a non-profit, comprehensive,
community mental health service

Vol. 3, No. 1
January 2012

MFS CHRONICLE

Dialectical Behavioral Therapy (DBT) Training Provided to MFS Employees

This month, Carla Kirsh– a longtime member of the clinical staff at 93rd St and the DBT Team – led Dialectical Behavior Therapy (DBT) training for 35 MFS employees including therapists, case managers, and residential staff for adults and children.  So far, participants have spent three full work days training in the use of DBT.  Two more days of training for more advanced understanding of the approach are scheduled this spring for those intending to joint the DBT team.

DBT is an evidence-based treatment for borderline personality disorder.  It has also benefited individuals with other diagnoses that have severe emotional components in community mental health settings, especially in state-supported services.  Each individual who undergoes DBT works individually with a therapist and in skills training groups for approximately one year in the Adult program and 6 weeks in the Adolescent program.  A major component of DBT is the establishment of the therapist-client alliance, which provides the stability the client needs to engage in treatment when the client is facing the need to make major changes in how they respond to stressors.  This alliance is achieved through radical acceptance and mindfulness, which draws from the Zen philosophical tradition.  Clients are encouraged to accept and validate their emotions, that they are doing the best they can, and need to learn new behaviors to counteract their past experiences in deeply invalidating environments.  At the same time, cognitive behavioral intervention is used to help the clients learn new skills that decrease problem behaviors.  This provides clients with the opportunity to make tangible changes in measurable and concrete ways. Cognitive Behavioral therapy has them change behavior versus asking them to understand what happened in the past before the changes occur because what they are doing is life threatening and they are often discouraged by other approaches to change. The therapist models radical acceptance while simultaneously presenting constructive behavioral alternatives.

Marsha Linehan, the founder of DBT, began training New Hampshire community mental health practitioners in the approach in 1991.  Carla Kirsh and other MFS team members have been treating clients using DBT since 1994.

DBT is appropriate for adults diagnosed with borderline personality disorder and other disorders with similar components, such as self-harm behaviors and emotional instability.  Participants must score between an eight and ten on the Diagnostic Interview for Borderlines (DIB), indicating that they have the set of symptoms that DBT has been proved to be effective with.  The approach is also used with adolescents who have been hospitalized at least once for self harming and life threatening behaviors.  Parents of adolescents are included in treatment to provide support for the adolescent and to increase the number of people in the family who will then have the skill knowledge.  Currently, no adolescent who has completed the DBT program at MFS has ever sought continuing DBT services as an adult, which speaks to the effectiveness of the approach.

Beyond helping therapy participants, DBT supports therapists in the development of critical skills to avoid burn-out.  Therapists work in an environment that is constantly changing and has high stress levels.  The DBT training addresses these issues by developing effective boundary-setting, meta-communication, and skills for therapists to deal with the level of intense emotions that they deal with in having a caseload of suicidal individuals.  Some mental health agencies train their entire staffs – including administrative and support staff – so that they learn to cope with work-related stresses and better serve their clientele.

If you are interested in undergoing DBT training, please watch for future announcements notifying staff of the opportunity, then get permission from your supervisor.  Trainings are offered periodically depending on the availability of the agency and staff to invest in the blocks of time required.

Featured Program of the Month: Monadnock Substance Abuse Services (MSAS)

Begun in 1986, Monadnock Substance Abuse Services (MSAS) treats individuals who are addicted to or who abuse alcohol and drugs. These individuals include those referred to mandatory counseling by the county court. MSAS seeks to reduce the impact of substance abuse on individuals, families, and the community through comprehensive education, prevention, treatment, and outreach.  MSAS provides participants with individual and/or group counseling, support, education, and a variety of self-help models.

The 2009 National Survey on Drug Use and Health, conducted by the federal Substance Abuse and Mental Health Services Administration (SAMHSA), reports that only 4.3 million of the approximately 22.5 million Americans classified with a substance dependency, abuse, or addiction in 2009 received treatment.  That leaves 81% of individuals needing treatment going without.  Nationally, the need for competent drug and alcohol counseling continues to outstrip its availability.

New Hampshire reflects national trends.  According to New Futures, a nonprofit New Hampshire organization working to reduce substance abuse in our state, the 2009 National Survey on Drug Use and Health indicated that more than 125,000 adults in New Hampshire were struggling with substance abuse. Statistics compiled by the administrators of the Cheshire County jail indicate that more than 75% of inmates are incarcerated because of offenses that directly or indirectly arose from drug or alcohol abuse.

Monadnock area youth are disproportionately subject to alcohol and drug abuse, according to surveys taken in 2009 at the Keene and Monadnock Regional high schools.  The results indicate that students in our region are more prone to use alcohol and drugs than others in the state. For example, Monadnock Regional High School saw violations of its drug use policy rise 25% from fall 2005 through spring 2008, with anecdotal evidence that the rise increased during the 2008 school year.

The availability of qualified substance abuse treatment services in the Monadnock region lags the scope and persistence of the challenge that our region faces.  From 1992 through 2002, at least 14 treatment programs or facilities in New Hampshire closed their doors (New Hampshire Division of Alcohol and Drug Abuse Prevention and Recovery).  While much is being done to serve individuals struggling with substance abuse and addiction, the need and demand for qualified treatment is undiminished as state budgets supporting treatment programs continue to shrink.

In 2010, MSAS worked with 472 individuals, of which 324 were discharged from treatment.  Of those discharged, 67% reported being clean and sober.  MSAS serves a critical need in the Monadnock region: it has been able to help the majority of program participants to overcome their personal struggles with drug and alcohol abuse so that they and their families can pursue happier, healthier lives.

MFS Employees to Receive Compassion Fatigue Training

Dave Tenney, Manager of Emergency Services, has arranged a free “Compassion Fatigue” training for MFS employees on the morning of Friday, February 17th. Attendees signed up through their supervisors or in person last week.

Compassion Fatigue has been defined as “a combination of secondary traumatic stress (vicarious traumatization) and burnout, both of which negatively impact care giving skills” (Figley, Baranowsky). This training is designed to help social service providers be more aware of the nature of compassion fatigue and to learn skills that are useful for both preventing it or healing from it.

Paul Deignan, Director of the Disaster Behavioral Health Response Team (DBHRT) of the N. H. Department of Health and Human Services, will be the presenter. He is a knowledgeable, articulate, and interesting speaker who provides an excellent presentation integrating both didactic and experiential learning approaches.

This training will likely have a meaningful impact on the employees who are able to attend. Self-care practices are a critical component of providing quality, effective other-care.  Compassion fatigue management skills help us to better serve the needs of our clients.