Therese is the only native Arkansan to complete Linehan Dialectical Behavior Therapy (DBT) Certification. She is a licensed clinical social worker in Arkansas, Louisiana, Washington State, Georgia, Colorado, Tennessee and tele-licensed in South Carolina. 

Therese is the only clinician in Arkansas and few in the world trained in DBT-SUD (Substance Use Disorder), Advanced Level 2 DBT-ED (Eating Disorder) Adults and Adolescents, DBT-Adolescent, DBT-Family (High Conflict Couple 4 Day Training), Advanced DBT-PE (Prolonged Exposure) for trauma, and DBT-PTSD (Post Traumatic Stress Disorder), RO (Radically Open) DBT Level 1, Level 2, Level 3 trained. 

In addition, Therese is a Certified Eating Disorder Specialist (CEDS) through the International Association of Eating Disorder Specialists. Therese specializes in trauma, personality disorders, and eating disorders with her practice in the Heights area of Little Rock.

Therese began her mindfulness training professionally through Marsha Lineahan's Empty Cloud Sangha with trainings in 2019 San Fransisco, 2022 Tuscon, and 2022 San Fransisco. To expand mindfulness training and be more effective with clients that had somatic impact from Trauma Therese branched into yoga to help with somatic healing during trauma treatment. 

Therese is the only Kundalini Research Institute (KRI) Level 1 Kundalini Certified Instructor in Arkansas. Therese began Kundalini training 220hr following completion of 500hr Yoga Alliance Registered Yoga Teacher Certification training. Therese’s initial teacher training was through Arkansas Yoga Collective. Completion of 200 hr basic yoga teacher training and 300 hr advanced yoga teacher training. KRI is internationally recognized as as the gold standard in Western Kundalini Training. 

DBT asks for a one year commitment for treatment. This is by the client and the clinician to determine commitment for treatment and healing.*

DBT is delivered in 4 stages:

Pretreatment Stage-During this stage (usually the first four sessions) a detailed history and assessment/diagnosis is done to assess compatibility  of the client with the therapist and DBT itself. Orientation to the DBT model, understanding of how DBT is delivered, requirements and responsibilities of client and/or family (adolescent) is done. There is no therapy given during the pre-treatment stage. Following pre-treatment a DBT case conceptualization is done for each client in adherence of the DBT Model. **Therese does not do consultations as the DBT model clearly allows for consultation during the first 4 sessions. 

Stage 1-Life threatening behaviors-addressing suicidal or significant self-harming behaviors, at times eating disorders are categorized in this stage of treatment to stabilize or make sure re-feeding is done successfully.

Stage 2-There are two main areas of treatment targets during Stage 2 DBT:

• Target 1-Therapy interfering behaviors-these are behaviors that interfere with successful treatment. Not attending appointments, cancelling, harrasing therapist, not taking prescribed medications, not doing homework, refusing to return communication etc...

• Target 2-Quality of life interfering behaviors. These can include financial stability, employment or school stability, housing, transportation, substance abuse/misuse, eating disorders, trauma, and any behaviors that get in the way of a life worth living

Stage 3-building a life worth living. At this stage (end of the one year commitment or before) this stage looks at how to take all the skills and continue to grow and expand awareness and enjoyment in the individual's life. 

*One year is not required for DBT skills training only or for clients referred for specialty treatment by other DBT providers during Stage 2 treatment-ie. DBTPE, DBTPTSD, or DBTED.

For more information on DBT and importance of Linehan Certified Clinician please visit:

https://dbt-lbc.org/consumers/

Therese's practice is adherent to the Linehan DBT Model. The intensive approach is not always appropriate for every presentation. It includes the following components:

• Individual psychotherapy-this happens once weekly to address the issues that are causing suffering in an individual's life

• Phone Coaching-this is to help the client integrate skills, regulate emotions, and learn effective behaviors outside of the therapy session. This is not 24/7 and it is not for "therapy"

• DBT Skills training-this allows clients to learn 4 key areas of skills to help expand and grow in ability to tolerate emotion and to learn effective behaviors

• DBT Consultation Group-this is a group of DBT clinicians that are intensively trained by Linehan in DBT that reviews practice and helps keep Therese adherent to the DBT protocol and model

DBT skills are individually taught at Wind River Therapy. A case conceptualization is done for each client and the specific skills needed are focused in adhering to Linehan's protocol. Focus on what skills are needed if trauma treatment is done are priority to move the client into Stage 2 and helping create relief from PTSD or trauma symptoms. Individualized skills training sessions are extremely productive and effective.

There are 4 areas of skills training:

• Mindfulness-DBT focuses on an awareness of the present moment (helpful with dissociation/avoidance/ADHD) and to notice the difference between emotional mind, reasonable mind, and how to act from an effective combination of both. DBT introduces how to reduce judgment and begins to integrate "fact checking"

• Distress Tolerance Skills-these skills are designed to help regulate the nervous system from the sympathetic nervous system reaction (fight/flight/freeze) to allow the parasympathetic (calming) to come in and decisions on behavior or reactions changed. Distress Tolerance Skills help stop immediate, impulsive, and ineffective reactions from taking place.

• Emotional Regulation Skills-these skills are designed to begin to identify what emotions an individual experiences, learning how to experience and not avoid (or dissociate), and tolerate emotions. They integrate mindfulness skills and learn how to check the facts to reduce ineffective behaviors and problem solve how to change life to long term have a life worth living.

