Service Overviews

Dialectical Behavior Theory

Dialectical Behavior Theory (DBT) is a treatment approach that combines individual therapy and classroom instruction to help people learn to manage and regulate intense emotions and extreme mood swings. DBT helps people reduce impulsivity and/or self-destructive behaviors, and cultivate a meaningful life. The skills and principles taught in DBT improve quality of life, parenting effectiveness, and communication and satisfaction in key relationships for most people.  Although originally designed to address the issues of Borderline Personality Disorder (BPD), DBT can be helpful to a wide range of people who would like to more effectively regulate their emotional reactions and behaviors, and directly influence and change their central nervous system’s responses.

If you would like more detailed information about DBT philosophy, principles and curriculum, please visit the BTech website. Unless otherwise stated, Clearwater teaches the adult curriculum developed by Marsha Linehan, PhD and the adolescent curriculum developed by Alec Miller, PhD. We hold skills classes for Young Adults (post-high school but prior to establishing an independent life structure) using the adult curriculum.  We also hold weekly two-hour Consultation Team Meetings, an essential component of comprehensive DBT treatment as stipulated by Dr. Linehan. All DBT therapists at Clearwater have been intensively trained in DBT through Behavioral Tech, Dr. Linehan’s training organization.  Most have a strong background in mindfulness, and have a personal practice that is part of their professional commitment.

Teen with Parent/Legal Guardian Classes

  • Distress Tolerance

    • Mondays 6:15-7:45 pm December 9, 2024 – Feb 3, 2025 In Person
    • Wednesdays 6:15-7:45 pm December 11, 2024 – Feb 5, 2025 In Person

  • Walking The Middle Path

    • Mondays 6:15-7:45 pm February 10 – March 24, 2025 In Person
    • Wednesdays 6:15-7:45 pm February 12 – March 26, 2025 In Person

  • Interpersonal Effectiveness

    • Mondays 6:15-7:45 pm April 7 – May 12, 2025 In Person
    • Wednesdays 6:15-7:45 pm April 9 – May 14, 2025 In Person

  • Emotional Regulation

    • Mondays 6:15-7:45 pm May 19, 2025 – June 30, 2025 In Person
    • Wednesdays 6:15-7:45 pm May 21, 2025 – July 2, 2025 In Person

There are no DBT classes July 1-August 15th.  Our new fall program begins August 8, 2025.

Parent/Legal Guardian Classes

  • Distress Tolerance

    • Thursdays 5:30-7 pm December 12, 2024 – February 6, 2025 Zoom

  • Walking The Middle Path

    • Thursdays 5:30-7 pm February 13, 2025 – March 27, 2025 Zoom

  • Interpersonal Effectiveness

    • Thursdays 5:30-7 pm April 10 – May 15, 2025 Zoom

Young Adult Classes

  • Interpersonal Effectiveness

    • Wednesdays 4-5:30 pm November 13, 2024 – January 22, 2025 In Person

  • Distress Tolerance

    • Wednesdays 4-5:30 pm February 5, 2024 – March 26, 2025 In Person

Adult Classes

  • Emotional Regulation

    • Mondays 10-11:45 am January 6 – March 10, 2025 In Person
    • Tuesdays 6:15-8 pm January 7 – March 11, 2025 Zoom

  • Interpersonal Effectiveness

    • Mondays 10-11:45 am March 24 – May 19, 2025 In Person
    • Tuesdays 6:15-8 pm March 25 – May 20, 2025 Zoom

