Dialectical Behavior Therapy for a College Population: Applications at Sarah Lawrence College and Beyond

Abstract

Journal of College Student PsychotherapyPublication details, including instructions for authors and subscription information:Trends in college mental health literature suggest many college and university counseling centers are facing increased demands for services. Moreover, survey data suggest that counseling center directors and staff perceive increases in serious psychopathology, suicidality, and nonsuicidal self-injurious behavior, along with other typical student problems. At Sarah Lawrence College, a marked increase in the number of students hospitalized for psychiatric reasons, many meeting criteria for borderline personality disorder (BPD), required Health Services to rethink clinical service delivery, staff training, and resource allocation. Owing to its proven efficacy in the treatment of BPD, dialectical behavior therapy (DBT) was adapted at our setting. An overview of DBT is presented, followed by a brief history and a detailed description of the Sarah Lawrence College DBT Program, initial data on its impact for student retention and hospitalizations, and a discussion of the potential benefits of employing DBT with students in other collegiate settings. As one of few college counseling centers offering such treatment, the DBT Program at Sarah Lawrence College represents a promising model of treatment for college students with BPD.

Assessment and Treatment of Patients with Borderline Personality Disorder in the College and University Population

“…At Sarah Lawrence College beginning in 2009, the health service offered its own "in house" DBT program in response to a pattern noted in previous years of multiple hospitalizations and withdrawals from school, many involving students who met criteria for BPD (Engle et al, 2013). The program is notable for it flexibility in adapting DBT for the college campus setting by, for example, shortening the DBT skills group to fit with students' schedules, requiring a one semester (not one year) commitment, and ensuring continuity of care over vacations and summer breaks by referring students to home therapists.…”

Dialectical Behavior Therapy in College Counseling Centers: Current Literature and Implications for Practice

“…It can be successfully applied with college students in both standard and adapted formats (Chugani et al, 2013;Engle et al, 2013). Further, Pistorello and colleagues (2012) note that the dropout rate in their study was partially explained by clinical improvement; some students did not need to continue for the full treatment period.…”

“…Additionally, only one student in the DBT group left school on mental health/medical leave as compared with 13 students in the TAU group. Findings from both studies (Engle et al, 2013;Pistorello et al, 2012) offer preliminary support for the effectiveness of comprehensive college counseling center DBT programs as a means of treating suicidal, self-injuring students with BPD or BPD traits.…”

Treating Suicidality in College Counseling Centers: A Response to Polychronis

“…The students who may need comprehensive DBT constitute a small subset of suicidal students, who, on a campus setting, could continue to experience crises that could affect the whole campus community (Engle, Gadischkie, Roy, & Nunziato, 2013), such as writing a suicidal paper for a class or cutting in a public area, when not in effective treatment. The cost of comprehensive DBT for a short term may need to be gauged against the cost to the campus and the specific context of each CCC.…”

“…The cost of comprehensive DBT for a short term may need to be gauged against the cost to the campus and the specific context of each CCC. Those with a set session limit may not be able to implement comprehensive DBT, but those CCCs which are providing longer treatment, or “revolving door” treatment (a student receives brief dosages of treatment by different therapists; May, 1992), might want to explore the option of training their counselors in DBT and providing some of their students with comprehensive DBT (see Engle et al, 2013; Pistorello et al, 2012) as a specialty track (perhaps in conjunction with other student affairs departments, such as residence halls or disability resource services). The creation of a DBT specialty track could help contain the number of students who are treated at any one time and could help CCCs justify providing more sessions for students in that track.…”