The young woman is thinking about cutting herself, harming herself, so she texts her therapist at CenterPointe.
She’s had another fight with her boyfriend, and he has called her names.
Often after these fights she thinks, “I will feel better if I cut on my arm.”
And the self-harming behavior also means she gets the attention of her boyfriend and family members, said Shala Hartmann, outpatient clinical program director at CenterPointe. So there is both an emotional and logical connection to the self-harming thoughts and behavior.
The therapist calls the woman back, and in a telephone coaching session the two discuss what happened, what she is feeling at the moment, and strategies the young woman has practiced in therapy to move beyond those thoughts – strategies that can help her feel better and get the attention of her family.
She can calmly assert her needs, telling her boyfriend, “I want you to stop calling me names, then I’ll come back inside.” Or she can go to the gym and work out, clearing her mind, and giving her time to calm down and think of other options.
In a later therapy session, the counselor and individual will process the incident, including what happened, the emotions involved and what skills worked or didn’t work. This is all part of DBT (dialectical behavior therapy) that CenterPointe counselors have been using with some of the people they counsel for seven years.
CenterPointe staff members are now developing a DBT-based intensive outpatient program for youth in crises, children with suicidal behavior, aggression, substance abuse, relationship issues.
There are few local options for these youth with difficult behavior issues.
Almost 1,000 of the 1,770 youth who went to Lincoln emergency rooms during a recent 12-month period did not meet the criteria for admission, said Ryan Paul Carruthers, CenterPointe director of clinical operations.
“What happens to these youth? That is the million-dollar question,” said Carruthers. Parents are left to fend for themselves.
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The state Medicaid program withdrew its financial support for youth residential programs about a decade ago, and local agencies could not afford to maintain those programs, said Carruthers.
Except for Boys Town, there are no nearby residential programs for youth with substance abuse and mental health issues, said Michelle Nelson, chief clinical officer for CenterPointe.
CenterPointe’s new adolescent and family DBT program, an intensive outpatient program, will help address this gap, said Topher Hansen, CenterPointe CEO.
DBT, developed in the 1970s to treat borderline personality disorders, uses mindfulness (paying attention to the moment) and cognitive behavioral therapy to help people increase self-awareness, control self-defeating thoughts, modify thinking and handle conflict and stress. It helps people work through trauma, said Hansen.
DBT is an intensive program that includes learning and practicing skills, often in a group setting, then using those skills in real-life situations. It also includes phone coaching with the counselor during a crisis, said Hartmann.
And research shows DBT works well with youth, said Carruthers.
CenterPointe staff will be teaching some of the DBT coping skills to a group of Lincoln High students this school year. The students will learn mindfulness, focusing on calming the mind. They will learn how to better communicate with others, how to cope with stress and how to manage extreme emotions, said Hartmann.
CenterPointe staff and some counselors in other Lincoln agencies completed adolescent and family DBT program training in July, with help from a Lincoln Community Foundation grant.
CenterPointe staff members are now setting up an intensive outpatient program for youth and families, and looking for grant money to help offset the costs, said Hansen.
DBT really emphasizes the individual. Everyone’s situation is totally unique; there is no cookie-cutter treatment plan, especially with youth and their family dynamics, said Carruthers.