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CAMHS Dialectical Behaviour Therapy Service

How our service can help you

We are a national service specialising in the assessment and treatment of severe emotion dysregulation and related problems including self-harm and suicidal behaviours/ideation.

Our primary intervention is a comprehensive Dialectical Behaviour Therapy (DBT) programme, which is based on the evidence-based model as adapted for working with young people and their families and carers.

  • Service Type: Child and Adolescent Mental Health Services (National and Specialist) Service Borough Covers: National (Child and Adolescent services) Treatment type: Outpatient
  • Contact the service

    Site Location: Maudsley Hospital Email: DBTServiceCAMHS@slam.nhs.uk Fax Number: 020 3228 2749
  • Disabled Access:

    Yes

  • Address: Michael Rutter Centre
    Maudsley Hospital
    De Crespigny Park,
    London,
    SE5 8AZ
  • Business Hours/Visiting Hours:

    24 hours a day, 7 days a week.

  • Other essential information

  • Conditions: Conduct disorder, Depression, Personality disorders, Post-traumatic stress disorder (PTSD), Self-harm

More Info

Our primary intervention is a comprehensive Dialectical Behaviour Therapy (DBT) programme, which is based on the evidence-based model as adapted for working with young people and their families and carers. All of our therapists have completed an accredited intensive training in DBT. Our programme includes:

  • Weekly individual sessions with a DBT therapist
  • Weekly group skills training for the young person
  • Weekly group skills training for parents/ carers
  • Telephone coaching for skills support (offered Monday to Friday, 9am-5pm, for young people and parents/carers)
  • Family work and parent/carer sessions as required
  • Medication reviews for young people or expert psychiatry consultation to referring teams as required

Where sufficient progress is made in the treatment of the core problems of high-risk behaviours and emotion dysregulation, and when needed, we can also provide treatments for PTSD (Dialectical Behaviour Therapy-Prolonged Exposure) and for addressing historic ruptures in family relationships that may be contributing to a young person’s continuing distress (Attachment-Based Family Therapy).

As a national and specialist service, we have an active research and service evaluation programme, as we are dedicated to increasing knowledge and understanding of the problems we treat, contributing to the evidence-base for DBT and other therapies, and improving experiences and outcomes for the young people and families we serve.

We recognise that many disadvantaged and minority groups struggle to access the supports and treatments they need and may have experienced stigma and discrimination. We are committed to providing a welcoming, inclusive and affirmative experience for anyone who accesses the service.

Interventions

  • Dialectical Behaviour Therapy (DBT)

  • DBT – Prolonged Exposure (DBT-PE) for PTSD

  • Attachment Based Family Therapy (ABFT)

  • Psychopharmacology

Eligibility criteria

Young people of any culture, gender identity and sexual orientation

Young people aged 13 to 17 years. The age limit for referrals is 17 years and 2 months

Symptoms/behaviours associated with emotion dysregulation and related problems such as self-harm/suicidality

Two or more episodes of self-harm or high-risk behaviour in the past six months

Exclusion

Substance dependence (not misuse)

Presence of another psychiatric disorder or health problem requiring more urgent assessment or treatment

Previous exclusion from the DBT Service within the last three months

Outcomes

Analysis of our clinical outcome data over the past six years suggests that by the end of our DBT programme young people, on average, experience:

  • a reduction in self-reported emotion dysregulation and related problems
  • a reduction in depression and anxiety symptoms, and overall mental health difficulties
  • a marked reduction in self-harm and suicidal behaviours
  • a decrease in the use of psychiatric inpatient admissions and A&E attendances
  • an increase in effective coping behaviours
  • increased engagement in work/education/training

Training and Consultation Services

We offer a variety of training courses and consultation services for individuals, mental health services and other agencies supporting young people with emotion dysregulation, self-harm and related difficulties, and their parents or carers. These are primarily provided by our in-house training team, however, we periodically host training events with international presenters. Check our website for any upcoming events.

Training

We can provide a range of teaching and training events to meet your organisation’s requirements.

Our packages and topics include

  • Dialectical behaviour therapy (DBT) skills for clinicians
  • Assessment and treatment of Self-Harm and Suicidal Behaviours
  • Emotion Regulation
  • DBT skills for parents
  • DBT skills for carers of looked after children
  • DBT-informed crisis telephone support
  • DBT-informed psychiatry with complex, high-risk cases
  • Developing a DBT service in a CAMHS setting


We can also tailor courses to your organisation’s needs and we are happy to discuss these with you in advance if a more bespoke package is required.

