Individual therapy begins with a comprehensive assessment of the client to identify problems, strengths, history and former treatment. Treatment goals are collaboratively established. We use diary cards to track one’s emotions, problem behaviors, behaviors one wants to develop (e.g. conflict resolution, assertiveness), the skills the person has been using and if they are working. When a problem behavior shows up, we conduct an analysis to identify what is influencing that behavior to occur and what skills and strategies one might use to avoid the problem behavior. Consequently, in future situations one can more easily identify when they are heading toward problem behaviors and how to avoid them.
Welcome to The DBT Clinic
Life can be messy and feel overwhelming, and sometimes we can feel ill-equipped to handle it effectively. We might find ourselves having a difficult time controlling our emotions and reacting in ways that we later regret. Perhaps we blow up at others, pushing those closest to us away; or we might turn on ourselves with self-criticism, self-harming behaviors and/or thoughts of death. We can find ourselves trapped in troubled relationships, or stuck in worry and despair.
Sound familiar? If you, or a loved one, can relate to this, then you have come to the right place. Dialectical Behavior Therapy (DBT) may be helpful for you!
Hours of Operations
The DBT Clinic in close-in Portland, OR provides full fidelity DBT services, including individual and group therapy from our highly trained staff. Our office is generally open Monday through Friday 9am – 6pm. We do not accept walk-ins.
Telehealth visits are available. Schedules are determined by individual providers.
Staff
We have a wide range of therapists to serve our community. Each of our providers are highly trained in DBT, as well as other modalities unique to their interests. Our providers are encouraged to use a range of therapeutic modalities that best fit the client’s needs. Our staff is led by clinic founder and owner Larry Smith, LPC with 30 years of experience.
Dialectical Behavior Therapy (DBT) is a type of psychotherapy that increases peoples’ ability to live life well.
DBT was developed by Marsha Linnehan, PhD, who wanted to develop a treatment for Borderline Personality Disorder (BPD). DBT is very effective, not only for BPD, but for a wide variety of problems, including depression, eating disorders, substance abuse and “multi-diagnostic, difficult-to-treat” patients.
Research studies comparing DBT to standard cognitive behavioral therapy (CBT) or to psychodynamic therapy have shown DBT to be more effective. Clients get better faster and retain gains made. Follow-up measures of symptoms conducted at 6, 12 and 18 months post treatment show clients become even more effective/less symptomatic after discharge. It doesn’t matter the diagnosis, or even if there is no diagnosis. If one has a model of strategies and skills to deal effectively with the inevitable stress that is part and parcel to the human experience, one is better equipped to manage life more effectively and learn to create “a life worth living”.
The component parts of DBT
Individual Therapy
Skills Group
Phone Coaching
Therapist Consultation
Individual Therapy
Skills Group
Skills group is the manner in which various skills and strategies are taught.
- Core Mindfulness is a set of ancient skills that help increase awareness, support living in the moment without judgement, to participate fully in the moments of our lives and to respond to situations in service of long-term goals.
- Distress Tolerance provides tools to use when one is feeling impulsive or reactive. When we are overwhelmed with intense, usually negative, emotions, we may react in ways that provide some modicum of relief in the short term, but create more problems long term. It’s not very useful to just say “stop that!” unless alternatives are provided. Distress tolerance provides alternative responses that don’t have longer-term problems.
- Emotion Regulation. In the DBT model, the heart of the problem, the thing that drives us to react ineffectively, is “emotions run amok”. In other words, our emotions get the better of us. They overwhelm our effective coping skills If we can learn to regulate our emotional world more effectively, we don’t get so easily overwhelmed and are thus less reactive or impulsive. The need for Distress Tolerance diminishes.
- Interpersonal Effectiveness. Many emotional problems occur in the context of our relationships with others. This module teaches skills in getting your needs met in relationships with others. One learns skills to set limits, ask for change from others, express one’s opinions in a manner others take seriously, resolve conflict and stand up for one’s legitimate rights. Further one learns skills to see others’ point of view, validate their perspective and attempt to find solutions that are “win-win”, where both parties feel their concerns are addressed. Finally, all this is done with another skill set that supports mastery and self-respect.
Phone Coaching
Especially early in DBT treatment, clients don’t have the skills needed to avoid the problem behaviors in which they engage. It takes time to learn and become proficient at all the skills and strategies that are offered in DBT, and part of the therapy includes providing phone coaching as needed. When one is having difficulty, they can call their therapist to get advice on skills-use in that situation.
In the event of a crisis, defined and suicidal thoughts or impulses one is having difficulty managing or, when one is at risk for engaging in tissue-damaging self-harm (e.g. cutting, burning self), they can call their individual DBT therapist 24/7. The therapist will evaluate for risk and the possible need to hospitalization and will provide crisis coaching to help the client deal with the crisis effectively. If one can’t stay safe, hospitalization is imperative. However, to develop a life worth living, we need to develop the ability to deal with difficulties effectively and become less reliant on, or not need at all, psychiatric hospitalizations to stay safe.
Therapist Consultation
Therapist consultation is an essential element in DBT therapy. The therapist is meeting weekly with other DBT therapists to discuss cases and get support for doing this kind of work. We call it “therapy for the therapist.”.
Sometimes, in this model of therapy, the therapist might get rewarded by clients for veering away from the model of treatment and punished for adhering to it. Weekly consultation helps us stay faithful to the treatment model and provides us the support needed to work with a “higher risk” population.
Research on this part of the therapy shows that client drop out rates become much higher when the therapist is not attending a consultation group.
Get started with The DBT Clinic by filling out our Contact form.
The Process
After filling out the form, we will contact you to schedule an intake appointment where you will meet with one of our clinicians to discuss your symptoms. This clinician will assess your needs in therapy, answer any questions you may have, and discuss their clinical recommendations based on your presented needs.
Insurance
If you intend to use insurance, please bring your insurance card, so we can get a copy of it. Among the staff members here, we try to panel with most of the major insurance companies in this area such as:
- AETNA
- First Choice
- HealthShare/OHP
- Kaiser
- MODA
- Pacific Source
- Providence
- Cash/Out-of-Pocket
Individual staff members are paneled with specific companies from this list. Please inquire about your therapist’s insurance pairings.
We also ask that you know the details of your individual insurance plan (plans can vary widely). You can find out the details of your plan by calling your insurance company (the number is usually printed on the back of your insurance card). By doing this before your session, you can find out specifics of your outpatient mental health benefits. Please know the following information:
- Your co-pay or co-insurance.
- If you have a deductible, and the amount remaining.
- If your clinician is in network with your particular plan. If not, find out the details of your out-of-network benefits, if any.