Similarly, a smooth diversion to another engagement strategy, which assesses the pros and cons of entering the DBT. It is important to highlight the differences between DBT and other treatment methods, which includes the disadvantages of entering treatment. DBT takes longer than CBT, taking into account individual therapy, group skills training and intersession contact components that occur each week. In addition, the therapist does not focus on the crisis of the week, but is committed to managing and responding to problems according to the DBT`s target hierarchies. Therefore, instead of participating in cardiac or aeration sessions, a therapist may repeatedly redirect a patient to the previous week`s discussion of life-involved behaviours. This can be aversive for some patients and it is therefore important to point out this as a potential disadvantage of treatment. Until the patient and therapist agree on how the treatment will unfold, the methods and goals, the patient is not involved in DBT, but in pre-treatment. As a general rule, pre-treatment should not last more than three sessions, during which there is a typical assessment that is no different from any other form of psychotherapy. The agreements are reviewed and the therapist begins to implement engagement strategies to strengthen the patient`s commitment to treatment.
All patients begin pre-treatment. Here, the individual therapist discusses DBT agreements and assesses the motivation for engagement. Individuals participating in the DBT must be volunteers. The DBT expressly prohibits non-voluntary treatment. Thus, if the treatment is not voluntary, the patient should have the opportunity to choose another non-DBT treatment. Thus, in DBT, there are patient agreements and therapist agreements. These may be verbal, but they are written and returned optimally if necessary in the future. The patient also agrees to participate in weekly sessions and weekly qualification training. They agree to work to eliminate life-threatening behaviours, including suicidal behaviours and self-injury behaviours. They also agree to work on all behaviors that disrupt therapy, called behavior disrupting treatment. And when the payment is received by the therapist, they agree to make the necessary payment.
Engagement strategies are therefore not an easy thing to do at the beginning of treatment. This is something that a therapist would come back again and again when the engagement seems to fluctuate, when an episode of self-injury has occurred, when a patient`s suicidal urges have intensified and if he is considering cancelling treatment. The way the therapist goes back to this one can vary depending on the style. You can withdraw written commitments or simply recant the verbal obligation to work on treatment disorder behaviors or life-threatening behaviors that say something like «but you promised at first that you wouldn`t stop treatment.» As soon as the therapist and patient accept how the therapy will work and the therapist commits to engaging appropriately and treatment is voluntary, we can enter Level 1 of the DBT. Another engagement strategy is called foot in the door. And a bit like walking in the door, what`s called the door on the face. Foot in the door, if a therapist can apply for a simple first application, put his foot in the door, which then expands the possibility of complying and increases the likelihood that the patient will accept another request.