The Dialectical Behavior Therapy Primer: How DBT Can Inform Clinical Practice

Dialectical Behavior Therapy (DBT) has quickly become a treatment of choice for individuals with borderline personality disorder (BPD), suicidal behavior, non–suicidal self injury, and other complicated psychiatric conditions. However, there are very few well–trained DBT practitioners, limited opportunities for training, and a dearth of easily accessible reading material. Becoming proficient in fully adherent DBT requires intensive training and years of experience. Fortunately, many DBT principles and procedures can be readily adapted for therapists conducting supportive, psychodynamic, and even cognitive behavioral treatments. The Dialectical Behavior Therapy Primer fulfills a great demand for an easy to read, simplified translation of the complexities of DBT. The authors provide a clear, comprehensive summary of DBT principles and techniques illustrated with rich clinical vignettes. Through addressing the top ten questions clinicians ask about working with individuals who have BPD, the authors encourage a conversion to the “DBT way of thinking” about psychotherapy as well as BPD. Through personal discussion of their experience, they share how they have come to understand the emotional and behavioral world of individuals with severe difficulty with emotion regulation. Their orientation is that, in order to maintain these individuals in treatment, to reduce symptoms, and to increase capacity for positive life experience, therapists need to rethink their assumptions and interpretations and take on more responsibility for treatment failure. The dialectic worldview, when applied to the treatment of BPD, provides therapists with a viable alternative theoretical approach. The authors take pains to illustrate how the dialectic philosophy underlies each DBT intervention and how integral this way of thinking is to the effective practice of DBT. This book is the ideal guide to DBT for clinicians at all levels of experience. Related Titles Psychodynamic Formulation Deborah L. Cabaniss, Sabrina Cherry, Carolyn J. Douglas, Ruth Graver, and Anna R. Schwartz 9781119962342 Psychodynamic Psychotherapy: A Clinical Manual Deborah L. Cabaniss, Sabrina Cherry, Carolyn J. Douglas, and Anna R. Schwartz 9780470684719

About the Authors ix Foreword xi Acknowledgments xiii 1 Introduction 3 Part I Theoretical, research, and clinical foundations 13 2 When DBT is indicated: The patients, the clinicians, and the evidence 15 3 BPD: Treatable or untreatable? 27 4 BPD: Diagnosis, stigma, and phenomenology 33 5 Understanding and treating self–harm behaviors in BPD 45 6 The ABC’s of DBT – the theoretical perspective 63 7 The ABC’s of DBT – overview of the treatment 75 Part II Using DBT in clinical practice 83 8 Commitment and goal setting 85 9 The DBT tool kit: The essential DBT strategies and what happens in the individual session 101 10 Skills training: The rationale and structure 125 11 Skills training: The four skill modules 135 12 Between–session contact and observing limits 153 13 Management of suicidal behavior 177 14 The Safety Planning Intervention 185 15 The three C’s of consultation 193 16 DBT case formulation 205 17 Beyond Target 1 – Therapy and “quality of life” interfering behaviors 221 18 The end of treatment 239 Index 245

Beth S. Brodsky , Ph.D. is Associate Clinical Professor of Medical Psychology in Psychiatry at Columbia University, and a research scientist at the New York State Psychiatric Institute.  Her areas of expertise include  and psychotherapeutic  treatment of self–destructive behavior in borderline   disorder (BPD). She is the Principal Investigator (along with Barbara Stanley)of a NIMH Excellence in Education  to develop and implement a clinical/research curriculum teaching  Dialectical  Therapy  (DBT) in a medical setting. She is the author of many articles and chapters on BPD, DBT, suicide and self–injury and is a frequently invited speaker on BPD, suicidal behavior and DBT.  She is a member of the Virginia Apgar Academy of Medical Educators at Columbia University College of Physicians and Surgeons. Barbara Stanley , Ph.D. is Professor of Clinical Psychology in the Department of Psychiatry at Columbia University College of Physicians & Surgeons and Research Scientist at New York State Psychiatric Institute. She is a trainer in Dialectical Behavior Therapy for Behavioral Tech, LLC. She has been the principal investigator on NIH–funded grants investigating suicidal behavior, self injury, aggression and borderline personality disorder. She is currently conducting a treatment trial investigating the mechanisms of action of DBT and antidepressants. Along with Dr. Beth Brodsky, she is a principal investigator on an NIMH–funded grant to develop a DBT training curriculum for psychiatrists–in–training.  She has won numerous awards including the American Foundation for Suicide Prevention Research Award and the Suicide Prevention Center of New York Research Award.

“As the authors state at the outset, it is likely most useful for clinicians wondering what DBT is and what it includes, as well as for non–clinicians wondering what DBT is about. Some of the concepts are good therapy (e.g., the emphasis on validation), whereas some are unique to DBT (e.g., the consult team). Because some of the elements of DBT are good practice and can be incorporated into other treatment modalities, the authors succeed in finding a middle path between ignorance of DBT and trained practice of allelements.”  ( British Journal of Psychology , 6 January 2014)