Fundamental dialectic:
acceptance vs. change
5 common factors for therapies for BPD
- clear treatment framework
- attention to affect
- focus on the therapeutic alliance
- active/directive therapist
- exploratory and change-oriented
five essential functions of DBT
- increase motivation
- teach skills
- generalize skills to environment
- enhance therapist motivation/skills
- structure program/environment
dialectics in DBT
synthesis of opposites; truth is contextual
nine fundamental dialectics:
- acceptance v. change
- caring v. accountability
- emotion v. reason
- doing your best v. doing better
- client-directed v. therapist-directed
- sitting with v. problem-solving
- intervene v. consult
- availability v. limits
- help-seeking v. self-efficacy
- other-focused v. self-focused
four core DBT assumptions of clients:
- clients do their best and can do better
- clients can’t fail therapy but therapy can fail them
- clients want to improve but need skills to do so
- skills need to generalize to all areas of life
dialectical abstinence
not using dialectics with extremely negative behaviors (e.g., suicidal behavior, etc.)
abstinence violation effect
tendency to go to extremes once a boundary is crossed
core DBT assumptions of therapists:
- therapists practice the core conditions (empathy, congruence, positive regard)
- therapists are unrelenting in approach but strengths-based
- therapists use consultation
- therapists practice skills
- therapists favor consultation to intervening
core DBT assumptions of treatment:
- treatment is non-judgmental and accountable
- behavior that doesn’t work in life should not be reinforced in session; behaviors that work should be reinforced
DBT biosocial theory
emotional dysregulation/vulnerability interacting with invalidating social environments drives dysfunction
three components of emotional dysregulation:
- emotional sensitivity
- emotional reactivity
- slow return to baseline
kindling effect
frequent emotional reactions lead to greater emotional reactivity
three common types of invalidation
- abuse/neglect
- verbal invalidation (rejection, pathologizing)
- unrealistic expectations
validation is a primary intervention to:
- reduce acute emotions
- exposure to emotions
- corrective validating environment
- creates bridge to self-validation
- opens up client to change techniques
emotion regulation taught to:
- identify emotions
- reduce emotional vulnerability
- create positive emotions
- help change ineffective mood-congruent behaviors
mindfulness taught to:
- reduce amplifying emotions
- reduce escape and avoidance
- create qualitatively different and effective experience of emotions
distress tolerance taught to:
provide healthy ways of coping with emotions
radically open DBT
-some people have emotional regulation issues related to over-regulation
stage 1 treatment targets:
1: reduce life-threatening behavior
2: reduce therapy-interfering behavior
3: reduce quality of life decreasing behavior
4: increase skill use
stage 1 goals:
stability and behavioral control
stage 2 goals:
work on trauma, increase stability
stage 3 goals:
increase self-respect/competence
stage 4 goals:
self-actualize
