Why Inpatient Treatment is not ALWAYS the best solution
When unsafe emotions and behaviors like suicidal ideation and self harm arise, the first line of defense is often mental health hospitalization. This makes sense when our lives, or the life of someone close to us, are in danger. And we are taught that hospitals have healthcare providers to keep us safe.
This is true! And thank goodness for our healthcare providers! However, research shows that when it comes to a mental health crises, inpatient hospitalizations increase the likelihood that unsafe behaviors will occur repeatedly.
This is for many reasons. But most importantly, while hospitals DO keep people safe, they DO NOT provide clients with the long-term treatment. Clients need tools and coping skills to address long standing feelings and behaviors, even once they are out of imminent danger. Hospitalization is a short-term solution for an oftentimes long-term problem.
Mental health hospitalizations is essential to keep people safe. But it’s not enough to solve the issues that led to the safety risks in the first place.
And this is where Dialectical Behavior Therapy comes in.
Outpatient DBT might be the long-term solution instead of repeated mental health hospitalization.
While there are many types of therapy modalities, all of which have a specific function and purpose, DBT is indicated when the most frequent questions are
- “How do I stay safe?”
- “How do I keep my loved one safe?”
- “Do we need to go to the hospital?”
DBT is a very prescribed therapy that was developed for individuals experiencing suicidal ideation and self-harming behaviors. The goal is to prevent repeated cycles of frequent mental health hospitalizations. And the research shows that it works!
Skills to solve long-term underlying problems.
DBT skills groups focus on four categories of skills that provide both short-term and long-term solutions to risky behaviors and the emotions that underly them.
- Increasing mindfulness: awareness of ourselves and the world around us
- Emotion regulation: regulating and experiencing emotions in safe and healthy ways,
- Interpersonal effectiveness: how to have healthy relationships with others and get our needs met effectively,
- Distress tolerance: how to manage thoughts, feelings and behaviors in safe and adaptive ways.
Commitment strategies to use skills when in crisis.
In addition to weekly DBT Skills group, clients also participate in weekly individual therapy. A DBT therapist and client work to form a real relationship based on trust, communication, and care. Because of this, the therapist will ask the client to commit to safety, and the idea that life *could* be worth living. They work together to create specific goals and target behaviors to focus on. The therapist is very clear about how this CAN be done. DBT therapists use very specific commitment strategies to get clients to commit to using their skills and working this treatment.
Safety planning in the moment to avoid hospitalization.
If and when unsafe behaviors arise, the client (and sometimes the family too) commits to reaching out for in-the-moment support. They can put in place a very specific safety plan, curtailed to the client’s needs and environment. If everyone uses the safety plan, the client and family can ride out the wave of discomfort and risk. With time they can calm down safely. This prevents the need for a trip to the hospital, thereby interrupting the cycle that perpetuates risky emotions and behaviors.
The beauty of this process? It works if you work it! Once dangerous behaviors are stabilized and the need for hospitalizations decrease, the client then learns how to use the skills in order to build a life worth living. When used effectively, DBT can interrupt the cycling in and out of mental health hospitalization, create stability, and then improve general life satisfaction.
About the Authors
Adam Freidfertig, LGPC and Laura Goldstein, LCMFT co-authored this article.
Adam Freidfertig, LGPC is a licensed graduate professional counselor at Montgomery County Counseling Center in Rockville, MD. He obtained his bachelors degree from University of Delaware and his master’s degree in clinical Mental Health Counseling at Johns Hopkins University. Adam has extensive training in DBT and in IFS (Internal Family System). Adam is not currently accepting clients at Montgomery County Counseling Center.
Laura Goldstein, LCMFT is a Licensed Clinical Marriage and Family Therapist Founder of Montgomery County Counseling Center, LLC. Laura obtained her Bachelor’s degree in Neuroscience and then went on to earn her Master’s degree in Family Therapy. She became intensively trained in Dialectical Behavioral Therapy (DBT) through Behavioral Tech Linehan Institute in 2015. Laura sees clients in both the Rockville and Olney offices and provides consultation for other therapists.