Emotion regulation pathway

You will first be offered an assessment with an ERP worker. The assessment will usually take place over 4 to 6 sessions and will work on understanding your difficulties and agreeing short and long term goals.

Following this assessment, the findings will be discussed with you and a programme of treatment will be discussed with you.

Some people may feel ready to engage with our treatment programmes, or an alternative option, immediately after completing their assessment.

However, some people may benefit from up to 12 weeks of socialisation. This time will be used to problem solve any difficulties about coming to group sessions or committing to change. 

Your ERP worker will work with you to set short- and long-term goals, agree a treatment contract about what to expect and what is expected of you, and develop a more in-depth safety plan to help you during difficult times.

In this stage, you will be offered weekly individual sessions as well as weekly group sessions. All our treatments require attendance at both group and individual sessions: both the individual and group aspects of treatment are crucial to change. The treatment stage usually lasts 6 to 12 months.  

For more information about the different treatments, see the sections about Structured Clinical Management and Dialectical Behaviour Therapy below.
 

In the ending or transitions stage, you will continue to have access to support from your worker over a six-month period but contacts will be less frequent.

You and your worker will review the skills you have developed, plan how you can maintain these in the future and explore the resources you will need.

Dialectical Behaviour Therapy (DBT) is one of the main treatments available within the Emotion Regulation Pathway.

DBT is a structured, evidence-based, treatment for people with Borderline Personality Disorder (BPD) or Emotionally Unstable Personality Disorder.  It was developed by Marsha Linehan, informed by her own experiences of these problems. It has been developed and researched over the last 30 years.

The main goals of DBT are:

• To stop self-harming behaviours and suicidal behaviours
• To remove any blocks to therapy
• To change behaviours that stop the person achieving a reasonable quality of life.

DBT therapists set treatment goals in a certain order. The therapy teaches coping skills to use at times of stress and distress. It teaches you more successful ways of reacting when you feel strong emotions.

In line with all Emotion Regulation Pathway interventions, there are four main stages: assessment, socialisation, treatment and transitions.

In the DBT treatment stage you will be offered attendance at a two-hour skills training group once a week. In the group you will learn skills that can help you deal more successfully with upsetting events. These skills include:

• Ways of increasing your awareness of what you are feeling and doing
• Ways of stopping yourself from acting in a harmful way when you have painful emotions and thoughts
• Ways of helping yourself to manage strong emotions
• Ways of improving your relationship with other people.

In DBT there is an expectation that you will practise skills between sessions, feeding back on your skills practice in group.

You will also be offered one-to-one sessions, and contact can be made between sessions if necessary. A genuine, accepting relationship between you and your therapist is essential.  Your therapist will work to make a strong and positive relationship with you from the start.

The main purpose of individual sessions will be to examine any upsetting events that have occurred in the past week and help you to find different ways of reacting to them. You will be asked to complete diary cards to monitor your progress.

Researchers have compared DBT with other psychological therapies. The results are better for those who have completed a DBT programme.

Many people say they have found the different parts of the programme very useful. They say:

• They have felt a lot of help and support from other members of the group
• The programme has helped them to deal better with many parts of their lives
• The programme has helped them to stop harming themselves.

Most people who complete the programme say that they feel stronger, more confident and have better control over their lives. They usually say they are having a better quality of life.

What is it actually like to be in therapy?

Here is a client’s description:

Structured Clinical Management (SCM) is one of the main treatments available within the Emotion Regulation Pathway.

SCM is a psychologically informed, evidence-based, systematic approach to help people address their personality and relational difficulties. It was developed by Professor Anthony Bateman and Professor Peter Fonagy at St Ann’s Hospital in London using the principles outlined within the 2009 NICE guidelines for recognition and management of borderline personality disorder.

SCM may be helpful if you have difficulties in the following areas:

• Managing your emotions
• Managing urges to act quickly (acting without thinking)
• Self-harm and suicidal thoughts
• Making and keeping healthy relationships.

SCM has a clear, reliable and consistent structure, to help you feel safe. SCM aims to develop a secure therapeutic relationship by the use of a curious, responsive, and optimistic therapeutic stance, and giving validation of mental states. Together you will then develop a shared understanding of your difficulties, establish a collaborative detailed crisis plan, set clearly focussed goals, and then use problem-solving practices to work towards these goals.

Despite its name, Structured Clinical Management is actually a more flexible approach than many other formal therapies, such as DBT. SCM can work better for people who find the highly structured nature of DBT with its expectations of intensive skills practice difficult.

In line with all Emotion Regulation Pathway interventions, there are four main stages: assessment, socialisation, treatment and transitions.

In the SCM treatment stage your SCM practitioner will also act as your care coordinator. Any contact you have with a psychiatrist will usually remain unchanged.

Your SCM practitioner will help you to develop further understanding of your difficulties and develop specific skills to solve problems and meet your goals. You will learn and practice skills in four key areas:

• Problem solving
• Tolerating and managing emotions
• Impulsivity, self-harm and suicidality
• Improving relationships.

At this stage, you will be offered weekly individual sessions as well as weekly group sessions.

Your practitioner will work with you to develop individualised understandings and solve any problems that come up. Through groups sessions you will learn new skills, learn solutions from others with similar problems, and practice problem-solving together.

SCM has been found to be as effective as other specialist treatments such as Dialectical Behavioural Therapy (DBT) and Mentalisation-Based Treatment (MBT) in helping people address their personality and relational difficulties. Emotion and mood regulation, managing urges and interpersonal problems and quality of life all improve with SCM treatment, and are usually maintained over time. There is evidence for SCM being particularly effective within the initial 6 months of treatment, and compared to more specialist treatments, it can be faster at reducing self-harm

Within Derbyshire our SCM service has been shown to lead to significant improvements in people’s quality of life, emotion dysregulation, and symptoms of borderline personality. People also had significantly fewer hospital admissions, spent less time in hospital and had fewer contacts with crisis teams following starting SCM.