Dialectical Behavior Therapy - University of Daytonacademic.udayton.edu/CatherineLutz/Indivi… ·...
Transcript of Dialectical Behavior Therapy - University of Daytonacademic.udayton.edu/CatherineLutz/Indivi… ·...
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Dialectical Behavior Therapy
Borderline Personality Borderline Personality DisorderDisorder
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General OverviewGeneral Overview• Marsha Linehan (1993).– Recommended readings.
• Orientation combines systemic/transactional approach, CBT, Buddhism, and principles of Dialectics.
• Developed for use with persons with BPD, but has also been applied to suicidal behavior in adolescents and bulimia.
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“Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”--Marsha Linehan
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Linehan’s Theory of the Linehan’s Theory of the Development of BPDDevelopment of BPD• Based on a bio-social theory of BPD.
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The Dialectical Dilemma of The Dialectical Dilemma of Person’s with BPDPerson’s with BPD• Inappropriate blame of
other vs. In appropriate blame of self.
• Inhibited grieving vs. Unrelenting crisis.
• Active passivity vs. Apparent competence.
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Therapists’ Working Therapists’ Working Assumptions about the ClientAssumptions about the Client1) The client wants to change, and despite
appearances, is trying his/her best as a particular time.
2) His/Her behavior pattern is understandable given his/her background and present circumstances.
3) In spite of this, he/she needs to try harder if things are to improve.
4) Clients can not fail at DBT.
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Therapists’ Dialectical StyleTherapists’ Dialectical Style• Reciprocal communication vs.
Irreverent communication.– Accepting of the client as he/she is, but
encouraging change.
– Centered and firm, yet flexible when the circumstances require it.
–Nurturing, but benevolently demanding.
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Clients’ and Therapists’ Clients’ and Therapists’ AgreementsAgreements• To work in therapy for a specified period of
time, and to attend the majority of therapy session.
• If suicidal or para-suicidal behaviors are present, he/she must agree to work on reducing these.
• To work on therapy interfering behaviors.
• To attend skills training.
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Modes of TreatmentModes of Treatment1. Individual therapy.
2. Group skills training.
3. Telephone contact.
4. Therapist consultation.
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Skills TrainingSkills Training1. Core mindfulness skills.
2. Interpersonal effectiveness.
3. Emotion modulation skills.
4. Distress tolerance skills.
http://www.dbtselfhelp.com/html/dbt_skills__defined_.htmlhttp://www.behavioraltech.com/index.cfm
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Individual TherapyIndividual Therapy• Stages of therapy.
• Hierarchy of therapy targets.
• Treatment strategies.
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Stages of TherapyStages of Therapy• Pre-treatment.
• Stage 1: focus on suicidal behaviors and therapy interfering behaviors.
• Stage 2: focus on PTSD related problems.
• Stage 3: focus on self-esteem and individual treatment goals.
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Hierarchy of Therapy Hierarchy of Therapy Targets Targets • Decreasing suicidal behaviors.
• Decreasing therapy interfering behaviors.
• Decreasing behaviors that interfere with quality of life.
• Increasing behavioral skills.
• Decreasing behaviors related to post-traumatic stress.
• Improving self-esteem.
• Individual targets negotiated with the client.
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Treatment StrategiesTreatment Strategies• Contingency management.
• Cognitive therapy.
• Exposure based therapies.
• Pharmacotherapy.
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Recommended ReadingsRecommended Readings• Dimeff et al. (2007). Dialectical Behavior Therapy in Clinical
Practice: Applications across Disorders and Settings.
• Linehan (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder.
• McKay et al. (2007). Dialectical Behavior Therapy Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance .
• Moonshine (2008). Dialectical Behavior Therapy Volume 2 - Companion Worksheets.