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Dialectical Behavior Therapy: An Introduction to the Philosophy and Skills

Dialectical Behavior Therapy: An Introduction to the Philosophy and Skills

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Dialectical Behavior Therapy: An Introduction to the Philosophy and Skills

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

  2. 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

  3. 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

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

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

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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

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

  13. 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

  14. Distress tolerance Getting through the moment without making matters worse.

  15. 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

  16. Emotion regulation Not about changing or controlling our emotions- instead is about changing our reactions to emotions

  17. 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

  18. Interpersonal effectiveness Getting our needs met while respecting both ourselves and others.

  19. Questions

  20. 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)

  21. 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.

  22. 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)

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