Dialectical Behavioral Therapy (DBT)
Is it evidence based? - answerYes
Major Theorist(s)? - answer Marsha Linehan
What are some major assumptions? - answerBPD is caused by both environmental and
biological factors - individuals are born with emotional vulnerability and grow up in
invalidating environments, leading to a dysfunction in the emotion regulation system and
learning to invalidate the self (they suppress, judge and punish their own emotions)
Emotional, cognitive and behavioral dysregulation can be attributed to a transaction
between... - answerEmotionally vulnerable individual' (high emotional sensitivity &
reactivity & slow return to baseline emotional states) and
an invalidating environment
What is emotional modulation? - answerability to ...
- Inhibit inappropriate behavior related to strong emotions [+ or -]
- Organize oneself for coordinated action in service of an external goal
- Self soothe physiological arousal
- Refocus attention in the presence of strong emotion
Four Areas of DBT Emphasized - answer1. Acceptance and validation of behavior as it
is in the moment
2. Treating therapy-interfering behaviors of both client and therapist
3. The assumption that the therapeutic relationship is essential to the treatment
4. Dialectic process [persuasive dialogue, focus on reality]
Foundational Assumptions - answer1. Clients are doing the best they can.
2. Clients want to get better.
3. Clients need to be motivated to change and work hard to change.
4. Clients may not have caused their problems but need to solve them anyway.
5. The lives of persons with borderline and suicidal traits are unbearable as
currentlylived.
6. Clients must learn new behaviors in all areas of life in which they are
havingproblems.
7. Clients cannot fail in counseling.
8. Counselors working with clients diagnosed with borderline personality disorder need
support.
Goals for Therapy - answer- Emotional regulation and stabilization of the client
- Decrease impulsiveness, interpersonal chaos, unstable emotions, and confusion about
self, and cognitive dysregulation
, - The overarching goal of DBT is to increase dialectical behavior patterns in order to
increase emotional and behavioral regulation.
- The goal of treatment is to enable clients to effective engage dialectic tensions and
transcend them through synthesis.
- Increase acceptance using core mindfulness and distress tolerance skills, and change
emotion regulation and interpersonal effectiveness skills
- Seek a balance between acceptance vs changing, the client's vs other's points of view,
meeting needs of the client vs needs of others, work vs play, autonomy vs dependence
- Realizing acceptance doesn't mean viewing something as good and choosing to
accept reality
- Radical Acceptance
1) Enhance behavioral capabilities, 2) improves motivation to change 3) assures that
new capabilities generalize to the natural environment, 4) structures the treatment
environment in the way essential to support client/therapist capabilities, 5) enhances
therapist capabilities and motivation to treat clients effectively
Role of Therapist - answerMust strike a balance between:
1. Unwavering centeredness (i.e., believing in oneself, the client, and the treatment) and
2. Compassionate flexibility (i.e., the ability to take in relevant information about the
client and modify one's position accordingly, including the ability to admit to and repair
one's inevitable mistakes)
AND
- Nurturing style (i.e., teaching, coaching, and assisting the client)
- Benevolently demanding approach (i.e., dragging out new behaviors from the client,
recognizing the client's existing capacity to change, having clients "do for themselves"
rather than "doing for them")
Interventions - answer- Non-blaming stance towards adolescents, parents and families
- Empathic view of the family behavioral patterns
- DBT assumes that adolescents and families are in tremendous pain with parents
feeling intense shame, feelings of failure, excessive fear for safety of the child, and guilt
about their participation
- Use terms such as "poorness of fit of temperament"
- Labeling behaviors as invalidating
Intervention: Genograms - answerto gain insight into intergenerational transmission of
invalidation
Intervention: Acceptance - answerDBT is based on a non-pejorative and compassionate
theory of BPD. the non-pejorative stance is crucial and necessary when working with
family.
