USING DBT TO INCREASE COUNSELOR SELF-EFFICACY

WENDY S. BRUTON, PH.D, LPC, ACS

STUDY TITLE The Impact of a DBT Training on the

Counselor Self-Efficacy of Pre-service Counselors Working with Borderline Personality Disordered Clients

LITERATURE REVIEW

A literature review on three main themes was conducted.Borderline Personality DisorderDialectical Behavior TherapyPre-ervice Counselor Self-Efficacy

BORDERLINE PERSONALITY DISORDER (BPD)

Symptomology Emotional dis-regulation &Impulsivity Increased self-harm risk Chronically suicidal Lack of sense of self

Serious Mental Health Concern Vast majority have made at least one suicide

attempt Treatment Concerns

20% clients in community mental heath agencies meet criteria for BPD

Counselor’s Experience with BPD Clients Overwhelmed & Underprepared BPD clients do not respond to TAU

THERAPEUTIC ALLIANCE &IMPACT ON CLINICIANS

Counselors are continually assessing… creating hyper-vigilance Individuals with BPD are 16 time more likely to engage in

suicidal behavior than people with Major Depressive Disorder (Kelly, Soloff, Lynch, Haas, & Mann, 2001).

Clients are “all in” or “all out” of therapeutic alliance Therapy is a “way of life”

97% receive outpatient treatment over a life time with an average of 6 therapists (Lieb, et al., 2004)

Impulsivity and Psychotic Reactivity create nervousness and confusion for counselors.

“They latch on to you and it’s like suck suck suck suck……I feel that we’re like in this kind of quicksand, and I might be on the edge, but they’re in there, and I’m holding their hands, but I feel… urghhh (gestures)… pulled in, no firm foothold.” (Rizq, 2012, p. 40)

Countertransference is almost always present.

DIALECTICAL BEHAVIOR THERAPY (DBT)

HistoryDeveloped by Marsha Linehan

in late 1980s Effectiveness

First method of therapy to be shown in clinical trials to be effective with BPD clients

Significant drop in parasuicidal actions

Decreased dropout rate in counseling

GENERALIZABILITY OF DBT DBT covers most presenting problems that

counselors face. The inability to handle difficult emotions (ie:

sadness, fear, anger) The inability to change emotions when needed (ie:

stop being angry, stop being sad… etc. ) Difficulty staying in the “here and now” Unable to be effective in relationships.

INTRODUCTION TO DBT Dialectics~ (holding two things in

balance that are in conflict or contrary) Sustaining Balance

Four ModulesCore MindfulnessDistress ToleranceEmotional Regulation Interpersonal Effectiveness

SkillsEach module has specific skills that require

practice.

IMPACT OF DBT ON THE CLINICIAN Empowerment with tools Professional application

Dialectics Mindfulness

Personal application Dialectics Emotional Regulation Mindfulness

Normalizing Attention to internal

experience with clients Counselor’s reaction is

diagnostic criteria Skills increase CSE

COUNSELOR SELF-EFFICACY(CSE)

Defining CSE “One’s beliefs or judgments about his or

her capabilities to effectively counsel a client in the near future.” (Larson, 1998, p. 180)

Importance of CSE With higher CSE counselors are able to:

Use more skills Handle difficult situations more effectively Accept feedback from instructors and supervisors

CSE as a Predictor of Career Choice As CSE increases so does the likelihood that

they will accept and maintain the therapeutic relationship (Larson, 1992)

RESEARCH QUESTION

The “hole” in the research:

What is the impact of DBT training on the counselor self-efficacy of counselors with regards to their work with BPD clients?

This study examined changes in counselor self-efficacy (CSE) with regards to counselor’s work with BPD clients, following a DBT training.

PURPOSE OF THE STUDY

The inclusion criteria for this study:All participants were enrolled in the final semester of

their clinical internship experience.All participants were in their final semester of study

and enrolled in a clinical internship supervision class. All participants were recruited by the researcher

during a regularly scheduled class time. The participants were divided by class

room into treatment and comparison groups.

PARTICIPANTS

Demographic Questionnaire Counselor Self-Estimate

Inventory (COSE) Self-assessment measurement of

counseling effectivenessSub-scales: micro-skills, counseling

process, difficult clients, cultural competence, and awareness of values

INSTRUMENT: QUESTIONNAIRE/COSE

DESIGN

Quasi-Experimental, Nonequivalent Group,

Pretest~Posttest Design

The study demonstrated that training pre-service counselors in DBT can positively impact their counselor self-efficacy.

Gives insight into changes that need to be made:Willingness of counselors to work with BPD

Population Increase in training on personality

disorders… specifically BPD… and other high needs clients.

RESULTS

Your experience with BPD? Your use or non-use of the four DBT

Modules:MindfulnessDistress ToleranceEmotional RegulationInterpersonal Effectiveness

Where do you use these skills in daily life... Work, personal time, etc?

Where can you find support in using these skills more effectively?

DISCUSSION

DBT TRAINING Oak Springs Wellness Centre, LLC

Salem, OR ~ 503-983-1559www.oakspringswellness.com

January 23-24, 2015Friday & Saturday: 9:00am-4:00pmCost: $300: Price includes a one hour

individual coaching session($50 off if you came to this session)

QUESTIONS?

~Thank you~