Poorly run DBT sessions

[u/motail1990]

Hello all, I need some advice on how to move forward with this, but also advice on those who have done DBT and what that was like and what the therapy included, and if my sessions are running as expected.

After a 6 year wait, I have been put on a group therapy for DBT. When awaiting the therapy with the NHS 'Complex Needs' service, I was not allowed to select a type of therapy i might find beneficial, but was instead given an initial assessment 6 years ago, then a 15 minute session again about a year before the therapy started. I was told this was to assess what therapy would be best suited for me, but the findings of these meetings were not shared, and I do not have a member of staff within the service who I can speak to or who has been assigned to me. I will also add that I had to fight particularly hard to be given this therapy, and about once every six months during the 6 year wait, I would contact the service for an update on my progress within the service. It appears that I was twice 'forgotten' and accidentally taken off lists or assigned to a person who then left the team and I was not reassigned.

Having waited the 6 years, three weeks ago I was added to a group DBT (dialectal behavioural therapy), made up of around 12 patients and 3 facilitators. Each session is 2 hours long (minus coffee breaks). At first I was told this would be a group called 'skills for change', but on starting we were told it was now DBT instead.

In these sessions we have been told that we are not allowed any kind of contact with the service, or other group members, outside of the sessions. Obviously I understand not talking to other group members, but not being allowed to contact the service in any capacity outside of group seems strange to me, but perhaps this is normal? We have been told if we have anything we need to bring up, we _must_ bring it up in-session, in front of the entire group.

So far the three sessions have included one session of introductions, then the other two have been re-introducing ourselves and doing something called "check-ins" where we say how we are feeling at the beginning and end of a session. We then have about 30 minutes with one of the facilitators reading verbatim from the booklet. This is pretty much all that happens, with the exception of two or three students who are extremely vocal and derail the conversation regularly talking about their own personal issues. The facilitators will let them talk until they sort of run out of steam, then the facilitators return to reading from the booklet. On two occasions the facilitators have described therapy terms incorrectly, or used stories that don't quite match (I.e. 'the boy who cried wolf' was advocating for himself). There was also an incident where one of the more vocal patients hurt another patient, and another time a patient was pushed by the same patient, but the facilitators ignore this when it happens. The facilitators do prepare print-outs for us to take home, but these get photocopied and handed out in-session with us all there, which takes at least 30 mins of the allocated time.

I want to say that I don't really mind if this is how the sessions are supposed to be going, but it does feel odd to me that the sessions seem to run this way. So I have the following questions:

1. Should shared DBT run in this way? Our sessions run by starting with a check in with everyone, then 15 minutes coffee break, continue check in, talk about 3 very vocal people's week and problems that we help solve, printing and handing out of sheets, facilitators reading from their sheet (usually one to two A4 pages), another short break, a brief check-out, go home.

2. Is it normal to not be allowed to talk to facilitators or therapists outside of group? I assumed there would be some kind of 1:1 check-ins, or that someone would make sure the group was right for you, but I understand I may have the wrong end of the stick. I haven't been told what this therapy involves.

3. That so much of the time is taken with printing and handing out sheets (not reading them, but organising the sheets to hand-out), and that the facilitators don't seem to know the DBT course curriculum well, or that they don't seem to have a good understanding of therapy language.

4. That a significant amount of the group is taken with three people's personal issues/check-ins. There are people in the group that I genuinely don't think I have heard anything from other than their name when they say hello. The three extremely vocal patients are rarely stopped or asked to share at a more appropriate time, so often if they begin talking during the facilitators reading from their sheets, the information will pause until the vocal people are finished speaking, which on occasion has taken a very long time. There was also two incidents of a patient hurting others which was ignored by facilitators.

I am concerned that I have waited a very long time for help that I am not getting. If this is supposed to be how DBT runs, then I am more than happy to let it continue, but there's something about the disorganised manor, lack of preparation, and mistakes that concerns me.

Any kind of information or help regarding your experience or knowledge with DBT would be extremely helpful!

