Behavior Therapy for the Difficult to Treat Client: DBT Tools & Skills for Therapists

Behavior Therapy for the Difficult to Treat Client: DBT Tools & Skills for Therapists

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Date(s) - 10/26/2019
9:00 am - 4:30 pm

Calvary Church Los Gatos

About the Course

Christian Counseling Centers presents “Behavior Therapy for the Difficult to Treat Client: DBT Tools and Skills for Therapists” taught by Melinda Carlisle Brackett, M.A., LMFT & Elisabeth Bellows, M.D., Psychiatrist, held on Saturday, October 26, 2018 from 9 a.m. – 4:30 p.m. at Calvary Church Los Gatos.

This course will introduce you to Dialectical Behavior Therapy, an empirically supported, comprehensive behavior therapy program with over 20 published randomized controlled clinical trials. Designed to treat multi-diagnostic, difficult-to-treat clients, we will look at applications of DBT and include a brief review of the current research on DBT adaptations as well as an important “dismantling study” conducted by Marsha Linehan, Ph.D., ABPP, treatment developer.

We will present an overview of DBT treatment goals and concepts, including the structure of a comprehensive DBT treatment program.  Providers new to DBT will learn how the comprehensive DBT program uniquely serves a specific type of client presenting with emotional and behavioral dysregulation. Dysregulation will be defined in behavioral terms to aid providers in accurate client assessments.  An intake protocol will be presented to teach providers when to refer clients to comprehensive DBT programs.  Participants will also learn how and when to use specific behavioral strategies and interventions without offering a comprehensive DBT program.

Many DBT trainings focus on theoretical concepts and programmatic considerations to assist therapists in starting DBT programs. However, many therapists choose not to offer comprehensive DBT programs due to the treatment complexity and the difficult client population. This training is specifically designed to teach stand-alone behavior therapy skills as well as DBT stylistic strategies.  Strategic use of behavioral interventions can transform an uncooperative client and a frustrated therapist to a genuinely collaborative alliance.

Course Objectives

  1. Participants will learn 8 steps for performing a behavioral analysis of a problematic therapy-interfering-behavior. The behavioral analysis will serve as the framework for understanding and learning the following DBT Skills from Marsha Linehan’s DBT Skills Training Manual. These skills are not just for clients but can also be used by the therapist to enhance in-session effectiveness, increase therapist authenticity, and prevent burnout. We will teach them experientially:
    • 3 Assumptions made by DBT therapist about their client (from the DBT Skills Training Manual):
      • Client is doing the best they can
      • All behavior is caused: the myth of manipulation
      • All clients want to improve
    • 4 Steps to Defining Problems Behaviorally
    • DBT Core Mindfulness “What” Skills: 8 steps to Observing and Describing client behavior and clinical situations
    • DBT Core Mindfulness “How” Skill: Non-judgmental Thinking
    • DBT Skill of “Validation” used by therapist
      • 4 key reasons to Validate that facilitate change
      • 6 step guide to Validation
    • DBT Skill of Radical Acceptance (of the therapist and the client) including how to practice the following:
      • 3 steps to practice willingness
      • 7 aspects of Willfulness that cause the therapist to be ineffective
      • Radical Acceptance step-by-step: 10 ways to practice
  2. The following behavior therapy skills are used to promote change so that the client can achieve their stated goals (from the DBT Skills Training Manual). Therapists can focus the session to increase the client’s ability to make progress.
    • How to shape a behavior (3 steps)
    • How the therapist provides reinforcement (3 types of reinforcement)
    • How the therapists coaches the client to set up the environment for reinforcement
    • How to do in-session rehearsal (5 steps) and troubleshooting (3 steps)
  3. We will also teach participants DBT Stylistic Strategies for the therapist (from the DBT Skills Training Manual). These strategies can be used to reorient difficult moments in session and keep the therapeutic progress on track.
    • How to be irreverent
    • Radical Genuineness
    • Paradoxical interventions (3 types)
  4. Putting it all together: Dialectics balances change vs. acceptance

Course meets the qualifcations for 6 hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences.

Christian Counseling Centers is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LCSWs, LPCCs, and/or LEPs (#64926). Christian Counseling Centers maintains responsibility for this program/course and its content.

About the Presenters

Melinda Carlisle Brackett, M.A., LMFT, DBT Therapist and Skills Trainer – Melinda is the Founder and President of San Jose DBT, the longest running full fidelity DBT Program in the south bay area- going on 14 years. She has received her advanced level intensive training from Marsha Linehan’s organization Behavioral Tech ( and the Treatment Implementation Collaborative ( Melinda runs a DBT consultation team and is a highly experienced Exposure Therapist utilizing ERP and Prolonged Exposure Therapy for Trauma. Melinda received her master’s degree from Mennonite Brethren Biblical Seminary as well as a certificate in mediation from the Center for Peacemaking and Conflict Studies in Fresno, CA. She completed her internship with Christian Counseling Center in San Mateo and welcomes the opportunity to help therapists and clients integrate their faith in this empirically supported treatment.

Elisabeth Bellows, M.D., Psychiatrist, DBT Therapist (Retired) – Since 2002, Dr. Bellows has specialized in the treatment of dual diagnosis conditions using DBT and other behavioral approaches. Dr. Bellows completed her residency at Stanford University Hospital and has extensive experience in offering comprehensive DBT as a therapist, skills trainer, psychiatrist, and team leader. Dr. Bellows is a Consulting Psychiatrist to San Jose DBT and she currently works as a staff psychiatrist for the Camden Center, a treatment center for psychiatric and addictive disorders.  Dr. Bellows believes that using DBT principles and skills can transform the therapist, as well as the patient.  With this goal in mind, Dr. Bellows creates experiential training workshops for medical and mental health providers who find themselves struggling with difficult-to-treat patients.

Course Schedule

8:30 a.m. – 9:00 a.m. Check-in
9:00 a.m. – 10:30 a.m. Session #1
10:30 a.m. – 10:45 a.m. Break
10:45 a.m. – 12:15 p.m. Session #2
12:15 p.m. – 1:15 p.m. Lunch
1:15 p.m. – 2:45 p.m. Session #3
2:45 p.m. – 3:00 p.m. Break
3:00 p.m. – 4:30 p.m. Session #4

Time spent on breaks (including meal breaks) are not offered for continuing education credit. Course completion certificates will be awarded when participants sign-in/sign-out sheet, course evaluation and self-evaluation forms are submitted at the end of the course.

Fees & Payment

The course fee can be paid by check only. Make the check out to Christian Counseling Centers, and mail it to:

CE Program Administrator
1510 Fashion Island Blvd., #110
San Mateo, CA 94404.

Please send payment the day you register.Refunds are only granted if a written cancellation notice is received by the program administrator at least 2 weeks prior to the date of the course.

Special Needs

All requests for accommodations for special needs can be submitted in writing to the program administrator. Upon receiving the written request, the program administrator will make every effort to accommodate the request. A written response from the program administrator will be sent within 2 weeks of receiving the request.


All complaints or grievances can be submitted in writing to the program administrator, and/or to the CEPA Program Coordinator. The program administrator will respond in writing to the complaint or grievance within one week of receiving the submission.



Registration is closed for this event.