Dialectical Behavior Therapy (eBook)

A Contemporary Guide for Practitioners

Lane D. Pederson (Autor)

eBook Download: EPUB

2015
John Wiley & Sons (Verlag)
978-1-118-95789-9 (ISBN)

Infos

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

Lane D. Pederson is the owner of Mental Health Systems, one of the largest DBT-specialized practices in the USA, and is the founder of the Dialectical Behavior Therapy National Certification and Accreditation Association. As a DBT speaker, Dr. Pederson has trained over 7,000 therapists across the United States, Canada, and Australia. He is an outspoken advocate of flexible and evidence-based applications of DBT, and his books include DBT Skills Training for Integrated Dual Disorder Treatment Settings (2013) and The Expanded Dialectical Behavior Therapy Skills Training Manual (2012). Dr. Pederson can be contacted for DBT Training and other inquiries at www.drlanepederson.com.

Textauszug

2
Introduction to DBT
Brief Background and Current Controversies

DBT was developed by Marsha Linehan in the late 1980s and early 1990s at the University of Washington. Interested in helping those with chronic suicidality and self-injury, Linehan specialized in the treatment of women diagnosed with borderline personality disorder.

Linehan's (1993a) initial work with this population used cognitive-behavioral therapy (CBT). However, she found that traditional CBT administered with too much problem and solution focus was ineffective and left her clients feeling misunderstood and invalidated. To compensate, Linehan began to incorporate acceptance strategies, but she found that too much acceptance focus was also ineffective, leaving her clients demoralized and thinking nothing would change. Linehan observed that her clients responded best to fluid combinations of acceptance and change strategies rather than the emphasis of one over the other. The balanced movement and flow between acceptance and change is a fundamental dialectic in DBT.

As DBT evolved, Linehan (1993a) searched for and integrated philosophies, relationship practices, and interventions that distinguished DBT from traditional CBT. Dialectical philosophies were used to bring balance and save clients and therapists from all-or-nothing concepts and behaviors. Treatment assumptions were drafted to orient clients and therapists to effective treatment. Mindfulness practices, taught from a secular perspective, emphasized nonjudgmental experiencing in the moment and effective rather than reactive behavioral responses in life. Systematic skills training bridged the gap between behavioral deficits and desired behavioral change. Treatment stages and a hierarchy to prioritize treatment targets decreased chaos and increased therapeutic focus. Functional behavioral analysis structured sessions with systematic pattern recognition aided by problem-solving with skills. And validation underpinned a strong relationship focus that included communication styles ranging from reciprocal to irreverent. Last, Linehan created a multimodal treatment-delivery framework to structure and administer DBT. Called the “standard model,” the treatment-delivery modes of standard DBT include weekly individual therapy, weekly group skills training, weekly therapist consultation, and individual therapists providing 24/7 telephone-coaching availability to their clients.

The prodigious changes from CBT seemed to better fit the needs and preferences of clients with borderline personality disorder, and therapists were inspired by this radically new yet highly derivative theoretical orientation. The therapy became in high demand, and Linehan with her associates founded a training company dedicated to teaching teams of therapists how to implement and deliver standard DBT as it was researched in Linehan's clinical trials.

The dedicated focus on one delivery of DBT, the standard model, makes historical sense given that DBT's initial development happened during the empirically supported treatment (EST) zeitgeist,1 when a major emphasis was placed on diagnosis-specific treatments, forever pairing DBT with borderline personality disorder. During this time period, therapists were compelled to adopt evidence-based treatments (EBTs) with fidelity to how the models were researched, with adherence2 to the specific ingredients prescribed by treatment manuals. In the case of DBT, treatment fidelity meant also following the researched treatment-delivery framework, the standard model.

With a paucity of evidence, the EBT movement created and perpetuated a myth that stubbornly persists today: that specific models of therapy and their interventions should be applied prescriptively to diagnoses vis-à-vis a medical model of treatment, as if clients, therapists, and other important mediating factors are irrelevant in psychological treatment.3

Despite the EBT movement and Linehan's efforts to promote fidelity to the standard model, DBT has been widely disseminated as a theoretical orientation for a broad variety of diagnoses in many adapted treatment frameworks (Andion et al., 2012; Apsche et al., 2006; Christensen et al., 2013; Chugani et al., 2013; Engle et al., 2013; Erb et al., 2013; Evershed et al., 2003; Federici et al., 2012; Goldstein et al., 2007; Harley et al., 2007; Hashim et al., 2013; Iverson et al., 2009; Keuthen et al., 2010; Klein et al., 2013; Kroger et al., 2005; Linehan et al., 1999; Low et al., 2001; Lynch & Cheavens, 2008; Rakfeldt, 2005; Ritschel et al., 2012; Roosen et al., 2012; Rosenfeld et al., 2007; Simpson et al., 1998; Sneed et al., 2003; Soler et al., 2009; Steil, 2011; Sunseri, 2004; Vitacco & Van Rybroek, 2006; Ward-Ciesielski, 2013; Wasser et al., 2008; Wolpow et al., 2000). In fact, research articles on adapting DBT to differing diagnoses and settings, frequently with changes from the standard model in service delivery, outnumber articles on standard DBT. As therapists continue to customize DBT to diverse populations in new settings, levels of adherence to the standard model differ, and, while DBT's reputation as a go-to treatment for borderline personality disorder and other difficult-to-treat issues has been enhanced by successful treatment adaptors, this has not happened without controversy.

