DBT and behavior planning

In preparation for working with my client with Borderline Personality Disorder, I had read the book excerpted for this week's reading. The first thing the ward administrator--who is heading up the effort to engage the client in DBT-- and I did was to draft a list of the client's most high-risk behaviors. In the process, we were struck by how much progress she has really made while on the ward and how much she has begun to engage treatment, DBT in particular.

I was tasked with drafting a behavior plan for the client. From my years working with emotionally disordered kids and writing/implementing behavior plans, it is one of the few things I feel fully competent in doing. However, the behavior plans I had drafted in the past were grounded in a cognitive-behavioral methodology. While DBT is grounded in CBT, it has unique aspects that were interesting to explore in the process of writing the plan. Another confound was the influence of Trauma-Informed Care, another methodology being implemented across the hospital. This process eschewed the behaviorist interventions of a daily inventory (diary cards in DBT), a token economy, and ABC processing. Instead, TIC promotes understanding of self-soothing methods and bodily awareness during stress.

Integrating these plans was difficult for me and the other members of the treatment team. We ended up throwing out most of the behavior plan I had drafted because it was too CBT-oriented and instead favored a more TIC-centerd approach to behavior processing. However, the overall DBT structure within the forensic setting (there is an entire chapter on it in the book you excerpted for class) remains intact.