Dialectical Behavior Therapy: An Introduction to the Philosophy and Skills Jancey Wickstrom, AM, LCSW Tweet us at #NASWIL

Overview Philosophy based treatment Overall goal: creating a meaningful life Skills are easily adaptable to variety of situations, abilities, and interests Helps a wide range of behaviors intended to regulate emotion Tweet us at #NASWIL

Dialectics Middle ground From either/or to both/and Black or White thinking to Black AND White thinking Emerged from repeated ineffective interventions Counteracts rigidity Tweet us at #NASWIL

Dialectic of DBT Acceptance Mindfulness Distress tolerance Change Emotion regulation Interpersonal effectiveness Tweet us at #NASWIL

DBT Framework Four components: –Skills training –Individual therapy –Telephone consultation –Consultation group Tweet us at #NASWIL

Consultation Agreements Dialectical Agreement Consultation to the Client Agreement Consistency Agreement Observing Limits Agreement Phenomenological Empathy Agreement Fallibility Agreement

Assumptions in DBT Clients are doing the best they can Clients want to improve Clients must do better, try harder and be more motivated to change Clients may not have caused their own problems but must solve them anyway Tweet us at #NASWIL

Assumptions in DBT (cont.) Clients’ lives are unbearable as they currently live Clients must learn new behaviors in all relevant contexts Clients cannot fail in therapy Therapists need support Tweet us at #NASWIL

DBT Principles People with problems regulating emotion have: –High sensitivity –High reactivity –Slow return to baseline Generally raised in invalidating environments. Tweet us at #NASWIL

DBT Principles (cont.) “Problematic” behaviors served a purpose at one point, but are now ineffective. Clients reward us for reinforcing old ways of living and punish us for doing DBT effectively. Only way to realize meaningful life is through practice and more practice. Tweet us at #NASWIL

Acceptance: Mindfulness Becoming aware of and present with our thoughts and emotions Differentiating ourselves from our thoughts and emotions- getting “unfused” Practicing controlling our attention NEVER about controlling our thoughts -- underlies every single aspect of DBT Tweet us at #NASWIL

Learning how to control your mind/attention so it does not control you. MINDFULNESS

Acceptance: Distress Tolerance Skills to help get through a crisis situation without making matters worse Not intended to help clients feel better Anything can help tolerate the moment Willingness vs. Willfulness Mindfulness: practice going back and back and back to skill being used Tweet us at #NASWIL

Getting through the moment without making matters worse. DISTRESS TOLERANCE

Change: Emotion Regulation Change our reaction to our emotions NOT changing/controlling emotions Learn to identify and use emotions as allies not enemies Mindfulness: Very skilled at distancing from emotions, must slow down and practice this skill Tweet us at #NASWIL

Not about changing or controlling our emotions- instead is about changing our reactions to emotions EMOTION REGULATION

Change: Interpersonal Effectiveness How to get along with others more effectively Helping clients get their needs met (make requests and say no) in a way respectful to both self and others “Manipulation” Mindfulness: being aware of reactions to others as well as what goals are Tweet us at #NASWIL

Getting our needs met while respecting both ourselves and others. INTERPERSONAL EFFECTIVENESS

Questions

Other Useful Resources Mindfulness resources: Jon Kabat-Zinn; Sharon Salzberg; Pema Chodron; Tich Nhat Hahn Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance (New Harbinger). McKay, Wood, Brantley (also available in teen version)

References Linehan, M. M. (1993). Cognitive- behavioral treatment of borderline personality disorder. New York, NY: Guilford Press. Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press. Holmes, Paul. Contextual behavioral approaches, personal communication. Emotion Management Program, Orland Park, IL.

Other Useful Resources Learning to Breathe: A Mindfulness Curriculum for Adolescents to Cultivate Emotion Regulation, Attention, and Performance. Patricia Broderick Don't Let Your Emotions Run Your Life: How Dialectical Behavior Therapy Can Put You in Control (New Harbinger). Spradlin (also available in teen version)

Thank you! Jancey Wickstrom, AM, LCSW Tweet us at #NASWIL