New women`s house at The Ranch meets clinical challenges with DBT

Among women in treatment for co-occurring addiction and mental health disorders, a subset likely will struggle with mood instability and emotional reactivity that could generate disruptive behaviors in the treatment setting. Leaders at Elements Behavioral Health believe that placing these individuals within a general treatment milieu will inevitably cause problems.

“If you don’t have a specific program for this disorder, your staff will become overwhelmed,” says David Sack, MD, Elements’ president and CEO.

Elements last month opened a new 14-bed facility for women in Nunnelly, Tenn., in a remodeled Southern mansion adjacent to its campus for The Ranch program. The teachings of Dialectical Behavior Therapy (DBT) serve as the cornerstone of the clinical approach for this facility.

For its female patients who show higher-than-average instability, “We needed a program organized around DBT principles, to manage this population more effectively,” Sack says.

Clinical program

The facilities operated by The Ranch specialize in working with individuals affected by a constellation of issues around addictions, mental health problems and trauma. Antisocial traits often complicate the picture for some male clients, while emotional instability and rejection sensitivity often interfere with prospects for a healthy recovery in women.

“They can perceive themselves as slighted or disrespected, and this becomes a significant impediment to creating the relationship needed to further recovery and progress in psychotherapy,” Sack says of the subset of women who are being targeted in the Mill House program.

Program staff members also can react poorly to trying to manage these cases in a larger treatment setting with other clients who don’t exhibit as much instability.

“If you don’t have a separate program, these clients are perceived as the ‘bad clients,’ who take time and attention away from the ‘good clients,’” Sack says. “The staff gets into the splitting activity.”

The Ranch therefore established a separate program for the more difficult-to-treat clients and located it at Mill House, but it did not create the initiative from scratch just last month. Sack explains that a year ago it had recruited clinicians to begin working specifically with this subpopulation well before the specialized program was created, so now those clinicians who are assigned to Mill House have had significant experience with these individuals.

Sack says that while residents at Mill House also will be exposed to interventions such as trauma-based treatment, DBT clearly constitutes the predominant therapeutic approach. It emphasizes core skills that allow patients to slow down their decision-making processes in order to avoid engaging in self-defeating behaviors.

Mill House residents receive DBT skills training groups four times a week, with the goal of teaching all DBT skills in only one month’s time. In addition, weekly mindfulness meditation groups allow for the practicing of skills, and each patient also gets a weekly DBT skills review.

Results encouraging

Sack said in early October that Mill House already was operating at capacity. Results from The Ranch’s prior work with this subpopulation indicate that treatment completion rates for this group are improving—an important factor considering that this population’s challenges often land these individuals in hospital placements because they end up not succeeding in less-intensive settings.

Mill House is one of seven houses operated by The Ranch in Tennessee; the organization presently is trying to centralize all of its gender-specific services for women at the campus. Other interventions being incorporated into the program at Mill House include cognitive-behavioral therapy, equine therapy and psychodrama.