Skills Training Groups - How do they work?
What does a skills training group look like?
A skills training group has a strong structure. The group runs for approximately 2 to 2/12 hours (depending on the group), and is divided into two halves. There is usually a 10-15 minute break in between each part. The first part of the group involves settling in. Most groups will begin by presenting a mindfulness or opening activity to help you transition into a frame of mind ready for group. Sometimes this might be a more meditative exercise, such as breathing. Other times, it might be an activity that promotes a positive experience or positive thought process, like writing an affirmation or an appreciation.
After the opening activity, many groups will review diary cards. This portion of the group is where you have a chance to talk about what has been going on in your life. In the groups I run, I tend to ask general questions or make comments such as, "It looks like this was a hard week for you." By doing this, I allow my participants to choose how much they want to talk about or disclose in group. We also look for patterns of distress, ineffective coping, and what skills you tried. Usually, I ask what worked best and what didn't work so well. If there is something I'd like to speak to you privately about, I will ask to check in with you during the break.
Once diary card review is finished, groups move to discussing and troubleshooting the homework assignments. One reason for doing this out loud is that it provides each group member the chance to get input from all the other members and from the leaders. This process can be incredibly validating and supportive. Another reason is that group members get to share what worked, and can inspire each other. Homework review also invovles some troubleshooting, to help you maximize your chances of being effective when practicing the skills you're learning.
After the break, the new skill or concept is taught. Usually the leaders will present the new material, and encourage you to participate in discussions or group activities related to practicing this skill. Once the new material has been presented, homework is assigned. At this point, some groups will engage in a wind-down activity, while others will have an informal, less formal ending to the session. At the end of each session in my groups, I let each member know that I appreciate their willingness to be there.
Are there any requirements for DBT?
When you join a DBT group, you’ll be asked to adhere to group guidelines. Additionally, some groups require that you sign a contract committing to attending each session and to paying for every session whether or not you attend.
General “Rules” (Guidelines) for DBT Groups: (Note: These guidelines are taken from "DBT Skills Training Handouts and Worksheets, 2nd Ed." by Marsha Linehan, 2015, Guilford Publishing. I have added explanations for why these guidelines are important.)
1. Participants who drop out of skills training are not out of skills training. The only way out is to miss four scheduled sessions of skills training in a row. The reason for this rule is that if you miss 4 sessions in a row of skills training, you've missed a large chunk of the module or cycle. You simply won’t get the information you need. Some groups will have you commit to paying for any missed sessions, or to paying for the full module whether or not you attend. Linehan's new edition states that if you drop out of therapy you are NOT out of DBT. This is a new twist, and means that even if you drop out of DBT, you can come back. You might need to wait for the beginning of the next module or cycle, but you are able to rejoin and recommit to the group.
2. Participants who join the skills training group support each other and:
In my groups, I ask participants to call me or their individual therapist for help if they are in crisis. Calls to other group members can be triggering, and create pressure to fix things in the person you call. Your skills training group leaders and your individual therapist are trained to handle crises and to coach you in using skills.
If you call someone for help when you’re feeling in crisis (regardless of who it is), you must be willing to accept the help from the person you called. If you are in an emergency situation, call 911 for assistance, or go to the nearest emergency room. If your situation is a crisis, but not a life-threatening emergency, call your therapist. I can’t emphasize this one enough. Following this rule is critical, on several levels. First, if you need immediate help, GO. Second, if you call someone for help, please don’t do a “yes, but…” At least be willing to seriously try their suggestions and work with them. We want to help, and we can’t help you if you shoot us down. Third, this will give you opportunities to practice your skills in real life, when you need them, with support.
3. Participants who join the skills training group call ahead of time if they are going to be late or miss a session. This is common courtesy. It's also a guideline because (believe it or not), your skills group leaders and the other participants worry about you. You may not realize it or believe it, but your absence really does affect how the group runs – and if members simply stop showing up and don’t call, no one feels that the group is serious, and may affect their willingness to show up.
