DBT Client Agreements
Self-Harming Behaviors Agreement
If suicidal or other self-harm behaviors are a problem for a particular client, reducing these behaviors will be a primary treatment goal. It is required that clients contract to reduce suicidal and self-injurious behavior; to work on behaviors that interfere with therapy; and to attend skills training groups and individual therapy weekly. Clients who participate in our program agree to work toward solving problems in ways that do not include intentional self-harm or suicide.
Period of Therapy Agreement
The initial period of therapy is generally one year. Throughout this period, the client and therapist will review progress, which may lead to refining targets and goals. At the end of this period, the question of whether a further phase of therapy is needed will be discussed and may be implemented by mutual consent.
Frequency of Contact Agreement
Individual sessions will occur weekly for 45-60 minutes, but from time to time, a session may be at different intervals depending on circumstances of either party and by mutual arrangement. DBT Skills Group sessions will occur weekly and will last 1.5 hours. Optional DBT Graduate Group sessions occur weekly and last 60 minutes.
Homework Assignments and Participation Agreement
Clients agree to take responsibility for ensuring they bring their own copy of the DBT Skills Training Handouts and Worksheets book and the latest homework assignments completed to each individual and group session because these will be a vital part of in-session work. In addition, clients agree to complete the Skills Training/Diary Card on a daily basis. They agree to practice the skills to the best of their ability and to participate verbally in group and individual sessions to the best of their ability.
Clients agree to attend scheduled individual and group sessions. It is not acceptable to miss sessions because a client finds them too uncomfortable or aversive; is not in the mood for therapy; or is tired, wishes to avoid certain topics, or feels hopeless. Clients understand that it is important to attend every session, both for their own sake and for the success of the skills training group. Therefore, they commit to attending every session unless they are prevented by circumstances beyond their control. We ask that each group member commit to attending all sessions of each module. The material offered builds from one session to the next. Clients are expected to arrive on time as late arrivals can be disruptive.
Absences detract from the group’s ability to work as a unit, and we encourage clients to consider this group as a primary commitment. If a client cannot attend, they must inform the facilitators within 24-hours notice, with the understanding that it is a courtesy for the facilitators and participants to know who will be absent. Similarly, therapists will do their best to give clients at least 24-hours notice if it has become necessary to re-schedule a session. Clients who know ahead of time that they will miss a meeting should let group facilitators know at the previous meeting.
Termination of Therapy
These are the conditions, due to absences, in which clients cannot return to therapy until the end of the contracted period, and then return is a matter of negotiation (this includes for reasons of prolonged hospitalization or illness). Clients understand they will have voluntarily dropped out of the DBT Program:
- If they miss 4 consecutive scheduled individual therapy sessions.
- If they miss 4 consecutive skills group sessions.
- If they do not maintain individual therapy with a DBT trained primary therapist, or refuse to participate in skills group.
What is said in group stays in group. Clients may wish to discuss their own experiences in group with others, but the names of other group members and their experiences must be safely guarded. Confidentiality may be broken only if someone reports: danger to oneself or to others, or abuse of a minor or an elderly person. In either of these events, it will be the facilitators, not the members, who break confidentiality to report what was said to the appropriate agencies. While facilitators will make every attempt to emphasize the importance of confidentiality in skills group, we cannot be held responsible for the individual actions of group members.