All of our training events are provided by experts in the field of self-harm and child and adolescent mental health. Our team of trainers are all experienced CAMHS clinicians, DBT therapists, and dedicated practitioners and teachers of effective, evidence-based interventions.

We ensure that our training events provide a learning environment that is active, interesting and experiential with an emphasis on skills development for participants.

We do not provide accredited, intensive DBT training as provided by British Isles DBT Training.

Feedback from our workshops:

  • “Super effective…helped solidify my DBT skills”
  • “Interactive…engaging…the trainers have clear passion and knowledge for the topic”
  • “I would 100% recommend this course to a colleague”
  • “Great training…really creative and informative”

Consultation and supervision

Our clinicians are experienced in supporting the development and effectiveness of other services.

We provide consultation and supervision to assist with the setting up of new DBT services and to support the ongoing effectiveness of these programmes.

We also offer consultation and supervision to CAMHS teams, schools and third sector agencies to support their effective working with young people who self-harm and their parents or carers.
 

Examples of specific consultation services we can provide include:

  • Joining teams’ DBT consultation meetings to help promote effectiveness and adherence to the DBT model – this can be at a frequency according to the teams needs
  • Attending meetings to support complex case formulation and intervention planning
  • Ongoing clinical supervision post-DBT training to support the implementation and development of clinicians’ DBT skills and competencies (for individual therapy and/or DBT skills groups)
  • Consultation to newer DBT services in the earlier stages of development to assist with service planning and design

If you are interested in any of our training or consultation services and would like some further information please contact Dr Andre Morris (Principal Clinical Psychologist/Training and Consultation Lead) on 020 3228 2749 or  andre.morris@slam.nhs.uk.

Eileen's Story

Eileen’s story (Charlie’s mother)


“We didn’t see he had any particular problems.”

He was a good little boy and really popular with people and the other children at school. Though, I do remember him being sensitive if he hurt himself in some way.

He’s 16 years old now. His sister is five years younger than him and she had cancer at the age of two-and-a-half, which meant Charlie had to go and stay with his friends a lot. He coped though. When I asked him recently if he thought what happened had an effect on him, he said he didn’t think so.

In secondary school he had his first serious girlfriend and after six to nine months they both decided to end the relationship. I remember thinking they dealt with it really sensitively, but two months later he asked if he could talk to me about something.

 

“He told me he’d started getting bad feelings in his chest.”

He felt worthless, he felt that no one liked him, and he didn’t see any kind of future for himself. I was so sad about what he’d told me and couldn’t help but think that it was something I’d done. His dad had been working a lot and I wondered if I’d leant on him too much. It tore me apart that he felt like that.

 

“Charlie has always been very clever, but he was finding it difficult to concentrate at school.”

He had to drum his fingers on the desk or dig his pen into his hand to stay focused. He also had a new girlfriend who lived next door to us and that made him want to stay off school. He was quite obsessed really – he’d agree. When he heard her through the wall, he said it upset him because he wasn’t with her. He got quite unkempt in his appearance actually because he wanted to be around there all the time.

Then, that relationship also ended suddenly. From being with her all the time, one day he said ‘I just don’t love her anymore’ and cut his feelings off completely.

 

“He said he didn’t feel safe at school.”

His school attendance had dropped to around 50 per cent and he said he didn’t feel safe there. He’d started to hear a voice in his head that told him to hurt people, so he was really worried he might harm someone.

 

“It got to the stage where he used to come into my bedroom late at night when I was on my own to talk about his feelings.”

He self-harmed to distract himself from how bad he felt, and in the end I used to dread going to bed – though I felt bad about that. It made me so sad that I couldn’t make him better.

In theory, one night he also took an overdose, though luckily they weren’t really the kind of tablets that would have a fatal effect. I’ve asked him ‘did you really want to die?’ and he said that at that moment he did.

We’d already been referred to child and adolescent mental health services (CAMHS) and there was a psychologist at school and a school liaison officer, who were both very good. But the doctors felt the voice in his head should be investigated further so Charlie, his dad and I went to a psychiatry appointment, where he was referred onto the Dialectical Behaviour Therapy Service at the Maudsley.

