Compass Treatment Modalities

A psychiatrist or psychiatric nurse practitioner may recommend and prescribe medication as a part of treatment. After performing an initial psychiatric assessment, a psychiatrist or nurse practitioner may order laboratory tests or imaging to rule out other underlying medical conditions leading to symptom presentation or obtain baseline values that will be monitored during medication treatment. The goal is always to maximize benefits and minimize risks and side effects from prescribed medication. Suppose a psychiatrist or nurse practitioner prescribes medication. In that case, a thorough discussion of the medication dosing, length of treatment, side effects, benefits, and risks should be discussed with the patient (and parents/guardians if the patient is a minor), and informed consent should be obtained. The psychiatrist and nurse practitioner will continue to assess for tolerability and benefits on subsequent visits. If the patient has been working with an outpatient prescriber, the Compass psychiatrist will coordinate care with the outpatient team within the bounds of releases of information signed by the patient.

Group therapy includes one or two group facilitators and a cohort of participants (typically between 4 – 16 people in the space). The number and make-up of participants in each group may depend upon program census, type/content of group, and various other factors. The group therapy space is developed to be a confidential and supportive milieu in which participants can learn and practice coping skills and discuss topics to build insight and actively move towards identified treatment goals. Group members are encouraged to validate and relate to each other and engage with therapists to discuss and process skill integration, emotions, and thought processes that influence specific behaviors and share about current struggles and successes.

Group therapy at Compass Health Center focuses on building awareness around behavioral goals, learning and practicing evidenced-based skills, and using a confidential space to process relevant and relatable topics with peers. Group facilitators guide understanding related to skills and topics linked to ACT, DBT, and CBT while connecting these topics to treatment objectives and skill application and integration in the home, school, and work settings. Groups may be didactic, psychoeducational, interpersonal/process, or experiential and often employ multiple techniques to increase engagement and impact.

Individual therapy is dedicated time for therapists and patients to meet 1:1 in a confidential space. This time is used to develop and reflect upon treatment goals. The therapist and patient form a trusted partnership to process and build awareness around positive patterns and those that may interfere with a patient’s wellness goals. Patterns identified as unhelpful and ineffective are acknowledged, while more effective options are discussed and practiced inside the therapeutic setting and encouraged in the patient’s home environment. The therapist often follows up on homework assignments and navigates support around skill-building and healthy coping options.

Individual therapy at Compass Health Center is part of the multidisciplinary approach to care. All patients will receive individual therapy sessions, the focus, frequency, and length determined collaboratively between the patient and primary therapist based on each patient’s unique goals and needs. Individual sessions utilize CBT, DBT, and ACT approaches on a more granular level, supporting patients in making steps toward their treatment goals and having a space to process individually. The Primary Therapist will follow up on assigned homework, monitor progress toward treatment objectives and engage in case management related to outpatient support and discharge planning. The primary therapist will coordinate care with a client’s outpatient therapist within the bounds of any releases of information.

Family therapy occurs between a therapist and all or some family members. It is often focused on exploring the dynamics within a family, improving communication, resolving conflict, and helping families live more harmoniously. Supporting families in family therapy to integrate evidence-based skills as a family and as individuals can be incredibly impactful. Skills can help family members feel more connected with one another and empower them to manage stressors in the family system. At times, the therapist might want to meet with individuals alone to prepare for sessions with the whole family system; however, most of the treatment is provided with families together.

At Compass, family therapy is an essential part of our treatment model. Ensuring our patients and their loved ones feel informed, supported, and engaged in the treatment process and practicing evidence-based skills is a top priority. Our dedicated family therapists work closely with patients to identify who should participate in family therapy sessions and to create a focus for those sessions to best support their goals at Compass.

Couples therapy occurs between a person and their partner(s), led by a therapist. Couples therapy focuses on strengthening relationships through improving communication, connection, support, and interpersonal awareness. This type of therapy can also help address struggles and conflicts between the partners. The quality of a person’s relationships dramatically impacts their overall well-being. Integrating evidence-based skills can be especially useful in couples therapy as it empowers all partners to cope more effectively as individuals and, therefore, with their partners. Sometimes, the therapist might want to meet with individuals to prepare for sessions with one another; however, the bulk of the treatment is provided to the couple as a unit.

At Compass, engaging patients’ partners in couples therapy is often critical in supporting our patients and their partners in navigating the treatment process. We want partners to feel informed and engaged and to feel empowered to support the practice of evidence-based skills and treatment progress. Our dedicated couples and family therapists work closely with patients to identify who should participate in couples therapy sessions and to create a focus for those sessions to best support their goals at Compass.

Coping skills are tools to help individuals effectively manage difficult, distressing, and/or intense experiences. These tools can support people in sitting with what is coming up inside them (thoughts, feelings, urges, physical reactions), navigating interactions with the world around them, and choosing meaningful next steps supporting their goals and values. Evidence-based modalities like CBT, DBT, and ACT offer research-supported tools to help people cope as effectively as possible. CBT teaches skills to help notice, identify, challenge, and reframe unhelpful thoughts and offers strategies for creating change by shifting thinking patterns and behaviors. DBT teaches skills to help balance acceptance and change and tools that support the ability to tolerate distress, communicate successfully, regulate emotions, and practice mindfulness. ACT skills help to be present, open up, and do what matters, taking committed action toward values even when things are tough.

