Dialectical Behavioural Therapy at Castle Craig

Dialectics is about looking at two contradictory ideas and trying to resolve their conflict. In the case of Dialectical Behavioural Therapy the two contradictory ideas are acceptance and change.

It is an evidence based therapy for people with borderline personality disorder (BPD), although you don’t need to have BPD diagnosis in order to benefit from this therapy. It is a very suitable therapy to employ in an addiction treatment setting, and it has a particular role for people with co-occurring disorders or challenging behaviour such as self-harm and binge eating disorder.

We are not offering “pure” and comprehensive DBT at Castle Craig, because this is normally delivered on an outpatient basis over the course of 1 year or longer. We will instead offer an adapted DBT programme that is more suited to an inpatient programme of between 6 and 18 weeks. We will cover 3 of the 4 modules found in a standard DBT programme which are: mindfulness, emotional regulation and distress tolerance.

So far we have introduced DBT based mindfulness in the form of a weekly group, and this equips patients with basic skills in practising mindfulness. Patients can then be referred from this group into an extended DBT skills group, this will be a smaller group for those who are suited to this type of therapy. This group will be starting in July.

Carolina Czepil, a counselling psychologist at Castle Craig explains: “DBT is psycho-educational as well as about skills building. Mindfulness is known to be very beneficial for any mental health disorder – so we have held mindfulness experiential groups for many years – and this is moving into the DBT informed mindfulness group which is psycho-educational and experiential. DBT is different from other treatments because it teaches skills and the DBT therapist really has a teaching role especially in terms of how to regulate emotions.”

Carolina Czepil has received additional training and is helping to lead the involvement of DBT in our programme alongside treatment coordinator Dr. Glynis Read PhD. Half of Castle Craig therapists have received basic training in DBT from the Association of Psychological Therapies (APT), and there are plans to extend this training to all Castle Craig therapists later in the year.

Carolina explains further, “Some elements of DBT have always been covered in other groups that we offer at Castle Craig. In particular, our extended care programme always focused on skills that we could give to patients in order to regulate their emotions. This concept of emotional regulation has been around for many years – but we haven’t addressed it explicitly until now – with a set of skills that had an evidence base and a theoretical under-pinning.”

Glynis Read, Treatment Coordinator explains: “Looking to the future there could be a growing role for DBT. It depends on the numbers of patients who require this treatment. It is still a therapy that works best for people with a diagnosis of BPD, or those who are emotionally dis-regulated – people with poor social skills. That covers quite a wide range of people but we have to be prudent to ensure that we maintain our focus on addiction. We are trying to tailor the DBT group model to what we need but also to our setting and based on how long the patients are in treatment with us.”