DBT [dialectical behaviour therapy] works well because it’s about trying to deal with the emotions. So, rather than drowning in emotions or not feeling emotions at all, it’s about tolerating them.

 

“Charlie is now 10 weeks in on the programme and I think it’s already helped him hugely.”

He’s still not fully letting the emotions in, but I feel like I can talk to him more, and I’ve spoken to a lot of mums who have said the programme really works.

 

“He’s with people who understand.”

What’s really helped him is not being on his own with what he’s going through. He’s with people who understand much more than his dad and I can. He says it’s brilliant having others to talk to who have gone through the same things. He also gets on well with his DBT therapist.

I remember Charlie wanting to watch the film 'Shaun of the Dead' when he was a bit younger. He ended up hating the film because of all the gory parts and had to hide his eyes at certain bits. Since becoming ill, he is having those kinds of gory thoughts himself, about harming people. It’s horrible for him and he can’t just cover his eyes. But we can now talk about these kinds of things. We’ve spoken about the people who write these films – that it’s OK to have these thoughts, you just don’t put them into action.

 

“I can see the difference in me as well as him.”

We have a parents’ skills group, where we’re taught the same things as they are in their group. It’s been so useful because we’ve learnt about managing emotions, tolerating stress when you’re in situations in which you can’t walk away, and normal and exaggerated responses. It’s helped me to understand Charlie.

At first, I couldn’t think of anything worse than involving myself in things like role-plays. I also didn’t think my husband would want to take part in the activities, but he’s said it’s been really good.

At times it’s really destroyed me to see Charlie feeling so sad and hopeless. I wanted to go into things in detail to sort things out, but now I understand I don’t have to solve everything myself.

 

“I want him to be happy and not frightened about how he feels.”

He’s a lovely person and I hope that he’ll meet someone where he can manage the emotions well. I so want him to be happy and not be frightened about how he feels.

Charlie said he couldn’t see a future for himself before, but he’s trying now. His teachers at school have also been good. They were worried because they like him as a pupil, but in the past months they’ve said he’s really come a long way.

He really looks forward to his individual and group sessions. Even when it’s half-term he still wants to go.

Case Studies

Charlie’s story (Eileen’s son)


“I do really enjoy it. It’s useful.”

I was sceptical about the programme at first and thought ‘what if it makes me worse?’, but I do really enjoy it. It’s useful and the skills are quite helpful.

We all have different problems, so my individual therapy sessions are personal to me. I value them highly because it’s a chance to spill out all my feelings without feeling guilty. They’re there to listen and my therapist has become one of the most trusted people in my life.

In the sessions, I tell him what’s been going on, he asks me more to get to the root of it, and then we come up with techniques that help.

 

“One technique is particularly good: mindfulness.”

Sometimes I feel the other young people in the group aren’t particularly sensitive to how I am, but I like all of them and it’s always helpful to know I’m not the only one going through certain things. The focus is on what goes through our heads in certain situations. Hearing what others are thinking in these situations is helpful; then we speak about the techniques that can help us deal with them.

Some techniques work better than others, but one particularly helpful one for me is mindfulness. If you don’t know what mindfulness is, it’s about being in the moment. It teaches you to try and step back in a situation, to look at your emotions and try to separate yourself from them – to look at why you’re feeling what you’re feeling. It depends on the situation, but it usually helps me to cope with my emotions better.

 

“When the programme’s run its course, I should be better.”

My aim is to learn to cope well with my emotions, whereas they’ve always got the better of me before. Part of me doesn’t want the programme to end because I’ve really taken to it. When the programme has run its course though, I should be better.

I really didn’t want to do it at first. I hated talking to other people, especially in group situations, but after the first week I could tell it was a caring service. I’d really recommend the programme to others. I’d say, just try it out.

Our experts

Dr Katrina Hunt, Consultant Clinical Psychologist - Read more

Dr Sacha Guglani, Consultant Child & Adolescent Psychiatrist - Read More

Dr André Morris, Consultant Clinical Psychologist - Read more

Helen Wilde, Principal Systemic Psychotherapist - Read more

Dr Keren Smith, Principal Clinical Psychologist - Read more

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