CEU Course
ON DEMAND TRAINING

DBT Intensive Part 5: Using DBT tools in Individual Therapy

with instructor Emily Wharton, PsyD

Cost $99.00
Credit Hours 4 CEs
Level Introductory
Delivery Method Recorded Webinar
Interactivity Type Non / Self-Study*
Date Developed April 2024
*A post test must be taken and passed in order to receive CE credit. Participants may retake the post test a maximum of 3 times to receive a passing score. A qualifying passing score is 80% or above.
DBT Intensive Part 5: Using DBT tools in Individual Therapy

4 clinical CEs

$99.00

Register Now

Course Overview

This workshop is Part 5 of a 5-Part Series on DBT theory, skills, and practice. It is recommended to attend all five parts to receive the full DBT training, however you may attend a portion of the series if you are unable to attend all parts.

Dialectical Behavior Therapy (DBT) was originally created to treat adults with Borderline Personality Disorder (BPD) and suicidal behaviors (Mehlum, 2021). The creation of DBT was ground-breaking in providing a highly effective approach for previously stigmatized presentations. DBT is a cognitive behavioral treatment that incorporates dialectics of acceptance and change, behavioral conceptualization, and concrete skills in mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. DBT has been shown to be highly effective in reducing symptoms such as suicidal and self-harm behaviors and improving quality of life for adolescents and adults struggling with BPD (Gillespie et al., 2022).

The full adherent treatment model of DBT, called “Comprehensive DBT” consists of four components: weekly skills group (2 to 2.5 hours long, with modules consisting of Mindfulness, Emotion Regulation, Interpersonal Effectiveness, and Distress Tolerance), weekly individual therapy, 24/7 in vivo phone coaching, consultation team (attended by all DBT therapists) (O’Hayer, 2021). However, many patients do not have access to comprehensive DBT programs, and many clinicians are unable to provide every component of the model (Valentine et al., 2020). Thus, many clinics offer standalone DBT skills groups, and many providers offer DBT-informed individual psychotherapy.

Since DBT became the “gold standard” treatment for BPD, self-harm, and suicidal behaviors, numerous studies have emerged regarding the effectiveness of DBT for other disorders as well. Emerging studies have found strong outcomes in using DBT for substance use disorders (Warner & Murphy, 2022), Posttraumatic Stress Disorder and complex trauma (Bohus et al., 2020), and eating disorders (Brown et al., 2020). Researchers have developed cultural adaptations of DBT to more effectively support communities of color and marginalized groups that were not sufficiently represented in earlier DBT studies (Haft et al., 2022). DBT practitioners and critics have examined ways to challenge problematic aspects of DBT interventions and have suggested ways to hold an anti-racist DBT stance, such as ideas presented in the article, “You Didn’t Cause Racism, and You Have to Solve it Anyways”: Antiracist Adaptations to Dialectical Behavior Therapy for White Therapists (Pierson et al., 2022).


Given these multicultural, diagnostic, and practical considerations, flexibility and responsiveness are key in providing effective, individualized DBT. While some DBT trainings often focus on only the fully adherent, BPD-specific application of DBT, this training will teach the core DBT interventions and discuss how to provide DBT flexibly with responsiveness to different presentations and cultural populations. Experiential exercises, case examples, and multimedia will be used to provide applied, practical, clinical learning. The primary focus of this training series is on how to provide DBT in a flexible, responsive, and individualized manner, while maintaining fidelity to DBT core principles and practices.


The focus of Part 5 is on DBT tools used in individual therapy. Participants will learn how to use the DBT Diary Card, Chain Analysis, Solution Analysis, and the Treatment Targets Hierarchy. Participants will practice using DBT tools in an individualized manner that is responsive to clients’ needs.

Learning Objectives

       
    • Participants will identify target behaviors and how to incorporate them on a diary card.
    •  
    • Participants will demonstrate chain analyses.
    •  
    • Participants will illustrate solution analyses.
    •  
    • Participants will distinguish the three levels of treatment targets and how to prioritize them.
    •  
    • Participants will identify therapist therapy-interfering target behaviors.

