GreenWood provides a private Dialectical Behaviour Therapy (DBT) service involving individual and group sessions plus coaching or group-only sessions. We cater for clients who do not severely self-harm or attempt suicide. All our sessions are delivered using Zoom or similar.
GreenWood’s DBT therapists attend peer supervision groups known as “consult groups” to ensure DBT adherence. We also receive external DBT consultancy and supervision.
What problems does DBT work well for?
If your problems meet the criteria for borderline personality disorder/emotionally unstable personality disorder (BPD/EUPD) DBT is an effective therapy for you. The UK National Institute for Health and Care Excellence (NICE) recommends DBT for BPD/EUPD. It also recommends schema-focused therapy and mentalisation therapy. GreenWood can sometimes offer schema-focused therapy.
If you have not been diagnosed with BPD?EUPD but think your problems meet the criteria, we can help with an assessment.
DBT also is proven effective for substance and alcohol misuse, gambling, pornography addiction, eating disorders, especially bulimia and binge-eating, overspending and other addictive and impulsive behaviours. It is also very effective for people who have multiple problems and difficult-to-treat presentations.
What is BPD/EUPD?
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following:
- Frantic efforts to avoid real or imagined abandonment.
- Unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
- Identity disturbance:
- Potentially self-damaging impulsivity in at least two areas (e.g. spending, sex, substance abuse, reckless driving, binge eating).
- Recurrent suicidal behaviour, gestures, or threats of self-mutilating behaviour.
- Affective instability
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
This definition is from the American Psychiatric Association.
The central problem we work with in BPD/EUPD is emotional dysregulation.
What causes BPD/EUPD?
A combination of nature and nurture. “Nature” or biological factors include genetic and epigenetic factors as well as physical/neurological characteristics causing sensitivity and hyper-responsiveness. “Nurture” or social factors include growing up in an invalidating environment, where you might have been neglected, abused, humiliated, ignored, mocked, told you are worthless, forced to always be perfect, etc.
What does doing DBT involve?
If you decide to pursue DBT with GreenWood, you will be allocated a potential therapist.
You will then have a period of “pre-commitment” work, where you and your therapist will discuss any diagnoses you have as well as your life story and current problems. The therapist will ensure you are aware of exactly what you will be committing to if you sign up for DBT. The DBT contract is six months minimum, more usually one year. You will need to agree to work weekly with an individual therapist on reducing all the problem behaviours that are ruining your life, as well as attend a group to learn new more effective emotion-regulation skills.
If you sign up for group-only DBT you will need to attend for at least six months, weekly.
If you sign up for individual DBT you will attend weekly individual sessions and weekly group sessions as well as receiving coaching on-demand from your therapist.
You cannot receive individual-only DBT. If you are on the ASD spectrum and cannot tolerate groups at all, your therapist will consider teaching the skills individually on separate weekly sessions.
During the pre-commitment stage, both parties are free to walk away and say the contract is not for them. Once the contract is signed the commitment is considered binding.
If you miss four sessions of DBT in a row (individual and group) you will be considered to have dropped out of DBT and will not able to return for at least six months.
Although DBT sounds very strict and structured, it is also very validating and nurturing and provides the opportunity to develop a genuine and healthy relationship with the therapist, within which you can turn your life around.
How effective is DBT?
It depends what we are using DBT to work on. There is good evidence for the effectiveness of DBT for all of the problems mentioned above. There is good evidence for both individual plus group and coaching as well as for group only. The choice of which model usually depends on the severity of the problems we are working with. In terms of BPD, around half of those who undertake DBT do not meet the criteria for BPD at the end of therapy. DBT is very good at reducing behaviour which occurs often and has been difficult to change. It increases our ability to manage intense emotions, handle relationships, and get a life worth living.
Risk management in DBT
We often get enquiries seeking DBT from people who do self-harm and have suicidal behaviours. We are unable to provide therapy for you if this is the case, because we do not have the multi-disciplinary team (MDT) including psychiatry and care-co-ordination to manage the risk effectively. There are some exceptions to this rule, for example if we can establish connections with your local MDT. We are always happy to discuss your needs and help you seek out the right DBT treatment for you.
What will I do with my individual therapist in DBT?
You will meet weekly and keep a diary of the main behaviours which are ruining your life, “target behaviours”. When you see your therapist you will both look at the diary and pick out a target behaviour to study together. You will do something called a “chain analysis” where you work out your thoughts, feelings, behaviours (and urges) and body sensations in the run up to the target behaviour, as well as what happens in the short and longer-term afterwards. The aim is to work out what “reinforces” the behaviour (makes it stronger and makes it happen again and again). This might be a pleasurable feeling but more often is the chance to avoid aversive (bad) internal feelings and states.
You will then carry out a “solution analysis” thinking of things you could do differently next time, and make a solid plan to take away.
If you find yourself having a strong urge to carry out a target behaviour between sessions, you are expected to call your therapist, within specified hours. Outside those hours you should know who else you might call. This is known as phone coaching.
What will I do in the skills group sessions?
Because all our groups are online, they often involve people from all around the world. There are four modules which each last six weeks: Mindfulness, Emotion Regulation, Distress Tolerance and Interpersonal Skills. For adolescents there is another module, Walking the Middle Path.
A typical DBT Skills Group starts with mindfulness, followed by a review of your homework from the last session. We then review your skills diary (not your target behaviour diary) t see what skills you have used and what works for you. After a short break we move into the teaching session, where new skills are taught and homework set. After a closing exercise the group ends.
Our DBT Team
Our DBT team is
Dr Gill Green (DBT co-ordinator, trainer and therapist)
Catherine Parker (DBT therapist and trainer)
Margaret McGuigan (DBT therapist)
Dr Jonathan Hutchins (DBT therapist)
Marie Wassberg (DBT therapist adolescents only, and trainer)
Darryl Christie (DBT therapist and trainer)
What is the Consult Group?
The Consult Group is the peer supervision group which is compulsory for DBT therapists with current clients to attend weekly. This group is used to do DBT with ourselves, to make sure we stick to DBT (are DBT adherent) and stay compassionate and effective. It means you will receive expertise from a group of us not just your own therapist.
What is the cost of DBT?
The cost of DBT is £130 per session for individual work; £60 per session for group. Thus for the first six months of DBT you would pay £180 per week. After this you may or may not need or choose to repeat the group for another six months, or you may decide with your therapist that you have adequately learned the skills and can continue just doing individual sessions. The duration of therapy is a minimum six months more usually a year. This can be ended earlier if the therapy is proving ineffective for you, or extended later if you decide you need more.
If you are offered and choose group only this will cost £60 per session weekly for at least six months.
We often have therapists who are already experienced and established in other therapies, who are training to provide DBT with us. These therapists offer individual work at half price, so £60 per session, because they are in training. They receive weekly supervision in their Consult Groups and further supervision from the trainers.