TRAINING AND CONSULTATION Training and consultation are the foundation for a solid clinical framework.  Good training can enhance client care, foster therapist skill, reduce burnout, facilitate good risk management and add to an agency’s reputation. Portland DBT offers everything your agency needs to learn Dialectical Behavior Therapy - the evidence-based treatment that most effectively helps multi-diagnostic, difficult-to-treat clients.  Whether you are looking for introductory workshops or more advanced consultation, Portland DBT has offerings by experienced clinicians who blend DBT knowledge and skill with in-the-trenches experience.  With over a dozen years in Portland specializing in DBT, we pride ourselves on providing training and consultation services that emphasize full-fildelity DBT and at the same time, are sensitive to cost, systemic, and follow-up/continuity issues that impact successful implementation in the model. Trainings are offered at our John's Landing site and run from 8:30 a.m. to 4 p.m. Trainings include materials, continental breakfast, snacks, and CEUs. CURRENT SCHEDULED TRAININGS DBT 2-Day Introductory  Oct. 3 & 4, 2008  Katherine Calvert DBT & Trauma Nov. 7, 2008 Wendi Adams DBT Introductory Workshop Nov. 14 & 15, 2008 Mark Schorr DBT 2-Day Individual Therapy Dec. 5 & 6, 2008   Tracy Jendritza Completion of our 2-day introductory workshop, or demonstrated knowledge of DBT, is required to participate in our one-day advanced workshops. Please download a registration form by clicking here. INTRODUCTORY PRESENTATION A mid-to large group didactic presentation.  This presentation can be from two to four hours long depending upon your agency’s needs.  Topics covered include: - Biosocial theory of BPD - Dialectics in treatment - DBT components & functions - Stages and targets INTRODUCTORY WORKSHOP A one-day introductory workshop that covers: - Understanding BPD - Biosocial theory - Dialectics in treatment - Assumptions about clients and therapy - DBT components, functions, stages, targets - Skills overview of select individual therapy strategies Also available is a two-day workshop that adds a second day devoted to skills training (see description). SKILLS TRAINING WORKSHOP A one-day introductory workshop that coves: - Structuring and running skills group - Understanding skills in the context of DBT as a comprehensive treatment - Skills training units: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness, problem-solving and relapse prevention INDIVIDUAL THERAPY WORKSHOP A one-day intermediate workshop that covers: - Assessment and case conceptualization - Structuring and orienting to treatment - Stylistic strategies - Dialectics in treatment - Use of acceptance and validation - Conducting chain and solution analyses - Responding to crisis behavior - Managing therapy interfering behavior Prerequisite:  Completion of Introductory Workshop including skills training component.  Beginning to intermediate level psychotherapy experience. ADAPTATIONS TO DBT One-day, introductory workshops focusing on the application of DBT to: - Adolescents - Eating Disorders - Substance Abuse Disorders OTHER TRAININGS DBT Integrated Care Workshop This workshop is designed to train community providers in how to asses and refer clients to DBT, as well as in two community-based groups: 1) Prep and Practice: A group for clients who are concurrently receiving treatment at Portland DBT and in the community and 2) Advanced DBT: A group for graduates of Portland DBT who have transitioned back to community treatment. DBT protocols for managing crises (including hospital protocols) and dealing with set-backs, whether clients are dually enrolled or have transitioned back to community treatment only, will be provided. DBT-Informed Family Treatment Topics include: Session structure and targets, accurate expression, validation/invalidation, responding to crises, dialectical dilemmas for parents and partners, and problem-solving strategies. DBT Therapist and Team Development Topics include: Qualities of a an effective DBT therapist, application of DBT to therapist and team issues (e.g. validation, mindfulness, problem-solving) dysfunctions in teams, team agreements, how-to’s of running a consult group, and managing burnout on your team. DBT Coaching:  Strategies and Skills An interactive workshop that covers the "how to's" of DBT skills coaching including targets and goals.  Protocols for face-to-face and telephone coaching in non-emergent and crisis situations in a variety of settings (e.g., in session, on-unit, natural contexts) are presented, as well as obstacles to coaching and how to manage them. DBT Guiding Principles and Perspectives An overview of the underlying principles central to DBT that guide us in decison-making and treatment planning.  Topics include dialectics, mindfulness, assumptions about clients and therapy, behavior therapy, and treatment for the therapist and team. Treatment for Trauma: A Biosocial Approach This one-day workshop covers:: - Types of trauma and associated diagnoses - A biosocial approach to conceptualizing and treating trauma - Treatment targets and modalities - Symptom specific interventions - Integrating DBT into trauma treatment and visa versus CONSULTATION After formal DBT training, clinical consultation is strongly recommended to generalize and refine new knowledge and skill.  Individual and small group consultation services are available on a one-time only, on-going, or as needed  basis.   The consultant helps with team development, building on therapist knowledge and skill, continued program development and evaluation, risk management, case consultation and DBT adherence. ADVANCED TOPICS CONSULTATION GROUP An intermediate level consultation group conducted on site at the Portland DBT Program. The group is designed for individuals with DBT training looking for more individualized consultation in how to apply and refine new knowledge and skill. Though case presentation, practice exercises, feedback and discussion particpants will learn how to: • Conceptualize and solve problems according to theory • Get unstuck from power struggles and treatment impasses • Use informal exposure strategies in the therapeutic relationship • Treat life-threatening/crisis behavior without reinforcing it PROGRAM DEVELOPMENT Phase I:  Assessment and Recommendations The assessment process includes meeting with providers of service to DBT appropriate clients including interviewing existing DBT therapists, observation of relevant groups including any existing DBT or DBT-like groups, interviews with clients appropriate for DBT or who are currently receiving DBT services, and review of relevant materials in current use including DBT materials.  Interviewing case managers or psychiatrists who refer to and concurrently treat DBT appropriate clients are also conducted if appropriate.   Meetings with administrative staff, program managers and supervisors are scheduled to assess setting, staffing, payor, and population specific variables that will likely influence program development.  After the assessment process the consultant will provide a written report of recommendations.  Phase II:  Program and Material Development Examples of program and material development: Obtain exit material in use with specific population (e.g. teens, incarcerated, elderly). Review and revise. Develop entrance and exit criteria.  Structure and format different types of group (e.g., Motivation Group, Skills Training Group, Problem-solving Group, Relapse Prevention Group). Develop orientation phase – procedures and material. Coordinate with researchers on program evaluation procedures and measures. Phase III:  Staff Training Examples of staff training: Train DBT staff in new materials and program implementation. Train all staff in the basics of the model including:  Assumptions about clients and treatment, the biosocial model, learning theory and a self-management paradigm, dialectics and dialectical dilemmas (for staff and for clients), and the “A-A-A” model. Train DBT staff in how to conduct chain and solution analyses, in the levels and use of validation, in how to intervene with “in-session dysfunctional behavior”, in commitment and stylistic strategies, in how to conceptualize and respond to crises and life-threatening behavior. Train ancillary service providers including milieu staff in the “on-the-spot coaching” procedure and the skills. Train prescribers in DBT compatible medication management strategies.   Train case managers and other relevant individuals in how to assess and refer. Phase IV: Team Consultation After training and program implementation, on-going clinical consultation is provided.  A senior consultant sits in on DBT team meetings (schedule varies depending upon agency need and resources available).  The consultant helps in team development, refinement of therapist knowledge and skill, continued program development and evaluation, risk management, case consultation and DBT adherence. For those interested in developing a program, large or small group training, or our consultation services, please feel free to download any of the following files or call Mark Schorr at (503) 290-3268.  You can also e-mail us at training@portlanddbt.com.