Congruent Counseling Services - Mental Health and Substance Abuse Care for Adults, Teens, and Children. Locations in Columbia, Eldersburg, Millersville, Olney, and Towson, Maryland. Angry man shouting into a cell phone


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Dialectic Behavioral Therapy (DBT) Informed Addictions Treatment

Who are we seeing?
Clients attending our DBT Informed Addictions Treatment Program may have a dual diagnosis of Addictions or Substance Use Disorder (SUD) and a Mental Health Disorder.  They might also be people who have struggled to achieve or maintain sobriety through standard SUD treatment models.  We offer DBT informed addictions treatment programs for three different age groups. Adolescent program is 15 to 20 while still living in their parents care. Young Adult program for folks between 20 and 27. Adult program is for those adults on their own after age 27.

What is DBT?
Dialectic Behavioral Therapy is a form of Cognitive Behavioral Therapy (CBT) that was originally created to work with people with persistent suicidal thoughts or Borderline Personality Disorder.  Many other symptoms or pieces of other mental health diagnoses are similar to BPD, have overlapping symptoms and respond very well to this treatment. It was originally created by Professor Marsha Linehan at University of Washington in Seattle. It is gaining momentum to treat a wide variety of disorders across the US and internationally. Here is an FAQ page about DBT from the founder of DBT (PDF).

Why add DBT to addictions treatment?
Unfortunately, many people seeking treatment for addictions relapse and need to attend multiple treatments or struggle to find a sober life style that works for them long term.  In many cases, this is because underlying mental health issues have not been addressed in standard addiction treatment.  In other cases, people (recovering addicts) are unable to "control" thoughts and impulses that lead to relapse.  DBT was designed to help people with persistent difficulty with negative, unhealthy thinking and behavior learn to recognize, change, and control that thinking and behavior.  Using four modules; Mindfulness, Interpersonal Effectiveness, Distress Tolerance, and Emotional Regulation, clients are able to learn new ways of dealing with triggers and ineffective life styles to make the changes for long-term recovery.  These combined programs can include up to 14 hours of treatment and groups a wSmiling familyeek.

Why do we provide ‘DBT Informed’ treatment?
The "informed" piece of our program is important in that it allows us to utilize different skills and training to meet the individual needs of our clients. We do not offer a one size fits all model.  The "Informed" portion of our program allows us to draw from multiple treatment modalities including 12 step and Rational Recovery in addition to Cognitive Behavioral Therapy (CBT), ACT (Acceptance and Commitment Therapy), Person Centered Therapy (Rogerian Therapy or PCT), and Individual Psychology (Adlerian Therapy). We are able to tailor our program to the needs of each of our unique clients and clients families.  All team members are well trained in the DBT model of treatment and the clinical therapists are all working on their individual certification, but also have the flexibility to choose, at times, other treatment models or components in order to meet the needs of the clients.

Why is DBT so difficult to get covered by insurance?
DBT treatment has many components of treatment that are not paid for by any health insurance at this time, including but not limited to skills training, phone sessions, parent coaching, crisis intervention, case coordination with schools and psychiatrists. At this time, no insurance is covering these services. Most DBT programs require out of pocket payment and do not bill insurance because of this challenge.

Why do I get charged by two different companies every month?
In order to get as much covered by insurance as we can, our DBT program straddles two companies. Congruent Counseling Services bills the insurance for the in-person office individual, Intensive Outpatient Program (IOP), or family therapy. Integrative Counseling holds no insurance contractsand manages the monthly subscription and services not covered by insurance.

What is the standard course of treatment?
Typically individuals who have multiple hospitalizations and several other failed treatment attempts require 3 to 6 months of the intense treatment (with the monthly subscription). After a period of time of not needing treatment in between sessions and no further dangerous episodes, they can step down to other levels of care that are less intensive and less costly. We know that the longer we keep people in care, even at a lower level, the better they do and the less likely they “relapse” into old behaviors. 

teen boyWhy are intakes so hard to get?
Because our team needs time to get to know each client and schedule the individual treatment sessions, the decision is to limit the intakes we complete each week into our program. While this makes intakes hard to come by, it insures that you have our attention as we get to know your family. We do those intakes during the day to insure that we can get all of your paperwork in order and into the hands of the team during our staff meeting on Wednesdays. We appreciate your flexibility and understanding of our admissions process.

