| |  | | | | DBT continued... | | | | | | | | | Skills Training
Skills are taught in a didactic fashion but in addition there is discussion, role-play and homework. Handouts support the patients through the modules of skills, most modules being associated with homework tasks and recording sheets. The patient attends standard Skills Training Groups conducted twice per week, and, in the milieu, all staff members reinforce the use of the skills.
These skills comprise:
 Mindfulness is a concept taken from Zen practice, but not in the field of mental health unique to DBT. Mindfulness is training oneself to be specifically aware of events, feelings, surroundings, etc., in a manner that allows one to shed extraneous issues in a state of awareness rather than relaxation. DBT has, as an underlying concept, concentration on the here and now, ultimately the present moment. Mindfulness is a skill, a way of life and being, which can hopefully assist in the use of all the other skills that are taught.
Distress Tolerance includes skills intended to assist patients to tolerate painful events and emotions when they cannot in any way be changed. Distress Tolerance skills are geared to the acceptance that a state exists and is not readily changeable.
Emotion Regulation attempts to explain to the Borderline patient the place of emotions, to assist her to understand the emotions she experiences, to identify them in a fashion that others can recognise and to understand the function any feeling may have. The module attempts also to deal with vulnerability to negative emotions and encourages the use of other skills and mindfulness as means of decreasing emotional suffering.
Interpersonal Effectiveness teaches skills in dealing with other people. A large number of difficulties are identified and solutions suggested making reasonable relationships, be effective within them and keep them.
There are homework exercises related to most modules of Skills Training. They can be used as examples within Skills Training sessions, or in discussion with the Individual Therapist. Homework is an attempt to assist the patient to go over the same ground repeatedly in a fashion that helps the exercises become nearer to second nature.
Individual Therapy
Individual Therapy provides a singular relationship for the patient, the Therapist becoming an individual to whom she can turn and hopefully grow to trust. Individual Therapy attempts to balance a leader/teacher/therapist role with that of equal friend. The Individual Therapist remains available at moments of crisis when the main role is one of encouragement and assistance to use the skills learned. At the heart of the relationship are a non-judgmental stance, validation, avoiding of invalidation, praise of progress and avoidance of accidentally validating or supporting inappropriate behaviours.
Risk Assessment
Clinical risk is assessed and reviewed at each stage of the patient's contact with the Unit, including risks appropriate to discharge planning. Risk Assessment is part of everyday practice, and review of risks is required at each Ward Round. This more frequent assessment of risk is reflected in the Risk Status System. There are six levels within the Risk Status System each of which is associated with defined restrictions and observation requirements to ensure safe management. At first, the emphasis is on external management of risk by staff, and increasingly thereafter there is greater reliance on the patient's self-management of risks.
Communication
The patient is invited to attend any Meeting at which she is to be discussed:
Weekly Community Meeting attended by all patients and appropriate staff
Weekly Multi-Disciplinary Ward Round. Patients are encouraged to take an active part in the establishment of their Care Plan with the assistance of their Individual Therapist and Named Nurse
Clinical Review / s117 Meetings held at four monthly intervals thereafter are used for discharge planning under the Care Programme Approach (CPA). Reports are prepared as appropriate by the various disciplines and the Key Worker/DBT Individual Therapist, in which current progress and future recommendations are recorded. Prior to the Section 117 Meeting the patient's Care Plan and Risk Assessment will be reviewed
There is an expectation that the Clinical Team from the patient's home area is represented at each Clinical Review / s117 Meeting. Family members (with the consent of the patient) are also invited to attend.
Team
Consultant Psychiatrist
Consultant Psychologist
Senior Ward Sister
Head Occupational Therapist
Principal Social Worker
Nursing Staff
Occupational Therapy Staff
Further information
For enquiries or referral information, please contact Dr David Nevison-Andrews, Consultant Psychiatrist, on 01604 616502. Alternatively, contact the Admissions Officer on 01604 616601
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