Course Outline

Module Topic
Section 1

Individual Therapy: Using a Diary Card

  • Tracking target behaviors, daily mood, skills use
  • Help client identify patterns of how behaviors and skills affect mood
  • Use as impetus for chain analysis/identifying skills to incorporate into session
Section 2

Lecture/Practice: Function of Behaviors and Conducting Chain Analysis

  • Functional analysis of “target-behavior”
  • Chain analysis: validating, curious approach rather than punishing
  • Building insight into vulnerability factors, prompting event, emotions/thoughts/behaviors, short-term/long-term consequences
Section 3

Chain Analysis Practice

  • Using a chain for oneself to understand function and consequences of our own behaviors
  • Chain Analysis practice
  • Role-play: Creating a chain analysis
Section 4

Solution Analysis and Practice

  • Solution Analysis and Contextual Use of DBT Skills
  • Completing a Solution Analysis
  • How each core skill address part of chain
  • Breakout Rooms: Create a chain and solution analysis


 

Section 5

The DBT Targets Hierarchy

  • Life-threatening, therapy-interfering, quality-of-life interfering behaviors
  • Therapist-interfering behaviors
  • Using Target Hierarchy for case consultation
  • Running a DBT Case Consultation team
Section 6

Reflection and Wrap-up

  • Next Steps, DBT Group Consultation
  • Resources, ongoing support and DBT Community
  • Answering questions/case-specific needs

Instructor Bio

Dr. Emily Wharton is a Clinical Psychologist providing psychotherapy to individuals and couples in her private practice, and a Clinical Instructor at the Cognitive Behavior Institute, where she teaches courses in Acceptance and Commitment Therapy, Motivational Interviewing, and Dialectical Behavior Therapy. Dr. Wharton has also served in roles of Clinical Assistant Professor (Affiliated) of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, and licensed clinical psychologist in the Palo Alto VA. She has provided supervision and training for VA and Stanford psychiatry residents, medical students, and psychology trainees in ACT, DBT, and MI. Dr. Wharton trained at the PGSP-Stanford PsyD Consortium, San Francisco VA, UCSF, and Palo Alto VA. Dr. Wharton has also served as the Member-At-Large Director for the San Francisco Bay Area Chapter of the Association for Contextual Behavioral Sciences. Dr. Wharton has given lectures and trainings for the Palo Alto VA, Stanford University, and the Association for Contextual and Behavioral Science. Dr. Wharton has published papers and book chapters on ACT for PTSD, ACT for moral injury, mindfulness practices for anxiety disorders, and group trauma-focused CBT for parents of preterm infants.

Course Bibliography

Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., Fydrich, T., Kuehner, C., Resick, P. A., Stiglmayr, C., Schmahl, C., & Priebe, K. (2020). Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial. JAMA Psychiatry, 77(12), 1235–1245.

Brown, T. A., Wisniewski, L., & Anderson, L. K. (2020). Dialectical Behavior Therapy for Eating Disorders: State of the Research and New Directions. Eating Disorders, 28(2), 97–100.

Germer, C. & Neff, K. (2013). The Mindful Self-Compassion training program. In T. Singer & M. Bolz..Compassion: Bridging theory and practice: A multimedia book (pp. 365-396). Leipzig, Germany: Max-Planck Institute.

Gillespie, C., Murphy, M., & Joyce, M. (2022). Dialectical Behavior Therapy for Individuals With Borderline Personality Disorder: A Systematic Review of Outcomes After One Year of Follow-Up. Journal of Personality Disorders, 36(4), 431–454.

Haft, S. L., O’Grady, S. M., Shaller, E. A. L., & Liu, N. H. (2022). Cultural adaptations of dialectical behavior therapy: A systematic review. Journal of Consulting and Clinical Psychology.

Harned, M. S., Korslund, K. E., & Linehan, M. M. (2014). A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy, 55, 7–17.

