group he could recommend and he told me about the other one I called. I was frustrated because we had no phone or internet service yesterday and I had neglected to give them my cell phone #. I asked this guy on the phone if he could give me their phone number and he refused, telling me I could wait until I had my internet service again! What kind of reply is that from a mental health department? Or was he already teaching me distress tolerance skills?

So, I'm waiting for the other program to call me. I think they tried when our phone wasn't working. I can't find any other programs near me when I google. I don't want to get my hopes up about this one. Sigh.

[LoneWolfie]

Did someone post the link to the yahoo group? It sounds very interesting and I would consider doing it while I wait for the intensive in the fall.

Can someone either pm or email with the link, it would be appreciated, thanks.

LW

[Kacey2]

Originally Posted by rainbow8

The program REQUIRES that I don't see my own T for half of the DBT sessions. I've heard programs don't let you see your T for the entire time. Didn't that happen to you, Kacey? They have their own Ts in the program.

Rainbow,
Yes, the program that I'm in requires you to have a DBT therapist from their clinic. They say it is for continuity. They have weekly team meetings and it is important that skills trainers and individual t's to consult about the patients progress and struggles. For example, if you aren't participating in skills they will talk to your own t and then your t will work with you in your sessions to get you to change your behavior. My problem was that my t eventually became the skills trainer in my group due to some unforseen events and I did not like having him in there with all his other clients and myself. I got really jealous. I tried to switch t's so I could stay in DBT but I was not able to do that. The other reason is that they want your individual to know the protocol and be applying in your individual sessions. They want issues addressed on a higherarchy because that is how it is the most successful.

On the other piece. I personally think that you would have more success in a program that is once weekly for a longer period of time rather than a condensed intensive program. The reason is that these are not easy skills to apply and it takes a lot of practice and examing homework. A lot of my learning was "Wow, this happened and I didn't like how it went. Then fill out the homework of how I can handle it the next time." Also you would have additional support for a longer period of time. You will most likely develop relationships with the other members of your group and your skills trainers. They will first offer you more support in addition to your current t and also it will give you some other relationships to put some energy into thus hopefully reducing your obsession (your words) with current t.

My therapist told me repeatedly that the most loving, caring thing he could do for me was dbt and he was right. DBT therapists aren't snarky boot camp t's, they really are in tuned to what you need and are most conscientous of being non judgemental and finding the grain of truth. They also have an art to validating your pain or point of view. Yes they have some standards that they stand by and rules that I personally didn't enjoy but it was the most caring way for me to receive treatment.

Hopefully that other program you are going to contact would allow you to do the skills training, meet weekly with a dbt t, and also see your t once a week. That would be awesome. You could also use your skills trainers and co dbt groupies to sort out some problems you have with your current t. Keep pursuing this Rainbow!

[splitimage]

I just finished a DBT program. It was 20 weeks, 2 hrs a week & I found that intense. I can't imagine doing it for longer hours in a shorter period of time. Plus you need time to practice and integrate the skills into your life, which I had in the week between sessions. My program specified that you also had to have your own T that you were seeing at least every other week, during the program - but it didn't have to be a T from their practice, so I just continued with my normal T.

I think DBT is really good and it helped me a lot, but if I had to choose, I'd go for shorter sessions spread out over a longer period of time.

splitimage

[adel34]

Hi Rainbow,
I think it's so great you're doing this! It seems so challenging to find resources that are a good fit.
In spite of the long ride, I really do like my day program in how flexible it is. They have groups monday through friday from 9 to 2 ( except on thursdays when they end at 12) but you can choose which groups work for you. You also don't have to go everyday and it's not time-limited. They do have a CBT/DBTT group on Wednesdays, but I'm gonna do only the DBT part because I can't stand plain CBT.
I don't know if others in the program have been in the hospital previously to coming. I know many have come for years and years. As long as you set goals every 12 weeks you can use the program as an ongoing source of support.
Good luck with this!

[rainbow8]

I am SO excited!! The T called me back from the other program and it sounds perfect! I can still see my own T; they require you to see a T but doesn't have to be theirs. They are covered by Blue Cross PPO which I have, and they meet once/week for 6 months.

There is no waiting time for the day group, which would work out better than the night groups anyway. However, I have personal reasons why I may not be able to start until mid-October. It's so strange/funny. I just started thinking about DBT and now I'm a little upset that I can't start right away! The T said I can miss a few weeks, but maybe it's better to wait until I know I'm in town. The location is perfect too. It's about 15 minutes from where I live, and I'm in that area a lot so I know where it is.

So, I can have the intake interview now, or if I'm sure I want to wait until October, I should wait. I have to look at the calendar, talk to my T, and talk to my H, who does not like when we have to come home from visiting "because of a T appointment". If I've waited this long, I can wait a few months longer.

[sunrise]

That sounds really great, rainbow! Sounds like a really good fit for what you want. And insurance coverage too!

Originally Posted by LoneWolfie

Did someone post the link to the yahoo group? It sounds very interesting and I would consider doing it while I wait for the intensive in the fall.

Can someone either pm or email with the link, it would be appreciated, thanks.

LW

To learn more about the dbtclass group, please visit
http://groups.yahoo.com/group/dbtclass

Rainbow~I am so excited for you. DBT is something I have been trying to get into for a few months now. I understand so well the struggles that you have. It is so hard to change the way we think and feel. It is also very painful to feel this way when others don't understand why we think and act the way we do. We don't know any other way, so its hard to change without intense intervention.

My therapist said that using DBT can be like "telling a right handed person that they can no longer use their right hand. They will have to be left-handed from now on."

It is not natural for that person and its extremely hard to force the left hand to do what we depended on the right hand to do for so long. It is awkward and challenging, but it is doable. It takes LOTS of practice, though. This is what DBT requires. LOTS of hard work and practice.

I hope this works out for you. Kuddos for stepping out of your comfort zone and making this giant leap to healing and a healthier, happier life.

[LoneWolfie]

Thank you for the link to the DBT classes online. Very much appreciated and it is bookmarked!

LoneWolfie