A segment of self-described adherent therapists assert that only the standard model is “real” DBT, claiming a specious empirical high ground4 while ignoring a large body of research evidence and current guidelines on evidence-based practice (EBP). With varying applications and treatment frameworks, the natural question is: “Who is following the evidence?”

Standard DBT is an EBT for borderline personality disorder, but it may surprise many that adherence to an EBT is not necessarily EBP. Whereas adherence to an EBT meets a “minimum standard of empirical support,” EBP “is a process of applying research that involves clinical expertise and judgment in the context of client needs and preferences” (Duncan and Reese, 2012, p. 1009). EBP supersedes prescriptive therapy applications because it recognizes the important contextual roles played by therapists and clients in determining therapeutic outcomes, roles that have significantly greater impact than models and their techniques.

Movement to EBP is based on a larger view of the evidence, illuminating a cogent answer to the “who is following the evidence” question. We know therapy works, and its effect size is robust (Smith et al., 1980; Wampold, 2007), but the reasons why therapy is effective differ from those therapists and researchers often promote. The jury has been in for some time, and empirical evidence overwhelmingly supports the thesis that therapy works due to pan-theoretical therapeutic factors5 that operate within a contextual model. As noted in Chapter 1 and further explained in Chapter 3, this thesis rests on the fact that no therapy model, including DBT, has reliably demonstrated efficacy superior to that of other therapy models (Clarkin et al., 2007; Duncan et al., 2010; McMain et al., 2009; Wampold, 2001). The competing thesis—that the “specific ingredients” that comprise particular therapies such as DBT applied vis-à-vis a medical model account for change—has comparatively little empirical support (Wampold, 2001).

To compel therapists to attend to specific ingredients through high adherence to particular therapies is empirically misguided and narrows the scope and practice of therapy, both generally and with specific models such as DBT. Moreover, to adopt only certain therapies, in certain applications, with certain diagnoses, has moral and ethical implications when clients end up with limited and restricted options that neglect their needs and preferences.

Regardless, many adherent DBT providers continue to lobby that providers adopt only standard DBT, and they at times openly denigrate therapists who deliver DBT in differing treatment frameworks. The unfortunate result is that presumably well-intentioned policy-makers, payers, and providers end up “privileging”6 a narrow application of a robust theoretical orientation derived from other established orientations that have broad empirical bases. Even Linehan has acknowledged that the evidence may ultimately show that the effectiveness of DBT is due to its “standard cognitive-behavioral components” with differences being “not as sharp” as she suggested (Linehan, 1993a, p. 22).7

The split between those who adhere to the standard model and those who adapt from it begs for an appraisal of research evidence beyond DBT's important yet limited empirical base as well as a thorough understanding of current trends in EBP. In the foreword to Dialectical Behavior Therapy in Clinical Practice, Linehan offered a “word of wisdom” that DBT change in response to emerging DBT and CBT research to be “in sync with the empirical literature” (Dimeff & Koerner, 2007, p. xiii). I go further to recommend that DBT change to be in sync with decades of established yet often neglected research to bridge the dialectical split and to demonstrate that changes to standard DBT are legitimate,...

Produkt-Details

• Erscheint lt. Verlag: 4.3.2015
• Sprache: englisch
• Themenwelt: Geisteswissenschaften ► Psychologie
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Psychiatrie / Psychotherapie
• Schlagworte: Clinical psychology • Cognitive behavioral therapy (CBT) • Klinische Psychologie • Kognitive Verhaltenstherapie • <p>DBT, dialectical behaviour therapy, CBT, cognitive behaviour therapy, behaviour therapy, psychotherapy, BPD,DBT, clinical psychology, cognitive interventions, Biopsychosocial Model, Alliance, Collaboration, CBT, third-wave therapies</p> • Psychologie • Psychology • Psychotherapie • Psychotherapie u. Beratung • Psychotherapy & Counseling • Verhaltenstherapie
• ISBN-10: 1-118-95789-X / 111895789X
• ISBN-13: 978-1-118-95789-9 / 9781118957899