Description of DBT Cohorts

Our Teen DBT Program

  • Comprehensive DBT includes the following components: 
    • Weekly individual therapy for the teen
    • Parent coaching sessions: Ongoing frequency is determined after 2-3 initial parent sessions
    • Phone coaching 7 days/week for teens and parents
    • Weekly DBT Skills Class for teens and parents
    • Weekly consultation group for all therapists on the DBT team.
  • DBT Skills Class Only 
    • As an alternative to our Comprehensive DBT program, we open class enrollment to teens and parents who are meeting regularly with a mental health provider outside of Clearwater. We ask that this provider actively supports this adjunctive DBT intervention.
      All interested in this option will need to participate in a pre-enrollment 50-minute intake appointment with the skills class instructor. The fee for this intake appointment is $250. We do not contract with insurance companies. We will provide participants with a superbill at the end of each module to submit for an out-of-network reimbursement

Overview of DBT Skills Classes: 

  • Skills classes for teens and their parents are formatted as a family intervention. The teen and one parent takes the class together as equal participants in the learning environment. The ratio in class is balanced equally between parents and teens. Co-parents can enroll in one of our weekly parent-only skills training classes. Classes meet weekly in a group setting with other families. The curriculum is divided into four 6-week modules. It is strongly encouraged that families complete the entire 24-week curriculum at least once, consistent with clinical research recommendations for optimal results. The four modules are briefly summarized below:
    • Distress Tolerance: Crisis coping skills for high emotional distress
    • Emotion Regulation: Skills to increase emotional resilience, effective problem solving, and exposure techniques
    • Interpersonal Effectiveness: Increasing relationship effectiveness, self-advocacy, and skillful requesting
    • Middle Path: Skills to improve understanding, validation and communication within the family.
      • Core DBT Mindfulness Skills are woven into each module

Our DBT Skills classes fill up very quickly. If you interested in enrollment in an upcoming module, please submit an online inquiry right away. Our enrollment process (i.e., initial inquiry, paperwork completion, intake appointment, enrollment confirmation) can take up to 3 weeks. Please plan accordingly to provide enough time for all steps. 

Our Adult DBT Program

  • Comprehensive DBT includes the following components: 
    • Weekly individual therapy
    • Phone coaching 7 days/week
    • Weekly DBT Skills Class
    • Weekly consultation group for all therapists on the DBT team
  • DBT Skills Class Only 
    • As an alternative to our Comprehensive DBT program, we open class enrollment to adults who are meeting regularly with a mental health provider outside of Clearwater. We ask that this provider actively supports this adjunctive DBT intervention. All adults interested in this option will need to participate in a pre-enrollment 50-minute intake appointment with the skills class instructor. The fee for this intake appointment is $250. We do not contract with insurance companies. We will provide participants with an invoice at the end of each module to submit for an out-of-network reimbursement.

Overview of DBT Skills Classes: 

  • DBT Skills Classes meet weekly. The curriculum is divided into three 8-week modules. It is strongly encouraged that adults complete the entire 24-week curriculum at least once, consistent with clinical research recommendations for optimal results. Class has a maximum of 13 participants. The three modules are briefly summarized below:
    • Distress Tolerance: Crisis coping skills for high emotional distress
    • Emotion Regulation: Skills to increase emotional resilience, effective problem solving, and exposure techniques
    • Interpersonal Effectiveness: Increasing relationship effectiveness, self-advocacy, and skillful requesting
      • Core DBT Mindfulness Skills are woven into each module

Our DBT Skills classes fill up very quickly. If you interested in enrollment in an upcoming module, please submit an online inquiry right away. Our enrollment process (i.e., initial inquiry, paperwork completion, intake appointment, enrollment confirmation) can take up to 3 weeks. Please plan accordingly to provide enough time for all steps. 

DBT skills classes for parents/legal guardians follows the same 24-week curriculum as our standard teen/parent classes. It is intended for parents or legal guardians who want to learn the skills being taught to their family members in our teen/parent classes, or parents who have clinical or logistical reasons to be in a different skills class than their teen, or whose teen is in treatment elsewhere (i.e., residential, hospital-based programs, or wilderness). Enrollment is open to new participants at 6-week intervals.
All interested in this option will need to participate in a pre-enrollment 50-minute intake appointment with the skills class instructor. The fee for this intake appointment is $250. We do not contract with insurance companies. We will provide participants with a superbill at the end of each module to submit for an out-of-network reimbursement.