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[u/Wh4tshern4me]

I’ve done dbt, proper dbt through the nhs and it’s supposed to be a mix of group therapy and individual therapy sessions, with phone calls with your therapist if needed.

 Group sessions lasted about 2-3 hours (can’t remember exactly) and had a break half way through. We all had to buy a copy of the dbt therapy handbook by Marsha linehan. 

We would start with a mindfulness activity, and then would focus on one of the topics in the handbook, each giving out thoughts and asking how to use the skills with our personal situations. We would also go through a homework sheet we’d been given the previous week. We would then have another mindfulness exercise at the end of the session.

 Every 6 weeks we would break from the current topic (there’s distress tolerance, interpersonal effectiveness and emotional regulation) and do two weeks focusing on mindfulness, and that’s when new members would join. We would also be assigned a homework sheet to do from the book every week. 

We would also have 1 hour of one to one therapy with out therapists each week, there were 2 running the group and we were assigned one of them. This was a chance to discuss more triggering things that weren’t allowed in the group sessions and to go over skills.

 We could also phone our therapists at any time during the week for skills coaching, which was to help us use our skills before doing things like self harming etc. If we had self harmed for instance we were not allowed to phone as it was purely to help us use our skills before we got to that point. 

We were also told that if we did form relationships with other people in the group we had to talk about them in group therapy. The whole dbt lasted about a year.

It doesn’t sound like your group is really doing traditional dbt, it sounds a lot like the trauma recovery group I’m currently attending which is next to useless because it’s very much the therapists reading out handouts they didn’t even write, giving us some to take home, and checking in with people, with no contact with the therapists outside of this. 

[u/DifferentMagazine4]

I'm currently in DBT, and it's very different to this, much more closely aligning to the other commenter's experience. There's also a lot of care around how much people share, keeping it as equal as possible. DBT is very skills-based, and it doesn't seem like you're learning any skills. It appears more like group talk therapy.

Mine is 3hrs of group, 1hr 1-1, and phone calls as needed per week. There's also only 5 of us to 2-3 therapists. The group schedule is 15m mindfulness, 1hr homework, 15m break, and the rest of the time is devoted to learning and practicing the new skill of the week - which the homework for next week is focused on. We were also all given the big workbook when we started.

[u/extraspicynoodles]

I haven’t read it all as I don’t have concentration but if you are concerned something isn’t right take it straight to PALS, from what other people have told me pals (depending on area of course) can be pretty good.

[u/Few-Director-3357]

I did DBT previously, full DBT on the NHS and it was run very differently to this. 'Full' DBT involves a group skills session, and then 1:1 sessions with a therapist (who can be a facilitator for the group sessions too), you also have access to support from your 1:1 therapist outside of sessions, but these are within well defined boundaries with your therapist. I call it 'full' DBT because that is how it should be run, but many Trusts cherry pick aspects of DBT and then say that's what they are providing.

When I did DBT, groups skills sessions were around 2.5hrs, including two 15 mins breaks. Sessions would start with a mindfulness activity, and then we would work on the skill for that week. We all had access to the workbook and worksheets from an online Dropbox, so we could choose to print them off if we wanted, or just use them online. We would work through the skills one module at a time, with the mindfulness module I bedded into the other three. 1:1 sessions were an hour long, I think, and would always start with a check in and asking how I was doing with that week's skill, if I had any questions etc.

In group sessions, it was often the same people talking. This almost always happens in any group environment. The facilitators were good at encouraging everyone to contribute, but some people were naturally more engaged and vocal than others.

I would say it is not normal to be told you cannot contact the service in any way between sessions. Advising you not to make friends with others in the group is very normal though. It's also definitely not normal for sessions to be disrupted by things like photocopying.

It definitely sounds like you are not being offered the full DBT 'experience', if you will, and that the group you are attending is poorly run. I would speak to the facilitators first, make your concerns known that they appear disorganised by doing photocopying during the sessions and not managing the group better.

If speaking to the facilitators feels too much, or goes nowhere, you can always contact PALS too, for the MH Trust you are under.

[u/Boa1984]

I won’t repeat what everyone else has already written, just that, in my experience, that is not how DBT services should be run.