Session 4 is used to plan this meeting if events have not required an earlier appointment (e.g., school is requiring prompt action by parents).

At a minimum, the therapist, the parent(s), and one school official should be present. This school official (e.g., school counselor, school social worker/psychologist, academic teacher, or administrator) serves as the point-person for the case. Ideally, a school representative who knows the youth best (e.g., an academic teacher or counselor) is also included. The goals for the school meeting LGK-974 cell line are to (a) establish a working relationship/collaboration with the school, (b) exchange information about the youth’s in-school and out-of-school patterns and efforts, (c) agree on goals for school re-integration, (d) identify school resources (staff availability,

study periods, counselor visits) and limits (maximum absences before severe consequences set in and nature of consequences), (e) incentives to use both in- and out-of-school, (f) to brainstorm ways to practice skills inside and outside of school, and (g) identify ways to track progress and find more provide feedback. Realistic expectations for school re-entry should be individualized and negotiated with parents and schools. Treatment seekers at our clinic tend to be chronic refusers who have missed over 20 school days or a substantial portion of days for several months or longer. Creating expectations for 100% attendance after two weeks may be unrealistic, especially when refusal behavior has recurred over several years. We tend to target 75%-80% attendance within 6-8 weeks. More acute, recent episodes of SR can be addressed more quickly. Such expectations need to be negotiated within the realities of school rules, but we have found that most schools welcome realistic goals, particularly when the only other option is to transfer the student to alternative schooling at great expense to the district. After the first four sessions, the manual takes a principles-based approach, wherein problem behaviors are functionally assessed and each DBT-A skill (mindfulness, emotion regulation, distress tolerance interpersonal effectiveness, walking

the middle path) can be used flexibly to address the most Meloxicam current concerns. The manual provides examples to help place each skill in the context of SR. The DBT target hierarchy guides therapists in structuring each session, such that life-threatening behaviors take precedence over therapy-interfering and quality-of-life interfering behaviors (Linehan, 1993a). Web-based Coaching (WBC) In standard DBT and DBT-A, the individual therapist is available to the client outside of therapy sessions via phone (or other methods, like texting or email) to provide coaching in DBT skills in “real world” situations. For DBT-SR, we extended this mode of treatment in two important ways: the medium (web-based) and the timing (early morning when SR behaviors are most prominent).