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Q&A

DBT with Individuals Adjudicated Not Guilty by Reason of Insanity (NGRI)

DBT with Individuals Adjudicated Not Guilty by Reason of Insanity (NGRI)

Expert on DBT in criminal justice and forensic settings Robin McCann explains how DBT can be adapted for people with multiple diagnoses and violent histories.

Q
How do you deal with not liking a client?
A

Hard to help someone you don't like, right?
DBT has a mode to address this concern: DBT Team Consult. DBT Team Consult treats the DBT therapist; hence this is the perfect setting to request help increasing empathy for a client or their family, thereby likely decreasing dislike for a client or their family.

Q
Hi Robin, Im wondering if you use a certain "protocol" or "skills manual" adapted for persons found NGRI given the common and significant cognitive impairments found in this population?
A

More than two decades ago we rewrote the 1993 DBT Skills handouts to address our concerns regarding problem solving deficits and (lack of) gender neutrality. The second edition of the DBT Skills Manual and handouts have addressed these concerns. Specifically ER Handout 8 (Check the Facts) and ER Handout 12 (Problem Solving) help to address problem solving deficits. As an adjunct treatment, we have also (intermittently) provided the Reasoning and Rehabilitation Program which more specifically targets problem solving (Fabiano et al, 1991 in Corrections Today).

Q
If a person has anti-social personality disorder then how can we treat them with DBT and how effective is it in this case?
A

To date, I am unaware of randomized studies addressing DBT effectiveness with individuals diagnosed with antisocial personality disorder. There are several nonrandomized studies addressing DBT effectiveness with correctional populations (Moore et al. 2018 in Psychological Services, Shelton et al. 2011 in J. Child Adolescent Psychiatric Nursing) suggesting increased adaptive coping and decreased physical aggression, blaming, and disciplinary tickets.

Q
Does the type of crime that was committed play a large role in determining the way forward with DBT?
A

Short answer is no.
What does determine "the way forward" is the risk assessment: clients' specific risk factors and their level of risk.

Q
What aspects of DBT are particularly helpful when working with individuals with violent histories?
A

DBT Team Consult, especially maintaining the Phenomenological Empathy Agreement. Your DBT Program is as strong as your DBT Team Consult.
For help with your DBT Team Consult, see Sayrs & Linehan (2019), DBT Teams: Development and Practice, NY: Guilford.

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