A dozen years in the making, Trinitas unveils the Institute for DBT and Allied Treatments.

Caleb MacLean

For some people, change is difficult. For others, self-acceptance is the long hill to climb. For individuals undergoing Dialectical Behavior Therapy  (DBT), positive outcomes are the

result of finding a comfortable middle ground between these seemingly contradictory and often uncomfortable life challenges. At the Trinitas Institute for DBT and Allied Treatments, outpatient clients—including those diagnosed with Borderline Personality Disorder and substance, eating, and mood disorders—learn behavioral skills that get them back, and keep them on track.

The Institute is new, but the work being done in this area has been going on at Trinitas for 12 years. “We’ve offered high-quality DBT treatment to adolescents and adults for years,” says Dr. James McCreath, the hospital’s VP of Psychiatry and Behavioral Health. “The DBT team has reached a level of  skill, experience, and competencies that we feel we are ready to train other clinicians who seek to provide high-fidelity DBT services.”

Truth be told, Trinitas has been working toward “institute status” for more than a decade.

“We already give presentations around the state and offer in-depth training as opposed to just outpatient therapy services,” explains Dr. Essie Larson, who has been with the program since its start and is co-director of the Institute along with Dr. Atara Hiller. “We train psychology and social work interns, psychology externs, as well as psychiatry residents. Our goal is to have trainees who come through really learn what the empirically-based DBT model looks like in practice.”

The Institute team has undergone intensive formal training with Behavioral Tech, an organization created by Dr. Marsha Linehan, the developer of Dialectical Behavior Therapy in the 1980s. The treatment provided is completely in line with Linehan’s original model and is considered the gold standard for treating emotional regulation issues. “We do it by the book,” Dr. Larson stresses. “Lots of consultation and training—even for those of us who have been doing it for a long time.”

DBT treatment has gained a reputation in some circles as a “treatment for the wealthy.” At Trinitas, however, the adult DBT outpatient program is one of only a handful in New Jersey that take clients who want to go through their insurance providers, while the adolescent DBT program is the only outpatient program of its kind that regularly takes insurance. “We are dedicated to providing this treatment for clients who would not be able to afford it otherwise,” Dr. Larson says. Moreover, the adolescent DBT program also offers Spanish multi-family skills groups.

“We also value helping families who cannot access evidence-based treatments because of language barriers. The Spanish Adolescent DBT program has been an incredible resource for teens and their Spanish- speaking family members, enabling them to get the clinical results they desperately needed but could not access,” Dr. Hiller says.

The Institute is focused on recovery-based outpatient treatment, so success is dependent on a high level of motivation. A doctor or insurer can suggest to a client or family that it is a good idea, but clients (or the family for an adolescent client) must make first contact themselves and put themselves on the waitlist. For adult DBT, the staff will do an initial phone contact to answer any questions and then send out a packet that explains in full detail what is involved in the program. The prospective client answers some questions about

themselves and returns the packet as an initial screening to determine fit within DBT. For the adolescent DBT program, the family must call directly. A phone screening is conducted to ensure that they meet the treatment criteria before being placed on the waitlist.

“Following that, when a spot in the program opens up, an in-person intake is completed to further assess the ‘fit’ with our DBT program. Then there are three pre-treatment sessions (four for the adolescent program) before fully joining the program,” says Dr. Hiller. “That’s when we discuss goals, obstacles, and start working to increase the client’s commitment. After the final pre-treatment session, clients and therapists sign a contract together, agreeing to work together for a specified amount of time.”

For adults, that amount of time is a minimum of one year, and with contract renewals, can run as long as 30 months. For adolescents, the program runs a minimum of 24 weeks for English-speaking families (4 pretreatment sessions and 20 treatment weeks) and

28 for Spanish-speaking families (4 pretreatment sessions and 24 treatment weeks).

For both the adult and adolescent DBT programs, treatment consists of a once-a-week individual session and a once-a-week two-hour skills group. In addition, clients (and their caretakers in adolescent DBT) have access to between-session phone coaching to help use the skills they learn in sessions out in the real world.

“While this may sound like very little therapy for individuals who are struggling so much in life, this is exactly what the empirically-based DBT model is based on. It is the quality and the specificity of the treatment, as well as the intense training and supervision of the clinicians, that makes it effective for these clients. Not the quantity of weekly sessions,” says Dr. Larson. Both programs also have Consultation Team meetings each week to ensure that clinicians are getting support themselves and are adhering to the DBT model.

The overarching goal of the Trinitas Institute for DBT and Allied Treatments is creating a strong foundation of skills to deal with daily life—building a “Life Worth Living”, DBT’s primary goal. That may sound simple, but it’s not. DBT clients tend to have an “exquisitely sensitive” emotional regulation system (they become upset more quickly, more intensely and take longer to cool down) and more than 90 percent come to the program with a significant history of trauma.

According to Dr. Larson, while DBT itself is not a trauma treatment, the staff at the Institute is also trained in empirically-based treatments like Prolonged Exposure (PE) to help clients overcome the often paralyzing symptoms of their traumas once they have learned skills to manage their suicidal, self-harming and other high-risk behaviors. “We recognize that building a Life Worth Living does not just mean stopping behaviors,” she says. “It also means treating the suffering that often drives the behaviors.”

“No one has taught them what to do with all these intense emotions,” laments Dr. Hiller. “So we see the clients trying to tolerate the emotions and problem- solve using behaviors that include self-harm, drugs, and eating disorders. They have often been unsuccessful in other types of treatment.”

Indeed, most individuals entering the DBT program see and respond to things in their world as black-and-white, which leads to less effective coping decisions. At the Trinitas Institute for DBT and Allied Treatments, therapists help clients see reality as a whole, not a collection of extremes.

“We spend a lot of time teaching that there is no absolute truth, that everything is a mixed bag,” says  Dr. Larson. “This is where the ‘dialectical’ part of DBT comes in. Simply put, it means that everything is composed of opposites. But that middle ground can be so uncomfortable for the people we treat. They do tend to gravitate towards the black or the white, the right or the wrong—just to have a clear answer. The statement ‘it depends‘ is very accurate when making decisions and it is also hard to tolerate for our clients.” 

Editor’s Note: The Trinitas Institute for DBT and Allied Treatments is located at 655 East Jersey Ave. in Elizabeth. For more information on its programs, visit www.dbtnj.org or call (908) 994-7378 for more information on the adolescent DBT program and  (908) 994-7087 for more information on the adult DBT program.