Dialectical Behavioral Therapy

IntroductionDialectical Behavioral Therapy is a cognitive behavioral model of psych another(prenominal)apy workoutd primarily to treat individuals diagnosed with B sayline spirit Disorder (BPD). The manipulation was manualized in 1993 (Linehan, 1993a Linehan, 1993b) and met criteria as an empirically validated, well-established treatment for BPD in 2001 (Koons et al, 2001). DBT has in addition been found to be effective in a range of treatment settings with a variety of populations.The empirically based treatment of DBT is a series of cognitive behavioral strategies that are applied to BPD populations. The approach provides psycho-social skills training to encourage development of effective cognitive, emotional, and behavioral skills. Learning DBT skills increases a leaf nodes ability to achieve positive outcomes by ashesatically developing effective make out mechanisms, and facilitating the decrease of maladaptive behaviors (Linehan, 1993a Linehan, 1993b).The characteristic s that distinguish DBT are (1) the immediate focus on acceptance and validation (2) the fierceness on treating behavior that interferes with therapy (3) the emphasis on the therapeutic relationship (4) the focus on dialectics, synthesis, and process (Linehan, 1993a).DBT suppositious FrameworkDBT is based upon a dialectal view of human behavior consisting of three primary doctrines. The first normal is one of interrelatedness and exclusivelyness a system must be analyzed as a totality, as the pcts are temporary and only exist in relation to the whole. The second principle is polarity reality is not static but is made up of opposing forces, that when integrated, create a new set of opposing forces.The third principle is continuous convince the tension between oppositional as yet connected parts produces a process of exchange, rather than a structure, which is an underlying condition of human spirit (Linehan, 1993a).In the DBT process, change occurs in the midst of dialectica l tension. This tension is a process created by the clients attempt to give homeostasis, while the healer uses persuasion techniques to support the clients process of self-transformation. The therapist overcomes the clients resistance by on-going dialogue with the client that is both encouraging and directive (Linehan, 1993a).One of the hollow out components of DBT is increasing the capacity to regulate emotions (Linehan, 1993a). Among persons suffering from Borderline Personality Disorder, the inability to regulate emotions results in emotional vulnerability and maladaptive strategies for deal. Emotional vulnerability is defined by (1) high sensitivity to emotional stimuli, (2) intense response to emotional sensitivity, and (3) difficulty reducing the sensitivity and return to a normal emotional baseline.Similar to Cognitive Behavior Therapy (CBT), DBT also accepts ongoing self-monitoring of behaviors, realistic treatment goals, a strong therapeutic alliance, and treatment co mpliance. Client agreement in the manualized treatment includes, but is not modified to the following (1) A commitment to a one year, renewable agreement, (2) Compliance to the weekly meetings and attendance, (3) Notification to the therapist in advance if they are unable to attend scheduled therapy sessions, (4) Confidentiality in group settings, (5) Willingness to work on any and all problems that interfere with therapy, (6) Agreement in group treatment settings to not form individualized or sexual relationships with other group members, (8) Commitment to not come to therapy under the influence of drugs or alcohol, and (9) Willingness to participate in both individual and group treatment if appropriate (Linehan, 1993a Linehan, 1993b).Therapist agreements in the manualized treatment include but are not limited to (1) Professional and reasonable effort to conduct therapy with client, (2) Adherence to honourable guidelines, (3) Attendance at all scheduled sessions, and if unable, agreement to reschedule with advance notice, (4) Agreement to respect the self-direction and integrity of the client, and (5) Confidentiality within the confines of the law (Linehan, 1993a).DBT PhilosophyIn order to truly run across DBT, it is first important to examine how Marsha Linehan designed DBT to treat BPD. In her book Cognitive-Behavioral Treatment of Borderline Personality Disorder, Linehan (1993 a) describe DBT as the coating of cognitive and behavioral therapy strategies to military service work through problems.DBT is based on a dialectical philosophy that emphasizes reality as an interrelated system composed of opposing forces that are continuously changing. At the core of this philosophy is accepting the client as they are while assisting to promote healthy change. Linehan (1993a) further described DBT asThe emphasis on assessment data collection on current behaviors precise practicable