DBT is an evidence-based model of treatment designed by Dr. Marsha Linehan to help patients build meaningful lives and improve their ability to regulate emotions. DBT guides patients through identifying patterns in thinking, behavior, emotions, and interpersonal interactions that contribute to problems in living. Once identified, the goal is to change these patterns using coping skills. The “D” in DBT refers to dialectics, the presence or co-occurrence of two seemingly contradictory or opposing concepts simultaneously. DBT centers on the dialectic of acceptance and change and encourages individuals to walk the middle path between the two, working to balance acceptance (“I’m doing the best I can,” “this is how things are right now”) and change (“I need to try different for things to be different”). DBT comprises four central tenets to help people accept and change: Mindfulness, Distress Tolerance, Interpersonal Effectiveness, and Emotion Regulation.

Mindfulness is a term used in various ways based on setting and context. DBT defines Mindfulness as “the act of consciously focusing the mind in the present moment without judgment and attachment to the moment.” Mindfulness is active—it is something all people can engage in, actively choose to do, and can develop into practice with repeated effort. Most Mindfulness activities and tools, including the DBT Mindfulness skills, are adapted from cultural and spiritual traditions like meditation and breathwork. DBT Mindfulness skills help individuals practice being fully present in the moment, tuning in to what is happening inside and around them, and moving forward aligned with inner wisdom.

Citation: Page 39 of Linehan, M. M. (2015) DBT Skills Training: Handouts and Worksheets (2nd ed. The Guilford Press.)

Distress tolerance refers to sitting with experiences of distress (distressing thoughts, emotions, urges, and/or physiological responses). In DBT, distress tolerance refers to specific skills designed to help individuals navigate crisis moments as effectively as possible. These skills focus on guiding individuals through radically accepting the situation as it is and, at the same time, working to change what they can. DBT Distress Tolerance skills support individuals in skillfully moving through distressing realities without increasing their suffering.

Emotion regulation refers to adjusting or modulating one’s emotions. The phrase “Emotion Regulation” is a DBT term that denotes a set of skills designed to help individuals both increase resilience to intense emotions and decrease suffering related to emotions. These skills are not designed to “eliminate” or “avoid” emotions, but rather to help individuals identify and express emotions, alter their responses to their emotions, shift the emotions they are experiencing and/or the intensity of their emotions, and navigate difficult to sit with emotions safely and effectively.

Interpersonal effectiveness refers to constructive communication. The phrase “Interpersonal Effectiveness” is a DBT term that denotes a set of skills designed to help individuals manage challenging situations, validate the emotions and experience of self and others, improve and maintain current connections, and create new meaningful relationships. Interpersonal Effectiveness skills offer concrete guidance and support around balancing acceptance and change within relationships, asserting wants and needs in effective ways that maintain the relationship, and navigating complex situations in values-aligned ways.

ACT is an evidence-based therapeutic model that combines behavior modification interventions with specific types of acceptance and mindfulness exercises. ACT aims to change a person’s relationship with their own troubling thoughts, whether it is ruminating on past mistakes, focusing on potential threats in the future, or feeling overwhelmed by traumatic memories. In changing how a person thinks about and responds to these troubling thoughts, that person frees themselves up to live a value-based, rich, full, and meaningful life. Since there is no manualized protocol for ACT, Compass adapts tools to meet patients and groups where they are at in their treatment journey. These tools assist patients in making room for their emotional experiences and to have space to focus on identifying and doing what is most important to them.

ERP is one of the most effective treatments for Obsessive Compulsive Disorder (OCD) and other complex anxiety diagnoses, including Illness Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, and other anxiety disorders. Patients gradually confront their feared object or situation in a hierarchical, prolonged, and planned manner. By doing so, patients learn to gain mastery over their anxiety and fears.

CPT addresses “stuck points” (trauma-centered cognitive distortions) via applying cognitive-behavioral techniques, such as Socratic dialogue, challenging questions, and collaborative identification of common thinking errors. These interventions aid patients’ trauma recovery processes, allowing for more flexible thinking and the development of new, balanced beliefs.

Motivational Interviewing is a therapeutic technique that helps individuals bridge the gap between their current behavioral choices and their identified goals. The four tenets of Motivational Interviewing (MI) are facilitating engagement, focusing on goals, evoking awareness and motivation, and planning for reasonable steps to move toward helpful goals. Open-ended questions, validation, reflective listening, and summarizing are helpful tools to guide these steps.

Art therapy is a specific type of experiential therapy that engages individuals in art-making and creative expression to explore internal experiences, build insight, and learn and apply skills related to treatment goals. Art therapy is a therapeutic intervention led by professionally trained art therapists with specific educational and practical experiences. At Compass, art therapy is integrated into programming in age-specific, values-aligned, and skills-focused ways.

Executive functioning skills are mental skills that allow a person to organize, plan, and follow instructions, think flexibly, and demonstrate impulse control. These skills are utilized daily as individuals prioritize tasks, achieve goals, and learn. Executive function challenges can make it hard to focus, follow directions, and regulate emotions. Executive function skills are learned; patients benefit from modeling and explicit teaching.