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Dialectic Behavior Therapy is a broad-based cognitive-behavioral model of treatment developed by Marsha Linehan, Ph.D. Although initially designed to treat chronically suicidal and high-risk patients who struggle with patterns of behavior characteristic of Borderline Personality Disorder (BPD), current research shows the effectiveness of the model with other populations such as Post-Traumatic Stress Disorder, Eating Disorders, Substance Dependence, and Depression – all of which involve problems of emotion regulation. Dr. Linehan has often remarked that much of DBT is not new at all. She simply brought together very basic, well-documented behavioral strategies: contingency management, exposure treatment, cognitive modification, and skills training to create a strong behavioral treatment model. She then made it more palatable to both client and therapist by embedding it within Eastern philosophic principles that encourage the development of dialectical thinking and psychological flexibility. According to Linehan, change can only occur in the context of acceptance of what is and “acceptance of what is” is itself change.”

Essential to the practice of and appreciation of DBT is an understanding of the biosocial theory of BPD and, by extension, the general problems of emotion regulation. Disorders that are suited to DBT are essentially defined by problems in regulating emotion due to a combination of biological disposition, environmental context, and the mix between the two during development. There is a continuous and mutual interaction that occurs between a vulnerable individual and a more or less invalidating environment over time that may lead to maladaptive or inadequate emotion modulation strategies and the behavioral and cognitive dysregulation that tends to follow. This theory not only provides a base for effective intervention, it fosters a compassionate attitude toward the intensity of emotion and the difficulty of changing ingrained patterns of behavior.

DBT in its comprehensive form is a very structured approach that involves four components: DBT individual therapy, DBT Skills Training, DBT phone coaching, and DBT therapist consultation team. Although there is some evidence that skills training alone can be helpful, comprehensive DBT requires that all four components are present. The clients who are appropriately referred to DBT programs are those with multiple concurrent problems who often exhibit suicidal and other high-risk behaviors. Phone coaching between sessions is essential – you don’t send the team out on the floor for the championship game without a coach to guide plays. Coaching calls are intended to be brief interactions that help clients identify and use skills to get them through the moment. Team meetings are essentially therapy for the therapist to enable her to stay motivated and provide the best treatment possible. Despite all the structure, DBT is a not a manualized treatment. The therapist is guided by principles at every juncture to work with the client to establish treatment priorities, to build a strong, collaborative relationship, to select specific strategies to solve specific problems, to assign homework, and to clarify and maintain his/her own limits with firmness, compassion and flexibility.

Further information about DBT resources, training, and research can be found at behavioraltech.org

Debora B. Dixon, Ph.D.
20 York Street, Bath, ME 04530
207 443-3692
deborabdixon@gmail.com

Heading to college of the first time, or returning after a summer away, can be a big adjustment. Aspects of your day to day routine get turned upside down, from when you wake in the morning to how much free time you have during the day. Many college students find this adjustment to be quite jarring. So, if this is happening to you, your client, or someone you know, don’t be alarmed, you are not alone. 

As a clinical psychologist, I have worked with hundreds of students who have nailed this transition. I have put together a short list of techniques that many of my students have found helpful. 

1. Survey Your Present Time Management Habits (see below for this tool)- This exercise will give you a sense as to how much free time you have, whether you are overcommitting yourself, and whether you need to make any adjustments. One of the things students often find when starting college is that they have too much free time. Students often don’t anticipate this will be an issues, but it can cause things such as “procrastination” to creep up, as students often get into the “I can do it later” attitude. Plan ahead! This leads to my next tool…

1. Create a schedule (see below for this tool) – Once you have evaluated your use of time, it’s time to create a schedule. Include things that happen on a weekly basis- things that are scheduled or that need to get done. Make sure that you include all of your classes, travel time, study time (usually one hour for each hour of class time), labs, breakfast/lunch/dinner, sports/hobbies, sleep, personal care (time it takes to get ready in the morning), etc. This will give you a visual as to your “week at a glance” and allow you to see where you can fit in other activities, should you choose, or when you can sit back and relax. 

1. Sleep Hygiene- Ensure that you are getting enough sleep. Pulling an all-nighter is not beneficial in any sense. Sleep helps with learning. This is the time when memory is consolidated. So, the best thing you can do before a big test/exam if to get a good night’s sleep. 

1. Self-Care- Everything in moderation. This includes a balanced diet, exercise, socializing, school work, social media/electronics, etc. You may be overwhelmed with the opportunities at college. It’s okay to say no and to set personal limits. 

1. Personal Strengths-  We often forget to look within to examine how we have coped with previous transitions or past difficult times in our life. Ask yourself: What worked for me in the past? What didn’t work for me? What strategies/coping mechanisms help me when I am faced with a challenge? Using tried and true strategies are the easiest, as you know how they work for you and how they make you feel. 

1. Ask for Help- If things get too difficult to manage reach out for help. Most colleges offer counseling services, academic supports, tutoring services, and library supports. If you don’t know where to go for help, ask a professor, resident advisor, or upperclassman. If you don’t feel comfortable talking with anyone directly, most college websites have an online listing of the services they offer and where you can go for help. 

Dr. Quynn Morehouse
Clinical Psychologist
Portland, ME
Work: (207) 773-7993, ex 26
Email: drquynnmorehouse@gmail.com
www.drquynnmorehouse.com

The Psychologically Healthy Workplace Award is sponsored by the Maine Psychological Association and the American Psychological Association.  The award was created to recognize organizations that make a commitment to workplace well-being and creating a psychologically healthy work environment for employees. Awards may be given to large, small, for-profit, and not-for-profit organizations based on the following criteria:

1. Employee Involvement
   2.  Employee Growth and Development
   3.  Employee Recognition
   4.  Work/Life Balance
   5.  Health, Safety and Security

Previous winners include Coffee By Design, Alpha One, Kennebec Technologies, Spurwink Portland Help Center and the Pine Tree Society.

For more information on the program, contact the MePA office at 1/800-287-5065.

We are very excited to be launching this project.  The idea is that MePA members will contribute a monthly informational blog on topics of interest to MePA members and the general public. MePA is lucky to have more than our fair share of excellent psychologists who have a wealth of knowledge about a wide range of topics.  Many of us have tapped into that knowledge through the list serve.  This will be another way of disseminating the knowledge. The focus would be on sharing information rather than advocating for a position or policy.  Looking forward, we are hoping to have topics related to: concussions, hypnosis, back to school issues, drug use, and other interesting or relevant subjects.

At this point it is a simple process.  If there is something you’d like to blog about, reach out to me, let me know, and we’ll get you on the schedule.  If I get in touch with you about blogging, just say, “Sure, I’ll be happy to do it!” Or, you could suggest another topic you’re interested in. There is a lot of editorial freedom.  At this point, the MePA president will review the article to make sure it isn’t completely crazy, and then we’ll publish it on our web page.  We’ll take care of the formatting for the blog, so you don’t have to worry about that.

MePA already provides many great services for our members.  We have the free ethics consultation, high quality continuing education, referral services, and a newsletter.  Above and beyond that we provide lobbying at the state and national levels on topics that are critical to the practice of psychology.  We’re excited to add this blog post to the benefits MePA provides its members.

I look forward to hearing from you about which topics you want to blog about and feedback in general about the blog!

Elise Magnuson, Psy.D., LCSW
Licensed Psychologist
MePA President
207-632-6965
drecmagnuson@gmail.com