This feature by Carla Chugani, PhD, LPC is Part 1 of 2 in a series about DBT with college students. Through this series, Carla will explore both the use of DBT in college counseling centers and bringing DBT skills to the masses with college coursework. In this first part, Carla begins by looking at offering DBT in college counseling centers.
It’s no secret that collegiate mental health has been a public health issue for quite some time. As a former counselor in a college counseling center, I am intimately aware of the challenges of meeting rising student demands for therapy with a small center of clinicians. Moreover, the acuity of students presenting for services can be extremely high. This can put college counseling centers in a difficult bind – especially in cases where few or no community resources are available, the counseling center must extend limits to support the student, but extending limits may mean practicing outside of the typical scope of services. These challenges have only been heightened by the COVID-19 pandemic, which has caused emotional stress for students as well as financial strain on institutions of higher education.
Given these challenges, an exciting trend in college counseling centers has been to increase the availability of evidence-based therapies for students, including the availability of DBT! DBT in college counseling centers can take a variety of different forms, but the most popular way to offer DBT on a college campus is to offer a skills training group. Skills training groups fit well into the existing practices of many college counseling centers where the focus is on offering a limited number of individual sessions per year, but unlimited access to groups. The research on skills training groups for college students is promising and shows that they can lead to clinically meaningful improvements. However, the research in this area is still somewhat nascent, and large-scale trials are needed. It is also important to note that it is very rare to offer a true “skills only” model. Most of the time, DBT is implemented to address serious presenting concerns and, as such, it is most often not appropriate to deliver group services without any individual follow-up or case management. In many cases, students who receive DBT skills training through their college counseling center are receiving some form of individual therapy, case management, and/or medication management. These services are usually not considered part of the DBT program, nor are they typically operating within the DBT framework.
Another model of offering DBT in college counseling centers is to offer the comprehensive DBT model (i.e., all four modes of treatment) with strategic adaptations. Anyone who works with college students (either on or off campus) knows that access to students is largely dictated by the academic calendar. Therefore, common adaptations to DBT that we might see on a college campus include structuring treatment contracts around the length of terms for the specific campus (e.g., 16-week semesters) and waiving the 4-miss rule when it is practical to do so, such as over summer break. These programs are also sometimes considered as a specialized service within the broader counseling center services with specific eligibility and exclusion criteria.
There are also models of offering DBT in college counseling centers that fall somewhere in between “skills only” or comprehensive DBT programs. For example, a counseling center might not have the resources to offer comprehensive DBT, but they can offer a skills training group, bi-weekly individual therapy, and telephone coaching during business hours only. Although it is important to keep in mind that these iterations of DBT fall outside the current research evidence and, as such, are best described as DBT-informed models, I have found that it is often a helpful starting point with a program. It may feel more realistic for the staff involved, with the understanding that as confidence and support grows, more training can be sought to expand the program into a comprehensive DBT program.
Whatever type of DBT or DBT-informed program is offered, my best piece of guidance is to think very critically about which students the program is intended to treat when you are structuring your program. If you are interested in offering DBT because you have many suicidal and self-injuring students presenting for treatment, but your center only has the resources to offer a “skills only” model, there is a clear mismatch between the population you want to treat and the program you are able to offer.
Finally, when operating outside of the standard DBT approach, you should always plan for how you will evaluate your program. Especially within institutions of higher education, you may be able to connect with students and faculty interested in helping you run a small study or conduct your program evaluation to help ensure that your DBT program is achieving the student outcomes that you intended.
Now that part 1 has set the stage for offering DBT in college counseling centers, read here for part 2 of this series, in which Carla will discuss making DBT skills available in college coursework.
Carla Chugani, PhD, LPC, is an Assistant Professor in the Department of Pediatrics, Division of Adolescent and Young Adult Medicine at the University of Pittsburgh and licensed professional counselor currently practicing DBT at Western Psychiatric Hospital, Pittsburgh, PA. Read Carla’s full bio here.