definition of treatment targets a collaborative operative relationship betw een therapist and patient, including attention to lie the patient to the therapy program and mutual commitment to treatment goals application of standard cognitive and behavior therapy techniques, (p. 19)DBT therapists use treatment procedures such as problem solving, exposure techniques, skill training, contingency management, and cognitive modification to help clients find new ways of working through the problems that brought them into therapy. DBT requires that the therapist balance change and acceptance in each interaction with the patient (Linehan, 1993a, p. 19).This treatment philosophy along with the application of problem-solving and validation strategies becomes the DBT process (Linehan, 1993a). DBT blends a matter of fact, somewhat irreverent, and at times outrageous attitude about current and previous parasuicidal and other dysfunctional behaviors with therapist warmth, flexibility, responsiveness to the client, and strategic self-disclosure (Linehan, 1993a, p. 19).DBT w orks to reframe suicidal and other dysfunctional behaviors that had previously been part of the clients learned problem solving patterns. Therapy focuses on active problem solving and is balanced with a correspondent emphasis on validating the clients current emotional, cognitive, and behavioral responses as they are in that moment. Focus on dialectics and the balance of acceptance and change are pivotal elements of the DBT process (Linehan, 1993b).DialecticsAlthough DBT has similarities to standard cognitive and behavioral techniques, it also has many defining characteristics that make it a unique treatment. It is important to review the key elements of DBT in order to extend its application to a population such as BPD. For example, DBT emphasizes dialectics. Dialectics can be described as the reconciliation of opposites in a continual process of synthesis (Linehan, 1993a, p. 19). It stresses interrelatedness and wholeness, parts of a system is of limited value unless the analysi s clearly relates the part to the whole (Linehan, 1993a, p. 19).DBT therapists work with clients to examine a more global meaning to what had previously been polarized as extreme ideas or thoughts. Linehan stated that the most fundamental dialectic is the necessity of accepting patients as they are within a context of trying to teach them to change. Linehan continue by stating that reality is not static, but is comprised of internal opposing forces, thesis and antithesis, out of whose integration (synthesis) evolves a new set of opposing forces (Linehan, 1993a, p. 19).Linehan described how although dialectics focus on the whole, they also emphasize how complex the whole can be, including the oppositions they contain. With this notion in mind, DBT places an emphasis on acceptance as a balance to change (Linehan, 1993a). DBT therefore focuses on accepting the client for who he or she is in the moment, while also working toward more effective behaviors and ways of interacting with one s present experience and the surroundings.In addition, DBT emphasizes the necessity of teaching clients to accept themselves and their world as they are in the moment. Linehan discussed how this unique strategy works well with BPD because it provides the validating environment so crucial to those with injured self-esteems. She also discussed the importance of providing a structured setting to learn and practice new skills.DBT includes both acceptance of the patients experiences including validation of their emotional pain and suffering, and offering new psychological coping strategies that include a refocus on meaning and substance in their life, exposure to previously intolerated emotions, prevention of emotional escape, and ledger entry of a behavior focus. (Marra, 2005, p. 7) This behavior focus includes goal orientation and new solution-based strategies to replace maladaptive coping skills (Marra, 2005, p. 7).An important caveat to remember as treatment progresses is that ther e is a natural process of change that occurs as treatment progresses. Linehan discussed how DBT assumes that reality is a process full of movement and change. Therefore, immediate client stability and consistency are not a focus. Conversely, acceptance and movement with change are key elements of this process. The therapist and client work together in a changing relationship and a changing environment (Linehan, 1993 a).In her work with individuals who struggled with self-injurious and suicidality, Linehan utilized dialectics and the philosophy of balancing acceptance with change to enhance treatment effectiveness. She also detect that most of her clients presented with BPD characteristics. As such, she incorporated dialectical philosophy as the bedrock of her treatment when designing DBT for individuals with BPD characteristics.