Teach 1 summary of course
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This document provides an overview of Dialectical Behavior Therapy (DBT) training. It aims to enable participants to begin practicing DBT with supervision, provide enough information and skills to be effective practitioners, and offer continued support after training. The training will use an adult learning model of acting, reviewing, reflecting, and planning. DBT is a mix of behavior therapy, validation, and Zen practice using a dialectical view of change. The training will cover the components, stages, and assumptions of DBT as well as the core skills modules of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
Teach 1 summary of course
- 1. DBT Training 2014 Part 1 Fiona Kennedy for Skills Development Service
- 2. Aims of the week To enable participants to begin practising DBT with supervision as soon as they get home! To give enough information to allow practitioners to be effective To develop enough skills to allow practitioners to be effective To provide sufficient support after the week to allow further learning and safe practice
- 3. How we plan to do this Using the Kolb/Lewin model of adult learning act review reflect plan
- 4. What is DBT? A mix of behaviour therapy validation and Zen practice in context of dialectical thinking about change
- 5. How Dialectics views the world Reality is interrelated and whole (don’t just look at parts look at whole) Reality isn’t static but made up of internal opposing forces
- 7. Dialectical view of thinking Both-and NOT either-or Black and white and extreme thinking = not dialectical Individual is unable to move to synthesis Can be translated as ‘value opposites and find the middle way’
- 10. BIO Aspects affecting development loosely categorised as biological: e.g. genetics, epigenetics, neural structures, hormonal influences, nutrition SOCIAL Aspects affecting development loosely categorised as social environment: parenting, stimulation, friendships, traumatic events, abuse, neglect theory
- 11. Biology (‘bio’) Limbic system reactivity? Attentional control? Genetic links? Environment in the womb? Trauma modifying neurology? epigenetics
- 12. Social: Invalidating environments Communication of private experiences is met by erratic, inappropriate and extreme responses Expression of private emotion is punished/trivialised - Invalidated Intolerant of expressed emotion ‘Perfect environments/perfect child’ Be happy, never give in, there’s nothing you can’t do’ Behaviours attributed to manipulation/not trying/hostility
- 13. Biosocial Theory
- 14. Component Parts of DBT Skills Training Group Individual Therapy Support for generalisation of skills – telephone coaching Consultation Meeting
- 15. Orienting client to treatment Building commitment (strategies) Testing motivation and ability Individual therapy Session agenda Behaviours to reduce Collaborative behavioural analysis Acceptance Change Skills group Learn new skills Behaviours to increase Mindfulness Interpersonal Emotion regulation Distress tolerance Coaching Give input at time needed Close to target behaviour Use relationship Contact also possible to repair relationship Consult group Support and supervision for therapists Therapist assumptions Recursive values and techniques Role play Review Target behaviours Skills acquired Clients perception Discharge Planned ending Relapse plan Goodbye letter? Post discharge Stage 2 needed? If relapse? Gap between therapies? DBT in a nutshell
- 16. Orienting client to treatment Building commitment (strategies) Testing motivation and ability Commitment (pre-therapy) stage
- 17. Individual therapy Session agenda Behaviours to reduce Collaborative behavioural analysis Acceptance Change Skills group Learn new skills Behaviours to increase Mindfulness Interpersonal Emotion regulation Distress tolerance Coaching Give input at time needed Close to target behaviour Use relationship Contact also possible to repair relationship Consult group Support and supervision for therapists Therapist assumptions Recursive values and techniques Role play Therapy Stage: 4 aspects
- 19. Twin Tasks of DBT INCREASE skills DECREASE problematic & unskilful behaviour
- 20. Individual therapy ◦ Target behaviours list ◦ Create a context of validation rather than blaming ◦ Block or extinguish maladaptive behaviours ◦ Drag out effective behaviours ◦ Make the effective behaviours so reinforcing that the client stops using the maladaptive ones!
- 21. Further work (Linehan) Stage 2: PTSD Stage 3: achieve self- validation and self-respect
- 23. client therapist
- 24. Validation (acceptance) 1. Find the nugget of wisdom somewhere in what the client says/does! 2. Observe and believe in client’s ability to get out of the misery that is her life and build a life worth living Play to client’s strengths, not her fragility
- 25. Problem solving (change) Analyse target behaviours (chain analysis) Solution analyses Orient client to solution Get commitment to engage Do it!
- 27. Consultation to the client Strong bias towards client being her own case manager Therapist coaches client how to solve problems herself Inappropriate behaviour of professionals regarded as learning opportunity
- 28. Consultation to the environment Interventions by DBT therapists to change the environment, solve problems, co-ordinate professional treatment are used when 1. It is important 2. Client clearly is not capable of producing the outcome
- 29. Treating the therapist Supervision Case consultation Consult group Stay in DBT frame Treatment of the therapist is integral to the therapy
- 30. Telephone consultation Inhibition of asking for help Asking for help abusively, demandingly Phone provides practice in changing these patterns Generalisation of skills Repair of relationship
- 31. DBT assumptions Clients are doing the best they can Clients want to improve Clients need to do better, try harder Clients may not have caused all their problems but have to solve them anyway
- 32. DBT assumptions Suicidal clients’ lives are unbearable as currently lived Clients must learn new behaviours in all relevant contexts Clients cannot fail in therapy
- 33. DBT therapist assumptions Therapists treating clients with BPD need support Therapists should show: Warm empathy Persistent focus Endless hope Dialectical view Non- judgmental stance Practice DBT on themselves and each other
- 34. Skills Training in DBT To learn and refine skills in changing behavioural, emotional and thinking patterns associated with problems in living that are causing misery and distress.
- 35. Core Mindfulness WHAT Observe Describe Participate HOW Non-judgmental stance Focus on one thing in-the- moment Being effective: do what works
- 36. DISTRESS TOLERANCE Distracting Self-soothing Improving the moment Radical acceptance (turning the mind, willingness)
- 37. EMOTION REGULATION Identify and label affect Obstacles to change Reducing vulnerability to emotional mind Mindfulness to emotion Opposite action
- 38. INTERPERSONAL EFFECTIVENESS Asking and saying no Coping with conflict Obtaining desired changes while keeping the relationship and one’s own self-respect
- 39. Increasing behavioural skills- SELF-MANAGEMENT NOT A MODULE Knowing principles of behaviour change Realistic goal-setting Behavioural analysis skills Contingency management skills Environmental control Relapse prevention Tolerating limited progress
- 40. Consult Groups Read and sign therapist consultation agreements Set any other rules you feel necessary for working as a team Discuss how you will manage lateness/non-attendance Read and discuss case study- how would you usually approach this case?