Table Of ContentAcknowledgments ix To the Reader xi Definitions xiii 1 Why Learn DBT? 1 2 Introduction to DBT: Brief Background and Current Controversies 4 3 The Contextual Model and DBT 9 Comparisons of DBT with Other Therapies 10 Therapeutic Factors that Most Affect Outcomes 13 Adopting versus Adapting Standard DBT: The Question of Treatment Fidelity 15 The Answer to Fidelity: EBP 21 4 DBT: An Eclectic yet Distinctive Approach 23 5 Is It DBT? A Guide for DBT-Identified Therapists and Programs 27 6 Dialectical Philosophy 31 Dialectics in Practice 32 Validation versus Change 32 Acceptance of Experience versus Distraction from or Changing Experience 33 Doing One''s Best versus Needing to Do Better 34 Noting the Adaptive in What Seems Maladaptive 34 Nurturance versus Accountability 35 Freedom versus Structure 36 Active Client versus Active Therapist 37 Consultation to the Client versus Doing for the Client 37 Dialectics and Evidence-Based Practice 38 When Not to Be Dialectic: Dialectical Abstinence 38 Dialectics with Clients 39 7 The Biosocial Theory: Emotional Vulnerability, Invalidating Environments, and Skills Deficits 41 The Role of Invalidation 44 How the Biosocial Theory Guides Practice 45 Being Flexible to the Client''s Theory of Change 47 8 Client, Therapist, and Treatment Assumptions 49 Client Assumptions 49 Therapist Assumptions 51 Treatment Assumptions 53 9 The Five Functions of Comprehensive DBT 55 Motivate Clients 55 Teach Skills 56 Generalize the Skills with Specificity 56 Motivate Therapists and Maximize Effective Therapist Responses 57 Structure the Environment 57 10 Treatment Structure 58 How Much Structure? Level-of-Care Considerations 59 Program Treatment Models 61 Individual Therapy Treatment Structure 70 Group Skills-Training Session Structure 72 Additional Treatments and Services 73 Expectations, Rules, and Agreements 73 11 DBT Treatment Stages and Hierarchies 79 Pretreatment Preparation 80 Pretreatment and the "Butterfly" Client 81 Stage One: Stability and Behavioral Control 82 Stage Two: Treating PTSD, Significant Stress Reactions, and Experiencing Emotions More Fully 85 Stage Three: Solving Routine Problems of Living 85 Stage Four: Finding Freedom, Joy, and Spirituality 85 12 The DBT Therapeutic Factors Hierarchy 87 1. Develop and Maintain the Therapy Alliance 87 2. Develop Mutual Goals and Collaboration on Methods 88 3. Identify and Engage Client Strengths and Resources to Maximize Helpful Extratherapeutic Factors 89 4. Establish and Maintain the Treatment Structure 89 13 Self-Monitoring with the Diary Card 90 14 Validation: The Cornerstone of the Alliance 96 Levels of Validation 97 Validation versus Normalization 99 15 Commitment Strategies 101 16 Educating, Socializing, and Orienting 107 17 Communication Styles 110 Reciprocal Communication 110 Irreverent Communication 114 18 Mindfulness 118 19 Skills Training 125 20 Changing Behaviors 133 Behavioral Contingencies 139 Behaviorism and the Therapist 142 The Most Effective Methods of Changing Behaviors 143 21 Behavioral Analysis 150 Behavioral Analysis Example 152 22 Dialectical Strategies 160 23 Cognitive Interventions 168 24 Telephone Coaching 177 25 Dealing with Safety Issues 180 Essential Practices 180 Suicide Risk Factors 183 Protective Factors 183 Suicide Assessment 184 Self-Injury Assessment 187 Creating the Safety Plan 190 Safety or No-Harm Contracts 193 From a Safety Plan to a Safety Commitment 194 26 Use of the Hospital 197 27 Consultation 200 28 Evaluation of Clinical Outcomes 209 Appendix A Mindfulness Exercises 216 Appendix B Plans for Safety and Skills Implementation 218 Appendix C Professional Growth in DBT 227 References 229 Index 241
SynopsisDr. Pederson s clinical expertise shines as he takes DBT out of the hands of researchers and translates it into a practical, flexible, and powerful approach to human problems. This is your all-in-one source for understanding and practicing DBT and, beyond that, for doing good clinical work in tough client situations. Barry L. Duncan, Psy.D., author of On Becoming a Better Therapist: Evidence-Based Practice One Client at a Time Bridging research and practice, with this straightforward, accessible guide, Pederson delivers on his promise to place DBT philosophies and techniques all-squarely into the hands of real-world clinicians working with real-world clients who so desperately need it! Linda Curran, clinician, trainer, and author of Trauma Competency: A Clinician s Guide and 101 Trauma-Informed Interventions New to DBT? Been using it for a while? Either way, this text will deepen your knowledge and strengthen your clinical skills. Dr. Pederson is an expert DBT clinician and trainer. He has created a comprehensive overview of DBT that has sufficient breadth and depth to empower readers to begin using DBT or improve their current practice. This text will be your go-to resource for all things DBT. Cathy Moonshine, author of Acquiring Competency and Achieving Proficiency with Dialectical Behavior Therapy, Volumes I and II This book promises to be the most influential DBT publication to date, not only in its superb description of the approach but also in the way it builds a bridge between research and practice with a focus on what is most effective for clients. The future of our field rests on outcome-based modifications and customizations to evidence-based treatments, and Dr. Pederson provides an in-depth analysis of research that empowers DBT therapists to embrace the future now. This is a must read for all DBT therapists. Dr. Mark Carlson, DBT trainer for PESI Healthcare and author of CBT for Chronic Pain and Psychological Well-Being This is a clear, succinct, and readable guide for those who want to understand DBT. Dr. Pederson describes the components and techniques necessary to deliver the comprehensive treatment as well as some intriguing adaptations to standard DBT. Readers will find practical information that allows them to provide effective, evidence-based treatment with a sharp focus on the therapeutic relationship and, ultimately, outcomes. Anyone looking to improve his or her clinical skill and be a more effective clinician will find this book to be a useful resource. Britt H. Rathbone, co-author of Dialectical Behavior Therapy for At-Risk Adolescents This is the first book to show in detail how dialectical behavior therapy skills and approaches can be adapted and integrated into the broader evidence-based practice of psychotherapy. DBT was first developed in the late 1980s by Marsha Linehan as a response to the failure of standard cognitive and behavioral models to effectively treat chronically suicidal clients, and was built on a dialectical balance of acceptance and change. The standard form of DBT remains highly structured, as was appropriate to its original treatment group. However, today s therapists are increasingly encouraged to combine and integrate empirically supported treatments in a broader form of evidence-based practice that recognizes the importance of therapist expertise and judgment balanced with client needs and preferences. In short, most therapists want to incorporate DBT into their skills portfolio rather than become a specialist. This groundbreaking book makes a compelling case that today s best research evidence supports the adaptation of DBT, and presents the approach as a robust theoretical orientation that can be applied to a wide range of clinical presentations., A definitive new text for understanding and applying Dialectical Behavior Therapy (DBT). Offers evidence-based yet flexible approaches to integrating DBT into practice Goes beyond adherence to standard DBT and diagnosis-based treatment of individuals Emphasizes positivity and the importance of the client's own voice in assessing change Discusses methods of monitoring outcomes in practice and making them clinically relevant Lane Pederson is a leader in the drive to integrate DBT with other therapeutic approaches