Dialectical Behavior Therapy: (DBT) Philosophy and Applications

DBT Clientele Attributes Unbalanced interpersonal relationships Unstable self-image Impulsivity Recurring suicidal or self-harming behavior Mood instability Perfectionism Attachment / abandonment issues Borderline traits

DBT Incorporates: Dialectics Zen tradition Cognitive behavioral therapy

DBT Philosophy Dialectical Worldview Interconnectedness Opposing forces. Thesis – Antithesis – Synthesis – Thesis – Etc. Walking the middle path. Change is constant. Example: Cutting relieves emotional pain versus health implications and dangers= Finding healthy ways to relieve emotional pain.

Choose the Dialectical Statement People hate me / everyone thinks I am the coolest / some people enjoy being around me and others do not. I can’t do anything right / I have strengths and things I am learning / I have it all figured out There are things I like and dislike about others/ I hate them / They are so perfect

DBT Philosophy Zen Tradition Mindfulness Wide mind Non-judgmental stance Observing Acceptance as a balance to change Irreverence versus warmth Radical acceptance Example: Clients may not have caused all of their own problems, AND they have to solve them anyway. Tao Te Ching: So it is that existence and non-existence give birth the one to (the idea of) the other; that difficulty and ease produce the one (the idea of) the other;

DBT Filosophy Cognitive Behavioral Therapy Thoughts, feelings, behaviors. Eliminate negative secondary gains. Example: Crisis call to therapist after self-harming, therapist will ensure 911 is called and call will end. Behavior skills training. Example of Dear Man

Mindfulness Activity What Skills: How Skills: Observe: Pay attention to what is Non-Judgmentally: See and do not going on around you. 5 senses. evaluate. Do not judge your judging. Describe: Use words to say what Stay Focused: Do one thing at a time, you are observing. let go of distraction, concentrate. Participate: Enter the experience Do What Works: Act skillfully, play by fully. the rules, let go of feelings that hurt you. Balance Rational and Emotional. Ex: Often rationalizing with someone in an emotional stated is very ineffective.

Biosocial Theory of BPD Emotional vulnerability Invalidating environments. Biological issues. One cannot ignore the 75% prevalence of sexual abuse among those diagnosed with BPD. Some kids are Orchids versus Dandelions in terms of resilience and vulnerability. Some kids are an 8 pack of crayons versus a 64 pack in terms of emotional intensity and complexity.

DBT Therapy Assumptions Clients are doing the best they can. Clients want to improve. Clients need to do better, try harder, and be more motivated to change. Clients must learn new behaviors in all relevant contexts. Clients cannot fail in DBT. Clients may not have caused all their problems, and they have to solve them anyway. The lives of suicidal BPD clients are unbearable as they are currently being lived.

Modes of DBT Individual Therapy Individual therapist is main contact. Commitment to program and safety Eliminate life threatening and therapy-interfering behaviors. Improve quality of life. PTSD treatment, application of skills, and self concept development. Processing is to take place in individual therapy.

Links and Chains Mad Lib Relates to LRBI Manual ABC Observation form in Behavioral Intervention Plans.

Modes of DBT Group Skills Training In parallel with individual therapy – skills focus. Core mindfulness Interpersonal effectiveness Emotional regulation Distress tolerance Walking the middle path

Interpersonal Effectiveness Activity Validation Exercise

Modes of DBT Telephone Consultation Individual therapist contact. Support and assistance with skills before crisis. Clear limits and boundaries.

Distress Tolerance Activities Radical Acceptance Ice Pros and Cons of unhealthy behavior

Modes of DBT Therapist Consultation Meeting Weekly meetings Team acquires skills Provides support Integrates DBT philosophy Plans treatment for clients.

Emotional Regulation Activity Rope Challenge

DBT at Children’s Outpatient 16 weeks of skills group. No more than 2 client absences. Open ended with entry dates every 4 weeks. Mandatory guardian and client attendance. Staff supervision one hour weekly. YOQ monitoring. 2 hours of group and family/individual session weekly. Broadened client symptomology.

References Linehan, M. (1993a). Cognitive- behavioral treatment of borderline personality disorder. New York, NY: The Guilford Press Linehan, M. (1993b). Skills training manual for treating borderline personality disorder. New York, NY: The Guilford Press