Interventions: Levels of Validation - answerLevel 1: therapist listens to family in
unbiased manner without attempting to change in the moment
Is it evidence based? - answerYes
Major Theorist(s)? - answer Marsha Linehan
What are some major assumptions? - answerBPD is caused by both environmental and
biological factors - individuals are born with emotional vulnerability and grow up in
invalidating environments, leading to a dysfunction in the emotion regulation system and
learning to invalidate the self (they suppress, judge and punish their own emotions)
Emotional, cognitive and behavioral dysregulation can be attributed to a transaction
between... - answerEmotionally vulnerable individual' (high emotional sensitivity &
reactivity & slow return to baseline emotional states) and
an invalidating environment
What is emotional modulation? - answerability to ...
- Inhibit inappropriate behavior related to strong emotions [+ or -]
- Organize oneself for coordinated action in service of an external goal
- Self soothe physiological arousal
- Refocus attention in the presence of strong emotion
Four Areas of DBT Emphasized - answer1. Acceptance and validation of behavior as it
is in the moment
2. Treating therapy-interfering behaviors of both client and therapist
3. The assumption that the therapeutic relationship is essential to the treatment
4. Dialectic process [persuasive dialogue, focus on reality]
Foundational Assumptions - answer1. Clients are doing the best they can.
2. Clients want to get better.
3. Clients need to be motivated to change and work hard to change.
4. Clients may not have caused their problems but need to solve them anyway.
5. The lives of persons with borderline and suicidal traits are unbearable as
currentlylived.
6. Clients must learn new behaviors in all areas of life in which they are
havingproblems.
7. Clients cannot fail in counseling.
8. Counselors working with clients diagnosed with borderline personality disorder need
support.
Goals for Therapy - answer- Emotional regulation and stabilization of the client
- Decrease impulsiveness, interpersonal chaos, unstable emotions, and confusion about
self, and cognitive dysregulation
, - The overarching goal of DBT is to increase dialectical behavior patterns in order to
increase emotional and behavioral regulation.
- The goal of treatment is to enable clients to effective engage dialectic tensions and
transcend them through synthesis.
- Increase acceptance using core mindfulness and distress tolerance skills, and change
emotion regulation and interpersonal effectiveness skills
- Seek a balance between acceptance vs changing, the client's vs other's points of view,
meeting needs of the client vs needs of others, work vs play, autonomy vs dependence
- Realizing acceptance doesn't mean viewing something as good and choosing to
accept reality
- Radical Acceptance
1) Enhance behavioral capabilities, 2) improves motivation to change 3) assures that
new capabilities generalize to the natural environment, 4) structures the treatment
environment in the way essential to support client/therapist capabilities, 5) enhances
therapist capabilities and motivation to treat clients effectively
Role of Therapist - answerMust strike a balance between:
1. Unwavering centeredness (i.e., believing in oneself, the client, and the treatment) and
2. Compassionate flexibility (i.e., the ability to take in relevant information about the
client and modify one's position accordingly, including the ability to admit to and repair
one's inevitable mistakes)
AND
- Nurturing style (i.e., teaching, coaching, and assisting the client)
- Benevolently demanding approach (i.e., dragging out new behaviors from the client,
recognizing the client's existing capacity to change, having clients "do for themselves"
rather than "doing for them")
Interventions - answer- Non-blaming stance towards adolescents, parents and families
- Empathic view of the family behavioral patterns
- DBT assumes that adolescents and families are in tremendous pain with parents
feeling intense shame, feelings of failure, excessive fear for safety of the child, and guilt
about their participation
- Use terms such as "poorness of fit of temperament"
- Labeling behaviors as invalidating
Intervention: Genograms - answerto gain insight into intergenerational transmission of
invalidation
Intervention: Acceptance - answerDBT is based on a non-pejorative and compassionate
theory of BPD. the non-pejorative stance is crucial and necessary when working with
family.
Interventions: Levels of Validation - answerLevel 1: therapist listens to family in
unbiased manner without attempting to change in the moment