• Interpersonal effectiveness skills-learning how to be effective in getting objectives met by others, preserving and maintaining relationships or ending destructive relationships, perserving and growing self-respect with every interaction with others. 

Electronic version of diary cards are used daily with Therese. This gives the opportunity to monitor progress or areas of concern out of session to make individual psychotherapy sessions more effective. Diary cards are an essential way to collect data to identify needed areas of target within the individual session. Each week a behavior to decrease is set and a behavior to increase that both the client and Therese focuses on for growth. Mood is monitored, adherence to medication management if needed, urge to self-harm, suicidal urges, body pain, and for ED clients-ED behaviors are monitored. This is the beginning form of mindfulness of current states and of each individual's life. A typical DBT indivdual psychotherapy begins with review of diary card and agenda set for the session. 

Therese has been trained directly by DBTPE (Prolonged Exposure) developer and is advanced trained in DBTPE. She expanded her initial training with supervision directly from Dr. Melanie Harned. In addtion, Therese is trained in DBTPTSD, a specified treatment for complex PTSD (chronic is DSM5TR) that expands the exposure treatment to encompass integrating the DBT skills further. Trauma is treated during DBT Stage 2 treatment. 

Therese completed the rigorous certification process by IAEDP that took 2 years. Eating disorders and trauma go hand in hand. Therese did not have adequately trained clinicians initially locally to refer clients that had ED presentations. The training took place through IAEDP and Therese's supervisor was out of Atlanta, GA from a psychodynamic perspective. Therese continues to keep up ED training with attendance at the IAEDP conference once every other year.  If eating disorders are not life threatening, ED is addressed during Stage 2 treatment for both DBT and RODBT protocols.

To learn more on the importance of ED treatment with a CEDS please visit:

https://iaedpfoundation.com/about-us/

Therese was trained by Alan Fruzetti in his DBT High Conflict Couples/Family Model in his advanced 4 day training. This model integrates an assessment of communication styles along with behaviors and skills deficits to help couples reduce immediate reactivity, understand the prompting events for behaviors, and get to the underlying causes of issues in a relationship. This is the same model that is used with families including adolescents. DBT is a behavior based therapy. Focusing initially on the behavior and helping individuals learn effective behaviors to facilitate strong bonds and relationships helps to then expand to the thoughts and emotions that go along with ineffective behaviors.  At times, couples may also need individual therapy to make couples therapy more effective. During pre-treatment stage, this assessment as well as referals or plans for individual healing will be made. 

Therese is trained by Rauthaus and Miller, the original developers of DBT Adolescent model. Therese is adherent to this model. Adolescent DBT is intensive with both the family system being taught DBT skills alongside the adolescent. Family sessions are integrated as needed and individual psychotherapy is done weekly. This requires a commitment on the part of the parent(s)/guardian(s) not just the adolescent. Depending on the age of the adolescent the DBT Skills training manual or the DBT Adolescent Skills trianing manual is used. If parent presentation is in need of therapy as well, a referal will be made to appropriate resources to help in facilitating healing in the adolescent. 

What are the components of outpatient RO DBT?

Outpatient RO DBT is comprised of four components delivered over an average of 30 weeks. The first three components are specific to patients with the final component specific to the RO DBT therapist. Specifically, the components are:

1) Weekly individual therapy 

2) Weekly skills training class 

3) Telephone consultation 

4) Therapist participation in RO DBT consultation meetings 

How is RO DBT different from other psychotherapies?

RO DBT differs from other psychotherapies in several ways, but the most fundamental distinctions between RO DBT and all other treatments is that RO DBT is the first treatment to prioritize social-signaling as the primary mechanism of change. This is based on research showing that overcontrolled individuals have a heightened bio-temperamental threat sensitivity that makes it more difficult for them to enter into their neurobiologically based social-safety system. When individuals feel safe, they naturally experience a desire to explore and flexibly communicate with others. To address this difficulty, RO DBT teaches clients how to express emotions in a context-appropriate way and to use non-verbal social-signaling strategies to enhance social connectedness. It also teaches skills that activate areas of the brain associated with the social-safety system. Finally, radical openness involves skills for actively seeking one’s “personal unknown” in order to learn from a constantly changing environment.

How is RO DBT different from standard DBT?

Radically Open Dialectical Behavior Therapy and standard Dialectical Behavior Therapy share a similar name because they both emphasize their common roots in dialectics and behavior therapy. Although they share this common ancestry, they differ in several substantive ways. Understanding their differences is important because the similarities in their names can lead to the misperception that they are substantially alike or even the same treatment.

-RODBT Fact Sheet, Radically Open.Net

To learn more about RO DBT, please visit http://www.radicallyopen.net/.

Please send an email to:

tskinner@windrivertherapyservices.com

or

Text:

501-454-5697

Emails or texts will be returned at the end of business day or as soon as able.

BCBS is the only insurance Therese accepts. All other insurances a "superbill" will be issued for each individual to submit for reimbursement if eligible. 

All communication is done via text or email, orientating the client to means of "phone coaching" from the initial contact. Therese is a solo practioner and has a protocol for phone coaching. Therese does not provide emergency interventions if there is an urge to harm yourself or others, please dial 911.