Teach 9 and 10 dialectical and stylistic strategies and dbt with selves
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This document discusses dialectical strategies and stylistic strategies used in Dialectical Behavior Therapy (DBT). Some key dialectical strategies mentioned include entering the paradox, using metaphors, making lemonade out of lemons, playing devil's advocate, and activating wise mind. Stylistic strategies discussed are reciprocal style, self-disclosure, warm engagement, genuineness, vulnerability, and an irreverent style. The document also covers environmental intervention, consultation to patients and therapists, and applying DBT principles within the consultation group itself.
![Business Meeting
Mindfulness
Client tracking
New referrals
Allocation
Audit
Service issues (referral criteria)
Managing the wider system]](https://image.slidesharecdn.com/teach9and10dialecticalandstylisticstrategiesanddbtwithselves-140511140715-phpapp01/85/Teach-9-and-10-dialectical-and-stylistic-strategies-and-dbt-with-selves-25-320.jpg)
Teach 9 and 10 dialectical and stylistic strategies and dbt with selves
- 1. Acceptance & change: DIALECTICAL strategies Balance acceptance and change; teach patient to be dialectical 1 therapeutic relationship: be aware of dialectical tensions 2 in all interactions, teach and model dialectical behaviour patterns
- 2. Acceptance & change: DIALECTICAL strategies
- 3. Dialectical strategies 1 Entering the paradox Eg koans Refuse to step in with logical explanation to allow the client to step out of the struggle ‘Both-and’ not ‘either-or’
- 4. Dialectical strategies 2 Using metaphor Stories are easier to remember Metaphors can communicate difficult stuff-e.g. the effect of client’s behaviour on others Useful metaphors: marathon not sprint; rescuing vs visiting; use e.g.s from client’s interests Keep a metaphor book
- 5. Dialectical strategies 3 Devil’s advocate Therapist presents thesis (extreme maladaptive belief) Client presents antithesis Eg T:‘if you offend anyone it is a mortal catastrophe. You should be deported form the country and all your assets seized’ C:’ well, I’m not that bad’
- 6. Dialectical strategies 4 Extending Take the patient more seriously than she takes herself Take anticipated consequences literally then respond to seriousness E.g. ‘I see, you really can’t carry on with DBT, we must take that seriously…do you think we really need to consider ending therapy?’
- 7. Dialectical strategies 5 Activating wise mind Convince client she can do this Can use ‘Well’ metaphor/floating on cloud/etc ‘What do you know in your wise mind to be true/right?’
- 8. Dialectical strategies 6 Making lemonade out of lemons ‘I got the sack’ ‘Wow now we have a chance to practise distress tolerance big time’ ‘was (the homework) hard? ‘yes’ ‘good, now we know you can do hard things’
- 9. Dialectical strategies 7 Allowing natural change Change, development and inconsistency are inherent in any environment and are allowed to proceed naturally The client is encouraged to learn to tolerate and adapt to change rather than keep environment stable
- 10. Dialectical strategies Dialectical assessment ?is the problem a fatal flaw in the client or a fatal flaw in the social fabric? Be aware of the oppressive/problem-producing nature of some therapeutic rules, styles and systems
- 11. Dialectical Skills Enter the Paradox (both – and) Metaphors Lemonade out of Lemons (what a great opportunity….) Devil’s Advocate (you may find this too difficult...) Extending (this is serious – perhaps we/you should..) Wise Mind (taking both your emotions and knowledge, what do you know in your gut/heart to be right?)
- 12. STYLISTIC STRATEGIES Reciprocal style: responsiveness staying awake considering the client’s agenda, clients’ desired session content.
- 13. STYLISTIC STRATEGIES Self-disclosure orient patient to what types of self-disclosure will occur from the therapist self-involving self-disclosure (reactions to patient, heart to heart, ‘when you do X I feel Y’) personal information: qualifications, experience
- 14. STYLISTIC STRATEGIES Warm engagement: observing limits coping with rage at the patient use of touch
- 15. STYLISTIC STRATEGIES Genuineness Being a ‘real’ therapist Having a ‘real’ relationship Be yourself
- 16. STYLISTIC STRATEGIES Vulnerability This is a high-power-low-power relationship Because the therapist could not bear to be more/equally vulnerable than client Also, because the focus must be on the client
- 17. STYLISTIC STRATEGIES Irreverent style: 1 reframing (in unorthodox manner) E.g. ‘so, what you’re saying is that you’d rather suffer from anxiety for the rest of your life than do this one hard thing? 2 where angels fear to tread E.g. ‘I’m sorry, we just have no success with corpses’
- 18. STYLISTIC STRATEGIES Irreverent style (contd) 3 confrontational tone E.g. so what the hell have we been doing all these months? 4 calling patient’s bluff e.g. ‘OK so I am no good as a therapist, perhaps you should sack me?’
- 19. STYLISTIC STRATEGIES Irreverent style (contd) 5 Intensity and silence E.g. look long at client and say nothing 6 omnipotence and impotence E.g. ‘that can always be sorted’ Or ‘well I am completely helpless here’
- 20. Environmental intervention (consultation to staff/the wider care system): keep to minimum; do only when patient is unable, when environment is high power, to save life, when humane, when minor issue. Consultation to the patient strategies: effective self-care, decrease ‘splitting’, how to manage other professionals. Consultation to the therapist: consult group: meeting agenda, consultation agreements, cheerleading, dialectical balance, staff splitting, unethical behaviour, confidentiality. CASE MANAGEMENT strategies
- 21. CONSULT GROUP: APPLYING DBT WITH OURSELVES Environmental events and context are just as important in shaping therapeutic behaviour as in shaping clients’ behaviour, laws of human behaviour apply to us as well!
- 22. Consult Group Agreements Dialectical agreement; consultation to the client; consistency; observing limits, phenomenological empathy; fallibility.
- 23. Consult Group Agreements Dialectical agreement; consultation to the client; consistency; observing limits, phenomenological empathy; fallibility.
- 24. Consult Group Agendas: Supervision Meeting: Mindfulness Problems with treatment, review at least one case Skills trainers tell individual therapists what skills being taught and individual issues in skills training Chain Analysis of lateness/absence Institutional limits on client behaviour. Staying DBT adherent Review an aspect of DBT
- 25. Business Meeting Mindfulness Client tracking New referrals Allocation Audit Service issues (referral criteria) Managing the wider system]
- 26. Consult Group Cheerleading Therapist demoralisation: seeing the wood for the trees Hopeless thoughts Validation and problem solving therapist mistakes.
- 27. Providing Dialectical Balance Applying DBT strategies with one another Over-protectiveness, rage, validate and reframe
- 28. ‘Staff Splitting’ Arguments among staff are seen as failures in synthesis Staff splits staff, client does not Become aware of what precipitates disagreement and of ‘wave patterns’ of attachment
- 29. Unethical or Destructive Therapist Behaviour Minimum levels of competence, ethics and non- defensiveness not met: elephant in the room
- 30. Confidentiality Therapist disclosures are confidential to consult group Case discussion may be disclosed judiciously to client