Intensive Outpatient Programs

Adult Intensive Outpatient Program

The DBT Center offers an Intensive Outpatient Program (IOP) consisting of nine hours of therapy per week. Our programs are seven hours of skills training and two hours of individual therapy.  Regular weekly DBT sessions are recommended (based on the research on DBT effectivenss) for one year.  Often regular weekly DBT sessions with a skills group are indicated rather than the IOP.

Referrals

Appropriate referrals include individuals with a diagnosis of Borderline Personality Disorder or features of Borderline Personality Disorder, Post Traumatic Stress Disorder, and mood disorders that seriously impair the individual’s functioning, such as Major Depression, Generalized Anxiety Disorder or Bipolar Disorder. We also work with treatment resistance depression. Ages 16 and up will be considered.

The program is a voluntary program and will not accept patients who, after the initial evaluation, do not make a commitment to the program. Referrals can be made at any time.

Medication evaluation or follow up is not included in the program. Psychiatrists typically follow the patients they refer or a referral is made to a psychiatrist for psychiatric evaluation.

For additonal information please call the DBT Center at 713-973-2800.

 Initial Evaluation/ Pretreatment

The initial evaluation will consist of  a structured history. The first few sessions will focus on identifying goals and agreeing on commitment to the program. Testing will be completed if necessary and as discussed with the patient.

Five Functions of Comprehensive Treatment

Pathways to Healthy Living is committed to the five functions of comprehensive treatment as developed by Marsha Linehan, Ph.D. The five functions are: To enhance the capabilities of the patients, improve the motivation of the patient, to assure generalization from the treatment program to the patient’s environment, to structure the patient’s environment to help with recovery, and to motivate the therapists working with the patient to use effective treatment strategies. These functions are addressed by our program in the following ways, outlined originally by Dr. Linehan:

Enhance Patients’ Capabilities to Recover
Skills Training
Psychoeducation
Handouts Readings
Pharmacotherapy

Improve Patients’ Motivation to Recover
Contingent Reinforcement
Extinction
Exposure/response prevention
Cognitive modification

Assure Generalization to the Patients’ Natural Environments
After hours/crisis phone coaching
E-mail consultation
Homework/practice

Enhance Therapist Capabilities and Motivation to Treat Effectively
Supervision when indicated
DBT Consultation Team
Continuing Education
Treatment manuals

Structure the Patients’ Environment

Contingency management within the treatment program as a whole
Contingency management within the community (family, marital interventions) when possible

Treatment Components

Individual DBT
Skills Coaching
Skills Groups

Consultation Team for Therapists

Description of Groups

In the Intensive Outpatient Program, the Skills Training Groups are offered seven hours each week to help participants learn how to manage a crisis without making it worse and how to manage their emotions so they do not feel overwhelmed by them. The following areas are covered: Mindfulness, Interpersonal Effectiveness, Distress Tolerance, Goal Setting, Chain Analysis, and Emotion Regulation.

Mindfulness Group

Mindfulness is at the core of all the skills learned and therefore is given a strong emphasis in the program. In this group clients learn what mindfulness is, the ways in which many people are not mindful and do not see or accept the world as it is, and ways to being to see reality in a more accurate way. Many Cognitive Behavior Therapy techniques will be discussed here as ways to not cognitively distort what you experience. Mindfulness will address grounding techniques, living in the present, and learning self validation as well.

Interpersonal Effectiveness Group

Often much of the stress for patients comes from relationships with other people or the lack of relationships with others. In this group, issues important to being effective interpersonally will be explored and discussed. Resolving conflicts, setting relationship priorities, learning to say no, learning to ask for what you need, and learning to maintain relationships will be included in the topics.

Distress Tolerance

Skills taught in this group are about getting through a crisis without making it worse. Comforting yourself, tolerating difficult emotions and managing urges are discussed.

Emotion Regulation

Learning to manage intense emotions is challenging. This group teaches skills that enable people to not be controlled by their emotions.

Individual Sessions

Clients meet with their individual therapist twice weekly. In these sessions, clients  learn about the Biosocial Theory, address any self harm urges, therapy interfering behavior, and quality of life interfering behavior. Diary cards are reviewed and areas of concern addressed. In individual sessions clients have the opportunity to apply the skills they learned in group to their unique situations and learn and apply problem solving options (skills, behavior analysis, insight or pattern highlighting, solution analysis, cognitive modification, contingency management, exposure therapy or opposite action) to help improve their ability to manage life stresses.

Skills Coaching

Skills Coaching is provided by the individual therapist to help clients think about and use their skills.

Program Length

The anticipated length of treatment in the IOP is 8 to 12 weeks however it will be based on the needs of the individual.

Generalization of Skills

Phone and/or email contact between sessions will be made available to the patient and discussed between the patient and the individual therapist. The goal of the phone contact is to help the patient apply the coping skills being learned outside of the therapy sessions. This interaction is handled according to the guidelines set forth by Linehan (1993) in order to focus on increasing independent, not dependent, functioning on the part of the patient.

Homework (practicing the skill being learned) will be emphasized. Homework diary cards will be collected each week. Homework will be reviewed by both the group and the individual therapist. Practice of the skills being learned is believed to be a major criterion of who benefits from the program and is thus emphasized repeatedly.

Handouts concerning all the skills will be given during the group sessions and a patient handbook concerning the DBT skills will be given to each patient.

Aftercare
Aftercare is a transition to once weekly psychotherapy, with a skills group for a minimum of six months.  Part of the program includes encouraging the client to develop more social support in the community.