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L6 Dialectical Behavioral Therapy.docx

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Neil Rector

L6 Reading Linehan Dialectical Behavioral TherapyMainly for Borderline Personality Disorderoutpatient treatment for personality disordered and chronically suicidal individuals but has been increasingly applied to a host of other complex disorders such as deliberate selfinjury substance dependence and eating disordersDBT blends skills training and crisis intervention methods drawn from behavior therapies with acceptance and mindfulness drawn from meditation practicesDBT addresses the dialecticthe apparent contradiction between opposing forcesof changing dysfunctional behavior and accepting itThe primary mode is individual psychotherapy once or twice a week Because ongoing skills training proves difficult in individual therapy aimed at reducing suicidal behavior and handling crises DBT mandates a separate psychoeducation group for skills training The group typically meets weekly for 2 hours during the first year of therapy and explicitly teaches core mindfulness interpersonal effectiveness emotional regulation and distress tolerance skills Homework exercises for these skills are provided in published skills training manualsPhone consultation with the individual therapist between sessions is routinely provided and even encouraged To ameliorate some of the enormous stress encountered in treating borderline psychopathology DBT therapists are asked to attend case consultation meetings held weekly with an experienced supervisor or with a group of fellow therapistsTherapeutic relationshipMany behavior therapists prefer the operational term validation to the personcentered empathy in describing their relationship goals In DBT for example validation occurs when the therapist communicates to the patient that her responses make sense and are understandable within her current life context There are at least six levels of validation in session 1 listening and observing 2 accurately reflecting 3 articulating the unverbalized 4 validating in terms of sufficient causes 5 validating as reasonable in the moment and 6 treating the person as valid or being radically genuineEmerging approaches to counselling intervention DBTBased on behavioral theory but also includes principles of acceptance mindfulnessvalidationIntended for suicidal individuals patients with BPD1Also applied to treat substance dependence eating disorder major depressive disorder oppositional children victims of domestic abuse stalking offenders families of highly suicidal individuals difficulttomanage correctional populationPhilosophy and AssumptionsDialectics Zen behavioral scienceAcceptance strategies balance the emphasis on changeAcceptance from Zen perspective find the middle path through means of acceptance selfvalidationtoleranceoFocusing on current movementaccepting reality without judgementMindfulnessintentionally living with awareness in the present moment without judging or rejecting the moment and without the attachment to the moment core of DBToPractices include the nonjudgemental observingdescribing objects physical sensations and emotions and participating fully in experiencing a connection with the universe3 overarching principlesoDialectical philosophy is holisticno event in the universe can be understood without reference to the whole both the context of behavior and the wider context of environment are critical for understanding each individualoDialectical philosophy is encapsulates opposites emotionmind thinking vs rational thinkingsolve through the synthesis integration of 2 poles once a synthesis is reached the system evolves and changes occurs accept the emotional arousalthe difficulty of solving the problem in this state while accepting the need to solve the problemoDialectical philosophy leads to continuous movementtherapist maintain the balance between himself and the client in such a way that both move toward the middle point instead of moving toward extremesAssumptions about clientso1 Clients are doing the best they cano2 Clients want to improve search for more solvable problemsreinforcers reduce interfering factorso3 Clients must learn new behaviors in all relevant contexts learn to change behavior under extreme moods2
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