The Decider: A Skills Manual is a 105-page ring bound book containing 32 CBT/DBT-informed healthy and effective coping and change skills using the 4 core skill sets of Distress Tolerance, Mindfulness, Emotion Regulation & Interpersonal Effectiveness. Each of the skills has its own photocopy-able Client Handout page and Clinician page which provides a detailed explanation for the clinician on how to teach and present the skill in ways that the client will really understand and want to start putting into practice (see example page below).
Each skill has a specific visual reminder which is depicted on ‘The Decider’.
The Decider: A Skills Manual is most effective when used with groups, when clinicians have the opportunity to be as creative as they like for the best possible effects! The manual is also designed to be used with individuals, and the client handouts pages can also be used for self help.
The group is designed to be delivered in a highly original and innovative way. It is future focussed and presented in a fun, creative and interactive style using demonstration, music and visuals to aid learning. The skills can also be used individually with clients.
We have found that we are now using the skills in our own personal lives - and they really do work!
All the skills come together in a laminated A4 sheet: 'The Decider'.
The Decider* is a pictorial reference card which summarises the 32 skills and is used by the client to help remind them of the skills they have learned.
The Decider: A Skills Manual is designed to be fun, creative, bright, positive, affirming, validating, effective, and potentially life-changing.
Whilst a comprehensive DBT service is recognised as the ideal, it is expensive and impractical for small or isolated services like ours to provide. ‘The Decider’ has enabled our service to fill that gap to some degree and may be a valuable initiative for other services.
‘The Decider and Skills Manual’ have the potential to be adapted for a range of service settings. ‘The Decider’ enables clinicians to introduce an effective 14 week Skills Group, staff who have been trained to use ‘The Decider’ also report an increase in their own clinical knowledge, skills and confidence.
‘The Lifejacket Metaphor’ is central to ‘The Decider’. The concept: that each skill helps to inflate the lifejacket. The client recognises when they are in a situation for which the use of skills could prove useful. They are able to use the skills if an ‘emotional emergency’ occurs. This enables the client to float rather than sink when it seems they are drowning in a sea of distressing emotion.
* It is not possible to use The Decider independently of the manual. The Decider is a pictorial reference card which summarises the 32 skills and is used by the client to help remind them of the skills they learn when attending The Decider Skills Group. The manual explains all the skills with client handouts and clinicians' guides on how to teach the skills. Some of the names of skills and pictures on The Decider will have little or no meaning without the backup of the manual. In that case it would then be left to individuals to interpret those skills in their own way, which will inevitably be much less effective. The Decider can only maintain its effectiveness and integrity when accompanied by the manual.
From the Introduction page:
In 2010, in response to service need, we introduced a new Skills Group to the adult mental health service in Guernsey. As a result of that initial pilot group we developed ‘The Decider’ and from that the Skills Manual.
The emphasis is on helping clients to deal with impulsive behaviours such as self harm, avoidance, withdrawal and isolation, aggression, substance misuse and binge eating. These behaviours are often associated with anxiety, depression, anger, addictions, eating disorders and personality disorders and can have devastating consequences.
The Decider summarises thirty-two cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT) informed skills under four core skill sets; the acceptance skills of distress tolerance and mindfulness and the change skills of emotion regulation and interpersonal effectiveness. The manual provides a client handout and a detailed explanation for the clinician for each skill. The Decider has the potential to be adapted for a range of service settings; adult mental health, child and adolescent, learning disability, substance misuse, prisons.
Michelle Ayres and Carol Vivyan