Some therapists use engagement strategies in pre-treatment, but also throughout the year, when behaviors such as life-threatening behaviors, threats of treatment actions, or apparent resistance to the implementation of new change procedures arise. All patients begin pre-treatment. Then, the individual therapist discusses the DBT agreements and assesses the motivation for the engagement. People involved in DBT must be voluntary. The DBT expressly prohibits any involuntary processing. Thus, if the treatment is not voluntary, the patient should have the opportunity to choose another non-DBT treatment. Thus, in DBT, there are patient agreements and therapist agreements. These can be oral, but are written and returned optimally if they are needed in the future. Some of these strategies are the devil`s advocate technique, in which the therapist pleads for the site that he does not commit to treatment.
This helps to strengthen the patient`s sense of choice and autonomy. Until the patient and therapist agree on how the treatment will proceed, methods and goals, the patient is not involved in DBT, but is in pre-treatment. As a rule, pre-treatment should not last more than three sessions, during which a typical assessment is no different from any other form of psychotherapy. The agreements are reviewed and the therapist begins to implement the engagement strategies in order to strengthen the patient`s engagement in the treatment. Binding strategies are therefore not something that is done simply at the beginning of treatment. This is something a therapist would always resort to if engagement seems to fluctuate, if an episode of self-injury has occurred, if a patient`s thirst for suicide has intensified, and if they are considering eventually discontinuing treatment. The way the therapist returns to these may vary depending on the style. You can remove written obligations or simply refer to the oral obligation to work on therapeutic or life-threatening behaviors by saying something like “but you promised at first that you would not stop treatment.” As soon as the therapist and the patient agree on how the therapy will proceed and the therapist assesses that there is appropriate commitment and that the treatment is voluntary, we can move on to stage 1 of DBT. .