Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression
Dialectical Behavior Therapy (DBT) has been applied not only for adults with personality disorders, but has more recently also been modified for the treatment of adolescents, couples, or people dealing with eating disorders or substance use issues. DBT has also been used to help family members of people with personality disorders and other mental illnesses. Dr. Elizabeth Wade, the clinical psychologist I mentioned in last week’s blog, facilitates a DBT group for family members and concerned significant others of patients who may be people who are suffering from a personality disorder, or bipolar disorders, depression, anxiety, substance use, and eating disorders. “The DBT family group is not confined to only family members of those with personality disorders, but is open to families and significant others of clients with a variety of different issues, “ says Dr. Wade.
Family DBT is set up similar to a regular DBT skills training group and covers interpersonal effectiveness skills, emotions regulation skills, and distress tolerance skills. This means that the family members learn the same skills as their loved one who is attending DBT groups.
The basis of all these skills is mindfulness, the idea that it is important to raise one’s awareness of one’s own thoughts, feelings, and behaviors and how they play out with their family member who is in treatment. Mindfulness practice can be helpful for dealing with the concerned family member’s own emotions, since anxiety, anger, or regret can build up in families and impact people’s ability to participate in a satisfying life.
The group meets once a week for an hour and fifteen minutes. It is an ongoing group, which means that new members can join at any time. A lot of family members like to go through multiple rounds of learning the skills. It takes about 6 months to complete a full round of skills, though family members are welcome to stay longer. Group participants practice their skills in the group and are assigned a small amount of homework, which they bring back to the group for fine-tuning and trouble-shooting, much like a workshop.
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Participants in the DBT family group reinforce each other in using effective behaviors, and the group can include as many members of one family as possible, since they can all affect the family system. The family member’s participation is often valued by the person in treatment as a sign that the family cares, a sign that they are interested and working towards supporting their recovery.
Over the course of the group sessions, family members share their experiences and support each other, giving suggestions and offering up resources. It can be helpful for family members to see how other people are dealing with similar issues. Often, there is a lot of shame in the family, so that frequently is a liberating experience to get a sense that one is not the only family dealing with these problems.
The family members of the patient don’t necessarily have to be in treatment themselves, but it certainly can be helpful if they are. What is important for the participation in the group is that the patient is in treatment, and that the family member is willing to listen to others and to participate in the group by speaking about their personal experiences as they relate to the skills. In the course of the group, participants learn some skills for effective communication and some crisis management skills, and they also are encouraged to learn how to take care of their own emotional needs. Often, the group provides a sense of relief that while another family member is going through difficulties, there is something that a concerned other can do, and that it is acceptable, even important, to take care of one’s own needs and concerns in order to be able to support a loved one.
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