Harrell, S. P. (2014). Compassionate confrontation and empathic exploration: The integration of race-related narratives in clinical supervision. In Multiculturalism and diversity in clinical supervision: A competency-based approach (pp. 83–110). American Psychological Association.

Lenz, A., Taylor, R., Fleming, M., & Serman, N. (2014). Effectiveness of Dialectical Behavior Therapy for Treating Eating Disorders. Journal of Counseling & Development, 92.

Linehan, M. (2014a). DBT Skills Training Handouts and Worksheets: Second Edition. Guilford Press.

Linehan, M. (2014b). DBT Skills Training Manual, Second Edition. Guilford Publications.

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder (pp. xvii, 558). Guilford Press.

NEA BPD (Director). (2020, June 18). Racism is an extreme invalidating environment.

O’Hayer, C. V. (2021). Building a Life Worth Living During a Pandemic and Beyond: Adaptations of Comprehensive DBT to COVID-19. Cognitive and Behavioral Practice, 28(4), 588–596.

Pierson, A. M., Arunagiri, V., & Bond, D. M. (2022). “You Didn’t Cause Racism, and You Have to Solve it Anyways”: Antiracist Adaptations to Dialectical Behavior Therapy for White Therapists. Cognitive and Behavioral Practice, 29(4), 796–815.

Rathus, J. H., & Miller, A. L. (2014). DBT Skills Manual for Adolescents. Guilford Publications.

Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy adapted for bulimia: A case report. International Journal of Eating Disorders, 30(1), 101–106.

Valentine, S. E., Smith, A. M., & Stewart, K. (2020). Chapter 15—A review of the empirical evidence for DBT skills training as a stand-alone intervention. In J. Bedics (Ed.), The Handbook of Dialectical Behavior Therapy (pp. 325–358). Academic Press.

Warner, N., & Murphy, M. (2022). Dialectical behaviour therapy skills training for individuals with substance use disorder: A systematic review. Drug and Alcohol Review, 41(2), 501–516.

Approvals

Cognitive Behavior Institute, #1771, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 06/30/2022-06/30/2025. Social workers completing this course receive 4 clinical continuing education credits.

Cognitive Behavior Institute, LLC is recognized by the New York State Education Department's State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0098 and the State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0646 and the State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors #MHC-0216.

Cognitive Behavior Institute has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7117. Programs that do not qualify for NBCC credit are clearly identified. Cognitive Behavior Institute is solely responsible for all aspects of the programs.

Cognitive Behavior Institute is approved by the American Psychological Association to sponsor continuing education for psychologists. Cognitive Behavior Institute maintains responsibility for content of this program.

Social workers, marriage and family therapists, and professional counselors in Pennsylvania can receive continuing education from providers approved by the American Psychological Association. Since CBI is approved by the American Psychological Association to sponsor continuing education, licensed social workers, licensed marriage and family therapists, and licensed professional counselors in Pennsylvania will be able to fulfill their continuing education requirements by attending CBI continuing education programs. For professionals outside the state of Pennsylvania, you must confirm with your specific State Board that APA approved CE's are accepted towards your licensure requirements. The Association of Social Work Boards (ASWB) has a process for approving individual programs or providers for continuing education through their Approved Continuing Education (ACE) program. ACE approved providers and individual courses approved by ASWB are not accepted by every state and regulatory board for continuing education credits for social workers. Every US state other than New York accepts ACE approval for social workers in some capacity: New Jersey only accepts individually approved courses for social workers, rather than courses from approved providers. The West Virginia board requires board approval for live courses, but accepts ASWB ACE approval for other courses for social workers. For more information, please see https://www.aswb.org/ace/ace-jurisdiction-map/. Whether or not boards accept ASWB ACE approved continuing education for other professionals such as licensed professional counselors or licensed marriage and family therapists varies by jurisdiction. To determine if a course can be accepted by your licensing board, please review your board’s regulations or contact them. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit.

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