Group Skills

Training
Introduction to Group Training

DBT Skills is based on a set of strategies that we have found most helpful. As the name suggests, DBT
Skills is a skills-based treatment.

(10) Setting up a skill training program.mp4

"Skills training is about providing the

tools that are needed to accept and
tolerate difficult life circumstances,
while actively changing the things we
are able to change. This is where
clients learn the skills they need to
build a life worth living."
Guidelines for Group Therapy

It’s important to orient clients to these guidelines for skills training.

The guidelines inform the clients of the behaviors that are expected of them in skills training, as well
as behaviors to avoid so that skills training can be done effectively.

"You’ll be pleased later on when you

orient your clients from the start!"
Guidelines

1.

For a client to drop out of a DBT Skills program, they must miss 4 consecutive sessions of Skills
Training.
In a standard DBT Program this is the only way for a client to be considered as no longer in the
group. Even if a client repeatedly tells you that they are dropping out, it requires 4 consecutive
missed sessions for the quitting to actually occur.

2.

Ensure there is a culture of support for each of the group members.

Participants who join the skills training group must agree to support one another throughout the
entire duration of group skills training.

3.

It is recommended that group leaders meet regularly, in order to strengthen their interpersonal
connection.

A strong relationship and understanding between group leaders and co-leaders can improve their
ability to work together effectively during skills training sessions, and better enables them to work as
a team in order to deal with difficult situations that may arise.

4.

Communicate about problem behaviors with your clients using vague language.

The use of specific language or terminology around topics such as suicidal behavior may increase
urges for other group members to engage in these problem behaviors. Similarly, clients are asked to
refrain from engaging in problem behaviors together outside of group. These behaviors may include
drug or alcohol use, cutting, or any other behaviors that the skills trainer sees as problematic for
those clients.

5.

Private relationships outside of groups are prohibited.

Group members are unable to have private relationships where the content of those relationships
cannot be shared with the group. Romantic relationships between group members have often
resulted in a lot of turbulence among the group and this should be avoided.

6.

The severity of the clinical problem will determine the treatment.

Therefore, a standard DBT program might be clinically recommended for certain clients.

For example

Orienting the clients from day one that there can be no romantic relationships between group
members can avoid these related problems from happening in the future. Individual Skills Training is
a setting where several of the guidelines focused around group member's interactions aren’t
applicable, however it’s expected that Individual Skills Training clients are oriented to the other
guidelines. It will help the skills training process run more smoothly.

(11) Skill training guidelines.mp4

Group Training is a Structured Approach

Group Skills Training in DBT uses a structured approach that is designed for clients to acquire new
skills. It’s important to consider when orienting clients to DBT Skills group that this is more of a
structured setting for learning new materials, similar to a class, and might be different from other
therapy groups they may have attended that are more process-oriented and less structured.

(12) Structure of group trainings.mp4

Benefits of Group Therapy 

Group Skills Training can include as few as two participants.
Benefits of group treatment include:
1. Opportunity to observe and discuss.
Therapists have an opportunity to observe and work with
interpersonal behaviors that are more likely to manifest in a group
as opposed to a one-on-one setting.
2. The group can provide support and validation that have a
therapeutic effect on individual participants. 
This is one of the greatest benefits of teaching skills in a group
setting. The participants help each other through the process, and
can assist each other when the going gets tough!
3. Input from the group provides additional learning
opportunities.
Other group participants may share stories, experiences or
examples of when using a particular skill has been useful to them.
This is a great example of modeling the use of DBT Skills, and can
often be beneficial to other group participants.
4. Groups typically reduce the intensity of the personal
relationship between the individual clients and leaders. 
This can be beneficial for some clients who have problems
regulating their emotions.
5. Norms established on a group-level can increase skills
practice and homework adherence.
6. Skills groups offer a non-threatening opportunity for
individuals to learn how to be in a group.

Group skills training in DBT can be a

creative and fun process.
Don't underestimate opportunities for clients to actively participate
and teach themselves. Doing role-plays or dividing clients into
teams and letting them figure out the answers to skills questions
can help bring your teaching to life!

Individual Skills
Introduction to
Training
Individual Training

There might be circumstances where doing Individual Skills Training is a better option than Group
Skills Training.

(13) DBT Skills.mp4

One thing to consider about this format is that it’s up to you as the therapist to provide lots of
examples of your own skills practice. This will provide modelling for your client on how they can use
the skills.

Use examples from other sessions to provide a model to help clients understand the process.

Individual Skills Training will not have the advantage of group members providing examples to
increase learning for your client, so you’ll want to prepare lots of examples of how to use the skills
and include them in your teaching.

"Use DBT Skills to teach people displaying problematic behavior, or behavior that won’t help resolve
a problem."

Guidelines for Individual Skills

Training
Carefully read the teaching notes for each of the skills you are
going to teach.

Doing so will help you to understand the ways to teach the skills,
and the kinds of problems the skills are designed to target. Having
handouts and worksheets readily available will make it easiest for
individual practitioners to slip skills training into the fabric of ongoing
individual care.
Practice the skill with the client if possible.

This may involve role-playing, or cueing them to respond using the

skill. Provide an assignment or suggestion that the client practices
the skill before the next visit - homework might be difficult, but it
provides an opportunity to integrate the skills into the client's real
world! Be sure to follow up about their skills practice homework in
the next visit. 

Make the context of skills training different from that of usual

psychotherapy.

A task of individual therapists is to reinforce the use of skills, and to

teach them “ahead of time”, as needed. It can help to differentiate
skills training from your regular psychotherapy, so that the client
knows when you are teaching skills.

"If you foresee a problem coming up in your client's life, such as distress about an
upcoming job interview, that's your cue to teach them new skills that are
applicable!"
Compliant Clients:

When your client agrees to learn DBT Skills

(14) Compliant Clients.mp4

 Pay attention to their behavior and observe when the skills are helping.
 Reinforce good behavior and the use of skills.
 Do not punish the client for not using the skills.
 Ask the client if they recognise when the skills are helping the situation.

(15) Using Praise to Reinforce.mp4

 Praise is the most effective reinforcer.

 Do not move onto a new skill if it will be percieved as a punishment by the client.
 Do not tell the client that they are doing well when they are not, only reinforce good
behavior otherwise you will encourage dysfunctional behavior.
 Give praise, but don't reinforce dysfunctional behavior!

Non-compliant Clients:

When a client refuses to learn DBT Skills

(16) When clients refuse to learn the skills.mp4

 Some clients may be adamant that they are not the problem.
 Give skills to interact better, and reinforce that no one is to blame.
 If the client still refuses to learn skills, revert to using your primary model of therapy until a
later date.
  Always stay mindful to ensure that the client does not feel like they are being blamed for the
behavior.

Summary

One advantage of Individual DBT Skills Training is that you have a lot more freedom to emphasize
specific skills than when you teach in a group.

We talked about when to consider Individual DBT Skills Training, how to increase motivation for
clients to work on skills, and some tips for teaching them in a 1-1 setting.

You are able to select the tools that you see as most useful for your client to accept and tolerate
their difficult life circumstances, as well as the tools that will best assist the client to actively change
these circumstances.

You can teach DBT skills at a pace that best suits each client.