Structuring the environment

Structuring the environment refers to both the treatment and non-treatment environments of clients. In terms of the latter, clients often live in environments that provide insufficient structure, support and validation. Additionally, these environments may reinforce inappropriate behaviours and punish more skilful behaviours. In some adaptations of the treatment, DBT therapists work alongside family members or social-care staff, assisting them in modifying their own behaviour to promote the sustainability of changes that clients are making. For example, in DBT-A, an adapted form of the treatment for adolescents, parents attend skills training groups along with their adolescent children (Rathus & Miller, 2015). Dedicated family sessions may also take place to address specific problematic family interactions (Miller at al., 2007). Adult clients may also benefit from similar involvement from family members but such interventions rarely form a routine part of the intervention (Fruzzetti et al., 2007; Rajalin et al., 2009).

In terms of structuring the treatment itself, delivering a five- function programme requires a degree of coordination within the system hosting the DBT programme. For example, all programmes need to initially acquire and subsequently maintain resources to deliver the programme and attend to the interaction or fit between the programme and the wider treatment system. Chapter 13 discusses this aspect of the treatment more fully.

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