DBT IOP clients use individual therapy sessions to apply the skills learned in group to the individual’s life challenges. While participating in the DBT IOP program, clients are expected to work with a DBT IOP therapist at least once a week. With the client’s permission, we will provide treatment updates to outpatient clinicians and collaborate on discharge planning. We can also assist clients in selecting a DBT therapist to work with after discharge.
Individual DBT therapy follows a hierarchical approach to problems; this may feel different than types of therapy that encourage clients to speak about ‘whatever is on your mind’. Session time, in DBT, is used to address problems in the following order:
- Tier 1: Life-threatening problems such as suicide ideation, life-threatening behaviors, etc. Also, self-injurious behavior.
- Tier 2: Therapy-interfering behaviors on the client’s part or the client’s therapist’s part, including urges to quit therapy, willfulness about completing homework assignments, missing sessions, not feeling understood by the therapist, etc.
- Tier 3: Quality of life-interfering behaviors or conditions, like mood disorders, substance abuse, eating disorders, anxiety disorders, serious interpersonal conflict, etc.
- Tier 4: Increasing behavioral skills.
- Tier 5: Creating a life worth living.
The hierarchy serves to guide treatment, prioritize the most pressing problems, and ensure that one problem is focused on long enough to make progress (versus discussing a different crisis each session). Thus, the therapist may conclude that discussing a recent episode of self-injury, for example, is a more pressing use of therapy time than discussing a fight with a significant other, even though the latter may be more distressing to the client.