Why are initial consultations not covered by insurance?
During the initial consultation we meet to talk about if you or your family member are appropriate for the program and allow time for discussion and questions.  Because DBT is an involved and time intensive program, we want to spend the time with you and your family to fully understand and agree to commit to treatment.

Our DBT program has three levels of care. They are different depending on the age group.

  • Level I - Intensive/Comprehensive: Individuals who have difficulties between sessions and difficulty calming down on their own. This level of care is supported by the monthly subscription that gives you access to care 7 days a week.  
  • Level II – Moderate: You can manage in between sessions and are making good use of individual and group treatment. This level of care is less intense without client being fully outpatient with only once a week treatment. 
  • Level III - Groups only: For most clients this will mean that their individual/family treatment is being handled outside of the DBT team, however, they are in need of skills group. This level gets access to all groups and once-a-month coordination with the individual therapist. This does not include on-call or in between crisis management. 
  • Level IV: Individual sessions only: This level is there for those clients who no longer need group skills or who choose to work the skills independently. This level is available to those people who want to continue to receive DBT therapy by a team member and who no longer have any of the high risk behaviors that would require more intense treatment. This therapy is provided under Integrative Counseling and is not billed through insurance.

How are we different from other programs?

We are a Dialectical Behavior Therapy (DBT)-informed treatment program offering services for individuals who have not found success in decreasing emotion dysregulation, impulse control, and self-harm behaviors with other modes of treatment. We draw from the work of Dr. Marsha Linehan and Dr. Lane Peterson, and offer the components of a DBT “program”. Many others offer groups that teach DBT skills that are not fully encompassing programs. Much of the learning, practice, and application is lost with just a group. We work hard to help our clients incorporate new skills, a new way of living, into their lives. Even individual and family therapy is done differently in a DBT Program. As noted above, those features important to making change, learning, and using DBT include:

  • DBT skills group twice a week
  • Individual therapy with a DBT-informed clinician once to twice a week
  • A parent or spouse/significant other group once a week where the parents/SO learn the skills that the clients are taught
  • Access to the 24-hour, seven-days-a-week on-call phone
  • Case management/Wrap around services
  • Weekly staff clinical supervision and consultation meetings - we constantly re direct treatment based on what our clients need
  • Homework given to each client to reinforce the skills taught in groups and in individual therapy
  • Most insurances accepted for a portion of the program

We also incorporate aspects of other treatment modalities, including cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), Adlerian Therapy, etc., while holding true to the core DBT principles and skills. The program at Integrative Counseling and Congruent Counseling is one of the only programs around that can incorporate our full DBT informed program and addiction treatment programs. This has been very effective for clients who cannot maintain clean time or who have dual diagnosis who have not been able to maintain a healthy life style.

Each of these components of our program is what makes us stand out from other groups, which may offer only one group a week or just individual therapy. We tailor the program to each client’s needs, hence the four levels of treatment noted above. We are also different because the individual and family therapy portion of the program can be covered in-network with most commercial insurance companies. No other program in the area offers this.

What are the expectations of family participation?
For Teens, expect parent participation in most sessions. Teens should not be coming by themselves. Most individual sessions will require a parent for at least a few minutes. Teens have an expectation of privacy for therapy. However, until they are safe and without episodes of suicidality and cutting (or other risky behaviors) the safety planning and treatment may occur with the adult in the room.  For adults living at home with parents, parents are also encouraged to participate in weekly sessions and in scheduled family sessions.  For adults living on their own, we encourage participation by spouses, significant others, or family members. 

For further information please call the front desk at 410-740-8066 and schedule a consultation.


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