Wednesday, August 13, 2008

An Illustration of DBT

Linehan, M.M. (1998). An Illustration of Dialectical Behavior Therapy. In Session: Psychotherapy in Practice, 4, 2, 21-44.

In addition to providing illustrative transcripts from dialectical behavior therapy (DBT) sessions, the bulk of the read, this paper also summarizes DBT's theoretical perspective, its various treatment stages and targets, as well as treatment strategies. DBT was developed to treat clients meeting criteria for borderline personality disorder (BPD) whose behavioral patterns are commonly problematic and stressful for clients and therapists alike, not the least of which is suicidality. DBT theorizes that BPD individuals lack interpersonal, self-regulation, and distress-tolerance skills, and what skills they do possess are often undermined by behaviors which block the use of the capabilities the client does have. As such, outcomes are typically unpredictable, even for patients who resist the tempting urge to quit and remain in treatment.

DBT recommends splitting up therapy into different stages, each with unique goals. In Stage I, treatment tries to achieve self-control, with control over one's suicidal behaviors being most important. In Stage II, clients try to experience emotions without resistance and to form and maintain connections to people, places, and activities, even if they are somehow associated with past trauma. Stage III focuses on reducing residual problematic patterns that interfere with clients achieving other important goals. When successful, Stage IV achieves a lasting sense of completeness and the capacity for sustained joy.

DBT's treatment strategies include: (1) dialectical strategies which combine acceptance with change, synthesize opposites, and move the client from "either-or" thinking to "both-and" thinking; (2) core strategies of client validation and problem-solving; (3) communication strategies which balance warm responsiveness to the client's wishes with irreverence; and (4) case management strategies which help the therapist tackle the difficult problems of suicidality with team support and aim to ultimately teach the client how to effectively interact with their world, rather than teaching the environment how to interact with them.

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