4. Participants do not tempt others to engage in problem behaviors and:
5. Participants do not form confidential relationships with each other outside of skills
training sessions and:
Also, If there is an existing partnership or intimate relationship, bringing that relationship into the group risks seting up an “us/them” dynamic that is disruptive to the safety of the group.
Other guidelines for this group/notes: There are some additional guidelines that I ask members of my groups to hold:
6. You have to be in ongoing individual therapy, and your skills trainer must have a release of information to talk with your therapist. Basically, this is so we can coordinate with each other and make sure you’re getting the best treatment possible. You will need the support of your individual therapist, to help you practice and integrate the material you are learning in group into your life. Your individual therapist is also the first person you will call in a crisis, depending on their guidelines.
7. You must be willing to do and must actually do the diary card and homework every week. The diary card is a very valuable tool for many reasons. One big reason is that it allows the group facilitators to see what happened during your week in a quick, efficient way. Another valuable aspect is that it gets you to face up to patterns in your life that you might have been avoiding or that you may want to work on changing. It also allows you to see how outside influences and impulsive actions (especially self-harming or addictive behaviors) affect your emotional well-being and outlook on life. Finally, it allows you to see progress over time. As you learn and use the skills, ideally you’ll see improvement in the way you interact with your world, and a result, see improvement in the way you feel. The homework gives you the opportunity to practice the skills in your everyday life - where you need them!
A skills training group has a strong structure. The group runs for approximately 2 to 2/12 hours (depending on the group), and is divided into two halves. There is usually a 10-15 minute break in between each part. The first part of the group involves settling in. Most groups will begin by presenting a mindfulness or opening activity to help you transition into a frame of mind ready for group. Sometimes this might be a more meditative exercise, such as breathing. Other times, it might be an activity that promotes a positive experience or positive thought process, like writing an affirmation or an appreciation.
After the opening activity, many groups will review diary cards. This portion of the group is where you have a chance to talk about what has been going on in your life. In the groups I run, I tend to ask general questions or make comments such as, "It looks like this was a hard week for you." By doing this, I allow my participants to choose how much they want to talk about or disclose in group. We also look for patterns of distress, ineffective coping, and what skills you tried. Usually, I ask what worked best and what didn't work so well. If there is something I'd like to speak to you privately about, I will ask to check in with you during the break.
Once diary card review is finished, groups move to discussing and troubleshooting the homework assignments. One reason for doing this out loud is that it provides each group member the chance to get input from all the other members and from the leaders. This process can be incredibly validating and supportive. Another reason is that group members get to share what worked, and can inspire each other. Homework review also invovles some troubleshooting, to help you maximize your chances of being effective when practicing the skills you're learning.
After the break, the new skill or concept is taught. Usually the leaders will present the new material, and encourage you to participate in discussions or group activities related to practicing this skill. Once the new material has been presented, homework is assigned. At this point, some groups will engage in a wind-down activity, while others will have an informal, less formal ending to the session. At the end of each session in my groups, I let each member know that I appreciate their willingness to be there.
Are there any requirements for DBT?
When you join a DBT group, you’ll be asked to adhere to group guidelines. Additionally, some groups require that you sign a contract committing to attending each session and to paying for every session whether or not you attend.
General “Rules” (Guidelines) for DBT Groups: (Note: These guidelines are taken from "DBT Skills Training Handouts and Worksheets, 2nd Ed." by Marsha Linehan, 2015, Guilford Publishing. I have added explanations for why these guidelines are important.)
1. Participants who drop out of skills training are not out of skills training. The only way out is to miss four scheduled sessions of skills training in a row. The reason for this rule is that if you miss 4 sessions in a row of skills training, you've missed a large chunk of the module or cycle. You simply won’t get the information you need. Some groups will have you commit to paying for any missed sessions, or to paying for the full module whether or not you attend. Linehan's new edition states that if you drop out of therapy you are NOT out of DBT. This is a new twist, and means that even if you drop out of DBT, you can come back. You might need to wait for the beginning of the next module or cycle, but you are able to rejoin and recommit to the group.