Our DBT Skills classes fill up very quickly. If you interested in enrollment in an upcoming module, please submit an online inquiry right away. Our enrollment process (i.e., initial inquiry, paperwork completion, intake appointment, enrollment confirmation) can take up to 3 weeks. Please plan accordingly to provide enough time for all steps. 

Clearwater has developed a DBT-informed child curriculum called CAMMP (Clearwater’s Affect Management and Mindfulness Program for kids) that teaches children some of the DBT skills that are useful in managing strong emotion and learning to direct attention.  Derived from the adolescent materials developed by Alec Miller, and including materials found useful in working with ADHD children, the emphasis is on mindfulness, basic distress tolerance, and age-appropriate social skills (including managing teasing and bullying).

Individual DBT informed therapy incorporating the CAMMP curriculum is offered for children between the ages of 8 and 10.  We help children apply DBT skills using simplified systems for monitoring behavior change with the goals of helping pre-teens learn about emotion regulation, and  improve control of their attention and behavior.   We use the CAMMP curriculum in the individual therapy to introduce concepts and even do homework that involves practicing skills.

For children in this age group to change in therapy, it is imperative that the parents be involved.  If parents are already getting parenting help from another therapist, we would ask that their therapist coordinate care with Clearwater.  If parents are not involved in therapy that addresses parenting issues elsewhere, we do require that parents participate with a therapist at Clearwater. We offer individualized parent coaching, where parents can meet one-on-one with a therapist and investigate how to effectively apply DBT skills to the particular difficulties they are facing with their child.

Clearwater is not primarily a research institution, and unlike the curriculums that have been developed and researched within academic or hospital settings, our curriculum has not been empirically validated.

Psychological and Educational Evaluations

Testing is used to answer a whole host of diagnostic and functional questions about people of all ages. It can clarify why school or work failure is occurring; who is gifted; what school or testing accommodations should be available for students; what are the individual’s strengths; what is the most appropriate diagnosis; and why emotional problems persist despite therapy and/or other mental health interventions. Often, when there are many possible reasons for persistent learning and functional difficulties, testing will be the quickest and most precise way to understand what is going wrong and what will help.

Psychological and educational testing is the administration of a series of cognitive, psychosocial, projective, memory, and academic tasks designed to reveal in detail the resources, strengths, and relative weaknesses of the person being tested.  Psychiatric diagnoses can be clarified through testing, and often cognitive and educational testing are required before institutions like schools will provide appropriate accommodations and services.  At Clearwater, we recognize that assessments can serve multiple purposes, and we attempt to be flexible in our approach and tailor the testing to the referral question(s).

Frequently used tests include the various Wechsler instruments (WAIS, WISC, etc.) for assessing overall cognitive abilities; the WIAT, GORT and Nelson-Denny for academic assessment; the WRAML for evaluating memory; and the TOVA and TEACH for looking at attentional issues.  Personality assessment typically includes the Rorschach, an apperception test, self-report questionnaires, and occasionally the MMPI.  Neuropsychological screening may include tests like the Delis-Kaplan Executive Function System, the NEPSY, and the Wisconsin Card Sort.   At Clearwater, every client tested is given an individually tailored battery of tests designed to answer their specific questions, and illuminate their individual strengths and weaknesses.

Whenever possible, Clearwater utilizes a collaborative assessment model during assessments, titrating feedback to clients throughout the testing process, and writing reports that are user-friendly and not unnecessarily full of jargon.  Although a full collaborative assessment can be more costly than a standard evaluation, it may decrease the time spent in therapy after assessment, and therefore can often prove a sound investment of time and resources.

Jocelin Saks, Ph.D., is the Director of the assessment clinic, and she will personally respond to all inquiries about services at Clearwater.