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Dialectical Behavior Therapy

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Jennifer Thacker

on 10 December 2013

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Transcript of Dialectical Behavior Therapy

Dialectical Behavior Therapy
Marsha Linehan
View of Human Nature
Positive view of human nature
Biosocial Theory of Psychopathology
Grounded in Dialectical Philosophy
Rooted in Zen Tradition
Development of Psychological Issue
Designed for:
Self-harming patients
Borderline Personality Disorder
Suicidal individuals
Therapeutic Goals
• Give client a life worth living
• Have a collaborative relationship between the client and therapist
• Different goals at 5 stages of treatment
o Make sure client stays alive
o Keep client in treatment
o Client learns to use more positive problem-solving skills
o Reconcile self-acceptance and change
• Address five functions

Counselor/Therapist Role
Maintain client motivation
Work with treatment team effectively
Encourage change
Enhance the client's capabilities
Structure the environment
Enhance the therapist motivation
Andrew Coyle, Kristyn Kamke, Candace Oglesby & Jennifer Thacker
Personal Experience with Mental Illness
Educational History
Work by Client
Encouraged to work out their relationship with the therapist
Take an active role in therapy
Attend group therapy sessions
Signing and abiding by a behavioral contract
Counseling/Therapy Techniques and procedures
Stage 1: stabilizing the client's behavior
Diary card
Stage 2: replace traumatic emotional experiences with non-traumatic emotional experiences
Stage 3: Helping the client focus on self-esteem and treatment goals
Stage 4: Help the client resolve a sense of incompleteness and achieve happiness
Strengths & Weaknesses
Empirically supported treatment for BPD
Offers a substantial length of treatment interventions
Utilizes both group and individual sessions
Little research conducted for follow-up treatment and efficacy
Markers for Successful Treatment
Absence of suicidal ideation and gestures
Emotional Regulation
Utilization of coping skills
Healthy interpersonal relationships
Reducing life threatening behaviors
Client is attending sessions regularly and on time
Alleviated behaviors that interfere with the quality of life
Completion of homework assignments and participants in group sessions
Completion of measurable objects on treatment plan
Client has gained a sense of self control
Application to Culturally Diverse Clients
Easily adaptive to clients principles, collaboration and flexibility
Structured around the client's goals and aspirations
Less westernized cultures may have reservations
Group Therapy Techniques
Mindfulness skills
Distress Tolerance skills
Emotion-regulation skills
Interpersonal effectiveness skills
Telephone contact is encouraged between sessions but are also encouraged to be kept to a minimum. It is to be used more as an opportunity to coach rather than provide talk therapy.
Empirical Support
Mini Case Review
Lisa is a 28- year- old account executive with a long history of interpersonal problems. At the office, her co-workers see her as being intensely moody and unpredictable. On some days, she is pleasant and high spirited, but on others she exhibits uncontrollable anger. People are often struck by her inconsistent attitudes towards her supervisors. She vacillates between idealizing them and devaluing them. For example, she may boast about the “brilliance” of her supervisor one day, only to deliver a burning criticism the next day. Her co-workers keep their distance from her, because they have become annoyed with her constant demands for attention. She has also gained a reputation in the office for her promiscuous involvements with a variety of people, male and female. On several occasions, she has been reprimanded for becoming inappropriately involved in the personal lives of her clients. One day, after losing one of her accounts, she became distraught that she slashed her wrists. The incident prompted her supervisor to insist that Lisa obtain professional help.

Borderline Personality Disorder
Diagnosed by a mental professional
Possible symptoms
Burckell & McMain (2011)
Burkell & McMain studied the importance of the therapeutic alliance on a client's success in treatment for borderline personality disorder.
The results of their study showed the client who rated having a strong therapeutic alliance had more success in treatment than the client that did not.

Wanted to see the effect of DBT vs. Optimized treatment as usual in College Counseling Centers
Year long study with an 18th month follow-up
Looked at 6 area: Suicidality, Depression, Non-Suicidal Self Injury, Borderline Criteria, Social Adjustment, and Psychiatric Medication use post treatment
Participants who received DBT were show to have statistically significant changes in all 6 areas

Dialectical Behavior Therapy (DBT) Applied to College Students: A Randomized Clinical Trial
McMain, Korman, & Dimeff
Demonstrated how DBT was used to assist clients in regulating their emotions
Utilized transcripts from “real life” sessions to show the effectiveness of DBT within the lives of specific clients
Certain techniques were also utilized to assist these clients in treating their DBT which included exposure based practices

• Adolescents often suffer from suicidal behaviors and non-suicidal self-injurious behaviors
• Adolescents often drop out of therapy and 11% die from suicide
• DBT may be applied to Adolescents
• Reduction in suicidal behaviors, self-injurious behaviors, diagnoses of Axis I and BPD, and symptoms
• Increase in quality of life

Dialectical Behavior Therapy for Adolescents


Burckell, L. A., & McMain, S. (June 2011). Contrasting Clients in Dialectical Behavior Therapy for
Borderline Personality Disorder: “Marie” and “Dean,” Two Cases with Different Alliance Trajectories & Outcomes. Pragmatic Case Studies in Psychotherapy, 7(2), 246-267.

Corey, G. (2013). Theory and Practice of Counseling and Psychotherapy (9th ed.). Belmont, CA:
Thomson. pp. 101-135.Christian Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C., & Schulz, E. (2010). Dialectical behavioral therapy for adolescents (DBT-A): A clinical trial for patients with suicidal and self injurious behavior and borderline symptoms with a one-year follow-up. Child and Adolescent Psychiatry and Mental Health, 5(3).

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New
York, NY: Guilford Press. Neacsiu, A. D., Ward-Ciesielski, E. F., Linehan, M. M. (2012). Emerging approaches to counseling intervention: Dialectical behavior therapy. The Counseling Psychologist, 40, 1003-1032.

McMain, S., Korman, L., & Dimeff, L. (2001). Dialetical behavior therapy and the treatment of
emotion dysregulation. Psychotherapy in Practice, 57(2), 183-196.

Pistorello, J., Fruzzetti, A., MacLane, C., Gallop, R., Iverson, K. (2012) Dialectical Behavior Therapy
(DBT) Applied to College Students: A Randomized Clinical Trial. Journal of Consulting and Clinical Psychology. DOI: 10.1037/a0029096

Robins, C. J., & Rosenthal, M. Z. (2011). Dialectical behavior therapy. In J. D. Herbert & E. M.
Forman (Eds.), Acceptance and mindfulness in cognitive behavior therapy: Understanding and applying the new therapies (pp. 164-209). Hoboken, NJ: Wiley.

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