2. Participants who join the skills training group support each other and:
- Keep names of other participants and information obtained during sessions confidential. What goes on in session, stays in session. You can talk about topics we covered and discussions we had, but you can't mention other people by name, or mention any characteristics that could identify a person in your group.
- Come to each group session on time and stay until the end.
- Make every effort to practice skills between sessions.
- Validate each other, avoid judging each other, and assume the best about each other.
- Give helpful, noncritical feedback when asked.
- Are willing to accept help from a person they ask or call for help.
In my groups, I ask participants to call me or their individual therapist for help if they are in crisis. Calls to other group members can be triggering, and create pressure to fix things in the person you call. Your skills training group leaders and your individual therapist are trained to handle crises and to coach you in using skills.
If you call someone for help when you’re feeling in crisis (regardless of who it is), you must be willing to accept the help from the person you called. If you are in an emergency situation, call 911 for assistance, or go to the nearest emergency room. If your situation is a crisis, but not a life-threatening emergency, call your therapist. I can’t emphasize this one enough. Following this rule is critical, on several levels. First, if you need immediate help, GO. Second, if you call someone for help, please don’t do a “yes, but…” At least be willing to seriously try their suggestions and work with them. We want to help, and we can’t help you if you shoot us down. Third, this will give you opportunities to practice your skills in real life, when you need them, with support.
3. Participants who join the skills training group call ahead of time if they are going to be late or miss a session. This is common courtesy. It's also a guideline because (believe it or not), your skills group leaders and the other participants worry about you. You may not realize it or believe it, but your absence really does affect how the group runs – and if members simply stop showing up and don’t call, no one feels that the group is serious, and may affect their willingness to show up.
4. Participants do not tempt others to engage in problem behaviors and:
- Do not come to sessions under the influence of drugs or alcohol.
- If drugs or alcohol have already been used, come to sessions acting and appearing clean and sober. If you come under the influence, 1) You won’t get much (if anything) from the session if you’re drunk, stoned, or high. 2) It’s very disruptive to the group as well – being in this state gets in the way of their learning.
- Do not discuss, inside or outside sessions, current or past problem behaviors that could be contagious to others. This one is really important. Every now and then these issues will come up inside group – this is ok, because the facilitators are there to help everyone deal with their reactions to it. Outside of group, you may feel triggered and not know what to do, so we ask people not to discuss these issues outside of the group. We generally ask that if you need to discuss these behaviors that you not go into detail so that the risk of triggering other people is minimized. You are not to discuss details of parasuicidal or self-harming behaviors within the group, but may discuss them with your skills training group leaders in private. This guideline is also in place to maintain safety in the group.
5. Participants do not form confidential relationships with each other outside of skills
training sessions and:
- Do not start a sexual relationship or a private relationship that cannot be discussed in group.
- Are not partners in risky behaviors, crime, or drug use.
Also, If there is an existing partnership or intimate relationship, bringing that relationship into the group risks seting up an “us/them” dynamic that is disruptive to the safety of the group.
Other guidelines for this group/notes: There are some additional guidelines that I ask members of my groups to hold:
6. You have to be in ongoing individual therapy, and your skills trainer must have a release of information to talk with your therapist. Basically, this is so we can coordinate with each other and make sure you’re getting the best treatment possible. You will need the support of your individual therapist, to help you practice and integrate the material you are learning in group into your life. Your individual therapist is also the first person you will call in a crisis, depending on their guidelines.
7. You must be willing to do and must actually do the diary card and homework every week. The diary card is a very valuable tool for many reasons. One big reason is that it allows the group facilitators to see what happened during your week in a quick, efficient way. Another valuable aspect is that it gets you to face up to patterns in your life that you might have been avoiding or that you may want to work on changing. It also allows you to see how outside influences and impulsive actions (especially self-harming or addictive behaviors) affect your emotional well-being and outlook on life. Finally, it allows you to see progress over time. As you learn and use the skills, ideally you’ll see improvement in the way you interact with your world, and a result, see improvement in the way you feel. The homework gives you the opportunity to practice the skills in your everyday life - where you need them!